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WWW - Ust.edu - PH: ODC Form 2 B O.R. Circulating FORM Major

The document is a form for tracking surgical circulating experiences at the University of Santo Tomas in Manila, Philippines. It includes fields to record the patient's initials, date and time of the procedure, case number, surgical procedure performed, operating room nurse on duty, and clinical instructor who supervised. The form must be signed by the student, clinical coordinator, and dean to verify completion.

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Nerissa Neri Natata
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© © All Rights Reserved
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50 views

WWW - Ust.edu - PH: ODC Form 2 B O.R. Circulating FORM Major

The document is a form for tracking surgical circulating experiences at the University of Santo Tomas in Manila, Philippines. It includes fields to record the patient's initials, date and time of the procedure, case number, surgical procedure performed, operating room nurse on duty, and clinical instructor who supervised. The form must be signed by the student, clinical coordinator, and dean to verify completion.

Uploaded by

Nerissa Neri Natata
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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UNIVERSITY OF SANTO TOMAS

Espaa Boulevard, Sampaloc, Manila, Philippines 1015


Tel. Nos. 406-1611 loc. 8241 Telefax 731-5738; / Website www.ust.edu.ph
Accredited by PACUCOA, Level III Accredited Status, August 2015

ODC Form 2 B
O.R. Circulating FORM
Major

SURGICAL CIRCULATING in _____________________________________________________


Hospital, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student ______________________________________________________
Patients INITIAL Only
Date Performed
And
Time Started

Case Number

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse on Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
Name and Signature

Noted by: __________________________________________________________

_______________________________________________

(Print Name and Signature)

(Print Name and Signature)

Clinical Coordinator, PRC I.D. No. ______________ Valid Until: ___________

Dean, PRC I.D. No. __________________ Valid Until: _____________

Date document is signed: ________________________Time: ________________

Date document is signed: _________________Time: ________________

Please specify Highest Nursing Degree Earned: ____________________________

Specify Highest Nursing Degree Earned: __________________________

(STRICTLY NO DESIGNATES)
AA: 19-00-FO06

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