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PRC Cases Form

The document appears to be forms from Justice Jose Abad Santos General Hospital related to surgical procedures and delivery/newborn care. It includes forms for surgical scrub, circulating in the operating room, actual delivery, and immediate newborn cord care. The forms require information such as the date, time, patient initials, case number, procedure performed, and signatures of the supervising nurse or instructor.

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Vanessa Kyla Umiten
Copyright
© Attribution Non-Commercial (BY-NC)
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Download as DOCX, PDF, TXT or read online on Scribd
70 views

PRC Cases Form

The document appears to be forms from Justice Jose Abad Santos General Hospital related to surgical procedures and delivery/newborn care. It includes forms for surgical scrub, circulating in the operating room, actual delivery, and immediate newborn cord care. The forms require information such as the date, time, patient initials, case number, procedure performed, and signatures of the supervising nurse or instructor.

Uploaded by

Vanessa Kyla Umiten
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Pres. Diosdado Macapagal Blvd., Metropolitan Park, Pasay City Tel. No. (02)859-0812/ Fax No.

(02) 859-0875 PAASCU Level II Re-Accredited Status, November 2011 - November 2016
SURGICAL SCRUB IN JUSTICE JOSE ABAD SANTOS GENERAL HOSPITAL Hospital, Municipality/City/Province

O.R. Form 1A
Prepared by: Printed Name with Signature of Student: VANESSA KYLA C. UMITEN
Date Performed and Time Started Patients INITIAL (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature)
O.R. SCRUB FORM Major

SUPERVISED BY: Clinical Instructor Name and Signature

JULY 13, 2012 10:45 am

R.L.M 552448

ELECTIVE FUNCTIONAL ENDOSCOPIC SINUS SX

MARIE KATHLEEN D. CASTRO, RN

SHIELA S. TORRES RN, MAN

O.R. Form 1A
Prepared by: Printed Name with Signature of Student _______________________________________________
Date Performed and Time Started Patients INITIAL (only) Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature)
O.R. CIRCULATING FORM

SUPERVISED BY: Clinical Instructor Name and Signature

(STRICTLY NO DESIGNATES) (This Forms must be printed at the back of the 1st page of the Competency-Based Performance Evaluation Checklist prescribed by the BoN)

Pres. Diosdado Macapagal Blvd., Metropolitan Park, Pasay City Tel. No. (02)859-0812/ Fax No. (02) 859-0875 PAASCU Level II Re-Accredited Status, November 2011 - November 2016
ACTUAL DELIVERY IN ______________________________________________________________________________________ Hospital/Home/Lying-In Clinic, Municipality/City/Province D.R. FORM
ACTUAL DELIVERY FORM

Prepared by: Printed Name with Signature of Student _______________________________________________


Date Performed and Time Started Patients INITIAL (only) Case Number (not applicable for
Birthing/Lying-in Clinics/Home)

PROCEDURE PERFORMED

D.R. Nurse on Duty (Name and Signature)


(If Midwife on Duty, Signature Not Required)

SUPERVISED BY: Clinical Instructor Name and Signature

IMMEDIATE NEWBORN CORD CARE IN ______________________________________________________________________________________ Hospital/Home/Lying-In Clinic, Municipality/City/Province ICNB FORM Prepared by: IMMEDIATE CARE OF THE NEWBORN FORM Printed Name with Signature of Student _______________________________________________
Date Performed and Time Started Patients INITIAL (only) Case Number (not applicable for
Birthing/Lying-in Clinics/Home)

IMMEDIATE NEWBORN CORD CARE PERFORMED


Performed e.g. DR, Nursery , NICU Or Home

D.R. Nurse on Duty (Name and Signature)


(If Midwife on Duty, Signature Not Required)

SUPERVISED BY: Clinical Instructor Name and Signature

(STRICTLY NO DESIGNATES) (This Forms must be printed at the back of the 1st page of the Competency-Based Performance Evaluation Checklist prescribed by the BoN)

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