Final prc
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UNIVERSITY OF CEBU – BANILAD CAMPUS College of Nursing Governor Cuenco Avenue, Banilad, Cebu City 6000 (032) 233-8888; (032) 231-8613; www.uc.edu.ph PACUCOA Level II 3 rd Reaccredited Status, June 2007 SURGICAL SCRUB in CEBU CITY MEDICAL CENTER Prepared by: ______________________________ LEONIDA N. MUÑEZ Date Performed and Time Started PATIENT’S Initials Only SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Complete Name and Signature) Supervised by Clinical Instructor (Complete Name and Signature) Case Number May 20, 2011 8:27 AM F.B.G. 432044 Exploratory, Laparotomy Right Hemicolectomy (Gastro-intestinal Anastomosis) with Side to Side Anastomosis Application of Internal Retraction Suture (Tumor 4 Node 1 Metastasis 0 ) Ms. Ofelia B. Songahid R.N. Ms. Maria Flordeliz G. Padayao, R.N., M.A.N. O.R. FORM 1A O.R. SCRUB FORM
Transcript of Final prc
UNIVERSITY OF CEBU – BANILAD CAMPUS College of Nursing Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.phPACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL SCRUB in CEBU CITY MEDICAL CENTER
Prepared by: ______________________________ LEONIDA N. MUÑEZ
Date Performed and Time Started
PATIENT’S Initials Only
SURGICAL PROCEDURE PERFORMED
O.R. Nurse on Duty(Complete Name and
Signature)
Supervised by Clinical Instructor
(Complete Name and Signature)
Case Number
May 20, 20118:27 AM
F.B.G.432044
Exploratory, Laparotomy Right Hemicolectomy (Gastro-intestinal
Anastomosis) with Side to Side Anastomosis Application of Internal
Retraction Suture (Tumor4 Node1
Metastasis0)
Ms. Ofelia B. Songahid R.N.
Ms. Maria Flordeliz G. Padayao, R.N., M.A.N.
Noted by: ____________________________________________ Approved by: _______________________________________ PILUCHI VICTORINA M. VILLEGAS R.N., M.N DR. HELEN C. ESTRELLA
Clinical Coordinator Dean PRC I.D No. ___________ Valid Until ____________ PRC I.D. No. ____________ Valid Until _____________ Date document is signed: _______________________ Date document is signed: _________________________ Time: _______________________ Time: _______________________ Highest Nursing Degree Earned:_________________ Highest Nursing Degree Earned:___________________
O.R. FORM 1AO.R. SCRUB
FORM
UNIVERSITY OF CEBU – BANILAD CAMPUS College of Nursing Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.phPACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL CIRCULATING in __________________________________________________
Prepared by: _________________________________
Date Performed and Time Started
PATIENT’S Initials Only
SURGICAL PROCEDURE PERFORMED
O.R. Nurse on Duty(Complete Name and
Signature)
Supervised by Clinical Instructor
(Complete Name and Signature)
Case Number
Noted by: ____________________________________________ Approved by: ____________________________________ PILUCHI VICTORINA M. VILLEGAS, R.N., M.N DR. HELEN C. ESTRELLA
Clinical Coordinator Dean
PRC I.D No. ___________ Valid Until ____________ PRC I.D. No. ____________ Valid Until _____________ Date document is signed: _______________________ Date document is signed: _________________________ Time: _______________________ Time: _______________________ Highest Nursing Degree Earned:_________________ Highest Nursing Degree Earned:___________________
O.R. FORM 1BO.R. CIRCULATING
FORM
UNIVERSITY OF CEBU – BANILAD CAMPUS College of Nursing Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.phPACUCOA Level II 3rd Reaccredited Status, June 2007
ACTUAL DELIVERY in _______________________________________________________
Prepared by: _________________________________
Date Performed and Time Started
PATIENT’S Initials Only
PROCEDUREPERFORMED
D.R. Nurse on Duty(Complete Name and
Signature)
Supervised by Clinical Instructor
(Complete Name and Signature)
Case Number
Noted by: ____________________________________________ Approved by: _______________________________________ PILUCHI VICTORINA M. VILLEGAS, R.N., M.N DR. HELEN C. ESTRELLA
Clinical Coordinator Dean
PRC I.D No. ___________ Valid Until ____________ PRC I.D. No. ____________ Valid Until _____________ Date document is signed: _______________________ Date document is signed: _________________________ Time: _______________________ Time: _______________________ Highest Nursing Degree Earned:_________________ Highest Nursing Degree Earned:___________________
D.R. FORM ACTUAL DELIVERY
FORM
UNIVERSITY OF CEBU – BANILAD CAMPUS College of Nursing Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.phPACUCOA Level II 3rd Reaccredited Status, June 2007
IMMEDIATE NEWBORN CORD CARE in ____________________________________________________
Prepared by: __________________________________
Date Performed and Time Started
PATIENT’S Initials Only
IMMEDIATE NEWBORNCORD CAREPERFORMED
D.R. Nurse on Duty(Complete Name and
Signature)
Supervised by Clinical Instructor
(Complete Name and Signature)
Case Number
Noted by: ____________________________________________ Approved by: _______________________________________ PILUCHI VICTORINA M. VILLEGAS, R.N., M.N DR. HELEN C. ESTRELLA
Clinical Coordinator Dean
PRC I.D No. ___________ Valid Until ____________ PRC I.D. No. ____________ Valid Until _____________ Date document is signed: _______________________ Date document is signed: _________________________ Time: _______________________ Time: _______________________ Highest Nursing Degree Earned:_________________ Highest Nursing Degree Earned:___________________
ICNB FORM IMMEDIATE CARE OF THE NEWBORN FORM
UNIVERSITY OF CEBU – BANILAD CAMPUS College of Nursing Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.phPACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL SCRUB in CEBU CITY MEDICAL CENTER
Prepared by: ______________________________ RANI MAE P. VALENZONA
Date Performed and Time Started
PATIENT’S Initials Only
SURGICAL PROCEDURE PERFORMED
O.R. Nurse on Duty(Complete Name and
Signature)
Supervised by Clinical Instructor
(Complete Name and Signature)
Case Number
March 13, 201210:00 AM
E.S.S506020
Open Reduction Internal Fixation (Log Screw Fixation) Medial
Malleolus Left; Open Reduction Internal Fixation Plate and Screw
Fibula Left
Mr. Romil Galahad M. Blancas, R.N
Ms. Maria Flordeliz G. Padayao, R.N., M.A.N
Noted by: ____________________________________________ Approved by: _______________________________________ PILUCHI VICTORINA M. VILLEGAS R.N., M.N DR. HELEN C. ESTRELLA
Clinical Coordinator Dean PRC I.D No. ___________ Valid Until ____________ PRC I.D. No. ____________ Valid Until _____________ Date document is signed: _______________________ Date document is signed: _________________________ Time: _______________________ Time: _______________________ Highest Nursing Degree Earned:_________________ Highest Nursing Degree Earned:___________________
O.R. FORM 1AO.R. SCRUB
FORM
UNIVERSITY OF CEBU – BANILAD CAMPUS College of Nursing Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.phPACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL SCRUB in CEBU CITY MEDICAL CENTER
Prepared by: ______________________________ RANI MAE P. VALENZONA
Date Performed and Time Started
PATIENT’S Initials Only
SURGICAL PROCEDURE PERFORMED
O.R. Nurse on Duty(Complete Name and
Signature)
Supervised by Clinical Instructor
(Complete Name and Signature)
Case Number
March 12, 201210:07 AM
J.L.P.E507081
Abdomino-Endo Rectal Pull Through Take Down of Colostomy
Mr. Jason Noel A. Manigos, R.N
Ms. Maria Flordeliz G. Padayao, R.N., M.A.N
Noted by: ____________________________________________ Approved by: _______________________________________ PILUCHI VICTORINA M. VILLEGAS R.N., M.N DR. HELEN C. ESTRELLA
Clinical Coordinator Dean PRC I.D No. ___________ Valid Until ____________ PRC I.D. No. ____________ Valid Until _____________ Date document is signed: _______________________ Date document is signed: _________________________ Time: _______________________ Time: _______________________ Highest Nursing Degree Earned:_________________ Highest Nursing Degree Earned:___________________
O.R. FORM 1AO.R. SCRUB
FORM
UNIVERSITY OF CEBU – BANILAD CAMPUS College of Nursing Governor Cuenco Avenue, Banilad, Cebu City 6000
(032) 233-8888; (032) 231-8613; www.uc.edu.phPACUCOA Level II 3rd Reaccredited Status, June 2007
SURGICAL SCRUB in ____________________________________________________________
Prepared by: ______________________________
Date Performed and Time Started
PATIENT’S Initials Only
SURGICAL PROCEDURE PERFORMED
O.R. Nurse on Duty(Complete Name and
Signature)
Supervised by Clinical Instructor
(Complete Name and Signature)
Case Number
Noted by: ____________________________________________ Approved by: _______________________________________ PILUCHI VICTORINA M. VILLEGAS R.N., M.N DR. HELEN C. ESTRELLA
Clinical Coordinator Dean PRC I.D No. ___________ Valid Until ____________ PRC I.D. No. ____________ Valid Until _____________ Date document is signed: _______________________ Date document is signed: _________________________ Time: _______________________ Time: _______________________ Highest Nursing Degree Earned:_________________ Highest Nursing Degree Earned:__________________
O.R. FORM 1AO.R. SCRUB
FORM
