Summary Cmo 14
3
TRACE COLLEGE El Danda Street, Batong Malake, Los Baños, Laguna Telephone no. (049) 536-3944, Fax (049) 536-1425, Web-Site www.tracecollege.edu.ph SURGICAL SCRUB in ____________________________________________________________________________________ Hospital, Municipality/City/Province Prepared by: Printed Name with Signature of Student: _____________________________________________ Date Performed and Time Started Patient’s INITIALS only Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name AND Signature) SUPERVISED BY Clinical Instructor Name and Signature Prepared by: Printed Name with Signature of Student: _____________________________________________ Date Performed and Time Started Patient’s INITIALS only Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name AND Signature) SUPERVISED BY Clinical Instructor Name and Signature O.R. Form 1A O.R. SCRUB FORM Major O.R. Form 1B O.R. CIRCULATING FORM
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Transcript of Summary Cmo 14
TRACE COLLEGEEl Danda Street, Batong Malake, Los Baños, Laguna
Telephone no. (049) 536-3944, Fax (049) 536-1425, Web-Site www.tracecollege.edu.phSURGICAL SCRUB in ____________________________________________________________________________________
Hospital, Municipality/City/Province
Prepared by:Printed Name with Signature of Student: _____________________________________________
Date Performed and
Time Started
Patient’s INITIALS only
Case NumberSURGICAL PROCEDURE
PERFORMED
O.R. Nurse on Duty (Name AND Signature)
SUPERVISED BYClinical Instructor
Name and Signature
Prepared by:Printed Name with Signature of Student: _____________________________________________
Date Performed and
Time Started
Patient’s INITIALS only
Case NumberSURGICAL PROCEDURE
PERFORMED
O.R. Nurse on Duty (Name AND Signature)
SUPERVISED BYClinical Instructor
Name and Signature
(STRICTLY NO DESIGNATES)
O.R. Form 1AO.R. SCRUB FORM
Major
O.R. Form 1BO.R. CIRCULATING
FORM
TRACE COLLEGEEl Danda Street, Batong Malake, Los Baños, Laguna
Telephone no. (049) 536-3944, Fax (049) 536-1425, Web-Site www.tracecollege.edu.phACTUAL DELIVERY in ____________________________________________________________________________________
Hospital/ Home/ Lying-In Clinic, Municipality/City/ProvincePrepared by:Printed Name with Signature of Student: _____________________________________________
Date Performed and
Time Started
Patient’s INITIALS only
Case Number(not applicable for Birthing/Lying-In
Clinics/Homes)
PROCEDURE PERFORMED
D.R. Nurse on Duty(Name AND Signature)
SUPERVISED BYClinical Instructor
Name and Signature
IMMEDIATE NEWBORN CORD CARE in ____________________________________________________________________ Hospital/ Home/ Lying-In Clinic, Municipality/City/Province
Prepared by:Printed Name with Signature of Student: _____________________________________________
Date Performed and
Time Started
Patient’s INITIALS only
Case Number(not applicable for Birthing/Lying-In
Clinics/Homes)
Immediate Newborn Cord Care
PERFORMED
O.R. Nurse on Duty(Name AND Signature)
SUPERVISED BYClinical Instructor
Name and Signature
(STRICTLY NO DESIGNATES)
ICNB FormIMMEDIATE CARE OF THE
NEWBORN FORM
D
D.R. Form
ACTUAL DELIVERY Form
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