Usjr Prc Forms-new Curriculum
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UNIVERSITY OF SAN JOSE-RECOLETOS COLLEGE OF NURSING, CORNER P. LOPEZ ST & MAGALLANES ST CEBU CITY PHILIPPINES 6000 PHONE: 032 253 7900 Loc 543; FAX: 032254 1720;www.usjr.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) SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty (Name and Signature) SUPERVISED BY Clinical Instructor (Name and Signature) Case Number O.R. Form 1A O.R. Scrub Form Major
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Transcript of Usjr Prc Forms-new Curriculum
UNIVERSITY OF SAN JOSE-RECOLETOS COLLEGE OF NURSING, CORNER P. LOPEZ ST & MAGALLANES ST CEBU CITY PHILIPPINES 6000
PHONE: 032 253 7900 Loc 543; FAX: 032254 1720;www.usjr.edu.ph
SURGICAL SCRUB in ______________________________________________________________________ Hospital, Municipality/City/Province
Prepared by:Printed Name with Signature of Student: ________________________________________
Date Performedand
Time Started
Patient’s INITIALS (only)SURGICAL PROCEDURE PERFORMED
O.R. Nurse On Duty (Name and Signature)
SUPERVISED BYClinical Instructor
(Name and Signature)Case Number
O.R. Form 1AO.R. Scrub Form
Major
UNIVERSITY OF SAN JOSE-RECOLETOS COLLEGE OF NURSING, CORNER P. LOPEZ ST & MAGALLANES ST CEBU CITY PHILIPPINES 6000
PHONE: 032 253 7900 Loc 543; FAX: 032254 1720;www.usjr.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)SURGICAL PROCEDURE PERFORMED
O.R. Nurse On Duty (Name and Signature)
SUPERVISED BYClinical Instructor
(Name and Signature)Case Number
O.R. Form 1BO.R. Circulating Form
UNIVERSITY OF SAN JOSE-RECOLETOS COLLEGE OF NURSING, CORNER P. LOPEZ ST & MAGALLANES ST CEBU CITY PHILIPPINES 6000
PHONE: 032 253 7900 Loc 543; FAX: 032254 1720;www.usjr.edu.ph
ACTUAL DELIVERY 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)PROCEDURE PERFORMED
D.R. Nurse On Duty (Name and Signature)
(If Midwife on Duty, signature not required)
SUPERVISED BYClinical Instructor
(Name and Signature)Case Number
(not applicable for Birthing/Lying-
in Clinics/Homes)
D.R. FORM
ACTUAL DELIVERY FORM
UNIVERSITY OF SAN JOSE-RECOLETOS COLLEGE OF NURSING, CORNER P. LOPEZ ST & MAGALLANES ST CEBU CITY PHILIPPINES 6000
PHONE: 032 253 7900 Loc 543; FAX: 032254 1720;www.usjr.edu.ph
ACTUAL DELIVERY 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)Immediate Newborn CORD CARE Performed
(Indicate where performed e.g. DR, Nursery, NICU, Home)
D.R. Nurse On Duty (Name and Signature)
(If Midwife on Duty, signature not required)
SUPERVISED BYClinical Instructor
(Name and Signature)Case Number
(not applicable for Birthing/Lying-
in Clinics/Homes)
ICNB FormIMMEDICATE CARE OF THE
NEWBORN FORM
UNIVERSITY OF SAN JOSE-RECOLETOS ODC Form 1B COLLEGE OF NURSING, CORNER P. LOPEZ ST & MAGALLANES ST CEBU CITY PHILIPPINES 6000 ASSISTED DELIVERY
PHONE: 032 253 7900 Loc 543; FAX: 032254 1720;www.usjr.edu.ph FORM
ACTUAL DELIVERY 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)PROCEDURE PERFORMED
ASSISTED DELIVERY
D.R. Nurse On Duty (Name and Signature)
(If Midwife on Duty, signature not required)
SUPERVISED BYClinical Instructor
(Name and Signature)Case Number
(not applicable for Birthing/Lying-
in Clinics/Homes)
Noted by: MARIVEC V. DELDA, RN MAN. Approved by: AURORA Q. PESTAÑO, R.N., M.AN.,DM. (Print Name and Signature) (Print Name and Signature)Clinical Coordinator, PRC I.D. No. 080543 Valid Until April 12, 2011 Dean, PRC I.D. 0186407 Valid Until _April 23, 2011Date documented is signed ________________________ Time _________________ Date documented is signed ___________________ Time __________________Please specify Highest Nursing Degree Earned Master of Arts in Nursing Please specify Highest Nursing Degree Earned Master of Arts in Nursing;
(STRICTLY NO DESIGNATES)
