Medina College Ozamiz OR-DR CASE SAMPLE
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MEDINA COLLEGE College of Nursing Jose Abad Santos Street, Ozamiz City, Philippines (088)521-0036/ 521-1166 SURGICAL SCRUB in MEDINA GENERAL HOSPITAL, OZAMIZ CITY, MISAMIS OCCIDENTAL Prepared By: __________________________________________________ Printed Name and Signature of Student: __________________________________________________ Date Perform ed and Time Operati on Patient’ s INITIALS only Case Number SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty (Name and Signature) SUPERVISED BY Clinical Instructor Name and Signature ODC Form 2A O.R. SCRUB FORM MAJOR ______________________________ ______ JOSEPHINE P. CATAPANG, BSN, RN, MN, MAN CLINICAL COORDINATOR Date Signed: _________________ Degree : BSN, RN, MN, MAN_ ______________________________ MARIVIC M. OCAMPOS, BSN, RN, MAN DEAN Date Signed: ____________ Degree: BSN, RN, MAN a) PRC NO: 0152858_____ Valid Until: Aug. 17, 2013_ b) PNA NO: 007840______ Valid Until: Oct. 31, 2012_ c) ADPCN NO: 108_________ Valid Until: May 31, 2012_
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Transcript of Medina College Ozamiz OR-DR CASE SAMPLE
MEDINA COLLEGE College of Nursing
Jose Abad Santos Street, Ozamiz City, Philippines(088)521-0036/ 521-1166
SURGICAL SCRUB in MEDINA GENERAL HOSPITAL, OZAMIZ CITY, MISAMIS OCCIDENTAL
Prepared By: __________________________________________________Printed Name and Signature of Student: __________________________________________________
Date Performed and Time Operation
Patient’s INITIALS only
Case Number
SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty(Name and Signature)
SUPERVISED BY Clinical InstructorName and Signature
NOTED BY: APPROVED BY:
MEDINA COLLEGE College of Nursing
ODC Form 2AO.R. SCRUB FORM
MAJOR
____________________________________JOSEPHINE P. CATAPANG, BSN, RN, MN, MAN
CLINICAL COORDINATORDate Signed: _________________Degree : BSN, RN, MN, MAN_a) PRC NO: 0171058__________Valid Until: Jan. 20, 2014_b) PNA NO: 007841______Valid Until: Oct. 31, 2012_
______________________________MARIVIC M. OCAMPOS, BSN, RN, MAN DEANDate Signed: ____________Degree: BSN, RN, MANa) PRC NO: 0152858_____Valid Until: Aug. 17, 2013_b) PNA NO: 007840______Valid Until: Oct. 31, 2012_c) ADPCN NO: 108_________Valid Until: May 31, 2012_
ODC Form 2BO.R. CIRCULATING FORM
Jose Abad Santos Street, Ozamiz City, Philippines(088)521-0036/ 521-1166
SURGICAL SCRUB in MEDINA GENERAL HOSPITAL,OZAMIZ CITY, MISAMIS OCCIDENTAL
Prepared By: __________________________________________________Printed Name and Signature of Student: __________________________________________________
Date Performed and Time Operation
Patient’s INITIALS only
Case Number
SURGICAL PROCEDURE PERFORMED O.R. Nurse on Duty(Name and Signature)
SUPERVISED BY Clinical InstructorName and Signature
NOTED BY: APPROVED BY:
MEDINA COLLEGE College of Nursing
Jose Abad Santos Street, Ozamiz City, Philippines(088)521-0036/ 521-1166
____________________________________JOSEPHINE P. CATAPANG, BSN, RN, MN, MAN
CLINICAL COORDINATORDate Signed: _________________Degree : BSN, RN, MN, MAN_a) PRC NO: 0171058__________Valid Until: Jan. 20, 2014_b) PNA NO: 007841______Valid Until: Oct. 31, 2012_
______________________________MARIVIC M. OCAMPOS, BSN, RN, MAN DEANDate Signed: ____________Degree: BSN, RN, MANa) PRC NO: 0152858_____Valid Until: Aug. 17, 2013_b) PNA NO: 007840______Valid Until: Oct. 31, 2012_c) ADPCN NO: 108_________Valid Until: May 31, 2012_
ODC Form 1AACTUAL DELIVERY FORM
ACTUAL DELIVERY in MAYOR HILARION A. RAMIRO SR. REGIONAL TRAINING and TEACHING HOSPITALOZAMIZ CITY, MISAMIS OCCIDENTAL
Prepared By: __________________________________________________Printed Name and Signature of Student: __________________________________________________
Date Performed and Time Operation
Patient’s INITIALS only
Case Number
PROCEDURE PERFORMEDHANDLED DELIVERY
D.R. Nurse on Duty(Name and Signature)
(If Midwife on Duty, Signature Not Required)
SUPERVISED BY Clinical InstructorName and Signature
. HANDLED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
HANDLED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
HANDLED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
. HANDLED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
HANDLED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
NOTED BY: APPROVED BY:
MEDINA COLLEGE College of Nursing
Jose Abad Santos Street, Ozamiz City, Philippines(088)521-0036/ 521-1166
ACTUAL DELIVERY in MEDINA GENERAL HOSPITAL,
____________________________________JOSEPHINE P. CATAPANG, BSN, RN, MN, MAN
CLINICAL COORDINATORDate Signed: _________________Degree : BSN, RN, MN, MAN_a) PRC NO: 0171058__________Valid Until: Jan. 20, 2014_b) PNA NO: 007841______Valid Until: Oct. 31, 2012_
______________________________MARIVIC M. OCAMPOS, BSN, RN, MAN DEANDate Signed: ____________Degree: BSN, RN, MANa) PRC NO: 0152858_____Valid Until: Aug. 17, 2013_b) PNA NO: 007840______Valid Until: Oct. 31, 2012_c) ADPCN NO: 108_________Valid Until: May 31, 2012_
ODC Form 1BASSISTED DELIVERY
FORM
OZAMIZ CITY, MISAMIS OCCIDENTAL
Prepared By: __________________________________________________Printed Name and Signature of Student: __________________________________________________
Date Performed and Time Operation
Patient’s INITIALS only
Case Number
PROCEDURE PERFORMEDASSISTED DELIVERY
D.R. Nurse on Duty(Name and Signature)
(If Midwife on Duty, Signature Not Required)
SUPERVISED BY Clinical InstructorName and Signature
. ASSISTED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
ASSISTED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
ASSISTED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
ASSISTED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
ASSISTED ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
NOTED BY: APPROVED BY:
MEDINA COLLEGE College of Nursing
Jose Abad Santos Street, Ozamiz City, Philippines(088)521-0036/ 521-1166
IMMEDIATE NEWBORN CORD CARE in MAYOR HILARION A. RAMIRO SR. REGIONAL TRAINING and TEACHING HOSPITALOZAMIZ CITY, MISAMIS OCCIDENTAL
Prepared By: __________________________________________________Printed Name and Signature of Student: __________________________________________________
____________________________________JOSEPHINE P. CATAPANG, BSN, RN, MN, MAN
CLINICAL COORDINATORDate Signed: _________________Degree : BSN, RN, MN, MAN_a) PRC NO: 0171058__________Valid Until: Jan. 20, 2014_b) PNA NO: 007841______Valid Until: Oct. 31, 2012_
______________________________MARIVIC M. OCAMPOS, BSN, RN, MAN DEANDate Signed: ____________Degree: BSN, RN, MANa) PRC NO: 0152858_____Valid Until: Aug. 17, 2013_b) PNA NO: 007840______Valid Until: Oct. 31, 2012_c) ADPCN NO: 108_________Valid Until: May 31, 2012_
ODC Form 1CCORD CARE FORM
Date Performed and Time Operation
Patient’s INITIALS only
Case Number
PROCEDURE PERFORMEDImmediate Newborn Cord Care
D.R. Nurse on Duty(Name and Signature)
(If Midwife on Duty, Signature Not Required)
SUPERVISED BY Clinical InstructorName and Signature
CORD CARE ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
CORD CARE ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
CORD CARE ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
CORD CARE ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
CORD CARE ( NORMAL SPONTANEOUS VAGINAL DELIVERY)
NOTED BY: APPROVED BY:
____________________________________JOSEPHINE P. CATAPANG, BSN, RN, MN, MAN
CLINICAL COORDINATORDate Signed: _________________Degree : BSN, RN, MN, MAN_a) PRC NO: 0171058__________Valid Until: Jan. 20, 2014_b) PNA NO: 007841______Valid Until: Oct. 31, 2012_
______________________________MARIVIC M. OCAMPOS, BSN, RN, MAN DEANDate Signed: ____________Degree: BSN, RN, MANa) PRC NO: 0152858_____Valid Until: Aug. 17, 2013_b) PNA NO: 007840______Valid Until: Oct. 31, 2012_c) ADPCN NO: 108_________Valid Until: May 31, 2012_
