Professional Documents
Culture Documents
OR
OR
College of Nursing
Corrales Ext. & Osmea Ext. Sts., Cagayan de Oro City (CHED 070: PACUCOA Level 2, June 14, 1982 Manila)
ODC Form 2A
O.R. SCRUB FORM Major
SURGICAL SCRUB in Northern Mindanao Medical Center Hospital, Municipality/City/Province Prepared by: Maria Sol Fontillas Aguirre
____________________________ Year of Admission in the BSN Program: Year Graduated in BSN Program: June 2007 October 2011
No.
1 2 3 4 5
Date Performed
Time Started
Case No.
Patients Name
Noted by: ________ Mrs. Jenny R. Balo, R.N., M.A.N._____________ (Print Name & Signature) Clinical Coordinator, PRC I.D. No.: _0257481__ Valid Until: June 20, 2012_ Date Document is signed: __________________ Time: _________________ Highest Nursing Degree Earned: ___R.N., M.A.N.____
Approved by: ______ Mrs. Fidela B. Ansale, R.N., M.A.N._______ (Print Name & Signature) Dean, PRC I.D. No.: ____0085045____ Valid Until: February 7, 2010_
Date Document is signed: ____________ Time: ____________________ Highest Nursing Degree Earned: ___B.S.N., M.A.N.____
Capitol University
College of Nursing
Corrales Ext. & Osmea Ext. Sts., Cagayan de Oro City (CHED 070: PACUCOA Level 2, June 14, 1982 Manila)
ODC Form 2C
O.R. SCRUB FORM Minor
SURGICAL SCRUB in Northern Mindanao Medical Center/ Cagayan de Oro Medical Center/ Capitol University Medical City Hospital, Municipality/City/Province Prepared by: Maria Sol Fontillas Aguirre
____________________________ Year of Admission in the BSN Program: Year Graduated in BSN Program: June 2007 October 2011
No.
Date Performed
February 19, 2011
Time Started
4:30pm
Case No.
2664
Patients Name
Marlene Oca
2 3 4 5
8:50am
016207
Joy Monteza
Airen Salbadana, RN
Jessele B. Janioso, RN, MN Marithel R. Moreno, RN, MN Bergris M. Puerto, RN, MN Marithel R. Moreno, RN, MN
2:08pm 5:00pm
497886 00739
3:15pm
552103
Danica Paulino
Excision
Giovanni Capistrano, RN
Noted by: _________ Mrs. Jenny R. Balo, R.N., M.A.N.____________ (Print Name & Signature) Clinical Coordinator, PRC I.D. No.: _0257481__ Valid Until: June 20, 2012_ Date Document is signed: __________________ Time: _________________ Highest Nursing Degree Earned: ___R.N., M.A.N.____
Approved by: ______ Mrs. Fidela B. Ansale, R.N., M.A.N._______ (Print Name & Signature) Dean, PRC I.D. No.: ____0085045____ Valid Until: February 7, 2010_
Date Document is signed: ____________ Time: ____________________ Highest Nursing Degree Earned: ___B.S.N., M.A.N.____
Capitol University
College of Nursing
Corrales Ext. & Osmea Ext. Sts., Cagayan de Oro City (CHED 070: PACUCOA Level 2, June 14, 1982 Manila)
ODC Form 2B
O.R. CIRCULATING FORM
SURGICAL SCRUB in Northern Mindanao Medical Center/ Capitol University Medical City Hospital, Municipality/City/Province
Prepared by:
Year of Admission in the BSN Program: Year Graduated in BSN Program: O.R. Nurse On Duty (Name & Signature)
No.
1 2 3 4 5
Case No.
Patients Name
Noted by: _________ Mrs. Jenny R. Balo, R.N., M.A.N.____________ (Print Name & Signature) Clinical Coordinator, PRC I.D. No.: _0257481__ Valid Until: June 20, 2012_ Date Document is signed: __________________ Time: _________________ Highest Nursing Degree Earned: ___R.N., M.A.N.____
Approved by: ______ Mrs. Fidela B. Ansale, R.N., M.A.N._______ (Print Name & Signature) Dean, PRC I.D. No.: ____0085045____ Valid Until: February 7, 2010_
Date Document is signed: ____________ Time: ____________________ Highest Nursing Degree Earned: ___B.S.N., M.A.N.____