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_