Amando Cope Colege College of Nursing: ODC Form 1A
Amando Cope Colege College of Nursing: ODC Form 1A
Amando Cope Colege College of Nursing: ODC Form 1A
OR SCRUB FORM
Patients INITIALS(only)
Case Number
Noted by:
VILMA U. BORLAGDAN, RN
(Printed Name and Signature)
Clinical Coordinator, PRC I.D. No. 0083327 Valid Until:
signed: _________________ Time: ____________
Please specify Highest Nursing Degree Earned: MAN
SURGICAL PROCEDURE
PERFORMED
Approved by:
OR Nurse On Duty
(Name and Signature)
SUPERVISED BY
Clinical Instructor
Name and Signature