Scribd
Upload
53 views5 pages

PRC Forms

The documents are forms used by Bicol University's Nursing Department to document nursing students' clinical experiences and procedures performed under supervision. The forms include sections for the student and supervising nurse to provide their names and signatures, as well as details of the procedure such as the date, time, patient's initials, hospital, and type of procedure performed.

Uploaded by

Celline Isabelle Reyes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
53 views5 pages

PRC Forms

The documents are forms used by Bicol University's Nursing Department to document nursing students' clinical experiences and procedures performed under supervision. The forms include sections for the student and supervising nurse to provide their names and signatures, as well as details of the procedure such as the date, time, patient's initials, hospital, and type of procedure performed.

Uploaded by

Celline Isabelle Reyes
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 5

Republic of the Philippines

ODC Form 1A
Bicol University Tabaco Campus
Actual Delivery Form
Nursing Department
Tabaco City

ACTUAL DELIVERY in _________________________________________________


Hospital, Municipality/ City/ Province

Prepared by:

Printed Name with Signature of Student: ____________________________________

Date Performed Patient’s INITIALS (only) PROCEDURE PERFORMED D.R. Nurse On Duty SUPERVISED BY
and (Name and Signature) Clinical Instructor
Time Started Case Number (If Midwife on Duty, Name and Signature
(not applicable for Birthing/Lying- Signature NOT
In Clinic/Homes) Required)

Noted by: Approved by:


(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No. Valid Until Dean, PRC I.D. No. Valid Until
Date document is signed: Time Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Please specify Highest Nursing Degree Earned:
Republic of the Philippines
ODC Form 1B
Bicol University Tabaco Campus
Assisted Delivery Form
Nursing Department
Tabaco City

ASSISTED DELIVERY in _________________________________________________


Hospital, Municipality/ City/ Province

Prepared by:

Printed Name with Signature of Student: ____________________________________

Date Performed Patient’s INITIALS (only) PROCEDURE PERFORMED D.R. Nurse On Duty SUPERVISED BY
and (Name and Signature) Clinical Instructor
Time Started Case Number (If Midwife on Duty, Name and Signature
(not applicable for Birthing/Lying- Signature NOT
In Clinic/Homes) Required)

Noted by: Approved by:


(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No. Valid Until Dean, PRC I.D. No. Valid Until
Date document is signed: Time Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Please specify Highest Nursing Degree Earned:
Republic of the Philippines
ODC Form 1C
Bicol University Tabaco Campus
Cord Care Form
Nursing Department
Tabaco City

IMMEDIATE CARE OF NEWBORN in _________________________________________________


Hospital, Municipality/ City/ Province

Prepared by:

Printed Name with Signature of Student: ____________________________________

Date Performed Patient’s INITIALS (only) Immediate Newborn Cord Care NICU Nurse On Duty SUPERVISED BY
and PERFORMED (Name and Signature) Clinical Instructor
Time Started Case Number Indicate where performed e.g. D.R., Nursery, (If Midwife on Duty, Name and Signature
(not applicable for Birthing/Lying- NICU, or Home Signature NOT
In Clinic/Homes) Required)

Noted by: Approved by:


(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No. Valid Until Dean, PRC I.D. No. Valid Until
Date document is signed: Time Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Please specify Highest Nursing Degree Earned:
Republic of the Philippines
ODC Form 2A
Bicol University Tabaco Campus
OR Scrub Form
Nursing Department
Tabaco City

SURGICAL SCRUB in _________________________________________________


Hospital, Municipality/ City/ Province
Prepared by:

Printed Name with Signature of Student: ____________________________________

Date Performed Patient’s INITIALS (only) SURGICAL PROCEDURE O.R. Nurse On Duty SUPERVISED BY
and PERFORMED (Name and Signature) Clinical Instructor
Time Started Name and Signature
Case Number

Noted by: Approved by:


(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No. Valid Until Dean, PRC I.D. No. Valid Until
Date document is signed: Time Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Please specify Highest Nursing Degree Earned:
Republic of the Philippines
ODC Form 2B
Bicol University Tabaco Campus
OR Circulating Form
Nursing Department
Tabaco City

SURGICAL SCRUB in _________________________________________________


Hospital, Municipality/ City/ Province

Prepared by:

Printed Name with Signature of Student: ____________________________________

Date Performed Patient’s INITIALS (only) SURGICAL PROCEDURE O.R. Nurse On Duty SUPERVISED BY
and PERFORMED (Name and Signature) Clinical Instructor
Time Started Name and Signature
Case Number

Noted by: Approved by:


(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No. Valid Until Dean, PRC I.D. No. Valid Until
Date document is signed: Time Date document is signed: Time:
Please specify Highest Nursing Degree Earned: Please specify Highest Nursing Degree Earned:

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy