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    New PRC Case Form

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    gyds_17
    This document contains forms for documenting surgical scrubs, deliveries, and newborn cord care performed by nursing students. The forms include fields for the student and supervisor names and signatures, patient identifying information, procedure details, and approvals from clinical coordinators and the nursing program dean. Strict confidentiality of patient information is noted.

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    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd

    New PRC Case Form

    Uploaded by

    gyds_17
    304 views5 pages
    This document contains forms for documenting surgical scrubs, deliveries, and newborn cord care performed by nursing students. The forms include fields for the student and supervisor names and signatures, patient identifying information, procedure details, and approvals from clinical coordinators and the nursing program dean. Strict confidentiality of patient information is noted.

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    New Prc Case Form

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    This document contains forms for documenting surgical scrubs, deliveries, and newborn cord care performed by nursing students. The forms include fields for the student and supervisor names and signatures, patient identifying information, procedure details, and approvals from clinical coordinators and the nursing program dean. Strict confidentiality of patient information is noted.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    304 views5 pages

    New PRC Case Form

    Uploaded by

    gyds_17
    This document contains forms for documenting surgical scrubs, deliveries, and newborn cord care performed by nursing students. The forms include fields for the student and supervisor names and signatures, patient identifying information, procedure details, and approvals from clinical coordinators and the nursing program dean. Strict confidentiality of patient information is noted.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    You are on page 1of 5

    ODC Form 2A O.R.

    SCRUB FORM Major

    SURGICAL SCRUB in ________________________________________________________


    Hospital , Municipality /City / Province

    Prepared by: Printed Name with Signature of Student _______________________________________

    Date Performed and Time Started

    Patients INITIAL (only) Case Number

    SURGICAL PROCEDURE PERFORMED

    O.R. Nurse On Duty


    (Name and Signature)

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: TITA B. BUENAOBRA, RN MAN Clinical Coordinator


    PRC I.D. No. ___________0241227_________________ Valid Until ___01/ 03/ 2013___ Date document is signed: ______________________________ Time _________________ Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING

    Approved by: MARY NELLIE T. ROA, DMD, RN MAN Dean


    PRC I.D. No. ____________________________________ Valid Until _________________ Date document is signed: ______________________________ Time _________________ Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING

    STRICLTY NO DESIGNATES

    ODC Form 2B O.R. Minor Form

    SURGICAL SCRUB in ________________________________________________________


    Hospital , Municipality /City / Province

    Prepared by: Printed Name with Signature of Student _______________________________________

    Date Performed and Time Started

    Patients INITIAL (only) Case Number

    SURGICAL PROCEDURE PERFORMED

    O.R. Nurse On Duty


    (Name and Signature)

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: TITA B. BUENAOBRA, RN MAN Clinical Coordinator

    Approved by: MARY NELLIE T. ROA, DMD, RN MAN Dean

    PRC I.D. No. ___________0241227_________________ Valid Until ___01/ 03/ 2013___ PRC I.D. No. ____________________________________ Valid Until _________________ Date document is signed: ______________________________ Time _________________ Date document is signed: ______________________________ Time _________________ Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING Please specify Highest Nursing Degree EarnedMASTER OF ARTS IN NURSING

    STRICLTY NO DESIGNATES

    ODC Form 1A Actual Delivery Form

    ACTUAL DELIVERY in ________________________________________________________


    Hospital/ Home/ Lying-In Clinic , Municipality /City / Province

    Prepared by: Printed Name with Signature of Student _______________________________________

    Date Performed and Time Started

    Patients INITIAL (only) Case Number


    (not applicable for Birthing/ Lying-In Clinic/ Homes)

    D.R. Nurse On Duty PROCEDURE PERFORMED


    (Name and Signature) (If Midwife on Duty, Signature Not Required)

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: TITA B. BUENAOBRA, RN MAN Clinical Coordinator


    PRC I.D. No. ___________0241227_________________ Valid Until ___01/ 03/ 2013___ Date document is signed: ______________________________ Time _________________ Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING

    Approved by: MARY NELLIE T. ROA, DMD, RN MAN Dean


    PRC I.D. No. ____________________________________ Valid Until _________________ Date document is signed: ______________________________ Time _________________ Please specify Highest Nursing Degree Earned:MASTER OF ARTS IN NURSING

    STRICLTY NO DESIGNATES

    ODC Form 1B AssitedDelivery Form

    ACTUAL DELIVERY in ________________________________________________________


    Hospital/ Home/ Lying-In Clinic , Municipality /City / Province

    Prepared by: Printed Name with Signature of Student _______________________________________

    Date Performed and Time Started

    Patients INITIAL (only) Case Number


    (not applicable for Birthing/ Lying-In Clinic/ Homes)

    D.R. Nurse On Duty PROCEDURE PERFORMED


    (Name and Signature) (If Midwife on Duty, Signature Not Required)

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: TITA B. BUENAOBRA, RN MAN Clinical Coordinator


    PRC I.D. No. ___________0241227_________________ Valid Until ___01/ 03/ 2013___ Date document is signed: ______________________________ Time _________________ Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING

    Approved by: MARY NELLIE T. ROA, DMD, RN MAN Dean


    PRC I.D. No. ____________________________________ Valid Until _________________ Date document is signed: ______________________________ Time _________________ Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING

    STRICLTY NO DESIGNATES

    ODC Form 1C CORD CARE Form

    IMMEDIATE NEWBORN CORD CARE in_______________________________________________________________________________


    Hospital/ Home/ Lying-In Clinic , Municipality /City / Province

    Prepared by: Printed Name with Signature of Student _______________________________________

    Date Performed and Time Started

    Patients INITIAL (only) Case Number


    (not applicable for Birthing/ Lying-In Clinic/ Homes)

    Immediate Newborn Cord Care PERFORMED


    Indicate where performed e.g. D.R. Nursery, NICU, or Home

    D.R. Nurse On Duty


    (Name and Signature) (If Midwife on Duty, Signature Not Required)

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: TITA B. BUENAOBRA, RN MAN Clinical Coordinator


    PRC I.D. No. ___________0241227_________________ Valid Until ___01/ 03/ 2013___ Date document is signed: ______________________________ Time _________________ Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING

    Approved by: MARY NELLIE T. ROA, DMD, RN MAN Dean


    PRC I.D. No. ____________________________________ Valid Until _________________ Date document is signed: ______________________________ Time _________________ Please specify Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING

    STRICLTY NO DESIGNATES

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