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    Amando Cope Colege College of Nursing: ODC Form 1A

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    Ibrahim Regacho
    This document is an OR scrub form from Amando Cope Colege College of Nursing in Tabaco City, Philippines. It records surgical scrubs performed by students in Dr. Amando D. Cope Memorial Hospital, including the date, time, patient initials, case number, surgical procedure, supervising OR nurse, and supervising clinical instructor. The form must be signed by the student, clinical coordinator Vilma U. Borlagdan, and dean Maria Renee O. Cope to verify completion of the scrub.

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    Amando Cope Colege College of Nursing: ODC Form 1A

    Uploaded by

    Ibrahim Regacho
    9 views1 page
    This document is an OR scrub form from Amando Cope Colege College of Nursing in Tabaco City, Philippines. It records surgical scrubs performed by students in Dr. Amando D. Cope Memorial Hospital, including the date, time, patient initials, case number, surgical procedure, supervising OR nurse, and supervising clinical instructor. The form must be signed by the student, clinical coordinator Vilma U. Borlagdan, and dean Maria Renee O. Cope to verify completion of the scrub.

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    fwfwfwfwfwef

    Original Title

    SCRUB OR IN

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    This document is an OR scrub form from Amando Cope Colege College of Nursing in Tabaco City, Philippines. It records surgical scrubs performed by students in Dr. Amando D. Cope Memorial Hospital, including the date, time, patient initials, case number, surgical procedure, supervising OR nurse, and supervising clinical instructor. The form must be signed by the student, clinical coordinator Vilma U. Borlagdan, and dean Maria Renee O. Cope to verify completion of the scrub.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    9 views1 page

    Amando Cope Colege College of Nursing: ODC Form 1A

    Uploaded by

    Ibrahim Regacho
    This document is an OR scrub form from Amando Cope Colege College of Nursing in Tabaco City, Philippines. It records surgical scrubs performed by students in Dr. Amando D. Cope Memorial Hospital, including the date, time, patient initials, case number, surgical procedure, supervising OR nurse, and supervising clinical instructor. The form must be signed by the student, clinical coordinator Vilma U. Borlagdan, and dean Maria Renee O. Cope to verify completion of the scrub.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    ODC Form 1A

    OR SCRUB FORM

    Republic of the Philippines


    AMANDO COPE COLEGE
    COLLEGE OF NURSING
    Baranghawon, Tabaco City
    Telephone Nos. (052) 830-2770 / 487-4454
    CHED Recognition No. 316-2007
    SURGICAL SCRUB in DR. AMANDO D. COPE MEMORIAL HOSPITAL, Tabaco City
    Hospital, Municipality/City Province
    Prepared by:
    Printed Name with Signature of Student:

    Date Performed and


    Time Started

    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

    MARIA RENEE O. COPE, RN


    (Printed Name and Signature)
    Dean, PRC I.D. No. 0090644
    Valid Until: Date document is
    Date document is signed: _________________ Time: ___________
    Please specify Highest Nursing Degree Earned: MAN, PhD

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