Operating Room Surgical Case Slip Operating Room Surgical Case Slip

Anesthesia Stated: Anesthesia Finished:
Easter College Operation Started: Operation Finished:

Easter School Rd., Guisad, Baguio City
Phone: (074) 424-5483
E-mail: ndcon2013@gmail.com
Website: www.eastercollege.ph
CHED Recognition No. 005 series of 2007 Easter College
Easter Easter School Rd., Guisad, Baguio City
Phone: (074) 424-5483
OPERATING ROOM SURGICAL CASE SLIP Easter
CHED Recognition No. 005 series of 2007
CASE NO. Age: Sex:

Date: Ward: OPERATING ROOM SURGICAL CASE SLIP
Pre-Op Diagnosis: CASE NO. Age: Sex:
_______________________________________________________________ Date: Ward:
_______________________________________________________________ Pre-Op Diagnosis:
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________ _______________________________________________________________
Post -Op Diagnosis: _______________________________________________________________
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________ Post -Op Diagnosis:
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________ _______________________________________________________________
Operation Performed: _______________________________________________________________
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________ Operation Performed:
_______________________________________________________________ _______________________________________________________________
_______________________________________________________________
Surgeon: _______________________________________________________________
Assistants:
Instrument Nurse: Surgeon:
Sponge Nurse: Assistants:
Circulating Nurse: Instrument Nurse:
Nurse-on-Duty: Sponge Nurse:
Nurse Instructor: Circulating Nurse:
Anesthesiologist: Nurse-on-Duty:
Type of Anesthesia: Nurse Instructor:
Medicine Used: Anesthesiologist:
Type of Anesthesia:
Medicine Used: Easter College
Easter College
Anesthesia Stated: Anesthesia Finished:
Phone: (074) 424-5483
Phone: (074) 424-5483 Website: www.eastercollege.ph
Operation Started: Operation Finished:
E-mail: ndcon2013@gmail.com CHED Recognition No. 005 series of 2007
DELIVERY ROOM CASE SLIP

DELIVERY ROOM CASE SLIP NAME OF STUDENT:
NAME OF STUDENT:
Course/ Year: Section:
CASE NO. TYPE:
CASE NO. TYPE:
ACTUAL: ASSIST:
ACTUAL: ASSIST:
GRAVIDA PARA:
GRAVIDA PARA:
DATE OF DELIVERY: TIME:
DATE OF DELIVERY: TIME:
SEX OF BABY:
SEX OF BABY:
OBSTRETRICIAN:
OBSTRETRICIAN:
NURSE ON DUTY:
NURSE ON DUTY:
NURSE INSTRUCTOR:
NURSE INSTRUCTOR:
ADMISSION DIAGNOSIS:
ADMISSION DIAGNOSIS: ______________________________________________________________
______________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________
______________________________________________________________
FINAL DIAGNOSIS:
FINAL DIAGNOSIS: ______________________________________________________________
______________________________________________________________ _____________________________________________________________
_____________________________________________________________ _____________________________________________________________
_____________________________________________________________ _____________________________________________________________
_____________________________________________________________ _____________________________________________________________
_____________________________________________________________
Easter College
Phone: (074) 424-5483
Easter College
Phone: (074) 424-5483
IMMEDIATE NEWBORN CORD CARE SLIP CHED Recognition No. 005 series of 2007
NAME OF STUDENT:
IMMEDIATE NEWBORN CORD CARE SLIP
NAME OF STUDENT:

CASE NO.: TYPE:
GRAVIDA: PARA: CASE NO.: TYPE:
DATE OF DELIVERY: TIME: GRAVIDA: PARA:
SEX OF BABY: DATE OF DELIVERY: TIME:
SEX OF BABY:
POST DIAGNOSIS: ________________________________________________
______________________________________________________________ POST DIAGNOSIS: ________________________________________________
______________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________
______________________________________________________________ ______________________________________________________________
______________________________________________________________
PEDIATRICIAN:
NURSE ON DUTY: PEDIATRICIAN:
CLINICAL INSTRUCTOR: NURSE ON DUTY:
CLINICAL INSTRUCTOR:

Operating Room Surgical Case Slip Operating Room Surgical Case Slip

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Operating Room Surgical Case Slip Operating Room Surgical Case Slip

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Anesthesia Stated: Anesthesia Finished:

Easter College Operation Started: Operation Finished:

CASE NO. Age: Sex:

DELIVERY ROOM CASE SLIP

Course/ Year: Section:

Course/ Year: Section:

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