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    033 Orc or Scrub Circulating Case Form

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    Dana Marie Leano
    This document is a form for students to record their surgical scrub experiences in the circulating role. It includes fields to record the date and time of the procedure, the patient's initials, the surgical procedure performed, the operating room nurse on duty, the supervising clinical instructor, and spaces for signatures. It also includes notes and approvals sections for the clinical coordinator and dean. All information collected on the form will be used by the University and processed according to their data privacy policies.

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    033 Orc or Scrub Circulating Case Form

    Uploaded by

    Dana Marie Leano
    6 views1 page
    This document is a form for students to record their surgical scrub experiences in the circulating role. It includes fields to record the date and time of the procedure, the patient's initials, the surgical procedure performed, the operating room nurse on duty, the supervising clinical instructor, and spaces for signatures. It also includes notes and approvals sections for the clinical coordinator and dean. All information collected on the form will be used by the University and processed according to their data privacy policies.

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    Original Title

    033-ORC-OR-SCRUB-CIRCULATING-CASE-FORM

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    This document is a form for students to record their surgical scrub experiences in the circulating role. It includes fields to record the date and time of the procedure, the patient's initials, the surgical procedure performed, the operating room nurse on duty, the supervising clinical instructor, and spaces for signatures. It also includes notes and approvals sections for the clinical coordinator and dean. All information collected on the form will be used by the University and processed according to their data privacy policies.

    Copyright:

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

    033 Orc or Scrub Circulating Case Form

    Uploaded by

    Dana Marie Leano
    This document is a form for students to record their surgical scrub experiences in the circulating role. It includes fields to record the date and time of the procedure, the patient's initials, the surgical procedure performed, the operating room nurse on duty, the supervising clinical instructor, and spaces for signatures. It also includes notes and approvals sections for the clinical coordinator and dean. All information collected on the form will be used by the University and processed according to their data privacy policies.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 1

    UPHSD-LP-CONORC-033

    01-03-2022-02
    UNIVERSITY OF
    PERPETUAL
    SYSTEM DALTA
    HELP
    COLLEGE OF NURSING
    PACUCOA Accredited – Level IV Accredited Status
    SURGICAL SCRUB (CIRCULATING) in ____________________________________________
    Hospital/Lying-in Clinic, Municipality/City/Province

    Prepared by: _______________________________________


    (Printed Name and Signature of Student)
    Date Performed Patient’s INITIAL Only SURGICAL PROCEDURE O.R. Nurse on Duty SUPERVISED BY
    and PERFORMED (Name and Signature) Clinical Instructor’s
    Time Started Case Number Name and Signature

    Noted by: Approved by:


    ________________________________________________ _________________________________________________________
    Clinical Coordinator Dean
    PRC ID No. _______________ Valid Until : _____________ PRC ID No. ________________ Valid Until : _____________________

    All information shall be used by the University for legitimate purposes and shall be processed by
    authorized personnel in accordance with the Data Privacy Policies of the UPHSD Las Piñas Campus .
    Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (+632) 8871.06.39
    www.perpetualdalta.edu.ph
    Las Piñas Campus

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