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  • Intra Operative Care OR Form

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    Drex Curitana
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    This document contains surgical scrub forms from Mary Chiles College documenting procedures performed at Tondo Medical Center. It lists 3 procedures performed on November 13th and 2 on November 14th, including radical orchiectomy, LTCS II with bilateral salpingectomy, LTCS I under SAB, exploratory laparotomy with hepatic packing and primary repair of diaphragmatic and stomach injuries, and Whipples procedure. Each entry includes the patient's initials, case number, date, time, surgical procedure, performing surgeon's name and license number, and supervising nurse and clinical instructor.

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    Intra-Operative-Care-OR-Form (4)

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    This document contains surgical scrub forms from Mary Chiles College documenting procedures performed at Tondo Medical Center. It lists 3 procedures performed on November 13th and 2 on November 14th, including radical orchiectomy, LTCS II with bilateral salpingectomy, LTCS I under SAB, exploratory laparotomy with hepatic packing and primary repair of diaphragmatic and stomach injuries, and Whipples procedure. Each entry includes the patient's initials, case number, date, time, surgical procedure, performing surgeon's name and license number, and supervising nurse and clinical instructor.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    1 views4 pages

    Intra Operative Care OR Form

    Uploaded by

    Drex Curitana
    This document contains surgical scrub forms from Mary Chiles College documenting procedures performed at Tondo Medical Center. It lists 3 procedures performed on November 13th and 2 on November 14th, including radical orchiectomy, LTCS II with bilateral salpingectomy, LTCS I under SAB, exploratory laparotomy with hepatic packing and primary repair of diaphragmatic and stomach injuries, and Whipples procedure. Each entry includes the patient's initials, case number, date, time, surgical procedure, performing surgeon's name and license number, and supervising nurse and clinical instructor.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 4

    O.R.

    FORM 1A
    O.R SCRUB FORM
    Major
    MARY CHILES COLLEGE
    667 F.T. Dalupan Sr. St., Sampaloc, Manila
    Tel. No. 735-5341 local 262 / Fax No. 735-5437 / E-mail: info@marychilescollege.edu.ph / website: www.marychilescollege.edu.ph
    SURGICAL SCRUB in TONDO MEDICAL CENTER
    Hospital / Home / Lying-In Clinic, Municipality / City / Province
    Prepared by:
    Printed Name and Signature of Student ORCUSE, BEATRIX ANN S. _

    Date Performed SUPERVISED BY


    Patient’s INITIAL Only SURGICAL PROCEDURE O.R. Nurse On Duty
    and Clinical Instructor
    PERFORMED (Name and Signature)
    Time Started Case Number Name and Signature

    11/13/23
    JLT
    3:10pm Radical Orchiectomy
    1130943 Carmen Thomar S. Yabut
    Ferdinand P. Abadier
    License No. 0672097 RN, MAN

    11/13/23 RAV
    LTCS II with bilateral Salpingectomy Carmen Thomar S. Yabut
    6:33pm 0110194 Tom Wilfred Ogena
    License No. 0813909 RN, MAN

    11/14/23
    FB
    5:11pm LTCS I under SAB
    1143172 Carmen Thomar S. Yabut
    Denice Cyril M. Gatmaitan
    License No. 0570076 RN, MAN
    O.R. FORM 1B
    O.R CIRCULATING FORM

    MARY CHILES COLLEGE


    667 F.T. Dalupan Sr. St., Sampaloc, Manila
    Tel. No. 735-5341 local 262 / Fax No. 735-5437 / E-mail: info@marychilescollege.edu.ph / website: www.marychilescollege.edu.ph
    SURGICAL SCRUB in TONDO MEDICAL CENTER
    Hospital / Home / Lying-In Clinic, Municipality / City / Province
    Prepared by:
    Printed Name and Signature of Student ORCUSE, BEATRIX ANN S.

    Date Performed Patient’s INITIAL Only SUPERVISED BY


    SURGICAL PROCEDURE O.R. Nurse On Duty
    and Clinical Instructor
    Case Number PERFORMED (Name and Signature)
    Time Started Name and Signature

    Exploratory laparotomy hepatic


    11/14/23 J.D. packing primary repair of
    2:46pm 1143098 Diaphragmatic injury, Primary repair Ferdinand P. Abadier Carmen Thomar S. Yabut RN,
    of Stomach injury License No. 0672097 MAN
    11/14/23 C. C. JR.
    Whipples Procedure Franz Balitaan Carmen Thomar S. Yabut RN,
    8:44am 1082888
    License No. 0890504 MAN
    O.R. FORM 1A
    O.R SCRUB FORM
    Major
    MARY CHILES COLLEGE
    667 F.T. Dalupan Sr. St., Sampaloc, Manila
    Tel. No. 735-5341 local 262 / Fax No. 735-5437 / E-mail: info@marychilescollege.edu.ph / website: www.marychilescollege.edu.ph
    SURGICAL SCRUB in TONDO MEDICAL CENTER
    Hospital / Home / Lying-In Clinic, Municipality / City / Province
    Prepared by:
    Printed Name and Signature of Student ORCUSE, BEATRIX ANN S. _

    Date Performed SUPERVISED BY


    Patient’s INITIAL Only SURGICAL PROCEDURE O.R. Nurse On Duty
    and Clinical Instructor
    PERFORMED (Name and Signature)
    Time Started Case Number Name and Signature

    11/13/23
    JLT
    3:10pm Radical Orchiectomy
    1130943 Carmen Thomar S. Yabut
    Ferdinand P. Abadier
    License No. 0672097 RN, MAN

    11/13/23 RAV
    LTCS II with bilateral Salpingectomy Carmen Thomar S. Yabut
    6:33pm 0110194 Tom Wilfred Ogena
    License No. 0813909 RN, MAN

    11/14/23
    FB
    5:11pm LTCS I under SAB
    Denice Cyril M. Gatmaitan Carmen Thomar S. Yabut
    License No. 0570076 RN, MAN
    MARY CHILES COLLEGE
    667 F.T. Dalupan Sr. St., Sampaloc, Manila
    Tel. No. 735-5341 local 262 / Fax No. 735-5437 / E-mail: info@marychilescollege.edu.ph / website: www.marychilescollege.edu.ph
    SURGICAL SCRUB in TONDO MEDICAL CENTER
    Hospital / Home / Lying-In Clinic, Municipality / City / Province
    Prepared by:
    Printed Name and Signature of Student ORCUSE, BEATRIX ANN S. _

    Date Performed SUPERVISED BY


    Patient’s INITIAL Only SURGICAL PROCEDURE O.R. Nurse On Duty
    and Clinical Instructor
    PERFORMED (Name and Signature)
    Time Started Case Number Name and Signature

    11/13/23
    JLT
    3:10pm Radical Orchiectomy
    1130943 Carmen Thomar S. Yabut
    Ferdinand P. Abadier
    License No. 0672097 RN, MAN

    11/13/23 RAV
    LTCS II with bilateral Salpingectomy Carmen Thomar S. Yabut
    6:33pm 0110194 Tom Wilfred Ogena
    License No. 0813909 RN, MAN

    11/14/23
    FB
    5:11pm LTCS I under SAB
    1107839 Carmen Thomar S. Yabut
    Denice Cyril M. Gatmaitan
    License No. 0570076 RN, MAN

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