MAYOR HILARION A. RAMIRO SR. MEDICAL CENTER NSGOR-FM-006/Rev.

3/31July2022
Maningcol, Ozamiz City
OPERATING ROOM CHARGE SLIP
Name of Patient: _________________________________________________________________ Hospital No._____________ Date: _________________
QNTY ITEMS Amount QNTY ITEMS Amount
Abdominal pack-Lap sponge with x-ray detectable thread 8x36x12ply, 28x24
75 mm Selectable Linear Cutter Reload
mesh, individually packed, sterile
Abdominal pack-Lap sponge with x-ray detectable thread 8x12ply, 28x24
Circular stapler
mesh, individually packed, sterile
Gauze sponges 4x8x16ply, sterile with x ray tag Hernia Kit
Gauze sponges 4x4x8 ply, sterile Disposable Syringes 1cc
Gauze sponge 4x8x28x24mesh,8 ply (OS) Disposable Syringes 3cc
Cherry Balls sterile ready to use with x ray detectable (OR use) Disposable Syringes 5cc
Cherry Balls sterile ready to use Disposable Syringes 10cc
Peanut ball with x ray detectable thread, sterile Disposable Syringes _______cc
Absorbable braided polygalactin suture, antibacterial-1 with 40mm Gigli Saw (Zimmer) round blade 50.8cm 20” length
round needle
Absorbable braided polygalactin suture, antibacterial 2-0 with round Skin staple with remover 35mm wide with remover
needle 90cm/70cm
Absorbable braided polygalactin suture, antibacterial 3-0 with Specimen Container for urine with screen cap,
cutting needle disposable with calibration, sterile
Absorbable braided polygalactin suture, antibacterial_________ Surgical Blade # 11 appablade crescent knives
Absorbable braided polygalactin suture, antibacterial_________ Surgical Blade # 15 appablade crescent knives
Absorbable braided polygalactin suture, antibacterial-1 with blunt
Surgical Blade # 10
taperpoint needle, 40mm (Liver Suture)
Non-absorbable polypropylene 6-0 suture, double arm Surgical Blade # 20
Non-absorbable monofilament polypropylene_______ Hydrogen Peroxide 20 vol./150ml
Lubricant gel sachet 5 gms (Purified water USP,
Non-absorbable monofilament polypropylene_______
Glycerin USP)
Non absorbable braided silk suture 0 with needle round, 38mm Nasogastric Tube fr._____
Non absorbable braided silk suture 2-0 with 25mm, needle round Nebulizing Kit with mouthpiece (Adult)
Non absorbable braided silk suture_____________ Nebulizing Kit with mask (Pedia/Neonate)
Non absorbable braided silk suture_____________ O2 Cannula Pedia/Adult, nasal curved tip
Non absorbable braided silk suture_____without needle (multipack) O2 Face Mask- with reservoir bag, ____
Non absorbable braided silk suture_____without needle (multipack) Gloves-sterile lightly powdered size ______
Absorbable monofilament natural 1 with 40mm ½ circle, 75cm
Gloves-sterile lightly powdered size ______
round needle
Absorbable monofilament natural 2-0 with 30mm round needle, Gloves advance powder free latex, with micro-rough
75cm outer surface for secure grip- size 6.5
Gloves advance powder free latex, with micro-rough
Absorbable monofilament natural_______
outer surface for secure grip- size 7.0
Absorbable monofilament polydioxanone suture 1, with needle Gloves advance powder free latex, with micro-rough
round outer surface for secure grip- size 7.5
Absorbable monofilament polydioxanone suture, antibacterial 0 Gloves advance powder free latex, with micro-rough
loop suture 150 cm outer surface for secure grip- size 8.0
Knotless Tissue Control Device, Barbed Suture 1, Bidirectional Plaster of Paris
Knotless Tissue Control Device, Barbed Suture 2-0, Unidirectional Elastic Bandage 4x5 yards
Absorbable gelatin sponge hemostat 7cmx5cmx1cm Wadding Sheet 5x6
Bone Wax 2.5 grams Suction catheter #____ with thumb control
Vaselinized gauze- (Suftra-tulle) Surgical brush disposable________
Airway Guedel Disposable (Pedia) Color________ Surgical marking pen, sterile
Airway Guedel Disposable (Adult) Color________ Thoracic Catheters with connector Fr._____
Supraglottic Airway, with unique non-inflatable cuff, and soft-gel like Tracheostomy with inner cannula, cuffed, fenestrated,
tip Size #____ size____
Endotracheal Tube # ______with cuff/without cuff Tracheostomy, Flexible, Cuffed, size ____
Endotracheal Tube # ______with cuff, preloaded stylet T Tube Fr. _____
Endotracheal Tube # ______with cuff/without cuff Underpads- 30x30”x6 ply (blue sheet)
Pre-Form Endotracheal Tube #______north/south with cuff Dri Sheet 70x36, 6 ply, peach
Wound drainage 4x10, 80cm L 20cm perf 20cm pull
Electrodes Disposable (Adult/Pedia)
150
Epidural Catheter set with Epimatic syringe Wound Irrigation Solution
Spinale needle g.25x90mm Carbacol solution
Eye drape with attach drain pouch size 100x70cm, adhesive
Blood Transfusion Set with Y port (superior quality material) – OR Use
area 7x9cm (OR use)
Infusion Set Macroset/Micro (Adult/Pedia) with Y port Eye goggles 38cm
Volumetric Set with Y-Port Eye pad oval 1-5/8” (4.2cmx70cm adhesive area 7x9cm
(OR use)
IV connector and extension set Hydroxy Propyl Methylcellulose ophthalmic gel
Non Absorbable monofilament synthetic nylon 10-0
Octopus triple lumen with 3 bionector and clamps 10cm
suture with needle
3 Way Stop Cock, sterile disposable Tryphan blue Ophthalmic solution
IV cannula G.______ Cotton Balls Ready made
IV cannula G.______ Cotton Buds
Asepto Syringe 50cc with rubber bulb, disposable, sterile Intraocular lens Powder + ________
Colostomy Bag (Adult/Pedia) O2 consumption_______l/min.
Disposable Cautery Pencil CO2 Consumption __________ flow per min.
Universal Cautery grounding pads Use of Cautery Machine
FBC Fr.________ (2 way) Use C-Mac
FBC Fr.________ (3 way) Use of Lap Tower
Supra Pubic Catheter Frecnh______3-way silicon elastomer coated
Urine Bag-disposable with hanger, with T bulb 2,000 cc capacity
Mesh 3x6 inches size (10cmx12cm) light weight
Polymer Plastic Ligating Clips, medium large
Penrose Drain (1/2”/1”) double packing, latex, sterile
Poole Drain suction set without control, double packing, sterile
Yankuer Suction Set
Disposable Razor- double ended with slide cover
Disposable Surgical Clipper blades
Prepared By: _________________________
NOD