Professional Documents
Culture Documents
PRC Form of New Curri (Odc Form 1a)
PRC Form of New Curri (Odc Form 1a)
ACTUAL DELIVERY
FORM
Date Performed
And
Time Started
PROCEDURE
PERFORMED
Noted by:
(
Concurred by:
)
SUPERVISED BY
Clinical Instructor
Name and Signature
Concurred by:
)
Approved by:
(
Printed Name and Signature
)
Dean
FORM
(STRICTLY NO DESIGNATES)
Time Started
Case Number
Concurred
by:Nurse
D.R.
(
On Duty
(Name
and
Signature)
Printed Name and Signature
(If Midwife on Duty,
Chief Nurse
of required)
the Hospital
Signature
not
Approved by:
)
BY
( SUPERVISED
Printed Name
and Signature
Clinical
Instructor
)
Dean
Name and Signature
PRC I.D. No.: ________ Valid Until: _________
(STRICTLY NO DESIGNATES)
Our Lady of Fatima University
Esperanza St., Hilltop Mansion, Lagro, Quezon City
ODC Form 1C
CORD CARE FORM
Approved by:
SUPERVISED
BY Signature
(
Printed Name and
)
Clinical Instructor
Dean
Name and Signature
PRC I.D. No.: ______ Valid Until:
_________
PNA I.D. No.: _____ Valid Until: _________
__________________________________
_________________________________
____________________________________
___________________________________
ODC Form 2A
Noted by:
Concurred by:
( DatePrinted
Performed
Name and Signature
Patients INITIALS
(
Printed Name and Signature
)
And
(only))
Coordinator______________________
Chief Nurse of the Hospital
TimeClinical
Started
PRC I.D. No.: __________ Valid Until:
PRC
I.D.
No.: _________ Valid Until:
Case Number
_________
________
PNA I.D. No.: _________ Valid Until:
PNA I.D. No.: ________ Valid Until: ________
__________
Approved by:
(
SUPERVISED
Printed Name BY
and Signature
)
Clinical Instructor
Dean
Name and Signature
PRC I.D. No.: ______ Valid Until:
_________
PNA I.D. No.: _____ Valid Until: _________
Concurred by:
(
Printed
O.R.
Name
Nurse
and Signature
On Duty
)
(Name and Signature)
Chief Nurse of the Hospital
PRC I.D. No.: ________ Valid Until:
________
PNA I.D. No.: _______ Valid Until:
________
__________________________________
_________________________________
____________________________________
___________________________________
SURGICAL
PROCEDURE
PERFORMED
(STRICTLY NO DESIGNATES)
Our Lady of Fatima University
Esperanza St., Hilltop Mansion, Lagro, Quezon City
ODC Form 2B
O.R. CIRCULATING
FORM
CIRCULATING ___________________________________________________________________________
HospitaL, Municipality/City/Province
Prepared by:
Printed Name and Signature of Student_____________________________________________________________________________________________
Concurred by:
Noted
Dateby:
Performed
Patients INITIALS
(
Printed
(
Printed Name and Signature
And Name and SignatureOnly
) Time Started
)
______________________
Clinical CoordinatorCase Number
Chief Nurse of the Hospital
PRC I.D. No.: __________ Valid Until:
PRC I.D. No.: _________ Valid Until:
_________
________
PNA I.D. No.: _________ Valid Until:
PNA I.D. No.: ________ Valid Until: ________
__________
Date document is signed: ______ Time:
Date document is signed: _____ Time:
____
_____
Please specify Highest Nursing Degree
Please specify Highest Nursing Degree
Earned:
Earned:
__________________________________
_________________________________
Concurred by:
SURGICAL PROCEDURE
(
)
PERFORMED
(STRICTLY NO DESIGNATES)
Approved by:
SUPERVISED BY
( Clinical
Printed
Name and Signature
Instructor
)Name and Signature
Dean
PRC I.D. No.: ______ Valid Until:
_________
PNA I.D. No.: _____ Valid Until: _________
Date document is signed: ____ Time:
_____
Please specify Highest Nursing Degree
Earned:
___________________________________