Professional Documents
Culture Documents
PRC Form Com 14
PRC Form Com 14
SURGICAL SCRUB in _____________________________________________________________ Hospital, Municipality/ City/ Province Date Performed and Time Started Patients INITIALS (only) CASE NUMBER SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty ( Name and Signature)
O.R. FORM 1A
MAJOR O.R. SCRUB FORM Supervised by Clinical Instructor (Name and Signature)
Clinical Coordinator
Student
Signature over Printed Name CTC Number: ____________ Date : __________________ Place: __________________
JENNIFER S. CENTENO, RN, MSN Signature over Printed Name Degree: BSN, MSN Date Signed:_____________ PRC No: 0241987 Valid Until: March 24, 2015 PNA No: 053382 Valid Until: December 31, 2012
Dean LOIDA O. CRESPO, RN, MSN, MAEd Signature over Printed Name Degree:BSN, MSN, MAEd Date Signed:_____________ PRC No: 0094388 Valid Until: December 5, 2013 PNA No: 18308 Valid Until: Lifetime ADPCN No: 11167 Valid Until: April 30, 2012
SURGICAL SCRUB in _____________________________________________________________ Hospital, Municipality/ City/ Province Date Performed and Time Started Patients INITIALS (only) CASE NUMBER SURGICAL PROCEDURE PERFORMED
O.R. FORM 1B
MAJOR O.R. CIRCULATING FORM Supervised by Clinical Instructor (Name and Signature)
Clinical Coordinator
Student
Signature over Printed Name CTC Number: ____________ Date : __________________ Place: __________________
JENNIFER S. CENTENO, RN, MSN Signature over Printed Name Degree: BSN, MSN Date Signed:_____________ PRC No: 0241987 Valid Until: March 24, 2015 PNA No: 053382 Valid Until: December 31, 2012
Dean LOIDA O. CRESPO, RN, MSN, MAEd Signature over Printed Name Degree:BSN, MSN, MAEd Date Signed:_____________ PRC No: 0094388 Valid Until: December 5, 2013 PNA No: 18308 Valid Until: Lifetime ADPCN No: 11167 Valid Until: April 30, 2012
SURGICAL SCRUB in _____________________________________________________________ Hospital, Municipality/ City/ Province Date Performed and Time Started Patients INITIALS (only) CASE NUMBER SURGICAL PROCEDURE PERFORMED O.R. Nurse On Duty ( Name and Signature)
O.R. FORM 1C
MINOR FORM Supervised by Clinical Instructor (Name and Signature)
Clinical Coordinator
Student
Signature over Printed Name CTC Number: ____________ Date : __________________ Place: __________________
JENNIFER S. CENTENO, RN, MSN Signature over Printed Name Degree: BSN, MSN Date Signed:_____________ PRC No: 0241987 Valid Until: March 24, 2015 PNA No: 053382 Valid Until: December 31, 2012
Dean LOIDA O. CRESPO, RN, MSN, MAEd Signature over Printed Name Degree:BSN, MSN, MAEd Date Signed:_____________ PRC No: 0094388 Valid Until: December 5, 2013 PNA No: 18308 Valid Until: Lifetime ADPCN No: 11167 Valid Until: April 30, 2012
ACTUAL DELIVERY SCRUB in _____________________________________________________________ D.R. FORM 1D Hospital, Municipality/ City/ Province ACTUAL DELIVERY FORM Date Performed and Time Started Patients INITIALS (only) CASE NUMBER PROCEDURE PERFORMED D.R. Nurse On Duty ( Name and Signature) Supervised by Clinical Instructor (Name and Signature)
Clinical Coordinator
Student
Signature over Printed Name CTC Number: ____________ Date : __________________ Place: __________________
JENNIFER S. CENTENO, RN, MSN Signature over Printed Name Degree: BSN, MSN Date Signed:_____________ PRC No: 0241987 Valid Until: March 24, 2015 PNA No: 053382 Valid Until: December 31, 2012
Dean LOIDA O. CRESPO, RN, MSN, MAEd Signature over Printed Name Degree:BSN, MSN, MAEd Date Signed:_____________ PRC No: 0094388 Valid Until: December 5, 2013 PNA No: 18308 Valid Until: Lifetime ADPCN No: 11167 Valid Until: April 30, 2012
IMMEDIATE NEWBORN CORD CARE in _____________________________________________________________ Hospital, Municipality/ City/ Province Date Performed and Time Started Patients INITIALS (only) CASE NUMBER Immediate Newborn Cord Care Performed
ICNB FORM 1E
IMMEDIATE CARE OF THE NEWBORN FORM
Clinical Coordinator
Student
Signature over Printed Name CTC Number: ____________ Date : __________________ Place: __________________
JENNIFER S. CENTENO, RN, MSN Signature over Printed Name Degree: BSN, MSN Date Signed:_____________ PRC No: 0241987 Valid Until: March 24, 2015 PNA No: 053382 Valid Until: December 31, 2012
Dean LOIDA O. CRESPO, RN, MSN, MAEd Signature over Printed Name Degree:BSN, MSN, MAEd Date Signed:_____________ PRC No: 0094388 Valid Until: December 5, 2013 PNA No: 18308 Valid Until: Lifetime ADPCN No: 11167 Valid Until: April 30, 2012