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College of Nursing Cebu City: Surgical Scrub In: Hospital, Municipality/City/ Province

The document appears to be a form for students to record information about surgical scrubs they participate in, including the date, patient's initials, surgical procedure, operating room nurse on duty, and signatures of the student, clinical instructor, and supervisor.

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46 views2 pages

College of Nursing Cebu City: Surgical Scrub In: Hospital, Municipality/City/ Province

The document appears to be a form for students to record information about surgical scrubs they participate in, including the date, patient's initials, surgical procedure, operating room nurse on duty, and signatures of the student, clinical instructor, and supervisor.

Uploaded by

rey.dngg
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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UNIVERSITY OF CEBU LAPULAPU AND MANDAUE

A.C. Cortes, Ave. Looc, Mandaue City


COLLEGE OF NURSING
CEBU CITY

SURGICAL SCRUB in: ________________________________________________________________


Hospital, Municipality/City/ Province

O.R. Form 1A
O.R. SCRUB FORM
Prepared by: Major
Printed Name with Signature of Student ___________________________________________________________________

Date Performed Patient’s INITIALS SUPERVISED BY


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

( STRICTLY NO DESIGNATES )
UNIVERSITY OF CEBU LAPULAPU AND MANDAUE
A.C. Cortes, Ave. Looc, Mandaue City
COLLEGE OF NURSING
CEBU CITY

SURGICAL SCRUB in: ________________________________________________________________


Hospital, Municipality/City/ Province

O.R. Form 1B
O.R. CIRCULATING
FORM
Prepared by:
Printed Name with Signature of Student __________________ _ __________________________________

Date Performed Patient’s INITIALS ( only ) SUPERVISED BY


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

( STRICTLY NO DESIGNATES )

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