Scribd
Upload
218 views

Benguet State University College of Nursing: Procedure Performed

This document is a surgical scrub form from Benguet State University College of Nursing. It contains information for recording a student's surgical scrub performed in either Benguet General Hospital or Baguio General Hospital and Medical Center, including the student's name, date and time of the procedure, patient name and case number, procedure performed, supervising nurse, and signatures of the clinical coordinator and dean approving the procedure. It also provides contact information for Benguet State University College of Nursing.

Uploaded by

Audi Kyle Saydoven
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
218 views

Benguet State University College of Nursing: Procedure Performed

This document is a surgical scrub form from Benguet State University College of Nursing. It contains information for recording a student's surgical scrub performed in either Benguet General Hospital or Baguio General Hospital and Medical Center, including the student's name, date and time of the procedure, patient name and case number, procedure performed, supervising nurse, and signatures of the clinical coordinator and dean approving the procedure. It also provides contact information for Benguet State University College of Nursing.

Uploaded by

Audi Kyle Saydoven
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 3

OCD FORM 2B

O.R. Scrub Form


BENGUET STATE UNIVERSITY MINOR
College of Nursing
La Trinidad, Benguet, 2601 Philippines
Phone number: 309-3882; Fax number: 422-2281; E-mail:[email protected]; Web site:www.bsu.edu.ph
LEVEL III RE-ACCREDITED,AACCUP,December 1,2007- November 3, 2011

SURGICAL SCRUB in BENGUET GENERAL HOSPITAL

Name of Student: Signature of student:


Date Performed Patient Name
and PROCEDURE PERFORMED O.R. Nurse On Duty SUPERVISED BY:
Case Number
Time Started

Noted by: LAWRENCE C. CARANTO,RN Concurred by: VIRGINIA B. SAGUIDIC, RN


Clinical Coordinator, PRC I.D No.: 0311507 Valid Until : September 11,2011 Chief Nurse, PRC I.D No.: 003986 Valid until: January 15,2012
PNA No.: 063312 Valid Until: December 31,2010 PNA No.: 02806 Valid until: Lifetime
Date signed: Time signed : ANSAP No.: 01376 Valid until: December 31,2010
Highest Nursing Degree Earned: Master of Arts in Nursing ( MAN) Date signed: Time Signed:
Highest Nursing degree earned: Master of arts in Nursing (MAN)
OCD FORM 2B
O.R. Scrub Form
BENGUET STATE UNIVERSITY MINOR
Approved by: VICENTE G.PANAGAN JR.,RN
College of Nursing Dean, PRC I.D. No. 296633 Valid Until: April 11,2011
La Trinidad, Benguet, 2601 Philippines
PNA No.: 063313 Valid Until:December 31,2010
Phone number: 309-3882; Fax number: 422-2281; E- mail:[email protected]; Web site:www.bsu.edu.ph
LEVEL III RE-ACCREDITED,AACCUP,December 1,2007- ADPCN NO.: 0838 Valid Until: December 31,2010 November 3, 2011
Date signed: Time signed:
SURGICAL SCRUB in BAGUIO GENERAL HOSPITAL AND MEDICAL Specify Highest Nursing Degree Earned: CENTER, Baguio City
Name of Student: Signature of student:

Date Performed Patient Name


and PROCEDURE PERFORMED O.R. Nurse On Duty SUPERVISED BY:
Case Number
Time Started

Noted by: LAWRENCE C. CARANTO,RN Concurred by: ELENA B. TAMPICAN,RN


Clinical Coordinator, PRC I.D No.: 0311507 Valid Until : September 11,2011 Chief Nurse, PRC I.D No.: 004369 Valid until: January 27,2011
PNA No.: 063312 Valid Until: December 31,2010 PNA No.: 04718 Valid until: Lifetime
Date signed: Time signed : ANSAP No.: 01036 Valid until: December 31,2010
Highest Nursing Degree Earned: Master of Arts in Nursing ( MAN) Date signed: Time Signed:
Highest Nursing degree earned: Master of arts in Nursing (MAN)

Approved by: VICENTE G.PANAGAN JR.,RN


Dean, PRC I.D. No. 296633 Valid Until: April 11,2011
PNA No.: 063313 Valid Until:December 31,2010
ADPCN NO.: 0838 Valid Until: December 31,2010
Date signed: Time signed:
Specify Highest Nursing Degree Earned:

You might also like