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  • Minor UoPCN Case Slip

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    Keith Giomeer Petrola
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    Note: I have typed the docus manually and please report here and bear with me if there are any error (typographical/format) that you've seen.. Thanks! :) More helpful Documents and Infos @ http://bit.ly/8X5HJS

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    Note: I have typed the docus manually and please report here and bear with me if there are any error (typographical/format) that you've seen.. Thanks! :) More helpful Documents and Infos @ http://bit.ly/8X5HJS

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    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
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    214 views2 pages

    Minor UoPCN Case Slip

    Uploaded by

    Keith Giomeer Petrola
    Note: I have typed the docus manually and please report here and bear with me if there are any error (typographical/format) that you've seen.. Thanks! :) More helpful Documents and Infos @ http://bit.ly/8X5HJS

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    21

    UNIVERSITY OF PANGASINAN Name of Patient:_______________________________________ Name of Patient:_____________________ __________________


    PHINMA Education Network Address: _____________________________________________ Address: _____________________________________________
    College of Nursing Age: _______ Sex: _________ Ward: _____________________ Age: _______ Sex: _________ Ward: _____________________
    Case No: ______________________ Date: _________________ Case No: ______________________ Date: _________________
    Dagupan City
    Pre-Op Diagnosis: _____________________________________ Pre-Op Diagnosis: _____________________________________
    ____________________________________________________ ____________________________________________________
    MINOR CASE SLIP Post-Op Diagnosis: ____________________________________ Post-Op Diagnosis: ____________________________________
    ____________________________________________________ ____________________________________________________
    Operation Performed: __________________________________ Operation Performed: __________________________________
    ____________________________________________________ ____________________________________________________
    Name of Student Time Started: _____________ Time Finished: _______________
    Time Started: _____________ Time Finished: _______________
    Surgeon: _____________________________________________ Surgeon: _____________________________________________
    ___________________________ Assistant: ____________________________________________ Assistant: ____________________________________________
    Student Number Anesthesiologist: ______________________________________ Anesthesiologist: ______________________________________
    Type of Anesthesia: ____________________________________ Type of Anesthesia: ____________________________________
    Medicine Used: _______________________________________ Medicine Used: _______________________________________
    PROF. ZENAIDA M. BAUTISTA BSN-RN, MAN Anesthesia Started: ____________________________________ Anesthesia Started: ____________________________________
    Instrument Nurse: _____________________________________ Instrument Nurse: _____________________________________
    Clinical Coordinator Sponge Nurse: ________________________________________
    Sponge Nurse: ________________________________________
    _________________________ _____________________ _________________________ _____________________
    PRC NO: 0133422 VALID UNTIL: July 27, 2011 . Staff Nurse on Duty Nurse Instructor Staff Nurse on Duty Nurse Instructor
    PNA NO: .VALID UNTIL: . PRC No. __________ PRC No. ___________ PRC No. __________ PRC No. ___________
    ANSAP NO: .VALID UNTIL: .
    Agency: _____________________________________________ Agency: _____________________________________________
    354
    Name of Patient:_______________________________________ Name of Patient:_______________________________________ Name of Patient:_______________________________________
    Address: _____________________________________________ Address: _____________________________________________ Address: _____________________________________________
    Age: _______ Sex: _________ Ward: _____________________ Age: _______ Sex: _________ Ward: _____________________ Age: _______ Sex: _________ Ward: _____________________
    Case No: ______________________ Date: _________________ Case No: ______________________ Date: _________________ Case No: ______________________ Date: _________________
    Pre-Op Diagnosis: _____________________________________ Pre-Op Diagnosis: _____________________________________ Pre-Op Diagnosis: _____________________________________
    ____________________________________________________ ____________________________________________________ ____________________________________________________
    Post-Op Diagnosis: ____________________________________ Post-Op Diagnosis: ____________________________________ Post-Op Diagnosis: ____________________________________
    ____________________________________________________ ____________________________________________________ ____________________________________________________
    Operation Performed: __________________________________ Operation Performed: __________________________________ Operation Performed: __________________________________
    ____________________________________________________ ____________________________________________________ ____________________________________________________
    Time Started: _____________ Time Finished: _______________ Time Started: _____________ Time Finished: _______________ Time Started: _____________ Time Finished: _______________
    Surgeon: _____________________________________________ Surgeon: _____________________________________________ Surgeon: _____________________________________________
    Assistant: ____________________________________________ Assistant: ____________________________________________ Assistant: ____________________________________________
    Anesthesiologist: ______________________________________ Anesthesiologist: ______________________________________ Anesthesiologist: ______________________________________
    Type of Anesthesia: ____________________________________ Type of Anesthesia: ____________________________________ Type of Anesthesia: ____________________________________
    Medicine Used: _______________________________________ Medicine Used: _______________________________________ Medicine Used: _______________________________________
    Anesthesia Started: ____________________________________ Anesthesia Started: ____________________________________ Anesthesia Started: ____________________________________
    Instrument Nurse: _____________________________________ Instrument Nurse: _____________________________________ Instrument Nurse: _____________________________________
    Sponge Nurse: ________________________________________ Sponge Nurse: ________________________________________ Sponge Nurse: ________________________________________
    _________________________ _____________________ _________________________ _____________________ _________________________ _____________________
    Staff Nurse on Duty Nurse Instructor Staff Nurse on Duty Nurse Instructor Staff Nurse on Duty Nurse Instructor
    PRC No. __________ PRC No. ___________ PRC No. __________ PRC No. ___________ PRC No. __________ PRC No. ___________

    Agency: _____________________________________________ Agency: _____________________________________________ Agency: _____________________________________________

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