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  • Ivt Form (3-3-2 Format)

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    Shiela Lyn Mijares
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    This document records a nurse's completion of a 3-day basic intravenous therapy training program. It documents the nurse initiating and maintaining IV infusions, administering IV drugs, and administering and maintaining blood and blood components on three patients under the supervision of certified trainers. The nurse's name, hospital, training program date and venue are listed at the top, along with the patient details, procedures, dosages, and signatures of the certified trainers for each of the three days of training.

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    This document records a nurse's completion of a 3-day basic intravenous therapy training program. It documents the nurse initiating and maintaining IV infusions, administering IV drugs, and administering and maintaining blood and blood components on three patients under the supervision of certified trainers. The nurse's name, hospital, training program date and venue are listed at the top, along with the patient details, procedures, dosages, and signatures of the certified trainers for each of the three days of training.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    2K views1 page

    Ivt Form (3-3-2 Format)

    Uploaded by

    Shiela Lyn Mijares
    This document records a nurse's completion of a 3-day basic intravenous therapy training program. It documents the nurse initiating and maintaining IV infusions, administering IV drugs, and administering and maintaining blood and blood components on three patients under the supervision of certified trainers. The nurse's name, hospital, training program date and venue are listed at the top, along with the patient details, procedures, dosages, and signatures of the certified trainers for each of the three days of training.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 1

    IVT FORM 09 s 09

    3+3+2 ACCOMPLISHED REQUIREMENTS of


    3-DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES

    Name of Registered Nurse: ____________________________________________ PRC No.:________________________


    Name of Hospital offering I V Training: ___________________________________ Provider No.: _____________________
    Date of I V Training Program Attended: __________________________________ Venue: __________________________

    I. Initiating/ Maintaining Peripheral IV Infusions

    Patient Name of Patient Age Date Time Kind of Infusion Site Type of Dose Rate Signature over Printed name of License
    No. Cannula Certified Trainer/Preceptor No.

    II. Administering Intravenous Drugs

    Patient Name of Patient Age Date Time Drugs Incorporated Dose Diagnosis Signature over Printed name of License
    No. Certified Trainer/Preceptor No.

    III. Administering and Maintaining Blood and Blood Components

    Patient Name of Patient Age Date Time Volume/Blood Type/ IV Type of Diagnosis Signature over Printed name of License
    No. Components/Rate Insertion Cannula Certified Trainer/Preceptor No.

    Submit ted by:____________________ Date Submitted:__________ Received by:__________________ Approved by: _______________________
    (Signature over Printed Name) Director of Nursing Service
    (Signature over Printed Name)

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