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  • ODC Form 1 Surgical Scrub - Major

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    ODC Form 1 O.R. SCRUB FORM MAJOR SURGICAL SCRUB in hospital,municipality / city / Province Prepared by: Name of Student Date Performed and Time Started Patient's Name and Case Number Signature of Student PROCEDURE PERFORMED Noted by: JULIE ANNE E. ALCALA, RN, MSN Clinical Coordinator, PRC I.D NO. 0346657 Valid Until JULY 29, 2011 PNA No

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    ODC Form 1 O.R. SCRUB FORM MAJOR SURGICAL SCRUB in hospital,municipality / city / Province Prepared by: Name of Student Date Performed and Time Started Patient's Name and Case Number Signature of Student PROCEDURE PERFORMED Noted by: JULIE ANNE E. ALCALA, RN, MSN Clinical Coordinator, PRC I.D NO. 0346657 Valid Until JULY 29, 2011 PNA No

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    24 views1 page

    ODC Form 1 Surgical Scrub - Major

    Uploaded by

    joshua_reyes_30
    ODC Form 1 O.R. SCRUB FORM MAJOR SURGICAL SCRUB in hospital,municipality / city / Province Prepared by: Name of Student Date Performed and Time Started Patient's Name and Case Number Signature of Student PROCEDURE PERFORMED Noted by: JULIE ANNE E. ALCALA, RN, MSN Clinical Coordinator, PRC I.D NO. 0346657 Valid Until JULY 29, 2011 PNA No

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    EMILIO AGUINALDO COLLEGE ODC Form 1

    1113-1117 San Marcelino cor. Gonzales St. Ermita, Manila O.R. SCRUB FORM
    521-27-10 loc. 5319 www.eac.edu.ph MAJOR

    SURGICAL SCRUB in ---------------------------------------------------------------


    Hospital,Municipality/city/Province

    Prepared by:
    Name of Student ----------------------------------------------------- Signature of Student _______________________

    Date Performed and Patient’s Name SUPERVISED BY


    Time Started and PROCEDURE PERFORMED O.R. Nurse on Duty Clinical Instructor
    Case Number Name and Signature

    Noted by: JULIE ANNE E. ALCALA, RN, MSN Concurred by: ________________________________
    Clinical Coordinator, PRC I.D No. 0346657 Valid Until JULY 29, 2011 Chief Nurse. PRC I.D NO. _____________ Valid Until __________
    PNA No. 18581 Valid Until LIFETIME MEMBER PNA No. __________ Valid Until ______________
    Date document is signed:________________ Time ___________ ANSAP No. ________ Valid Until ____________
    Highest Nursing Degree Earned: MASTER OF SCIENCE IN NURSING Date document is signed:_______________ Time ___________
    Highest Nursing Degree Earned:____________________________

    Approved by: MARY JANE L. OLID, RN, MAN


    Dean, PRC I.D No. 0209678 Valid Until JANUARY 23, 2012
    PNA No. 001859 Valid Until DECEMBER 2009
    ADPCN No. 0449 Valid Until DECEMBER 2009
    Date document is signed:______________ Time ____________
    Highest Nursing Degree Earned: MASTER OF ARTS IN NURSING

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