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    New PRC Exhibit Form

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    Pixel Dinibit
    This document contains forms and guidelines for various clinical procedures used by Notre Dame University College of Health Sciences. It includes forms for immediate newborn cord care, assisted delivery, actual delivery, surgical scrubbing, and surgical circulating. The forms require information such as the procedure performed, date, time, location, signatures of the student, supervising instructor, clinical coordinator and dean.

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

    New PRC Exhibit Form

    Uploaded by

    Pixel Dinibit
    358 views6 pages
    This document contains forms and guidelines for various clinical procedures used by Notre Dame University College of Health Sciences. It includes forms for immediate newborn cord care, assisted delivery, actual delivery, surgical scrubbing, and surgical circulating. The forms require information such as the procedure performed, date, time, location, signatures of the student, supervising instructor, clinical coordinator and dean.

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    New Prc Exhibit Form

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    This document contains forms and guidelines for various clinical procedures used by Notre Dame University College of Health Sciences. It includes forms for immediate newborn cord care, assisted delivery, actual delivery, surgical scrubbing, and surgical circulating. The forms require information such as the procedure performed, date, time, location, signatures of the student, supervising instructor, clinical coordinator and dean.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    358 views6 pages

    New PRC Exhibit Form

    Uploaded by

    Pixel Dinibit
    This document contains forms and guidelines for various clinical procedures used by Notre Dame University College of Health Sciences. It includes forms for immediate newborn cord care, assisted delivery, actual delivery, surgical scrubbing, and surgical circulating. The forms require information such as the procedure performed, date, time, location, signatures of the student, supervising instructor, clinical coordinator and dean.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 6

    Notre Dame University College of Health Sciences Notre Dame Avenue, Cotabato City Tel. (064) 421-2698 Loc.

    307, Telefax No. (064) 421-4312, E-mail Address: nducotabato.org PAASCU Level I: November 30 1984 IMMEDIATE NEWBORN CORD CARE In IMMEDIATE NEWBORN CORD CARE In Hospital/Home/Lying-In Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student Patients INITIALS Only Case Number (not applicable for Birthing Homes/Lying-In Clinics/ Homes) Immediate Newborn Cord Care PERFORMED Indicate where performed e.g. D.R., Nursery, NICU, or Home Nurse On Duty (Name and Signature) (If Midwife on Duty, signature not required)

    ICNB Form IMMEDIATE CARE OF THE NEWBORN FORM

    Date Performed and Time Started

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: (Print name and Signature) Clinical Coordinator, PRC I.D No. Date document is signed: Please specify Highest Nursing Degree Earned:

    Valid Until Time

    Approved by: (Print name and Signature) Dean, PRC I.D No. Date document is signed: Specify Highest Nursing Degree Earned:

    Valid Until Time

    Notre Dame University College of Health Sciences Notre Dame Avenue, Cotabato City Tel. (064) 421-2698 Loc. 307, Telefax No. (064) 421-4312, E-mail Address: nducotabato.org PAASCU Level I: November 30 1984 ACTUAL DELIVERY In ACTUAL DELIVERY In Hospital/Home/Lying-In Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student Patients INITIALS Only Case Number (not applicable for Birthing Homes/Lying-In Clinics/ Homes) PROCEDURE PERFORMED ASSISTED DELIVERY D. R. Nurse On Duty (Name and Signature) (If Midwife on Duty, signature not required)

    D. R. Form 1B ASSISTED DELIVERY FORM

    Date Performed and Time Started

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: (Print name and Signature) Clinical Coordinator, PRC I.D No. Date document is signed: Please specify Highest Nursing Degree Earned:

    Valid Until Time

    Approved by: (Print name and Signature) Dean, PRC I.D No. Date document is signed: Specify Highest Nursing Degree Earned:

    Valid Until Time

    Notre Dame University College of Health Sciences Notre Dame Avenue, Cotabato City Tel. (064) 421-2698 Loc. 307, Telefax No. (064) 421-4312, E-mail Address: nducotabato.org PAASCU Level I: November 30 1984 ACTUAL DELIVERY In ACTUAL DELIVERY In Hospital/Home/Lying-In Clinic, Municipality/City/Province Prepared by: Printed Name and Signature of Student Patients INITIALS Only Case Number (not applicable for Birthing Homes/Lying-In Clinics/ Homes) PROCEDURE PERFORMED D. R. Nurse On Duty (Name and Signature) (If Midwife on Duty, signature not required)

    D. R. Form 1A ACTUAL DELIVERY FORM

    Date Performed and Time Started

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: (Print name and Signature) Clinical Coordinator, PRC I.D No. Date document is signed: Please specify Highest Nursing Degree Earned:

    Valid Until Time

    Approved by: (Print name and Signature) Dean, PRC I.D No. Date document is signed: Specify Highest Nursing Degree Earned:

    Valid Until Time

    Notre Dame University College of Health Sciences Notre Dame Avenue, Cotabato City Tel. (064) 421-2698 Loc. 307, Telefax No. (064) 421-4312, E-mail Address: nducotabato.org PAASCU Level I: November 30 1984 SURGICAL SCRUB In SURGICAL SCRUB In Hospital, Municipality/City/Province Prepared by: Printed Name and Signature of Student Date Performed and Time Started Patients INITIALS Only Case Number

    O. R. Form 1A O. R. SCRUB FORM Major

    SURGICAL PROCEDURE PERFORMED

    O. R. Nurse On Duty (Name and Signature)

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: (Print name and Signature) Clinical Coordinator, PRC I.D No. Date document is signed: Please specify Highest Nursing Degree Earned:

    Valid Until Time

    Approved by: (Print name and Signature) Dean, PRC I.D No. Date document is signed: Specify Highest Nursing Degree Earned:

    Valid Until Time

    Notre Dame University College of Health Sciences Notre Dame Avenue, Cotabato City Tel. (064) 421-2698 Loc. 307, Telefax No. (064) 421-4312, E-mail Address: nducotabato.org PAASCU Level I: November 30 1984 SURGICAL CIRCULATING In SURGICAL SCRUB In Hospital, Municipality/City/Province Prepared by: Printed Name and Signature of Student Patients INITIALS Only Case Number (not applicable for Birthing Homes/Lying-In Clinics/ Homes) PROCEDURE PERFORMED Nurse On Duty (Name and Signature) (If Midwife on Duty, signature not required)

    O. R. Form 1B O. R. CIRCULATING FORM

    Date Performed and Time Started

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: (Print name and Signature) Clinical Coordinator, PRC I.D No. Date document is signed: Please specify Highest Nursing Degree Earned:

    Valid Until Time

    Approved by: (Print name and Signature) Dean, PRC I.D No. Date document is signed: Specify Highest Nursing Degree Earned:

    Valid Until Time

    College of Health Sciences Notre Dame Avenue, Cotabato City Tel. (064) 421-2698 Loc. 307, Telefax No. (064) 421-4312, E-mail Address: nducotabato.org PAASCU Level I: November 30 1984 SURGICAL SCRUB In SURGICAL SCRUB In Hospital, Municipality/City/Province Prepared by: Printed Name and Signature of Student Patients INITIALS Only Case Number (not applicable for Birthing Homes/Lying-In Clinics/ Homes) PROCEDURE PERFORMED Nurse On Duty (Name and Signature) (If Midwife on Duty, signature not required)

    O. R. Form 1B O. R. CIRCULATING FORM

    Date Performed and Time Started

    SUPERVISED BY Clinical Instructor Name and Signature

    Noted by: (Print name and Signature) Clinical Coordinator, PRC I.D No. Date document is signed: Please specify Highest Nursing Degree Earned:

    Valid Until Time

    Approved by: (Print name and Signature) Dean, PRC I.D No. Date document is signed: Specify Highest Nursing Degree Earned:

    Valid Until Time

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