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IV Therapy Accomplished Requirements (Short Bond Paper Size)

IV Therapy Accomplished Requirements (Short Bond Paper Size)

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Published by Noel
Sample of the IV Therapy Accomplished Requirements prescribed by ANSAP for issuance of IVT cards.
For 8 1/2" x 11" (short bond paper) size
Sample of the IV Therapy Accomplished Requirements prescribed by ANSAP for issuance of IVT cards.
For 8 1/2" x 11" (short bond paper) size

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Published by: Noel on Apr 09, 2009
Copyright:Attribution Non-commercial

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05/21/2013

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I V THERAPY ACCOMPLISHED REQUIREMENTS
Venue:Name of Hospital Offering I V TrainingProvince/Region:ANSAP Chapter:Address
Accomplished Requirements of:
Name of Registered Nurse: PRC No. Expiry Date:Date of I V Training Program Attended: Requirements: 6 + 6 + 2Registration No. of Institution Offering the I V Training Program:
Name of PatientAgeKind of IVInfusion givenDate / Time / Site of I V InsertionType of Cannula / Dose / Rate /Drug Incorporation presentSignature of WitnessM.D./I V TrainedPreceptor I. Initiating & Maintaining Peripheral I V Infusions
1.2.3.4.5.6.
II. Administering I V DrugsDrug Incorporated/DoseDate / Time / Diagnosis
1.2.3.4.5.6.
III. Administering & Maintaining Blood & Blood ComponentsBlood Type /Volume / ComponentsDate / Time / Site of I V InsertionsType of Cannula / Rate
1.2.This is to certify that I had successfully performed the above requirements, as countersigned by my witnesses.Received by: ____________________________________________Submitted by: _____________________________________________ ANSAP Signature over Printed Name of RNI V Therapy Certification Card No. _____________________________Approved by: ______________________________________________ Director, Nursing ServiceIssued by: ____________________ Date: ______________________Date Submitted: ___________________________________________

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