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Minor UoPCN Case Slip

Minor UoPCN Case Slip

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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! :)

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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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Published by: Keith Giomeer Petrola on Apr 30, 2010
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04/26/2011

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