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Or and Dr Cases Record New

Or and Dr Cases Record New

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Published by api-3739910

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Published by: api-3739910 on Oct 17, 2008
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07/15/2015

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Capitol University
CU-QMS-NURSING-0014
College of Nursing
Cagayan de Oro City
OPERATING ROOM CASES RECORD
Case Number:_______________
Date of Operation:_________________

Name of Patient:_________________________________ Age:__________ Sex:_______
Civil Status:_______________ Ward/Room:_______________ Bed No.:_________
Name of Hospital:_______________________________________________________

Pre-Operative Diagnosis:
Operation Performed:
( ) Major Operation
( ) Minor Operation
( ) Circulating
Post-Operative Diagnosis:

Name of Surgeon:_________________________________ 1st Asst:____________________________________ 2nd Asst:____________________________________

Type of Anesthesia:________________________________
Anesthesiologist:___________________________________
Time Anesthesia Began:______________
Time Anesthesia Ended:____________
Time Operation Started:______________
Time Operation Ended:_____________
Name & Signature of Student:__________________________________
_____________________________
_____________________________
_____________________________
_____________________________
Name & Signature of OR Scrub Nurse
Name & Signature of OR Circulating Nurse
_____________________________
_____________________________
Name & Signature of OR Clinical Instructor
Name & Signature of OR Supervisor
Issue: 05April 2006
Revision Code :003

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