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  • MSHC Ordr PRC Format

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    Cristina L. Jayson
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    This document contains forms from Mindanao Sanitarium & Hospital College in the Philippines. It provides information about the school such as its accreditation status and contact information. It then includes several forms that nursing students must complete when performing procedures like deliveries, newborn care, surgical scrubs, and circulating in the operating room. The forms require documentation of key details like the patient's initials, date, time, procedure performed, and supervisor's approval.

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    Mshc Ordr Prc Format

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    This document contains forms from Mindanao Sanitarium & Hospital College in the Philippines. It provides information about the school such as its accreditation status and contact information. It then includes several forms that nursing students must complete when performing procedures like deliveries, newborn care, surgical scrubs, and circulating in the operating room. The forms require documentation of key details like the patient's initials, date, time, procedure performed, and supervisor's approval.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    26 views5 pages

    MSHC Ordr PRC Format

    Uploaded by

    Cristina L. Jayson
    This document contains forms from Mindanao Sanitarium & Hospital College in the Philippines. It provides information about the school such as its accreditation status and contact information. It then includes several forms that nursing students must complete when performing procedures like deliveries, newborn care, surgical scrubs, and circulating in the operating room. The forms require documentation of key details like the patient's initials, date, time, procedure performed, and supervisor's approval.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 5

    MindanaoSanitarium&HospitalCollege

    Barangay San Miguel, Iligan City 9200


    Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshcnet@yahoo.com
    Accredited By: Association of Christian Schools, Colleges, & Universities, Accrediting Agency, Incorporated
    Accreditation Level: Level II, April 29, 2011-April 2014
    Accredited By: Adventist Accrediting Association
    Accreditation Level: Level II, October 4, 2010-December 31, 2012

    D.R. Form
    ACTUAL DELIVERY FORM

    ACTUAL DELIVERY in:


    Hospital/Home/Lying-in, Municipality/City/Province
    Prepared by:
    Printed Name and Signature of Student:
    Date Performed
    and
    Time Started

    Patients INITIAL Only


    Case Number
    (Not Applicable for Birthing/Lying-in
    Clinics/Homes)

    PROCEDURE PERFORMED

    D.R. Nurse on Duty


    (Name and Signature)
    (If Midwife on Duty, Signature Not
    Required)

    Noted by:

    Approved by:

    (Print Name and Signature)


    Clinical Coordinator, PRC I.D. No.:
    Valid Until:
    Date document is signed:
    Time:
    Please specify Highest Nursing Degree Earned:

    (Print Name and Signature)


    Dean, PRC I.D. No.:
    Valid Until:
    Date document is signed:
    Time:
    Please specify Highest Nursing Degree Earned:

    SUPERVISED BY:
    Clinical Instructor
    Name and Signature

    MindanaoSanitarium&HospitalCollege

    ICNB Form
    IMMEDIATE CARE OF THE
    NEWBORN FORM

    Barangay San Miguel, Iligan City 9200


    Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshcnet@yahoo.com
    Accredited By: Association of Christian Schools, Colleges, & Universities, Accrediting Agency, Incorporated
    Accreditation Level: Level II, April 29, 2011-April 2014
    Accredited By: Adventist Accrediting Association
    Accreditation Level: Level II, October 4, 2010-December 31, 2012
    IMMEDIATE NEWBORN CORD CARE in:
    Hospital/Home/Lying-in, Municipality/City/Province
    Prepared by:
    Printed Name and Signature of Student:
    Date Performed
    And
    Time Started

    Patients INITIAL Only


    Case Number
    (Not Applicable for Birthing/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)

    Noted by:

    Approved by:

    (Print Name and Signature)


    Clinical Coordinator, PRC I.D. No.:
    Valid Until:
    Date document is signed:
    Time: ______________________
    Please specify Highest Nursing Degree Earned:

    (Print Name and Signature)


    Dean, PRC I.D. No.:
    Valid Until:
    Date document is signed:
    Time:
    Please specify Highest Nursing Degree Earned:

    SUPERVISED BY:
    Clinical Instructor
    Name and Signature

    MindanaoSanitarium&HospitalCollege
    Barangay San Miguel, Iligan City 9200
    Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshcnet@yahoo.com
    Accredited By: Association of Christian Schools, Colleges, & Universities, Accrediting Agency, Incorporated
    Accreditation Level: Level II, April 29, 2011-April 2014
    Accredited By: Adventist Accrediting Association
    Accreditation Level: Level II, October 4, 2010-December 31, 2012

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

    SURGICAL SCRUB in:


    Hospital/Home/Lying-in, Municipality/City/Province
    Prepared by:
    Printed Name and Signature of Student:
    Date Performed
    and
    Time Started

    Patients INITIAL Only


    Case Number

    SURGICAL PROCEDURE PERFORMED

    Noted by:

    Approved by:

    (Print Name and Signature)


    Clinical Coordinator, PRC I.D. No.:
    Valid Until:

    Dean, PRC I.D. No.:

    O.R. Nurse on Duty


    (Name and Signature)

    (Print Name and Signature)


    Valid Until:

    SUPERVISED BY:
    Clinical Instructor
    Name and Signature

    Date document is signed:


    Please specify Highest Nursing Degree Earned:

    Time: ______________________

    Date document is signed:


    Time:
    Please specify Highest Nursing Degree Earned:

    MindanaoSanitarium&HospitalCollege

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

    Barangay San Miguel, Iligan City 9200


    Phone No.(063) 221-9219, Fax No. (063) 223-2114, mshcnet@yahoo.com
    Accredited By: Association of Christian Schools, Colleges, & Universities, Accrediting Agency, Incorporated
    Accreditation Level: Level II, April 29, 2011-April 2014
    Accredited By: Adventist Accrediting Association
    Accreditation Level: Level II, October 4, 2010-December 31, 2012
    CIRCULATING NURSE in:
    Hospital/Home/Lying-in, Municipality/City/Province
    Prepared by:
    Printed Name and Signature of Student:
    Date Performed
    and
    Time Started

    Patients INITIAL Only


    Case Number

    SURGICAL PROCEDURE PERFORMED

    Noted by:

    Approved by:

    (Print Name and Signature)


    Clinical Coordinator, PRC I.D. No.:
    Valid Until:
    Date document is signed:
    Time: ______________________

    Dean, PRC I.D. No.:


    Date document is signed:

    O.R. Nurse on Duty


    (Name and Signature)

    (Print Name and Signature)


    Valid Until:
    Time:

    SUPERVISED BY:
    Clinical Instructor
    Name and Signature

    Please specify Highest Nursing Degree Earned:

    Please specify Highest Nursing Degree Earned:

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