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College of Nursing

Name of Student: ________________________________ Date: ________ Score:_________


Check () the appropriate box representing how the student performed the procedure for the
graded return demonstration.
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Post Mortem Care (Score_____) pg. 146
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Remarks: ____________________________________________________________________
Students Signature: _________________________
Clinical Instructors/ Preceptors Signature: _________________________
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Application of Restraints (Score_____) pg. 163
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Remarks: ____________________________________________________________________
Students Signature: _________________________
Clinical Instructors/ Preceptors Signature: _________________________
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Blood Glucose Monitoring (Score_____) pg. 214
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Remarks: ____________________________________________________________________
Students Signature: _________________________
Clinical Instructors/ Preceptors Signature: _________________________
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