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BUKIDNON STATE UNIVERSITY

COLLEGE OF NURSING
Malaybalay City

OPERATING ROOM CASE RECORD

Date: __________________
Time Started: ___________
Time Ended: ____________
Hospital/Agency: _______________________________________________________________
Name of Patient: _____________________________________________ Age: __________
Case Number: _______________________________________________ Sex: __________
Address: ______________________________________________________________________

MAJOR Scrub Nurse


MINOR Circulating Nurse

Operation Performed:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___

Diagnosis: ____________________________________________________________________
Pre- Operative:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___

Post- Operative:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___

Name of Surgeon: ___________________________________________________________


Name of Anesthesiologist: ____________________________________________________

Anesthesia Used:
_____________________________________________________________________________
_____________________________________________________________________________
__
Name of Staff/ Signature: ________________________________________________________

Name of Clinical Instructor/ Signature: ______________________________________________


Name of Student: _______________________________________________________________

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