FAR EASTERN UNIVERSITY

INSTITUTE OF NURSING

OR / DR COMPLETION

_________________________________________
(Name of Hospital)

AREA: OR or DR
DATE:
SHIFT:
CI:

List of Students: BSN _____ / GROUP ____

1
2
3
4
5
6

Prepared by:

JULIE C. DANOFRATA, RN, MAN

Level IV – Coordinator

Endorsed by:

GLENDA S. ARQUIZA, RN, PhD

DEAN, Institute of Nursing

Cc: Clinical Instructor

Affiliated Agency
Level IV Coordinator's
FEU/QSF-NUR05Rev,No.:00Effectivity Date 31 August 2005