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  • Operating Room Case Slip

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    16 views1 page

    Operating Room Case Slip

    Uploaded by

    shehada bondad

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    BAGUIO CENTRAL UNIVERSITY BAGUIO CENTRAL UNIVERSITY

    College of Nursing & School of Midwifery College of Nursing & School of Midwifery
    Lower P. Burgos Campus, Baguio City Lower P. Burgos Campus, Baguio City

    OPERATING ROOM SURGICAL SLIP OPERATING ROOM SURGICAL SLIP

    Name of Hospital:__________________________________________________ Name of Hospital:__________________________________________________


    Name of Student:___________________________________________________ Name of Student:___________________________________________________
    Course: _________________ Year:____________________________ Course: _________________ Year:____________________________
    Case No. _______________________ Shift:______________________________ Case No. _______________________ Shift:______________________________
    Name of Patient:______________________________________________ Name of Patient:______________________________________________
    Date of Birth: _________________________________________________ Date of Birth: _________________________________________________
    Address:_______________________________________________________ Address:_______________________________________________________
    Pre-Op Diagnosis:_____________________________________________ Pre-Op Diagnosis:_____________________________________________
    _________________________________________________________________ _________________________________________________________________
    _________________________________________________________________ _________________________________________________________________
    Operation Performed: _______________________________________ Operation Performed: _______________________________________
    _________________________________________________________________ _________________________________________________________________
    _________________________________________________________________ _________________________________________________________________
    _________________________________________________________________ _________________________________________________________________
    Surgeon:_______________________________________________________ Surgeon:_______________________________________________________
    Assistants:_____________________________________________________ Assistants:_____________________________________________________
    Instrument Nurse:____________________________________________ Instrument Nurse:____________________________________________
    Sponge Nurse:_________________________________________________ Sponge Nurse:_________________________________________________
    Circulating Nurse:____________________________________________ Circulating Nurse:____________________________________________

    Staff Nurse on Duty:__________________________________________ Staff Nurse on Duty:__________________________________________


    Anesthesiologist:_____________________________________________ Anesthesiologist:_____________________________________________
    Anesthesia:____________________________________________________ Anesthesia:____________________________________________________
    Medicines Used:______________________________________________ Medicines Used:______________________________________________
    Anesthesia Started:_______ Anesthesia finished:___________ Anesthesia Started:_______ Anesthesia finished:___________
    Operation Started:_______ Operation Finished:____________ Operation Started:_______ Operation Finished:____________

    Clinical Instructor:____________________________________________ Clinical Instructor:____________________________________________


    License Number:_____________ Expiry Date:_________________ License Number:_____________ Expiry Date:_________________

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