Form No.

: BWH-NSD-04-100
BATAAN WOMEN’S HOSPITAL
Sampaguita St., St. Joseph Subd., Balanga City Bataan 2100 Revision No.: 00
Tel No. (047) 237 1256
Revision Date: 00-00-00

E-CART CHECKLIST

MONTH/YEAR: AUGUST 16 - 31, 2020 DEPARTMENT: 5TH FLOOR WARD

E-CART MEDICINES DATE 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

QUANTITY EXPIRATION DATE A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P
Adenosine 6 mg vial 1
Amiodarone 150 mg ampule 1
Atropine Sulfate 1 mg ampule 5
Calcium Gluconate 10 mg ampule 2
Diazepam 10 mg ampule 2
Digoxin 0.5 mg ampule 2
Diphenhydramine 50 mg ampule 2
Dobutamine 250 mg ampule 1
Dopamine 20 mg ampule 1
Epinephrine 1 mg ampule 5
Furosemide 20 mg ampule 5
Haloperidol 50 mg ampule 1
Hydrocortisone 250 mg vial 1
Hydrocortisone 100 mg vial 1
Lidocaine 2% solution 2
Magnesium Sulfate 1g ampule 2
Metoclopramide 10 mg ampule 5
Morphine Sulfate 10 mg ampule 1
Noradrenaline 2 mg ampule 1
Paracetamol 300 mg ampule 5
NURSES SIGNATURE
 Form No.: BWH-NSD-04-100
BATAAN WOMEN’S HOSPITAL
Sampaguita St., St. Joseph Subd., Balanga City Bataan 2100 Revision No.: 00
Tel No. (047) 237 1256
Revision Date: 00-00-00

E-CART CHECKLIST

E-CART MEDICINES DATE 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

QUANTITY EXPIRATION A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P
Phenobarbital 30 mg ampule 1 DATE
Phenytoin 300 mg ampule 1
Potassium Chloride 40 meq vial 2
Sodium Bicarbonate 50 meq vial 2
Vitamin B Complex 5
Verapamil 5 mg ampule 1
Aspirin 80 mg tablet 5
Methylprednisolone 4 mg tablet 5
Isosorbide Dinitrate 5 mg SL tablet 1
Clopidogrel 75 mg tablet 5
Budesonide nebule 5
Salbutamol nebule 5
Ipratropium + Salbutamol nebule 5
Clonidine 75 mcg tablet 5
Nitroglycerin 5 mg patch 5
Nitroglycerin 10 mg ampule 1
Nalbuphine ampule 1
Nicardipine 10 mg ampule 2
Terbutaline 500 mcg/ml ampule 1
Distilled water 50 ml 2
 Form No.: BWH-NSD-04-100
BATAAN WOMEN’S HOSPITAL
Sampaguita St., St. Joseph Subd., Balanga City Bataan 2100 Revision No.: 00
Tel No. (047) 237 1256
Revision Date: 00-00-00

E-CART CHECKLIST
DATE 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
QUANTITY EXPIRATIONDATE A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P
SYRINGE 50 CC 5
SYRINGE 30 CC 5
SYRINGE 10 CC 5
SYRINGE 5 CC 5
SYRINGE 3 CC 5
TBS 5
INSULIN SYRINGE 5
ASEPTO SYRINGE 3
BT SET 5
MACROSET 5
MICRM
MICROSET 5
SOLUSET 5
LEUKOPLAST 1
MICROPORE 1
ET TUBE SIZE 2.0 1
2.5 1
3.0 1
3.5 1
4.0 1
4.5 1
5.0 1
5.5 1
6.0 1
6.5 1
7.0 1
NURSES SIGNATURE
 Form No.: BWH-NSD-04-100
BATAAN WOMEN’S HOSPITAL
Sampaguita St., St. Joseph Subd., Balanga City Bataan 2100 Revision No.: 00
Tel No. (047) 237 1256
Revision Date: 00-00-00

E-CART CHECKLIST
MONTH/YEAR: AUGUST 16 - 31, 2020 DEPARTMENT: 5TH FLOOR WARD

DATE 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
QTY EXPIRATION DATE A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P
ET TUBE SIZE 7.5 1
8.0 1
8.5 1
FOLEY CATHETER FR.18 1
16 1
14 1
12 1
8 1
URINE BAG 1
INSYTE G-18 5
20 5
22 5
24 5
26 5
NEB KIT 3
NEB KIT WITH MASK( PEDIA) 3
NEB KIT WITH MASK ( ADULT) 3
GUEDEL AIRWAY 1
OXYGEN MASK ( PEDIA) 3
OXYGEN MASK ( ADULT) 3
O2 CANNULA ( NEONATE) 3
O2 CANNULA ( PEDIA) 3
O2 CANNULA ( ADULT) 3
 Form No.: BWH-NSD-04-100
BATAAN WOMEN’S HOSPITAL
Sampaguita St., St. Joseph Subd., Balanga City Bataan 2100 Revision No.: 00
Tel No. (047) 237 1256
Revision Date: 00-00-00
E-CART CHECKLIST

DATE 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
QTY EXPIRATION DATE A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P
D50 50 VIAL 2
NGT F.18 1
16 1
14 1
12 1
10 1
8 1
5 1
STRAIGHT CATHETER F.16 1
14 1
12 1
10 1
SUCTION CATHETER F.16 1
14 1
12 1
8 1
5 1
STERILE GLOVES SIZE 8 1
7.5 1
7 1
6.5 1
6 1
 Form No.: BWH-NSD-04-100
BATAAN WOMEN’S HOSPITAL
Sampaguita St., St. Joseph Subd., Balanga City Bataan 2100 Revision No.: 00
Tel No. (047) 237 1256
Revision Date: 00-00-00
E-CART CHECKLIST

DATE 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
QTY EXPIRATION DATE A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P A P
CLEAN GLOVES 1 BOX
ALCOHOL 500 ML 1
COTTON BALLS 1
DIAPER 1
ECG PADS
KIDNEY BASIN 1
KY JELLY 5
OS PACK 5
TONGUE DEPRESSOR
UNDERPADS
URINAL 1
BEDPAN 1
D5LR 1L 2
D5LR 500 CC 2
PLR 1L 2
PLR 500 CC 2
D5 0.3 NACL 500 CC 2
D5W 500 CC 2
PNSS 1L 2
PNSS 500 CC 2
D5IMB 500 CC 2
D5NSS 1L 2
MANNITOL 500 CC 2
D5NM 1L 2
PNSS 50 ML 2
D5W 250 ML
 Form No.: BWH-NSD-04-100
BATAAN WOMEN’S HOSPITAL
Sampaguita St., St. Joseph Subd., Balanga City Bataan 2100 Revision No.: 00
Tel No. (047) 237 1256
Revision Date: 00-00-00
E-CART CHECKLIST
DATE QTY EXPIRATION DATE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REMARKS
Micropore
Microset
Neb Kit
Neb kit w/ mask (P) 1 07-2023
Neb kit w/ mask (A)
NGT F. 16
O2 mask (P)
02 mask (A)
O2 cannula (P)
O2 cannula (A) 3 03-2021/ 11-2024 /10-
2021
O2 cannula (N) 1 10-2021
OR mask
OS pack 9 06-2024/ 03-2023/ 12-
2024
Protective Face shield, mask or
goggles
Standard Face Mask
Soluset
Straight catheter F. 16
Straight catheter F.14
Sterile gloves F. 6.5 1 09-2022
Sterile gloves F. 7 4 08-2024/03-2023
Sterile gloves F. 7.5
Suction catheter F. 5
Suction catheter F. 16
Tongue depressor
 Form No.: BWH-NSD-04-100
BATAAN WOMEN’S HOSPITAL
Sampaguita St., St. Joseph Subd., Balanga City Bataan 2100 Revision No.: 00
Tel No. (047) 237 1256
Revision Date: 00-00-00
E-CART CHECKLIST

DATE QTY EXPIRATION DATE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 REMARKS

Underpads
Urine bag 5
Urinal
D5LR 1L 1
D5LR 500cc
PLR 1L 1
PLR500cc 1
D5.3NaCL 500cc 1
D5W 500cc 1
PNSS 1L 1
PNSS 500cc 1
D5 IMB 500cc 1
D5NSS 1L 1
Mannitol 500cc
D5NM 1L 1
D10W 500cc
D5W 500cc 1

Remarks

Signature/Initials
PM
Signature/Initials

AM