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BATAAN WOMEN’S HOSPITAL

Sampaguita St. St Joseph Subd. San Jose Balanga City Bataan 2100

ORDERLY ENDORSMENT & INVENTORY SHEET

NAME:

DATE:

TIME:

NUMBER OF PATIENTS 5TH & 4TH FLOOR

5TH: ADMISSION:

4TH: DISCHARGE:

GENERATOR (AIRMAN AND PERKINS, OIL LEVEL, RADIATOR WATER, DIESEL CLEANING OF POD)

AUTOCLAVE (WATER INVENTORY, STATUS OF EQUIPMENT , TIME USED , OPERATOR)

OXYGEN INVENTORY

LEFT BANK PORTABLE : USED:

RIGHT BANK STOCKS:

DRINKING WATER

REPLACED: STOCKS:

MAINTENANCE REPORT:

OTHER DIRECTIVES

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