Professional Documents
Culture Documents
_________________________________________ (Surgeon),
_________________________________________ (Asst.Surgeon),
_________________________________ ( Anesthesiologist),
_________________________ (Scrub Nurse),
____________________________________ (Circulating Nurse), and
(FOR CS) _________________________________________ (Pediatrician).
(DOES EVERYONE AGREE THAT) THIS IS _________________________________
(Patient), ________(Age) FROM ___________ (Room), WITH AN IMPRESSION OF
_______________________________________________________(Diagnosis) TO
UNDERGO ________________________________ (PROCEDURE W/ SITE), IN
__________________(Position) UNDER ___________________________
(Anesthesia), VIA_____________________________ (Incision)
WITH_____________________________ (Min/Mod/Heavy) BLOOD LOSS EXPECTED.
PLEASE STATE THE FOLLOWING THAT APPLIES
1. PRE-OPERATIVE ANTIBIOTICS GIVEN DURING THE PREVIOUS 60 MINUTES
2. PRE-OPERATIVE MEDICATION GIVEN.
3. SKIN TEST OF ¬__________________ (Antibiotic) DUE ON ________(Time) AT
THE ________________(Site)
4. PRESENT IVF WITH _______________ INCORPORATION.
5. WITH AVAILABLE ______UNIT/S OF ___________ BLOOD. BLOOD TYPE ____.
COMPATIBLE
6. FOR CBG AT __________(Time)
7. WITH INSULIN DRIP
8. WITH X-RAY PI ATE PLACED UNDER OPERATIVE SITE.
9. REQUEST FOR INTRA-OPERATIVE X-RAY SENT.
10. X-RAY FILM/S AVAILABLE
11. PORTARLE XRAY WITH PLATE/S READY
12. NITRO PATCH PLACED OVER ACW.
13. (FOR PEDIA) WEIGHT: _____ KGS: TEMP:______-C.
PRAYER BEFORE ENDORSEMENT