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Saint Louis University: D.R. Form

Saint Louis University is a nursing school located in Baguio City, Philippines. It provides various clinical forms for procedures like delivery, newborn care, and surgical scrubbing/circulating. The forms collect information on the student, procedure, supervising staff, and are used in different hospitals to document clinical experiences.

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Nicole Gonzales
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40 views

Saint Louis University: D.R. Form

Saint Louis University is a nursing school located in Baguio City, Philippines. It provides various clinical forms for procedures like delivery, newborn care, and surgical scrubbing/circulating. The forms collect information on the student, procedure, supervising staff, and are used in different hospitals to document clinical experiences.

Uploaded by

Nicole Gonzales
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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SAINT LOUIS UNIVERSITY

A. Bonifacio Street, 2600 Baguio Municipality, Province


(074) 442-3043; (074) 442-2793; (074) 442-8246 to 48
FAX: (074) 442-2842
Website: www.slu.edu.ph
ACCREDITED BY: PAASCU, LEVEL 3 Accreditation Status, 2013-2016
D.R. Form

ACTUAL DELIVERY In: __________________________________________________________


Hospital, Municipality, Province

ACTUAL DELIVERY FORM

Prepared by: _________________________________________


Printed Name with Signature
Date Performed
And
Time Started

Patients INITIALS
Case Number

PROCEDURE
PERFORMED

Nurse On Duty
(Name and Signature)

SUPERVISED BY
Clinical Instructor
Name and Signature

SAINT LOUIS UNIVERSITY


A. Bonifacio Street, 2600 Baguio Municipality, Province
(074) 442-3043; (074) 442-2793; (074) 442-8246 to 48
FAX: (074) 442-2842
Website: www.slu.edu.ph
ACCREDITED BY: PAASCU, LEVEL 3 Accreditation Status, 2013-2016

D.R. Form

ASSIST DELIVERY in: _________________________________________________________

ASSIST DELIVERY FORM

Hospital, Municipality, Province

Prepared by: _________________________________________


Printed Name with Signature
Date Performed
And
Time Started

Patients INITIALS
Case Number

PROCEDURE
PERFORMED

Nurse On Duty
(Name and Signature)

SUPERVISED BY
Clinical Instructor
Name and Signature

SAINT LOUIS UNIVERSITY


A. Bonifacio Street, 2600 Baguio Municipality, Province
(074) 442-3043; (074) 442-2793; (074) 442-8246 to 48
FAX: (074) 442-2842
Website: www.slu.edu.ph
ACCREDITED BY: PAASCU, LEVEL 3 Accreditation Status, 2013-2016

IMMEDIATE NEWBORN CARE in: _________________________________________________


Hospital, Municipality, Province

ICNB Form
IMMEDIATE CARE
OF THE NEWBORN

Prepared by: _________________________________________


Printed Name with Signature
Date Performed
And
Time Started

Patients INITIALS
Case Number

Immediate Newborn Cord Care


WHERE PERFORMED

Nurse On Duty
(Name and Signature)

SUPERVISED BY
Clinical Instructor
Name and Signature

SAINT LOUIS UNIVERSITY


A. Bonifacio Street, 2600 Baguio Municipality, Province
(074) 442-3043; (074) 442-2793; (074) 442-8246 to 48
FAX: (074) 442-2842
Website: www.slu.edu.ph
ACCREDITED BY: PAASCU, LEVEL 3 Accreditation Status, 2013-2016

MAJOR SURGICAL SCRUB in: __________________________________________________

O.R Form 1A
O.R. SCRUB FORM
Major

Hospital, Municipality, Province

Prepared by: _________________________________________


Printed Name with Signature

Date Performed
And
Time Started

Patients INITIALS
Case Number

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
Name and Signature

SAINT LOUIS UNIVERSITY


A. Bonifacio Street, 2600 Baguio Municipality, Province
(074) 442-3043; (074) 442-2793; (074) 442-8246 to 48
FAX: (074) 442-2842
Website: www.slu.edu.ph
ACCREDITED BY: PAASCU, LEVEL 3 Accreditation Status, 2013-2016

MINOR SURGICAL SCRUB in: __________________________________________________

O.R. Form 1C
O.R. SCRUB FORM
Minor

Hospital, Municipality, Province

Prepared by: _________________________________________


Printed Name with Signature

Date Performed
And
Time Started

Patients INITIALS
Case Number

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
Name and Signature

SAINT LOUIS UNIVERSITY


A. Bonifacio Street, 2600 Baguio Municipality, Province
(074) 442-3043; (074) 442-2793; (074) 442-8246 to 48
FAX: (074) 442-2842
Website: www.slu.edu.ph
ACCREDITED BY: PAASCU, LEVEL 3 Accreditation Status, 2013-2016

SURGICAL CIRCULATING in: __________________________________________________

O.R Form 1B
O.R. CIRCULATING
FORM

Hospital, Municipality, Province

Prepared by: _________________________________________


Printed Name with Signature

Date Performed
And
Time Started

Patients INITIALS
Case Number

SURGICAL PROCEDURE
PERFORMED

O.R. Nurse On Duty


(Name and Signature)

SUPERVISED BY
Clinical Instructor
Name and Signature

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