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The document appears to be forms from Northern Christian College for students to document procedures performed during clinical training. The forms include spaces for the date, time, patient initials, procedure performed, supervising nurse, student signature, and signatures of the clinical coordinator and dean for approval and notation.

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218 views

Ordr New Form

The document appears to be forms from Northern Christian College for students to document procedures performed during clinical training. The forms include spaces for the date, time, patient initials, procedure performed, supervising nurse, student signature, and signatures of the clinical coordinator and dean for approval and notation.

Uploaded by

Jeoforms
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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NORTHERN CHRISTIAN COLLEGE

“The Institution for Better Life”


COLLEGE OF NURSING
Mabini Street Laoag City Ilocos Norte 2009 Philippines

Accredited by Association of Christian Schools and Colleges Accrediting Agency, Inc. (ACSC-AAI)/LEVEL II/ April 2007-April 2012

ACTUAL DELIVERY in ____________________________________________________________________

Prepared by:
Printed Name and Signature of Student: ____________________________________________________

Date Performed and Time Patient’s INITIAL only PROCEDURE PERFORMED D. R. Nurse On Duty SUPERVISED BY
Started Case Number

Noted by: ______________________________________________________ Approved by: ___________________________________________________


(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No. __________Valid Until ______________ Dean, PRC I.D. No. _____________________ Valid Until ______________
Date document is signed: _________________ Time____________________ Date document is signed: _________________ Time____________________
Press specify Highest Nursing Degree Earned: ________________________ Press specify Highest Nursing Degree Earned: ________________________
NORTHERN CHRISTIAN COLLEGE
“The Institution for Better Life”
COLLEGE OF NURSING
Mabini Street Laoag City Ilocos Norte 2009 Philippines

Accredited by Association of Christian Schools and Colleges Accrediting Agency, Inc. (ACSC-AAI)/LEVEL II/ April 2007-April 2012

SURGICAL SCRUB in ____________________________________________________________________

Prepared by:
Printed Name and Signature of Student: ____________________________________________________

Date Performed and Time Patient’s INITIAL only PROCEDURE PERFORMED D. R. Nurse On Duty SUPERVISED BY
Started Case Number

Noted by: ______________________________________________________ Approved by: ___________________________________________________


(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No. __________Valid Until ______________ Dean, PRC I.D. No. _____________________ Valid Until ______________
Date document is signed: _________________ Time____________________ Date document is signed: _________________ Time____________________
Press specify Highest Nursing Degree Earned: ________________________ Press specify Highest Nursing Degree Earned: ________________________
NORTHERN CHRISTIAN COLLEGE
“The Institution for Better Life”
COLLEGE OF NURSING
Mabini Street Laoag City Ilocos Norte 2009 Philippines

Accredited by Association of Christian Schools and Colleges Accrediting Agency, Inc. (ACSC-AAI)/LEVEL II/ April 2007-April 2012

IMMEDIATE NEWBORN CORD CARE in ____________________________________________________________________

Prepared by:
Printed Name and Signature of Student: ____________________________________________________

Date Performed and Time Patient’s INITIAL only PROCEDURE PERFORMED D. R. Nurse On Duty SUPERVISED BY
Started Case Number

Noted by: ______________________________________________________ Approved by: ___________________________________________________


(Print Name and Signature) (Print Name and Signature)
Clinical Coordinator, PRC I.D. No. __________Valid Until ______________ Dean, PRC I.D. No. _____________________ Valid Until ______________
Date document is signed: _________________ Time____________________ Date document is signed: _________________ Time____________________
Press specify Highest Nursing Degree Earned: ________________________ Press specify Highest Nursing Degree Earned: ________________________

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