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Saint Louis University 1

1) The document contains forms from Saint Louis University in Baguio City for documenting procedures performed by nursing students, including delivery, newborn care, surgery, and operating room experience. 2) Saint Louis University is located in Baguio City and accredited by PAASCU at Level 3 status from 2013-2016. 3) The forms include information such as the procedure performed, date, time, and signatures of the nursing student, supervising nurse, and clinical instructor to confirm supervised experience.

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vicenteturas
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114 views6 pages

Saint Louis University 1

1) The document contains forms from Saint Louis University in Baguio City for documenting procedures performed by nursing students, including delivery, newborn care, surgery, and operating room experience. 2) Saint Louis University is located in Baguio City and accredited by PAASCU at Level 3 status from 2013-2016. 3) The forms include information such as the procedure performed, date, time, and signatures of the nursing student, supervising nurse, and clinical instructor to confirm supervised experience.

Uploaded by

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

A. Bonifacio Street, 2600 Baguio City


(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/ City/ Province

ACTUAL DELIVERY FORM

Prepared by: _________________________________________


Printed Name with Signature

Date Performed
And
Time Started

Patients INITIALS
Case Number

PROCEDURE
PERFORMED

D.R. Nurse On Duty


(Name and Signature)

SAINT LOUIS UNIVERSITY

SUPERVISED BY
Clinical Instructor
(Name and Signature)

A. Bonifacio Street, 2600 Baguio City


(074) 442-3043; (074) 442-2793; (074) 442-8246 to 48
FAX: (074) 442-2842
Website: www.slu.edu.ph
ACCREDITED BY: PAASCU, LEVEL 2 Accreditation Status, 2013-2016
D.R. Form
ASSIST DELIVERY FORM

ASSIST DELIVERY in:________________________________________________________


Hospital, Municipality/ City/ Province

Prepared by: _________________________________________


Printed Name with Signature

Date Performed
And
Time Started

Patients INITIALS
Case Number

PROCEDURE
PERFORMED

D.R. Nurse On Duty


(Name and Signature)

SAINT LOUIS UNIVERSITY

SUPERVISED BY
Clinical Instructor
(Name and Signature)

A. Bonifacio Street, 2600 Baguio City


(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
ICNB Form
IMMEDIATE CARE
OF THE NEWBORN
IMMEDIATE NEWBORN CARE in: ______________________________________________
Hospital, Municipality/ City/ Province
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)

SAINT LOUIS UNIVERSITY

SUPERVISED BY
Clinical Instructor
(Name and Signature)

A. Bonifacio Street, 2600 Baguio City


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

MAJOR SURGICAL SCRUB in: __________________________________________________


Hospital, City

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

MINOR SURGICAL SCRUB in: _________________________________________________


Hospital, City

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

SURGICAL CIRCULATING in: ___________________________________________________


Hospital, City

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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