SAINT TONIS COLLEGE, INC.

ODC FORM 1
(Formerly: Kalinga Christian Learning Center) OR SCRUB NURSE FORM
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

Affiliating Institution:
Address:

Name of Student: Student ID No.: -

No. Date Performed Patient’s Name Pre-Operative Procedure Performed OR Nurse On-Duty
Case Number Diagnosis (Signature over Printed Name)

Noted by:

_________________________________ _________________________________ ________________________________

Clinical Coordinator, STCI - CON Head of Nursing Division Dean, STCI-College of Nursing
PRC ID No.: _________ PRC ID No.: ________ PRC ID No.: _________
Validity: __________ Validity: __________ Validity: __________
Date Signed: __________ Date Signed: __________ Date Signed: __________

An institution of the United Church of Christ in the Philippines (UCCP)

Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC. ODC FORM 1
ODC FORM 1
(Formerly: Kalinga Christian Learning Center) OR CIRCULATING NURSE
OR SCRUB NURSE FORM
United Church of Christ in the Philippines FORM
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

Affiliating Institution:
Address:

Name of Student: Student ID No.: -

No. Date Performed Patient’s Name Pre-Operative Procedure Performed OR Nurse On-Duty
Case Number Diagnosis (Signature over Printed Name)

Noted by:

_________________________________ _________________________________ ________________________________

Clinical Coordinator, STCI - CON Head of Nursing Division Dean, STCI-College of Nursing
PRC ID No.: _________ PRC ID No.: ________ PRC ID No.: _________
Validity: __________ Validity: __________ Validity: __________
Date Signed: __________ Date Signed: __________ Date Signed: __________

An institution of the United Church of Christ in the Philippines (UCCP)

Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC. ODC FORM 1
(Formerly: Kalinga Christian Learning Center) DROR
ACTUAL
SCRUBDELIVERY FORM
NURSE FORM
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

Affiliating Institution:
Address:

Name of Student: Student ID No.: -

No. Date Performed Patient’s Name Diagnosis Type of Delivery DR Nurse On-Duty
Case Number (Signature over Printed Name)

Noted by:

_________________________________ _________________________________ ________________________________

Clinical Coordinator, STCI - CON Head of Nursing Division Dean, STCI-College of Nursing
PRC ID No.: _________ PRC ID No.: ________ PRC ID No.: _________
Validity: __________ Validity: __________ Validity: __________
Date Signed: __________ Date Signed: __________ Date Signed: __________

An institution of the United Church of Christ in the Philippines (UCCP)

Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC. ODC FORM 1
(Formerly: Kalinga Christian Learning Center) DR
ORASSIST
SCRUB DELIVERY FORM
NURSE FORM
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

Affiliating Institution:
Address:

Name of Student: Student ID No.: -

No. Date Performed Patient’s Name Diagnosis Type of Delivery DR Nurse On-Duty
Case Number (Signature over Printed Name)

Noted by:

_________________________________ _________________________________ ________________________________

Clinical Coordinator, STCI - CON Head of Nursing Division Dean, STCI-College of Nursing
PRC ID No.: _________ PRC ID No.: ________ PRC ID No.: _________
Validity: __________ Validity: __________ Validity: __________
Date Signed: __________ Date Signed: __________ Date Signed: __________

An institution of the United Church of Christ in the Philippines (UCCP)

Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)
 SAINT TONIS COLLEGE, INC. ODC FORM 1
(Formerly: Kalinga Christian Learning Center) DR
ORNEWBORN CAREFORM
SCRUB NURSE FORM
United Church of Christ in the Philippines
Purok 4, Bulanao Centro, Tabuk City, Kalinga
Philippines 3800
Tel. No. (074) 627-5930, Email Address: [email protected]

Affiliating Institution:
Address:

Name of Student: Student ID No.: -

No. Date Performed Patient’s Name Clinical Diagnosis of Mother Type of Delivery DR Nurse On-Duty
Case Number (Signature over Printed Name)

Noted by:

_________________________________ _________________________________ ________________________________

Clinical Coordinator, STCI - CON Head of Nursing Division Dean, STCI-College of Nursing
PRC ID No.: _________ PRC ID No.: ________ PRC ID No.: _________
Validity: __________ Validity: __________ Validity: __________
Date Signed: __________ Date Signed: __________ Date Signed: __________

An institution of the United Church of Christ in the Philippines (UCCP)

Member: Association of Christian Schools, Colleges and Universities (ACSCU)
UCCP Church Related Educational Action Towards Empowerment (UCCP CREATE)
Cordillera Schools Group (CSG)