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45 views1 page

Or Circulating

Uploaded by

pkintanar78597
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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COLLEGE OF NURSING

OPERATION RECORD (CIRCULATING)

Name of Patient: _____________________________________________________________________________________

Age: _____________ Sex: _____________ Status: _____________ Ward/Room: ________________


Case No.: ______________________________ RVU: _________________________

Name of Hospital: ___________________________________________________

PRE-OPERATIVE DIAGNOSIS: _____________________________________________________________________


_____________________________________________________________________

POST-OPERATIVE DIAGNOSIS:_____________________________________________________________________
_____________________________________________________________________

Name of Surgeon: _____________________________________________________________________

Name of Anesthesiologist: _____________________________________________________________________

Type of Anesthesia: __________________________________________________

Time Anesthesia Inducted/Intubated: ______________(AM/PM)


Time Anesthesia Ended/Extubated: ______________(AM/PM)

Time Operation Started: __________(AM/PM)


Time Operation Ended: __________(AM/PM)

OPERATION PERFORMED: ___________________________________________________________________


___________________________________________________________________
___________________________________________________________________

Date of Operation: _______________________

Name and Signature of Student: ______________________________________________________________


Date Signed: __________________________________
Name and Signature of Clinical Instructor: ______________________________________________________
Date Signed: _________________________________
Name and Signature of Circulating Nurse on Duty: _____________________________________________
Date Signed: _________________________________
Name and Signature of Operating Room Supervisor: ___________________________________________
Date Signed: _________________________________

Document Number Effectivity Date Revision Number


LDCU-FORMS-CON-023 August 7, 2023 000

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