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CAGAYAN DE ORO COLLEGE

PHINMA EDUCATION NETWORK


COLLEGE OF NURSING
Max Suniel St.,Carmen, Cagayan de Oro City

OPERATION RECORD : MAJOR

Name of Patient: ___________________ Age: ______ Sex: _____ Civil Status: _____

Ward / Room: ____________________________ Hospital #: ____________________

Name of Hospital: _________________________________________

PRE – OPERATIVE DIAGNOSIS:

POST – OPERATIVE DIAGNOSIS:

SURGEON: __________________________ 1st Asst. __________________________


Anesthesiologist: ______________________ 2nd Asst. _________________________
Type of Anesthesia: ____________________ 3rd Asst. __________________________
Time Anesthesia Began: ______am / pm
Time Anesthesia Ended: ______am / pm
Operation Date: _______________________
Time Operation Began: _______ am / pm Time Operation Ended: ______am / pm

OPERATION PERFORMED:

Name & Signature of SCRUB NURSE: ____________________________________


Date Signed: ______________________

Name & Signature of CIRCULATING STAFF NURSE: _______________________


Date Signed: _______________________

Name of Student: _______________________________________________________

Name and Signature of Clinical Instructor: __________________________________


Date Signed: _______________________

Name and Signature of Operating Room Supervisor: __________________________


Date Signed: _______________________
CAGAYAN DE ORO COLLEGE
PHINMA EDUCATION NETWORK
COLLEGE OF NURSING
Max Suniel St.,Carmen, Cagayan de Oro City

HANDLING OF DELIVERY

NAME OF PATIENT : ______________________________________________


ADDRESS : ______________________________________________
AGE :
______________________________________________
DATE OF DELIVERY : ______________________________________________
TIME OF DELIVERY : ______________________________________________
TYPE OF DELIVERY : ______________________________________________
NAME OF HOSPITAL : ______________________________________________
NAME OF DOCTOR : ______________________________________________
ADMITTING DIAGNOSIS :______________________________________________
CASE NUMBER : ______________________________________________

NAME & SIGNATURE OF STUDENT : ___________________________________


DATE : ___________________________________

NAME & SIGNATURE OF NURSE / MIDWIFE : ___________________________


DATE : ___________________________

NAME & SIGNATURE OF CLINICAL INSTRUCTOR : _____________________


DATE : _____________________

NAME & SIGNATURE OF DR SUPERVISOR : ____________________________


DATE : ____________________________

Name and Signature of OR / DR Coordinator : __________________________


Date Signed: _______________________
CAGAYAN DE ORO COLLEGE
PHINMA EDUCATION NETWORK
COLLEGE OF NURSING
Max Suniel St.,Carmen, Cagayan de Oro City

DELIVERY CIRCULATING NURSE

NAME OF PATIENT : ______________________________________________


ADDRESS : ______________________________________________
AGE :
______________________________________________
DATE OF DELIVERY : ______________________________________________
TIME OF DELIVERY : ______________________________________________
TYPE OF DELIVERY : ______________________________________________
NAME OF HOSPITAL : ______________________________________________
NAME OF DOCTOR : ______________________________________________
ADMITTING DIAGNOSIS :______________________________________________
CASE NUMBER : ______________________________________________

NAME & SIGNATURE OF STUDENT : ___________________________________


DATE : ___________________________________

NAME & SIGNATURE OF NURSE / MIDWIFE : ___________________________


DATE : ___________________________

NAME & SIGNATURE OF CLINICAL INSTRUCTOR : _____________________


DATE : _____________________

NAME & SIGNATURE OF DR SUPERVISOR : ____________________________


DATE : ____________________________

Name and Signature of OR / DR Coordinator : __________________________


Date Signed: _______________________
CAGAYAN DE ORO COLLEGE
PHINMA EDUCATION NETWORK
COLLEGE OF NURSING
Max Suniel St.,Carmen, Cagayan de Oro City

IMMEDIATE NEWBORN CARE

NAME OF NEWBORN : ______________________________________________


NAME OF MOTHER : ______________________________________________
DATE OF DELIVERY : ______________________________________________
TIME OF DELIVERY : ______________________________________________
TYPE OF DELIVERY : ______________________________________________
NAME OF HOSPITAL : ______________________________________________
NAME OF DOCTOR : ______________________________________________
CASE NUMBER : ______________________________________________

VITAL MEASUREMENTS

WEIGHT : ______________________________________
HEAD CIRCUMFERENCE : ______________________________________
CHEST CIRCUMFERENCE : ______________________________________
ABDOMINAL CIRCUMFERENCE : ______________________________________
LENGTH : ______________________________________
TEMPERATURE : ______________________________________
APGAR SCORE : ______________________________________

NAME & SIGNATURE OF STUDENT : ___________________________________


DATE : ___________________________________

NAME & SIGNATURE OF NURSE / MIDWIFE : ___________________________


DATE : ___________________________

NAME & SIGNATURE OF CLINICAL INSTRUCTOR : _____________________


DATE : _____________________

NAME & SIGNATURE OF DR SUPERVISOR : ____________________________


DATE : ____________________________

Name and Signature of OR / DR Coordinator : __________________________


Date Signed: _______________________
CAGAYAN DE ORO COLLEGE
PHINMA EDUCATION NETWORK
COLLEGE OF NURSING
Max Suniel St.,Carmen, Cagayan de Oro City

OPERATION RECORD : MINOR

Name of Patient: ___________________ Age: ______ Sex: _____ Civil Status: _____

Ward / Room: ____________________________ Hospital #: ____________________

Name of Hospital: _________________________________________

PRE – OPERATIVE DIAGNOSIS:

POST – OPERATIVE DIAGNOSIS:

SURGEON: __________________________ 1st Asst. __________________________


Anesthesiologist: ______________________ 2nd Asst. _________________________
Type of Anesthesia: ____________________ 3rd Asst. __________________________
Time Anesthesia Began: ______am / pm
Time Anesthesia Ended: ______am / pm
Operation Date: _______________________
Time Operation Began: _______ am / pm Time Operation Ended: ______am / pm

OPERATION PERFORMED:

Name & Signature of SCRUB NURSE: ____________________________________


Date Signed: ______________________

Name & Signature of CIRCULATING STAFF NURSE: _______________________


Date Signed: _______________________

Name of Student: _______________________________________________________

Name and Signature of Clinical Instructor: __________________________________


Date Signed: _______________________

Name and Signature of Operating Room Supervisor: __________________________


Date Signed: _______________________

Name and Signature of OR / DR Coordinator: __________________________


Date Signed: _______________________