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Republic of The Philippines Province of Ilocos Sur Metro Vigan Hospital

This document is an operating room record from Metro Vigan Hospital in Ilocos Sur, Philippines. It contains fields to record a patient's name, age, sex, civil status, ward, OPD and hospital numbers, operating diagnosis, surgeons, assistants, anesthesiologist, anesthetic used, dates and times of anesthesia and surgery, surgical nurses, title of operation performed, description of procedure, findings, medication orders, and spaces for signatures verifying counts.

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Ryrey Abraham Pacamana
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85 views2 pages

Republic of The Philippines Province of Ilocos Sur Metro Vigan Hospital

This document is an operating room record from Metro Vigan Hospital in Ilocos Sur, Philippines. It contains fields to record a patient's name, age, sex, civil status, ward, OPD and hospital numbers, operating diagnosis, surgeons, assistants, anesthesiologist, anesthetic used, dates and times of anesthesia and surgery, surgical nurses, title of operation performed, description of procedure, findings, medication orders, and spaces for signatures verifying counts.

Uploaded by

Ryrey Abraham Pacamana
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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Republic of the Philippines

Province of Ilocos Sur


Metro Vigan Hospital

OPERATING ROOM RECORD

Name: Age: Sex: Civil Status:

Ward: OPD No.: Hospital No.:

Operating Diagnosis:

Surgeon: 1st Asst.:

Anesthesiologist: 2nd Asst.:

Anesthetic: Time Anesthesia Begun:

Operating Date: Time Anesthesia Ended:

Operating Begun: AM/PM Surgical Nurse:

Operating Ended: AM/PM Circulating Nurse:

Title of Operation(s) Performed:

Tissue to Lab ( ) Yes


( ) No

Description of procedure:

Findings:

_________________________, MD
OR Medication Order: Sponge Count Verified
_________________________
Signature
_________________________
Kind and Number
_________________________
Republic of the Philippines
Province of Ilocos Sur
Metro Vigan Hospital

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