HAMEED LATIF HOSPITAL
CARE, CONCERN, COMPASSION
PATIENT: MR#
DATE: PATIENT NAME. MR#.
SR# PROCEDURE YES NO REMARKS
1. Check doctors order for the CT Scan YES
2. Verify the region and type of CT Scan YES
3. Check appointment form CT Scan department and also YES
confirm date and time
4. Assess the patient’s general condition YES
5. Check NPO status as per order YES
6. CT scan report and fresh RFT’s done before procedure YES
7. Explain the procedure to patient and attendant YES
8. Take consent for the procedure YES
9. Check vital signs before shifting the patient and document YES
10. Check doctor’s shifting notes. YES
11. Assign the nurse ,accompany the patient YES
BEFORE PROCEDURE
AFTER PROCEDURE
SR# PROCEDURE YES NO REMARKS
1. Received the patient after procedure YES
2. Assess the vital sign of patient and document YES
3. Inform to on duty doctor immediately YES
4. Document in nursing notes YES
5. Inform to admin and nursing supervisor YES
6. Take feedback from patient /attendant regarding YES
procedure/transportation
7. Follow the CT Scan report from department, video, CD, film. YES
8. Inform to consultant regarding patient report YES
9. Handover CT Scan reports to patient attendant on discharge YES
Time:
DATE:
Staff nurse
Head Nurse Name & E.I.D
HAMEED LATIF HOSPITAL
CARE, CONCERN, COMPASSION
PATIENT: MR#