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Surgical Slip

The document is a record of an operation conducted at Notre Dame of Marbel University Nursing Department, detailing patient information, surgical team members, anesthesia used, and operation specifics. It includes sections for pre-operative and post-operative diagnoses, as well as specimen forwarding and remarks from the surgeon. Additionally, it requires signatures from clinical instructors and nursing staff to validate the record.

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Rechel Mae Servañez
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12 views1 page

Surgical Slip

The document is a record of an operation conducted at Notre Dame of Marbel University Nursing Department, detailing patient information, surgical team members, anesthesia used, and operation specifics. It includes sections for pre-operative and post-operative diagnoses, as well as specimen forwarding and remarks from the surgeon. Additionally, it requires signatures from clinical instructors and nursing staff to validate the record.

Uploaded by

Rechel Mae Servañez
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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JMJ

Notre Dame of Marbel University


Nursing Department

RECORD OF OPERATION

Patient’s Name: Name of Hospital: Case Number:


Family Name First Name Middle Name

Age: Sex: Civil Status: Religion: Attending Physician:

Surgeon: First Assistant: Second Assistant:

Anesthetist: Anesthesia Used: Date: Time Started: Time Ended:

Circulating Nurse: Scrub Nurse: Date: Time Started: Time Ended:

Drains: (Kind and Numbers): Sponge Count Verified:

Pre- operative Diagnosis: Post- Operative Diagnosis:


Operation Performed:
Specimen Forwarded to laboratory: Surgeons Remarks:

Noted by:

Clinical Instructor OR/DR Nurse, Head Nurse/ Nurse on Duty OR/DR Coordinator – NDMU Nursing Dept.
Date Signed: Date Signed: Date Signed:

Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing Degree: Bachelor of Science in Nursing
Masters Degree: Masters Degree: Masters Degree:
a. PRC No. a. PRC No. a. PRC No.
Valid until: Valid until: Valid until:
b. PNA No. b. PNA No. b. PNA No.
Valid until: Valid until: Valid until:

Name of student: ( ) Major


Date of Duty : ( ) Minor

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