Perpetual Succor Hospital & Maternity
OR
OPERATION RECORD
Patient
Doctor
Date
Case No.
Pre-operative diagnosis
Pre-operative diagnosis
Operative diagnosis
Operative diagnosis
Operation
Surgeon
Assistants
Anesthesia
Anesthetic
Amount
Anesthetist
Pro-operative medication
Post-operative orders
Post-operative orders
Time started
Time finished
Remarks
Remarks
Remarks
Nurse
Nurse In-Charge Signature *
Clear
Please provide a signature.
Technic of operation
Specimen
Disposition
Gross description
Biopsy report
Attending Physician/Assistant
Attending Physician/Assistant Signature *
Clear
Please provide a signature.
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