I. MAJOR OPERATIONS
Date of
No. Case No. Name of Patient Diagnosis Operation Performed Type of Anesthesia Name of Surgeon Name of Hospital
Operation
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Prepared by: Supervised by: Noted by: Concurred by: Approved by:
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
Prepared by: Supervised by: Noted by: Concurred by: Approved by:
V. CORD DRESSING
No. Case No. Date Performed Name of Baby Gender Name of Mother Age Name of Hospital
Prepared by: Supervised by: Noted by: Concurred by: Approved by: