CU-QMS-NURSING-0021

Capitol University
College of Nursing

ON -CALL FORM

Date of Duty:_______________________________ Time of Duty: __________________

Name of Hospital:__________________________________ Area:_______________________

Name of Students:

1. _________________________________ 4. _________________________________
2. _________________________________ 5. _________________________________
3. _________________________________ 6. _________________________________

Prepared by: Approved by:

________________________________ _____________________________
Level ______ / Clinical Coordinator OR / OPD /DR Superior / Headnurse

Noted by:

Mrs. Fidela B. Ansale, R.N.,MAN ____________________________

Dean, College of Nursing Chief Nurse

Issue: 05 April 2006 Revision Code : 003

CU-QMS-NURSING-0023

Capitol University
College of Nursing

ON -CALL FORM

Date of Duty:_______________________________ Time of Duty: __________________

Name of Hospital:__________________________________ Area:_______________________

Name of Students:

1. _________________________________ 4. _________________________________
2. _________________________________ 5. _________________________________
3. _________________________________ 6. _________________________________

Prepared by: Approved by:

________________________________ _____________________________
Level ______ / Clinical Coordinator OR / OPD /DR Superior / Headnurse

Noted by:

Mrs. Fidela B. Ansale, R.N.,MAN ____________________________

Dean, College of Nursing Chief Nurse

Issue: 05 April 2006 Revision Code : 003