MUBARAK AL KABEER HOSPITAL KUWAIT
MAIN
OPERATING THEATRE
SPONGES COUNT
PATIENT’S
NAME ………………………………………… AGE..…….SEX……….. DATE…………………….
NATIONALITY
………………………WARD……..ROOM. #.........BED…….HOSPITAL.#...................................
DIAGNOSIS…………………………………………… OPERATION………………………………………………..
TIME
STARTED……………………………………… TIME
FINISHED…………………………………………..
SURGEON
……………………………………………..
ASST.SURGEON…………………………………………...
1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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11
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12
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ABDOMINAL SWABS
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ABDOMINAL SWABS
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RAY TEC GAUZES
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RAY TEC GAUZES
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PEANUTS
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VESSEL LOOPS
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NYLON TAPE
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OTHERS
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§ SPONGES :
COMPLETE ………………………….
INCOMPLETE …..…………………
§ INSTRUMENTS :
COMPLETE ………………………… INCOMPLETE …..……………….
§ NEEDLES :
COMPLETE ………………………… INCOMPLETE …..……………….
SCRUB NURSE …………………………………………. SIGNATURE…………………………………………….
CIRCULATING NURSE ………………………………….SIGNATURE……………………………………………
REMARKS ……………………………………………………………………………………………………………….
……………………………………………………………………………………………………………….
THIS IS TO BE
INCLUDED IN THE FILE .
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