CASE STUDY FORMAT I. Introduction II. Objective General Objectives Specific Objectives III.

I. Demographic Data Name Address Age Date of Birth Place of Birth Occupation Marital Status Number of Children Gender Religion Weight Height BMI Date and Time of Admission Date received patient IV. Chief Complaint Admitting Diagnosis V. History of Present Illness VI. Past Medical Health History VII. Psychosocial History/ OB History (If in OB ward) VIII. Family Health History (Genogram) Gordons Functional Health Pattern IX. Review of Systems (Narrative) General HEENT Respiratory Cardiovascular Gastrointestinal Genitourinary Hematology Endocrine Musculoskeletal Neurologic X.Physical Assessment General Skin HEENT Chest and Lungs Heart Abdomen Extremities Neurologic (including Cranial Nerves exam) XI. Anatomy and Physiology XII. Pathophysiology XIII.Diagnostic Procedures/ Lab results with Analysis XIV. Medical-Surgical Management XV. Drug Study XVI. Nursing Care Plan XVII. Discharge Plan (If applicable)