Patient: Age: Hospital # Physician/s: Drug Therapeutic Record Drug/ Dose/ Frequency/ Route Classification & Mechanism Indication,

C/I & S/E Principle of Care

Date: SN:

Treatment

Evaluation

Patient: Room/Bed # Chief Complaint/s:

Age:

Date: SN: Nursing Care Plan

Needs/ Problems/ Cues

Nursing Diagnosis

Scientific Basis/ Significance

Objectives of Care

Nursing Actions

Rationale

Patient: Room/Bed # Chief Complaint/s:

Age:

Date: SN:

Health Teaching Plan Objectives Contents Methodology Evaluation