Nursing Care Plan

Patient’s Code: __________________ Age: _______ Sex: _________ Civil Status: ___________ Religion: ____________ Date & Time of Admission: _____________________ Room: ______
Attending Physician: ___________________________ Chief Complaints: _______________________________________________________________________________________

Nursing Diagnosis (PES):

Definition:

Assessment/ Cues Planning Interventions Rationale Evaluation

(Subjective/ Objective) (Goals and Objectives)
Subjective Data Independent

Dependent

Objective Data

Collaborative

References:

Name of Student: ____________________________________ Yr/Crs/Sec: ________________ RLE Group: __________ CI: ____________________________