NURSING CARE PLAN

Patient’s Initials: _____________ Chief Complaint: ___________________ Name of Student Nurse:

Age & Gender: _______________
Birthdate: ___________________
Address: ____________________
Admitting Diagnosis:_________________________
Date of Confinement: _______________
_____________________________
Level/Block/Group: ____________
Hospital/Area: ________________
Clinical Instructor: __________
Date: _______

ASSESSMENT NURSING ANALYSIS PLANNING INTERVENTIONS RATIONALE EVALUATION

NURSING DIAGNOSIS