DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE

College of Nursing
Dasmariñas City, Cavite 4114

GRADING CRITERIA – NURSING HEALTH HISTORY OUTPUT

Use the scale below to grade/rate each item:

3 – data complete, properly stated and written*
2 – data complete, not properly stated and/nor written or data incomplete, properly stated/written
1 – data incomplete, not properly stated and/nor written
0 – no data presented

* properly stated – data should be phrased or stated as agreed upon, including the use of accepted abbreviations and/or acronyms
*properly written – data should be presented using agreed upon format including the correct manner of erasing or changing
data/entries

NAME OF STUDENT: _________________________________________ YEAR & SEC.: ________ GRADE: __________________

WRITTEN OUTPUT TECHNIQUE

Item Wt. Score Wt.x score Correct/ Incorrect/
Done Not done
Greeted the client 1
Introduced self 1
Explained the purpose of the interview 1
Secured verbal consent 1

1. Demographic data 1
2. Source and reliability of information
a. source 1
b. description of the source as to his/her reliability
to provide information 1
3. Chief complaint 2
4. HPI (if applicable)
a. chronology of events 2
b. description of symptoms ( timing, location, quality/character, quantity, 2
setting, associated manifestations, aggravating factors, alleviating
factors, meaning and impact to client) - rate only those which are
applicable)
5. Past medical/health history 2
a. childhood illnesses (with dates of occurrence)
b. injuries or accidents
c. hospitalization and operations
d. reproductive history (only menstrual history)
e. childhood immunizations
f. allergies
g. medications
6. Family history
a. age of family members 1
b. present health status/cause of death
c. synthesis 1
7. Socio-economic data/social history
a. family members 1
b. source of income/monthly income
c. lifestyle/practices that can affect health
d. synthesis 1
8. Psychosocial assessment
 c. elimination 1
d. activity – exercise 1
e. sleep – rest 1
f. cognitive-perceptual 1
g. self-perception – self-concept 1
h. role – relationship 1
i. sexuality – reproductive 1
j. coping – stress tolerance 1
k. value – belief 1
10. Review of systems
a. General 1
b. Integument 1
c. Head 1
d. Eyes 1
e. Ears 1
f. Nose and sinuses 1
g. Mouth and throat 1
h. Neck 1
i. Breast and axilla 1
j. Respiratory 1
k. Cardiac 1
l. Gastrointestinal 1
m. Urinary 1
n. Genitalia 1
o. Peripheral vascular 1
p. Musculoskeletal 1
q. Neurologic 1
r. Hematologic 1
s. Endocrine 1
t. Psychiatric 1

Thanked the client. 1

Finished within prescribed time 2
TOTAL

_______________________________ ___________________________________
Student’s signature over printed name Evaluator’s signature over printed name