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GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION, INC.


EVALUATION TOOL FOR ASSESSMENT OF PATIENT (WRITTEN)
NAME ________________________________________________ AREA _________________________________ DATE

AREAS EXCELLENT GOOD FAIR POOR


4 3 2 1
GORDON’S 11 All of the data are organized and Most of the data are organized and There are patterns that are inappropriately All of the patterns were inappropriately
FUNCTIONAL HEALTH described correctly. Past and present described correctly. Past and present history organized and described. Past and present described
CARE PATTERNS history of the patient’s illness are of the patient’s illness are described history are incompletely described.
described exhaustively. superficially.
PHYSICAL ASSESSMENT All of the body systems/parts are Most of the body systems/parts are Some of the body systems/parts are Assessment of the body systems/parts are
correctly and thoroughly assessed and correctly and thoroughly assessed and correctly and thoroughly assessed and incomplete and incorrectly described.
described following the correct method described following the correct method of described following the correct method of
of assessment. assessment. assessment.

PRIORITIZATION All of the problems are correctly Most of the problems are correctly Only a few of the problems are correctly Problems were incorrectly prioritized.
prioritized based on Maslow’s Hierarchy prioritized based on Maslow’s Hierarchy of prioritized based on Maslow’s Hierarchy of
of needs or other methods of needs or other methods of prioritization. needs or other methods of prioritization.
prioritization.

Justification of the problems are all Most of the justification of the problem are Only a few were justified and are correctly Justification of the problem was based on
JUSTIFICATION correctly stated and are based on related correctly stated and are based on related stated. Justification is based on related personal opinion.
literature. literature. literature.
Writing is totally free of grammar and There are occasional grammar and spelling There are more than occasional grammar Grammar and spelling errors are
WRITING SKILLS spelling errors. errors. and spelling errors. frequent.
Clear and concise presentation of ideas. Clear presentation of ideas. Most ideas are presented clearly.
Hard to follow the ideas.
All references used are important and Most of the references cited and listed are No references cited.
REFERENCES current; are of good/scholarly quality. not important and/or not of good/scholarly
References are correctly cited. quality. References are not correctly cited
and listed.
COMMENTS: _________________________________________________________________________________________________________________________________
CI’S NAME AND SIGNATURE: _______________________

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