Foundation University

COLLEGE OF NURSING
Dumaguete City

GFHP & NCP

Student Name: Level & Section:

RLE Area: Institution:

Clinical Instructor: Inclusive Dates:

 Demographic Information:

Patient Name: Age:

Date of Birth: Gender:

Civil Status: Address:

Occupation: Room No:

Date of Admission: Physician:

Chief Complaints:

Diagnosis/ Admitting Impression:

Present Health History:

Past Health History:

Usual Pattern Initial Pattern On-Going Pattern On-Going Pattern
( / / ) ( / / ) ( / / ) ( / / )
 NURSING CARE PLAN

Patient’s Name: Age: Date:

Assessment Nursing Diagnosis Objectives/ Planning Intervention Rationale Evaluation