Evaluation form:

Name of the student nurse :_____________ ______________________

Date of health assessment:_____________________________________
Sr Content Out Obtained Obtained
no of I II

1 Health information 1
2 Past and present history 2
3 Anthropometric assessment and vital 2
signs
4 Head to foot assessment systematic and 5
chemical examination

5 Need in identification 5
6 List of nursing diagnosis 5
7 Summary and conclusion 2
8 Overall performance 2
9 Biblography 1
Total 25

Strong points:_______________________________________
Point to be improved :_________________________________
Signature of student:__________________________________