College of Health Sciences Education

3rd Floor, DPT Building

Matina Campus, Davao City
Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117

A Nursing Care Plan on:

Title:

Submitted by:

Year Level/ Code:

Submitted to:

Name of Supervising Clinical Instructor:

Date of Submission:
 College of Health Sciences Education
3rd Floor, DPT Building
Matina Campus, Davao City
Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117
NURSING CARE PLAN
Code Name of Patient: Age: Ward/Room/Bed No.:
Chief Complaints: Gender:
Date and Time of Admission Religion:
Medical Diagnosis/ Impression:
Attending Physician:
Date and Time of Assessment:

Cues & Evidences Nursing Diagnosis Objective of Care Nursing Interventions Rationale Evaluation
 College of Health Sciences Education
3rd Floor, DPT Building
Matina Campus, Davao City
Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117
Cues & Evidences Nursing Diagnosis Objective of Care Nursing Interventions Rationale Evaluation
 College of Health Sciences Education
3rd Floor, DPT Building
Matina Campus, Davao City
Telefax: (082)
Phone No.: (082)300-5456/300-0647 Local 117
Cues & Evidences Nursing Diagnosis Objective of Care Nursing Interventions Rationale Evaluation

References: (APA 7th Edition Format)

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Submitted by: Checked by:

Signature over Printed Name of the Student Nurse: Signature over Printed Name of the Clinical Instructor: