#nursingEnglish

Patient Admission Form

Objectives:

 Students are able to analyze and understand all the points to ask on
patient admission form
 Students are able to create a conversation between nurse and patient
related to the topic
 Students are able to perform a role play between nurse and patient
related to the topic

Assignments:

 Compose the conversation

 Role play video

Language Focus:

 Introducing yourself as a nurse as saying Hi

 Asking the personal details
 Asking the medical information
 Asking whether he/she needs help/ assistance
 Closing
#nursingEnglish

Patient Admission Form

Personal Details

Nurse : Good morning, Sir. Have a seat please.

Patient : Good morning nurse. Thank you.

Nurse : I’m Ns. Ridhwan who will ask several information about yourself
before being checked by doctor. Are you willing to do so?

Patient : Sure, nurse.

Nurse : Alright, What’s your name sir?

Patient :

Nurse : When were you born?

Patient :

Nurse : Where do you live now?

Patient :

Nurse : Who is the person we could contact to if ever something

happens to you?

Patient :

Nurse : Who is your gp (general practicioner)?

Patient :

Nurse : What makes you come here today and having checked by
doctor?

Patient :
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Medical Information

Nurse : Do you have another complaint or illness you suffered before?

Patient :

Nurse : Do you have any allergies on specific term?

Patient :

Nurse : How do you feel on your bowels now?

Patient :

Nurse : Sorry to ask, How many times you peed yesterday and what’s the
color?

Patient :

Nurse : (female only/menstruation) .....

Patient :

Nurse : Can you hear clearly?

Patient :

Nurse : Can you see clearly?

Patient :

Nurse : .....

Patient :

Nurse : That is all information I’d like to ask, Sir. Thank you for your
cooperation. Please wait in the waiting room as your name will be called
to see doctor. Whenever you need any help, please let us know. (with
attitude/smile)

Patient : Thank you nurse.