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Patient Health History Template

This document contains a template for a patient health history form used by Lorma Colleges nursing students on clinical rotations. The template includes sections for biographic data, reasons for seeking care, present health history, past health history, family health history, and lifestyle and practices such as nutrition, stress levels, relationships, and sleep habits. It aims to gather a comprehensive overview of a patient's medical background and lifestyle factors relevant to their health.

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Aisha Mae
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18 views1 page

Patient Health History Template

This document contains a template for a patient health history form used by Lorma Colleges nursing students on clinical rotations. The template includes sections for biographic data, reasons for seeking care, present health history, past health history, family health history, and lifestyle and practices such as nutrition, stress levels, relationships, and sleep habits. It aims to gather a comprehensive overview of a patient's medical background and lifestyle factors relevant to their health.

Uploaded by

Aisha Mae
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

LORMA COLLEGES CON TEMPLATE

PATIENT HEALTH HISTORY


RELATED LEARNING EXPERIENCE

STUDENT NAME: ROTATION:


    AREA:
YR LEVEL AND SEC: DATES: CLINICAL INSTRUCTOR:

A. BIOGRAPHIC DATA

B. REASONS FOR SEEKING HEALTH CARE

C. PRESENT HEALTH HISTORY

D. PAST HEALTH HISTORY

E. FAMILY HEALTH HISTORY

F. LIFESTYLE AND PRACTICES


1. DESCRIPTION OF TYPICAL DAY
2. NUTRITION
3. ACTIVITY LEVEL AND EXERCISE
4. SELF-CONCEPT
5. RELATIONSHIP
6. STRESS LEVEL
7. ENVIRONMENT
8. EDUCATION AND WORK
9. VALUES AND BELIEFS
10. SLEEP AND REST

G. DEVELOPMENTAL STAGE

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