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General Santos Doctors’ Medical School Foundation, Inc.

Bulaong Subd., Brgy. West, General Santos City, Philippines


Telephone Nos. (083) 825-8372/552-9793; Email gsdmsfihumanresource@gmail.com | gsdmsfi.marketing@gmail.com

NCM 114n RLE


Area: _________________________ Inclusive Dates: ____________________
Student’s Name: _______________________________________________________ Year & Section: __________ Group: _______

BIOGRAPHICAL DATA
Patients Full Name: _______________________________________________ Age and Sex:____________________________
Attending Physician: ______________________________________________ Diagnosis:_______________________________
Chief Complaints:__________________________________________________________________________________________

GORDON'S FUNCTIONAL HEALTH PATTERN

Health Prior To Admission During Admission Identified Nursing Priority Justification


Pattern Problem
Health
Perception-
Health
Management

Nutritional-
Metabolic
General Santos Doctors’ Medical School Foundation, Inc.
Bulaong Subd., Brgy. West, General Santos City, Philippines
Telephone Nos. (083) 825-8372/552-9793; Email gsdmsfihumanresource@gmail.com | gsdmsfi.marketing@gmail.com

Health Prior To Admission During Admission Identified Nursing Priority Justification


Pattern Problem
Elimination

Activity-
Exercise

Sleep-Rest

Cognitive-
Perceptual
General Santos Doctors’ Medical School Foundation, Inc.
Bulaong Subd., Brgy. West, General Santos City, Philippines
Telephone Nos. (083) 825-8372/552-9793; Email gsdmsfihumanresource@gmail.com | gsdmsfi.marketing@gmail.com

Health Prior To Admission During Admission Identified Nursing Priority Justification


Pattern Problem

Self
Perception-
Self Concept

Role
Relationship

Sexuality-
Reproductive
General Santos Doctors’ Medical School Foundation, Inc.
Bulaong Subd., Brgy. West, General Santos City, Philippines
Telephone Nos. (083) 825-8372/552-9793; Email gsdmsfihumanresource@gmail.com | gsdmsfi.marketing@gmail.com

Health Prior To Admission During Admission Identified Nursing Priority Justification


Pattern Problem

Coping-
Stress
Tolerance

Value-Belief

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