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Patient History, GORDON - Soft
Patient History, GORDON - Soft
PATIENT HISTORY
Name of Student:
Republic of the Philippines
BILIRAN PROVINCE STATE UNIVERSITY
Naval, Biliran
Telefax No. (053)-500- 9045
SUC LEVEL III-A
(Per DBM-CHED Joint Circular #1-B dated June 21, 2007)
School of Nursing and Health Sciences
Date of Assessment:
I. PATIENT’S PROFILE
Name of Patient: Age: Sex:
Occupation: Civil Status: Religion:
Address: Nationality:
No. of Children: Work of Husband/Wife:
Date of Admission: Time of Admission: Admitting Physician:
Chief Complain:
Admitting Diagnosis:
Source of Data:
GYNECOLOGIC HISTORY
OBSTETRICAL HISTORY
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GORDON’S HEALTH PROBLEM
B. NUTRITIONAL-METABOLIC PATTERN
C. ELIMINATION PATTERN
D. ACTIVITY-EXERCISE PATTERN
G. SELF-PERCEPTION PATTERN
I. SEXUALITY-SEXUAL FUNCTIONING
J. COPING-STRESS MANAGEMENT
Republic of the Philippines
BILIRAN PROVINCE STATE UNIVERSITY
Naval, Biliran
Telefax No. (053)-500- 9045
SUC LEVEL III-A
(Per DBM-CHED Joint Circular #1-B dated June 21, 2007)
School of Nursing and Health Sciences
K. VALUE-BELIEF SYSTEM