Medical Diagnosis: _________________________________________ Physician: _________________________________________________ Date of Admission: _________________________________________ Hospital: __________________________________________________
SUBJECTIVE OBJECTIVE NURSING PLAN OF CARE
SCIENTIFIC REFERENCE IMPLEMENTATION RATIONALE EVALUATION CUES CUES DIAGNOSIS / OBJECTIVES SUBJECTIVE OBJECTIVE NURSING PLAN OF CARE SCIENTIFIC IMPLEMENTATION RATIONALE EVALUATION CUES CUES DIAGNOSIS / OBJECTIVES REFERENCE SUBJECTIVE OBJECTIVE NURSING PLAN OF CARE SCIENTIFIC IMPLEMENTATION RATIONALE EVALUATION CUES CUES DIAGNOSIS / OBJECTIVES REFERENCE
Medications Date Ordered/ Given/ Taken Route of Administration/ Dosage/ Frequency Mechanism of Action Indication Contraindication Client's Response Nursing Responsibilities