COLLEGE OF ALLIED MEDICAL PROFESSIONS

BACHELOR OF SCIENCE IN NURSING

NURSING CARE PLAN

Patient’s Initial: __________________________ Age: _______________ Date of Birth: __________________ Gender: ___________________

Chief Complaint: _____________________________________ Medical Diagnosis: _______________________________________________ Room/Bed #: _______________

INTERVENTION EVALUATION
PLANNING
ASSESSMENT NURSING DIAGNOSIS (at least 3 Independent, 3 RATIONALE (Short-Term and Long-Term)
(Short-Term and Long-Term)
Dependent, 3 Collaborative) Met, Partially Met, Unmet
Subjective: Short-Term Goal: Short-Term Evaluation:

______ Met
______ Partially Met
______ Unmet

as evidenced by:
Objective: Long-Term Goal:

Submitted by: ____________________________________ Section/Group #: _________ Submitted to: _____________________ Hospital/Area: ______________ Date: ___________
 Long-Term Evaluation:

______ Met
______ Partially Met
______ Unmet

as evidenced by:

Submitted by: ____________________________________ Section/Group #: _________ Submitted to: _____________________ Hospital/Area: ______________ Date: ___________