NURSING CARE PLAN Template

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Patient’s Initials: Chief Complaint: Name of Student

_____________ _________________________ Nurse:


Age & Gender: _________ ____________________
_______________ _________
Birthdate: Admitting Level/Block/Group:
_________________________ Diagnosis:________________ ____________________
_ ___________ _________ _________
Address: _________________________ Hospital/Area:
_________________________ _________ ____________________
_ ___________ _________
_________________________ Date of Confinement: Clinical Instructor:
_ ___________ _________________________ __________
NURSING CARE PLAN _____ Date: _______

ASSESSME NURSING PLANN INTERV RATIO EVALUATION


NT ANALYSIS IN G EN NA LE
TIONS

NURSING
DIAGNOSIS

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