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  • Assessment Forms For The Client With Cleft Lip and Palate

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    Diane grace Soriano
    21 views6 pages
    This document contains a biographical data form asking for information such as name, age, gender, civil status, birthplace, religion, education, occupation, date of confinement, source of history, description of the patient, history of present illness, past history, family history, social history including a genogram and information on immunizations, allergies, and Gordon's 11 Health Perception areas including past health, present health during hospitalization, health metabolical, elimination, activity/exercise, sleep/rest, cognitive/perceptual, role relationship, coping/stress tolerance, and values/beliefs.

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    Original Title

    ASSESSMENT FORMS FOR THE CLIENT WITH CLEFT LIP AND PALATE

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    This document contains a biographical data form asking for information such as name, age, gender, civil status, birthplace, religion, education, occupation, date of confinement, source of history, description of the patient, history of present illness, past history, family history, social history including a genogram and information on immunizations, allergies, and Gordon's 11 Health Perception areas including past health, present health during hospitalization, health metabolical, elimination, activity/exercise, sleep/rest, cognitive/perceptual, role relationship, coping/stress tolerance, and values/beliefs.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    21 views6 pages

    Assessment Forms For The Client With Cleft Lip and Palate

    Uploaded by

    Diane grace Soriano
    This document contains a biographical data form asking for information such as name, age, gender, civil status, birthplace, religion, education, occupation, date of confinement, source of history, description of the patient, history of present illness, past history, family history, social history including a genogram and information on immunizations, allergies, and Gordon's 11 Health Perception areas including past health, present health during hospitalization, health metabolical, elimination, activity/exercise, sleep/rest, cognitive/perceptual, role relationship, coping/stress tolerance, and values/beliefs.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    of 6

    J.H.

    CERILLES STATE COLLEGE


    In consortium with
    Western Mindanao State University
    Balangasan, Pagadian City
    Zamboanga del Sur 7016
    ___________________________________________________________________________________________________

    BIOGRAPHICAL DATA

    NAME:
    ROOM NUMBER:

    AGE:
    GENDER:
    CIVIL STATUS:
    DATE OF BIRTH:

    BIRTHPLACE

    CULTURAL GROUP:

    RELIGION:

    HIGHEST EDUCATIONAL
    ATTAINMENT:

    OCCUPATION:

    DATE OF CONFINEMENT

    :
    SOURCE OF HISTORY:

    DESCRIPTION OF PATIENT
    :
    HISTORY OF PRESENT ILLNESS

    PAST HISTORY:

    FAMILY HISTORY:

    SOCIAL HISTORY
    Genogram
    Immunizations/ exposure to
    communicable diseases

    Allergies

    Gordon's Assessment
    PAST HEALTH PRESENT HEALTH (DURING
    HOSPITALIZATION)

    HEALTH PERCEPTION

    HEALTH METABOLICAL

    ELIMINATION
    ACTIVITY/EXERCISE

    SLEEP/REST

    COGNITIVE/PERCEPTUAL

    Role Relationship

    COPING/STRESS TOLERANCE
    VALUES/BELIEFS

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