Health Assessment Tool (Adult)

Nursing Care Plan Form Name:

Hospital No:

Hospital: Location: Age: Sex:

Diagnosis/es: _______________________________________________________________

Assessment Nursing Planning Implementation *Rationale (Literature- Evaluation

Diagnosis (Expected Based; EBP, If (Client’s
Outcomes) Applicable) Outcomes)
Subjective Data: 1.

Objective Data

*All scientific rationales for each nursing intervention must be based on utilization of research findings (citation and reference list should be included)

16
 Health Assessment Tool (Adult)

Assessment Nursing Planning Implementation *Rationale (Literature- Evaluation

Diagnosis (Expected Based; EBP, If (Client’s
Outcomes) Applicable) Outcomes)
Subjective Data: 2.

Objective Data

*All scientific rationales for each nursing intervention must be based on utilization of research findings (citation and reference list should be included)

17
 Health Assessment Tool (Adult)

Assessment Nursing Planning Implementation *Rationale (Literature- Evaluation

Diagnosis (Expected Based; EBP, If Applicable) (Client’s
Outcomes) Outcomes)
Subjective Data: 3.

Objective Data

*All scientific rationales for each nursing intervention must be based on utilization of research findings (citation and reference list should be included)

18
 Health Assessment Tool (Adult)

References

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