FORMAT

CASE STUDY ON ----------------

1. PATIENT PROFILE :
Name :
Age :
Gender :
Education :
Religion :
Marital status :
Address :
Informant :
Date of admission :
IP. No. :
Diagnosis :

2. CHIEF/ PRESENTING COMPLAINTS:

3. PAST HISTORY: a. Medical History
b. Surgical History
4. MEDICATION:
5. FAMILY HISTORY:
Family Tree:
 6. PERSONAL HISTORY: a. Personal Details
b. Immunization History
c. Obstetric History (In case of
females)
7. SOCIO –ECONOMIC HISTORY:
8. PHYSICAL EXAMINATION:
9. NEUROLOGICAL EXAMINATION:
10. MENTAL STATUS EXAMINATION:
11. DISEASE CONDITION:

i. DEFINITION:
ii. ETIOLOGICAL FACTORS:
Book Picture Patient Picture

iii. CLINICAL FEATURES

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iv. PSYCHO-PATHOPHYSIOLOGY

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v. INVESTIGATION:

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vi. MEDICAL/PSYCHOLOGICAL MANAGEMENT

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12. NURSING MANAGEMENT:

13. COMPLICATION:
14. NCP (3 days)
(1st Day)
Nsg.
Nsg. Diagnosis Planning Implementation Evaluation
Assessment

(2nd Day)
Nsg.
Nsg. Diagnosis Planning Implementation Evaluation
Assessment

(3rd Day)
Nsg.
Nsg. Diagnosis Planning Implementation Evaluation
Assessment

15. HEALTH EDUCATION: on - About disease condition,

- Prevention, Promotion, etc.
19. SUMMARY
20. BIBLIOGRAPHY