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Students name: Chief complain:

Patients name: Age/Gender:


Attending physician: Religion:
Admitting Diagnosis: Room #:

Nursing Care Plan


Assessment Nursing Diagnosis Background Study Planning Intervention Rationale Evaluation

Resources:
Students Name: Attending physician:
Patients Name: Admitting Diagnosis:
Age: Chief Complain:
Religion: Room #:
Endorsement Assessment Medications Vital Signs

Time BP T P R O

10

11

12

INTAKE AN OUTPUT
RECEIVE: IVF FINAL: IVF URINE OUTPUT

PO PO STOOL

Date and Time: Focus: Data/Action/Response: