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GENOGRAM

DIRECTIONS: Represent into a diagram your patients family tree. Use the appropriate symbol and placement as indicated.

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GORDONSS FUNCTIONAL HEALTH PATTERNS

DIRECTIONS: Write down the patients data on the table below

I. HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN


INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

II. NUTRITIONAL-METABOLIC PATTERN


INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

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III. ELIMINATION PATTERN
INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

IV. ACTIVITY-EXERCISE PATTERN


INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

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V. SLEEP-REST PATTERN
INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

VI. COGNITIVE-PERCEPTUAL PATTERN


INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

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VII. SELF-PERCEPTION AND SELF CONCEPT PATTERN
INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

VIII. ROLE-RELATIONSHIP PATTERN


INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

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IX. SEXUALITY- REPRODUCTIVE PATTERN
INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

X. COPING-STRESS TOLERANCE PATTERN


INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

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XI. VALUE-BELIEF PATTERN
INITIAL APPRAISAL ONGOING APPRAISAL ONGOING APPRAISAL
DATE: DATE: DATE:

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