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NURSING CARE PLAN

(INDIVIDUAL)
IDENTIFICATION DATA

Name of the patient :-

Age/Sex :-

Address :-

Area :-

Marital status :-

Educational status :-

Occupation :-

Religion :-

Family income :-

Disease :-

FAMILY BIODATA

Head of the family --

Type of Family --
S/N NAME OF RELATIONSHIP AGE/SEX EDUCATION MARITAL
O FAMILY STATUS
MEMBER

SOCIO-ECONOMIC STATUS

LIVING ENVIRONMENT:- .

WATER & ELECTRICITY SUPPLY

HISTORY OF ILLNESS
PAST HISTORY

PRESENT HISTORY

PRESENT COMPLAINT
HABITS:- :-

FUNCTIONAL HEALTH PATTERN


HYGIENE

DIETETIC HISTORY.

ELIMINATION PATTERN..

ACTIVITY / EXERCISE

VALUES / BELIEFS

HEALTH EDUCATION:-

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