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FHPformat

This nursing history document records demographic information about a patient including their name, age, gender, address, occupation, religion, and more. It documents their chief complaints, history of present illness, and general impression. It also has a section to record assessments of the patient's usual functional health patterns at initial, ongoing, and ongoing appraisal stages.

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kotonashi
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36 views2 pages

FHPformat

This nursing history document records demographic information about a patient including their name, age, gender, address, occupation, religion, and more. It documents their chief complaints, history of present illness, and general impression. It also has a section to record assessments of the patient's usual functional health patterns at initial, ongoing, and ongoing appraisal stages.

Uploaded by

kotonashi
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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NURSING HISTORY

Part I. Demographic Information

Name: ___________________________ Civil Status: ____________ Age: _______ Sex: _______ Educational Attainment: _____________________
Address: _________________________ Religion: _____________________________ Occupation: _______________________________
Room and Bed No.: ________________ Doctor(s) in charge: ______________________________________Nationality: _______________________________
Date & Time of Admission: _______________________
Chief Complaint(s):___________________________________________________________________________________________________________________

History of present illness:

General Impression of Client:

Part II. Functional Health Patterns


USUAL FUNCTION INITIAL APPRAISAL ONGOING ONGOING APPRAISAL ONGOING APPRAISAL
PATTERNS APPRAISAL
USUAL FUNCTION INITIAL APPRAISAL ONGOING ONGOING ONGOING
PATTERNS APPRAISAL APPRAISAL APPRAISAL

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