NURSING CARE PLAN
(NCP)
Document
Code
Effectivity
QF-CN-25
Revision
Number
1
August 17, 2018
NAME/ INITIALS OF PATIENT: ________________________________________________ AGE: ____________ SEX: ___________ STATUS: ______________
ADDRESS: ________________________________________________________________ HOSPITAL: ______________________ WARD: _______________
PRINCIPAL MEDICAL DIAGNOSIS: ___________________________________________________________________________________________________
NURSING CARE PLAN DEVSED BY: _______________________________________________ YEAR AND SECTION: ______________ GROUP______________
IMPLEMENTATION
SCORING
CRITERIA
VL
L
H
VH
Content
Complete
Assessment
Parameters
Nursing
Diagnosis
Short-term
Outcome
Long-term
Outcome
Nursing
Orders
Rationales
Actual
outcome
NURSING ORDERS/ APPROACHES
RATIONALE
TOTAL SCORE
VH – Very High
H – High
L – Low
VL – Very Low
Rated by:
Date: __________________
Conforme:
ACTUAL OUTCOME
Date:__________________
DATE AND TIME RESOLVED
NURSING CARE PLAN
(NCP)
DATE AND TIME
ASSESSMET PARAMETERS
Document
Code
Effectivity
NURSING DIAGNOSIS
QF-CN-25
Revision
Number
1
August 17, 2018
SHORT – TERM AND LONG – TERM OUTCOMES
IMPLEMENTATION
NURSING ORDERS / APPROACHES
ACTUAL OUTCOME
RATIONALE
DATE AND TIME RESOLVED