CLINICAL DATABASE
Patient Profile
Patient’s Initials: __________ Room#: ________
Diagnosis: ______________________________
Age: _________ Admission Date: ___________
Ordered Plan of
Care
(Kardex;Doctor’s
Orders, TNP)
Oxygenation
(circulation and respiratory)
Sensory
Student’s Name: _________________
Skin/Immune System
Activity/
Rest/Sleep
Nutrition
Elimination
(bladder and bowel)
Neurological
Self
Concept
Role
Performance
Endocrine
Fluid
Electrolytes/
Acid Base balance
Significant others
and support
systems
0
