Patient Concept Care Map
Assessment Data
Date:
Patient’s Initials:
Positive Outcomes
Patient Goal
Antecedents
Patient Concept Problem:
Negative Outcomes
(Complications)
Consequences
3.
a.
b.
c
Interventions
1.
a.
b.
c.
Patient Priority Problem
1.
2.
3.
Interrelated Concept:
4.
a.
b.
c.
1.
2.
3.
Interrelated Concept:
1.
2.
3.
Patient Education
1.
2.
3.
Interrelated Concept:
2.
a.
b.
c.
5.
a.
b.
c.
1.
2.
3.
Teamwork and
Collaboration
1.
2.
3.
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Patient Concept Care Map
Patient Concept Care Map Instructions:
1. Put the patient’s priority concept problem in the oval in the middle.
2. Add assessment data that supports the patient concept problem in the assessment data
box. Be sure to include subjective data, objective data, and diagnostic exams (including
labs).
3. Add antecedents that support the patient concept problem in the antecedent’s box. Be
sure to include health history and risk factors.
4. Add the positive consequences in the yellow box. Develop a patient goal that is
measureable and reflects a positive outcome.
5. Add interventions specifically for the patient priority problem in the blue box.
6. Add interrelated concepts in the green boxes. Add corresponding applicable
interventions.
7. Under the interrelated concept: Patient Education, add applicable patient teaching
interventions.
8. Under the interrelated concept: Teamwork & Collaboration, add appropriate referrals.
9. Add complications to watch for in the gray boxes under negative outcomes. For each
complication add interventions. Include clinical manifestations to watch for. Add when
the HCP should be notified. Add any interventions that should be done before notifying
the HCP.
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