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Fillable Printable Plan of Care Sample Form

Fillable Printable Plan of Care Sample Form

Plan of Care Sample Form

Plan of Care Sample Form

Care Plan for (insert condition)
Student Name:
Current
Date:
Patient:
Age:
Sex:
Dates Care Given:
Admission Diagnosis/History:
Nursing Diagnosis:
ASSESSMENT
Objective Data
Subjective Data
Potential Complications:
GOALS
Expected Outcome
TD
DA
TD: Target Date DA: Date Achieved
NURSING INTERVENTIONS
Interventions
Rationale
Evaluation:
Signature:
_____________________________________
Date:
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