Nursing Health History Format (Used For Client Care Plan)
Nursing Health History Format (Used For Client Care Plan)
Nursing Health History Format (Used For Client Care Plan)
Biographical Data
Name
Address
Phone
Gender
Provider of history (patient or other)
Birth date
Place of birth
Race or ethnic background
Primary and secondary languages (spoken and read)
Marital Status
Religious or Spiritual Practices
Educational Level
Occupation
Significant others or support persons (availability)
Reasons for Seeking Health Care
Problems at birth
Childhood illnesses
Immunizations to date
Adult illnesses (physical, emotional, mental)
Surgeries
Accidents
Prolonged pain or pain patterns
Allergies
Physical, emotional, social, or spiritual weaknesses
Physical, emotional, social, or spiritual strengths
Developmental Level
Young adult: Intimacy versus isolation
Middlescent: Generativity versus stagnation
Older adult: Ego integrity versus despair