NURSING HISTORY

Name: ____________________________ Civil Status: _________ Sex: ___ Educational Attainment: ___________
Address: ___________________________________________ Religion: ________________Occupation: ___________
Room and Bed No.: _____________Doctor(s) In-Charge: _____________________________Nationality:__________
Chief Complaint(s): ________________________________________Date and Time of Admission: _______________
History of present illness: ____________________________________________________________________________

General Impression of Client:

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