HTML Preview Individual Health Care Plan page number 1.


Sample Individual Health Plan
Name: Date of Last Revision:
Date of Birth:
Address/Phone/Parents:
Primary Doctor:
Address/Phone:
Principal Diagnosis:
Problem List: Consultants/Hospital/Phone/Date Last Seen:
1.
2.
3.
Hospital Admissions in the last 12 months
Reason/Outcome/Discharge Date:
1.
2.
Curre nt Medications:
Dosage/Frequency/Method of Administration/Reason for taking/Prescribed by/Date
started/effectiveness/side effects
1.
2.
3.
Allergies:
Equipment:
Type of equipment/company providing equipment/date prescribed/new equipment needed
DOWNLOAD HERE


Whatever the mind of man can conceive and believe, it can achieve. Thoughts are things! And powerful things at that, when mixed with definiteness of purpose, and burning desire, can be translated into riches. | Napoleon Hill