NURSING PLAN OF CARE
TEMPLATE
Each diagnostic statement (actual, psychosocial, risk) must include all required components for the
statement.
Priority Nursing Diagnosis (#1):
_______________________________________________________________________________________
Goal: The client will _____________________________________________________________________
Interventions:
1._____________________________________________________________________________________
2._____________________________________________________________________________________
3._____________________________________________________________________________________
Evaluation:
______________________________________________________________________________________
Nursing Diagnosis (#2):
_______________________________________________________________________________________
Goal: The client will _____________________________________________________________________
Interventions:
1._____________________________________________________________________________________
2._____________________________________________________________________________________
3._____________________________________________________________________________________
Evaluation:
______________________________________________________________________________________
TEMPLATE
Each diagnostic statement (actual, psychosocial, risk) must include all required components for the
statement.
Priority Nursing Diagnosis (#1):
_______________________________________________________________________________________
Goal: The client will _____________________________________________________________________
Interventions:
1._____________________________________________________________________________________
2._____________________________________________________________________________________
3._____________________________________________________________________________________
Evaluation:
______________________________________________________________________________________
Nursing Diagnosis (#2):
_______________________________________________________________________________________
Goal: The client will _____________________________________________________________________
Interventions:
1._____________________________________________________________________________________
2._____________________________________________________________________________________
3._____________________________________________________________________________________
Evaluation:
______________________________________________________________________________________
