Clinical Forms

Follow the link above for clinical forms not linked here.

AM Report

This form is used to organize your thoughts about your patient and prepare you for giving report to your instructor.  Check with your instructor to see if this form is required.

Patient Care Plan (PCP) Page 1

Example

This form is required and must be completed before clinical.  It is part of your patient research.  This form contains a place to plan your day.  Organization is an important part of your clinical preparedness.  The lab and diagnostic tests are related to the primary diagnosis on the patient and may not have been performed.

Patient Care Plan (PCP) Page 2

Example

This form is required and must be completed before clinical with the exception of the patient and your perspectives after clinical.

Medication Sheet

Example

You are to complete up to 10 medications on your patient completing all research about the drugs prior to clinical.  When you are administering medications you must research all meds to be given.

Signs & Symptoms

Example

This form must be complete before clinical and is a textbook explanation of the primary and secondary diagnoses with nursing care.  This is not a patient specific plan but is to be created for reuse.

LPAT

This form is to be used during clinical for recording your physical assessment.

KATZ/Mini-mental

This form is used during clinical for recording your neuro assessment.

Weekly Progress

You will use this form to evaluate your care for the clinical day and to relate your theory class to the clinical experience.  Each week you are to come with some specific goals for that clinical experience.

Clinical Site Orientation

This is to be completed prior to clinical at each new site except Mercy Medical Center.

Mercy Orientation

This is to be completed prior to clinical at each new unit at Mercy Medical Center.

Outmigration Evaluation

This form is completed following your experience at DayOut or DayBreak to evaluate the location.