CEREBRAL PALSY IHP

Student's Name *
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DoB
Would you like to add the student's ID number?
Would you like to add the student's homeroom number and teacher's name?
Address
Add contact info?

Treating Physician
Physician Phone Number
Physician Fax Number
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Add a medication or procedure?
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Nursing Diagnosis: Potential for injury
Nursing Diagnosis: Potential disturbance in self-concept
Nursing Diagnosis: Self-care deficit
Nursing Diagnosis: Health Maintenance Alteration
Nursing Diagnosis: Impaired Communication
Nursing Diagnosis: Impaired Physical Mobility
Nursing Diagnosis: Risk for Impaired Skin Integrity
Nursing Diagnosis: Chronic Pain
Nursing Diagnosis: Fatigue
Nursing Diagnosis: Deficient Knowledge (Health Management/Seizure Safety)
Nursing Diagnosis: Social Isolation / Anxiety
Would you like to add another nursing diagnosis?

IHP Developed By

Name
Date
Do you want to include physician and parent signature lines?

 

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