PHYSICAL DISABILITY IHP

Student's Name *
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DoB
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Address
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Treating Physician
Physician Phone Number
Physician Fax Number
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Nursing Diagnosis: Impaired Physical Mobility
Nursing Diagnosis: Self-Care Deficit (Toileting/Personal Care)
Nursing Diagnosis: Risk for Skin Integrity Impairment
Nursing Diagnosis: Risk for Urinary Tract Infection
Nursing Diagnosis: Anxiety Related to Dependence
Nursing Diagnosis: Deficient Knowledge (Safe Mobility & Emergency Protocols)
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IHP Developed By

Name
Date
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