PSORIASIS 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
Emergency Contact List is attached to IHP.

Treating Physician
Physician Phone Number
Physician Fax Number

Add a medication or procedure?

Nursing Diagnosis: Impaired Skin Integrity
Nursing Diagnosis: Disturbed Body Image
Nursing Diagnosis: Chronic Pain
Nursing Diagnosis: Social Isolation
Nursing Diagnosis: Risk for Infection
Nursing Diagnosis: Ineffective Coping
Nursing Diagnosis: Knowledge Deficit
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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