TABLE OF CONTENTS

Page
I. Demographic 1

Data………………………………………………………………....
II. Reason for seeking health 1

care………………………………………………….....
III. History of present 1

illness…………………………………………………………..
IV. Past medical 1

history………………………………………………………………..
A. Childhood illness…………………………………………………………... 1
B. Immunization……………………………………………......... ..……….... 1
C. Injuries/accidents………………………………………………. …………. 1
D. Allergies…………………. ……………………………………………….. 1
E. Medications………………………… …………………………………….. 1
F. Hospitalization……………………………………….. …………………... 2
V. Family Medical History…………………………………. 2

………………………..
VI. MMDST…………………………………………………………… 4

……………...
A. Personal - Social ……………………. ………………………..................... 6
B. Fine-Motor Adaptive………………………………………. ……………... 9
C. Language………………… ……………………………………………….. 12
D. Gross-Motor…………………… …………………………………………. 14
VII. Developmental History……………………………………. 18

……………………...
A. Freud’s Psychoanalytic Development……………. ………………………. 18
B. Erikson’s Psychosocial Development… ………………………………….. 18
C. Piaget’s Cognitive Development…….. …………………………………… 19
D. Kohlberg’s Moral Development…………………… …………………….. 19
VIII. Play Behavior ......................................................................................................... 20
IX. Gordon’s Functional Assessment………………………….. ……………………... 20
A. Health Perception – Health Management………....………………………. 20
B. Nutritional – Metabolic Pattern……………………………………………. 20
C. Elimination Pattern……………………………………................................ 21
D. Activity – Exercise Pattern………………………………………………… 21
E. Sleep and Rest Pattern……………………………………………………... 22
F. Cognitive – Perceptual Pattern…………………………………………….. 22
G. Self-Perception and Self- Concept Pattern………………………………... 22
 H. Role – Relationship Pattern………………………………………………... 22
I. Coping - Stress Tolerance Pattern………………………………………..... 22
J. Value – Belief Pattern……………………………………………………... 22
XI. Physical Examination………………………….………………………………….... 23
XII. Nursing Care Plan…………………………………………………………………. 32