School of Nursing , Arka Jain University
GNM 2nd Year , Mental Health Nursing
PROCESS RECORDING FORMAT
1. Identification Data :
Name:
Age :
Sex :
Religion:
Marital status:
Educational status:
Occupation:
Income per month
Languages known
IP. No:
Ward:
Diagnosis:
Address
Date of admission:
Date and time of process recording:
II. Brief Summary of the Patient Problem :
III. Place of Interaction :
IV. Description of the Environment :
V. Reason for Selecting the Patient :
VI. Objectives :
1.
2.
3.
Nurse’s Response Patient’s Response Communication Technique Inference
Verbal & non verbal Verbal & non verbal
Nurse’s Response Patient’s Response Communication Technique Inference
Verbal & non verbal Verbal & non verbal
Conclusion-fixing the time and place for the next interview :
List of inferences:
Any special difficulties faced during the inference:
Techniques used to overcome difficulties:
Name and Signature of Student Name and Signature of Supervisor