Geriatric Nursing Assessment
Patient Name
Date of Assessment
Date of Birth
Medical Record Number
Presenting Complaints
Medical History
Surgical History
Medications
Allergies
Immunizations
Functional Assessment
ADLs (Activities of Daily Living)
IADLs (Instrumental Activities of Daily Living)
Cognitive Assessment
Mood Assessment / Depression
Nutrition / Weight
Vision / Hearing
Falls
Social History
Physical Assessment
Plan & Recommendations