Nursing Diagnosis Submission

Diagnosi(e)s Label Information

Proposed Diagnosis Label:

Related NANDA-I Diagnosi(e)s:
 

Submission is intended to be:
 

- Select One - A Replacement of current NANDA-I label noted above. Used in addition to NANDA-I label noted above.

 

Note: For each of the following items, please include the appropriate reference number(s) for each of your Reference List entries, below.

Use a separate line per item.

New/Revised Diagnosi(e)s

Current Related NANDA Diagnosi(e)s

Proposed Definition:
[Please label each diagnosis with
(N) or (R) to indicate New or
Revised Diagnosis]

Defining Characteristics:
[Actual, Health Promotion, and Wellness Diagnoses]
 

Related Factors:
[Actual diagnoses only]
 

Risk Factors:
[Risk diagnoses only]
 

Examples of Nursing Interventions: 

Examples of Nursing Outcomes: 

Reference List:
(APA Format)

Note: Remember to number each
reference and assign those numbers as appropriate, above.

Please complete the contact information below in case we need additional information.

First Name:

Last Name:

Address:

City:

State/Province and Zip:

Country:

 (If USA, leave blank.)

Phone:

Fax:

Email Address:

 Note: Required in order to submit form.

I am a current NANDA-I Member:

- Select One - Yes No

 

Are you a student:

- Select One - Yes No

 

If so, please include faculty contact information:

Name:
University/College: