Care Plan Template — Goals, Interventions, Review
One patient, one plan, one owner — the document that turns an assessment into action and a ward round into accountability
What it is
A structured nursing and clinical care plan template. One row per identified patient problem: the problem, the goal (measurable, time-bound), the interventions, the responsible person, and the review date. A care plan that says “improve nutrition” is not a care plan — it has no goal, no timeline, and no owner. This template forces specificity: “Patient will achieve unaided oral intake of 1200 kcal/day by Day 5 — dietitian review on Day 3.”
ASF criterion
Evidence for: Hospital Standard 4, criterion 4.9 (Non-Negotiable) — There’s an Actual Care Plan.
| CARE PLAN · ASF-TOOL-CAP-03 · Patient: ID: Date started: | |||||
|---|---|---|---|---|---|
| Problem identified | Goal (specific & time-bound) | Interventions | Responsible person | Review date | Outcome / Status |
| |
|
|
|||
| |
|
|
|||
| |
|
|
|||
| |
|
|
|||
| Care plan completed by (name & role): | |||||
| Signature & date: | |||||
| Patient / family informed of plan: | ☐ Yes ☐ No — reason: | ||||
ASF-TOOL-CAP-03 · Toolkit 33 — Clinical Assessment & Care Planning · france-asf.fr/tools · ASF original © Accréditation Sans Frontières · CC BY-NC-SA 4.0 · Keep this line on all adapted versions
