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Normal UE Exam
Normal LE Exam
GAIT
Gait Free Text
1st Site Examined
Inspection/Palpation
• • •
Inspection/Palpation Free Text
Muscle Strength
Muscle Strength Free Text
Instability
• • •
Instability Free Text
Active ROM
• • •
Active ROM Free Text
Passive ROM
• • •
Passive ROM Free Text
Skin
• • •
Skin Free Text
Upper Extremity Special Tests
• • •
Lower Extremity Special Tests
• • •
Special Test Free Text
EXAM Free Text
2nd Site Examined
Inspection/Palpation
• • •
Inspect/Palpation Free Text
Muscle Strength
Muscle Strength Free Text
Instability
• • •
Instability Free Text
Active ROM
• • •
Active ROM
Passive ROM
• • •
Passive ROM Free Text
Skin
• • •
Skin Free Text
Upper Extremity Special Test
• • •
Lower Extremity Special Test
• • •
Special Tests Free Text
EXAM FREE TEXT
3rd Site Examined
Inspection/Palpation
• • •
Inspection/Palpation Free Text
Muscle Strength
Instability
• • •
Instability Free Text
Active ROM
• • •
Active ROM Free Text
Passive ROM
• • •
Passive ROM Free Text
Skin
• • •
Skin Free Text
Upper Extremity Special Tests
• • •
Lower Extremity Special Tests
• • •
Special Test Free Text
Exam Free Text
LEFT XRAY HERE
• • •
LEFT OUTSIDE XRAY
• • •
LEFT XRAY DROPBOX
• • •
LEFT XRAY FREE TEXT
RIGHT XRAY HERE
• • •
RIGHT OUTSIDE XRAY
• • •
RIGHT XRAY DROPBOX
• • •
RIGHT XRAY FREE TEXT
MRI
• • •
CT SCAN
• • •
EMG
• • •
BONE SCAN/DEXA
• • •
MRI FINDINGS
MRI/CT/EMG/BS/DEXA Results

Orthopedic Physical Exam Medical Form

Internist

There are 11 copies in use.
Published: Nov. 27, 2015, 7:10 p.m.
Doctor: Dr. History Physical
Rating: +1   /

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