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Start time of exam
End time of exam
Time spent in review of records
Opening statement/handedness
• • •
General Statements
• • •
Comments on general findings
Head findings
• • •
Comments on head
Eye findings
• • •
Comments on eye
Ear findings
• • •
Comments on ear
Nose findings
• • •
Comments on nose
Oropharynx findings
• • •
Comments on oropharynx
Neck Soft Tissue Findings
• • •
Comments on neck
Cardiovascular findings
• • •
Comments on cardiovascular
Pulmonary
• • •
Comments on pulmonary
Abdominal findings
• • •
Comments on abdomen
Male GU
• • •
Comments on male GU
Female GU
• • •
Comments on female GU
Skin findings
• • •
Comments on skin
C-SPINE FINDINGS ON
NORMAL EXAM C-SPINE
• • •
C-SPINE ROM
• • •
C-SPINE ROM CHANGE
• • •
C-SPINE MUSCLE PALPATION
• • •
C-SPINE FINGER SPREAD
• • •
C-SPINE THUMB EXTENSION (radial n.)
• • •
C-SPINE WRIST EXTENSION (RADIAL N)
• • •
C-SPINE WRIST FLEXION (M&U NERVE)
• • •
C-SPINE REFLEXES
• • •
C-SPINE GRIP
• • •
COMMENTS RE: C-SPINE EXAM
ROM MEASUREMENTS C-SPINE:
• • •
Shoulder NO is NOrmal:
SHOULDER ROM
• • •
SHOULDER ROM CHANGE
• • •
CLAVICULAR TENDERNESS?
Site of clavicular tenderness
• • •
Sterno-clavicular joint pain
STERNO-CLAVICULAR JOINT
• • •
ACROMIO-CLAVICULAR JOINT
ACROMIO-CLAVICULAR JOINT
• • •
TRAPEZIUS MUSCLE PAIN?
TRAP MUSCLE PAIN AREA
• • •
POST.SHOULDER EXAM NO=NORMAL
POST. SHOULDER
• • •
SHOULDER MUSCLE ATROPHY
SHOULDER ATROPHY
• • •
Apley Scratch
• • •
Drop arm
• • •
Neer's Test
• • •
Cross-Arm
• • •
Patte/Hornblower's Test
• • •
Painful Arc
• • •
Lift off test
• • •
Hawkin's test
• • •
Apprehension Test
• • •
Yergason Test
• • •
Speed's Maneuver
• • •
Spurling's Test
• • •
FREE WRITE SHOULDER
Elbow NO is NOrmal:
SITE MAX ELBOW PAIN
• • •
ELBOW ROM
• • •
ELBOW ROM CHANGE
• • •
BICEPS
• • •
TRICEPS
• • •
MEDIAL HUMERAL EPICONDYLE
• • •
LATERAL HUMERAL EPICONDYLE
• • •
RADIAL HEAD
• • •
OLECRANON
• • •
NEUROVASCULAR
• • •
COMMENTS RE: ELBOW EXAM
W/H/F NO is NOrmal:
SWELLING W/H/F
SITE SWELLING W/H/F
• • •
ECCHYMOSIS W/H/F
SITE ECCHYMOSIS W/H/F
• • •
NEUROVASCULAR W/H/F
• • •
TINEL'S SIGN
• • •
PHALEN
• • •
ELBOW TINEL
• • •
ROM WRIST
• • •
ROM FINGERS
• • •
ULNAR DEVIATION
• • •
RADIAL DEVIATION
• • •
COMMENTS RE: W/H/F EXAM
HIPS
PAIN/TENDERNESS HIPS
• • •
ROM HIPS
• • •
COMMENTS RE: HIPS
PAIN/TENDERNESS THIGHS
• • •
L & T SPINE FINDINGS ON
LEGS EQUAL LENGTH
PELVIS LEVEL
RIGHT SLR SITTING
• • •
LEFT SLR SITTING
• • •
DORSIFLEXION RIGHT
DORSIFLEXION LEFT
SLR WITH DIVERSION
MUSCLE STRENGTH NORMAL
MUSCLE STRENGTH DECREASED
• • •
SENSATION NORMAL
DECREASED SENSATION LEGS
• • •
RIGHT KNEE REFLEXES DECREASED?
LEFT KNEE REFLEXES DECREASED?
RIGHT KNEE REFLEXES INCREASED
LEFT KNEE REFLEXES INCREASED?
RIGHT ANKLE REFLEXES DECREASED?
LEFT ANKLE REFLEXES DECREASED?
RIGHT ANKLE REFLEXES INCREASED?
LEFT ANKLE REFLEXES INCREASED?
FLEX-ABDUCTION/EXT ROTATION HIPS
• • •
PALPATION LOWER BACK
• • •
COMMENTS RE: LUMBAR EXAM
Knee NO is NOrmal:
LEG LENGTHS EQUAL?
STANDING ALIGNMENT KNEES
• • •
SWELLING KNEE
• • •
PATELLA
• • •
QUADS
• • •
POPLITEAL FOSSA
• • •
MEDIAL COLLATERAL LIGAMENT
• • •
LATERAL COLLATERAL LIGAMENT
• • •
VALGUS STRESS
• • •
VARUS STRESS
• • •
ANTERIOR DRAWER SIGN
• • •
POSTERIOR DRAWER SIGN
• • •
TIBIAL TUBERCLE
• • •
ROM KNEE
• • •
LACHMAN TEST KNEE
• • •
McMURRAY EXAM
• • •
JOINT LINE TENDERNESS
• • •
SENSATION NORMAL?
APPEARANCE KNEE
• • •
COMMENTS RE: KNEE EXAM
A/F NO is NOrmal:
SWELLING/APPEARANCE A/F
• • •
ECCHYMOSIS A/F
• • •
ROM A/F
• • •
TENDERNESS A/F
• • •
ACHILLES TENDON
• • •
COMMENTS RE: A/F EXAM
OBJECTIVE COMMENTS
OBJECTIVE COMMENTS
OBJECTIVE COMMENTS
OBJECTIVE COMMENTS
OBJECTIVE COMMENTS
OBJECTIVE COMMENTS
OBJECTIVE COMMENTS

H&P Physical Exam Medical Form

Orthopedic Surgeon

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Published: Feb. 10, 2016, 7:28 p.m.
Doctor: Dr. History Physical
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