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

Zack's H&P Medical Form

Orthopedic Surgeon

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Published: Feb. 10, 2016, 7:43 p.m.
Doctor: Dr. History Physical
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Sunnyvale, CA 94089

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