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A O x3
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General Comments
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Gait
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Demeanor
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HEENT
• • •
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HEENT Comment
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Heart
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Heart Comments
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Lungs
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Lungs Comment
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Abdominal
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Abdominal Comments
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Extremities
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Extremities Comment
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Vascular
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Vascular Comments
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Skin
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Skin Comments
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Lymphatic System
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Lymphatic Comments
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Neurological
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B/L 2+ DTR?
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Abnormal DTRs
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Rt. Biceps
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Lt. Biceps
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Rt. Triceps
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Lt. Triceps
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Rt. Brachioradialis
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Lt. Brachioradialis
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Rt. Patella
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Left Patella
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Rt. Achilles'
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Lt. Achilles'
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Babinski
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Clonus
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Hoffman's
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Motor Strength UE 5/5
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Abnormal MS UE
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Rt. Deltoid
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Lt. Deltoid
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Rt. Biceps
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Lt. Biceps
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Rt. Triceps
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Lt. Triceps
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Rt. Wrist Flexion
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Lt. Wrist Flexion
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Rt. Wrist Extension
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Lt. Wrist Extension
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Rt. Grip
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Lt. Grip
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Rt. Interossei
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Lt. Interossei
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Motor Strength LE 5/5
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Abnormal MS LE
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Rt. Hip Flexion
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Lt. Hip Flexion
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Rt. Hip Extension
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Lt. Hip Extension
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Rt. Knee Flexion
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Lt. Knee Flexion
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Rt. Knee Extension
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Lt. Knee Extension
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Rt. Dorsiflexion
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Lt. Dorsiflexion
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Rt. EHL
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Lt. EHL
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Sensory UE
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Sensory UE Location/Comment
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Sensory LE
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Sensory LE Location/Comment
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Atrophy
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Hypertrophy
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Cervical Exam
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Flexion
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Extension
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Right Lateral Flexion
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Left Lateral Flexion
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Right Rotation
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Left Rotation
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ROM Comments
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CSP Special Testing
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Compression Test
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Max Compression
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Kemps
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Shoulder Depression
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Distraction Test
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Soto-Hall Test
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Shoulder Depressor Exam
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Spurling's
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Midline Tenderness
• • •
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Facet Tenderness, Right
• • •
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Facet Tenderness, Left
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Spasm, Right
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Spasm, Left
• • •
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Cervical Testing Comments
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Thoracic Exam
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Flexion
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Extension
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Right Lateral Flexion
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Left Lateral Flexion
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ROM Comments
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TSP Special Testing
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Kemps
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Adam's Forward Bend Test
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Passive Neck Flexion
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Thoracic Compression
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Thoracic Distraction
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Thoracic Foraminal Closure Test
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Midline Tenderness
• • •
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Facet Tenderness, Right
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Facet Tenderness, Left
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Spasm, Right
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Spasm, Left
• • •
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Thoracic Testing Comments
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Lumbar Exam
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Flexion
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Extension
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Right Lateral Flexion
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Left Lateral Flexion
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Right Rotation
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Left Rotation
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ROM Comments
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LSP Special Testing
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Rt. Straight Leg Raise
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Rt. SLR Degrees
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Lt. Straight Leg Raise
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Lt. SLR Degrees
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Crossed Straight Leg Raise
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Patrick/FABERE
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Braggards
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Valsalva Test
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Fortin's Finger Test
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Compression Test
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Gaenselens
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Sciatic Notch Tenderness
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Sacral Thrust
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Femur Thrust
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Kemps
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PSIS
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Midline Tenderness
• • •
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Facet Tenderness, Right
• • •
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Facet Tenderness, Left
• • •
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Spasm, Right
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Spasm, Left
• • •
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Lumbar Testing Comments
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