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Physical Examination
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Normal General Exam
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Abnormal General Exam (fill each section)
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Insert NO TOUCH EXAM
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Constitutional
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Comments on Constitutional
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HEENT
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Comments on HEENT
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Neck
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Comments on Neck
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Cardiovascular
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Comments on Cardiovascular
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Respiratory
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Comments on Respiratory
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Gastrointestinal
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Comments on Gastrointestinal
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Skin
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Comments on Skin
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Psychiatric
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Comments on Psychiatric
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Gait
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Comments on Gait
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Extremities
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Comments on Extermities
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Neurologic
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Comments on Neurologic
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Reflexes: grading scale
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Reflexes tested
• • •
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Reflexes: Select Diminished asymmetric reflexes (optional)
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Reflexes: Select Increased asymmetric reflexes (optional)
• • •
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MSK Exam - Special Tests
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Cervical Exam
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Inspection
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Palpation
• • •
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Range of Motion
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Special Tests
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Cervical Exam Additional Comments (optional)
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Thoracic Exam
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Inspection
• • •
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Palpation
• • •
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Special Tests
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Thoracic Exam Additional Comments (optional)
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Lumbar Exam
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Inspection
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Palpation
• • •
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Range of Motion
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Special Tests
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Lumbar Exam Additional Comments (optional)
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Chest Wall
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Inspection
• • •
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Palpation
• • •
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Chest walll Exam Additional Comments (optional)
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Shoulder Exam
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Special Tests
• • •
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Shoulder Exam Additional Comments (optional)
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Upper Arm
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Special Tests
• • •
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Upper Arm Exam Additional Comments (optional)
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Elbow Exam
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Special Tests
• • •
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Elbow Exam Additional Comments (optional)
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Forearm
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Special Tests
• • •
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Forearm Exam Additional Comments (optional)
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Hand and Wrist Exam
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Special Tests
• • •
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Hand and Wrist Exam Additional Comments (optional)
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Hip Exam
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Special Tests
• • •
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Hip Exam Additional Comments (optional)
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Upper leg Exam
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Upper leg Exam Additional Comments (optional)
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Knee Exam
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Special Tests
• • •
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Knee Exam Additional Comments (optional)
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Lower Leg
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Special Tests
• • •
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Lower Leg Exam Additional Comments (optional)
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Foot and Ankle Exam
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Inspection
• • •
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Palpation
• • •
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Range of Motion
• • •
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Special Tests
• • •
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Foot and Ankle Exam Additional Comments (optional)
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Neurological
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Special Tests
• • •
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King-Devick Score
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Neurological comments(optional)
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Diagnostic Tests
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Any diagnostic/imaging studies reviewed with patient today?
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Imaging reviewed #1
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Type of imaging study #1
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Body region imaged #1
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Date of Imaging #1
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Significant Findings #1
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Imaging reviewed #2
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Type of imaging study #2
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Body region imaged #2
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Date of Imaging #2
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Significant Findings #2
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Imaging reviewed #3
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Type of imaging study #3
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Body region imaged #3
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Date of Imaging #3
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Significant Findings #3
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Comments on Diagnostic Tests
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