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Phys Findings 1
• • •
Location 1
• • •
Phys Findings 2
• • •
Location 2
• • •
Phys Findings 3
• • •
Location 3
• • •
Abd Phys Findings 1
• • •
Abdominal Location 1
• • •
Abd Phys Findings 2
• • •
Abdominal Location 2
• • •
Provocative Test 1
Provocative Test 2
Facial Observation
• • •
Cervicothoracic Exam
CT observation
• • •
Comments (swelling, bruising, scars)
Cervical palpation 1
• • •
CT palpation area 1
• • •
Cervical palpation 2
• • •
CT palpation area 2
• • •
CT ROM
Cervical flexion
Cervical extension
R cervical lateral flexion
L cervical lateral flexion
R cervical rotation
L cervical rotation
CT Orthopedic Tests
Cervical compression
Spurling's test
Eden test
Shoulder ROM
R shoulder flexion
L shoulder flexion
R shoulder extension
L shoulder extension
R shoulder abduction
L shoulder abduction
R shoulder adduction
L shoulder adduction
R shoulder internal rotation
L shoulder internal rotation
R shoulder external rotation
L shoulder external rotation
Lumbar Exam
Lumbar observation
• • •
Comments (swelling, bruising, scars)
Lumbar palpation 1
• • •
Lumbar palp 1
• • •
Lumbar palpation 2
• • •
Lumbar palp 2
• • •
Lumbar ROM
Lumbar flexion
Lumbar flexion - hands reach
Lumbar extension
Lumbar R lateral flexion
Lumbar L lateral flexion
Lumbar R rotation
Lumbar L rotation
Lumber Provocative Test
Oblique extension
Slump test (radiculopathy)
Lumbar neuro & motor
L2 (hip flexors)
L3 (quads)
L4 (ankle dorsiflexion)
L5 (EHL)
S1 (ankle plantarflexion)
L2 (mid thigh)
L3 (inner knee)
L4 (inner ankle)
L5 (first web space)
S1 (outside foot)
General WNL
General Abnormal
• • •
General Comments
HEENT WNL
HEENT Abnormal
• • •
HEENT Comments
Skin WNL
Skin Lesion
Skin Comments
Neck WNL
Neck Abnormal
• • •
Neck Comments
Cardiovascular WNL
Cardiovascular Abnormal
• • •
Cardiovascular Comments
Lungs WNL
Lungs Abnormal
• • •
Lungs Comments
Abdomen WNL
Abdomen Abnormal
• • •
Abdomen Comments
MSK WNL
MSK Abnormal
• • •
MSK Comments
Breasts WNL
Breasts Abnormal
• • •
Breasts Comments
Neuro WNL
Neuro Abnormal
• • •
Neuro Comments
Extremities WNL
Extrem Abnormal
• • •
Extrem Comments

H&P Physical Exam Medical Form

Acupuncture

230416

There are 2 copies in use.
Published: April 16, 2023, 12:52 p.m.
Doctor: Dr. History Physical
Rating: +5   /

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