| Exam free write |  | 
| General WNL | General Abnormal• • • | 
| General Comments |  | 
| HEENT WNL | HEENT Abnormal• • • | 
| HEENT Comments |  | 
| Skin WNL | Skin Abnormal• • • | 
| 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 |  | 
| Genital (Female) [-] | Genital (Female)• • • | 
|  | Genital Comments | 
| Neuro WNL | Neuro Abnormal• • • | 
| Neuro Comments |  | 
| Extremities WNL | Extrem Abnormal• • • | 
| Extrem Comments |  | 
| Psychiatric [-] | Psychiatric• • • | 
|  | Comments | 
| Procedure• • • | Consent Obtained | 
| Procedure Note | Staff | 

