To Waterparkman, Here is your requested physical exam form. I had trouble scanning and downloading but here it is.
PHYSICAL EXAMINATION BY PHYSICIAN/PA/NP
Name ________________________ Sex ___ DOB __________
Weight _______ Height __________ B/P ____________
Tobacco ______ Alcohol ______ Drug Allergies _____________
Vision: L ______ R ______ Hearing: L ______ R ______
Check if normal ____ List abnormal findings
Appearance: WDWN ____ NAD ____ A&Ox3 ____
Lymph: no palpable cervical, clavicular, axillary or inguinal nodes ____
Skin: warm/dry/intact ___ no rash ___ turgor adequate ___
Neck: supple ____ no bruits ____ no thyromegaly ____
Eyes: conjunctiva/lids clear ____ PERRLA ____
ENT: normal landmarks ____ nasal ____ oropharyngeal mucosa pink/no exudates ____
Dental: ____
Lungs: CTAB ____ respirations unlabored ____
Heart: normal S1/S2 ___ RRR ___ no murmurs/rubs ___
GI: soft/NT ____ +BSx4 ____ no organomegaly/masses ____ no CVAT ____ anus/rectum-nl ____
Hernia: none ____
Brsts: N/T ____ symmetrical/no masses ____ no midline-no spontaneous discharge ____
GU (female): vulva pink/no lesions ____ vaginal mucosa pink/normal discharge ____ no adnexal tenderness/masses ____
GU (male): penis circumcised ___ non-circumcised ___ foreskin pliant/fully retractable ___ Phimosis___ scrotum/testicles w/o lesions/masses ___ prostate –nl ___
Neuro: PERRLA __ EOMI __ cranial nerves II-Xll grossly intact __ DTRs 2+/= ____ strength 5/5 ____
MU/SK: normal ____
Emotional: normal ____
Please review findings with client. Return this form to the client in a sealed envelope with your clinic name on it.
Signed _________________________ date ________
Clinic ___________________ Address_____________