Printable physical exam form pdf
[DOC File]Family Practice History and Physical
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NL male/ female exam Endocrine. No thyroid disease or diabetes Rectal. Heme negative, normal prostate Hematologic. No easy bruising or bleeding Lymph. Neck, Axilla, Groin Psychiatric. No h/o anxiety, depression, mental illness MSK. strength 5/5, tone, gait, FROM Allergies: No hayfever, runny nose. Back . neg. SLR test x2, no scoliosis, no spasm
fitness for duty - Human Resources
Indicate the exact work restrictions which apply to the employee at this time on the chart on the back of this form. (Complete this section if the employee is being released to modified duty.) PHYSICAL EXAMINATIONS FULL. RESTRICTIONS PARTIAL. RESTRICTIONS NO. RESTRICTIONS Sedentary-Lifting 0 to 10 pounds Light-Lifting 10 to 20 pounds
[DOC File]DFPS Medical/Dental/Vision Examination Form
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Speech Therapy Physical Therapy Occupational Therapy Specialist, as specified_____ Other, as specified_____ Please complete the following information or attach a copy of your own medical record or the Texas Health Steps form: Physical Exam Results: Age: Temperature Height: %:
Basic Physical Assessment Handout - Quia
Basic Physical Assessment (Head to Toe Assessment) Subjective: Ask patient to describe current health status in own words. Objective: Obtain objective data by performing a basic physical assessment. Assess the integumentary system while progressing through. the basic physical assessment. Assess in the following order: 1. Neurological Assessment 2.
[DOCX File]Physical Exam Form - Department of Health Home
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Adapted in part from the Pre-participation Physical Evaluation History Form; ©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine.
NAME [Patient Name]
Risk factors and disease prevention; RISK FACTORS REVIEWED. Diet. Exercise. Safety (seat belts, smoke detectors, firearms, violence) Smoking. Alcohol and other drugs
[DOC File]LOWER EXTREMITY EXAM – (ANKLE/FOOT)
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Title: LOWER EXTREMITY EXAM – (ANKLE/FOOT) Author: Parker Last modified by: Parker Created Date: 1/19/2010 1:11:00 PM Company: HNS Other titles: LOWER EXTREMITY EXAM – (ANKLE/FOOT)
comprehensive_physical_assess_form_attach1.PDF
Lymph nodes C/A/I FEMALE 19. External genitalia 20. Vagina/adnexa 21. Cervix 22. Uterus MALE 23. Scrotum/testes 24. Penis 25. Anus 26. Rectum (Digital Exam) 27. Other Assessment/Diagnosis: I have Reviewed this Youth’s Health-Related History. Physical/Activity Restrictions:
[DOC File]History and Physical Exam Form - Jim Berg, M.D
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PSA at age 50+, with life expectancy greater than 10 years Testicular Cancer Screening 21-39 yrs. Testicular exam and self-exam instructions as part of the periodic health exam. For Women Only Cervical Cancer Screening Yearly; if three consecutive exams are normal, Pap test may be performed less frequently at discretion of the physician.
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