PHYSICAL EXAMINATION AND HEALTH ASSESSMENT



Physical Examination and Health Assessment

(RN-BSN NURN211)

Student's Name ___________________________________________

Examinee's initials: __________ Date: __________

Height _______ Weight _______ BMI_________ W/H ratio_______

General Survey:

Integument:

Head:

Eyes:

Ears:

Nose and paranasal sinuses:

Mouth and pharynx:

Neck and Lymphatics:

Breast and axilla:

Thorax and Lungs:

Peripheral Vascular System:

|Pulses | Right | Left |

|Carotid | | |

|Brachial | | |

|Radial | | |

|Femoral | | |

|Popliteal | | |

|Dorsalis pedis | | |

|Posterior tibial | | |

| 0 | 1 | 2 | 3 | 4 |

| |Markedly |Moderately | Slightly | Normal |

|Absent |Impaired |Impaired |Impaired | |

Abdomen:

Musculoskeletal:

Genitalia and Genitourinary:

Neurological:

-Mental status and speech:

Cranial Nerves:

|Cranial | |

|Nerve: |Evaluation Comments: |

| | |

| | |

|I | |

| | |

| | |

|II | |

| | |

| | |

|III, IV, VI | |

| | |

| | |

|V | |

| | |

| | |

|VII | |

| | |

| | |

|VIII | |

| | |

| | |

|IX, X | |

| | |

| | |

|XI | |

| | |

| | |

|XII | |

Motor assessment:

Sensory assessment:

Reflexes:

| | | |

|Reflexes: |R |L |

| | | |

|Biceps | | |

| | | |

|Triceps | | |

| | | |

|Brachioradialis | | |

| | | |

|Patellar | | |

| | | |

|Ankle | | |

| | | |

|Plantar | | |

| | | | | |

|0 |1 |2 |3 |4 |

| | | | | |

|Absent |Diminished |Average |Brisker than |Very Brisk |

| | | |Normal | |

Revised 10/01KH; HH 06

PHYS EXAM Documentation Form

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