Orthopedic Physical Exam Documentation Form
Complete this form to document findings from an orthopedic physical examination.
Patient Full Name
*
First Name
Last Name
Date of Examination
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Chief Complaint
*
History of Present Illness or Injury
*
Inspection Findings
*
Palpation Findings
*
Range of Motion (describe limitations, if any)
*
Strength Testing (describe findings)
*
Special Tests Performed (list and describe results)
*
Assessment and Plan
*
Submit
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