Adolescent Physical Exam Checklist Form
Routine screening and documentation for adolescent physical examinations.
General Appearance
*
Normal
Abnormal
Vital Signs Within Normal Limits?
*
Yes
No
Vision Screening Result
*
Normal
Referred
Hearing Screening Result
*
Normal
Referred
Musculoskeletal Assessment
*
Normal
Abnormal
Skin Examination
*
Normal
Abnormal
Mental Health Screening
*
No concerns
Further evaluation needed
Immunizations Up To Date?
*
Yes
No
Risk Behaviors Discussed (e.g., tobacco, alcohol, safety)?
Tobacco
Alcohol
Drugs
Sexual Health
Safety
Other
Additional Notes / Follow-Up Recommendations
Submit
Should be Empty: