Pediatric Head-to-Toe Physical Exam Form
Complete this form to document findings from a pediatric head-to-toe physical exam. Use the fields below to record observations for each body system.
Patient Name
*
First Name
Last Name
Date of Exam
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
General Appearance
*
Please Select
Alert and active
Lethargic
Irritable
Other
Head and Scalp Findings
*
Eyes (pupils, conjunctiva, movement)
*
Ears, Nose, and Throat
*
Chest and Lungs
*
Please Select
Clear breath sounds
Wheezing
Crackles
Other
Heart (rhythm, murmurs, sounds)
*
Please Select
Regular, no murmurs
Irregular rhythm
Murmur present
Other
Abdomen (palpation, bowel sounds)
*
Extremities and Neurological Status
*
Submit Exam
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