Head-to-Toe Patient Assessment Checklist Form
Complete this comprehensive checklist to document a head-to-toe patient assessment. Ensure each section is reviewed and findings are noted.
General Appearance
Assessment Areas Checklist
Rows
Completed
Abnormalities Noted
Head & Neck
1
2
Chest & Lungs
3
4
Heart
5
6
Abdomen
7
8
Extremities
9
10
Skin
11
12
Neurological
13
14
Mobility
15
16
Vital Signs (enter values or N/A if not assessed)
Key Observations / Abnormal Findings
Pain Assessment (0 = No pain, 10 = Worst pain)
No pain
0
1
2
3
4
5
6
7
8
9
Worst pain
10
0 is No pain, 10 is Worst pain
Mobility Status
Please Select
Independent
Assisted
Bedbound
Wheelchair
Other
Skin Integrity Issues
No issues
Bruising
Redness
Ulcer
Other
Neurological Status
Please Select
Alert and Oriented
Disoriented
Confused
Unresponsive
Other
Overall Patient Condition
1
2
3
4
5
Additional Comments
Submit Assessment
Should be Empty: