Pharyngeal Examination Form
Document findings from a pharyngeal/throat examination clearly and efficiently. All fields are designed for clarity and ease of use.
Patient Full Name
*
First Name
Last Name
Date of Examination
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Examination
*
General Appearance of Pharynx
*
Please Select
Normal
Redness
Swelling
Exudate
Ulceration
Other
Tonsil Appearance
*
Please Select
Normal
Enlarged
Red
Exudate
Cryptic
Absent
Other
Uvula Position
*
Midline
Deviated
Absent
Palate Integrity
*
Intact
Lesion
Other
Presence of Lymphadenopathy
*
None
Anterior Cervical
Posterior Cervical
Submandibular
Other
Additional Observations
Examiner Name
*
Submit Examination
Should be Empty: