Respiratory Palpation Assessment Form
Complete this assessment to document respiratory palpation findings in a structured, professional format.
Patient Initials
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Chest Expansion Symmetry
*
Symmetrical
Mildly Asymmetrical
Markedly Asymmetrical
Tactile Fremitus Intensity
*
Decreased
1
2
3
4
Increased
5
1 is Decreased, 5 is Increased
Presence of Chest Wall Tenderness
*
None
Mild
Moderate
Severe
Tracheal Position
*
Midline
Shifted Left
Shifted Right
Palpable Masses or Abnormalities
*
None Detected
Present
Assessment of Subcutaneous Emphysema
*
Absent
Present
Pain on Palpation
*
No Pain
0
1
2
3
4
5
6
7
8
9
Severe Pain
10
0 is No Pain, 10 is Severe Pain
Palpation Findings Table
*
Rows
Left
Right
Upper Lobe
1
2
Middle Lobe
3
4
Lower Lobe
5
6
Additional Comments
Submit Assessment
Should be Empty: