Diaphragmatic Excursion Assessment Form
Complete this form to record and assess diaphragmatic excursion parameters in a structured, professional format.
Assessment Side
*
Right
Left
Assessment Method
*
Palpation
Percussion
Ultrasound
Other
Excursion Measurements (cm)
*
Rows
Measurement (cm)
Inspiration
Expiration
Excursion Difference (cm)
Quality of Excursion
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Effort Level Required
*
Minimal
1
2
3
4
Maximal
5
1 is Minimal, 5 is Maximal
Additional Observations
Assessor Name
First Name
Last Name
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
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