External Genital Exam Checklist Form
Document external genital exam findings quickly and accurately using this streamlined checklist. Do not enter sensitive personal information.
Examiner Name
*
First Name
Last Name
Date of Examination
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
General Appearance
*
Normal
Abnormal
Pubic Hair
Normal distribution
Sparse
Absent
Other
Skin Findings
No lesions
Erythema
Ulcers
Vesicles
Warts
Other
Swelling or Masses
None
Present
Discharge
None
Clear
Purulent
Other
Anatomical Findings
Normal anatomy
Labia abnormalities
Scrotal abnormalities
Penile abnormalities
Other
Additional Notes
Submit Checklist
Should be Empty: