Medical Student Physical Examination Checklist Form

Medical Student Physical Examination Checklist Form
Complete this checklist during a physical examination to ensure all key components are addressed. This form is for educational use only.
Student Name
First NameLast Name
Date of Examination
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Vital Signs Checked
General Appearance Assessed
HEENT Exam Completed
Chest and Lungs Exam Completed
Heart Exam Completed
Abdomen Exam Completed
Extremities Exam Completed
Neurological Exam Completed
Should be Empty:

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