PEDIATRICS HISTORY AND PHYSICAL EXAMINATION

© Bautista,CPIII & Aranas, DR

GENERAL DATA HISTORY OF PRESENT ILLNESS (PART 2)

NAME / AGE / SEX RE-ADMISSION Yes / No

ADDRESS SUMMARY OF RE-ADMISSION

BIRTHDAY

BIRTHPLACE

NATIONALITY

RELIGION

MARITAL STATUS

OCCUPATION

ADMISSION DATE:

CONSULTATION NO:

INFORMANT / IMPT:
RELATIONTO PT • Newborn patient / problems related to prenatal and perinatal periods, the MATERNAL and BIRTH HISTORIES
RELIABILITY should be incorporated to the HPI
• If previous admissions are related to present illness, then, it must be written in the first paragraph of the HPI
CHIEF COMPLAINT

HISTORY OF PRESENT ILLNESS (PART 1)

ONSET EXPOSURE Infectious Disease:

LOCATION CONSULTATION Place / Date:

RADIATION MEDICATION Drug / Dose:

DURATION Duration of treatment:

TIMING/Frequency Prescribed / Self-medicated?

QUALITY Effect:

QUANTITY HOME REMEDIES Change of Position: Diet:

SEVERITY (1-10) Herbals: Massage / Rituals / Religious Beliefs:

PRECIPITANTS Effect:

ASSOCIATED SX EFFECTS TO ADL


PERSONAL HISTORY

A. GESTATIONAL HISTORY / PRENATAL HISTORY

<2 years old
AGE OF MOTHER (During pregnancy):

OB SCORE

G/P T/P/A/L

YEAR PLACE NSVD / CS STATUS SEX TPA COMPLICATIONS

G1

G2

G3

G4

G5

CURRENT PREGNANCY

COGNIZANT Pregnancy: UTZ Date:

AOG: Result:

PT Date: UA Date:

Place (Home / Clinic / Health Care / OPD / Other): Result:

Result

PREGNANCY Planned / Unplanned AND Wanted / Unwanted OTHER TESTS

Abortion: With Attempt / Without Attempt

FIRST Date: MEDICATIONS DOSE INDICATION DURATION DATE GIVEN

PRENATAL CARE
Health Center / Private OB / OPD / Other 1

AOG: 2

SUBSEQUENT No. of times: 3

PRENATAL
CHECK-UP Monthly / Weekly / Every 2 weeks / Other 4

 PERSONAL HISTORY

B. GESTATIONAL HISTORY / PRENATAL HISTORY

<2 years old
ASSOCIATED S/SX DATE MANAGEMENT VACCINATION DATE GIVEN QUICKENING

Nausea 1 HEALTH STATUS

Vomiting 2 NUTRITION

Urine Disturbance 3 INFECTION

Fatigue 4 DRUG INTAKE 1

Breast Tenderness 5 2

Breast Tingling ALCOHOL

Chloasma/Melasma --- SMOKING

Weight Gain kg / lbs: Prepregnant weight: RADIATION

OTHER S/SX DATE MANAGEMENT TOXIC CHEM

1 ACCIDENT

2 TRAUMA

3 TRAVEL

PERSONAL HISTORY

C. NATAL HISTORY
<2 years old
AOG Term / Preterm / Postmature:

HOURS OF LABOR

MANNER NSVD / LSCS

PLACE

PERSON WHO
ATTENDED
BAG OF WATER

BIRTH HEIGHT

APGAR SCORE

RESUSCITATIVE
MEASURES

 PERSONAL HISTORY

C. NEONATAL HISTORY D. FEEDING HISTORY

<2 years old
STAT LATCHED Yes / No INFANCY CHILDHOOD TO ADOLESCENCE
ON AFTER <2 years old 2-20 years old
BIRTH
BREASTFED Yes / No TYPE OF FEEDING Breastfeeding / Formula / Mix ACUTE CALORIC INTAKE

VACCINATION REASON (if not breastfeeding) RENI

1. BCG Yes / No FORMULA MILK USED BASIC GROUPS EATEN DAILY

2. HBV Yes / No DILUTION & AMOUNT PER DAY FOOD LIKES FOOD DISLIKES

3. OPV Yes / No FEEDING No of Times / day 1 1

JAUNDICE Yes / No Bottle / Cup 2 2

CONVULSIONS Yes / No COMPLIMENTARY FOODS 1 3 3

(above 4 months)
HEMORRHAGES Yes / No 2 4 4

RESPIRATORY Yes / No 3 5 5
DIFFICULTY
FEEDING Yes / No 4 FEEDING DIFFICULTIES
DIFFICULTY
CONGENITAL Age Introduced MULTIVITAMINS / Drug
ABNORMALITY Fe SUPPLEMENTS
BIRTH INJURY Consistency: Pureed / Soft / Lumpy / Table Dosage

BLOOD TYPE No of Times / day Frequency

ACUTE CALORIC INTAKE DIET PLAN

RENI MEALS SAMPLE DIET CALORIES

FOOD INTOLERANCE BREAKFAST

MULTIVITAMINS / Drug AM SNACK

Fe SUPPLEMENTS
Dosage LUNCH

Frequency PM SNACK

CAREGIVER Mother / Father / Grandparents / Siblings / Uncle / DINNER

Aunt / Household Helper / Other: TOTAL CALORIC INTAKE

RECOMMENDED DAILY CALORIC INTAKE

APPETITE Good / Picky Eater

 PERSONAL HISTORY

E. GROWTH AND DEVELOPMENT

YOUNG CHILDREN (1-5 years old) MIDDLE CHILDHOOD (6-11 years old)

DEVELOPMENTAL Checklist HOME

MILESTONES (SEE NEXT PAGE)
DENTAL ERUPTION EDUCATION

EATING BEHAVIOR

ACTIVITIES 1
BEHAVIORAL PROBLEMS REMARKS
2
Urinary Incontinence ☐Yes ☐No
3

Toilet Training ☐Yes ☐No Start: SEXUAL

Completed:

Temper Tantrums ☐Yes ☐No DRUGS DOSE FREQUENCY INDICATION

Head Banging ☐Yes ☐No 1

Phobias ☐Yes ☐No 2

Pica ☐Yes ☐No 3

Night terrors ☐Yes ☐No SUICIDAL IDEATION

Sleep Disturbance ☐Yes ☐No

 DE VELOPMENTAL MILESTONES
AGE MOTOR DEVELOPMENT AGE LANGUAGE AND COMMUNICATION

1 month ! Raises head slightly 1 month ! Cries

! hands fisted
! Lifts head momentarily when on prone
2 months ! Motor activity generalized 2 months ! Smiles and coos socially
! Head lags on pull to sit
3 months ! Visually tracks objects well 3 months ! Orients to voice
! Good head control on prone and looks around ! Sustained smiling and cooing
! Improved head control on sitting position
4 months ! Begins to reach for toys symmetrically 4 months ! Able to recognize faces
! Regards toys and puts them into mouth ! coos indiscriminately
! Good head control on sitting position ! Laughs
6 months ! Rolls over 6 months ! Looks at the environment
! May sit briefly when placed ! coos or jabbers to imitate sounds
! Chest up when prone ! Laughs and plays with examiner
! Reaches with either hand
8 months ! Sits alone 8 months ! Babbles
! Begins to creep ! Says papa and mama indiscriminately
! Crude prehension ! Responds to commands of “no”
! Transfer object from 1 hand to another
10 months ! Crawls and pulls to stand 10 months ! Utters mama or dada
! Begins to cruise around the crib or furniture ! Waves bye bye
! Better prehension ! Gesture language
! Holds bottle
! Feed self with crackers
12 months ! Walks alone with one hand held 12 months ! 2 words other than mama, dada
! Stands alone ! Kisses on request
! Begins to feed with fingers ! Releases object on request
! Obeys commands with gestures
15 months ! Independent walking 15 months ! 3-4 words other than mama, dada
! Creeps upstairs ! Vocalizes and points on something
! Drinks from cup ! Obeys simple commands without gesture
! Begins to feed with spoon
18 months ! Walks well 18 months ! 10 word vocabulary
! Throws a ball
! Stacks 3-4 blocks
2 years ! Runs well; jumps 2 years ! Uses pronouns and produce 3-word sentences
! Feeds self with spoon
! Toilet trained by day
2.5 years ! Partially undresses self 2.5 years ! Knows full name, uses “I”
! Helps put things away
! Draws vertical and horizontal lines
3 years ! Alternate feet in climbing stairs 3 years ! Uses plurals and obeys prepositional commands
! Puts on shoes ! Counts 1-10
! Copies a circle ! Plays simple games
! Pedals a tricycle
4 years ! Runs and climbs well 4 years ! Role plays
! Descends stairs on alternate feet ! Sing songs
! Hops on one foot ! Names one or more colors
! Throws ball overhead
! Toilet trained
5 years ! Skips 5 years ! Ask meaning of words
! Draws a person ! Counts > 10
! Dresses / undresses unaided ! Names 4 or more colors
! Ties shoelaces
6 years ! Draws a person with hands and clothes 6 years ! Knows morning and afternoon
! Copies a diamond ! Knows right and left sides
 PERSONAL HISTORY

F. PAST ILLNESS

CONTAGIOUS AGE CLINICAL COURSE SEVERITY COMPLICATIONS HOSPITALIZATION AGE PLACE DURATION SEVERITY COMPLICATIONS
ILLNESS WHY?
Measles 1

Varicella 2

Mumps 3

Pertussis 4

Others 5

1 OPERATION TYPE AGE PLACE SEVERITY COMPLICATIONS

WHY?
2 1

3 2

ALLERGENS AGE SEVERITY COMPLICATIONS MANAGEMENT 3

1 4

2 5

3 INJURY AGE EFFECTS COURSE SEVERITY COMPLICATIONS

ASTHMA AGE 1

SEVERITY 2

COMPLICATIONS 3

MANAGEMENT 4

 OB-GYNE HISTORY

MENSTRUAL HISTORY SEXUAL HISTORY

MENARCHE Age / Date: SEXUAL Date of First Sexual Contact:

CONTACT
Duration: Age:

# pads/day: Contact Experienced:

Type of pads: Subsequent Contact:

Dysmenorrhea: + or – No of Sexual Partners:

Medication:

SUBSEQUENT Cycle: Regular / Irregular LAST SEXUAL Date:

MENSES CONTACT
Days: Partner’s Sexual History:

MENSES Duration: SEXUAL OUTLET

/ ACTIVITIES /
# pads/day: FUNCTIONS

Type of pads:

Dysmenorrhea: + or –

Medication:

GYNE / NON-PREGNANT PATIENTS GYNECOLOGIC HISTORY

LMP STATUS

PMP GYNE ILLNESS

GYNE OPERATIONS

HORMONAL THERAPY

FAMILY PLANNING

PAP SMEAR

VACCINATION HPV:

 IMMUNIZATION HISTORY AND TUBERCULIN SKIN TEST

VACCINE 1ST DOSE 2ND DOSE 3RD DOSE ADVERSE REACTION

AGE PLACE AGE PLACE AGE PLACE
! BCG
! DTwP / DTaP
! OPV / IPV
! Hepatitis B
! Measles
! MMR
! HiB
! Influenza
! Pneumococcal
! Rotavirus
! Meningococcal
! Hepatitis A
! Varicella
! Thyroid
! JE
! HPV


FAMILY HISTORY

AGE STATUS HEALTH CONDITION HTN ☐Yes ☐No Hematologic ☐Yes ☐No

FATHER ☐Living ☐Deceased DM ☐Yes ☐No Seizures ☐Yes ☐No

MOTHER ☐Living ☐Deceased Arthritis ☐Yes ☐No PUD ☐Yes ☐No

SIBLINGS (No. of Brothers _____ ) (No. of Sisters _____ ) PTB ☐Yes ☐No BPH ☐Yes ☐No

1 ☐Living ☐Deceased CVD ☐Yes ☐No Twinning ☐Yes ☐No

2 ☐Living ☐Deceased Asthma ☐Yes ☐No Chromosomal/Congenital ☐Yes ☐No

3 ☐Living ☐Deceased Allergies ☐Yes ☐No Heredofamilial Diseases ☐Yes ☐No

4 ☐Living ☐Deceased Cancer ☐Yes ☐No Others

5 ☐Living ☐Deceased Psychiatric ☐Yes ☐No

6 ☐Living ☐Deceased

7 ☐Living ☐Deceased

8 ☐Living ☐Deceased

9 ☐Living ☐Deceased

10 ☐Living ☐Deceased

POSITION IN
FAMILY



SOCIOECONOMIC AND ENVIRONMENTAL HISTORY

EDUCATIONAL SLEEP Habit: ALCOHOL

ATTAINMENT
SCHOOL ☐Private: _____________________________________________________________ Hour: TEA

☐Public: _____________________________________________________________ Sedative: COFFEE

LIVING Family / Friends / Relatives POLLUTANTS Exposure: ☐Yes ☐No SMOKIMG Exposure: ☐Yes ☐No
ARRANGEMENT
SOURCE OF Type: User: ☐Yes ☐No
INCOME
FATHER Occupation: Pack-years:

Educational Attainment: Brand / Amount / Frequency:

MOTHER Occupation:

Educational Attainment:

HOME

No. of Storeys LOCATION

No. of Rooms WINDOW

TYPE
No. of Occupants VENTILATION

No. of CR INTERPERSONAL
RELATIONSHIP

SOURCES OF Drinking: GARBAGE

WATER DISPOSAL
Domestic:

SANITATION Inside: TOILET TYPE

Outside

PETS 1


REVIEW OF SYSTEMS

GENERAL ( ) fatigue, ( ) weight change, ( ) fever, ( ) chills, ( ) delay in growth GASTROINTESTINAL ( ) anorexia, ( ) nausea/retching, ( ) vomiting, ( ) dysphagia, ( ) hematemesis,

SKIN ( ) rash, ( ) itching, ( ) moles, ( ) sores, ( ) hives, ( ) pigmentation , ( ) acne, ( ) indigestion, ( ) melena, ( ) hematochezia, ( )heartburn, ( ) abdominal pain,

( ) pruritus ( ) hernia, ( ) hemorrhoids, ( ) use of laxatives

HEAD & NECK ( ) headache, ( ) trauma, ( ) pain, ( ) stiffness, ( ) swelling

EYES ( ) pain, ( ) diplopia, ( ) scotoma, ( ) visual dysfunction , ( ) dryness, ( ) redness, RENAL ( ) dysuria, ( ) hematuria, ( ) incontinence, ( ) nocturia, ( ) urinary frequency,

( ) tearing, ( ) use of corrective lenses ( ) dribbling, ( ) kidney stones

EARS ( ) difficulty hearing/ deafness, ( ) tinnitus, ( ) pain, ( ) discharges, GYNECOLOGICAL ( ) menarche (age), ( ) cycle, ( ) duration of menstruation, ( ) abdominal bleeding,

( ) vertigo/dizziness ( ) vaginal discharge, ( ) itchiness, ( ) dysmenorrhea/ pelvic pain, ( ) dyspareunia,

NOSE ( ) epistaxis, ( ) dryness, ( ) pain, ( ) discharges, ( ) obstruction, ( ) contraceptive use, ( ) history of venereal diseases, ( ) number of pregnancies,

( ) smell dysfunction, ( ) sneezing ( ) number and types of deliveries, ( ) abortions, ( ) birth control method,

( ) menopause (age)

MOUTH ( ) soreness, ( ) pain, ( ) ulcers, ( ) hoarseness, ( ) dryness, MALE GENITALIA ( ) pain, ( ) swelling, ( ) urethral discharge, ( ) hernias, ( ) testicular pain,

( ) gum and dental problems ( ) masses, ( ) history of venereal diseases, ( ) erectile dysfunction/ potency,

( ) sexual habits, ( ) ulcers

BREASTS ( ) discharges, ( ) lump/mass, ( )pain, ( ) bleeding, ( ) infection MUSCULOSKELETAL ( ) muscle pains, ( ) joint pains, ( ) cramps, ( ) weakness, ( ) stiffness,

( ) history of trauma, ( ) swelling, ( ) limitation of motion, ( ) backache

RESPIRATORY ( ) cough, ( ) dyspnea/shortness of breath, ( ) sputum, ( ) hemoptysis, ENDOCRINE and ( ) heat/cold intolerance ( ) weight/ change, ( ) polydipsia, ( ) polyphagia,
METABOLIC
( ) cyanosis, ( ) wheezing/ asthma, ( ) occupational exposure, ( ) polyuria, ( ) hair change

( ) tuberculosis/PTB exposure, ( ) past PPD, ( ) previous chest x-ray

CARDIAC ( ) chest pains/discomfort, ( )orthopnea, ( ) dyspnea, NERVOUS ( ) headaches, ( ) syncope, ( ) seizures, ( ) weakness, ( ) head trauma,

( ) paroxysmal nocturnal dyspnea, ( ) palpitations, ( ) undue fatigue, ( ) edema, ( ) stroke, ( ) sleep disorder, ( ) coordination problem, ( ) sensory disturbance,

( ) cyanosis, ( ) syncope, ( ) hypertension, ( ) past heart diseases, ( ) motor problem, ( ) tremors, ( ) memory

( ) exercise limits

VASCULAR ( ) intermittent claudication, ( ) leg cramps, ( ) ulcers, ( ) varicose veins PSYCHIATRIC ( ) anxiety, ( ) depression, ( ) loss of control / violence, ( ) nervousness,

HEMATOLOGICAL ( ) anemia, ( ) excessive bleeding, ( ) easy bruising, ( ) past transfusions, ( ) memory change, ( ) suicide attempts, ( ) substance abuse

( ) pallor
 PHYSICAL EXAMINATION
GENERAL SURVEY VITAL SIGNS
Mental state of sensorium Temperature
Level of activity ☐Ambulatory ☐Bedridden PR
Cardiopulmonary Distress ☐Yes ☐No RR
Nutritional State ☐Well ☐Under ☐ Over BP (>3 y/o)
State of hydration SpO2
Ill-looking ☐Yes ☐No ANTHROPOMETRIC DATA VALUES INTERPRETATION
SKIN Growth Parameters cm
Color Head Circumference (<3 y/o) cm
Skin Turgor Chest Circumference cm
Loss of Subcutaneous Tissue ☐Yes ☐No Upper arm Circumference cm
Rash / Eruptions ☐Yes ☐No Abdominal Circumference cm
Hemorrhages ☐Yes ☐No Length (<2 y/o) cm
Scars ☐Yes ☐No Height (≥2 y/o) cm
Edema ☐Yes ☐No Weight kg
Jaundice ☐Yes ☐No BMI kg/m2
HEAD Lower segment
HAIR Quantity: 0-3 y/o >3y/o
Color: supine standing
Texture: from umbilicus to tip of toes with feet flexed 90o at heel from ASIS to the floor
Strength:
Surface Characteristics: Z SCORES VALUE INTERPRETATION
EYES Lids: Weight for Age
Conjunctiva: Length for Age
Sclera: Height for Age
Opacities: ☐Yes ☐No BMI for Age
Discharge: ☐Yes ☐No EARS Size: Shape:
Red-orange Reflex Location & Position
Periorbital edema: ☐Yes ☐No Ear discharge: ☐Yes ☐No
Sunken eyeballs: ☐Yes ☐No Ear canal:
Tears: ☐Yes ☐No Tympanic membrane:
Continuity ☐Intact ☐Imperforated
NOSE Patency of nares: Position of septum: Color ☐Light pink ☐Transluscent
Alar flaring: ☐Yes ☐No Sinus tenderness: ☐Yes ☐No Cone of light
Effusions ☐Yes ☐No
Discharge: ☐Yes ☐No Others: Bubbles ☐Yes ☐No

MOUTH AND THROAT NECK
Color Venous engorgement ☐Yes ☐No Flexibility ☐Yes ☐No
Findings Rigidity ☐Yes ☐No Lymph nodes ☐Yes ☐No
Level of Hydration NECK MASSES
Excoriations ☐Yes ☐No Location Size
Cleft ☐Yes ☐No Rate of growth Shape
GUMS Margin Surface
Color Vesicles ☐Yes ☐No Consistency Color
Vesicles ☐Yes ☐No Bleeding ☐Yes ☐No Warmth ☐Yes ☐No Pulsation ☐Yes ☐No
TONGUE Adhesion to surr structures ☐Yes ☐No Goiter ☐Yes ☐No
Size Moisture CHEST AND LUNGS
Color Milky-white coatings ☐Yes ☐No INSPECTION PALPATION
Ankyloglossia ☐Yes ☐No Ulcers ☐Yes ☐No Size & Shape ! Round / Barrel Vocal fremitus ! Normal
! Shield shape ! Increased
! Pectus excavatum (consolidation)
! Pigeon chest ! Decreased
(atelectasis, pneumothorax,
! Rachitic rosary pleural effusion)
! Harrison’s groove AUSCULTATION
DENTITION Movement with Breath sounds ! Clear
respirations ! Rales
20 milk teeth at 12 ☐Yes ☐No Color Chest retractions ! Subcostal ! Wheezes
months ! Intercostal ! Rhonchi
! Supraclavicular ! Bronchial
Mottling ☐Yes ☐No Fluorosis ☐Yes ☐No Chest expansion ! Symmetry ! Tubular
! Assymetry ! Pleural friction rub
! Stridor
! Grunting
Ulcers ☐Yes ☐No PERCUSSION Egophony ☐Yes ☐No
OROPHARYNGEAL MUCOSA Bronchophony ☐Yes ☐No
Thrush ☐Yes ☐No Vesicles ☐Yes ☐No HEART
Ulcers ☐Yes ☐No Enanthems ☐Yes ☐No INSPECTION PALPATION
PALATE AND UVULA AREA Apex beat ! 4 -ICS (<7y/o)
th Thnrills ☐Yes ☐No
! 5th-ICS (>7y/o)
Symmetry High-arched ! cardiomegaly Lifts ☐Yes ☐No
Cleft ☐Yes ☐No
THROAT EXAM AUSCULTATION
Findings: S1 closure of AV valves apex
Posterior Pharyngeal Area (Post nasal drippings): ☐Yes ☐No Excessive drooling: ☐Yes ☐No S2 closure of SL valves left & right sternal borders splits on inspiration
TONSILS S3 gallop apex in mid-diastole heart failure
Presence ☐Yes ☐No Size S4
Surface Color MURMURS
Exudates ☐Yes ☐No Adherent membrane ☐Yes ☐No

ABDOMEN INGUINAL REGION
INSPECTION AUSCULTATION Hydrocele ☐Yes ☐No Undescended testes ☐Yes ☐No
Size and Shape ! Flat Bowel sounds (gurgling) ! 5-10 sec intervals or Lymph Nodes Findings:
! Globular longer
! Protruberant ! 10-30 sec intervals in
! Distended infants and younger
! Scaphoid ! 5-34 / minute
Prominent Vessels ! Distended veins PERCUSSION GENITALIA
! Pulsations
Striae ☐Yes ☐No Fluid wave ☐Yes ☐No MALE FEMALE
Peristaltic Movements ☐Yes ☐No Shifting dullness ☐Yes ☐No Tanner Stage Tanner Stage
Umbilical Hernia ☐Yes ☐No Size of liver = ____________ Prepuce retract easily ☐Yes ☐No Discharge ☐Yes ☐No
Paradoxical Breathing ☐Yes ☐No RMCL ☐Yes ☐No Urethra opens at ☐Yes ☐No Laceration ☐Yes ☐No
tip of penis
Scratch Test ☐Yes ☐No Left scrotum lower than ☐Yes ☐No Hymen ☐Yes ☐No
right but equal size
PALPATION ANUS AND RECTUM
CVA Tenderness ☐Yes ☐No Location Fissures ☐Yes ☐No
SPINE Patency Tags ☐Yes ☐No
Deformities Pilonidal sinus Pinworms ☐Yes ☐No Hemoorhoids ☐Yes ☐No
Sacrococcygeal dimple Local tenderness ☐Yes ☐No Prolapse ☐Yes ☐No Sphincter Tone
Bend Forward Test ☐Yes ☐No Others Mass / Impacted Feces ☐Yes ☐No
(scoliosis)
NEUROLOGICAL EXAM Tenderness ☐Yes ☐No
Cerebral EXTREMITIES
Color of nailbeds Cyanosis ☐Yes ☐No
Cerebellum Tremors ☐Yes ☐No Others Peripheral pulses Edema ☐Yes ☐No
Nystagmus ☐Yes ☐No Mobility of joints Clubbing (Schamroth’s) ☐Yes ☐No
REFLEXES YES NO INTERPRETATION Deformities Lymph nodes
Moro Congenital Hip
Grasping Dislocation (Infants)
Rooting
Blink
Sucking
Patellar
Biceps
Triceps
Babinski
Myoclonus
MENINGEAL SIGNS Kernig’s Sign ☐Yes ☐No
Brudzinski Sign ☐Yes ☐No


CRANIAL NERVES
I VII
II VIII
III IX
IV X
VI XI
V XII
Other Findings

MOTOR SENSORY MENTAL STATUS EXAMINATION

Good muscle tone, bulk, ☐Yes ☐No Light touch % Cooperative Pt ☐Yes ☐No Oriented to ☐Yes ☐No
activity Time, Person, Place
Flaccidity ☐Yes ☐No Sharp and dull % Mood and Affect ☐Yes ☐No Concentration ☐Yes ☐No
Atrophy ☐Yes ☐No Insight & Judgment ☐Yes ☐No
Motor Strength against
resistance