Physical Assessment Checklist 1 PDF

NAME (INITIALS ONLY): _________________________
SKIN
Skin Colour ( ) light to deep ( ) Pallor
brown ( ) Cyanosis
( ) ruddy pink to ( ) Jaundice
light pink ( ) Erythema
( ) yellow
overtones to olive
( ) generally ( )
uniform except in Hyperpigmentation
areas exposed to the ( )
sun and areas of Hypopigmentation
lighter pigmentation
(eg. Palms, lips, nail
beds)
Moisture ( ) Moist
( ) Excessive
Dryness
( ) Excessive
Moisture
Temperature ( ) Uniform ( ) Generalized
( ) Within normal Hyperthermia
range ( ) Generalized
Hypothermia
( ) Localized
hyperthermia
( ) localized
hypothermia
Turgor ( ) elastic ( ) Tenting; Time:

____ sec
Lesions ( ) Freckles Primary Skin
( ) Birthmarks Lesions
( ) Moles ( ) Macule
( ) No abrasions ( ) Patch
( ) Papule
( ) Plaque
( ) Pustule
( ) Vestibule
( ) Bulla
( ) Nodule
( ) Tumor
( ) Cyst
( ) Wheal
Secondary Skin
Lesions
( ) Atrophy
( ) Erosion
( ) Lichenification
( ) Scales
( ) Crust
( ) Ulcer
( ) Fissure
( ) Scar
( ) Keloid
( ) Excoriation
HAIR
Evenness ( ) Evenly ( ) Patches of hair

distributed hair loss
Thickness ( ) Thick ( ) Very thin hair
Texture ( ) Silky ( ) Brittle
( ) Resilient ( ) Excessively
oily
( ) Excessively dry
Infection ( ) Free of ( ) Flaking
infections ( ) Sores
( ) Free of ( ) Lice
infestations ( ) Nits
( ) Ringworm
Amount of ( ) Variable ( ) Hirsutism
Body Hair ( ) Absent
( ) Sparse
SKULL AND FACE
Skull: Size, ( ) Symmetric ( ) Lack of
Shape, ( ) Round ( ) symmetry
Symmetry Square ( ) Oval ( ( ) Increased skull
) Rectangular size
( ) Erect ( ) Prominence;
( ) Normocephalic Description:
( ) Hard ________________
( ) Smooth __________
( ) No lesions ( ) Longer
Nodules, ( ) No nodules Mandible
Masses, ( ) No masses
Depressions ( ) No depressions
( ) Lesions
( ) Lumps
Face: ( ) Symmetric ( ) increased facial
Symmetry ( ) Slightly hair
asymmetrical ( ) low hairline
( ) Palpebral ( ) asymmetric
Fissures equal in features
size ( ) exophthalmos
( ) symmetric ( ) myxedema
nasolabial folds ( ) moon face
CN VII ( ( ) Intact ( ) Asymmetric
Facial) Facial Movements
( ) Drooping of
lower eyelid and
mouth
( ) Involuntary
facial movements
Temporal ( ) Elastic ( ) Hard
Artery ( ) Nontender ( ) Thick
( ) Tender with
inflammation
Temporoma ( ) No swelling ( ) Swelling
ndibular ( ) No Tenderness ( ) Tenderness
Joint ( ) No Crepitation ( ) Crepitation
( ) Full ROM ( ) Limited ROM
( ) Mouth opens
and closes fully
( ) Lower jaw
moves laterally
CN V ( ) Intact
(Trigeminal)
EYES AND VISION
Eyebrows ( ) Hair evenly ( ) Loss of hair
distributed ( ) scaling
( ) Intact Skin ( ) flakiness
( ) Symmetrically ( ) unequal
aligned alignment
( ) Equal ( ) unequal
movement movement
Eyelashes ( ) equally ( ) turned inward
distributed
( ) curled slightly
outward
Eyelids ( ) intact skin ( ) redness
( ) no discharge ( ) swelling
( ) no discoloration ( ) Flaking
( ) lids close ( ) crusting
symmetrically ( ) plaques
( ) ___ blinks/ ( ) discharge
minute ( ) nodules
( ) bilateral ( ) lesions
blinking lids close ( )
( ) no visible sclera asymmetrically,
when eyes are ( ) incompletely, (
closed ) painfully
( ) upper and lower ( ) rapid, ( )

borders of cornea monocular, ( )
are slightly covered absent, ( )
infrequent blinking
( ) ptosis, ( )
ectropion, ( )
entropion
( ) rim of sclera
visible between lid
and iris
Bulbar ( ) Transparent ( ) jaundice, ( )
Conjunctiva ( ) evident excessively pale, (
capillaries ) reddened sclera
( ) white, ( ) dark, ( ) lesions
( ) yellow sclera ( ) nodules
Palpebral ( ) Transparent ( ) jaundice, ( )
Conjuctiva ( ) evident excessively pale, (
capillaries ) reddened sclera
( ) white, ( ) dark, ( ) lesions
( ) yellow sclera ( ) nodules
Lacrimal ( ) no swelling ( ) swelling
Apparatus ( ) no redness ( ) redness
( ) puncta is visible ( ) excessive
and turned toward tearing
the eye
Cornea ( ) Transparent ( ) opaque
( ) Shiny ( ) not smooth
( ) smooth
( ) details of iris ( ) arcus senilis;

are visible age: _____ y/o
( ) arcus senilis;
age: _____ y/o
Anterior ( ) transparent ( ) Hyphemia
chamber ( ) Hypopyon
CN II ( ) 20/20 ( ) >20/30; __/__
(Optic) ( ) legally blind
Peripheral ( ) Inferior: 70° ( ) Delayed, ( )
Visual ( ) Superior: 50° Absent Perception
Fields ( ) Temporal: 90°
( ) Nasal: 60°
Cover test ( ) Uncovered eye ( ) uncovered eye
remain fixed moved
( ) covered eye ( ) covered eye
remain fixed moved
( ) Phoria
( ) Strabismus
( ) Esotropia
( ) Exotropia
Six Cardinal ( ) Intact ( ) Weakness in
Fields of ( ) Smooth _____ muscle
Gaze/ CN III ( ) Symmetric ( ) Nystagmus
(Oculomotor
) , IV
(Trochlear),
VI
(Abducens)
Pupils PERRLA ( ) No reaction to

direct pupillary
testing
( ) No reaction to
consensual
pupillary testing
( ) do not constrict
( ) do not converge
Corneal ( ) Parallel ( ) Asymmetric
Reflex Alignment Position
( ) Eyes blink ( ) Absent Corneal
bilaterally Reflex
EARS AND HEARING
Auricles ( ) Equal ( ) <4cm, ( )
bilaterally >10cm
( ) 10° vertically ( ) malaligned, ( )
( ) free, ( ) low-set ears
attached, ( ) Enlarged ( )
soldered preauricular, ( )
( ) smooth postauricular lymph
( ) no lesions nodes
( ) no nodules ( ) tophi
( ) no lumps ( ) blocked
( ) no tenderness sebaceous glands
( ) color same as ( ) ulcerated, ( )
facial skin; _______ crusted nodules
( ) redness
( ) swelling
( ) scaling
( ) itching
( ) pale blue ear
color
External ear ( ) odourless, ( ) ( ) foul-smelling, (
canal soft, ( ) moist, ( ) ) sticky,
flaky, ( ) hard , ( ) ( ) yellow
yellow, ( ) orange, discharge
( ) red, ( ) brown, ( ) bloody, ( )
( ) gray, ( ) black purulent discharge
cerumen ( ) blood, ( )
watery drainage
( ) impacted
cerumen
( ) presence of
foreign bodies
Canal walls ( ) pink ( ) redness
( ) smooth ( ) swelling
( ) no nodules ( ) nodules
( ) polyps
Tympanic ( ) pearly, ( ) gray ( ) red ( ) yellow (
Membrane ( ) shiny ) blue
( ) translucent ( ) bulging
( ) no bulging ( ) distorted ( )
( ) no retraction diminished
( ) slightly concave ( ) absent light
( ) smooth reflex
( ) intact ( ) white spots
( ) perforations
( ) retraction
( ) swelling
Voice test ( ) normal voice ( ) normal voice
tones audible tones were not
heard; description:
__________
Whisper Able to correctly ( ) Unable to
Test repeat the two- repeat the two-
syllable word as syllable word after
whispered in two tries
( ) right, ( ) left
ear
Watch tick ( ) Able to hear the ( ) unable to hear
test ticking of the watch the ticking of the
watch
Weber Test ( ) Weber Negative ( ) Conductive
hearing loss
(lateralization on
bad ear)
( ) sensorineural
hearing loss
(lateralization on
good ear)
Rinne test ( ) Positive Rinne ( ) Conductive
Hearing loss (BC ≥
AC)
( ) Sensorineural
Hearing loss (AC >
BC if anything is
heard at all)
NOSE AND SINUSES
Nasal ( ) Dark Pink ( ) swollen
Mucosa ( ) Moist ( ) pale pink ( )
( ) Free of exudate bluish gray
( ) no swelling ( ) discharge
( ) no redness ( ) ulceration
( ) no growth ( ) polyps
( ) no discharge
( ) no nasal polyps
( ) patent
Turbinates ( ) Dark pink
( ) moist
( ) free of lesions
Nasal ( ) intact ( ) deviated septum
Septum ( ) midline
( ) straight
( ) symmetric
( ) no lesions
( ) no perforations
External ( ) intact ( ) lesions
nose ( ) no tenderness ( ) tender
Maxillary ( ) no tenderness ( ) tender
Sinus ( ) no swelling ( ) crepitus
( ) red glow
( ) absence of red
glow
Frontal ( ) no tenderness ( ) tender
Sinus ( ) no swelling ( ) crepitus
( ) red glow ( ) absence of red
glow
CN I ( ) Intact ( ) unable to
(Olfactory) determine smell
MOUTH AND THROAT
Lips ( ) smooth ( ) pale ( ) blue (
( ) moist ) red
( ) no lesions ( ) swelling
( ) pink ( ) ( ) lesions
brownish
Inner ( ) smooth ( ) leukoplakia
Mucosa ( ) moist
( ) no lesions
( ) salivary ducts
visible
( ) no redness
( ) no swelling
( ) no pain
Buccal ( ) smooth ( ) leukoplakia
Mucosa ( ) moist
( ) no lesions
( ) salivary ducts
visible
( ) no redness
( ) no swelling
( ) no pain
Teeth number of teeth ( ) yellow ( )
present: ____ brown ( ) black
( ) pearly white ( ) tooth decay
( ) no decayed ( ) missing teeth;
areas number of missing
( ) no missing teeth teeth: ____;
Evidence of repair location: _____
work: ( ) Malocclusion
( ) fillings ( ) ( ) poor occlusion
crowns
( ) veneers
Gums ( ) pink ( ) receding gums
( ) moist ( ) redness
( ) firm with tight ( ) swelling
margins to the tooth ( ) enlarged
( ) no lesions ( ) bluish-gray ( )
( ) no masses white line along the
gum line
Tongue— ( ) pink ( ) deep
dorsal ( ) moist longitudinal fissures
( ) moderate size ( ) black
( ) papillae present ( ) enlarged ( )
( ) no lesions atrophied
( ) leukoplakia
( ) smooth
ventral ( ) shiny
( ) pink ( )
slightly pale
( ) visible veins
( ) no lesions
( ) no swelling
Frenulum ( ) intact
( ) midline
Hard palate ( ) pale ( ) white
firm transverse
rugae
( ) torus palatinus
present
Soft palate ( ) pink
( ) movable
( ) spongy
( ) smooth
Salivary ( ) visible
Glands ( ) with salivary
flow
( ) moist
( ) no swelling
( ) no redness
( ) pain
Palatine ( ) no redness
Arches ( ) no swelling
( ) no plaque
Tonsils ( ) present ( ) ( ) 2+ ( ) 3+ ( )
absent 4+
( ) pink ( ) exudate
( ) symmetric
( ) 1+
( ) no exudate
Oropharynx ( ) pink ( ) bright red with (
( ) no exudate ) white
( ) no lesions ( ) yellow exudate
( ) no swelling ( ) yellow mucus
Uvula (“ah”) ( ) midline ( ) asymmetric ( )
( ) symmetric loss of movement
elevation
Motor ( ) able to swallow ( ) unable to
activity of swallow
pharynx
CN VII ( ) intact ( ) unable to
(Facial; identify taste
sense of
taste)
CN IX, X ( ) intact ( ) unable to gag
(glossophary
ngeal, vagus;
gag reflex)
CN XII ( ) intact ( ) decrease
(hypoglossal ( ) strong resistance
; movement resistance
and muscle
strength of
tongue)
NECK
Neck ( ) symmetric
( ) head centered
( ) no bulging
masses
Jugular ( ) 2+
veins ( ) distented
Lymph ( ) no swelling ( ) enlarged
nodes ( ) no enlargement ( ) swelling
( ) no tenderness ( ) tenderness
( ) not palpable ( ) hardness
( ) immobility
Carotid ( ) 2+
pulse
Trachea ( ) midline ( ) pulled to the
affected side
( ) pushed to the
unaffected side
Thyroid ( ) not palpable ( ) enlarged
gland
CN XI ( ) flexion ( ) limited ROM;
(Accessory) ( ) extension specify:
( ) hyperextension ________________
( ) lateral flexion ___
( ) rotation ( ) muscle spasm
( ) inflammation
( ) equal strength
( ) 5+
POSTERIOR CHEST
Respirations ( ) 12- 20 ( ) bradypnea
breaths/min; ( ) tachypnea
specify: ______ ( ) apnea
breaths/min
( ) relaxed
( ) effortless
( ) quiet
Skin color ( ) generally
uniform
Chest ( ) 1:2 ( ) barrel ( )
configuratio anteroposterior: pigeon ( ) funnel
n transverse diameter
( ) symmetric
thorax
Spine ( ) Vertically ( ) kyphosis
aligned ( ) lordosis
( ) straight ( ) scoliosis
( ) right ( ) left ( ( ) shoulders ( )
) hips are at the hips not even
same height
Scapulae ( ) symmetric ( ) asymmetric
( ) nonprotruding ( ) protruding
( ) shoulders and ( ) shoulders and
scapulae are at scapulae are at
horizontal equal unequal positions
positions
Chest ( ) full ( ) asymmetric

expansion ( ) symmetric ( ) decreased
( ) 3-5cm
Tactile ( ) bilateral ( ) decreased ( )
fremitus symmetry absent
( ) fremitus heard ( ) increased
most clearly at the fremitus
apex of the lungs
Lung fields ( ) resonance over
( ) hyperresonance
lung fields ( ) asymmetry in
( ) flat over
percussion notes
scapula ( ) dull ( ) flat
over lung tissue
Diaphragmat ( ) equal bilaterally ( ) dullness
ic excursion ( ) 3-5cm; specify: ( ) diaphragmatic
___ cm descent
( ) 7-8cm; specify: ( ) uneven
___ cm excursion
( ) higher on the
right
Breath ( ) Bronchial ( ) crackles: ( )
Sounds ( ) fine ( ) coarse
Bronchovesicular ( ) gurgles
( ) Vesicular ( ) wheeze: ( )
( ) No adventitious sibilant ( )
sounds sonorous
( ) friction rub
( ) absent breath
sounds
Bronchopho ( ) soft ( ) easily
ny (“ninety- ( ) muffled understood
nine”) ( ) indistinct
Egophony ( ) soft ( ) loud
(“ee-ee-ee”) ( ) muffled ( ) sounds like “aa”
( ) “ee” is
distinguishable
Whispered ( ) very faint ( ) ( ) clear
pectoriloquy inaudible ( ) distinct
(whisper ( ) muffled
“abc-abc-
abc”)
ANTERIOR CHEST
Respirations ( ) 12-20 ( ) labored
breaths/min; ( ) use of accessory
specify: ___ muscles
breaths/min ( ) noisy
( ) relaxed ( ) tachypnea; ___
( ) effortless breaths/min
( ) quiet ( ) bradypnea; ___
breaths/min
( ) hyperventilation
( ) hypoventilation
( ) Cheyne-Stokes
respiration
( ) Biot’s
respiration
Skin colour ( ) generally
uniform
Chest ( ) 1:2 ( ) barrel
Configuratio anteroposterior: ( ) pigeon
n transverse diameter
Chest ( ) Full ( ) asymmetric
Expansion ( ) symmetric ( ) decreased
Tactile ( ) symmetric ( ) decreased ( )
Fremitus bilaterally absent
( ) increased
fremitus
Lung fields Resonance: ( ) ( ) Hyperresonance
lungs ( ) Dull
Dull: ( ) breast ( )
heart
Flat: ( ) muscles (
) bones
Breath Bronchial: ( ) ( ) crackles: ( )
Sounds trachea fine ( ) coarse
( ) thorax ( ) friction rub
Bronchovesicular: ( ( ) wheeze: ( )
) main bronchi sibilant
Vesicular: ( ) ( ) sonorous
Peripheral lung ( ) absent breath
fields sounds
HEART
Chest ( ) no pulsations ( ) thrill
( ) no vibrations ( ) pulsation
Heart ( ) S1 ( ) S3
Sounds ( ) S2 ( ) S4
( ) no extra heart ( ) clicks
sounds ( ) ejection sounds
( ) no murmurs ( ) heart murmurs
Heart rate ( ) 60-100 ( ) <60 beats/min;
beats/min; specify: specify: ___
____ beats/min beats/min
( ) regular ( ) >100 beats/min
( ) irregular
UPPER EXTREMITIES
Temperature ( ) generally
uniform
Shoulders ( ) symmetric ( ) asymmetric
( ) round ( ) swelling
( ) no swelling ( ) pain
( ) no pain
Elbow ( ) symmetric ( ) asymmetric
( ) no deformities ( ) deformities
( ) no swelling ( ) swelling
( ) no pain ( ) pain
Wrist ( ) symmetric ( ) symmetric
Hands and ( ) symmetric ( ) asymmetric

palms ( ) no deformities ( ) deformities
Brachial ( ) 2+
pulses
Radial ( ) 2+
pulses
Epitrochlear ( ) not palpable ( ) swelling
nodes ( ) tenderness
Allen test ( ) ulnar artery: ( ) pallor;
patent; ___ sec _________artery:
( ) radial artery: ___ sec
patent; ___ sec
ROM ( ) limited ROM;
Shoulders ( ) flexion specify:
( ) extension ________________
( ) hyperextension __________
( ) abduction ( ) muscle spasm
( ) adduction ( ) inflammation
( ) internal rotation
( ) external
rotation
( ) circumduction
Elbow
( ) flexion
( ) extension
Wrist
( ) flexion
( ) extension
( ) hyperextension
( ) abduction
( ) adduction
Fingers
( ) flexion
( ) extension
( ) hyperextension
( ) abduction
( ) adduction
Muscle
Strength ( ) against
Shoulders resistance
Elbow ( ) against
Wrist resistance
Fingers ( ) against
resistance
( ) against
resistance
NAILS
Curvature, ( ) 160° ( ) early clubbing;
Angle 180°
( ) late clubbing;
>180°
( ) spoon nails
Texture ( ) hard ( ) thickened
( ) immobile ( ) inflammation
Nail bed ( ) pink ( ) pale ( )

cyanotic ( ) yellow
Surrounding ( ) intact
tissue
Blanch test ( ) pink tones ( ) delayed; >2sec
return when
pressure is released;
____ sec
BREAST AND AXILLA
Breast ( ) round ( ) recent change in
( ) slightly unequal breast size;
( ) generally description:
symmetric ________________
( ) mobile ( ) marked
( ) no tenderness asymmetry
( ) no nodules ( ) immobile
( ) no masses ( ) mass;
( ) no dimpling description:
( ) no retraction ________________
__________
( ) dimpling;
description:
________________
__________
( ) retraction;
description:
________________
__________
( ) nodules;
description:
________________
__________
( ) tenderness
Location: ___ cm
from nipples; ___
quadrant; ___
o’clock
Size: ___cm
Shape: ( ) round (
) oval
( ) lobulated ( )
indistinct
( ) irregular
Consistency: ( )
hard ( ) soft
Mobility: ( )
movable ( ) fixed
Skin over lump: ( )
reddened
( ) dimpled ( )
retracted
Nipple: ( )
displaced ( )
retracted
ABDOMEN
Skin ( ) unblemished ( ) lesions;

Integrity ( ) uniform colour description:
( ) silver-white ________________
striae __________
( ) surgical marks; ( ) tense
description: ( ) glistening skin
________________ ( ) purple striae
__________
Contour and ( ) scaphoid ( ) ( ) distended
symmetry flat ( ) round ( ) Evidence of
protuberant enlargement of
No signs ( ) liver ( ) spleen
enlargement of ( ) ( ) asymmetric
liver ( ) spleen contour
Umbilicus ( ) midline at
lateral line
Movements ( ) symmetric ( ) limited
movements caused movement due to
by respiration pain (specify:
( ) visible ____________) or
peristalsis (lean disease process
people) (specify:
( ) aortic _____________)
pulsations at ( ) visible
epigastric area (thin peristalsis (nonlean
people) clients)
( ) marked aortic
pulsations
Bowel ( ) 5-30 bowel ( ) hypoactive

Sounds sounds/min; ____ (1/min)
bowel sounds/min ( ) hyperactive/
( ) audible borborygmi (every
3 sec)
( ) absent (none
heard in 3-5 mins)
Vascular ( ) Absence of ( ) Loud bruits
Sounds arterial bruits over aortic area
Bruit over ( ) renal
( ) iliac arteries
Peritoneal ( ) Absence of ( ) friction rub
Friction Rub friction rub
Four Tympany: ( ) ( ) large dull areas
quadrants of stomach
the abdomen Dull: ( ) liver ( )
spleen
Liver size ( ) 6-12 cm; ( ) atrophy; <6cm;
specify: ____cm specify: ___cm
*size decreases after ( ) hepatomegaly;
age 50 >12cm; specify:
___cm
Spleen size ( ) 7cm near 10th ( ) splenomegaly;
rib specify: ___cm
Light ( ) nontender ( ) involuntary
Palpation ( ) soft reflex guarding
RLQ ( ) no guarding ( ) right-sided
RUQ guarding
LUQ
LLQ
Deep
Palpation mild tenderness ( ) severe
RLQ over tenderness;
RUQ ( ) xiphoid ( ) location: ________
LUQ aorta ( ) mass: location:
LLQ ( ) cecum ( ) __________
sigmoid colon
( ) ovaries
Liver ( ) no masses
( ) hard ( ) firm
( ) not palpable ( ) nodules
Spleen ( ) mild tenderness ( ) severe
tenderness
( ) soft ( ) enlarged
( ) nontender ( ) tender
Rebound
tenderness ( ) no rebound ( ) Sharp, stabbing
Blumberg’s tenderness pain upon release of
Sign pressure
( ) no rebound ( ) pain on the
Rovsing’s tenderness opposite of the
Sign palpated area
Psoas Sign ( ) no abdominal ( ) pain in RLQ
pain
Murphy’s ( ) no abdominal ( ) pain
Sign pain
Abdominal ( ) present ( ) absent

reflexes
INGUINAL REGION
Inguinal ( ) nontender ( ) movement
Lymph ( ) movable lymph >2cm ( ) with
nodes nodes up to 1-2 cm ( ) without
tenderness
( ) fixed nodes
Hernia ( ) no hernias ( ) hernias present;
description:
________________
__________
Femoral ( ) 2+ ( ) weak
Pulse ( ) equal bilaterally ( ) absent
LOWER EXTREMITIES
Skin ( ) intact
( ) generally
uniform color
Hair ( ) evenly
distributed
Temperature ( ) within normal
range
Popliteal ( ) 2+ ( ) weak ( )
pulse absent
Posterior ( ) 2+ ( ) weak ( )
Tibial pulse absent
Dorsalis ( ) 2+ ( ) weak ( )
Pedis Pulse absent
Hip + Hip ( ) no deformities
joint ( ) no pain
( ) no swelling
Thighs + ( ) no deformities
Tibiofemoral ( ) no pain
Joint ( ) no edema
Legs ( ) no deformities
( ) no pain
( ) no edema
Knees ( ) no deformities
( ) no pain
( ) no swelling
Ankles + ( ) no deformities
Achilles ( ) no pain
Tendon ( ) no swelling
Feet + ( ) no deformities
Metatarsoph ( ) no pain
alangeal ( ) no swelling
joint +
interphalang
eal joint
Capillary ( ) pink tones after ( ) delayed
Refill <2sec
ROM ( ) limited ROM;
Hips ( ) flexion specify:
( ) extension ________________
( ) hyperextension __________
( ) abduction
( ) adduction
( ) internal rotation
( ) external
rotation
( ) circumduction
Knees
( ) flexion
( ) extension
Ankles
( ) dorsiflexion
( ) plantar flexion
Feet
( ) inversion
( ) eversion
Muscle
Strength ( ) against gravity
Hips and resistance
( ) against gravity
Knees and resistance
( ) against gravity
Ankles and resistance
( ) against gravity
Feet and resistance
MUSCULOSKELETAL
Supine to
sitting
position:
ease of
movement,
muscle
strength,
coordination
Standing
posture
Romberg ( ) Negative
test Romberg
Natural gait ( ) evenly
distributed weight
( ) able to stand on
heels and toes
( ) toes point
straight ahead
( ) toes positioned
equally
( ) erect
( ) coordinated
( ) rhythmic
( ) arms swing in
opposition
( ) stride length
appropriate
Heel-to-toe ( ) maintains heel-

to-toes walking
along a straight line
Stands on maintains stance for
right/ left at least 5sec on ( )
foot with right ( ) left foot
eyes closed
Right/ left Able to bend ( )
knee bend right ( ) left knee
ROM of ( ) flexion ( ) limited ROM;
Spine specify:
________________
__________
NEUROLOGIC
Light touch ( ) light tickling ( ) unable to
sensation sensation perceive sensation
and tactile
location
Pain ( ) able to ( ) absence of
sensation discriminate touch sensation
between sharp and ( ) decreased
dull sensitivity to touch
( ) increased
sensitivity to touch
( ) absence of pain
sensation
( ) decreased
sensitivity to pain
( ) increased
sensitivity to pain
Temperature ( ) able to
sensation determine hot and
cold
Vibratory ( ) able to feel and ( ) unable to
sense locate vibrations identify vibrations
Kinaesthetic ( ) can determine ( ) unable to
sensation the position of identify the position
fingers and toes
Stereognosis ( ) able to correctly ( ) unable to
identify the object correctly identify
the object
Graphesthesi ( ) able to identify ( ) unable to
a the writing on the correctly identify
palm the writing on the
palm
Topognosis ( ) able to ( ) unable to
determine the determine the
location being location being
touched touched
Fine Motor
Function ( ) repeatedly ( ) ( ) uncoordinated
Touch nose rhythmically ( ) tremors
with touches nose ( ) deviation of
alternating ( ) bilateral equal heel to one side
movements coordination
Heel-to-shin
test
Reflexes
Biceps ( ) +2 ( ) 0= no reflex
Triceps ( ) +2 ( ) +1= minimal
Brachioradia ( ) +2 ( ) +3= more than
lis ( ) +2 normal
Patellar ( ) +2 ( ) +4= hyperactive
Achilles ( ) +2
Plantar
(Babinski)

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Physical Assessment Checklist 1 PDF

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NAME (INITIALS ONLY): _________________________

Turgor ( ) elastic ( ) Tenting; Time:

Evenness ( ) Evenly ( ) Patches of hair

( ) upper and lower ( ) rapid, ( )

( ) details of iris ( ) arcus senilis;

Pupils PERRLA ( ) No reaction to

Chest ( ) full ( ) asymmetric

Hands and ( ) symmetric ( ) asymmetric

Nail bed ( ) pink ( ) pale ( )

Skin ( ) unblemished ( ) lesions;

Bowel ( ) 5-30 bowel ( ) hypoactive

Abdominal ( ) present ( ) absent

Heel-to-toe ( ) maintains heel-

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