GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION, INC.

Bulaong Subdivision, Barangay West, General Santos City 9500

Tel No.: (083) 302-3507, Telefax No.: (083) 552-9793

NCM: RLE EXPOSURE

Area: Inclusive Dates:
Students Name:
Year and Section:
Group:
BIOGRAPHICAL DATA

Patients Full Name: Marital Status: Immunization:

Age and Sex: Educational Level: Allergies:

Birthdate: Occupation: Medications:

Religion: Recent Travel: Chief Complaints:

Family Health History: History of Past Illness (Childhood illness/ Hospitalization/ Surgeries/ Injuries/ Chronic History of Present Illness:
Illness):

VITAL SIGNS:

Temperature Rate:
Pulse Rate:
Respiratory Rate:
Blood Pressure:
02 Sat Level:
 GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION, INC.
Bulaong Subdivision, Barangay West, General Santos City 9500
Tel No.: (083) 302-3507, Telefax No.: (083) 552-9793

CEPHALOCAUDAL PHYSICAL ASSESSMENT

Inspection Palpation Percussion Auscultation Interpretation

SKIN

HAIR

NAILS
 GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION, INC.
Bulaong Subdivision, Barangay West, General Santos City 9500
Tel No.: (083) 302-3507, Telefax No.: (083) 552-9793

HEAD

EYES
 GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION, INC.
Bulaong Subdivision, Barangay West, General Santos City 9500
Tel No.: (083) 302-3507, Telefax No.: (083) 552-9793

EARS

NOSE

MOUTH AND THROAT

 GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION, INC.
Bulaong Subdivision, Barangay West, General Santos City 9500
Tel No.: (083) 302-3507, Telefax No.: (083) 552-9793

NECK

THORAX AND BACK

(CARDIO-PULMO)

BREAST
 GENERAL SANTOS DOCTORS’ MEDICAL SCHOOL FOUNDATION, INC.
Bulaong Subdivision, Barangay West, General Santos City 9500
Tel No.: (083) 302-3507, Telefax No.: (083) 552-9793

ABDOMEN

GENITO-URINARY

MUSCULOSKELETAL/
EXTREMITIES