Physical Examination Form For Students

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Medical history include:rheumatic fever,tuberculosis,epilepsy,allergies,operations,serious illness,congential defects and menstrual distrubances.
  • Date Format: MM slash DD slash YYYY

  • Physical Examination

  • Check

  • Additional Remarks

  • Normal,Abnormal,Not Examined
  • N
  • A
  • NE
  • General Weight & Nutrition
  • General Apperance
  • Skin(Acne,Tinea,Dermatitis)
  • Eye(Conjunctivae,Corena,EOM)
  • Ears(Perforations,Deafness)
  • Nose(Allergy,Deformities)
  • Teeth(Cavities,Gingivitis,Occlusion)
  • Tonsils
  • Lymph Nodes
  • Chest(Deformities)
  • Lungs
  • Heart(Size,Murmur,Rhythm)
  • Breast
  • Abdomen
  • Hernias
  • Genitalia
  • Back(Kyphosis,Lordosis,Scoliosis)
  • Skelton(Limited Motion,Deformities)
  • Feet(Flat,Pronated,Tinea)

  • This student may praticepate in:

  • Date Format: MM slash DD slash YYYY

  • PHYSICALS FROM A CHIROPRACTOR ARE NOT VALID FOR ATHLETIC CLEARANCE

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