HEAD TO TOE PHYSICAL ASSESSMENT

SYSTEMS FINDINGS
GENERAL I
P
P
A
INTEGUMENTARY I
SYSTEM P
[SKIN, HAIR, NAILS, P
APPENDAGES]
A
HEENT I
[HEAD, EYES, EARS, P
NOSE AND P
THROAT]
A
CARDIOVASCULAR I
SYSTEM P
[CENTRAL &
P
PERIPHERAL]
A
RESPIRATORY I
SYSTEM P
P
A
GASTROINTESTINAL I
SYSTEM P
P
A
URINARY SYSTEM I
P
P
A
MUSCOLOSKELETAL I
SYSTEM P
P
A
NEUROLOGICAL I
SYSTEM P
P
A
REPRODUCTIVE I
SYSTEM P
P
A
DATE & TIME DOCTORS ORDER RATIONALE
DIAGNOSTIC PROCEDURES CLIENTS RESULTS
LABORATORY CLIENTS RESULTS NORMAL VALUES INTERPRETATION
MEDICATION DOSE, TIMING, ROUTE