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Dermatologic Exam
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Freehand
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Normal Dermatologic Exam
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-or- Abnormal Dermatologic Exam
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Freetype
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Abnormal Derm Freehand
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Foot Diagram
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Click to Draw on Diagram
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Left Dorsal Foot (Skin)
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Right Dorsal Foot (Skin)
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Left Plantar Foot (Skin)
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Right Plantar Foot (Skin)
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Left Medial Foot (Skin)
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Right Medial Foot (Skin)
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Left Lateral Foot (Skin)
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Right Lateral Foot (Skin)
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Wounds
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No Wounds
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-or- Wounds Present
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Wound 1
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1) Wound Location ("wound noted to_______")
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2) Wound 1 Length (mm)*
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3) Wound 1 Width (mm)*
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4) Wound 1 Depth (mm)*
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5) Wound 1 Bed Description
• • •
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6) Pertinent negatives about the wound
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Freeform
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Wound 2
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Wound #2
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1) Wound Location ("wound noted to_______")
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2) Wound 2 Length (mm)*
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3) Wound 2 Width (mm)*
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4) Wound 2 Depth (mm)*
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5) Wound 2 Bed Description
• • •
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6) Pertinent Negatives of wound
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Freeform
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Wound 3
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Wound #3
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1) Wound Location ("wound noted to_______")
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2) Wound 3 Length (mm)*
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3) Wound 3 Width (mm)*
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4) Wound 3 Depth (mm)*
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5) Wound 3 Bed Description
• • •
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6) Pertinent Negatives of wound
• • •
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Freeform
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Nails
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Normal Nails
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-or- Abnormal Nails
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a) Nail Pathology Present
• • •
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b) Dystrophic nails present?
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Texture of Skin
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Normal Texture
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-or- Abnormal Texture
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Skin Texture
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Freeform
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Xerosis
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No Evidence of Xerosis
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-or- Xerosis Present
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Xerosis Location
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Xerosis freehand
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Lesions
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No Lesions
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-or- Lesions Present
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a) Lesion description?
• • •
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b) Lesion Pertinent positives
• • •
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c) Location of lesions ("are located at the ____")
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Additional Lesion Info (include measurements if applicable)
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Warts
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No Warts
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-or- Warts Present
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Click if Warts Present Left
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Click if Warts Present Right
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Number of warts left?
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Number of warts right?
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Location "located at the______"
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Location "located at the______"
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Freehand Wart Information
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Soft Tissue Mass
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No Soft Tissue Masses Noted
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-or- Soft Tissue Masses Noted
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a) Description of soft tissue mass #1
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b) Location of mass #1 ("located to the____")
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c) Description of soft tissue mass #2
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d) Location of mass #2 ("located to the____")
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Freehand Soft Tissue Mass Information
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Calluses
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No Calluses
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-or- Calluses Present (NO debridement done)
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-or- Calluses Present (with debridement plan)
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a) Calluses Location ("to the_____")
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a) Calluses Location ("to the_____"). Includes debridement plan.
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Freehand Callus Info
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Freehand Callus Info
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Rash
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No Rash
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-or- Rash Present
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a) +rash description?
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b) +rash location?*
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Freehand Rash Info
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Infection
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No Infection
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-or- Infection Present
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a) Location of Infection ("to the____")
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b) Description of infection #1
• • •
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c) Pertinent Negatives
• • •
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Freeform
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Laceration
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Laceration Present
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Location of Laceration (to the "___")
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Laceration Length (mm)*
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Laceration Width (mm)*
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Laceration Depth (mm)*
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Pertinent Negatives
• • •
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Freeform
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Other Dermatology Freehand
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Other Dermatology Not Noted
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Remainder of Physical Exam Unchanged
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Other Exams Normal
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If other objective findings are normal, select below. If other objective abnormal, go to corresponding OBJECTIVE template
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Normal Vascular Exam
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Normal Neurologic Exam
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Normal MSK Exam
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