Center for Epidemiologic Studies Depression Scale ... - myCME.com

Vital Signs BP P T Wt. lb Ht. in
Eyes V nl conjunctiva & lids
Pupils V pupils symmetrical, reactive
Fundus V nl discs & pos elements
ENT-External V no scars, lesions, masses
Otoscopic V nl canals & tympanic membranes
Hearing V nl to _ ________
Intranasal V nl mucosa, septum, turbinate
Ant. Oral V nl lips, teeth, gums
Oropharynx V nl tongue, palate, pharynx
Neck palp. V symmetrical without masses
Thyroid V no enlargement or tenderness
Resp. effort V nl without retractions
Chest percuss. V no dullness or hyperresonance
Chest palp. V no fremitus
Auscultation V nl bilateral breath sounds w/o rales
Heart palp. V nl location, size
Cardiac ausc. V no murmur, gallop, or rub
Carotids V nl intensity w/o bruit
Pedal pulses V nl posterior tibial & dorsalis pedis
MS Gait V nl gait & station
Nails V no clubbing, cyanosis
Check nl, circ abn ROM Strength Tone Abnormals
VVVV
Skin V nl to inspection & palpation
Neurologic V nl alertness, attentive
Cranial nerves V w/o gross deficit
Coordination V nl rapid alternating movement
DTR’s V symmetrical, __ (scale: 0-4+)
Sensation V nl touch, proprioception
MMSE
Psych Orient’n V nl to day, mo, yr, time, location _ /10
Registration V register 3 items _ _/3
Attn/Calc V serial subtraction, world bckwd _ _/5
Recall V recall 3 items _ _/3
Language V nl nam’g, repit’n,compr’n, read’g, rit’g _ _/8
Visuospatial V copy design, clock _ _/1
Knowledge V current/past presidents totals _ /30
Mood V nl GDS GDS Score _ _/15
Breasts V nl inspection & palpation GDS (circle positives)
Abdomen V no masses or tenderness
Satisfied Afraid Wonderful
L/S V no liver/spleen
Dropped Happy Worthless
Hernia V no hernia identified
Empty Helpless Energy
Anus/rectal V no abnormality or masses
Bored Stay home Hopeless
Spirits Memory Others better
GU male V nl to inspection & palpation
Prostate V nl size w/o nodularity
Better off dead
Considered harming yourself
GU female V external genitalia nl w/o lesions
Int. inspection V nl bladder, urethra, & vagina
Speech V nl rate, volume
Cervix V nl appearance w/o discharge
Thought cont. V logical, coherent
Uterus V nl size, position, w/o tenderness
Psychosis V no hallucinations, delusions
Adnexa V no masses or tenderness
Judgement V nl
Lymphatic V nl neck & axillae
Behavior V cooperative, appropriate
Lymph other V
Additional Description of positive findings:
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