Lumiform / Templates / Patient Assessment Checklist Template

Patient Assessment Checklist Template

With this template, a complete evaluation of the patient's condition can be made in any type of healthcare facility or see our SOAP note example checklist to follow SOAP patient interaction documentation.

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Patient Assessment Checklist Template

Patient Assessment

Primary Examination

Three questions

What Happened?

Where does it hurt most?

Can you take a deep breath?

SAMPLE

Signs and Symptoms

Allergies

Medications

Past Illness/Injuries

Last Intake of Food/Drink

Events Leading Up

Observations

Conscious State

Skin

Breathing

Pulse

Secondary Examination

Head to Toes

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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.