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Patient Assessment Checklist

Rated 4.8/5 stars on Capterra

Say goodbye to paper checklists!

Lumiform enables you to conduct digital inspections via app easier than ever before
  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 5,000 expert-proofed templates
With this template, a complete evaluation of the patient's condition can be made in any type of healthcare facility.
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Digitalize this paper form now

Register for free on lumiformapp.com and conduct inspections via our mobile app

  • Cut inspection time by 50%
  • Uncover more issues and solve them 4x faster
  • Select from over 4000 expert-proofed templates
Rated 4.8/5 stars on Capterra
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Patient Assessment Checklist

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