Adoption Candidate Physical Examination Sheet
Candidate Information
Name
Date of Birth
Sex
Date of Exam
Examiner
Physical Examination Data
Height
Weight
Head Circumference
Blood Pressure
Pulse
Examination Findings
System
Normal/Abnormal
Details
General Appearance
Skin
Head
Eyes
Ears
Nose/Throat
Chest/Lungs
Heart
Abdomen
Genitalia
Extremities
Neurological
Other
Immunization Status
Assessment/Recommendations
Examiner's Signature
Date