ALLEGANY COUNTY DEPARTMENT OF HEALTH REPRODUCTIVE HEALTH SERVICES
MALE PHYSICAL EXAM
NAME:____________________________________DATE:___________________ID#_____________
ALLERGIES:________________________________________________________________________
STD TESTING: INITIAL_____________ REVISIT____________ TREATMENT_________________
PHYSICAL EXAM OBJECTIVE FINDINGS (circle appropriate responses)
SKIN: clear rashes sores description/location of abnormalities_________________________________
HEAD/NECK: normal ROM adenopathy -yes/no/location______________________________________
THYROID: normal/ enlarged to palpation/ difficulty swallowing-yes.no
HEART: rate/min__________ rhythm_______murmur -yes/grade_______________no
LUNGS: clear to A&P/rales/rhonchi/wheezing/cough Respiratory rate/min______________
BREASTS: nipples-inverted/everted /spontaneous discharge . Masses/moles/dimpling /puckering/density/WNL
Axilliary nodes -normal/enlarged
ABDOMEN: flat/flabby/obese Organomegaly yes/no/not able to clearly define. Tenderness yes/no
GROIN: hernia yes/no Lymphadenopathy yes/no
EXTREMITIES: normal/swelling/sores
PUBIC AREA: rashes/sores/lesions
PENILE SHAFT: rashes/sores/HPV lesions/HSV lesions/normal
PENILE GLANS: rashes/sores/ HPV lesions/ HSV lesions/ normal
URETHRA: no discharge/ discharge-color_______ scant/moderate/heavy/crusting
SCROTUM: testicles descended/ rashes/sores/HPV lesions/HSVlesions/normal
PROSTATE/RECTUM: if >40________________________________________________________________
LABS: B/P_________________WEIGHT______________HEIGHT____________BMI___________
URINE DIPSTICK: wnl/ abnormal_________________________________________________
CHLAMYDIA/GC
HIV DONE
RX FOR VDRL/ HSV I&II Igg&Igm
EDUCATION:Testicular self exam yes/no
HIV/STD transmission/risk reduction/condom usage/ dental dams yes/no
Medications (all BCM’s & Treatment Meds) yes/no
IMPRESSION:____________________________________________________________________________
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PRESCRIPTIONS/TREATMENTS:____________________________________________________________
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□ All contraindications and side effects to any contraceptives/treatment/plan of care reviewed with client.
Verbalizes understanding.
RETURN TO CLINIC:_______________________________REASON:___________________________
SIGNATURE&TITLE:__________________________________________________________________
DATE:__________________________________________TIME:________________________________
ACDOH revised 1/2012