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Standard Form 506 Promulgated August 1948 By Bureau of the Budget Circular A-32 CLINICAL RECORD PHYSICAL EXAMINATION DATE OF EXAM. HEIGHT WEIGHT TEMPERATURE PULSE BLOOD PRESSURE AVERAGE MAXIMUM PRESENT 128/ 1952 5'8'2 175 179 177 103. 120 182 NSTRUCTIONS.-Describe (1) General Appearance and Mental Status; (2) Head and Neck (General); (3) Eyes; (4) Ears; (5) Nose; (6) Mouth; (7) Throat; (8) Teeth; (9) Chest (General); (10) Lungs; (11) Cardiovascular; (12) Ab- domen; (13) Hernia; (14) Genitalia; (15) Rectum; (16) Prostate; (17) Back; (18) Extremities; (19) Neurological; (20) Skin; (21) Lymphatics. playes The President very acutely ill, his face is very flushed and he appears extremely shakey and thervous, wishes The skin is to return hostand fairly most The sclense are slightly injected. He only to his desk Head normal in contour, shape s ang of hair normal partially bald hair. neck are no abnormal masses view M polpation. The thyroid is normal to bounding pulse in the carotide filaterally There and shape and consisting Thereis no tic nor nod detectable. proommer Eyes Pupils react normally to L&Q. The sclera are not jaundiced however are slightly injected. There is no mystagenes. Heavy memories lens are worn Ears : normal hearing external canal char, :no inflammation or abnormatt membrane. no detectable abnormality the difactory sense is normal; no mouth; the tongre is pataly white and heavily coated The throat amang spending or intra-nasal inflammation is moth as slightly inflammed The vocal cords offerar a trifle lax and slightly respond chest. Scattered fine rales in right lung base posterion. Heavy Teeth insurancy no caries none distribution. prissing Reundfull bust, crowns normalcontan all in Mullinteondition no abnormalities, moist) rales noted on inspiration and expiration throughout middle and lown lingfield on left noareas of consolidation noted, no 100 pain with blooking niareas of is notfall and deyna as usual Resperation to 36 per minute however full easily compressable The heart as within normal size and They las is rapid (120), and bounding with occassor al anythin it limits to perchasion. There is no detectable friction rul, nomrmre or me extra systement systols. Groom over for our for traphor for 10 (Continue on reverse side) PATIENT'S LAST NAME-FIRST NAME-MIDOLE NAME REGISTER NO. WARD NO. Suman Harry I President 2754638 WRAME PHYSICAL EXAMINATION Standard Form 506 (NAME OF HOSPITAL OR OTHER MEDICAL FACILITY) 16-56185-2

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