boys physical genital examination · male genitalia draw shape of anus and any lesions on...
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NHS number:Name:Address:
Date of birth:CR number:
Affixpatient label
File within Legal Section
CHA3524 V1 Printed 01/2015© RCHT Design & Publications 2015
Boys Physical Genital Examination
Tanner stage: Genitalia 1 2 3 4 5 Pubic hair: 1 2 3 4 5
External Genitalia Yes No Describe location & Extent
Penis circumcised
Foreskin retractable
Frenulum intact
Testes Present x 2 Present x 1 Absent
Findings - Genitalia Normal Non Specific Abnormal
Bruises
Lacerations
Burns
MALE GENITALIA Draw shape of anus and any lesions on genitalia, perineum or buttocks
Date of Exam: Examiner Name:
affix patient label
ExamPosition used: Supine Knee chest Left lateral
ANAL EXAMINATION
Anus Normal Non specific Abnormal
Yes No Describe location & Extent
Reddening
Bruises
Skin change
Oedema
Venous congestion
Fissures Superficial
Deep or extensive
Number
Scars Site
Number
Tags Site
Number
Folds Site
Number
Gaping
Laxity
Reflex andal dilation
Warts
Burns
Other
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