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