No visible abnormal findings
Balding or thinning areas in hair distribution
Texture (1/3 point)
Coarse
Fine
Scalp Observations (1/3 point)
No visible abnormal findings
Dandruff
Discoloration
Inspected fac
...
No visible abnormal findings
Balding or thinning areas in hair distribution
Texture (1/3 point)
Coarse
Fine
Scalp Observations (1/3 point)
No visible abnormal findings
Dandruff
Discoloration
Inspected face 1 of 1 point
Appearance (1/2 point)
No visible abnormal findings
Redness
Rash
Acne (papules, pustules, or comedones)
Moles or skin tags
Masses (warts, cysts, or tumors)
Freckles, birthmark, melasma, or other
discoloration
Excessive hair growth
Excessive dry or flaking skin
Scarring
Laceration or wound
Bruising
Location Of Observed Abnormal Findings (1/2
point)
No additional abnormal findings
Forehead
Nose
Cheeks
Chin
Upper lip
Inspected orbital area and eyelids 1 of 1 point
Right: Eyebrow (1/6 point)
Normal hair distribution
Irregular hair distribution
Right: Eyelashes (1/6 point)
Normal hair distribution
Irregular hair distribution
Right: Eyelid (1/6 point)
No visible abnormal findings
Ptosis
Eyelid edema
Left: Eyebrow (1/6 point)
Normal hair distribution
Irregular hair distribution
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Lesion
Allergic shiners
Left: Eyelashes (1/6 point)
Normal hair distribution
Irregular hair distribution
Left: Eyelid (1/6 point)
No visible abnormal findings
Ptosis
Eyelid edema
Lesion
Allergic shiners
Inspected neck 1 of 1 point
Appearance (1/1 point)
No visible abnormal findings
Swelling
Visible pulsation
Visible mass
Discoloration
Inspected anterior chest 1 of 1 point
Symmetry (1/2 point)
Symmetric
Asymmetric
Appearance (1/2 point)
No visible abnormal findings
Redness
Rash
Moles or skin tags
Masses (warts, cysts, or tumors)
Freckles, birthmark, or other discoloration
Excessive dry or flaking skin
Purpura
Striae
Laceration, lesion, or wound
Bruising
Scarring
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