Patient Assessment Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

DRSABCDE

Primary Examination

• Three questions

• What Happened?

• Where does it hurt most?

• Can you take a deep breath?

• SAMPLE

• Signs and Symptoms

• Allergies

• Medications

• Past Illness/Injuries

• Last Intake of Food/Drink

• Events Leading Up

• Observations

• Conscious State

• Skin

• Breathing

• Pulse

Secondary Examination

• Head to Toes