Low Back and Lower Extremity Exam Form - The Supply Center 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the patient's name and date at the top of the form. This information is crucial for identifying the patient and tracking their examination.
  3. In the Physical Examination section, provide details about the patient's general condition, including age, development, and distress level. Use dropdowns or text fields as needed.
  4. Fill out the Body Shape section by selecting options for posture, gait, and movements. Ensure accuracy as these observations are vital for assessment.
  5. Complete the General Data section with measurements such as weight, height, temperature, and blood pressure. This data is essential for a comprehensive evaluation.
  6. Proceed through each subsequent section methodically, documenting findings from cranial nerve examinations to orthopedic tests. Utilize checkboxes and text fields for clarity.

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The Lower Extremity Functional Scale (LEFS) is a questionnaire containing 20 questions about a persons ability to perform everyday tasks. The LEFS can be used by clinicians as a measure of patients initial function, ongoing progress and outcome, as well as to set functional goals.
Examination of the lower limbs involves assessment of the hips, knees, ankles, and feet to evaluate for signs of pathology. The examination includes inspection, palpation, assessment of range of movement, and provocative maneuvers.
A lower extremity arterial physiologic study may be requested to determine whether peripheral artery disease is present, what vessels are affected, and how severely the blood flow is impaired. A study may be ordered prior to an initial consultation with a vascular specialist for patients referred for evaluation of PAD.

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