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misleading statements or the withholding of relevant information by a DME may result in disciplinary action, including
criminal prosecution
1 EXAMINATION CATEGORY – Tick appropriate box.
Initial – Initial examination for either Medical Assessment Class 1, 2 or 3; also initial examination for upgrading from Class 2
to 1 (notate ‘upgrading’ in Section 281).
Renewal – Subsequent ROUTINE examinations.
2 HEIGHT – Measure height without shoes in centimetres to nearest cm.
3 WEIGHT – Measure weight in underwear to nearest half kilogram.
4 EYE COLOUR – State colour of applicants eyes from the following list: brown, blue, green, hazel, grey, multi.
5 HAIR COLOUR – State colour of applicants hair from the following list: brown, black, blonde, auburn, red, grey,
white, bald.
6 BLOOD PRESSURE – Blood Pressure readings should be recorded as Phase 1 for Systolic pressure and Phase 5
for Diastolic pressure. The applicant should be seated. Record pressure in mm Hg.
7 PULSE (RESTING) – The pulse rate should be recorded in beats per minute and the rhythm should be recorded as
regular or irregular. Further comments if necessary may be written in Section 228, 281 or separately.
SECTION 8 – 27 inclusive constitute the general clinical examination and each of the sections must be checked as Normal
or Abnormal.
8 HEAD, FACE, NECK, SCALP – To include appearance, range of neck movements, symmetry of facial movements,
etc.
9 MOUTH, THROAT, TEETH – To include appearance of buccal cavity, soft palate motility, tonsillar area, pharynx as
well as gums, teeth and tongue.
10 NOSE, SINUSES – To include appearance and any evidence of nasal obstruction or sinus tenderness on palpation.
11 EARS, ESPECIALLY EARDRUM APPEARANCE AND MOTILITY – To include otoscopy of external ear, ear canal,
and tympanic membrane. Eardrum motility assessed by Valsalva manoeuvre or pneumatic otoscopy.
12 EYES – ORBIT AND ADNEXA, VISUAL FIELDS – To include appearance, position and movement of eyes and
their surrounding structures in general, including eyelids and conjunctiva. Visual fields should be checked by campimetry,
perimetry or confrontation.
13 EYES – PUPILS AND OPTIC FUNDI – To include appearance, size, reflexes, red reflex and fundoscopy. Corneal
scars, if any, should be noted.
14 EYES – OCULAR MOTILITY, NYSTAGMUS – To include range of movement of eyes in all directions; symmetry of
movement of both eyes; ocular muscle balance; convergence; accommodation; nystagmus. Objective methods of measuring
convergence and near point are available.
15 LUNGS, CHEST, BREASTS – To include inspection of chest for deformities, operation scars, abnormality of
respiratory movement, auscultation of breath sounds. Physical examination of the female applicant’s breasts is optional. If
not examined, state so.
16 HEART – To include apical heart beat, position, auscultation for murmurs, carotid bruits, palpation for thrills.
17 VASCULAR SYSTEM – To include examination for varicose veins, character and feel of pulse, peripheral pulses,
evidence of peripheral circulatory disease.
18 ABDOMEN, HERNIA, LIVER, SPLEEN – To include inspection of abdomen; palpation of internal organs; check for
inguinal hernias in particular.
19 ANUS, RECTUM – Clinical examination is mandatory only when indicated by history. If not examined, state so.
20 GENITO-URINARY SYSTEM – Clinical examination is mandatory only if indicated by history. If not examined, state
so.
21 ENDOCRINE SYSTEM – To include inspection, palpation for evidence of hormonal abnormalities/imbalance; thyroid
gland.
22 UPPER AND LOWER LIMBS, JOINTS – To include full range of movements of joints and limbs, any deformities,
weakness or loss. Evidence of arthritis.
23 SPINE, OTHER MUSCULOSKELETAL – To include range of movements, abnormalities of joints.
24 NEUROLOGIC – REFLEXES ETC. To include reflexes, sensation, power, vestibular system – balance, Romberg
test, etc.
25 PSYCHIATRIC – To include evaluation of appearance, mood/thought, behaviour (see also 60-61).
26 SKIN and LYMPHATICS – To include inspection of skin; inspection and palpation for lymphadenopathy, etc.
Describe identififying marks in 229.
27 GENERAL SYSTEMIC – All other areas and systems, including nutritional status.
28 NOTES – Any notes, comments or abnormalities to be described – add extra notes if required on separate sheet of
paper, signed and dated and including the applicant’s name.
29 IDENTIFYING MARKS, TATTOOS, SCARS ETC – List items that may be used for physical identification
　
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