<p> Osteopathic Exam Module Pediatric Osteopathic Manipulative Treatment Module</p><p>Name ______Date ______</p><p>TECHNIQUE: Checklist</p><p> General appearance (including vault hold)  Heel to toe  Tip toe  Heel walking  Knee bend  Balance  Spine inspection  Upper extremity screen  Horizontal plane levelness (anterior/posterior)  Cervical rotation  Cervical flexion and extension  Cervical side bending  Thoracic side bending  Thoracic flexion and extension  ThoracoLumbar rotation  Standing Flexion Test  Hip Drop Test  Pelvic Side Shift Test  Palpate 1st Rib  Palpate Rib Angles  Chest expansion  Hip flexion (Straight Leg Raise)  Hip extension  Hip abduction and adduction</p><p>GLOBAL ASSESSMENT: Demonstrated understanding of Osteopathic management considerations to the pediatric patient presented in this module: ( ) Competent and able to perform OMT independently ( ) Competent with more knowledge ( ) Competent with more clinical experience ( ) Not competent Signatures:</p><p>______Intern / Resident Supervising / Evaluating physician</p><p>______Pediatric Residency Director Director of Medical Education</p>