Skin examination documentation

Dermatology Exam: Learning the Language Stanford

The text in this sample documentation can be considered an outline to use when you follow the Skin Observation Protocol. Each client's response to the Skin Observation Protocol will be unique to that client and should reflect their individualized assessment and care needs The General Dermatology Exam: Learning the Language. The diagnosis of any skin lesion starts with an accurate description of it. To do that, you need to know how to describe a lesion with the associated language. This language, reviewed here, can be used to describe any skin finding

Examining a Skin Lesion - OSCE Guide Geeky Medic

Skin. Color, texture, hygiene, moisture. Braden score. Intactness, lesions, breakdown: Skin pink, cool and dry. Braden score- 18. Abdominal sagittal midline well approximated incision with packed wound at inferior and superior ends, both approx 1 cm in circumference and 11-12 mm in depth, no site redness or swelling, scant sanguiness drainage Documentation serves two very important purposes. First, it keeps you out of jail. Okay, okay, incarceration might not be totally realistic, but there are plenty of scenarios in which your actions as a healthcare provider might be called into question. And, in the medical world, if you didn't write it down, it didn't happen. Documenting Cheat Sheet: Normal Physical Exam Template Read.

Performing a skin assessment : Nursing202

Skin cancer is the commonest cancer and any examination of the skin should include a check for sun damage and potential skin malignancy. Malignant melanoma must be distinguished from more common pigmented lesions such as: Seborrhoeic warts (common in the elderly) Sunspots (solar lentigines Get And Sign Skin Exam Physical Exam Documentation 2017-2021 Form (Home) _____ (Cell) _____ Dates of Immunization and Titer results: (if health care provider [HCP] elects to write see attached in the spaces for each immunization below, student is responsible for making sure that the HCP's immunization list is securely attached) CHARTING EXAMPLES FOR PHYSICAL ASSESSMENT SKIN, HAIR AND NAILS Skin pink, warm, dry and elastic. No lesions or excoriations noted. Old appendectomy scar right lower abdomen 4 inches long, thin, and white. Sprinkling of freckles noted across cheeks and nose. Hair brown, shoulder length, clean, shiny. Normal distribution of hair on scalp and perineum 2. The documentation of each patient encounter should include: reason for encounter and relevant history, physical examination findings, and prior diagnostic test results NOTE: For comprehensive level, the examination of all four anatomic areas must be performed and documented. For the three lower levels of examination, each body area is counted separately. For example, inspection and/or palpation of the skin and subcutaneous tissue of the head and neck and extremities constitutes two areas

Exam Documentation: Charting Within the Guidelines -- FP

Haylee Hazlet September 21, 2020 NRSE-2030-902 - Health Assessment Skin, Hair, and Nails Documentation Skin-Inspection: Skin of arms, color is even, pinkish tan, warm to touch, no excessive moisture or dryness, smooth and firm, no bumps, no scabs, no bruising, no lesions, no rashes, skin is blanchable, uniform thickness, no edema, appears clean and well-groomed, skin turgor checked anterior. Note: For the comprehensive level of examination, all eight anatomic areas must be performed and documented. For the three lower levels of examination, each body area is counted separately. For example, inspection and/or palpation of the skin and subcutaneous tissue of the right upper extremity and the left upper extremity constitutes two elements Dermatologists all over the world recommend a skin check, a head-to-toe self-examination on a regular basis in order to find any changing lesions on the skin or new marks or moles in adults (although it can be normal for new moles to appear and to change in childhood, puberty and early adult life, and in pregnancy, after 35 years of age it is more unusual)

Normal Physical Exam Template Samples. Physical Exam Format 1: Subheadings in ALL CAPS and flush left to the margin. GENERAL APPEARANCE: The patient is a [x]-year-old well-developed, well-nourished male/female in no acute distress. VITAL SIGNS: Blood pressure [x] mmHg, pulse rate [x] beats per minute, respirations [x] breaths per minute. EXAMINATION NAILS drsudeeshshetty@gmail.com 133 134. EXAMINATION NAILS Spooning - kiolonychia drsudeeshshetty@gmail.com 134 135. EXAMINATION NAILS drsudeeshshetty@gmail.com 135 136. Example Documentation No abnormalities - General Statement about overall skin assessment: - Skin is warm, smooth and well hydrated Skin examination is essential to inspect all areas of the skin from head to toe (including the nails, scalp, hair and mucous membranes). At a dermatology appointment in secondary care, a full skin assessment involves the need for the patient to undress, so privacy and dignity is essential. However, chaperones will be required to examine genital.

PHYSICAL EXAMINATION: General Appearance: This is a (XX)-year-old female, who answers questions appropriately and currently is in no apparent distress. Vital Signs: Her blood pressure is 142/74, heart rate is 72, respiratory rate is 22, saturation 98% on room air, currently afebrile, temperature 98.2. Skin: Warm and dry without exanthem Exam of the left inguinal area is done in the same way, though hand positioning is reversed. Hernias are generally non-tender and there should be no evidence of acute inflammation (i.e. skin edema or redness)

Typically the history and physical examination for the skin is done in the same sequence and manner as with any other organ system. In some cases it is helpful to examine the patient after taking only a brief history so the questions for the patient can be more focused. Wood lamp examination is a diagnostic test in which the skin or hair is examined while exposed to the black light emitted by Wood lamp. Blacklight is invisible to the naked eye because it is in the ultraviolet spectrum, with a wavelength just shorter than the colour violet. The lamp glows violet in a dark environment because it also emits some. Skin and dermatology coding includes unique challenges with its extensive terminology and the need to calculate wound and lesion sizes. Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, discusses common documentation problems and how coders can improve their efficiency and proficiency Assessment of skin cancer risk. High risk (3 monthly self examination and 12 monthly skin check with doctor) Red hair. Type 1 skin and age more than 45 years. Type 2 skin and age more than 65 years. Family history of melanoma in a first degree relative in patients aged more than 15 years

Odors from skin, breath, wound 5. Develop and use nursing instincts detailed, or comprehensive. Regardless, documentation must be completed for each visit and/or assessment. Physical Examination A comprehensive physical examination should be performed according to age specific preventive health guidelines. American Medical Association. Infantile seborrhoeic dermatitis is often mistaken for eczema. However it is not pruritic, and causes cradle cap and moist red areas in the skin folds.It tends to improve after the age of 6 months. Assessment. Assessment requires a careful history and physical examination

complete neurological exam template | Paspas

Trouvez vos marques préférées, maintenant avec des réductions supplémentaires jusqu'à 70%. Craquez pour les best-sellers et dernières collections de la saison. Livraison express Examples of the documentation of general appearance are found in Bates , p. 19 and 113. Your documentation will vary based on the patient's physical exam findings. Objectives C ­ F: Bates covers the evaluation of skin, h air and nails. General appearance includes the skin color and obvious lesions In summary it's especially important when you're looking for melanoma to always do a thorough skin exam. Remember: be systematic, don't miss those hidden areas like the conchal bowls the medial canthi, the inner gluteal cleft and perianal region and the finger and toe web spaces 14.4 Integumentary Assessment. Open Resources for Nursing (Open RN) Now that we have reviewed the anatomy of the integumentary system and common integumentary conditions, let's review the components of an integumentary assessment. The standard for documentation of skin assessment is within 24 hours of admission to inpatient care

Is the scar painful on examination? 4. Is there skin breakdown? 5. Is the scar superficial, meaning there is no underlying soft tissue damage? Page 2. 6. Is the scar deep, meaning there is underlying soft tissue damage? 7. Describe any limitation of motion or other limitation of function caused by th Example of a Complete History and Physical Write-up Patient Name: Unit No: Location: Informant: patient, who is reliable, and old CPMC chart. Chief Complaint: This is the 3rd CPMC admission for this 83 year old woman with a long history of hypertension who presented with the chief complaint of substernal toothache like chest pain of 12 hour Performing an Integumentary Physical Assessment. Once the general survey and head-to-toe assessment are completed, begin the focused examination of the skin, hair, and nails, using inspection and palpation. For purposes of simplicity, inspection and palpation are discussed separately below.However, rather than inspecting all areas of skin, hair, and nails, and then palpating all areas an

The physical examination is generally focused on the skin condition, ostomy, or wound healing history. Generally, it is based on the patient's history and the nature of the presenting problems. Documentation of the affected system (s) is mandatory. The physical examination provides necessary objective information for the practitioner to. SPECIALTY EXAM: DERMATOLOGY Refer to data section (table below) in order to quantify. After reviewing the medical record documentation, identify the level of examination. Circle the level of examination within the appropriate grid in Section 5 (Page 3). Performed and Documented Level of Exam One to five bullets Six to eleven bullets Twelve or. snwflknurse. Nov 13, 2004. thanks! bet you can't guess what i'm doing right now.. . Cubby said: Her turgor then would be within normal limits,if it takes longer than just a millisecond then you record it as-skin turgor + 2 (seconds) or whatever number you come up with. 1 Likes Crepitus - A crackling or popping sensation felt under the skin as a result of subcutaneous emphysema. May be caused by trauma or rupture of the airway. Sample Normal Exam Documentation. For patients presenting with respiratory complaints, or known respiratory system abnormalities, you will want to document a complete respiratory exam Documentation Guideline: Wound Assessment & Treatment Flow Sheet June 2011 Revised July 2014 1 GENERAL CONSIDERATIONS . a. A wound assessment is done as part of the overall client assessment (cardiorespiratory status, nutritional status, etc

Assessment Documentation Examples Student Nursing Study Blo

Complete Head-to-Toe Physical Assessment Cheat Sheet. Nursing assessment is an important step of the whole nursing process. Assessment can be called the base or foundation of the nursing process. With a weak or incorrect assessment, nurses can create an incorrect nursing diagnosis and plans therefore creating wrong interventions and. Objective Data / Physical Examination • Assessment of the skin involves the entire skin area, including the mucous membranes, scalp, hair, and nails. • The skin is a reflection of a person's overall health, and alterations commonly correspond to disease in other organ systems How to perform a skin self-exam. Examine your body in a full-length mirror. Examine your body front and back in the mirror, then look at the right and left sides with your arms raised. Look at your underarms, forearms, and palms. Bend elbows and look carefully at forearms, underarms, and palms

The purpose of this module is to help medical students develop a systematic approach to the skin exam and highlight the importance of examining the entire cutaneous surface. After completing this module, the learner should be able to: Discuss the key questions that make up a dermatologic history. Explain the indications for a total body skin exam Skin checks are critical for comprehensive assessment and examination for evidence of skin cancer. While routine skin cancer screening is not advocated, 3 it largely falls within the realm of primary care to stratify and understand which patients require routine checks in accordance with their presenting risk factors

A dry, flaky, peeling appearance of the skin is very common in newborns. Although this can be distressing to parents, it does not need treatment and will spontaneously resolve. Documentation of these unusual birthmarks in the medical record is helpful. photo by Janelle Aby, MD. Slate Grey Patches (Mongolian Spots) On examination of this. Ear, nose and throat examination documentation. Example documentation of a normal ENT examination. Example documentation of an abnormal ENT examination . Clinical Skills Teaching and Learning Centre. 70 Pembroke Place L69 3GF Liverpool United Kingdom. 0151 794 8242. clinicalskills@liverpool.ac.uk

Therefore, this would be EPF with 3 Organ Systems documented- Constitutional, Psych and Skin. To break it down further and count bullets you would be using 1997. Also, for skin exam the provider is only listing the areas he examined but giving no further documentation to findings, I would recommend strengthening the skin documentation General Multi-System Pg 1 of 5 14 CONTENT AND DOCUMENTATION REQUIREMENTS General Multi-System Examination System/Body Elements of Examination Area Constitutional C Measurement of any three of the following seven vital signs: 1) sitting or standing blood pressure, 2) supine blood pressure, 3) pulse rate and regularity, 4) respiration, 5

Grab a mirror and perform a skin exam of your own every three to six months, Dr. Riley suggests. Look for moles or spots that: Have changed in size, shape or color over time Human scabies is an intensely pruritic skin infestation caused by the host-specific mite Sarcoptes scabiei var hominis. A readily treatable infestation, scabies remains common primarily because of diagnostic difficulty, inadequate treatment of patients and their contacts, and improper environmental control measures The exam also includes auscultation of heart and examination of extremities for edema and/or varicosities (two cardiac elements). With three elements documented, the exam is problem. Conflicting efficacy in studies; Ultrasound may alter clinical management by identifying occult abscess (occurred in 50% of cases in one study). Tayal (2006) Acad Emerg Med 13(4): 384-8 [PubMed] Ultrasound is more accurate than clinical exam in one study. Test Sensitivity up to 97% Test Sensitivity and 83-85% Test Specificity; Gaspari (2012) Crit Ultrasound J 4(1): 5 [PubMed • Documentation of examination, evaluation, diagnosis, prognosis, plan of care, and discharge equipment that may produce or relieve trauma to the skin o Skin characteristics • Wound o Activities, positioning, and postures that aggravate the wound or scar or that produce or relieve traum

Skin Turgor. Time required for skin to return to position prior to pinching. Skin Tenting. Skin maintains a pinched position for a prolonged period after pinching. III. Protocol. Pinch skin on the lateral abdominal wall at the level of the Umbilicus. IV. Interpretation The characteristic physical examination finding of herpes zoster is the maculopapular rash. The rash in typically unilateral and its distribution is confined to one or two adjacent dermatomes . As the rash crusts and heals in 7-10 days, a post-inflammatory hyperpigmentation of the skin may result The Basics About Skin Cancer . By definition, skin cancer is the abnormal growth of skin cells. Two types of skin cancer, basal cell carcinoma and squamous cell carcinoma, develop primarily on areas of sun-exposed skin, including the scalp, face, lips, ears, neck, chest, arms, and hands.   It is also common on the legs of women

Heent Assignment - head to toe assessment - StuDocu

Normal breast examination documentation. Abnormal breast examination documentation. Clinical Skills Teaching and Learning Centre. 70 Pembroke Place L69 3GF Liverpool United Kingdom. 0151 794 8242. clinicalskills@liverpool.ac.uk What is the proper term for documentation of this finding by the nurse? Macule. The nurse is beginning the examination of the skin of a 25-year-old teacher. She previously visited the office for evaluation of fatigue, weight gain, and hair loss. The previous clinician had a strong suspicion that the client has hypothyroidism Skin; Levels of Complexity - There are four levels of complexity of the 1997 Examination. The level of exam is based upon documentation. Problem Focused Examination — should include performance and documentation of one to five elements identified by a bullet (•), whether in a box with a shaded or unshaded border

Skin with normal turgor snaps rapidly back to its normal position. Skin with poor turgor takes time to return to its normal position. Lack of skin turgor occurs with moderate to severe fluid loss. Mild dehydration is when fluid loss equals 5% of body weight. Moderate dehydration is 10% loss and severe dehydration is 15% or more loss of body weight Consistency 1 Color of Nailbeds 1 Clubbing 1 Capillary Refill 1 Writing Skills Use of appropriate descriptive terminology, pertinent negatives, spelling and organization. 2 TOTAL POINTS 25 Skin, Hair, and Nails Documentation Skin of arms, warm, no excessive dryness or moisture, smooth and firm to touch, no lesions, rashes, no bumps or scabs, no bruising, skin is blanches when touched , uniform.

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Cheat Sheet: Normal Physical Exam Template ThriveA

  1. Psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves hyperproliferation of the keratinocytes in the epidermis, with an increase in the epidermal cell turnover rate (see the image below). Environmental, genetic, and immunologic factors appear to play a role
  2. ing the Level of Exam An E/M service's exam component is, as the name implies, the physician's physical exa
  3. The Centers for Medicare & Medicaid Services (CMS) has developed documentation guidelines for use with evaluation and management (E/M) codes. While there are 2 versions of the guidelines (1995 and 1997), either can be used to justify the reporting of a particular E/M code because the CMS allows use of whichever [version] is most advantageous to the physician
  4. ation of bruising can guide the clinician in ordering radiographic imaging studies of children who have suffered trauma. Addi
  5. ation with the use of a Wood light. In preparing for this diagnostic test, the nurse should: this finding as: Anasarca. A nurse reviewing the medical record of a client with the diagnosis of heart failure notes documentation indicating that the client has deep pitting edema, that the indentation.
Unforgettable Printable Skin Assessment Form | Randall Website

Skin Examination - Oxford Medical Educatio

Physical Examination. The physical examination is generally focused on the skin condition, ostomy, or wound healing history. Generally, it is based on the patient's history and the nature of the presenting problems. Documentation of the affected system(s) is mandatory The main mechanisms behind venous ulcers are reflux, venous outflow obstruction, or the combination of the two. 5 Reflux is the most common reason, whereas obstruction is rare. Reflux and obstruction have the highest odds for skin damage. 6 Malfunction in the foot and calf muscle pumps by itself could cause ulceration, but it is most prevalent in patients with venous disease. 5 All the causes. Background: Despite existing guidelines and methods for standardized clinical photography in dermatology and plastic surgery, human skin exhibits exquisite site-specific morphologies and functions, and each body region can exhibit an individual pathologic phenotype. The aim of this work was to develop a standardized, representative and reproducible documentation of the multilocular. National Health and Nutrition Examination Survey 2001-2002 Data Documentation, Codebook, and Frequencies Dermatology (DEQ_B) Data File: DEQ_B.xpt First Published: May 2004 Questions about occupational skin exposure were deleted while questions about sun protective behavior were added. However, only questions appearing in both the 2001. Skin exam is not separate from the rest of the physical examination. Examine the patient in good lighting. Inspect and palpate skin for the following: Color: Contrast with color of mucous membrane. Turgor: Lift a fold of skin and note the ease with which it moves (mobility) and the speed with which it returns into place

Skin Exam Physical Exam Documentation - Fill Out and Sign

  1. Intact skin with a localized area of non-blanchable erythema, which may appear differently in darkly pigmented skin. Presence of blanchable erythema or changes in sensation, temperature, or firmness may payer for additional guidance on what may be required in terms of documentation. The amount/type of document required may vary depending.
  2. Fragile - Skin on the leg has a fragile appearance. Hairless - Skin on the leg has an absence of hair not associated to purposeful removal (e.g., shaving). Healed Wound or Scar - Area(s) on the skin show evidence of previously healed wounds or scar tissue is present
  3. ation, pressure ulcer risk assessment is the next step in pressure ulcer prevention
  4. ation • Check the nail shape • Exa
  5. Bimanual Exam- uterus is anterior, midline, smooth, not enlarged, adnexa not felt Rectovaginal Exam- nl sphincter tone; no masses Inspect anus-no fissures, no hemorrhoids Stool for Occult Blood- ɵ (negative) If this were a male patient, you would instead document the following: GENITAL EXAM (MALE) Penis: Inspect and Palpat
  6. Skin, Hair & Nails Student DocumentationStudent Documentation Model DocumentationModel Documentation. Subjective. Patient reports an improve in acne due to oral contraceptives. Skin on neck has stopped darkening and facial and body hair has improved. She reports I feel moles but no other hair or nail changes
  7. e for parietal edema: Press over or pinch the skin of abdo


  1. ation is grossly normal. PHYSICAL EXAMINATION: GENERAL: He is awake, alert and in no acute distress. VITAL SIGNS: Weight is 11 pounds 11 ounces. Temperature is 98.6, pulse 122 per
  2. Next the general medical exam: Patient is alert, oriented, no respiratory difficulty, no complaints of pain now, skin turgor good, skin color good, skin is warm and dry, no problems voiding, and no bowel movement for 2 days. Takes Dioxin and Lasix QD, dosage unknown, lungs sound slightly congested but no dyspnea, as stated above
  3. ent lesions Hair: Normal texture and distribution
  4. ation order is followed: Inspection, Palpation

Skin, Hair, Nails Documentation

Normal Pelvic Exam Documentation - . Pelvic: Pelvic exam revealed normal female external genitalia, urethra, and vagina with skin intact and no lesions noted. Internal exam revealed vaginal vault free of bleeding and discharge. Cervix is well visualized. ThinPrep Pap was obtained along with HPV DNA test Exam: Skin temperature of lower extremities is warm to cool on proximal to distal. Pulses palpable bilaterally, no edema, cyanosis or crepitus. Sensations are normal, tenderness with palpation of the right great toe. rdTenderness of right 3 to 4th interspace. Muscle strength is 5/5 for all groups tested. Muscle tone is normal Benign skin lesion removal for reasons other than those given in the Indications and Limitations of Coverage and/or Medical Necessity section of the DERM-008 LCD are considered to be cosmetic and will be denied as non-covered Detailed - an extended examination of the affected body area (s) and other symptomatic or related organ system (s). Comprehensive - a general multi-system examination or complete examination of a single organ system. For purposes of examination, the following body areas are recognized: Head, including the face. Neck Exam Guidelines. The Hospitalist. 2011 November;2011 (11) Author (s): Carol Pohlig. The extent of the exam should correspond to the nature of the presenting problem, the standard of care, and the physicians' clinical judgment. Remember, medical necessity issues can arise if the physician performs and submits a claim for a comprehensive.

Skin Check: The Complete Guide on Medical- and Self

What kind of documentation is the following? 0800-1300 0 45, pain scale 0/10, hand and leg strong to right, weak to left. Skin pink, warm and dry, turgor good, incision to Rt. anterior chest wall erythema or edema..Jane Night, LPN Diagnosing Lymphedema by Physical Examination. The information on this page has been updated. Please see our new Wiki page: Symptoms include swelling of limbs up to twice the normal size, skin that indents and stays that way when pressed (pitting), and thickening, hardening and darkening of the skin (brawniness). 1 PHYSICAL EXAMINATION AND HEALTH DOCUMENTATION FORM A medical history and physical exam is required as part of student clinical requirements prior to entry into a professional degree program at UTC. Immunizations, titers and TB skin tests must be completed as part of this and then updated as necessary. The physical exam should be complete Examination of male genitals and secondary sexual characteristics. Step-by-Step: Male Genital Examination Clinical Summary Guide Then stretch the scrotal skin, without compressing the testis 3. Use your orchidometer to make a manual side-by-side comparison between the testis and beads (see image 2). If skin lesions (11400-11646) are reported in addition to other procedures at the anatomic site, AAPC cautions that providers should take care to avoid bundling issues. Biopsy: A biopsy is described as an independent procedure to obtain tissue for pathologic examination. The basic assumption is that neither definitive clinical nor.

Normal Physical Exam Template Sample

  1. Physical exam documentation We recommend following the 1995 CMS coding guidelines. Under those guidelines, both 99213 and 99214 visits require two to seven of the below body areas or organ systems to be addressed. For 95 guidelines, only one exam component for that body area or organ system is required to receive credit. All the item
  2. ation, how to assess a wound, essential practice points, and examples of accurate and thorough documentation tools. A wound is a disruption of normal anatomic structure and.
  3. Documentation •Accurate and complete •Should paint a picture of the patient's encounter •Removal of skin tags -11200-11201 •Shaving - 11300-11313 Coding & Compliance Initiatives, Inc. 17. Choices •Excision benign skin lesions •Trunk, arms, legs - 11400-1140
  4. ation is part of your decision making
  5. By Diane L. Krasner, PhD, RN, FAAN Scope of Practice and Standards of Practice guide nurses and other members of the interprofessional wound care team in caring for patients with wounds. Documentation in the medical record is a key aspect of the standard of practice and serves to record the care delivered to the patient or resident. Your documentation should follow your facility guideline for.
  6. ation of the abdomen with note made of the shape of the abdomen, skin abnormalities, abdo
nursing notes | This article was not subject to the OstomyBestseller: Wound Assessment Wound Care Documentation ForPHYSICAL EXAMINATION

Press, turn, and scrape in a full circle, making sure to include the transformation zone and the squamocolumnar junction. Smear the specimen on a glass slide and place it within reach. Endocervical brush: place the brush into the cervical os. Roll it between your thumb and index finger, clockwise and counterclockwise What to expect. Skin exam. Clinical breast exam. Pap test and pelvic exam. Digital rectal exam. Summary. A physical exam, or a physical, is a routine test wherein a healthcare professional. The resident's skin condition must be reviewed for each MDS including the discharge assessment. Although not a requirement, it is advisable that documentation regarding the resident's skin condition be provided when the resident departs and returns from a leave of absence, e.g. home visits, out with the family, etc #4: Assess Skin Throughout The skin is a great barometer of overall wellness. Note if patient's skin seems unusually pale, flushed, cold, hot, clammy, or dry anywhere throughout the exam. Also not any lesions, abrasions, or rashes. You might not have a barometer, but you definitely have skin. Step 1: Check Vital Signs and Neurological Indicator Download File PDF Female Genitalia Examination Documentation Vital Signs, and Skin Available in 4 convenient formats--VHS, PAL, DVD and streaming video files--each video provides 25 minutes of step-by-step examination footage with rationales. Patients and examiners represent diverse age groups an

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