A revision walkthrough — for learning, not live patient decisions. In real practice, this is a senior-supported, local-guideline call. Start the walkthrough
● worked example · learn the approach

The child with a rash

Rashes make juniors panic — they don't need to. Ask the right questions, learn the visual cues, and most rashes name themselves. Decide how urgent it is, rule out the dangerous ones, then let the context make the diagnosis. Built for revision, not live patient decisions.

1

Settle them, and sort the urgency

before the diagnosis

Every rash falls into one of three groups

act now

  • Any rash with abnormal vitals or shock (tachycardia, slow CRT, low BP), whatever the rash looks like
  • Any rash with airway compromise: swollen lips or tongue, stridor, wheeze → anaphylaxis
  • Non-blanching rash in an unwell or febrile child
  • A rash a few days after a burn or wound → toxic shock
  • Skin that is painful, blistering or peeling, or sore eyes and mouth

act soon (hours)

  • Palpable rashes, such as vasculitic (HSP) purpura
  • Polymorphous rashes with mixed shapes and colours (pink, purple, brown), which suggest an abnormal immune reaction (e.g. erythema multiforme, Kawasaki, drug reaction)
  • Non-blanching rash in a well, afebrile child (ITP, leukaemia, NAI)

primary care

  • Blanching rash with normal vitals: mostly viral exanthems (over 200 viruses can cause one)
  • Papular delayed-hypersensitivity rashes (insect bites, pityriasis rosea)
  • Harmless in themselves; they often come to the ED for another reason

Red flags — what each should make you think

Non-blanching rash + fever or unwellmeningococcal sepsis Lip / tongue swelling, stridor, wheezeanaphylaxis Painful skin, blisters, skin sliding offSJS/TEN or SSSS Sore eyes + mouth ulcers + rashSJS / mucositis Erythroderma + shocktoxic shock syndrome Punched-out sores on eczemaeczema herpeticum Fever ≥5 days + red eyes, lips, handsKawasaki disease Bruises that don't fit the storynon-accidental injury Vesicles in a baby under 6 weeksneonatal HSV Bruise in a non-mobile babyNAI or bleeding disorder
🩺
Pearl

Three habits make you good at rashes. Use a good light. Carry a magnifying glass (3–5×). And always look in the mouth, even if the parents say there's nothing there. Koplik spots, ulcers and a strawberry tongue have each made a diagnosis on their own.

If they're in the "act now" group — ABCDE first, the diagnosis can wait

  • AAirwayangioedema or stridor → IM adrenaline now (anaphylaxis); get anaesthetics if the airway is at risk
  • BBreathingoxygen, look for wheeze
  • CCirculationIV/IO access, cultures, gas and lactate, fluid bolus if shocked
  • ℞Treat the likely killerpurpuric and unwell → IV ceftriaxone now; anaphylaxis → adrenaline
  • ☎Seniors and PICU earlyplus dermatology, ophthalmology or surgeons as the picture dictates
2

Ask the right questions, then describe what you see

history + visual cues

The focused rash history — seven questions

You don't have 40 minutes in the ED. Ask these seven every time:

  • Fever? Before, during or after the rash appeared?
  • Drugs? Anything in the last few weeks, especially antibiotics and anticonvulsants. Prescribed, bought or herbal.
  • Travel? Abroad, camping, forests (tick bites, Lyme disease).
  • Allergies or exposures? New foods, plants, chemicals, soaps, pets.
  • Contacts? Anyone at home, school or nursery with a similar rash (scabies, chickenpox, measles, mpox)?
  • Recent illness? Sore throat, cold or diarrhoea in the last 1–2 months. Some rashes are a delayed reaction to an earlier illness.
  • Associated features? Itch, pain, joint pain, abdominal pain, lymph nodes, liver or spleen, breathing or gut symptoms.

Also check vaccination status (measles, chickenpox), and whether vulnerable contacts at home (pregnant, newborn, immunocompromised) could be exposed.

Describe the rash — the four visual cues

  • 1 · Size and shape (morphology). What is each individual lesion? (See the glossary below.)
  • 2 · Distribution. Localised (one area) or generalised (more than two areas). Symmetric or asymmetric. Flexor or extensor surfaces. Central (trunk) or peripheral / acral (hands, feet, face). Discrete lesions or coalescing into patches.
  • 3 · Pattern. One type of lesion, or polymorphous (several types together)? Any shape: rings, target lesions, serpiginous lines, a "Christmas tree" along the skin lines of the back?
  • 4 · Colour. Pink, bright red, purple, brown, golden-yellow crust, or a mixture? Does it blanch (glass test)?

Darker skin: redness can look purple, brown or grey, and is easier to miss. Check the palms, soles, conjunctivae and mouth for petechiae, and feel for texture.

Glossary — the words that make your description useful

Flat

Macule
Flat colour change under 1 cm; you can't feel it.
Patch
A flat area over 1 cm.
Petechiae / purpura
Non-blanching bleeding into the skin: pinpoint (petechiae) or larger (purpura).

Raised & solid

Papule
Raised solid bump under 0.5 cm.
Nodule
Deeper or larger solid lump.
Plaque
Raised, flat-topped area over 1 cm.
Wheal
Raised oedematous lesion that comes and goes (urticaria).

Fluid-filled

Vesicle
Clear fluid, under 0.5 cm.
Bulla
Clear fluid, larger blister.
Pustule
Filled with pus.

Surface changes

Crust
Dried exudate on top (golden in impetigo).
Scale
Fine flakes of skin.
Erosion
Raw surface where a blister has burst.

Combine the terms: maculopapular (flat spots plus small bumps), papulovesicular (bumps plus blisters). A good description sounds like: "A generalised, symmetric, central, blanching, pink maculopapular rash, partly coalescing."

See examples: DermNet — terminology in dermatology ↗
3

The rashes you must not miss

tap to open each

What points toward it, what would rule it in, and how to manage it. Each card links to images.

Public health matters too

Measles is back in UK EDs as vaccination rates fall. Vaccinated children can still occasionally catch it. It is notifiable and very infectious, from shortly before the prodrome until 4 days after the rash appears. Isolate immediately, notify UKHSA, and identify vulnerable contacts. Scarlet fever, meningococcal disease and rubella are also notifiable. UKHSA — measles · images ↗

4

Reach a diagnosis — let the context decide

the algorithm
  • 1Abnormal vitals or airway?Yes → act now (stage 1). The exact diagnosis is secondary.
  • 2Does it blanch?No → the non-blanching pathway: meningococcal if febrile or unwell; ITP, leukaemia, HSP or NAI if well (stage 3).
  • 3Skin pain, blisters or mucosa involved?Yes → SJS/TEN, SSSS or eczema herpeticum until proven otherwise.
  • 4Describe the morphologyMaculopapular? Papular? Vesicular? Sandpaper? Wheals? This picks the branch below.
  • 5Add the contextFever, drugs, contacts, recent illness, itch, mouth lesions. The same-looking rash becomes a different diagnosis.
  • 6Look in the mouthKoplik spots → measles. Ulcers → HFMD or herpes. Strawberry tongue → scarlet fever or Kawasaki.
🩺
Pearl

Many rashes look almost the same; even a dermatologist couldn't separate them from a photo without a biopsy. What separates them is the context. Change one answer in the history (a new drug, a sibling with the same rash, ulcers in the mouth) and the diagnosis changes completely. That's why the seven questions matter.

Branch A — a central maculopapular rash on the trunk

Viral exanthem

Context
Infant or preschooler, febrile for a few days, a sibling with a cold, no drugs except antipyretics.
Looks
Fine, pink, blanching maculopapular rash on the trunk, symmetric, partly coalescing.
Do
Reassure. Don't chase the exact virus, but check the mouth for Koplik spots and ask about MMR status.

Pityriasis rosea

Context
Older child or teenager, afebrile and well, no drugs, often a minor illness weeks earlier, or a mild prodrome (malaise, headache, low-grade fever). The rash spreads over 24–48 hours.
Looks
Pink, oval, slightly scaly macules and papules on the back in a Christmas-tree pattern, sometimes after a single larger "herald patch".
Do
Reassure. It's self-limiting but takes 6–10 weeks to clear, so don't promise days. Emollients and antihistamine if itchy. In a sexually active teenager with palm or sole involvement, think of secondary syphilis.

Drug eruption

Context
Same-looking rash, but a drug started 4–14 days earlier (classically an antibiotic; amoxicillin with glandular fever).
Looks
Widespread symmetric morbilliform rash, often itchy.
Do
Stop the likely drug and document it. If bloods are done, eosinophilia is common. Check for danger features: mucosal involvement, blistering, facial swelling, fever or lymph nodes → SJS or DRESS (stage 3).

Branch B — a peripheral papular rash (limbs, hands, feet): same look, different story

Papular urticaria

Context
Itchy, no contacts. Pets, camping or summer. Often no remembered bite.
Looks
Crops of firm papules on exposed limbs, sometimes with a central punctum.
Do
A delayed reaction to insect or flea bites. Antihistamine, mild topical steroid, treat pets. Lesions can recur for months.

Scabies

Context
Itchy, and others at home are itchy too; worse at night.
Looks
Papules and burrows in finger webs, wrists, axillae and genitals. Infants can have it on the palms, soles and scalp.
Do
Permethrin 5% for the whole household on the same day, repeated after 7 days. Wash bedding. The itch can last weeks after cure.

Gianotti–Crosti

Context
Usually not very itchy, no contacts, often after a viral illness (EBV and others). Child well.
Looks
Symmetric firm papules on the face, buttocks and extensor limbs; spares the trunk.
Do
Reassure. Self-limiting, but can last several weeks.

Hand, foot & mouth

Context
Same peripheral spots, plus mouth ulcers. Under 5, mild fever, sore mouth, off food.
Looks
Grey oval vesicles on the palms and soles (often the buttocks too), with ulcers on the tongue and buccal mucosa.
Do
Coxsackievirus. Fluids and analgesia; antibiotics won't help. Check hydration. No need to exclude a well child from nursery.

Dermatitis herpetiformis

Context
Very itchy, no contacts, recurrent diarrhoea or poor growth (may have no gut symptoms). Rare in children.
Looks
Grouped papulovesicles and scratched erosions on the extensor surfaces: elbows, knees, buttocks.
Do
The skin sign of coeliac disease. Refer for coeliac serology (tTG-IgA plus total IgA) and to paediatrics or dermatology. Treated with a gluten-free diet (± dapsone, specialist only).

Branch C — the other common ones you'll see on a shift

Chickenpox

Looks
Itchy crops of papules → vesicles → crusts, all stages at once, starting on the trunk and scalp.
Infectious
From 2 days before the rash until all spots have crusted (about 5 days). Incubation 10–21 days.
Do
Supportive. Avoid ibuprofen (linked to severe skin infection). Off nursery until all lesions have crusted. Watch for complications: secondary bacterial infection (including iGAS), pneumonitis, cerebellar ataxia, encephalitis. Higher risk in neonates, the immunocompromised, adolescents and adults: consider aciclovir and seek advice. Pregnant or immunocompromised contacts should urgently contact their midwife or GP for immunity checks and possible prophylaxis.

Scarlet fever

Looks
Sore throat and fever, then a fine sandpaper rash worse in the flexures, flushed cheeks with pale skin around the mouth, strawberry tongue; peels later.
Timeline
Peak age 4–8. Sudden fever, sore throat, headache and vomiting; the rash appears 12–48 h later, starting on the neck and chest, and fades by about day 6. Peeling of the armpits, groin and fingertips can continue for weeks.
Do
Phenoxymethylpenicillin for 10 days. Notifiable. Off school until 24 h after starting antibiotics. Complications: otitis media, sinusitis, quinsy or retropharyngeal abscess, cervical adenitis; later rheumatic fever or glomerulonephritis. Warn about iGAS red flags.

Roseola

Looks
Age 6 months–3 years (HHV-6/7). 3–4 days of high fever, then, as the fever suddenly settles, a blanching pink rash on the neck and trunk spreading outward. The child often looks well, playing in the waiting room.
Do
Reassure. A common cause of febrile convulsions.

Urticaria

Looks
Itchy wheals that move about and fade within 24 h (mark one with a pen). Usually triggered by a viral infection in children.
Do
Non-sedating antihistamine. Always check for anaphylaxis features first.

Impetigo

Looks
Golden honey-coloured crusts, often around the nose and mouth; sometimes bullous.
Do
Localised: hydrogen peroxide 1% cream (or topical antibiotic). Widespread or unwell: oral flucloxacillin. Off school until lesions have crusted or 48 h after antibiotics.

HSP (IgA vasculitis)

Looks
Palpable purpura on the buttocks and backs of the legs, often with joint pain, colicky abdominal pain, or blood in the urine.
Also
Large-joint pain and swelling (usually settles in days); painful oedema of the scrotum, hands, feet or sacrum. Haematuria is very common but usually transient; nephritis can appear weeks later.
Do
Check BP, urine dip and FBC (normal platelets) ± U&E and clotting. Analgesia, mostly supportive. Arrange urine and BP follow-up for the kidneys. Examine the abdomen carefully: watch for intussusception, GI bleeding and, rarely, perforation.

Branch D — the classic childhood exanthems, side by side

Measles

Story
2–3 days of fever, coryza, cough and conjunctivitis; a miserable child. Incubation about 10 days. Late winter to spring.
Looks
Koplik spots (white dots on the buccal mucosa opposite the molars) before the rash. Then a blanching maculopapular rash starting on the face and behind the ears, spreading down and out.
Watch
Fever persisting past day 3–4 of the rash suggests a complication: otitis media, pneumonia, croup, encephalitis, myocarditis. SSPE can follow years later.
Do
Isolate, notify, PCR swab. Off school for 4 days from the rash. Identify vulnerable contacts.

Rubella

Story
Unvaccinated child or teenager. Mild or absent prodrome in children; teenagers get fever, sore throat and malaise. Up to half of infections cause no symptoms. Incubation 2–3 weeks.
Looks
Pinpoint pink maculopapules starting on the face and generalising within 24 h. Tender occipital and post-auricular lymph nodes. Joint pain in older children.
Do
Supportive. Notifiable. Infectious from about a week before to a few days after the rash, so keep away from pregnant women (congenital rubella).

Slapped cheek (parvovirus B19)

Story
School-age child, a mild illness a few days ago, now well.
Looks
Bright red cheeks, then a lacy, reticular rash on the limbs. It can be itchy, especially the soles.
Do
Reassure. Not infectious once the rash appears, so no exclusion. Pregnant contacts need testing and follow-up (risk of fetal anaemia), so advise them to contact their midwife or GP. Children with haemolytic anaemia (e.g. sickle cell) can have an aplastic crisis.

Shingles in a child

Story
Painful vesicles in one dermatome, low-grade fever, otherwise well. More likely if the child had chickenpox in utero or as an infant; little or no prodrome in children.
Do
Usually mild in a healthy child. Consider aciclovir if immunocompromised, very young, or the eye is involved (ophthalmic division → ophthalmology). Lesions are infectious to non-immune contacts until crusted.

Glandular fever (EBV)

Story
Teenager with fever, exudative tonsillitis and big lymph nodes, sometimes palatal petechiae and splenomegaly.
Looks
Occasionally its own rash. Classically a widespread itchy maculopapular rash 7–10 days after amoxicillin (or another beta-lactam) given for the "tonsillitis".
Do
Stop the antibiotic. It's a reaction to the drug during EBV infection, not usually a true penicillin allergy; discuss with a senior before labelling the child allergic. Advise no contact sports for a few weeks (splenic rupture risk).

Branch E — the newborn with spots (first weeks of life)

🩺
Pearl

Most newborn spots are benign and need only reassurance. Exhausted parents need a confident explanation. Two rules: vesicles in a neonate are herpes until proven otherwise, and any rash in a baby who is quiet, feeding poorly, or hot or cold is sepsis until proven otherwise.

Erythema toxicum neonatorum

Looks
Red blotches with small yellow-white papules or pustules on the trunk and proximal limbs; spares the palms and soles. Appears in the first 1–2 days, comes and goes.
Do
The commonest newborn pustular rash (up to 70% of term babies). Well baby → reassure; it settles within about a week. If the baby is unwell, or the pustules are on the palms and soles, think infection.

Milia

Looks
Tiny 1–2 mm white-yellow papules across the nose and face. The same thing on the palate is called Bohn's nodules or Epstein's pearls, and on the gums, gingival cysts.
Do
Retained keratin. Reassure: they clear by themselves within weeks. Don't squeeze.

Sucking blisters

Looks
Oval, thick-walled blisters or erosions on the lips, or on the back of a hand, finger or wrist, in a well baby who sucks a lot.
Do
A diagnosis of exclusion. Only reassure once you're confident it isn't HSV or a bullous infection.

Harlequin colour change

Looks
Lying on one side, the lower half of the body goes red and the upper half pale, with a sharp line down the middle. It fades within minutes (up to about 20), and goes when the baby cries or moves.
Do
Benign (about 1 in 10 newborns). Reassure. Not the same as the very rare harlequin ichthyosis.

Congenital dermal melanocytosis

Looks
Flat blue-grey patches with blurred edges, often large, over the sacrum, buttocks or shoulders. Present from birth; does not change colour over days like a bruise does. Commoner in babies with darker skin.
Do
Benign, fades over the first years. Document it clearly (site, size, photo with consent) so it isn't later mistaken for abuse. If you're not sure it isn't a bruise in a non-mobile baby → senior review for NAI or a bleeding disorder.
5

Investigate — most rashes need none

test with a question in mind

Non-blanching rash

Bloods
FBC and film, CRP, clotting, blood cultures, meningococcal PCR, gas and lactate.
Tells you
Sepsis vs low platelets vs leukaemia.

Purpura in a well child (HSP)

Do
BP, urine dip (± protein:creatinine ratio), FBC, U&E.
Tells you
Kidney involvement, and that platelets are normal.

Suspected drug reaction

Do
FBC (eosinophils), LFT, U&E if the child is unwell or has a fever.
Tells you
Simple rash vs DRESS.

Swabs

Viral PCR
HSV (eczema herpeticum); measles (throat swab, liaise with UKHSA).
Bacterial
Impetigo not responding; throat swab if needed for scarlet fever; the source in TSS or SSSS.

Neonate with vesicles or unwell

Do
Full septic screen with LP; HSV PCR of vesicle, blood and CSF; LFTs. Start aciclovir and antibiotics while waiting.

Kawasaki

Do
FBC, CRP / ESR, LFT and albumin, urine, echocardiogram.

Outpatient tests

DH
Coeliac serology (tTG-IgA plus total IgA), via GP or paediatrics.
Skin biopsy
Dermatology decision; rarely needed acutely except SJS/TEN.

Don't over-investigate

A well child with a blanching viral exanthem, pityriasis rosea, papular urticaria or Gianotti–Crosti needs a confident diagnosis and an explanation, not a blood test. Bloods in a drug rash often just show a raised white count or eosinophils, which can worry everyone without changing the plan.

6

How the plan comes together

disposition · safety net

home

Blanching rash, normal vitals, confident benign diagnosis (viral exanthem, roseola, slapped cheek, pityriasis rosea, papular urticaria, Gianotti–Crosti, HFMD, urticaria, benign newborn spots).

Tell them how long it lasts (days for most viral rashes, weeks for pityriasis rosea and Gianotti–Crosti).

same-day review

Palpable or polymorphous rashes, a non-blanching rash in a well child, a suspected drug reaction with any systemic feature, or possible Kawasaki → senior or paediatric review today.

admit / resus

Non-blanching rash and unwell, anaphylaxis, SJS/TEN, SSSS, TSS, eczema herpeticum, DRESS, any neonate with vesicles or who is unwell.

Hand over: vitals, rash description, drugs given and times, specialties contacted.

Infection control & school

  • Measles — isolate in the ED; off nursery or school for 4 days after the rash appears; notifiable
  • Chickenpox — until all spots have crusted over
  • Scarlet fever — until 24 h after starting antibiotics; notifiable
  • Impetigo — until lesions crust or 48 h after antibiotics
  • Scabies — can return after the first treatment
  • Rubella — notifiable; keep away from pregnant women while infectious
  • HFMD, slapped cheek, roseola — no exclusion needed if the child is well
  • Pregnant contacts of chickenpox, slapped cheek, rubella or measles → advise them to contact their midwife or GP promptly
Source: UKHSA — health protection in children's settings

Safety-netting — teach the glass test

  • Press a clear glass on the rash. If the spots don't fade, come straight back (999 if the child is unwell)
  • Come back if the child becomes drowsy, floppy, breathless, very pale or mottled, or stops drinking
  • Come back if the skin becomes painful or blisters, or the eyes or mouth become sore
  • Come back if a fever lasts 5 days or more
  • For drug rashes: stop the drug, and tell the GP to record the reaction
🩺
Pearl

Sort the urgency, ask the seven questions, describe what you see, look in the mouth, then let the context make the diagnosis. Parents mostly want to know three things: is it dangerous, is it catching, and how long will it last? Answer all three. Nicely done getting here.

✎

Clerking template

copy or download

The child with a rash — documentation structure

A structure and prompt list to help you document and think systematically. It is not a completeness check and cannot guarantee nothing is missed — use your trust's own proforma, your seniors, and your clinical judgement. Content is AI-generated and not yet fully reviewed.

CHILD WITH A RASH — CLERKING TEMPLATE AGE: WEIGHT (kg): Accompanied by: PRESENTING COMPLAINT: NEONATE (< 6 weeks)? Y / N Birth history / maternal HSV / GBS: Cold sores in family or visitors (last 6 weeks): Feeding / temperature (low or high) / tone: URGENCY: ACT NOW / ACT SOON / PRIMARY CARE FOCUSED RASH HISTORY Onset / where it started / how it spread: Itchy / painful: Fever (before / during / after rash): Drugs in last 8 weeks (incl. OTC / herbal): Travel / camping / tick bites: Allergies / new exposures (food, plants, chemicals, pets): Contacts with similar rash (home / nursery / school): Recent illness (1-2 months): Associated features (joints, abdo pain, D&V, cough, eyes, mouth): Immunisations up to date (MMR / varicella): Y / N Vulnerable contacts (pregnant / newborn / immunocompromised): RED FLAGS ASKED (record present or absent) [ ] Non-blanching rash + fever / unwell -> meningococcal [ ] Lip / tongue swelling, stridor, wheeze -> anaphylaxis [ ] Painful skin / blisters / peeling -> SJS/TEN, SSSS [ ] Mucosal involvement (eyes / mouth / genitals) [ ] Erythroderma + shock / recent burn -> TSS [ ] Eczema suddenly worse, punched-out -> eczema herpeticum [ ] Fever >= 5 days -> Kawasaki [ ] Bruising pattern / story inconsistent -> safeguarding [ ] Vesicles in a neonate / quiet baby -> neonatal HSV (aciclovir) [ ] Bruise-like mark in non-mobile baby -> senior review PAST MEDICAL HISTORY (eczema, immunocompromise): DRUG HISTORY: ALLERGIES: SOCIAL HISTORY / SAFEGUARDING: OBSERVATIONS: Temp HR RR SpO2 CRT BP AVPU BM PEWS RASH DESCRIPTION Morphology (macule / papule / vesicle / pustule / wheal / plaque / purpura): Distribution (localised / generalised; symmetric / asymmetric; flexor / extensor; central / peripheral; discrete / coalescing): Pattern (single type / polymorphous; rings, targets, Christmas tree): Colour: Blanches on glass test: Y / N Nikolsky sign: +ve / -ve / not tested MOUTH (Koplik / ulcers / strawberry tongue): Eyes: Genitals: Lymph nodes / liver / spleen / joints: INVESTIGATIONS (with indication): IMPRESSION: DIFFERENTIALS CONSIDERED: [ ] Viral exanthem [ ] Drug eruption [ ] Pityriasis rosea [ ] Papular urticaria [ ] Scabies [ ] Gianotti-Crosti [ ] HFMD / chickenpox [ ] Scarlet fever [ ] Urticaria / anaphylaxis [ ] Impetigo [ ] HSP [ ] ITP / leukaemia [ ] Meningococcal [ ] SJS/TEN / SSSS / TSS [ ] Eczema herpeticum [ ] Kawasaki / DRESS [ ] Measles (notify!) [ ] NAI [ ] Rubella [ ] Slapped cheek [ ] Roseola [ ] Shingles [ ] EBV / amoxicillin rash NEONATAL: [ ] Erythema toxicum [ ] Milia [ ] Sucking blisters [ ] Dermal melanocytosis (documented) [ ] Neonatal HSV TREATMENT GIVEN (drug / dose / time): PLAN: 1. 2. 3. NOTIFIABLE? Y / N Isolation needed? Y / N PREGNANT / IMMUNOCOMPROMISED CONTACTS ADVISED? Y / N / NA ESCALATION / SENIOR DISCUSSION: Discussed with: Time: Advice: DISPOSITION: Discharge / Same-day review / Admit SAFETY NET GIVEN (glass test taught, school exclusion advice): Documented by: Grade: Date/Time: