ü  A detailed description of pubertal status should be documented at least once yearly and include that the breast and genitalia (for girls) or genitalia alone (for boys) have been examined.

ü  Sexual Maturity Rating (SMR) documentation is recommended for both males and females.

-      In female patients, it is appropriate to document that the external genital anatomy is that of a normal female.

-      In male patients, it is appropriate to document that the genitalia are normal and specifically that both testes are scrotal.

-      Any anatomic variants or issues of early or delayed onset should be specifically described and a plan established for appropriate further evaluation.