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Routine: DVBCWCN3

DVBCWCN3.m

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DVBCWCN3 ;ALB/RLC CRANIAL NERVES WKS TEXT - 1 ; 12 FEB 2007

 ;;2.7;AMIE;**121**;Apr 10, 1995;Build 9

 ;

 ;

TXT ;

 ;;A.  Review of Medical Records:

 ;;

 ;;B.  Medical History (Subjective Complaints):

 ;;

 ;;    Comment on:

 ;;

 ;;    1.  Onset, course since onset.

 ;;    2.  Symptoms.

 ;;    3.  Current treatment, response, side effects.

 ;;    4.  Effects of condition on occupational functioning and daily activities.

 ;;    5.  History of hospitalizations or surgery, location and dates, if known,

 ;;        reason or type of surgery.

 ;;    6.  History of trauma to a cranial nerve, date, type, nerve.

 ;;    7.  History of neoplasm:

 ;;

 ;;        a.  Date of diagnosis, diagnosis.

 ;;        b.  Benign or malignant.

 ;;        c.  Types of treatment, dates.

 ;;        d.  Last date of treatment.

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;

 ;;    Address each of the following and fully describe current findings:

 ;;

 ;;    1.  Describe in detail specific motor and sensory impairment, quantifying

 ;;        as much as possible.

 ;;    2.  If smell or taste is affected, please also complete the appropriate

 ;;        worksheet.

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;

 ;;    1.  Include results of all diagnostic and clinical tests conducted

 ;;        in the examination report.

 ;;

 ;;E.  Diagnosis:

 ;;

 ;;    1.  Identify the nerve and the side.

 ;;    2.  Identify the disorder (i.e., paralysis, neuritis, neuralgia).

 ;;    3.  State etiology.

 ;;

 ;;

 ;;Signature:                             Date:

 ;;END