DVBCWDI7 ;ALB/RLC DIABETES MELLITUS WKS TEXT - 1 ; 24 MAY 2004
;;2.7;AMIE;**164**;Apr 10, 1995;Build 2
;
;
TXT ;
;;When a Diabetes Mellitus examination is requested, begin with this
;;worksheet. For each diabetic complication manifested by the veteran,
;;complete appropriate additional worksheets.
;;
;;Chronic complications from diabetes include vascular and nonvascular
;;complications. Vascular complications include microvascular
;;(eye disease, neuropathy, nephropathy) and macrovascular complications
;;(coronary artery disease, peripheral vascular disease, cerebrovascular
;;disease). Nonvascular complications include gastroparesis, sexual
;;dysfunction, and skin changes.
;;
;;Reference: Harrison's Principles of Internal Medicine, 2001, page 2119.
;;
;;
;;A. Review of Medical Records:
;;
;;B. Medical History (Subjective Complaints):
;;
;; As pertains to Diabetes Mellitus or its complications, comment on:
;;
;; 1. Age of onset.
;; 2. Details of hospitalizations or surgery due to diabetes.
;; 3. History of trauma to pancreas.
;; 4. If a neoplasm is or was present, state whether benign or malignant
;; and provide:
;;
;; a. Exact diagnosis and date of confirmed diagnosis, location of
;; neoplasm.
;; b. Types and dates of treatment.
;; c. For malignant neoplasm, also state exact date of the last
;; surgical, X-ray, antineoplastic chemotherapy, radiation, or other
;; therapeutic procedure.
;; d. State expected date treatment regimen is to be completed. If
;; treatment is already completed, provide date of last treatment
;; and fully describe residuals.
;;
;; 5. State whether veteran is being treated for hypertension. If so,
;; state date of diagnosis of hypertension, if known.
;; 6. State whether there are episodes of ketoacidosis or hypoglycemic
;; reactions, and state frequency per year of hospitalizations needed
;; to treat them (less than one per year, 1-2 per year, more than 2 per
;; year) and frequency of visits to a diabetic care provider they
;; require (weekly, 2-3 times per month, or monthly or less often).
;; 7. State whether veteran has been told to follow restricted or special
;; diet.
;; 8. Describe what regulation of activities, if any, is needed due to
;; diabetes (e.g., avoiding strenuous activity to prevent hypoglycemic
;; reactions).
;; 9. Treatment - oral hypoglycemic, insulin (frequency of injections).
;; 10. Other symptoms, such as anal pruritus, loss of strength.
;; 11. Visual symptoms. Refer to Eye examination worksheet, if indicated.
;; 12. Vascular (including peripheral vascular) and cardiac symptoms.
;; Refer to cardiovascular examinations worksheet(s): Hypertension,
;; Heart, Arteries, Veins, and Misc., etc., if indicated.
;; 13. Neurologic symptoms. Refer to neurologic examination worksheet(s):
;; Peripheral Nerves, etc., if indicated.
;; 14. Bladder or bowel symptoms. Refer to examination worksheet(s):
;; Genitourinary, Rectum and Anus exam, etc., if indicated.
;; 15. Symptoms of diabetic nephropathy, diabetes-related skin problems,
;; gastrointestinal symptoms, etc. Follow additional examination
;; worksheets, as indicated.
;; 16. Course since onset (stable, progressively worse, improved,
;; intermittent with remissions, etc.).
;;
;;C. Physical Examination (Objective Findings):
;;
;; Assess for all chronic complications of diabetes mellitus found or suggested
;; by history. Complete appropriate additional worksheets as indicated.
;;
;; 1. Weight loss or gain (percent of change) since last exam.
;; 2. Eye examination. NOTE: Positive eye signs or symptoms require an
;; examination by a vision specialist.
;; 3. Cardiovascular examination: include blood pressure x3, heart rate,
;; rhythm, PMI, abnormal heart sounds, signs of congestive heart
;; failure, breath sounds. NOTE: A determination of METs by exercise
;; testing may be required for certain conditions. Follow Heart
;; examination worksheet when there is an indication of heart disease.
;; 4. Examination of extremities, including feet: report status of
;; peripheral arteries, peripheral edema, trophic changes, ulcers, etc.
;; 5. Neurologic examination, including motor, sensory, and reflex
;; examinations.
;; 6. Skin examination.
;; 7. If there is or was a neoplasm, describe residuals of the neoplasm
;; and its treatment.
;;
;;D. Diagnostic and Clinical Tests:
;;
;; Provide:
;;
;; 1. Fasting blood sugars or other laboratory evaluation, such as
;; glucose tolerance test, if necessary to establish the diagnosis.
;; 2. Blood glucose.
;; 3. Evaluation of renal function by: urinalysis with special test for
;; microalbumnuria, blood urea nitrogen (BUN), and creatinine (Cr).
;; 4. Other tests as necessary to confirm or evaluate complications.
;; Follow appropriate worksheets for guidance on the tests.
;; 5. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWDI7 5611 printed Oct 16, 2024@17:51:09 Page 2
DVBCWDI7 ;ALB/RLC DIABETES MELLITUS WKS TEXT - 1 ; 24 MAY 2004
+1 ;;2.7;AMIE;**164**;Apr 10, 1995;Build 2
+2 ;
+3 ;
TXT ;
+1 ;;When a Diabetes Mellitus examination is requested, begin with this
+2 ;;worksheet. For each diabetic complication manifested by the veteran,
+3 ;;complete appropriate additional worksheets.
+4 ;;
+5 ;;Chronic complications from diabetes include vascular and nonvascular
+6 ;;complications. Vascular complications include microvascular
+7 ;;(eye disease, neuropathy, nephropathy) and macrovascular complications
+8 ;;(coronary artery disease, peripheral vascular disease, cerebrovascular
+9 ;;disease). Nonvascular complications include gastroparesis, sexual
+10 ;;dysfunction, and skin changes.
+11 ;;
+12 ;;Reference: Harrison's Principles of Internal Medicine, 2001, page 2119.
+13 ;;
+14 ;;
+15 ;;A. Review of Medical Records:
+16 ;;
+17 ;;B. Medical History (Subjective Complaints):
+18 ;;
+19 ;; As pertains to Diabetes Mellitus or its complications, comment on:
+20 ;;
+21 ;; 1. Age of onset.
+22 ;; 2. Details of hospitalizations or surgery due to diabetes.
+23 ;; 3. History of trauma to pancreas.
+24 ;; 4. If a neoplasm is or was present, state whether benign or malignant
+25 ;; and provide:
+26 ;;
+27 ;; a. Exact diagnosis and date of confirmed diagnosis, location of
+28 ;; neoplasm.
+29 ;; b. Types and dates of treatment.
+30 ;; c. For malignant neoplasm, also state exact date of the last
+31 ;; surgical, X-ray, antineoplastic chemotherapy, radiation, or other
+32 ;; therapeutic procedure.
+33 ;; d. State expected date treatment regimen is to be completed. If
+34 ;; treatment is already completed, provide date of last treatment
+35 ;; and fully describe residuals.
+36 ;;
+37 ;; 5. State whether veteran is being treated for hypertension. If so,
+38 ;; state date of diagnosis of hypertension, if known.
+39 ;; 6. State whether there are episodes of ketoacidosis or hypoglycemic
+40 ;; reactions, and state frequency per year of hospitalizations needed
+41 ;; to treat them (less than one per year, 1-2 per year, more than 2 per
+42 ;; year) and frequency of visits to a diabetic care provider they
+43 ;; require (weekly, 2-3 times per month, or monthly or less often).
+44 ;; 7. State whether veteran has been told to follow restricted or special
+45 ;; diet.
+46 ;; 8. Describe what regulation of activities, if any, is needed due to
+47 ;; diabetes (e.g., avoiding strenuous activity to prevent hypoglycemic
+48 ;; reactions).
+49 ;; 9. Treatment - oral hypoglycemic, insulin (frequency of injections).
+50 ;; 10. Other symptoms, such as anal pruritus, loss of strength.
+51 ;; 11. Visual symptoms. Refer to Eye examination worksheet, if indicated.
+52 ;; 12. Vascular (including peripheral vascular) and cardiac symptoms.
+53 ;; Refer to cardiovascular examinations worksheet(s): Hypertension,
+54 ;; Heart, Arteries, Veins, and Misc., etc., if indicated.
+55 ;; 13. Neurologic symptoms. Refer to neurologic examination worksheet(s):
+56 ;; Peripheral Nerves, etc., if indicated.
+57 ;; 14. Bladder or bowel symptoms. Refer to examination worksheet(s):
+58 ;; Genitourinary, Rectum and Anus exam, etc., if indicated.
+59 ;; 15. Symptoms of diabetic nephropathy, diabetes-related skin problems,
+60 ;; gastrointestinal symptoms, etc. Follow additional examination
+61 ;; worksheets, as indicated.
+62 ;; 16. Course since onset (stable, progressively worse, improved,
+63 ;; intermittent with remissions, etc.).
+64 ;;
+65 ;;C. Physical Examination (Objective Findings):
+66 ;;
+67 ;; Assess for all chronic complications of diabetes mellitus found or suggested
+68 ;; by history. Complete appropriate additional worksheets as indicated.
+69 ;;
+70 ;; 1. Weight loss or gain (percent of change) since last exam.
+71 ;; 2. Eye examination. NOTE: Positive eye signs or symptoms require an
+72 ;; examination by a vision specialist.
+73 ;; 3. Cardiovascular examination: include blood pressure x3, heart rate,
+74 ;; rhythm, PMI, abnormal heart sounds, signs of congestive heart
+75 ;; failure, breath sounds. NOTE: A determination of METs by exercise
+76 ;; testing may be required for certain conditions. Follow Heart
+77 ;; examination worksheet when there is an indication of heart disease.
+78 ;; 4. Examination of extremities, including feet: report status of
+79 ;; peripheral arteries, peripheral edema, trophic changes, ulcers, etc.
+80 ;; 5. Neurologic examination, including motor, sensory, and reflex
+81 ;; examinations.
+82 ;; 6. Skin examination.
+83 ;; 7. If there is or was a neoplasm, describe residuals of the neoplasm
+84 ;; and its treatment.
+85 ;;
+86 ;;D. Diagnostic and Clinical Tests:
+87 ;;
+88 ;; Provide:
+89 ;;
+90 ;; 1. Fasting blood sugars or other laboratory evaluation, such as
+91 ;; glucose tolerance test, if necessary to establish the diagnosis.
+92 ;; 2. Blood glucose.
+93 ;; 3. Evaluation of renal function by: urinalysis with special test for
+94 ;; microalbumnuria, blood urea nitrogen (BUN), and creatinine (Cr).
+95 ;; 4. Other tests as necessary to confirm or evaluate complications.
+96 ;; Follow appropriate worksheets for guidance on the tests.
+97 ;; 5. Include results of all diagnostic and clinical tests conducted
+98 ;; in the examination report.
+99 ;;
