DVBCWDO1 ;ALB/CMM DENTAL AND ORAL WKS TEXT - 1 ; 5 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
TXT ;
;;Narrative: Regional Office action is required for all dental treatment
;;based on combat wounds, service trauma, prisoner of war or extracted
;;teeth under 38 CFR 17.123.
;;
;;A. Review of Medical Records:
;;
;;
;;B. Medical History (Subjective Complaints):
;;
;;
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following and fully describe:
;; 1. Describe extent of functional impairment due to loss of motion
;; and masticatory function loss.
;;
;;
;; 2. Describe the extent and number of missing teeth and whether
;; the masticatory surface can be replaced by a prosthesis.
;;
;;
;; 3. If limitation of inter-incisal range of motion, provide actual
;; range in mm (i.e., 0-Xmm) and also provide lateral excursion
;; (i.e., 0-Xmm).
;;
;;
;; 4. Describe the extent of any bone loss of mandible, maxilla, or
;; hard palate. For hard palate and maxilla bone loss, state
;; whether replaceable by prosthesis.
;;
;;
;;D. Diagnostic and Clinical Tests:
;;
;; Provide:
;; 1. X-ray to determine extent of bone tissue loss.
;; 2. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;TOF
;;E. Diagnosis:
;;
;; 1. Give etiology where there is loss of teeth due to loss of
;; substance of body of maxilla or mandible.
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWDO1 1652 printed Dec 13, 2024@01:50:26 Page 2
DVBCWDO1 ;ALB/CMM DENTAL AND ORAL WKS TEXT - 1 ; 5 MARCH 1997
+1 ;;2.7;AMIE;**12**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;Narrative: Regional Office action is required for all dental treatment
+2 ;;based on combat wounds, service trauma, prisoner of war or extracted
+3 ;;teeth under 38 CFR 17.123.
+4 ;;
+5 ;;A. Review of Medical Records:
+6 ;;
+7 ;;
+8 ;;B. Medical History (Subjective Complaints):
+9 ;;
+10 ;;
+11 ;;
+12 ;;C. Physical Examination (Objective Findings):
+13 ;;
+14 ;; Address each of the following and fully describe:
+15 ;; 1. Describe extent of functional impairment due to loss of motion
+16 ;; and masticatory function loss.
+17 ;;
+18 ;;
+19 ;; 2. Describe the extent and number of missing teeth and whether
+20 ;; the masticatory surface can be replaced by a prosthesis.
+21 ;;
+22 ;;
+23 ;; 3. If limitation of inter-incisal range of motion, provide actual
+24 ;; range in mm (i.e., 0-Xmm) and also provide lateral excursion
+25 ;; (i.e., 0-Xmm).
+26 ;;
+27 ;;
+28 ;; 4. Describe the extent of any bone loss of mandible, maxilla, or
+29 ;; hard palate. For hard palate and maxilla bone loss, state
+30 ;; whether replaceable by prosthesis.
+31 ;;
+32 ;;
+33 ;;D. Diagnostic and Clinical Tests:
+34 ;;
+35 ;; Provide:
+36 ;; 1. X-ray to determine extent of bone tissue loss.
+37 ;; 2. Include results of all diagnostic and clinical tests conducted
+38 ;; in the examination report.
+39 ;;
+40 ;;TOF
+41 ;;E. Diagnosis:
+42 ;;
+43 ;; 1. Give etiology where there is loss of teeth due to loss of
+44 ;; substance of body of maxilla or mandible.
+45 ;;
+46 ;;
+47 ;;Signature: Date:
+48 ;;END
