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Routine: DVBCWEA7

DVBCWEA7.m

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DVBCWEA7 ;ALB/RLC - EATING DISORDERS WKS TEXT - 1 ; 12/26/06 14:00pm

 ;;2.7;AMIE;**170**;Apr 10, 1995;Build 1

 ;Per VHA Directive 10-92-142, this routine should not be modified

 ;

TXT ;

 ;;

 ;;The following health care providers can perform initial examinations for

 ;;Eating Disorders:

 ;;a board-certified or board "eligible" psychiatrist;

 ;;a licensed doctorate-level psychologist;

 ;;a doctorate-level mental health provider under the close supervision of a

 ;;board-certified or board eligible psychiatrist or licensed doctorate-level

 ;;psychologist;

 ;;a psychiatry resident under close supervision of a board-certified or

 ;;board eligible psychiatrist or licensed doctorate-level psychologist;

 ;;or a clinical or counseling psychologist completing a one-year internship

 ;;or residency (for purposes of a doctorate-level degree) under close

 ;;supervision of a board-certified or board eligible psychiatrist or licensed

 ;;doctorate-level psychologist.

 ;;

 ;;The following health care providers can perform review examinations for

 ;;Eating Disorders:

 ;;a board-certified or board "eligible" psychiatrist;

 ;;a licensed doctorate-level psychologist;

 ;;a doctorate-level mental health provider under the close supervision of a

 ;;board-certified or board eligible psychiatrist or doctorate-level

 ;;psychologist;

 ;;a psychiatry resident under close supervision of a board-certified or 

 ;;board eligible psychiatrist or licensed doctorate-level psychologist;

 ;;a clinical or counseling psychologist completing a one year internship or

 ;;residency (for purposes of a doctorate-level degree) under close

 ;;supervision of a board-certified or board eligible psychiatrist or licensed

 ;;doctorate-level psychologist;

 ;;a licensed clinical social worker (LCSW) or

 ;;a nurse practitioner, a clinical nurse specialist or physician assistant,

 ;;if they are clinically privileged to perform activities required for C&P

 ;;mental disorder examinations, under close supervision of a board-certified

 ;;or board eligible psychiatrist or licensed doctorate-level psychologist.

 ;;

 ;;A. Review of Medical Records:

 ;;

 ;;

 ;;B. Medical History (Subjective Complaints):

 ;;

 ;;Review examination.  If this is a review examination for an already service-

 ;;connected eating disorder, provide the medical and occupational history since

 ;;the last medical examination.  Otherwise, follow the history requirements below.

 ;;

 ;;   Comment on:

 ;;

 ;;   1.  Onset.  Date of onset of condition, and circumstances and initial

 ;;       manifestations.

 ;;   2.  Course of condition since onset.

 ;;   3.  Treatment.  Current treatment, response to treatment, and any side

 ;;       effects.

 ;;   4.  Hospitalizations or surgery.  History of related hospitalizations or

 ;;       surgery, dates and locations, if known, reason or type of surgery.

 ;;   5.  State number of hospitalizations required per year for parenteral

 ;;       nutrition or tube feeding.

 ;;   6.  Periods of incapacitation.  State whether there have been periods of

 ;;       incapacitation (requiring bed rest and treatment by a physician) because

 ;;       of an eating disorder.  If so, state the frequency and duration of the

 ;;       episodes (in days) and the total duration of days of incapacitation

 ;;       during the past 12-month period.

 ;;   7.  Binge eating.  State whether there is a history of binge eating.  If

 ;;       there is, state frequency and extent over the past 12-month period.

 ;;   8.  Self-induced vomiting.  State if there is a history of self-induced

 ;;       vomiting or other measure to prevent weight gain when weight is already

 ;;       below expected minimum normal weight.  If so, state frequency and extent

 ;;       over past 12-month period.

 ;;   9.  Other current symptoms.  Report other current (during past 12 months)

 ;;       symptoms of an eating disorder, such as amenorrhea, abdominal pain,

 ;;       lethargy, cold intolerance, disturbance in perception of body shape or

 ;;       size, etc., and other significant history.

 ;;

 ;;C. Examination (Objective Findings):

 ;;

 ;;   Address each of the following and fully describe:

 ;;

 ;;   1.  Weight-related issues.

 ;; 

 ;;       a.  Current weight and height.

 ;;       b.  Expected minimum weight based on age, height, and body build.

 ;;       c.  Pertinent weight history.

 ;;       d.  Percent of weight loss or gain compared to baseline (average weight

 ;;           in the 2 years preceding onset of the condition).

 ;;

 ;;   2.  Other significant findings on physical examination. 

 ;; 

 ;;D. Diagnostic and Clinical Tests

 ;;

 ;;   1.  Conduct psychological testing if deemed necessary.

 ;;

 ;;   2.  CBC, blood chemistry, EKG, renal function tests, or other studies, as

 ;;       indicated.

 ;;

 ;;   3.  Include results of all diagnostic and clinical tests conducted in the 

 ;;       examination report.

 ;;

 ;;E. Diagnosis:

 ;;

 ;;   1.  State whether the DSM-IV criteria for a diagnosis of anorexia nervosa

 ;;       have been met.

 ;;   2.  State whether the DSM-IV criteria for a diagnosis of bulimia nervosa

 ;;       have been met.

 ;;   3.  State whether the DSM-IV criteria for a diagnosis of eating disorder

 ;;       not otherwise specified have been met.

 ;;   4.  State any comments on the DSM-IV criteria.

 ;;   5.  For each diagnosis, state effects of the condition on occupational

 ;;       functioning and daily activities.

 ;;   6.  Capacity to handle financial affairs.  Mental competency, for VA

 ;;       benefits purposes, refers only to the ability of the veteran to manage

 ;;       VA benefit payments in his or her own best interest, and not to any

 ;;       other subject.  Mental incompetency, for VA benefits purposes, means

 ;;       that the veteran, because of injury or disease, is not capable of

 ;;       managing benefit payments in his or her own best interest.  In order to

 ;;       assist raters in making a legal determination as to competency, please

 ;;       address the following:

 ;;

 ;;         What is the impact of injury or disease on the veteran's ability to

 ;;         manage his or her financial affairs, including consideration of such

 ;;         things as knowing the amount of his or her VA benefit payment,

 ;;         knowing the amounts and types of bills owed monthly, and handling

 ;;         the payment prudently?  Does the veteran handle the money and pay the

 ;;         bills himself or herself?

 ;;

 ;;         Based on your examination, do you believe that the veteran is capable

 ;;         of managing his or her financial affairs?  Please provide examples to

 ;;         support your conclusion.

 ;;

 ;;         If you believe a Social Work Service assessment is needed before you

 ;;         can give your opinion on the veteran's ability to manage his or her

 ;;         financial affairs, please explain why.

 ;;

 ;;Include your name; your credentials, (i.e., board certified psychiatrist,

 ;;licensed psychologist; psychiatry resident or psychology intern,

 ;;LCSW, or NP); and circumstances under which you performed the examination,

 ;;if applicable (i.e., under the close supervision of an attending

 ;;psychiatrist or psychologist); name of supervising psychiatrist or

 ;;psychologist, if applicable.

 ;;

 ;;

 ;;Signature:                                            Date:

 ;;

 ;;

 ;;Signature of Supervising

 ;;  Psychiatrist or Psychologist:                       Date:

 ;;END