DVBCWFW3 ;ALB/RLC FEET WKS TEXT - 1 ; 16 JAN 2007
;;2.7;AMIE;**120**;Apr 10, 1995;Build 4
;
TXT ;
;;A. Review of Medical Records:
;;
;;B. Medical History (Subjective Complaints):
;;
;; Comment on:
;;
;; 1. Pain, weakness, stiffness, swelling, heat, redness,
;; fatigability, lack of endurance, etc.
;; 2. Describe symptoms at rest and on standing and walking.
;; 3. Treatment - type, dose, frequency, response, side effects.
;; 4. If there are periods of flare-up of joint disease:
;;
;; a. State their severity, frequency, and duration.
;; b. Name the precipitating and alleviating factors.
;; c. Estimate to what extent, if any, they result in additional
;; limitation of motion or functional impairment during the
;; flare-up. (Per veteran)
;;
;;
;; 5. Describe whether crutches, brace, cane, corrective shoes,
;; shoe inserts, etc., are needed and their efficacy.
;; 6. History of any hospitalization or surgery (Date, location, if known,
;; reason or type of surgery).
;; 7. Describe effects of the condition(s) on the veteran's usual
;; occupation and daily activities.
;; 8. Describe any injury to the feet.
;; 9. Functional limitations on standing (i.e., unable to stand, able
;; to stand 15-30 minutes) and walking (i.e., nonambulatory, able to
;; walk 1/4 mile).
;; 10. History of neoplasm:
;;
;; a. Date of diagnosis, diagnosis.
;; b. Benign or malignant.
;; c. Types and dates of treatment.
;; d. Date of last treatment.
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following as appropriate to the condition
;; being examined and fully describe current findings: A DETAILED
;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED.
;;
;; 1. Describe each foot separately. For nomenclature of toes use:
;; great toe, second, third, fourth, and fifth. The functional
;; loss should be related to the anatomical condition.
;; 2. Describe objective evidence of painful motion, edema,
;; instability, weakness, tenderness, etc.
;; 3. Describe gait.
;; 4. Describe any callosities, breakdown, or unusual shoe wear
;; pattern that would indicate abnormal weight bearing.
;; 5. Describe any skin and vascular changes.
;; 6. Describe hammertoes, high arch, clawfoot, or other deformity -
;; actively or passively correctable?
;; 7. For flatfoot
;;
;; a. Describe weight bearing and non-weight bearing alignment
;; of the Achilles tendon.
;; b. Describe whether the Achilles tendon alignment can be
;; corrected by manipulation and whether there is pain on
;; manipulation.
;; c. Describe degrees of valgus and whether correctable by
;; manipulation.
;; d. Describe extent of forefoot and midfoot malalignment and
;; whether correctable by manipulation.
;;
;; 8. For hallux valgus, describe angulation and dorsiflexion at
;; first metatarsal phalangeal joints.
;; 9. Is there any active motion in the metatarsophalangeal joint of
;; the great toe?
;;
;;D. Diagnostic and Clinical Tests:
;;
;; Comment on:
;;
;; 1. X-rays for flatfoot and clawfoot - weight bearing AP and
;; lateral views and non-weight bearing AP, lateral, and oblique
;; views, if none are of record or if of record and condition has or
;; may have progressed.
;; 2. For other conditions, AP, lateral, and oblique of entire foot,
;; as applicable.
;; 3. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;E. Diagnosis:
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWFW3 4017 printed Apr 09, 2024@20:58:51 Page 2
DVBCWFW3 ;ALB/RLC FEET WKS TEXT - 1 ; 16 JAN 2007
+1 ;;2.7;AMIE;**120**;Apr 10, 1995;Build 4
+2 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;B. Medical History (Subjective Complaints):
+4 ;;
+5 ;; Comment on:
+6 ;;
+7 ;; 1. Pain, weakness, stiffness, swelling, heat, redness,
+8 ;; fatigability, lack of endurance, etc.
+9 ;; 2. Describe symptoms at rest and on standing and walking.
+10 ;; 3. Treatment - type, dose, frequency, response, side effects.
+11 ;; 4. If there are periods of flare-up of joint disease:
+12 ;;
+13 ;; a. State their severity, frequency, and duration.
+14 ;; b. Name the precipitating and alleviating factors.
+15 ;; c. Estimate to what extent, if any, they result in additional
+16 ;; limitation of motion or functional impairment during the
+17 ;; flare-up. (Per veteran)
+18 ;;
+19 ;;
+20 ;; 5. Describe whether crutches, brace, cane, corrective shoes,
+21 ;; shoe inserts, etc., are needed and their efficacy.
+22 ;; 6. History of any hospitalization or surgery (Date, location, if known,
+23 ;; reason or type of surgery).
+24 ;; 7. Describe effects of the condition(s) on the veteran's usual
+25 ;; occupation and daily activities.
+26 ;; 8. Describe any injury to the feet.
+27 ;; 9. Functional limitations on standing (i.e., unable to stand, able
+28 ;; to stand 15-30 minutes) and walking (i.e., nonambulatory, able to
+29 ;; walk 1/4 mile).
+30 ;; 10. History of neoplasm:
+31 ;;
+32 ;; a. Date of diagnosis, diagnosis.
+33 ;; b. Benign or malignant.
+34 ;; c. Types and dates of treatment.
+35 ;; d. Date of last treatment.
+36 ;;
+37 ;;C. Physical Examination (Objective Findings):
+38 ;;
+39 ;; Address each of the following as appropriate to the condition
+40 ;; being examined and fully describe current findings: A DETAILED
+41 ;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED.
+42 ;;
+43 ;; 1. Describe each foot separately. For nomenclature of toes use:
+44 ;; great toe, second, third, fourth, and fifth. The functional
+45 ;; loss should be related to the anatomical condition.
+46 ;; 2. Describe objective evidence of painful motion, edema,
+47 ;; instability, weakness, tenderness, etc.
+48 ;; 3. Describe gait.
+49 ;; 4. Describe any callosities, breakdown, or unusual shoe wear
+50 ;; pattern that would indicate abnormal weight bearing.
+51 ;; 5. Describe any skin and vascular changes.
+52 ;; 6. Describe hammertoes, high arch, clawfoot, or other deformity -
+53 ;; actively or passively correctable?
+54 ;; 7. For flatfoot
+55 ;;
+56 ;; a. Describe weight bearing and non-weight bearing alignment
+57 ;; of the Achilles tendon.
+58 ;; b. Describe whether the Achilles tendon alignment can be
+59 ;; corrected by manipulation and whether there is pain on
+60 ;; manipulation.
+61 ;; c. Describe degrees of valgus and whether correctable by
+62 ;; manipulation.
+63 ;; d. Describe extent of forefoot and midfoot malalignment and
+64 ;; whether correctable by manipulation.
+65 ;;
+66 ;; 8. For hallux valgus, describe angulation and dorsiflexion at
+67 ;; first metatarsal phalangeal joints.
+68 ;; 9. Is there any active motion in the metatarsophalangeal joint of
+69 ;; the great toe?
+70 ;;
+71 ;;D. Diagnostic and Clinical Tests:
+72 ;;
+73 ;; Comment on:
+74 ;;
+75 ;; 1. X-rays for flatfoot and clawfoot - weight bearing AP and
+76 ;; lateral views and non-weight bearing AP, lateral, and oblique
+77 ;; views, if none are of record or if of record and condition has or
+78 ;; may have progressed.
+79 ;; 2. For other conditions, AP, lateral, and oblique of entire foot,
+80 ;; as applicable.
+81 ;; 3. Include results of all diagnostic and clinical tests conducted
+82 ;; in the examination report.
+83 ;;
+84 ;;E. Diagnosis:
+85 ;;
+86 ;;
+87 ;;Signature: Date:
+88 ;;END
