DVBCWGE1 ;ALB/CMM GENITOURINARY EXAMINATION WKS TEXT - 1 ; 5 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
TXT ;
;;A. Review of Medical Records:
;;
;;
;;
;;B. Medical History (Subjective Complaints):
;;
;; Comment on:
;; 1. Lethargy, weakness, anorexia, weight loss or gain.
;;
;;
;; 2. Frequency (day or night, indicate voiding intervals),
;; hesitancy, stream, dysuria.
;;
;;
;; 3. Incontinence - if present, describe required frequency of
;; absorbent material and whether an appliance is needed.
;;
;;
;; 4. Provide details of any history of:
;; a. Surgery on any part of the urinary tract. Residuals?
;; Impotence?
;;
;;
;; b. Recurrent urinary tract infections.
;;
;;
;;
;; c. Renal colic or bladder stones.
;;
;;
;; d. Acute nephritis.
;;
;;
;; e. Hospitalization for urinary tract disease, if so, how many
;; in the past year?
;;
;;
;; f. Treatment for malignancy, including type and date of last
;; treatment.
;;
;;
;; 5. Treatments.
;;
;; a. Is catheterization needed? Intermittent or continuous?
;;
;;
;; b. Frequency of dilations?
;;
;;
;; c. Drainage procedures.
;;
;;
;; d. Diet therapy - specify.
;;
;;
;; e. Medications.
;;
;;
;; f. Frequency per year of invasive and noninvasive procedures.
;;
;;
;; 6. Describe the effects of the condition(s) on the veteran's
;; usual occupation and daily activities.
;;
;;
;; For Male Loss of Use of a Creative Organ
;; Comment on:
;; 1. Trauma/surgery affecting penis/testicles (e.g. vasectomy?)
;;
;;
;; 2. Local and/or systemic diseases affecting sexual function.
;;
;; a. Endocrine.
;;
;;
;; b. Neurologic.
;;
;;
;; c. Infections.
;;
;;
;; d. Vascular.
;;
;;
;; e. Psychological.
;;
;;
;; 3. Symptoms: Vaginal penetration with ejaculation possible?
;;
;;
;; 4. Past treatment:
;;
;; a. Medications, injections, implants, pump, counseling.
;;
;;
;; b. Effectiveness in allowing intercourse.
;;
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following, as appropriate, to the condition
;; being examined and fully describe current findings:
;; 1. Blood pressure, cardiovascular examination, if indicated,
;; describe edema, to include persistence.
;;
;;
;; 2. If on dialysis, type, where done, and how often?
;;
;;
;; 3. Inspection and palpation of penis, testicles, epididymis, and
;; spermatic cord. If there is penis deformity, state whether
;; there is loss of erectile power. Inspection of anus and
;; digital exam of rectal walls, prostate, and seminal vesicles.
;;
;;
;; 4. Fistula.
;;
;;
;; 5. Specific residuals of genitourinary disease, including post-treatment
;; residuals of malignancy.
;;
;;
;; 6. Testicular atrophy - size and consistency.
;;
;;
;; 7. Sensation and reflexes.
;;
;;
;; 8. Peripheral pulses.
;;
;;
;;D. Diagnostic and Clinical Tests:
;;
;; 1. CBC.
;; 2. UA.
;; 3. Creatinine, BUN, albumin, electrolytes.
;; 4. Uroflowmetry, if indicated.
;; 5. Measurement of post-void residual, if indicated.
;; 6. Semen analysis, including sperm count and interpretation of
;; results, if applicable.
;; 7. Endocrine evaluation (glucose, TSH, testosterone, LH, FSH,
;; prolactin), if applicable.
;; 8. Psychiatric evaluation, if applicable.
;; 9. 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[HDVBCWGE1 4041 printed Dec 13, 2024@01:51:16 Page 2
DVBCWGE1 ;ALB/CMM GENITOURINARY EXAMINATION WKS TEXT - 1 ; 5 MARCH 1997
+1 ;;2.7;AMIE;**12**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;
+4 ;;
+5 ;;B. Medical History (Subjective Complaints):
+6 ;;
+7 ;; Comment on:
+8 ;; 1. Lethargy, weakness, anorexia, weight loss or gain.
+9 ;;
+10 ;;
+11 ;; 2. Frequency (day or night, indicate voiding intervals),
+12 ;; hesitancy, stream, dysuria.
+13 ;;
+14 ;;
+15 ;; 3. Incontinence - if present, describe required frequency of
+16 ;; absorbent material and whether an appliance is needed.
+17 ;;
+18 ;;
+19 ;; 4. Provide details of any history of:
+20 ;; a. Surgery on any part of the urinary tract. Residuals?
+21 ;; Impotence?
+22 ;;
+23 ;;
+24 ;; b. Recurrent urinary tract infections.
+25 ;;
+26 ;;
+27 ;;
+28 ;; c. Renal colic or bladder stones.
+29 ;;
+30 ;;
+31 ;; d. Acute nephritis.
+32 ;;
+33 ;;
+34 ;; e. Hospitalization for urinary tract disease, if so, how many
+35 ;; in the past year?
+36 ;;
+37 ;;
+38 ;; f. Treatment for malignancy, including type and date of last
+39 ;; treatment.
+40 ;;
+41 ;;
+42 ;; 5. Treatments.
+43 ;;
+44 ;; a. Is catheterization needed? Intermittent or continuous?
+45 ;;
+46 ;;
+47 ;; b. Frequency of dilations?
+48 ;;
+49 ;;
+50 ;; c. Drainage procedures.
+51 ;;
+52 ;;
+53 ;; d. Diet therapy - specify.
+54 ;;
+55 ;;
+56 ;; e. Medications.
+57 ;;
+58 ;;
+59 ;; f. Frequency per year of invasive and noninvasive procedures.
+60 ;;
+61 ;;
+62 ;; 6. Describe the effects of the condition(s) on the veteran's
+63 ;; usual occupation and daily activities.
+64 ;;
+65 ;;
+66 ;; For Male Loss of Use of a Creative Organ
+67 ;; Comment on:
+68 ;; 1. Trauma/surgery affecting penis/testicles (e.g. vasectomy?)
+69 ;;
+70 ;;
+71 ;; 2. Local and/or systemic diseases affecting sexual function.
+72 ;;
+73 ;; a. Endocrine.
+74 ;;
+75 ;;
+76 ;; b. Neurologic.
+77 ;;
+78 ;;
+79 ;; c. Infections.
+80 ;;
+81 ;;
+82 ;; d. Vascular.
+83 ;;
+84 ;;
+85 ;; e. Psychological.
+86 ;;
+87 ;;
+88 ;; 3. Symptoms: Vaginal penetration with ejaculation possible?
+89 ;;
+90 ;;
+91 ;; 4. Past treatment:
+92 ;;
+93 ;; a. Medications, injections, implants, pump, counseling.
+94 ;;
+95 ;;
+96 ;; b. Effectiveness in allowing intercourse.
+97 ;;
+98 ;;
+99 ;;C. Physical Examination (Objective Findings):
+100 ;;
+101 ;; Address each of the following, as appropriate, to the condition
+102 ;; being examined and fully describe current findings:
+103 ;; 1. Blood pressure, cardiovascular examination, if indicated,
+104 ;; describe edema, to include persistence.
+105 ;;
+106 ;;
+107 ;; 2. If on dialysis, type, where done, and how often?
+108 ;;
+109 ;;
+110 ;; 3. Inspection and palpation of penis, testicles, epididymis, and
+111 ;; spermatic cord. If there is penis deformity, state whether
+112 ;; there is loss of erectile power. Inspection of anus and
+113 ;; digital exam of rectal walls, prostate, and seminal vesicles.
+114 ;;
+115 ;;
+116 ;; 4. Fistula.
+117 ;;
+118 ;;
+119 ;; 5. Specific residuals of genitourinary disease, including post-treatment
+120 ;; residuals of malignancy.
+121 ;;
+122 ;;
+123 ;; 6. Testicular atrophy - size and consistency.
+124 ;;
+125 ;;
+126 ;; 7. Sensation and reflexes.
+127 ;;
+128 ;;
+129 ;; 8. Peripheral pulses.
+130 ;;
+131 ;;
+132 ;;D. Diagnostic and Clinical Tests:
+133 ;;
+134 ;; 1. CBC.
+135 ;; 2. UA.
+136 ;; 3. Creatinine, BUN, albumin, electrolytes.
+137 ;; 4. Uroflowmetry, if indicated.
+138 ;; 5. Measurement of post-void residual, if indicated.
+139 ;; 6. Semen analysis, including sperm count and interpretation of
+140 ;; results, if applicable.
+141 ;; 7. Endocrine evaluation (glucose, TSH, testosterone, LH, FSH,
+142 ;; prolactin), if applicable.
+143 ;; 8. Psychiatric evaluation, if applicable.
+144 ;; 9. Include results of all diagnostic and clinical tests conducted
+145 ;; in the examination report.
+146 ;;
+147 ;;
+148 ;;E. Diagnosis:
+149 ;;
+150 ;;
+151 ;;Signature: Date:
+152 ;;END
