©2011-2018 Open Source Electronic Health Record Alliance
This work is licensed under a Creative Commons Attribution 3.0 Unported License
This work is licensed under a Creative Commons Attribution 3.0 Unported License
DVBCWHI1 ;ALB/CMM HIV-RELATED ILLNESS WKS TEXT - 1 ; 6 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
TXT ;
;;A. Review of Medical Records:
;;
;;
;;
;;B. Medical History (Subjective Complaints):
;;
;; Comment On:
;; 1. Recurrent opportunistic infections.
;;
;;
;; 2. Recurrent constitutional symptoms.
;;
;;
;; 3. Diarrhea.
;;
;;
;; 4. Debility.
;;
;;
;; 5. Progressive weight loss.
;;
;;
;; 6. Remissions in any symptomatology.
;;
;;
;; 7. Depression or memory loss.
;;
;;
;; 8. Treatment - Is this an approved medication?
;;
;;
;; 9. Describe the effects of the condition on the veteran's usual
;; occupation and daily activities.
;;
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following and fully describe:
;; 1. Definitive diagnosis of AIDS. (Use CDC Definition.)
;;
;;
;; 2. Secondary diseases affecting multiple body systems - describe.
;;
;;
;; 3. HIV-related illnesses - describe.
;;
;;
;; 4. Neoplasm related to HIV-related illness. Describe.
;;
;;
;; 5. T4 cell counts.
;;
;;
;; 6. Hairy cell leukoplakia.
;;
;;
;; 7. Oral candidiasis.
;;
;;
;; 8. Use of HIV-related medications.
;;
;;
;; 9. Lymphadenopathy.
;;
;;
;;D. Diagnostic and Clinical Tests:
;;
;; Provide:
;; 1. T4 Cell counts.
;; 2. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;
;;E. Diagnosis:
;;
;;
;;Signature: Date:
;;END