- DVBCWHT1 ;ALB/CMM HAND, THUMB, FINGERS 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. 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.
- ;;
- ;;
- ;;C. Physical Examination (Objective Findings):
- ;;
- ;; Address each of the following as appropriate to the condition being
- ;; examined and full describe current findings:
- ;; 1. Anatomical defects.
- ;;
- ;;
- ;; 2. Functional defects (motion of thumb and fingers should be
- ;; described as to how near, in inches, the tip of thumb can
- ;; approximate the fingers, or how near the tips of fingers can
- ;; approximate the median transverse fold of the palm.
- ;;
- ;;
- ;; 3. Grasping objects (strength and dexterity).
- ;;
- ;;
- ;;The hand should be evaluated as a unit intricately adapted for grasping,
- ;;pushing, pulling, twisting, probing, writing, touching, and expression.
- ;;Do not designate fingers numerically; use thumb, index, middle (or
- ;;long), ring, and little. Specify which hand is involved and state
- ;;whether the individual is right- or left-handed. Designate the joints
- ;;as wrist, MP (metacarpophalangeal), PIP (proximal interphalangeal), or
- ;;DIP (distal interphalangeal). Designate phalanges as proximal, middle
- ;;or distal.
- ;;
- ;;TOF
- ;; 4. A detailed assessment of each affected joint is required.
- ;; a. Using a goniometer, measure the PASSIVE and ACTIVE range
- ;; of motion, including movement against gravity and against
- ;; strong resistance.
- ;;
- ;;
- ;; b. State to what extent (if any) and in which degrees (if
- ;; possible) the range of motion or joint function is
- ;; ADDITIONALLY LIMITED by pain, fatigue, weakness, or lack
- ;; of endurance following repetitive use or during flare-ups.
- ;; If more than one of these is present, state, if possible,
- ;; which has the major functional impact.
- ;;
- ;;
- ;;D. Diagnostic and Clinical Tests:
- ;;
- ;; 1. Include results of all diagnostic and clinical tests conducte
- ;; in the examination report.
- ;;
- ;;
- ;;E. Diagnosis:
- ;;
- ;;
- ;;Signature: Date:
- ;;END
- --- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWHT1 2699 printed Feb 18, 2025@23:18:12 Page 2
- DVBCWHT1 ;ALB/CMM HAND, THUMB, FINGERS WKS TEXT - 1 ; 6 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. If there are periods of flare-up of joint disease:
- +9 ;; a. State their severity, frequency, and duration.
- +10 ;;
- +11 ;;
- +12 ;; b. Name the precipitating and alleviating factors.
- +13 ;;
- +14 ;;
- +15 ;; c. Estimate to what extent, if any, they result in additional
- +16 ;; limitation of motion or functional impairment during the flare-up.
- +17 ;;
- +18 ;;
- +19 ;;C. Physical Examination (Objective Findings):
- +20 ;;
- +21 ;; Address each of the following as appropriate to the condition being
- +22 ;; examined and full describe current findings:
- +23 ;; 1. Anatomical defects.
- +24 ;;
- +25 ;;
- +26 ;; 2. Functional defects (motion of thumb and fingers should be
- +27 ;; described as to how near, in inches, the tip of thumb can
- +28 ;; approximate the fingers, or how near the tips of fingers can
- +29 ;; approximate the median transverse fold of the palm.
- +30 ;;
- +31 ;;
- +32 ;; 3. Grasping objects (strength and dexterity).
- +33 ;;
- +34 ;;
- +35 ;;The hand should be evaluated as a unit intricately adapted for grasping,
- +36 ;;pushing, pulling, twisting, probing, writing, touching, and expression.
- +37 ;;Do not designate fingers numerically; use thumb, index, middle (or
- +38 ;;long), ring, and little. Specify which hand is involved and state
- +39 ;;whether the individual is right- or left-handed. Designate the joints
- +40 ;;as wrist, MP (metacarpophalangeal), PIP (proximal interphalangeal), or
- +41 ;;DIP (distal interphalangeal). Designate phalanges as proximal, middle
- +42 ;;or distal.
- +43 ;;
- +44 ;;TOF
- +45 ;; 4. A detailed assessment of each affected joint is required.
- +46 ;; a. Using a goniometer, measure the PASSIVE and ACTIVE range
- +47 ;; of motion, including movement against gravity and against
- +48 ;; strong resistance.
- +49 ;;
- +50 ;;
- +51 ;; b. State to what extent (if any) and in which degrees (if
- +52 ;; possible) the range of motion or joint function is
- +53 ;; ADDITIONALLY LIMITED by pain, fatigue, weakness, or lack
- +54 ;; of endurance following repetitive use or during flare-ups.
- +55 ;; If more than one of these is present, state, if possible,
- +56 ;; which has the major functional impact.
- +57 ;;
- +58 ;;
- +59 ;;D. Diagnostic and Clinical Tests:
- +60 ;;
- +61 ;; 1. Include results of all diagnostic and clinical tests conducte
- +62 ;; in the examination report.
- +63 ;;
- +64 ;;
- +65 ;;E. Diagnosis:
- +66 ;;
- +67 ;;
- +68 ;;Signature: Date:
- +69 ;;END