DVBCWNW1 ;ALB/CMM NOSE, SINUS, ETC 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. Location and nature of the injury or disease.
;;
;;
;; 2. Interference with breathing through nose.
;;
;;
;; 3. Purulent discharge.
;;
;;
;; 4. Dyspnea at rest or on exertion?
;;
;;
;; 5. Treatments - type,(i.e., surgery, medications, oxygen,
;; respirator, etc.), frequency, duration, response, and side effects.
;;
;;
;; 6. If speech impairment (ability to communicate by speech,
;; ability to speak above a whisper, etc.).
;;
;;
;; 7. For chronic sinusitis, indicate which sinuses are affected and
;; whether pain and headaches are present. Describe severity and
;; frequency.
;;
;;
;; 8. If allergic attacks, frequency and baseline status between attacks.
;;
;;
;; 9. Other symptoms noted.
;;
;;
;; 10. Describe frequency and duration of periods of incapacitation
;; (defined as requiring bed rest and treatment by a physician).
;;
;;TOF
;;C. Physical Examination (Objective Findings):
;;
;; Provide:
;; 1. If there is nasal obstruction, indicate percent each nostril.
;;
;;
;; 2. Sinusitis - Describe tenderness, purulent discharge, or crusting.
;;
;;
;;D. Diagnostic and Clinical Tests:
;;
;; 1. If there is stenosis of larynx, order FEV-1 with flow-volume loop.
;; 2. If there is facial disfigurement, order COLOR PHOTOGRAPHS.
;; 3. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;
;;E. Diagnosis:
;;
;; Comment on whether the disease primarily involves or originates
;; from the nose, sinus, larynx, or pharynx.
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWNW1 2009 printed Dec 13, 2024@01:52:54 Page 2
DVBCWNW1 ;ALB/CMM NOSE, SINUS, ETC 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. Location and nature of the injury or disease.
+9 ;;
+10 ;;
+11 ;; 2. Interference with breathing through nose.
+12 ;;
+13 ;;
+14 ;; 3. Purulent discharge.
+15 ;;
+16 ;;
+17 ;; 4. Dyspnea at rest or on exertion?
+18 ;;
+19 ;;
+20 ;; 5. Treatments - type,(i.e., surgery, medications, oxygen,
+21 ;; respirator, etc.), frequency, duration, response, and side effects.
+22 ;;
+23 ;;
+24 ;; 6. If speech impairment (ability to communicate by speech,
+25 ;; ability to speak above a whisper, etc.).
+26 ;;
+27 ;;
+28 ;; 7. For chronic sinusitis, indicate which sinuses are affected and
+29 ;; whether pain and headaches are present. Describe severity and
+30 ;; frequency.
+31 ;;
+32 ;;
+33 ;; 8. If allergic attacks, frequency and baseline status between attacks.
+34 ;;
+35 ;;
+36 ;; 9. Other symptoms noted.
+37 ;;
+38 ;;
+39 ;; 10. Describe frequency and duration of periods of incapacitation
+40 ;; (defined as requiring bed rest and treatment by a physician).
+41 ;;
+42 ;;TOF
+43 ;;C. Physical Examination (Objective Findings):
+44 ;;
+45 ;; Provide:
+46 ;; 1. If there is nasal obstruction, indicate percent each nostril.
+47 ;;
+48 ;;
+49 ;; 2. Sinusitis - Describe tenderness, purulent discharge, or crusting.
+50 ;;
+51 ;;
+52 ;;D. Diagnostic and Clinical Tests:
+53 ;;
+54 ;; 1. If there is stenosis of larynx, order FEV-1 with flow-volume loop.
+55 ;; 2. If there is facial disfigurement, order COLOR PHOTOGRAPHS.
+56 ;; 3. Include results of all diagnostic and clinical tests conducted
+57 ;; in the examination report.
+58 ;;
+59 ;;
+60 ;;E. Diagnosis:
+61 ;;
+62 ;; Comment on whether the disease primarily involves or originates
+63 ;; from the nose, sinus, larynx, or pharynx.
+64 ;;
+65 ;;
+66 ;;Signature: Date:
+67 ;;END
