DVBCWPN1 ;ALB/CMM PERIPHERAL NERVES 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. Onset and course - If flare-ups exist, describe precipitating
;; factors, aggravating factors, alleviating factors, alleviating
;; medications, frequency, severity, duration, and whether the
;; flare-ups include pain, weakness, fatigue, or functional loss.
;;
;;
;; 2. Current treatment, response, and side effects.
;;
;;
;; 3. Paresthesias, dysesthesias, other sensory abnormalities.
;;
;;
;; 4. Describe extent to which condition interferes with daily activity.
;;
;;
;; 5. Specify nerves involved.
;;
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address reach of the following and fully describe current findings:
;; 1. If the disability is the result of brain disease or injury,
;; spinal cord disease or injury, cervical disc disease, or
;; trauma to the nerve roots themselves:
;; a. Report sensory and motor impairment by reference to the
;; distribution of the affected groups as paralysis,
;; neuritis, or neuralgia.
;;
;;
;; b. Report each affected extremity separately.
;;
;;
;; 2. If disability is NOT from the above:
;; a. Identify the specific major nerve involved, localize the
;; lesion and describe specific impairment of motor and
;; sensory function, fine motor control, etc.
;;
;;
;; b. Characterize as paralysis, neuritis, or neuralgia, and
;; indicate whether any muscle wasting or atrophy represents
;; direct effect of nerve damage or merely disuse.
;;
;;
;; c. Report each affected extremity separately.
;;
;;
;; 3. For each joint that is affected:
;; a. Using a goniometer, measure the PASSIVE and ACTIVE range
;; of motion, including movement against gravity and against
;; strong resistance.
;;
;;
;; b. If the joint is painful on motion, state at what point in
;; the range of motion pain begins and ends.
;;
;;
;; c. State to what extent, if any, the range of motion or
;; function is ADDITIONALLY LIMITED by pain, fatigue, weakness,
;; or lack of endurance. 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 conducted
;; in the examination report.
;;
;;
;;E. Diagnosis:
;;
;; 1. State etiology.
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWPN1 2942 printed Oct 16, 2024@17:54:26 Page 2
DVBCWPN1 ;ALB/CMM PERIPHERAL NERVES 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. Onset and course - If flare-ups exist, describe precipitating
+9 ;; factors, aggravating factors, alleviating factors, alleviating
+10 ;; medications, frequency, severity, duration, and whether the
+11 ;; flare-ups include pain, weakness, fatigue, or functional loss.
+12 ;;
+13 ;;
+14 ;; 2. Current treatment, response, and side effects.
+15 ;;
+16 ;;
+17 ;; 3. Paresthesias, dysesthesias, other sensory abnormalities.
+18 ;;
+19 ;;
+20 ;; 4. Describe extent to which condition interferes with daily activity.
+21 ;;
+22 ;;
+23 ;; 5. Specify nerves involved.
+24 ;;
+25 ;;
+26 ;;C. Physical Examination (Objective Findings):
+27 ;;
+28 ;; Address reach of the following and fully describe current findings:
+29 ;; 1. If the disability is the result of brain disease or injury,
+30 ;; spinal cord disease or injury, cervical disc disease, or
+31 ;; trauma to the nerve roots themselves:
+32 ;; a. Report sensory and motor impairment by reference to the
+33 ;; distribution of the affected groups as paralysis,
+34 ;; neuritis, or neuralgia.
+35 ;;
+36 ;;
+37 ;; b. Report each affected extremity separately.
+38 ;;
+39 ;;
+40 ;; 2. If disability is NOT from the above:
+41 ;; a. Identify the specific major nerve involved, localize the
+42 ;; lesion and describe specific impairment of motor and
+43 ;; sensory function, fine motor control, etc.
+44 ;;
+45 ;;
+46 ;; b. Characterize as paralysis, neuritis, or neuralgia, and
+47 ;; indicate whether any muscle wasting or atrophy represents
+48 ;; direct effect of nerve damage or merely disuse.
+49 ;;
+50 ;;
+51 ;; c. Report each affected extremity separately.
+52 ;;
+53 ;;
+54 ;; 3. For each joint that is affected:
+55 ;; a. Using a goniometer, measure the PASSIVE and ACTIVE range
+56 ;; of motion, including movement against gravity and against
+57 ;; strong resistance.
+58 ;;
+59 ;;
+60 ;; b. If the joint is painful on motion, state at what point in
+61 ;; the range of motion pain begins and ends.
+62 ;;
+63 ;;
+64 ;; c. State to what extent, if any, the range of motion or
+65 ;; function is ADDITIONALLY LIMITED by pain, fatigue, weakness,
+66 ;; or lack of endurance. If more than one of these is present,
+67 ;; state, if possible, which has the major functional impact.
+68 ;;
+69 ;;
+70 ;;D. Diagnostic and Clinical Tests:
+71 ;;
+72 ;; 1. Include results of all diagnostic and clinical tests conducted
+73 ;; in the examination report.
+74 ;;
+75 ;;
+76 ;;E. Diagnosis:
+77 ;;
+78 ;; 1. State etiology.
+79 ;;
+80 ;;
+81 ;;Signature: Date:
+82 ;;END
