DVBCWSD5.m

DVBCWSD5 ;ALB/RLC SKIN DISEASES (Other Than Scars) WKS TEXT - 1 ; 11/20/02 4:43pm

 ;;2.7;AMIE;**81**;Apr 10, 1995

 ;

 ;

TXT ;

 ;;A.  Review of Medical Records:

 ;;

 ;;

 ;;

 ;;B.  Medical History (Subjective Complaints):

 ;;

 ;;    1.  Describe onset and course of disease, whether it is

 ;;        intermittent or constant, and whether it is progressive.

 ;;

 ;;

 ;;    2.  Describe current treatment.  Specify the medication(s) 

 ;;        used and dosage.  State whether any is a corticosteroid

 ;;        or other immunosuppresive drug.  State whether medications

 ;;        used are systemic or topical.  Describe whether intensive

 ;;        light therapy, UVB, PUVA, or electron beam therapy are used. 

 ;;

 ;;

 ;;    3.  For EACH treatment, report the frequency of use and duration

 ;;        of treatment during the past 12-month period.

 ;;

 ;;

 ;;    4.  Describe any side effects of treatment.

 ;;

 ;;

 ;;    5.  Describe local (skin) symptoms and any systemic symptoms,

 ;;        such as fever or weight loss.

 ;;

 ;;

 ;;    6.  For malignant neoplasms of skin, additionally describe

 ;;        all treatment, including date and type of last treatment.

 ;;

 ;;

 ;;    7.  For benign neoplasms of skin, additionally describe any

 ;;        impairment of function.

 ;;

 ;;

 ;;    8.  For urticaria, primary cutaneous vasculitis, and 

 ;;        erythema multiforme, additionally describe the number of

 ;;        episodes during the past 12-month period, whether the 

 ;;        episodes are debilitating, how they are treated, and 

 ;;        whether they respond to treatment.

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;

 ;;    1.  For dermatitis, eczema, leishmaniasis, lupus, dermatophytosis,

 ;;        bullous disorders, psoriasis, infections of the skin,

 ;;        cutaneous manifestations of collagen vascular diseases, and

 ;;        papulosquamous disorders, report extent of disease.  Specify

 ;;        if any exposed areas (head, face, neck and hands) are

 ;;        affected.  Provide the percent affected of exposed areas.

 ;;        Provide the percent affected of the entire body.

 ;;

 ;;

 ;;    2.  If there is scarring or disfigurement, follow the "Scars"

 ;;        worksheet in addition to this one.

 ;;

 ;;

 ;;    3.  For acne or chloracne, describe whether the acne is 

 ;;        superficial (with comedones, papules, pustules, superficial

 ;;        cysts) or deep (with deep inflamed nodules and pus-filled

 ;;        cysts), which areas of the body are affected, and, 

 ;;        specifically, the PERCENT OF FACE AND NECK affected.

 ;;

 ;;

 ;;    4.  For scarring alopecia, describe the PERCENT OF THE SCALP  

 ;;        that is affected.

 ;;

 ;;

 ;;    5.  For alopecia areata, describe whether there is loss of all

 ;;        body hair or whether loss of hair is limited to the scalp 

 ;;        and face.

 ;;

 ;;

 ;;    6.  For hyperhidrosis, state whether veteran is able to handle

 ;;        paper or tools after therapy, or is unable to handle paper

 ;;        or tools because of moisture and is unresponsive to therapy.

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;

 ;;    1.  Biopsy, scrapings if indicated.

 ;;    2.  Include results of all diagnostic and clinical tests conducted

 ;;        in the examination report.

 ;;    3.  With disfigurement or disfiguring scar of head, face, or 

 ;;        neck, submit COLOR PHOTOGRAPHS. 

 ;;    4.  Test for hypoproteinemia if examining for exfoliative

 ;;        dermatitis (erythroderma).

 ;;

 ;;E.  Diagnosis:

 ;;

 ;;

 ;;Signature:                             Date:

 ;;END

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---DVBCWSD5   3681     printed  Mar 13, 2025@20:58:40                                                                                                                                                                                                    Page 2

DVBCWSD5  ;ALB/RLC SKIN DISEASES (Other Than Scars) WKS TEXT - 1 ; 11/20/02 4:43pm

 +1       ;;2.7;AMIE;**81**;Apr 10, 1995

 +2       ;

 +3       ;

TXT       ;

 +1       ;;A.  Review of Medical Records:

 +2       ;;

 +3       ;;

 +4       ;;

 +5       ;;B.  Medical History (Subjective Complaints):

 +6       ;;

 +7       ;;    1.  Describe onset and course of disease, whether it is

 +8       ;;        intermittent or constant, and whether it is progressive.

 +9       ;;

 +10      ;;

 +11      ;;    2.  Describe current treatment.  Specify the medication(s) 

 +12      ;;        used and dosage.  State whether any is a corticosteroid

 +13      ;;        or other immunosuppresive drug.  State whether medications

 +14      ;;        used are systemic or topical.  Describe whether intensive

 +15      ;;        light therapy, UVB, PUVA, or electron beam therapy are used. 

 +16      ;;

 +17      ;;

 +18      ;;    3.  For EACH treatment, report the frequency of use and duration

 +19      ;;        of treatment during the past 12-month period.

 +20      ;;

 +21      ;;

 +22      ;;    4.  Describe any side effects of treatment.

 +23      ;;

 +24      ;;

 +25      ;;    5.  Describe local (skin) symptoms and any systemic symptoms,

 +26      ;;        such as fever or weight loss.

 +27      ;;

 +28      ;;

 +29      ;;    6.  For malignant neoplasms of skin, additionally describe

 +30      ;;        all treatment, including date and type of last treatment.

 +31      ;;

 +32      ;;

 +33      ;;    7.  For benign neoplasms of skin, additionally describe any

 +34      ;;        impairment of function.

 +35      ;;

 +36      ;;

 +37      ;;    8.  For urticaria, primary cutaneous vasculitis, and 

 +38      ;;        erythema multiforme, additionally describe the number of

 +39      ;;        episodes during the past 12-month period, whether the 

 +40      ;;        episodes are debilitating, how they are treated, and 

 +41      ;;        whether they respond to treatment.

 +42      ;;

 +43      ;;C.  Physical Examination (Objective Findings):

 +44      ;;

 +45      ;;    1.  For dermatitis, eczema, leishmaniasis, lupus, dermatophytosis,

 +46      ;;        bullous disorders, psoriasis, infections of the skin,

 +47      ;;        cutaneous manifestations of collagen vascular diseases, and

 +48      ;;        papulosquamous disorders, report extent of disease.  Specify

 +49      ;;        if any exposed areas (head, face, neck and hands) are

 +50      ;;        affected.  Provide the percent affected of exposed areas.

 +51      ;;        Provide the percent affected of the entire body.

 +52      ;;

 +53      ;;

 +54      ;;    2.  If there is scarring or disfigurement, follow the "Scars"

 +55      ;;        worksheet in addition to this one.

 +56      ;;

 +57      ;;

 +58      ;;    3.  For acne or chloracne, describe whether the acne is 

 +59      ;;        superficial (with comedones, papules, pustules, superficial

 +60      ;;        cysts) or deep (with deep inflamed nodules and pus-filled

 +61      ;;        cysts), which areas of the body are affected, and, 

 +62      ;;        specifically, the PERCENT OF FACE AND NECK affected.

 +63      ;;

 +64      ;;

 +65      ;;    4.  For scarring alopecia, describe the PERCENT OF THE SCALP  

 +66      ;;        that is affected.

 +67      ;;

 +68      ;;

 +69      ;;    5.  For alopecia areata, describe whether there is loss of all

 +70      ;;        body hair or whether loss of hair is limited to the scalp 

 +71      ;;        and face.

 +72      ;;

 +73      ;;

 +74      ;;    6.  For hyperhidrosis, state whether veteran is able to handle

 +75      ;;        paper or tools after therapy, or is unable to handle paper

 +76      ;;        or tools because of moisture and is unresponsive to therapy.

 +77      ;;

 +78      ;;D.  Diagnostic and Clinical Tests:

 +79      ;;

 +80      ;;    1.  Biopsy, scrapings if indicated.

 +81      ;;    2.  Include results of all diagnostic and clinical tests conducted

 +82      ;;        in the examination report.

 +83      ;;    3.  With disfigurement or disfiguring scar of head, face, or 

 +84      ;;        neck, submit COLOR PHOTOGRAPHS. 

 +85      ;;    4.  Test for hypoproteinemia if examining for exfoliative

 +86      ;;        dermatitis (erythroderma).

 +87      ;;

 +88      ;;E.  Diagnosis:

 +89      ;;

 +90      ;;

 +91      ;;Signature:                             Date:

 +92      ;;END