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 ---[H[J[2J[HDVBCWSD5 3681 printed Oct 16, 2024@17:54:47 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
