©2011-2018 Open Source Electronic Health Record Alliance
This work is licensed under a Creative Commons Attribution 3.0 Unported License
This work is licensed under a Creative Commons Attribution 3.0 Unported License
DVBCWSW1 ;ALB/CMM SCARS WKS TEXT - 1 ; 6 MARCH 1997
;;2.7;AMIE;**12**;Apr 10, 1995
;
;
TXT ;
;;A. Review of Medical Records:
;;
;;
;;
;;B. Medical History (Subjective Complaints):
;;
;; 1. Type of injury or infection causing the wound or scar, its
;; date, the treatment used and the response to such treatment.
;;
;;
;; 2. Current symptoms.
;;
;;
;;C. Physical Examination (Objective Findings):
;;
;; Address each of the following and fully describe current findings
;; (for each scar):
;; 1. Location, measurements (cm. x cm.), and shape of each scar.
;;
;;
;; 2. Tenderness.
;;
;;
;; 3. Adherence.
;;
;;
;; 4. Texture.
;;
;;
;; 5. Ulceration or breakdown of skin.
;;
;;
;; 6. Elevation or depression of scar.
;;
;;
;; 7. Extent of underlying tissue loss.
;;
;;
;; 8. Inflammation, edema, or keloid formation.
;;
;;
;; 9. Color of scar compared to normal areas of skin.
;;
;;
;; 10. Disfigurement.
;;
;;
;; 11. For each burn scar, state if due to a 2nd or 3rd degree burn.
;;
;;
;; 12. Limitation of function by scar.
;;
;;
;; 13. An attachment is provided in the Handout of Instructions for
;; Compensation and Pension Examinations for plotting the
;; location of scars.
;;
;;
;;D. Diagnostic and Clinical Tests:
;;
;; 1. With disfigurement or disfiguring scar of head, face, or neck,
;; submit COLOR PHOTOGRAPHS.
;; 2. Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;
;;E. Diagnosis:
;;
;;
;;Signature: Date:
;;END