DVBCWSW3 ;ALB/CMM SCARS WKS TEXT - 1 ; 11/20/02 3:04pm
;;2.7;AMIE;**49**;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):
;;
;; For every scar to be examined, address EACH of the following and
;; fully describe the current findings. Note that, in addition
;; to measuring the scar itself, measurements of areas with certain
;; abnormal characteristics must also be provided. All measurements
;; should be reported in inches or centimeters.
;; 1. Describe precise location of each scar. Draw diagram if
;; necessary.
;;
;;
;; 2. Give MEASUREMENT of length and width (at its widest part) of
;; each scar.
;;
;;
;; 3. Is there pain in the scar on examination?
;;
;;
;; 4. Is there adherence to underlying tissue?
;;
;;
;; 5. Texture of skin. If irregular, atrophic, shiny, scaly, etc.,
;; give MEASUREMENT of length and width of area so affected.
;;
;;
;; 6. Is the scar unstable, meaning is there frequent loss of
;; covering of skin over the scar, such as from ulceration or
;; breakdown of skin?
;;
;;
;; 7. Is there elevation or depression of the surface contour
;; of the scar on palpation?
;;
;;
;; 8. Is the scar superficial (meaning there is no underlying
;; soft tissue damage)?
;;
;;
;; 9. Is the scar deep (meaning there is underlying soft tissue
;; loss or damage)? If yes, give MEASUREMENT of length and
;; width of underlying soft tissue damage.
;;
;;
;; 10. Describe any inflammation, edema, or keloid formation.
;;
;;
;; 11. Describe color of scar compared to normal areas of skin
;; (give MEASUREMENT of length and width of any hypopigmentation
;; or hyperpigmentation).
;;
;;
;; 12. For face, discuss whether there is gross distortion or
;; asymmetry of any feature or set of paired features (nose,
;; chin, forehead, eyes (including eyelids), ears (auricles),
;; cheeks, lips).
;;
;;
;; 13. Is there an area of induration and inflexibility of skin in
;; the area of the scar? If so, give MEASUREMENT of length
;; and width of area of induration.
;;
;;
;; 14. Describe any limitation of motion or other limitation of
;; function caused by a scar.
;;
;;
;; 15. With disfigurement or disfiguring scar of head, face, or
;; neck, submit COLOR PHOTOGRAPHS.
;;
;;D. Diagnostic and Clinical Tests:
;;
;; Include results of all diagnostic and clinical tests conducted
;; in the examination report.
;;
;;
;;E. Diagnosis:
;;
;;
;;Signature: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWSW3 3100 printed Nov 22, 2024@17:04:22 Page 2
DVBCWSW3 ;ALB/CMM SCARS WKS TEXT - 1 ; 11/20/02 3:04pm
+1 ;;2.7;AMIE;**49**;Apr 10, 1995
+2 ;
+3 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;
+4 ;;
+5 ;;B. Medical History (Subjective Complaints):
+6 ;;
+7 ;; 1. Type of injury or infection causing the wound or scar, its
+8 ;; date, the treatment used, and the response to such treatment.
+9 ;;
+10 ;;
+11 ;; 2. Current symptoms.
+12 ;;
+13 ;;
+14 ;;C. Physical Examination (Objective Findings):
+15 ;;
+16 ;; For every scar to be examined, address EACH of the following and
+17 ;; fully describe the current findings. Note that, in addition
+18 ;; to measuring the scar itself, measurements of areas with certain
+19 ;; abnormal characteristics must also be provided. All measurements
+20 ;; should be reported in inches or centimeters.
+21 ;; 1. Describe precise location of each scar. Draw diagram if
+22 ;; necessary.
+23 ;;
+24 ;;
+25 ;; 2. Give MEASUREMENT of length and width (at its widest part) of
+26 ;; each scar.
+27 ;;
+28 ;;
+29 ;; 3. Is there pain in the scar on examination?
+30 ;;
+31 ;;
+32 ;; 4. Is there adherence to underlying tissue?
+33 ;;
+34 ;;
+35 ;; 5. Texture of skin. If irregular, atrophic, shiny, scaly, etc.,
+36 ;; give MEASUREMENT of length and width of area so affected.
+37 ;;
+38 ;;
+39 ;; 6. Is the scar unstable, meaning is there frequent loss of
+40 ;; covering of skin over the scar, such as from ulceration or
+41 ;; breakdown of skin?
+42 ;;
+43 ;;
+44 ;; 7. Is there elevation or depression of the surface contour
+45 ;; of the scar on palpation?
+46 ;;
+47 ;;
+48 ;; 8. Is the scar superficial (meaning there is no underlying
+49 ;; soft tissue damage)?
+50 ;;
+51 ;;
+52 ;; 9. Is the scar deep (meaning there is underlying soft tissue
+53 ;; loss or damage)? If yes, give MEASUREMENT of length and
+54 ;; width of underlying soft tissue damage.
+55 ;;
+56 ;;
+57 ;; 10. Describe any inflammation, edema, or keloid formation.
+58 ;;
+59 ;;
+60 ;; 11. Describe color of scar compared to normal areas of skin
+61 ;; (give MEASUREMENT of length and width of any hypopigmentation
+62 ;; or hyperpigmentation).
+63 ;;
+64 ;;
+65 ;; 12. For face, discuss whether there is gross distortion or
+66 ;; asymmetry of any feature or set of paired features (nose,
+67 ;; chin, forehead, eyes (including eyelids), ears (auricles),
+68 ;; cheeks, lips).
+69 ;;
+70 ;;
+71 ;; 13. Is there an area of induration and inflexibility of skin in
+72 ;; the area of the scar? If so, give MEASUREMENT of length
+73 ;; and width of area of induration.
+74 ;;
+75 ;;
+76 ;; 14. Describe any limitation of motion or other limitation of
+77 ;; function caused by a scar.
+78 ;;
+79 ;;
+80 ;; 15. With disfigurement or disfiguring scar of head, face, or
+81 ;; neck, submit COLOR PHOTOGRAPHS.
+82 ;;
+83 ;;D. Diagnostic and Clinical Tests:
+84 ;;
+85 ;; Include results of all diagnostic and clinical tests conducted
+86 ;; in the examination report.
+87 ;;
+88 ;;
+89 ;;E. Diagnosis:
+90 ;;
+91 ;;
+92 ;;Signature: Date:
+93 ;;END
