DVBCWSW7 ;ALB/RLC SCARS WKS TEXT - 1 ; 16 JAN 2007
;;2.7;AMIE;**141**;Apr 10, 1995;Build 3
;
TXT ;
;;A. Review of Medical Records:
;;
;;B. Medical History (Subjective Complaints):
;;
;;NOTE: If examining multiple scars, report the data for each scar separately.
;; 1. Type of injury or infection causing the scar or other disfigurement,
;; and its date. For burns, provide the depth of the burn (deep partial
;; thickness-2nd degree, full-thickness-3rd degree, or subdermal-4th
;; degree) and percent total body surface area involved.
;;
;; 2. Current symptoms, including pain, skin breakdown (frequency), and
;; other problems.
;;
;; 3. Describe any limitations on routine daily activities or employment
;; due to the scar or disfigurement.
;;
;;C. Physical Examination (Objective Findings):
;;
;; Carefully measure all scars. Additionally, measure areas of skin with
;; certain abnormal characteristics, as specifically requested below. Report
;; all measurements in inches or centimeters (or, when reporting areas, in
;; square inches or square centimeters).
;;
;;For every scar to be examined, address each of the following 8 items.
;;
;; 1. Describe precise location of each scar, using anatomic landmarks.
;; Draw diagram if necessary. In the case of the trunk, state whether
;; the scar is on the anterior portion, the posterior portion, or both
;; portions. The midaxillary line on each side divides the trunk into
;; anterior and posterior portions.
;;
;; 2. Give MEASUREMENT of length and width of each scar and calculate the
;; area, for all but linear scars. Roughly describe shape of scar, if
;; it is nonlinear.
;;
;; 3. Is the scar painful on examination?
;;
;; 4. Is there skin breakdown?
;;
;; 5. Is the scar superficial, meaning there is no underlying soft tissue
;; damage?
;;
;; 6. Is the scar deep, meaning there is underlying soft tissue damage?
;;
;; 7. Describe any limitations of motion or other limitation of function
;; caused by the scar.
;;
;; 8. Is there any inflammation, edema, or keliod formation? If so, describe.
;;
;;In addition, for scars of the head, face, and neck and for other disfigurement
;;of the head, face, and neck, answer the following additional 8 questions.
;;You need not answer these questions unless the scar or disfigurement affects
;;the head, face, or neck.
;;
;; 1. Provide a MEASUREMENT of the greatest width of each scar.
;;
;; 2. State whether the scar is adherent to underlying tissue.
;;
;; 3. State whether the surface contour of the scar is elevated or depressed
;; on palpation.
;;
;; 4. Is there an area of abnormal texture (irregular, atrophic, shiny,
;; scaly, etc.) of the skin? If so, provide a MEASUREMENT of the area
;; of abnormal texture and describe the abnormal texture.
;;
;; 5. Is there an area of skin that is hypo- or hyper-pigmented? If so,
;; describe color of scar compared to normal areas of skin and provide
;; a MEASUREMENT of the area of abnormally pigmented skin.
;;
;; 6. Is there an area of skin that is indurated and inflexible? If so,
;; provide a MEASUREMENT of the area of induration.
;;
;; 7. Is there an area of underlying soft tissue loss? If yes, provide a
;; MEASUREMENT of the area of underlying soft tissue loss and state
;; whether or not the tissue loss is visible or palpable.
;;
;; 8. For the face, indicate each feature or set of paired features (nose,
;; chin, forehead, eyes (including eyelids), ears (auricles), cheeks,
;; lips) that shows gross distortion or asymmetry.
;;
;;NOTE: With disfigurement or disfiguring scar(s) 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[HDVBCWSW7 4272 printed Apr 09, 2024@20:57:51 Page 2
DVBCWSW7 ;ALB/RLC SCARS WKS TEXT - 1 ; 16 JAN 2007
+1 ;;2.7;AMIE;**141**;Apr 10, 1995;Build 3
+2 ;
TXT ;
+1 ;;A. Review of Medical Records:
+2 ;;
+3 ;;B. Medical History (Subjective Complaints):
+4 ;;
+5 ;;NOTE: If examining multiple scars, report the data for each scar separately.
+6 ;; 1. Type of injury or infection causing the scar or other disfigurement,
+7 ;; and its date. For burns, provide the depth of the burn (deep partial
+8 ;; thickness-2nd degree, full-thickness-3rd degree, or subdermal-4th
+9 ;; degree) and percent total body surface area involved.
+10 ;;
+11 ;; 2. Current symptoms, including pain, skin breakdown (frequency), and
+12 ;; other problems.
+13 ;;
+14 ;; 3. Describe any limitations on routine daily activities or employment
+15 ;; due to the scar or disfigurement.
+16 ;;
+17 ;;C. Physical Examination (Objective Findings):
+18 ;;
+19 ;; Carefully measure all scars. Additionally, measure areas of skin with
+20 ;; certain abnormal characteristics, as specifically requested below. Report
+21 ;; all measurements in inches or centimeters (or, when reporting areas, in
+22 ;; square inches or square centimeters).
+23 ;;
+24 ;;For every scar to be examined, address each of the following 8 items.
+25 ;;
+26 ;; 1. Describe precise location of each scar, using anatomic landmarks.
+27 ;; Draw diagram if necessary. In the case of the trunk, state whether
+28 ;; the scar is on the anterior portion, the posterior portion, or both
+29 ;; portions. The midaxillary line on each side divides the trunk into
+30 ;; anterior and posterior portions.
+31 ;;
+32 ;; 2. Give MEASUREMENT of length and width of each scar and calculate the
+33 ;; area, for all but linear scars. Roughly describe shape of scar, if
+34 ;; it is nonlinear.
+35 ;;
+36 ;; 3. Is the scar painful on examination?
+37 ;;
+38 ;; 4. Is there skin breakdown?
+39 ;;
+40 ;; 5. Is the scar superficial, meaning there is no underlying soft tissue
+41 ;; damage?
+42 ;;
+43 ;; 6. Is the scar deep, meaning there is underlying soft tissue damage?
+44 ;;
+45 ;; 7. Describe any limitations of motion or other limitation of function
+46 ;; caused by the scar.
+47 ;;
+48 ;; 8. Is there any inflammation, edema, or keliod formation? If so, describe.
+49 ;;
+50 ;;In addition, for scars of the head, face, and neck and for other disfigurement
+51 ;;of the head, face, and neck, answer the following additional 8 questions.
+52 ;;You need not answer these questions unless the scar or disfigurement affects
+53 ;;the head, face, or neck.
+54 ;;
+55 ;; 1. Provide a MEASUREMENT of the greatest width of each scar.
+56 ;;
+57 ;; 2. State whether the scar is adherent to underlying tissue.
+58 ;;
+59 ;; 3. State whether the surface contour of the scar is elevated or depressed
+60 ;; on palpation.
+61 ;;
+62 ;; 4. Is there an area of abnormal texture (irregular, atrophic, shiny,
+63 ;; scaly, etc.) of the skin? If so, provide a MEASUREMENT of the area
+64 ;; of abnormal texture and describe the abnormal texture.
+65 ;;
+66 ;; 5. Is there an area of skin that is hypo- or hyper-pigmented? If so,
+67 ;; describe color of scar compared to normal areas of skin and provide
+68 ;; a MEASUREMENT of the area of abnormally pigmented skin.
+69 ;;
+70 ;; 6. Is there an area of skin that is indurated and inflexible? If so,
+71 ;; provide a MEASUREMENT of the area of induration.
+72 ;;
+73 ;; 7. Is there an area of underlying soft tissue loss? If yes, provide a
+74 ;; MEASUREMENT of the area of underlying soft tissue loss and state
+75 ;; whether or not the tissue loss is visible or palpable.
+76 ;;
+77 ;; 8. For the face, indicate each feature or set of paired features (nose,
+78 ;; chin, forehead, eyes (including eyelids), ears (auricles), cheeks,
+79 ;; lips) that shows gross distortion or asymmetry.
+80 ;;
+81 ;;NOTE: With disfigurement or disfiguring scar(s) of head, face, or neck,
+82 ;;submit COLOR PHOTOGRAPHS.
+83 ;;
+84 ;;D. Diagnostic and Clinical Tests:
+85 ;;
+86 ;; Include results of all diagnostic and clinical tests conducted
+87 ;; in the examination report.
+88 ;;
+89 ;;
+90 ;;E. Diagnosis:
+91 ;;
+92 ;;
+93 ;;Signature: Date:
+94 ;;END
