source: FOIAVistA/tag/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWAV1.m@ 628

DVBCWAV1 ;ALB/CMM ARTERIES AND VEINS WKS TEXT - 1 ; 5 MARCH 1997
 ;;2.7;AMIE;**12**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;A.  Review of Medical Records:
 ;;
 ;;
 ;;
 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;    Comment on:
 ;;    1.  Symptoms due to aortic aneurysm, other large or small artery 
 ;;        aneurysm, or arteriovenous aneurysm.
 ;;
 ;;
 ;;    2.  Current and past treatment, including surgery - e.g., aortic 
 ;;        aneurysm grafting, varicose vein stripping, angioplasty of 
 ;;        peripheral vessels, etc.  Date and response, side effects.
 ;;
 ;;
 ;;    3.  Pain, cramping, claudication on exertion? standing? pain at 
 ;;        rest?  Give frequency, severity, level of exercise that 
 ;;        precipitates pain, duration.
 ;;
 ;;
 ;;    4.  Paresthesias or other abnormal sensations.
 ;;
 ;;
 ;;    5.  Attacks of angioneurotic edema - severity, location, frequency, 
 ;;        duration?
 ;;
 ;;
 ;;    6.  Cold sensitivity.
 ;;
 ;;
 ;;    7.  If treated for malignancy, state type of treatment and dates,
 ;;        including date of last treatment.  Describe any residual
 ;;        or recurrent symptoms if treated has been completed.
 ;;
 ;;
 ;;    8.  Is exercise and exertion precluded by the condition?
 ;;
 ;;
 ;;    9.  Is veteran confined to house or bed because of the condition?
 ;;
 ;;
 ;;   10.  Describe the effects of the condition(s) on the veteran's 
 ;;        usual occupation and daily activities.
 ;;
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Address each of the following and fully describe current findings:
 ;;    1.  Nutrition, general state of health.
 ;;
 ;;
 ;;    2.  Renal, cardiac, or cerebral arteriosclerotic foci.
 ;;
 ;;
 ;;    3.  Cardiac status - size, function.
 ;;
 ;;
 ;;    4.  Evidence and size of aneurysm.
 ;;
 ;;
 ;;    5.  Extremities:
 ;;        a.  Temperature.
 ;;
 ;;
 ;;
 ;;        b.  Evidence of superficial phlebitis.
 ;;
 ;;
 ;;
 ;;        c.  Ulceration or tissue loss.
 ;;
 ;;
 ;;
 ;;        d.  Edema (constant or intermittent, relieved by elevation?).
 ;;
 ;;
 ;;        e.  Scar.
 ;;
 ;;
 ;;
 ;;        f.  Color.
 ;;
 ;;
 ;;        g.  Eczema.
 ;;
 ;;
 ;;        h.  Tenderness.
 ;;
 ;;
 ;;    6.  If there are attacks of blanching or flushing, or blanching, 
 ;;        rubor, and cyanosis, indicate their frequency and duration.
 ;;
 ;;
 ;;    7.  If evidence or history of erythromelalgia - severity, frequency,
 ;;        duration?
 ;;
 ;;
 ;;    8.  If varicosities are present, indicate their size (diameter?),
 ;;        location, appearance, and if deep circulation is involved.
 ;;
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    1.  X-rays, Doppler vascular studies, angiogram, etc., as 
 ;;        appropriate, and if indicated.
 ;;    2.  Include results of all diagnostic and clinical tests conducted
 ;;        in the examination report.
 ;;
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;
 ;;Signature:                             Date:
 ;;END