DVBCWCN1 ;ALB/CMM CRANIAL NERVES WKS TEXT - 1 ; 6 MARCH 1997 ;;2.7;AMIE;**12**;Apr 10, 1995 ; ; TXT ; ;;A. Review of Medical Records: ;; ;; ;;B. Medical History (Subjective Complaints): ;; ;; Comment on: ;; 1. If flare-ups exist, describe precipitating factors, aggravating ;; factors, alleviating factors, alleviating medications, frequency, ;; severity, duration, and whether the flare-ups include pain, ;; weakness, fatigue, or functional loss. ;; ;; ;; 2. Current treatment, response, side effects. ;; ;; ;;C. Physical Examination (Objective Findings): ;; ;; Address each of the following and fully describe current findings: ;; 1. Identify the nerve and the side. ;; ;; ;; 2. Identify the disorder (i.e., paralysis, neuritis, neuralgia). ;; ;; ;; 3. Describe in detail specific motor and sensory impairment, ;; quantifying as much as possible. ;; ;; ;; 4. If smell or taste is affected, please also complete the ;; appropriate worksheet. ;; ;; ;;D. Diagnostic and Clinical Tests: ;; ;; 1. Include results of all diagnostic and clinical tests conducted ;; in the examination report. ;; ;; ;;E. Diagnosis: ;; ;; 1. State etiology. ;; ;; ;;Signature: Date: ;;END