DVBCWCN3 ;ALB/RLC CRANIAL NERVES WKS TEXT - 1 ; 12 FEB 2007 ;;2.7;AMIE;**121**;Apr 10, 1995;Build 9 ; ; TXT ; ;;A. Review of Medical Records: ;; ;;B. Medical History (Subjective Complaints): ;; ;; Comment on: ;; ;; 1. Onset, course since onset. ;; 2. Symptoms. ;; 3. Current treatment, response, side effects. ;; 4. Effects of condition on occupational functioning and daily activities. ;; 5. History of hospitalizations or surgery, location and dates, if known, ;; reason or type of surgery. ;; 6. History of trauma to a cranial nerve, date, type, nerve. ;; 7. History of neoplasm: ;; ;; a. Date of diagnosis, diagnosis. ;; b. Benign or malignant. ;; c. Types of treatment, dates. ;; d. Last date of treatment. ;; ;;C. Physical Examination (Objective Findings): ;; ;; Address each of the following and fully describe current findings: ;; ;; 1. Describe in detail specific motor and sensory impairment, quantifying ;; as much as possible. ;; 2. 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. Identify the nerve and the side. ;; 2. Identify the disorder (i.e., paralysis, neuritis, neuralgia). ;; 3. State etiology. ;; ;; ;;Signature: Date: ;;END