DVBCWDI1 ;ALB/CMM DIABETES MELLITUS 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. Age of onset. ;; ;; ;; 2. Frequency of ketoacidosis or hypoglycemic reactions ;; (hospitalization required?). ;; ;; ;; 3. Restricted diet, weight loss or gain since last exam. ;; ;; ;; 4. Describe any restriction of activities. ;; ;; ;; 5. Visual problems. ;; ;; ;; 6. Vascular or cardiac symptoms. ;; ;; ;; 7. Neurologic symptoms. ;; ;; ;; 8. Treatment - oral hypoglycemic, insulin (frequency of injections). ;; ;; ;; 9. Frequency of visits to diabetic care provider. ;; ;; ;; 10. Other symptoms, such as anal pruritus, loss of strength. ;; ;; ;;C. Physical Examination (Objective Findings): ;; ;; Address each of the following and fully describe current findings: ;; 1. Blood pressure, other cardiovascular findings, including ;; status of peripheral vessels. ;; ;; ;; 2. Neurologic examination. ;; ;; ;; 3. Eye examination. ;; ;; ;; 4. Skin examination. ;; ;; ;; 5. Examination of extremities, including feet. ;; ;; ;; 6. State if the veteran has bladder or bowel functional impairment. ;; If present, state whether partial or total, intermittent or ;; constant, and what measures are taken as a result of the impairment. ;; ;; ;;D. Diagnostic and Clinical Tests: ;; ;; Provide to establish diagnosis (Previously done test results should ;; be given to establish diagnosis.): ;; 1. Renal function tests, including 24 hour urine test for protein ;; if renal involvement is uncertain. ;; 2. Blood sugar. ;; 3. Urinalysis. ;; 4. Glucose tolerance test, if necessary to establish the diagnosis. ;; 5. Include results of all diagnostic and clinical tests conducted ;; in the examination report. ;; ;; ;;E. Diagnosis: ;; ;; Comment on: ;; 1. All complications noted - visual, cardiac, vascular, nephrologic, ;; neurologic (including both peripheral neuropathy and cerebral ;; effects), amputations. See examination worksheets for the ;; conditions found. ;; ;; ;;Signature: Date: ;;END