source: FOIAVistA/tag/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWDI1.m@ 628

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