DVBCWEH1 ;ALB/CMM ESOPHAGUS AND HIATAL HERNIA 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. Dysphagia - for solids, liquids (frequency and extent). ;; ;; ;; 2. Pyrosis, epigastric or other pain, including associated ;; substernal or arm pain (frequency and severity). ;; ;; ;; 3. Hematemesis or melena (describe any episodes). ;; ;; ;; 4. Reflux or regurgitation (frequency); for regurgitation, contents. ;; ;; ;; 5. Nausea, vomiting (frequency, precipitants). ;; ;; ;; 6. Current treatment - if dilatation, give frequency. ;; ;; ;;C. Physical Examination (Objective Findings): ;; ;; Address each of the following and fully describe current findings: ;; 1. General state of health, anemia. ;; ;; ;; 2. Nutrition, weight gain or loss. ;; ;; ;;D. Diagnostic and Clinical Tests: ;; ;; 1. X-ray or endoscopic confirmation of obstruction, abnormal ;; motility, esophagitis, reflux, etc. ;; 2. Include results of all diagnostic and clinical tests conducted ;; in the examination report. ;; ;;TOF ;;E. Diagnosis: ;; ;; 1. With obstruction or spasm, amenable to dilatation? ;; ;; ;;Signature: Date: ;;END