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1 | DVBCWLY1 ;ALB/CMM LYMPHATIC DISORDERS WKS TEXT - 1 ; 5 MARCH 1997
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2 | ;;2.7;AMIE;**12**;Apr 10, 1995
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3 | ;
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4 | ;
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5 | TXT ;
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6 | ;;A. Review of Medical Records:
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7 | ;;
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8 | ;;
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9 | ;;
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10 | ;;B. Medical History (Subjective Complaints):
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11 | ;;
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12 | ;; Comment on:
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13 | ;; 1. Disease activity (exacerbations/remission)? If there were
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14 | ;; exacerbations, what was the state of the veteran's health
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15 | ;; between exacerbations?
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16 | ;;
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17 | ;;
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18 | ;; 2. Current and past treatment history including date and type of
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19 | ;; last treatment, response, side effects.
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20 | ;;
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21 | ;;
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22 | ;; 3. If malignant neoplasm need date of diagnosis, date of
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23 | ;; treatment, or if treatment stopped when did it end.
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24 | ;;
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25 | ;;
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26 | ;; 4. Location of disease.
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27 | ;;
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28 | ;;
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29 | ;; 5. Current symptoms.
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30 | ;;
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31 | ;;
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32 | ;;C. Physical Examination (Objective Findings):
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33 | ;;
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34 | ;; Describe the residuals of each body system affected.
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35 | ;;
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36 | ;;
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37 | ;;D. Diagnostic and Clinical Tests:
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38 | ;;
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39 | ;; Include results of all diagnostic and clinical tests conducted in
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40 | ;; the examination report.
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41 | ;;
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42 | ;;
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43 | ;;E. Diagnosis:
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44 | ;;
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45 | ;;
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46 | ;;Signature: Date:
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47 | ;;END
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