DVBCWNW1 ;ALB/CMM NOSE, SINUS, ETC WKS TEXT - 1 ; 6 MARCH 1997 ;;2.7;AMIE;**12**;Apr 10, 1995 ; ; TXT ; ;;A. Review of Medical Records: ;; ;; ;; ;;B. Medical History (Subjective Complaints): ;; ;; Comment on: ;; 1. Location and nature of the injury or disease. ;; ;; ;; 2. Interference with breathing through nose. ;; ;; ;; 3. Purulent discharge. ;; ;; ;; 4. Dyspnea at rest or on exertion? ;; ;; ;; 5. Treatments - type,(i.e., surgery, medications, oxygen, ;; respirator, etc.), frequency, duration, response, and side effects. ;; ;; ;; 6. If speech impairment (ability to communicate by speech, ;; ability to speak above a whisper, etc.). ;; ;; ;; 7. For chronic sinusitis, indicate which sinuses are affected and ;; whether pain and headaches are present. Describe severity and ;; frequency. ;; ;; ;; 8. If allergic attacks, frequency and baseline status between attacks. ;; ;; ;; 9. Other symptoms noted. ;; ;; ;; 10. Describe frequency and duration of periods of incapacitation ;; (defined as requiring bed rest and treatment by a physician). ;; ;;TOF ;;C. Physical Examination (Objective Findings): ;; ;; Provide: ;; 1. If there is nasal obstruction, indicate percent each nostril. ;; ;; ;; 2. Sinusitis - Describe tenderness, purulent discharge, or crusting. ;; ;; ;;D. Diagnostic and Clinical Tests: ;; ;; 1. If there is stenosis of larynx, order FEV-1 with flow-volume loop. ;; 2. If there is facial disfigurement, order COLOR PHOTOGRAPHS. ;; 3. Include results of all diagnostic and clinical tests conducted ;; in the examination report. ;; ;; ;;E. Diagnosis: ;; ;; Comment on whether the disease primarily involves or originates ;; from the nose, sinus, larynx, or pharynx. ;; ;; ;;Signature: Date: ;;END