source: FOIAVistA/tag/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWSD3.m@ 628

DVBCWSD3 ;ALB/CMM SKIN DISEASES (Other Than Scars) WKS TEXT - 1 ; 11/20/02 4:43pm
 ;;2.7;AMIE;**49**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;A.  Review of Medical Records:
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 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;    1.  Describe onset and course of disease, whether it is
 ;;        intermittent or constant, and whether it is progressive.
 ;;
 ;;
 ;;    2.  Describe current treatment.  Specify the medication(s) 
 ;;        used and dosage.  State whether any is a corticosteroid
 ;;        or other immunosuppresive drug.  State whether medications
 ;;        used are systemic or topical.  Describe whether intensive
 ;;        light therapy, UVB, PUVA, or electron beam therapy are used. 
 ;;
 ;;
 ;;    3.  For EACH treatment, report the frequency of use and duration
 ;;        of treatment during the past 12-month period.
 ;;
 ;;
 ;;    4.  Describe any side effects of treatment.
 ;;
 ;;
 ;;    5.  Describe local (skin) symptoms and any systemic symptoms,
 ;;        such as fever or weight loss.
 ;;
 ;;
 ;;    6.  For malignant neoplasms of skin, additionally describe
 ;;        all treatment, including date and type of last treatment.
 ;;
 ;;
 ;;    7.  For benign neoplasms of skin, additionally describe any
 ;;        impairment of function.
 ;;
 ;;
 ;;    8.  For urticaria, primary cutaneous vasculitis, and 
 ;;        erythema multiforme, additionally describe the number of
 ;;        episodes during the past 12-month period, whether the 
 ;;        episodes are debilitating, how they are treated, and 
 ;;        whether they respond to treatment.
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    1.  Report extent of disease - specify if any exposed areas
 ;;        (head, face, neck, and hands) are affected and the PERCENT
 ;;        OF EXPOSED AREAS that is affected and specify the PERCENT
 ;;        OF THE ENTIRE BODY that is affected.
 ;;
 ;;
 ;;    2.  If there is scarring or disfigurement, follow the "Scars"
 ;;        worksheet in addition to this one.
 ;;
 ;;
 ;;    3.  For acne or chloracne, describe whether the acne is 
 ;;        superficial (with comedones, papules, pustules, superficial
 ;;        cysts) or deep (with deep inflamed nodules and pus-filled
 ;;        cysts), which areas of the body are affected, and, 
 ;;        specifically, the PERCENT OF FACE AND NECK affected.
 ;;
 ;;
 ;;    4.  For scarring alopecia, describe the PERCENT OF THE SCALP  
 ;;        that is affected.
 ;;
 ;;
 ;;    5.  For alopecia areata, describe whether there is loss of all
 ;;        body hair or whether loss of hair is limited to the scalp 
 ;;        and face.
 ;;
 ;;
 ;;    6.  For hyperhidrosis, state whether veteran is able to handle
 ;;        paper or tools after therapy, or is unable to handle paper
 ;;        or tools because of moisture and is unresponsive to therapy.
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    1.  Biopsy, scrapings if indicated.
 ;;    2.  Include results of all diagnostic and clinical tests conducted
 ;;        in the examination report.
 ;;    3.  With disfigurement or disfiguring scar of head, face, or 
 ;;        neck, submit COLOR PHOTOGRAPHS. 
 ;;    4.  Test for hypoproteinemia if examining for exfoliative
 ;;        dermatitis (erythroderma).
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;
 ;;Signature:                             Date:
 ;;END