| 1 | DVBCWCN1 ;ALB/CMM CRANIAL NERVES WKS TEXT - 1 ; 6 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 |  ;;B.  Medical History (Subjective Complaints):
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| 10 |  ;;
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| 11 |  ;;    Comment on:
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| 12 |  ;;    1.  If flare-ups exist, describe precipitating factors, aggravating 
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| 13 |  ;;        factors, alleviating factors, alleviating medications, frequency, 
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| 14 |  ;;        severity, duration, and whether the flare-ups include pain, 
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| 15 |  ;;        weakness, fatigue, or functional loss.
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| 16 |  ;;
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| 17 |  ;;
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| 18 |  ;;    2.  Current treatment, response, side effects.
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| 19 |  ;;
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| 20 |  ;;
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| 21 |  ;;C.  Physical Examination (Objective Findings):
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| 22 |  ;;
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| 23 |  ;;    Address each of the following and fully describe current findings:
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| 24 |  ;;    1.  Identify the nerve and the side.
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| 25 |  ;;
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| 26 |  ;;
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| 27 |  ;;    2.  Identify the disorder (i.e., paralysis, neuritis, neuralgia).
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| 28 |  ;;
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| 29 |  ;;
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| 30 |  ;;    3.  Describe in detail specific motor and sensory impairment, 
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| 31 |  ;;        quantifying as much as possible.
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| 32 |  ;;
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| 33 |  ;;
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| 34 |  ;;    4.  If smell or taste is affected, please also complete the 
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| 35 |  ;;        appropriate worksheet.
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| 36 |  ;;
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| 37 |  ;;
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| 38 |  ;;D.  Diagnostic and Clinical Tests:
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| 39 |  ;;
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| 40 |  ;;    1.  Include results of all diagnostic and clinical tests conducted
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| 41 |  ;;        in the examination report.
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| 42 |  ;;
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| 43 |  ;;
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| 44 |  ;;E.  Diagnosis:
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| 45 |  ;;
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| 46 |  ;;    1.  State etiology.
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| 47 |  ;;
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| 48 |  ;;
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| 49 |  ;;Signature:                             Date:
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| 50 |  ;;END
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