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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