source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWCN3.m@ 1154

DVBCWCN3 ;ALB/RLC CRANIAL NERVES WKS TEXT - 1 ; 12 FEB 2007
 ;;2.7;AMIE;**121**;Apr 10, 1995;Build 9
 ;
 ;
TXT ;
 ;;A.  Review of Medical Records:
 ;;
 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;    Comment on:
 ;;
 ;;    1.  Onset, course since onset.
 ;;    2.  Symptoms.
 ;;    3.  Current treatment, response, side effects.
 ;;    4.  Effects of condition on occupational functioning and daily activities.
 ;;    5.  History of hospitalizations or surgery, location and dates, if known,
 ;;        reason or type of surgery.
 ;;    6.  History of trauma to a cranial nerve, date, type, nerve.
 ;;    7.  History of neoplasm:
 ;;
 ;;        a.  Date of diagnosis, diagnosis.
 ;;        b.  Benign or malignant.
 ;;        c.  Types of treatment, dates.
 ;;        d.  Last date of treatment.
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Address each of the following and fully describe current findings:
 ;;
 ;;    1.  Describe in detail specific motor and sensory impairment, quantifying
 ;;        as much as possible.
 ;;    2.  If smell or taste is affected, please also complete the appropriate
 ;;        worksheet.
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    1.  Include results of all diagnostic and clinical tests conducted
 ;;        in the examination report.
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;    1.  Identify the nerve and the side.
 ;;    2.  Identify the disorder (i.e., paralysis, neuritis, neuralgia).
 ;;    3.  State etiology.
 ;;
 ;;
 ;;Signature:                             Date:
 ;;END