source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWGE1.m@ 1154

DVBCWGE1 ;ALB/CMM GENITOURINARY EXAMINATION WKS TEXT - 1 ; 5 MARCH 1997
 ;;2.7;AMIE;**12**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;A.  Review of Medical Records: 
 ;;
 ;;
 ;;
 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;    Comment on:
 ;;    1.  Lethargy, weakness, anorexia, weight loss or gain.
 ;;
 ;;
 ;;    2.  Frequency (day or night, indicate voiding intervals), 
 ;;        hesitancy, stream, dysuria.
 ;;
 ;;
 ;;    3.  Incontinence - if present, describe required frequency of 
 ;;        absorbent material and whether an appliance is needed.
 ;;
 ;;
 ;;    4.  Provide details of any history of:
 ;;        a.  Surgery on any part of the urinary tract.  Residuals?  
 ;;            Impotence?
 ;;
 ;;
 ;;        b.  Recurrent urinary tract infections.
 ;;
 ;;
 ;;
 ;;        c.  Renal colic or bladder stones.
 ;;
 ;;
 ;;        d.  Acute nephritis.
 ;;
 ;;
 ;;        e.  Hospitalization for urinary tract disease, if so, how many
 ;;            in the past year?
 ;;
 ;;
 ;;        f.  Treatment for malignancy, including type and date of last
 ;;            treatment.
 ;;
 ;;
 ;;    5.  Treatments.
 ;;
 ;;        a.  Is catheterization needed?  Intermittent or continuous?
 ;;
 ;;
 ;;        b.  Frequency of dilations?
 ;;
 ;;
 ;;        c.  Drainage procedures.
 ;;
 ;;
 ;;        d.  Diet therapy - specify.
 ;;
 ;;
 ;;        e.  Medications.
 ;;
 ;;
 ;;        f.  Frequency per year of invasive and noninvasive procedures.
 ;;
 ;;
 ;;    6.  Describe the effects of the condition(s) on the veteran's 
 ;;        usual occupation and daily activities.
 ;;
 ;;
 ;;    For Male Loss of Use of a Creative Organ
 ;;    Comment on:
 ;;    1.  Trauma/surgery affecting penis/testicles (e.g. vasectomy?)
 ;;
 ;;
 ;;    2.  Local and/or systemic diseases affecting sexual function.
 ;;
 ;;        a.  Endocrine.
 ;;
 ;;
 ;;        b.  Neurologic.
 ;;
 ;;
 ;;        c.  Infections.
 ;;
 ;;
 ;;        d.  Vascular.
 ;;
 ;;
 ;;        e.  Psychological.
 ;;
 ;;
 ;;    3.  Symptoms:  Vaginal penetration with ejaculation possible?
 ;;
 ;;
 ;;    4.  Past treatment:
 ;;
 ;;        a.  Medications, injections, implants, pump, counseling.
 ;;
 ;;
 ;;        b.  Effectiveness in allowing intercourse.
 ;;
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Address each of the following, as appropriate, to the condition 
 ;;    being examined and fully describe current findings:
 ;;    1.  Blood pressure, cardiovascular examination, if indicated, 
 ;;        describe edema, to include persistence.
 ;;
 ;;
 ;;    2.  If on dialysis, type, where done, and how often?
 ;;
 ;;
 ;;    3.  Inspection and palpation of penis, testicles, epididymis, and
 ;;        spermatic cord.  If there is penis deformity, state whether 
 ;;        there is loss of erectile power.  Inspection of anus and 
 ;;        digital exam of rectal walls, prostate, and seminal vesicles.
 ;;
 ;;
 ;;    4.  Fistula.
 ;;
 ;;
 ;;    5.  Specific residuals of genitourinary disease, including post-treatment 
 ;;        residuals of malignancy.
 ;;
 ;;
 ;;    6.  Testicular atrophy - size and consistency.
 ;;
 ;;
 ;;    7.  Sensation and reflexes.
 ;;
 ;;
 ;;    8.  Peripheral pulses.
 ;;
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    1.  CBC.
 ;;    2.  UA.
 ;;    3.  Creatinine, BUN, albumin, electrolytes.
 ;;    4.  Uroflowmetry, if indicated.
 ;;    5.  Measurement of post-void residual, if indicated.
 ;;    6.  Semen analysis, including sperm count and interpretation of 
 ;;        results, if applicable.
 ;;    7.  Endocrine evaluation (glucose, TSH, testosterone, LH, FSH, 
 ;;        prolactin), if applicable.
 ;;    8.  Psychiatric evaluation, if applicable.
 ;;    9.  Include results of all diagnostic and clinical tests conducted
 ;;        in the examination report.
 ;;
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;
 ;;Signature:                             Date:
 ;;END