source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWHI1.m@ 1757

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1DVBCWHI1 ;ALB/CMM HIV-RELATED ILLNESS WKS TEXT - 1 ; 6 MARCH 1997
2 ;;2.7;AMIE;**12**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;A. Review of Medical Records:
7 ;;
8 ;;
9 ;;
10 ;;B. Medical History (Subjective Complaints):
11 ;;
12 ;; Comment On:
13 ;; 1. Recurrent opportunistic infections.
14 ;;
15 ;;
16 ;; 2. Recurrent constitutional symptoms.
17 ;;
18 ;;
19 ;; 3. Diarrhea.
20 ;;
21 ;;
22 ;; 4. Debility.
23 ;;
24 ;;
25 ;; 5. Progressive weight loss.
26 ;;
27 ;;
28 ;; 6. Remissions in any symptomatology.
29 ;;
30 ;;
31 ;; 7. Depression or memory loss.
32 ;;
33 ;;
34 ;; 8. Treatment - Is this an approved medication?
35 ;;
36 ;;
37 ;; 9. Describe the effects of the condition on the veteran's usual
38 ;; occupation and daily activities.
39 ;;
40 ;;
41 ;;C. Physical Examination (Objective Findings):
42 ;;
43 ;; Address each of the following and fully describe:
44 ;; 1. Definitive diagnosis of AIDS. (Use CDC Definition.)
45 ;;
46 ;;
47 ;; 2. Secondary diseases affecting multiple body systems - describe.
48 ;;
49 ;;
50 ;; 3. HIV-related illnesses - describe.
51 ;;
52 ;;
53 ;; 4. Neoplasm related to HIV-related illness. Describe.
54 ;;
55 ;;
56 ;; 5. T4 cell counts.
57 ;;
58 ;;
59 ;; 6. Hairy cell leukoplakia.
60 ;;
61 ;;
62 ;; 7. Oral candidiasis.
63 ;;
64 ;;
65 ;; 8. Use of HIV-related medications.
66 ;;
67 ;;
68 ;; 9. Lymphadenopathy.
69 ;;
70 ;;
71 ;;D. Diagnostic and Clinical Tests:
72 ;;
73 ;; Provide:
74 ;; 1. T4 Cell counts.
75 ;; 2. Include results of all diagnostic and clinical tests conducted
76 ;; in the examination report.
77 ;;
78 ;;
79 ;;E. Diagnosis:
80 ;;
81 ;;
82 ;;Signature: Date:
83 ;;END
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