source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWHI1.m@ 1262

DVBCWHI1 ;ALB/CMM HIV-RELATED ILLNESS WKS TEXT - 1 ; 6 MARCH 1997
 ;;2.7;AMIE;**12**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;A.  Review of Medical Records:
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 ;;
 ;;
 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;    Comment On:
 ;;    1.  Recurrent opportunistic infections.
 ;;
 ;;
 ;;    2.  Recurrent constitutional symptoms.
 ;;
 ;;
 ;;    3.  Diarrhea.
 ;;
 ;;
 ;;    4.  Debility.
 ;;
 ;;
 ;;    5.  Progressive weight loss.
 ;;
 ;;
 ;;    6.  Remissions in any symptomatology.
 ;;
 ;;
 ;;    7.  Depression or memory loss.
 ;;
 ;;
 ;;    8.  Treatment - Is this an approved medication?
 ;;
 ;;
 ;;    9.  Describe the effects of the condition on the veteran's usual 
 ;;        occupation and daily activities.
 ;;
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Address each of the following and fully describe:
 ;;    1.  Definitive diagnosis of AIDS.  (Use CDC Definition.)
 ;;
 ;;
 ;;    2.  Secondary diseases affecting multiple body systems - describe.
 ;;
 ;;
 ;;    3.  HIV-related illnesses - describe.
 ;;
 ;;
 ;;    4.  Neoplasm related to HIV-related illness.  Describe.
 ;;
 ;;
 ;;    5.  T4 cell counts.
 ;;
 ;;
 ;;    6.  Hairy cell leukoplakia.
 ;;
 ;;
 ;;    7.  Oral candidiasis.
 ;;
 ;;
 ;;    8.  Use of HIV-related medications.
 ;;
 ;;
 ;;    9.  Lymphadenopathy.
 ;;
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    Provide:
 ;;    1.  T4 Cell counts.
 ;;    2.  Include results of all diagnostic and clinical tests conducted
 ;;        in the examination report.
 ;;
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;
 ;;Signature:                             Date:
 ;;END