source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWLY3.m@ 1607

DVBCWLY3 ;ALB/RLC LYMPHATIC DISORDERS 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.  If there are exacerbations/remissions, what is the state of the
 ;;        veteran's health, during remissions?
 ;;    2.  Current and past treatment history including date and type of
 ;;        last treatment, response, side effects.
 ;;    3.  If malignant neoplasm need diagnosis, date of diagnosis, dates of
 ;;        treatment, or if treatment ended, date of last treatment.
 ;;    4.  Current symptoms - lymphadenopathy, bleeding tendency, gastrointestinal
 ;;        symptoms, constitutional symptoms.
 ;;    5.  History of hospitalizations or surgery, reason or type of surgery,
 ;;        location and dates, if known.
 ;;    6.  Effects of condition on occupational functioning and daily activities.
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Describe the residuals of each body system affected and follow additional
 ;;    worksheets as appropriate.  Comment on the following:
 ;;
 ;;    1.  Lymphadenopathy.
 ;;    2.  Splenomegaly.
 ;;    3.  Hepatomegaly, jaundice.
 ;;    4.  Signs of bleeding.
 ;;    5.  Signs of anemia - Presence of Pallor (nail beds, mucosal surfaces and
 ;;        skin), tachycardia, systolic murmur.
 ;;    6.  Evidence of superior vena cava syndrome.
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    1.  Include results of all diagnostic and clinical tests conducted in
 ;;        the examination report.
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;    1.  Is the disease active?
 ;;
 ;;
 ;;
 ;;Signature:                             Date:
 ;;END