1 | DVBCWSW1 ;ALB/CMM SCARS WKS TEXT - 1 ; 6 MARCH 1997
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2 | ;;2.7;AMIE;**12**;Apr 10, 1995
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3 | ;
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4 | ;
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5 | TXT ;
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6 | ;;A. Review of Medical Records:
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7 | ;;
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8 | ;;
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9 | ;;
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10 | ;;B. Medical History (Subjective Complaints):
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11 | ;;
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12 | ;; 1. Type of injury or infection causing the wound or scar, its
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13 | ;; date, the treatment used and the response to such treatment.
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14 | ;;
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15 | ;;
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16 | ;; 2. Current symptoms.
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17 | ;;
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18 | ;;
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19 | ;;C. Physical Examination (Objective Findings):
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20 | ;;
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21 | ;; Address each of the following and fully describe current findings
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22 | ;; (for each scar):
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23 | ;; 1. Location, measurements (cm. x cm.), and shape of each scar.
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24 | ;;
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25 | ;;
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26 | ;; 2. Tenderness.
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27 | ;;
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28 | ;;
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29 | ;; 3. Adherence.
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30 | ;;
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31 | ;;
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32 | ;; 4. Texture.
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33 | ;;
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34 | ;;
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35 | ;; 5. Ulceration or breakdown of skin.
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36 | ;;
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37 | ;;
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38 | ;; 6. Elevation or depression of scar.
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39 | ;;
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40 | ;;
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41 | ;; 7. Extent of underlying tissue loss.
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42 | ;;
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43 | ;;
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44 | ;; 8. Inflammation, edema, or keloid formation.
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45 | ;;
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46 | ;;
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47 | ;; 9. Color of scar compared to normal areas of skin.
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48 | ;;
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49 | ;;
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50 | ;; 10. Disfigurement.
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51 | ;;
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52 | ;;
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53 | ;; 11. For each burn scar, state if due to a 2nd or 3rd degree burn.
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54 | ;;
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55 | ;;
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56 | ;; 12. Limitation of function by scar.
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57 | ;;
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58 | ;;
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59 | ;; 13. An attachment is provided in the Handout of Instructions for
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60 | ;; Compensation and Pension Examinations for plotting the
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61 | ;; location of scars.
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62 | ;;
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63 | ;;
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64 | ;;D. Diagnostic and Clinical Tests:
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65 | ;;
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66 | ;; 1. With disfigurement or disfiguring scar of head, face, or neck,
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67 | ;; submit COLOR PHOTOGRAPHS.
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68 | ;; 2. Include results of all diagnostic and clinical tests conducted
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69 | ;; in the examination report.
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70 | ;;
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71 | ;;
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72 | ;;E. Diagnosis:
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73 | ;;
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74 | ;;
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75 | ;;Signature: Date:
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76 | ;;END
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