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1DVBCWSW3 ;ALB/CMM SCARS WKS TEXT - 1 ; 11/20/02 3:04pm
2 ;;2.7;AMIE;**49**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;A. Review of Medical Records:
7 ;;
8 ;;
9 ;;
10 ;;B. Medical History (Subjective Complaints):
11 ;;
12 ;; 1. Type of injury or infection causing the wound or scar, its
13 ;; date, the treatment used, and the response to such treatment.
14 ;;
15 ;;
16 ;; 2. Current symptoms.
17 ;;
18 ;;
19 ;;C. Physical Examination (Objective Findings):
20 ;;
21 ;; For every scar to be examined, address EACH of the following and
22 ;; fully describe the current findings. Note that, in addition
23 ;; to measuring the scar itself, measurements of areas with certain
24 ;; abnormal characteristics must also be provided. All measurements
25 ;; should be reported in inches or centimeters.
26 ;; 1. Describe precise location of each scar. Draw diagram if
27 ;; necessary.
28 ;;
29 ;;
30 ;; 2. Give MEASUREMENT of length and width (at its widest part) of
31 ;; each scar.
32 ;;
33 ;;
34 ;; 3. Is there pain in the scar on examination?
35 ;;
36 ;;
37 ;; 4. Is there adherence to underlying tissue?
38 ;;
39 ;;
40 ;; 5. Texture of skin. If irregular, atrophic, shiny, scaly, etc.,
41 ;; give MEASUREMENT of length and width of area so affected.
42 ;;
43 ;;
44 ;; 6. Is the scar unstable, meaning is there frequent loss of
45 ;; covering of skin over the scar, such as from ulceration or
46 ;; breakdown of skin?
47 ;;
48 ;;
49 ;; 7. Is there elevation or depression of the surface contour
50 ;; of the scar on palpation?
51 ;;
52 ;;
53 ;; 8. Is the scar superficial (meaning there is no underlying
54 ;; soft tissue damage)?
55 ;;
56 ;;
57 ;; 9. Is the scar deep (meaning there is underlying soft tissue
58 ;; loss or damage)? If yes, give MEASUREMENT of length and
59 ;; width of underlying soft tissue damage.
60 ;;
61 ;;
62 ;; 10. Describe any inflammation, edema, or keloid formation.
63 ;;
64 ;;
65 ;; 11. Describe color of scar compared to normal areas of skin
66 ;; (give MEASUREMENT of length and width of any hypopigmentation
67 ;; or hyperpigmentation).
68 ;;
69 ;;
70 ;; 12. For face, discuss whether there is gross distortion or
71 ;; asymmetry of any feature or set of paired features (nose,
72 ;; chin, forehead, eyes (including eyelids), ears (auricles),
73 ;; cheeks, lips).
74 ;;
75 ;;
76 ;; 13. Is there an area of induration and inflexibility of skin in
77 ;; the area of the scar? If so, give MEASUREMENT of length
78 ;; and width of area of induration.
79 ;;
80 ;;
81 ;; 14. Describe any limitation of motion or other limitation of
82 ;; function caused by a scar.
83 ;;
84 ;;
85 ;; 15. With disfigurement or disfiguring scar of head, face, or
86 ;; neck, submit COLOR PHOTOGRAPHS.
87 ;;
88 ;;D. Diagnostic and Clinical Tests:
89 ;;
90 ;; Include results of all diagnostic and clinical tests conducted
91 ;; in the examination report.
92 ;;
93 ;;
94 ;;E. Diagnosis:
95 ;;
96 ;;
97 ;;Signature: Date:
98 ;;END
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