| [613] | 1 | DVBCEXM1 ;ALB/CMC REQUEST WORKSHEET TEXT ; 8/15/97
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| 2 | ;;2.7;AMIE;**12,16,80**;Apr 10, 1995
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| 3 | ;
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| 4 | TXT ;
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| 5 | ;; Body System: Musculoskeletal (DC Series 5000, 5100, 5200, 5300)
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| 6 | ;; ( ) Bones (Fractures and Bone Disease) ( ) Fibromyalgia
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| 7 | ;; ( ) Amputation, Residuals of ( ) Joints (Shoulder/Elbow/Wrist/Hip/Knee/Ankle)
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| 8 | ;; ( ) Hand, Thumb, and Fingers ( ) Feet
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| 9 | ;; ( ) Spine (Cervical, Thoracic & Lumbar) ( ) Muscles
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| 10 | ;;
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| 11 | ;; Body System: Organs of Sense (DC Series 6000, 6100, 6200)
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| 12 | ;; ( ) Eye Examination ( ) Audio
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| 13 | ;; ( ) Ear Disease ( ) Sense of Smell and Taste
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| 14 | ;;
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| 15 | ;; Body System: Infectious/Immune/Nutritional (DC Series 6300)
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| 16 | ;; ( ) Infectious, Immune, and Nutritional Disabilities
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| 17 | ;; ( ) HIV-Related Illness ( ) Chronic Fatigue Syndrome
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| 18 | ;;
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| 19 | ;; Body System: Respiratory (DC Series 6500, 6600, 6700, 6800)
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| 20 | ;; ( ) Nose, Sinus, Larynx, and Pharynx ( ) Respiratory (Obstructive, Restrictive,
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| 21 | ;; ( ) Pulmonary Tuberculosis and and Interstitial)
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| 22 | ;; Mycobacterial Diseases ( ) Respiratory Diseases, Miscellaneous
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| 23 | ;;
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| 24 | ;; Body System: Cardiovascular (DC Series 7000, 7100)
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| 25 | ;; ( ) Arrhythmias ( ) Heart
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| 26 | ;; ( ) Arteries, Veins and Miscellaneous ( ) Hypertension
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| 27 | ;;
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| 28 | ;; Body System: Digestive (DC Series 7200, 7300)
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| 29 | ;; ( ) Mouth, Lips, and Tongue ( ) Esophagus and Hiatal Hernia
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| 30 | ;; ( ) Intestines (Large and Small) ( ) Liver, Gall Bladder, and Pancreas
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| 31 | ;; ( ) Digestive Conditions, Miscellaneous ( ) Rectum and Anus
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| 32 | ;; ( ) Stomach, Duodenum, and Peritoneal Adhesions
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| 33 | ;;
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| 34 | ;; Body System: Genitourinary (DC Series 7500)
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| 35 | ;; ( ) Genitourinary Examination
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| 36 | ;;
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| 37 | ;; Body System: Gynecological and Breast (DC Series 7600)
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| 38 | ;; ( ) Gynecological Conditions and
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| 39 | ;; Disorders of the Breast
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| 40 | ;;
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| 41 | ;; Body System: Hemic and Lymphatic (DC Series 7700)
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| 42 | ;; ( ) Hemic Disorders ( ) Lymphatic Disorders
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| 43 | ;;
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| 44 | ;; Body System: Skin (DC Series 7800)
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| 45 | ;; ( ) Scars ( ) Skin Diseases (other than scars)
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| 46 | ;;
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| 47 | ;; Body System: Endocrine (DC Series 7900)
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| 48 | ;; ( ) Endocrine Diseases, Miscellaneous ( ) Thyroid and Parathyroid Diseases
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| 49 | ;; ( ) Cushing's Syndrome ( ) Acromegaly
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| 50 | ;; ( ) Diabetes Mellitus
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| 51 | ;;
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| 52 | ;; Body System: Neurologic (DC Series 8000, 8100, 8200, 8300, 8400, 8500, 8600, 8700, 8800, 8900)
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| 53 | ;; ( ) Brain and Spinal Cord ( ) Cranial Nerves
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| 54 | ;; ( ) Neurological Disorders, Miscellaneous ( ) Peripheral Nerves
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| 55 | ;; ( ) Epilepsy and Narcolepsy
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| 56 | ;;
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| 57 | ;; Body System: Mental Disorders (DC Series 9200, 9300, 9400, 9500)
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| 58 | ;; ( ) Mental Disorders (not PTSD and Eating Disorders)
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| 59 | ;; ( ) Initial Evaluation for Post-Traumatic Stress Disorder (PTSD)
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| 60 | ;; ( ) Review Examination for Post-Traumatic Stress Disorder (PTSD)
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| 61 | ;; ( ) Eating Disorders (Mental Disorders)
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| 62 | ;;
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| 63 | ;; Body System: Dental and Oral (DC Series 9900)
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| 64 | ;; ( ) Dental and Oral
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| 65 | ;;
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| 66 | ;; Special Examinations:
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| 67 | ;; ( ) Aid and Attendance or Housebound Examination
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| 68 | ;; ( ) Prisoner of War Protocol Examination
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| 69 | ;; ( ) Cold Injury Protocol Examination
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| 70 | ;; ( ) Gulf War Guidelines
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| 71 | ;; ( ) Social and Industrial Survey
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| 72 | ;;END
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