[613] | 1 | DVBCWCN1 ;ALB/CMM CRANIAL NERVES WKS TEXT - 1 ; 6 MARCH 1997
|
---|
| 2 | ;;2.7;AMIE;**12**;Apr 10, 1995
|
---|
| 3 | ;
|
---|
| 4 | ;
|
---|
| 5 | TXT ;
|
---|
| 6 | ;;A. Review of Medical Records:
|
---|
| 7 | ;;
|
---|
| 8 | ;;
|
---|
| 9 | ;;B. Medical History (Subjective Complaints):
|
---|
| 10 | ;;
|
---|
| 11 | ;; Comment on:
|
---|
| 12 | ;; 1. If flare-ups exist, describe precipitating factors, aggravating
|
---|
| 13 | ;; factors, alleviating factors, alleviating medications, frequency,
|
---|
| 14 | ;; severity, duration, and whether the flare-ups include pain,
|
---|
| 15 | ;; weakness, fatigue, or functional loss.
|
---|
| 16 | ;;
|
---|
| 17 | ;;
|
---|
| 18 | ;; 2. Current treatment, response, side effects.
|
---|
| 19 | ;;
|
---|
| 20 | ;;
|
---|
| 21 | ;;C. Physical Examination (Objective Findings):
|
---|
| 22 | ;;
|
---|
| 23 | ;; Address each of the following and fully describe current findings:
|
---|
| 24 | ;; 1. Identify the nerve and the side.
|
---|
| 25 | ;;
|
---|
| 26 | ;;
|
---|
| 27 | ;; 2. Identify the disorder (i.e., paralysis, neuritis, neuralgia).
|
---|
| 28 | ;;
|
---|
| 29 | ;;
|
---|
| 30 | ;; 3. Describe in detail specific motor and sensory impairment,
|
---|
| 31 | ;; quantifying as much as possible.
|
---|
| 32 | ;;
|
---|
| 33 | ;;
|
---|
| 34 | ;; 4. If smell or taste is affected, please also complete the
|
---|
| 35 | ;; appropriate worksheet.
|
---|
| 36 | ;;
|
---|
| 37 | ;;
|
---|
| 38 | ;;D. Diagnostic and Clinical Tests:
|
---|
| 39 | ;;
|
---|
| 40 | ;; 1. Include results of all diagnostic and clinical tests conducted
|
---|
| 41 | ;; in the examination report.
|
---|
| 42 | ;;
|
---|
| 43 | ;;
|
---|
| 44 | ;;E. Diagnosis:
|
---|
| 45 | ;;
|
---|
| 46 | ;; 1. State etiology.
|
---|
| 47 | ;;
|
---|
| 48 | ;;
|
---|
| 49 | ;;Signature: Date:
|
---|
| 50 | ;;END
|
---|