[613] | 1 | DVBCWDM1 ;ALB/CMM DIGESTIVE, MISC. DISEASES WKS TEXT - 1 ; 5 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 | ;;B. Medical History (Subjective Complaints):
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| 10 | ;;
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| 11 | ;; 1. Describe all hernia surgery and results.
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| 12 | ;;
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| 13 | ;;
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| 14 | ;; 2. For malignancy, state type of treatment, dates of treatment,
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| 15 | ;; including last date treatment if it has ended.
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| 16 | ;;
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| 17 | ;;
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| 18 | ;; 3. For peritoneal tuberculosis, state date of diagnosis, treatment,
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| 19 | ;; and date on which inactivity was established.
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| 20 | ;;
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| 21 | ;;
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| 22 | ;;C. Physical Examination (Objective Findings):
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| 23 | ;;
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| 24 | ;; Address each of the following and fully describe current findings:
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| 25 | ;; 1. For inguinal or ventral hernia, state whether reducible, how
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| 26 | ;; well supported by truss or belt, and whether irremediable or
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| 27 | ;; inoperable.
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| 28 | ;;
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| 29 | ;;
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| 30 | ;; 2. For ventral hernia, state size of hernia, extent of diastasis
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| 31 | ;; of recti muscles, status of muscles and fascia of abdominal wall.
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| 32 | ;;
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| 33 | ;;
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| 34 | ;; 3. All residuals of malignancy, including residuals from treatment.
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| 35 | ;;
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| 36 | ;;
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| 37 | ;;D. Diagnostic and Clinical Tests:
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| 38 | ;;
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| 39 | ;;1. Include results of all diagnostic and clinical tests conducted in
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| 40 | ;; the examination report.
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| 41 | ;;
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| 42 | ;;
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| 43 | ;;E. Diagnosis:
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| 44 | ;;
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| 45 | ;;
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| 46 | ;;Signature: Date:
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| 47 | ;;END
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