source: WorldVistAEHR/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWDO1.m@ 1211

Last change on this file since 1211 was 613, checked in by George Lilly, 15 years ago

initial load of WorldVistAEHR

File size: 1.6 KB
Line 
1DVBCWDO1 ;ALB/CMM DENTAL AND ORAL WKS TEXT - 1 ; 5 MARCH 1997
2 ;;2.7;AMIE;**12**;Apr 10, 1995
3 ;
4 ;
5TXT ;
6 ;;Narrative: Regional Office action is required for all dental treatment
7 ;;based on combat wounds, service trauma, prisoner of war or extracted
8 ;;teeth under 38 CFR 17.123.
9 ;;
10 ;;A. Review of Medical Records:
11 ;;
12 ;;
13 ;;B. Medical History (Subjective Complaints):
14 ;;
15 ;;
16 ;;
17 ;;C. Physical Examination (Objective Findings):
18 ;;
19 ;; Address each of the following and fully describe:
20 ;; 1. Describe extent of functional impairment due to loss of motion
21 ;; and masticatory function loss.
22 ;;
23 ;;
24 ;; 2. Describe the extent and number of missing teeth and whether
25 ;; the masticatory surface can be replaced by a prosthesis.
26 ;;
27 ;;
28 ;; 3. If limitation of inter-incisal range of motion, provide actual
29 ;; range in mm (i.e., 0-Xmm) and also provide lateral excursion
30 ;; (i.e., 0-Xmm).
31 ;;
32 ;;
33 ;; 4. Describe the extent of any bone loss of mandible, maxilla, or
34 ;; hard palate. For hard palate and maxilla bone loss, state
35 ;; whether replaceable by prosthesis.
36 ;;
37 ;;
38 ;;D. Diagnostic and Clinical Tests:
39 ;;
40 ;; Provide:
41 ;; 1. X-ray to determine extent of bone tissue loss.
42 ;; 2. Include results of all diagnostic and clinical tests conducted
43 ;; in the examination report.
44 ;;
45 ;;TOF
46 ;;E. Diagnosis:
47 ;;
48 ;; 1. Give etiology where there is loss of teeth due to loss of
49 ;; substance of body of maxilla or mandible.
50 ;;
51 ;;
52 ;;Signature: Date:
53 ;;END
Note: See TracBrowser for help on using the repository browser.