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
|
Rev | Line | |
---|
[613] | 1 | DVBCWHI1 ;ALB/CMM HIV-RELATED ILLNESS 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 | ;;
|
---|
| 10 | ;;B. Medical History (Subjective Complaints):
|
---|
| 11 | ;;
|
---|
| 12 | ;; Comment On:
|
---|
| 13 | ;; 1. Recurrent opportunistic infections.
|
---|
| 14 | ;;
|
---|
| 15 | ;;
|
---|
| 16 | ;; 2. Recurrent constitutional symptoms.
|
---|
| 17 | ;;
|
---|
| 18 | ;;
|
---|
| 19 | ;; 3. Diarrhea.
|
---|
| 20 | ;;
|
---|
| 21 | ;;
|
---|
| 22 | ;; 4. Debility.
|
---|
| 23 | ;;
|
---|
| 24 | ;;
|
---|
| 25 | ;; 5. Progressive weight loss.
|
---|
| 26 | ;;
|
---|
| 27 | ;;
|
---|
| 28 | ;; 6. Remissions in any symptomatology.
|
---|
| 29 | ;;
|
---|
| 30 | ;;
|
---|
| 31 | ;; 7. Depression or memory loss.
|
---|
| 32 | ;;
|
---|
| 33 | ;;
|
---|
| 34 | ;; 8. Treatment - Is this an approved medication?
|
---|
| 35 | ;;
|
---|
| 36 | ;;
|
---|
| 37 | ;; 9. Describe the effects of the condition on the veteran's usual
|
---|
| 38 | ;; occupation and daily activities.
|
---|
| 39 | ;;
|
---|
| 40 | ;;
|
---|
| 41 | ;;C. Physical Examination (Objective Findings):
|
---|
| 42 | ;;
|
---|
| 43 | ;; Address each of the following and fully describe:
|
---|
| 44 | ;; 1. Definitive diagnosis of AIDS. (Use CDC Definition.)
|
---|
| 45 | ;;
|
---|
| 46 | ;;
|
---|
| 47 | ;; 2. Secondary diseases affecting multiple body systems - describe.
|
---|
| 48 | ;;
|
---|
| 49 | ;;
|
---|
| 50 | ;; 3. HIV-related illnesses - describe.
|
---|
| 51 | ;;
|
---|
| 52 | ;;
|
---|
| 53 | ;; 4. Neoplasm related to HIV-related illness. Describe.
|
---|
| 54 | ;;
|
---|
| 55 | ;;
|
---|
| 56 | ;; 5. T4 cell counts.
|
---|
| 57 | ;;
|
---|
| 58 | ;;
|
---|
| 59 | ;; 6. Hairy cell leukoplakia.
|
---|
| 60 | ;;
|
---|
| 61 | ;;
|
---|
| 62 | ;; 7. Oral candidiasis.
|
---|
| 63 | ;;
|
---|
| 64 | ;;
|
---|
| 65 | ;; 8. Use of HIV-related medications.
|
---|
| 66 | ;;
|
---|
| 67 | ;;
|
---|
| 68 | ;; 9. Lymphadenopathy.
|
---|
| 69 | ;;
|
---|
| 70 | ;;
|
---|
| 71 | ;;D. Diagnostic and Clinical Tests:
|
---|
| 72 | ;;
|
---|
| 73 | ;; Provide:
|
---|
| 74 | ;; 1. T4 Cell counts.
|
---|
| 75 | ;; 2. Include results of all diagnostic and clinical tests conducted
|
---|
| 76 | ;; in the examination report.
|
---|
| 77 | ;;
|
---|
| 78 | ;;
|
---|
| 79 | ;;E. Diagnosis:
|
---|
| 80 | ;;
|
---|
| 81 | ;;
|
---|
| 82 | ;;Signature: Date:
|
---|
| 83 | ;;END
|
---|
Note:
See
TracBrowser
for help on using the repository browser.