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[613] | 1 | DVBCWLY1 ;ALB/CMM LYMPHATIC DISORDERS 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 | ;;
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| 10 | ;;B. Medical History (Subjective Complaints):
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| 11 | ;;
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| 12 | ;; Comment on:
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| 13 | ;; 1. Disease activity (exacerbations/remission)? If there were
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| 14 | ;; exacerbations, what was the state of the veteran's health
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| 15 | ;; between exacerbations?
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| 16 | ;;
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| 17 | ;;
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| 18 | ;; 2. Current and past treatment history including date and type of
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| 19 | ;; last treatment, response, side effects.
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| 20 | ;;
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| 21 | ;;
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| 22 | ;; 3. If malignant neoplasm need date of diagnosis, date of
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| 23 | ;; treatment, or if treatment stopped when did it end.
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| 24 | ;;
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| 25 | ;;
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| 26 | ;; 4. Location of disease.
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| 27 | ;;
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| 28 | ;;
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| 29 | ;; 5. Current symptoms.
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| 30 | ;;
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| 31 | ;;
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| 32 | ;;C. Physical Examination (Objective Findings):
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| 33 | ;;
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| 34 | ;; Describe the residuals of each body system affected.
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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 | ;; 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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