source: WorldVistAEHR/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWST1.m@ 1259

DVBCWST1 ;ALB/CMM STOMACH, DUODENUM, AND PERITONEAL ADHESIONS WKS TEXT - 1 ; 5 MARCH 1997
 ;;2.7;AMIE;**12**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;A.  Review of Medical Records:
 ;;
 ;;
 ;;
 ;;B.  Medical History (Subjective Complaints):
 ;;
 ;;    1.  Vomiting.
 ;;
 ;;
 ;;    2.  Hematemesis or melena (describe any episodes).
 ;;
 ;;
 ;;    3.  Treatment - type, duration, response, side effects.
 ;;
 ;;
 ;;    4.  Circulatory disturbance after meals, hypoglycemic reactions 
 ;;        (state time of onset in relation to meals, frequency).
 ;;
 ;;
 ;;    5.  Diarrhea, constipation.
 ;;
 ;;
 ;;    6.  Episodes of colic, distention, nausea, and/or vomiting - 
 ;;        frequency, duration, and severity.
 ;;
 ;;
 ;;C.  Physical Examination (Objective Findings):
 ;;
 ;;    Address each of the following and fully describe current findings:
 ;;    1.  Specific site of any ulcer disease.
 ;;
 ;;
 ;;    2.  Weight gain or loss.
 ;;
 ;;
 ;;    3.  Signs of anemia.
 ;;
 ;;
 ;;    4.  Pain or tenderness - location, type, precipitating factors.
 ;;
 ;;
 ;;D.  Diagnostic and Clinical Tests:
 ;;
 ;;    1.  For gastritis, endoscopic evidence - describe hemorrhage, 
 ;;        ulcerated or eroded areas.
 ;;    2.  For adhesions, X-ray to show partial obstruction, delayed 
 ;;        motility.
 ;;    3.  Include results of all diagnostic and clinical tests conducted
 ;;        in the examination report.
 ;;
 ;;
 ;;E.  Diagnosis:
 ;;
 ;;
 ;;Signature:                             Date:
 ;;END