| [613] | 1 | DVBCWSW1 ;ALB/CMM SCARS WKS TEXT - 1 ; 6 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 |  ;;    1.  Type of injury or infection causing the wound or scar, its 
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 | 13 |  ;;        date, the treatment used and the response to such treatment.
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 | 14 |  ;;
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 | 15 |  ;;
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 | 16 |  ;;    2.  Current symptoms.
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 | 17 |  ;;
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 | 18 |  ;;
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 | 19 |  ;;C.  Physical Examination (Objective Findings):
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 | 20 |  ;;
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 | 21 |  ;;    Address each of the following and fully describe current findings
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 | 22 |  ;;    (for each scar):
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 | 23 |  ;;    1.  Location, measurements (cm. x cm.), and shape of each scar.
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 | 24 |  ;;
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 | 25 |  ;;
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 | 26 |  ;;    2.  Tenderness.
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 | 27 |  ;;
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 | 28 |  ;;
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 | 29 |  ;;    3.  Adherence.
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 | 30 |  ;;
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 | 31 |  ;;
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 | 32 |  ;;    4.  Texture.
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 | 33 |  ;;
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 | 34 |  ;;
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 | 35 |  ;;    5.  Ulceration or breakdown of skin.
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 | 36 |  ;;
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 | 37 |  ;;
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 | 38 |  ;;    6.  Elevation or depression of scar.
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 | 39 |  ;;
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 | 40 |  ;;
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 | 41 |  ;;    7.  Extent of underlying tissue loss.
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 | 42 |  ;;
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 | 43 |  ;;
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 | 44 |  ;;    8.  Inflammation, edema, or keloid formation.
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 | 45 |  ;;
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 | 46 |  ;;
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 | 47 |  ;;    9.  Color of scar compared to normal areas of skin.
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 | 48 |  ;;
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 | 49 |  ;;
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 | 50 |  ;;   10.  Disfigurement.
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 | 51 |  ;;
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 | 52 |  ;;
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 | 53 |  ;;   11.  For each burn scar, state if due to a 2nd or 3rd degree burn.
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 | 54 |  ;;
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 | 55 |  ;;
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 | 56 |  ;;   12.  Limitation of function by scar.
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 | 57 |  ;;
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 | 58 |  ;;
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 | 59 |  ;;   13.  An attachment is provided in the Handout of Instructions for 
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 | 60 |  ;;        Compensation and Pension Examinations for plotting the 
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 | 61 |  ;;        location of scars.
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 | 62 |  ;;
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 | 63 |  ;;
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 | 64 |  ;;D.  Diagnostic and Clinical Tests:
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 | 65 |  ;;
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 | 66 |  ;;    1.  With disfigurement or disfiguring scar of head, face, or neck,
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 | 67 |  ;;        submit COLOR PHOTOGRAPHS.
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 | 68 |  ;;    2.  Include results of all diagnostic and clinical tests conducted
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 | 69 |  ;;        in the examination report.
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 | 70 |  ;;
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 | 71 |  ;;
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 | 72 |  ;;E.  Diagnosis:
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 | 73 |  ;;
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 | 74 |  ;;
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 | 75 |  ;;Signature:                             Date:
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 | 76 |  ;;END
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