[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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