| 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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