93 lines
3.8 KiB
Mathematica
93 lines
3.8 KiB
Mathematica
DVBCWFW3 ;ALB/RLC FEET WKS TEXT - 1 ; 16 JAN 2007
|
|
;;2.7;AMIE;**120**;Apr 10, 1995;Build 4
|
|
;
|
|
TXT ;
|
|
;;A. Review of Medical Records:
|
|
;;
|
|
;;B. Medical History (Subjective Complaints):
|
|
;;
|
|
;; Comment on:
|
|
;;
|
|
;; 1. Pain, weakness, stiffness, swelling, heat, redness,
|
|
;; fatigability, lack of endurance, etc.
|
|
;; 2. Describe symptoms at rest and on standing and walking.
|
|
;; 3. Treatment - type, dose, frequency, response, side effects.
|
|
;; 4. If there are periods of flare-up of joint disease:
|
|
;;
|
|
;; a. State their severity, frequency, and duration.
|
|
;; b. Name the precipitating and alleviating factors.
|
|
;; c. Estimate to what extent, if any, they result in additional
|
|
;; limitation of motion or functional impairment during the
|
|
;; flare-up. (Per veteran)
|
|
;;
|
|
;;
|
|
;; 5. Describe whether crutches, brace, cane, corrective shoes,
|
|
;; shoe inserts, etc., are needed and their efficacy.
|
|
;; 6. History of any hospitalization or surgery (Date, location, if known,
|
|
;; reason or type of surgery).
|
|
;; 7. Describe effects of the condition(s) on the veteran's usual
|
|
;; occupation and daily activities.
|
|
;; 8. Describe any injury to the feet.
|
|
;; 9. Functional limitations on standing (i.e., unable to stand, able
|
|
;; to stand 15-30 minutes) and walking (i.e., nonambulatory, able to
|
|
;; walk 1/4 mile).
|
|
;; 10. History of neoplasm:
|
|
;;
|
|
;; a. Date of diagnosis, diagnosis.
|
|
;; b. Benign or malignant.
|
|
;; c. Types and dates of treatment.
|
|
;; d. Date of last treatment.
|
|
;;
|
|
;;C. Physical Examination (Objective Findings):
|
|
;;
|
|
;; Address each of the following as appropriate to the condition
|
|
;; being examined and fully describe current findings: A DETAILED
|
|
;; ASSESSMENT OF EACH AFFECTED JOINT IS REQUIRED.
|
|
;;
|
|
;; 1. Describe each foot separately. For nomenclature of toes use:
|
|
;; great toe, second, third, fourth, and fifth. The functional
|
|
;; loss should be related to the anatomical condition.
|
|
;; 2. Describe objective evidence of painful motion, edema,
|
|
;; instability, weakness, tenderness, etc.
|
|
;; 3. Describe gait.
|
|
;; 4. Describe any callosities, breakdown, or unusual shoe wear
|
|
;; pattern that would indicate abnormal weight bearing.
|
|
;; 5. Describe any skin and vascular changes.
|
|
;; 6. Describe hammertoes, high arch, clawfoot, or other deformity -
|
|
;; actively or passively correctable?
|
|
;; 7. For flatfoot
|
|
;;
|
|
;; a. Describe weight bearing and non-weight bearing alignment
|
|
;; of the Achilles tendon.
|
|
;; b. Describe whether the Achilles tendon alignment can be
|
|
;; corrected by manipulation and whether there is pain on
|
|
;; manipulation.
|
|
;; c. Describe degrees of valgus and whether correctable by
|
|
;; manipulation.
|
|
;; d. Describe extent of forefoot and midfoot malalignment and
|
|
;; whether correctable by manipulation.
|
|
;;
|
|
;; 8. For hallux valgus, describe angulation and dorsiflexion at
|
|
;; first metatarsal phalangeal joints.
|
|
;; 9. Is there any active motion in the metatarsophalangeal joint of
|
|
;; the great toe?
|
|
;;
|
|
;;D. Diagnostic and Clinical Tests:
|
|
;;
|
|
;; Comment on:
|
|
;;
|
|
;; 1. X-rays for flatfoot and clawfoot - weight bearing AP and
|
|
;; lateral views and non-weight bearing AP, lateral, and oblique
|
|
;; views, if none are of record or if of record and condition has or
|
|
;; may have progressed.
|
|
;; 2. For other conditions, AP, lateral, and oblique of entire foot,
|
|
;; as applicable.
|
|
;; 3. Include results of all diagnostic and clinical tests conducted
|
|
;; in the examination report.
|
|
;;
|
|
;;E. Diagnosis:
|
|
;;
|
|
;;
|
|
;;Signature: Date:
|
|
;;END
|