308 lines
11 KiB
Plaintext
308 lines
11 KiB
Plaintext
English French Notes Complete/Exclude
|
|
salivary glands
|
|
range of motion
|
|
pain or tenderness
|
|
nipple discharge
|
|
Musculoskeletal - spine,upper and lower extremeties:
|
|
mobility, tenderness, pain of spine
|
|
joint pain
|
|
joint swelling
|
|
muscle weakness
|
|
rheumatic fever
|
|
shortness of breath
|
|
pulmonary embolus
|
|
configuration of thorax
|
|
respiratiory movements
|
|
inspiratory breath sounds
|
|
expiratiory breath sounds
|
|
heart inpulse
|
|
chest pain/discomfort
|
|
paroxysmal nocturnal dyspnea
|
|
neck veins
|
|
peripheral veins
|
|
nausea and vomiting
|
|
abdominal wall/distention/tenderness
|
|
food intolerance
|
|
bowel sounds
|
|
ventral hernia
|
|
gastric/marginal/duodenal ulcer
|
|
urinary infection
|
|
veneral disease
|
|
inguinal canal
|
|
Female:
|
|
external genitalia
|
|
abnormal menses
|
|
vaginal discharge
|
|
anus and sphincter
|
|
test for occult blood
|
|
MENTAL DISORDERS - POW PROTOCOL
|
|
Physician's Guide Reference: Chapter 14, 17, 20
|
|
1. Immediate pre-military events -
|
|
2. Events as a POW -
|
|
traumatic events as a POW, if not elsewhere
|
|
SOCIAL WORK SURVEY - POW PROTOCOL
|
|
Physician's Guide Reference: Chapter 17
|
|
A. Describe the veteran's personal appearance -
|
|
B. Describe the veteran's personal health -
|
|
C. Describe the veteran's family adjustment -
|
|
D. Describe the veteran's community adjustment -
|
|
E. Describe the veteran's economic adjustment -
|
|
cranial nerves
|
|
gait disturbance
|
|
biceps reflex
|
|
triceps reflex
|
|
patellar reflex
|
|
Achilles reflex
|
|
plantar response
|
|
peripheral nerves
|
|
sensory change
|
|
loss of consciousness
|
|
memory change
|
|
trouble with decisions
|
|
sleep disturbance
|
|
crying spells
|
|
thoughts of suicide
|
|
difficulty with work
|
|
loss of appetite
|
|
trouble with sex life
|
|
social withdrawal
|
|
improbable beliefs
|
|
C. Summary of findings:
|
|
PRISONER OF WAR PROTOCOL
|
|
A. Medical history (include childhood and adult illnesses and
|
|
B. Past history (include civilian and military occupation, military)
|
|
history including geographic locations and dates, habits
|
|
such as alcohol, tobacco and drugs, family history):
|
|
C. System review (comment specifically if positive symptom):
|
|
weight change
|
|
fever or chills
|
|
night sweats
|
|
irritable bowel syndrome
|
|
peptic ulcer
|
|
PYELITIS, NEPHROLITHIASIS, URETEROLITHIASIS,
|
|
URETERAL STRICTURE AND HYDRONEPHROSIS (GU)
|
|
4. Catheter drainage requirement (frequency of need) -
|
|
RECTUM AND ANUS (DIGESTIVE)
|
|
Diseases of the rectum, anal canal or perineum must be
|
|
differentiated as to type.
|
|
8. Fecal leakage -
|
|
9. Frequency of episodes -
|
|
EDIT C&P STATIC INFORMATION
|
|
The status of this request is not NEW or PENDING, REPORTED.
|
|
It cannot, therefore, be modified.
|
|
Since you have modified the REMARKS section,
|
|
a new copy of the request will be issued to the
|
|
medical center tomorrow morning.
|
|
1,3,0,2:1,0^Insufficient link info not updated!...Priority restored
|
|
Invalid user number (DUZ)
|
|
DVBA C RELEASE 2507
|
|
You are not authorized to release 2507 requests!!
|
|
is not complete
|
|
2507 Exam Release
|
|
Please wait while the individual exam statuses are checked.
|
|
All exams have been completed, please enter the following:
|
|
Since there are still incomplete exams,
|
|
this request cannot be released to the RO.
|
|
Press RETURN or
|
|
This request is now released.
|
|
Release NOT COMPLETED !!
|
|
This request has been cancelled by the RO.
|
|
This request has been completed and transferred out.
|
|
This request has been cancelled by MAS.
|
|
This request has been released to the RO.
|
|
This request has been printed by the RO.
|
|
This request is new and has not yet been reported to MAS.
|
|
COMPENSATION AND PENSION EXAM REQUEST
|
|
Requested by
|
|
0,0,0,2:1,0^** Priority of exam:
|
|
0,0,0,0,0^Date original 2507 Reported to MAS:
|
|
0,0,0,3:2,0^Selected exams:
|
|
Current Rated disabilities:
|
|
General remarks:
|
|
Unknown division
|
|
Medical Center Division at
|
|
*** Transferred from
|
|
Date Requested:
|
|
** Claim folder review will be required **
|
|
VA Form 21-2507
|
|
General remarks (continued):
|
|
No parameters in AMIE site parameter file!
|
|
New 2507 Request Report for
|
|
BDTRQ*
|
|
EDTRQ*
|
|
New Request Recap Sheet for Run Date
|
|
C&P Diagnostic Test Order Record
|
|
Initials
|
|
Laboratory:
|
|
Radiology:
|
|
Other:
|
|
Missing vet name
|
|
Manual New C&P Request Printing
|
|
Do you want just one request
|
|
Enter Y for only one Vet or N for all Vets.
|
|
Enter BEGINNING date of request:
|
|
and ENDING date of request:
|
|
Ending date is earlier than starting date!
|
|
New C&P request printing
|
|
New C&P Requests --
|
|
There were no new 2507 requests for
|
|
for division
|
|
C&P Request Modifications --
|
|
No modified requests to report.
|
|
C&P Exams Added --
|
|
No added exams to report.
|
|
Date of request:
|
|
Enter MED CENTER DIVISION:
|
|
C&P REQUESTS BY DATE RANGE
|
|
Enter DATE OF REQUEST FROM:
|
|
Do you want to report by physician
|
|
Enter <Y> to report by Physician or <N> to report only by date range.
|
|
This report uses
|
|
by Physician
|
|
by Date Range
|
|
EXAMINING PHYSICIAN
|
|
RESPIRATORY MANIFESTATIONS OF DISEASES OF OTHER SYSTEMS
|
|
An example of this type of exam is extremely unfavorable
|
|
ankylosis of the thoracic spine that so severely
|
|
restricts chest excursion that the veteran is dyspneic
|
|
on minimal exertion OR abdominal tumor interferes with
|
|
excursion of the diaphragm to such an extent that chronic
|
|
passive congestion of one lung results.
|
|
C. Objective findings :
|
|
1. Clinical findings -
|
|
2. Pulmonary function studies -
|
|
Since this request has reopened, its status will
|
|
be PENDING, REPORTED.
|
|
Be sure to regenerate any exam worksheets that will be needed
|
|
for this request.
|
|
Press RETURN to continue
|
|
Your user number (DUZ) is invalid !
|
|
Re-open Exams/Requests
|
|
Status prohibits activity except by supervisors.
|
|
1,0,0,2,0^This 2507 was never reported to MAS, it can NOT be reopened.
|
|
Do you want to reopen the ENTIRE request
|
|
Enter Y to reopen the ENTIRE request or N to reopen only selected exams.
|
|
Select EXAM TO REOPEN:
|
|
Exam name not found in file 396.6 !
|
|
Already open!
|
|
reopen error !
|
|
There are no cancelled or completed exams remaining on this request.
|
|
Reopen error on
|
|
Entire exam is now REOPENED.
|
|
Reopen error !
|
|
Sending a bulletin to the 2507 REOPENED mail group ...
|
|
DVBA C 2507 EXAM REOPENED
|
|
This request has not been released.
|
|
This reopen will not affect the AMIE AMIS 290.
|
|
**THIS REOPEN WILL AFFECT THE AMIE AMIS 290**
|
|
/Affects AMIE AMIS 290
|
|
G.DVBA C 2507 EXAM REOPENED@
|
|
I am sending updated information to
|
|
Select Reprint Option - (D)ate or (V)eteran: D//
|
|
Must be D or V
|
|
Do you want just the Lab/X-ray results
|
|
Enter Y to get just the Lab/X-ray results for the Vet
|
|
or N to get the entire exam results AND Lab/X-ray.
|
|
Enter original printing date:
|
|
Reprinted by the RO or MAS ? >>
|
|
Must be R for Regional Office or M for MAS.
|
|
2507 Final Exam Reprint
|
|
Single 2507 Final Exam Reprint
|
|
** REPRINT OF FINAL **
|
|
Physician signature: ___________________________________ Date: _____________
|
|
SCARS, OTHER THAN BURNS (ORTHOPEDIC/DISFIGUREMENT)
|
|
The type of injury or infection causing the wound or scar,
|
|
its date, the treatment used and the response to such
|
|
treatment should be described. Point of entrance and exit of
|
|
missiles are important
|
|
in evaluating injuries of nerves, vessels,
|
|
and muscles. Photographs, if indicated, (see Physician's Guide,
|
|
Paragraph 1.19) should be submitted.
|
|
2. Keloid formation, adherance, herniation -
|
|
3. Inflammation, swelling, depression, vascular supply, ulceration -
|
|
4. Tender and painful on objective demonstration -
|
|
5. Cosmetic effects (submit photographs of all facial
|
|
and other significant scars) -
|
|
6. Limitation of function of part affected -
|
|
SCHEDULE C&P EXAMS
|
|
You have no user number !
|
|
This request has no exams on it and should
|
|
be completely cancelled.
|
|
This request has been completely transferred to another site.
|
|
Scheduling will not be allowed.
|
|
Scheduling has been completed for this request as of
|
|
Only supervisors can change it.
|
|
Do you want to change
|
|
Enter Y to be able to change the scheduling information or N to backup.
|
|
Note: One or more exams on this request have transferred out.
|
|
Do you want to make an appointment for a clinic
|
|
Schedule a Clinic Appointment for 2507 Exam
|
|
Enter Y to make an appointment via ADT/Scheduling or N to skip.
|
|
Enter Scheduling Information for 2507 Exams
|
|
Has scheduling for all exams been completed
|
|
Enter Y if scheduling is completed, N if not.
|
|
Ok, then please complete the following:
|
|
Important scheduling information is missing!
|
|
2507 file NOT updated!
|
|
For SKIN, NOT ELSEWHERE CLASSIFIED
|
|
Type of Exam: SKIN, NOT ELSEWHERE CLASSIFIED
|
|
SKIN, OTHER THAN SCARS
|
|
When furnishing the history of the present skin disease
|
|
include a description of the skin changes, when the disorder
|
|
first appeared, and the progression of the illness since that
|
|
time. Note whether
|
|
remissions or exacerbations occurred
|
|
and whether they were related to the occupation or treatment.
|
|
Include the duration of remissions and factors that
|
|
may have influenced the course of the disorder.
|
|
B. Subjective complaints:
|
|
(List the types of complaints such as itching
|
|
burning, pain and anesthesia. Note whether environmental factors such as
|
|
temperature or seasonal change affect the severity of the symptoms.)
|
|
1. Description of skin disorder -
|
|
2. Distribution of skin disorder -
|
|
3. Configuration and characteristics of lesions -
|
|
4. Nervous manifestations -
|
|
5. Attach color photograph if condition is disfiguring.
|
|
(Note: If current diagnosis differs from the skin condition
|
|
for which the examination was ordered, then review prior records and
|
|
express opinion whether current disease is a new problem or original
|
|
diagnosis was in error.)
|
|
SENSE OF SMELL
|
|
Report whether loss is partial or complete and whether it
|
|
is on an organic or psychiatric basis. If a psychiatric
|
|
basis is suspected, a special psychiatric examination should
|
|
be ordered.
|
|
Substances used for testing olfaction and results (each side of nose
|
|
should be tested separately):
|
|
4. Oil of lemon -
|
|
5. Other (state substance) -
|
|
SPINE (ORTHOPEDIC)
|
|
Complete description of spinal orthosis, its impact on
|
|
motion before and after application, and whether the
|
|
usage is constant or intermittent should be part of the
|
|
To give uniformity in
|
|
describing limitation of motion or
|
|
ankylosis, THE USE OF A GONIOMETER IS REQUIRED. Report
|
|
each spinal segment separately.
|
|
1. Postural abnormalities -
|
|
2. Fixed deformity -
|
|
3. Musculature of back -
|
|
4. Range of motion:
|
|
a. Forward flexion -
|
|
b. Backward extension -
|
|
c. Left lateral flexion -
|
|
d. Right lateral flexion -
|
|
e. Rotation to left -
|
|
f. Rotation to right -
|
|
5. Objective evidence of pain on motion -
|
|
6. Identify and describe any evidence of neurological involvement -
|
|
SCARS, BURN
|
|
When true third degree burn involvement is established,
|
|
measure and describe all areas of scarring and all secondary
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|
|
#################### #################### ####################
|