Disability Examination Worksheets
Digestive Conditions, Miscellaneous
(Tuberculous Peritonitis, Inguinal Hernia, Ventral
Hernia, Femoral Hernia, Visceroptosis, and Benign and Malignant New
Growths)
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Date of Exam: |
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Place of Exam: |
A. Review of Medical Records: B.
Medical History (Subjective Complaints):
- Describe all hernia surgery and results.
- For malignancy, state type of treatment, dates of treatment,
including last date of treatment if it has ended.
- For peritoneal tuberculosis, state date of diagnosis, treatment,
and date on which inactivity was established.
C. Physical Examination (Objective Findings):
Address each of the following and fully describe current findings:
- For inguinal or ventral hernia, state whether reducible, how well
supported by truss or belt, and whether irremediable or inoperable.
- For ventral hernia, state size of hernia, extent of diastasis of
recti muscles, status of muscles and fascia of abdominal wall.
- All residuals of malignancy, including residuals from
treatment.
D. Diagnostic and Clinical Tests:
1. Include results of all diagnostic and clinical tests
conducted in the examination report.
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Date: |
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Reviewed/Updated Date: December 15, 2008 |
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