READMISSION DATE: 2/18/2004 ADMISSION DATE: 01/15/2004 DISCHARGE DATE: 02/16/2004

John Doevs.

ABC Inc.

READMISSION DATE: 2/18/2004

ADMISSION DATE: 01/15/2004DISCHARGE DATE: 02/16/2004

8/26 Pt continues to have problemsWith living area not being handicapaccessible.

9/2 Pt environment is very difficult because it isn’t set upfor handicapped.Pt needs boots due to footdropping while in bed.

9/25 Bowel system has changed. Pt unsure If it’s because of meds or not.Living area still not equipped for situation.

…poor scaffold erection procedures and would be unsafe to work on.

SYMPTOMS/SIGNS OF RSDSYMPTOMS/SIGNS OF RSD

Pain

History of Injury (Traumatic-Right Knee Fracture)

Temperature Change/Aymmetry

Response to Sympathetic Block

Cutaneous Hypersensitivity/Allodynia

Hair/Nail Change

Tremor

Joint Stiffness

Bone Scan Positive for RSD

Color Change

Swelling/Edema

Atrophy

Termographic Changes

Sweating Change

Weakness/Fatigue

Limitation of Use

Local Osteoporosis (X-Ray Examination)

YES NO

Cite: Reflex? Sympathetic? Dystrophy? Paradigm Shift?, The Clinical Journal of Pain; Vol.8, No.4, 1992: 281-84.

Interpretation:<3 RSD unlikely3-5 RSD possible>6 RSD probable

Number of Criteria Met: 17

SYMPTOMS/SIGNS OF RSDSYMPTOMS/SIGNS OF RSD

Pain

History of Injury (Traumatic-Right Knee Fracture)

Temperature Change/Aymmetry

Response to Sympathetic Block

Cutaneous Hypersensitivity/Allodynia

Hair/Nail Change

Tremor

Joint Stiffness

Bone Scan Positive for RSD

Color Change

Swelling/Edema

Atrophy

Termographic Changes

Sweating Change

Weakness/Fatigue

Limitation of Use

Local Osteoporosis (X-Ray Examination)

YES NO

Cite: Reflex? Sympathetic? Dystrophy? Paradigm Shift?, Peter R. Wilson, MD, The Clinical Journal of Pain; Vol.8, No.4, 1992: 281-84.