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Estimating Impairment Due to Skin Disorder

Purpose: To estimate the impairment to the patient caused by a skin disorder by the distribution of significant lesions.

Evaluation

Does the patient have a significant skin disease?

Give the percent involvement of each body part by skin lesions of moderate-to-severe intensity (enter from 0 to 100)

Center of face

percent

Let side of head (including ear)

percent

Right side of head (including ear)

percent

Scalp and back of head

percent

Chin

percent

Neck

percent

Left shoulder and upper arm

percent

Left forearm

percent

Left hand

percent

Right shoulder and upper arm

percent

Right forearm

percent

Right hand

percent

Anterior chest

percent

Anterior abdomen

percent

Upper back

percent

Lower back

percent

Left buttock, hip and thigh

percent

Left lower leg

percent

Left foot

percent

Right buttock, hip and thigh

percent

Right lower leg

percent

Right foot

percent

Results

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Specialty

Objective

ICD-10