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APPENDIX F
Chronic Lyme Disease Assessment Tool and CFS/Fibromyalgia Rating Scale
symptom list as at January 2016
SymptomsMildModerateSevereConstantIntermittentHeadache
Brain Ache
Migraine
Dizziness
Lightheadedness
FaintnessXXXXXXXSore
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To fill out the chronic lyme disease assessment, follow these steps:
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Begin by reading through each question thoroughly to understand the information being requested.
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Respond to each question honestly and accurately by marking the appropriate response or providing the necessary information.
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Who needs chronic lyme disease assessment?
01
Chronic lyme disease assessment is beneficial for individuals who suspect they may be suffering from chronic lyme disease or have received a diagnosis of Lyme disease in the past.
02
It is recommended for those experiencing long-term symptoms such as fatigue, joint pain, muscle aches, cognitive difficulties, and other associated symptoms.
03
Individuals who have been exposed to ticks or live in areas where Lyme disease is prevalent should also consider undergoing chronic lyme disease assessment.
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What is chronic lyme disease assessment?
Chronic lyme disease assessment is an evaluation or examination done to assess the presence and severity of Lyme disease in individuals over a long period of time.
Who is required to file chronic lyme disease assessment?
Individuals who have been diagnosed with chronic Lyme disease or healthcare professionals responsible for treating patients with chronic Lyme disease may be required to file the assessment.
How to fill out chronic lyme disease assessment?
The assessment can be filled out by providing relevant medical history, symptoms, test results, and treatment information related to chronic Lyme disease.
What is the purpose of chronic lyme disease assessment?
The purpose of chronic lyme disease assessment is to track the progression of Lyme disease, evaluate the effectiveness of treatments, and provide insights for further medical interventions.
What information must be reported on chronic lyme disease assessment?
Information such as medical history, symptoms, test results, treatment plans, and any other relevant details related to chronic Lyme disease must be reported on the assessment.
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