Veteran Health Network
The Undocumented Conditions Audit
Prepared 2026-08-23. Sources checked on that date and listed at the end.
Blank worksheet
The left column is what the veteran reports. The right column is what the record documents.
What the veteran reports
Reported
Frequency
Avoided because of it
Onset and duration
Functional impact
What the record documents
Diagnosis in the record
Most recent note
Severity in the record
Treatment and response
What the veteran reports
Reported
Frequency
Avoided because of it
Onset and duration
Functional impact
What the record documents
Diagnosis in the record
Most recent note
Severity in the record
Treatment and response
What the veteran reports
Reported
Frequency
Avoided because of it
Onset and duration
Functional impact
What the record documents
Diagnosis in the record
Most recent note
Severity in the record
Treatment and response
What the veteran reports
Reported
Frequency
Avoided because of it
Onset and duration
Functional impact
What the record documents
Diagnosis in the record
Most recent note
Severity in the record
Treatment and response
What the veteran reports
Reported
Frequency
Avoided because of it
Onset and duration
Functional impact
What the record documents
Diagnosis in the record
Most recent note
Severity in the record
Treatment and response
What the veteran reports
Reported
Frequency
Avoided because of it
Onset and duration
Functional impact
What the record documents
Diagnosis in the record
Most recent note
Severity in the record
Treatment and response
What the veteran reports
Reported
Frequency
Avoided because of it
Onset and duration
Functional impact
What the record documents
Diagnosis in the record
Most recent note
Severity in the record
Treatment and response
What the veteran reports
Reported
Frequency
Avoided because of it
Onset and duration
Functional impact
What the record documents
Diagnosis in the record
Most recent note
Severity in the record
Treatment and response
What this does not say
Everything on the left with nothing beside it is undocumented.
That does not mean it is not real. It means nobody wrote it down in a place a rater will look.
Documented and true are different things, and only one of them is in your file.
What to do next
- 01Bring this sheet to your next appointment and ask for what is missing to be recorded.
- 02Add a lay statement in your own words describing what you live with and how often.
- 03Ask someone who served with you to write down what they saw.
- 04A free VSO can help you file with what you already have. They are accredited and they do not charge.