DVBCADCK.m

DVBCADCK ;ALB/GTS-557/THM-AUDIO EXAM ; 5/10/91  9:13 AM

 ;;2.7;AMIE;;Apr 10, 1995

 ;

 S PG=1,HD91="Department of Veterans Affairs"

 S HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"

EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF

 W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1305 Worksheet" S HD7="AUDIO",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!

 W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,! I '$D(CMBN) W "Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7

 W !!!!,"Narrative:"

 W ?13,"When only pure tone results should be used to evaluate",!?13,"hearing loss, the Chief of the Audiology Clinic should",!?13,"certify that language difficulties or other problems make",!

 W ?13,"the use of both pure tone average and speech discrimination",!?13,"inappropriate.",!! I '$D(CMBN) W "A. Audiological history:",!!!!!!!!!!

 W $S($D(CMBN):"A. ",1:"B. ") W "Pure tone thresholds at indicated frequencies (air conduction):",!!?16,"dB",?49,"dB",!," ========== RIGHT EAR ========== + ========== LEFT EAR ===========",!

 W "   A*   B    C    D    E            A*   B    C    D    E",!

 W "+------------------------------**+------------------------------**+",!

 W "| 500|1000|2000|3000|4000|Average| 500|1000|2000|3000|4000|Average|",!,"+--------------------------------+--------------------------------+",!

 W "|    |    |    |    |    |       |    |    |    |    |    |       |",!,"+----+----+----+----+----+-------+----+----+----+----+----+-------+",!!

 W "* The pure tone threshold at 500 Hz is not currently used for evaluation",!,"purposes but is used in determining whether or not a ratable hearing",!,"loss exists.",!!,"** - average of B, C, D, and E"

 W !!!!,$S($D(CMBN):"B. ",1:"C. ") W "Speech recognition score:",!!,"   1. Maryland CNC word list _______ % right ear  _______ % left ear",!!

 W "   2.         W-22 word list _______ % right ear  _______ % left ear",!!,"      (Only if specifically requested by the regional office)",!!!! I $Y>58 D HD2

 W $S($D(CMBN):"C. ",1:"D. "),"Note whether tinnitus is present and if so, indicate the following:",!!!! S X1=0

 F X="Date/circumstance of onset","Unilateral vs bilateral","Constant vs periodic (indicate frequency)","Severity and effect on daily life","Veteran account of loudness/pitch" S X1=X1+1 W ?5,X1,". ",X," -",!!!! I $Y>58 D HD2

 K X1,X

 W $S($D(CMBN):"D. ",1:"E. "),"Note whether audiologic results indicate an ear or hearing problem",!,"that requires medical follow-up or a problem, which, if treated, may",!,"cause a change in hearing threshold levels -",!!!!!!!

 W $S($D(CMBN):"E. ",1:"F. "),"Summary of audiologic test results:",!!!!!!!!

 W $S($D(CMBN):"F. ",1:"G. "),"Recommendations/remarks:",!!!!!!!!

 W ?25,"Signature: ______________________________",!!?30,"Date: _________________________",!

 W !!?22,"Adequated by: ______________________________",!!?30,"Date: _________________________",!

 K LN,LN1,LN2

 Q

 ;

HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!,HD8,!!!

 Q

 ;

SETIOF ;  ** Set device control var's

 D HOME^%ZIS

 Q

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---DVBCADCK   3180     printed  Mar 13, 2025@20:48                                                                                                                                                                                                       Page 2

DVBCADCK  ;ALB/GTS-557/THM-AUDIO EXAM ; 5/10/91  9:13 AM

 +1       ;;2.7;AMIE;;Apr 10, 1995

 +2       ;

 +3        SET PG=1

           SET HD91="Department of Veterans Affairs"

 +4        SET HD9=$SELECT($DATA(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"

EN         if '$DATA(IOF)

               DO SETIOF

           if (IOST?1"C-".E)

               WRITE @IOF

 +1        WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!

           WRITE ?33,"# 1305 Worksheet"

           SET HD7="AUDIO"

           SET HD8="For "_HD7

           WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!

 +2        WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!

           IF '$DATA(CMBN)

               WRITE "Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7

 +3        WRITE !!!!,"Narrative:"

 +4        WRITE ?13,"When only pure tone results should be used to evaluate",!?13,"hearing loss, the Chief of the Audiology Clinic should",!?13,"certify that language difficulties or other problems make",!

 +5        WRITE ?13,"the use of both pure tone average and speech discrimination",!?13,"inappropriate.",!!

           IF '$DATA(CMBN)

               WRITE "A. Audiological history:",!!!!!!!!!!

 +6        WRITE $SELECT($DATA(CMBN):"A. ",1:"B. ")

           WRITE "Pure tone thresholds at indicated frequencies (air conduction):",!!?16,"dB",?49,"dB",!," ========== RIGHT EAR ========== + ========== LEFT EAR ===========",!

 +7        WRITE "   A*   B    C    D    E            A*   B    C    D    E",!

 +8        WRITE "+------------------------------**+------------------------------**+",!

 +9        WRITE "| 500|1000|2000|3000|4000|Average| 500|1000|2000|3000|4000|Average|",!,"+--------------------------------+--------------------------------+",!

 +10       WRITE "|    |    |    |    |    |       |    |    |    |    |    |       |",!,"+----+----+----+----+----+-------+----+----+----+----+----+-------+",!!

 +11       WRITE "* The pure tone threshold at 500 Hz is not currently used for evaluation",!,"purposes but is used in determining whether or not a ratable hearing",!,"loss exists.",!!,"** - average of B, C, D, and E"

 +12       WRITE !!!!,$SELECT($DATA(CMBN):"B. ",1:"C. ")

           WRITE "Speech recognition score:",!!,"   1. Maryland CNC word list _______ % right ear  _______ % left ear",!!

 +13       WRITE "   2.         W-22 word list _______ % right ear  _______ % left ear",!!,"      (Only if specifically requested by the regional office)",!!!!

           IF $Y>58

               DO HD2

 +14       WRITE $SELECT($DATA(CMBN):"C. ",1:"D. "),"Note whether tinnitus is present and if so, indicate the following:",!!!!

           SET X1=0

 +15       FOR X="Date/circumstance of onset","Unilateral vs bilateral","Constant vs periodic (indicate frequency)","Severity and effect on daily life","Veteran account of loudness/pitch"

               SET X1=X1+1

               WRITE ?5,X1,". ",X," -",!!!!

               IF $Y>58

                   DO HD2

 +16       KILL X1,X

 +17       WRITE $SELECT($DATA(CMBN):"D. ",1:"E. "),"Note whether audiologic results indicate an ear or hearing problem",!,"that requires medical follow-up or a problem, which, if treated, may",!,"cause a change in hearing threshold levels -",!!!!!!!

 +18       WRITE $SELECT($DATA(CMBN):"E. ",1:"F. "),"Summary of audiologic test results:",!!!!!!!!

 +19       WRITE $SELECT($DATA(CMBN):"F. ",1:"G. "),"Recommendations/remarks:",!!!!!!!!

 +20       WRITE ?25,"Signature: ______________________________",!!?30,"Date: _________________________",!

 +21       WRITE !!?22,"Adequated by: ______________________________",!!?30,"Date: _________________________",!

 +22       KILL LN,LN1,LN2

 +23       QUIT 

 +24      ;

HD2        SET PG=PG+1

           WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!,HD8,!!!

 +1        QUIT 

 +2       ;

SETIOF    ;  ** Set device control var's

 +1        DO HOME^%ZIS

 +2        QUIT