Routine: DVBCAOCK

DVBCAOCK ;ALB/GTS-557/THM-AGENT ORANGE/RESIDUALS OF DIOXIN ; 5/21/91  9:56 AM

 ;;2.7;AMIE;;Apr 10, 1995

 S PG=1,HD91="Department of Veterans Affairs",HD9="Full Exam Worksheet"

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

 W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1710 Worksheet" S HD7="RESIDUALS OF DIOXIN EXPOSURE (AGENT ORANGE)",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!

 W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7

 W !!!!,"Narrative:  "

 S LNS="__________",LX="TXT" F I=1:1 S LY=$T(@LX+I) Q:LY["$END"  W ?13,$P(LY,";;",2),!

 W !!,"A.  Initial data base for possible exposure to toxic chemicals:",!!,"Branch of service: ",LNS,?33,"Service serial number: ",LNS,!!

 S X="month/year",Y="from __________ to __________" W "Dates of service:",!?26,X,?40,X,!!,"Last period: ",?21,Y,!!?26,X,?40,X,!!,"Next to last period: ",Y,!!

 W "Date of birth: __________",!!,"Marital status: ___ married ___ divorced ___ separated",!!!

 W "Did veteran have military service in Vietnam? ___ Yes  ___ No",!!,"If yes, list all tours of duty in Vietnam:",!!?7,X,?35,X,!,"From:",?30,"To:",! D HD2

 W "Indicate the Corps or area where veteran served in Vietnam:",!!,"I Corps ___ II Corps ___ III Corps ___ IV Corps ___ Sea duty ___",!!,"More than one ___ Don't know ___ Other (specify)",LNS,!!

 W "List military units in which veteran served (specify complete",!,"unabbreviated titles such as company, battalion, etc.):",!!!!!

 W "B.  Veteran's exposure to Agent Orange (indicate one category for",!?5,"each circumstance):",!!?36,"Definitely  Probably  Not    Definitely",!?39,"yes",?50,"yes",?58,"sure",?69,"no",!!

 W ?3,"1. Veteran was involved in",!?3,"handling or spraying A.O.",!!?3,"2. Veteran was not directly",!?3,"sprayed but was in a recently",!?3,"sprayed area.",!!

 W ?3,"3. Veteran was exposed to",!?3,"herbicides other than A.O.",!!?3,"4. Veteran was directly",!?3,"sprayed with Agent Orange.",!!?3,"5. Veteran ate food or drink",!?3,"that could have been contaminated.",!!!

 W !!,"C.  Indicate how many exposures the veteran alleges:",!!!,"D.  Indicate the nature of each exposure:",! D HD2

 W "E.  Medical history (include symptoms at time of exposure or",!?4,"later attributed by veteran to exposure):",!!!!!!!,"F.  Subjective complaints:",!!!!!!!,"G.  Objective findings:",!!

 W ?2,"a. Height _____ weight _____ pulse _____ blood pressure _______",!! G ^DVBCAOC1

HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!

SETIOF ;  ** Set device control var's

 D HOME^%ZIS

TXT ;

 ;;Chloracne or other acneform disease consistant with

 ;;chloracne, non-Hodgkins lymphoma, and soft-tissue

 ;;sarcomas are presumtive Agent Orange-related

 ;;disabilities.  Veterans who served in Vietnam and

 ;;in the waters offshore are presumed to have been

 ;;exposed to Agent Orange and/or other herbicides

 ;;which may contain dioxin.  Attention should be paid

 ;;to examination of the skin, nervous system, muscular

 ;;function, liver, kidneys, lymphatic system and mental

 ;;status.  Questioning should attempt to uncover details

 ;;of exposure and any adverse affects.

 ;;$END

--- Routine Detail   --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCAOCK   3322     printed  Apr 09, 2024@20:55:40                                                                                                                                                                                                    Page 2

DVBCAOCK  ;ALB/GTS-557/THM-AGENT ORANGE/RESIDUALS OF DIOXIN ; 5/21/91  9:56 AM

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

 +2       ;

 +3        SET PG=1

           SET HD91="Department of Veterans Affairs"

           SET HD9="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,"# 1710 Worksheet"

           SET HD7="RESIDUALS OF DIOXIN EXPOSURE (AGENT ORANGE)"

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

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

 +4        SET LNS="__________"

           SET LX="TXT"

           FOR I=1:1

               SET LY=$TEXT(@LX+I)

               if LY["$END"

                   QUIT

               WRITE ?13,$PIECE(LY,";;",2),!

 +5        WRITE !!,"A.  Initial data base for possible exposure to toxic chemicals:",!!,"Branch of service: ",LNS,?33,"Service serial number: ",LNS,!!

 +6        SET X="month/year"

           SET Y="from __________ to __________"

           WRITE "Dates of service:",!?26,X,?40,X,!!,"Last period: ",?21,Y,!!?26,X,?40,X,!!,"Next to last period: ",Y,!!

 +7        WRITE "Date of birth: __________",!!,"Marital status: ___ married ___ divorced ___ separated",!!!

 +8        WRITE "Did veteran have military service in Vietnam? ___ Yes  ___ No",!!,"If yes, list all tours of duty in Vietnam:",!!?7,X,?35,X,!,"From:",?30,"To:",!

           DO HD2

 +9        WRITE "Indicate the Corps or area where veteran served in Vietnam:",!!,"I Corps ___ II Corps ___ III Corps ___ IV Corps ___ Sea duty ___",!!,"More than one ___ Don't know ___ Other (specify)",LNS,!!

 +10       WRITE "List military units in which veteran served (specify complete",!,"unabbreviated titles such as company, battalion, etc.):",!!!!!

 +11       WRITE "B.  Veteran's exposure to Agent Orange (indicate one category for",!?5,"each circumstance):",!!?36,"Definitely  Probably  Not    Definitely",!?39,"yes",?50,"yes",?58,"sure",?69,"no",!!

 +12       WRITE ?3,"1. Veteran was involved in",!?3,"handling or spraying A.O.",!!?3,"2. Veteran was not directly",!?3,"sprayed but was in a recently",!?3,"sprayed area.",!!

 +13       WRITE ?3,"3. Veteran was exposed to",!?3,"herbicides other than A.O.",!!?3,"4. Veteran was directly",!?3,"sprayed with Agent Orange.",!!?3,"5. Veteran ate food or drink",!?3,"that could have been contaminated.",!!!

 +14       WRITE !!,"C.  Indicate how many exposures the veteran alleges:",!!!,"D.  Indicate the nature of each exposure:",!

           DO HD2

 +15       WRITE "E.  Medical history (include symptoms at time of exposure or",!?4,"later attributed by veteran to exposure):",!!!!!!!,"F.  Subjective complaints:",!!!!!!!,"G.  Objective findings:",!!

 +16       WRITE ?2,"a. Height _____ weight _____ pulse _____ blood pressure _______",!!

           GOTO ^DVBCAOC1

 +17      ;

HD2        SET PG=PG+1

           WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!

 +1        QUIT

 +2       ;

SETIOF    ;  ** Set device control var's

 +1        DO HOME^%ZIS

 +2        QUIT

 +3       ;

TXT       ;

 +1       ;;Chloracne or other acneform disease consistant with

 +2       ;;chloracne, non-Hodgkins lymphoma, and soft-tissue

 +3       ;;sarcomas are presumtive Agent Orange-related

 +4       ;;disabilities.  Veterans who served in Vietnam and

 +5       ;;in the waters offshore are presumed to have been

 +6       ;;exposed to Agent Orange and/or other herbicides

 +7       ;;which may contain dioxin.  Attention should be paid

 +8       ;;to examination of the skin, nervous system, muscular

 +9       ;;function, liver, kidneys, lymphatic system and mental

 +10      ;;status.  Questioning should attempt to uncover details

 +11      ;;of exposure and any adverse affects.

 +12      ;;$END

DVBCAOCK.m