Prompt: !?25,HD91,!?22,"Compensation and Pension Examination",!
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Prompt: ?33,"# 1205 Worksheet"
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Prompt: ?33,"# 1205 Worksheet"
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Prompt: !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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Prompt: !!!!,"Narrative:"
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Prompt: ?13,$P(LY,";;",2),!
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Prompt: "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:"
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Prompt: $S($D(CMBN):"A. ",1:"D. "),"Specific evaluation information required by the rating board",!?4,"(if the information requested is included elsewhere, do not",!?4,"repeat here):",!!!
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Prompt: ?5,"1. Identify the nerve and the side -",!!!!!!?5,"2. Identify the disorder (paralysis, neuritis, neuralgia) -",!!!!!!
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Prompt: ?5,"3. Describe in detail, quantifying as much as possible, the",!?9,"motor and sensory impairment. Note if the entire nerve is",!?9,"affected or only that part of the distribution distal to a",!?9,"particular localized lesion -",!!!!!!
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Prompt: $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!,$S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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Prompt: @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!