DVBCCYCK ;ALB/GTS-557/THM-CYSTITIS,BLADDER CALCULUS,ETC ; 2/6/91 7:59 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0605 Worksheet" S HD5="CYSTITIS, BLADDER CALCULUS, RESIDUALS OF BLADDER INJURY,",HD6="ALL DISORDERS OF THE PROSTATE, URETHRA AND SURGICAL RESIDUALS (GU)"
S HD7="For "_HD5
W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD7)\2)),HD7,!?(40-($L(HD6)\2)),HD6,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,! I '$D(CMBN) W "Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD5,!?14,HD6
W !!!!,"Narrative:"
W ?13,"Complications and/or medical side effects should always be",!?13,"reported, even when not specifically requested.",!!
I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!!!!!!!!!!! D HD2
W $S($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):",!!!
W ?8,"1. Frequency of urination -",!!!!!?8,"2. Presence or absence of pyuria -",!!!!!
W ?8,"3. Pain or tenesmus -",!!!!!?8,"4. Incontinence requiring pads or appliance -",!!!!!
W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!! D:$Y>50 HD2 W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
K LN,LN1,LN2
Q
;
HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!!,HD5,!,HD6,!!!
Q
;
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCCYCK 1825 printed Sep 23, 2025@19:19:51 Page 2
DVBCCYCK ;ALB/GTS-557/THM-CYSTITIS,BLADDER CALCULUS,ETC ; 2/6/91 7:59 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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 0605 Worksheet"
SET HD5="CYSTITIS, BLADDER CALCULUS, RESIDUALS OF BLADDER INJURY,"
SET HD6="ALL DISORDERS OF THE PROSTATE, URETHRA AND SURGICAL RESIDUALS (GU)"
+2 SET HD7="For "_HD5
+3 WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD7)\2)),HD7,!?(40-($LENGTH(HD6)\2)),HD6,!!
+4 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!
IF '$DATA(CMBN)
WRITE "Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD5,!?14,HD6
+5 WRITE !!!!,"Narrative:"
+6 WRITE ?13,"Complications and/or medical side effects should always be",!?13,"reported, even when not specifically requested.",!!
+7 IF '$DATA(CMBN)
WRITE "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!!!!!!!!!!!
DO HD2
+8 WRITE $SELECT($DATA(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):",!!!
+9 WRITE ?8,"1. Frequency of urination -",!!!!!?8,"2. Presence or absence of pyuria -",!!!!!
+10 WRITE ?8,"3. Pain or tenesmus -",!!!!!?8,"4. Incontinence requiring pads or appliance -",!!!!!
+11 WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!
if $Y>50
DO HD2
WRITE $SELECT($DATA(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+12 KILL LN,LN1,LN2
+13 QUIT
+14 ;
HD2 SET PG=PG+1
WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!!,HD5,!,HD6,!!!
+1 QUIT
+2 ;
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
