DVBCDMCK ;ALB/GTS-557/THM-DIABETES MELLITUS ; 12/6/90 11:48 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0410 Worksheet" S HD7="DIABETES MELLITUS",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative:"
S LX="TXT" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W ?13,$P(LY,";;",2),!
W !! I '$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 ?5,"1. Frequency of ketoacidosis or hypoglycemic reactions -",!!!!!!?5,"2. Restricted diet and/or regulation of activities -",!!!!!!?5,"3. Loss of weight and strength since last exam -",!!!!!!
W ?5,"4. Anal pruritis -",!!!!!!?5,"5. Vascular deficiencies -",!!!!!!
W ?5,"6. Diabetic ocular disturbances -",!!!!!! D:$D(CMBN) HD2 W ?5,"7. Daily insulin requirements (type and amount) -",!!!!!!?5,"8. Blood sugar -",!!!!!! D:'$D(CMBN) HD2 W ?5,"9. Blood pressure -",!!!!!!
W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!,$S($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 ",HD7,!,"for ",NAME,!!!
Q
;
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
;
TXT ;
;;When symptoms interfere with normal daily activities or job
;;efficiency, it is essential that the extent of such handicaps
;;be described.
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCDMCK 2051 printed Dec 13, 2024@01:43:55 Page 2
DVBCDMCK ;ALB/GTS-557/THM-DIABETES MELLITUS ; 12/6/90 11:48 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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 0410 Worksheet"
SET HD7="DIABETES MELLITUS"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative:"
+4 SET LX="TXT"
FOR I=1:1
SET LY=$TEXT(@LX+I)
if LY["END"
QUIT
WRITE ?13,$PIECE(LY,";;",2),!
+5 WRITE !!
IF '$DATA(CMBN)
WRITE "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:"
DO HD2
+6 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):",!!!
+7 WRITE ?5,"1. Frequency of ketoacidosis or hypoglycemic reactions -",!!!!!!?5,"2. Restricted diet and/or regulation of activities -",!!!!!!?5,"3. Loss of weight and strength since last exam -",!!!!!!
+8 WRITE ?5,"4. Anal pruritis -",!!!!!!?5,"5. Vascular deficiencies -",!!!!!!
+9 WRITE ?5,"6. Diabetic ocular disturbances -",!!!!!!
if $DATA(CMBN)
DO HD2
WRITE ?5,"7. Daily insulin requirements (type and amount) -",!!!!!!?5,"8. Blood sugar -",!!!!!!
if '$DATA(CMBN)
DO HD2
WRITE ?5,"9. Blood pressure -",!!!!!!
+10 WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!,$SELECT($DATA(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+11 KILL LN,LN1,LN2
+12 QUIT
+13 ;
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 ;;When symptoms interfere with normal daily activities or job
+2 ;;efficiency, it is essential that the extent of such handicaps
+3 ;;be described.
+4 ;;END
