DVBCDNCK ;ALB/GTS-557/THM-DENTAL EXAM ; 12/5/90 2:16 PM
;;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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0205 Worksheet" S HD7="DENTAL",HD8="For "_HD7 W !?(40-($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. Disability effect on everyday activities -",!!!!!!?5,"2. Ancillary problems as a result of the dental condition -",!!!!!!
W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!! D:$D(CMBN) 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 ",HD7,!,"for ",NAME,!!!
Q
;
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
;
TXT ;
;;Regional Office action is required for all dental treatment
;;claims based on combat wounds, service trauma, prisoner of
;;war or extracted teeth under 38 CFR 17.123.
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCDNCK 1726 printed Nov 22, 2024@16:54:08 Page 2
DVBCDNCK ;ALB/GTS-557/THM-DENTAL EXAM ; 12/5/90 2:16 PM
+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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 0205 Worksheet"
SET HD7="DENTAL"
SET HD8="For "_HD7
WRITE !?(40-($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. Disability effect on everyday activities -",!!!!!!?5,"2. Ancillary problems as a result of the dental condition -",!!!!!!
+8 WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!
if $DATA(CMBN)
DO HD2
WRITE $SELECT($DATA(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+9 KILL LN,LN1,LN2
+10 QUIT
+11 ;
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 ;;Regional Office action is required for all dental treatment
+2 ;;claims based on combat wounds, service trauma, prisoner of
+3 ;;war or extracted teeth under 38 CFR 17.123.
+4 ;;END
