Prompt: !?25,HD91,!?22,"Compensation and Pension Examination",!
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Prompt: ?33,"# 1306 Worksheet"
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Prompt: ?33,"# 1306 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,"If, in the course of audiometric testing, there is any",!?13,"indication of ear disease, the veteran should be referred to",!?13,"a physician for additional exam. Examination should include"
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Prompt: !?13,"inspection of the auricle, the external canal, and tympanic",!?13,"membranes. Abnormalities in size, shape, or form of the",!?13,"structure should be noted.",!!
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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):",!!!?8,"1. Auricle -",!!!!!?8,"2. External canal -",!!!!!
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Prompt: ?8,"3. Tympanic membrane -",!!!!!?8,"4. The tympanum -",!!!!!?8,"5. The mastoid -",!!!!!
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Prompt: ?8,"5. State if an active ear disease is present -",!!!!!?8,"6. State if an infectious disease of the middle or inner",!?11,"ear is present -"
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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,!!!