DVBCEDCK ;ALB/GTS-557/THM-AUDIO-EAR DISEASE ; 6/27/91 7:21 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1306 Worksheet" S HD7="AUDIO-EAR DISEASE",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative:"
W ?13,"If, in the course of audiometric testing, there is any",!?13,"indication of ear disease, the veteran should be referred to",!?13,"a physician for additional exam. Examination should include"
W !?13,"inspection of the auricle, the external canal, and tympanic",!?13,"membranes. Abnormalities in size, shape, or form of the",!?13,"structure should be noted.",!!
I '$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):",!!!?8,"1. Auricle -",!!!!!?8,"2. External canal -",!!!!!
W ?8,"3. Tympanic membrane -",!!!!!?8,"4. The tympanum -",!!!!!?8,"5. The mastoid -",!!!!! D:$D(CMBN) HD2
W ?8,"5. State if an active ear disease is present -",!!!!!?8,"6. State if an infectious disease of the middle or inner",!?11,"ear is present -"
W !!!!!?8,"7. State whether ear disease is affecting any function other",!?11,"than hearing, such as balance, or is associated with any",!?11,"upper respiratory disease -",!!!!! D:'$D(CMBN) HD2
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
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCEDCK 2195 printed Nov 22, 2024@16:54:09 Page 2
DVBCEDCK ;ALB/GTS-557/THM-AUDIO-EAR DISEASE ; 6/27/91 7:21 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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 1306 Worksheet"
SET HD7="AUDIO-EAR DISEASE"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative:"
+4 WRITE ?13,"If, in the course of audiometric testing, there is any",!?13,"indication of ear disease, the veteran should be referred to",!?13,"a physician for additional exam. Examination should include"
+5 WRITE !?13,"inspection of the auricle, the external canal, and tympanic",!?13,"membranes. Abnormalities in size, shape, or form of the",!?13,"structure should be noted.",!!
+6 IF '$DATA(CMBN)
WRITE "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!
DO HD2
+7 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):",!!!?8,"1. Auricle -",!!!!!?8,"2. External canal -",!!!
!!
+8 WRITE ?8,"3. Tympanic membrane -",!!!!!?8,"4. The tympanum -",!!!!!?8,"5. The mastoid -",!!!!!
if $DATA(CMBN)
DO HD2
+9 WRITE ?8,"5. State if an active ear disease is present -",!!!!!?8,"6. State if an infectious disease of the middle or inner",!?11,"ear is present -"
+10 WRITE !!!!!?8,"7. State whether ear disease is affecting any function other",!?11,"than hearing, such as balance, or is associated with any",!?11,"upper respiratory disease -",!!!!!
if '$DATA(CMBN)
DO HD2
+11 WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!,$SELECT($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 ",HD7,!,"for ",NAME,!!!
+1 QUIT
+2 ;
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
