- DVBCEXM1 ;ALB/CMC REQUEST WORKSHEET TEXT ; 8/15/97
- ;;2.7;AMIE;**12,16,80**;Apr 10, 1995
- ;
- TXT ;
- ;; Body System: Musculoskeletal (DC Series 5000, 5100, 5200, 5300)
- ;; ( ) Bones (Fractures and Bone Disease) ( ) Fibromyalgia
- ;; ( ) Amputation, Residuals of ( ) Joints (Shoulder/Elbow/Wrist/Hip/Knee/Ankle)
- ;; ( ) Hand, Thumb, and Fingers ( ) Feet
- ;; ( ) Spine (Cervical, Thoracic & Lumbar) ( ) Muscles
- ;;
- ;; Body System: Organs of Sense (DC Series 6000, 6100, 6200)
- ;; ( ) Eye Examination ( ) Audio
- ;; ( ) Ear Disease ( ) Sense of Smell and Taste
- ;;
- ;; Body System: Infectious/Immune/Nutritional (DC Series 6300)
- ;; ( ) Infectious, Immune, and Nutritional Disabilities
- ;; ( ) HIV-Related Illness ( ) Chronic Fatigue Syndrome
- ;;
- ;; Body System: Respiratory (DC Series 6500, 6600, 6700, 6800)
- ;; ( ) Nose, Sinus, Larynx, and Pharynx ( ) Respiratory (Obstructive, Restrictive,
- ;; ( ) Pulmonary Tuberculosis and and Interstitial)
- ;; Mycobacterial Diseases ( ) Respiratory Diseases, Miscellaneous
- ;;
- ;; Body System: Cardiovascular (DC Series 7000, 7100)
- ;; ( ) Arrhythmias ( ) Heart
- ;; ( ) Arteries, Veins and Miscellaneous ( ) Hypertension
- ;;
- ;; Body System: Digestive (DC Series 7200, 7300)
- ;; ( ) Mouth, Lips, and Tongue ( ) Esophagus and Hiatal Hernia
- ;; ( ) Intestines (Large and Small) ( ) Liver, Gall Bladder, and Pancreas
- ;; ( ) Digestive Conditions, Miscellaneous ( ) Rectum and Anus
- ;; ( ) Stomach, Duodenum, and Peritoneal Adhesions
- ;;
- ;; Body System: Genitourinary (DC Series 7500)
- ;; ( ) Genitourinary Examination
- ;;
- ;; Body System: Gynecological and Breast (DC Series 7600)
- ;; ( ) Gynecological Conditions and
- ;; Disorders of the Breast
- ;;
- ;; Body System: Hemic and Lymphatic (DC Series 7700)
- ;; ( ) Hemic Disorders ( ) Lymphatic Disorders
- ;;
- ;; Body System: Skin (DC Series 7800)
- ;; ( ) Scars ( ) Skin Diseases (other than scars)
- ;;
- ;; Body System: Endocrine (DC Series 7900)
- ;; ( ) Endocrine Diseases, Miscellaneous ( ) Thyroid and Parathyroid Diseases
- ;; ( ) Cushing's Syndrome ( ) Acromegaly
- ;; ( ) Diabetes Mellitus
- ;;
- ;; Body System: Neurologic (DC Series 8000, 8100, 8200, 8300, 8400, 8500, 8600, 8700, 8800, 8900)
- ;; ( ) Brain and Spinal Cord ( ) Cranial Nerves
- ;; ( ) Neurological Disorders, Miscellaneous ( ) Peripheral Nerves
- ;; ( ) Epilepsy and Narcolepsy
- ;;
- ;; Body System: Mental Disorders (DC Series 9200, 9300, 9400, 9500)
- ;; ( ) Mental Disorders (not PTSD and Eating Disorders)
- ;; ( ) Initial Evaluation for Post-Traumatic Stress Disorder (PTSD)
- ;; ( ) Review Examination for Post-Traumatic Stress Disorder (PTSD)
- ;; ( ) Eating Disorders (Mental Disorders)
- ;;
- ;; Body System: Dental and Oral (DC Series 9900)
- ;; ( ) Dental and Oral
- ;;
- ;; Special Examinations:
- ;; ( ) Aid and Attendance or Housebound Examination
- ;; ( ) Prisoner of War Protocol Examination
- ;; ( ) Cold Injury Protocol Examination
- ;; ( ) Gulf War Guidelines
- ;; ( ) Social and Industrial Survey
- ;;END
- --- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCEXM1 4158 printed Mar 13, 2025@20:48:46 Page 2
- DVBCEXM1 ;ALB/CMC REQUEST WORKSHEET TEXT ; 8/15/97
- +1 ;;2.7;AMIE;**12,16,80**;Apr 10, 1995
- +2 ;
- TXT ;
- +1 ;; Body System: Musculoskeletal (DC Series 5000, 5100, 5200, 5300)
- +2 ;; ( ) Bones (Fractures and Bone Disease) ( ) Fibromyalgia
- +3 ;; ( ) Amputation, Residuals of ( ) Joints (Shoulder/Elbow/Wrist/Hip/Knee/Ankle)
- +4 ;; ( ) Hand, Thumb, and Fingers ( ) Feet
- +5 ;; ( ) Spine (Cervical, Thoracic & Lumbar) ( ) Muscles
- +6 ;;
- +7 ;; Body System: Organs of Sense (DC Series 6000, 6100, 6200)
- +8 ;; ( ) Eye Examination ( ) Audio
- +9 ;; ( ) Ear Disease ( ) Sense of Smell and Taste
- +10 ;;
- +11 ;; Body System: Infectious/Immune/Nutritional (DC Series 6300)
- +12 ;; ( ) Infectious, Immune, and Nutritional Disabilities
- +13 ;; ( ) HIV-Related Illness ( ) Chronic Fatigue Syndrome
- +14 ;;
- +15 ;; Body System: Respiratory (DC Series 6500, 6600, 6700, 6800)
- +16 ;; ( ) Nose, Sinus, Larynx, and Pharynx ( ) Respiratory (Obstructive, Restrictive,
- +17 ;; ( ) Pulmonary Tuberculosis and and Interstitial)
- +18 ;; Mycobacterial Diseases ( ) Respiratory Diseases, Miscellaneous
- +19 ;;
- +20 ;; Body System: Cardiovascular (DC Series 7000, 7100)
- +21 ;; ( ) Arrhythmias ( ) Heart
- +22 ;; ( ) Arteries, Veins and Miscellaneous ( ) Hypertension
- +23 ;;
- +24 ;; Body System: Digestive (DC Series 7200, 7300)
- +25 ;; ( ) Mouth, Lips, and Tongue ( ) Esophagus and Hiatal Hernia
- +26 ;; ( ) Intestines (Large and Small) ( ) Liver, Gall Bladder, and Pancreas
- +27 ;; ( ) Digestive Conditions, Miscellaneous ( ) Rectum and Anus
- +28 ;; ( ) Stomach, Duodenum, and Peritoneal Adhesions
- +29 ;;
- +30 ;; Body System: Genitourinary (DC Series 7500)
- +31 ;; ( ) Genitourinary Examination
- +32 ;;
- +33 ;; Body System: Gynecological and Breast (DC Series 7600)
- +34 ;; ( ) Gynecological Conditions and
- +35 ;; Disorders of the Breast
- +36 ;;
- +37 ;; Body System: Hemic and Lymphatic (DC Series 7700)
- +38 ;; ( ) Hemic Disorders ( ) Lymphatic Disorders
- +39 ;;
- +40 ;; Body System: Skin (DC Series 7800)
- +41 ;; ( ) Scars ( ) Skin Diseases (other than scars)
- +42 ;;
- +43 ;; Body System: Endocrine (DC Series 7900)
- +44 ;; ( ) Endocrine Diseases, Miscellaneous ( ) Thyroid and Parathyroid Diseases
- +45 ;; ( ) Cushing's Syndrome ( ) Acromegaly
- +46 ;; ( ) Diabetes Mellitus
- +47 ;;
- +48 ;; Body System: Neurologic (DC Series 8000, 8100, 8200, 8300, 8400, 8500, 8600, 8700, 8800, 8900)
- +49 ;; ( ) Brain and Spinal Cord ( ) Cranial Nerves
- +50 ;; ( ) Neurological Disorders, Miscellaneous ( ) Peripheral Nerves
- +51 ;; ( ) Epilepsy and Narcolepsy
- +52 ;;
- +53 ;; Body System: Mental Disorders (DC Series 9200, 9300, 9400, 9500)
- +54 ;; ( ) Mental Disorders (not PTSD and Eating Disorders)
- +55 ;; ( ) Initial Evaluation for Post-Traumatic Stress Disorder (PTSD)
- +56 ;; ( ) Review Examination for Post-Traumatic Stress Disorder (PTSD)
- +57 ;; ( ) Eating Disorders (Mental Disorders)
- +58 ;;
- +59 ;; Body System: Dental and Oral (DC Series 9900)
- +60 ;; ( ) Dental and Oral
- +61 ;;
- +62 ;; Special Examinations:
- +63 ;; ( ) Aid and Attendance or Housebound Examination
- +64 ;; ( ) Prisoner of War Protocol Examination
- +65 ;; ( ) Cold Injury Protocol Examination
- +66 ;; ( ) Gulf War Guidelines
- +67 ;; ( ) Social and Industrial Survey
- +68 ;;END
