DVBCGMCK ;ALB/GTS-557/THM-GENERAL MEDICAL EXAM ; 5/16/91 2:20 PM
;;2.7;AMIE;;Apr 10, 1995
;
K LINE S PG=1,HD91="Department of Veterans Affairs"
S HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
S $P(LINE,"-",75)="-"
EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0505 Worksheet" S HD7="GENERAL MEDICAL",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: ___________________"
W !!,"Type of Exam: ",HD7,!!!!,"Narrative:",!!
S TXT="TXT10" D PTXT W !!!,"A. Occupational history (List most current first):",!
W LINE,!,"Name/Address of employer Type Monthly Emp dates Time lost",!,"(if unemployed, enter none)",?29,"Work Wages from/to Last 12 mo",!!!
W "1. ",$E(LINE,2,75),!!,"2. ",$E(LINE,2,75),!!,"3. ",$E(LINE,2,75),!!!,"State if time from employment was lost and give reasons.",!!!?3,$E(LINE,2,75),!!!,"B. Medical history (since last rating exam):",!
D HD2 W "C. Present complaints (symptoms only, NOT diagnosis):",!!!!!!!!!!!!,"D. Examination data:",!!!!,"Height:",?25,"Weight:",?45,"Max wgt past year:",!!!
W "Build and state of nutrition:",!!!,"Temperature:",?23,"Time:",?35,"AM/PM",?50,"Carriage:",!!!,"Posture:",?23,"Gait:",?45,"Right- or left-handed:",!?45,"(How determined)",!!!!!!
W "E. Skin, including appendages " S TXT="TXT2" D PTXT,HD2 W "F. Lymphatic and hemic systems " S TXT="TXT3" D PTXT W !!!!!!!!!!,"G. Head, face and neck:",!!!!!!!!!!
W "H. Nose, sinuses, mouth and throat (include gross dental findings):"
W !! D HD2 W "I. Ears (describe canals, drums, perforations, discharge):",!!!!!!!!,"J. Eyes (describe external eye, pupil reaction, movements,",!
W ?3,"field of vision, any uncorrectable refractive error or",!?3,"any retinopathy):",!!!!!!!!,"K. Cardiovascular system "
W "(describe thrust, size, rhythm, sounds and condition",!," of peripheral vessels):",!!!!!!!!!!!!!!!?25,"Pulse",?39,"Blood pressure",?60,"Respiration",!,LINE,! S LNH="| | |"
W "Sitting",?21,LNH,!,LINE,!,"Recumbent",?21,LNH,!,LINE,!,"Standing",?21,LNH,!,LINE,!,"Sitting after exerc. ",LNH,!,LINE,!,"2 min after exercise ",LNH,!,LINE,! D HD2
W "L. Varicose veins (describe location, size, extent, ulcers, scars, and",!," competency of deep circulation):",!
W !!!!!!,"M. Respiratory system " S TXT="TXT9" D PTXT W !!!!!!!!!,"N. Digestive system " S TXT="TXT4" D PTXT W !!!!!!!!,"O. Hernia" S TXT="TXT5" D PTXT,HD2 W "P. Genito-urinary system " S TXT="TXT6" D PTXT W !
W !!!!!!!!!,"Q. Musculo-skeletal system",!! S TXT="TXT7" D PTXT,HD2 W "R. Endocrine system (describe disease of thyroid, pituitary, adrenals",!?3,"gonads, other body systems affected, etc.):",!!!!!!!!
W "S. Nervous system",!! S TXT="TXT8" D PTXT W !!!!!!!!!!,"T. Remarks:",!!!!!!!!!! D HD2 W "U. Other tests/exams recommended:",!!!!!!!!!!,"V. Diagnostic/clinical test results:",!!!!!!!!!
W "W. Diagnosis:",!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
W !!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
W !!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
W !!!?16,"Reviewing Official: ______________________________",!!?30,"Date: _________________________",!
K LN,LN1,LN2,LINE
Q
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HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam "_HD8_" for ",!,NAME,!!!
Q
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PTXT D PTXT^DVBCGMC1
Q
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SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCGMCK 3707 printed Dec 13, 2024@01:44:11 Page 2
DVBCGMCK ;ALB/GTS-557/THM-GENERAL MEDICAL EXAM ; 5/16/91 2:20 PM
+1 ;;2.7;AMIE;;Apr 10, 1995
+2 ;
+3 KILL LINE
SET PG=1
SET HD91="Department of Veterans Affairs"
+4 SET HD9=$SELECT($DATA(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
+5 SET $PIECE(LINE,"-",75)="-"
EN if '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 0505 Worksheet"
SET HD7="GENERAL MEDICAL"
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: ___________________"
+3 WRITE !!,"Type of Exam: ",HD7,!!!!,"Narrative:",!!
+4 SET TXT="TXT10"
DO PTXT
WRITE !!!,"A. Occupational history (List most current first):",!
+5 WRITE LINE,!,"Name/Address of employer Type Monthly Emp dates Time lost",!,"(if unemployed, enter none)",?29,"Work Wages from/to Last 12 mo",!!!
+6 WRITE "1. ",$EXTRACT(LINE,2,75),!!,"2. ",$EXTRACT(LINE,2,75),!!,"3. ",$EXTRACT(LINE,2,75),!!!,"State if time from employment was lost and give reasons.",!!!?3,$EXTRACT(LINE,2,75),!!!,"B. Medical history (since last rating exam):",!
+7 DO HD2
WRITE "C. Present complaints (symptoms only, NOT diagnosis):",!!!!!!!!!!!!,"D. Examination data:",!!!!,"Height:",?25,"Weight:",?45,"Max wgt past year:",!!!
+8 WRITE "Build and state of nutrition:",!!!,"Temperature:",?23,"Time:",?35,"AM/PM",?50,"Carriage:",!!!,"Posture:",?23,"Gait:",?45,"Right- or left-handed:",!?45,"(How determined)",!!!!!!
+9 WRITE "E. Skin, including appendages "
SET TXT="TXT2"
DO PTXT
DO HD2
WRITE "F. Lymphatic and hemic systems "
SET TXT="TXT3"
DO PTXT
WRITE !!!!!!!!!!,"G. Head, face and neck:",!!!!!!!!!!
+10 WRITE "H. Nose, sinuses, mouth and throat (include gross dental findings):"
+11 WRITE !!
DO HD2
WRITE "I. Ears (describe canals, drums, perforations, discharge):",!!!!!!!!,"J. Eyes (describe external eye, pupil reaction, movements,",!
+12 WRITE ?3,"field of vision, any uncorrectable refractive error or",!?3,"any retinopathy):",!!!!!!!!,"K. Cardiovascular system "
+13 WRITE "(describe thrust, size, rhythm, sounds and condition",!," of peripheral vessels):",!!!!!!!!!!!!!!!?25,"Pulse",?39,"Blood pressure",?60,"Respiration",!,LINE,!
SET LNH="| | |"
+14 WRITE "Sitting",?21,LNH,!,LINE,!,"Recumbent",?21,LNH,!,LINE,!,"Standing",?21,LNH,!,LINE,!,"Sitting after exerc. ",LNH,!,LINE,!,"2 min after exercise ",LNH,!,LINE,!
DO HD2
+15 WRITE "L. Varicose veins (describe location, size, extent, ulcers, scars, and",!," competency of deep circulation):",!
+16 WRITE !!!!!!,"M. Respiratory system "
SET TXT="TXT9"
DO PTXT
WRITE !!!!!!!!!,"N. Digestive system "
SET TXT="TXT4"
DO PTXT
WRITE !!!!!!!!,"O. Hernia"
SET TXT="TXT5"
DO PTXT
DO HD2
WRITE "P. Genito-urinary system "
SET TXT="TXT6"
DO PTXT
WRITE !
+17 WRITE !!!!!!!!!,"Q. Musculo-skeletal system",!!
SET TXT="TXT7"
DO PTXT
DO HD2
WRITE "R. Endocrine system (describe disease of thyroid, pituitary, adrenals",!?3,"gonads, other body systems affected, etc.):",!!!!!!!!
+18 WRITE "S. Nervous system",!!
SET TXT="TXT8"
DO PTXT
WRITE !!!!!!!!!!,"T. Remarks:",!!!!!!!!!!
DO HD2
WRITE "U. Other tests/exams recommended:",!!!!!!!!!!,"V. Diagnostic/clinical test results:",!!!!!!!!!
+19 WRITE "W. Diagnosis:",!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+20 WRITE !!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+21 WRITE !!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+22 WRITE !!!?16,"Reviewing Official: ______________________________",!!?30,"Date: _________________________",!
+23 KILL LN,LN1,LN2,LINE
+24 QUIT
+25 ;
HD2 SET PG=PG+1
WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam "_HD8_" for ",!,NAME,!!!
+1 QUIT
+2 ;
PTXT DO PTXT^DVBCGMC1
+1 QUIT
+2 ;
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
