- 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
- ;
- HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam "_HD8_" for ",!,NAME,!!!
- Q
- ;
- PTXT D PTXT^DVBCGMC1
- Q
- ;
- SETIOF ; ** Set device control var's
- D HOME^%ZIS
- Q
- --- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCGMCK 3707 printed Jan 18, 2025@02:45:25 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