Prompt: !?25,HD91,!?22,"Compensation and Pension Examination",!
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Prompt: ?33,"# 0705 Worksheet"
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Prompt: ?33,"# 0705 Worksheet"
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Prompt: !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",?14,HD7
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Prompt: !!!!,"Narrative:"
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Prompt: ?13,"An evaluation of the female reproductive system depends",!?13,"on a complete physical examination, a thorough medical",!
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Prompt: ?13,"history and all appropriate laboratory studies.",!!
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):"
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Prompt: !!!?8,"1. Uterus",!!?11,"a. Removal of, complete/imcomplete (if incomplete,",!?14,"state if pregnancy is prevented) -",!!!!!!
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Prompt: ?11,"b. Prolapse of, complete through vulva/imcomplete -",!!!!!!?11,"c. Displacement of; also identify adhesions and irregular",!?14,"menstruation -",!!!!!!
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Prompt: ?8,"2. Ovaries",!!?11,"a. Removal of both -",!!!!!!?11,"b. Removal of one with or without partial removal",!?14,"of the other -",!!!!!!?11,"c. Atrophy of one or both ovaries, complete -",!!!!!!
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Prompt: ?8,"4. If a malignant process has been present within the past year,",!
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Prompt: ?11,"give the date of the last surgical, radiation or chemical",!?11,"therapy -",!!!!!!
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Prompt: ?8,"5. If a tubercular or other mycobacterial infection has been treated",!?11,"within the past year, give the date of inactivity -",!!!!!!?8,"6. Has a voluntary sterilization procedure been performed? -",!!!!!!
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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 "_NAME,!,HD8,!!!