DVBCGNCK ;ALB/GTS-557/THM-GYNECOLOGICAL EXAM ; 4/29/91 11:31 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0705 Worksheet" S HD7="GYNECOLOGICAL",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",?14,HD7
W !!!!,"Narrative:"
W ?13,"An evaluation of the female reproductive system depends",!?13,"on a complete physical examination, a thorough medical",!
W ?13,"history and all appropriate laboratory studies.",!!
W:$D(CMBN) "Note: " I '$D(CMBN) W "A. Medical history "
S TXT=$S($D(CMBN):"TXT1",1:"TXT2") F AW=0:1 S AX=$T(@TXT+AW) S AY=$P(AX,";;",2) W:AY="END" !! Q:AY="END" W AY,!
I '$D(CMBN) W !!!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!!!!!!!!!! D HD2
W:$D(CMBN) !! 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):"
W !!!?8,"1. Uterus",!!?11,"a. Removal of, complete/imcomplete (if incomplete,",!?14,"state if pregnancy is prevented) -",!!!!!!
W ?11,"b. Prolapse of, complete through vulva/imcomplete -",!!!!!!?11,"c. Displacement of; also identify adhesions and irregular",!?14,"menstruation -",!!!!!!
D:$D(CMBN) HD2 W ?8,"2. Ovaries",!!?11,"a. Removal of both -",!!!!!!?11,"b. Removal of one with or without partial removal",!?14,"of the other -",!!!!!!?11,"c. Atrophy of one or both ovaries, complete -",!!!!!!
W ?8,"3. Rectal and rectovaginal; identify any surgical complications",!?11,"of pregnancy -",!!!!!! D:'$D(CMBN) HD2 W ?8,"4. If a malignant process has been present within the past year,",!
W ?11,"give the date of the last surgical, radiation or chemical",!?11,"therapy -",!!!!!!
W ?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? -",!!!!!!
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
;
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
;
HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!,HD8,!!!
Q
TXT2 ;;(it is very important that in claims for establishing
;;service connection that the past medical history, menstrual history, marital
;;and pregnancy history and urinary history be as complete as possible):
;;END
;
TXT1 ;;In completing the medical history for the primary examination to
;;which this supplemental examination is attached, it is very important
;;that in claims for establishing service connection that the past medical
;;history, menstrual history, marital and pregnancy history and urinary
;;history be as complete as possible.
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCGNCK 3270 printed Nov 22, 2024@16:54:24 Page 2
DVBCGNCK ;ALB/GTS-557/THM-GYNECOLOGICAL EXAM ; 4/29/91 11:31 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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 0705 Worksheet"
SET HD7="GYNECOLOGICAL"
SET HD8="For "_HD7
WRITE !?(40-($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: ",?14,HD7
+3 WRITE !!!!,"Narrative:"
+4 WRITE ?13,"An evaluation of the female reproductive system depends",!?13,"on a complete physical examination, a thorough medical",!
+5 WRITE ?13,"history and all appropriate laboratory studies.",!!
+6 if $DATA(CMBN)
WRITE "Note: "
IF '$DATA(CMBN)
WRITE "A. Medical history "
+7 SET TXT=$SELECT($DATA(CMBN):"TXT1",1:"TXT2")
FOR AW=0:1
SET AX=$TEXT(@TXT+AW)
SET AY=$PIECE(AX,";;",2)
if AY="END"
WRITE !!
if AY="END"
QUIT
WRITE AY,!
+8 IF '$DATA(CMBN)
WRITE !!!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!!!!!!!!!!
DO HD2
+9 if $DATA(CMBN)
WRITE !!
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):"
+10 WRITE !!!?8,"1. Uterus",!!?11,"a. Removal of, complete/imcomplete (if incomplete,",!?14,"state if pregnancy is prevented) -",!!!!!!
+11 WRITE ?11,"b. Prolapse of, complete through vulva/imcomplete -",!!!!!!?11,"c. Displacement of; also identify adhesions and irregular",!?14,"menstruation -",!!!!!!
+12 if $DATA(CMBN)
DO HD2
WRITE ?8,"2. Ovaries",!!?11,"a. Removal of both -",!!!!!!?11,"b. Removal of one with or without partial removal",!?14,"of the other -",!!!!!!?11,"c. Atrophy of one or both ovaries, complete -",!!!!!!
+13 WRITE ?8,"3. Rectal and rectovaginal; identify any surgical complications",!?11,"of pregnancy -",!!!!!!
if '$DATA(CMBN)
DO HD2
WRITE ?8,"4. If a malignant process has been present within the past year,",!
+14 WRITE ?11,"give the date of the last surgical, radiation or chemical",!?11,"therapy -",!!!!!!
+15 WRITE ?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? -",!!!!!!
+16 if $DATA(CMBN)
DO HD2
WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!,$SELECT($DATA(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+17 KILL LN,LN1,LN2
+18 QUIT
+19 ;
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
+3 ;
HD2 SET PG=PG+1
WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!,HD8,!!!
+1 QUIT
TXT2 ;;(it is very important that in claims for establishing
+1 ;;service connection that the past medical history, menstrual history, marital
+2 ;;and pregnancy history and urinary history be as complete as possible):
+3 ;;END
+4 ;
TXT1 ;;In completing the medical history for the primary examination to
+1 ;;which this supplemental examination is attached, it is very important
+2 ;;that in claims for establishing service connection that the past medical
+3 ;;history, menstrual history, marital and pregnancy history and urinary
+4 ;;history be as complete as possible.
+5 ;;END
