- DVBCGSCK ;ALB/GTS-557/THM-GYNECOLOGICAL, NOT ELSEWHERE CLASSIFIED ; 6/6/90 8:18 AM
- ;;2.7;AMIE;;Apr 10, 1995
- EN S DVBAX="For GYNECOLOGICAL, NOT ELSEWHERE CLASSIFIED"
- S PG=1 D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
- W !?22,"Compensation and Pension Examination",!?33,"# 0710 Worksheet",!,?(IOM-$L(DVBAX)\2),DVBAX,!!
- W "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: GYNECOLOGICAL, NOT ELSEWHERE CLASSIFIED",!!
- W "Physician's Guide Reference: None",!!,"Narrative:",!!
- F I=0:1 S LY=$T(TXT+I) D:LY["TOF" HD2 Q:LY["END" W:LY'["TOF" $P(LY,";;",2),! I $Y>55 D HD2
- K I,LY,DVBAX Q
- ;
- TXT ;;This exam is to handle the balance of currently recognized gynecological
- ;;disorders and to allow for new disorders not yet classified for V.A.
- ;;compensation evaluations. The severity of a condition is based upon the
- ;;residual disability. If there is a disease process that affects multiple
- ;;systems or extremeties, please evaluate each separately.
- ;;
- ;;
- ;;A. Medical history (W/P):
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;B. Subjective findings (W/P):
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;C. Objective findings (W/P):
- ;;TOF
- ;;
- ;;
- ;;D. Evaluation Information for the Rating Board:
- ;;
- ;;
- ;; Residual disability effect on:
- ;;
- ;;
- ;; 1) earning capacity/job performance (F/T):
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;; 2) everyday activities (F/T):
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;; 3) Is disability constant? (YES/NO):
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;; 4) If NO, give frequency, length of remissions (F/T):
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;; 5) Acute exacerbations effect on everyday life. (F/T)
- ;;TOF
- ;;
- ;;
- ;;E. Diagnosis (W/P):
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;;
- ;; Signature: ______________________________
- ;;
- ;; Date: _________________________
- ;;END
- Q
- ;
- HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
- W "For GYNECOLOGICAL, NOT ELSEWHERE CLASSIFIED",!!!
- Q
- ;
- SETIOF ; ** Set device control var's
- D HOME^%ZIS
- Q
- --- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCGSCK 2340 printed Jan 18, 2025@02:45:28 Page 2
- DVBCGSCK ;ALB/GTS-557/THM-GYNECOLOGICAL, NOT ELSEWHERE CLASSIFIED ; 6/6/90 8:18 AM
- +1 ;;2.7;AMIE;;Apr 10, 1995
- EN SET DVBAX="For GYNECOLOGICAL, NOT ELSEWHERE CLASSIFIED"
- +1 SET PG=1
- if '$DATA(IOF)
- DO SETIOF
- if (IOST?1"C-".E)
- WRITE @IOF
- +2 WRITE !?22,"Compensation and Pension Examination",!?33,"# 0710 Worksheet",!,?(IOM-$LENGTH(DVBAX)\2),DVBAX,!!
- +3 WRITE "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: GYNECOLOGICAL, NOT ELSEWHERE CLASSIFIED",!!
- +4 WRITE "Physician's Guide Reference: None",!!,"Narrative:",!!
- +5 FOR I=0:1
- SET LY=$TEXT(TXT+I)
- if LY["TOF"
- DO HD2
- if LY["END"
- QUIT
- if LY'["TOF"
- WRITE $PIECE(LY,";;",2),!
- IF $Y>55
- DO HD2
- +6 KILL I,LY,DVBAX
- QUIT
- +7 ;
- TXT ;;This exam is to handle the balance of currently recognized gynecological
- +1 ;;disorders and to allow for new disorders not yet classified for V.A.
- +2 ;;compensation evaluations. The severity of a condition is based upon the
- +3 ;;residual disability. If there is a disease process that affects multiple
- +4 ;;systems or extremeties, please evaluate each separately.
- +5 ;;
- +6 ;;
- +7 ;;A. Medical history (W/P):
- +8 ;;
- +9 ;;
- +10 ;;
- +11 ;;
- +12 ;;
- +13 ;;
- +14 ;;
- +15 ;;
- +16 ;;
- +17 ;;
- +18 ;;B. Subjective findings (W/P):
- +19 ;;
- +20 ;;
- +21 ;;
- +22 ;;
- +23 ;;
- +24 ;;
- +25 ;;
- +26 ;;
- +27 ;;
- +28 ;;
- +29 ;;C. Objective findings (W/P):
- +30 ;;TOF
- +31 ;;
- +32 ;;
- +33 ;;D. Evaluation Information for the Rating Board:
- +34 ;;
- +35 ;;
- +36 ;; Residual disability effect on:
- +37 ;;
- +38 ;;
- +39 ;; 1) earning capacity/job performance (F/T):
- +40 ;;
- +41 ;;
- +42 ;;
- +43 ;;
- +44 ;;
- +45 ;;
- +46 ;; 2) everyday activities (F/T):
- +47 ;;
- +48 ;;
- +49 ;;
- +50 ;;
- +51 ;;
- +52 ;;
- +53 ;;
- +54 ;; 3) Is disability constant? (YES/NO):
- +55 ;;
- +56 ;;
- +57 ;;
- +58 ;;
- +59 ;;
- +60 ;;
- +61 ;;
- +62 ;; 4) If NO, give frequency, length of remissions (F/T):
- +63 ;;
- +64 ;;
- +65 ;;
- +66 ;;
- +67 ;;
- +68 ;;
- +69 ;; 5) Acute exacerbations effect on everyday life. (F/T)
- +70 ;;TOF
- +71 ;;
- +72 ;;
- +73 ;;E. Diagnosis (W/P):
- +74 ;;
- +75 ;;
- +76 ;;
- +77 ;;
- +78 ;;
- +79 ;;
- +80 ;;
- +81 ;;
- +82 ;;
- +83 ;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
- +84 ;;
- +85 ;;
- +86 ;;
- +87 ;;
- +88 ;;
- +89 ;;
- +90 ;;
- +91 ;;
- +92 ;;
- +93 ;; Signature: ______________________________
- +94 ;;
- +95 ;; Date: _________________________
- +96 ;;END
- +97 QUIT
- +98 ;
- HD2 SET PG=PG+1
- WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
- +1 WRITE "For GYNECOLOGICAL, NOT ELSEWHERE CLASSIFIED",!!!
- +2 QUIT
- +3 ;
- SETIOF ; ** Set device control var's
- +1 DO HOME^%ZIS
- +2 QUIT