Prompt: !?25,HD91,!?22,"Compensation and Pension Examination",!
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Prompt: ?33,"# 1105 Worksheet"
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Prompt: ?33,"# 1105 Worksheet"
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Prompt: !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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Prompt: !!!!,"Narrative:"
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Prompt: ?13,"Complications and/or medical side effects should always be",!?13,"reported, even when not specifically requested.",!!
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Prompt: "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!
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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. Blood pressure -",!!!!!?8,"2. Presence or absence of albumin casts -",!!!!!
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Prompt: ?8,"3. Edema -",!!!!!?8,"4. Red blood cells -",!!!!!
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Prompt: ?8,"5. Retention of non-protein nitrogen, creatinine or urea nitrogen -",!!!!!?8,"6. Describe overall impairment of kidney function -",!!!!!?8,"7. Report presence or absence of any cardiac complications -",!!!!!!!
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Prompt: $S($D(CMBN):"B. ",1:"E. "),"Diagnosic/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 ",HD7,!," for "_NAME,!!!