DVBCNPCK ;ALB/GTS-557/THM-ALL FORMS OF NEPHRITIS ; 11/7/90 11:19 AM
;;2.7;AMIE;;Apr 10, 1995
;
S PG=1,HD91="Department of Veterans Affairs",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1105 Worksheet" S HD7="NEPHRITIS, EXCEPT CHRONIC PYELONEPHRITIS",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative:"
W ?13,"Complications and/or medical side effects should always be",!?13,"reported, even when not specifically requested.",!!
I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",! D HD2
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. Blood pressure -",!!!!!?8,"2. Presence or absence of albumin casts -",!!!!!
W ?8,"3. Edema -",!!!!!?8,"4. Red blood cells -",!!!!!
W ?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 -",!!!!!!!
D HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnosic/clinical test results:",!!!!!!!!!!!!,$S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
K LN,LN1,LN2
Q
;
HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!," for "_NAME,!!!
Q
;
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCNPCK 1839 printed Sep 23, 2025@19:21:04 Page 2
DVBCNPCK ;ALB/GTS-557/THM-ALL FORMS OF NEPHRITIS ; 11/7/90 11:19 AM
+1 ;;2.7;AMIE;;Apr 10, 1995
+2 ;
+3 SET PG=1
SET HD91="Department of Veterans Affairs"
SET HD9=$SELECT($DATA(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
EN if '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 1105 Worksheet"
SET HD7="NEPHRITIS, EXCEPT CHRONIC PYELONEPHRITIS"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative:"
+4 WRITE ?13,"Complications and/or medical side effects should always be",!?13,"reported, even when not specifically requested.",!!
+5 IF '$DATA(CMBN)
WRITE "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!
DO HD2
+6 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):",!!!
+7 WRITE ?8,"1. Blood pressure -",!!!!!?8,"2. Presence or absence of albumin casts -",!!!!!
+8 WRITE ?8,"3. Edema -",!!!!!?8,"4. Red blood cells -",!!!!!
+9 WRITE ?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 -",!!!!!!!
+10 DO HD2
WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnosic/clinical test results:",!!!!!!!!!!!!,$SELECT($DATA(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+11 KILL LN,LN1,LN2
+12 QUIT
+13 ;
HD2 SET PG=PG+1
WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!," for "_NAME,!!!
+1 QUIT
+2 ;
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
