DVBCPDCK ;ALB/GTS-557/THM-PULMONARY TB/OTHER MYCOBACTERIAL DISEASES ; 6/27/91 12:48 PM
;;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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1515 Worksheet" S HD7="PULMONARY TUBERCULOSIS AND MYCOBACTERIAL DISEASES",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative:"
W ?13,"Is pulmonary tuberculosis or other mycobacterial disease",!?13,"active? If so, identify the organism. In reactivated",!?13,"cases, it is necessary to know whether this is reactivation",!
W ?13,"of the old disease or a separate and distinct new infection.",!!!
I '$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 ?4,"1. IN ALL CASES:",!!?8,"a. Date of inactivity -",!!!!!?8,"b. Extent of structural damage to lungs -",!!!!!!?8,"c. Provide pulmonary function studies -",!!!!!?4,"2. In PENSION CASES ONLY:",!!!
W ?8,"a. Disease condition after six months of treatment -",!!!!!?8,"b. Disease condition after twelve months of treatment -",!!!!!
D:$D(CMBN) HD2 W " Additional note to the physician:",!!!,"In all claims, if the disease is inactive and if the inactivity was confirmed",!
W "at a non-VA facility, obtain the name and mailing address of the facility",!,"from the veteran so that the "
W "Regional Office may request the report.",!
D:'$D(CMBN) HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!! W $S($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[HDVBCPDCK 2306 printed Dec 13, 2024@01:45:10 Page 2
DVBCPDCK ;ALB/GTS-557/THM-PULMONARY TB/OTHER MYCOBACTERIAL DISEASES ; 6/27/91 12:48 PM
+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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 1515 Worksheet"
SET HD7="PULMONARY TUBERCULOSIS AND MYCOBACTERIAL DISEASES"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative:"
+4 WRITE ?13,"Is pulmonary tuberculosis or other mycobacterial disease",!?13,"active? If so, identify the organism. In reactivated",!?13,"cases, it is necessary to know whether this is reactivation",!
+5 WRITE ?13,"of the old disease or a separate and distinct new infection.",!!!
+6 IF '$DATA(CMBN)
WRITE "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!
DO HD2
+7 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):",!!!
+8 WRITE ?4,"1. IN ALL CASES:",!!?8,"a. Date of inactivity -",!!!!!?8,"b. Extent of structural damage to lungs -",!!!!!!?8,"c. Provide pulmonary function studies -",!!!!!?4,"2. In PENSION CASES ONLY:",!!!
+9 WRITE ?8,"a. Disease condition after six months of treatment -",!!!!!?8,"b. Disease condition after twelve months of treatment -",!!!!!
+10 if $DATA(CMBN)
DO HD2
WRITE " Additional note to the physician:",!!!,"In all claims, if the disease is inactive and if the inactivity was confirmed",!
+11 WRITE "at a non-VA facility, obtain the name and mailing address of the facility",!,"from the veteran so that the "
+12 WRITE "Regional Office may request the report.",!
+13 if '$DATA(CMBN)
DO HD2
WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!
WRITE $SELECT($DATA(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+14 KILL LN,LN1,LN2
+15 QUIT
+16 ;
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
