DVBCPNCK ;ALB/GTS-557/THM-LOSS OF PENIS ; 5/16/91 2:23 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0610 Worksheet" S HD7="LOSS OF PENIS, ALL OR PARTIAL; IMPOTENCE (GU)",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative:"
W ?13,"A complete and detailed examination of the entire",!?13,"genitourinary system is needed with close correlation",!?13,"between this, the history and laboratory studies.",!?13,"Any penile deformity should be described in detail.",!!
I '$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. Extent of loss -",!!!!!?8,"2. Erectile power preserved -",!!!!!?8,"3. If impotent, state cause -",!!!!!
W ?8,"4. State whether impotence is permanent or if erectile power",!?11,"can be restored -",!!!!!?8,"5. Describe any penile deformity in detail -",!!!!!!
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 "_NAME,!,HD8,!!!
Q
;
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCPNCK 1861 printed Dec 13, 2024@01:45:13 Page 2
DVBCPNCK ;ALB/GTS-557/THM-LOSS OF PENIS ; 5/16/91 2:23 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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 0610 Worksheet"
SET HD7="LOSS OF PENIS, ALL OR PARTIAL; IMPOTENCE (GU)"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative:"
+4 WRITE ?13,"A complete and detailed examination of the entire",!?13,"genitourinary system is needed with close correlation",!?13,"between this, the history and laboratory studies.",!?13,"Any penile deformity should be described in detail.",!!
+5 IF '$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. Extent of loss -",!!!!!?8,"2. Erectile power preserved -",!!!!!?8,"3. If impotent, state cause -",!!!!!
+8 WRITE ?8,"4. State whether impotence is permanent or if erectile power",!?11,"can be restored -",!!!!!?8,"5. Describe any penile deformity in detail -",!!!!!!
+9 if $DATA(CMBN)
DO HD2
WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!
+10 WRITE $SELECT($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 "_NAME,!,HD8,!!!
+1 QUIT
+2 ;
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
