DVBCSKCK ;ALB/GTS-557/THM-SKIN, OTHER THAN SCARS ; 12/11/90 7:31 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1610 Worksheet" S HD7="SKIN, OTHER THAN SCARS",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative:"
W ?13,"When furnishing the history of the present skin disease",!?13,"include a description of the skin changes, when the disorder",!?13,"first appeared, and the progression of the illness since that",!?13,"time. Note whether"
W " remissions or exacerbations occurred",!?13,"and whether they were related to the occupation or treatment.",!?13,"Include the duration of remissions and factors that",!?13,"may have influenced the course of the disorder.",!!!
I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints: "
I '$D(CMBN) W ?24,"(List the types of complaints such as itching",!,"burning, pain and anesthesia. Note whether environmental factors such as",!,"temperature or seasonal change affect the severity of the symptoms.)",! D HD2
I '$D(CMBN) W "C. Objective findings:",!!!!!!!!!!!!!
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. Description of skin disorder -",!!!!!?8,"2. Distribution of skin disorder -",!!!!!?8,"3. Configuration and characteristics of lesions -",!!!!!!?8,"4. Nervous manifestations -",!!
W !!!?8,"5. Attach color photograph if condition is disfiguring.",!
D HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!!!,$S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!
W "(Note: If current diagnosis differs from the skin condition",!,"for which the examination was ordered, then review prior records and",!,"express opinion whether current disease is a new problem or original ",!,"diagnosis was in error.)"
W !!!!!!!!!!!!?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[HDVBCSKCK 2548 printed Sep 23, 2025@19:24:45 Page 2
DVBCSKCK ;ALB/GTS-557/THM-SKIN, OTHER THAN SCARS ; 12/11/90 7:31 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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 1610 Worksheet"
SET HD7="SKIN, OTHER THAN SCARS"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative:"
+4 WRITE ?13,"When furnishing the history of the present skin disease",!?13,"include a description of the skin changes, when the disorder",!?13,"first appeared, and the progression of the illness since that",!?13,"time. Note whether"
+5 WRITE " remissions or exacerbations occurred",!?13,"and whether they were related to the occupation or treatment.",!?13,"Include the duration of remissions and factors that",!?13,"may have influenced the course of the disorder.",!!!
+6 IF '$DATA(CMBN)
WRITE "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints: "
+7 IF '$DATA(CMBN)
WRITE ?24,"(List the types of complaints such as itching",!,"burning, pain and anesthesia. Note whether environmental factors such as",!,"temperature or seasonal change affect the severity of the symptoms.)",!
DO HD2
+8 IF '$DATA(CMBN)
WRITE "C. Objective findings:",!!!!!!!!!!!!!
+9 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):",!!!
+10 WRITE ?8,"1. Description of skin disorder -",!!!!!?8,"2. Distribution of skin disorder -",!!!!!?8,"3. Configuration and characteristics of lesions -",!!!!!!?8,"4. Nervous manifestations -",!!
+11 WRITE !!!?8,"5. Attach color photograph if condition is disfiguring.",!
+12 DO HD2
WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!!!,$SELECT($DATA(CMBN):"C. ",1:"F. "),"Diagnosis:",!!
+13 WRITE "(Note: If current diagnosis differs from the skin condition",!,"for which the examination was ordered, then review prior records and",!,"express opinion whether current disease is a new problem or original ",!,"diagnosis was in error.)"
+14 WRITE !!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+15 KILL LN,LN1,LN2
+16 QUIT
+17 ;
HD2 SET PG=PG+1
WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",!,NAME,!!!
+1 QUIT
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
