Prompt: !?25,HD91,!?22,"Compensation and Pension Examination",!
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Prompt: ?33,"# 1450 Worksheet"
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Prompt: ?33,"# 1450 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,"Complete description of spinal orthosis, its impact on",!?13,"motion before and after application, and whether the ",!?13,"usage is constant or intermittent should be part of the",!?13,"findings.",!!?13,"To give uniformity in "
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Prompt: "describing limitation of motion or",!?13,"ankylosis, THE USE OF A GONIOMETER IS REQUIRED. Report",!?13,"each spinal segment separately.",!!!
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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. Postural abnormalities -",!!!!!?8,"2. Fixed deformity -",!!!!!?8,"3. Musculature of back -",!!!!!
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Prompt: ?8,"4. Range of motion:",!!?10,"a. Forward flexion -",!!!!?10,"b. Backward extension -",!!!!?10,"c. Left lateral flexion -",!!!!
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Prompt: ?10,"d. Right lateral flexion -",!!!!?10,"e. Rotation to left -",!!!!!?10,"f. Rotation to right -",!!!!!
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Prompt: ?8,"6. Identify and describe any evidence of neurological involvement -",!!!!!
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Prompt: $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/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,!!!