DVBCSPCK ;ALB/GTS-557/THM-SPINAL EXAM ; 5/17/91 9:08 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1450 Worksheet" S HD7="SPINE (ORTHOPEDIC)",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative:"
W ?13,"Complete description of spinal orthosis, its impact on",!?13,"motion before and after application, and whether the ",!?13,"usage is constant or intermittent should be part of the",!?13,"findings.",!!?13,"To give uniformity in "
W "describing limitation of motion or",!?13,"ankylosis, THE USE OF A GONIOMETER IS REQUIRED. Report",!?13,"each spinal segment separately.",!!!
I '$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. Postural abnormalities -",!!!!!?8,"2. Fixed deformity -",!!!!!?8,"3. Musculature of back -",!!!!!
W ?8,"4. Range of motion:",!!?10,"a. Forward flexion -",!!!!?10,"b. Backward extension -",!!!!?10,"c. Left lateral flexion -",!!!! D:$D(CMBN) HD2
W ?10,"d. Right lateral flexion -",!!!!?10,"e. Rotation to left -",!!!!!?10,"f. Rotation to right -",!!!!!
W ?8,"5. Objective evidence of pain on motion -",!!!!! D:'$D(CMBN) HD2 W ?8,"6. Identify and describe any evidence of neurological involvement -",!!!!!
W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/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[HDVBCSPCK 2208 printed Sep 23, 2025@19:24:47 Page 2
DVBCSPCK ;ALB/GTS-557/THM-SPINAL EXAM ; 5/17/91 9:08 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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 1450 Worksheet"
SET HD7="SPINE (ORTHOPEDIC)"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative:"
+4 WRITE ?13,"Complete description of spinal orthosis, its impact on",!?13,"motion before and after application, and whether the ",!?13,"usage is constant or intermittent should be part of the",!?13,"findings.",!!?13,"To give uniformity in "
+5 WRITE "describing limitation of motion or",!?13,"ankylosis, THE USE OF A GONIOMETER IS REQUIRED. Report",!?13,"each spinal segment separately.",!!!
+6 IF '$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 ?8,"1. Postural abnormalities -",!!!!!?8,"2. Fixed deformity -",!!!!!?8,"3. Musculature of back -",!!!!!
+9 WRITE ?8,"4. Range of motion:",!!?10,"a. Forward flexion -",!!!!?10,"b. Backward extension -",!!!!?10,"c. Left lateral flexion -",!!!!
if $DATA(CMBN)
DO HD2
+10 WRITE ?10,"d. Right lateral flexion -",!!!!?10,"e. Rotation to left -",!!!!!?10,"f. Rotation to right -",!!!!!
+11 WRITE ?8,"5. Objective evidence of pain on motion -",!!!!!
if '$DATA(CMBN)
DO HD2
WRITE ?8,"6. Identify and describe any evidence of neurological involvement -",!!!!!
+12 WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!,$SELECT($DATA(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+13 KILL LN,LN1,LN2
+14 QUIT
+15 ;
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
