DVBCVSCK ;ALB/GTS-557/THM-VISUAL EXAM ; 6/27/91 2:11 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1330 Worksheet" S HD7="VISUAL",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W "Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative: "
S LX="TXT" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W $P(LY,";;",2),!
W !!,"A. Medical history:",!!!!!!!!!
W !!,"B. Visual Acuity:",!!?44,"Near",?55,"Far",!?43,"______",?54,"______",!
W ?13,"Right Eye",?28,"Uncorrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!?43,"______",?54,"______",!?30,"Corrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!!
W ?44,"Near",?55,"Far",!?43,"______",?54,"______",!?13," Left Eye",?28,"Uncorrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!?43,"______",?54,"______",!?30,"Corrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!!
D HD2 S LX="TXT" D ^DVBCVSC1 W !!!!!
W "F. Diagnostic/clinical test results (other than visual acuity,visual fields",!,?4,"or diplopia):",!!!!!!!!!!,"G. Diagnosis:",!!!!!!!!!!
W ?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
;S LN22="Attachment - Visual Exam" W @IOF,!!?(80-$L(LN22)\2),LN22,!!! D ^DVBCVSC2 W !
K LN,LN1,LN22
Q
;
HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Examination",!,HD8," for ",NAME,!!!
Q
;
TXT ;
;;For visual acuity worse than 5/200 in either or both eyes, report
;; the distance in feet/inches (or meters/centimeters) from the face
;; at which the veteran can count fingers/detect hand motion/read the
;; largest line on the chart. If the veteran cannot detect hand motion
;; or count fingers at any distance, state whether he/she has light
;; perception.
;;END
SETIOF ; ** Set device control var's
D HOME^%ZIS
Q
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCVSCK 2167 printed Dec 13, 2024@01:49:20 Page 2
DVBCVSCK ;ALB/GTS-557/THM-VISUAL EXAM ; 6/27/91 2:11 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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 1330 Worksheet"
SET HD7="VISUAL"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE "Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative: "
+4 SET LX="TXT"
FOR I=1:1
SET LY=$TEXT(@LX+I)
if LY["END"
QUIT
WRITE $PIECE(LY,";;",2),!
+5 WRITE !!,"A. Medical history:",!!!!!!!!!
+6 WRITE !!,"B. Visual Acuity:",!!?44,"Near",?55,"Far",!?43,"______",?54,"______",!
+7 WRITE ?13,"Right Eye",?28,"Uncorrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!?43,"______",?54,"______",!?30,"Corrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!!
+8 WRITE ?44,"Near",?55,"Far",!?43,"______",?54,"______",!?13," Left Eye",?28,"Uncorrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!?43,"______",?54,"______",!?30,"Corrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!!
+9 DO HD2
SET LX="TXT"
DO ^DVBCVSC1
WRITE !!!!!
+10 WRITE "F. Diagnostic/clinical test results (other than visual acuity,visual fields",!,?4,"or diplopia):",!!!!!!!!!!,"G. Diagnosis:",!!!!!!!!!!
+11 WRITE ?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
+12 ;S LN22="Attachment - Visual Exam" W @IOF,!!?(80-$L(LN22)\2),LN22,!!! D ^DVBCVSC2 W !
+13 KILL LN,LN1,LN22
+14 QUIT
+15 ;
HD2 SET PG=PG+1
WRITE @IOF,!,"Page: ",PG,!!,"Compensation and Pension Examination",!,HD8," for ",NAME,!!!
+1 QUIT
+2 ;
TXT ;
+1 ;;For visual acuity worse than 5/200 in either or both eyes, report
+2 ;; the distance in feet/inches (or meters/centimeters) from the face
+3 ;; at which the veteran can count fingers/detect hand motion/read the
+4 ;; largest line on the chart. If the veteran cannot detect hand motion
+5 ;; or count fingers at any distance, state whether he/she has light
+6 ;; perception.
+7 ;;END
SETIOF ; ** Set device control var's
+1 DO HOME^%ZIS
+2 QUIT
