Prompt: !?25,HD91,!?22,"Compensation and Pension Examination",!
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Prompt: ?33,"# 1215 Worksheet"
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Prompt: ?33,"# 1215 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: None",!!
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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: ?5,"1. State whether a tumor is present. If so, note type and whether",!?9,"malignant -",!!!!!!!!
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Prompt: ?5,"2. If a malignancy is present but is now cured or in remission,",!?9,"report the date of last surgery, radiation therapy, chemotherapy",!?9,"or other treatment -",!!!!!!!!
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Prompt: ?5,"3. Identify the level of the lesion -",!!!!!!!!
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Prompt: ?5,"4. State if the impairment is total or partial -",!!!!!!!!
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Prompt: ?5,"6. If the lesion is partial, describe the impairment of function at",!?9,"the level of each affected radicular group -",!!!!!!!!!