DVBCXSCK ;ALB/GTS-557/THM-DISEASES/INJURIES OF THE SPINAL CORD ; 12/27/90 1:26 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1215 Worksheet" S HD7="DISEASES/INJURIES OF THE SPINAL CORD",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
W !!!!,"Narrative: None",!!
W !! I '$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 ?5,"1. State whether a tumor is present. If so, note type and whether",!?9,"malignant -",!!!!!!!!
W ?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 -",!!!!!!!!
W ?5,"3. Identify the level of the lesion -",!!!!!!!!
D:$D(CMBN) HD2 W ?5,"4. State if the impairment is total or partial -",!!!!!!!!
W ?5,"5. State if the veteran is incontinent of bladder and/or bowels -",!!!!!!!! D:'$D(CMBN) HD2 W ?5,"6. If the lesion is partial, describe the impairment of function at",!?9,"the level of each affected radicular group -",!!!!!!!!!
W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!! W:$D(CMBN) !!!!! W:'$D(CMBN) !!!!!!!!!! ;D:$D(CMBN) HD2
W $S($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[HDVBCXSCK 2083 printed Oct 16, 2024@17:55:23 Page 2
DVBCXSCK ;ALB/GTS-557/THM-DISEASES/INJURIES OF THE SPINAL CORD ; 12/27/90 1:26 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 '$DATA(IOF)
DO SETIOF
if (IOST?1"C-".E)
WRITE @IOF
+1 WRITE !?25,HD91,!?22,"Compensation and Pension Examination",!
WRITE ?33,"# 1215 Worksheet"
SET HD7="DISEASES/INJURIES OF THE SPINAL CORD"
SET HD8="For "_HD7
WRITE !?(40-($LENGTH(HD9)\2)),HD9,!?(40-($LENGTH(HD8)\2)),HD8,!!
+2 WRITE !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
+3 WRITE !!!!,"Narrative: None",!!
+4 WRITE !!
IF '$DATA(CMBN)
WRITE "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:"
DO HD2
+5 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):",!!!
+6 WRITE ?5,"1. State whether a tumor is present. If so, note type and whether",!?9,"malignant -",!!!!!!!!
+7 WRITE ?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 -",!!!!!!!!
+8 WRITE ?5,"3. Identify the level of the lesion -",!!!!!!!!
+9 if $DATA(CMBN)
DO HD2
WRITE ?5,"4. State if the impairment is total or partial -",!!!!!!!!
+10 WRITE ?5,"5. State if the veteran is incontinent of bladder and/or bowels -",!!!!!!!!
if '$DATA(CMBN)
DO HD2
WRITE ?5,"6. If the lesion is partial, describe the impairment of function at",!?9,"the level of each affected radicular group -",!!!!!!!!!
+11 ;D:$D(CMBN) HD2
WRITE $SELECT($DATA(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!
if $DATA(CMBN)
WRITE !!!!!
if '$DATA(CMBN)
WRITE !!!!!!!!!!
+12 WRITE $SELECT($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
