1 | DVBCARC1 ;ALB ISC/THM-TEXT FOR A&A/HOUSEBOUND EXAM ; 5/17/91 9:16 AM
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2 | ;;2.7;AMIE;;Apr 10, 1995
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3 | ;
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4 | PTXT F AW=0:1 S AX=$T(@TXT+AW) S AY=$P(AX,";;",2) D:AY["|TOP|" HD2^DVBCARCK W:AY="END" !! Q:AY="END" I AY'["|TOP|" W AY,!
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5 | G:TXT="TXT3" ^DVBCARC2 Q
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6 | ;
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7 | TXT2 ;;A. Indicate whether or not the veteran REQUIRES an attendant in reporting
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8 | ;; for this exam, and if so, identify the nurse or attendant and the
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9 | ;; mode of travel employed:
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10 | ;;
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11 | ;;
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12 | ;;
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13 | ;;
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14 | ;;
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15 | ;;
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16 | ;;B. Indicate whether or not the veteran is hospitalized, and if so, state
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17 | ;; where and the date of admission:
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18 | ;;
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19 | ;;
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20 | ;;
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21 | ;;
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22 | ;;
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23 | ;;
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24 | ;;C. Indicate whether or not the veteran is blind (best corrected vision
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25 | ;; is 5/200 or worse in both eyes, or central vision field is five degrees
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26 | ;; or less) or is permanently bedridden (if either skip items "D" through
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27 | ;; "I" and go directly to "J"):
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28 | ;;END
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29 | TXT3 ;;
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30 | ;;
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31 | ;;
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32 | ;;F. Extremeties and spine:
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33 | ;;
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34 | ;; 1. Upper extremities (reporting each upper extremity separately) -
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35 | ;;
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36 | ;; a. Describe functional restrictions with reference to strength
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37 | ;;and coordination and ability for self-feeding, fastening clothing, bathing,
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38 | ;;shaving, and attending to the needs of nature -
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39 | ;;
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40 | ;;
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41 | ;;
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42 | ;;
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43 | ;;
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44 | ;;
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45 | ;;
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46 | ;; b. Indicate level of amputation or length of stump and state
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47 | ;;whether or not use of prothesis is feasible -
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48 | ;;|TOP|
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49 | ;;
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50 | ;;
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51 | ;; 2. Lower extremities (reporting each lower extremity separately) -
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52 | ;;
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53 | ;; a. Describe functional restrictions with reference to extent
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54 | ;;of limitation of motion, muscle atrophy, contractures, weakness, lack
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55 | ;;of coordination, or other interference -
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56 | ;;
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57 | ;;
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58 | ;;
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59 | ;; b. Indicate any deficits of weight bearing, balance and propulsion -
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60 | ;;
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61 | ;;
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62 | ;;
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63 | ;;
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64 | ;;
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65 | ;; c. If amputated, give level or length of stump and whether use
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66 | ;;of prosthesis is feasible -
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67 | ;;
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68 | ;;
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69 | ;;
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70 | ;;
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71 | ;;
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72 | ;; 3. Spine, trunk, and neck -
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73 | ;;
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74 | ;; a. Describe any limitation of motion or deformity of lumbar,
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75 | ;;thoracic, and cervical spine -
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76 | ;;
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77 | ;;
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78 | ;;
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79 | ;;
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80 | ;;
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81 | ;; b. Note if deformity of thoracic spine interferes with breathing -
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82 | ;;
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83 | ;;
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84 | ;;
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85 | ;;
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86 | ;;
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87 | ;;
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88 | ;;G. Capacity to protect oneself from the hazards/dangers of daily environment:
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89 | ;;
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90 | ;; 1. Describe briefly any pathological processes involving other body
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91 | ;;parts and systems, including the effects of advancing age, such as dizziness,
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92 | ;;loss of memory, poor balance affecting ability to ambulate, perform self-
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93 | ;;care, or travel beyond the premises of the home or the ward or clinical
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94 | ;;area if hospitalized -
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95 | ;;|TOP|
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96 | ;; 2. Describe where the veteran goes and what he/she does during a
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97 | ;;typical day -
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98 | ;;
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99 | ;;
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100 | ;;
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101 | ;;
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102 | ;;
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103 | ;;
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104 | ;;END
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105 | ;
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106 | TXT10 ;;Once the existence of at least one permanent disability
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107 | ;; rated as being 100% disabling has been established, additional
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108 | ;; benefits are payable if the veteran is so helpless as to require
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109 | ;; the regular aid and attendance of another person in attending to
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110 | ;; the ordinary activities of daily living, or in protecting
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111 | ;; himself/herself from the ordinary hazards of his/her daily
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112 | ;; environment, or is restricted to his/her home or the immediate
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113 | ;; vicinity thereof, including the ward or immediate clinical area,
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114 | ;; if hospitalized.
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115 | ;;
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116 | ;; If a general medical examination is included as a part of this
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117 | ;; request specific findings as to the individual body systems and
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118 | ;; extremeties already noted in that examination need not be repeated.
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119 | ;; Items "G" through "L", as the examiner deems appropriate, must be
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120 | ;; completed in all cases unless the veteran is blind or permanently
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121 | ;; bedridden (see item "C").
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122 | ;;
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123 | ;;END
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