| 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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