| 1 | DVBCDICK ;ALB/GTS-557/THM-DIABETES INSIPIDUS ; 12/6/90  11:48 AM | 
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| 2 | ;;2.7;AMIE;;Apr 10, 1995 | 
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| 3 | ; | 
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| 4 | S PG=1,HD91="Department of Veterans Affairs" | 
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| 5 | S HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet" | 
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| 6 | EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF | 
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| 7 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0405 Worksheet" S HD7="DIABETES INSIPIDUS",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!! | 
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| 8 | W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7 | 
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| 9 | W !!!!,"Narrative:" | 
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| 10 | S LX="TXT" F I=1:1 S LY=$T(@LX+I) Q:LY["END"  W ?13,$P(LY,";;",2),! | 
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| 11 | W !! I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:" D HD2 | 
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| 12 | 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):",!!! | 
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| 13 | W ?5,"1.  Frequency of urination -",!!!!!!?5,"2.  Frequency of excessive thirst -",!!!!!!?5,"3.  Frequency of syncope -",!!!!!!?5,"4.  Blood pressure readings -",!!!!!!?5,"5.  Serum osmolality (m Osm/Kg) -",!!!!!! | 
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| 14 | W ?5,"6.  Urine osmolality (m Osm/Kg) -",!!!!!! D:$D(CMBN) HD2 | 
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| 15 | W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!! D:'$D(CMBN) HD2 W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",! | 
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| 16 | K LN,LN1,LN2 | 
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| 17 | Q | 
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| 18 | ; | 
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| 19 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!! | 
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| 20 | Q | 
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| 21 | ; | 
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| 22 | SETIOF ;  ** Set device control var's | 
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| 23 | D HOME^%ZIS | 
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| 24 | Q | 
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| 25 | ; | 
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| 26 | TXT ; | 
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| 27 | ;;When symptoms interfere with normal daily activities or job | 
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| 28 | ;;efficiency, it is essential that the extent of such handicaps | 
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| 29 | ;;be described. | 
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| 30 | ;;END | 
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