source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCDNCK.m@ 1354

DVBCDNCK ;ALB/GTS-557/THM-DENTAL EXAM ; 12/5/90  2:16 PM
 ;;2.7;AMIE;;Apr 10, 1995
 ;
 S PG=1,HD91="Department of Veterans Affairs"
 S HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
 W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0205 Worksheet" S HD7="DENTAL",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
 W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
 W !!!!,"Narrative:"
 S LX="TXT" F I=1:1 S LY=$T(@LX+I) Q:LY["END"  W ?13,$P(LY,";;",2),!
 W !! I '$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.  Disability effect on everyday activities -",!!!!!!?5,"2.  Ancillary problems as a result of the dental condition -",!!!!!!
 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: _________________________",!
 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
 ;
TXT ;
 ;;Regional Office action is required for all dental treatment
 ;;claims based on combat wounds, service trauma, prisoner of
 ;;war or extracted teeth under 38 CFR 17.123.
 ;;END