source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCGECK.m@ 1757

Last change on this file since 1757 was 628, checked in by George Lilly, 15 years ago

initial load of FOIAVistA 6/30/08 version

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1DVBCGECK ;ALB/GTS-557/THM-GENITOURINARY, NOT ELSEWHERE CLASSIFIED ; 6/6/90 8:18 AM
2 ;;2.7;AMIE;;Apr 10, 1995
3EN S DVBAX="For GENITOURINARY, NOT ELSEWHERE CLASSIFIED"
4 S PG=1 D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
5 W !?22,"Compensation and Pension Examination",!?33,"# 0610 Worksheet",!,?(IOM-$L(DVBAX)\2),DVBAX,!!
6 W "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: GENITOURINARY, NOT ELSEWHERE CLASSIFIED",!!
7 W "Physician's Guide Reference: None",!!,"Narrative:",!!
8 F I=0:1 S LY=$T(TXT+I) D:LY["TOF" HD2 Q:LY["END" W:LY'["TOF" $P(LY,";;",2),! I $Y>55 D HD2
9 K I,LY,DVBAX Q
10 ;
11TXT ;;This exam is to handle the balance of currently recognized genitourinary
12 ;;disorders and to allow for new disorders not yet classified for V.A.
13 ;;compensation evaluations. The severity of a condition is based upon the
14 ;;residual disability. If there is a disease process that affects multiple
15 ;;systems or extremeties, please evaluate each separately.
16 ;;
17 ;;
18 ;;A. Medical history (W/P):
19 ;;
20 ;;
21 ;;
22 ;;
23 ;;
24 ;;
25 ;;
26 ;;
27 ;;
28 ;;
29 ;;B. Subjective findings (W/P):
30 ;;
31 ;;
32 ;;
33 ;;
34 ;;
35 ;;
36 ;;
37 ;;
38 ;;
39 ;;
40 ;;C. Objective findings (W/P):
41 ;;TOF
42 ;;
43 ;;
44 ;;D. Evaluation Information for the Rating Board:
45 ;;
46 ;;
47 ;; Residual disability effect on:
48 ;;
49 ;;
50 ;; 1) earning capacity/job performance (F/T):
51 ;;
52 ;;
53 ;;
54 ;;
55 ;;
56 ;;
57 ;; 2) everyday activities (F/T):
58 ;;
59 ;;
60 ;;
61 ;;
62 ;;
63 ;;
64 ;;
65 ;; 3) Is disability constant? (YES/NO):
66 ;;
67 ;;
68 ;;
69 ;;
70 ;;
71 ;;
72 ;;
73 ;; 4) If NO, give frequency, length of remissions (F/T):
74 ;;
75 ;;
76 ;;
77 ;;
78 ;;
79 ;;
80 ;; 5) Acute exacerbations effect on everyday life. (F/T)
81 ;;TOF
82 ;;
83 ;;
84 ;;E. Diagnosis (W/P):
85 ;;
86 ;;
87 ;;
88 ;;
89 ;;
90 ;;
91 ;;
92 ;;
93 ;;
94 ;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
95 ;;
96 ;;
97 ;;
98 ;;
99 ;;
100 ;;
101 ;;
102 ;;
103 ;;
104 ;; Signature: ______________________________
105 ;;
106 ;; Date: _________________________
107 ;;END
108 Q
109 ;
110HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
111 W "For GENITOURINARY, NOT ELSEWHERE CLASSIFIED",!!!
112 Q
113 ;
114SETIOF ; ** Set device control var's
115 D HOME^%ZIS
116 Q
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