| 1 | DVBCHPCK ;ALB/GTS-557/THM-HIP EXAM ; 5/19/91 1:02 PM
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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",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
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| 5 | EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
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| 6 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1425 Worksheet" S HD7="HIP",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
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| 7 | W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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| 8 | W !!!!,"Narrative:"
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| 9 | W ?13,"Loss of range of motion of the hip will be recorded from",!?13,"the anatomical position (0 degrees) varying from 125 degrees",!
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| 10 | W ?13,"in flexion to 30 degrees in extension, from 25 degrees in",!?13,"adduction to 45 degrees "
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| 11 | W "in abduction, and from 60 degrees in",!?13,"external rotation to 40 degrees in internal rotation. To gain",!?13,"a true picure of hip flexion, i.e. movement between the pelvis",!
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| 12 | W ?13,"and femur in the hip joint, the opposide thigh should be",!,?13,"extended to minimize motion between the pelvis and spine.",!!
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| 13 | I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!! W "C. Objective findings:" D HD2
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| 14 | 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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| 15 | W ?5,"1. Describe movements of the thigh as it may rotate",!?8,"in a circular manner about the femoral head in the "
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| 16 | W !?8,"acetabulum. Discuss any pain, tenderness, weakness",!?8,"and fatigue on standing and any unusual motions on ",!?8,"walking -",!!!!!!!!!!!
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| 17 | W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!! D:$Y>50 HD2 W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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| 18 | K LN,LN1,LN2
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| 19 | Q
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| 20 | ;
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| 21 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for "_NAME,!!!
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| 22 | Q
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| 23 | ;
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| 24 | SETIOF ; ** Set device control var's
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| 25 | D HOME^%ZIS
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| 26 | Q
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