| 1 | DVBCNSCK ;ALB/GTS-557/THM-NOSE AND SINUS ; 7/1/91  10:14 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",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet" | 
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| 5 | EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF | 
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| 6 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1315 Worksheet" S HD7="NOSE AND SINUS",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!! | 
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| 7 | W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7 | 
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| 8 | W !!!!,"Narrative:",?13,"Report both functional and cosmetic impairment.",!! | 
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| 9 | I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",! D HD2 | 
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| 10 | 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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| 11 | W ?8,"1. External nose -",!!!!!?8,"2. Nasal vestibule -",!!!!!?8,"3. Right and left nasal cavities -",!!!!! | 
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| 12 | W ?11,"a. Septum -",!!!?10," b. Floor of the nose -",!!!!?9,"  c. Inferior meatus -",!!!! | 
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| 13 | W ?10," d. Inferior turbinates -",!!!!?10," e. The middle meati -",!!!!?10," f. The middle turbinate -",!!!! D HD2 W ?10," g. The spheno-ethmoidal recess -",!!!!?10," h. The olfactory area -",!!!!?10," i. The superior turbinates -",!!!!!! | 
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| 14 | W ?8,"4. The paranasal sinuses- ",!!!!!! | 
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| 15 | 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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| 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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