source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCNTCK.m@ 1742

DVBCNTCK ;ALB/GTS-557/THM-NOSE AND THROAT ; 12/10/90  2:11 PM
 ;;2.7;AMIE;;Apr 10, 1995
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 S PG=1,HD91="Department of Veterans Affairs",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
 W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1510 Worksheet" S HD7="NOSE AND THROAT",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
 W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
 W !!!!,"Narrative:"
 W ?13,"Describe the location and nature of the injury or disease",!?13,"with particular attention to the interference with speech,",!?13,"sense of smell, and/or breathing space.  If all or part of the",!?13,"nose is missing provide"
 W " photographs.  Localize manifestations",!?13,"of chronic sinusitis, if present.",!!!
 I '$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 ?8,"1. Interference with breathing space -",!!!!?8,"2. Headaches, severity, and frequency -",!!!!?8,"3. Purulent discharge -",!!!!
 W ?8,"4. Frequency of allergic attacks, baseline status in between -",!
 W !!!?8,"5. Dyspnea -",!!!!!!!
 D:$D(CMBN) HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!! W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
 K LN,LN1,LN2
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HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7," for ",!,NAME,!!!
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SETIOF ;  ** Set device control var's
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