source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCPRCK.m@ 1712

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1DVBCPRCK ;ALB/GTS-557/THM-THE PERIPHERAL NERVES EXAM ; 12/27/90 1:32 PM
2 ;;2.7;AMIE;;Apr 10, 1995
3 ;
4 S PG=1,HD91="Department of Veterans Affairs",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
5EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
6 W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1230 Worksheet" S HD7="THE PERIPHERAL NERVES",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
7 W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
8 W !!!!,"Narrative: None",!!
9 W !! I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:" D HD2
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):",!!!
11 S LX="TXT1" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W $P(LY,";;",2),!
12 D:$D(CMBN) HD2 S LX="TXT2" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W $P(LY,";;",2),!
13 D:'$D(CMBN) HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!
14 W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
15 K LN,LN1,LN2
16 Q
17 ;
18HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
19 Q
20 ;
21SETIOF ; ** Set device control var's
22 D HOME^%ZIS
23 Q
24 ;
25TXT1 ;
26 ;; 1. Where disability is the result of brain disease or injury, spinal cord
27 ;; disease or injury, cervical disc disease, or trauma to the nerve roots
28 ;; themselves, report sensory and motor impairment by reference to the
29 ;; distribution of the affected groups as paralysis, neuritis or
30 ;; neuralgia. Report each affected extremity separately -
31 ;;
32 ;;
33 ;; a. In the upper extremities -
34 ;;
35 ;;
36 ;;
37 ;;
38 ;;
39 ;;
40 ;;
41 ;; b. In the lower extremities -
42 ;;
43 ;;
44 ;;
45 ;;
46 ;;
47 ;;
48 ;;
49 ;;
50 ;;END
51TXT2 ;
52 ;; 2. Where disability is NOT from the above, identify the specific major
53 ;; nerve involved, localize the lesion and describe specific impairment
54 ;; of motor and sensory function, fine motor control, etc.. Again
55 ;; characterization as paralysis, neuritis or neuralgia is necessary
56 ;; Indicate whether any muscle wasting or atrophy represents direct
57 ;; effect of nerve damage or merely disuse. Report each affected
58 ;; extremity separately -
59 ;;
60 ;;
61 ;; a. In the upper extremities -
62 ;;
63 ;;
64 ;;
65 ;;
66 ;;
67 ;;
68 ;;
69 ;;
70 ;; b. In the lower extremities -
71 ;;
72 ;;
73 ;;
74 ;;
75 ;;
76 ;;
77 ;;
78 ;;
79 ;;END
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