source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCPWC3.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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1DVBCPWC3 ;ALB ISC/THM-POW PROTOCOL SOCIAL WORK SURVEY ; 5/5/91 1:40 PM
2 ;;2.7;AMIE;;Apr 10, 1995
3 ;
4 S PG=1,HD91="Department of Veterans Affairs",HD9="Full Exam Worksheet"
5EN W @IOF,!?25,HD91,!?22,"Compensation and Pension Examination",! S HD7="SOCIAL WORK SURVEY - POW PROTOCOL",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!!
6 W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
7 W !!,"Physician's Guide Reference: Chapter 17",!!
8 W !!,"A. Describe the veteran's personal appearance -",!!!!!!!!!!
9 W "B. Describe the veteran's personal health -",!!!!!!!!!!,"C. Describe the veteran's family adjustment -",! D HD2
10 W "D. Describe the veteran's community adjustment -",!!!!!!!!!!,"E. Describe the veteran's economic adjustment -",!!!!!!!!!!
11 W "E. Evaluation:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
12 K LN,LN1,LN2
13 Q
14 ;
15HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
16 Q
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