source: FOIAVistA/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCST1.m@ 677

DVBCST1 ;ALB/JEH SOCIAL AND INDUSTRIAL SURVEY WKS TEXT - 1 ; 24 MAY 2004
 ;;2.7;AMIE;**70**;Apr 10, 1995
 ;
 ;
TXT ;
 ;;A. Demographic & Information and Sources  
 ;;   -------------------------------------
 ;;
 ;;     1. Note the location of the interview/exam. 
 ;;
 ;;     2. List demographic data, including age, gender, marital status, and other
 ;;        relevant data.
 ;;
 ;;     3. List service connected disabilities.
 ;;
 ;;     4. Discuss capacity to manage financial affairs (if an issue). 
 ;;
 ;;     5. Verify accuracy of veteran's name, address, phone number. 
 ;;
 ;;     6. List informants or sources of information, such as claims folder,
 ;;        medical record, veteran, family members, employers, neighbors, friends,
 ;;        physician, or other persons. 
 ;;
 ;;     7. If S&I Survey is done in the community, list the collaterals residing in
 ;;        the home, their ages and relationship to the veteran, a brief 
 ;;        description at the household appearance and overall home environment.
 ;;
 ;;
 ;;B. Appearance & Response to Interview  
 ;;   ----------------------------------
 ;;
 ;;     1. Appearance - Describe the veteran's size, build, general physical 
 ;;        appearance and dress, noting any distinguishing features or
 ;;        characteristics.
 ;;
 ;;     2. Indicate if s/he was alone or interviewed with others.  
 ;;
 ;;     3. Make personal observations as to attitude, openness to interview,
 ;;        reality testing, physical or mental difficulties in communicating.  Does
 ;;        s/he find the interview stressful or threatening?  Is s/he cooperative
 ;;        and friendly or guarded and withdrawn?  Observe eye contact, facial
 ;;        expressions, and attention span during interview.
 ;;
 ;;
 ;;C. Disabilities
 ;;   ------------
 ;;
 ;;     1. Include disabilities listed on Form 2507 for which the exam is
 ;;        requested and any other complaints or conditions expressed by the
 ;;        veteran.
 ;;
 ;;     2. List of current medications.
 ;;
 ;;
 ;;D. Brief Pre-Military Social History
 ;;   ---------------------------------
 ;;
 ;;     Include where the veteran was born, his/her family configuration,
 ;;     education, etc.
 ;;
 ;;
 ;;E. Military History  
 ;;   ----------------
 ;;
 ;;     1. Date the veteran entered military service and branch of service. 
 ;;
 ;;     2. Where s/he completed basic training.
 ;;
 ;;     3. Military occupation(s).
 ;;
 ;;     4. Primary assignments and where stationed.
 ;;
 ;;     5. Any special training received in military.
 ;;
 ;;     6. Combat experiences.
 ;;
 ;;     7. Sexual trauma while in military.
 ;;
 ;;     8. Injuries or illness incurred while in military.
 ;;
 ;;     9. If claim is for PTSD, include a detailed account of the traumatic
 ;;        experience(s).
 ;;
 ;;    10. Relationships with peers, superiors, subordinates, etc.
 ;;
 ;;
 ;;F. Prisoner of War (POW) Data  (if applicable)
 ;;   --------------------------
 ;;
 ;;    1. Capture Data  
 ;;       ------------ 
 ;;
 ;;       a. Injuries/wounds incurred when captured and any treatment received. 
 ;;
 ;;       b. Captors - Date and place captured.
 ;;
 ;;       c. Internment - List names of camps where interred and dates of
 ;;          internment, psychological conditions, physical conditions, methods
 ;;          used to control prisoners.
 ;;
 ;;       d. Work - Physical & psychological conditions of work. 
 ;;
 ;;       e. Diet - Daily meals, including types of food, quantities, regularity
 ;;          of meals.
 ;;
 ;;       f. Illnesses or Injuries incurred when captured or while imprisoned
 ;;          and any treatment received.
 ;;
 ;;    2. Information from Veteran's Significant Other(s) 
 ;;       ----------------------------------------------- 
 ;;
 ;;       a. The significant other's relationship to the veteran.
 ;;
 ;;       b. Whether s/he knew veteran before or after capture.
 ;;
 ;;       c. Any changes observed.
 ;;
 ;;       d. General comments on impact of POW experience.
 ;;