| 1 | DVBCARCK ;ALB/GTS-557/THM-REGULAR A&A/HOUSEBOUND EXAM ; 1/3/91 8:25 AM
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| 2 | ;;2.7;AMIE;;Apr 10, 1995
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| 3 | ;
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| 4 | K LINE S PG=1,HD91="Department of Veterans Affairs",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet",$P(LINE,"-",75)="-"
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| 5 | EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
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| 6 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1715 Worksheet" S HD7="REGULAR AID AND ATTENDANCE/HOUSEBOUND STATUS",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: ___________________"
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| 8 | W !!,"Type of Exam: ",HD7,!!!!,"Narrative: "
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| 9 | S TXT="TXT10" D PTXT S TXT="TXT2" D PTXT W !!!
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| 10 | D HD2 W "D. Present complaints (symptoms only, NOT diagnosis):",!!!!!!!!!!!!,"E. Examination data:",!!!!,"Height:",?25,"Weight:",?45,"Max wgt past year:",!!!
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| 11 | W "Build and state of nutrition:",!!!,"Posture:",?23,"Gait:",!!!,"General appearance:",!!!
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| 12 | W "Pulse:",?20,"Blood pressure:",?51,"Respiration:",!
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| 13 | S TXT="TXT3" D PTXT,HD2 W !!!,"K. Diagnosis:",!!!!!!!!!!!
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| 14 | W "L. Additional remarks as examiner deems necessary in individual case:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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| 15 | K LN,LN1,LN2,LINE
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| 16 | Q
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| 17 | ;
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| 18 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam "_HD8,!,"for ",NAME,!!!
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| 19 | Q
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| 20 | ;
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| 21 | PTXT D PTXT^DVBCARC1
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| 22 | Q
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| 23 | ;
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| 24 | SETIOF ; ** Set device control var's
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| 25 | D HOME^%ZIS
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| 26 | Q
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