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1DVBCCRCK ;ALB/GTS-557/THM-THE CRANIAL NERVES ; 12/27/90 1:10 PM
2 ;;2.7;AMIE;;Apr 10, 1995
3 ;
4 S PG=1,HD91="Department of Veterans Affairs"
5 S HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
6EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
7 W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1205 Worksheet" S HD7="THE CRANIAL NERVES",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
8 W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
9 W !!!!,"Narrative:"
10 S LX="TXT" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W ?13,$P(LY,";;",2),!
11 W !! I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:" D HD2
12 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):",!!!
13 W ?5,"1. Identify the nerve and the side -",!!!!!!?5,"2. Identify the disorder (paralysis, neuritis, neuralgia) -",!!!!!!
14 W ?5,"3. Describe in detail, quantifying as much as possible, the",!?9,"motor and sensory impairment. Note if the entire nerve is",!?9,"affected or only that part of the distribution distal to a",!?9,"particular localized lesion -",!!!!!!
15 D HD2 ;W ?5,"4. Is tinnitus present? If so is it constant or intermittent? -",!!!!!! D HD2
16 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!,$S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
17 K LN,LN1,LN2
18 Q
19 ;
20HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
21 Q
22 ;
23SETIOF ; ** Set device control var's
24 D HOME^%ZIS
25 Q
26 ;
27TXT ;
28 ;;The first through fourth, sixth and eighth cranial nerves are
29 ;;covered under the instructions for examination of the Organs
30 ;;of Special Sense. This exam is limited to the examination of
31 ;;the fifth, seventh, and ninth through twelfth cranial nerves.
32 ;;END
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