| [613] | 1 | DVBCDBCK ;ALB/GTS-557/THM-DISEASES/INJURIES OF THE BRAIN ; 12/28/90 9:26 AM
|
|---|
| 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"
|
|---|
| 6 | EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
|
|---|
| 7 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1210 Worksheet" S HD7="DISEASES/INJURIES OF THE BRAIN",HD8="For "_HD7 W !?(40-($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. State if a tumor is present. If so, note type and whether ",!?9,"malignant -",!!!!!!!!
|
|---|
| 14 | W ?5,"2. If a malignancy is present but is now cured or in remission,",!?9,"report the date of last surgery, radiation therapy, chemotherapy",!?9,"or other treatment -",!!!!!!!!
|
|---|
| 15 | W ?5,"3. Describe in detail the motor and sensory impairment of the affected",!?9,"cranial nerves -",!!!!!!!!
|
|---|
| 16 | D:$D(CMBN) HD2 W ?5,"4. Describe in detail any functional impairment of the peripheral",!?9,"and autonomic systems -",!!!!!!!!
|
|---|
| 17 | D:'$D(CMBN) HD2 W ?5,"5. Describe any psychiatric manifestations in detail -",!!!!!!?5,"6. "
|
|---|
| 18 | S LX="TXT1" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W:$X'=5 ?5,$P(LY,";;",2),!
|
|---|
| 19 | W !!!!!!!!!,$S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!! D:$D(CMBN) HD2
|
|---|
| 20 | W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
|
|---|
| 21 | K LN,LN1,LN2
|
|---|
| 22 | Q
|
|---|
| 23 | ;
|
|---|
| 24 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
|
|---|
| 25 | Q
|
|---|
| 26 | ;
|
|---|
| 27 | SETIOF ; ** Set device control var's
|
|---|
| 28 | D HOME^%ZIS
|
|---|
| 29 | Q
|
|---|
| 30 | ;
|
|---|
| 31 | TXT ;
|
|---|
| 32 | ;;Since disorders of the brain are likely to produce psychiatric
|
|---|
| 33 | ;;manifestations as well as neurological, special psychiatric
|
|---|
| 34 | ;;examinations will often be necessary. If special senses are
|
|---|
| 35 | ;;impaired, the examiner should order additional testing as
|
|---|
| 36 | ;;appropriate.
|
|---|
| 37 | ;;END
|
|---|
| 38 | TXT1 ;
|
|---|
| 39 | ;;State if the veteran is capable of managing his/her benefit payments
|
|---|
| 40 | ;; in the individual's own best interest without restriction (a physical
|
|---|
| 41 | ;; disability which prevents the veteran from attending to financial
|
|---|
| 42 | ;; matters in person is not a proper basis for a finding of incompetency
|
|---|
| 43 | ;; unless the veteran is, by reason of that disability, incapable of
|
|---|
| 44 | ;; directing someone else in handling the individual's financial
|
|---|
| 45 | ;; affairs) -
|
|---|
| 46 | ;;END
|
|---|
