source: WorldVistAEHR/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCDNCK.m@ 1259

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1DVBCDNCK ;ALB/GTS-557/THM-DENTAL EXAM ; 12/5/90 2:16 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
7 W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0205 Worksheet" S HD7="DENTAL",HD8="For "_HD7 W !?(40-($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. Disability effect on everyday activities -",!!!!!!?5,"2. Ancillary problems as a result of the dental condition -",!!!!!!
14 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!! D:$D(CMBN) HD2 W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
15 K LN,LN1,LN2
16 Q
17 ;
18HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
19 Q
20 ;
21SETIOF ; ** Set device control var's
22 D HOME^%ZIS
23 Q
24 ;
25TXT ;
26 ;;Regional Office action is required for all dental treatment
27 ;;claims based on combat wounds, service trauma, prisoner of
28 ;;war or extracted teeth under 38 CFR 17.123.
29 ;;END
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