| 1 | DVBCJNCK ;ALB/GTS-557/THM-JOINT EXAM ; 5/17/91 8:47 AM
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| 2 | ;;2.7;AMIE;;Apr 10, 1995
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| 3 | ;
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| 4 | S PG=1,HD91="Department of Veterans Affairs",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
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| 5 | EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
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| 6 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1430 Worksheet" S HD7="JOINTS (ORTHOPEDIC)",HD8="FOR "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
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| 7 | W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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| 8 | W !!!!,"Narrative:"
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| 9 | W ?13,"Do not use negative values to indicate inability to achieve",!?13,"full extension. The anatomical position is the reference",!?13,"position EXCEPT with the regard to rotation of the shoulder",!?13,"and pronation/supination "
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| 10 | W "of the forearm (see fig. 2.1 and 2.2",!?13,"of the Physician's Guide). To give uniformity in describing",!?13,"limitation of motion or ankylosis of a joint, THE USE OF A",!?13,"GONIOMETER IS REQUIRED.",!!!
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| 11 | I '$D(CMBN) W "A. Medical history:",!!!!!!!!!! W "B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",! D HD2
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| 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):",!!!
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| 13 | W ?8,"1. Swelling -",!!!!!?8,"2. Deformity -",!!!!!
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| 14 | W ?8,"3. Other impairment of knee: subluxation or lateral instability;",!?11,"non-union, with loose motion; malunion -",!!!!!
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| 15 | D:$D(CMBN) HD2 W ?8,"4. Range of motion (complete chart below)-",!!?11,"Note: Enter joint names in blanks under numbers below. If more",!
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| 16 | W ?11,"than four joints are involved, please extend your dictation in the",!?11,"same format.",!!
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| 17 | S LN="|============|============|============|============|",LN1="| | | | |",LN2="|------------|------------|------------|------------|"
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| 18 | W ?19,"------------------ JOINT EXAMINED -------------------",!!?25,"1",?32,"|",?38,"2",?45,"|",?51,"3",?58,"|",?65,"4",?71,"|",!?19,LN,!,"Range of:",?19,LN1,!,"----- --",?19,LN,!
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| 19 | F JX="Flexion","Extension","Rotation","Abduction","Adduction","Pronation","Supination","Deviation (radial)","Deviation (ulnar)","Plantar Flexion","Dorsiflexion" W JX,?19,LN1,!?19,LN2,!
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| 20 | D HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!
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| 21 | W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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| 22 | K LN,LN1,LN2
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| 23 | Q
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| 24 | ;
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| 25 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for JOINTS for "_NAME,!!!
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| 26 | Q
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| 27 | ;
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| 28 | SETIOF ; ** Set device control var's
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| 29 | D HOME^%ZIS
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| 30 | Q
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