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

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1DVBCMOCK ;ALB/GTS-557/THM-MENTAL, NOT ELSEWHERE CLASSIFIED ; 5/10/90 9:17 AM
2 ;;2.7;AMIE;;Apr 10, 1995
3EN S DVBAX="For MENTAL, NOT ELSEWHERE CLASSIFIED"
4 S PG=1 D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
5 W !?22,"Compensation and Pension Examination",!?33,"# 0905 Worksheet",!,?(IOM-$L(DVBAX)\2),DVBAX,!!
6 W "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: MENTAL, NOT ELSEWHERE CLASSIFIED",!!
7 W "Physician's Guide Reference: None",!!,"Narrative:",!!
8 F I=0:1 S LY=$T(TXT+I) Q:LY["END" W $P(LY,";;",2),! I $Y>55 D HD2
9 K I,LY,DVBAX Q
10 ;
11TXT ;;This exam is to handle the balance of currently recognized mental disorders
12 ;;and to allow for new disorders not yet classified for V.A. compensation
13 ;;evaluations. The severity of a condition is based upon the residual
14 ;;disability. If there is a disease process that affects multiple systems or
15 ;;extremeties, please evaluate each separately.
16 ;;
17 ;;
18 ;;A. Medical history (W/P):
19 ;;
20 ;;
21 ;;
22 ;;
23 ;;
24 ;;
25 ;;
26 ;;
27 ;;
28 ;;
29 ;;B. Subjective findings (W/P):
30 ;;
31 ;;
32 ;;
33 ;;
34 ;;
35 ;;
36 ;;
37 ;;
38 ;;
39 ;;C. Objective findings (W/P):
40 ;;
41 ;;
42 ;;
43 ;;
44 ;;
45 ;;
46 ;;
47 ;;
48 ;;
49 ;;
50 ;;
51 ;;
52 ;;
53 ;;
54 ;;
55 ;;D. Evaluation information for the rating board:
56 ;;
57 ;;
58 ;;
59 ;; 1) State how the residual disability affects the earning capacity of the
60 ;; Veteran in job performance.
61 ;;
62 ;;
63 ;;
64 ;;
65 ;;
66 ;;
67 ;;
68 ;; 2) State how the residual disability affects normal everyday activities.
69 ;;
70 ;;
71 ;;
72 ;;
73 ;;
74 ;;
75 ;;
76 ;; 3) State if the disability has constant activity or give any periods
77 ;; of remission during the year.
78 ;;
79 ;;
80 ;;
81 ;;
82 ;;
83 ;;
84 ;;
85 ;; 4) If there are acute exacerbations, state the effect on everyday
86 ;; life.
87 ;;
88 ;;
89 ;;
90 ;;
91 ;;
92 ;;
93 ;;
94 ;;
95 ;;
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97 ;;
98 ;;
99 ;;
100 ;;
101 ;;E. Diagnosis (W/P):
102 ;;
103 ;;
104 ;;
105 ;;
106 ;;
107 ;;
108 ;;
109 ;;
110 ;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
111 ;;
112 ;;
113 ;;
114 ;;
115 ;;
116 ;;
117 ;;
118 ;;
119 ;;
120 ;;
121 ;;
122 ;;
123 ;; Signature: ______________________________
124 ;;
125 ;; Date: _________________________
126 ;;END
127 Q
128 ;
129HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
130 W "For MENTAL, NOT ELSEWHERE CLASSIFIED",!!!
131 Q
132 ;
133SETIOF ; ** Set device control var's
134 D HOME^%ZIS
135 Q
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