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

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1DVBCPDCK ;ALB/GTS-557/THM-PULMONARY TB/OTHER MYCOBACTERIAL DISEASES ; 6/27/91 12:48 PM
2 ;;2.7;AMIE;;Apr 10, 1995
3 ;
4 S PG=1,HD91="Department of Veterans Affairs",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
5EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
6 W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1515 Worksheet" S HD7="PULMONARY TUBERCULOSIS AND MYCOBACTERIAL DISEASES",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
7 W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
8 W !!!!,"Narrative:"
9 W ?13,"Is pulmonary tuberculosis or other mycobacterial disease",!?13,"active? If so, identify the organism. In reactivated",!?13,"cases, it is necessary to know whether this is reactivation",!
10 W ?13,"of the old disease or a separate and distinct new infection.",!!!
11 I '$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 ?4,"1. IN ALL CASES:",!!?8,"a. Date of inactivity -",!!!!!?8,"b. Extent of structural damage to lungs -",!!!!!!?8,"c. Provide pulmonary function studies -",!!!!!?4,"2. In PENSION CASES ONLY:",!!!
14 W ?8,"a. Disease condition after six months of treatment -",!!!!!?8,"b. Disease condition after twelve months of treatment -",!!!!!
15 D:$D(CMBN) HD2 W " Additional note to the physician:",!!!,"In all claims, if the disease is inactive and if the inactivity was confirmed",!
16 W "at a non-VA facility, obtain the name and mailing address of the facility",!,"from the veteran so that the "
17 W "Regional Office may request the report.",!
18 D:'$D(CMBN) HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!! W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
19 K LN,LN1,LN2
20 Q
21 ;
22HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",!,HD7,!!,"for "_NAME,!!!
23 Q
24 ;
25SETIOF ; ** Set device control var's
26 D HOME^%ZIS
27 Q
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