| 1 | DVBCPWC2 ;ALB ISC/THM-POW PROTOCOL MENTAL DISORDER EXAM ; 5/6/91 9:40 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="Full Exam Worksheet"
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| 5 | EN W @IOF,!?25,HD91,!?22,"Compensation and Pension Examination",! S HD7="MENTAL DISORDERS - POW PROTOCOL",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!!
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| 6 | W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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| 7 | W !!,"Physician's Guide Reference: Chapter 14, 17, 20",!!,"Narrative: "
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| 8 | W !!,"A. Medical and occupational history:",!!
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| 9 | W ?8,"1. Immediate pre-military events -",!!!!!!!!!?8,"2. Events as a POW -",!!!!!!!!!?8,"3. Post-active service events (to present) -",!!!!!!!!!
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| 10 | W ?8,"4. Employment history prior to and following",!?11,"active service -" D HD2
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| 11 | W "B. Subjective complaints (include the veteran's history of unusually ",!?27,"traumatic events as a POW, if not elsewhere",!?27,"indicated) -",!!!!!!!!!!!!!!! W "C. Objective findings:",! D HD2
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| 12 | W "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 | S LX="TXT1" F I=1:1 S LY=$T(@LX+I) Q:LY["$END" W $P(LY,";;",2),!
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| 14 | W !!!!!!!!!!!!,"E. Diagnosis:",!!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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| 15 | K LN,LN1,LN2
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| 16 | G ^DVBCPWC3
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| 17 | ;
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| 18 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
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| 19 | Q
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| 20 | TXT1 ;
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| 21 | ;; 1. State if the veteran is capable of managing his/her benefit
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| 22 | ;; payments in the individual's own best interests without restriction
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| 23 | ;; (a physical disability which prevents the veteran from attending
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| 24 | ;; to financial matters in person is not a proper basis for a finding
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| 25 | ;; of incompetency unless the veteran is, by reason of that disability,
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| 26 | ;; incapable of directing someone else in handling the individual's
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| 27 | ;; his financial affairs) -
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| 28 | ;;$END
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