source: WorldVistAEHR/trunk/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCSECK.m@ 1211

Last change on this file since 1211 was 613, checked in by George Lilly, 15 years ago

initial load of WorldVistAEHR

File size: 2.1 KB
Line 
1DVBCSECK ;ALB ISC/THM-SKIN, NOT ELSEWHERE CLASSIFIED ; 6/6/90 8:18 AM
2 ;;2.7;AMIE;;Apr 10, 1995
3EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
4 S DVBAX="For SKIN, NOT ELSEWHERE CLASSIFIED"
5 S PG=1
6 W !?22,"Compensation and Pension Examination",!?33,"# 1610 Worksheet",!,?(IOM-$L(DVBAX)\2),DVBAX,!!
7 W "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: SKIN, NOT ELSEWHERE CLASSIFIED",!!
8 W "Physician's Guide Reference: None",!!,"Narrative:",!!
9 F I=0:1 S LY=$T(TXT+I) D:LY["TOF" HD2 Q:LY["END" W:LY'["TOF" $P(LY,";;",2),! I $Y>55 D HD2
10 K I,LY,DVBAX Q
11 ;
12TXT ;;This exam is to handle the balance of currently recognized skin
13 ;;disorders and to allow for new disorders not yet classified for V.A.
14 ;;compensation evaluations. The severity of a condition is based upon the
15 ;;residual disability. If there is a disease process that affects multiple
16 ;;systems or extremeties, please evaluate each separately.
17 ;;
18 ;;
19 ;;A. Medical history (W/P):
20 ;;
21 ;;
22 ;;
23 ;;
24 ;;
25 ;;
26 ;;
27 ;;
28 ;;
29 ;;
30 ;;B. Subjective findings (W/P):
31 ;;
32 ;;
33 ;;
34 ;;
35 ;;
36 ;;
37 ;;
38 ;;
39 ;;
40 ;;
41 ;;C. Objective findings (W/P):
42 ;;TOF
43 ;;
44 ;;
45 ;;D. Evaluation Information for the Rating Board:
46 ;;
47 ;;
48 ;; Residual disability effect on:
49 ;;
50 ;;
51 ;; 1) earning capacity/job performance (F/T):
52 ;;
53 ;;
54 ;;
55 ;;
56 ;;
57 ;;
58 ;; 2) everyday activities (F/T):
59 ;;
60 ;;
61 ;;
62 ;;
63 ;;
64 ;;
65 ;;
66 ;; 3) Is disability constant? (YES/NO):
67 ;;
68 ;;
69 ;;
70 ;;
71 ;;
72 ;;
73 ;;
74 ;; 4) If NO, give frequency, length of remissions (F/T):
75 ;;
76 ;;
77 ;;
78 ;;
79 ;;
80 ;;
81 ;; 5) Acute exacerbations effect on everyday life. (F/T)
82 ;;TOF
83 ;;
84 ;;
85 ;;E. Diagnosis (W/P):
86 ;;
87 ;;
88 ;;
89 ;;
90 ;;
91 ;;
92 ;;
93 ;;
94 ;;
95 ;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
96 ;;
97 ;;
98 ;;
99 ;;
100 ;;
101 ;;
102 ;;
103 ;;
104 ;;
105 ;; Signature: ______________________________
106 ;;
107 ;; Date: _________________________
108 ;;END
109 Q
110 ;
111HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
112 W "For SKIN, NOT ELSEWHERE CLASSIFIED",!!!
113 Q
114SETIOF ; ** Set device control var's
115 D HOME^%ZIS
116 Q
Note: See TracBrowser for help on using the repository browser.