| [613] | 1 | DVBCSKCK ;ALB/GTS-557/THM-SKIN, OTHER THAN SCARS ; 12/11/90 7:31 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
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| 6 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1610 Worksheet" S HD7="SKIN, OTHER THAN SCARS",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
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| 7 | W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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| 8 | W !!!!,"Narrative:"
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| 9 | W ?13,"When furnishing the history of the present skin disease",!?13,"include a description of the skin changes, when the disorder",!?13,"first appeared, and the progression of the illness since that",!?13,"time. Note whether"
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| 10 | W " remissions or exacerbations occurred",!?13,"and whether they were related to the occupation or treatment.",!?13,"Include the duration of remissions and factors that",!?13,"may have influenced the course of the disorder.",!!!
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| 11 | I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints: "
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| 12 | I '$D(CMBN) W ?24,"(List the types of complaints such as itching",!,"burning, pain and anesthesia. Note whether environmental factors such as",!,"temperature or seasonal change affect the severity of the symptoms.)",! D HD2
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| 13 | I '$D(CMBN) W "C. Objective findings:",!!!!!!!!!!!!!
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| 14 | 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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| 15 | W ?8,"1. Description of skin disorder -",!!!!!?8,"2. Distribution of skin disorder -",!!!!!?8,"3. Configuration and characteristics of lesions -",!!!!!!?8,"4. Nervous manifestations -",!!
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| 16 | W !!!?8,"5. Attach color photograph if condition is disfiguring.",!
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| 17 | D HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!!!!!!!,$S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!
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| 18 | W "(Note: If current diagnosis differs from the skin condition",!,"for which the examination was ordered, then review prior records and",!,"express opinion whether current disease is a new problem or original ",!,"diagnosis was in error.)"
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| 19 | W !!!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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| 20 | K LN,LN1,LN2
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| 21 | Q
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| 22 | ;
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| 23 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",!,NAME,!!!
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| 24 | Q
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| 25 | SETIOF ; ** Set device control var's
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| 26 | D HOME^%ZIS
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| 27 | Q
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