| [613] | 1 | DVBCSPCK ;ALB/GTS-557/THM-SPINAL EXAM ; 5/17/91 9:08 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
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| 6 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1450 Worksheet" S HD7="SPINE (ORTHOPEDIC)",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
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| 7 | W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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| 8 | W !!!!,"Narrative:"
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| 9 | W ?13,"Complete description of spinal orthosis, its impact on",!?13,"motion before and after application, and whether the ",!?13,"usage is constant or intermittent should be part of the",!?13,"findings.",!!?13,"To give uniformity in "
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| 10 | W "describing limitation of motion or",!?13,"ankylosis, THE USE OF A GONIOMETER IS REQUIRED. Report",!?13,"each spinal segment separately.",!!!
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| 11 | I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",! D HD2
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| 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):",!!!
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| 13 | W ?8,"1. Postural abnormalities -",!!!!!?8,"2. Fixed deformity -",!!!!!?8,"3. Musculature of back -",!!!!!
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| 14 | W ?8,"4. Range of motion:",!!?10,"a. Forward flexion -",!!!!?10,"b. Backward extension -",!!!!?10,"c. Left lateral flexion -",!!!! D:$D(CMBN) HD2
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| 15 | W ?10,"d. Right lateral flexion -",!!!!?10,"e. Rotation to left -",!!!!!?10,"f. Rotation to right -",!!!!!
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| 16 | W ?8,"5. Objective evidence of pain on motion -",!!!!! D:'$D(CMBN) HD2 W ?8,"6. Identify and describe any evidence of neurological involvement -",!!!!!
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| 17 | W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!,$S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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| 18 | K LN,LN1,LN2
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| 19 | Q
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| 20 | ;
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| 21 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7," for "_NAME,!!!
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| 22 | Q
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| 23 | SETIOF ; ** Set device control var's
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| 24 | D HOME^%ZIS
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| 25 | Q
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