| [613] | 1 | DVBCTTCK ;ALB/GTS-557/THM-TESTES, TRAUMA, OR DISEASE ; 12/7/90 8:41 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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
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| 6 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0625 Worksheet" S HD7="TESTIS, TRAUMA, OR DISEASE (GU)",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
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| 7 | W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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| 8 | W !!!!,"Narrative:"
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| 9 | W ?13,"Loss of use of a testis when based upon its small size or soft",!?13,"consistency must be described by a board of at least three",!?13,"physicians including at least one urologist. The board of",!
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| 10 | W ?13,"physicians should review the physician's guide for special",!?13,"instructions.",!!
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| 11 | I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!
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| 12 | D:'$D(CMBN) HD2 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. Atrophy or absence of one or both testis -",!!!!!?8,"2. Measurements -",!!!!!?8,"3. Consistency -",!!!!!
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| 14 | W ?8,"4. Comparison -",!!!!!,$S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!!
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| 15 | I $Y>50 D HD2
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| 16 | W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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| 17 | K LN,LN1,LN2
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| 18 | Q
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| 19 | ;
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| 20 | HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!,HD8,!!!
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| 21 | Q
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| 22 | SETIOF ; ** Set device control var's
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| 23 | D HOME^%ZIS
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| 24 | Q
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