| [613] | 1 | DVBCVSCK ;ALB/GTS-557/THM-VISUAL EXAM ; 6/27/91 2:11 PM
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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:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
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| 6 | W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1330 Worksheet" S HD7="VISUAL",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
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| 7 | W "Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
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| 8 | W !!!!,"Narrative: "
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| 9 | S LX="TXT" F I=1:1 S LY=$T(@LX+I) Q:LY["END" W $P(LY,";;",2),!
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| 10 | W !!,"A. Medical history:",!!!!!!!!!
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| 11 | W !!,"B. Visual Acuity:",!!?44,"Near",?55,"Far",!?43,"______",?54,"______",!
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| 12 | W ?13,"Right Eye",?28,"Uncorrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!?43,"______",?54,"______",!?30,"Corrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!!
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| 13 | W ?44,"Near",?55,"Far",!?43,"______",?54,"______",!?13," Left Eye",?28,"Uncorrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!?43,"______",?54,"______",!?30,"Corrected",?42,"|______",?49,"|",?53,"|______",?60,"|",!!!
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| 14 | D HD2 S LX="TXT" D ^DVBCVSC1 W !!!!!
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| 15 | W "F. Diagnostic/clinical test results (other than visual acuity,visual fields",!,?4,"or diplopia):",!!!!!!!!!!,"G. Diagnosis:",!!!!!!!!!!
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| 16 | W ?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
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| 17 | ;S LN22="Attachment - Visual Exam" W @IOF,!!?(80-$L(LN22)\2),LN22,!!! D ^DVBCVSC2 W !
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| 18 | K LN,LN1,LN22
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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 Examination",!,HD8," for ",NAME,!!!
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| 22 | Q
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| 23 | ;
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| 24 | TXT ;
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| 25 | ;;For visual acuity worse than 5/200 in either or both eyes, report
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| 26 | ;; the distance in feet/inches (or meters/centimeters) from the face
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| 27 | ;; at which the veteran can count fingers/detect hand motion/read the
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| 28 | ;; largest line on the chart. If the veteran cannot detect hand motion
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| 29 | ;; or count fingers at any distance, state whether he/she has light
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| 30 | ;; perception.
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| 31 | ;;END
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| 32 | SETIOF ; ** Set device control var's
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| 33 | D HOME^%ZIS
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| 34 | Q
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