source: internationalization/trunk/TranslationSpreadsheets/WV-DIALOG-0055.txt@ 1589

Last change on this file since 1589 was 604, checked in by George Lilly, 15 years ago

Internationalization

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1English French Notes Complete/Exclude
2For CARDIOVASCULAR, NOT ELSEWHERE CLASSIFIED
3Type of Exam: CARDIOVASCULAR, NOT ELSEWHERE CLASSIFIED
4Physician's Guide Reference: None
5Request date
6Regional office number
7Requester
8Priority of exam
9Request status
10** No exams selected **
11This report will check the 2507 REQUEST file for missing crucial data.
12All requests will be checked and those found missing any of the following
13will be reported:
141) Request date
152) Regional office number
164) Priority of exam
175) Request status
186) Routing location
197) No exams selected
208) Requests older than 3 days without C&P Appt links
21Enter Y to print the report or N to quit.
222507 exam integrity report
23C & P Exam Integrity Report
24Nothing found to report
25Social Sec #
26Missing items
27Enter REASON FOR CANCELLATION:
28Cancelled by (M)AS or (R)O? M//
29Enter M to indicate cancellation by MAS or
30 R to indicate cancellation by the Regional Office.
31Cancelled by
32Unknown source
33Enter Y to verify or N to reselect
34None - (Request only)
35Unknown exam
36Cancellation error on
37Entire exam is now CANCELLED.
38Cancellation error !
39An error has occurred during cancellation - bulletin will not be sent!
40I am sending a copy of this cancellation to the
41cancellation mail group at
42since this was transferred in.
432507 Exam Veteran Selection
442507 Test Cancellation
45Select VETERAN:
46Zeroth node for ^DPT record missing!
47This request cannot be cancelled entirely because
48 one or more exams have
49been transferred.
50been completed.
51However, you may cancel other individual exams.
52Press RETURN
53Do you want to cancel the entire exam
54Enter Y to cancel the ENTIRE exam or N to cancel ONLY selected exams
55Select EXAM TO CANCEL:
56 for this
57Since all exams have been cancelled
58the entire request will be CANCELLED.
59 for this request:
60This exam or request has been
61cancelled by the RO
62cancelled by MAS
63completed, transferred out
64Please enter cancellation code
65CANCELLED BY
66NO '^' ALLOWED AT THIS PROMPT
67This is a required response.
68CANCELLED BY
69Appointment
70 was not linked to a 2507 request or was
71 manually rebooked and linked to another appointment.
72 (If the appointment was manually rebooked, you do not want to auto-rebook.)
73If the appointment was not properly linked, it will need to be linked with the
74 AMIE/C&P appointment link management option.
75Hit Return to continue.
76This C&P appointment has multiple links with the same Current Appt Date.
77Use the AMIE/C&P Appointment Link Management option to review and delete
78 any duplicate links.
79Hit any key to continue.
80AMIE C&P Appt Link update
81Initial Appt Date:
82Current Appt Date:
83has been cancelled!
84has been cancelled and rebooked for
85THE CRANIAL NERVES
861. Identify the nerve and the side -
872. Identify the disorder (paralysis, neuritis, neuralgia) -
883. Describe in detail, quantifying as much as possible, the
89motor and sensory impairment. Note if the entire nerve is
90affected or only that part of the distribution distal to a
91particular localized lesion -
924. Is tinnitus present? If so is it constant or intermittent? -
93HYPERPITUITARISM (CUSHING'S SYNDROME)
941. Muscular weakness -
952. Decalcification of bones -
964. Enlarged sella turcica, pituitary or adrenal glands -
975. Nervous, cardiovascular or gastrointestinal -
986. Disease in remission or demonstrably active -
997. Continuous medication required -
100CYSTITIS, BLADDER CALCULUS, RESIDUALS OF BLADDER INJURY,
101ALL DISORDERS OF THE PROSTATE, URETHRA AND SURGICAL RESIDUALS (GU)
102Complications and/or medical side effects should always be
103reported, even when not specifically requested.
1041. Frequency of urination -
1052. Presence or absence of pyuria -
1063. Pain or tenesmus -
1074. Incontinence requiring pads or appliance -
108DISEASES OF THE ARTERIES AND VEINS (CARDIOVASCULAR)
109Once a diagnosis is established, details about the
110permanent medical residuals and how they affect the
111veteran's industrial capabilities are very important as
112the degree of impairment is used by the rating board to
113determine the percentage of disability and payments therefore.
114A. Medical history (if a disability is already service connected, then
115provide data since last VA rating examination):
1161. Blood pressure -
1173. Skin appearance -
1184. Skin temperature (to the touch) -
1196. Cardiac involvement -
120DISEASES/INJURIES OF THE BRAIN
1211. State if a tumor is present. If so, note type and whether
1222. If a malignancy is present but is now cured or in remission,
123report the date of last surgery, radiation therapy, chemotherapy
124or other treatment -
1253. Describe in detail the motor and sensory impairment of the affected
126cranial nerves -
1274. Describe in detail any functional impairment of the peripheral
128and autonomic systems -
1295. Describe any psychiatric manifestations in detail -
130For DIGESTIVE, NOT ELSEWHERE CLASSIFIED
131Type of Exam: DIGESTIVE, NOT ELSEWHERE CLASSIFIED
132DISEASES OF THE HEART (CARDIOVASCULAR)
133In developing the diagnosis of a cardiac condition, the
134NOMENCLATURE AND CRITERIA FOR DIAGNOSIS OF DISEASE
135OF THE HEART published by the New York Heart Association
136serves as an acceptable standard. If a stress test
137could be conducted without cardiovascular contraindications
138but physical problems preclude, please state.
1393. X-Ray results -
1404. Stress test (after EKG, if indicated) -
141DIABETES INSIPIDUS
1421. Frequency of urination -
1432. Frequency of excessive thirst -
1443. Frequency of syncope -
1454. Blood pressure readings -
1465. Serum osmolality (m Osm/Kg) -
1476. Urine osmolality (m Osm/Kg) -
148DIABETES MELLITUS
1491. Frequency of ketoacidosis or hypoglycemic reactions -
1502. Restricted diet and/or regulation of activities -
1513. Loss of weight and strength since last exam -
1524. Anal pruritis -
1535. Vascular deficiencies -
1546. Diabetic ocular disturbances -
1557. Daily insulin requirements (type and amount) -
1568. Blood sugar -
1579. Blood pressure -
1581. Disability effect on everyday activities -
1592. Ancillary problems as a result of the dental condition -
160AUDIO-EAR DISEASE
161If, in the course of audiometric testing, there is any
162indication of ear disease, the veteran should be referred to
163a physician for additional exam. Examination should include
164inspection of the auricle, the external canal, and tympanic
165membranes. Abnormalities in size, shape, or form of the
166structure should be noted.
1672. External canal -
1683. Tympanic membrane -
1694. The tympanum -
1705. The mastoid -
1715. State if an active ear disease is present -
1726. State if an infectious disease of the middle or inner
173ear is present -
1747. State whether ear disease is affecting any function other
175than hearing, such as balance, or is associated with any
176upper respiratory disease -
1772507 Exam Data Entry
178This request has not been reported to MAS and may not be transcribed.
179Select Exam:
180This exam is currently being edited. <RETURN> to continue.
181These exam results have been electronically signed.
182No editing is allowed!
183But you may make changes until it is released.
184This exam has been transferred to another facility.
185DVBA C 2507 EXAM READY
186Do you want to print a review copy
187Enter Y to print a copy of the results for review
188or N to continue editing.
1892507 Review Report
190DVBC*
1912507 Request queued for review to device
1921. State the frequency and type of seizures during the past
193twelve months, including any change in frequency pattern. If
194possible, get the actual number of seizures in each calendar
195month. If the veteran keeps a seizure diary, get dates of
1962. If a medical examiner observes any indications of psychiatric
197disease associated with epilepsy, a psychiatric consultation
198should be ordered.
1992507 Request Inquiry
200 Date of request:
201Enter VETERAN NAME:
202C&P Request Inquiry
203COMPENSATION AND PENSION EXAM INQUIRY
204Res Phone:
205Bus Phone:
206Exam(s) transferred to another site -- see pending report.
207Other Disabilities:
208Rated Disability
209ESOPHAGUS (DIGESTIVE)
210This area of examination is limited to conditions
211from mouth to the esophagogastric sphincter.
212A. Medical history :
2131. Current weight -
2142. Maximum weight, past year -
2154. Disturbance of motility -
2165. Actual partial obstruction (indicate frequency of dilatation
217if required) -
2186. Reflux disturbances -
2197. Presence of pain -
220Print Exam Checklist for the Regional Office
221A margin of 132 is required for this printout
222Print Exam check list
223VA Regional Office -
224Compensation and Pension Examination Request Worksheet
225Veteran's Name: _________________________________________________
226VAMC: __________________________
227SSN: __________________________
228Telephone-Day: _______________________ Night:_______________________ Power of Attorney: _________________
229Date Ordered: ____________________________
230By: __________________________
231Priority of Exam: _________________________ ( ) Insufficient Exam Dated: _______________________
232( ) General Medical Examination ( ) Review of Pertinent Medical Records in
233Print Cover Sheet for Fee Exam
234Number of copies:
235You cannot print less than one or more than ten copies per session.
236Fee exam cover sheets should be sent to a printer.
237Print C&P Fee Cover Sheet
238URETHRAL OR BLADDER FISTULA (GU)
2391. Number and location of fistulae -
2402. Drainage constant or intermittent -
2413. Constant use of pad or appliance -
2424. Frequency of pad changing -
243FEET (ORTHOPEDIC)
244The findings in each foot will be separately and carefully
245described, as this will affect the evaluation. The nomenclature
246of toes for examination purposes will be the great toe, the second,
247third, fourth and fifth toes, named from the medial or inner side
248and which foot is being examined. The functional loss should
249be related to the anatomical condition.
2501. Posture (standing, squatting, supination, pronation and
251rising on toes and heels) -
2526. Secondary skin and vascular changes -
253For GENITOURINARY, NOT ELSEWHERE CLASSIFIED
254Type of Exam: GENITOURINARY, NOT ELSEWHERE CLASSIFIED
255GENERAL MEDICAL
256A. Occupational history (List most current first):
257Name/Address of employer Type Monthly Emp dates Time lost
258(if unemployed, enter none)
259Work Wages from/to Last 12 mo
260State if time from employment was lost and give reasons.
261B. Medical history (since last rating exam):
262C. Present complaints (symptoms only, NOT diagnosis):
263D. Examination data:
264Temperature:
265Time:
266AM/PM
267Carriage:
268Right- or left-handed:
269(How determined)
270E. Skin, including appendages
271F. Lymphatic and hemic systems
272G. Head, face and neck:
273H. Nose, sinuses, mouth and throat (include gross dental findings):
274I. Ears (describe canals, drums, perforations, discharge):
275J. Eyes (describe external eye, pupil reaction, movements,
276field of vision, any uncorrectable refractive error or
277any retinopathy):
278K. Cardiovascular system
279(describe thrust, size, rhythm, sounds and condition
280 of peripheral vessels):
281Pulse
282Blood pressure
283Respiration
284Sitting
285Recumbent
286Standing
287Sitting after exerc.
2882 min after exercise
289L. Varicose veins (describe location, size, extent, ulcers, scars, and
290 competency of deep circulation):
291M. Respiratory system
292N. Digestive system
293P. Genito-urinary system
294Q. Musculo-skeletal system
295R. Endocrine system (describe disease of thyroid, pituitary, adrenals
296gonads, other body systems affected, etc.):
297S. Nervous system
298U. Other tests/exams recommended:
299V. Diagnostic/clinical test results:
300Reviewing Official: ______________________________
301An evaluation of the female reproductive system depends
302on a complete physical examination, a thorough medical
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