source: internationalization/trunk/TranslationSpreadsheets/WV-DIALOG-0057.txt@ 1506

English French  Notes   Complete/Exclude
MISCELLANEOUS NEUROLOGICAL DISORDERS                    
For MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED                   
Type of Exam: MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED                 
This 2507 already has appointments.                     
    Enter '?' for help                  
Is this appointment due to a cancellation?                      
Enter NO if the appointment is not a reschedule of another appointment                  
 made previously.  Enter YES if the appointment is being scheduled because                      
 an appointment has been or will be canceled.                   
  '^' NOT ALLOWED                       
You have not selected the linked appointment being rescheduled.  You may                        
 need to adjust the link to the appointment with the AMIE link                  
 management option to ensure proper processing time calculation for this 2507.                  
Enter Yes if the veteran requested a reschedule or 'No Showed' the appointment                  
Enter No if the Clinic required a reschedule.                   
Is this appointment due to a veteran requested cancellation or 'No Show'                        
You have not indicated if the reschedule was due to action by the veteran.                      
The new appointment will not be linked.  You will need to adjust                        
the link for this appointment with the AMIE/C&P appointment link management                     
option to ensure proper processing time calculation for this 2507.                      
Remember to cancel the appointment for                  
 and do NOT auto-rebook.                        
Hit Return to continue                  
Currently:                      
You have not selected a 2507 request to link the C&P appointment to.                    
The appointment should be linked with the AMIE/C&P Appointment Link                     
 Management Option to ensure proper processing time calculation for this 2507                   
 in the event of a veteran cancellation.                        
You have made a C&P appointment for a patient who has no pending 2507 request!                  
Adding new C&P appointment link for 2507 request dated                  
Adjusting C&P appointment link for 2507 request dated                   
MALIGNANCIES OR TUBERCULOSIS (GU)                       
1. Disease active or inactive -                 
2. If inactive, date last treatment or date determined inactive -                       
3. Assess clinical findings -                   
4. Assess laboratory findings -                 
Narrative:  NONE                        
A. Medical history (note history of augmentation mammoplasty with                       
prosthetic implant or reduction mammoplasty):                   
1. Axillary glands removal -                    
2. Size of scar -                       
3. Fixation of scar -                   
4. Contour of scar -                    
5. Muscle loss -                        
6. Tenderness of scar -                 
7. Nerve damage -                       
8. Presence of aching, pain or limited use of upper extremeties -                       
9. Note whether active malignant process is present -                   
10. If malignancy is inactive, state date of last surgical, radiation                   
or chemical treatment -                 
MENTAL DISORDERS                        
A. Medical and occupational history                     
D. Specific evaluation information required by the rating board                 
E. Diagnostic tests (including psychological testing if deemed necessary):                      
For MENTAL, NOT ELSEWHERE CLASSIFIED                    
Type of Exam: MENTAL, NOT ELSEWHERE CLASSIFIED                  
MUSCLES (ORTHOPEDIC)                    
1. Tissue loss comparison -                     
2. Muscles penetrated -                 
3. Scar formation measurement (sensitiveness, tenderness) -                     
5. Damage to tendons -                  
6. Damage to bones, joints, nerves -                    
8. Evidence of pain -                   
9. Evidence of muscle hernia -                  
MOUTH AND THROAT                        
All pertinent data must be recorded in the history in order                     
that the otolaryngological change discovered may be correlated                  
with evidence of disease found in other systems of the                  
1. Oral cavity -                        
5. Pyriform fossae -                    
Type of Exam:  NEPHROLOGICAL                    
1. Report presence or absence of calculi -                      
2. If stone, presence and size if retained -                    
3. Frequency of attacks of colic -                      
4. Catheter drainage requirments, including frequency -                 
5. Presence or absence of infection -                   
6. Involvement of other kidney -                        
INTESTINE (DIGESTIVE)                   
in the                  
 portion of this examination                    
is critical to the degree of disability assigned for the                        
3. Is the veteran anemic? -                     
6. Diarrhea and/or constipation -                       
7. Bowel disturbance -                  
8. Abdominal disturbance -                      
NECK, ABNORMALITIES OF,                         
NOT RESULT OF INJURY OR BONE DISEASE                    
The report of examination should include any abnormal position                  
of the head, range of motion of the head, evidence of                   
paralysis of the neck muscles, and asymmetry produced by                        
abnormal swelling or masses.                    
1. Range of motion -                    
, NOT ELSEWHERE CLASSIFIED                      
1)  How does the residual disability affect the earning capacity                        
of the veteran in job performance?                      
2)  How does the residual disability affect normal everyday activities?                 
3)  If the disability has constant activity, are there                  
any periods of remission during the year?                       
4)  If there are acute exacerbations, what effects are there on                 
everyday life?                  
Compensation and Pension Exam for                       
For NEUROLOGICAL, NOT ELSEWHERE CLASSIFIED                      
Type of Exam: NEUROLOGICAL, NOT ELSEWHERE CLASSIFIED                    
NEPHRITIS, EXCEPT CHRONIC PYELONEPHRITIS                        
2. Presence or absence of albumin casts -                       
4. Red blood cells -                    
5. Retention of non-protein nitrogen, creatinine or urea nitrogen -                     
6. Describe overall impairment of kidney function -                     
7. Report presence or absence of any cardiac complications -                    
Diagnosic/clinical test results:                        
NOSE AND SINUS                  
Report both functional and cosmetic impairment.                 
1. External nose -                      
2. Nasal vestibule -                    
3. Right and left nasal cavities -                      
 b. Floor of the nose -                 
  c. Inferior meatus -                  
 d. Inferior turbinates -                       
 e. The middle meati -                  
 f. The middle turbinate -                      
 g. The spheno-ethmoidal recess -                       
 h. The olfactory area -                        
 i. The superior turbinates -                   
4. The paranasal sinuses-                       
NOSE AND THROAT                 
Describe the location and nature of the injury or disease                       
with particular attention to the interference with speech,                      
sense of smell, and/or breathing space.  If all or part of the                  
nose is missing provide                 
 photographs.  Localize manifestations                  
of chronic sinusitis, if present.                       
1. Interference with breathing space -                  
2. Headaches, severity, and frequency -                 
3. Purulent discharge -                 
4. Frequency of allergic attacks, baseline status in between -                  
2507 Exams Not Scheduled Within Three Days                      
Enter STARTING DATE REPORTED TO MAS:                    
    and ENDING DATE REPORTED TO MAS:                    
2507 Requests Not Scheduled in Three Days at                    
A right margin of 132 is required for this output!                      
2507 exams not scheduled in 3 days                      
SDATE*                  
HD*                     
Total requests:                         
patient file record missing                     
Date reported-MAS                       
Date scheduled                  
Requested by                    
For NEPHROLOGICAL, NOT ELSEWHERE CLASSIFIED                     
Type of Exam: NEPHROLOGICAL, NOT ELSEWHERE CLASSIFIED                   
For ORGANS OF SENSE, NOT ELSEWHERE CLASSIFIED                   
Type of Exam: ORGANS OF SENSE, NOT ELSEWHERE CLASSIFIED                 
Additional Veteran Information                  
Is this the correct Veteran                     
Enter Y if it is the correct Veteran, N to reselect                     
Edit Veteran Data                       
Want to edit it again                   
Enter Y to edit the information again or N to skip.                     
1,5,0,2,0^...Error, required information missing!....                   
0,7,0,1:2,0^...Unable to complete, Request aborted!.....                        
DVBA C NEW C&P VETERAN                  
PULMONARY TUBERCULOSIS AND MYCOBACTERIAL DISEASES                       
Is pulmonary tuberculosis or other mycobacterial disease                        
active?  If so, identify the organism.  In reactivated                  
cases, it is necessary to know whether this is reactivation                     
of the old disease or a separate and distinct new infection.                    
1. IN ALL CASES:                        
a. Date of inactivity -                 
b. Extent of structural damage to lungs -                       
c. Provide pulmonary function studies -                 
2. In PENSION CASES ONLY:                       
a. Disease condition after six months of treatment -                    
b. Disease condition after twelve months of treatment -                 
  Additional note to the physician:                     
In all claims, if the disease is inactive and if the inactivity was confirmed                   
at a non-VA facility, obtain the name and mailing address of the facility                       
from the veteran so that the                    
Regional Office may request the report.                 
For PULMONARY, NOT ELSEWHERE CLASSIFIED                 
Type of Exam: PULMONARY, NOT ELSEWHERE CLASSIFIED                       
NON-TUBERCULOUS DISEASES AND INJURIES OF THE RESPIRATORY SYSTEM                 
1. State if active malignant process is present.  If so, nothing                        
further is needed -                     
2. If malignancy is inactive, report date/place of last                 
surgery, radiation or chemical therapy -                        
3. For non-malignant diseases, injuries, residuals of inactive or                       
cured malignancies  -                   
a.  Report structural changes to the lungs -                    
b.  Provide pulmonary function studies -                        
c.  Schedule additional special studies as necessary to evaluate                        
any extra-pulmonary manifestations that may be detected -                       
d.  State whether the disease is in remission or demonstrably                   
LOSS OF PENIS, ALL OR PARTIAL; IMPOTENCE (GU)                   
A complete and detailed examination of the entire                       
genitourinary system is needed with close correlation                   
between this, the history and laboratory studies.                       
Any penile deformity should be described in detail.                     
1. Extent of loss -                     
2. Erectile power preserved -                   
3. If impotent, state cause -                   
4. State whether impotence is permanent or if erectile power                    
can be restored -                       
5. Describe any penile deformity in detail -                    
Press RETURN                    
No pending requests found for selected parameters.                      
Pending 2507 Request Report                     
Do you want to sort by:                 
(A)ge of request                        
(V)eteran name                  
(R)outing location                      
Selection:   V//                        
Answer must be A, S, V, or R.                   
eteran name                     
ge of request                   
outing location                 
Status selection:                       
Select STATUS (enter A for all): P//                    
Status must be N (new), P (pending), T (transcribed) or A (all)                 
Age selection:                  
Enter EARLIEST age:                     
Enter the shortest time span (in days) which 2507 processing has elapsed.                       
Cannot be less than one day !                   
If you want NEW requests (zero days), sort by status.                   
 and OLDEST age:                        
Enter the longest time span (in days) which 2507 processing has elapsed.                        
Cannot be less than 1 day                       
Earliest age must be less than oldest age                       
Routing Location Selection:                     
Enter MEDICAL CENTER DIVISION:                  
Do you want elapsed time reported                       
 in (C)alender days or (W)ork days?  C//                        
Must be C for Calendar, W for Workdays                  
or simply press RETURN to accept the default.                   
Calendar                        
(Elapsed time in                        
Work                    
2507 PENDING REPORT                     
THE PERIPHERAL NERVES                   
Narrative:  None                        
Examining provider:                     
Examined on:                    
Examination results:                    
This exam was CANCELLED by                      
the RO.                 
MAS.                    
Exam Results Continued                  
Processing time:                        
AGENT ORANGE                    
Last rating exam date:                  
Priority of exam:                       
Site name not in file                   
Continued on next page                  
VA Form 2507                    
This exam has been reviewed and approved by the examining provider                      
and signed by the veteran                       
 Approved by: ___________________________________     Date: _____________                       
Provider signature: ___________________________________     Date: _____________                 
You DIVISION NUMBER is incorrect.                       
Your DIVISION NUMBER is invalid.                        
C & P Exam Printing                     
Note:  All reports will be produced in 'terminal-digit' order.                  
2507 Final Exam Report                  
Nothing to print                        
Total requests to be printed:                   
Final C&P Reports for print date                        
Operator:                       
Too many locations to store!  Some locations may not be reported.                       
A bad 'D' X-Reference exists on the 2507 Request File (#396.3) for                      
Please notify IRM at the facility where you have created                        
 this report.                   
POST-TRAUMATIC STRESS DISORDER                  
A. Medical and occupational history:                    
1. Immediate pre-military events and details of training -                      
2. Events in the war zone -                     
3. Post-active service events (to present) -                    
4. Employment history prior to and following                    
active service -                        
B. Subjective complaints (include the veteran's history of unusually                    
traumatic stressors)                    
1) Describe the duration of the disturbance from the symptoms shown above.                      
Attachment A for Post-Traumatic Stress Disorder                 
DSM-III-R Diagnostic Criteria for PTSD                  
PITUITARY TUMORS - ACROMEGALY, PROLACTINOMA                     
1.  Frequency of headaches -                    
2.  Changes in vision -                 
3.  Cardiac symptoms -                  
4.  Joint pain -                        
6.  Kyphosis of cervicodorsal spine -                   
7.  Abnormal glucose tolerance -                        
8.  Genital atrophy -                   
lumps or masses                 
diabetes mellitus                       
thyroid disorders                       
b. Head, eye, ear, nose and throat                      
eye pain                        
Ears:                   
hearing loss                    
external ear                    
Nose:                   
Mouth-throat:                   
bleeding gums                   
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