English	French	Notes	Complete/Exclude
 does not exist, AMIE Exam 			
Pension: 			
Claim Folder Loc: 			
------- Admission data -------			
Current			
Prior			
------ Admission date -------  			
---- Admitting diagnosis ----  			
------- Discharge date ------- 			
------- Discharge type ------- 			
-------- Bed Service --------- 			
PATIENT LOOKUP			
Which would you prefer			
 has both Admission and Non Admission information.			
0,0,0,2,0^Searching file for existing 7131 requests for 			
0,0,0,2:2,0^No selection made!			
Select 1-			
   or '^' to Exit or Return to continue 			
Is this the correct information? 			
Display Admission or Activity information			
Date Range will allow the user to select the specific dates.			
All Dates will show the user all possible information.			
1,0,0,2,0^There is a 7131 already on file for 			
0,0,0,1:1,0^Status is 			
Do you want to delete the existing 7131 for this date: 			
Answer YES or No.  You may not have two 7131s for the same admission date.			
Do you want to add a NEW 7131			
'YES' to enter a new 7131. 'NO' to search for an existing one.			
Are you sure you want to edit this 7131 request: 			
'YES' to edit the 7131 request.			
1,0,0,2,0^Unable to add this new record!			
Enter Patient name: 			
0,0,0,2:1,1^The following is a list of Admission dates for 			
0,0,0,2:1,1^The following is a list of activity dates for 			
Stop Code(s)			
1,0,0,2:1,0^There is a problem with the Disposition Login information.  Contact IRM			
Disposition Login			
Date Range			
For REMOTE SITE (Press RETURN for all sites) : 			
Are you sure you want ALL REMOTE SITES: 			
Enter Y to get all remote sites N for just one			
BEGINNING date: 			
   ENDING date: 			
1,0,0,2:2,0^Invalid dates!  Ending must not be before beginning.			
0,0,0,3,0^Notice to MAS on 			
0,0,0,1,0^There were no new 7131 requests			
AMIE New Req for 			
0,0,0,1:3,1^AMIE New Request Report			
Amie new request rpt			
CLAIM NO: 			
 ACTIVITY DATE: 			
REQUEST DATE: 			
Items Requested:			
 (Not specified)			
This record was FINALIZED on 			
**Request is incomplete, contact the Regional Office to complete**			
Record Processing Notes: 			
AMIE 7131 NEW REQUEST REPORT FOR 			
 * LONG VERSION *			
, DIVISION NOT GIVEN			
, UNABLE TO DETERMINE DIVISION			
 to stop   			
0,0,0,4:1,0^AMIE 7131 NEW REQUEST REPORT FOR 			
 **Long Version**			
UNABLE TO DETERMINE			
VARO 7131 NEW REQUEST REPORT FOR 			
 * SHORT VERSION *			
ACT/ADM DATE			
DOCUMENT TYPE: 			
** REGIONAL OFFICE MUST EDIT THE INCOMPLETE REQUEST LISTED ABOVE **			
Select version			
Long			
ACTIVITY DATE			
You have no user number.			
21-DAY CERTIFICATE TEXT ENTRY/EDITING			
This record is now released.			
DVBA 21-DAY CERT CLERK			
You do not have the proper key to use this option.			
Wrong request type !			
This is an ACTIVITY DATE request, not ADMISSION DATE.			
This request has already been FINALIZED and the text may not be changed.			
No 21-day certificate has been requested for this Veteran.			
This Veteran has a 21-day certificate requested but			
 it has not yet been processed.			
This certificate has been released to the RO			
 but has not been printed.			
 and has already been printed.			
 but the status is unknown.			
Admit date: 			
DVBA RELEASE 21-DAY CERT			
Ok to release this 21-day certificate text			
Enter Y to go ahead and release this certificate to the RO			
or N to be able to make corrections and release later.			
7131 Report Requesting			
Select Report: 			
initially mark the report as 'YES'.  If the number is selected again then it			
will be changed to 'NO' or vice versa			
Vet already discharged - you cannot request Notice of Discharge.			
Cannot select 'Notice of Discharge', 'Hospital Summary', 'Certificate (21-day)', or 'Admission Report' for an activity date.			
The patient has no Claim Folder Location in the Patient File.			
Notice of Discharge would not be returned.			
The patient's Claim Folder Location has no Station Number in file #4.			
Please check the Claim Folder Location and its entry in file #4.			
21 Day Certificate would not be returned.			
1,0,0,2,0^You have not selected any reports for this 7131 request			
0,0,0,1:2,0^or have selected number 4 but not entered any remarks.			
);29Routing Location;.5;23///			
Do you want to file this request			
AMIE SITE PARAMETER EDITING			
Enter SITE NAME: 			
VARO REPORT			
 FOR PENSION			
SPECIAL 			
AMIE PENSION/A&A REPORT			
REGIONAL OFFICE SPECIAL REPORT			
FOR A&A AND PENSION			
This report prints only Veterans receiving A&A or Pension.			
Do you want (A)&A or (P)ension ?  			
Must be either A for A&A 			
or P for Pension or 			
 or [RETURN] to escape.			
(NOT COMPLETE)			
Enter E to end, 			
 to EXIT or RETURN to continue   			
Sort by Regional Office number			
Enter Y to sort by the Regional Office number you			
select or enter N to get ALL Regional Offices reported.			
Regional Office number: 			
     Must be 1-3 numbers.			
The entry of future dates is NOT allowed.			
Invalid date sequence.  Beginning date must be before the ending date.			
  Admission date: 			
Finalized			
  Activity date: 			
You have no division code.  Please contact the site manager.			
Your division code is invalid.			
Your division has no station number defined in the INSTITUTION file.			
Please consult IRM to request a unique station number for your division.			
DVBA;ADVB;DVBB;ADVB			
Are you sure you want to DELETE the existing 7131 for this date			
and log a NEW one			
Enter Y to delete the finalized 7131 request that			
exists for this date and log a new one.			
Enter N to leave the existing 7131 as is.			
Activity or admission date is missing !  Cannot reopen.			
You may now enter a new 7131 for this date.			
No site parameters have been setup in file 396.1.			
Do you want (A)&A, (P)ension, (S)ervice-connected, or AL(L) discharges ?  S// 			
Must be A for A&A, P for Pension, S for Service-connected, or L for All			
SERVICE-CONNECTED			
 DISCHARGE REPORT			
Are you sure you want to delete this request			
7131 entry deleted.			
<Return to continue>			
Notice of discharge			
Hospital Summary			
Certificate (21-day)			
Other/Exam (Review Remarks)			
Special Report			
Competency Report			
VA Form 21-2680			
Asset Information			
Admission Report			
Beginning Date Care			
Original processing date 			
Adm.			
Act.			
1,0,0,2,0^Record is currently in use!			
1,0,0,2:2,0^There is no Admission or Non Admission information			
 for this date range!			
1,0,0,2:2,0^You must select a 7131 with Pending reports!			
Activity Date:  			
1,0,0,2,0^The admission you selected is an ASIH admission.			
0,0,0,1,0^This means the veteran was admitted from a Nursing			
0,0,0,1,0^ Home or Domiciliary.  It is suggested that you			
0,0,0,1,0^ review the veteran's claim folder before requesting			
0,0,0,1,0^This parameter can be adjusted to allow the site to keep 2507 requests			
0,0,0,1,0^for up to 999 days.  The site can not select to retain the requests			
0,0,0,1,0^for less than 120 days.  Selection of a number of days between			
0,0,0,1:2,0^120 and 999 is the allowable response.			
NOT a stand-alone program !			
Eligibility data:			
Please review previous information entered as well as			
entering additional REQUIRED information:			
RSaR			
RFXaR			
FXOaR			
NJ3,0XOaR			
SERVICE ENTRY DATE [LAST]			
SERVICE SEPARATION DATE [LAST]			
Need to edit the information you've just entered			
Enter Y to go back and correct any errors or 			
you may enter N to proceed.			
FaR			
DAYS TO			
FINALIZED BY			
Requisition			
Operator			
Current Division			
Notice/Discharge:			
Hospital Summary:			
21-day Certificate:			
Other/Exam:			
Special Report:			
Competency Report:			
Form 21-2680:			
Asset Information:			
Admission Report:			
OPT Treatment Rpt:			
Beg Date/Care:			
REMARKS:			
NOTICE/DISCHG STATUS			
P:PENDING;C:COMPLETED;			
NOTICE/DISCHG COMPLETION DATE			
EDIT4.5			
Completed status must have date.			
HOSPITAL SUMMARY STATUS			
HOSP SUMMARY COMPLETION DATE			
EDIT5.5			
(21-DAY) CERTIFICATE STATUS			
(21-DAY) COMPLETION DATE			
EDIT6.5			
STATUS OF OTHER/EXAM			
OTHER/EXAM COMPLETION DATE			
STATUS OF SPECIAL REPORT			
SPECIAL REPORT COMPLETION DATE			
STATUS OF COMPETENCY REPORT			
COMPETENCY RPT COMPLETION DATE			
STATUS OF VA FORM 21-2680			
FORM 21-2680 COMPLETION DATE			
STATUS OF ASSET INFORMATION			
ASSET INFO COMPLETION DATE			
ADMISSION REPORT STATUS			
ADMISSION RPT COMPLETION DATE			
EDIT17.4			
STATUS OF OPT TREATMENT RPT			
OPT TREAT RPT COMPLETION DATE			
STATUS-BEG DATE/CARE (CHAP 17)			
BEG/DATE/CARE COMPLETION DATE			
DVBA*2.7*4 - APE x-ref cleanup process			
 APE x-ref cleanup queued...task=			
DVBA*2.7*4			
Start Time of process:  			
Results of search in DA^DFN^Request Date^Exam Type format			
No bad APE x-refs found!			
End Time:  			
NOTHING WAS KILLED!!  D EN^DVBAYAPE TO HAVE KILLS EXECUTED			
DVBA*2.7*4 			
Diagnostic			
 has run			
Department of Veterans Affairs			
Abbreviated			
Full			
 Exam Worksheet			
ALIMENTARY APPENDAGES (DIGESTIVE)			
Date of exam: ____________________			
Place of exam: ___________________			
Type of Exam: 			
Narrative:			
Detailed description of chronic, active symptomatology in the			
subjective complaints			
 portion of this or the main examination is			
critical to the degree of disability assigned for the veteran.			
A. Medical history:			
B. Subjective complaints:			
C. Objective findings:			
Specific evaluation information required by the rating board			
(if the information requested is included elsewhere, do not			
repeat here):			
1. Abdominal discomfort -			
2. Food intolerance -			
5. Degree of pain -			
8. Weight loss -			
9. Generalized weakness -			
Diagnostic/clinical test results:			
Diagnosis:			
Signature: ______________________________			
Date: _________________________			
Compensation and Pension Exam for 			
When only pure tone results should be used to evaluate			
hearing loss, the Chief of the Audiology Clinic should			
certify that language difficulties or other problems make			
the use of both pure tone average and speech discrimination			
A. Audiological history:			
Pure tone thresholds at indicated frequencies (air conduction):			
 ========== RIGHT EAR ========== + ========== LEFT EAR ===========			
* The pure tone threshold at 500 Hz is not currently used for evaluation			
purposes but is used in determining whether or not a ratable hearing			
loss exists.			
** - average of B, C, D, and E			
Speech recognition score:			
   1. Maryland CNC word list _______ % right ear  _______ % left ear			
   2.         W-22 word list _______ % right ear  _______ % left ear			
      (Only if specifically requested by the regional office)			
Note whether tinnitus is present and if so, indicate the following:			
Date/circumstance of onset			
Unilateral vs bilateral			
Constant vs periodic (indicate frequency)			
Severity and effect on daily life			
Veteran account of loudness/pitch			
Note whether audiologic results indicate an ear or hearing problem			
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