23 lines
1.7 KiB
Mathematica
23 lines
1.7 KiB
Mathematica
|
DVBCSRCK ;ALB/GTS-557/THM-SCARS,BURN ; 12/27/90 2:11 PM
|
||
|
|
;;2.7;AMIE;;Apr 10, 1995
|
||
|
|
;
|
||
|
|
S PG=1,HD91="Department of Veterans Affairs",HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet"
|
||
|
|
EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
|
||
|
|
W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 1605 Worksheet" S HD7="SCARS, BURN",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!!
|
||
|
|
W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",HD7
|
||
|
|
W !!!!,"Narrative:"
|
||
|
|
W ?13,"When true third degree burn involvement is established,",!?13,"measure and describe all areas of scarring and all secondary",!?13,"functional impairments.",!!!
|
||
|
|
I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!!,"C. Objective findings:",! D 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):",!!!
|
||
|
|
W ?8,"1. Shape and dimension (specify units) -",!!!?8,"2. Color -",!!!?8,"3. Extent -",!!!?8,"4. Provide photographs for all facial burns and any",!?11,"areas of especially repugnant disfigurement -",!!!!!
|
||
|
|
W ?8,"5. Tender and painful on objective demonstration -",!!!!!
|
||
|
|
D:$D(CMBN) HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!! D:$Y>50 HD2 W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",!
|
||
|
|
K LN,LN1,LN2
|
||
|
|
Q
|
||
|
|
;
|
||
|
|
HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for ",HD7,!,"for ",NAME,!!!
|
||
|
|
Q
|
||
|
|
SETIOF ; ** Set device control var's
|
||
|
|
D HOME^%ZIS
|
||
|
|
Q
|