117 lines
2.2 KiB
Mathematica
117 lines
2.2 KiB
Mathematica
DVBCMECK ;ALB/GTS-557/THM-MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED ; 6/18/90 8:45 AM
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;;2.7;AMIE;;Apr 10, 1995
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EN S DVBAX="For MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED"
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S PG=1 D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF
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W !?22,"Compensation and Pension Examination",!?33,"# 1455 Worksheet",!,?(IOM-$L(DVBAX)\2),DVBAX,!!
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W "Name: ",NAME,?45,"SSN: ",SSN,!,?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED",!!
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W "Physician's Guide Reference: None",!!,"Narrative:",!!
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F I=0:1 S LY=$T(TXT+I) D:LY["TOF" HD2 Q:LY["END" W:LY'["TOF" $P(LY,";;",2),! I $Y>55 D HD2
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K I,LY,DVBAX Q
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;
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TXT ;;This exam is to handle the balance of currently recognized musculoskeletal
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;;disorders and to allow for new disorders not yet classified for V.A.
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;;compensation evaluations. The severity of a condition is based upon the
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;;residual disability. If there is a disease process that affects multiple
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;;systems or extremeties, please evaluate each separately.
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;;
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;;
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;;A. Medical history (W/P):
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;;
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;;
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;;
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;;
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;;B. Subjective findings (W/P):
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;;
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;;
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;;
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;;
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;;
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;;
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;;C. Objective findings (W/P):
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;;TOF
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;;
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;;
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;;D. Evaluation Information for the Rating Board:
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;;
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;;
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;; Residual disability effect on:
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;;
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;;
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;; 1) earning capacity/job performance (F/T):
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;;
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;;
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;;
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;;
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;;
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;;
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;; 2) everyday activities (F/T):
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;;
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;;
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;;
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;;
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;;
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;;
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;; 3) Is disability constant? (YES/NO):
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;;
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;;
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;;
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;;
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;;
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;;
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;;
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;; 4) If NO, give frequency, length of remissions (F/T):
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;;
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;;
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;;
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;;
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;;
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;; 5) Acute exacerbations effect on everyday life. (F/T)
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;;TOF
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;;
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;;
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;;E. Diagnosis (W/P):
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;;
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;;
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;;
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;;
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;;
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;;
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;;
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;;
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;;
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;;F. Diagnostic tests (Lab,X-Ray, etc) (W/P):
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;;
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;;
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;;
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;;
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;;
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;;
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;;
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;;
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;; Signature: ______________________________
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;;
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;; Date: _________________________
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;;END
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Q
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;
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HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!
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W "For MUSCULOSKELETAL, NOT ELSEWHERE CLASSIFIED",!!!
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Q
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;
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SETIOF ; ** Set device control var's
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D HOME^%ZIS
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Q
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