Veteran Exam MA Workflow for [select name="examcontractor" value="LHI|QTC" memo=" <-- select exam contract company" memo_color="blue"] Scribed by: [text memo="<-- enter your name"]
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Veteran's employment: [checkbox name="unemployed" value="" memo="unemployed/retired/disabled"][conditional field="unemployed" condition="(unemployed).is('')"]unemployed/retired/disabled, formerly employed as [comment memo_color="red" memo="IMPORTANT: if unemployed, you must specify the claimant's most recent paid occupation -->"][/conditional][text memo="<-- current or most recent paid occupation"][comment memo="For musculoskeletal exams "]Veteran's dominant hand: [select value="|right|left|ambidextrous"]
Does the veteran use any assistive devices? [select name="assistive" value="|no|yes"]
[conditional field="assistive" condition="(assistive).is('')||(assistive).is('yes')"][comment memo="If yes, identify assistive devices used (check all that apply and indicate frequency)"]
[checkbox value="wheelchair"] [select memo="<--frequency of use" value="|occasional|regular|constant"]
[checkbox value="brace"] [select memo="<--frequency of use" value="|occasional|regular|constant"]
[checkbox value="crutches"] [select memo="<--frequency of use" value="|occasional|regular|constant"]
[checkbox value="cane"] [select memo="<--frequency of use" value="|occasional|regular|constant"]
[checkbox value="walker"] [select memo="<--frequency of use" value="|occasional|regular|constant"]
[checkbox value="other"] [select memo="<--frequency of use" value="|occasional|regular|constant"][comment memo="If the veteran uses any assistive devices, specify the condition and identify the assistive device used for each condition: "]
[textarea cols=45 rows=2][/conditional]
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select the DBQs requested for the veteran below and obtain indicated history" memo_color="blue"] [comment memo=" General Administrative" memo_color="yellow"] [checkbox name="SHA" memo="Separatiom Health Assessment DBQ (vitals and far and near vision needed)" value=""][conditional field="SHA" condition="(SHA).is('')"][frontload soapnote="subjective/drgfms-va-dbq-sha"]
=====================================================================================[/conditional][comment memo="Musculoskeletal" memo_color="yellow"] [checkbox name="Muscle" memo="Muscle DBQ" value=""][conditional field="Muscle" condition="(Muscle).is('')"][frontload soapnote="subjective/drgfms-va-dbq-muscle"]
=====================================================================================[/conditional] [checkbox name="TemporomandibularJointConditions" memo="Temporomandibular Joint Conditions DBQ" value=""][conditional field="TemporomandibularJointConditions" condition="(TemporomandibularJointConditions).is('')"][frontload soapnote="subjective/drgfms-va-dbq-tmj"]
=====================================================================================[/conditional] [checkbox name="Back" memo="Back DBQ" value=""][conditional field="Back" condition="(Back).is('')"][frontload soapnote="subjective/drgfms-va-dbq-back"]
=====================================================================================[/conditional] [checkbox name="Shoulder" memo="Shoulder DBQ" value=""][conditional field="Shoulder" condition="(Shoulder).is('')"][frontload soapnote="subjective/drgfms-va-dbq-shoulder"]
=====================================================================================[/conditional] [checkbox name="Hand" memo="Hand DBQ" value=""][conditional field="Hand" condition="(Hand).is('')"][frontload soapnote="subjective/drgfms-va-dbq-hand"]
=====================================================================================[/conditional] [checkbox name="HipandThigh" memo="Hip and Thigh DBQ" value=""][conditional field="HipandThigh" condition="(HipandThigh).is('')"][frontload soapnote="subjective/drgfms-va-dbq-hip"]
=====================================================================================[/conditional] [checkbox name="Knee" memo="Knee DBQ" value=""][conditional field="Knee" condition="(Knee).is('')"][frontload soapnote="subjective/drgfms-va-dbq_knee"]
=====================================================================================[/conditional] [checkbox name="Foot" memo="Foot DBQ" value=""][conditional field="Foot" condition="(Foot).is('')"][frontload soapnote="subjective/drgfms-va-dbq-foot"]
=====================================================================================[/conditional] [checkbox name="Ankle" memo="Ankle DBQ" value=""][conditional field="Ankle" condition="(Ankle).is('')"][frontload soapnote="subjective/drgfms-va-dbq-ankle"]
=====================================================================================[/conditional][comment memo="Neurologic" memo_color="yellow"] [checkbox name="Headaches" memo="Headaches DBQ" value=""][conditional field="Headaches" condition="(Headaches).is('')"][frontload soapnote="subjective/drgfms-va-dbq-headaches"]
=====================================================================================[/conditional] [checkbox name="SleepApnea" memo="Sleep Apnea DBQ" value=""][conditional field="SleepApnea" condition="(SleepApnea).is('')"][frontload soapnote="subjective/drgfms-va-dbq-sleep-apnea"]
=====================================================================================[/conditional] [checkbox name="Ear" memo="Ear DBQ" value=""][conditional field="Ear" condition="(Ear).is('')"][frontload soapnote="subjective/drgfms-va-dbq-ear"]
=====================================================================================[/conditional] [checkbox name="Peripheralnervesconditions" memo="Peripheral Nerves Conditions DBQ" value=""][conditional field="Peripheralnervesconditions" condition="(Peripheralnervesconditions).is('')"][frontload soapnote="subjective/drgfms-va-dbq-peripheral-nerves-conditions"]
=====================================================================================[/conditional][comment memo="Dermatologic" memo_color="yellow"] [checkbox name="Skin" memo="Skin DBQ" value=""][conditional field="Skin" condition="(Skin).is('')"][frontload soapnote="subjective/drgfms-va-dbq-skin"]
=====================================================================================[/conditional] [checkbox name="Scars" memo="Scars DBQ (complete if requested, or if veteran has painful, unstable, or extensive scars)" value=""][conditional field="Scars" condition="(Scars).is('')"][frontload soapnote="subjective/drgfms-va-dbq-scars"]
=====================================================================================[/conditional][comment memo="Internal Medicine" memo_color="yellow"] [checkbox name="Esophagus" memo="Esophagus DBQ" value=""][conditional field="Esophagus" condition="(Esophagus).is('')"][frontload soapnote="subjective/drgfms-va-dbq-esophagus"]
=====================================================================================[/conditional] [checkbox name="OtherIntestinalProblems" memo="Other Intestinal Problems DBQ" value=""][conditional field="OtherIntestinalProblems" condition="(OtherIntestinalProblems).is('')"][frontload soapnote="subjective/drgfms-va-dbq-int-other"]
=====================================================================================[/conditional] [checkbox name="Hepatitis" memo="Hepatitis DBQ" value=""][conditional field="Hepatitis" condition="(Hepatitis).is('')"][frontload soapnote="subjective/drgfms-dbq-liver"]
=====================================================================================[/conditional] [checkbox name="Kidney" memo="Kidney DBQ" value=""][conditional field="Kidney" condition="(Kidney).is('')"][frontload soapnote="subjective/drgfms-dbq-kidney"]
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Does the veteran have any scars (surgical or othemise) related to any conditions or to the treatment of any conditions listed in the diagnosis section above? [select name="yn-scars" value="|no|yes"]
[conditional field="yn-scars" condition="(yn-scars).is('yes')||(yn-scars).is('')"][comment memo="If yes, describe"]
[textarea cols=45 rows=2][/conditional]
[checkbox name="Scars" memo="Scars DBQ (complete if requested, or if veteran has painful, unstable, or extensive scars)" value=""][conditional field="Scars" condition="(Scars).is('')"][frontload soapnote="subjective/drgfms-va-dbq-scars"]
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