Subjective/History Elements
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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]
=====================================================================================[comment memo="
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"]
=====================================================================================[/conditional]
=====================================================================================
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"]
=====================================================================================[/conditional]
Veteran Exam MA Workflow for <-- select exam contract company Scribed by: <-- enter your name
=====================================================================================
Veteran's employment: unemployed/retired/disabled<-- current or most recent paid occupationFor musculoskeletal exams Veteran's dominant hand:
Does the veteran use any assistive devices?

=====================================================================================
select the DBQs requested for the veteran below and obtain indicated history
General Administrative Separatiom Health Assessment DBQ (vitals and far and near vision needed)Musculoskeletal Muscle DBQ Temporomandibular Joint Conditions DBQ Back DBQ Shoulder DBQ Hand DBQ Hip and Thigh DBQ Knee DBQ Foot DBQ Ankle DBQNeurologic Headaches DBQ Sleep Apnea DBQ Ear DBQ Peripheral Nerves Conditions DBQDermatologic Skin DBQ Scars DBQ (complete if requested, or if veteran has painful, unstable, or extensive scars)Internal Medicine Esophagus DBQ Other Intestinal Problems DBQ Hepatitis DBQ Kidney DBQ
=====================================================================================
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?

Scars DBQ (complete if requested, or if veteran has painful, unstable, or extensive scars)

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