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BOX_00
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.DRFNAM, PROV.LORPNAME
(IF EVNT.PROVNUM ^= -1), EVNT.EVNTTYPE (IF SET),
EVNT.EVNTBEGM,D (EVNTBEGM ONLY FOR HH),
(PRND.BEGREFMM, DD FOR OM), EVNT.EVNTENDM, D (IF
EVNT = HS), (PRND.ENDREFMM, DD FOR OM).
BOX_01
IF COMING FROM WITHIN PERSON LOOP IN PROVIDER
PROBES, CODE EV01 AUTOMATICALLY BY CAPI WITH THE
CORRECT PERSON NAME AND GO TO EV02
OTHERWISE, CONTINUE WITH EV01
EV01
INTERVIEWER: SELECT CORRECT PERSON FOR THIS EVENT.
[1. First Name,[Middle Name],Last Name-65] ...
[2. First Name,[Middle Name],Last Name-65] ...
[3. First Name,[Middle Name],Last Name-65] ...
[Code One]
ROSTER DETAILS:
TITLE: RU_MEMBERS_SELECTONE
COL # 1 HEADER: PERSON-TYPE-PROVIDER
INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
ROSTER DEFINITION: THIS ITEM DISPLAYS THE
RU-MEMBERS-ROSTER FOR SELECTION OF RU MEMBERS.
ROSTER BEHAVIOR:
1. SELECT ALLOWED. INTERVIEWER MAY SELECT ONE
FROM THE LISTED MEMBERS.
2. MULTIPLE SELECT DISALLOWED.
3. ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER:
NONE. DISPLAY ALL.
EV02
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD {EV-1A/EV-1B}.
Where did {you/{PERSON}} receive the care?
REFER TO TAB 7 OF QUICK REFERENCE GUIDE FOR EVENT TYPE
FOLLOW-UP PROBES.
HOSPITAL STAY ......................... HS {BOX_02}
HOSPITAL EMERGENCY ROOM ............... ER {BOX_02}
HOSPITAL OUTPATIENT DEPARTMENT ........ OP {BOX_02}
MEDICAL PROVIDER VISIT ................ MV {BOX_02}
DENTAL CARE ........................... DN {BOX_02}
HOME HEALTH ........................... HH {EV06}
OTHER MEDICAL EXPENSES ................ OM
INSTITUTIONAL/LONG TERM CARE STAY ..... IC {BOX_02}
HELP AVAILABLE FOR DEFINITION OF EVENT TYPES.
[Code One]
DISPLAY ‘EV-1A’ IF ROUND 1, 2, OR 4.
DISPLAY ‘EV-1B’ IF ROUND 3 OR 5.
IF ROUNDS 3 OR 5 AND EV02 IS CODED ‘OM’, GO TO
EV02A
IF ROUNDS 1, 2, OR 4 AND EV02 IS CODED ‘OM’,
GO TO EV03
BOX_02
ASK PROVIDER ROSTER (PV) SECTION FOR THIS EVENT
AT COMPLETION OF THE PV SECTION, GO TO BOX_03
EV02A
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV}
INTERVIEWER: SELECT GROUP TYPE OF OTHER MEDICAL
EXPENSE (OM)
EVENT YOU NEED TO ADD:
NOTE: ONLY ONE OM GROUP TYPE MAY BE ADDED AT THIS
SCREEN.
REGULAR (GLASSES OR CONTACTS, INSULIN,
OTHER DIABETIC SUPPLIES) .............. 1 {EV03}
ADDITIONAL (E.G., AMBULANCE SERVICES,
ORTHOPEDIC ITEMS, HEARING DEVICES,
MEDICAL EQUIPMENT, ETC.) .............. 2 {EV03A}
[Code One]
EV03
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}
{END-DT}
IF KNOWN, SELECT CORRECT OME ITEM GROUP.
OTHERWISE ASK: Did {you/{PERSON}} obtain glasses or
contact
lenses, insulin, or other diabetic equipment or
supplies
since {START DATE}?
GLASSES OR CONTACT LENSES .............. 1 {BOX_06}
INSULIN ................................ 2 {BOX_06}
OTHER DIABETIC EQUIPMENT OR SUPPLIES ... 3 {BOX_06}
[Code All That Apply]
IF CODED ‘2’ (INSULIN), ADD ‘INSULIN’ TO
PERSON’S-PRESCRIBED-MEDICINES-ROSTER, CREATING
NECESSARY RECORDS FOR INSULIN.
IF CODED ‘3’ (OTHER DIABETIC EQUIPMENT OR
SUPPLIES), ADD ‘OTHER DIABETIC EQUIP/SUPPLIES’
TO PERSON’S-PRESCRIBED-MEDICINES-ROSTER, CREATING
NECESSARY RECORDS FOR ‘OTHER DIABETIC
EQUIP/SUPPLIES’.
EV03A
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} JAN 01
DEC 31
SHOW CARD PP-4A OR PP-12
IF KNOWN, SELECT CORRECT ADDITIONAL OME ITEM GROUP
OTHERWISE ASK: Looking at this card, what type of
other
medical expenses did {you/{PERSON}} obtain, purchase
or rent during
the calendar year {YEAR}?
AMBULANCE SERVICES ....................... 1
ORTHOPEDIC ITEMS ......................... 2
HEARING DEVICES .......................... 3
PROSTHESES ............................... 4
BATHROOM AIDS ............................ 5
MEDICAL EQUIPMENT ........................ 6
DISPOSABLE SUPPLIES ...................... 7
ALTERATIONS/MODIFICATIONS ................ 8
OTHER ................................... 91
[Code All That Apply]
(FOR SPECIFICATIONS ONLY, ‘YEAR’ IN PROGRAM IS
HARD-CODED.) IF ROUND 3, DISPLAY FIRST YEAR OF
PANEL FOR {YEAR}. IF ROUND 5, DISPLAY SECOND
YEAR OF PANEL FOR {YEAR}.
IF CODED ‘91’ (OTHER) ALONE OR IN COMBINATION
WITH ANY OTHER CODES, CONTINUE WITH EV03AOV
OTHERWISE, GO TO BOX_06
EV03AOV
OTHER GROUPING OF OTHER MEDICAL EXPENSES:
[Enter Other Specify] ................ {BOX_06}
REF .................................. -7 {BOX_06}
DK ................................... -8 {BOX_06}
BOX_03
IF EVENT TYPE IS HS OR IC, CONTINUE WITH EV04
OTHERWISE, GO TO EV05
EV04
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......} {EV} {STR-DT}
{END-DT}
IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS
PERSON-PROVIDER
PAIR WITH THE EVENT TYPE {EV}.
IF DATES NOT KNOWN, ASK: When {were/was}
{you/{PERSON}} admitted to
and discharged from {PROVIDER}? Please tell me
the dates of
all stays between {START DATE} and {END DATE}.
IF NECESSARY, PROBE: On what date did {you/he/she}
enter
{PROVIDER}? On what date did {you/he/she} leave
{PROVIDER}?
PROBE: Any other stays?
| ADMISSION DATE |
DISCHARGE DATE |
| [Enter Month,Day,Year-4] |
[Enter Month,Day,Year-4] |
| [Enter Month,Day,Year-4] |
[Enter Month,Day,Year-4] |
| [Enter Month,Day,Year-4] |
[Enter Month,Day,Year-4] |
DISPLAY ‘OR RELEASED IN {YEAR}’ IF ROUND 5, WHERE
‘YEAR’ IS THE CALENDAR YEAR SUBSEQUENT TO THE
SECOND YEAR OF THE PANEL. OTHERWISE, USE A NULL
DISPLAY.
DISPLAY A RADIO BUTTON ON THE DATE ENTRY SCREEN
LABELED ‘CHECK IF STILL IN PROVIDER {OR RELEASED
IN {YEAR}}.
ALLOW RF AND DK FOR THE DAY AND YEAR BUT NOT FOR
THE MONTH.
HARD CHECK:
EDIT CHECK:
IN ROUND 1 ONLY, ALLOW AN ADMIT DATE ONE YEAR
PRIOR TO THE RU MEMBER’S REFERENCE PERIOD START
DATE.
GO TO BOX_06
ROSTER DETAILS:
TITLE: PERS_EVNT_ADD_1
COL # 1 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE
(EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)
COL # 2 HEADER: DISCHARGE DATE
INSTRUCTIONS: DISPLAY EVENT END DATE
(EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY)
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-MEDICAL-EVENTS-
ROSTER FOR ADDING BEGIN AND END DATES.
ROSTER BEHAVIOR:
1. EDIT AND SELECT DISALLOWED.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD
RECORD THE EVENT BEGIN AND END DATES.
3. LIMITED DELETE ALLOWED. INTERVIEWER CAN DELETE
AN EVENT THAT WAS ENTERED ON THE SCREEN WHERE
DELETE IS USED. THAT IS, AS LONG AS THE
INTERVIEWER HAS NOT LEFT THE SCREEN, THEY SHOULD
BE ABLE TO DELETE AN EVENT ENTERED IN ERROR.
ROSTER FILTER:
DISPLAY NO EVENTS ON ROSTER INITIALLY. THIS SCREEN
RELATES TO HS AND IC EVENT TYPES (EVNT.EVNTTYPE)
ONLY.
EV05
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......} {EV} {STR-DT}
{END-DT}
IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS
PERSON-PROVIDER
PAIR WITH THE EVENT TYPE (EV).
IF DATES NOT KNOWN, ASK: When did {you/{PERSON}} visit
{PROVIDER}?
Please tell me all the dates between {START
DATE} and
{END DATE}.
PROBE: Any other dates?
[Enter Month,Day,Year-4]
[Enter Month,Day,Year-4]
[Enter Month,Day,Year-4]
DISPLAY ‘ADD EVENT DATE’, ‘EDIT EVENT DATE’, AND
‘DELETE EVENT DATE’ BUTTONS ON THIS SCREEN.
ALLOW RF AND DK FOR THE DAY AND YEAR BUT NOT FOR
THE MONTH.
GO TO BOX_06
ROSTER DETAILS:
TITLE: PERS_EVNT_ADD_2
COL # 1 HEADER: EVENT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE
(EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON’S-
MEDICAL-EVENTS-ROSTER FOR ADDING EVENT BEGIN
DATES.
ROSTER BEHAVIOR:
THIS ITEM CAN COLLECT ONLY THOSE EVENTS THAT ARE
THE SAME PROVIDER, PERSON, AND EVENT TYPE AS THE
EVENT BEING ASKED ABOUT.
1. SELECT DISALLOWED.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD
RECORD THE EVENT BEGIN DATES.
3. LIMITED DELETE ALLOWED. INTERVIEWER CAN DELETE
AN EVENT THAT WAS ENTERED ON THE SCREEN WHERE
DELETE IS USED. THAT IS, AS LONG AS THE
INTERVIEWER HAS NOT LEFT THE SCREEN, THEY SHOULD
BE ABLE TO DELETE AN EVENT ENTERED IN ERROR.
4. LIMITED EDIT ALLOWED. INTERVIEWER CAN EDIT AN
EVENT THAT WAS ENTERED ON THE SCREEN WHERE EDIT
IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS
NOT LEFT THE SCREEN, THEY SHOULD BE ABLE TO EDIT
AN EVENT.
ROSTER FILTER:
DISPLAY NO EVENTS ON ROSTER INITIALLY.
EV06
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}
{END-DT}
Thinking about the health care {you/{PERSON}} received
at home, was
the person who provided the care a friend or neighbor,
a relative, a volunteer, or some type of provider who
was paid?
Please do not include health care received from
friends
or relatives living here.
PROBE: Do you have a brochure, folder, binder of
papers,
telephone listing, or anything which might help?
NOTE: select only one type of provider at this time.
FRIEND/NEIGHBOR ........................ 1 {EV08}
RELATIVE ............................... 2 {EV07}
VOLUNTEER .............................. 3 {EV08}
OTHER-PAID ............................. 4 {EV06A}
VOLUNTEERED: MEAL DELIVERY SERVICE .... 5 {BOX_06}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code One]
IF CODED ‘5’ (VOLUNTEERED: MEAL DELIVERY SERVICE),
DO NOT CREATE AN EVENT RECORD.
EV06A
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}
{END-DT}
Did this person work for a home health agency,
hospital, or
nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of
papers,
telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR
NURSING HOME ........................... 1 {BOX_04}
WORKED FOR SELF ........................ 2 {BOX_04}
REF ................................... -7 {BOX_04}
DK .................................... -8 {BOX_04}
[Code One]
EV07
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}
{END-DT}
What is the relationship of the relative who provided
home
care services to {you/{PERSON}}?
IF MORE THAN ONE
DAUGHTER/DAUGHTER-IN-LAW/SON/SON-IN-LAW, CODE
ONLY ONE AT THIS TIME AND TREAT EACH AS A SEPARATE
HOME HEALTH
EVENT.
INCLUDE ALL OTHER TYPES OF RELATIVES AS ONE GROUP AND
CODE
‘OTHER-RELATIVE’ ONLY ONE TIME.
DAUGHTER ............................... 1 {BOX_04}
DAUGHTER-IN-LAW ........................ 2 {BOX_04}
SON .................................... 3 (BOX_04}
SON-IN-LAW ............................. 4 {BOX_04}
OTHER RELATIVE ......................... 5 {EV07OV1}
[Code One]
EV07OV1
CODE RELATIONSHIPS OF ALL DIFFERENT TYPES OF RELATIVES
WHO
PROVIDED HOME CARE SERVICES SINCE {START DATE} TO
{PERSON}.
CHECK ALL THAT APPLY.
MOTHER ................................. 1
FATHER ................................. 2
SISTER ................................. 3
BROTHER ................................ 4
GRANDPARENT ............................ 5
GRANDCHILD ............................. 6
AUNT/UNCLE ............................. 7
NIECE/NEPHEW ........................... 8
COUSIN ................................. 9
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
FOR SPECIFICATION PURPOSES ONLY: CAPI DOES NOT
ALLOW ‘RF’ OR ‘DK’ IN COMBINATION WITH ANY OTHER
CODE.
IF EV07OV1 IS CODED ‘91’ (OTHER) ALONE OR IN
COMBINATION WITH ANY OTHER CODES, CONTINUE WITH
EV07OV2
OTHERWISE, GO TO EV08
EV07OV2
SPECIFY:
[Enter Other Specify] .................. {EV08}
REF ................................... -7 {EV08}
DK .................................... -8 {EV08}
EV08
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}
{END-DT}
How many different {friends or
neighbors/volunteers/relatives,
other than daughters, daughters-in-law, sons, and
sons-in-law}
provided home care services for {you/{PERSON}} since
{START DATE}?
[Enter Number-2] ....................... {BOX_05}
REF ................................... -7 {BOX_05}
DK .................................... -8 {BOX_05}
DISPLAY ‘friends or neighbors’ IF EV06 IS CODED
‘1’ (FRIEND/NEIGHBOR). DISPLAY ‘volunteers’ IF
EV06 IS CODED ‘3’ (VOLUNTEER). DISPLAY ‘relatives,
other than daughters, daughters-in-law, sons, and
sons-in-law’ IF EV07 IS CODED ‘5’
(OTHER-RELATIVE).
IF EV06 IS CODED ‘1’ (FRIEND/NEIGHBOR):
- ADD ‘FRIEND/NEIGHBOR’ TO THE
RU-MEDICAL-PROVIDERS-ROSTER, PERSON-TYPE-
PROVIDER NAME COLUMN. NO ADDRESS INFORMATION
IS NECESSARY.
- FLAG PROVIDER AS ‘INFORMAL’.
IF EV06 IS CODED ‘3’ (VOLUNTEER):
- ADD ‘VOLUNTEER’ TO THE
RU-MEDICAL-PROVIDERS-ROSTER, PERSON-TYPE-
PROVIDER NAME COLUMN. NO ADDRESS INFORMATION
IS NECESSARY.
- FLAG PROVIDER AS ‘INFORMAL’.
IF EV07 IS CODED ‘5’ (OTHER RELATIVE):
- ADD ‘OTHER RELATIVE’ TO THE
RU-MEDICAL-PROVIDERS-ROSTER, PERSON-TYPE-
PROVIDER NAME COLUMN. NO ADDRESS INFORMATION
IS NECESSARY.
- FLAG PROVIDER AS ‘INFORMAL’.
BOX_04
ASK PROVIDER ROSTER (PV) SECTION FOR THIS EVENT
AT COMPLETION OF THE PV SECTION, CONTINUE WITH
BOX_05
BOX_05
IF EV06 IS CODED ‘1’ (FRIEND/NEIGHBOR) OR ‘3’
(VOLUNTEER) AND ROUND 1, GO TO EV12
IF EV06 IS CODED ‘1’ (FRIEND/NEIGHBOR) OR ‘3’
(VOLUNTEER) AND NOT ROUND 1, GO TO EV13
IF EV06 IS CODED ‘2’ (RELATIVE), FLAG PROVIDER
JUST COLLECTED IN PV SECTION AS ‘INFORMAL’ AND
GO TO EV13
IF EV06A IS CODED ‘2’ (WORKED FOR SELF), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW), FLAG PROVIDER
JUST COLLECTED IN PV SECTION AS ‘PAID INDEPENDENT’
AND GO TO EV10
IF EV06A IS CODED ‘1’ (WORKED FOR AGENCY,
HOSPITAL, OR NURSING HOME), FLAG PROVIDER JUST
COLLECTED IN PV SECTION AS ‘AGENCY’ AND
CONTINUE WITH EV09
EV09
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......} {EV} {STR-DT}
{END-DT}
How many people from {PROVIDER} provided home care
services for
{you/{PERSON}}?
[Enter Number-2] ......................
REF ................................... -7
DK .................................... -8
IF ROUND 1, GO TO EV12
OTHERWISE, GO TO EV13
EV10
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......} {EV} {STR-DT}
{END-DT}
Is {PROVIDER} a companion, a professional homemaker, a
home
health or nurse’s aide, a health professional, or
something
else?
PROBE: Health professionals include people like
nurses, social
workers, therapists of any type.
COMPANION .............................. 1
DOMESTIC WORKER/HOUSE CLEANER .......... 2
HEALTH PROFESSIONAL .................... 3 {EV11}
HOMEMAKER .............................. 4
HOME HEALTH AIDE ....................... 5
NURSE’S AIDE ........................... 6
PERSONAL CARE ATTENDANT ................ 7
OTHER ................................. 91 {EV10OV}
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
IF EV10 NOT CODED ‘3’ (HEALTH PROFESSIONAL), OR
‘91’ (OTHER), AND ROUND 1, GO TO EV12
OTHERWISE, GO TO EV13
EV10OV
SPECIFY:
[Enter Other Specify] .................
REF ................................... -7
DK .................................... -8
IF ROUND 1, GO TO EV12
OTHERWISE, GO TO EV13
EV11
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......} {EV} {STR-DT}
{END-DT}
What type of health professional is {PROVIDER}?
DIETITIAN/NUTRITIONIST ................. 1
HOME HEALTH AIDE ....................... 2
HOSPICE WORKER ......................... 3
I.V./INFUSION THERAPIST ................ 4
MEDICAL DOCTOR ......................... 5
NURSE/NURSE PRACTITIONER ............... 6
NURSE’S AIDE ........................... 7
OCCUPATIONAL THERAPIST ................. 8
PERSONAL CARE ATTENDANT ................ 9
PHYSICAL THERAPIST .................... 10
RESPIRATORY THERAPIST ................. 11
SOCIAL WORKER ......................... 12
SPEECH THERAPIST ...................... 13
OTHER ................................. 91 {EV11OV}
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
IF EV11 NOT CODED ‘91’ (OTHER), AND ROUND 1,
GO TO EV12
IF EV11 NOT CODED ‘91’ (OTHER), AND ROUNDS 2-5,
GO TO EV13
EV11OV
SPECIFY:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
IF ROUND 1, CONTINUE WITH EV12
OTHERWISE, GO TO EV13
EV12
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......} {EV} {STR-DT}
{END-DT}
Did {someone from} {PROVIDER} ever provide home
care services
for {you/{PERSON}} before January 1, {YEAR}?
YES .................................... 1 {EV13}
NO ..................................... 2 {EV13}
REF ................................... -7 {EV13}
DK .................................... -8 {EV13}
DISPLAY ‘someone from’ IF PROVIDER IS A FACILITY.
OTHERWISE, USE A NULL DISPLAY.
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS FIRST
CALENDAR YEAR OF PANEL.
EV13
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......} {EV} {STR-DT}
{END-DT}
{Last time we recorded that {you/{PERSON}} received
home care
services from {PROVIDER} during some part of {PRV RD
INTV MTH}.
Did {you/he/she} continue to receive home care
services from
{PROVIDER} during the rest of {PRV RD INTV MTH}?}
Did {someone from} {PROVIDER} provide home care
services for
{you/{PERSON}} during the month of (MONTH)?
How about in (MONTH)?
YES NO REF DK
EV13_01
{MONTH} 1 2 -7 -8
EV13_02
{MONTH} 1 2 -7 -8
EV13_03
{MONTH} 1 2 -7 -8
EV13_04
{MONTH} 1 2 -7 -8
DISPLAY FIRST PARAGRAPH IF A HOME HEALTH EVENT FOR
THE MONTH OF THE PREVIOUS ROUND’S INTERVIEW
FOR THIS PERSON-PROVIDER PAIR WAS CREATED DURING
THE PREVIOUS ROUND. (HOWEVER, IT WOULD NOT HAVE
BEEN ASKED ABOUT.) OTHERWISE, USE A NULL DISPLAY.
DISPLAY THE MONTH OF THE PREVIOUS ROUND’S
INTERVIEW DATE FOR ‘{PRV RD INTV MTH}’.
DISPLAY ‘someone from’ IF PROVIDER IS A FACILITY.
OTHERWISE, USE A NULL DISPLAY.
EV13 SCREEN DISPLAY SPECIFICATIONS:
1. THE NUMBER AND NAMES OF THE MONTHS LISTED ARE
DETERMINED BY THE NUMBER OF MONTHS BETWEEN THE
MONTH OF THE START DATE AND THE MONTH OF THE
END DATE FOR THIS PERSON. FOR EXAMPLE, IF THE
START DATE IS JANUARY 1 AND THE END DATE IS
APRIL 10 FOR THIS PERSON’S REFERENCE PERIOD,
‘JANUARY’, 'FEBRUARY', 'MARCH', AND ‘APRIL’
ARE DISPLAYED. THAT IS, THE MONTHS ARE ALL THE
MONTHS OF THE PERSON’S REFERENCE PERIOD.
2. ‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW) ARE
ALLOWED FOR EV13_01, EV13_02, EV13_03, AND
EV13_04. HOWEVER, THEY WILL BE TREATED AS A
‘NO’ WHEN CREATING EVENTS.
3. THE MONTHS ARE DISPLAYED IN GRID FORMAT WITH
YES/NO/DK/RF RADIO BUTTONS.
4. EV13 HAS TO ACCOMMODATE AT LEAST 10 MONTHS.
5. A SEAM MONTH WILL BE ASKED ONLY ONE HOME
HEALTH UTILIZATION SECTION WHENEVER IT
RECEIVES (OR RECEIVED) A CODE OF ‘1’ (YES) IN
EITHER THE CURRENT ROUND OR THE PREVIOUS ROUND.
MESSAGE: IF CURRENT INTERVIEW MONTH IS CODED ‘1’
(YES), DISPLAY THE FOLLOWING MESSAGE: "HOME
HEALTH UTILIZATION SEC FOR {INT MONTH} WILL NOT
BE ASKED UNTIL NEXT ROUND."
EACH MONTH CODED ‘1’ (YES) BECOMES A SEPARATE HOME
HEALTH EVENT FOR THIS PERSON-PROVIDER PAIR.
HOWEVER, IF THE CURRENT INTERVIEW MONTH IS CODED
‘1’ (YES), IT WILL NOT BE ASKED ABOUT UNTIL THE
NEXT ROUND. IF THE MONTH OF THE PREVIOUS ROUND’S
INTERVIEW DATE IS CODED ‘1’ (YES), IT IS ASKED
ONE TIME. THAT IS, IT IS NOT A SEPARATE EVENT FOR
BOTH THE PREVIOUS ROUND AND THIS ROUND, IT IS
ONLY ONE EVENT.
HARD CHECK:
EDIT: CAPI REQUIRES A RESPONSE FOR EACH MONTH
DISPLAYED. ALL MONTHS DURING THE REFERENCE PERIOD
CANNOT BE CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW). IF ALL ARE, WVS ERROR HANDLER WILL
FORCE THE INTERVIEWER TO RECTIFY THE DATA.
BOX_06
RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN PP
OR ED.
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