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BOX_00
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.LORPNAME,
EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY
MV01
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
Did {you/{PERSON}} visit {PROVIDER} on {VISIT DATE} in
person or was
this a telephone call?
SAW PROVIDER ........................... 1 {MV02A}
TELEPHONE CALL ......................... 2 {MV03}
REF ................................... -7 {MV03}
DK .................................... -8 {MV03}
[Code One]
IF MV01 IS CODED ‘1’ (SAW PROVIDER), FLAG EVENT AS
‘MV-IN-PERSON’.
IF MV01 IS CODED ‘2’ (TELEPHONE CALL), ‘-7’,
(REFUSED), OR ‘-8’ (DON’T KNOW), FLAG EVENT AS
‘MV-TELEPHONE’. (THIS EVENT IS FLAGGED FOR
PURPOSES OF SKIPS IN THE C/P SECTION. HOWEVER
‘-7’ AND ‘-8’ WILL USE THE SAME QUESTION WORDING
AS IN ‘MV-IN-PERSON’ EVENTS DURING THE
ADMINISTRATION OF THE MV SECTION.)
MV02
OMITTED.
MV02A
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
SHOW CARD MV-1.
What kind of place is that -- a managed care plan
center or
HMO, a clinic, a doctor’s office, or some other place?
DOCTOR’S OFFICE OR GROUP PRACTICE ..... 1 {MV03}
MANAGED CARE PLAN CENTER/HMO .......... 3 {MV03}
MEDICAL CLINIC ........................ 2 {MV03}
RURAL HEALTH CLINIC ................... 7 {MV03}
COMPANY CLINIC ........................ 8 {MV03}
SCHOOL CLINIC ......................... 9 {MV03}
OTHER CLINIC .......................... 10 {MV03}
NEIGHBORHOOD/FAMILY HEALTH CENTER ..... 4 {MV03}
COMMUNITY HEALTH CENTER ............... 13 {MV03}
BIRTHING CENTER ....................... 15 {MV03}
WALK-IN URGENT CARE ................... 11 {MV03}
LABORATORY/X-RAY FACILITY ............. 14 {MV03}
LASER EYE SURGERY CENTER .............. 5 {MV03}
OTHER FREESTANDING SURGICAL CENTER .... 6 {MV03}
VA FACILITY
........................... 12 {MV03}
INDIAN HEALTH SERVICE (IHS)
FACILITY .. 16 {MV03}
SOME OTHER PLACE ...................... 91 {MV03}
REF ................................... -7 {MV03}
DK .................................... -8 {MV03}
[Code One]
CODE ‘16’ (IHS FACILITY) WAS INTRODUCED IN PANEL
12 ROUND 3 AND WILL BE INCLUDED IN ALL FUTURE
PANELS AND ROUNDS. ‘16’ WAS NOT AVAILABLE IN
PANEL 12 ROUNDS 1 AND 2.
HARD CHECK:
EDIT: IF CODED ‘15’ BIRTHING CENTER, AND PERSON IS
NOT FEMALE, DISPLAY THE FOLLOWING MESSAGE:
"‘BIRTHING CENTER’ CAN BE SELECTED ONLY IF PERSON
IS FEMALE. VERIFY AND RE-ENTER."
MV03
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
{Did {you/{PERSON}} see a medical doctor during this
particular
visit?/Was this telephone call about {your/{PERSON}’s}
health with a
medical doctor?}
YES .................................... 1 {MV03A}
NO ..................................... 2 {MV04}
REF ................................... -7 {MV04}
DK .................................... -8 {MV04}
HELP AVAILABLE FOR DEFINITION OF MEDICAL DOCTOR.
DISPLAY ‘Did {you/{PERSON}} see a medical doctor
during this particular visit?’ IF MV01 IS CODED
‘1’ (SAW PROVIDER), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW) FOR THIS EVENT.
DISPLAY ‘Was this telephone call about {your/
{PERSON}’s} health with a medical doctor?’ IF MV01
IS CODED ‘2’ (TELEPHONE CALL) FOR THIS EVENT.
MV03A
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
What was the doctor’s specialty?
IF TALKED TO MORE THAN ONE DOCTOR, PROBE FOR MAIN
PROVIDER.
ALLERGY/IMMUNOLOGY .................... 1 {BOX_01}
ANESTHESIOLOGY ........................ 2 {BOX_01}
CARDIOLOGY (HEART) .................... 3 {BOX_01}
DERMATOLOGY (SKIN) .................... 4 {BOX_01}
ENDOCRINOLOGY/METABOLISM
(DIABETES, THYROID) ................. 5 {BOX_01}
FAMILY PRACTICE ....................... 6 {BOX_01}
GASTROENTEROLOGY ...................... 7 {BOX_01}
GENERAL PRACTICE ...................... 8 {BOX_01}
GENERAL SURGERY ....................... 9 {BOX_01}
GERIATRICS (ELDERLY) .................. 10 {BOX_01}
GYNECOLOGY/OBSTETRICS ................. 11 {BOX_01}
HEMATOLOGY (BLOOD) .................... 12 {BOX_01}
HOSPITAL RESIDENCE .................... 13 {BOX_01}
INTERNAL MEDICINE
(INTERNIST) ......................... 14 {BOX_01}
NEPHROLOGY (KIDNEYS) .................. 15 {BOX_01}
NEUROLOGY ............................. 16 {BOX_01}
NUCLEAR MEDICINE ...................... 17 {BOX_01}
ONCOLOGY (TUMORS, CANCER) ............. 18 {BOX_01}
OPHTHALMOLOGY (EYES) .................. 19 {BOX_01}
ORTHOPEDICS ........................... 20 {BOX_01}
OSTEOPATHY (DO) ....................... 21 {BOX_01}
OTORHINOLARYNGOLOGY
(EAR, NOSE, THROAT) ................. 22 {BOX_01}
PATHOLOGY ............................. 23 {BOX_01}
PEDIATRICIAN .......................... 24 {BOX_01}
PHYSICAL MEDICINE/REHAB ............... 25 {BOX_01}
PLASTIC SURGERY ....................... 26 {BOX_01}
PROCTOLOGY ............................ 27 {BOX_01}
PSYCHIATRY/PSYCHIATRIST................ 28 {BOX_01}
PULMONARY ............................. 29 {BOX_01}
RADIOLOGY ............................. 30 {BOX_01}
RHEUMATOLOGY (ARTHRITIS) .............. 31 {BOX_01}
THORACIC SURGERY (CHEST) .............. 32 {BOX_01}
UROLOGY ............................... 33 {BOX_01}
OTHER DR SPECIALTY .................... 91 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}
[Code One]
MV04
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
What type of medical person did {you/{PERSON}} talk to
on {VISIT
DATE}?
IF TALKED TO MORE THAN ONE MEDICAL PERSON, PROBE FOR
MAIN
PROVIDER.
CHIROPRACTOR .......................... 1 {BOX_01}
DENTIST/DENTAL CARE PERSON ............ 2 {BOX_01}
MIDWIFE ............................... 3 {BOX_01}
NURSE/NURSE PRACTITIONER .............. 4 {BOX_01}
OPTOMETRIST ........................... 5 {BOX_01}
PODIATRIST ............................ 6 {BOX_01}
PHYSICIAN’S ASSISTANT ................. 7 {BOX_01}
PHYSICAL THERAPIST .................... 8 {BOX_01}
OCCUPATIONAL THERAPIST ................ 9 {BOX_01}
PSYCHOLOGIST .......................... 10 {BOX_01}
SOCIAL WORKER ......................... 11 {BOX_01}
TECHNICIAN ............................ 12 {BOX_01}
RECEPTIONIST, CLERK, SECRETARY ........ 13 {BOX_01}
ACUPUNCTURIST ......................... 14 {BOX_01}
MASSAGE THERAPIST ..................... 15 {BOX_01}
HOMEOPATHIC/NATUROPATHIC/HERBALIST .... 16 {BOX_01}
OTHER ALTERNATIVE/COMPLEMENTARY
CARE PROVIDER ....................... 17 {BOX_01}
OTHER ................................. 91 {BOX_01}
REF ................................... -7 {BOX_01}
DK .................................... -8 {BOX_01}
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
MV05
OMITTED.
BOX_01
IF MV01 IS CODED ‘1’ (SAW PROVIDER) AND MV03 IS
CODED ‘1’ (YES), GO TO MV07
IF MV01 IS CODED ‘2’ (TELEPHONE CALL), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW) AND MV03 IS CODED
‘1’ (YES), GO TO MV08
OTHERWISE, CONTINUE WITH MV06
MV06
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
TYPE OF PERSON HAD CONTACT: {MEDICAL PERSON TYPE FROM
MV04}
CODE WITHOUT ASKING IF OBVIOUS. OTHERWISE, ASK:
Do any medical doctors work at {the same location as
{PROVIDER}/{PROVIDER}}?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF MEDICAL DOCTOR.
DISPLAY ‘the same location as {PROVIDER}’ IF
PROVIDER IS FLAGGED AS ‘PERSON-TYPE-PROVIDER’.
DISPLAY ‘{PROVIDER}’ IF PROVIDER IS FLAGGED AS
‘FACILITY-PROVIDER’.
FOR ‘MEDICAL PERSON TYPE FROM MV04’, DISPLAY THE
FOLLOWING TEXT FOR EACH CODE SELECTED AT MV04:
CODE ‘1’ = CHIROPRACTOR
CODE ‘2’ = DENTIST/DENTAL CARE PERSON
CODE ‘3’ = MIDWIFE
CODE ‘4’ = NURSE/NURSE PRACTITIONER
CODE ‘5’ = OPTOMETRIST
CODE ‘6’ = PODIATRIST
CODE ‘7’ = PHYSICIAN’S ASSISTANT
CODE ‘8’ = PHYSICAL THERAPIST
CODE ‘9’ = OCCUPATIONAL THERAPIST
CODE ‘10’= PSYCHOLOGIST
CODE ‘11’= SOCIAL WORKER
CODE ‘12’= TECHNICIAN
CODE ‘13’= RECEPTIONIST/CLERK/SECRETARY
CODE ‘14’= ACUPUNCTURIST
CODE ‘15’= MASSAGE THERAPIST
CODE ‘16’= HOMEOPATHIC/NATUROPATHIC/HERBALIST
CODE ‘17’= OTHER ALTERNATIVE/COMPLEMENTARY
CARE PROVIDER
CODE ‘91’= OTHER
CODE ‘-7’= REFUSED PROVIDER TYPE
CODE ‘-8’= DON’T KNOW PROVIDER TYPE
IF MV01 IS CODED ‘2’ (TELEPHONE CALL), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW), GO TO MV08
OTHERWISE, CONTINUE WITH MV07
MV07
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
SHOW CARD MV-2.
Please look at this card and tell me which category best
describes the care {you/{PERSON}} received during the
visit to
{PROVIDER} on {VISIT DATE}.
GENERAL CHECKUP ........................ 1 {MV08}
DIAGNOSIS OR TREATMENT ................. 2 {MV08}
EMERGENCY (E.G., ACCIDENT OR INJURY) ... 3 {MV08}
PSYCHOTHERAPY OR MENTAL HEALTH
COUNSELING ............................. 4 {MV08}
FOLLOW-UP OR POST-OPERATIVE VISIT ...... 5 {MV08}
IMMUNIZATIONS OR SHOTS ................. 6 {MV08}
VISION EXAM ............................ 7 {MV08}
PREGNANCY-RELATED (INCLUDING PRENATAL
CARE AND DELIVERY) ................... 8 {MV08}
WELL CHILD EXAM ........................ 9 {MV08}
LASER EYE SURGERY ..................... 10 {MV08}
OTHER ................................. 91 {MV08}
REF ................................... -7 {MV08}
DK .................................... -8 {MV08}
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
HARD CHECK:
EDITS: IF MV07 IS CODED ‘8’ (PREGNANCY-RELATED
(INCLUDING PRENATAL CARE AND
DELIVERY)), CHECK
THAT PERSON IS FEMALE. IF NOT, DISPLAY THE
FOLLOWING MESSAGE: "CODE UNAVAILABLE FOR MALES.
VERIFY AND RE-ENTER."
IF MV07 IS CODED ‘9’ (WELL CHILD EXAM), CHECK THAT
PERSON IS < 7 YEARS OLD (OR AGE CATEGORIES 1
THROUGH 3). IF NOT, DISPLAY THE FOLLOWING
MESSAGE: "CODE UNAVAILABLE FOR PERSONS 7 AND
OLDER. VERIFY AND RE-ENTER."
MV08
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
Was this {visit/telephone call} related to any
specific health
condition or were any conditions discovered during
this {visit/
telephone call}?
YES .................................... 1 {MV09}
NO ..................................... 2 {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
DISPLAY ‘visit’ IF MV01 IS CODED ‘1’ (SAW
PROVIDER), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW)
FOR THIS EVENT. DISPLAY ‘telephone call’ IF MV01
IS CODED ‘2’(TELEPHONE CALL) FOR THIS EVENT.
MV09
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
What conditions were discovered or led {you/{PERSON}}
to make this
{visit/telephone call}?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON
ROSTER.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
DISPLAY ‘visit’ IF MV01 IS CODED ‘1’ (SAW
PROVIDER), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW)
FOR THIS EVENT. DISPLAY ‘telephone call’ IF MV01
IS CODED ‘2’(TELEPHONE CALL) FOR THIS EVENT.
DISPLAY ‘ADD CONDITION’ AS AN OPTION ON THIS
SCREEN.
GO TO BOX_02
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: MEDICAL CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION
(COND.CONDNAM)
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR
SELECTION AND ADDITION OF ONE OR MANY MEDICAL
CONDITION(S) ASSOCIATED WITH THIS EVENT.
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. MULTIPLE ADD ALLOWED.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE
A CONDITION ADDED ON THIS SCREEN AS LONG AS
CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS
CONDITION AND THE EVENT.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A
CONDITION NAME NEWLY ADDED ON THIS SCREEN AS
LONG AS CAPI HAS NOT YET CREATED THE LINK
BETWEEN THIS CONDITION AND THE EVENT.
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON’S ROSTER; NO
FILTER.
BOX_02
IF MV01 IS CODED ‘2’ (TELEPHONE CALL), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW), GO TO MV14
IF MV01 IS CODED ‘1’ (SAW PROVIDER), CONTINUE WITH
BOX_03
BOX_03
IF MV04 IS CODED ‘2’ (DENTIST/DENTAL CARE PERSON),
‘3’ (MIDWIFE), ‘5’ (OPTOMETRIST), OR ‘13’
(RECEPTIONIST, CLERK, SECRETARY), GO TO MV11
OTHERWISE, CONTINUE WITH MV10
MV10
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
SHOW CARD MV-3.
Looking at this card, which of these treatments,
if any, did
{you/{PERSON}} receive during this visit?
CHECK ALL THAT APPLY.
PHYSICAL THERAPY ....................... 1 {MV11}
OCCUPATIONAL THERAPY ................... 2 {MV11}
SPEECH THERAPY ......................... 3 {MV11}
CHEMOTHERAPY ........................... 4 {MV11}
RADIATION THERAPY ...................... 5 {MV11}
KIDNEY DIALYSIS ........................ 6 {MV11}
IV THERAPY ............................. 7 {MV11}
DRUG OR ALCOHOL TREATMENT .............. 8 {MV11}
ALLERGY SHOT ........................... 9 {MV11}
PSYCHOTHERAPY/COUNSELING .............. 10 {MV11}
SHOTS, OTHER THAN ALLERGY ............. 11 {MV11}
NO TREATMENTS RECEIVED ................ 95 {MV11}
REF ................................... -7 {MV11}
DK .................................... -8 {MV11}
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
ALLOW CODE ‘95’ (NO TREATMENTS RECEIVED), ‘-7’
(REFUSED), AND ‘-8’ (DON’T KNOW) ALONE ONLY.
THESE RESPONSES MAY NOT BE SELECTED WITH ANY OTHER
RESPONSE.
‘NO TREATMENTS RECEIVED’ IS NOT DISPLAYED ON SHOW
CARD.
HARD CHECK:
EDIT: IF CODED ‘95’ (NO TREATMENTS RECEIVED),
NO OTHER TREATMENT CATEGORIES CAN BE CODED. IF
INTERVIEWER SELECTS ANOTHER CODE WITH ‘NO
TREATMENTS’ DISPLAY THE FOLLOWING MESSAGE: "NO
TREATMENTS RECEIVED CANNOT BE SELECTED WITH OTHER
OPTIONS. VERIFY AND RE-ENTER."
MV11
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
SHOW CARD MV-4.
Looking at this card, which of these services, if
any, did
{you/{PERSON}} have during this visit?
CHECK ALL THAT APPLY.
LABORATORY TESTS ....................... 1 {MV12}
SONOGRAM OR ULTRASOUND ................. 2 {MV12}
X-RAYS ................................. 3 {MV12}
MAMMOGRAM .............................. 4 {MV12}
MRI OR CATSCAN ......................... 5 {MV12}
EKG OR ECG ............................. 6 {MV12}
EEG .................................... 7 {MV12}
VACCINATION ............................ 8 {MV12}
ANESTHESIA ............................. 9 {MV12}
OTHER DIAGNOSTIC TEST ................. 10 {MV12}
THROAT SWAB ........................... 11 {MV12}
NO SERVICES RECEIVED .................. 95 {MV12}
REF ................................... -7 {MV12}
DK .................................... -8 {MV12}
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
ALLOW CODE ‘4’ (MAMMOGRAM) ONLY IF PERSON IS
FEMALE AND AGE IS > 17 YEARS (OR AGE CATEGORIES 4
THROUGH 9).
ALLOW CODE ‘95’ (NO SERVICES RECEIVED), ‘-7’
(REFUSED), AND ‘-8’ (DON’T KNOW) ALONE ONLY.
THESE RESPONSES MAY NOT BE SELECTED WITH ANY OTHER
RESPONSE.
‘NO SERVICES RECEIVED’ IS NOT DISPLAYED ON SHOW
CARD.
HARD CHECK:
EDIT: IF CODED ‘95’ (NO SERVICES RECEIVED),
NO OTHER TREATMENT CATEGORIES CAN BE CODED. IF
INTERVIEWER SELECTS ANOTHER CODE WITH ‘NO
SERVICES’ DISPLAY THE FOLLOWING MESSAGE: "NO
SERVICES RECEIVED CANNOT BE SELECTED WITH OTHER
OPTIONS. VERIFY AND RE-ENTER."
NOTE: CODE ‘11’ (THROAT SWAB) IS DISPLAYED ON
THE SCREEN AND ON THE SHOW CARD BETWEEN CODES
‘1’ (LABORATORY TESTS) AND ‘2’ (SONOGRAM OR
ULTRASOUND).
MV12
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
Was a surgical procedure performed on {you/{PERSON}}
during this
visit?
YES .................................... 1 {MV14}
NO ..................................... 2 {MV14}
REF ................................... -7 {MV14}
DK .................................... -8 {MV14}
HELP AVAILABLE FOR DEFINITION OF SURGICAL PROCEDURE.
MV13
OMITTED.
MV14
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
During this {visit/telephone call}, were any medicines
prescribed for {you/{PERSON}}? Please include only
prescriptions
which were filled.
YES .................................... 1 {MV15}
NO ..................................... 2 {BOX_04}
REF ................................... -7 {BOX_04}
DK .................................... -8 {BOX_04}
HELP AVAILABLE FOR DEFINITION OF PRESCRIBED MEDICINE.
DISPLAY ‘visit’ IF MV01 IS CODED ‘1’ (SAW
PROVIDER), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW)
FOR THIS EVENT. DISPLAY ‘telephone call’ IF MV01
IS CODED ‘2’(TELEPHONE CALL) FOR THIS EVENT.
MV15
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
Please tell me the names of the prescriptions from
this {visit/
telephone call} that were filled.
PROBE: Any other prescribed medicines from this
{visit/telephone
call} that were filled?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
DISPLAY ‘ADD MEDICINE’ AS AN OPTION ON THIS
SCREEN.
DISPLAY ‘visit’ IF MV01 IS CODED ‘1’ (SAW
PROVIDER), ‘-7’ (REFUSED), OR ‘-8’ (DON’T KNOW)
FOR THIS EVENT. DISPLAY ‘telephone call’ IF MV01
IS CODED ‘2’ (TELEPHONE CALL) FOR THIS EVENT.
GO TO BOX_04
ROSTER DETAILS:
TITLE: PERSON'S_PRESCRIBED_MEDICINES_1
COL # 1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE
(DRUG.DRUGNAME)
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-PRESCRIPTION-
MEDICINES-ROSTER FOR SELECTION.
ROSTER BEHAVIOR:
1. MULTIPLE SELECT AND ADD ALLOWED.
2. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE
A PMED ADDED ON THIS SCREEN AS LONG AS CAPI HAS
NOT YET CREATED THE LINK BETWEEN THIS PMED AND
THE EVENT.
3. EDIT DISALLOWED.
ROSTER FILTER:
DISPLAY ALL MEDICINES IN PERSON’S ROSTER; NO
FILTER.
BOX_04
IF MV01 IS CODED ‘1’ (SAW PROVIDER), CONTINUE
WITH BOX_05
IF MV01 IS CODED ‘2’ (TELEPHONE CALL), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW), GO TO BOX_07
BOX_05
IF NO CONDITION IS ASSOCIATED WITH THIS VISIT TO
THIS PROVIDER FOR THIS PERSON, GO TO BOX_07
OTHERWISE, CONTINUE WITH BOX_06
BOX_06
IF 2 OR MORE VISITS TO THIS PROVIDER FOR THIS
PERSON HAVE NOT COMPLETED THE MEDICAL PROVIDER
VISITS UTILIZATION MODULE AND IF THIS EVENT IS NOT
PART OF A FLAT FEE GROUP, CONTINUE WITH MV16
OTHERWISE, GO TO BOX_07
MV16
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
Earlier I recorded that {you/{PERSON}} had some other
visits to
{PROVIDER}. Were any of these visits related to any
condition
associated with {your/his/her} visit on {VISIT DATE}?
That is,
were any of the other visits for the (READ CONDITIONS
BELOW)
and did {you/{PERSON}} receive {(READ SERVICES
BELOW)/the same
services}?
CONDITIONS SERVICES
{PERSON’S MV MEDICAL CONDITION} {SERVICES RECEIVED}
{PERSON’S MV MEDICAL CONDITION} {SERVICES RECEIVED}
{PERSON’S MV MEDICAL CONDITION} {SERVICES RECEIVED}
YES .................................... 1 {MV17}
NO ..................................... 2 {BOX_07}
REF ................................... -7 {BOX_07}
DK .................................... -8 {BOX_07}
HELP AVAILABLE FOR DEFINITION OF REPEAT VISITS.
DISPLAY ‘(READ SERVICES BELOW)’ IF MV11 IS NOT
CODED ‘95’ (NO SERVICES RECEIVED), ‘-7’ (REFUSED),
OR ‘-8’ (DON’T KNOW). IF MV11 IS CODED ‘95’ (NO
SERVICES RECEIVED), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), DISPLAY ‘the same services’.
FOR ‘PERSON’S MV MEDICAL CONDITION’, DISPLAY ALL
CONDITIONS SELECTED FROM OR ADDED TO PERSON’S-
MEDICAL-CONDITIONS-ROSTER AT MV09.
FOR ‘SERVICES RECEIVED’, DISPLAY THE FOLLOWING
TEXT FOR EACH SERVICE SELECTED AT MV11:
CODE ‘1’ = LABORATORY TESTS
CODE ‘2’ = SONOGRAM/ULTRASOUND
CODE ‘3’ = X-RAYS
CODE ‘4’ = MAMMOGRAM
CODE ‘5’ = MRI/CATSCAN
CODE ‘6’ = EKG/ECG
CODE ‘7’ = EEG
CODE ‘8’ = VACCINATION
CODE ‘9’ = ANESTHESIA
CODE ‘10’ = OTHER SERVICES
CODE ‘11’ = THROAT SWAB
MV17
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
Did any of these visits or calls cost the same amount
as
{your/{PERSON}’s} visit on {VISIT DATE}?
YES .................................... 1 {MV18}
NO ..................................... 2 {BOX_07}
REF ................................... -7 {BOX_07}
DK .................................... -8 {BOX_07}
HELP AVAILABLE FOR DEFINITION OF COST THE SAME AMOUNT.
NOTE: THE ISSUES OF COST WHEN THE PERSON HAS A
COPAY AND DOES NOT KNOW THE TOTAL CHARGE WILL BE
HANDLED IN THE HELP DEFINITION.
MV18
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
Which of the following visits were related to the
(READ
CONDITIONS BELOW) {and (READ SERVICES BELOW)/and the
same services}
and cost the same amount as the {VISIT DATE} visit
we’ve just
talked about?
PROBE: Any other visits related to this condition and
cost
the same amount?
CONDITIONS SERVICES
{PERSON’S MV MEDICAL CONDITION} {SERVICES RECEIVED}
{PERSON’S MV MEDICAL CONDITION} {SERVICES RECEIVED}
{PERSON’S MV MEDICAL CONDITION} {SERVICES RECEIVED}
[1. Month,Day,Year-4]
[2. Month,Day,Year-4]
[3. Month,Day,Year-4]
DISPLAY ‘and (READ SERVICES BELOW)’ IF MV11 IS NOT
CODED ‘95’ (NO SERVICES RECEIVED), ‘-7’ (REFUSED),
OR ‘-8’ (DON’T KNOW). IF MV11 IS CODED ‘95’ (NO
SERVICES RECEIVED), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), DISPLAY ‘and the same services’.
FOR ‘PERSON’S MV MEDICAL CONDITION’, DISPLAY ALL
CONDITIONS SELECTED OR ADDED TO PERSON’S-MEDICAL-
CONDITIONS-ROSTER AT MV09.
FOR ‘SERVICES RECEIVED’, DISPLAY THE FOLLOWING
TEXT FOR EACH SERVICE SELECTED AT MV11:
CODE ‘1’ = LABORATORY TESTS
CODE ‘2’ = SONOGRAM/ULTRASOUND
CODE ‘3’ = X-RAYS
CODE ‘4’ = MAMMOGRAM
CODE ‘5’ = MRI/CATSCAN
CODE ‘6’ = EKG/ECG
CODE ‘7’ = EEG
CODE ‘8’ = VACCINATION
CODE ‘9’ = ANESTHESIA
CODE ‘10’ = OTHER SERVICES
CODE ‘11’ = ‘THROAT SWAB’
FLAG EACH VISIT SELECTED AT MV18 AS A REPEAT VISIT
RELATED TO THE EVENT BEING ASKED ABOUT.
FLAG THE CHARGE PAYMENT (CP) STATUS OF EACH REPEAT
VISIT AS ‘PROCESSED’.
LINK CONDITION(S) AND SERVICE(S) ASSOCIATED WITH
THE EVENT BEING ASKED ABOUT WITH EACH REPEAT
VISIT.
THE EVENT DRIVER WILL NOT SERVE THESE REPEAT
VISITS FOR THE MV SECTION.
GO TO MV19
ROSTER DETAILS:
TITLE: PERS_EVNT_1
COL # 1 HEADER: MONTH/DAY/YEAR
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE
(EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)
ROSTER DEFINITION:
THIS ITEM DISPLAYS ALL MEDICAL EVENTS (DATES) ON
PERSON’S MEDICAL-EVENTS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER:
DISPLAY ONLY THOSE EVENTS WITH THE FOLLOWING
CHARACTERISTICS.
1. EVENT WAS CREATED THIS ROUND.
2. EVENT HAS NOT BEEN PROCESSED IN UTILIZATION.
3. EVENT HAS EVENT TYPE ‘MV’.
4. EVENT IS ASSOCIATED WITH THE SAME PROVIDER AS
THE EVENT BEING ASKED ABOUT.
MV19
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER} {EVN-DT}
INTERVIEWER: RECORD ‘NAME OF REPEAT VISIT GROUP’ FOR
EVENTS
SELECTED IN PREVIOUS QUESTION:
[Enter Repeat Visit Group] ............ {BOX_07}
BOX_07
IF THE CHARGE/PAYMENT (CP) SECTION IS NOT
COMPLETED FOR THIS MEDICAL PROVIDER VISIT (MV)
EVENT, GO TO THE CHARGE/PAYMENT (CP) SECTION
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION
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