Provider Probes (PP) Section

BOX_00

CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PRND.BEGREFMM,DD,YY AND
PRND.ENDREFMM,DD,YY.

BOX_01A

THE PROVIDER PROBES (PP) SECTION (INCLUDING THE
EVENT ROSTER (EV) AND PROVIDER ROSTER (PV)
SECTIONS WHICH ARE CALLED IN THE COURSE OF PP)
COLLECTS THE INFORMATION REQUIRED TO CREATE AN
EVENT. THIS INFORMATION INCLUDES THE EVENT TYPE,
PERSON, PROVIDER, AND DATE OR DATE RANGE. ONCE
THE EV SECTION IS COMPLETED FOR AN EVENT, THE
INTERVIEWER CANNOT BACK UP TO EDIT THAT EVENT OR
ANY OTHER EVENTS THAT WERE CREATED PREVIOUSLY.
HOWEVER, EVENTS CAN BE EDITED IN THE EVENT DRIVER
(ED) SECTION OF THE QUESTIONNAIRE.

BOX_01

IF DISCHARGE DATE CODED '95' (STILL IN HOSPITAL)
FOR ANY HOSPITAL STAY (HS) EVENT REPORTED IN
PREVIOUS ROUND FOR ANY RU MEMBER, CONTINUE WITH
LOOP_01

OTHERWISE, GO TO BOX_02

LOOP_01

FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
PP01 - END_LP01

LOOP DEFINITION: LOOP_01 COLLECTS THE DISCHARGE
DATE OF A HOSPITAL STAY FOR ANY PERSON STILL IN
THE HOSPITAL AT THE END OF THE PREVIOUS ROUND.
THIS LOOP CYCLES ON PERSONS THAT MEET BOTH OF THE
FOLLOWING CONDITIONS:
- PERSON HAD AN HS EVENT DURING THE PREVIOUS ROUND
AND
- ONE OF PERSON’S HS EVENTS HAD A DISCHARGE DATE
CODED ‘95’ (STILL IN HOSPITAL).

PP01

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}

Last time, we recorded that {you/{PERSON}} entered {PROVIDER} on
{ADMIT DATE} and {were/was} still in the hospital at the time of
our interview on {PREV RD INTV DT}.

On what date {were/was} {you/he/she} discharged from {PROVIDER}?

IF STILL IN HOSPITAL {OR RELEASED IN {YEAR}, SELECT EVENT AND
CONTINUE INTERVIEW.

PP01_01.ADMIT DATE PP01_02.DISCHARGE DATE
{Display Month,Day,Year-4} [Enter Month,Day,Year-4]
{Display Month,Day,Year-4} [Enter Month,Day,Year-4]
{Display Month,Day,Year-4} [Enter Month,Day,Year-4]
DISPLAY THE DATE OF THE PREVIOUS ROUND’S INTERVIEW
FOR ‘{PREV RD INTV DT}’.
DISPLAY ‘OR RELEASED IN {YEAR}’ IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.

(FOR SPECIFICATION PURPOSES ONLY, YEAR IN PROGRAM
IS AUTOMATICALLY SET): DISPLAY THE YEAR SUBSEQUENT
TO THE SECOND CALENDAR YEAR OF THE PANEL.

GO TO END_LP01

ROSTER DETAILS:
Title: PERS_EVNT_EDIT_1

COL #1 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE
(EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)

COL #2 HEADER: DISCHARGE DATE
INSTRUCTIONS: ENTER EVENT END DATE
(EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY)

ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON’S-MEDICAL-EVENTS-ROSTER
FOR ENTERING THE DISCHARGE DATE FOR ALL OPEN-ENDED
HOSPITAL STAYS.

ROSTER BEHAVIOR:
1. SELECT, ADD, AND DELETE DISALLOWED.

2. LIMITED EDIT ALLOWED. ADMIT DATE IS A PROTECTED
FIELD. INTERVIEWER CAN UPDATE DISCHARGE DATE.

ROSTER FILTER:
DISPLAYS ALL HS EVENTS THAT WERE CODED ‘95’ (STILL
IN HOSPITAL) IN THE PREVIOUS ROUND.

END_LP01

CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER
WHO MEETS THE CONDITIONS STATED IN THE LOOP
DEFINITION.

IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_01 AND CONTINUE WITH BOX_02

BOX_02

IF DISCHARGE DATE CODED '95' (STILL IN
INSTITUTION) FOR ANY INSTITUTIONAL STAY (IC) EVENT
REPORTED IN PREVIOUS ROUND FOR ANY RU MEMBER,
CONTINUE WITH LOOP_02

OTHERWISE, GO TO BOX_03

LOOP_02

FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK
PP02 - END_LP02

LOOP DEFINITION: LOOP_02 COLLECTS THE DISCHARGE
DATE OF AN INSTITUTIONAL STAY FOR ANY PERSON STILL
IN THE INSTITUTION AT THE END OF THE PREVIOUS
ROUND. THIS LOOP CYCLES ON PERSONS THAT MEET THE
FOLLOWING CONDITIONS:
- PERSON HAD AT LEAST ONE IC EVENT DURING THE
PREVIOUS ROUND
AND
- ONE OF PERSON’S IC EVENTS HAD A DISCHARGE DATE
CODED ‘95’ (STILL IN INSTITUTION).

PP02

{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}

Last time we recorded that {you/{PERSON}} entered {PROVIDER} on
{ADMIT DATE} and {were/was} still there at the time of our interview
on {PREV RD INTV DT}.

On what date {were/was} {you/he/she} discharged from {PROVIDER}?

IF STILL IN AN INSTITUTION OR LONG-TERM CARE FACILITY, {OR
RELEASED IN {YEAR}, SELECT EVENT AND CONTINUE INTERVIEW.

PP02_01.ADMIT DATE PP02_02.DISCHARGE DATE
{Display Month,Day,Year-4} [Enter Month,Day,Year-4]
{Display Month,Day,Year-4} [Enter Month,Day,Year-4]
{Display Month,Day,Year-4} [Enter Month,Day,Year-4]
DISPLAY THE DATE OF THE PREVIOUS ROUND’S INTERVIEW
FOR ‘{PREV RD INTV DT}’.
DISPLAY ‘OR RELEASED IN {YEAR}’ IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.

(FOR SPECIFICATION PURPOSES ONLY, YEAR IN PROGRAM
IS AUTOMATICALLY SET): DISPLAY THE YEAR SUBSEQUENT
TO THE SECOND CALENDAR YEAR OF THE PANEL.

GO TO END_LP02

ROSTER DETAILS:
Title: PERS_EVNT_EDIT_2

COL #1 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE
(EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)

COL #2 HEADER: DISCHARGE DATE
INSTRUCTIONS: ENTER EVENT END DATE
(EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY)

ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON’S-MEDICAL-EVENTS-ROSTER
FOR ENTERING THE DISCHARGE DATE FOR ALL OPEN-ENDED
STAYS IN INSTITUTIONS.

ROSTER BEHAVIOR:
1. SELECT, ADD, AND DELETE DISALLOWED.

2. LIMITED EDIT ALLOWED. ADMIT DATE IS A PROTECTED
FIELD. INTERVIEWER CAN UPDATE DISCHARGE DATE.

ROSTER FILTER:
DISPLAYS ALL IC EVENTS THAT WERE CODED ‘95’ (STILL
IN INSTITUTION) IN THE PREVIOUS ROUND.

END_LP02

CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER
WHO MEETS THE CONDITIONS STATED IN THE LOOP
DEFINITION.

IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_02 AND CONTINUE WITH BOX_03

BOX_03

IF ROUND 1 AND IF CA03 IS CODED ‘5’ (VOLUNTEERED
NO EVENTS TO RECORD), GO TO PP14

IF ROUNDS 2-5 AND CA03 IS CODED ‘5’, GO TO PP03A

IF CA03 IS CODED ‘3’ (SOME VISITS RECORDED), ‘4’
(DID NOT USE), ‘-7’ (REFUSED), ‘-8’ (DON’T KNOW),
OR IS NOT ASKED (CALENDAR NEVER USED), GO TO PP14

OTHERWISE, CONTINUE WITH LOOP_03

LOOP_03

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_04 - END_LP03

LOOP DEFINITION: LOOP_03 ASKS THE EVENT ROSTER
(EV) SECTION FOR EACH EVENT RECORDED ON THE
CALENDAR. THE RESPONSE TO PP03 DETERMINES WHETHER
THE LOOP CYCLES AGAIN. IF PP03 IS CODED ‘1’
(YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT.
IF PP03 IS CODED ‘2’ (NO) OR ‘3’ (NO EVENTS ON
CALENDAR TO RECORD), THE LOOP ENDS.

BOX_04

IF FIRST CYCLE OF LOOP_03, GO TO PP03

OTHERWISE, CONTINUE WITH BOX_05

BOX_05

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP03

PP03

INTERVIEWER: ADD (AN/ANOTHER) EVENT?

YES .................................... 1 {END_LP03)
NO ..................................... 2 {END_LP03)

END_LP03

IF PP03 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP03 IS CODED ‘2’ (NO), END LOOP_03 AND
CONTINUE WITH PP03A

PP03A

{STR-DT}
{END-DT}

Next, I am going to show you several lists of health care providers
to be sure we haven’t missed any visits or phone calls, including those
made just for advice, prescriptions, tests, shots, or x-rays.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

PP04

{STR-DT}
{END-DT}

SHOW CARD PP-1.

{Since {START DATE}/Between {START DATE} and {END DATE}}, has
anyone in the family seen or spoken with a medical or mental
health professional, dentist, or other health care provider
listed on this card [other than what we have already talked about]?

YES .................................... 1 {LOOP_04}
NO ..................................... 2 {PP06}
REF ................................... -7 {PP06}
DK .................................... -8 {PP06}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_04

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_06 - END_LP04

LOOP DEFINITION: LOOP_04 COLLECTS ALL DENTAL (DN)
AND MEDICAL PROVIDER VISIT (MV) EVENTS NOT ALREADY
RECORDED.

THE RESPONSE TO PP05 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP05 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP05 IS
CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_06

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP05

PP05

{STR-DT}
{END-DT}

SHOW CARD PP-1.

{Have/Has} {you/{PERSON’S FIRST MIDDLE AND LAST NAME}} had any other
visits or calls to health care providers listed on this card? Or has
anyone else in the family visited or called a health care provider
listed here? [Please include any visits or calls we have not yet
talked about.]

YES .................................... 1 {END_LP04}
NO ..................................... 2 {END_LP04}
REF ................................... -7 {END_LP04}
DK .................................... -8 {END_LP04}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.

END_LP04

IF PP05 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP05 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_04 AND CONTINUE WITH PP06

PP06

{STR-DT}
{END-DT}

SHOW CARD PP-2. READ ALL THREE PROBES BELOW.

{Since {START DATE}/Between {START DATE} and {END DATE}}, has anyone
in the family received any type of care...

... in a hospital?
... in a hospital emergency room?
... in a hospital outpatient department?

[Please include any hospital care we have not yet talked about.]

CODE ‘YES’ IF R SAYS ‘YES’ TO ANY PROBE ABOVE.

YES .................................... 1 {LOOP_05}
NO ..................................... 2 {PP07A}
REF ................................... -7 {PP07A}
DK .................................... -8 {PP07A}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}}’
IF ROUND 5.

LOOP_05

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_07 - END_LP05.

LOOP DEFINITION: LOOP_05 COLLECTS ALL HOSPITAL-
BASED AND INSTITUTIONAL STAY EVENTS (I.E., HS,
ER, OP, AND IC EVENTS) NOT ALREADY RECORDED.

THE RESPONSE TO PP07 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP07 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07 IS
CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_07

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP07

PP07

{STR-DT}
{END-DT}

SHOW CARD PP-2. READ ALL THREE PROBES BELOW.

{Have/Has} {you/{PERSON’S FIRST MIDDLE AND LAST NAME}} or has anyone
in the family received any (other) type of care...

... in a hospital?
... in a hospital emergency room?
... in a hospital outpatient department?

[Please include any hospital care we have not yet talked about.]

CODE ‘YES’ IF R SAYS ‘YES’ TO ANY PROBE ABOVE.

YES .................................... 1 {END_LP05}
NO ..................................... 2 {END_LP05}
REF ................................... -7 {END_LP05}
DK .................................... -8 {END_LP05}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.

END_LP05

IF PP07 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP07 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_05 AND CONTINUE WITH PP07A

PP07A

{STR-DT}
{END-DT}

{Since {START DATE}/Between {START DATE} and {END DATE}},
has anyone in the family had any visits to an independent
lab or testing facility for x-rays or other tests? [Please
include any care we have not yet talked about.]

YES .................................... 1 {LOOP_05A}
NO ..................................... 2 {PP07B}
REF ................................... -7 {PP07B}
DK .................................... -8 {PP07B}

HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR TESTING FACILITY.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_05A

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_07A - END_LP05A.

LOOP DEFINITION: LOOP_05A COLLECTS ALL LAB EVENTS
(I.E., OP, OR MV EVENTS) NOT ALREADY RECORDED.

THE RESPONSE TO PP07AA DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP07AA IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07AA
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_07A

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP07AA

PP07AA

{STR-DT}
{END-DT}

{Have/Has} {you/{PERSON’S FIRST MIDDLE AND LAST NAME}} had any other
visits to an independent lab or testing facility? Or has anyone else
in the family been seen at an independent lab or testing facility?
[Please include any care we have not yet talked about.]

YES .................................... 1 {END_LP05A}
NO ..................................... 2 {END_LP05A}
REF ................................... -7 {END_LP05A}
DK .................................... -8 {END_LP05A}

HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR TESTING FACILITY.

DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.

END_LP05A

IF PP07AA IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.

IF PP07AA IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_05A AND CONTINUE WITH
PP07B

PP07B

{STR-DT}
{END-DT}

{Since {START DATE}/Between {START DATE} and {END DATE}},
has anyone in the family had any visits to someone who
practices alternative care such as acupuncture, massage
therapy, hypnosis, or other treatments? [Please include any
alternative care we have not yet talked about.]

YES .................................... 1 {LOOP_05B}
NO ..................................... 2 {PP08}
REF ................................... -7 {PP08}
DK .................................... -8 {PP08}

HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE PROVIDER.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_05B

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_07B - END_LP05B.

LOOP DEFINITION: LOOP_05B COLLECTS ALL
ALTERNATIVE CARE EVENTS (I.E., MV EVENTS) NOT
ALREADY RECORDED.

THE RESPONSE TO PP07BB DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP07BB IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07BB
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_07B

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP07BB

PP07BB

{STR-DT}
{END-DT}

{Have/Has} {you/{PERSON’S FIRST MIDDLE AND LAST NAME}} had any other
visits to someone who practices alternative care? Or has anyone else
in the family been seen by someone who practices alternative care?
[Please include any alternative care we have not yet talked about.]

YES .................................... 1 {END_LP05B}
NO ..................................... 2 {END_LP05B}
REF ................................... -7 {END_LP05B}
DK .................................... -8 {END_LP05B}

HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE PROVIDER.

DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.

END_LP05B

IF PP07BB IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.

IF PP07BB IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_05B AND CONTINUE WITH
PP08

PP08

{STR-DT}
{END-DT}

SHOW CARD PP-3.

What about visits to the home because of a health problem for
any of these services {between {START DATE} and {END DATE}}?
[Please include any home care services we have not yet talked
about.]

YES .................................... 1 {LOOP_06}
NO ..................................... 2 {PP10}
REF ................................... -7 {PP10}
DK .................................... -8 {PP10}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘between {START DATE} and {END DATE}’ IF
ROUND 5. OTHERWISE, USE A NULL DISPLAY.

LOOP_06

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_08 - END_LP06.

LOOP DEFINITION: LOOP_06 COLLECTS ALL HOME
HEALTH (HH) EVENTS NOT ALREADY RECORDED.

THE RESPONSE TO PP09 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP09 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP09
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_08

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP09

PP09

{STR-DT}
{END-DT}

SHOW CARD PP-3.

Because of a health problem, {have/has} {you/{PERSON’S FIRST MIDDLE AND
LAST NAME}} received any other home care services? Or has anyone
else in the family received home care services such as those
listed on this card? [Please include any home care services we
have not yet talked about.]

YES .................................... 1 {END_LP06}
NO ..................................... 2 {END_LP06}
REF ................................... -7 {END_LP06}
DK .................................... -8 {END_LP06}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.

END_LP06

IF PP09 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP09 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_06 AND CONTINUE WITH PP10

PP10

{STR-DT}
{END-DT}

SHOW CARD PP-3A.

{Since {START DATE}/Between {START DATE} and {END DATE}}, has anyone in
the family received health care in a place like those listed on this
card, where they stayed overnight?

IF NECESSARY, SAY: Do not include assisted living or other permanent
residences.

YES .................................... 1 {LOOP_06A}
NO ..................................... 2 {PP12}
REF ................................... -7 {PP12}
DK .................................... -8 {PP12}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF ROUNDS 1-4.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

SOFT ERROR:
IF CODED ‘2’ (NO) AND IF RE35A CODED ‘1’ (100 DAYS
OR LESS) AND NO HOSPITAL STAY (HS) EVENTS HAVE
BEEN RECORDED, DISPLAY THE FOLLOWING MESSAGE:
"SOMEONE IN RU WAS RECORDED AS BEING
INSTITUTIONALIZED FOR 100 DAYS OR LESS IN THE
REENUMERATION SECTION. PLEASE RECORD ANY REMAINING
LONG TERM HEALTH CARE EVENTS."

SOFT ERROR:
IF CODED ‘2’ (NO) AND IF RE35A CODED ‘-7’
(REFUSED) OR ‘-8’ (DON’T KNOW) AND NO HOSPITAL
STAY (HS) EVENTS HAVE BEEN RECORDED, DISPLAY THE
FOLLOWING MESSAGE: "SOMEONE IN RU WAS RECORDED AS
BEING INSTITUTIONALIZED FOR A PERIOD OF TIME IN
THE REENUMERATION SECTION. PLEASE RECORD ANY
REMAINING LONG TERM HEALTH CARE EVENTS."

LOOP_06A

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_08A - END_LP06A.

LOOP DEFINITION: LOOP_06A COLLECTS ALL LONG TERM
CARE FACILITY EVENTS NOT ALREADY RECORDED.

THE RESPONSE TO PP11 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP11 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP11
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_08A

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP11

PP11

{STR-DT}
{END-DT}

SHOW CARD PP-3A.

{Have/Has} {you/{PERSON’S FIRST MIDDLE AND LAST NAME}} received any
other health care where {you/he/she} stayed overnight? Or has anyone
in the family received health care in a place like those listed on this
card where they stayed overnight? [Please include any health care we
have not yet talked about.]

YES .................................... 1 {END_LP06A}
NO ..................................... 2 {END_LP06A}
REF ................................... -7 {END_LP06A}
DK .................................... -8 {END_LP06A}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.

END_LP06A

IF PP11 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP11 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_06A AND CONTINUE WITH PP12

PP12

{STR-DT}
{END-DT}

SHOW CARD PP-4.

{And finally, did/Did/Between {START DATE} and {END DATE}, did}
anyone in the family obtain eyeglasses, contact lenses, or diabetic
equipment or supplies {since {START DATE}} [other than what we have
already talked about]?

YES .................................... 1 {LOOP_07}
NO ..................................... 2 {BOX_09A}
REF ................................... -7 {BOX_09A}
DK .................................... -8 {BOX_09A}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘And finally, did’ IF ROUNDS 1, 2, OR 4.
DISPLAY ‘Did’ IF ROUND 3. DISPLAY ‘Between {START
DATE} and {END DATE}, did’ IF ROUND 5.

DISPLAY ‘since {START DATE}’ IF NOT ROUND 5.
OTHERWISE, USE A NULL DISPLAY.

LOOP_07

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_09 - END_LP07.

LOOP DEFINITION: LOOP_07 COLLECTS ALL OTHER
MEDICAL EXPENSE (OM) EVENTS NOT ALREADY RECORDED.

THE RESPONSE TO PP13 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP13 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP13
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_09

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP13

PP13

{STR-DT}
{END-DT}

SHOW CARD PP-4.

Has anyone else in the family obtained eyeglasses, contact
lenses, or diabetic equipment or supplies [other than what we
have already talked about]?

YES .................................... 1 {END_LP07}
NO ..................................... 2 {END_LP07}
REF ................................... -7 {END_LP07}
DK .................................... -8 {END_LP07}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

END_LP07

IF PP13 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP13 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_07 AND CONTINUE WITH
BOX_09A

BOX_09A

IF ROUND 3 OR ROUND 5, CONTINUE WITH PP13A

OTHERWISE, GO TO BOX_10

PP13A

JAN 01 DEC 31

SHOW CARD PP-5.

Now I would like you to think about the entire calendar year
{YEAR}, that is from January 1, {YEAR} until December 31, {YEAR}.

During {YEAR}, did anyone in the family have expenses for any of
the types of things listed on this card?

PROBE: These could include ambulance services, canes,
wheelchairs, corrective shoes, hearing aids or amplifiers for a
telephone, artificial limbs, raised toilet seats, a
modification to the house or a car because of some illness or
injury, for example ramps or handrails, etc.

YES .................................... 1 {LOOP_07A}
NO ..................................... 2 {BOX_10}
REF ................................... -7 {BOX_10}
DK .................................... -8 {BOX_10}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN
PROGRAM IS AUTOMATICALLY SET.)

IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR
‘YEAR’.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR
‘YEAR’.

LOOP_07A

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_09B - END_LP07A.

LOOP DEFINITION: LOOP_07A COLLECTS ALL OTHER
TYPES OF MEDICAL EXPENSE (OM) EVENTS FOR THE
CALENDAR YEAR. IF ROUND 3, THE YEAR IS THE FIRST
CALENDAR YEAR OF THE PANEL. IF ROUND 5, THE YEAR
IS THE SECOND CALENDAR YEAR OF THE PANEL NOT
ALREADY RECORDED.

THE RESPONSE TO PP13B DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP13B IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP13B
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_09B

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP13B

PP13B

JAN 01 DEC 31

SHOW CARD PP-5.

During the calendar year {YEAR}, has anyone else in the family
obtained, purchased, or rented any of the types of other
medical expenses listed on this card [other than what we have
already talked about]?

YES .................................... 1 {END_LP07A}
NO ..................................... 2 {END_LP07A}
REF ................................... -7 {END_LP07A}
DK .................................... -8 {END_LP07A}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN
PROGRAM IS AUTOMATICALLY SET.)

IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR
‘YEAR’.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR
‘YEAR’.

END_LP07A

IF PP13B IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.

IF PP13B IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_07A AND CONTINUE WITH
BOX_10

BOX_10

GO TO BOX_18

PP14

{STR-DT}
{END-DT}

These next questions ask about medical and dental care each family
member received {since {START DATE}/between {START DATE} and {END
DATE}}. You can use your calendar, electronic records, checkbook,
or receipts to help you remember. We are interested in any type
of visit or phone call, including those made just for advice,
prescriptions, tests, shots, or x-rays.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

DISPLAY ‘since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_08

FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK
PP15 - END_LP08.

LOOP DEFINITION: LOOP_08 COLLECTS ALL EVENTS FOR
EACH RU MEMBER WHEN THE CALENDAR IS INCOMPLETE OR
WAS NOT USED. THIS LOOP CYCLES ON ALL ELIGIBLE
RU MEMBERS INCLUDING PERSONS WHO WERE DECEASED OR
INSTITUTIONALIZED AFTER THE REFERENCE PERIOD START
DATE.

PP15

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-6.

Now think about the health care {you/{PERSON}} {have/has} received
{since {START DATE}/between {START DATE} and {END DATE}}.

{Since {START DATE}/Between {START DATE} and {END DATE}}, did
{you/he/she} see or talk to any type of dental care provider, such
as the types listed on this card, for dental care or a dental
check-up?

YES .................................... 1 {LOOP_09}
NO ..................................... 2 {PP17}
REF ................................... -7 {PP17}
DK .................................... -8 {PP17}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘since {START DATE}’ AND ‘Since {START
DATE}’ IF NOT ROUND 5. DISPLAY ‘between {START
DATE} and {END DATE}’ AND ‘Between {START DATE}
and {END DATE}’ IF ROUND 5.

LOOP_09

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_11- END_LP09.

LOOP DEFINITION: LOOP_09 COLLECTS ALL DENTAL (DN)
EVENTS NOT ALREADY RECORDED FOR PERSON BEING
ASKED ABOUT.

THE RESPONSE TO PP16 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP16 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP16
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_11

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP16

PP16

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-6.

{Since {START DATE}/Between {START DATE} and {END DATE}}, did
{you/{PERSON}} see or talk to any other type of dental care provider,
such as the types listed on this card (other than what you’ve
already told me about)?

YES .................................... 1 {END_LP09}
NO ..................................... 2 {END_LP09}
REF ................................... -7 {END_LP09}
DK .................................... -8 {END_LP09}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

END_LP09

IF PP16 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP16 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_09 AND CONTINUE WITH PP17

PP17

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-7.

{Since {START DATE}/Between {START DATE} and {END DATE}}, did
{you/{PERSON}} see or talk to any medical doctor or nurse, such as
those types listed on this card? (Please include telephone
calls or visits where {you/he/she} received advice, prescriptions,
or test results.)

YES .................................... 1 {LOOP_10}
NO ..................................... 2 {PP19}
REF ................................... -7 {PP19}
DK .................................... -8 {PP19}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_10

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_12 - END_LP10.

LOOP DEFINITION: LOOP_10 COLLECTS ALL MEDICAL
PROVIDER VISIT (MV) EVENTS NOT ALREADY RECORDED
FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP18 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP18 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP18
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_12

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP18

PP18

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-7.

{Since {START DATE}/Between {START DATE} and {END DATE}}, did
{you/{PERSON}} see or talk to any other type of medical professional,
such as the types listed on this card (other than what you’ve
already told me about)?

YES .................................... 1 {END_LP10}
NO ..................................... 2 {END_LP10}
REF ................................... -7 {END_LP10}
DK .................................... -8 {END_LP10}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

END_LP10

IF PP18 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP18 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_10 AND CONTINUE WITH PP19

PP19

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-8. READ ALL THREE PROBES BELOW.

{Since {START DATE}/Between {START DATE} and {END DATE}}, did
{you/PERSON}} receive any type of care...

... in a hospital?
... in a hospital emergency room?
... in a hospital outpatient department?

CODE ‘YES’ IF R SAYS ‘YES’ TO ANY PROBE ABOVE.

YES .................................... 1 {LOOP_11}
NO ..................................... 2 {PP21}
REF ................................... -7 {PP21}
DK .................................... -8 {PP21}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_11

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_13 - END_LP11.

LOOP DEFINITION: LOOP_11 COLLECTS ALL HOSPITAL-
BASED EVENTS (I.E., HS, ER, AND OP EVENTS) NOT
ALREADY RECORDED FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP20 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP20 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP20
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_13

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP20

PP20

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-8. READ ALL THREE PROBES BELOW.

[Other than what you’ve already told me about,] {since {START
DATE}/between {START DATE} and {END DATE}}, did {you/{PERSON}}
receive any other type of care ...

... in a hospital?
... in a hospital emergency room?
... in a hospital outpatient department?

CODE ‘YES’ IF R SAYS ‘YES’ TO ANY PROBE ABOVE.

YES .................................... 1 {END_LP11}
NO ..................................... 2 {END_LP11}
REF ................................... -7 {END_LP11}
DK .................................... -8 {END_LP11}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

END_LP11

IF PP20 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP20 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_11 AND CONTINUE WITH PP21

PP21

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-9.

{Since {START DATE}/Between {START DATE} and {END DATE}}, did
{you/{PERSON}} see or talk to any of the health care providers listed
on this card?

YES .................................... 1 {LOOP_12}
NO ..................................... 2 {PP22A}
REF ................................... -7 {PP22A}
DK .................................... -8 {PP22A}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_12

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_14 - END_LP12.

LOOP DEFINITION: LOOP_12 COLLECTS ALL MEDICAL
PROVIDER VISIT (MV) EVENTS NOT ALREADY RECORDED
FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP22 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP22 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_14

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP22

PP22

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-9.

{Since {START DATE}/Between {START DATE} and {END DATE}}, did
{you/{PERSON}} see or talk to any other type of health care provider,
such as the types listed on this card (other than what you’ve
already told me about)?

YES .................................... 1 {END_LP12}
NO ..................................... 2 {END_LP12}
REF ................................... -7 {END_LP12}
DK .................................... -8 {END_LP12}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

END_LP12

IF PP22 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP22 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_12 AND CONTINUE WITH PP22A

PP22A

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

{Since {START DATE}/Between {START DATE} and {END DATE}},
did {you/{PERSON}} have any visits to an independent lab or
testing facility for x-rays or other tests?

YES .................................... 1 {LOOP_12A}
NO ..................................... 2 {PP22B}
REF ................................... -7 {PP22B}
DK .................................... -8 {PP22B}

HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR TESTING FACILITY.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_12A

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_14A - END_LP12A.

LOOP DEFINITION: LOOP_12A COLLECTS ALL LAB EVENTS
(I.E., OP, OR MV EVENTS) NOT ALREADY RECORDED.

THE RESPONSE TO PP22AA DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP22AA IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22AA
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_14A

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP22AA

PP22AA

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

Since {START DATE}/Between {START DATE} and {END DATE}},
did {you/(PERSON}} have any other visits to an independent lab
or testing facility (other than what you’ve already told
me about)?

YES .................................... 1 {END_LP12A}
NO ..................................... 2 {END_LP12A}
REF ................................... -7 {END_LP12A}
DK .................................... -8 {END_LP12A}

HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR TESTING FACILITY.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

END_LP12A

IF PP22AA IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.

IF PP22AA IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_12A AND CONTINUE WITH
PP22B

PP22B

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

{Since {START DATE}/Between {START DATE} and {END DATE}},
did {you/{PERSON}} have any visits to someone who practices
alternative care such as acupuncture, massage therapy,
hypnosis, or other treatments?

YES .................................... 1 {LOOP_12B}
NO ..................................... 2 {PP23}
REF ................................... -7 {PP23}
DK .................................... -8 {PP23}

HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE PROVIDER.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_12B

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_14B - END_LP12B.

LOOP DEFINITION: LOOP_12B COLLECTS ALL
ALTERNATIVE CARE EVENTS (I.E., MV EVENTS) NOT
ALREADY RECORDED.

THE RESPONSE TO PP22BB DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP22BB IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22BB
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_14B

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP22BB

PP22BB

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

{Since {START DATE}/Between {START DATE} and {END DATE}},
did {you/{PERSON}} have any other visits to someone who practices
alternative care (other than what you’ve already told me
about)?

YES .................................... 1 {END_LP12B}
NO ..................................... 2 {END_LP12B}
REF ................................... -7 {END_LP12B}
DK .................................... -8 {END_LP12B}

HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE PROVIDER.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

END_LP12B

IF PP22BB IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.

IF PP22BB IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_12B AND CONTINUE WITH
PP23

PP23

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-10

{Since {START DATE}/Between {START DATE} and {END DATE}},
because of a health problem, did {you/{PERSON}} receive any home care
services such as the types listed on this card? Please include
home care services received for medical care, personal care,
supervision, and household help.

YES .................................... 1 {LOOP_13}
NO ..................................... 2 {PP25}
REF ................................... -7 {PP25}
DK .................................... -8 {PP25}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_13

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_15 - END_LP13.

LOOP DEFINITION: LOOP_13 COLLECTS ALL HOME
HEALTH (HH) EVENTS NOT ALREADY RECORDED FOR PERSON
BEING ASKED ABOUT.

THE RESPONSE TO PP24 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP24 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP24
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_15

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP24

PP24

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-10.

{Since {START DATE}/Between {START DATE} and {END DATE}},
because of a health problem, did {you/{PERSON}} receive home care
services such as the types listed on this card (other than what
you’ve already told me about)?

YES .................................... 1 {END_LP13}
NO ..................................... 2 {END_LP13}
REF ................................... -7 {END_LP13}
DK .................................... -8 {END_LP13}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

END_LP13

IF PP24 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP24 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_13 AND CONTINUE WITH PP25

PP25

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-11.

{Since {STATE DATE}/Between {START DATE} and {END DATE}}, did
{you/{PERSON}} receive health care in a place like those listed on
this card, where {you/he/she} stayed overnight?

IF NECESSARY, SAY: Do not include assisted living or other permanent
residences.

YES .................................... 1 {LOOP_14}
NO ..................................... 2 {PP27}
REF ................................... -7 {PP27}
DK .................................... -8 {PP27}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

SOFT ERROR:
IF CODED ‘2’ (NO) AND IF RE35A CODED ‘1’ (100 DAYS
OR LESS) FOR {PERSON} AND NO HOSPITAL STAY (HS)
EVENTS HAVE BEEN RECORDED FOR {PERSON}, DISPLAY
THE FOLLOWING MESSAGE: "{PERSON} WAS RECORDED AS
AS BEING INSTITUTIONALIZED FOR 100 DAYS OR LESS
IN THE REENUMERATION SECTION. PLEASE RECORD ANY
REMAINING LONG TERM HEALTH CARE EVENTS FOR
{PERSON}."

SOFT ERROR:
IF CODED ‘2’ (NO) AND IF RE35A CODED ‘-7’
(REFUSED) OR ‘-8’ (DON’T KNOW) FOR {PERSON} AND NO
HOSPITAL STAY (HS) EVENTS HAVE BEEN RECORDED FOR
{PERSON}, DISPLAY THE FOLLOWING MESSAGE: "{PERSON}
WAS RECORDED AS BEING INSTITUTIONALIZED FOR
FOR A PERIOD OF TIME IN THE REENUMERATION SECTION.
PLEASE RECORD ANY REMAINING LONG TERM HEALTH CARE
EVENTS FOR {PERSON}."

LOOP_14

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_16 - END_LP14.

LOOP DEFINITION: LOOP_14 COLLECTS ALL
INSTITUTIONAL (IC) EVENTS NOT ALREADY RECORDED FOR
PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP26 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP26 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP26
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_16

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP26

PP26

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-11.

(Other than what you’ve already told me about,){since {START
DATE}/between {START DATE} and {END DATE}}, did {you/{PERSON}}
receive any other health care in a place like those listed on
this card, where {you/he/she} stayed overnight?

YES .................................... 1 {END_LP14}
NO ..................................... 2 {END_LP14}
REF ................................... -7 {END_LP14}
DK .................................... -8 {END_LP14}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘between {START DATE} and {END DATE}’ IF
ROUND 5.

END_LP14

IF PP26 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP26 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_14 AND CONTINUE WITH PP27

PP27

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-12.

{Since {START DATE}/Between {START DATE} and {END DATE}}, did
{you/{PERSON}} obtain eyeglasses, contact lenses, or diabetic equipment
or supplies?

YES .................................... 1 {LOOP_15}
NO ..................................... 2 {BOX_17A}
REF ................................... -7 {BOX_17A}
DK .................................... -8 {BOX_17A}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

LOOP_15

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_17 - END_LP15.

LOOP DEFINITION: LOOP_15 COLLECTS ALL OTHER
MEDICAL EXPENSE (OM) EVENTS NOT ALREADY RECORDED
FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP28 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP28 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP28
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_17

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP28

PP28

{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}

SHOW CARD PP-12.

{Since {START DATE}/Between {START DATE} and {END DATE}}, did
{you/{PERSON}} obtain any other medical supplies listed on this card
(other than what you’ve already told me about)?

YES .................................... 1 {END_LP15}
NO ..................................... 2 {END_LP15}
REF ................................... -7 {END_LP15}
DK .................................... -8 {END_LP15}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.

END_LP15

IF PP28 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP28 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_15 AND CONTINUE WITH
BOX_17A

BOX_17A

IF ROUND 3 OR ROUND 5, CONTINUE WITH PP29

OTHERWISE, GO TO END_LP08

PP29

{PERSON’S FIRST MIDDLE AND LAST NAME} JAN 01 DEC 31

SHOW CARD PP-13.

Now I would like you to think about the entire calendar year
{YEAR}, that is from January 1, {YEAR} until December 31, {YEAR}.

During {YEAR}, did {you/{PERSON}} have expenses for any of the types of
things listed on this card?

PROBE: These could include ambulance services, canes,
wheelchairs, corrective shoes, hearing aids or amplifiers for a
telephone, artificial limbs, raised toilet seats, a
modification to the house or a car because of some illness or
injury, for example ramps or handrails, etc.

YES .................................... 1 {LOOP_16}
NO ..................................... 2 {END_LP08}
REF ................................... -7 {END_LP08}
DK .................................... -8 {END_LP08}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN
PROGRAM IS AUTOMATICALLY SET.)

IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR
‘YEAR’.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR
‘YEAR’.

LOOP_16

For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_17B - END_LP16.

LOOP DEFINITION: LOOP_16 COLLECTS ALL OTHER
TYPES OF MEDICAL EXPENSE (OM) EVENTS THAT ARE NOT
ALREADY RECORDED FOR THE CALENDAR YEAR. IF ROUND
3, THE YEAR IS THE FIRST CALENDAR YEAR OF THE
PANEL. IF ROUND 5, THE YEAR IS THE SECOND CALENDAR
YEAR OF THE PANEL.

THE RESPONSE TO PP30 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP30 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP30
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.

BOX_17B

ASK THE EVENT ROSTER (EV) SECTION

AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP30

PP30

{PERSON’S FIRST MIDDLE AND LAST NAME} JAN 01 DEC 31

SHOW CARD PP-13.

During the calendar year {YEAR}, {have/has} {you/{PERSON}} obtained,
purchased, or rented any of the types of other medical expenses
listed on this card (other than what we have already talked
about)?

YES .................................... 1 {END_LP16}
NO ..................................... 2 {END_LP16}
REF ................................... -7 {END_LP16}
DK .................................... -8 {END_LP16}

HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN
PROGRAM IS AUTOMATICALLY SET.)

IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR
‘YEAR’.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR
‘YEAR’.

END_LP16

IF PP30 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.

IF PP30 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_16 AND CONTINUE WITH
END_LP08

END_LP08

CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER
WHO MEETS THE CONDITIONS STATED IN THE LOOP
DEFINITION.

IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_08 AND CONTINUE WITH BOX_18

BOX_18

GO TO NEXT QUESTIONNAIRE SECTION.

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