Accident/Injury & Conditions (CN) Section
BOX_00 ======
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| CONTEXT HEADER DISPLAY INSTRUCTIONS: |
| DISPLAY PERS.FULLNAME, COND.CONDNAM, PRND.BEGREFMM,|
| PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, |
| PRND.ENDREFDD, PRND.ENDREFYY |
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BOX_01 ======
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| IF AT LEAST ONE CONDITION ON PERSON’S-MEDICAL- |
| CONDITIONS-ROSTER MEETS THE FOLLOWING CONDITIONS: |
| |
| - CONDITION IS FLAGGED AS ‘CREATED’ DURING THE |
| CURRENT ROUND |
| - CONDITION IS NOT A PRIORITY CONDITION, THAT IS, |
| IT IS NOT FLAGGED AS CREATED IN THE PE SECTION |
| - CONDITION IS NOT FLAGGED AS ‘UNLIKELY ACCIDENT/ |
| INJURY’ (THIS FLAG WILL BE DETERMINED LATER AS |
| IT MAY BE SET FOR CERTAIN CONDITIONS THAT ARE |
| PART OF A CONDITION LOOK-UP TABLE AND ARE |
| DETERMINED TO BE UNLIKLY DUE TO AN ACCIDENT OR |
| INJURY) |
| |
| CONTINUE WITH CN01 |
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| OTHERWISE, GO TO BOX_12 |
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BOX_02
======
OMITTED.
CN01 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
Now I’m going to read you a list of some of the health conditions
that were reported for (PERSON) between (START DATE) and (END DATE).
READ CONDITIONS ABOVE.
Were any of these health conditions due to an accident or injury?
YES .................................... 1 {CN01A}
NO ..................................... 2 {BOX_12}
REF ................................... -7 {BOX_12}
DK .................................... -8 {BOX_12}
HELP AVAILABLE FOR DEFINITION OF ACCIDENT/INJURY.
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| THE THIRD CRITERION FOR DISPLAY IN THE ROSTER WILL |
| BE DETERMINED LATER AS THE FLAG MAY BE SET FOR |
| CERTAIN CONDITIONS THAT ARE PART OF A CONDITION |
| LOOK-UP TABLE AND ARE DETERMINED TO BE UNLIKLY DUE |
| TO AN ACCIDENT/INJURY. |
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----------------------------------------------------
| ROSTER DETAILS: |
| Title: PERS_COND_1 |
| |
| COL #1 HEADER: CONDITION |
| INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION |
| (COND.CONDNAM) |
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| ROSTER DEFINITION: |
| THIS ITEM DISPLAYS THE PERSON’S-CONDITIONS- |
| ROSTER. |
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| ROSTER BEHAVIOR: |
| 1. DISPLAY ONLY. |
| 2. ADD, DELETE, SELECT, AND EDIT DISALLOWED. |
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| ROSTER FILTER: |
| DISPLAY ONLY THE CONDITIONS FOR PERSON THAT ARE |
| |
| - CREATED THIS ROUND |
| - NOT FLAGGED AS PRIORITY CONDITIONS (THAT IS, |
| THOSE NOT FLAGGED AS CREATED IN THE PE SECTION) |
| - NOT FLAGGED AS ‘UNLIKELY ACCIDENT/INJURY’ |
| |
| THE CONDITIONS ARE LISTED FOR DISPLAY ONLY; THEY |
| ARE NOT SELECTABLE. |
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CN01A =====
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
Which of (PERSON)’s health conditions were due to an accident
or injury?
PROBE: Any other health conditions due to an accident or injury?
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
HELP AVAILABLE FOR DEFINITION OF ACCIDENT/INJURY.
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| FLAG ALL CONDITIONS SELECTED AT CN01A AS ‘DUE TO |
| ACCIDENT/INJURY’. |
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| THE THIRD CRITERION FOR DISPLAY IN THE ROSTER WILL |
| BE DETERMINED LATER AS THE FLAG MAY BE SET FOR |
| CERTAIN CONDITIONS THAT ARE PART OF A CONDITION |
| LOOK-UP TABLE AND ARE DETERMINED TO BE UNLIKLY DUE |
| TO AN ACCIDENT/INJURY. |
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| CONTINUE WITH BOX_03 |
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| ROSTER DETAILS: |
| Title: PERS_COND_1 |
| |
| COL #1 HEADER: CONDITION |
| INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION |
| (COND.CONDNAM) |
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| ROSTER DEFINITION: |
| DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR |
| SELECTION. |
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| ROSTER BEHAVIOR: |
| 1. MULTIPLE SELECT ALLOWED. |
| 2. ADD, EDIT, AND DELETE DISALLOWED. |
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| ROSTER FILTER: |
| DISPLAY CONDITIONS THAT MEET THE FOLLOWING: |
| |
| 1. CONDITION IS FLAGGED AS ‘CREATED’ DURING THE |
| CURRENT ROUND. |
| 2. CONDITION IS NOT A PRIORITY CONDITION, THAT IS,|
| THE CONDITION IS NOT FLAGGED AS CREATED IN THE PE |
| SECTION. |
| 3. CONDITION IS NOT FLAGGED AS ‘UNLIKELY |
| ACCIDENT/INJURY’. |
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CN02
====
OMITTED.
BOX_03 ======
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| IF ANY CONDITIONS FLAGGED AS ‘DUE TO ACCIDENT/ |
| INJURY’, CONTINUE WITH LOOP_01 |
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| OTHERWISE, GO TO BOX_12 |
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LOOP_01 =======
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| FOR EACH ELEMENT IN PERSON’S-MEDICAL-CONDITIONS- |
| ROSTER, ASK CN06-END_LP01 |
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| LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION |
| ABOUT MEDICAL CONDITIONS CREATED DURING THE |
| CURRENT ROUND THAT ARE DUE TO AN ACCIDENT OR |
| INJURY. THIS LOOP CYCLES ON MEDICAL CONDITIONS |
| THAT MEET THE FOLLOWING CONDITIONS: |
| |
| - MEDICAL CONDITION IS FLAGGED AS ‘DUE TO AN |
| ACCIDENT OR INJURY’ (CONDITION SELECTED AT |
| CN01A) |
| - MEDICAL CONDITION IS FLAGGED AS ‘CREATED’ |
| DURING THE CURRENT ROUND |
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BOX_04
======
OMITTED.
CN03
====
OMITTED.
CN04
====
OMITTED.
CN05
====
OMITTED.
CN05OV1
=======
OMITTED.
CN05OV2
=======
OMITTED.
CN06 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {PERSON'S CN MEDICAL
CONDITION.} {STR-DT}
{END-DT}
Let’s talk about (CONDITION).
When did the accident or injury happen?
{PROBE IF ANY EVENTS LISTED: The dates we have recorded for
the medical care for (CONDITION) include (READ EVENT DATES
BELOW).}
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
| CN06_01. PROVIDER | ROSTER. EVENT DATE | CN06_03. EVENT TYPE |
|---|---|---|
| 1. Medical Provider-35 | [Display Month Day Year-4] |
[Display Event Code] |
| 2. Medical Provider-35 | [Display Month Day Year-4] |
[Display Event Code] |
| 3. Medical Provider-35 | [Display Month Day Year-4] |
[Display Event Code] |
[Enter Year-4] .........................
REF ................................... -7 {CN06A}
DK .................................... -8 {CN06A}
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| IF THERE ARE NO EVENTS CREATED THIS ROUND RELATED |
| TO THE CONDITION BEING ASKED ABOUT, DO NOT DISPLAY|
| THE PROBE AND DISPLAY THE MESSAGE ‘THE EVENT |
| ROSTER IS EMPTY’. OTHERWISE, DISPLAY THE PROBE AND|
| EVENTS ROSTER. |
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| IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS |
| 1, CONTINUE WITH CN06OV1 |
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| OTHERWISE, GO TO BOX_05 |
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| HARD CHECK: |
| EDIT: THE COMPLETE DATE CANNOT BE BEFORE THE |
| PERSON’S DATE OF BIRTH OR AFTER THE CURRENT |
| REFERENCE PERIOD END DATE FOR THIS PERSON. |
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| ROSTER DETAILS: |
| Title: PERS_EVNT_2 |
| |
| COL #1 HEADER: PROVIDER |
| INSTRUCTIONS: DISPLAY MEDICAL PROVIDER |
| (EVPV.LORPNAME, EVPV.DRFNAM, EVPV.DRMNAM) |
| |
| COL #2 HEADER: EVENT DATE |
| INSTRUCTIONS: DISPLAY EVENT DATE |
| (EVPV.EVNTBEGM, EVPV.EVNTBEGD, EVPV.EVNTBEGY) |
| |
| COL #3 HEADER: EVENT TYPE |
| INSTRUCTIONS: DISPLAY EVENT CODE (EVPV.EVNTTYPE) |
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| ROSTER DEFINITION: |
| DISPLAY THE PERSON-MEDICAL-EVENTS-ROSTER FOR |
| DISPLAY AS THE SECOND COLUMN. INCLUDE THE PROVIDER|
| AS THE FIRST COLUMN AND THE EVENT TYPE AS THE |
| THIRD COLUMN. |
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| ROSTER BEHAVIOR: |
| 1. DISPLAY ONLY. |
| 2. ADD, DELETE, SELECT, AND EDIT DISALLOWED. |
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| ROSTER FILTER: |
| DISPLAY EVENTS CREATED THIS ROUND THAT ARE LINKED |
| TO THE CONDITION BEING ASKED ABOUT EXCEPT PM |
| EVENTS. |
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CN06OV1 =======
MONTH:
[Enter Month-2] ........................
REF ................................... -7 {BOX_05}
DK .................................... -8 {BOX_05}
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| IF YEAR IS REFERENCE YEAR, CONTINUE WITH CN06OV2 |
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| OTHERWISE, GO TO BOX_05 |
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| HARD CHECK: |
| |
| ENTRIES FOR MONTH FIELD MUST CORRESPOND TO |
| CALENDAR MONTHS. THAT IS, ALLOWABLE VALUES = |
| 01 - 12. |
| |
| MISSING VALUES = -7 AND -8 ALLOWED. |
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| EDIT: THE COMPLETE DATE CANNOT BE BEFORE THE |
| PERSON’S DATE OF BIRTH OR AFTER THE CURRENT |
| REFERENCE PERIOD END DATE FOR THIS PERSON. |
----------------------------------------------------
CN06OV2 =======
DAY:
[Enter Day-2] ........................... {BOX_05}
REF ................................... -7 {BOX_05}
DK .................................... -8 {BOX_05}
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| HARD CHECK: |
| |
| ENTRIES FOR DAY FIELD MUST CORRESPOND TO CALENDAR |
| DAYS. THAT IS, |
| - ALLOWABLE VALUES = 01 - 31 IF MONTH CODED |
| ‘01’, ‘03’, ‘05’, ‘07’, ‘08’, ‘10’, ‘12’; |
| - ALLOWABLE VALUES = 01 - 30 IF MONTH CODED |
| ‘04’, ‘06’, ‘09’, ‘11’; |
| - ALLOWABLE VALUES = 01 - 29 IF MONTH CODED |
| ‘02’ AND YEAR IS 1996, 2000, 2004 OR 2008 |
| (LEAP YEAR); |
| - ALLOWABLE VALUES = 01 - 28 IF MONTH CODED |
| ‘02’ AND YEAR IS NOT 1996, 2000, 2004 OR |
| 2008 (I.E., NOT LEAP YEAR). |
| |
| MISSING VALUES = -7 AND -8 ALLOWED. |
----------------------------------------------------
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| EDIT: THE COMPLETE DATE CANNOT BE BEFORE THE |
| PERSON’S DATE OF BIRTH OR AFTER THE CURRENT |
| REFERENCE PERIOD END DATE FOR THIS PERSON. |
----------------------------------------------------
CN06A =====
{PERSON'S FIRST MIDDLE AND LAST NAME} {PERSON'S CN MEDICAL
CONDITION.} {STR-DT}
{END-DT}
Did the (CONDITION) occur before or after January 1, {YEAR}?
BEFORE ................................. 1 {BOX_05}
AFTER .................................. 2 {BOX_05}
REF ................................... -7 {BOX_05}
DK .................................... -8 {BOX_05}
[Code One]
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| (FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES |
| AUTOMATICALLY): IF ROUNDS 1 AND 2, DISPLAY THE |
| FIRST YEAR OF THE PANEL FOR ‘YEAR’. IF ROUNDS 3, |
| 4, AND 5, DISPLAY THE SECOND YEAR OF THE PANEL |
| FOR ‘YEAR’. |
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BOX_05 ======
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| IF PERSON IS = OR > 16 YEARS OF AGE OR IN AGE |
| CATEGORIES 4-9, CONTINUE WITH CN07 |
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| OTHERWISE, GO TO END_LP01 |
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CN07 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {PERSON'S CN MEDICAL
CONDITION.} {STR-DT}
{END-DT}
Did the (CONDITION) happen while (PERSON) (were/was) at
work?
YES .................................... 1 {END_LP01}
NO ..................................... 2 {END_LP01}
DOES NOT WORK .......................... 3 {END_LP01}
REF ................................... -7 {END_LP01}
DK .................................... -8 {END_LP01}
[Code One]
CN08
====
OMITTED.
CN09
====
OMITTED.
CN10
====
OMITTED.
BOX_06
======
OMITTED.
CN11
====
OMITTED.
CN12
====
OMITTED.
CN13
====
OMITTED.
CN13OV
======
OMITTED.
CN14
====
OMITTED.
CN15
====
OMITTED.
END_LP01 ========
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| CYCLE ON NEXT CONDITION IN PERSON’S-MEDICAL- |
| CONDITIONS-ROSTER THAT MEETS THE CONDITIONS STATED|
| IN THE LOOP DEFINITION. |
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| IF NO OTHER CONDITIONS MEET THE STATED CONDITIONS,|
| END LOOP_01 AND CONTINUE WITH BOX_12 |
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BOX_07
======
OMITTED.
BOX_08
======
OMITTED.
LOOP_02
=======
OMITTED.
CN16
====
OMITTED.
CN17
====
OMITTED.
CN18
====
OMITTED.
CN19
====
OMITTED.
CN19OV
======
OMITTED.
END_LP02
========
OMITTED.
BOX_09
======
OMITTED.
BOX_10
======
OMITTED.
BOX_11
======
OMITTED.
CN20
====
OMITTED.
CN21
====
OMITTED.
BOX_12 ======
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| GO TO NEXT QUESTIONNAIRE SECTION |
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