Hospital Stay (HS) Section
BOX_01
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| IF HOSPITAL STAY DISCHARGE DATE IS ‘95’ (STILL IN |
| HOSPITAL) [OR IF ROUND 5, CODE ‘95’ INDICATES |
| ‘STILL IN HOSPITAL’ AND ‘RELEASED IN 2009’], DO |
| NOT ASK THE HOSPITAL STAY (HS) SECTION OR THE |
| CHARGE/PAYMENT (CP) SECTION FOR THIS EVENT. |
| (WE WILL FOLLOW UP WITH THESE EVENTS NEXT ROUND. |
| IF ROUND 5, WE WILL OBTAIN NECESSARY INFORMATION |
| DURING MPS FOLLOW-UP.) |
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| IF THE MONTH OR DAY OR YEAR FOR THE HOSPITAL STAY |
| ADMIT DATE OR DISCHARGE DATE IS ‘-7’ (REFUSED) OR |
| ‘-8’ (DON’T KNOW), CONTINUE WITH HS01 |
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| OTHERWISE, GO TO HS02 |
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HS01
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
How many nights did (PERSON) stay in (PROVIDER)?
[Enter Number of Nights] ............... {HS02}
REF ................................... -7 {HS02}
DK .................................... -8 {HS02}
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| SOFT RANGE CHECK: 1 TO 30. |
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HS02
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
Did this hospital stay begin with a visit to an emergency room?
YES .................................... 1 {HS03}
NO ..................................... 2 {HS03}
REF ................................... -7 {HS03}
DK .................................... -8 {HS03}
HELP AVAILABLE FOR DEFINITION OF EMERGENCY ROOM.
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| IF CODED ‘1’ (YES), DISPLAY THE FOLLOWING |
| MESSAGE: “PLEASE BE SURE YOU HAVE ENTERED THIS |
| EMERGENCY ROOM VISIT FOR THIS PERSON.” |
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HS03
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
Was this hospital stay related to any specific health condition
or were any conditions discovered during this hospital stay?
YES .................................... 1 {HS04}
NO ..................................... 2 {HS05}
REF ................................... -7 {HS05}
DK .................................... -8 {HS05}
HS04
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
What conditions were discovered or led (PERSON) to enter the
hospital?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
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| DISPLAY ‘ADD CONDITION’ AS AN OPTION ON THIS |
| SCREEN. |
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| ROSTER DETAILS: |
| Title: PERS-COND-1 |
| |
| COL #1 HEADER: MEDICAL CONDITION |
| INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION |
| (COND.CONDNAM) |
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| ROSTER DEFINITION: |
| THIS ITEM DISPLAYS PERSON-MEDICAL-CONDITIONS- |
| ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY |
| MEDICAL CONDITIONS ASSOCIATED WITH THIS EVENT |
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| 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
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----------------------------------------------------
| ROSTER FILTER: |
| DISPLAY ALL CONDITIONS ON PERSON’S ROSTER; |
| DISPLAY ALL. |
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HS05
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
SHOW CARD HS-1.
Please look at this card and tell me which category best
describes the reason (PERSON) entered (PROVIDER) on (ADMIT
DATE).
IF NECESSARY, PROBE: What was the main reason (PERSON)
entered (PROVIDER)?
OPERATION OR SURGICAL PROCEDURE ........ 1 {HS08}
TREATMENT OR THERAPY, NOT INCLUDING
SURGERY .............................. 2 {HS06}
DIAGNOSTIC TESTS ONLY .................. 3 {HS06}
GIVE BIRTH TO A BABY - NORMAL OR
CAESAREAN SECTION (MOTHER) ........... 4 {HS06}
TO BE BORN (BABY) ...................... 5 {HS06}
PREGNANCY-RELATED COMPLICATIONS ........ 6 {HS06}
OTHER ................................. 91 {HS06}
REF ................................... -7 {HS06}
DK .................................... -8 {HS06}
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
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| ALLOW CODE ‘4’ (GIVE BIRTH TO A BABY) AND CODE ‘6’|
| (PREGNANCY-RELATED COMPLICATIONS) ONLY IF PERSON |
| IS FEMALE. ALLOW CODE ‘5’ (TO BE BORN) ONLY IF |
| PERSON IS < OR = 1 YEAR OLD (OR AGE CATEGORY 1). |
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| IF CODED ‘4’ (GIVE BIRTH TO A BABY), DISPLAY THE |
| FOLLOWING MESSAGE: “PLEASE BE SURE YOU HAVE ALSO |
| ENTERED A HOSPITAL STAY EVENT FOR THE BABY.” IF |
| CODED ‘5’ (TO BE BORN), DISPLAY THE FOLLOWING |
| MESSAGE: “PLEASE BE SURE YOU HAVE ALSO ENTERED |
| A HOSPITAL STAY EVENT FOR THE MOTHER.” |
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| IF HS05 IS CODED ‘1’ (OPERATION OR SURGICAL |
| PROCEDURE), AUTOMATICALLY CODE HS06 AS ‘1’ (YES) |
| BY CAPI |
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HS06
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
Were any operations or surgical procedures performed on
(PERSON) during this stay?
YES .................................... 1 {BOX_01A}
NO ..................................... 2 {BOX_01A}
REF ................................... -7 {BOX_01A}
DK .................................... -8 {BOX_01A}
HELP AVAILABLE FOR DEFINITION OF OPERATIONS/SURGICAL PROCEDURES.
BOX_01A
=======
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| IF HS05 IS CODED ‘4’ (GIVE BIRTH TO A BABY), |
| CONTINUE WITH HS06A |
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| OTHERWISE, GO TO HS08 |
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HS06A
=====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
What kind of delivery did (PERSON) have? Was it vaginal
delivery or caesarean section?
VAGINAL DELIVERY ....................... 1 {HS06B}
CAESAREAN SECTION ...................... 2 {HS06B}
REF ................................... -7 {HS06B}
DK .................................... -8 {HS06B}
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
HS06B
=====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
Did (PERSON) receive an epidural or a 'spinal' for pain?
YES .................................... 1 {HS08}
NO ..................................... 2 {HS08}
REF ................................... -7 {HS08}
DK .................................... -8 {HS08}
HELP AVAILABLE FOR DEFINITION OF EPIDURAL/SPINAL.
HS07
====
OMITTED.
HS08
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
At the time (PERSON) (were/was) discharged, were any medicines
prescribed for (PERSON)? Please do not include medications
received while (PERSON) (were/was) a patient in the hospital.
YES .................................... 1 {HS09}
NO ..................................... 2 {BOX_04}
REF ................................... -7 {BOX_04}
DK .................................... -8 {BOX_04}
HELP AVAILABLE FOR DEFINITION OF PRESCRIBED MEDICINE.
HS09
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
{DIS-DT}
Please tell me the names of the prescribed medicines from this
stay that were filled.
PROBE: Any other prescribed medicines from this stay that were
filled?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
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| DISPLAY ‘ADD MEDICINE’ AS AN OPTION ON THIS SCREEN|
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| ROSTER DETAILS: |
| TITLE: PERSON'S-PRESCRIBED-MEDICINES_1. |
| |
| COL # 1 HEADER: PRESCRIBED MEDICINE |
| INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE |
| (DRUG.DRUGNAME) |
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| ROSTER DEFINITION: |
| THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES- |
| ROSTER FOR SELECTION AND ADDITION OF PRESCRIBED |
| MEDICINES. |
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| ROSTER BEHAVIOR: |
| 1. MULTIPLE SELECT AND ADD ALLOWED. |
| |
| 2. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE |
| MEDICINES ADDED AT THE SECCTION AS LONG AS CAPI|
| HAS NOT YET CREATED THE LINK BETWEEN THIS |
| MEDICINE AND THE EVENT. |
| |
| 3. EDIT DISALLOWED. |
| |
| 4. ANY MEDICINE ADDED TO THE ROSTER SHOULD BE |
| FLAGGED AS ‘CREATED’ THIS ROUND. ANY MEDICINE |
| SELECTED AT THE ROSTER SHOULD BE FLAGGED AS |
| ‘SELECTED’ THIS ROUND. THIS FLAGGING SHOULD |
| OCCUR AT EACH PERSON’S-PRESCRIBED-MEDICINES- |
| ROSTER THROUGHOUT THE INSTRUMENT (UNLESS |
| OTHERWISE SPECIFIED), THE FIRST TIME THE |
| MEDICINE IS ADDED OR SELECTED DURING THE ROUND.|
| FOR EXAMPLE, IF IT IS ROUND 1, ALL MEDICINES ON|
| THE ROSTER WOULD HAVE THE FLAG ‘CREATED – |
| ROUND 1’. IF A MEDICINE IS CREATED IN HS, BUT |
| SELECTED IN MV, ALL DURING ROUND 1, IT WOULD |
| ONLY HAVE THE FLAG ‘CREATED – ROUND 1’. THUS, |
| FOR ANY ONE ROUND, A MEDICINE CAN BE FLAGGED |
| ONLY AS EITHER ‘CREATED’ OR ‘SELECTED’. IF IT |
| IS ROUND 2 AND A MEDICINE THAT WAS CREATED IN |
| ROUND 1 IS SELECTED, IT SHOULD BE FLAGGED AS |
| ‘SELECTED – ROUND 2’. THIS FLAG IS IN ADDITION |
| TO THE ORIGINAL ‘CREATED – ROUND 1’ FLAG. |
| |
| 5. WHEN A MEDICINE FROM A PREVIOUS ROUND IS |
| SELECTED, A NEW EVENT IS CREATED SINCE IT |
| INVOLVES A NEW PURCHASE OF THE MEDICINE. A NEW |
| PURCHASE REQUIRES ASKING CP AND THE PHARMACY. |
| THE REASON FOR INCLUDING ALL OF THE PRESCRIBED |
| MEDICINES ON THE ROSTER IS SIMPLY TO AVOID THE |
| INTERVIEWER HAVING TO TYPE THEM IN AGAIN (IF |
| THE PERSON IS GETTING REFILLS OF THE SAME |
| MEDICINE EVERY ROUND). |
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| ROSTER FILTER: |
| DISPLAY ALL MEDICINES ON PERSON’S ROSTER; |
| NO FILTER. |
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HS10
====
OMITTED.
HS11
====
OMITTED.
LOOP_01
=======
OMITTED.
BOX_02
======
OMITTED.
BOX_03
======
OMITTED.
HS12
====
OMITTED.
END_LP01
========
OMITTED.
BOX_04
======
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| IF THE CHARGE/PAYMENT (CP) SECTION FOR THIS |
| HOSPITAL STAY IS NOT COMPLETED, ASK THE CHARGE/ |
| PAYMENT (CP) SECTION. |
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| OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION. |
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