Other Medical Expenses (OM) Section
BOX_01A
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| IF ROUND 3, CONTINUE WITH BOX_01B |
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| OTHERWISE, GO TO BOX_01 |
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BOX_01B
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| IF OM ITEM TYPE IS GLASSES/CONTACT LENSES, |
| CONTINUE WITH OM01A |
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| OTHERWISE, GO TO BOX_01 |
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OM01A
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{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}{END-DT}
Of the times (PERSON) obtained glasses or contact lenses since
(START DATE), how many were during {YEAR}?
[Enter Number of Times]................ {OM01B}
REF.................................... -7 {OM01B}
DK..................................... -8 {OM01B}
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| (FOR SPECIFICATIONS ONLY; CAPI HANDLES |
| AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS FIRST |
| CALENDAR YEAR OF PANEL. |
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OM01B
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{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}{END-DT}
Of the times (PERSON) obtained glasses or contact lenses since
(START DATE), how many were during {YEAR}?
[Enter Number of Times]................
REF.................................... -7
DK..................................... -8
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| (FOR SPECIFICATIONS ONLY; CAPI HANDLES |
| AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS SECOND |
| CALENDAR YEAR OF PANEL. |
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| IF THE CHARGE/PAYMENT (CP) SECTION HAS NOT BEEN |
| ASKED FOR THE EVENT BEING ASKED ABOUT, GO TO THE |
| CP SECTION. |
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| OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION. |
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BOX_01
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| IF THE OM ITEM TYPE IS INSULIN OR OTHER DIABETIC |
| EQUIPMENT OR SUPPLIES, GO TO OM02 |
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| OTHERWISE, CONTINUE WITH OM01 |
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OM01
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{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}{END-DT}
NOTE:
NO UTILIZATION SECTION IS REQUIRED FOR {GLASSES OR CONTACT
LENSES/AMBULANCE SERVICES/ORTHOPEDIC ITEMS/HEARING DEVICES/
PROSTHESES/BATHROOM AIDS/MEDICAL EQUIPMENT/DISPOSABLE SUPPLIES/
ALTERATIONS OR MODIFICATIONS/{TEXT FROM OTHER SPECIFY}}.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
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| DISPLAY ‘GLASSES OR CONTACT LENSES’ IF EVENT TYPE |
| IS OM AND ITEM TYPE IS CODED ‘1’ (GLASSES OR |
| CONTACT LENSES.) DISPLAY ‘AMBULANCE SERVICES’ |
| IF EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘4’ |
| (AMBULANCE SERVICES). DISPLAY ‘ORTHOPEDIC ITEMS’ |
| IF EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘5’ |
| (ORTHOPEDIC ITEMS). DISPLAY ‘HEARING DEVICES’ |
| IF EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘6’ |
| (HEARING DEVICES). DISPLAY ‘PROSTHESES’ IF EVENT |
| TYPE IS OM AND ITEM TYPE IS CODED ‘7’ |
| (PROSTHESES). DISPLAY ‘BATHROOM AIDS’ IF EVENT |
| TYPE IS OM AND ITEM TYPE IS CODED ‘8’ (BATHROOM |
| AIDS). DISPLAY ‘MEDICAL EQUIPMENT’ IF EVENT TYPE |
| IS OM AND ITEM TYPE IS CODED ‘9’ (MEDICAL |
| EQUIPMENT). DISPLAY ‘DISPOSABLE SUPPLIES’ IS |
| EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘10’ |
| (DISPOSABLE SUPPLIES). DISPLAY ‘ALTERATIONS OR |
| MODIFICATIONS’ IF EVENT TYPE IS OM AND ITEM TYPE |
| IS CODED ‘11’ (ALTERATIONS/MODIFICATIONS). FOR |
| ‘TEXT FROM OTHER SPECIFY’, DISPLAY THE TEXT |
| ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS |
| WHEN OM ITEM TYPE IS CODED ‘91’ (OTHER). |
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| IF THE CHARGE/PAYMENT (CP) SECTION HAS NOT BEEN |
| ASKED FOR THE EVENT BEING ASKED ABOUT, GO TO THE |
| CP SECTION |
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| OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION |
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OM02
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{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}{END-DT}
NOTE:
{INSULIN/OTHER DIABETIC EQUIPMENT OR SUPPLIES} WILL BE PROCESSED
LIKE A PRESCRIBED MEDICINE.
AT THIS TIME, NO UTILIZATION OR CHARGE/PAYMENT SECTION WILL BE
ASKED.
PRESCRIBED MEDICINE QUESTIONS AND CHARGE/PAYMENT DATA WILL BE
COLLECTED LATER.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
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| DISPLAY ‘INSULIN’ IF OM ITEM TYPE BEING ASKED |
| ABOUT IS INSULIN. DISPLAY ‘OTHER DIABETIC |
| EQUIPMENT OR SUPPLIES’ IF OM TYPE BEING ASKED |
| ABOUT IS OTHER DIABETIC EQUIPMENT OR SUPPLIES. |
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| FLAG THE OM CHARGE/PAYMENT (CP) SECTION AS |
| ‘PROCESSED’. INSULIN AND OTHER DIABETIC EQUIPMENT|
| AND SUPPLIES WILL BE PROCESSED THROUGH CP AS |
| PRESCRIBED MEDICINES. |
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| GO TO BOX_02 |
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BOX_02
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| GO TO THE EVENT DRIVER (ED) SECTION |
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