Provider Directory (PD) Section
----------------------------------------------------
| NOTE: THERE ARE THREE BASIC TYPES OF PROVIDERS: |
| 1. PERSON-TYPE-PROVIDERS |
| 2. PERSON-IN-FACILITY-PROVIDERS |
| 3. FACILITY PROVIDERS |
| THE PROVIDER DIRECTORY (PD) SECTION DEALS |
| ONLY WITH THE FIRST AND THIRD TYPES. THE |
| SECOND TYPE (PERSON-IN-FACILITY-PROVIDERS) |
| SHOULD BE TREATED AS A FACILITY FOR THE |
| PURPOSES OF THE PD SECTION. THAT IS, THE |
| PERSON'S NAME IS NOT DISPLAYED OR SEARCHED |
| ON, BUT RATHER THE FACILITY WITH WHICH |
| S/HE IS ASSOCIATED WILL BE DISPLAYED AND |
| SEARCHED ON. THEREFORE, IF THERE IS MORE |
| THAN ONE PERSON-IN-FACILITY-PROVIDER |
| ASSOCIATED WITH THE SAME FACILITY, THE |
| PROVIDER LOOP WILL BE CYCLED ON ONCE FOR |
| THAT FACILITY. |
----------------------------------------------------
BOX_00 ======
----------------------------------------------------
| CONTEXT HEADER DISPLAY INSTRUCTIONS: |
| DISPLAY PROV.LORPNAME, PROV.PVSTRT1 |
----------------------------------------------------
PD01AA ======
ENTER PROVIDER DIRECTORY REGION TO SEARCH
PROVIDER DIRECTORY 1 ................... 1 {LOOP_01}
PROVIDER DIRECTORY 2 ................... 2 {LOOP_01}
PROVIDER DIRECTORY 3 ................... 3 {LOOP_01}
PROVIDER DIRECTORY 4 ................... 4 {LOOP_01}
LOOP_01 =======
-----------------------------------------------------
| FOR EACH ELEMENT IN RU-MEDICAL-PROVIDERS-ROSTER, |
| ASK PD01A - END_LP01 |
-----------------------------------------------------
-----------------------------------------------------
| LOOP DEFINITION: LOOP_01 COLLECTS VA AFFILIATION |
| AND ADDRESS INFORMATION FOR PROVIDERS. THIS LOOP |
| CYCLES ON PROVIDERS THAT MEET THE FOLLOWING |
| CONDITIONS: |
| - CREATED THIS ROUND |
-----------------------------------------------------
-----------------------------------------------------
| NOTE THAT, STARTING IN PANEL 12 ROUND 3, THE LOOP |
| DEFINITION AND CRITERIA WERE AS FOLLOWS. STARTING |
| IN PANEL 13, THIS DEFINITION AND CRITERIA WILL BE |
| IMPLEMENTED IN ALL ROUNDS. |
| |
| LOOP DEFINITION: LOOP_01 COLLECTS VA AFFILIATION |
| AND ADDRESS INFORMATION FOR PROVIDERS. THIS LOOP |
| CYCLES ON PROVIDERS THAT MEET THE FOLLOWING |
| CONDITIONS: |
| - CREATED THIS ROUND AND LINKED TO A KEY RU MEMBER |
| OR |
| - CREATED IN A PREVIOUS ROUND AND NOW LINKED TO A |
| KEY RU MEMBER (AND HAS NOT BEEN THROUGH THE PD |
| SECTION PREVIOUSLY) |
| |
| AND |
| - ASSOCIATED WITH AN HS, ER, OP, OR IC EVENT |
| OR |
| - ASSOCIATED WITH AN MV EVENT |
| OR |
| - ASSOCIATED WITH AN HH EVENT AND FLAGGED AS |
| ‘AGENCY’ |
-----------------------------------------------------
PD01A =====
PROVIDER: {NAME OF MEDICAL CARE PROVIDER......}
{Is the clinic or place where (PROVIDER) was seen a
facility of the Veteran’s Administration?/ Is
(PROVIDER) a facility of the Veteran’s Administration?}
YES .................................... 1 {BOX_01A}
NO ..................................... 2 {BOX_01A}
REF ................................... -7 {BOX_01A}
DK .................................... -8 {BOX_01A}
-----------------------------------------------------
| DISPLAY NAME OF PROVIDER BEING LOOPED ON FOR |
| ‘NAME OF MEDICAL CARE PROVIDER.’ |
-----------------------------------------------------
-----------------------------------------------------
| IF PERSON PROVIDER DISPLAY ‘Is the clinic or place |
| where (PROVIDER) was seen a facility of the |
| Veteran’s Administration?’ |
| |
| IF FACILITY PROVIDER DISPLAY ‘Is (PROVIDER) a |
| facility of the Veteran’s Administration?’ |
-----------------------------------------------------
BOX_01A =======
----------------------------------------------------
| IF PROVIDER IS: |
| - ASSOCIATED WITH AN HS, ER, OP, OR IC EVENT |
| OR |
| - ASSOCIATED WITH AN MV EVENT AND MV03 IS CODED |
| ‘1’ (YES-TALKED TO A MEDICAL DOCTOR) OR MV03 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED) OR ‘-8’ |
| (DON’T KNOW) AND MV06 IS CODED ‘1’ (YES-MEDICAL|
DOCTORS WORK AT LOCATION) |
| OR |
| - ASSOCIATED WITH A HH EVENT AND FLAGGED AS |
| ‘AGENCY’, |
| CONTINUE WITH BOX_03 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO END_LP01 |
----------------------------------------------------
BOX_01
======
OMITTED.
BOX_02
======
OMITTED.
PD01
====
OMITTED.
PD02
====
OMITTED.
BOX_03 ======
----------------------------------------------------
| IF LOOPING ON PROVIDER ASSOCIATED ONLY WITH AN MV |
| EVENT AND RU IS NOT SELECTED FOR THE MEDICAL |
| PROVIDER COMPONENT (MPC), GO TO END_LP01 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH BOX_04 |
----------------------------------------------------
BOX_04 ======
-----------------------------------------------------
| IF FIRST TIME THROUGH LOOP_01, CONTINUE WITH PD03 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO PD05A IF PERSON-PROVIDER OR PD05B|
| IF FACILITY-PROVIDER |
----------------------------------------------------
PD03 ====
Now I would like to make sure I have complete information
for the medical providers you mentioned. I will use a
directory to look up the names, addresses, and telephone
numbers of the sources of medical care you mentioned.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
| IF PROVIDER TYPE IS PERSON GO TO PD05A |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE GO TO PD05B |
----------------------------------------------------
PD04
====
OMITTED.
PD05A =====
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}
STREET ADDRESS: {STREET ADDRESS FROM PV}
CURRENT STATE CODE: {STATE ABBREVIATION FOR RESPONDENT}
STATE: [_____] [CHANGE STATE FOR SEARCH]
SELECT A SEARCH STRATEGY:
_ SEARCH ON PROVIDER NAME SHOWN ABOVE
_ SEARCH ON CORE STREET NAME
_ SEARCH ON TELEPHONE NUMBER
----------------------------------------------------
| ITEM DETAILS |
| PROVID: ...... {Display PROVID} |
| TITLE: ....... {Display Provider Title} |
| FIRST NAME: .. {Display Provider First Name} |
| LAST NAME: ... {Display Provider Last Name} |
| ADDRESSS: .... {Display Provider Street Address} |
| .... {Display Provider City, State, Zip}|
| PHONE: ....... {Display Provider Telephone Number}|
| SPECIALTY: ... {Display Provider Specialty} |
----------------------------------------------------
{SEARCH CRITERIA 1}
{SEARCH CRITERIA 2}
[SEARCH]
THE NUMBER OF POTENTIAL MATCHES FOUND: {NUMBER OF MATCHES}
| PROVID | PROVIDER | STREET | PHONE |
|---|---|---|---|
| [Display Provider ID] |
[Display Provider Name] |
[Display Street Address] |
[Display Phone Number] |
| [Display Provider ID] |
[Display Provider Name] |
[Display Street Address] |
[Display Phone Number] |
{DON’T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES}
----------------------------------------------------
| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |
| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |
| BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER |
| FROM PV’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |
| THE PROVIDER ROSTER FROM SECTION PV FOR THE |
| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM |
| PV’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘FIRST NAME’ FOR SEARCH CRITERIA 1 AND |
| ‘LAST NAME’ FOR SEARCH CRITERIA 2 IF ‘SEARCH ON |
| PROVIDER NAME SHOWN ABOVE’ SELECTED. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘STREET LIKE’ FOR SEARCH CRITERIA 1 IF |
| ‘SEARCH ON CORE STREET NAME’ SELECTED. DISPLAY NO |
| SEARCH CRITERIA 2. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘PHONE NUMBER’ FOR SEARCH CRITERIA 1 IF |
| ‘SEARCH ON TELEPHONE NUMBER’ SELECTED. DISPLAY NO |
| SEARCH CRITERIA 2. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY TWO-CHARACTER STATE ABBREVIATION |
| ASSOCIATED WITH THIS RU’S ADDRESS FOR ‘STATE |
| ABBREVIATION FOR RESPONDENT’. |
----------------------------------------------------
----------------------------------------------------
| A LIST OF PROVIDERS IS DISPLAYED ON THE BOTTOM |
| HALF OF THE SCREEN AFTER SEARCH CRITERIA ENTERED |
| AND ‘SEARCH’ BUTTON SELECTED. |
----------------------------------------------------
----------------------------------------------------
| AN ‘ITEM DETAILS’ BOX WILL APPEAR AFTER A PROVIDER|
| HAS BEEN SELECTED FROM THE LIST OF PROVIDERS. |
----------------------------------------------------
----------------------------------------------------
| SEARCHES CAN BE CONDUCTED MULTIPLE TIMES FROM THIS|
| SCREEN WITHOUT MOVING FORWARD IN THE INSTRUMENT. |
----------------------------------------------------
----------------------------------------------------
| YOU CAN ONLY PROCEED AFTER A PROVIDER OR ‘DON’T |
| SEARCH ANYMORE/NONE OF THE ABOVE MATCHES’ HAS BEEN|
| SELECTED. |
----------------------------------------------------
----------------------------------------------------
| IF A PROVIDER IS SELECTED, PROCEED TO PD14 |
----------------------------------------------------
----------------------------------------------------
| IF ‘DON’T SEARCH ANYMORE/NONE OF THE ABOVE |
| MATCHES’ HAS BEEN SELECTED, PROCEED TO PD18 |
----------------------------------------------------
PD05B =====
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}
STREET ADDRESS: {STREET ADDRESS FOR RESPONDENT}
STATE: {STATE ABBREVIATION FOR RESPONDENT}
STATE: [_____] [CHANGE STATE FOR SEARCH]
SELECT A SEARCH STRATEGY:
_ SEARCH ON PROVIDER NAME SHOWN ABOVE
_ SEARCH ON CORE STREET NAME
_ SEARCH ON TELEPHONE NUMBER
_ SEARCH ON PROVIDER NAME AND STREET
----------------------------------------------------
| ITEM DETAILS |
| PROVID: ...... {Display PROVID} |
| PROVIDER: .... {Display Provider Name} |
| ADDRESSS: .... {Display Provider Street Address} |
| .... {Display Provider City, State, Zip}|
| PHONE: ....... {Display Provider Telephone Number}|
----------------------------------------------------
{SEARCH CRITERIA 1}
{SEARCH CRITERIA 2}
[SEARCH]
THE NUMBER OF POTENTIAL MATCHES FOUND: {NUMBER OF MATCHES}
| PROVID | PROVIDER | STREET | PHONE |
|---|---|---|---|
| [Display Provider ID] |
[Display Provider Name] |
[Display Street Address] |
[Display Phone Number] |
| [Display Provider ID] |
[Display Provider Name] |
[Display Street Address] |
[Display Phone Number] |
{DON’T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES}
----------------------------------------------------
| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |
| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |
| BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER |
| FROM PV’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY TWO-CHARACTER STATE ABBREVIATION |
| ASSOCIATED WITH THIS RU’S ADDRESS FOR ‘STATE |
| ABBREVIATION FOR RESPONDENT’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |
| THE PROVIDER ROSTER FROM SECTION PV FOR THE |
| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM |
| PV’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘PROVIDER LIKE’ FOR SEARCH CRITERIA 1 IF |
| ‘SEARCH ON PROVIDER NAME SHOWN ABOVE’ SELECTED. |
| DISPLAY NO SEARCH CRITERIA 2. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘STREET LIKE’ FOR SEARCH CRITERIA 1 IF |
| ‘SEARCH ON CORE STREET NAME’ SELECTED. DISPLAY NO |
| SEARCH CRITERIA 2. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘PHONE NUMBER’ FOR SEARCH CRITERIA 1 IF |
| ‘SEARCH ON TELEPHONE NUMBER’ SELECTED. DISPLAY NO |
| SEARCH CRITERIA 2. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY ‘PROVIDER LIKE’ FOR SEARCH CRITERIA 1 AND |
| ‘STREET LIKE’ FOR SEARCH CRITERIA 2 IF ‘SEARCH ON |
| PROVIDER NAME AND STREET SHOWN ABOVE’ SELECTED. |
----------------------------------------------------
----------------------------------------------------
| A LIST OF PROVIDERS IS DISPLAYED ON THE BOTTOM |
| HALF OF THE SCREEN AFTER SEARCH CRITERIA ENTERED |
| AND ‘SEARCH’ BUTTON SELECTED. |
----------------------------------------------------
----------------------------------------------------
| AN ‘ITEM DETAILS’ BOX WILL APPEAR AFTER A PROVIDER|
| HAS BEEN SELECTED FROM THE LIST OF PROVIDERS. |
----------------------------------------------------
----------------------------------------------------
| SEARCHES CAN BE CONDUCTED MULTIPLE TIMES FROM THIS|
| SCREEN WITHOUT MOVING FORWARD IN THE INSTRUMENT. |
----------------------------------------------------
----------------------------------------------------
| YOU CAN ONLY PROCEED AFTER A PROVIDER OR ‘DON’T |
| SEARCH ANYMORE/NONE OF THE ABOVE MATCHES’ HAS BEEN|
| SELECTED. |
----------------------------------------------------
----------------------------------------------------
| IF A PROVIDER IS SELECTED, PROCEED TO PD14 |
----------------------------------------------------
----------------------------------------------------
| IF ‘DON’T SEARCH ANYMORE/NONE OF THE ABOVE |
| MATCHES’ HAS BEEN SELECTED, PROCEED TO PD18 |
----------------------------------------------------
LOOP_02
=======
OMITTED.
PD05
====
OMITTED.
PD06
====
OMITTED.
PD07
====
OMITTED.
PD08
====
OMITTED.
PD09
====
OMITTED.
PD10
====
OMITTED.
PD11
====
OMITTED.
BOX_05
======
OMITTED.
PD12
====
OMITTED.
PD13
====
OMITTED.
PD14 ====
YOU HAVE CHOSEN THE FOLLOWING PROVIDER:
{NAME OF PROVIDER SELECTED AT PD05A/B}
{ADDRESS OF PROVIDER SELECTED AT PD05A/B}
YOUR ORIGINAL INPUT PROVIDER:
{NAME OF MEDICAL CARE PROVIDER FROM PV}
{STREET ADDRESS FROM PV}
YOUR OPTIONS:
ACCEPT PROVIDER AS SHOWN ............... 1 {END_LP01}
ACCEPT PROVIDER BUT MAKE CHANGES ....... 2 {PD15}
WRONG PROVIDER, GO BACK TO PREVIOUS
SCREEN ............................... 3
DON’T SEARCH ANYMORE ................... 4 {PD18}
----------------------------------------------------
| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |
| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |
| BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER |
| FROM PV’. IF PERSON-TYPE-PROVIDER, DISPLAY |
| PERSON NAME. IF FACILITY-PROVIDER, DISPLAY |
| FACILITY NAME. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |
| THE PROVIDER ROSTER FROM SECTION PV FOR THE |
| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM |
| PV’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY FULL INFORMATION (I.E., NAME, ADDRESS, |
| CITY, STATE, ZIP, TELEPHONE, AND SPECIALTY) FOR |
| PROVIDER SELECTED IN PD05A OR PD05B FOR ‘NAME OF |
| PROVIDER SELECTED AT PD05A/PD05B’. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘1’ (ACCEPT PROVIDER AS SHOWN) OR ‘2’ |
| (ACCEPT PROVIDER BUT MAKE CHANGES), STORE THIS |
| PROVIDER DIRECTORY ID. |
----------------------------------------------------
----------------------------------------------------
| NOTE: INFORMATION OBTAINED FROM THE PROVIDER |
| DIRECTORY SEARCH IS NOT USED TO REPLACE DATA |
| REPORTED BY THE RESPONDENT DURING THE INTERVIEW |
| OR INCORPORATED INTO PROVIDER ROSTER DISPLAYS. |
----------------------------------------------------
----------------------------------------------------
| IF CODED ‘3’ (WRONG PROVIDER, GO BACK TO PREVIOUS |
| SCREEN), CAPI AUTOMATICALLY RETURNS TO PD05A OR |
| PD05B. |
----------------------------------------------------
PD15 ====
PROVIDER NAME: {NAME OF PROVIDER SELECTED AT PD05A/B}
PROVIDER ADDRESS: {ADDRESS OF PROVIDER SELECTED AT PD05A/B}
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}
STREET ADDRESS: {STREET ADDRESS FROM PV}
MAKE CORRECTIONS TO ADDRESS BELOW.
USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH
NEED CORRECTION.
{Display Prov Name from ProvDir}
NAME: [______________________________]
{Display Prov Street Address from ProvDir}
1ST_STR_ ADDRESS: [______________________________]
{Display Prov City from ProvDir}
CITY: [______________________________]
{Display Prov State from ProvDir}
STATE: [______________________________]
{Display Prov Zip Code from ProvDir}
ZIP CODE: [______________________________]
{Display Prov Telephone from ProvDir}
TELEPHONE: [______________________________]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |
| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |
| BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER |
| FROM PV’. IF PERSON-TYPE-PROVIDER, DISPLAY |
| PERSON NAME. IF FACILITY-PROVIDER, DISPLAY |
| FACILITY NAME. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |
| THE PROVIDER ROSTER FROM SECTION PV FOR THE |
| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM |
| PV’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY NAME, ADDRESS, CITY, STATE, ZIP, AND |
| TELEPHONE FOR PROVIDER SELECTED IN PD05A OR PD05B |
| ‘NAME OF PROVIDER SELECTED AT PD05A/B’. |
----------------------------------------------------
----------------------------------------------------
| ENTRY FIELD SPECIFICATIONS: |
| |
| - FOR NAME, IF PERSON-TYPE-PROVIDER, DISPLAY |
| TITLE, FIRST NAME, AND LAST NAME FIELDS. |
| |
| - ELSE, DISPLAY FACILITY NAME FIELD. |
----------------------------------------------------
----------------------------------------------------
| FLAG THIS RECORD AS ‘UPDATED. NEEDS HOME OFFICE |
| REVIEW.’ |
----------------------------------------------------
----------------------------------------------------
| CONTINUE WITH PD16 |
----------------------------------------------------
PD16 ====
PROVIDER NAME: {NAME OF PROVIDER SELECTED AT PD05A/B}
PROVIDER ADDRESS: {ADDRESS OF PROVIDER SELECTED AT PD05A/B}
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}
STREET ADDRESS: {STREET ADDRESS FROM PV}
DO YOU WANT TO MAKE ANY NOTES ABOUT THIS PROVIDER?
YES .................................... 1 {PD16OV}
NO ..................................... 2 {END_LP01}
----------------------------------------------------
| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |
| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |
| BEING LOOPED ON FOR ‘NAME OF MEDICAL CARE |
| PROVIDER’. IF PERSON-TYPE-PROVIDER, DISPLAY |
| PERSON NAME. IF FACILITY-PROVIDER, DISPLAY |
| FACILITY NAME. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |
| THE PROVIDER ROSTER FROM SECTION PV FOR THE |
| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS’. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY NAME, ADDRESS, CITY, STATE, ZIP, AND |
| TELEPHONE FOR PROVIDER SELECTED IN PD05A OR PD05B |
| ‘NAME OF PROVIDER SELECTED AT PD05A/B’. |
----------------------------------------------------
PD16OV ======
PROVIDER NAME: {NAME OF PROVIDER SELECTED AT PD05A/B}
PROVIDER ADDRESS: {ADDRESS OF PROVIDER SELECTED AT PD05A/B}
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}
STREET ADDRESS: {STREET ADDRESS FROM PV}
[ENTER TEXT].........................{END_LP01}
----------------------------------------------------
| ALLOW MULTIPLE LINES FOR ENTRY. |
----------------------------------------------------
PD17
====
OMITTED.
PD18 ====
ENTER COMPLETE PROVIDER NAME, ADDRESS, AND TELEPHONE.
USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH
NEED CORRECTION.
IF NEEDED, TYPE THREE Xs (XXX) TO DELETE 2ND STREET ADDRESS.
{Provider Name from PV}
NAME: [______________________________]
{1ST_STR_Provider Address from PV}
1ST_STR_ADDRESS: [______________________________]
{2ND_STR_Provider Address from PV}
2ND_STR_ADDRESS: [______________________________]
CITY: [______________________________]
STATE: [______________________________]
ZIP CODE: [______________________________]
PHONE: [______________________________]
SPECIALTY: [______________________________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
| IF STREET ADDRESS LINES ARE CODED REFUSED OR DON’T|
| KNOW (-7 OR -8) IN PROVIDER ROSTER (PV) SECTION, |
| DISPLAY BLANK LINES FOR THESE FIELDS. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY THE NAME AND ADDRESS AS RECORDED ON THE |
| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |
| BEING LOOPED ON FOR ‘PROVIDER NAME FROM PV’. IF |
| PERSON-TYPE-PROVIDER, DISPLAY PERSON NAME. IF |
| FACILITY-PROVIDER, DISPLAY FACILITY NAME. |
----------------------------------------------------
----------------------------------------------------
| ENTRY FIELD SPECIFICATIONS: |
| |
| - FOR NAME, IF PERSON-TYPE-PROVIDER, DISPLAY |
| TITLE, FIRST NAME, AND LAST NAME FIELDS. |
| |
| - ELSE, DISPLAY FACILITY NAME FIELD. |
| |
| - DISPLAY THE NAME (IN APPROPRIATE FIRST & LAST |
| NAME OR FACILITY FIELDS) AS RECORDED ON THE |
| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER|
| BEING LOOPED ON IN THE ENTRY FIELD FOR THE |
| INTERVIEWER TO EITHER ACCEPT OR EDIT. |
| |
| - DISPLAY THE ADDRESS (IN APPROPRIATE FIRST AND |
| SECOND STREET FIELDS) AS RECORDED ON THE |
| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER|
| BEING LOOPED ON IN THE ENTRY FIELD FOR THE |
| INTERVIEWER TO EITHER ACCEPT OR EDIT. |
----------------------------------------------------
----------------------------------------------------
| FLAG THIS RECORD AS ‘NEW NAME/ADDRESS INFORMATION.|
| NEEDS HOME OFFICE REVIEW.’ |
----------------------------------------------------
----------------------------------------------------
| REFUSED AND DON’T KNOW ALLOWED IN ALL FIELDS, |
| EXCEPT THE ‘NAME’ AND ‘STATE’ FIELDS. |
----------------------------------------------------
----------------------------------------------------
| CONTINUE WITH PD19 |
----------------------------------------------------
PD19 ====
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}
STREET ADDRESS: {STREET ADDRESS FROM PV}
DO YOU WANT TO MAKE ANY NOTES ABOUT THIS PROVIDER?
YES .................................... 1 {PD19OV}
NO ..................................... 2 {END_LP01}
----------------------------------------------------
| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |
| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |
| BEING LOOPED ON FOR ‘NAME OF MEDICAL CARE |
| PROVIDER’. IF PERSON-TYPE PROVIDER, DISPLAY |
| PERSON NAME. IF FACILITY-PROVIDER, DISPLAY |
| FACILITY NAME. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |
| THE PROVIDER ROSTER FROM SECTION PV FOR THE |
| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS’. |
----------------------------------------------------
PD19OV ======
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}
STREET ADDRESS: {STREET ADDRESS FROM PV}
[ENTER TEXT].................... {END_LP01}
----------------------------------------------------
| ALLOW MULTIPLE LINES FOR ENTRY. |
----------------------------------------------------
END_LP02
========
OMITTED.
END_LP01 ========
----------------------------------------------------
| CYCLE ON NEXT PROVIDER THAT MEETS THE CONDITIONS |
| STATED IN THE LOOP DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PROVIDER MEETS THE STATED CONDITIONS, |
| END LOOP_01 AND CONTINUE WITH BOX_06 |
----------------------------------------------------
BOX_06 ======
----------------------------------------------------
| GO TO NEXT QUESTIONNAIRE SECTION. |
----------------------------------------------------