|
Access to Care (AC) Section
BOX_00A
=======
----------------------------------------------------
THE AC SECTION IS ASKED IN ROUNDS 2 AND 4 ONLY. IF
IT IS ROUND 1, 3, OR 5, CONTINUE TO THE NEXT
SECTION.
----------------------------------------------------
BOX_00
======
----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.LORPNAME
----------------------------------------------------
AC01
====
What language is spoken in your home most of the time?
ENGLISH ................................ 1 {AC02}
SPANISH ................................ 2 {AC02}
ANOTHER LANGUAGE ....................... 3 {AC02}
REF ................................... -7 {AC02}
DK .................................... -8 {AC02}
[Code One]
AC02
====
Are all members of your household comfortable
conversing in
English?
YES .................................... 1 {LOOP_01A}
NO ..................................... 2
REF ................................... -7 {LOOP_01A}
DK .................................... -8 {LOOP_01A}
----------------------------------------------------
IF SINGLE-PERSON RU AND AC02 CODED ‘2’ (NO), SELECT
PERSON AUTOMATICALLY FOR AC02A AND GO TO LOOP_01A
----------------------------------------------------
----------------------------------------------------
IF MULTI-PERSON RU AND AC02 CODED ‘2’ (NO),
CONTINUE WITH AC02A
----------------------------------------------------
AC02A
=====
Who is not comfortable conversing in English?
PROBE: Is anyone else not comfortable conversing in
English?
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS TO BE INCLUDED ON
ROSTER FOR AC31.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_01A
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER
EXCLUDING DECEASED AND INSTITUTIONALIZED RU
MEMBERS.
----------------------------------------------------
LOOP_01A
========
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
AC03-END_LP01A.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01A COLLECTS WHETHER OR NOT
PERSON WAS BORN IN THE U.S., AND IF NOT, HOW LONG
PERSON HAS LIVED IN THE U.S. THIS LOOP CYCLES ON
PERSONS THAT MEET THE FOLLOWING CONDITION:
- PERSON IS A CURRENT RU MEMBER.
- PERSON IS NOT DECEASED.
- PERSON IS NOT INSTITUTIONALIZED.
----------------------------------------------------
AC03
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
(Were/Was) (PERSON) born in the United States?
YES .................................... 1 {END_LP01A}
NO ..................................... 2 {AC04}
REF ................................... -7 {AC04}
DK .................................... -8 {AC04}
AC04
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
How long (have/has) (PERSON) lived in the United
States?
IF LESS THAN 1 YEAR, CODE 0.
YEARS:
[Enter years] .......................... {END_LP01A}
REF ................................... -7 {END_LP01A}
DK .................................... -8 {END_LP01A}
[Code One]
END_LP01A
=========
----------------------------------------------------
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 CONDITION,
END LOOP_01A AND CONTINUE WITH LOOP_01
----------------------------------------------------
LOOP_01
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
AC05-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS THE NAME OF
THE USUAL SOURCE OF CARE PROVIDER, IF ANY, FOR
EACH CURRENT RU MEMBER. THIS LOOP CYCLES ON
PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
----------------------------------------------------
AC05
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
Is there a particular doctor’s office, clinic, health
center,
or other place that (PERSON) usually (go/goes) if
(PERSON)
(are/is) sick or (need/needs) advice about (PERSON)’s
health?
YES ..................................... 1 {AC09}
NO ...................................... 2 {AC07}
MORE THAN ONE PLACE ..................... 3 {AC06}
REF ..................................... -7
{END_LP01}
DK ...................................... -8
{END_LP01}
[Code One]
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF
HEALTH CARE.
AC06
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
Would (PERSON) go to one of these places first or most
often
if (PERSON) (are/is) sick?
YES ..................................... 1 {AC09}
NO ...................................... 2 {AC07}
REF ..................................... -7
{END_LP01}
DK ...................................... -8
{END_LP01}
AC07
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
What is the main reason (PERSON) (do/does) not
have a usual
source of health care?
SELDOM OR NEVER GETS SICK ............... 1 {AC08}
RECENTLY MOVED INTO AREA ................ 2 {AC08}
DON’T KNOW WHERE TO GO FOR CARE ......... 3 {AC08}
USUAL SOURCE OF MEDICAL CARE IN THIS
AREA IS NO LONGER AVAILABLE ........... 4 {AC08}
CAN’T FIND A PROVIDER WHO SPEAKS
(PERSON)’S LANGUAGE ................... 5 {AC08}
LIKES TO GO TO DIFFERENT PLACES FOR
DIFFERENT HEALTH NEEDS ................ 6 {AC08}
JUST CHANGED INSURANCE PLANS ............ 7 {AC08}
DON’T USE DOCTORS/TREAT MYSELF .......... 8 {AC08}
COST OF MEDICAL CARE .................... 9 {AC08}
NO HEALTH INSURANCE ..................... 10 {AC08}
OTHER REASON ............................ 91 {AC07OV}
REF ..................................... -7
{END_LP01}
DK ...................................... -8
{END_LP01}
[Code One]
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF
HEALTH CARE.
----------------------------------------------------
"(PERSON)" IN THE TEXT FOR ANSWER CATEGORY 5
SHOULD BE PURPLE.
----------------------------------------------------
AC07OV
======
ENTER OTHER REASON:
[Enter Other Specify] .................. {AC08}
REF ................................... -7 {AC08}
DK .................................... -8 {AC08}
AC08
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
What are the other reasons (PERSON) (do/does) not have
a usual
source of health care?
CHECK ALL THAT APPLY.
NO OTHER REASONS ........................ 0 {END_LP01}
SELDOM OR NEVER GETS SICK ............... 1
RECENTLY MOVED INTO AREA ................ 2
DON’T KNOW WHERE TO GO FOR CARE ......... 3
USUAL SOURCE OF MEDICAL CARE IN THIS
AREA IS NO LONGER AVAILABLE ........... 4
CAN’T FIND A PROVIDER WHO SPEAKS
(PERSON)’S LANGUAGE ................... 5
LIKES TO GO TO DIFFERENT PLACES FOR
DIFFERENT HEALTH NEEDS ................ 6
JUST CHANGED INSURANCE PLANS ............ 7
DON’T USE DOCTORS/TREAT MYSELF .......... 8
COST OF MEDICAL CARE .................... 9
NO HEALTH INSURANCE ..................... 10
OTHER REASON ............................ 91 {AC08OV}
REF ..................................... -7
{END_LP01}
DK ...................................... -8
{END_LP01}
[Code All That Apply]
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF
HEALTH CARE.
----------------------------------------------------
(PERSON) IN THE TEXT FOR ANSWER CATEGORY 5
SHOULD BE PURPLE.
----------------------------------------------------
----------------------------------------------------
IF ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW) IS
SELECTED, CAPI SHOULD CODE AS ‘0’ (NO OTHER
REASONS).
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATION PURPOSES ONLY: CAPI DOES NOT
ALLOW CODES ‘0’ (NO OTHER REASONS), ‘RF’
(REFUSED), OR ‘DK’ (DON’T KNOW) IN COMBINATION
WITH ANY OTHER CODES.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘91’ (OTHER REASON) ALONE OR IN
COMBINATION WITH OTHER CODES, CONTINUE WITH AC08OV
(NOTE THAT AC08OV IS AN OVERLAY ON AC08.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------
AC08OV
======
ENTER OTHER REASON:
[Enter Other Specify] .................. {END_LP01}
REF ................................... -7 {END_LP01}
DK .................................... -8 {END_LP01}
AC09
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
Please give me the name of the medical person,
doctor’s office,
clinic, health center, or other place that (PERSON)
usually
(go/goes) if (PERSON) (are/is) sick or (need/needs)
advice
about (PERSON)’s health.
If possible, give me the name of the particular
person that
(PERSON) usually (see/sees).
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF
HEALTH CARE.
----------------------------------------------------
BEGINNING IN PANEL 12, ROUND 4 AND PANEL 13,
ROUND 2, AC09 AND PV01 WERE REVISED TO PROMPT
RESPONDENTS TO NAME A PERSON-PROVIDER AS THE USC
PROVIDER IF POSSIBLE. THE DATA AT VARIABLE
PROVTY42 IS EXPECTED TO CHANGE SIGNIFICANTLY
BASED ON THIS NEW WORDING AND PROBING.
----------------------------------------------------
BOX_01
======
----------------------------------------------------
ASK THE PROVIDER ROSTER (PV) SECTION
----------------------------------------------------
----------------------------------------------------
AT THE COMPLETION OF THE PROVIDER ROSTER (PV)
SECTION, CONTINUE WITH BOX_02
----------------------------------------------------
BOX_02
======
----------------------------------------------------
FLAG THE PROVIDER ADDED OR SELECTED AS THE ‘USC
(USUAL SOURCE OF CARE) PROVIDER’ FOR THIS PERSON
FOR THIS PARTICULAR ROUND.
----------------------------------------------------
----------------------------------------------------
IF THIS USC PROVIDER IS FLAGGED AS ‘FACILITY-
TYPE-PROVIDER’ OR AS ‘PERSON-IN-FACILITY-PROVIDER’
AND AC11 WAS NOT ALREADY ASKED FOR THIS USC
PROVIDER IN AN EARLIER LOOP, GO TO AC11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, (THAT IS, IF THIS USC PROVIDER IS
FLAGGED AS ‘PERSON-TYPE-PROVIDER’ OR IF THIS USC
PROVIDER IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER’
OR AS 'PERSON-IN-FACILITY-PROVIDER’ AND AC11 HAS
ALREADY BEEN ASKED FOR THIS USC PROVIDER), GO TO
AC12
----------------------------------------------------
AC10
====
OMITTED.
AC11
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......}
ASK IF NOT OBVIOUS.
{Is (PROVIDER)/Does (PROVIDER) work at} a clinic in a
hospital,
a hospital outpatient department, an emergency room at
a
hospital, or some other kind of place?
HOSPITAL CLINIC OR OUTPATIENT
DEPARTMENT ............................ 1 {AC12}
HOSPITAL EMERGENCY ROOM ................. 2 {AC12}
OTHER KIND OF PLACE ..................... 3 {AC12}
REF ..................................... -7 {AC12}
DK ...................................... -8 {AC12}
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY ‘Is (PROVIDER)’ IF USC PROVIDER IS FLAGGED
AS ‘FACILITY-TYPE-PROVIDER’. DISPLAY ‘Does
(PROVIDER) work at’ IF USC PROVIDER IS FLAGGED AS
‘PERSON-IN-FACILITY-PROVIDER’.
----------------------------------------------------
----------------------------------------------------
NOTE: FOR QUESTIONS AC11 – AC20, THE CONTEXT
HEADER WILL DISPLAY THE PERSON-PROVIDER NAME IF
THE USC PROVIDER BEING ASKED ABOUT IS FLAGGED AS
‘PERSON-TYPE-PROVIDER’ OR ‘PERSON-IN-FACILITY-
PROVIDER’. IF THE USC PROVIDER BEING ASKED ABOUT
IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER’, THE
CONTEXT HEADER WILL DISPLAY THE FACILITY-PROVIDER
NAME.
----------------------------------------------------
AC12
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......}
How (do/does) (PERSON) usually get to (PROVIDER)?
DRIVE ................................. 1 {AC13}
IS DRIVEN ............................. 2 {AC13}
TAXI, BUS, TRAIN, OTHER
PUBLIC TRANSPORTATION ............... 3 {AC13}
WALKS ................................. 4 {AC13}
SOME OTHER WAY ........................ 5 {AC13}
REF .................................. -7 {AC13}
DK ................................... -8 {AC13}
[Code One]
AC13
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER.......}
How long does it take (PERSON) to get to (PROVIDER)?
LESS THAN 15 MINUTES ................... 1 {AC14}
15 TO 30 MINUTES ....................... 2 {AC14}
31 TO 60 MINUTES (1 HOUR) .............. 3 {AC14}
61 TO 90 MINUTES ....................... 4 {AC14}
91 TO 120 MINUTES (2 HOURS) ............ 5 {AC14}
MORE THAN 120 MINUTES (2 HOURS) ........ 6 {AC14}
REF ................................... -7 {AC14}
DK .................................... -8 {AC14}
[Code One]
AC14
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER.......}
SHOW CARD AC-1.
How difficult is it for (PERSON) to get to (PROVIDER)?
Would you say it is ...
very difficult, ........................ 1 {BOX_03}
somewhat difficult, .................... 2 {BOX_03}
not too difficult, or .................. 3 {BOX_03}
not at all difficult? .................. 4 {BOX_03}
REF ................................... -7 {BOX_03}
DK .................................... -8 {BOX_03}
[Code One]
BOX_03
======
----------------------------------------------------
IF THIS USC PROVIDER IS FLAGGED AS ‘PERSON-
TYPE-PROVIDER’ OR ‘PERSON-IN-FACILITY-PROVIDER’
AND AC15 WAS NOT ALREADY ASKED FOR THIS USC
PROVIDER IN AN EARLIER LOOP, CONTINUE WITH AC15
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------
AC15
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......}
Is (PROVIDER) a medical doctor?
YES ..................................... 1 {AC17}
NO ...................................... 2 {AC16}
REF ..................................... -7 {AC18}
DK ...................................... -8 {AC18}
HELP AVAILABLE FOR DEFINITION OF MEDICAL DOCTOR.
AC16
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......}
Is (PROVIDER) a nurse, nurse practitioner, physician’s
assistant, midwife, or some other kind of person?
SELECT ‘CHIROPRACTOR’ IF CHIROPRACTOR VOLUNTEERED AS
TYPE
OF MEDICAL PERSON.
NURSE ................................... 1 {AC18}
NURSE PRACTITIONER ...................... 2 {AC18}
PHYSICIAN’S ASSISTANT ................... 3 {AC18}
MIDWIFE ................................. 4 {AC18}
CHIROPRACTOR ............................ 5 {AC18}
OTHER ................................... 91 {AC16OV}
REF ..................................... -7 {AC18}
DK ...................................... -8 {AC18}
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
AC16OV
======
OTHER:
[Enter Other Specify] .................. {AC18}
REF ................................... -7 {AC18}
DK .................................... -8 {AC18}
AC17
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......}
What is (PROVIDER)’s specialty?
GENERAL/FAMILY PRACTICE ................. 1 {AC18}
INTERNAL MEDICINE ....................... 2 {AC18}
PEDIATRICS .............................. 3 {AC18}
OB/GYN .................................. 4 {AC18}
SURGERY ................................. 5 {AC18}
CHIROPRACTOR ............................ 6 {AC18}
CARDIOLOGIST ............................ 7 {AC18}
DOCTOR OF OSTEOPATHY..................... 8 {AC18}
OTHER ................................... 91 {AC17OV}
REF ..................................... -7 {AC18}
DK ...................................... -8 {AC18}
[Code One]
AC17OV
======
OTHER:
[Enter Other Specify] .................. {AC18}
REF ................................... -7 {AC18}
DK .................................... -8 {AC18}
AC18
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER.......}
Is (PROVIDER) Hispanic or Latino?
YES .................................... 1 {AC19}
NO ..................................... 2 {AC19}
REF ................................... -7 {AC19}
DK .................................... -8 {AC19}
AC19
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER.......}
SHOW CARD AC-2.
What is (PROVIDER)'s race?
CHECK ALL THAT APPLY.
WHITE .................................. 1
BLACK/AFRICAN AMERICAN ................. 2
ASIAN .................................. 3
INDIAN/NATIVE AMERICAN/ALASKA NATIVE ... 4
OTHER PACIFIC ISLANDER ................. 5
SOME OTHER RACE ....................... 91 {AC19OV}
REF ................................... -7 {AC20}
DK .................................... -8 {AC20}
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (SOME OTHER RACE) ALONE OR IN
COMBINATION WITH OTHER CODES, CONTINUE WITH
AC19OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC20
----------------------------------------------------
AC19OV
======
OTHER RACE:
[Enter Other Specify] .................. {AC20}
REF ................................... -7 {AC20}
DK .................................... -8 {AC20}
AC20
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER.......}
Is (PROVIDER) male or female?
MALE ................................... 1 {END_LP01}
FEMALE ................................. 2 {END_LP01}
REF ................................... -7 {END_LP01}
DK .................................... -8 {END_LP01}
[Code One]
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_04
----------------------------------------------------
BOX_04
======
----------------------------------------------------
IF AT LEAST ONE PROVIDER FLAGGED AS ‘USC PROVIDER’
ON THE RU-MEDICAL-PROVIDERS-ROSTER, CONTINUE WITH
LOOP_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC32A
----------------------------------------------------
LOOP_02
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEDICAL-PROVIDERS-
ROSTER, ASK AC21-END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS DETAILED
INFORMATION ON EACH UNIQUE USUAL SOURCE OF CARE
PROVIDER IDENTIFIED FOR THIS RU. THIS LOOP CYCLES
ON PROVIDERS WHO MEET THE FOLLOWING CONDITION:
- PROVIDER FLAGGED AS ‘USC PROVIDER’ DURING THE
CURRENT ROUND FOR A CURRENT RU MEMBER.
----------------------------------------------------
----------------------------------------------------
NOTE: IF THE USC PROVIDER BEING LOOPED ON IS
FLAGGED AS ‘PERSON-TYPE-PROVIDER’ OR ‘PERSON-IN-
FACILITY-PROVIDER’ THE CONTEXT HEADER IN LOOP_02
WILL DISPLAY THE PERSON-PROVIDER NAME. IF THE USC
PROVIDER BEING LOOPED ON IS FLAGGED AS ‘FACILITY-
TYPE-PROVIDER’ THE CONTEXT HEADER IN LOOP_02 WILL
DISPLAY THE FACILITY-PROVIDER NAME.
----------------------------------------------------
AC21
====
{NAME OF MEDICAL CARE PROVIDER......}
The next few questions ask about the experience (READ
NAME(S)
BELOW) (have/has) had with (PROVIDER). Please think
about their
overall experiences when answering the following
questions.
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN
'YOU' OR
THE PARENT'S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
CONTINUE WITH AC22
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER
WHO IDENTIFIED PROVIDER BEING ASKED ABOUT AS
PERSON’S USC PROVIDER FOR THE CURRENT ROUND.
----------------------------------------------------
AC22
====
{NAME OF MEDICAL CARE PROVIDER......}
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
Is (PROVIDER) the {person/place} (READ NAME(S) ABOVE)
would
go to for ...
YES = 1
NO = 2
RF = -7
DK = -8
AC22_01 a. New health problems? ( )
AC22_02 b. Preventive health care, such as general
checkups, examinations, and immunizations? ( )
AC22_03 c. Referrals to other health professionals
when
needed? ( )
AC22_04 d. Ongoing health problems? ( )
HELP AVAILABLE FOR DEFINITION OF PREVENTIVE HEALTH
CARE
AND REFERRAL.
----------------------------------------------------
DISPLAY ‘person’ IF THE USC PROVIDER BEING LOOPED
ON IS FLAGGED AS ‘PERSON-TYPE-PROVIDER’ OR
‘PERSON-IN-FACILITY-PROVIDER’. DISPLAY ‘place’ IF
USC PROVIDER BEING LOOPED ON IS FLAGGED AS
‘FACILITY-TYPE-PROVIDER’.
----------------------------------------------------
----------------------------------------------------
ALLOW ‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW) ON ALL
FORM ITEMS.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER
WHO IDENTIFIED PROVIDER BEING ASKED ABOUT AS
PERSON’S USC PROVIDER FOR THE CURRENT ROUND.
----------------------------------------------------
AC23
====
{NAME OF MEDICAL CARE PROVIDER......}
SHOW CARD AC-1.
How difficult is it to contact {a medical person at}
(PROVIDER)
during regular business hours over the telephone about
a health
problem?
Would you say it is ...
very difficult, ......................... 1
somewhat difficult, ..................... 2
not too difficult, or ................... 3
not at all difficult? ................... 4
REF ..................................... -7
DK ...................................... -8
[Code One]
----------------------------------------------------
DISPLAY ‘a medical person at’ IF USC PROVIDER
BEING LOOPED ON IS FLAGGED AS ‘FACILITY-TYPE-
PROVIDER’. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF AC11 WAS CODED ‘2’ (HOSPITAL EMERGENCY ROOM)
FOR THIS USC PROVIDER, GO TO AC25
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH AC24
----------------------------------------------------
AC24
====
{NAME OF MEDICAL CARE PROVIDER......}
Does (PROVIDER) have office hours at night or on
weekends?
YES ..................................... 1 {AC25}
NO ...................................... 2 {AC25}
REF ..................................... -7 {AC25}
DK ...................................... -8 {AC25}
AC25
====
{NAME OF MEDICAL CARE PROVIDER.......}
SHOW CARD AC-1.
How difficult is it to contact {a medical person at}
(PROVIDER)
after their regular hours in case of urgent medical
needs?
Would you say it is ...
very difficult, ........................ 1 {AC26}
somewhat difficult, .................... 2 {AC26}
not too difficult, or .................. 3 {AC26}
not at all difficult? .................. 4 {AC26}
REF ................................... -7 {AC26}
DK .................................... -8 {AC26}
[Code One]
----------------------------------------------------
DISPLAY ‘a medical person at’ IF USC PROVIDER
BEING LOOPED ON IS FLAGGED AS ‘FACILITY-TYPE-
PROVIDER’. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
AC26
====
{NAME OF MEDICAL CARE PROVIDER......}
Does {someone at} (PROVIDER) usually ask about
prescription
medications and treatments other doctors may give
them?
YES ..................................... 1 {AC27}
NO ...................................... 2 {AC27}
REF ..................................... -7 {AC27}
DK ...................................... -8 {AC27}
----------------------------------------------------
DISPLAY ‘someone at’ IF USC PROVIDER BEING LOOPED
ON IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER’.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
AC27
====
{NAME OF MEDICAL CARE PROVIDER.......}
SHOW CARD AC-3.
Thinking about the types of medical, traditional and
alternative
treatments that (READ NAME(S) BELOW) are happy with,
how often does
{a medical person at} (PROVIDER) show respect for
these treatments?
Would you say...
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN
‘YOU’ OR THE
PARENT’S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
never, ................................. 1 {AC28}
sometimes, ............................. 2 {AC28}
usually, or ............................ 3 {AC28}
always? ................................ 4 {AC28}
REF ................................... -7 {AC28}
DK .................................... -8 {AC28}
[Code One]
----------------------------------------------------
DISPLAY 'a medical person at' IF USC PROVIDER
BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-
PROVIDER.' OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER
WHO IDENTIFIED PROVIDER BEING ASKED ABOUT AS
PERSON’S USC PROVIDER FOR THE CURRENT ROUND.
----------------------------------------------------
AC28
====
{NAME OF MEDICAL CARE PROVIDER.......}
SHOW CARD AC-3.
If there were a choice between treatments, how often
would
{a medical person at} (PROVIDER) ask (READ NAME(S)
BELOW) to
help make the decision?
Would you say...
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN
‘YOU’ OR
THE PARENT’S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
never, ................................. 1 {AC30}
sometimes, ............................. 2 {AC30}
usually, or ............................ 3 {AC30}
always? ................................ 4 {AC30}
REF ................................... -7 {AC30}
DK .................................... -8 {AC30}
[Code One]
----------------------------------------------------
DISPLAY ‘a medical person at’ IF USC PROVIDER
BEING LOOPED ON IS FLAGGED AS ‘FACILITY-TYPE-
PROVIDER’. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER
WHO IDENTIFIED PROVIDER BEING ASKED ABOUT AS
PERSON’S USC PROVIDER FOR THE CURRENT ROUND.
----------------------------------------------------
AC29
====
OMITTED.
AC30
====
{NAME OF MEDICAL CARE PROVIDER.......}
Does {a medical person at} (PROVIDER) present and
explain all
options to (READ NAME(S) BELOW)?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN
‘YOU’ OR
THE PARENT’S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1 {BOX_05}
NO ..................................... 2 {BOX_05}
REF ................................... -7 {BOX_05}
DK .................................... -8 {BOX_05}
----------------------------------------------------
DISPLAY ‘a medical person at’ IF USC PROVIDER
BEING LOOPED ON IS FLAGGED AS ‘FACILITY-TYPE-
PROVIDER.’ OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER
WHO IDENTIFIED PROVIDER BEING ASKED ABOUT AS
PERSON’S USC PROVIDER FOR THE CURRENT ROUND.
----------------------------------------------------
BOX_05
======
----------------------------------------------------
IF AT LEAST ONE RU MEMBER WAS SELECTED AT AC02A
(FLAGGED AS NOT COMFORTABLE CONVERSING IN ENGLISH)
AND PERSON IDENTIFIED THIS USC PROVIDER AS THEIR
USC PROVIDER (AC05 IS SET TO ‘1’ OR AC06 IS SET TO
‘1’), CONTINUE WITH AC31
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP02
----------------------------------------------------
AC31
====
{NAME OF MEDICAL CARE PROVIDER.......}
Does {someone at} (PROVIDER) speak the language (READ
NAME(S)
BELOW) prefer(s) or provide translator services for
them?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN
‘YOU’ OR
THE PARENT’S NAME.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1 {END_LP02}
NO ..................................... 2 {END_LP02}
REF ................................... -7 {END_LP02}
DK .................................... -8 {END_LP02}
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED
ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER.'
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER
WHO
- IDENTIFIED PROVIDER BEING ASKED ABOUT AS
PERSON’S USC PROVIDER FOR THE CURRENT ROUND
AND
- WERE IDENTIFIED AS NOT COMFORTABLE CONVERSING
IN ENGLISH AT AC02A.
----------------------------------------------------
END_LP02
========
----------------------------------------------------
CYCLE ON NEXT PROVIDER IN THE RU-MEDICAL-
PROVIDERS-ROSTER WHO MEETS THE CONDITIONS STATED
IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PROVIDERS MEET THE STATED CONDITIONS,
END LOOP_02 AND CONTINUE WITH AC32A
----------------------------------------------------
AC32A
=====
When answering the next few questions, do not include
dental care
and prescription medicines.
In the last 12 months, did anyone in the family or a
doctor
believe they needed any medical care, tests, or
treatment?
YES .................................... 1 {AC32}
NO ..................................... 2 {AC40A}
REF ................................... -7 {AC40A}
DK .................................... -8 {AC40A}
AC32
====
In the last 12 months, was anyone in the family
unable to
obtain medical care, tests, or treatments
they or a doctor
believed necessary?
YES .................................... 1
NO ..................................... 2 {AC36}
REF ................................... -7 {AC36}
DK .................................... -8 {AC36}
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS 'UNMET NEED FOR
MEDICAL CARE' AT AC33 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO
LOOP_03
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE
WITH AC33
----------------------------------------------------
AC33
====
Who was that?
PROBE: Was anyone else in the family unable to get
medical
care, tests, or treatments they or a doctor believed
necessary?
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR
INSTITUTIONALIZED, GO TO AC36
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_03
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL.
----------------------------------------------------
LOOP_03
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
AC34 – END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS THE MAIN REASON
AND THE PROBLEM WITH THE UNMET NEED FOR MEDICAL
CARE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE
FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR MEDICAL CARE (I.E.,
PERSON WAS SELECTED AT AC33)
----------------------------------------------------
AC34
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
(PERSON) (were/was)
unable to get medical care, tests, or
treatments (he/she)or a
doctor believed necessary?
COULDN’T AFFORD CARE ..................... 1 {AC35}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {AC35}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {AC35}
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 {AC35}
DIFFERENT LANGUAGE ....................... 5 {AC35}
COULDN’T GET TIME OFF WORK ............... 6 {AC35}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7 {AC35}
WAS REFUSED SERVICES ..................... 8 {AC35}
COULDN’T GET CHILD CARE .................. 9 {AC35}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10 {AC35}
OTHER ................................... 91 {AC35}
REF ..................................... -7 {AC35}
DK ...................................... -8 {AC35}
[Code One]
AC35
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) did not get
medical
care, tests, or treatments (he/she) or a doctor
believed necessary?
Would you say ...
a big problem, ......................... 1 {END_LP03}
a small problem, or .................... 2 {END_LP03}
not a problem? ......................... 3 {END_LP03}
REF ................................... -7 {END_LP03}
DK .................................... -8 {END_LP03}
[Code One]
END_LP03
========
----------------------------------------------------
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_03 AND CONTINUE WITH AC36
----------------------------------------------------
AC36
====
In the last 12 months, was anyone in the family
delayed in
getting medical care, tests, or treatments they
or a doctor
believed necessary?
YES .................................... 1
NO ..................................... 2 {AC40A}
REF ................................... -7 {AC40A}
DK .................................... -8 {AC40A}
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS 'DELAY IN RECEIVING
MEDICAL CARE' AT AC37 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO
LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE
WITH AC37
----------------------------------------------------
AC37
====
Who was that?
PROBE: Was anyone else in the family delayed in
getting
medical care, tests, or treatments they or a
doctor believed
necessary?
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR
INSTITUTIONALIZED, GO TO AC40A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_04
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL.
----------------------------------------------------
LOOP_04
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
AC38 – END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 COLLECTS THE MAIN REASON
AND THE PROBLEM WITH THE DELAY IN RECEIVING
MEDICAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO
MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING MEDICAL CARE
(I.E., PERSON WAS SELECTED AT AC37)
----------------------------------------------------
AC38
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
(PERSON) (were/was)
delayed in getting medical care, tests, or
treatments (he/she) or
a doctor believed necessary?
COULDN’T AFFORD CARE ..................... 1 {AC39}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {AC39}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {AC39}
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 {AC39}
DIFFERENT LANGUAGE ....................... 5 {AC39}
COULDN’T GET TIME OFF WORK ............... 6 {AC39}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7 {AC39}
WAS REFUSED SERVICES ..................... 8 {AC39}
COULDN’T GET CHILD CARE .................. 9 {AC39}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10 {AC39}
OTHER ................................... 91 {AC39}
REF ..................................... -7 {AC39}
DK ...................................... -8 {AC39}
[Code One]
AC39
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) (were/was)
delayed
in getting medical care, tests, or treatments
(he/she) or a
doctor believed necessary?
Would you say ...
a big problem, ......................... 1 {END_LP04}
a small problem, or .................... 2 {END_LP04}
not a problem? ......................... 3 {END_LP04}
REF ................................... -7 {END_LP04}
DK .................................... -8 {END_LP04}
[Code One]
END_LP04
========
----------------------------------------------------
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_04 AND CONTINUE WITH AC40A
----------------------------------------------------
AC40A
=====
In the last 12 months, did anyone in the family or a
dentist
believe they needed any dental care, tests, or
treatment?
YES .................................... 1 {AC40}
NO ..................................... 2 {AC48A}
REF ................................... -7 {AC48A}
DK .................................... -8 {AC48A}
AC40
====
In the last 12 months, was anyone in the family
unable to
obtain dental care, tests, or treatments they or a
dentist
believed necessary?
YES .................................... 1
NO ..................................... 2 {AC44}
REF ................................... -7 {AC44}
DK .................................... -8 {AC44}
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS 'UNMET NEED FOR
DENTAL CARE' AT AC41 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO
LOOP_05
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE
WITH AC41
----------------------------------------------------
AC41
====
Who was that?
PROBE: Was anyone else in the family unable to get
dental
care, tests, or treatments they or a dentist believed
necessary?
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR
INSTITUTIONALIZED, GO TO AC44
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_05
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL.
----------------------------------------------------
LOOP_05
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
AC42 – END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS THE MAIN REASON
AND THE PROBLEM WITH THE UNMET NEED FOR DENTAL
CARE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE
FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR DENTAL CARE (I.E.,
PERSON WAS SELECTED AT AC41)
----------------------------------------------------
AC42
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
(PERSON) (were/was)
unable to get dental care, tests, or treatments
(he/she) or a
dentist believed necessary?
COULDN’T AFFORD CARE ..................... 1 {AC43}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {AC43}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {AC43}
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 {AC43}
DIFFERENT LANGUAGE ....................... 5 {AC43}
COULDN’T GET TIME OFF WORK ............... 6 {AC43}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7 {AC43}
WAS REFUSED SERVICES ..................... 8 {AC43}
COULDN’T GET CHILD CARE .................. 9 {AC43}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10 {AC43}
OTHER ................................... 91 {AC43}
REF ..................................... -7 {AC43}
DK ...................................... -8 {AC43}
[Code One]
AC43
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) did not get
dental
care, tests, or treatments (he/she) or a dentist
believed necessary?
Would you say ...
a big problem, ......................... 1 {END_LP05}
a small problem, or .................... 2 {END_LP05}
not a problem? ......................... 3 {END_LP05}
REF ................................... -7 {END_LP05}
DK .................................... -8 {END_LP05}
[Code One]
END_LP05
========
----------------------------------------------------
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_05 AND CONTINUE WITH AC44
----------------------------------------------------
AC44
====
In the last 12 months, was anyone in the family
delayed in
getting dental care, tests, or treatments they
or a dentist
believed necessary?
YES .................................... 1
NO ..................................... 2 {AC48A}
REF ................................... -7 {AC48A}
DK .................................... -8 {AC48A}
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS 'DELAY IN RECEIVING
DENTAL CARE' AT AC45 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO
LOOP_06
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE
WITH AC45
----------------------------------------------------
AC45
====
Who was that?
PROBE: Was anyone else in the family delayed in
getting
dental care, tests, or treatments they or a
dentist believed
necessary?
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR
INSTITUTIONALIZED, GO TO AC48A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_06
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL.
----------------------------------------------------
LOOP_06
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
AC46 – END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS THE MAIN REASON
AND THE PROBLEM WITH THE DELAY IN RECEIVING
DENTAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO
MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING DENTAL CARE
(I.E., PERSON WAS SELECTED AT AC45)
----------------------------------------------------
AC46
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
(PERSON) (were/was)
delayed in getting dental care, tests, or
treatments (he/she) or
a dentist believed necessary?
COULDN’T AFFORD CARE ..................... 1 {AC47}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {AC47}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {AC47}
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 {AC47}
DIFFERENT LANGUAGE ....................... 5 {AC47}
COULDN’T GET TIME OFF WORK ............... 6 {AC47}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7 {AC47}
WAS REFUSED SERVICES ..................... 8 {AC47}
COULDN’T GET CHILD CARE .................. 9 {AC47}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10 {AC47}
OTHER ................................... 91 {AC47}
REF ..................................... -7 {AC47}
DK ...................................... -8 {AC47}
[Code One]
AC47
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) (were/was)
delayed in
getting dental care, tests, or treatments
(he/she) or a dentist
believed necessary?
Would you say ...
a big problem, ......................... 1 {END_LP06}
a small problem, or .................... 2 {END_LP06}
not a problem? ......................... 3 {END_LP06}
REF ................................... -7 {END_LP06}
DK .................................... -8 {END_LP06}
[Code One]
END_LP06
========
----------------------------------------------------
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_06 AND CONTINUE WITH AC48A
----------------------------------------------------
AC48A
=====
In the last 12 months, did anyone in the family or a
doctor
believe they needed prescription medicines?
YES .................................... 1 {AC48}
NO ..................................... 2 {BOX_06}
REF ................................... -7 {BOX_06}
DK .................................... -8 {BOX_06}
AC48
====
In the last 12 months, was anyone in the family
unable to
obtain prescription medicines they or a doctor
believed
necessary?
YES .................................... 1
NO ..................................... 2 {AC52}
REF ................................... -7 {AC52}
DK .................................... -8 {AC52}
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS 'UNMET NEED FOR
PRESCRIPTION MEDICINES' AT AC49 BY CAPI AND GO TO
LOOP_07
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE
WITH AC49
----------------------------------------------------
AC49
====
Who was that?
PROBE: Was anyone else in the family unable to get
prescription medicines they or a doctor
believed necessary?
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR
INSTITUTIONALIZED, GO TO AC52
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_07
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL.
----------------------------------------------------
LOOP_07
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
AC50 – END_LP07
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07 COLLECTS THE MAIN REASON
AND THE PROBLEM WITH THE UNMET NEED FOR
PRESCRIPTION MEDICINES. THIS LOOP CYCLES ON RU
MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR PRESCRIPTION
MEDICINES (I.E., PERSON WAS SELECTED AT AC49)
----------------------------------------------------
AC50
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
(PERSON) (were/was)
unable to get prescription medicines (he/she)
or a doctor believed
necessary?
COULDN’T AFFORD CARE ..................... 1 {AC51}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {AC51}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {AC51}
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 {AC51}
DIFFERENT LANGUAGE ....................... 5 {AC51}
COULDN’T GET TIME OFF WORK ............... 6 {AC51}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7 {AC51}
WAS REFUSED SERVICES ..................... 8 {AC51}
COULDN’T GET CHILD CARE .................. 9 {AC51}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10 {AC51}
OTHER ................................... 91 {AC51}
REF ..................................... -7 {AC51}
DK ...................................... -8 {AC51}
[Code One]
AC51
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) did not get
prescription medicines (he/she) or a doctor
believed
necessary?
Would you say ...
a big problem, ......................... 1 {END_LP07}
a small problem, or .................... 2 {END_LP07}
not a problem? ......................... 3 {END_LP07}
REF ................................... -7 {END_LP07}
DK .................................... -8 {END_LP07}
[Code One]
END_LP07
========
----------------------------------------------------
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_07 AND CONTINUE WITH AC52
----------------------------------------------------
AC52
====
In the last 12 months, was anyone in the family
delayed in
getting prescription medicines they or a doctor
believed
necessary?
YES .................................... 1
NO ..................................... 2 {BOX_06}
REF ................................... -7 {BOX_06}
DK .................................... -8 {BOX_06}
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU,
AUTOMATICALLY CODE PERSON AS 'DELAY IN RECEIVING
PRESCRIPTION MEDICINES' AT AC53 BY CAPI AND GO TO
LOOP_08
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE
WITH AC53
----------------------------------------------------
AC53
====
Who was that?
PROBE: Was anyone else in the family delayed in
getting
prescription medicines they or a doctor
believed necessary?
[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR
INSTITUTIONALIZED, GO TO BOX_06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_08
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1
COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL.
----------------------------------------------------
LOOP_08
=======
----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
AC54 – END_LP08
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_08 COLLECTS THE MAIN REASON
AND THE PROBLEM WITH THE DELAY IN RECEIVING
PRESCRIPTION MEDICINES. THIS LOOP CYCLES ON RU
MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING PRESCRIPTION
MEDICINES (I.E., PERSON WAS SELECTED AT AC53)
----------------------------------------------------
AC54
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
(PERSON) (were/was)
delayed in getting prescription medicines
(he/she) or a doctor
believed necessary?
COULDN’T AFFORD CARE ..................... 1 {AC55}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {AC55}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {AC55}
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 {AC55}
DIFFERENT LANGUAGE ....................... 5 {AC55}
COULDN’T GET TIME OFF WORK ............... 6 {AC55}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7 {AC55}
WAS REFUSED SERVICES ..................... 8 {AC55}
COULDN’T GET CHILD CARE .................. 9 {AC55}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10 {AC55}
OTHER ................................... 91 {AC55}
REF ..................................... -7 {AC55}
DK ...................................... -8 {AC55}
[Code One]
AC55
====
{PERSON'S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) (were/was)
delayed
in getting prescription medicines (he/she) or a
doctor believed
necessary?
Would you say ...
a big problem, ......................... 1 {END_LP08}
a small problem, or .................... 2 {END_LP08}
not a problem? ......................... 3 {END_LP08}
REF ................................... -7 {END_LP08}
DK .................................... -8 {END_LP08}
[Code One]
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_06
----------------------------------------------------
BOX_06
======
----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------
Return to Top
|