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?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[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}
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
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}
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}
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?
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]
Would you say...
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?
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]
Would you say...
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 |
----------------------------------------------------
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