|
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
LOOP_01
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
NAV_AC01 - 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
NAVIGATOR DETAILS: LOOP_01 USES NAV_AC01 TO
CONTROL THE FLOW OF THE LOOP.
NAV_AC01
SERIES: Identifying USC Provider (e.g., provider’s
name,
transportation mode, provider’s specialty and race)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED “DONE,” USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER
EXCLUDING DECEASED AND INSTITUTIONALIZED RU
MEMBERS.
CONTINUE WITH AC05 FOR SELECTED RU MEMBER
AC05
{PERSON’S FIRST MIDDLE AND LAST NAME}
Is there a particular doctor’s office, clinic, health
center, or other
place that {you/{PERSON}} usually {go/goes} if
{you/he/she} {are/is}
sick or {need/needs} advice about {your/his/her}
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 {you/{PERSON}} go to one of these places first
or most often if
{you/he/she} {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 {you/{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
{YOUR/HIS/HER} 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.
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 {you/{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
{YOUR/HIS/HER} 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.
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 {you/{PERSON}}
usually {go/goes} if
{you/he/she} {are/is} sick or {need/needs} advice
about {your/his/her}
health.
If possible, give me the name of the particular
person that
{you/he/she} 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
AC13
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 {AC13}
HOSPITAL EMERGENCY ROOM ................. 2 {AC13}
OTHER KIND OF PLACE ..................... 3 {AC13}
REF ..................................... -7 {AC13}
DK ...................................... -8 {AC13}
[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.
AC13
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER.......}
How long does it usually take {you/{PERSON}} to get to
{PROVIDER}?
LESS THAN 15 MINUTES ................... 1 {BOX_03}
15 TO 30 MINUTES ....................... 2 {BOX_03}
31 TO 60 MINUTES (1 HOUR) .............. 3 {BOX_03}
61 TO 90 MINUTES ....................... 4 {BOX_03}
91 TO 120 MINUTES (2 HOURS) ............ 5 {BOX_03}
MORE THAN 120 MINUTES (2 HOURS) ........ 6 {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 {AC20}
BLACK/AFRICAN AMERICAN ................. 2 {AC20}
ASIAN .................................. 3 {AC20}
INDIAN/NATIVE AMERICAN/ALASKA NATIVE ... 4 {AC20}
OTHER PACIFIC ISLANDER ................. 5 {AC20}
SOME OTHER RACE ....................... 91 {AC20}
REF ................................... -7 {AC20}
DK .................................... -8 {AC20}
[Code All That Apply]
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 IntroUSCP
OTHERWISE, GO TO AC32A
IntroUSCP
THE NEXT QUESTIONS WILL ONLY BE ASKED ONCE ABOUT
EACH USUAL SOURCE OF CARE PROVIDER.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
CONTINUE WITH LOOP_02
LOOP_02
FOR EACH ELEMENT IN THE RU-MEDICAL-PROVIDERS-
ROSTER, ASK NAV_AC02 - 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.
NAVIGATOR DETAILS: LOOP_02 USES NAV_AC02 TO
CONTROL THE FLOW OF THE LOOP.
NAV_AC02
SERIES: USC Provider Detail (e.g., experience with
provider,
provider hours, satisfaction with provider’s care)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED “DONE,” USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
USC Provider
[1. Provider or Facility Name-30] [Status-25]
[2. Provider or Facility Name-30] [Status-25]
[3. Provider or Facility Name-30] [Status-25]
ROSTER DETAILS:
COL # 1 HEADER: USC PROVIDER
INSTRUCTIONS: DISPLAY PROVIDER FIRST INITIAL AND
LAST NAME IF PERSON-PROVIDER OR PERSON-IN-FACILITY
PROVIDER. DISPLAY FACILITY NAME IF FACILITY-
PROVIDER.
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH PROVIDER EACH TIME THE NAVIGATOR
IS PRESENTED
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEDICAL-PROVIDERS-ROSTER
FOR SELECTION.
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
ROSTER FILTER:
DISPLAY ALL PROVIDERS WHO MEET THE FOLLOWING
CONDITIONS:
- PROVIDER FLAGGED AS ‘USC PROVIDER’ DURING THE
CURRENT ROUND FOR A CURRENT RU MEMBER.
CONTINUE WITH AC21 FOR SELECTED PROVIDER.
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) (is/are) 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.
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 RE102B WAS CODED ‘3’ (NOT WELL) OR ‘4’ (NOT AT
ALL) FOR AT LEAST ONE RU MEMBER IN ANY ROUND 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
- RE102B WAS CODED ‘3’ (NOT WELL) OR ‘4’ (NOT AT
ALL) FOR THIS PERSON IN ANY ROUND.
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
NAV_AC03 – 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)
NAVIGATOR DETAILS: LOOP_03 USES NAV_AC03 TO
CONTROL THE FLOW OF THE LOOP.
NAV_AC03
SERIES: Reason for Being Unable to Obtain Medical Care
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED “DONE,” USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
ROSTER FILTER:
DISPLAY ALL 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)
CONTINUE WITH AC34 FOR SELECTED RU MEMBER
AC34
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
{you/{PERSON}} {were/was}
unable to get medical care, tests, or
treatments {you/he/she} or a
doctor believed necessary?
COULDN’T AFFORD CARE ..................... 1
{END_LP03}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {END_LP03}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {END_LP03}
PROBLEMS GETTING TO DOCTOR’S OFFICE ...... 4
{END_LP03}
DIFFERENT LANGUAGE ....................... 5
{END_LP03}
COULDN’T GET TIME OFF WORK ............... 6
{END_LP03}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7
{END_LP03}
WAS REFUSED SERVICES ..................... 8
{END_LP03}
COULDN’T GET CHILD CARE .................. 9
{END_LP03}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10
{END_LP03}
OTHER ................................... 91
{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
NAV_AC04 – 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)
NAVIGATOR DETAILS: LOOP_04 USES NAV_AC04 TO
CONTROL THE FLOW OF THE LOOP.
NAV_AC04
SERIES: Reason for Delay In Obtaining Medical Care
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED “DONE,” USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
ROSTER FILTER:
DISPLAY ALL 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)
CONTINUE WITH AC38 FOR SELECTED RU MEMBER
AC38
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
{you/{PERSON}} {were/was}
delayed in getting medical care, tests, or
treatments {you/he/she} or
a doctor believed necessary?
COULDN’T AFFORD CARE ..................... 1
{END_LP04}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {END_LP04}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {END_LP04}
PROBLEMS GETTING TO DOCTOR’S OFFICE ...... 4
{END_LP04}
DIFFERENT LANGUAGE ....................... 5
{END_LP04}
COULDN’T GET TIME OFF WORK ............... 6
{END_LP04}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7
{END_LP04}
WAS REFUSED SERVICES ..................... 8
{END_LP04}
COULDN’T GET CHILD CARE .................. 9
{END_LP04}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10
{END_LP04}
OTHER ................................... 91
{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
NAV_AC05 – 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)
NAVIGATOR DETAILS: LOOP_05 USES NAV_AC05 TO
CONTROL THE FLOW OF THE LOOP.
NAV_AC05
SERIES: Reason for Being Unable to Obtain Dental Care
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED “DONE,” USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
ROSTER FILTER:
DISPLAY ALL 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)
CONTINUE WITH AC42 FOR SELECTED RU MEMBER
AC42
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
{you/{PERSON}} {were/was}
unable to get dental care, tests, or treatments
{you/he/she} or a
dentist believed necessary?
COULDN’T AFFORD CARE ..................... 1
{END_LP05}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {END_LP05}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {END_LP05}
PROBLEMS GETTING TO DOCTOR’S OFFICE ...... 4
{END_LP05}
DIFFERENT LANGUAGE ....................... 5
{END_LP05}
COULDN’T GET TIME OFF WORK ............... 6
{END_LP05}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7
{END_LP05}
WAS REFUSED SERVICES ..................... 8
{END_LP05}
COULDN’T GET CHILD CARE .................. 9
{END_LP05}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10
{END_LP05}
OTHER ................................... 91
{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
NAV_AC06 – 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)
NAVIGATOR DETAILS: LOOP_06 USES NAV_AC06 TO
CONTROL THE FLOW OF THE LOOP.
NAV_AC06
SERIES: Reason for Delay In Obtaining Dental Care
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED “DONE,” USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
ROSTER FILTER:
DISPLAY ALL 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)
CONTINUE WITH AC46 FOR SELECTED RU MEMBER
AC46
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
{you/{PERSON}} {were/was}
delayed in getting dental care, tests, or
treatments {you/he/she} or
a dentist believed necessary?
COULDN’T AFFORD CARE ..................... 1
{END_LP06}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {END_LP06}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {END_LP06}
PROBLEMS GETTING TO DOCTOR’S OFFICE ...... 4
{END_LP06}
DIFFERENT LANGUAGE ....................... 5
{END_LP06}
COULDN’T GET TIME OFF WORK ............... 6
{END_LP06}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7
{END_LP06}
WAS REFUSED SERVICES ..................... 8
{END_LP06}
COULDN’T GET CHILD CARE .................. 9
{END_LP06}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10
{END_LP06}
OTHER ................................... 91
{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
NAV_AC07 – 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)
NAVIGATOR DETAILS: LOOP_07 USES NAV_AC07 TO
CONTROL THE FLOW OF THE LOOP.
NAV_AC07
SERIES: Reason for Being Unable to Obtain Prescription
Medicines
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED “DONE,” USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
ROSTER FILTER:
DISPLAY ALL 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)
CONTINUE WITH AC50 FOR SELECTED RU MEMBER
AC50
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
{you/{PERSON}} {were/was}
unable to get prescription medicines
{you/he/she} or a doctor believed
necessary?
COULDN’T AFFORD CARE ..................... 1
{END_LP07}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {END_LP07}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {END_LP07}
PROBLEMS GETTING TO DOCTOR’S OFFICE ...... 4
{END_LP07}
DIFFERENT LANGUAGE ....................... 5
{END_LP07}
COULDN’T GET TIME OFF WORK ............... 6
{END_LP07}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7
{END_LP07}
WAS REFUSED SERVICES ..................... 8
{END_LP07}
COULDN’T GET CHILD CARE .................. 9
{END_LP07}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10
{END_LP07}
OTHER ................................... 91
{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
NAV_AC08 – 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)
NAVIGATOR DETAILS: LOOP_08 USES NAV_AC08 TO
CONTROL THE FLOW OF THE LOOP.
NAV_AC08
SERIES: Reason for Delay In Obtaining Prescription
Medicines
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS
WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED “DONE,” USE [Continue
Interview] TO GO
PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS
BEFORE THIS
SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE,
AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR
STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR
IS PRESENTED
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR
SELECTION.
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT
DISALLOWED.
ROSTER FILTER:
DISPLAY ALL 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)
CONTINUE WITH AC54 FOR SELECTED RU MEMBER
AC54
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason
{you/{PERSON}} {were/was}
delayed in getting prescription medicines
{you/he/she} or a doctor
believed necessary?
COULDN’T AFFORD CARE ..................... 1
{END_LP08}
INSURANCE COMPANY WOULDN’T APPROVE,
COVER, OR PAY FOR CARE ................. 2 {END_LP08}
DOCTOR REFUSED TO ACCEPT FAMILY’S
INSURANCE PLAN ......................... 3 {END_LP08}
PROBLEMS GETTING TO DOCTOR’S OFFICE ...... 4
{END_LP08}
DIFFERENT LANGUAGE ....................... 5
{END_LP08}
COULDN’T GET TIME OFF WORK ............... 6
{END_LP08}
DIDN’T KNOW WHERE TO GO TO GET CARE ...... 7
{END_LP08}
WAS REFUSED SERVICES ..................... 8
{END_LP08}
COULDN’T GET CHILD CARE .................. 9
{END_LP08}
DIDN’T HAVE TIME OR TOOK TOO LONG ....... 10
{END_LP08}
OTHER ................................... 91
{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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