Calendar (CA) Section

BOX_00 (CA1000)

Route Details: 01 Box = BOX_10, BOX_20, BOX_30, BOX_40, BOX_50

02 Loop = LOOP_10, LOOP_20, LOOP_30

03 End Loop = END_LP10, END_LP20, END_LP30

04 Single Select = CA10, CA20, CA60, CA90, CA100

05 Single Select with Roster Display = CA30_01, CA30_02, CA30_03, CA30_04, CA30_05, CA30_06, CA30_07, CA80_01

16 Date Picker = CA70

20 OS Text Field = CA30_08

24 Information Screen = CA40, CA50

Grid 2 = CA30_01, CA30_02, CA30_03, CA30_04, CA30_05, CA30_06, CA30_07, CA30_08, CA80_01



CA10 (CA1005)

BLAISE NAME: AnyRec

Question Text:

To answer the next set of questions, you will find it helpful to refer to records about the health care {you/{REFERENCE PERSON}/{your/{REFERENCE PERSON}’s} household} received since {START OF REFERENCE PERIOD}. Records that identify the place or person that provided the health care, the dates of health care visits, and any charges for the care will help answer the questions.

Any records you refer to should cover health care {since {START DATE OF REFERENCE PERIOD}/between {START DATE OF REFERENCE PERIOD} and {END DATE OF REFERENCE PERIOD}}.

Do you have any records you can use to help answer this next set of questions?

Responses: HAS RECORD KEEPING MATERIALS FOR AT LEAST 1 PERSON 1 CA30_01 (CA1015)

DOES NOT HAVE ANY RECORDS 2

WILL NOT USE RECORDS 3

Programmer Instructions: RF/DK disallowed

If Round 2-5 and CA10 is coded ‘2’ (DOES NOT HAVE ANY RECORDS) or ‘3’ (WILL NOT USE RECORDS) and CA30 was not asked in the prior round, go to CA40 (Preload.UseRecLRnd=Empty).

If Round 2-5 and CA10 is coded ‘2’ (DOES NOT HAVE ANY RECORDS) or ‘3’ (WILL NOT USE RECORDS) and CA30 was asked in the prior round, go to CA20 (Preload.UseRecLRnd=Yes).

Otherwise, go to CA40.

Display Instructions: If a 1 person RU display ‘you/{REFERENCE PERSON}’. Otherwise, display ‘{your/{REFERENCE PERSON}’s} household’.

Display ‘you’ if RU member respondent. Otherwise display ‘{REFERENCE PERSON}’ substituting the name of the reference person.

Display ‘your’ if RU member respondent. Otherwise, display ‘{REFERENCE PERSON}’s’ substituting the name of the reference person.

Display ‘since {START DATE OF REFERENCE PERIOD}’ if Rounds 1-4, substituting the reference period start date. Otherwise, display ‘between {START DATE OF REFERENCE PERIOD} and {END DATE OF REFERENCE PERIOD}’ substituting the reference period start and end dates.

For “START DATE OF REFERENCE PERIOD”, display the RU level reference period start date (typically-but not always Jan 1 if Round 1 or the previous round interview date if Rds 2-5).

For “END DATE OF REFERENCE PERIOD”, display the RU level reference period end date (typically but not always current round interview date if Rds 1-4 or Dec 31 if Round 5).


CA20 (CA1010)

BLAISE NAME: LRndRec

Question Text:

During the last interview, we used {{a calendar},} {{provider or insurance statements},} {{patient portal information},} {{payment records},} {{medicine bottles, tubes, containers, or other prescription records},} {CA30_08 text string/OM90 text string} to help answer the next set of questions. Do you have any of these same records or any other records available that cover the health care each person in {your/this} household received {since {START DATE OF REFERENCE PERIOD}/between {START DATE OF REFERENCE PERIOD} and {END DATE OF REFERENCE PERIOD}}?

Responses: HAS RECORD KEEPING MATERIALS FOR AT LEAST 1 PERSON 1 CA30_01 (CA1015)

DOES NOT HAVE ANY RECORDS 2 CA40 (CA1055)

WILL NOT USE RECORDS 3 CA40 (CA1055)

Display Instructions: If proxy respondent, display “this”, otherwise, “your".

Display the following text when there was at least 1 YES response for this record type or it was selected at OM80 for at least one RU member in the previous round. If CA30_ 01 was coded ‘1’ (Calendar with Health Care Entries) or OM80 was coded ‘1’ for at least one RU member in the previous round, display “a calendar” (Preload.UseCalndrFlag=Yes). Otherwise, use a null display.

If CA30_02 was coded ‘1’ (Provider or Insurance Statements) or OM80 was coded ‘2’ for at least one RU member in the previous round, display “provider or insurance statements” (Preload.ProvHinsstmtFlag=Yes). Otherwise, use a null display.

If CA30_03 was coded ‘1’ (Patient Portal) or OM80 was coded ‘3’ for at least one RU member in the nrevious round, display “patient portal information” (Preload.PtntPortalFlag=Yes). Otherwise, use a null display.

If CA30_04 was coded ‘1’ (Payment Records) or OM80 was coded ‘4’for at least one RU member in the previous round, display “payment records” (Preload.PymtRecFlag=Yes). Otherwise, use a null display.

If CA30_05 was coded ‘1’ (RX Records/Bottles) or OM80 was coded ‘5’ for at least one RU member in the previous round, display “medicine bottles, tubes, containers, or other prescription records' (Preload.RxRecBottleFlag=Yes). Otherwise, use a null display.

If CA30_07 was coded ‘1’ (Other record) or OM80 was coded ‘7’ for at least one RU member in the nrevious round, display “{CA30_08 text string/OM90 text string}” (Preload.OthRecFlag=Yes). Display only one, if both had values set in the prior round, CA30_07 supersedes what was entered at OM90 (Use Preload.OthRecOSPrev). Otherwise, use a null display.

Display ‘and’ before the last record in the question text. Display the ‘,’ in between multiple records, otherwise, if only one record displayed, do not display the comma.

Display 'and' if only two records are displayed. Do not display the comma.

For “START DATE OF REFERENCE PERIOD”, display the RU level reference period start date (typically-but not always Jan 1 if Round 1 or the previous round interview date if Rds 2-5).

For “END DATE OF REFERENCE PERIOD”, display the RU level reference period end date (typically but not always current round interview date if Rds 1-4 or Dec 31 if Round 5).


CA30_01 (CA1015)

BLAISE NAME: UseCalndr

Question Text:

{Thanks for keeping these records. Let me review the records with you first.}

Please tell me who the record is for, and the type of record you’re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, or something else.

{Do/Does} {you/{PERSON}} have a calendar with health entries?

NAVIGATION: Complete the grid in order of respondent's answers.

Responses: YES, HAS CALENDAR WITH HEALTH CARE ENTRIES FOR {PERSON} 1

NO, DOES NOT HAVE CALENDAR WITH HEALTH CARE ENTRIES FOR {PERSON} 2

Programmer Instructions: Preloaded Grid Type 2: flexible navigation, including CA30_01, CA30_02, CA30_03, CA30_04, CA30_05, CA30_06, CA30_07, and CA30_08

Allow empty.

RF/DK not allowed.

Enable movement on screen so interviewer can enter record types for all persons by row.

Display Instructions: Roster Report 1

Display RU-Members-Roster

Col #1 Header: Records for RU member

Instructions: Display RU members' first, middle, and last names (FULLNAME)

Format response pane in columns with headers: Col#2 Header: CA30_01 Calendar with health care entries, Col# 3 Header: CA30_02 Provider or Insurance Statements, Col# 4 Header: CA30_03 Patient Portal, Col# 5 Header: CA30_04 Payment Records, Col# 6 Header: CA30_05 RX Records/Bottles, Col# 7 Header: CA30_06 PR/MB Follow-Up, Col# 8 Header: CA30_07 Other, Col# 9 Header: CA30_08 Other Specify, Col#10 Header : CA30DONE

Roster filter:

Display all RU members.

Display “Thanks for keeping these records. Let me review the record with you first.” Only for the first person in the grid. Otherwise, use null display.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.


CA30_02 (CA1020)

BLAISE NAME: ProvHinsStmt

Question Text:

[Please tell me who the record is for, and the type of record you’re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]

{Do/Does} {you/{PERSON}} have provider or insurance statements?

NAVIGATION: Complete the grid in order of respondent's answers.

Responses: YES, HAS PROVIDER OR INSURANCE STATEMENT(S) FOR {PERSON} 1

NO, DOES NOT HAVE PROVIDER OR INSURANCE STATEMENTS FOR {PERSON} 2

Display Instructions: Display “Please tell me who the record is for...” text in grayed out in lighter text and in brackets.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.


CA30_03 (CA1025)

BLAISE NAME: PtntPortal

Question Text:

[Please tell me who the record is for, and the type of record you’re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]

{Do/Does} {you/{PERSON}} have a patient portal?

NAVIGATION: Complete the grid in order of respondent's answers.

Responses: YES, HAS PATIENT PORTAL FOR {PERSON} 1

NO, DOES NOT HAVE PATIENT PORTAL FOR {PERSON} 2

Display Instructions: Display “Please tell me who the record is for...” text in grayed out in lighter text and in brackets.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.


CA30_04 (CA1030)

BLAISE NAME: PymtRec

Question Text:

[Please tell me who the record is for, and the type of record you’re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]

{Do/Does} {you/{PERSON}} have payment records?

NAVIGATION: Complete the grid in order of respondent's answers.

Responses: YES, HAS PAYMENT RECORDS FOR {PERSON} 1

NO, DOES NOT HAVE PAYMENT RECORDS FOR {PERSON} 2

Display Instructions: Display “Please tell me who the record is for...” text in grayed out in lighter text and in brackets.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.


CA30_05 (CA1035)

BLAISE NAME: RxRecBottle

Question Text:

[Please tell me who the record is for, and the type of record you’re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]

{Do/Does} {you/{PERSON}} have prescription records such as medicine bottles, tubes, or containers?

NAVIGATION: Complete the grid in order of respondent's answers.

Responses: YES, HAS PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR {PERSON} 1

NO, DOES NOT HAVE PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR {PERSON} 2

Programmer Instructions: If coded ‘1’ (YES) for anyone in the RU, go to CA30_06, otherwise, go to CA30_07.

Display Instructions: Display “Please tell me who the record is for...” text in grayed out in lighter text and in brackets.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.


CA30_06 (CA1037)

BLAISE NAME: RxRecBottleInfo

Question Text:

Does this prescription record/medicine bottle for {PERSON} contain information for a health care visit that occurred between {START DATE} and {END DATE}?

NAVIGATION: Complete the grid in order of respondent's answers.

Responses: YES, PRESCRIPTION RECORD/MEDICINE BOTTLE CONTAINS HEALTH CARE VISIT INFORMATION FOR {PERSON} 1

NO, PRESCRIPTION RECORD/MEDICINE BOTTLE DOES NOT CONTAIN HEALTH CARE VISIT INFORMATION FOR {PERSON} 2

Programmer Instructions: Allow Empty. Display this cell as active only if RU member coded CA30_05 '1' (YES,HAS PRESCRIPTION RECORD/MEDICINE BOTTLES FOR {PERSON} ). Otherwise, display cell as inactive.

Display Instructions: For “START DATE”, display the person level reference period start date.

For “END DATE”, display the person level reference period end date.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.


CA30_07 (CA1040)

BLAISE NAME: OthRec

Question Text:

[Please tell me who the record is for, and the type of record you’re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]

{Do/Does} {you/{PERSON}} have another type of record?

NAVIGATION: Complete the grid in order of respondent's answers.

Responses: YES, HAS OTHER RECORD FOR {PERSON} 1

NO, DOES NOT HAVE OTHER RECORD FOR {PERSON} 2

Programmer Instructions: If coded ‘1’ (YES), go to CA30_08, for each person in the grid, otherwise, go to BOX_10. .

Hard check: at least one cell in grid (CA30_01 through CA30_07) should be coded ‘1’ (YES, HAS RECORDS).

If not, display error message: AT {CA10 (AnyRec)/CA20 (LRndRec)} YOU INDICATED SOMEONE IN THIS HOUSEHOLD HAD RECORDS, GO BACK TO REVIEW GRID. IF NO ONE IN THIS HOUSEHOLD HAS RECORDS, BACK UP TO {CA10 (AnyRec)/CA20 (LRndRec)} AND CHANGE YOUR ANSWER TO CONTINUE.

Error message should display two options: to return to CA10 (AnyRec)/CA20 (LRndRec) or return to the last question in the grid answered NO. If “AnyRec” selected, CAPI should go back to CA10 or CA20, whichever was answered.

Display the question that was answered either {CA10/CA20} in display error message and the response options. Go to BOX_10.

Display Instructions: Display “Please tell me who the record is for...” text in grayed out in lighter text and in brackets.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.


CA30_08 (CA1045)

BLAISE NAME: OthRecOS

Question Text:

[Please tell me who the record is for, and the type of record you’re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]

ENTER OTHER RECORD.

NOTE: BE AS SPECIFIC AS POSSIBLE BECAUSE YOU WILL BE REFERRING TO THIS TEXT IN THE NEXT ROUND.

NAVIGATION: Complete the grid in order of respondent's answers.

Responses: 1

Programmer Instructions: RF/DK disallowed.

Display this cell as active only if RU member coded CA30_07 '1' (YES, HAS OTHER RECORD FOR {PERSON}). Otherwise, display cell as inactive.

Hard check: at least one cell in grid (CA30_01 through CA30_07) should be coded ‘1’ (YES, HAS RECORDS).

If not, display error message: AT {CA10 (AnyRec)/CA20 (LRndRec)} YOU INDICATED SOMEONE IN THIS HOUSEHOLD HAD RECORDS, GO BACK TO REVIEW GRID. IF NO ONE IN THIS HOUSEHOLD HAS RECORDS, BACK UP TO {CA10 (AnyRec)/CA20 (LRndRec)} AND CHANGE YOUR ANSWER TO CONTINUE.

Error message should display two options: to return to CA10 (AnyRec)/CA20 (LRndRec) or return to the last question in the grid answered NO. If “AnyRec” or “LRndRec” selected, CAPI should go back to CA10 or CA20, whichever was answered.

Display the question that was answered either {CA10 (AnyRec)/CA20 (LRndRec)} in display error message and the response options.

Display Instructions: Display “Please tell me who the record is for...” text in grayed out in lighter text and in brackets.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.


CA40 (CA1055)

BLAISE NAME: GiveCalndr

Question Text:

GIVE RESPONDENT A MONTHLY PLANNER (CALENDAR). Through the rest of the interview, there are questions that will ask for dates. When you do not remember the date, we can refer to this calendar for help.

CIRCLE {TODAY’S DATE/12/31/{YEAR}} {AND DATE OF LAST INTERVIEW ({PREV RD INTV DT})}.

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_10 (CA1060)

Display Instructions: Display “today's date” is not round 5. Display “12/31/{year}” if round 5. For {year} display second year of panel.

Display “and date of last interview” if not round 1. Otherwise, use a null display.

For “(PREV RD INTV DT)”, display the date of the previous round interview. Typically, but not always, the current round RU reference period start date.


BOX_10 (CA1060)

Route Details: (If rounds 2-5) and (if at least one open HS, IC, or HH event continue with LOOP_10.

Otherwise, go to BOX_30



LOOP_10 (CA1065)

Route Details: For each element in the RU-Members-Roster, ask LOOP_20-END_LP10

Loop definition: LOOP_10 cycles on persons who had an open HS, IC, or HH event in the nrevious round. This loop cycles on RU members who meet any of the following conditions (Preload.CaseID, Preload.EvntID, Preload.PersID, Preload.ProvID, Preload.EvntType, Preload.EvntEndDt, Preload.EvntEndM, Preload.EvntEndD, Preload.EvntEndY):

-Person had an HS event during the previous round and one of person’s HS events had a discharge date coded ‘95’ (STILL IN HOSPITAL).

-Person had at least one IC event during the previous round and one of person’s IC events had a discharge date coded ‘95’ (STILL IN INSTITUTION).

-Person had an HH event coded “1” (YES) during the previous round interview month.

Note: If the respondent is eligible for this loop, CAPI should cycle on the respondent first, followed by eligible RU members in PID order.



LOOP_20 (CA1070)

Route Details: For each element in person’s-medical-events-roster, ask BOX_15-END_LP20

Loop definition: Loop_10 closes out HS, IC, or HH event that were “OPEN” in the previous round. This loop cycles on this person’s events that meet any of the following conditions:

-Event type is HS and event had a discharge date reported in the previous round as code ‘95’ (STILL IN HOSPITAL).

-Event type is IC and event had a discharge date reported in the previous round as ‘95’ (STILL IN INSTITUTION).

-Event type is HH and EV70 for the previous round interview month was coded ‘1’ (YES).



BOX_15 (CA1071)

Programmer Instructions: (If rounds 2-5) and if at least one open HS, or IC event and preload.providerID=empty for any RU member from the previous round, go to the Provider Roster (PV) section. At the completion of the PV section, continue with CA50.

(If rounds 2-5) and if at least one open HH event and preload.providerID=empty for any RU member from the previous round, go to CA43. Otherwise, continue with CA50.


CA43 (CA1072)

BLAISE NAME: CA43

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:

{{Before we discuss the health care events for each household member since {PREV RD INTV DT }/Next} I need to update the information for {you/{PERSON}} {who was receiving care at home/when you were receiving care at home} at the time of the last interview on {PREV RD INTV DT}.

Thinking about the health care {you/{PERSON}} received at home, was the person who provided the care a friend or neighbor, a relative, a volunteer, or some type of provider who was paid? Please do not include health care received from friends or relatives living here.

PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?

NOTE: SELECT ONLY ONE TYPE OF PROVIDER AT THIS TIME.

HELP: F1

Responses: FRIEND/NEIGHBOR 1 CA80_01 (CA1095)

RELATIVE 2 CA80_01 (CA1095)

VOLUNTEER 3 CA80_01 (CA1095)

OTHER - PAID 4 CA46 (CA1073)

VOLUNTEER: MEAL DELIVERY SERVICE 5 END_LP20 (CA1115)

Programmer Instructions: If coded ‘1’ (FRIEND/NEIGHBOR):

-Add ‘FRIEND(S) OR NEIGHBOR(S)’ to the RU-medical-providers-roster, person- type- nrovider name column. No address information is necessary.

If coded ‘2’ (RELATIVE):

-Add ‘RELATIVE(S)’ to the RU-medical-providers-roster, person-type-provider name column. No address information is necessary.

If coded ‘3’ (VOLUNTEER):

-Add ‘VOLUNTEER(S)’ to the RU-medical-providers-roster, person-type-provider name column. No address information is necessary.

If coded ‘5’ (VOLUNTEERED: MEAL DELIVERY SERVICE), create an event record with HH as the event type and the only attribute for this record is VOLUNTEERED: MEAL DELIVERY SERVICE. No other information is necessary.

If CA43 is coded '1' (FRIEND/NEIGHBOR), '2' (RELATIVE), or '3' (VOLUNTEER), flag nrovider as ‘INFORMAL’ for PROV.HHTYPE (this will have to be replaced when we know what variable it is being stored as).

Display Instructions: Display 'Before we discuss the health care events...” if it’s the first open HH event with preload.providerID=empty being cycled on.

Otherwise, if it's not the first open HH event with preload.providerID=empty being cycled on, display 'Next'.

Display “who was receiving care at home” if the person being looped on is not the respondent.

Otherwise, display “when you were receiving care at home”.


CA46 (CA1073)

BLAISE NAME: CA46

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}

Question Text:

Did this person work for a home health agency, hospital, or nursing home or did they work for themselves? PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?

Responses: WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME 1 BOX_18 (CA1074)

WORKED FOR SELF 2 BOX_18 (CA1074)

REFUSED RF BOX_18 (CA1074)

DON'T KNOW DK BOX_18 (CA1074)

Display Instructions:


BOX_18 (CA1074)

Route Details: Ask Provider Roster (PV) section for this event.

If CA46 is coded '1' (WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME), flag nrovider just collected in PV section as ‘AGENCY’ for PROV.HHTYPE.

If CA46 is coded '2' (WORKED FOR SELF), 'RF' (REFUSED), or 'DK' (DON'T KNOW), flag provider just collected in PV section as ‘PAID INDEPENDENT’ for PROV.HHTYPE.

(After flagging, continue with BOX_20.)



CA50 (CA1075)

BLAISE NAME: ContinEvnt

Question Text:

{Before we discuss the health care events for each household member since {PREV RD INTV DT}/Next}, I need to update the information for {PERSON} who {was in the hospital/was staying at a residential care facility/was receiving care at home} at the time of the last interview on {PREV RD INTV DT}. {Please refer to any of the records that you might have for {you/{PERSON}}.}

{I have a few more questions to ask about the {hospital stay/stay at a residential care facility/home health care} recorded for {PERSON} at the time of the last interview on {PREV RD INTV DT} {Please refer to any of the records you have for {you/{PERSON}}.}

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_20 (CA1080)

Display Instructions: Display instructions for the first paragraph:

First cycle of LOOP_10 and not coming from the PV section display: ‘Before we discuss the health care events for each household member since {START DATE}” Otherwise, if it's not the first cycle and not coming from the PV section, display “Next". Do not display the second paragraph if not coming from the PV section, “I have a few more questions to ask about the...”

If cycling on open HS event: “was in the hospital”

If cycling on open IC event: “was staying at a residential care facility” If cycling on open HH event: “receiving care at home” If at least one code ‘1’ (YES, HAS RECORD TYPE) at CA30_01 through CA30_06 for this person, display: “Please refer to any records that you might have for {you/{PERSON}}.

Otherwise, use a null display.

For “PREV RD INTV DT”, display the date of the previous round interview. Typically, but not always, the current round RU reference period start date if rounds 2-5, and Jan 1 if round 1.

Display instructions for the second paragraph:

Display “I have a few more questions to ask for...” if coming from the PV section, and do not display the first paragraph “{Before we discuss the health care events for each household member since...”

If at least one code ‘1’ (YES, HAS RECORD TYPE) at CA30_01 through CA30_06 for this person, display: “Please refer to any records that you might have for {you/{PERSON}}.” Otherwise, use a null display.

If cycling on open HS event: “was in the hospital”

If cycling on open IC event: “was staying at a residential care facility” If cycling on open HH event: “receiving care at home”


BOX_20 (CA1080)

Route Details: If cycling on an open HS or IC event and the respondent is not the person this event is for, continue with CA60. Otherwise, go to CA70.

If cycling on an open HH event, go to CA80_01.



CA60 (CA1085)

BLAISE NAME: StillHSIC

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER….}

Question Text:

Last time, we recorded that {PERSON} entered {PROVIDER} on {DAY OF WEEK, MONTH, DAY, YEAR OF ADMIT DATE}. Was {he/she} discharged from {PROVIDER}?

Responses: YES 1 CA70 (CA1090)

NO 2 END_LP20 (CA1115)

Programmer Instructions: If coded ‘2’ (NO), set this event to ’95’ (STILL IN HOSPITAL/IC FACILITY).

Display Instructions: Display the admit date for this event for {DAY OF WEEK, MONTH, DAY, YEAR OF ADMIT DATE}.


CA70 (CA1090)

BLAISE NAME: DischDate

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER….}

Question Text:

On what date {were/was} {you/he/she} discharged from {PROVIDER}?

PRESS ALT AND DOWN ARROW KEY TO SELECT THE DATE FROM THE CALENDAR. PRESS ENTER TO CONTINUE.

Responses: 1 END_LP20 (CA1115)

REFUSED RF END_LP20 (CA1115)

DON'T KNOW DK END_LP20 (CA1115)

Programmer Instructions: Pressing the ALT- down arrow key will bring up the pop-up calendar, or it can be entered manually.

CAPI should record this date to the event array as the hospital end date for this now closed event.

Hard check:

If open event occurred in round 1, admit date allowed to be 1 year prior to the start of the nerson’s reference period. The discharge date must be after the admit date. If a date outside of this range is entered, display the following message: “UNLIKELY RESPONSE. DATE MUST BE ON OR AFTER ADMITTANCE DATE AND BEFORE THE PERSON'S REFERENCE PERIOD END DATE. CONFIRM DATES WITH RESPONDENT.”

If open event occurred in rounds 2-4, date entered must be between the person’s reference period begin date (BegRefM, BegRefD, BegRefY) and the person’s reference period end date (EndRefM, EndRefD, EndRefY). If a date outside of this range is entered, display the following message: “DATE CANNOT BE AFTER PERSON’S REFERENCE PERIOD END DATE OR BEFORE PERSON’S REFERENCE PERIOD BEGIN DATE. VERIFY WITH RESPONDENT AND REENTER.”

NOTE: If the open event was created in round 1, admit date allowed to be 1 year prior to the start of the person’s reference period. The discharge date must be after the admit date. If a date outside of this range is entered, display the following message: “UNLIKELY RESPONSE. DATE MUST BE ON OR AFTER ADMITTANCE DATE. CONFIRM DATES WITH RESPONDENT.”

Display Instructions: Display the empty date field for entry.

Default to display the previous round interview month.


CA80_01 (CA1095)

BLAISE NAME: EvpvBegMM

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER….}

Question Text:

On {PREV ROUND INTV DATE}, we recorded that {you/{PERSON}} received care at home from {someone from} {PROVIDER} during some part of {PREV ROUND INTERVIEW MONTH}.

Did you continue to receive care at home from {someone from} {PROVIDER} into {MONTH AFTER PREV ROUND INTV MONTH}?

PROBE: How about in {MONTH}?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded grid type 1: forced navigation including CA80_01, CA80_02, CA80_03, CA80_04, CA80_N.

The CA80 grid has to accommodate at least 10 months.

Display Instructions:

Roster 1- Report

Col #1 Header: Month

Instructions: Display months in person’s reference period in the form pane

Roster Filter:

Grid displays all the months of the person’s reference period excluding the previous round interview month.

Display ‘someone from’ if provider is a facility. Otherwise, use a null display.

Display the months of the person’s reference period excluding the current month, as that was asked about in the last round. For example, for a round 2 interview the person’s reference period is March 5-August 15, CAPI would display months ‘APRIL’, ‘MAY’, ‘JUNE’, ‘JULY’, and ‘AUGUST’.

RF (REFUSED) and DK (DON’T KNOW) are allowed for CA80_01, CA80_02, CA80_03, CA80_04, CA80_N but will be treated as a ‘NO’ when creating events.

If current interview month is coded ‘1’ (YES), display the following message: “HOME HEALTH UTILIZATION SEC FOR {INT MONTH} WLL NOT BE ASKED UNTIL NEXT ROUND.”

Variable question text display for each of the question in the grid: CA80_02: “…during the month of {MONTH_2}? “ CA80_03: “How about during the month of {MONTH_3}?” CA80_04: “…during the month of {MONTH_4}?” CA80_N: “ …during the month of {MONTH_N}?” Repeat question text from CA80_02-CA80_N for months displayed beyond. Display “on {PREV ROUND INTV DATE}…” in bold black text every fourth month displayed, otherwise, display in lighter grayed out text.

“PREV ROUND INTV DATE”, display the date of the previous round interview. Typically, but not always, the current round RU reference period start date.

For “PREV ROUND INTERVIEW MONTH”, display the full month name of previous round interview month for this HH event that is being carried forward for this person-provider pair (Preload.EvntEndDt, Preload.EvntEndM).

For “MONTH AFTER PREV ROUND INTV MONTH”, display the first full month of the person's current reference period to be asked about for this round.


END_LP20 (CA1115)

Route Details: Cycle on next event for this person being looped on that meets the conditions stated in the loop definition.

If no more events meet the stated conditions, end LOOP_20 and continue with END_LP10.



END_LP10 (CA1120)

Route Details: Cycle on next person in RU-Members-Roster that meets the conditions stated in the loop definition.

If no more persons meet the stated conditions, end LOOP_10 and continue with BOX_30.



BOX_30 (CA1125)

Route Details: If coded 1 ‘YES, HAS RECORD’ for at least one RU member at either CA30_01, CA30_02, CA30_03, CA30_04, or CA30_07 continue with LOOP_30. Otherwise, go to BOX_50.

If CA30_05 is the only item in the CA30 grid that is coded and it is coded ‘1’ (YES), check to see if CA30_06 is coded ‘1’ (YES) and continue with LOOP_30, otherwise (if CA30_05 is coded ‘1’ (YES) and CA30_06 is coded ‘2’ (NO), go to BOX_50.



LOOP_30 (CA1130)

Route Details: For each of the following:

Record 1

Record 2

Record 3

Record 4

Ask BOX_40-END_LP30.

Loop definition: LOOP_30 enumerates events from records. The response to CA90 or CA100 determines if the loop cycles again. If CA90 or CA100 is coded ‘1’ (YES), the loop cycles to collect the next even from records. When both CA90 and CA100 are coded ‘2’ (NO), ‘RF’ (REFUSED), or ‘DK’ (DON’T KNOW), the loop ends.



BOX_40 (CA1135)

Route Details: Ask the Event Roster (EV) Section for record collection.

At completion of the EV section, continue with CA90.



CA90 (CA1140)

BLAISE NAME: AnotherEvnt

Question Text:

CODE ‘YES’ IF THE RECORD YOU ARE LOOKING AT HAS ANOTHER HEALTH CARE EVENT NOT YET ENTERED INTO CAPI. THE HEALTH CARE EVENT CAN BE FOR ANY PERSON.

IF UNSURE, ASK: Is there another health care visit covered in that record?

Responses: YES 1 END_LP30 (CA1150)

NO 2 CA100 (CA1145)

Programmer Instructions: RF and DK disallowed.

Display Instructions:


CA100 (CA1145)

BLAISE NAME: AnotherRec

Question Text:

CODE ‘YES’ IF YOU HAVE ANOTHER RECORD NOT YET REVIEWED WHICH CONTAINS HEALTH CARE EVENT INFORMATION. THE RECORD CAN BE FOR ANY PERSON.

IF UNSURE, ASK: Do you have another record for any person in the household?

Responses: YES 1 END_LP30 (CA1150)

NO 2 END_LP30 (CA1150)

Programmer Instructions: RF and DK disallowed.

Soft Check: If coded ‘2’ (NO), check that every person who has a record reported at CA30 grid has at least one health care event recorded through the EV section. If at least one person who reported a record at CA30 grid, does not have a health care event recorded through the EV section, display the following message: “You mentioned earlier that {you/{PERSON 1, }} {PERSON 2, } {PERSON 3, } {PERSON 4, } {PERSON N} had a record to help them report their health care, but you didn’t report any health care events for them yet. TO ADD A HEALTH CARE EVENT, SELECT YES AT THIS QUESTION.”

Display the names of the RU members that have records reported in the CA30 grid, but do not have at least one event recorded for them.

Display Instructions:


END_LP30 (CA1150)

Route Details: If CA90 or CA100 is coded ‘1’ (YES), cycle to collect next event from records.

If both CA90 and CA100 are coded ‘2’ (NO), end LOOP_30 and continue with BOX_50.



BOX_50 (CA1155)

Route Details: Go to next questionnaire section, Provider Probes (PP) section.



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