Institutional Care Stay (IC) Section

BOX_00 (IC1000)

BOX_05 (IC1005)

Programmer Instructions: If provider already has IC10 (provider type) recorded for this round (for any RU member) or in a previous round (for any RU member) (preload.ICPlaceTp=1) go to IC20, otherwise, continue with IC10.

IC10 (IC1010)

BLAISE NAME: ICPlaceTP

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER......} {ADM-DT} {DIS-DT}

Question Text:

&IC-1.

Looking at card IC-1, what kind of place is {PROVIDER}?

HELP: F1

Responses: INPATIENT REHABILITATION FACILITY OR CONVALESCENT HOME 1 IC20 (IC1015)

NURSING HOME 2 IC20 (IC1015)

RESIDENTIAL MENTAL HEALTH TREATMENT CENTER 3 IC20 (IC1015)

RESIDENTIAL EATING DISORDER TREATMENT CENTER 4 IC20 (IC1015)

RESIDENTIAL DRUG AND ALCOHOL OR ADDICTION TREATMENT CENTER 5 IC20 (IC1015)

RESIDENTIAL HOSPICE CARE 6 IC20 (IC1015)

RESIDENTIAL RESPITE CARE 7 IC20 (IC1015)

OTHER 91 IC20 (IC1015)

REFUSED RF IC20 (IC1015)

DON'T KNOW DK IC20 (IC1015)

Display Instructions:

IC20 (IC1015)

BLAISE NAME: ICRelCond

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER......} {ADM-DT} {DIS-DT}

Question Text:

Was {your/{PERSON}’s} stay at {PROVIDER} related to any specific health condition or were any conditions discovered during this stay?

Responses: YES 1 IC30 (IC1020)

NO 2 BOX_10 (IC1025)

REFUSED RF BOX_10 (IC1025)

DON'T KNOW DK BOX_10 (IC1025)

Display Instructions:

IC30 (IC1020)

BLAISE NAME: ICCondRoster

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER......} {ADM-DT} {DIS-DT}

Question Text:

What conditions were discovered or led {you/{PERSON}} to enter {PROVIDER}?

PROBE: Any other condition?

ENTER ALL THAT APPLY

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

HELP: F1

Responses: {MEDICAL CONDITION} 1 1 BOX_10 (IC1025)

{MEDICAL CONDITION} 2 2 BOX_10 (IC1025)

{MEDICAL CONDITION} 3 3 BOX_10 (IC1025)

{MEDICAL CONDITION} 4 4 BOX_10 (IC1025)

{MEDICAL CONDITION}N 5 BOX_10 (IC1025)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.
   
   
2. Multiple add allowed.
   
   
3. Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
   
   
4. Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event.

The link is created when the collection of utilization and/or charge/payment data is complete.

Display Instructions: Roster 3 – add/edit/delete allowed

Roster definition:

This item displays Person-Medical-Conditions-Roster for selection and addition of one or many medical conditions associated with this event. Display name of medical condition (COND.CONDNAM)

Roster filter:

Display all conditions on person's roster; display all.

BOX_10 (IC1025)

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