Provider Probes (PP) Section

BOX_00 (PP1000)

Route Details: 01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100, BOX_110, BOX_120, BOX_130, BOX_140, BOX_150, BOX_160, BOX_170, BOX_180, BOX_190, BOX_200, BOX_210, BOX_220, BOX_230, BOX_240, BOX_250, BOX_260, BOX_270, BOX_280, BOX_290, BOX_300, BOX_310, BOX_320, BOX_330, BOX_340, BOX_350, BOX_360, BOX_370

05 Single Select with Display Roster = PP10, PP20, PP30, PP40, PP50, PP60, PP70, PP80, PP90, PP100, PP110, PP120, PP130, PP140, PP150, PP160_01, PP160_02, PP160_03, PP160_04, PP320_01, PP320_02, PP320_03, PP320_04, PP325_01, PP325_02, PP325_03, PP325_04

10 Multiple Select with Fill in Answer Text = PP170, PP180, PP190, PP200. PP210, PP220, PP230, PP240, PP250, PP260, PP270, PP280, PP290, PP300, PP310

Grid 1 = PP10, PP20, PP30, PP40, PP50, PP60, PP70, PP80, PP90, PP100, PP110, PP120, PP130, PP140, PP150, PP160_01, PP160_02, PP160_03, PP160_04, PP320_01, PP320_02, PP320_03, PP320_04, PP325_01, PP325_02, PP325_03, PP325_04

Roster 2 = PP170, PP180, PP190, PP200. PP210, PP220, PP230, PP240, PP250, PP260, PP270, PP280, PP290, PP300, PP310



BOX_10 (PP1005)

Route Details: The following definitions of family and non-family subunit are specified and created in RE930.

For family subunit, which consists only of respondent, respondent’s spouse/partner(RE900= ‘7’ HUSBAND/WIFE/SPOUSE or ‘8’ UNMARRIED PARTNER) , respondent’s dependent children under age 21 (RE900 = 5 DAUGHTER/ADOPTED DAUGHTER, ‘6’ SON/ADOPTED SON, ’17’ STEPDAUGHTER, or ‘18’ STEPSON), children of partner under age 21 (RE900 = ‘30'DAUGHTER OF {PERSON LOOPING ON}'s PARTNER, ‘31’ SON OF {PERSON LOOPING ON}'s PARTNER), and children under age 18 in a legal guardian relationship with the respondent (Respondent was selected as the legal guardian for child at RE920). If respondent is a proxy, Family Subunit is the reference person and the reference person’s spouse/partner (RE900= ‘7’ HUSBAND/WIFE/SPOUSE or ‘8’ UNMARRIED PARTNER), reference person’s dependent children under age 21 (RE900 = 5 DAUGHTER/ADOPTED DAUGHTER, ‘6’ SON/ADOPTED SON, ’17’ STEPDAUGHTER, or ‘18’ STEPSON), reference person’s partners children under age 21 (RE900 = ‘30’ DAUGHTER OF {PERSON LOOPING ON}'s PARTNER, ‘31’ SON OF {PERSON LOOPING ON}'s PARTNER), and children under age 18 in a legal guardian relationship with the reference person (Reference person was selected as the legal guardian for child at RE920).

  • For all other situations that are not inclusive of the above definition for family subunit, they would be considered a non-Family Subunit- all other household members, not part of Family Subunit

  • For the Family Subunit ask PP10-PP160, which is to be administered with a forced choice format for each person on the household roster who is part of the Family Subunit. There will always be at least one person in the family subunit- the respondent at the very least.

For the non-family subunit: ask PP170-PP320 in a select-all-that-apply format for each person on the household roster who is part of the Non-Family Subunit. Option of “other household member” and “no one” are available.

Throughout this section, the {DISPLAY FAMILY SUBUNIT NAMES} and {DISPLAY NON-FAMILY SUBUNIT NAMES} refers to displaying the FIRST, MIDDLE, LAST NAME of each RU member in the corresponding subunit. For the first probe in each set (PP10 and PP170 respectively), display full names (FIRST, MIDDLE, LAST NAME) for each RU member in the subunit, otherwise only display FIRST name for each subsequent probe (PP20-PP160_01-N; PP180-PP325_01-N) for each RU member in the family or non-family subunit. This is different than other sections. Separate each name with a comma and before the last RU member’s name display an “or”. Display “you” rather than the respondent’s name, when respondent’s name is included in the list. Display reference person’s name, when the respondent is a proxy.



PP10 (PP1010)

BLAISE NAME: ProbeHosp

Question Text:

& PP-1

The next set of questions {help make sure we haven’t missed any additional health care for any of the/ ask about health care received by the} people living here. {Earlier you mentioned that {DISPLAY NAME 1} {DISPLAY NAME 2} {DISPLAY NAME 3} {and DISPLAY NAME N} had some health care visits that we haven’t yet talked about. I can collect that information during these next series of questions}

{As I ask the questions, please look at the corresponding show cards and think about {any additional} health care each person received. / As I ask the questions, please look at the corresponding show cards. For now, I’d like you to think about {yourself/you/{REFERENCE PERSON}} {and {your/his/her} {spouse/partner}}/ {and {your/his/her} children} when answering. We’ll cover the other household members next. }

Let’s start with hospitals. Looking at card PP-1, {since {START DATE}/between {START DATE} and {END DATE}}, {were/was} {DISPLAY FAMILY SUBUNIT NAMES} admitted to the hospital for any period of time?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_20.

Otherwise, go to PP20.

Display Instructions: Roster type 1- Report Roster definition:

Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘was’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘were’.

Display “help make sure we haven’t missed any additional health care for any of the” if at least one event record has already been created for any RU member.(e.g., EV20 in (1-7))

Display “ask about health care received by the” if no event records exist for any RU member (e.g., EV20 not set)

Display “As I ask the questions, please look at the corresponding show cards and think about {any additional} health care each person received” if all persons in the RU are part of the FAMILY SUBUNIT. Within this sentence, display “any additional” if there are events enumerated on the roster for anyone in this family subfamily unit.

Display “As I ask the questions, please look at the corresponding show cards. For now, I’d like you to think about {yourself/you/{REFERENCE PERSON}}{and {your/his/her} {spouse/partner}} {and {your/his/her} children} when answering. We’ll cover the other household members next.” if 1 or more but not all RU members included in the FAMILY subunit. Within this sentence, use the following display logic:

{yourself/you/{REFERENCE PERSON}}

  • Display “yourself” if the family subunit only includes the respondent.

  • Display “you” if the family subunit only include the respondent and at least one other person.

  • Display “{REFERENCE PERSON}” substituting the reference person’s name if the respondent is a proxy.

{and {your/his/her} {spouse/partner}}

  • Display “and {your/his/her} {spouse/partner}” if the respondent/reference person has a spouse or partner (RE900= ‘7’ HUSBAND/WIFE/SPOUSE ) or (RE900= ‘8’ UNMARRIED PARTNER)

  • Otherwise use a null display.

{spouse/partner}

  • Display “spouse” if the if RE900= ‘7’ HUSBAND/WIFE/SPOUSE

  • Display “partner” if RE900= ‘8’ UNMARRIED PARTNER

{and {your/his/her} children}

  • Display “and {your/his/her} children” if the respondent/reference person or the respondent/reference person’s partner has any children.

RE900=’5’ (DAUGHTERADOPTED DAUGHTER), ‘6’ (SON/ADOPTED SON}, ‘17’ (STEPDAUGHTER), ‘18’ (STEPSON) ‘30’ (DAUGHTER OF {PERSON LOOPING ON}’S PARTNER), ‘31’ (SON OF {PERSON LOOPING ON}’S PARTNER)

  • Otherwise use a null display.

Display “Earlier you mentioned…” if EV15 has a value set for it for any person in the family subunit. For DISPLAY NAMES within that sentence, display only the first, middle, and last names of the persons within the FAMILY SUBUNIT for which EV15 value is set.

For {DISPLAY FAMILY SUBUNIT NAMES}, display the first names of all RU members in the family subunit. Use the word ‘or’ before the last person's name.

For the fill ‘VARIABLE QUESTION TEXT’ Display the following:

For PERSON 1, always use a null display.

Display‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid.

Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid.

Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} been admitted to the hospital for any period of time?’ when the cursor is on the fourth person in the grid.

Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display.

Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_20 (PP1015)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP20.



PP20 (PP1020)

BLAISE NAME: ProbeER

Question Text:

& PP-2

Now think about hospital emergency rooms. Looking at card PP-2, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} received any type of care in a hospital emergency room?

{VARIABLE QUESTION TEXT

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_30.

Otherwise, go to PP30.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always use a null display.

Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} received any type of care in a hospital emergency room? ’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_30 (PP1025)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP30.



PP30 (PP1030)

BLAISE NAME: ProbeOP

Question Text:

& PP-3

Looking at card PP-3, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} received any type of care in a hospital outpatient department?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_40.

Otherwise, go to PP40.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always use a null display.

Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} received any type of care in a hospital outpatient department ?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_40 (PP1035)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP40.



PP40 (PP1040)

BLAISE NAME: ProbeGP

Question Text:

& PP-4

Now I’d like you to think about different kinds of medical doctors and health care professionals who provided care to {you/you and your family}/{REFERENCE PERSON}/{REFERENCE PERSON}’s family}} {{other than the} {hospital} {{and }emergency room} {{and }outpatient} {visit/visits} we already talked about}}.

Looking at card PP-4, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} seen a primary care doctor such as a general practitioner, internist, pediatrician, or family medicine provider?

HELP: F1

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_50.

Otherwise, go to PP50.

Display Instructions: Roster type 1- Report Roster Definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “Since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

Display “you/you and your family” if an RU member is the respondent. Otherwise, display “{REFERENCE PERSON}/{REFERENCE PERSON}’s family”.

Display “you” if RU member respondent is the only RU member in the family subunit. Otherwise, display “you and your family”.

Display “{REFERENCE PERSON}” if the reference person is the only RU member in the family subunit. Otherwise, display “{REFERENCE PERSON}’s family.

Search the event array for RU members in the family subunit. If at least one person in the family subunit reported an HS, ER, and/or OP event, display ‘other than the…we already talked about’, otherwise use a null display.

Display “hospital” if a HS event is on the event array for at least one person in the family subunit. Otherwise, use a null display.

Display “{and} emergency room” if an ER event is on the event array for at least one person in the family subunit. Otherwise, use a null display.

Display the “{and}” “ only if both HS and ER events are on the event array for at least one person in the family subunit, but not an OP event. Otherwise, use a null display.

Display “{and }outpatient” if there is an OP event on the event array for at least one person in the family subunit. Otherwise, use a null display.

Display the “and” only if there is a HS event and/or an ER event on the event array, along with an OP event for at least one person. Otherwise, use a null display.

Display ‘visit’ if there is only one HS, ER, or OP event for the family subunit reported on the event array. Display ‘visits’ if there are two or more events for the family subunit reported on the event array. Otherwise, use a null display.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} seen a primary care doctor?’ when the cursor is on the fourth person in the grid.

Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display.

Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_50 (PP1045)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP50.



PP50 (PP1050)

BLAISE NAME: ProbeSpeclt

Question Text:

& PP-5

Looking at card PP-5, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} seen any type of specialist such as an orthopedist, cardiologist, dermatologist, oncologist, neurologist, gynecologist, allergist or any other type of specialist?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_60.

Otherwise, go to PP60.

Display Instructions: Roster type 1- Report Roster definition:

Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following: For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} seen any type of specialist when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_60 (PP1055)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP60.



PP60 (PP1060)

BLAISE NAME: ProbeNurse

Question Text:

& PP-6

Looking at card PP-6, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} seen any other type of medical professional such as a nurse, nurse practitioner or nurse’s aide, a physician’s assistant or a midwife?

{VARIABLE QUESTION TEXT}

HELP: F1

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_70.

Otherwise, go to PP70.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following: For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} seen any other type of medical professional?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_70 (PP1065)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP70.



PP70 (PP1070)

BLAISE NAME: ProbeClinic

Question Text:

& PP-7

Looking at card PP-7, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} received care at any type of health clinic, such as a walk-in urgent care, a retail clinic at a pharmacy or grocery store, a family planning center or a clinic at a college or university?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_80.

Otherwise, go to PP80.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always display null. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} received care at any type of health clinic?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_80 (PP1075)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP80.



PP80 (PP1080)

BLAISE NAME: ProbeLab

Question Text:

& PP-8

Looking at card PP-8, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAME} been to any medical lab or testing facility for bloodwork, x-rays or other tests?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_90.

Otherwise, go to PP90.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTIONT EXT’ display the following:

For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} been to any medical lab or testing facility?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_90 (PP1085)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP90.



PP90 (PP1090)

BLAISE NAME: ProbeMentalHlth

Question Text:

& PP-9

Looking at card PP-9, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} seen any type of mental health professional such as a psychiatrist, psychologist, a licensed clinical social worker or any other type of mental health therapist or counselor?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_100.

Otherwise, go to PP100.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} seen any type of mental health professional?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_100 (PP1095)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP100.



PP100 (PP1100)

BLAISE NAME: ProbeTherap

Question Text:

& PP-10

Looking at card PP-10, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} had any visits to any other type of therapist such as a physical therapist, occupational therapist, speech therapist or chiropractor?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_110.

Otherwise, go to PP110.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always use a null display. Replace the fill for PERSON 1 and display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} had any visits to any other type of therapist?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_110 (PP1105)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP110.



PP110 (PP1110)

BLAISE NAME: ProbeDN

Question Text:

& PP-11

Looking at card PP-11, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} seen any type of dental care provider such as dentists, oral surgeons, orthodontists, or dental assistants?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_120.

Otherwise, go to PP120.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} seen any type of dental care provider ?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_120 (PP1115)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP120.



PP120 (PP1120)

BLAISE NAME: ProbeVision

Question Text:

& PP-12

Looking at card PP-12, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} seen any type of vision or eye care provider such as an optometrist, ophthalmologist or vision technician?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_130.

Otherwise, go to PP130.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “Since {START DATE}” if not round 5, otherwise display “Between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} seen any type of vision or eye care provider?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_130 (PP1125)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP130.



PP130 (PP1130)

BLAISE NAME: ProbeAltCare

Question Text:

& PP-13

Looking at card PP-13, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} had any visits to someone who practices alternative care such as acupuncture, homeopathic care, massage therapy, hypnosis, or other treatments?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_140.

Otherwise, go to PP140.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “Since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} had any visits to someone who practices alternative care?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_140 (PP1135)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP140.



PP140 (PP1140)

BLAISE NAME: ProbeHH

Question Text:

& PP-14

Now I would like you to think about care {DISPLAY FAMILY SUBUNIT NAMES} may have received at home. Please look at card PP-14. Because of a health problem, {since {START DATE}/between{START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} received any type of care at home, such as

… care from a home care nurse or any type of therapist or social worker?

… care from someone who helps with bathing, dressing, or taking medication?

… help with cooking or cleaning ?

… or companionship services?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_150.

Otherwise, go to PP150.

Display Instructions: Roster type 1- Report Roster definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “Since {START DATE}” if not round 5, otherwise display “Between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following:

For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} received any type of care at home?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display. Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_150 (PP1145)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP150.



PP150 (PP1150)

BLAISE NAME: ProbeIC

Question Text:

& PP-15

Now let’s talk about health care provided in a residential setting. {Earlier we discussed that {DISPLAY NAMES FROM RE350 WITH VISIT OF LESS THAN 100 DAYS}{was/were} institutionalized in a facility for less than 100 days. If {he/she/they} received care in a residential health care facility, I can record that care now.}

Looking at card PP-15, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY FAMILY SUBUNIT NAMES} received any type of care in a residential rehabilitation or treatment facility, such as for rehab after surgery, hospice or respite care, mental health treatment, or treatment for drug, alcohol or other addiction?

{VARIABLE QUESTION TEXT}

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1: Forced navigation

If at least one person in the grid coded ‘1’ (YES), continue with BOX_160.

Otherwise, go to BOX_170.

Display Instructions: Roster 1- Report Roster Definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members’ First, Middle, Last Names

Roster Filter: Display all RU members’ part of the family subunit as defined in BOX_10.

Display “Since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘has’ if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ‘have’.

Display “Earlier we discussed that {DISPLAY NAMES FROM RE350 WITH VISIT OF LESS THAN 100 DAYS} {was/were} institutionalized in a facility for less than 100 days. If {he/she/they} received care in a residential health care facility, I can record that care now.” if RE350 was coded ‘1’ (100 DAYS OR LESS) for at least one RU member in this family subunit in the current round, otherwise use null display.

For {DISPLAY NAMES FROM RE350 WITH VISIT OF LESS THAN 100 DAYS} display the first and last names of all RU members, separated by a comma, in this subfamily where the person that was coded ‘1’ (100 DAYS OR LESS) at RE350 in the current round. Before the last person’s name, if displaying more than one person, use the word ‘and.’

Display ‘was’ if only one name is displayed in the fill for ‘DISPLAY NAMES FROM RE350…”, otherwise, display ‘were’.

For the fill ‘VARIABLE QUESTION TEXT’ display the following: For PERSON 1, always use a null display. Display ‘What about {PERSON 2}?’ in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ‘What about {PERSON 3}?’ in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ‘What about {PERSON 4}? Since {START DATE}/between {START DATE} and {END DATE} has {he/she} received any type of care in a residential rehabilitation or treatment facility?’ when the cursor is on the fourth person in the grid. Replace the fill for PERSON 4 and display ‘What about {PERSON N}?’ in brackets when the cursor is on the Nth person in the grid.

Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display.

Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.


BOX_160 (PP1155)

Route Details: Ask the EE section.

At the completion of the EE section, continue with BOX_170.



BOX_170 (PP1160)

Route Details: Check to see if any RU members in this family subunit reported no events during this round. If one or more RU members , but not all RU members, reported 0 events continue to PP160_01.

Otherwise, go to BOX_190.

If only one RU member in the family subunit, and that person reported 0 events, go to BOX 190.



PP160_01 (PP1165)

BLAISE NAME: ProbeOthEvnt

Question Text:

I see that we don’t have any health care recorded for {DISPLAY NAMES OF FAMILY SUBUNIT MEMBERS WITH NO

HEALTH CARE 1-N}. Please take a look at this card (RECORDS JOB AID-EVENT SIDE), and make sure that I didn’t miss anything.

Did {DISPLAY NAME 1} receive any care like that listed on the card, or any other kind of care?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded grid type 1: forced navigation including PP160_01, PP160_02, PP160_03, PP160_ 04…,PP160_N on the same form pane.

If anyone coded ‘1’ (YES), go to BOX_180, otherwise go to BOX_190.

Display Instructions: Roster 1- Report

Roster Definition: Col #1: RU Member’s name Display First, Middle, and Last name of RU members.

Roster Filter: Display names of RU members within the family subunit that have not reported any heath care events during the current round. Variable question text display for each person in the roster display the following: PP160_02, 2nd person on the roster: What about {DISPLAY NAME 2}? PP160_03, 3rd person on the roster: What about {DISPLAY NAME 3}? PP160_04, 4th person on the roster: What about {DISPLAY NAME 4}? Did {you/he/she} receive any health care like those listed on the card, or any other kind of care? PP160_ N: repeat question text from PP160_01-160_04

For {DISPLAY NAMES OF FAMILY SUBUNIT MEMBERS WITH NO HEALTHCARE 1-N}, display all

RU members in the family subunit that have not reported any healthcare during this interview

Display the first paragraph ‘I see that we don't have any health...and make sure that I didn't miss anything’ in brackets and grayed out text when displaying the variable text PP160_02-PP160N.


BOX_180 (PP1170)

Route Details: Ask the EE section.

At the completion of the EE section, continue with BOX_190.



BOX_190 (PP1175)

Route Details: Check for any RU members that fit the criteria for Non-family subunit members as defined in BOX_10. If there are any RU members that fit these criteria, go to PP170, otherwise go to BOX_370.



PP170 (PP1180)

BLAISE NAME: RosterHosp

Question Text:

& PP-1

Just to be sure I haven’t missed any health care for anyone else, now I’m going to ask those same questions again, but this time please think about {DISPLAY NAMES OF NONFAMILY SUBUNIT MEMBERS} when answering. {This is also where I can record information for {DISPLAY NAME 1} {DISPLAY NAME 2} {DISPLAY NAME 3} {DISPLAY NAME N}, who you had mentioned earlier had health care that we haven’t talked about yet.}

Let’s start with hospitals. Looking at card PP-1, {since {START DATE}/between {START DATE} and {END DATE}}, {was/were} {DISPLAY NON-FAMILY SUBUNIT NAMES} admitted to the hospital for any period of time?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_200, otherwise go to PP180.

Hard check: If coded ‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10. Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display RU members’ full name, first, middle, last name in first sentence of “Just to be sure…” for “DISPLAY NAMES OF NON-FAMILY SUBUNIT MEMBERS” as described in BOX_10. In the third sentence display only the RU members in the non-family subunit’s first name.

In the first paragraph, use the word ‘and’ before the last person’s name. In the second paragraph, follow the conventions described in BOX_10 and use ‘or’ before the last name is displayed.

Display “This is also where I can…” if EV15 has a value set for it for any person in the nonfamily subunit . Display the names of the nonfamily subunit for which EV15 value is set for DISPLAY NAMES 1-N.

Display ‘were’ if more than one person in the non-family subunit, otherwise, display ‘was'.


BOX_200 (PP1185)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP180.



PP180 (PP1190)

BLAISE NAME: RosterER

Question Text:

& PP-2

Now think about hospital emergency rooms. Looking at card PP-2{since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} received any type of care in a hospital emergency room?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_210, otherwise go to PP190.

Hard check: If coded ‘99’ (NO ONE) selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10. Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_210 (PP1195)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP190.



PP190 (PP1200)

BLAISE NAME: RosterOP

Question Text:

& PP-3

Looking at card PP-3, {since {START DATE}/between {START DATE} and {END DATE}} {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} received any type of care in a hospital outpatient department?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_220, otherwise go to PP200.

Hard check: If coded ‘99’ (NO ONE) selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10. Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_220 (PP1205)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP200.



PP200 (PP1210)

BLAISE NAME: RosterGP

Question Text:

& PP-4

Now I’d like you to think about different kinds of medical doctors and health care professionals who provided care to {DISPLAY NAMES OF NON-FAMILY SUBUNIT}, {{other than the} {hospital} {{and }emergency room} {{and } outpatient} {visit/visits} we already talked about}.

Looking at card PP-4, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NONFAMILY SUBUNIT NAMES} seen a primary care doctor?

If R ISN’T LOOKING AT CARD: Primary care doctor, such as a general practitioner, internist, pediatrician or family medicine provider.

ENTER ALL THAT APPLY.

HELP: F1

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_230, otherwise go to PP210.

Hard check: If coded ‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.

Display first and last names for the first sentence “DISPLAY NAMES OF NON-FAMILY SUBUNIT.”

Display only first names for the second sentence “DISPLAY NON-FAMILY SUBUNIT NAMES”

Search the event array for RU members in the non-family subunit. If at least one person in the family subunit reported an HS, ER, and/or OP event, display “other than at the...we already talked about”. Otherwise, use a null display.

Display “hospital” if a HS event is on the event array type is coded for at least one person in the non-family subunit. Otherwise, use a null display.

Display “{and }emergency room” if an ER event is on the event array coded for at least one person in the non-family subunit. Otherwise, use a null display.

Display the “and” only if both HS and ER events are on the event array for at least one person in the non-family subunit, but not an OP event. Otherwise, use a null display.

Display “{and }outpatient” if an OP event is on the event array for at least one person in the non- family subunit. Otherwise, use a null display.

Display the “and” only if there is a HS event and/or ER event, along with an OP event for at least one person in the non-family subunit. Otherwise, use a null display.

Display ‘visit’ if there is only one event for the non-family subunit reported on the event array. Display ‘visits’ if there are two or more events for the non-family subunit on the event array. Otherwise, use a null display.


BOX_230 (PP1215)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP210.



PP210 (PP1220)

BLAISE NAME: RosterSpeclt

Question Text:

& PP-5

Looking at card PP-5, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} seen any type of specialist?

IF R ISN’T LOOKING AT CARD: Specialists, such as an orthopedist, cardiologist, dermatologist, oncologist, neurologist, gynecologist, allergist, or any other type of specialist.

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_240, otherwise go to PP220.

Hard check: If coded ‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_240 (PP1225)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP220.



PP220 (PP1230)

BLAISE NAME: RosterNurse

Question Text:

& PP-6

Looking at card PP-6, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} seen any other type of medical professional?

IF R ISN’T LOOKING AT CARD: Other type of medical professional such as a nurse, nurse practitioner or nurse’s aide, a physician’s assistant or a midwife?

ENTER ALL THAT APPLY.

HELP: F1

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_250, otherwise go to PP230.

Hard check: If coded ‘99’ (NO ONE) in conjunction with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_250 (PP1235)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP230.



PP230 (PP1240)

BLAISE NAME: RosterClinic

Question Text:

& PP-7

Looking at card PP-7, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} received care at any type of health clinic?

IF R ISN’T LOOKING AT CARD: A health clinic, such as a walk-in urgent care, a retail clinic at a pharmacy or grocery store, a family planning center, or a clinic at a college or university?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_260, otherwise go to PP240.

Hard check: If coded ‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_260 (PP1245)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP240.



PP240 (PP1250)

BLAISE NAME: RosterLab

Question Text:

& PP-8

Looking at card PP-8, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} been to any medical lab or testing facility for bloodwork, x-rays or other tests?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_270, otherwise go to PP250.

Hard check: If coded ‘99’ (NO ONE), you cannot select another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_270 (PP1255)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP250.



PP250 (PP1260)

BLAISE NAME: RosterMentalHlth

Question Text:

& PP-9

Looking at card PP-9, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} seen any type of mental health professional?

IF R ISN’T LOOKING AT CARD: Mental health professionals such as a psychiatrist, psychologist, a licensed clinical social worker or any other type of mental health therapist or counselor?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_280, otherwise go to PP260.

Hard check: If code ‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_280 (PP1265)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP260.



PP260 (PP1270)

BLAISE NAME: RosterTherap

Question Text:

& PP-10

Looking at card PP-10, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} had any visits to any other type of therapist?

IF R ISN’T LOOKING AT CARD: Therapists, such as a physical therapist, occupational therapist, speech therapist or chiropractor?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, automatically code this event as an HH event for each event created and go to BOX_290, otherwise go to PP270.

Hard check: If code‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_290 (PP1275)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP270.



PP270 (PP1280)

BLAISE NAME: RosterDN

Question Text:

& PP-11

Looking at card PP-11, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} seen any type of dental care provider?

IF R ISN’T LOOKING AT CARD: Dental care providers such as dentists, oral surgeons, orthodontists, or dental assistants?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_300, otherwise go to PP280.

Hard check: If code‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_300 (PP1285)

Route Details: Ask the EE section.

At completion of the EE section, continue with PP280.



PP280 (PP1290)

BLAISE NAME: RosterVision

Question Text:

& PP-12

Looking at card PP-12, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} seen any type of vision or eye care provider?

IF R ISN’T LOOKING AT CARD: Vision or eye care providers such as an optometrist, ophthalmologist or vision technician?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_310, otherwise go to PP290.

Hard check: If code‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_310 (PP1295)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP290.



PP290 (PP1300)

BLAISE NAME: RosterAltCare

Question Text:

& PP-13

Looking at card PP-13, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} had any visits to someone who practices alternative care?

IF R ISN’T LOOKING AT CARD: Alternative care such as acupuncture, homeopathic care, massage therapy, hypnosis, or other treatments?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_320, otherwise go to PP300.

Hard check: If code‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_320 (PP1305)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP300.



PP300 (PP1310)

BLAISE NAME: RosterHH

Question Text:

& PP-14

Now I would like you to think about care {DISPLAY NON-FAMILY SUBUNIT NAMES} may have received at home.

Please look at card PP-14. Because of a health problem, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} received any type of care at home, such as

… care from a home care nurse or any type of therapist or social worker?

… care from someone who helps with bathing, dressing, or taking medication?

… to help with cooking or cleaning ?

… to provide companionship services?

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_330, otherwise go to PP310.

Hard check: If code‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.


BOX_330 (PP1315)

Route Details: Ask the EE section.

At the completion of the EE section, continue with PP310.



PP310 (PP1320)

BLAISE NAME: RosterIC

Question Text:

& PP-15

Now let’s talk about health care provided in a residential setting. {Earlier we discussed that {DISPLAY NAMES sOF RU MEMBERS FROM RE350 WITH VISIT OF LESS THAN 100 DAYS} {was/were} institutionalized in a facility for less than 100 days. If {he/she/they} received care in a residential health care facility, I can record that care now.}

Looking at card PP-15, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {DISPLAY NON-FAMILY SUBUNIT NAMES} received care in any type of residential rehabilitation facility or treatment facility?

IF R ISN’T LOOKING AT CARD: Residential rehabilitation or treatment facilities such as for rehab after surgery, or mental health treatment, or treatment for drug, alcohol or other addiction, for hospice or respite care.

ENTER ALL THAT APPLY.

Responses: {FIRST NAME, [MIDDLE NAME], LAST NAME}1 1

{FIRST NAME, [MIDDLE NAME], LAST NAME}2 2

{FIRST NAME, [MIDDLE NAME], LAST NAME}3 3

{FIRST NAME, [MIDDLE NAME], LAST NAME}4 4

{FIRST NAME, [MIDDLE NAME], LAST NAME}N 5

OTHER RU MEMBER 98

NO ONE 99

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

If at least one RU member or code ‘98’ (OTHER RU MEMBER) is selected, go to BOX_340, otherwise, go to BOX_350.

Hard check: If code‘99’ (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.

Display Instructions: Roster 2- no add/edit/delete

Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.

Col #1- RU Members Display RU members’ First, Middle, Last Names

Display “since {START DATE}” if not round 5, otherwise display “between {START DATE} and {END DATE}”.

Display ‘have’ if more than one person in the non-family subunit, otherwise, display ‘has’.

Display “Earlier we discussed that {DISPLAY NAMES FROM RE350 WITH VISIT OF LESS THAN 100 DAYS} {was/were} institutionalized in a facility for less than 100 days. If {he/she/they} received care in a residential health care facility, I can record that care now” if RE350 was coded ‘1’(100 DAYS OR LESS) for at least one RU member in this non- family subunit in the current round, otherwise use null display.

For {DISPLAY NAMES FROM RE350 WITH VISIT OF LESS THAN 100 DAYS} display the first and last names of all RU members, separated by a comma, in this subfamily where the person that was coded ‘1’ (100 DAYS OR LESS) at RE350 in the current round. Before the last person’s name, if displaying more than one person, use the word ‘and.’

Display ‘was’ if only one name is displayed in the fill for ‘DISPLAY NAMES FROM RE350…”, otherwise, display ‘were’.


BOX_340 (PP1325)

Route Details: Ask the EE section.

At the completion of the EE section, continue with BOX_350.



BOX_350 (PP1330)

Route Details: Check to see if any RU members in this non-family subunit reported any events during this round. If one or more persons, but not all RU members of this non-family subunit reported 0 events, continue with PP320_01. If only one RU member in the non-family subunit and they reported 0 events, continue with PP320_01.

Otherwise, go to BOX_370.



PP320_01 (PP1335)

BLAISE NAME: AnyCare1

Question Text:

I see that we don’t have any health care recorded for {DISPLAY NAMES OF NON-FAMILY SUBUNIT MEMBERS WITH

NO HEALTHCARE REPORTED 1-N}. Please take a look at this card (RECORDS JOB AID-EVENT SIDE), and make sure that I didn’t miss anything.

Did {PERSON 1} receive any care like that listed on the card, or any other kind of care?

Responses: YES 1

NO 2 PP325_01 (PP1336)

REFUSED RF PP325_01 (PP1336)

DON'T KNOW DK PP325_01 (PP1336)

Programmer Instructions: Preloaded grid type 1: forced navigation including PP320_01, PP325_01, PP320_02, PP325_02, PP320_03, PP325_03, PP320_ 04, PP325_04...PP320_N on the same form pane.

PP325_01-PP325_04 should display on a separate column to the right after PP320_01 is asked. Only asking PP325_01... if PP320_01 is coded ‘2’ (NO), ‘RF’ (REFUSED, or ‘DK’ (DON’T KNOW).

At completion of grid, if anyone coded ‘1’ (YES) to PP320_01, PP320_02, PP320_03, PP320_04….PP320_N go to BOX_360.

Display Instructions: Roster 1- Report Roster Definition: Col #1 Header: RU Member’s name Display First, Middle, and Last name of RU members.

Display variable question text display for each question in the grid:

PP320_02: How about {PERSON 2}? PP320_03: How about {PERSON 3}? PP320_04: Did {PERSON 4} receive any care like that listed on the card, or any other kind of care?

PP320_N: Repeat the question text of PP320_02-PP320_04 for RU members beyond.

Display the first paragraph “I see that we don’t have any health care recorded for…” in brackets and grayed out when on any row other than the first one. (PP320_02-PP320_N).

Roster Filter: Display names of RU members within the non-family subunit that have not reported any events during this interview.

For {DISPLAY NAMES OF NON-FAMILY SUBUNIT MEMBERS WITH NO HEALTHCARE REPORTED 1-N} display the names of the RU members that did not report any health care events during the current interview.

PP325_01 (PP1336)

BLAISE NAME: RespKnowsCare1

Question Text:

In general, would you say that {DISPLAY NAME} lets you know when {he/she} visits any kind of health care provider?

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Display PP325 as an active cell when PP320_01-PP320_N is ‘2’ (NO), ‘RF’ (REFUSED), or ‘DK’ (DON’T KNOW) for the corresponding person in this row.

Go to PP320 for next person in the grid. At the completion of the grid, if at least 1 person coded ‘1’ (YES) at PP320 go to BOX_360. Otherwise (if no one coded ‘1’ (YES) at PP320) go to BOX_370.

Display Instructions:


BOX_360 (PP1344)

Route Details: Ask the EE section.

At the completion of the EE section, continue with BOX_370.



BOX_370 (PP1345)

Route Details: End of section. Go to the next section of the questionnaire.


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