Provider Roster (PV) Section

BOX_00 (PV1000)

Route Details: 01 Box = BOX_00, BOX_10, BOX_20, BOX_30

04 Single Select = PV10, PV40

06 Single Select with Fill in Answer Text = PV80

12 Address-Newly Confirmed = PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_07, PV50_08, PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06, PV60_07

24 Information Screen = PV15

28 Trigram Lookup = PV20LU, PV30LU

29 Single Select with Fill in Answer Text and Display Roster = PV70

Grid 1= PV20LU, PV30LU

Roster 3 = PV20LU, PV30LU, PV70, PV80

BOX_10 (PV1005)

Route Details: Context Header Instructions:

Display PERS.FULLNAME and EVNT.EVNTTYPE.

If the Provider Roster section is launched from the Access to Care section, event type will not be displayed in the context header.

BOX_20 (PV1010)

Route Details: If coming from the Event Roster and event type is MV, go to PV10.

If coming from the Event Roster section and event type is DN, go to PV80.

If coming from the Calendar section BOX_15, go to PV15. If coming from the Calendar section BOX_18, go to PV20LU.

If coming from the Access to Care section go to PV30LU. Otherwise, go to PV20LU.

PV10 (PV1015)

BLAISE NAME: MPPartGrp

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

Question Text:

To the best of your knowledge, is the provider that provided the health care to {you/{PERSON}} associated with any group practice, HMO, or clinic?

Responses: YES 1 PV20LU (PV1020)

NO 2 PV20LU (PV1020)

REFUSED RF PV20LU (PV1020)

DON’T KNOW DK PV20LU (PV1020)

Display Instructions:

PV15 (PV1016)

BLAISE NAME: IntroFromCA

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

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 in the hospital/was staying at a residential care facility/was receiving care at home/when you were {in the hospital/staying at a residential care facility/receiving care at home}} at the time of the last interview on {PREV RD INTV DT}.

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 PV20LU (PV1020)

Display Instructions: Display 'Before we discuss the health care events..." if coming from the CA section and it’s the first open event being cycled on.

Otherwise, if it’s not the first open event being cycled on, display 'Next'.

Display “who {was in the hospital... at home” if the person being looped on is not the respondent.

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

PV20LU (PV1020)

BLAISE NAME: ProvLookup

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

Question Text:

(I have a directory to look up medical providers.) To get us started, please tell me just the {last} name, the street name, city, or the telephone number of the {individual} {or} {hospital/facility/home health agency/group practice, HMO, or clinic} that provided health care to {you/{PERSON}}.

{SELECT ONE PROVIDER - PRESS 1 AND ENTER TO SELECT A PROVIDER./TO ADD A PROVIDER PRESS CTRL-A.} VERIFY FULL PROVIDER NAME AND ADDRESS BEFORE SELECTING.

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

{{number of providers displayed} out of {total number of providers} providers shown – scroll for more}

Responses: CONTINUE 1

EMPTY Empty

Programmer Instructions: Preloaded Grid Type 2 including PV20 - Flexible navigation, allow empty.

If PV20LU is EMPTY for all of the medical providers and interviewer tries to move off of this page display the message: “YOU MUST SELECT A MEDICAL PROVIDER BEFORE CONTINUING. PRESS ENTER TO RETURN TO PV20LU.”

If coming from the CA section, after a provider is selected return immediately to the calendar section.

If provider selected (PV20LU='1' for one provider) and event type is OP or MV and linked to a facility-provider (either facility provider was selected from NPI or from the roster or PV40 is coded = '2' (FACILITY PROVIDER)), immediately go to PV70.

Otherwise, after a provider is selected (PV20LU='1' for one provider), immediately return to the Event Roster (EV) section.

Once a provider is added, that provider should be automatically selected. If the interviewer adds a provider, but then decides to ‘unselect’ it, another provider could be added. CTRL-A should not work if there is already a provider selected on this screen.

Hard Check:

If CTRL-E is pressed for a provider that is linked to a NPI ID or the provider was added during a previous round, display the following error message: "THIS PROVIDER CAN’T BE EDITED BECAUSE IT WAS ADDED DURING A PREVIOUS ROUND OR IT IS LINKED TO A NPI ID.”
If CTRL-D is pressed for a provider that was not added at the current question, display the following error message: “THIS PROVIDER CAN’T BE DELETED. ONLY PROVIDERS ADDED AT THE CURRENT QUESTION CAN BE DELETED.“
If the provider selected is linked to a person-provider and the event type is HS, ER, OP or IC, display the following error message: “A FACILITY PROVIDER MUST BE SELECTED FOR THIS EVENT TYPE. SELECT/ADD ANOTHER PROVIDER.”
CTRL-A: Only one provider can be selected per this instance of PV. If FI tries to back up and add another provider, display the following hard check: ‘YOU MUST DESELECT THE CURRENT PROVIDER TO SELECT A DIFFERENT PROVIDER TO ASSOCIATE WITH THIS EVENT’. CAPI should go back to PV20LU.

Roster Behavior:

1. Display roster entries in the following order: Display by provider last name or facility name. Entries that are added during the current round will appear at the bottom of the list of entries until the next round.

Grid Behavior:

The ‘Type of Provider’, ‘Provider’, ‘Address’, ‘City’, ‘State’, ‘Zip Code’, ‘Phone Number’, and ‘Editable’ are protected columns. No changes are allowed.
In the ‘PV20’ column, only one provider can be selected by pressing 1 and enter in the active field for that provider.
In the ‘PV20’ column a provider that is not linked to an NPI ID and was added during the current round, can be edited by navigating to that providers active field and pressing CTRL-E.
In the ‘PV20’ column a provider that was added at the current question, can be deleted by navigating to that providers active field and pressing CTRL-D.
The provider roster entries are displayed in the form pane. To maximize the number of rows that we can display in the form pane without vertical scrolling, reduce the size of the info pane to fit the question text displayed. Thirteen rows display at one time before scrolling is necessary.

When CTRL-A is selected the provider directory should pop-up. The following fields should be displayed in the look-up: Name1, Name 2, Address, City, Phone number, Taxonomy.

There should be an option on the look-up for ‘PROVIDER NOT FOUND’. When 'PROVIDER NOT FOUND' is selected, go to BOX_30 to start the collect of provider information using PV50_01-PV50_08 or PV60_01-PV60_07. After the completion of these questions, the provider will be added to the medical provider roster and the interview should route back to PV20LU. At PV20LU, the provider that was just added from PV50_01-PV50_08 or PV60_01-PV60_07 should appear at the bottom of the grid with a '1' prefilled in the PV20 field. Interviewers must press Enter to confirm their selection.

If the provider selected (either at PV20LU or within the NPI look-up window) is linked to a person-provider and the event type is HS, ER, OP or IC, display the following error message: ‘A FACILITY PROVIDER MUST BE SELECTED FOR THIS EVENT TYPE. SELECT ANOTHER PROVIDER.” After the FI has viewed the error message they will return to the provider directory pop-up. The same search string will still be listed in the field.

The following search rules should appear at the bottom of the pop-up:

“SEARCH RULES:

Fewer words often work better than lot of words – but you must type at least 5 letters
Unusual or unique aspects of provider name or address finds better matches
Common identifiers (e.g., medical center, office, associates, group, health) can increase the number of ‘extra’ matches displayed
If searching by address – include street number and name, but not office, suite, or room number
If searching by phone number – do not include hyphens
Review the DETAILS line at the top to verify correct selection

After the FI picks a provider and presses ‘SELECT’, the provider will appear at the bottom of the grid with a ‘1’ prefilled in the PV20 field for this provider. FI’s must press ENTER to confirm their selection.

When CTRL-E is selected for a person-provider that is not linked to a NPI ID and that was added during the current round, go to PV50_01. PV50_01-PV50_08 will be used to update the providers information. After PV50_08, update the provider roster entry and return to PV20LU.

When CTRL-E is selected for a facility-provider that is not linked to a NPI ID and that was added during the current round, go to PV60_01. PV60_01-PV60_09 will be used to update the provider’s information. After PV60_09, update the provider roster entry and return to PV20LU.

When CTRL-D is selected for a provider that was added at the current question, a verification screen will appear to confirm that the interviewer wants to delete this provider.

Display Instructions: Roster 3 – Add, Edit, Delete Allowed

Roster Definition:

Display the RU medical providers roster for selection of one medical provider. The ‘medical providers roster’ excludes dental providers which is now on the ‘dental providers roster’. Display the following columns formatted on the form pane:

Column Header #1: PV20

This field is used to select, edit, or delete a provider.

Column Header #2: Type of Provider

Display “P” to represent a person-provider, “F” to represent a facility-provider, or “F (&p)” to represent a facility-provider ever linked to an MV or OP event AND a specific department or a doctor.

Column Header #3: Provider

Display the first and last name of the person-provider or the name of the facility. Set truncation length to 50 characters.

Column Header #4: Address

Display address 1 and address 2 for the provider. Set truncation length to 45 characters.

Column Header #5: City

Display the city for the provider. Set truncation length to 25 characters.

Column Header #6: State

Display the two letter state abbreviation for the provider.

Column Header #7: Zip code

Display the zip code for the provider.

Column Header #8: Phone Number

Display the telephone number for the provider

Column Header #9: Editable

Display ‘Yes’ if the provider is not linked to an NPI ID and added in the current round. Display ‘No’ if the provider is linked to an NPI ID or if the provider was added during a previous round (Provider[I].OrigRnd).

Roster Filter:

Exclude home health provider entries - ‘FRIEND(S) OR NEIGHBOR(S)’, ‘RELATIVE(S)’, and ‘VOLUNTEER(S)’.

Display 'last' if PV10 was coded '2' NO and the event type is MV.

Display ‘individual’ if PV10 was coded ‘2’ NO, RF, or DK OR if the event type is HH Paid Independent.

Otherwise, use a null display.

Display ‘or’ if PV10 was coded DK or RF. Otherwise, use a null display. Display ‘hospital’ if the event type is HS. Display ‘facility’ if the event type is OP, ER, or IC. Display ‘home health agency’ if the event type is HH Agency. Display ‘group practice, HMO, or clinic’ if PV10 was coded ‘1’ YES, DK or RF. Otherwise, use a null display.

Display ‘SELECT ONE PROVIDER - PRESS 1 AND ENTER TO SELECT A PROVIDER’ if at least one provider appears on the roster, otherwise, if the roster is empty, display ‘TO ADD A PROVIDER PRESS CTRL-A.

Display “{number of providers displayed} OUT OF {total number of providers} PROVIDERS SHOWN - SCROLL TO SEE MORE" in red text only if there are more than the 13 providers, otherwise, use null display.

Note: The display for the CTRL-A, CTRL-E, CTRL-D instructions does not follow the UI rules for display. It will display as follows: CTRL-D will display on the same line as the second interviewer instruction. There will not be a line separating the two interviewer instructions. This is for maximum use of space for the form pane.

PV30LU (PV1025)

BLAISE NAME: ProvLookupUSC

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

Question Text:

Please give me the name of the {medical person}{,} {doctor’s office, clinic, health center, or other place} that {you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health.

PRESS 1 AND ENTER TO SELECT A PROVIDER.

VERIFY FULL PROVIDER NAME AND ADDRESS BEFORE SELECTING.

TO LAUNCH THE PROVIDER DIRECTORY AND ADD A NEW PROVIDER, PRESS CTRL-A.

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

{{number of providers displayed} out of {total number of providers} providers shown - scroll for more}

Responses: CONTINUE 1

EMPTY Empty

Programmer Instructions: Preloaded Grid Type 2 including PV30 - Flexible navigation, allow empty.

If PV30LU is EMPTY for all of the medical providers and interviewer tries to move off of this page, display the following message: ‘YOU MUST SELECT A MEDICAL PROVIDER BEFORE CONTINUING. PRESS ENTER TO RETURN TO PV30LU.

If provider selected (PV30LU='1' for one provider) and it is a person-provider, immediately return to the Access to Care section.

If provider selected (PV30LU='1' for one provider) and it is a facility-provider (either facility provider was selected from NPI or from the roster or PV40 is coded= '2' (FACILITY PROVIDER)), immediately go to PV70.

Flag the providers selected to the RU level provider roster that displays at PV20LU and PV30LU.

Hard Check:

If CTRL-E is pressed for a provider that is linked to a NPI ID or the provider was added during a previous round, display the following error message: "THIS PROVIDER CAN’T BE EDITED BECAUSE IT WAS ADDED DURING A PREVIOUS ROUND OR IT IS LINKED TO A NPI ID.”
If CTRL-D is pressed for a provider that was not added at the current question, display the following error message: " THIS PROVIDER CAN’T BE DELETED. ONLY PROVIDERS ADDED AT THE CURRENT QUESTION CAN BE DELETED.“

Roster Behavior:

1. Display roster entries in the following order:

Display by provider last name or facility name. Entries that are added during the current round will appear at the bottom of the list of entries until the next round.

Grid Behavior:

The ‘TYPE OF PROVIDER’, ‘PROVIDER’, ‘ADDRESS’, ‘CITY’, ‘STATE’, ‘ZIP CODE’, ‘PHONE NUMBER’, and ‘EDITABLE’ are protected columns. No changes are allowed.
In the ‘PV30’ column, only one provider can be selected by pressing 1 and enter in the active field for that provider.
In the ‘PV30’ column a provider that is not linked to an NPI ID and was added during the current round, can be edited by navigating to that providers active field and pressing CTRL-E.
In the ‘PV30’ column a provider that was added at the current question, can be deleted by navigating to that providers active field and pressing CTRL-D.
The provider roster entries are displayed in the form pane. To maximize the number of rows that we can display in the form pane without vertical scrolling, reduce the size of the info pane to fit the question text displayed. At a minimum, at least 10 rows should be displayed in the form pane but 15 rows would be ideal.

When CTRL-A is selected the provider directory should pop-up.

The following fields should be displayed in the look-up: Name1, Name 2, Address, City, Phone number, Taxonomy.

There should be an option on the look-up for ‘PROVIDER NOT FOUND’. When 'PROVIDER NOT FOUND' is selected, go to BOX_30 to start the collection of provider information using PV50_01-PV50_08 or PV60_01-PV60_07. After the completion of thesequestions, the provider will be added to the medical provider roster and the interview should route back to PV30LU. At PV30LU the provider that as just added from PV50_01-PV50_08 or PV60_01-PV60_07 should appear at the bottom of the grid with a '1' prefilled in the PV30 field. Interviewers must press Enter to confirm their selection.

The following search rules should appear at the bottom of the pop-up:

“SEARCH RULES:

Fewer words often work better than lot of words – but you must type at least 5 letters
Unusual or unique aspects of provider name or address finds better matches
Common identifiers (e.g., medical center, office, associates, group, health) can increase the number of ‘extra’ matches displayed
If searching by address – include street number and name, but not office, suite, or room number
If searching by phone number – do not include hyphens
Review the DETAILS line at the top to verify correct selection

After the FI picks a provider and presses ‘SELECT’, the provider will appear at the bottom of the grid with a ‘1’ prefilled in the PV30 field for this provider. FI’s must press ENTER to confirm their selection.

When CTRL-E is selected for a facility-provider that is not linked to a NPI ID and that was added during the current round , go to PV60_01. PV50_01-PV50_08 will be used to update the provider’s information. After PV50_08, update the provider roster entry and return to PV30LU.

When CTRL-E is selected for a person-provider that is not linked to a NPI ID and that was added during the current round, go to PV50_01. PV50_01-PV50_08 will be used to update the provider’s information. After PV50_08, update the provider roster entry and return to PV30LU.

When CTRL-D is selected for a provider that was added at the current question, a verification screen will appear to confirm that the interviewer wants to delete this provider.

Display Instructions: Roster 3 – Add, Edit, Delete Allowed

Roster Definition:

Column Header #1: PV30

This field is used to select, edit, or delete a provider.

Column Header #2: Type of Provider

Column Header #3: Provider

Display the first and last name of the person-provider or the name of the facility. Set truncation length to 50 characters.

Column Header #4: Address

Display address 1 and address 2 for the provider. Set truncation length to 45 characters.

Column Header #5: City

Display the city for the provider. Set truncation length to 25 characters.

Column Header #6: State

Display the two letter state abbreviation for the provider.

Column Header #7: Zip code

Display the zip code for the provider.

Column Header #8: Phone Number

Display the telephone number for the provider

Column Header #9: Editable

Display ‘Yes’ if the provider is not linked to an NPI ID. Display ‘No’ if the provider is linked to an NPI ID.

Roster Filter:

-Exclude home health provider entries - ‘FRIEND(S) OR NEIGHBOR(S)’, ‘RELATIVE(S)’, and ‘VOLUNTEER(S)’.

Display ‘medical person’ if AC30 is coded ‘1’ (OWN PRACTICE, NOT PART OF GROUP/FACILITY), ‘RF’ (REFUSED) or ‘DK’ (DON’T KNOW). Otherwise, use a null display.

Display ‘doctor’s office, clinic, health center, or other place’ if AC30 is coded ‘2’ (PRACTICE IS ASSOCIATED WITH GROUP/FACILITY), ‘RF’ (REFUSED) or ‘DK’ (DON’T KNOW). Otherwise, use a null display.

Display "{,}" if AC30 is coded 'RF' (REFUSED) or 'DK' (DON’T KNOW). Otherwise, use a null display.

Display "{{number of providers displayed} OUT OF {total number of providers} PROVIDERS SHOWN - SCROLL TO SEE MORE}" in red text only if there are more than 12 providers, otherwise, use a null display.

BOX_30 (PV1030)

Route Details: If ‘PROVIDER NOT FOUND’ was selected from the provider directory and the event type is MV or HH or the provider roster section was launched from the access to care section, go to PV40.

If 'PROVIDER NOT FOUND’ was selected from the provider directory and event type is HS, ER, OP, IC, code ‘FACILITY-PROVIDER’ at PV40 and go to PV60_01.

PV40 (PV1035)

BLAISE NAME: MPTp

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

Question Text:

INTERVIEWER: SELECT WHETHER {EVENT TYPE} HEALTH CARE FOR {PERSON} WAS TO A PERSON OR A FACILITY.

Responses: PERSON-PROVIDER 1 PV50_01 (PV1040)

FACILITY-PROVIDER 2 PV60_01 (PV1085)

Programmer Instructions: Refused and Don’t Know are not allowed.

Display Instructions: Display ‘MV’ for ‘EVENT TYPE’ if the current event is MV. Display ‘HH’ for ‘EVENT TYPE’ if the current event is HH. Otherwise, use a null display.

PV50_01 (PV1040)

BLAISE NAME: MPFName

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

Question Text:

{I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who {provided health care to {you/{PERSON}} {at home}?/{you/{PERSON} } usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?} }

What is the first name?

ENTER FIRST NAME AND VERIFY SPELLING.

Responses: 1 PV50_02 (PV1045)

Programmer Instructions: Refused and Don’t Know are not allowed.

Display Instructions: Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_07 and PV50_08 on the same form pane.

Display "I was not able to...advice about {your/his/her} health?}" if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Display "provided health care to {you/{PERSON}}{at home}?" if PV section was launched from the EV section. Display "{you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?" if PV section was launched from AC section.

Display ‘at home’ if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Prefill the provider’s first name in the info pane if an existing medical provider entry is being edited/updated.

PV50_02 (PV1045)

BLAISE NAME: MPLName

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

Question Text:

{[I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who {provided health care to {you/{PERSON}} {at home}?/{you/{PERSON} } usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?}]}

What is the last name?

ENTER LAST NAME AND VERIFY SPELLING.

Responses: 1 PV50_03 (PV1050)

Programmer Instructions: Refused and Don’t Know are not allowed.

Display Instructions: Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_07 and PV50_08 on the same form pane.

Display ‘I was not able to find...advice about {your/his/her} health?}' in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Display "provided health care to {you/{PERSON}}{at home}?" if PV section was launched from the EV section. Display "{you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {you/his/her} health?" if PV section was launched from AC section.

Display ‘at home’ if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Prefill the provider’s last name in the info pane if an existing medical provider entry is being edited/updated.

PV50_03 (PV1050)

BLAISE NAME: MPStrt1

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

Question Text:

{[I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who provided health care to {you/{PERSON}} {at home}?}?/{you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?}]}

What is the street address?

ENTER STREET ADDRESS.

Responses: 1 PV50_04 (PV1055)

REFUSED RF PV50_04 (PV1055)

DON’T KNOW DK PV50_04 (PV1055)

Display Instructions: Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.

Display ‘I was not able to find... advice about {your/his/her} health?}’ in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Display “provided health care to {you/{PERSON}} {at home}?” if PV section was launched from the EV section. Display “{you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?” if PV section was launched from AC section.

Display ‘at home’ if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Prefill the provider’s street address in the info pane if an existing medical provider entry is being edited/updated.

PV50_04 (PV1055)

BLAISE NAME: MPStrt2

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

Question Text:

{[I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who {provided health care to {you/{PERSON}} {at home}?/{you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?}]}

ENTER BUILDING OR ADDITIONAL ADDRESS INFORMATION, IF AVAILABLE. IF NONE, PRESS ENTER.

Responses: 1 PV50_05 (PV1060)

EMPTY Empty PV50_05 (PV1060)

REFUSED RF PV50_05 (PV1060)

DON’T KNOW DK PV50_05 (PV1060)

Display Instructions: Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.

Display ‘at home’ if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Prefill the provider’s second address, if available, in the info pane if an existing medical provider entry is being edited/updated.

PV50_05 (PV1060)

BLAISE NAME: MPCity

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

Question Text:

{[I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who {provided health care to {you/{PERSON}} {at home}?/{you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?}]}

What is the city?

ENTER CITY.

Responses: 1 PV50_06 (PV1065)

REFUSED RF PV50_06 (PV1065)

DON’T KNOW DK PV50_06 (PV1065)

Display Instructions: Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.

Prefill the provider’s city in the info pane if an existing medical provider entry is being edited/updated.

PV50_06 (PV1065)

BLAISE NAME: MPSt

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

Question Text:

{[I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who {provided health care to {you/{PERSON}} {at home}?/{you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?}]}

What is the state?

ENTER STATE.

TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND PRESS ENTER TO SELECT.

Responses: 1 PV50_07 (PV1070)

REFUSED RF PV50_07 (PV1070)

DON’T KNOW DK PV50_07 (PV1070)

Programmer Instructions: Use the state lookup file.

Note: The entry Foreign Country (FC is allowed).

Display Instructions: Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.

Display ‘at home’ if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Prefill the provider’s state in the info pane if an existing medical provider entry is being edited/updated.

PV50_07 (PV1070)

BLAISE NAME: MPZip

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

Question Text:

{[I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who {provided health care to {you/{PERSON}} {at home}?/{you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?}]}

What is the zip code?

ENTER ZIP CODE.

Responses: 1 PV50_08 (PV1075)

REFUSED RF PV50_08 (PV1075)

DON’T KNOW DK PV50_08 (PV1075)

Programmer Instructions: Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered or any characters entered that are not numeric, display the following message: "ZIP CODE ENTRY REQUIRES EXACTLY 5 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON’T KNOW) IF FULL ZIP CODE IS NOT KNOWN."

Display Instructions: Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.

Display ‘at home’ if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Prefill the provider’s zip code in the info pane if an existing medical provider entry is being edited/updated.

PV50_08 (PV1075)

BLAISE NAME: MPPhone

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

Question Text:

{[I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who {provided health care to {you/{PERSON}} {at home}?/{you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health?}]}

What is the telephone number?

ENTER TELEPHONE NUMBER.

Responses: 1

REFUSED RF

DON’T KNOW DK

Programmer Instructions: Ten digit entry required.

Use number input mask (xxx-xxx-xxxx) in the response field.

If the provider roster section was launched from the access to care section, go back to PV30LU. Otherwise, go back to PV20LU.

Display Instructions: Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.

Display ‘at home’ if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Prefill the provider’s telephone number in the info pane if an existing medical provider entry is being edited/updated.

PV60_01 (PV1085)

BLAISE NAME: FacMPName

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

Question Text:

{I was not able to find that provider in my directory. Please give me the name, street address, city, state, zip code, and phone number of the {{hospital/provider/facility} where {you/{PERSON}} received care/place that provided home care to {you/{PERSON}}/ place {you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health}}

What is the name of the {hospital/provider/facility/place} {that provided the care {at home}}?

ENTER FACILITY NAME AND VERIFY SPELLING.

Responses: 1 PV60_02 (PV1090)

Programmer Instructions: Refused and Don’t Know are not allowed.

Display Instructions: Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.

Display “I was not able to... advice about {your/his/her} health}.” if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Display “{hospital/provider/facility} where {you/{PERSON}} received care” if PV section was launched from the EV section and the event type is not HH. Display “place that provided home care to {you/{PERSON}}” if PV section was launched from the EV section and the event type is HH. Display “place {you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health” if PV section was launched from AC section.

Display “hospital” if event type is HS. Display “provider” if event type is MV. Otherwise, display ‘facility”.

Display “hospital” if PV section was launched from the EV section and the event type is HS. Display “provider” if PV section was launched from the EV section and the event type is MV. Display “facility” if PV section was launched from the EV section and the event type is ER, OP, or IC. Otherwise, display “place”.

Display “that provided the care {at home}” if PV section was launched from the EV section. Otherwise, use a null display.

Display “at home” if PV section was launched from the EV section and the event type is HH. Otherwise, use a null display.

Prefill the providers name in the info pane if an existing medical provider entry is being edited/updated.

PV60_02 (PV1090)

BLAISE NAME: FacMPStrt1

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

Question Text:

{[I was not able to find that provider in my directory. Please give me the name, street address, city, state, zip code, and phone number of the {{hospital/provider/facility} where {you/{PERSON}} received care / place that provided home care to {you/{PERSON}}/place {you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health}.]}

What is the street address?

ENTER STREET ADDRESS.

Responses: 1 PV60_03 (PV1095)

REFUSED RF PV60_03 (PV1095)

DON’T KNOW DK PV60_03 (PV1095)

Display Instructions: Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.

Display ‘I was not able to find... advice about {your/his/her} health}.’ in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.

Display “hospital” if event type is HS. Display “provider” if event type is MV. Otherwise, display ‘facility”.

Prefill the provider’s street address in the info pane if an existing medical provider entry is being edited/updated.

PV60_03 (PV1095)

BLAISE NAME: FacMPStrt2

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

Question Text:

{[I was not able to find that provider in my directory. Please give me the name, street address, city, state, zip code, and phone number of the {{hospital/provider/facility} where {you/{PERSON}} received care/place that provided home care to {you/{PERSON}}/ place {you/{PERSON}} usually {go/goes} if {you/he/she} {are/is} sick or {need/needs} advice about {your/his/her} health}.]}

ENTER BUILDING OR ADDITIONAL ADDRESS INFORMATION, AS NECESSARY. IF NONE, PRESS ENTER.

Responses: 1 PV60_04 (PV1100)

EMPTY Empty PV60_04 (PV1100)

REFUSED RF PV60_04 (PV1100)

DON’T KNOW DK PV60_04 (PV1100)

Display Instructions: Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.

Display “hospital” if event type is HS. Display “provider” if event type is MV. Otherwise, display ‘facility”.

Prefill the provider’s second street address, if available, in the info pane if an existing medical provider entry is being edited/updated.

Prefill the provider’s name in the info pane in an existing medical provider entry is being edited/updated.

PV60_04 (PV1100)

BLAISE NAME: FacMPCity

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

Question Text:

What is the city?

ENTER CITY.

Responses: 1 PV60_05 (PV1105)

REFUSED RF PV60_05 (PV1105)

DON’T KNOW DK PV60_05 (PV1105)

Display Instructions: Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.

Display “hospital” if event type is HS. Display “provider” if event type is MV. Otherwise, display ‘facility”.

Prefill the provider’s city in the info pane if an existing medical provider entry is being edited/updated.

PV60_05 (PV1105)

BLAISE NAME: FacMPSt

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

Question Text:

What is the state?

ENTER STATE.

TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND PRESS ENTER TO SELECT.

Responses: 1 PV60_06 (PV1110)

REFUSED RF PV60_06 (PV1110)

DON’T KNOW DK PV60_06 (PV1110)

Programmer Instructions: Use the state lookup file.

Note: The entry Foreign Country (FC is allowed).

Display Instructions: Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.

Display “hospital” if event type is HS. Display “provider” if event type is MV. Otherwise, display ‘facility”.

Prefill the provider’s state in the info pane if an existing medical provider entry is being edited/updated.

PV60_06 (PV1110)

BLAISE NAME: FacMPZip

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

Question Text:

What is the zip code?

ENTER ZIP CODE.

Responses: 1 PV60_07 (PV1115)

REFUSED RF PV60_07 (PV1115)

DON’T KNOW DK PV60_07 (PV1115)

Display Instructions: Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.

Display “hospital” if event type is HS. Display “provider” if event type is MV. Otherwise, display ‘facility”.

Prefill the provider’s zip code in the info pane if an existing medical provider entry is being edited/updated.

PV60_07 (PV1115)

BLAISE NAME: FacMPPhone

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

Question Text:

What is the telephone number?

ENTER TELEPHONE NUMBER.

Responses: 1

REFUSED RF

DON’T KNOW DK

Programmer Instructions: Ten digit entry required.

Use number input mask (xxx-xxx-xxxx) in the response field.

If the provider roster section was launched from the access to care section, go back to PV30LU. Otherwise, go back to PV20LU.

Display Instructions: Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.

Display “hospital” if event type is HS. Display “provider” if event type is MV. Otherwise, display ‘facility”. Display “hospital” if PV section was launched from the EV section and the event type is HS. Display “provider” if PV section was launched from the EV section and the event type is MV. Display “facility” if PV section was launched from the EV section and the event type is ER, OP, or IC. Otherwise, display “place”.

Prefill the provider’s telephone number in the info pane if an existing medical provider entry is being edited/updated.

PV70 (PV1130)

BLAISE NAME: RosterMPPersDept

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

Question Text:

{If it will help you remember the details, I can enter the name of the particular medical doctor or health care provider {you/{PERSON}} saw or talked to, or the particular department {you/{PERSON}} visited / If there is a particular medical doctor or health care professional that {you/{PERSON}} {see/sees} at {PROVIDER}, please give me that name. }.

{Previously, we have recorded {{PROVIDER DOCTOR OR DEPT}1, {PROVIDER DOCTOR OR DEPT}2, {PROVIDER DOCTOR OR DEPT}3, {PROVIDER DOCTOR OR DEPT}4, {PROVIDER DOCTOR OR DEPT}N} as health care providers or departments associated with {PROVIDER}.} TO ADD A NEW DOCTOR OR DEPARTMENT, PRESS CTRL-A.

{DO NOT SELECT OR ADD A DEPARTMENT AS A USUAL SOURCE OF CARE PROVIDER.}

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

Responses: {VISIT/USUAL SOURCE OF CARE} NOT LINKED TO SPECIFIC DOCTOR 0

{PROVIDER DOCTOR OR DEPT}1 1

{PROVIDER DOCTOR OR DEPT}2 2

{PROVIDER DOCTOR OR DEPT}3 3

{PROVIDER DOCTOR OR DEPT}4 4

{PROVIDER DOCTOR OR DEPT}N 5

Programmer Instructions: If the provider roster section was launched from the EV section, return to the EV section.

If the provider roster section was launched from the AC section, return to the AC section.

Hard Check:

If CTRL-E is pressed for a doctor/department that was not added at the current question, display the following error message: " THIS DOCTOR/DEPARTMENT CAN’T BE EDITED. ONLY DOCTORS/DEPARTMENTS ADDED AT THE CURRENT QUESTION CAN BE EDITED.“
If CTRL-D is pressed for a doctor/department that was not added at the current question, display the following error message: " THIS DOCTOR/DEPARTMENT CAN’T BE DELETED. ONLY DOCTORS/DEPARTMENTS ADDED AT THE CURRENT QUESTION CAN BE DELETED.“

Roster 3 behavior:

Single select allowed.
Add allowed.
Delete is allowed for roster entries added at the current question.
Edit is allowed for roster entries added at the current question.

Display Instructions: Roster 1 – Report

Roster Definition:

Display the doctors and departments linked to this facility provider pair. For ‘PROVIDER DOCTOR OR DEPT’ display the doctors first and last name or the department name (Note that doctors name and department name are stored in the same variable).

Roster filter:

None. Display all doctors and departments

Roster 3 – add/edit/delete allowed

Roster Definition:

Display the doctors and departments linked to this facility provider pair. For ‘PROVIDER DOCTOR OR DEPT’ display the doctors first and last name or the department name.

Roster filter:

None. Display all doctors and departments

Display ‘If there is a particular medical doctor or health care professional that {you/{PERSON}} {see/sees} at {PROVIDER}, I can enter that name now.’ if the provider roster section was launched from the access to care section.

Otherwise, display ‘If it will help you remember the details, I can enter the name of the particular medical doctor or health care provider {you/{PERSON}} saw or talked to, or the particular department {you/{PERSON}} visited’.

Display ‘PREVIOUSLY, WE HAVE...WITH {PROVIDER}’ if the provider roster section was not launched from the access to care section and there is at least one doctor/department entry on the roster. Otherwise, use a null display. Display the interviewer instruction, ‘DO NOT SELECT OR ADD A DEPARTMENT AS A USUAL SOURCE OF CARE PROVIDER’ only if the provider roster section was launched from the Access to Care section, otherwise use a null display

When CTRL-A selected, display the following customized question wording in the pop-up:

“Please give me the name of the {doctor or department/provider}.

VERIFY SPELLING”

Display "doctor or department" if the provider roster section was launched from the event roster section. Display "provider" if the provider section was launched from the access to care section.

Display "USUAL SOURCE OF CARE" if PV30LU was asked (PV section was launched from Access to Care). Otherwise, display "VISIT".

PV80 (PV1135)

BLAISE NAME: RosterDNProv

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

Question Text:

Can you please give me the name of the dental provider or dental practice {you/PERSON} visited?

VERIFY PROVIDER NAME BEFORE SELECTING.

TO ADD A NEW DENTAL PROVIDER, PRESS CTRL-A.

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

Responses: {DENTAL PROVIDER NAME}1 1

{DENTAL PROVIDER NAME}2 2

{DENTAL PROVIDER NAME}3 3

{DENTAL PROVIDER NAME}4 4

{DENTAL PROVIDER NAME}N 5

Programmer Instructions: Note: MPTp=Facility for providers added to PV80 (dental providers)

Return to the Event Roster section.

Hard Check:

If CTRL-E is pressed for a provider that was not added at the current question, display the following error message: " THIS PROVIDER CAN’T BE EDITED. ONLY PROVIDERS ADDED AT THE CURRENT QUESTION CAN BE EDITED.“
If CTRL-D is pressed for a provider that was not added at the current question, display the following error message: " THIS PROVIDER CAN’T BE DELETED. ONLY PROVIDERS ADDED AT THE CURRENT QUESTION CAN BE DELETED.“

Roster behavior:

Single select allowed.
Add allowed.
Delete is allowed for roster entries added at the current question.
Edit is allowed for roster entries added at the current question.

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

Roster Definition:

Display the RU dental providers roster.

Roster filter:

None. Display all dental providers.

When CTRL-A selected, display the following customized question wording in the pop-up:

“Please give me the name of the dental provider or dental practice.

VERIFY SPELLING”

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