Prescribed Medicines (PM) Section

Fall 2021

BOX_00 (PM1000)

BOX_05 (PM1005)

PMIntro (PM1006)

BLAISE NAME: PMIntro

Question Text:

PRESCRIBED MEDICINES (PM), OTHER MEDICAL (OM), {AND} ADDITIONAL HEALTHCARE (AH){, AND CHILD HEALTH (CS)} SECTIONS – ASKED FOR EACH RU MEMBER AS A LOOP.

CTRL-S: SWITCH TO A DIFFERENT RU MEMBER.

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_10 (PM1010)

Programmer Instructions: This item is presented only for the first person that goes through the PM, OM, AH and CS loop.

Skip PMIntroduction for all other RU members.

Display Instructions: Display “AND” if current round is in the Spring cycle (RndCycle=Spring). Otherwise, use a null display.

Display “, AND CHILD HEALTH (CS)” if current round is in the Fall cycle (RndCycle=Fall). Otherwise, use a null display.

BOX_10 (PM1010)

PM10 (PM1020)

BLAISE NAME: HasPmedRecords

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

{Earlier you mentioned that {you/{PERSON}} had prescription medicine bottles, containers, tubes, or bags available.} For these next questions, please have any bottles, containers, tubes, or bags, a pharmacy print out or patient portal information available for each of {your/PERSON}'s medicines we will be talking about.

Responses: HAS PRESCRIPTION MEDICINE BOTTLES/RECORDS FOR {PERSON} 1 BOX_20 (PM1030)

DOES NOT HAVE ANY PRESCRIPTION MEDICINE BOTTLES/RECORDS FOR {PERSON} 2 BOX_20 (PM1030)

REFUSED TO USE ANY PRESCRIPTION MEDICINE BOTTLES/RECORDS FOR {PERSON} 3 BOX_20 (PM1030)

Programmer Instructions: Refused and Don't Know are disallowed.

If CA30_05 is coded '1' (YES, HAS PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR {PERSON}), prefill the response entry field with '1' (HAS PRESCRIPTION MEDICINE BOTTLES/RECORDS) as selected, but the field should be editable.

Display Instructions: Display 'Earlier you mentioned that {you/{PERSON}} had prescription medicine bottles, containers, tubes, or bags available.' If CA30_5 is coded '1' (YES, HAS PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR {PERSON}. Otherwise, use a null display.

BOX_20 (PM1030)

PM20 (PM1040)

BLAISE NAME: PmedDiab

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

{Since {START DATE}/Between {START DATE} and {END DATE}}, {have/has} {you/{PERSON}} obtained insulin or any other prescribed medicines related to {your/his/her} diabetes?

HELP:F1

Responses: YES 1 PM30 (PM1050)

NO 2 PM40 (PM1060)

REFUSED RF PM40 (PM1060)

DON'T KNOW DK PM40 (PM1060)

Programmer Instructions:

Display Instructions: Display 'since {START DATE}' if current round is not the final round of the panel (RndType<>Final).

Display 'between {START DATE} and {END DATE}' if current round is the final round of the panel (RndType=Final).

PM30 (PM1050)

BLAISE NAME: PmedDiabRoster

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

What are the names of these medicines related to {your/his/her} diabetes?

PROBE: Any other medicines related to {your/his/her} diabetes?

ENTER ALL THAT APPLY.

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

Responses: {PRESCRIBED MEDICINE}1 1 PM40 (PM1060)

{PRESCRIBED MEDICINE}2 2 PM40 (PM1060)

{PRESCRIBED MEDICINE}3 3 PM40 (PM1060)

{PRESCRIBED MEDICINE}4 4 PM40 (PM1060)

{PRESCRIBED MEDICINE}N 5 PM40 (PM1060)

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

2. Multiple add allowed.

3. Limited delete allowed. Interviewer may delete a medicine added at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be deleted until the end of interview.

4. Limited edit allowed. Interviewer may edit medicines added at this item at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be edited until the end of interview.

NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.

Display the following question text on the pop-up manipula: ‘What are the names of these prescribed medicines?’

When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.

When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name.

General flag rules for medicines:

-Round medicine first created (by definition a medicine is selected the same time it is created)

-Question number medicine first created

-Round medicine selected

Soft Check:

If 2 or more of the same following text strings are found in a single medicine entry (e.g. DROXIA 200MG CAPMAXALT 10MG) upon leaving the single entry field by pressing ‘TAB’ or ‘ENTER:

• MG

• ML

• CAP

• MCG

• TAB

• GM

• %

Or if the following text combinations strings are found in a single medicine entry (e.g. aspirin 5mg triamcinolone acetonide .5% ointment) upon leaving the single entry field by pressing ‘TAB’ or ‘ENTER:

MG and %

MCG and MG

Display a separate pop-up below the field that triggered the soft check with the message:

“Verify only one medicine per field is entered. If entry is a compound medicine (medicine label lists two or more different medicines) select ‘Suppress’. If entry error was made, select ‘GoTo’ and re-enter each medicine in a separate field. Press ‘TAB’ between each separate entry.”

At the top of the pop-up above the message, display the medicine that triggered the soft check. With the text string that triggered the check displayed in bold.

Prescribed Medicine Soft Check Flag (PMedSoftChk):

The purpose of this flag is to ensure that once the soft check is triggered, that particular entry row will not trigger the soft check again, even when the text entry of the field has changed. The flag records whether the interviewer selected “Suppress” or “GoTo”. Suppressing the soft check may not indicate that the medicine is a compound drug as a medicine name could have the targeted text string in both the form/strength and drug name, such as “captopril capsule”. When the interviewer selects ‘GoTo’ to return to the field to make a correction, the soft check will not run again to check the entry.

Pressing ‘tab’ then selecting ‘Suppress’ or ‘GoTo’ closes the soft check pop-up and moves the cursor to the next empty field.

Pressing ‘enter’ then selecting ‘Suppress’ closes the soft check pop-up and moves the focus back to the prescribed medicine roster. Or if ‘GoTo’ is selected moves the cursor back to the entry field that triggered the soft check.

Display Instructions: Roster 3- Add/Edit/Delete Allowed.

Roster Definition:

This item displays the person’s-prescribed-medicines-roster for selection/addition. Display name of prescribed medicine (DRUG.DRUGNAME).

Roster Filter:

Display all; no filter.

PM40 (PM1060)

BLAISE NAME: DiabEquip

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

{Other than what we just listed, did/Did} {you/{PERSON}} obtain any other diabetic equipment or supplies, typically prescribed by a physician; for example, syringes, a blood glucose monitor machine, glucose meter, insulin pumps, lancets, alcohol swabs or control solution {since {START DATE}/between {START DATE} and {END DATE}}?

Responses: YES 1 BOX_30 (PM1070)

NO 2 BOX_30 (PM1070)

REFUSED RF BOX_30 (PM1070)

DON'T KNOW DK BOX_30 (PM1070)

Programmer Instructions: If PM40 is coded ‘1’ (YES), automatically select the entry ‘OTHER DIABETIC EQUIPMENT/SUPPLIES’ on person’s-prescribed-medicines-roster. If ‘OTHER DIABETIC EQUIPMENT/SUPPLIES’ is not already on roster, create the entry and select it.

General flag rules for medicines:

- Round medicine first created (by definition a medicine is selected the same time it is created)

- Question number medicine first created

- Round medicine selected

Display Instructions: Display ‘Other than what we just listed, did’ if PM20 was coded ‘1’ (YES). Otherwise, display ‘Did’.

Display ‘since {START DATE}’ if current round is not the final round of the panel (RndType<>Final).

Display ‘between {START DATE} and {END DATE}’ if current round is the final round of the panel (RndType=Final).

BOX_30 (PM1070)

PM50 (PM1080)

BLAISE NAME: PmedAsthma

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

Including any medicines for quick relief of asthma symptoms, such as inhalers, and those that prevent symptoms over the long term, {have/has} {you/{PERSON}} obtained any prescribed medicines related to {your/his/her} asthma {since {START DATE}/between {START DATE} and {END DATE}}?

HELP:F1

Responses: YES 1 PM60 (PM1090)

NO 2 PM70 (PM1100)

REFUSED RF PM70 (PM1100)

DON'T KNOW DK PM70 (PM1100)

Display Instructions: Display ‘since {START DATE}’ if current round is not the final round of the panel (RndType<>Final).

Display ‘between {START DATE} and {END DATE}’ if current round is the final round of the panel (RndType=Final).

PM60 (PM1090)

BLAISE NAME: PmedAsthmaRoster

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

What are the names of these medicines related to {your/his/her} asthma?

PROBE: Any other medicines related to {your/his/her} asthma?

ENTER ALL THAT APPLY

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

Responses: {PRESCRIBED MEDICINE}1 1 PM70 (PM1100)

{PRESCRIBED MEDICINE}2 2 PM70 (PM1100)

{PRESCRIBED MEDICINE}3 3 PM70 (PM1100)

{PRESCRIBED MEDICINE}4 4 PM70 (PM1100)

{PRESCRIBED MEDICINE}N 5 PM70 (PM1100)

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

2. Multiple add allowed.

3. Limited delete allowed. Interviewer may delete a medicine added at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be deleted until the end of interview.

4. Limited edit allowed. Interviewer may edit medicines added at this item at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be edited until the end of interview.

NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.

Display the following question text on the pop-up manipula: ‘What are the names of these prescribed medicines?’

When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.

When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name.

General flag rules for medicines:

-Round medicine first created (by definition a medicine is selected the same time it is created)

-Question number medicine first created

-Round medicine selected

Soft Check:

If 2 or more of the same following text strings are found in a single medicine entry (e.g. DROXIA 200MG CAPMAXALT 10MG) upon leaving the single entry field by pressing ‘TAB’ or ‘ENTER:

• MG

• ML

• CAP

• MCG

• TAB

• GM

• %

Or if the following text combinations strings are found in a single medicine entry (e.g. aspirin 5mg triamcinolone acetonide .5% ointment) upon leaving the single entry field by pressing ‘TAB’ or ‘ENTER:

MG and %

MCG and MG

Display a separate pop-up below the field that triggered the soft check with the message:

“Verify only one medicine per field is entered. If entry is a compound medicine (medicine label lists two or more different medicines) select ‘Suppress’. If entry error was made, select ‘GoTo’ and re-enter each medicine in a separate field. Press ‘TAB’ between each separate entry.”

At the top of the pop-up above the message, display the medicine that triggered the soft check. With the text string that triggered the check displayed in bold.

Prescribed Medicine Soft Check Flag (PMedSoftChk):

The purpose of this flag is to ensure that once the soft check is triggered, that particular entry row will not trigger the soft check again, even when the text entry of the field has changed. The flag records whether the interviewer selected “Suppress” or “GoTo”. Suppressing the soft check may not indicate that the medicine is a compound drug as a medicine name could have the targeted text string in both the form/strength and drug name, such as “captopril capsule”. When the interviewer selects ‘GoTo’ to return to the field to make a correction, the soft check will not run again to check the entry.

Pressing ‘tab’ then selecting ‘Suppress’ or ‘GoTo’ closes the soft check pop-up and moves the cursor to the next empty field.

Pressing ‘enter’ then selecting ‘Suppress’ closes the soft check pop-up and moves the focus back to the prescribed medicine roster. Or if ‘GoTo’ is selected moves the cursor back to the entry field that triggered the soft check.

Display Instructions: Roster 3- Add/Edit/Delete Allowed.

Roster Definition:

This item displays the person’s-prescribed-medicines-roster for selection/addition. Display name of prescribed medicine (DRUG.DRUGNAME).

Roster Filter:

Display all; no filter.

PM70 (PM1100)

BLAISE NAME: NewMeds

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

In answering the next couple of questions, remember to think about prescriptions obtained at any pharmacy, including mail-order or on-line. {Since {START DATE}/Between {START DATE} and {END DATE}}, {have/has} {you/{PERSON}} obtained any new prescription medicines or any refills {we have not yet talked about}?

HELP: F1

Responses: YES 1 PM80 (PM1110)

NO 2 PM90 (PM1120)

REFUSED RF PM90 (PM1120)

DON'T KNOW DK PM90 (PM1120)

Display Instructions: DISPLAY ‘Since {START DATE}’ IF current round is not the final round of the panel (RndType<>Final). DISPLAY ‘Between {START DATE} and {END DATE}’ IF current round is the final round of the panel (RndType=Final).

Display "we have not yet talked about" if 1 or more medicines have been selected during this round.

Otherwise use a null display.

PM80 (PM1110)

BLAISE NAME: NewMedsRoster

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

What were the names of these medicines?

PROBE: Any other medicines?

ENTER ALL THAT APPLY

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

Responses: {PRESCRIBED MEDICINE}1 1 PM90 (PM1120)

{PRESCRIBED MEDICINE}2 2 PM90 (PM1120)

{PRESCRIBED MEDICINE}3 3 PM90 (PM1120)

{PRESCRIBED MEDICINE}4 4 PM90 (PM1120)

{PRESCRIBED MEDICINE}N 5 PM90 (PM1120)

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

2. Multiple add allowed.

3. Limited delete allowed. Interviewer may delete a medicine added at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be deleted until the end of interview.

4. Limited edit allowed. Interviewer may edit medicines added at this item at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be edited until the end of interview.

NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.

Display the following question text on the pop-up manipula: ‘What are the names of these prescribed medicines?’

When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.

When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name.

General flag rules for medicines:

- Round medicine first created (by definition a medicine is selected the same time it is created)

- Question number medicine first created

- Round medicine selected

Soft Check:

If 2 or more of the same following text strings are found in a single medicine entry (e.g. DROXIA 200MG CAPMAXALT 10MG) upon leaving the single entry field by pressing ‘TAB’ or ‘ENTER:

• MG

• ML

• CAP

• MCG

• TAB

• GM

• %

Or if the following text combinations strings are found in a single medicine entry (e.g. aspirin 5mg triamcinolone acetonide .5% ointment) upon leaving the single entry field by pressing ‘TAB’ or ‘ENTER:

MG and %

MCG and MG

Display a separate pop-up below the field that triggered the soft check with the message:

“Verify only one medicine per field is entered. If entry is a compound medicine (medicine label lists two or more different medicines) select ‘Suppress’. If entry error was made, select ‘GoTo’ and re-enter each medicine in a separate field. Press ‘TAB’ between each separate entry.”

At the top of the pop-up above the message, display the medicine that triggered the soft check. With the text string that triggered the check displayed in bold.

Prescribed Medicine Soft Check Flag (PMedSoftChk):

The purpose of this flag is to ensure that once the soft check is triggered, that particular entry row will not trigger the soft check again, even when the text entry of the field has changed. The flag records whether the interviewer selected ‘Suppress’ or ‘GoTo’. Suppressing the soft check may not indicate that the medicine is a compound drug as a medicine name could have the targeted text string in both the form/strength and drug name, such as “captopril capsule”. When the interviewer selects ‘GoTo’ to return to the field to make a correction, the soft check will not run again to check the entry.

Pressing ‘tab’ then selecting ‘Suppress’ or ‘GoTo’ closes the soft check pop-up and moves the cursor to the next empty field.

Pressing ‘enter’ then selecting ‘Suppress’ closes the soft check pop-up and moves the focus back to the prescribed medicine roster. Or if ‘GoTo’ is selected moves the cursor back to the entry field that triggered the soft check.

Display Instructions: Roster 3- Add/Edit/Delete Allowed.

Roster Definition:

This item displays the person’s-prescribed-medicines-roster for selection/addition. Display name of prescribed medicine (DRUG.DRUGNAME).

Roster Filter:

Display all; no filter.

PM90 (PM1120)

BLAISE NAME: PmedAsNeeded

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

{Since {START DATE}/Between {START DATE} and {END DATE}}, did {you/{PERSON}} obtain any {other} prescriptions, even if {you/{PERSON}} {are/is} no longer taking the medicine or only {take/takes} it as-needed?

HELP: F1

Responses: YES 1 PM100 (PM1130)

NO 2 BOX_40 (PM1140)

REFUSED RF BOX_40 (PM1140)

DON'T KNOW DK BOX_40 (PM1140)

Display Instructions: Display ‘Since {START DATE}’ if current round is not the final round of the panel (RndType<>Final).

Display ‘Between {START DATE} and {END DATE}’ if current round is the final round of the panel (RndType=Final).

Display ‘other’ if at least one medicine is flagged as selected for the current round (that is, at least one medicine was selected at HS100, ER70, OP100, MV120, TH110, PM30, PM60, or PM80 in the current round or PM40 was coded ‘1’ (YES) in the current round). Otherwise, use a null display.

PM100 (PM1130)

BLAISE NAME: PmedAsNeededRoster

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

What were the names of these medicines?

PROBE: Any other medicines?

ENTER ALL THAT APPLY.

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

Responses: {PRESCRIBED MEDICINE}1 1 BOX_40 (PM1140)

{PRESCRIBED MEDICINE}2 2 BOX_40 (PM1140)

{PRESCRIBED MEDICINE}3 3 BOX_40 (PM1140)

{PRESCRIBED MEDICINE}4 4 BOX_40 (PM1140)

{PRESCRIBED MEDICINE}N 5 BOX_40 (PM1140)

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

2. Multiple add allowed.

3. Limited delete allowed. Interviewer may delete a medicine added at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be deleted until the end of interview.

4. Limited edit allowed. Interviewer may edit medicines added at this item at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be edited until the end of interview.

NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.

Display the following question text on the pop-up manipula: ‘What are the names of these prescribed medicines?’

When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.

When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name.

General flag rules for medicines:

- Round medicine first created (by definition a medicine is selected the same time it is created)

- Question number medicine first created

- Round medicine selected

Soft Check:

If 2 or more of the same following text strings are found in a single medicine entry (e.g. DROXIA 200MG CAPMAXALT 10MG) upon leaving the single entry field by pressing ‘TAB’ or ‘ENTER:

• MG

• ML

• CAP

• MCG

• TAB

• GM

• %

Or if the following text combinations strings are found in a single medicine entry (e.g. aspirin 5mg triamcinolone acetonide .5% ointment) upon leaving the single entry field by pressing ‘TAB’ or ‘ENTER:

MG and %

MCG and MG

Display a separate pop-up below the field that triggered the soft check with the message:

“Verify only one medicine per field is entered. If entry is a compound medicine (medicine label lists two or more different medicines) select ‘Suppress’. If entry error was made, select ‘GoTo’ and re-enter each medicine in a separate field. Press ‘TAB’ between each separate entry.”

At the top of the pop-up above the message, display the medicine that triggered the soft check. With the text string that triggered the check displayed in bold.

Prescribed Medicine Soft Check Flag (PMedSoftChk):

The purpose of this flag is to ensure that once the soft check is triggered, that particular entry row will not trigger the soft check again, even when the text entry of the field has changed. The flag records whether the interviewer selected “Suppress” or “GoTo”. Suppressing the soft check may not indicate that the medicine is a compound drug as a medicine name could have the targeted text string in both the form/strength and drug name, such as “captopril capsule”. When the interviewer selects ‘GoTo’ to return to the field to make a correction, the soft check will not run again to check the entry.

Pressing ‘tab’ then selecting ‘Suppress’ or ‘GoTo’ closes the soft check pop-up and moves the cursor to the next empty field.

Pressing ‘enter’ then selecting ‘Suppress’ closes the soft check pop-up and moves the focus back to the prescribed medicine roster. Or if ‘GoTo’ is selected moves the cursor back to the entry field that triggered the soft check.

Display Instructions: Roster 3- Add/Edit/Delete Allowed.

Roster Definition:

This item displays the person’s-prescribed-medicines-roster for selection/addition. Display name of prescribed medicine (DRUG.DRUGNAME).

Roster Filter:

Display all; no filter.

BOX_40 (PM1140)

LOOP_10 (PM1150)

BOX_50 (PM1180)

PM110 (PM1190)

BLAISE NAME: PmedSpecCond

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT}

Question Text:

Now, let's talk about {MEDICINE}.

Is {MEDICINE} used for a specific health problem?

Responses: YES 1 PM120 (PM1200)

NO 2 BOX_60 (PM1210)

REFUSED RF BOX_60 (PM1210)

DON'T KNOW DK BOX_60 (PM1210)

Display Instructions:

PM120 (PM1200)

BLAISE NAME: PmedCondRoster

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT}

Question Text:

{Now, let's talk about {MEDICINE}.}

What health problem is {MEDICINE} prescribed for?

PROBE: Any other health problems?

ENTER ALL THAT APPLY

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

HELP:F1

Responses: {MEDICAL CONDITION} 1 1 BOX_60 (PM1210)

{MEDICAL CONDITION} 2 2 BOX_60 (PM1210)

{MEDICAL CONDITION} 3 3 BOX_60 (PM1210)

{MEDICAL CONDITION} 4 4 BOX_60 (PM1210)

{MEDICAL CONDITION}N 5 BOX_60 (PM1210)

Programmer Instructions: Roster Behavior:

1. Multiple select allowed. Selection should not impact the round flag of the condition.

2. Multiple add allowed. Interviewer should record condition name.

3. Limited delete allowed. Interviewer may delete a condition added at this item as long as CAPI has not created a link between this condition and an event. If a condition, added in PMed section, is never linked to an event, that condition can be deleted until a link is made between the condition and the medicine. The link between condition and the medicine is created at END_LP10 (the end of the cuycle for the medicine being asked about).

4. Limited edit allowed. Interviewer may edit a condition name added at this item as long as CAPI has not created a link between this condition and an event. If a condition, added in PMed section, is never linked to an event, that condition can be edited until a link is made between the condition and the medicine. The link between the condition and the medicine is created at END_LP10 (the end of the cycle for the medicine being asked about).

Soft Check:

If 2 or more of the same following text strings are found in a single medicine entry (e.g. DROXIA 200MG CAPMAXALT 10MG) upon leaving the single entry field by pressing ‘TAB’ or ‘ENTER:

• MG

• ML

• CAP

• MCG

• TAB

• GM

• % or PERCENT

Display a separate pop-up below the field that triggered the soft check with the message:

“Verify only one medicine per field is entered. If entry is a compound medicine (medicine label lists two or more different medicines) select ‘Suppress’. If entry error was made, select ‘GoTo’ and re-enter each medicine in a separate field. Press ‘TAB’ between each separate entry.”

If the interviewer selects, ‘Suppress’ via keyboard or mouse, set a compound medicine flag for the medicine that triggered the soft check.

If the interviewer selects ‘GoTo’ via keyboard or mouse, reset the flag and return the cursor to the medicine entry field that needs revision.

Pressing ‘Suppress’ closes the soft check pop-up and moves the cursor to the next empty field.

If all fields contain data, return the interviewer to the prescribed medicine roster.

Display Instructions: Roster 3- Add/Edit/Delete allowed.

Roster Definition:

Display the person-medical-conditions-roster for the selection and addition of one or many medical condition(s) associated with this medicine.

Roster Filter:

Display all conditions on person's roster; no filter.

Display ‘Now let’s talk about {MEDICINE}.’ if this is the first question presented in LOOP_10, otherwise, use a null display.

BOX_60 (PM1210)

PM130_01 (PM1220)

BLAISE NAME: PMedStartYYYY

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT}

Question Text:

{Now, let's talk about {MEDICINE}.}

In what year did {you/{PERSON} first use {MEDICINE}?

ENTER ' XXXX' IF PERSON HAS NOT YET TAKEN/USED MEDICINE.

ENTER 4- DIGIT YEAR

Responses: 1

REFUSED RF PM140 (PM1240)

DON'T KNOW DK PM140 (PM1240)

Programmer Instructions: If ' XXXX' (HAS NOT YET TAKEN/USED) entered, go to PM140.

If Rounds 1-3 and year entered is equal to or greater than person's begin reference period year or FirstPanYear minus 1, continue with PM130_02.

If Rounds 4-5 and year entered is equal to or greater than person's begin reference period year or SecondPanYear minus 1, continue with PM130_02.

If Rounds 6-7 and year entered is equal to or greater than person's begin reference period year or ThirdPanYear minus 1, continue with PM130_02.

If Rounds 8-9 and year entered is equal to or greater than person's begin reference period year or FourthPanYear minus 1, continue with PM130_02 .

Otherwise, go to PM140.

Range Check: Year = 1900 - 2100.

Date entered at PM130_01 must be = or > than Person.DOBM, Person.DOBD, Person.DOBY. If date is outside of this range display this message: "THE DATE ENTERED CANNOT BE BEFORE THE RU MEMBER WAS BORN."

If person's DOB is not available, then date must be < or = the reference period end date for this person. If date is outside of this range display this message: "THE DATE CANNOT BE AFTER THE REFERENCE PERIOD END DATE FOR THIS PERSON."

If less than four numbers are entered, display the following message: "YOU MUST ENTER A 4-DIGIT YEAR OR 'XXXX' IF PERSON HAS NOT YET TAKEN/USED MEDICINE."

Display Instructions: Display ‘Now let’s talk about {MEDICINE}.’ if this is the first question presented in LOOP_10, otherwise, use a null display.

Display the interviewer instruction ‘ENTER 4- DIGIT YEAR’ in bold, red text.

Display PM130_01 and PM130_02 on a single form pane, separate from other items.

PM130_02 (PM1230)

BLAISE NAME: PMedStartMM

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} {NAME OF PRESCRIPTION MEDICINE.}

Question Text:

[In what year did {you/{PERSON} first use {MEDICINE}?]

What month did {you/he/she} first use {MEDICINE}?

ENTER MONTH

Responses: 1 PM140 (PM1240)

REFUSED RF PM140 (PM1240)

DON'T KNOW DK PM140 (PM1240)

Programmer Instructions: For specifications purposes only (CAPI handles automatically): allowable values for month are 1-12.

The complete date cannot be before the person's date of birth or after the reference period end date for this person.

Display Instructions: Display bracketed question text in lighter "grayed-out" text.

Display the interviewer instruction ‘ENTER MONTH.’ in bold, red text.

Display PM130_01 and PM130_02 on a single form pane, separate from other items.

PM140 (PM1240)

BLAISE NAME: PmedXFill

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT}

Question Text:

{Now, let's talk about {MEDICINE}.}

How many times was {MEDICINE} obtained or purchased for {you/{PERSON}} {since {START DATE} /between {START DATE} and {END DATE}}?

ENTER NUMBER OF TIMES

Responses: 1 BOX_70 (PM1250)

REFUSED RF BOX_70 (PM1250)

DON'T KNOW DK BOX_70 (PM1250)

Programmer Instructions: Soft Check:

If PM140 =>9, display the following message: “Unlikely response. Verify the number of times {MEDICINE} was obtained or purchased within the reference period.”

Display Instructions: DISPLAY 'since {START DATE}' if current round is not the final round of the panel (RndType<>Final).

DISPLAY 'between {START DATE} and {END DATE}' if current round is the final round of the panel (RndType=Final) .

Display ‘Now let’s talk about {MEDICINE}.’ if this is the first question presented in LOOP_10, otherwise, use a null display.

Display the interviewer instruction ‘ENTER NUMBER OF TIMES’ in bold, red text.

Display PM140 and PM150 on a single form pane, separate from other items.

BOX_70 (PM1250)

BOX_80 (PM1260)

PM150 (PM1270)

BLAISE NAME: PmedXFillLYr

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT}

Question Text:

NUMBER OF TIMES OBTAINED/PURCHASED SINCE {START DATE}: {NUMBER OF TIMES} Of these times, how many were in {YEAR}?

ENTER NUMBER OF TIMES

Responses: 1 END_LP10 (PM1280)

REFUSED RF END_LP10 (PM1280)

DON'T KNOW DK END_LP10 (PM1280)

Programmer Instructions: If current round is round 3, for ‘YEAR’ display the first calendar year of the panel.

If current round is round 5, for ‘YEAR’ display the second calendar year of the panel (SecondPanYear).

If current round is round 7, for ‘YEAR’ display the third calendar year of the panel (ThirdPanYear).

Hard Check: Number of times must be <= number of times obtained/purchased at PM140 (PmedXFill).

Display Instructions: For 'NUMBER OF TIMES,' display the number entered at PM140 (PmedXFill).

Display the interviewer instruction ‘ENTER NUMBER OF TIMES’ in bold, red text.

Display PM140 and PM150 on a single form pane, separate from other items

END_LP10 (PM1280)

PM160LU (PM1290)

BLAISE NAME: PharmRoster

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

Please tell me the name of the pharmacy or pharmacies that filled the prescription(s) for {you/{PERSON}} {since {START DATE}/between {START DATE} and {END DATE}}

PROBE: Any other pharmacy?

PRESS ENTER WHEN DONE SELECTING OR ADDING PHARMACIES.

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

HELP:F1

Responses: {{PHARMACY}, {STREET ADDRESS}, {CITY}, {ST}}1 1 BOX_90 (PM1300)

{{PHARMACY}, {STREET ADDRESS }, {CITY}, {ST}}2 2 BOX_90 (PM1300)

{{PHARMACY}, {STREET ADDRESS}, {CITY}, {ST}}3 3 BOX_90 (PM1300)

{{PHARMACY}, {STREET ADDRESS}, {CITY}, {ST}}4 4 BOX_90 (PM1300)

{{PHARMACY}, {STREET ADDRESS}, {CITY}, {ST}}N 5 BOX_90 (PM1300)

PHARMACY NOT IN LOOKUP 91 BOX_90 (PM1300)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

2. Multiple add allowed. Interviewer adds one pharmacy at a time; interviewer uses CTRL-A to begin the add process for the each new pharmacy.

3. Limited delete allowed.

4. Limited edit allowed.

5. CTRL-A launches the pharmacy look-up. Whether a pharmacy is added through the look- up or via PM170, CAPI will return to PM160LU to allow the interviewer to add or select another pharmacy.

General flag rules for pharmacies:

- Round pharmacy first created (by definition a pharmacy is selected the same time it is created)

- Round pharmacy selected for this RU member

- RU member pharmacy is linked to (however, this is known by virtue that the medicine was selected at PM160 for this person).

NOTE: The round flag and which RU member the pharmacy is linked to, also known as a person-pharmacy-pair, is key for the collection of pharmacy authorization forms.

Display Instructions: Roster 3- add/edit/delete allowed.

Roster Definition:

This item displays the RU-pharmacies-roster for selection/addition. Display pharmacy name (PHAR.PHARNAME), street address, city, and state.

Roster Filter:

Display all; no filter.

Display the roster in non-proportional text.

The allowable characters for each field should be as follow before truncation:

Pharmacy: 40 characters

Street Address: 35 characters

City: 23 characters

State: 2 characters

Phone: 10 characters - stored with pharmacy info but not displayed at PM160LU.

NOTE: When a pharmacy is selected from the lookup, the name of the pharmacy saved to the pharmacy array and will display on this roster under the 'Pharmacy' column header be pulled from the PharmName1 column in the NPI database.

DISPLAY 'since {START DATE}' if not Round 5.

DISPLAY 'between {START DATE} and {END DATE}' if Round 5.

Display only one column of pharmacy response option categories. Each response category should have pharmacy name, address, city, and state separated by commas.

Upon return to PM160LU, after CTRL-A has been launched at least once, display the question text “Please tell me the name of the pharmacy or pharmacies that filled the prescription(s) for {you/{PERSON}} {since {START DATE}/between {START DATE} and {END DATE}}” in brackets and “grayed out” text. The instruction “PROBE: Any other pharmacy?” remains in bold black text.

BOX_90 (PM1300)

PM170_01 (PM1310)

BLAISE NAME: PharmName

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?

ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED.

ENTER WEB ADDRESS ON STREET ADDRESS LINE(S).

[What is the pharmacy name?]

HELP:F1

Responses: 1 PM170_02 (PM1320)

Programmer Instructions: Refused and Don’t Know are disallowed.

Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.

PM170_02 (PM1320)

BLAISE NAME: PharmStrt1

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?]

ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED.

ENTER WEB ADDRESS ON STREET ADDRESS LINE(S).

What is the address?

Responses: 1 PM170_03 (PM1330)

REFUSED RF PM170_03 (PM1330)

DON'T KNOW DK PM170_03 (PM1330)

Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.

Display question text "[What is the name...{you/{PERSON}}?]" and interviewer instruction “ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED.” in lighter "grayed-out" text.

PM170_03 (PM1330)

BLAISE NAME: PharmStrt2

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?]

ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED.

ENTER WEB ADDRESS ON STREET ADDRESS LINE(S).

ENTER SECOND STREET ADDRESS, IF AVAILABLE. IF NONE, PRESS ENTER TO CONTINUE.

Responses: 1 PM170_04 (PM1340)

EMPTY Empty PM170_04 (PM1340)

REFUSED RF PM170_04 (PM1340)

DON'T KNOW DK PM170_04 (PM1340)

Programmer Instructions: Allow empty.

Display Instructions:

Display question text "[What is the name...{you/{PERSON}}?]" and interviewer instruction “ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED.” in lighter "grayed-out" text.

PM170_04 (PM1340)

BLAISE NAME: PharmCity

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?]

What is the city?

Responses: 1 PM170_05 (PM1350)

REFUSED RF PM170_05 (PM1350)

DON'T KNOW DK PM170_05 (PM1350)

Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.

Display question text "[What is the name...{you/{PERSON}}?]" in lighter "grayed-out" text.

PM170_05 (PM1350)

BLAISE NAME: PharmSt

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?]

What is the state?

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

ENTER TO SELECT.

Responses: 1 PM170_06 (PM1360)

REFUSED RF PM170_06 (PM1360)

DON'T KNOW DK PM170_06 (PM1360)

Programmer Instructions: Use state look-up file.

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

Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.

Display question text "[What is the name...{you/{PERSON}}?]" in lighter "grayed-out" text.

PM170_06 (PM1360)

BLAISE NAME: PharmZip

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?]

What is the zip code?

Responses: 1 PM170_07 (PM1370)

REFUSED RF PM170_07 (PM1370)

DON'T KNOW DK PM170_07 (PM1370)

Programmer Instructions: Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered in PM170_06 (PharmZip) 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 PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.

Display question text "[What is the name...{you/{PERSON}}?]" in lighter "grayed-out" text.

PM170_07 (PM1370)

BLAISE NAME: PharmPhone

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?]

What is the telephone number?

IF NO TELEPHONE, ENTER DK.

Responses: 1

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Ten digit entry required for this field.

Display hard check if less than 10 digits are entered in PM170_07 (PharmPhone) : “PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON’T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN.”

Use number input mask (XXX-XXX-XXXX) in the response field.

Add the pharmacy created at PM170_01 through PM170_07 to the roster at PM160LU and select it.

Return to PM160LU for interviewer to continue to select pharmacies.

Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.

Display question text "[What is the name...{you/{PERSON}}?]" in lighter "grayed-out" text.

BOX_100 (PM1380)

PM180 (PM1390)

BLAISE NAME: PharmTp

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {PHARMACY NAME} {STR-DT} {END-DT}

Question Text:

What type of pharmacy is {PHARMACY}? Is it a mail-order pharmacy; a pharmacy located in another store such as a grocery or department store; a pharmacy located in an HMO, clinic, or hospital; a drug store that is not located within another facility; or is it an on-line pharmacy?

HELP: F1

Responses: MAIL-ORDER 1

IN ANOTHER STORE 2

IN HMO/CLINIC/HOSPITAL 3

DRUG STORE 4

ON-LINE 5

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Preloaded Grid Type 1 including question PM180.

Continue with PM190 once grid is complete.

Display Instructions: Roster 1 – Report

Roster Definition:

This item displays the RU-pharmacies-roster as the first two columns of the grid. Display only pharmacy name and first street address in these columns. These columns are protected and cannot be changed.

Roster Filter:

Display only pharmacies that are newly added to the roster (do not have a pharmacy type associated with them).

When on grid rows, 2-n, display the text “Is it a mail-order…on-line pharmacy?” in grayed out text. The question “What type of pharmacy is {PHARMACY}?” will stay in bold black when on every row of the grid. Display the actual pharmacy name for the row the cursor is on for “PHARMACY”.

PM190 (PM1400)

BLAISE NAME: PMed3Part

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

Now I’d like to ask you about the charges for {your/{PERSON}’s} prescription medicine(s).

Has {your/{PERSON}’s} health insurance or another source of coverage helped pay for any of {your/his/her} prescription medications {since {START DATE}/between {START DATE} and {END DATE}}?

SELECT ‘NO’ IF PERSON REPORTS NO HEALTH INSURANCE OR ANOTHER SOURCE OF COVERAGE.

HELP: F1

Responses: YES 1 PM200 (PM1410)

NO 2 BOX_110 (PM1420)

REFUSED RF BOX_110 (PM1420)

DON'T KNOW DK BOX_110 (PM1420)

Display Instructions: Display Instructions:

DISPLAY ‘since {START DATE}’ If current round is not the final round of the panel (RndType<>Final)

DISPLAY ‘between {START DATE} and {END DATE}’ If current round is the final round of the panel (RndType=Final)

PM200 (PM1410)

BLAISE NAME: PMed3Roster

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}

Question Text:

Who usually helps pay?

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

Responses: {NAME OF SOURCE OF DIRECT PAYMENT}1 1 BOX_110 (PM1420)

{NAME OF SOURCE OF DIRECT PAYMENT}2 2 BOX_110 (PM1420)

{NAME OF SOURCE OF DIRECT PAYMENT}3 3 BOX_110 (PM1420)

{NAME OF SOURCE OF DIRECT PAYMENT}4 4 BOX_110 (PM1420)

{NAME OF SOURCE OF DIRECT PAYMENT}N 5 BOX_110 (PM1420)

Programmer Instructions: Write sources selected to the sources-of-payment roster.

If at least one source is added or selected during the current round, the flag SOPFlag should be set to YES.

Roster Behavior:

1. Add one only or select one only.

2. Add allowed. Selecting CTRL-A displays a pop-up with a text entry field and a selectable list of 15 common sources of payment. (See BOX_20 in the Charge/Payment (CP) Section Specifications for a detailed list). The interviewer can type a new source or select one from the list. Upon return to PM200, the added source will appear on the roster as selected.

3. Limited delete allowed. If interviewer adds a source of payment, delete is possible for that source only, as long as the interviewer has not left the screen. If delete is attempted when it is not allowed, CAPI displays the following error message: ‘Delete Allowed only when source of payment is first entered.’

4. Limited edit allowed. If interviewer adds a source of payment, editing is possible for that source only, as long as the interviewer has not left the screen. If edit is attempted when it is not allowed, CAPI displays the following error message: ‘Edit allowed only when source of payment first entered.’

Display Instructions: Roster 3 – Add/Edit/Delete allowed

Roster Definition:

Display the RU-Sources-Of-Payment-Roster for selection.

Roster Filter:

Display all sources of payment that are not "PERSON/FAMILY".

BOX_110 (PM1420)

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