Telehealth (TH) Section

Fall 2021

BOX_00 (TH1000)

BOX_10 (TH1005)

Context Header: Context Header Display Instructions:

SEE CONTEXT HEADER SPEC

TH10 (TH1010)

BLAISE NAME: VisitType

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER}-{DOC OR DEPT}

Question Text:

Was {your/{PERSON}’s} visit to {PROVIDER} over the phone, through real-time video, or some other way?

Responses: PHONE 1 BOX_20 (TH1020)

VIDEO 2 BOX_20 (TH1020)

SOME OTHER WAY 3 TH10OS (TH1015)

REFUSED RF BOX_20 (TH1020)

DON'T KNOW DK BOX_20 (TH1020)

Display Instructions:

TH10OS (TH1015)

BLAISE NAME: VisitTypeOS

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER}-{DOC OR DEPT}

Question Text:

SPECIFY:

Responses: 1 BOX_20 (TH1020)

REFUSED RF BOX_20 (TH1020)

DON'T KNOW DK BOX_20 (TH1020)

Programmer Instructions: Go to Box_20.

Display Instructions:

BOX_20 (TH1020)

TH20 (TH1025)

BLAISE NAME: THSeeDoc

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER}-{DOC OR DEPT}

Question Text:

{Is {PROVIDER} a medical doctor?/Did {you/{PERSON}} {talk to/have contact with}a medical doctor during this particular visit?}

HELP: F1

Responses: YES 1

NO 2

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If TH20 is coded ‘1’ (YES) and provider associated with event is a facility-provider, go to TH30.

If TH20 is coded ‘2’ (NO), ‘RF’ or ‘DK’ and provider associated with event is a facility- provider, go to TH40.

Otherwise, continue with BOX_30.

Display Instructions: Display ‘Is {PROVIDER} a medical doctor?’ if provider linked to this event is flagged as a ‘person- provider’. Otherwise, display ‘Did {you/{PERSON}} {talk to/have contact with} a medical doctor during this particular visit?’

Display ‘talk to’ if TH10 is coded ‘1’ (PHONE) or ‘2’ (VIDEO). Otherwise, display ‘have contact with’.

BOX_30 (TH1030)

TH30 (TH1035)

BLAISE NAME: THDocSpeclty

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER}-{DOC OR DEPT}

Question Text:

& TH-1

Looking at card TH-1, what was the doctor's specialty?

IF TALKED TO MORE THAN ONE DOCTOR, PROBE FOR MAIN PROVIDER.

Responses: ALLERGY/IMMUNOLOGY 1

CARDIOLOGY (HEART) 3

DERMATOLOGY (SKIN) 4

ENDOCRINOLOGY/METABOLISM (DIABETES, THYROID) 5

FAMILY PRACTICE 6

GASTROENTEROLOGY 7

GENERAL PRACTICE 8

GENERAL SURGERY 9

GYNECOLOGY/OBSTETRICS 11

INTERNAL MEDICINE (INTERNIST) 14

NEPHROLOGY (KIDNEYS) 15

NEUROLOGY 16

ONCOLOGY (TUMORS, CANCER) 18

OPHTHALMOLOGY (EYES) 19

ORTHOPEDICS 20

OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT) 22

PEDIATRICIAN 24

PSYCHIATRY/PSYCHIATRIST 28

UROLOGY 33

OTHER DR SPECIALTY 91

REFUSED RF

DON'T KNOW DK

Programmer Instructions: If coded ‘91’ (OTHER DR SPECIALTY), go to TH30LU.

Otherwise, go to BOX_40.

Display Instructions:

TH30LU (TH1040)

BLAISE NAME: THDocSpecltyLU

Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER}-{DOC OR DEPT}

Question Text:

ENTER OTHER DOCTOR SPECIALTY.

TYPE THE FIRST 3 LETTERS OF THE SPECIALTY, THEN USE ARROW KEYS IF NEEDED TO LOCATE SPECIALTY, AND PRESS ENTER TO SELECT.

Responses: ALLERGY/IMMUNOLOGY 1

ANESTHESIOLOGY 2

CARDIOLOGY (HEART) 3

DERMATOLOGY (SKIN) 4

ENDOCRINOLOGY/METABOLISM (DIABETES, THYROID) 5

FAMILY PRACTICE 6

GASTROENTEROLOGY 7

GENERAL PRACTICE 8

GENERAL SURGERY 9

GERIATRICS (ELDERLY) 10

GYNECOLOGY/OBSTETRICS 11

HEMATOLOGY (BLOOD) 12

HOSPITAL RESIDENCE 13

INTERNAL MEDICINE (INTERNIST) 14

NEPHROLOGY (KIDNEYS) 15

NEUROLOGY 16

NUCLEAR MEDICINE 17

ONCOLOGY (TUMORS, CANCER) 18

OPHTHALMOLOGY (EYES) 19

ORTHOPEDICS 20

OSTEOPATHY (DO) 21

OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT) 22

PATHOLOGY 23

PEDIATRICIAN 24

PHYSICAL MEDICINE/REHAB 25

PLASTIC SURGERY 26

PROCTOLOGY 27

PSYCHIATRY/PSYCHIATRIST 28

PULMONARY 29

RADIOLOGY 30

RHEUMATOLOGY (ARTHRITIS) 31

THORACIC SURGERY (CHEST) 32

UROLOGY 33

OTHER DR SPECIALTY 91

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Go to BOX_40.

Responses listed are part of the provider specialty look-up file that works similar to a trigram search.

Browser window should be labeled “SELECT SPECIALTY”.

Response code numbers should be stored behind the scenes and not visible in the look-up window.

Display Instructions:

TH40 (TH1045)

BLAISE NAME: THMPTp

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER} - {DOC OR DEPT}

Question Text:

& TH-2

Looking at card TH-2, what type of medical person did {you/{PERSON}} {talk to/have contact with} on {VISIT DATE}?

IF TALKED TO MORE THAN ONE MEDICAL PERSON, PROBE FOR MAIN PROVIDER.

HELP: F1

Responses: ACUPUNCTURIST 1

CHIROPRACTOR 2

DENTIST/DENTAL CARE PERSON 3

HOMEOPATHIC/NATUROPATHIC/HERBALIST/OTHER ALTERNATIVE/COMPLEMENTARY CARE PROVIDER 4

MASSAGE THERAPIST 5

MENTAL HEALTH COUNSELOR/MARITAL OR FAMILY THERAPIST 6

MIDWIFE 7

NURSE/NURSE PRACTITIONER 8

OPTOMETRIST 9

PHYSICAL/OCCUPATIONAL THERAPIST 10

PHYSICIAN'S ASSISTANT 11

PODIATRIST 12

PSYCHOLOGIST 13

SOCIAL WORKER 14

TECHNICIAN 15

OTHER 91

REFUSED RF

DON'T KNOW DK

Programmer Instructions: Go to BOX_40.

Display Instructions: Display ‘talk to’ if TH10 is coded ‘1’ (PHONE) or ‘2’ (VIDEO).

Otherwise, display ‘have contact with’.

BOX_40 (TH1050)

TH50 (TH1055)

BLAISE NAME: THDocLoctn

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER} - {DOC OR DEPT}

Question Text:

TYPE OF PERSON HAD CONTACT: {MEDICAL PERSON TYPE FROM TH40}

CODE WITHOUT ASKING IF OBVIOUS. OTHERWISE, ASK:

Do any medical doctors work at {the same location as {PROVIDER}/{PROVIDER}}?

HELP: F1

Responses: YES 1 BOX_50 (TH1060)

NO 2 BOX_50 (TH1060)

REFUSED RF BOX_50 (TH1060)

DON'T KNOW DK BOX_50 (TH1060)

Programmer Instructions: Go to BOX_50.

Display Instructions: Display ‘the same location as {PROVIDER}’ if provider is flagged as ‘PERSON-TYPE-PROVIDER’. Display ‘{PROVIDER}’ if provider is flagged as ‘FACILITY-PROVIDER’.

For ‘MEDICAL PERSON TYPE FROM TH40’, display the following text for each code selected at TH40 (regardless if TH40 was collected for this RU member or in a previous round) (Provider.MPTp):

Code ‘1’= ACUPUNCTURIST

Code ‘2’ = CHIROPRACTOR

Code ‘3’ = DENTIST/DENTAL CARE PERSON

Code ‘4’= HOMEOPATHIC/NATUROPATHIC/HERBALIST/ OTHER ALTERNATIVE/COMPLEMENTARY CARE PROVIDER

Code ‘5’= MASSAGE THERAPIST

Code ‘6’= MENTAL HEALTH COUNSELOR/MARITAL OR FAMILY THERAPIST

Code ‘7’ = MIDWIFE

Code ‘8’ = NURSE/NURSE PRACTITIONER

Code ‘9’ = OPTOMETRIST

Code ‘10’ = PHYSICAL’/ OCCUPATIONAL THERAPIST

Code ‘11’ = PHYSICIAN’S ASSISTANT

Code ‘12’ = PODIATRIST

Code ‘13’= PSYCHOLOGIST

Code ‘14’= SOCIAL WORKER

Code ‘15’= TECHNICIAN

Code ‘91’= OTHER

Code ‘RF’= REFUSED PROVIDER TYPE

Code ‘DK’= DON’T KNOW PROVIDER TYPE

BOX_50 (TH1060)

TH60 (TH1065)

BLAISE NAME: HospOprtd

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER} - {DOC OR DEPT}

Question Text:

Is {the place where} {PROVIDER} {works} owned or operated by a hospital?

HELP: F1

Responses: YES 1 TH70 (TH1070)

NO 2 TH70 (TH1070)

REFUSED RF TH70 (TH1070)

DON'T KNOW DK TH70 (TH1070)

Programmer Instructions: Go to TH70.

Display Instructions: Display ‘the place where’ and ‘works’ if provider is flagged as a person-provider. Otherwise, use a null display.

TH70 (TH1070)

BLAISE NAME: THVstCat

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER} - {DOC OR DEPT}

Question Text:

& TH-3

Please look at card TH-3 and tell me which category best describes the care {you/{PERSON}} received on {VISIT DATE}.

HELP: F1

Responses: GENERAL CHECKUP 1 TH80 (TH1075)

DIAGNOSIS OR TREATMENT 2 TH80 (TH1075)

EMERGENCY (E.G., ACCIDENT OR INJURY) 3 TH80 (TH1075)

PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING 4 TH80 (TH1075)

FOLLOW-UP OR POST-OPERATIVE VISIT 5 TH80 (TH1075)

IMMUNIZATIONS OR SHOTS 6 TH80 (TH1075)

VISION EXAM 7 TH80 (TH1075)

{PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)} 8 TH80 (TH1075)

{WELL CHILD EXAM} 9 TH80 (TH1075)

LASER EYE SURGERY 10 TH80 (TH1075)

OTHER 91 TH80 (TH1075)

REFUSED RF TH80 (TH1075)

DON'T KNOW DK TH80 (TH1075)

Display Instructions: Display response option ‘8’ (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)) if person is female and age 15 to 55 inclusive (or age categories 3 to 8). Otherwise, use a null display.

Display response option ‘9’ (WELL CHILD EXAM) if PERSON IS < 7 YEARS OLD (OR AGE CATEGORIES 1 THROUGH 3). Otherwise, use a null display.

TH80 (TH1075)

BLAISE NAME: THSpecCond

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER} - {DOC OR DEPT}

Question Text:

{Other than {your/his/her} {general checkup/well child exam}, was/Was} this {call/contact} related to any specific health condition or were any conditions discovered during this {call/contact}?

HELP:F1

Responses: YES 1 TH90 (TH1080)

NO 2 TH100 (TH1085)

REFUSED RF TH100 (TH1085)

DON'T KNOW DK TH100 (TH1085)

Display Instructions: Display ‘Other than {your/his/her} {general checkup/well child exam}, was’ if TH70 was coded ‘1’ (GENERAL CHECKUP) OR ‘9’ (WELL CHILD EXAM). Otherwise, display ‘Was’.

Display ‘general checkup’ if TH70 was coded ‘1’ (GENERAL CHECKUP). Display ‘well child exam’ if TH70 was coded ‘9’ (WELL CHILD EXAM).

Display ‘call’ if TH10 is coded ‘1’ (PHONE). Otherwise, display ‘contact’.

TH90 (TH1080)

BLAISE NAME: THCondRoster

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER} - {DOC OR DEPT}

Question Text:

What conditions were discovered or led {you/{PERSON}} to make this {call/contact}?

PROBE: Any other condition?

ENTER ALL THAT APPLY.

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

HELP:F1

Responses: {MEDICAL CONDITION} 1 1

{MEDICAL CONDITION} 2 2

{MEDICAL CONDITION} 3 3

{MEDICAL CONDITION} 4 4

{MEDICAL CONDITION}N 5

Programmer Instructions: Go to TH100.

Roster behavior:

1. Multiple select allowed.

2. Multiple add allowed.

3. Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.

4. Display the following message if interviewer tries to delete a condition after link is created:

"DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED."

5. Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.

Display Instructions: Display ‘call’ if TH10 is coded ‘1’ (PHONE). Otherwise, display ‘contact’.

Roster 3-add/edit/delete allowed. Roster definition:

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

Roster filter:

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

TH100 (TH1085)

BLAISE NAME: THPmed

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL

CARE PROVIDER} - {DOC OR DEPT}

Question Text:

During this {call/contact}, were any medicines prescribed for {you/{PERSON}}? Please include only prescriptions which were filled.

HELP:F1

Responses: YES 1 TH110 (TH1090)

NO 2 TH120 (TH1095)

REFUSED RF TH120 (TH1095)

DON'T KNOW DK TH120 (TH1095)

Display Instructions: Display ‘call’ if TH10 is coded ‘1’ (PHONE). Otherwise, display ‘contact’.

TH110 (TH1090)

BLAISE NAME: THPmedRoster

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER} - {DOC OR DEPT}

Question Text:

Please tell me the names of the prescriptions from this {call/contact} that were filled.

PROBE: Any other prescribed medicines from this {call/contact} that were filled?

ENTER ALL THAT APPLY.

CTRL-A: ADD

CTRL-E: EDIT

CTRL-D: DELETE

Responses: {PRESCRIBED MEDICINE}1 1 TH120 (TH1095)

{PRESCRIBED MEDICINE}2 2 TH120 (TH1095)

{PRESCRIBED MEDICINE}3 3 TH120 (TH1095)

{PRESCRIBED MEDICINE}4 4 TH120 (TH1095)

{PRESCRIBED MEDICINE}N 5 TH120 (TH1095)

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 until CAPI creates the link between this medicine and the event. The link is created when the collection of utilization and/or charge/payment data is complete.

4. Limited edit allowed. Interviewer may edit medicines added at this item until CAPI creates the link between this medicine and the event. The link is created when the collection of utilization and/or charge/payment data is complete.

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?’

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

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

- Event medicine is linked to (however, this is known by virtue that the medicine was selected at TH120 for this event)

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: Display ‘call’ if TH10 is coded ‘1’ (PHONE). Otherwise, display ‘contact’.

Roster 3- Add/Edit/Delete Allowed Roster definition:

This item displays the Person’s-Prescription-Medicines-Roster for selection. Display name of prescribed medicine (DRUG.DRUGNAME)

Roster filter:

Display all medicines in person's roster; no filter.

TH120 (TH1095)

BLAISE NAME: RefLabTst

Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {EVN-DT} {NAME OF MEDICAL CARE PROVIDER} - {DOC OR DEPT}

Question Text:

During this {call/contact}, did {someone at} {PROVIDER} refer {you/{PERSON}} for lab tests? Please include only lab tests {you/he/she} obtained between {START DATE} and {END DATE}.

Responses: YES 1 BOX_60 (TH1100)

NO 2 BOX_60 (TH1100)

REFUSED RF BOX_60 (TH1100)

DON'T KNOW DK BOX_60 (TH1100)

Display Instructions: Display ‘call’ if TH10 is coded ‘1’ (PHONE). Otherwise, display ‘contact’.

Display ‘{someone at}’ if provider associated with this event is a facility provider. Otherwise, use a null display.

BOX_60 (TH1100)

BOX_70 (TH1105)

TH130 (TH1110)

BLAISE NAME: THOthSameCond

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

Question Text:

Earlier I recorded that {you/{PERSON}} had some other {calls to/contacts with} {PROVIDER}. {Were any of these for {your/his/her} {PERSON’S TH MEDICAL CONDITION}?/Were any of the other {calls/contacts} also for {your/his/her} {PERSON’S TH MEDICAL CONDITION} or {PERSON’S TH MEDICAL CONDITION} {or {PERSON’S TH MEDICAL CONDITION}}?/ Were any of the other {calls/contacts} also for one of these conditions (READ CONDITIONS BELOW):}

{CONDITIONS

{PERSON'S TH MEDICAL CONDITION}1

{PERSON'S TH MEDICAL CONDITION}2

{PERSON'S TH MEDICAL CONDITION}3

{PERSON'S TH MEDICAL CONDITION}4

{PERSON'S TH MEDICAL CONDITION}N}

Responses: YES 1 TH140 (TH1115)

NO 2 BOX_80 (TH1125)

REFUSED RF BOX_80 (TH1125)

DON'T KNOW DK BOX_80 (TH1125)

Programmer Instructions: {DOC OR DEPT} should not display in context header.

Display ‘Were any of these for {your/his/her} {PERSON’S TH MEDICAL CONDITION}?’ if only one condition selected or added to Person’s-Medical-Conditions- Roster at TH90. Display ‘Were any of the other {calls/contacts} also for {your/his/her} {PERSON’S TH MEDICAL CONDITION} or {PERSON’S TH MEDICAL CONDITION} {or {PERSON’S TH MEDICAL CONDITION}}?’ if exactly 2 or 3 conditions selected or added to Person’s-Medical-Conditions-Roster at TH90. Otherwise, display ‘Were any of the other {calls/contacts} also for one of these conditions (READ CONDITIONS BELOW):”

Display ‘or {PERSON’S TH MEDICAL CONDITION’ if exactly 3 conditions selected or added to Person’s-Medical-Conditions-Roster at TH90. Otherwise, use a null display.

For ‘PERSON’S TH MEDICAL CONDITION’ display the condition selected from or added to Person’s-Medical-Conditions-Roster at TH90.

Display the header ‘CONDITIONS’ and the list of conditions if more than three conditions selected or added to Person’s-Medical-Conditions-Roster at TH90. Otherwise, use a null display. For ‘PERSON’S TH MEDICAL CONDITION’, display all conditions selected from or added to Person’s- Medical-Conditions-Roster at TH90.

Display Instructions: Display ‘calls to’ and ‘calls’ if TH10 is coded ‘1’ (PHONE). Otherwise, display ‘contacts with’ and ‘contacts’.

TH140 (TH1115)

BLAISE NAME: THRepVstRoster

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

Question Text:

{Which of the following {calls/contacts} were also for {your/{PERSON}’s} {PERSON’S TH MEDICAL CONDITION} {{or {your/his/her}/,} {PERSON’S TH MEDICAL CONDITION}} {or {your/his/her} {PERSON’S TH MEDICAL CONDITION}}?/ Which of the following {calls/contacts} were also for one of these conditions (READ CONDITIONS BELOW)?}

PROBE: Any other {calls/contacts} for the same condition?

ENTER ALL THAT APPLY.

{CONDITIONS

{PERSON'S TH MEDICAL CONDITION}1

{PERSON'S TH MEDICAL CONDITION}2

{PERSON'S TH MEDICAL CONDITION}3

{PERSON'S TH MEDICAL CONDITION}4

{PERSON'S TH MEDICAL CONDITION}N}

Responses: {SELECT ALL EVENTS} 0

{MONTH, DAY, YEAR} {PROVIDER} 1 1

{MONTH, DAY, YEAR} {PROVIDER} 2 2

{MONTH, DAY, YEAR} {PROVIDER} 3 3

{MONTH, DAY, YEAR} {PROVIDER} 4 4

{MONTH, DAY, YEAR} {PROVIDER} N 5

Programmer Instructions: Go to TH150.

If coded '0' SELECT ALL EVENTS, CAPI should automatically select all of the events displayed on the roster and flag as being part of the repeat visit group.

Flag each visit selected at TH140 as a repeat visit related to the event being asked about. (NOTE: The event being cycled on through this TH section administration is the “stem” repeat visit. The events selected at TH140 are the “leaves”. The event driver (ED) section will not serve these repeat visits for the TH section.)

Assign next repeat visit number at the household level. (NOTE: Each repeat visit grouping, whether OP, MV, TH, or HH is assigned this number at a household level. The number will start over every round.)

Roster behavior:

1. Multiple select allowed.

Display Instructions: {DOC OR DEPT} should not display in context header.

Roster 2- No Add/Edit/Delete

Roster definition:

This item displays all medical events (dates) on person's medical- events-roster for selection. Display event begin date (EVNT.EVNTBEGM,EVNT.EVNTBEGD,EVNT.EVNTBEGY)

Roster filter:

Display only those event with the following characteristics.

1. Event was created this round.

2. Event has not been processed in utilization.

3. Event has event type ‘TH’.

4. Event is associated with the same provider as the event being asked about (regardless of the doctor or department linked to the specific event if provider is a facility provider).

5. Event is not already flagged as part of a flat fee bundle.

Next to each event date, display the doctor or department linked to that specific visit date.

Display ‘Which of the following {calls/contact} were also for {your/{PERSON}’s} {PERSON’S TH MEDICAL CONDITION} {{or {your/his/her}/,} {PERSON’S TH MEDICAL CONDITION}} {or {your/his/her} {PERSON’S TH MEDICAL CONDITION}}?’ if three or less conditions selected or added to Person’s-Medical-Conditions-Roster at TH90. Otherwise display, ‘Which of the following {calls/contact}were also for one of these conditions (READ CONDITIONS BELOW)?’

Display ‘{or {your/his/her}/,} {PERSON’S TH MEDICAL CONDITION}’ if two or three conditions selected or added to Person’s-Medical-Conditions-Roster at TH90. Otherwise, use a null display.

Display “or {your/his/her}” if exactly two conditions selected or added to Person’s-Medical- Conditions-Roster at TH90. Otherwise, display ‘,’.

Display ‘or {your/his/her} {PERSON’S TH MEDICAL CONDITION}’ if exactly three conditions selected or added to Person’s-Medical-Conditions-Roster at TH90. Otherwise, use a null display.

For ‘PERSON’S TH MEDICAL CONDITION’ display the condition selected from or added to Person’s-Medical-Conditions-Roster AT TH90.

Display ‘calls’ if TH10 is coded ‘1’ (PHONE). Otherwise, display ‘contacts’.

Display the header ‘CONDITIONS’ and the list of conditions if more than three conditions selected or added to Person’s-Medical-Conditions-Roster at TH90. Otherwise, use a null display. For ‘PERSON’S TH MEDICAL CONDITION’, display all conditions selected from or added to Person’s- Medical-Conditions-Roster at TH90.

For "MONTH,DAY,YEAR" in the response option area, display visit dates as "MON DD, YYYY".

Abbreviate the month name as three letters.

Display the response option '0' SELECT ALL EVENTS when there is more than one event to display on the roster, otherwise use a null display.

TH150 (TH1120)

BLAISE NAME: THEvntVstGrp

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

Question Text:

INTERVIEWER: RECORD ‘NAME OF REPEAT VISIT GROUP’ FOR EVENTS SELECTED IN PREVIOUS QUESTION:

Responses: 1

Programmer Instructions: Go to BOX_80.

'RF/DK not allowed'.

Display Instructions: {DOC OR DEPT} should not display in context header.

BOX_80 (TH1125)

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