Provider Roster (PV) Section
PV01 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV}
{[What is the name of the person or place that provided health care to (PERSON)?]}
INTERVIEWER: IS THE PROVIDER {ASSOCIATED WITH THIS EVENT} A PERSON OR A FACILITY (INCLUDING GROUP PRACTICES AND HMOs)?
PERSON ................................. 1 FACILITY ............................... 2 {BOX_01}
PRESS F1 FOR DEFINITION OF PERSON/FACILITY.
---------------------------------------------------- | DISPLAY '[What is ... (PERSON)?]' AND 'ASSOCIATED | | WITH THIS EVENT' IF THE PROVIDER ROSTER (PV) | | SECTION WAS NOT CALLED FROM THE ACCESS TO CARE | | (AC) SECTION. IF THE PV SECTION WAS CALLED FROM | | THE AC SECTION, USE A NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '1' (PERSON), SET PROVIDER TYPE TO | | 'PERSON-TYPE-PROVIDER'. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '2' (FACILITY), SET PROVIDER TYPE TO | | 'FACILITY-PROVIDER'. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '1' (PERSON) AND NO PROVIDERS THAT ARE | | TYPE 'PERSON-TYPE-PROVIDER' ON | | RU-MEDICAL-PROVIDERS-ROSTER, GO TO PV04 | ----------------------------------------------------
---------------------------------------------------- | IF CODED '1' (PERSON) AND AT LEAST ONE PROVIDER | | THAT IS TYPE 'PERSON-TYPE-PROVIDER' ON | | RU-MEDICAL-PROVIDERS-ROSTER, CONTINUE WITH PV02 | ----------------------------------------------------
---------------------------------------------------- | EDIT: IF EVENT TYPE IS HS, ER, OP, OR IC, PV01 | | CANNOT BE CODED '1' (PERSON). IF PV01 IS CODED | | '1' (PERSON) FOR AN HS, ER, OP, OR IC EVENT, | | DISPLAY THE FOLLOWING MESSAGE: 'A FACILITY MUST | | BE ASSOCIATED WITH {EV} TYPE. VERIFY PROVIDER AND| | RE-ENTER.' | ----------------------------------------------------
PV02 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV}
SELECT CORRECT {USUAL SOURCE OF CARE} PROVIDER {ASSOCIATED WITH THE EVENT}.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
ROSTER. PERSON-TYPE-PROVIDER |
PV02_02. FACILITY |
PV02_03. STREET |
---|---|---|
1. [Display Truncated |
[Display Truncated Facility-Provider-30] |
[Display Truncated Street Address-15] |
2. [Display Truncated |
[Display Truncated Facility-Provider-30] |
[Display Truncated Street Address-15] |
3. [Display Truncated |
[Display Truncated Facility-Provider-30] |
[Display Truncated Street Address-15] |
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS THE | | PROVIDERS ON THE RU-MEDICAL-PROVIDERS-ROSTER THAT | | ARE OF THE TYPE PERSON-TYPE-PROVIDER, WHICH | | INCLUDES THE SUBGROUP FLAGGED AS | | 'PERSON-IN-FACILITY-PROVIDER'. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'USUAL SOURCE OF CARE' IF THE PROVIDER | | ROSTER (PV) SECTION WAS CALLED FROM THE ACCESS TO | | CARE (AC) SECTION. OTHERWISE, USE A NULL DISPLAY.| | | | DISPLAY 'ASSOCIATED WITH THE EVENT' IF THE | | PROVIDER ROSTER (PV) SECTION WAS NOT CALLED FROM | | THE ACCESS TO CARE (AC) SECTION. IF THE PV | | SECTION WAS CALLED FROM THE AC SECTION, USE A NULL| | DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | ROSTER BEHAVIOR SPECIFICATIONS: | | | | 1. INTERVIEWER MAY SELECT ANY PROVIDER ALREADY | | LISTED OR SELECT 'NONE OF THE ABOVE.' | | 2. ONLY ONE SELECTION MAY BE MADE. | | 3. INTERVIEWER CANNOT ADD AT THIS SCREEN. | | PROVIDERS ARE 'ADDED' BY USING THE 'NONE OF | | THE ABOVE' SELECTION. | | 4. INTERVIEWER CANNOT DELETE AT THIS SCREEN | | (I.E., CTRL/D). | | 5. IF NO FACILITY IS ASSOCIATED WITH THE | | PERSON-PROVIDER, LEAVE THE FACILITY COLUMN | | BLANK FOR THAT PERSON-TYPE-PROVIDER. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON | | ROSTER. | ----------------------------------------------------
---------------------------------------------------- | IF 'NONE OF THE ABOVE' IS SELECTED, GO TO PV04 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH PV03 | ----------------------------------------------------
PV03 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV}
Is the address of (READ NAME AND ADDRESS OF PROVIDER BELOW)...
{PERSON-TYPE-PROVIDER NAME SELECTED AT PV02} {FACILITY-PROVIDER W/ PERSON-TYPE-PROVIDER} {PERSON-TYPE-PROVIDER STREET ADDRESS LINE1} {PERSON-TYPE-PROVIDER STREET ADDRESS LINE2}
ADDRESS {& FACILITY NAME} CORRECT ...... 1 {BOX_02} ADD NEW ADDRESS FOR PROVIDER ........... 2 {PV06} ADD NEW/DIFFERENT FACILITY FOR PROVIDER ............................. 3 {BOX_01} ABOVE PROVIDER NAME/ADDRESS {OR FACILITY NAME} NEEDS SPELLING OR MINOR CORRECTION .................. 4 {BOX_02} SELECTED WRONG PROVIDER/ADDRESS ........ 5 REF ................................... -7 {BOX_02} DK .................................... -8 {BOX_02}
[Code One]
---------------------------------------------------- | FOR: {PERSON-TYPE-PROVIDER NAME SELECTED AT PV02},| | DISPLAY THE PERSON-TYPE-PROVIDER NAME SELECTED AT | | PV02. | | FOR: {FACILITY-PROVIDER W/ PERSON-TYPE-PROVIDER.},| | DISPLAY THE FACILITY-PROVIDER NAME ASSOCIATED WITH| | THE PERSON-TYPE-PROVIDER SELECTED AT PV02. IF NO | | FACILITY-PROVIDER NAME ASSOCIATED WITH THIS | | PERSON-TYPE-PROVIDER, USE A NULL DISPLAY. | | FOR: {PERSON-TYPE-PROVIDER STREET ADDRESS LINE1.}| | AND {PERSON-TYPE-PROVIDER STREET ADDRESS LINE2.}, | | DISPLAY LINES 1 & 2 OF THE PERSON-TYPE-PROVIDER'S | | ADDRESS FOR THE PERSON-TYPE-PROVIDER SELECTED AT | | PV02. | | | | DISPLAY '& FACILITY NAME' AND 'OR FACILITY NAME' | | IF FACILITY-PROVIDER NAME ASSOCIATED WITH THE | | PERSON-TYPE-PROVIDER SELECTED AT PV02. IF NO | | FACILITY-PROVIDER NAME ASSOCIATED WITH THIS | | PERSON-TYPE-PROVIDER, USE A NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '5' (SELECTED WRONG PROVIDER/ADDRESS), | | CAPI REDISPLAYS PV02 TO ALLOW INTERVIEWER TO | | SELECT CORRECT PROVIDER. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '4' (ABOVE PROVIDER NAME/ADDRESS | | {OR FACILITY NAME} NEEDS SPELLING OR MINOR | | CORRECTIONS), DISPLAY THE FOLLOWING MESSAGE: | | 'THIS OPTION IS DISABLED. PLEASE RECORD | | INFORMATION IN COMMENTS.' | ----------------------------------------------------
PV04 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV}
ENTER NAME OF PROVIDER {ASSOCIATED WITH EVENT}.
ENTER COMPLETE PROVIDER NAME AND VERIFY SPELLING.
[Enter Provider Name-65] ...............
---------------------------------------------------- | DISPLAY 'ASSOCIATED WITH EVENT' IF THE PROVIDER | | ROSTER (PV) SECTION WAS NOT CALLED FROM THE ACCESS| | TO CARE (AC) SECTION. IF THE PV SECTION WAS | | CALLED FROM THE AC SECTION, USE A NULL DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | WRITE PROVIDER NAME TO THE PERSON-TYPE-PROVIDER | | COLUMN OF THE RU-MEDICAL-PROVIDERS-ROSTER. | ----------------------------------------------------
PV05 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER......} {EV}
Is (PROVIDER) in a group practice, that is, do other doctors practice at the same office (or are part of an HMO)?
YES .................................... 1 {BOX_01} NO ..................................... 2 REF ................................... -7 DK .................................... -8
---------------------------------------------------- | IF CODED '1' (YES), FLAG PERSON-TYPE-PROVIDER AS | | 'PERSON-IN-FACILITY-PROVIDER'. | ----------------------------------------------------
PV06 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER......} {EV}
ENTER {NEW} STREET ADDRESS FOR (PROVIDER).
ENTER STREET ADDRESS AND VERIFY SPELLING. IF PROVIDER HAS MORE THAN ONE LOCATION, RECORD LOCATION PERSON VISITED.
PROVIDER_STR1 (PV06_01): [_____________] PROVIDER_STR2 (PV06_02): [_____________]
---------------------------------------------------- | DISPLAY 'NEW' IF PV03 IS CODED '2' (ADD NEW | | ADDRESS FOR PROVIDER). OTHERWISE, USE A NULL | | DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | CODES '-7' (REF) AND '-8' (DK) ARE ALLOWED ON EACH| | FORM ITEM. | ----------------------------------------------------
---------------------------------------------------- | IF PV04 WAS ASKED, ASSOCIATE ADDRESS WITH | | PERSON-TYPE-PROVIDER ENTERED AT PV04. | ----------------------------------------------------
---------------------------------------------------- | IF PV03 WAS CODED '2' (ADD NEW ADDRESS FOR | | PROVIDER), WRITE ANOTHER RECORD FOR PROVIDER IN | | RU-MEDICAL-PROVIDERS-ROSTER AND ASSOCIATE ADDRESS | | WITH THAT NEW PROVIDER RECORD. SET PROVIDER TYPE | | TO 'PERSON-TYPE-PROVIDER'. | | | | IF A FACILITY WAS DISPLAYED AS PART OF PROVIDER'S | | ADDRESS AT PV03, ASSOCIATE THAT FACILITY WITH THE | | NEW PROVIDER RECORD AND FLAG THE PERSON-TYPE- | | PROVIDER AS A 'PERSON-IN-FACILITY-PROVIDER'. | ----------------------------------------------------
---------------------------------------------------- | GO TO BOX_02 | ----------------------------------------------------
PV07 ==== OMITTED.
BOX_01 ======
---------------------------------------------------- | IF NO PROVIDERS THAT ARE TYPE 'FACILITY-PROVIDERS'| | ON RU-MEDICAL-PROVIDERS-ROSTER, GO TO PV10 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH PV08 | ----------------------------------------------------
PV08 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV}
SELECT CORRECT {USUAL SOURCE OF CARE} {PROVIDER/FACILITY} {ASSOCIATED WITH THE EVENT}.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER. TO LEAVE, PRESS ESC.
ROSTER. FACILITY-PROVIDERS | PV08_02. STREET |
---|---|
[Display Truncated Facility-Provider-30] |
[Display Truncated Street Address-15] |
[Display Truncated Facility-Provider-30] |
[Display Truncated Street Address-15] |
[Display Truncated Facility-Provider-30] |
[Display Truncated Street Address-15] |
---------------------------------------------------- | ROSTER DEFINITION: THIS ITEM DISPLAYS THE | | PROVIDERS ON THE RU-MEDICAL-PROVIDERS-ROSTER THAT | | ARE TYPE FACILITY-PROVIDERS. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'USUAL SOURCE OF CARE' IF THE PROVIDER | | ROSTER (PV) SECTION WAS CALLED FROM THE ACCESS TO | | CARE (AC) SECTION. OTHERWISE, USE A NULL DISPLAY.| | | | DISPLAY 'PROVIDER' IF PV01 IS CODED '2' | | (FACILITY). DISPLAY 'FACILITY' IF PV01 IS CODED | | '1' (PERSON). | | | | DISPLAY 'ASSOCIATED WITH THE EVENT' IF THE | | PROVIDER ROSTER (PV) SECTION WAS NOT CALLED FROM | | THE ACCESS TO CARE (AC) SECTION. IF THE PV | | SECTION WAS CALLED FROM THE AC SECTION, USE A NULL| | DISPLAY. | ----------------------------------------------------
---------------------------------------------------- | ROSTER BEHAVIOR SPECIFICATIONS: | | | | 1. INTERVIEWER MAY SELECT ANY PROVIDER ALREADY | | LISTED OR SELECT 'NONE OF THE ABOVE.' | | 2. ONLY ONE SELECTION MAY BE MADE. | | 3. INTERVIEWER CANNOT ADD AT THIS SCREEN. | | PROVIDERS ARE 'ADDED' BY USING THE 'NONE OF | | THE ABOVE' SELECTION. | | 4. INTERVIEWER CANNOT DELETE AT THIS SCREEN | | (I.E., CTRL/D). | ----------------------------------------------------
---------------------------------------------------- | DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON | | ROSTER. | ----------------------------------------------------
---------------------------------------------------- | IF 'NONE OF THE ABOVE' IS SELECTED, GO TO PV10 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH PV09 | ----------------------------------------------------
PV09 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV}
Is the address of (READ NAME AND ADDRESS OF ({PROVIDER/FACILITY}) BELOW)...
{FACILITY NAME SELECTED AT PV08} {FACILITY STREET ADDRESS LINE1.} {FACILITY STREET ADDRESS LINE2.}
FACILITY NAME AND ADDRESS CORRECT ...... 1 {BOX_02} ADD NEW ADDRESS FOR FACILITY ........... 2 ABOVE NAME/ADDRESS NEEDS SPELLING OR MINOR CORRECTION ..................... 3 {BOX_02} SELECTED WRONG FACILITY/ADDRESS ........ 4 REF ................................... -7 {BOX_02} DK .................................... -8 {BOX_02}
[Code One]
---------------------------------------------------- | DISPLAY 'PROVIDER' IF PV01 IS CODED '2' | | (FACILITY). DISPLAY 'FACILITY' IF PV01 IS CODED | | '1' (PERSON). | | | | FOR: {FACILITY NAME SELECTED AT PV08}, DISPLAY | | THE FACILITY-PROVIDER NAME SELECTED AT PV08. | | FOR: {FACILITY STREET ADDRESS LINE1.} AND | | {FACILITY STREET ADDRESS LINE2.}, DISPLAY LINES | | 1 AND 2 OF THE FACILITY-PROVIDER'S ADDRESS FOR THE| | FACILITY-PROVIDER SELECTED AT PV08. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '1' (FACILITY NAME AND ADDRESS CORRECT) | | OR '3' (ABOVE NAME/ADDRESS FOR FACILITY NEEDS | | SPELLING OR MINOR CORRECTION) AND PV01 IS CODED | | '1' (PERSON), LINK THE FACILITY SELECTED AT PV08 | | TO THE PERSON-TYPE-PROVIDER FLAGGED AS | | 'PERSON-IN-FACILITY-PROVIDER'. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '4' (SELECTED WRONG FACILITY/ADDRESS), | | CAPI REDISPLAYS PV08 TO ALLOW INTERVIEWER TO | | SELECT CORRECT FACILITY. | ----------------------------------------------------
---------------------------------------------------- | IF CODED '3' (ABOVE NAME/ADDRESS NEEDS SPELLING | | OR MINOR CORRECTIONS), DISPLAY THE FOLLOWING | | MESSAGE: 'THIS OPTION IS DISABLED. PLEASE | | RECORD INFORMATION IN COMMENTS.' | ----------------------------------------------------
PV10 ====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER......} {EV}
ENTER {NEW} {NAME AND} ADDRESS OF ({PROVIDER/FACILITY}).
ENTER {NAME AND} STREET ADDRESS AND VERIFY SPELLING. IF ({PROVIDER/FACILITY}) HAS MORE THAN ONE LOCATION, RECORD LOCATION PERSON VISITED.
FACILITY_NAME (PV10_01): [_____________] FACILITY_STR1 (PV10_02): [_____________] FACILITY_STR2 (PV10_03): [_____________]
---------------------------------------------------- | DISPLAY 'NEW' IF PV09 IS CODED '2' (ADD NEW | | ADDRESS FOR FACILITY). OTHERWISE, USE A NULL | | DISPLAY. DISPLAY 'PROVIDER' IF PV01 IS CODED '2' | | (FACILITY). DISPLAY 'FACILITY' IF PV01 IS CODED | | '1' (PERSON). DISPLAY 'NAME AND' IF 'NONE OF THE | | ABOVE' WAS SELECTED AT PV08 OR PV08 WAS NOT ASKED.| | IF 'NONE OF THE ABOVE' WAS SELECTED AT PV08 OR | | PV08 WAS NOT ASKED, THE CONTEXT HEADER WILL NOT | | DISPLAY THE NAME OF THE MEDICAL CARE PROVIDER. | | THE CONTEXT HEADER WILL ONLY HAVE THE NAME OF THE | | PROVIDER(S) ASSOCIATED WITH THE EVENT IF PV09 WAS | | CODED '2' (ADD NEW ADDRESS FOR FACILITY). | ----------------------------------------------------
---------------------------------------------------- | CODES '-7' (REF) AND '-8' (DK) ARE ALLOWED ON | | PV10_02 AND PV10_03 ONLY. | ----------------------------------------------------
---------------------------------------------------- | IF PV09 IS CODED '2' (ADD NEW ADDRESS FOR | | FACILITY), PV10 WILL NOT COLLECT THE FACILITY | | NAME. | ----------------------------------------------------
---------------------------------------------------- | IF FACILITY-PROVIDER NOT SELECTED AT PV08 (I.E., | | PV08 WAS NOT ASKED OR 'NONE OF THE ABOVE' WAS | | SELECTED), WRITE NAME AND ADDRESS ENTERED ABOVE TO| | FACILITY-PROVIDER NAME COLUMN AND ADDRESS COLUMN | | OF THE RU-MEDICAL-PROVIDERS-ROSTER. | | | | IF FACILITY-PROVIDER SELECTED AT PV08 AND PV09 WAS| | CODED '2' (ADD NEW ADDRESS FOR FACILITY), WRITE | | ANOTHER RECORD FOR THE FACILITY-PROVIDER TO THE | | RU-MEDICAL-PROVIDERS-ROSTER AND ASSOCIATE ADDRESS | | WITH THAT NEW PROVIDER RECORD. | | | | IF PV01 IS CODED '1' (PERSON), LINK THE FACILITY | | TO THE PERSON-TYPE-PROVIDER FLAGGED AS | | 'PERSON-IN-FACILITY-PROVIDER'. | ----------------------------------------------------
---------------------------------------------------- | GO TO BOX_02 | ----------------------------------------------------
PV11 ==== OMITTED.
BOX_02 ====== ---------------------------------------------------- | RETURN TO QUESTIONNAIRE SECTION FROM WHICH THE | | PROVIDER ROSTER (PV) SECTION WAS CALLED. | ----------------------------------------------------