Provider Directory (PD) Section
---------------------------------------------------- | NOTE: THERE ARE THREE BASIC TYPES OF PROVIDERS: | | 1. PERSON-TYPE-PROVIDERS | | 2. PERSON-IN-FACILITY-PROVIDERS | | 3. FACILITY PROVIDERS | | THE PROVIDER DIRECTORY (PD) SECTION DEALS | | ONLY WITH THE FIRST AND THIRD TYPES. THE | | SECOND TYPE (PERSON-IN-FACILITY-PROVIDERS) | | SHOULD BE TREATED AS A FACILITY FOR THE | | PURPOSES OF THE PD SECTION. THAT IS, THE | | PERSON'S NAME IS NOT DISPLAYED OR SEARCHED | | ON, BUT RATHER THE FACILITY WITH WHICH | | S/HE IS ASSOCIATED WILL BE DISPLAYED AND | | SEARCHED ON. THEREFORE, IF THERE IS MORE | | THAN ONE PERSON-IN-FACILITY-PROVIDER | | ASSOCIATED WITH THE SAME FACILITY, THE | | PROVIDER LOOP WILL BE CYCLED ON ONCE FOR | | THAT FACILITY. | ----------------------------------------------------
BOX_00 ======
---------------------------------------------------- | CONTEXT HEADER DISPLAY INSTRUCTIONS: | | DISPLAY PROV.LORPNAME, PROV.PVSTRT1 | ----------------------------------------------------
PD01AA ======
ENTER PROVIDER DIRECTORY REGION TO SEARCH
PROVIDER DIRECTORY 1 ................... 1 {LOOP_01} PROVIDER DIRECTORY 2 ................... 2 {LOOP_01} PROVIDER DIRECTORY 3 ................... 3 {LOOP_01} PROVIDER DIRECTORY 4 ................... 4 {LOOP_01}
LOOP_01 =======
----------------------------------------------------- | FOR EACH ELEMENT IN RU-MEDICAL-PROVIDERS-ROSTER, | | ASK PD01A - END_LP01 | -----------------------------------------------------
----------------------------------------------------- | LOOP DEFINITION: LOOP_01 COLLECTS VA AFFILIATION | | AND ADDRESS INFORMATION FOR PROVIDERS. THIS LOOP | | CYCLES ON PROVIDERS THAT MEET THE FOLLOWING | | CONDITIONS: | | - CREATED THIS ROUND | -----------------------------------------------------
----------------------------------------------------- | NOTE THAT, STARTING IN PANEL 12 ROUND 3, THE LOOP | | DEFINITION AND CRITERIA WERE AS FOLLOWS. STARTING | | IN PANEL 13, THIS DEFINITION AND CRITERIA WILL BE | | IMPLEMENTED IN ALL ROUNDS. | | | | LOOP DEFINITION: LOOP_01 COLLECTS VA AFFILIATION | | AND ADDRESS INFORMATION FOR PROVIDERS. THIS LOOP | | CYCLES ON PROVIDERS THAT MEET THE FOLLOWING | | CONDITIONS: | | - CREATED THIS ROUND AND LINKED TO A KEY RU MEMBER | | OR | | - CREATED IN A PREVIOUS ROUND AND NOW LINKED TO A | | KEY RU MEMBER (AND HAS NOT BEEN THROUGH THE PD | | SECTION PREVIOUSLY) | | | | AND | | - ASSOCIATED WITH AN HS, ER, OP, OR IC EVENT | | OR | | - ASSOCIATED WITH AN MV EVENT | | OR | | - ASSOCIATED WITH AN HH EVENT AND FLAGGED AS | | ‘AGENCY’ | -----------------------------------------------------
PD01A =====
PROVIDER: {NAME OF MEDICAL CARE PROVIDER......}
{Is the clinic or place where (PROVIDER) was seen a facility of the Veteran’s Administration?/ Is (PROVIDER) a facility of the Veteran’s Administration?}
YES .................................... 1 {BOX_01A} NO ..................................... 2 {BOX_01A} REF ................................... -7 {BOX_01A} DK .................................... -8 {BOX_01A}
----------------------------------------------------- | DISPLAY NAME OF PROVIDER BEING LOOPED ON FOR | | ‘NAME OF MEDICAL CARE PROVIDER.’ | -----------------------------------------------------
----------------------------------------------------- | IF PERSON PROVIDER DISPLAY ‘Is the clinic or place | | where (PROVIDER) was seen a facility of the | | Veteran’s Administration?’ | | | | IF FACILITY PROVIDER DISPLAY ‘Is (PROVIDER) a | | facility of the Veteran’s Administration?’ | -----------------------------------------------------
BOX_01A =======
---------------------------------------------------- | IF PROVIDER IS: | | - ASSOCIATED WITH AN HS, ER, OP, OR IC EVENT | | OR | | - ASSOCIATED WITH AN MV EVENT AND MV03 IS CODED | | ‘1’ (YES-TALKED TO A MEDICAL DOCTOR) OR MV03 | | IS CODED ‘2’ (NO), ‘-7’ (REFUSED) OR ‘-8’ | | (DON’T KNOW) AND MV06 IS CODED ‘1’ (YES-MEDICAL| DOCTORS WORK AT LOCATION) | | OR | | - ASSOCIATED WITH A HH EVENT AND FLAGGED AS | | ‘AGENCY’, | | CONTINUE WITH BOX_03 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO END_LP01 | ----------------------------------------------------
BOX_01 ====== OMITTED.
BOX_02 ====== OMITTED.
PD01 ==== OMITTED.
PD02 ==== OMITTED.
BOX_03 ======
---------------------------------------------------- | IF LOOPING ON PROVIDER ASSOCIATED ONLY WITH AN MV | | EVENT AND RU IS NOT SELECTED FOR THE MEDICAL | | PROVIDER COMPONENT (MPC), GO TO END_LP01 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, CONTINUE WITH BOX_04 | ----------------------------------------------------
BOX_04 ======
----------------------------------------------------- | IF FIRST TIME THROUGH LOOP_01, CONTINUE WITH PD03 | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE, GO TO PD05A IF PERSON-PROVIDER OR PD05B| | IF FACILITY-PROVIDER | ----------------------------------------------------
PD03 ====
Now I would like to make sure I have complete information for the medical providers you mentioned. I will use a directory to look up the names, addresses, and telephone numbers of the sources of medical care you mentioned.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
---------------------------------------------------- | IF PROVIDER TYPE IS PERSON GO TO PD05A | ----------------------------------------------------
---------------------------------------------------- | OTHERWISE GO TO PD05B | ----------------------------------------------------
PD04 ==== OMITTED.
PD05A =====
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV} STREET ADDRESS: {STREET ADDRESS FROM PV}
CURRENT STATE CODE: {STATE ABBREVIATION FOR RESPONDENT}
STATE: [_____] [CHANGE STATE FOR SEARCH]
SELECT A SEARCH STRATEGY:
_ SEARCH ON PROVIDER NAME SHOWN ABOVE _ SEARCH ON CORE STREET NAME _ SEARCH ON TELEPHONE NUMBER
---------------------------------------------------- | ITEM DETAILS | | PROVID: ...... {Display PROVID} | | TITLE: ....... {Display Provider Title} | | FIRST NAME: .. {Display Provider First Name} | | LAST NAME: ... {Display Provider Last Name} | | ADDRESSS: .... {Display Provider Street Address} | | .... {Display Provider City, State, Zip}| | PHONE: ....... {Display Provider Telephone Number}| | SPECIALTY: ... {Display Provider Specialty} | ----------------------------------------------------
{SEARCH CRITERIA 1} {SEARCH CRITERIA 2} [SEARCH]
THE NUMBER OF POTENTIAL MATCHES FOUND: {NUMBER OF MATCHES}
PROVID | PROVIDER | STREET | PHONE |
---|---|---|---|
[Display Provider ID] |
[Display Provider Name] |
[Display Street Address] |
[Display Phone Number] |
[Display Provider ID] |
[Display Provider Name] |
[Display Street Address] |
[Display Phone Number] |
{DON’T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES}
---------------------------------------------------- | DISPLAY NAME OF PROVIDER AS RECORDED ON THE | | PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER | | BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER | | FROM PV’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON | | THE PROVIDER ROSTER FROM SECTION PV FOR THE | | PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM | | PV’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘FIRST NAME’ FOR SEARCH CRITERIA 1 AND | | ‘LAST NAME’ FOR SEARCH CRITERIA 2 IF ‘SEARCH ON | | PROVIDER NAME SHOWN ABOVE’ SELECTED. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘STREET LIKE’ FOR SEARCH CRITERIA 1 IF | | ‘SEARCH ON CORE STREET NAME’ SELECTED. DISPLAY NO | | SEARCH CRITERIA 2. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘PHONE NUMBER’ FOR SEARCH CRITERIA 1 IF | | ‘SEARCH ON TELEPHONE NUMBER’ SELECTED. DISPLAY NO | | SEARCH CRITERIA 2. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY TWO-CHARACTER STATE ABBREVIATION | | ASSOCIATED WITH THIS RU’S ADDRESS FOR ‘STATE | | ABBREVIATION FOR RESPONDENT’. | ----------------------------------------------------
---------------------------------------------------- | A LIST OF PROVIDERS IS DISPLAYED ON THE BOTTOM | | HALF OF THE SCREEN AFTER SEARCH CRITERIA ENTERED | | AND ‘SEARCH’ BUTTON SELECTED. | ----------------------------------------------------
---------------------------------------------------- | AN ‘ITEM DETAILS’ BOX WILL APPEAR AFTER A PROVIDER| | HAS BEEN SELECTED FROM THE LIST OF PROVIDERS. | ----------------------------------------------------
---------------------------------------------------- | SEARCHES CAN BE CONDUCTED MULTIPLE TIMES FROM THIS| | SCREEN WITHOUT MOVING FORWARD IN THE INSTRUMENT. | ----------------------------------------------------
---------------------------------------------------- | YOU CAN ONLY PROCEED AFTER A PROVIDER OR ‘DON’T | | SEARCH ANYMORE/NONE OF THE ABOVE MATCHES’ HAS BEEN| | SELECTED. | ----------------------------------------------------
---------------------------------------------------- | IF A PROVIDER IS SELECTED, PROCEED TO PD14 | ----------------------------------------------------
---------------------------------------------------- | IF ‘DON’T SEARCH ANYMORE/NONE OF THE ABOVE | | MATCHES’ HAS BEEN SELECTED, PROCEED TO PD18 | ----------------------------------------------------
PD05B =====
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV} STREET ADDRESS: {STREET ADDRESS FOR RESPONDENT}
STATE: {STATE ABBREVIATION FOR RESPONDENT}
STATE: [_____] [CHANGE STATE FOR SEARCH]
SELECT A SEARCH STRATEGY:
_ SEARCH ON PROVIDER NAME SHOWN ABOVE _ SEARCH ON CORE STREET NAME _ SEARCH ON TELEPHONE NUMBER _ SEARCH ON PROVIDER NAME AND STREET
---------------------------------------------------- | ITEM DETAILS | | PROVID: ...... {Display PROVID} | | PROVIDER: .... {Display Provider Name} | | ADDRESSS: .... {Display Provider Street Address} | | .... {Display Provider City, State, Zip}| | PHONE: ....... {Display Provider Telephone Number}| ----------------------------------------------------
{SEARCH CRITERIA 1} {SEARCH CRITERIA 2} [SEARCH]
THE NUMBER OF POTENTIAL MATCHES FOUND: {NUMBER OF MATCHES}
PROVID | PROVIDER | STREET | PHONE |
---|---|---|---|
[Display Provider ID] |
[Display Provider Name] |
[Display Street Address] |
[Display Phone Number] |
[Display Provider ID] |
[Display Provider Name] |
[Display Street Address] |
[Display Phone Number] |
{DON’T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES}
---------------------------------------------------- | DISPLAY NAME OF PROVIDER AS RECORDED ON THE | | PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER | | BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER | | FROM PV’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY TWO-CHARACTER STATE ABBREVIATION | | ASSOCIATED WITH THIS RU’S ADDRESS FOR ‘STATE | | ABBREVIATION FOR RESPONDENT’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON | | THE PROVIDER ROSTER FROM SECTION PV FOR THE | | PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM | | PV’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘PROVIDER LIKE’ FOR SEARCH CRITERIA 1 IF | | ‘SEARCH ON PROVIDER NAME SHOWN ABOVE’ SELECTED. | | DISPLAY NO SEARCH CRITERIA 2. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘STREET LIKE’ FOR SEARCH CRITERIA 1 IF | | ‘SEARCH ON CORE STREET NAME’ SELECTED. DISPLAY NO | | SEARCH CRITERIA 2. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘PHONE NUMBER’ FOR SEARCH CRITERIA 1 IF | | ‘SEARCH ON TELEPHONE NUMBER’ SELECTED. DISPLAY NO | | SEARCH CRITERIA 2. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY ‘PROVIDER LIKE’ FOR SEARCH CRITERIA 1 AND | | ‘STREET LIKE’ FOR SEARCH CRITERIA 2 IF ‘SEARCH ON | | PROVIDER NAME AND STREET SHOWN ABOVE’ SELECTED. | ----------------------------------------------------
---------------------------------------------------- | A LIST OF PROVIDERS IS DISPLAYED ON THE BOTTOM | | HALF OF THE SCREEN AFTER SEARCH CRITERIA ENTERED | | AND ‘SEARCH’ BUTTON SELECTED. | ----------------------------------------------------
---------------------------------------------------- | AN ‘ITEM DETAILS’ BOX WILL APPEAR AFTER A PROVIDER| | HAS BEEN SELECTED FROM THE LIST OF PROVIDERS. | ----------------------------------------------------
---------------------------------------------------- | SEARCHES CAN BE CONDUCTED MULTIPLE TIMES FROM THIS| | SCREEN WITHOUT MOVING FORWARD IN THE INSTRUMENT. | ----------------------------------------------------
---------------------------------------------------- | YOU CAN ONLY PROCEED AFTER A PROVIDER OR ‘DON’T | | SEARCH ANYMORE/NONE OF THE ABOVE MATCHES’ HAS BEEN| | SELECTED. | ----------------------------------------------------
---------------------------------------------------- | IF A PROVIDER IS SELECTED, PROCEED TO PD14 | ----------------------------------------------------
---------------------------------------------------- | IF ‘DON’T SEARCH ANYMORE/NONE OF THE ABOVE | | MATCHES’ HAS BEEN SELECTED, PROCEED TO PD18 | ----------------------------------------------------
LOOP_02 ======= OMITTED.
PD05 ==== OMITTED.
PD06 ==== OMITTED.
PD07 ==== OMITTED.
PD08 ==== OMITTED.
PD09 ==== OMITTED.
PD10 ==== OMITTED.
PD11 ==== OMITTED.
BOX_05 ====== OMITTED.
PD12 ==== OMITTED.
PD13 ==== OMITTED.
PD14 ====
YOU HAVE CHOSEN THE FOLLOWING PROVIDER: {NAME OF PROVIDER SELECTED AT PD05A/B} {ADDRESS OF PROVIDER SELECTED AT PD05A/B}
YOUR ORIGINAL INPUT PROVIDER: {NAME OF MEDICAL CARE PROVIDER FROM PV} {STREET ADDRESS FROM PV}
YOUR OPTIONS:
ACCEPT PROVIDER AS SHOWN ............... 1 {END_LP01} ACCEPT PROVIDER BUT MAKE CHANGES ....... 2 {PD15} WRONG PROVIDER, GO BACK TO PREVIOUS SCREEN ............................... 3 DON’T SEARCH ANYMORE ................... 4 {PD18}
---------------------------------------------------- | DISPLAY NAME OF PROVIDER AS RECORDED ON THE | | PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER | | BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER | | FROM PV’. IF PERSON-TYPE-PROVIDER, DISPLAY | | PERSON NAME. IF FACILITY-PROVIDER, DISPLAY | | FACILITY NAME. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON | | THE PROVIDER ROSTER FROM SECTION PV FOR THE | | PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM | | PV’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY FULL INFORMATION (I.E., NAME, ADDRESS, | | CITY, STATE, ZIP, TELEPHONE, AND SPECIALTY) FOR | | PROVIDER SELECTED IN PD05A OR PD05B FOR ‘NAME OF | | PROVIDER SELECTED AT PD05A/PD05B’. | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘1’ (ACCEPT PROVIDER AS SHOWN) OR ‘2’ | | (ACCEPT PROVIDER BUT MAKE CHANGES), STORE THIS | | PROVIDER DIRECTORY ID. | ----------------------------------------------------
---------------------------------------------------- | NOTE: INFORMATION OBTAINED FROM THE PROVIDER | | DIRECTORY SEARCH IS NOT USED TO REPLACE DATA | | REPORTED BY THE RESPONDENT DURING THE INTERVIEW | | OR INCORPORATED INTO PROVIDER ROSTER DISPLAYS. | ----------------------------------------------------
---------------------------------------------------- | IF CODED ‘3’ (WRONG PROVIDER, GO BACK TO PREVIOUS | | SCREEN), CAPI AUTOMATICALLY RETURNS TO PD05A OR | | PD05B. | ----------------------------------------------------
PD15 ====
PROVIDER NAME: {NAME OF PROVIDER SELECTED AT PD05A/B} PROVIDER ADDRESS: {ADDRESS OF PROVIDER SELECTED AT PD05A/B}
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV} STREET ADDRESS: {STREET ADDRESS FROM PV}
MAKE CORRECTIONS TO ADDRESS BELOW. USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH NEED CORRECTION.
{Display Prov Name from ProvDir} NAME: [______________________________] {Display Prov Street Address from ProvDir} 1ST_STR_ ADDRESS: [______________________________] {Display Prov City from ProvDir} CITY: [______________________________] {Display Prov State from ProvDir} STATE: [______________________________] {Display Prov Zip Code from ProvDir} ZIP CODE: [______________________________] {Display Prov Telephone from ProvDir} TELEPHONE: [______________________________]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
---------------------------------------------------- | DISPLAY NAME OF PROVIDER AS RECORDED ON THE | | PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER | | BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER | | FROM PV’. IF PERSON-TYPE-PROVIDER, DISPLAY | | PERSON NAME. IF FACILITY-PROVIDER, DISPLAY | | FACILITY NAME. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON | | THE PROVIDER ROSTER FROM SECTION PV FOR THE | | PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM | | PV’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY NAME, ADDRESS, CITY, STATE, ZIP, AND | | TELEPHONE FOR PROVIDER SELECTED IN PD05A OR PD05B | | ‘NAME OF PROVIDER SELECTED AT PD05A/B’. | ----------------------------------------------------
---------------------------------------------------- | ENTRY FIELD SPECIFICATIONS: | | | | - FOR NAME, IF PERSON-TYPE-PROVIDER, DISPLAY | | TITLE, FIRST NAME, AND LAST NAME FIELDS. | | | | - ELSE, DISPLAY FACILITY NAME FIELD. | ----------------------------------------------------
---------------------------------------------------- | FLAG THIS RECORD AS ‘UPDATED. NEEDS HOME OFFICE | | REVIEW.’ | ----------------------------------------------------
---------------------------------------------------- | CONTINUE WITH PD16 | ----------------------------------------------------
PD16 ====
PROVIDER NAME: {NAME OF PROVIDER SELECTED AT PD05A/B} PROVIDER ADDRESS: {ADDRESS OF PROVIDER SELECTED AT PD05A/B}
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV} STREET ADDRESS: {STREET ADDRESS FROM PV}
DO YOU WANT TO MAKE ANY NOTES ABOUT THIS PROVIDER?
YES .................................... 1 {PD16OV} NO ..................................... 2 {END_LP01}
---------------------------------------------------- | DISPLAY NAME OF PROVIDER AS RECORDED ON THE | | PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER | | BEING LOOPED ON FOR ‘NAME OF MEDICAL CARE | | PROVIDER’. IF PERSON-TYPE-PROVIDER, DISPLAY | | PERSON NAME. IF FACILITY-PROVIDER, DISPLAY | | FACILITY NAME. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON | | THE PROVIDER ROSTER FROM SECTION PV FOR THE | | PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS’. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY NAME, ADDRESS, CITY, STATE, ZIP, AND | | TELEPHONE FOR PROVIDER SELECTED IN PD05A OR PD05B | | ‘NAME OF PROVIDER SELECTED AT PD05A/B’. | ----------------------------------------------------
PD16OV ======
PROVIDER NAME: {NAME OF PROVIDER SELECTED AT PD05A/B} PROVIDER ADDRESS: {ADDRESS OF PROVIDER SELECTED AT PD05A/B}
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV} STREET ADDRESS: {STREET ADDRESS FROM PV}
[ENTER TEXT].........................{END_LP01}
---------------------------------------------------- | ALLOW MULTIPLE LINES FOR ENTRY. | ----------------------------------------------------
PD17 ==== OMITTED.
PD18 ====
ENTER COMPLETE PROVIDER NAME, ADDRESS, AND TELEPHONE. USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH NEED CORRECTION. IF NEEDED, TYPE THREE Xs (XXX) TO DELETE 2ND STREET ADDRESS.
{Provider Name from PV} NAME: [______________________________] {1ST_STR_Provider Address from PV} 1ST_STR_ADDRESS: [______________________________] {2ND_STR_Provider Address from PV} 2ND_STR_ADDRESS: [______________________________] CITY: [______________________________] STATE: [______________________________] ZIP CODE: [______________________________] PHONE: [______________________________] SPECIALTY: [______________________________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
---------------------------------------------------- | IF STREET ADDRESS LINES ARE CODED REFUSED OR DON’T| | KNOW (-7 OR -8) IN PROVIDER ROSTER (PV) SECTION, | | DISPLAY BLANK LINES FOR THESE FIELDS. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY THE NAME AND ADDRESS AS RECORDED ON THE | | PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER | | BEING LOOPED ON FOR ‘PROVIDER NAME FROM PV’. IF | | PERSON-TYPE-PROVIDER, DISPLAY PERSON NAME. IF | | FACILITY-PROVIDER, DISPLAY FACILITY NAME. | ----------------------------------------------------
---------------------------------------------------- | ENTRY FIELD SPECIFICATIONS: | | | | - FOR NAME, IF PERSON-TYPE-PROVIDER, DISPLAY | | TITLE, FIRST NAME, AND LAST NAME FIELDS. | | | | - ELSE, DISPLAY FACILITY NAME FIELD. | | | | - DISPLAY THE NAME (IN APPROPRIATE FIRST & LAST | | NAME OR FACILITY FIELDS) AS RECORDED ON THE | | PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER| | BEING LOOPED ON IN THE ENTRY FIELD FOR THE | | INTERVIEWER TO EITHER ACCEPT OR EDIT. | | | | - DISPLAY THE ADDRESS (IN APPROPRIATE FIRST AND | | SECOND STREET FIELDS) AS RECORDED ON THE | | PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER| | BEING LOOPED ON IN THE ENTRY FIELD FOR THE | | INTERVIEWER TO EITHER ACCEPT OR EDIT. | ----------------------------------------------------
---------------------------------------------------- | FLAG THIS RECORD AS ‘NEW NAME/ADDRESS INFORMATION.| | NEEDS HOME OFFICE REVIEW.’ | ----------------------------------------------------
---------------------------------------------------- | REFUSED AND DON’T KNOW ALLOWED IN ALL FIELDS, | | EXCEPT THE ‘NAME’ AND ‘STATE’ FIELDS. | ----------------------------------------------------
---------------------------------------------------- | CONTINUE WITH PD19 | ----------------------------------------------------
PD19 ====
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV} STREET ADDRESS: {STREET ADDRESS FROM PV}
DO YOU WANT TO MAKE ANY NOTES ABOUT THIS PROVIDER?
YES .................................... 1 {PD19OV} NO ..................................... 2 {END_LP01}
---------------------------------------------------- | DISPLAY NAME OF PROVIDER AS RECORDED ON THE | | PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER | | BEING LOOPED ON FOR ‘NAME OF MEDICAL CARE | | PROVIDER’. IF PERSON-TYPE PROVIDER, DISPLAY | | PERSON NAME. IF FACILITY-PROVIDER, DISPLAY | | FACILITY NAME. | ----------------------------------------------------
---------------------------------------------------- | DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON | | THE PROVIDER ROSTER FROM SECTION PV FOR THE | | PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS’. | ----------------------------------------------------
PD19OV ======
PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV} STREET ADDRESS: {STREET ADDRESS FROM PV}
[ENTER TEXT].................... {END_LP01}
---------------------------------------------------- | ALLOW MULTIPLE LINES FOR ENTRY. | ----------------------------------------------------
END_LP02 ======== OMITTED.
END_LP01 ========
---------------------------------------------------- | CYCLE ON NEXT PROVIDER THAT MEETS THE CONDITIONS | | STATED IN THE LOOP DEFINITION. | ----------------------------------------------------
---------------------------------------------------- | IF NO OTHER PROVIDER MEETS THE STATED CONDITIONS, | | END LOOP_01 AND CONTINUE WITH BOX_06 | ----------------------------------------------------
BOX_06 ======
---------------------------------------------------- | GO TO NEXT QUESTIONNAIRE SECTION. | ----------------------------------------------------