Home Health (HH) Section
BOX_00A
=======
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CONTEXT HEADER DISPLAY
INSTRUCTIONS:
DISPLAY EVNT.EVNTBEGM AS THREE
LETTERS.
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BOX_00
======
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IF NOT ROUND 5 AND EVENT MONTH IS
INTERVIEW MONTH,
GO TO BOX_05
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OTHERWISE, CONTINUE WITH BOX_01
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BOX_01
======
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IF PROVIDER IS FLAGGED AS
‘AGENCY’, CONTINUE WITH
HH01
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OTHERWISE, GO TO HH03
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HH01
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
SHOW CARD HH-1.
Please look at this card. During
(VISIT MONTH), what types of
health care workers from
(PROVIDER) provided home care services
for (PERSON)?
CHECK ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)
...... 1
COMPANION
.............................. 2
DIETITIAN/NUTRITIONIST
................. 3
HOME HEALTH/HOME CARE AIDE
............. 4
HOSPICE WORKER
......................... 5
HOMEMAKER
.............................. 6
I.V. OR INFUSION THERAPIST
............. 7
MEDICAL DOCTOR
......................... 8
NURSE/NURSE PRACTITIONER
............... 9
NURSE’S AIDE
.......................... 10
OCCUPATIONAL THERAPIST
................ 11
PERSONAL CARE ATTENDANT
............... 12
PHYSICAL THERAPIST
.................... 13
RESPIRATORY THERAPIST
................. 14
SOCIAL WORKER
......................... 15
SPEECH THERAPIST
...................... 16
SOME OTHER TYPE OF HEALTH CARE
WORKER . 91 {HH02}
REF
................................... -7 {HH03}
DK
.................................... -8 {HH03}
HELP AVAILABLE FOR DEFINITION OF
ANSWER CATEGORIES.
[Code All That Apply]
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‘SOME OTHER TYPE OF HEALTH CARE
WORKER’ NOT
DISPLAYED ON SHOW CARD.
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FOR SPECIFICATIONS PURPOSES ONLY
(THIS CHECK IS
AUTOMATIC): CAPI DOES NOT ALLOW -7
OR -8 IN
COMBINATION WITH ANY OTHER CODE.
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IF CODED ‘91’ (ALONE OR IN
COMBINATION WITH ANY
OTHER CODE), CONTINUE WITH HH02
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OTHERWISE, GO TO HH03
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HH02
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
What type of health care worker
was it?
CHECK ALL THAT APPLY.
NONSKILLED WORKER (ANY TYPE OF
WORKER
WHO PROVIDES HOME CARE SERVICES
WHICH GENERALLY FALL INTO
COMPANION,
HOMEMAKER, PERSONAL CARE
CATEGORIES.
THESE WORKERS MAY ALSO PERFORM
MINOR
HEALTH CARE ACTIVITIES SUCH AS
ADMINISTERING MEDICATIONS)
............ 1
SKILLED WORKER (TRAINED,
CERTIFIED, OR
LICENSED MEDICAL PERSONNEL WHO PERFORM
SERVICES OR OTHER MEDICAL PROCEDURES
INCLUDING: NURSE/NURSE PRACTITIONER,
ANY TYPE OF THERAPIST, HOSPICE WORKER,
MEDICAL DOCTOR, DIETICIAN/NUTRITIONIST,
AND SOCIAL WORKER.).................... 2
OTHER TYPE OF HEALTH CARE WORKER
....... 91
REF
.................................... -7 {HH03}
DK
..................................... -8 {HH03}
[Code All That Apply]
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY
(THIS CHECK IS
AUTOMATIC): CAPI DOES NOT ALLOW -7
OR -8 IN
COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED ‘1’ (NONSKILLED WORKER)
ALONE, GO TO
HH03
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IF CODED ‘2’ (SKILLED WORKER)
ALONE OR IN
COMBINATION WITH ANY OTHER CODE,
CONTINUE WITH
HH02OV1
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IF CODED ‘91’ (ALONE OR IN
COMBINATION WITH ANY
CODE EXCEPT ‘2’), GO TO HH02OV2
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HARD CHECK: REFUSED AND DON’T KNOW
CANNOT BE
ENTERED IN CONJUNCTION WITH ANY
OTHER CODE.
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HH02OV1
=======
TYPE OF SKILLED WORKER:
[Enter Other
Specify]...................
REF.................................... -7
DK..................................... -8
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IF RESPONSE TO HH02 INCLUDES CODE
'91', CONTINUE
WITH HH02OV2
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OTHERWISE, GO TO HH03
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HH02OV2
=======
OTHER TYPE OF HEALTH CARE WORKER:
[Enter Other
Specify]................... {HH03}
REF.................................... -7 {HH03}
DK..................................... -8 {HH03}
HH03
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Thinking about the home care services (PERSON)
(have/has)
received from {someone from} (PROVIDER) during (VISIT
MONTH),
were any of these home care services because of a
hospitalization, either before or after {PERSON’S
STR-DT}?
YES .................................... 1 {HH04}
NO ..................................... 2 {HH04}
REF ................................... -7 {HH04}
DK .................................... -8 {HH04}
HELP AVAILABLE FOR DEFINITION OF HOSPITALIZATION.
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DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
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DISPLAY THE REFERENCE PERIOD START DATE FOR THE
PERSON BEING ASKED ABOUT FOR ‘PERSON’S STR-DT’.
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HH04
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Thinking about all of the home care services (PERSON)
(have/has)
received from {someone from} (PROVIDER) during (VISIT
MONTH),
were any of these home care services related to any
specific
health problem?
IF OLD AGE MENTIONED, SELECT ‘YES’ AND ENTER ‘OLD AGE’
AS
CONDITION.
YES .................................... 1 {HH05}
NO ..................................... 2 {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
HELP AVAILABLE FOR DEFINITION OF HEALTH PROBLEM.
----------------------------------------------------
DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
----------------------------------------------------
HH05
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
What health condition led (PERSON) to receive home
health care
services from {someone from} (PROVIDER) during (VISIT
MONTH)?
PROBE: Any other health condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON
ROSTER.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
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DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’. OTHERWISE, USE A NULL
DISPLAY.
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DISPLAY ‘ADD CONDITION’ AS AN
OPTION ON THIS
SCREEN.
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CONTINUE WITH BOX_02
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ROSTER DETAILS:
TITLE: PERS-COND-1
COL #1 HEADER: MEDICAL CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL
CONDITION
(COND.CONDNAM)
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ROSTER DEFINITION:
DISPLAY THE PERSON’S-MEDICAL-CONDITIONS ROSTER
FOR THE SELECTION AND ADDITION OF ONE OR MANY
MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
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ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
SELECTION SHOULD NOT
IMPACT THE ROUND FLAG OF THE
CONDITION.
2. MULTIPLE ADD ALLOWED.
INTERVIEWER SHOULD RECORD
THE CONDITION NAME.
3. LIMITED DELETE ALLOWED.
INTERVIEWER MAY DELETE
A CONDITION ADDED ON THIS SCREEN
AS LONG AS
CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS
CONDITION AND THE EVENT. IF THE
INTERVIEWER
ATTEMPTS TO DELETE A CONDITION
WHEN DELETE IS
NOT ALLOWED, DISPLAY THE FOLLOWING MESSAGE:
"DELETE ALLOWED ONLY WHEN
CONDITION IS FIRST
ENTERED."
4. LIMITED EDIT ALLOWED.
INTERVIEWER MAY EDIT A
CONDITION NAME NEWLY ADDED ON THIS
SCREEN AS
LONG AS CAPI HAS NOT YET CREATED THE LINK
BETWEEN THIS CONDITION AND THE EVENT.
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ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON’S
ROSTER; NO
FILTER.
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BOX_02
======
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IF PROVIDER FLAGGED AS ‘INFORMAL’,
GO TO HH08
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OTHERWISE, CONTINUE WITH HH06
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HH06
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
SHOW CARD HH-2.
Please look at the top of this
card.
During (VISIT MONTH), did {someone
from} (PROVIDER) help (PERSON)
by providing medical treatments
or any type of therapy?
PROBE: Medical treatments include
things like changing bandages,
wound care, giving medication,
taking blood pressure, or giving
shots or injections. Therapy
includes physical, occupational,
and speech therapy.
YES, AT LEAST ONCE
..................... 1 {HH07}
NO
..................................... 2 {HH07}
REF
................................... -7 {HH07}
DK
.................................... -8 {HH07}
[Code One]
HELP AVAILABLE FOR OTHER EXAMPLES
OF MEDICAL TREATMENTS AND THERAPY.
----------------------------------------------------
DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
----------------------------------------------------
HH07
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
SHOW CARD HH-2.
Now look at the gray area
in the middle of the card.
During (VISIT MONTH), did {someone
from} (PROVIDER) provide or
teach (PERSON) or a friend or
relative how to use any medical
equipment or assistive
device, such as the items listed on this
card?
PROBE: For example, an oxygen
tank, a wheelchair, a walker, a
hospital bed, a tub seat, or a
special railing or commode.
YES, AT LEAST ONCE
..................... 1 {HH08}
NO
..................................... 2 {HH08}
REF
................................... -7 {HH08}
DK
.................................... -8 {HH08}
[Code One]
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DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
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HH08
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
{SHOW CARD HH-2/SHOW CARD HH-3.}
{Now look at the bottom of this
card.}
During (VISIT MONTH), did {someone
from} (PROVIDER) help (PERSON)
with daily activities or
personal care tasks, such as those listed
on this card?
PROBE: For example, using the
telephone, paying bills, shopping,
driving, doing housework,
preparing meals, bathing, dressing,
using the toilet, getting in or
out of a bed or chair, walking or
eating.
YES, AT LEAST ONCE
..................... 1 {HH09}
NO
..................................... 2 {HH09}
REF
................................... -7 {HH09}
DK
.................................... -8 {HH09}
[Code One]
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DISPLAY ‘SHOW CARD HH-2.’ AND ‘Now
look at the
bottom of this card.’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’ OR ‘PAID INDEPENDENT’.
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DISPLAY ‘SHOW CARD HH-3.’ IF
PROVIDER IS FLAGGED
AS ‘INFORMAL’.
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DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
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HH09
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
During (VISIT MONTH), did
{someone
from} (PROVIDER) provide
companionship or company
for (PERSON)?
PROBE: For example, reading,
watching T.V., playing games, going
for a walk or to a restaurant, or
just being together.
YES, AT LEAST ONCE
..................... 1 {HH10}
NO
..................................... 2 {HH10}
REF
................................... -7 {HH10}
DK
.................................... -8 {HH10}
[Code One]
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DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
----------------------------------------------------
HH10
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Did {someone from} (PROVIDER)
provide (PERSON) with any other home
care services we have not
yet talked about?
YES, AT LEAST ONCE
..................... 1 {HH10OV}
NO
..................................... 2 {HH11}
REF
................................... -7 {HH11}
DK
.................................... -8 {HH11}
[Code One]
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DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
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HH10OV
======
What other services?
{IF MEDICAL TREATMENT OR THERAPY
MENTIONED, BACKUP TO HH06 TO BE
SURE ‘YES’ IS CODED.
IF MEDICAL EQUIPMENT OR ASSISTIVE
DEVICE MENTIONED, BACKUP TO HH07
TO BE SURE ‘YES’ IS CODED.}
IF DAILY ACTIVITIES OR PERSONAL
CARE TASKS MENTIONED, BACKUP TO
HH08 TO BE SURE ‘YES’ IS CODED.
IF COMPANIONSHIP MENTIONED, BACKUP
TO HH09 TO BE SURE ‘YES’ IS
CODED.
[Enter Other Specify]
.................. {HH11}
REF
................................... -7 {HH11}
DK
.................................... -8 {HH11}
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DISPLAY ‘IF MEDICAL TREATMENT OR
THERAPY
MENTIONED, BACKUP TO BE SURE ‘YES’
IS CODED...’
IF PROVIDER IS FLAGGED AS ‘AGENCY’
OR ‘PAID
INDEPENDENT’.
----------------------------------------------------
HH11
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
Generally speaking, during (VISIT
MONTH), did {someone from}
(PROVIDER) come to the home to
help (PERSON) every week or only
during some weeks?
EVERY WEEK
............................. 1 {HH12}
SOME WEEKS
............................. 2 {HH13}
ONLY CAME ONCE
......................... 3 {HH16}
REF
................................... -7 {BOX_03}
DK
.................................... -8 {BOX_03}
[Code One]
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DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
----------------------------------------------------
HH12
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
During (VISIT MONTH), about how
many days per week did {someone
from} (PROVIDER) come?
PROBE: We just need to know in
general.
NUMBER OF DAYS PER WEEK:
[Enter Number of Days Per Week]
....... {HH14}
REF
................................... -7 {BOX_03}
DK
.................................... -8 {BOX_03}
----------------------------------------------------
DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY
(RANGE IS
DETERMINED IN PROGRAM): ALLOW
RESPONSES 1-7 ONLY.
----------------------------------------------------
HH13
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
About how many days during (VISIT MONTH) did {someone from}
(PROVIDER) come?
PROBE: We just need to know in
general.
NUMBER OF DAYS PER MONTH:
[Enter Number of Days Per Month]
....... {HH14}
REF
................................... -7 {BOX_03}
DK
.................................... -8 {BOX_03}
----------------------------------------------------
DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
WVS ERROR HANDLER WILL DISPLAY AN
ERROR MESSAGE
AND FORCE THE INTERVIEWER TO
RECTIFY THE DATA IF
ANY OF THE FOLLOWING SITUATIONS
OCCUR:
IF (VISIT MONTH) IS: JANUARY,
MARCH, MAY, JULY,
AUGUST, OCTOBER OR DECEMBER: 1-31
FOR
NUMBER OF DAYS.
IF (VISIT MONTH) IS: APRIL, JUNE,
SEPTEMBER OR
NOVEMBER: 1-30 FOR NUMBER OF DAYS.
IF (VISIT MONTH) IS: FEBRUARY:
1-29 FOR NUMBER
OF DAYS IF 2008. OTHERWISE, 1-28
FOR NUMBER
OF DAYS.
----------------------------------------------------
HH14
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
During (VISIT MONTH), did {someone
from} (PROVIDER) come once per
day or more than once per
day?
PROBE: We just need to know in
general.
ONCE PER DAY
........................... 1 {HH16}
MORE THAN ONCE PER DAY
................. 2 {HH15}
24 HOURS PER DAY
....................... 3 {BOX_03}
REF
................................... -7 {BOX_03}
DK
.................................... -8 {BOX_03}
[Code One]
----------------------------------------------------
DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
----------------------------------------------------
HH15
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
During (VISIT MONTH), how many times per day did {someone from}
(PROVIDER) come to the home to
help (PERSON)?
PROBE: We just need to know in
general.
NUMBER OF TIMES PER DAY:
[Enter Number of Times Per Day]
....... {HH16}
REF
................................... -7 {BOX_03}
DK
.................................... -8 {BOX_03}
----------------------------------------------------
DISPLAY ‘someone from’ IF PROVIDER
IS FLAGGED AS
‘AGENCY’.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
ALLOW ONLY 2-6 FOR NUMBER OF TIMES
PER DAY.
----------------------------------------------------
HH16
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
How long did {each visit
usually/the visit} last?
PROBE: We just need to know in
general.
IF RESPONSE IS LESS THAN ONE HOUR,
ENTER ‘0’ FOR HOURS.
HH16_01
=======
HOURS:
[Enter Hours]
.......................
REF
................................. -7 {BOX_03}
DK
.................................. -8 {BOX_03}
HH16_02
=======
MINUTES:
[Enter Minutes]
..................... {BOX_03}
REF
................................. -7 {BOX_03}
DK
.................................. -8 {BOX_03}
----------------------------------------------------
DISPLAY ‘each visit usually’ IF
HH11 IS NOT CODED
‘3’ (ONLY CAME ONCE). DISPLAY ‘the
visit’ IF HH11
IS CODED ‘3’ (ONLY CAME ONCE).
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY
(CAPI HANDLES
THIS AUTOMATICALLY): ALLOW 0-24
FOR HOURS AND
0-59 FOR MINUTES.
----------------------------------------------------
----------------------------------------------------
IF ‘-7’ (REFUSED), ‘-8’ (DON’T
KNOW), OR ‘24’
ENTERED FOR HOURS, GO TO BOX_03.
----------------------------------------------------
----------------------------------------------------
HARD CHECK: IF ‘0’ ENTERED IN BOTH
HOURS AND
MINUTES, THE WVS ERROR HANDLER
WILL FORCE THE
INTERVIEWER TO RECTIFY THE DATA.
----------------------------------------------------
BOX_03
======
----------------------------------------------------
IF 2 OR MORE MONTHS, EXCLUDING
INTERVIEW MONTH,
FOR THIS PROVIDER FOR THIS PERSON
HAVE NOT
COMPLETED THE HOME HEALTH (HH)
UTILIZATION SECTION
AND IF THIS EVENT IS NOT PART OF A
FLAT FEE GROUP,
CONTINUE WITH HH17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_04
----------------------------------------------------
HH17
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
I have recorded that (PERSON)
received services from (PROVIDER)
during other months. Were the
services received from (PROVIDER)
during the other months similar to
the services received during
(VISIT MONTH). That is, in the
other months, did (PROVIDER)
visit {the same number of
times/(READ FREQUENCY BELOW)} and
provide {the same services/(READ
SERVICES BELOW)}?
FREQUENCY SERVICES
{FREQUENCY OF SERVICES...}
{Description of serviceS RECEIVED}
{Description of serviceS RECEIVED}
{Description of serviceS RECEIVED}
{Description of serviceS RECEIVED}
{Description of serviceS RECEIVED}
YES
.................................... 1 {HH18}
NO
..................................... 2 {BOX_04}
REF
................................... -7 {BOX_04}
DK
.................................... -8 {BOX_04}
----------------------------------------------------
DISPLAY ‘the same number of times’ IF HH12 AND
HH13 WERE NOT ASKED OR WERE CODED '-7' (REFUSED)
OR '-8' (DON’T KNOW). OTHERWISE, DISPLAY ‘(READ
FREQUENCY BELOW)’.
IF HH06 - HH10 ARE ALL CODED ‘2’ (NO), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW), OR ANY
COMBINATION OF ONLY THESE CODES, DISPLAY ‘the same
services’. OTHERWISE, DISPLAY ‘(READ SERVICES
BELOW)’.
----------------------------------------------------
----------------------------------------------------
FREQUENCY =
DISPLAY NUMBER AND ‘DAYS PER WEEK’
IF A
RESPONSE WAS RECORDED AT HH12.
DISPLAY NUMBER AND ‘DAYS PER
MONTH’ IF A
RESPONSE WAS RECORDED AT HH13.
DISPLAY ‘THE SAME NUMBER OF TIMES’
IF HH12 AND
HH13 WERE NOT ASKED OR WERE CODED
'-7'
(REFUSED) OR '-8' (DON’T KNOW).
----------------------------------------------------
----------------------------------------------------
SERVICES =
FOR EACH CODE 1 RECORDED AT HH06, HH07, HH08,
HH09, AND HH10, DISPLAY THE FOLLOWING SERVICE
ABBREVIATIONS FOR ‘Description of service’:
IF HH06 = 1, DISPLAY ‘MEDICAL TREATMENT OR
THERAPY’
IF HH07 = 1, DISPLAY ‘MEDICAL EQUIPMENT OR
ASSISTIVE DEVICE INSTRUCTION.’
IF HH08 = 1, DISPLAY ‘HELP WITH DAILY ACTIVITIES
OR PERSONAL CARE’
IF HH09 = 1, DISPLAY ’COMPANIONSHIP’
IF HH10 = 1, DISPLAY TEXT ENTERED AT HH10OV
IF HH06 - HH10 ARE ALL CODED ‘2’ (NO), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW), OR ANY
COMBINATION OF ONLY THESE CODES, DISPLAY ‘the
same services’.
----------------------------------------------------
HH18
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
During which of the following
months did (PROVIDER) visit {the
same number of times/(READ
FREQUENCY BELOW)} and provide {the
same services/(READ SERVICES
BELOW)}?
PROBE: Any other months with the
same number of visits and the
same services?
FREQUENCY SERVICES
{FREQUENCY OF SERVICES...}
{Description of serviceS RECEIVED}
{Description of serviceS RECEIVED}
{Description of serviceS RECEIVED}
{Description of serviceS RECEIVED}
{Description of serviceS RECEIVED}
[1. Month, Year-4]
[2. Month, Year-4]
[3. Month, Year-4]
----------------------------------------------------
DISPLAY ‘the same number of times’ IF HH12 AND
HH13 WERE NOT ASKED OR WERE CODED '-7' (REFUSED)
OR '-8' (DON’T KNOW). OTHERWISE, DISPLAY ‘(READ
FREQUENCY BELOW)’.
IF HH06 - HH10 ARE ALL CODED ‘2’ (NO), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW), OR ANY
COMBINATION OF ONLY THESE CODES, DISPLAY ‘the same
services’. OTHERWISE, DISPLAY ‘(READ SERVICES
BELOW)’.
----------------------------------------------------
----------------------------------------------------
FREQUENCY =
DISPLAY NUMBER AND ‘DAYS PER WEEK’
IF A
RESPONSE WAS RECORDED AT HH12.
DISPLAY NUMBER AND ‘DAYS PER
MONTH’ IF A
RESPONSE WAS RECORDED AT HH13.
DISPLAY ‘THE SAME NUMBER OF TIMES’
IF HH12 AND
HH13 WERE NOT ASKED OR WERE CODED
'-7'
(REFUSED) OR '-8' (DON’T KNOW).
----------------------------------------------------
----------------------------------------------------
SERVICES =
FOR EACH CODE 1 RECORDED AT HH06, HH07, HH08,
HH09, AND HH10, DISPLAY THE FOLLOWING SERVICE
ABBREVIATIONS FOR ‘Description of service’:
IF HH06 = 1, DISPLAY ‘MEDICAL TREATMENT OR
THERAPY’
IF HH07 = 1, DISPLAY ‘MEDICAL EQUIPMENT OR
ASSISTIVE DEVICE INSTRUCTION.’
IF HH08 = 1, DISPLAY ‘HELP WITH DAILY ACTIVITIES
OR PERSONAL CARE’
IF HH09 = 1, DISPLAY ’COMPANIONSHIP’
IF HH10 = 1, DISPLAY TEXT ENTERED AT HH10OV
IF HH06 - HH10 ARE ALL CODED ‘2’ (NO), ‘-7’
(REFUSED), OR ‘-8’ (DON’T KNOW), OR ANY
COMBINATION OF ONLY THESE CODES, DISPLAY ‘the
same services’.
----------------------------------------------------
----------------------------------------------------
FLAG EACH MONTH SELECTED AT HH18
AS A REPEAT
VISIT RELATED TO THE EVENT BEING
ASKED ABOUT.
FLAG THE CHARGE PAYMENT (CP)STATUS
OF EACH REPEAT
VISIT AS ‘PROCESSED.’
----------------------------------------------------
----------------------------------------------------
LINK FREQUENCY AND SERVICE(S)
ASSOCIATED WITH THE
EVENT BEING ASKED ABOUT WITH EACH
REPEAT VISIT.
FLAG EVENT AS PROCESSED SO THAT
THE EVENT DRIVER
WILL NOT SERVE THESE REPEAT VISITS
FOR THE
HH SECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_EVNT_1
COL #1 HEADER: MONTH/YEAR
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE
(EVNT.EVNTBEGM, EVNT.EVNTBEGY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON’S
MEDICAL-EVENTS-ROSTER FOR
SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT
DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL EVENTS (DATES) IN
PERSON’S MEDICAL-
EVENTS-ROSTER THAT MEET THE
FOLLOWING CRITERIA:
- CREATED THIS ROUND, EXCLUDING
THE INTERVIEW
MONTH
- HAVE NOT BEEN PROCESSED THROUGH
UTILIZATION
- HAVE EVENT TYPE ‘HH’
- ARE ASSOCIATED WITH THE SAME
PROVIDER AS THE
EVENT BEING ASKED ABOUT DURING
THIS ROUND
----------------------------------------------------
HH19
====
{PERSON'S FIRST MIDDLE AND LAST
NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EVN-MO}
INTERVIEWER: RECORD ‘NAME OF
REPEAT VISIT GROUP’ FOR MONTHS
SELECTED IN PREVIOUS QUESTION.
[Enter Repeat Month Group]
.......... {BOX_04}
BOX_04
======
----------------------------------------------------
IF THE CHARGE/PAYMENT (CP) SECTION
IS NOT
COMPLETED FOR THIS HOME HEALTH
EVENT, ASK THE
CHARGE/PAYMENT (CP) SECTION
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_05
----------------------------------------------------
BOX_05
======
----------------------------------------------------
GO TO THE EVENT DRIVER (ED)
SECTION
----------------------------------------------------
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