Other Medical Expenses (OM) Section


BOX_01A
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IF ROUND 3, CONTINUE WITH BOX_01B
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OTHERWISE, GO TO BOX_01
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BOX_01B
=======

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IF OM ITEM TYPE IS GLASSES/CONTACT LENSES,
CONTINUE WITH OM01A
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OTHERWISE, GO TO BOX_01
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OM01A
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{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}{END-DT}

Of the times (PERSON) obtained glasses or contact lenses since
(START DATE), how many were during {YEAR}?

NUMBER OF TIMES

[Enter Number of Times]................ {OM01B}
REF.................................... -7 {OM01B}
DK..................................... -8 {OM01B}

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(FOR SPECIFICATIONS ONLY; CAPI HANDLES
AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS FIRST
CALENDAR YEAR OF PANEL.
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OM01B
=====

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

Of the times (PERSON) obtained glasses or contact lenses since
(START DATE), how many were during {YEAR}?

NUMBER OF TIMES

[Enter Number of Times]................
REF.................................... -7
DK..................................... -8

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(FOR SPECIFICATIONS ONLY; CAPI HANDLES
AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS SECOND
CALENDAR YEAR OF PANEL.
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IF THE CHARGE/PAYMENT (CP) SECTION HAS NOT BEEN
ASKED FOR THE EVENT BEING ASKED ABOUT, GO TO THE
CP SECTION.
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OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION.
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BOX_01
======

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IF THE OM ITEM TYPE IS INSULIN OR OTHER DIABETIC
EQUIPMENT OR SUPPLIES, GO TO OM02
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OTHERWISE, CONTINUE WITH OM01
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OM01
====

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

NOTE:

NO UTILIZATION SECTION IS REQUIRED FOR {GLASSES OR CONTACT
LENSES/Ambulance Services/Orthopedic Items/Hearing Devices/
Prostheses/Bathroom Aids/Medical Equipment/Disposable Supplies/
Alterations or Modifications/{text from other specify}}.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

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DISPLAY ‘GLASSES OR CONTACT LENSES’ IF EVENT TYPE
IS OM AND ITEM TYPE IS CODED ‘1’ (GLASSES OR
CONTACT LENSES.) DISPLAY ‘AMbulance Services’
IF EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘4’
(AMBULANCE SERVICES). DISPLAY ‘Orthopedic Items’
IF EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘5’
(ORTHOPEDIC ITEMS). DISPLAY ‘Hearing Devices’
IF EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘6’
(HEARING DEVICES). DISPLAY ‘Prostheses’ IF EVENT
TYPE IS OM AND ITEM TYPE IS CODED ‘7’
(PROSTHESES). DISPLAY ‘BATHROOM Aids’ IF EVENT
TYPE IS OM AND ITEM TYPE IS CODED ‘8’ (BATHROOM
AIDS). DISPLAY ‘Medical Equipment’ IF EVENT TYPE
IS OM AND ITEM TYPE IS CODED ‘9’ (MEDICAL
EQUIPMENT). DISPLAY ‘Disposable Supplies’ IS
EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘10’
(DISPOSABLE SUPPLIES). DISPLAY ‘Alterations or
Modifications’ IF EVENT TYPE IS OM AND ITEM TYPE
IS CODED ‘11’ (ALTERATIONS/MODIFICATIONS). FOR
‘text from other specify’, DISPLAY THE TEXT
ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS
WHEN OM ITEM TYPE IS CODED ‘91’ (OTHER).
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IF THE CHARGE/PAYMENT (CP) SECTION HAS NOT BEEN
ASKED FOR THE EVENT BEING ASKED ABOUT, GO TO THE
CP SECTION
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OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION
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OM02
====

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

NOTE:

{INSULIN/OTHER DIABETIC EQUIPMENT OR SUPPLIES} WILL BE PROCESSED
LIKE A PRESCRIBED MEDICINE.

AT THIS TIME, NO UTILIZATION OR CHARGE/PAYMENT SECTION WILL BE
ASKED.

PRESCRIBED MEDICINE QUESTIONS AND CHARGE/PAYMENT DATA WILL BE
COLLECTED LATER.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

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DISPLAY ‘INSULIN’ IF OM ITEM TYPE BEING ASKED
ABOUT IS INSULIN. DISPLAY ‘OTHER DIABETIC
EQUIPMENT OR SUPPLIES’ IF OM TYPE BEING ASKED
ABOUT IS OTHER DIABETIC EQUIPMENT OR SUPPLIES.
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FLAG THE OM CHARGE/PAYMENT (CP) SECTION AS
‘PROCESSED’. INSULIN AND OTHER DIABETIC EQUIPMENT
AND SUPPLIES WILL BE PROCESSED THROUGH CP AS
PRESCRIBED MEDICINES.
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GO TO BOX_02
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BOX_02
======

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GO TO THE EVENT DRIVER (ED) SECTION
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