|
BOX_00
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PRND.BEGREFMM,DD,YY AND
PRND.ENDREFMM,DD,YY.
BOX_01A
THE PROVIDER PROBES (PP) SECTION (INCLUDING THE
EVENT ROSTER (EV) AND PROVIDER ROSTER (PV)
SECTIONS WHICH ARE CALLED IN THE COURSE OF PP)
COLLECTS THE INFORMATION REQUIRED TO CREATE AN
EVENT. THIS INFORMATION INCLUDES THE EVENT TYPE,
PERSON, PROVIDER, AND DATE OR DATE RANGE. ONCE
THE EV SECTION IS COMPLETED FOR AN EVENT, THE
INTERVIEWER CANNOT BACK UP TO EDIT THAT EVENT OR
ANY OTHER EVENTS THAT WERE CREATED PREVIOUSLY.
HOWEVER, EVENTS CAN BE EDITED IN THE EVENT DRIVER
(ED) SECTION OF THE QUESTIONNAIRE.
BOX_01
IF DISCHARGE DATE CODED '95' (STILL IN HOSPITAL)
FOR ANY HOSPITAL STAY (HS) EVENT REPORTED IN
PREVIOUS ROUND FOR ANY RU MEMBER, CONTINUE WITH
LOOP_01
OTHERWISE, GO TO BOX_02
LOOP_01
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK
PP01 - END_LP01
LOOP DEFINITION: LOOP_01 COLLECTS THE DISCHARGE
DATE OF A HOSPITAL STAY FOR ANY PERSON STILL IN
THE HOSPITAL AT THE END OF THE PREVIOUS ROUND.
THIS LOOP CYCLES ON PERSONS THAT MEET BOTH OF THE
FOLLOWING CONDITIONS:
- PERSON HAD AN HS EVENT DURING THE PREVIOUS ROUND
AND
- ONE OF PERSON’S HS EVENTS HAD A DISCHARGE DATE
CODED ‘95’ (STILL IN HOSPITAL).
PP01
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......} {ADM-DT}
Last time, we recorded that {you/{PERSON}} entered
{PROVIDER} on
{ADMIT DATE} and was still in the hospital at the time
of our
interview on {PREV RD INTV DT}.
On what date {were/was} {you/he/she} discharged from
{PROVIDER}?
IF STILL IN HOSPITAL {OR RELEASED IN {YEAR}, SELECT
EVENT AND
CONTINUE INTERVIEW.
| ADMISSION DATE |
DISCHARGE DATE |
| {Display Month, Day, Year-4} |
[Enter Month, Day, Year-4] |
| {Display Month, Day, Year-4} |
[Enter Month, Day, Year-4] |
| {Display Month, Day, Year-4} |
[Enter Month, Day, Year-4] |
DISPLAY THE DATE OF THE PREVIOUS ROUND’S INTERVIEW
FOR ‘{PREV RD INTV DT}’.
DISPLAY ‘OR RELEASED IN {YEAR}’ IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
(FOR SPECIFICATION PURPOSES ONLY, YEAR IN PROGRAM
IS AUTOMATICALLY SET): DISPLAY THE YEAR SUBSEQUENT
TO THE SECOND CALENDAR YEAR OF THE PANEL.
GO TO END_LP01
ROSTER DETAILS:
Title: PERS_EVNT_EDIT_1
COL #1 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE
(EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)
COL #2 HEADER: DISCHARGE DATE
INSTRUCTIONS: ENTER EVENT END DATE
(EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY)
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON’S-MEDICAL-EVENTS-ROSTER
FOR ENTERING THE DISCHARGE DATE FOR ALL OPEN-ENDED
HOSPITAL STAYS.
ROSTER BEHAVIOR:
1. SELECT, ADD, AND DELETE DISALLOWED.
2. LIMITED EDIT ALLOWED. ADMIT DATE IS A PROTECTED
FIELD. INTERVIEWER CAN UPDATE DISCHARGE DATE.
ROSTER FILTER:
DISPLAYS ALL HS EVENTS THAT WERE CODED ‘95’ (STILL
IN HOSPITAL) IN THE PREVIOUS ROUND.
END_LP01
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER
WHO MEETS THE CONDITIONS STATED IN THE LOOP
DEFINITION.
IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_01 AND CONTINUE WITH BOX_02
BOX_02
IF DISCHARGE DATE CODED '95' (STILL IN
INSTITUTION) FOR ANY INSTITUTIONAL STAY (IC) EVENT
REPORTED IN PREVIOUS ROUND FOR ANY RU MEMBER,
CONTINUE WITH LOOP_02
OTHERWISE, GO TO BOX_03
LOOP_02
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK
PP02 - END_LP02
LOOP DEFINITION: LOOP_02 COLLECTS THE DISCHARGE
DATE OF AN INSTITUTIONAL STAY FOR ANY PERSON STILL
IN THE INSTITUTION AT THE END OF THE PREVIOUS
ROUND. THIS LOOP CYCLES ON PERSONS THAT MEET THE
FOLLOWING CONDITIONS:
- PERSON HAD AT LEAST ONE IC EVENT DURING THE
PREVIOUS ROUND
AND
- ONE OF PERSON’S IC EVENTS HAD A DISCHARGE DATE
CODED ‘95’ (STILL IN INSTITUTION).
PP02
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER......} {ADM-DT}
Last time we recorded that {you/{PERSON}} entered
{PROVIDER} on
{ADMIT DATE} and was still there at the time of our
interview
on {PREV RD INTV DT}.
On what date {were/was} {you/he/she} discharged from
{PROVIDER}?
IF STILL IN AN INSTITUTION OR LONG-TERM CARE FACILITY,
{OR
RELEASED IN {YEAR}, SELECT EVENT AND CONTINUE
INTERVIEW.
| ADMISSION DATE |
DISCHARGE DATE |
| {Display Month, Day, Year-4} |
[Enter Month, Day, Year-4] |
| {Display Month, Day, Year-4} |
[Enter Month, Day, Year-4] |
| {Display Month, Day, Year-4} |
[Enter Month, Day, Year-4] |
DISPLAY THE DATE OF THE PREVIOUS ROUND’S INTERVIEW
FOR ‘{PREV RD INTV DT}’.
DISPLAY ‘OR RELEASED IN {YEAR}’ IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
(FOR SPECIFICATION PURPOSES ONLY, YEAR IN PROGRAM
IS AUTOMATICALLY SET): DISPLAY THE YEAR SUBSEQUENT
TO THE SECOND CALENDAR YEAR OF THE PANEL.
GO TO END_LP02
ROSTER DETAILS:
Title: PERS_EVNT_EDIT_2
COL #1 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE
(EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)
COL #2 HEADER: DISCHARGE DATE
INSTRUCTIONS: ENTER EVENT END DATE
(EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY)
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON’S-MEDICAL-EVENTS-ROSTER
FOR ENTERING THE DISCHARGE DATE FOR ALL OPEN-ENDED
STAYS IN INSTITUTIONS.
ROSTER BEHAVIOR:
1. SELECT, ADD, AND DELETE DISALLOWED.
2. LIMITED EDIT ALLOWED. ADMIT DATE IS A PROTECTED
FIELD. INTERVIEWER CAN UPDATE DISCHARGE DATE.
ROSTER FILTER:
DISPLAYS ALL IC EVENTS THAT WERE CODED ‘95’ (STILL
IN INSTITUTION) IN THE PREVIOUS ROUND.
END_LP02
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER
WHO MEETS THE CONDITIONS STATED IN THE LOOP
DEFINITION.
IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_02 AND CONTINUE WITH BOX_03
BOX_03
IF CA03 IS CODED ‘5’ (VOLUNTEERED NO EVENTS TO
RECORD), GO TO PP03A
IF CA03 IS CODED ‘3’ (SOME VISITS RECORDED), ‘4’
(DID NOT USE), ‘-7’ (REFUSED), ‘-8’ (DON’T KNOW),
OR IS NOT ASKED (CALENDAR NEVER USED), GO TO PP14
OTHERWISE, CONTINUE WITH LOOP_03
LOOP_03
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_04 - END_LP03
LOOP DEFINITION: LOOP_03 ASKS THE EVENT ROSTER
(EV) SECTION FOR EACH EVENT RECORDED ON THE
CALENDAR. THE RESPONSE TO PP03 DETERMINES WHETHER
THE LOOP CYCLES AGAIN. IF PP03 IS CODED ‘1’
(YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT.
IF PP03 IS CODED ‘2’ (NO) OR ‘3’ (NO EVENTS ON
CALENDAR TO RECORD), THE LOOP ENDS.
BOX_04
IF FIRST CYCLE OF LOOP_03, GO TO PP03
OTHERWISE, CONTINUE WITH BOX_05
BOX_05
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP03
PP03
INTERVIEWER: ADD (AN/ANOTHER) EVENT?
YES .................................... 1 {END_LP03)
NO ..................................... 2 {END_LP03)
{NO EVENTS ON CALENDAR TO RECORD ........ 3}
{END_LP03)
DISPLAY CODE 3 (NO EVENTS ON CALENDAR TO RECORD),
ONLY IF FIRST CYCLE OF LOOP_03. OTHERWISE, USE A
NULL DISPLAY.
END_LP03
IF PP03 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP03 IS CODED ‘2’ (NO) OR ‘3’ (NO EVENTS ON
CALENDAR TO RECORD), END LOOP_03 AND CONTINUE
WITH PP03A
PP03A
{STR-DT}
{END-DT}
Next, I am going to show you several lists of health
care providers
to be sure we haven’t missed any visits or phone
calls, including those
made just for advice, prescriptions, tests, shots, or
x-rays.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
PP04
{STR-DT}
{END-DT}
SHOW CARD PP-1.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, has
anyone in the family seen or spoken with a medical or
mental
health professional, dentist, or other health care
provider
listed on this card [other than what we have already
talked about]?
YES .................................... 1 {LOOP_04}
NO ..................................... 2 {PP06}
REF ................................... -7 {PP06}
DK .................................... -8 {PP06}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_04
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_06 - END_LP04
LOOP DEFINITION: LOOP_04 COLLECTS ALL DENTAL (DN)
AND MEDICAL PROVIDER VISIT (MV) EVENTS NOT ALREADY
RECORDED.
THE RESPONSE TO PP05 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP05 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP05 IS
CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_06
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP05
PP05
{STR-DT}
{END-DT}
SHOW CARD PP-1.
{Have/Has} {you/{PERSON’S FIRST MIDDLE AND LAST NAME}}
had any other
visits or calls to health care providers listed on
this card? Or has
anyone else in the family visited or called a health
care
provider listed here? [Please include any visits or
calls
we have not yet talked about.]
YES .................................... 1 {END_LP04}
NO ..................................... 2 {END_LP04}
REF ................................... -7 {END_LP04}
DK .................................... -8 {END_LP04}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.
END_LP04
IF PP05 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP05 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_04 AND CONTINUE WITH PP06
PP06
{STR-DT}
{END-DT}
SHOW CARD PP-2.
{Has/Between {START DATE} and {END DATE}, has} anyone
in the
family been a patient in a hospital or been seen in a
hospital
emergency room or outpatient department? Or has anyone
been a
patient in any type of long term care facility?
[Please include
any hospital care we have not yet talked about.]
YES .................................... 1 {LOOP_05}
NO ..................................... 2 {PP07A}
REF ................................... -7 {PP07A}
DK .................................... -8 {PP07A}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Has’ IF NOT ROUND 5. DISPLAY ‘Between
{START DATE} and {END DATE}, has’ IF ROUND 5.
LOOP_05
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_07 - END_LP05.
LOOP DEFINITION: LOOP_05 COLLECTS ALL HOSPITAL-
BASED AND INSTITUTIONAL STAY EVENTS (I.E., HS,
ER, OP, AND IC EVENTS) NOT ALREADY RECORDED.
THE RESPONSE TO PP07 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP07 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07 IS
CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_07
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP07
PP07
{STR-DT}
{END-DT}
SHOW CARD PP-2.
{Have/Has} {you/{PERSON’S FIRST MIDDLE AND LAST NAME}}
had any other
visits to a hospital or long term care facility? Or
has anyone else
in the family been a patient in or seen at a hospital
or long
term care facility? [Please include any hospital care
we have
not yet talked about.]
YES .................................... 1 {END_LP05}
NO ..................................... 2 {END_LP05}
REF ................................... -7 {END_LP05}
DK .................................... -8 {END_LP05}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.
END_LP05
IF PP07 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP07 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_05 AND CONTINUE WITH PP07A
PP07A
{STR-DT}
{END-DT}
{Since {START DATE}/Between {START DATE} and {END
DATE}},
has anyone in the family had any visits to an
independent
lab or testing facility for x-rays or other tests?
[Please
include any care we have not yet talked about.]
YES .................................... 1 {LOOP_05A}
NO ..................................... 2 {PP07B}
REF ................................... -7 {PP07B}
DK .................................... -8 {PP07B}
HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR
TESTING FACILITY.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_05A
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_07A - END_LP05A.
LOOP DEFINITION: LOOP_05A COLLECTS ALL LAB EVENTS
(I.E., OP, OR MV EVENTS) NOT ALREADY RECORDED.
THE RESPONSE TO PP07AA DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP07AA IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07AA
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_07A
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP07AA
PP07AA
{STR-DT}
{END-DT}
{Have/Has} {you/{PERSON’S FIRST MIDDLE AND LAST NAME}}
had any other
visits to an independent lab or testing facility? Or
has anyone else
in the family been seen at an independent lab or
testing facility?
[Please include any care we have not yet talked
about.]
YES .................................... 1 {END_LP05A}
NO ..................................... 2 {END_LP05A}
REF ................................... -7 {END_LP05A}
DK .................................... -8 {END_LP05A}
HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR
TESTING FACILITY.
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.
END_LP05A
IF PP07AA IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.
IF PP07AA IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_05A AND CONTINUE WITH
PP07B
PP07B
{STR-DT}
{END-DT}
{Since {START DATE}/Between {START DATE} and {END
DATE}},
has anyone in the family had any visits to someone who
practices alternative care such as acupuncture,
massage
therapy, hypnosis, or other treatments? [Please
include any
alternative care we have not yet talked about.]
YES .................................... 1 {LOOP_05B}
NO ..................................... 2 {PP08}
REF ................................... -7 {PP08}
DK .................................... -8 {PP08}
HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE
PROVIDER.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_05B
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_07B - END_LP05B.
LOOP DEFINITION: LOOP_05B COLLECTS ALL
ALTERNATIVE CARE EVENTS (I.E., MV EVENTS) NOT
ALREADY RECORDED.
THE RESPONSE TO PP07BB DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP07BB IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07BB
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_07B
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP07BB
PP07BB
{STR-DT}
{END-DT}
{Have/Has} {you/{PERSON’S FIRST MIDDLE AND LAST NAME}}
had any other
visits to someone who practices alternative care? Or
has anyone else
in the family been seen by someone who practices
alternative care?
[Please include any alternative care we have not yet
talked about.]
YES .................................... 1 {END_LP05B}
NO ..................................... 2 {END_LP05B}
REF ................................... -7 {END_LP05B}
DK .................................... -8 {END_LP05B}
HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE
PROVIDER.
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.
END_LP05B
IF PP07BB IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.
IF PP07BB IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_05B AND CONTINUE WITH
PP08
PP08
{STR-DT}
{END-DT}
SHOW CARD PP-3.
What about visits to the home because of a health
problem for
any of these services {between {START DATE} and {END
DATE}}?
[Please include any home care services we have not yet
talked
about.]
YES .................................... 1 {LOOP_06}
NO ..................................... 2 {PP12}
REF ................................... -7 {PP12}
DK .................................... -8 {PP12}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘between {START DATE} and {END DATE}’ IF
ROUND 5. OTHERWISE, USE A NULL DISPLAY.
LOOP_06
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_08 - END_LP06.
LOOP DEFINITION: LOOP_06 COLLECTS ALL HOME
HEALTH (HH) EVENTS NOT ALREADY RECORDED.
THE RESPONSE TO PP09 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP09 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP09
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_08
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP09
PP09
{STR-DT}
{END-DT}
SHOW CARD PP-3.
Because of a health problem, {have/has} {you/{PERSON’S
FIRST MIDDLE AND
LAST NAME}} received any other home care services? Or
has anyone
else in the family received home care services such as
those
listed on this card? [Please include any home care
services we
have not yet talked about.]
YES .................................... 1 {END_LP06}
NO ..................................... 2 {END_LP06}
REF ................................... -7 {END_LP06}
DK .................................... -8 {END_LP06}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT
WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND
LAST NAME}’.
END_LP06
IF PP09 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP09 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_06 AND CONTINUE WITH PP12
PP12
{STR-DT}
{END-DT}
SHOW CARD PP-4.
{And finally, did/Did/Between {START DATE} and {END
DATE}, did}
anyone in the family obtain eyeglasses, contact
lenses, or diabetic
equipment or supplies {since {START DATE}} [other than
what we have
already talked about]?
YES .................................... 1 {LOOP_07}
NO ..................................... 2 {BOX_09A}
REF ................................... -7 {BOX_09A}
DK .................................... -8 {BOX_09A}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘And finally, did’ IF ROUNDS 1, 2, OR 4.
DISPLAY ‘Did’ IF ROUND 3. DISPLAY ‘Between {START
DATE} and {END DATE}, did’ IF ROUND 5.
DISPLAY ‘since {START DATE}’ IF NOT ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
LOOP_07
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_09 - END_LP07.
LOOP DEFINITION: LOOP_07 COLLECTS ALL OTHER
MEDICAL EXPENSE (OM) EVENTS NOT ALREADY RECORDED.
THE RESPONSE TO PP13 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP13 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP13
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_09
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP13
PP13
{STR-DT}
{END-DT}
SHOW CARD PP-4.
Has anyone else in the family obtained eyeglasses,
contact
lenses, or diabetic equipment or supplies [other than
what we
have already talked about]?
YES .................................... 1 {END_LP07}
NO ..................................... 2 {END_LP07}
REF ................................... -7 {END_LP07}
DK .................................... -8 {END_LP07}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
END_LP07
IF PP13 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP13 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_07 AND CONTINUE WITH
BOX_09A
BOX_09A
IF ROUND 3 OR ROUND 5, CONTINUE WITH PP13A
OTHERWISE, GO TO BOX_10
PP13A
JAN 01 DEC 31
SHOW CARD PP-5.
Now I would like you to think about the entire
calendar year
{YEAR}, that is from January 1, {YEAR} until December
31, {YEAR}.
During {YEAR}, did anyone in the family have expenses
for any of
the types of things listed on this card?
PROBE: These could include ambulance services, canes,
wheelchairs, corrective shoes, hearing aids or
amplifiers for a
telephone, artificial limbs, raised toilet seats, a
modification to the house or a car because of some
illness or
injury, for example ramps or handrails, etc.
YES .................................... 1 {LOOP_07A}
NO ..................................... 2 {BOX_10}
REF ................................... -7 {BOX_10}
DK .................................... -8 {BOX_10}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN
PROGRAM IS AUTOMATICALLY SET.)
IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR
‘YEAR’.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR
‘YEAR’.
LOOP_07A
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_09B - END_LP07A.
LOOP DEFINITION: LOOP_07A COLLECTS ALL OTHER
TYPES OF MEDICAL EXPENSE (OM) EVENTS FOR THE
CALENDAR YEAR. IF ROUND 3, THE YEAR IS THE FIRST
CALENDAR YEAR OF THE PANEL. IF ROUND 5, THE YEAR
IS THE SECOND CALENDAR YEAR OF THE PANEL NOT
ALREADY RECORDED.
THE RESPONSE TO PP13B DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP13B IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP13B
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_09B
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP13B
PP13B
JAN 01 DEC 31
SHOW CARD PP-5.
During the calendar year {YEAR}, has anyone else in
the family
obtained, purchased, or rented any of the types of
other
medical expenses listed on this card [other than what
we have
already talked about]?
YES .................................... 1 {END_LP07A}
NO ..................................... 2 {END_LP07A}
REF ................................... -7 {END_LP07A}
DK .................................... -8 {END_LP07A}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN
PROGRAM IS AUTOMATICALLY SET.)
IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR
‘YEAR’.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR
‘YEAR’.
END_LP07A
IF PP13B IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.
IF PP13B IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_07A AND CONTINUE WITH
BOX_10
BOX_10
GO TO BOX_18
PP14
{STR-DT}
{END-DT}
These next questions ask about medical and dental care
each family
member received {since {START DATE}/between {START
DATE} and {END
DATE}}. You can use your calendar, electronic records,
checkbook,
or receipts to help you remember. We are interested in
any type
of visit or phone call, including those made just for
advice,
prescriptions, tests, shots, or x-rays.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
DISPLAY ‘since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_08
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK
PP15 - END_LP08.
LOOP DEFINITION: LOOP_08 COLLECTS ALL EVENTS FOR
EACH RU MEMBER WHEN THE CALENDAR IS INCOMPLETE OR
WAS NOT USED. THIS LOOP CYCLES ON ALL ELIGIBLE
RU MEMBERS INCLUDING PERSONS WHO WERE DECEASED OR
INSTITUTIONALIZED AFTER THE REFERENCE PERIOD START
DATE.
PP15
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-6.
Now think about the health care {you/{PERSON}}
{have/has} received
{since {START DATE}/between {START DATE} and {END
DATE}}.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, did
{you/he/she} see or talk to any type of dental care
provider, such
as the types listed on this card, for dental care or a
dental
check-up?
YES .................................... 1 {LOOP_09}
NO ..................................... 2 {PP17}
REF ................................... -7 {PP17}
DK .................................... -8 {PP17}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘since {START DATE}’ AND ‘Since {START
DATE}’ IF NOT ROUND 5. DISPLAY ‘between {START
DATE} and {END DATE}’ AND ‘Between {START DATE}
and {END DATE}’ IF ROUND 5.
LOOP_09
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_11- END_LP09.
LOOP DEFINITION: LOOP_09 COLLECTS ALL DENTAL (DN)
EVENTS NOT ALREADY RECORDED FOR PERSON BEING
ASKED ABOUT.
THE RESPONSE TO PP16 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP16 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP16
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_11
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP16
PP16
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-6.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, did
{you/{PERSON}} see or talk to any other type of
dental care provider,
such as the types listed on this card (other than what
you’ve
already told me about)?
YES .................................... 1 {END_LP09}
NO ..................................... 2 {END_LP09}
REF ................................... -7 {END_LP09}
DK .................................... -8 {END_LP09}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
END_LP09
IF PP16 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP16 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_09 AND CONTINUE WITH PP17
PP17
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-7.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, did
{you/{PERSON}} see or talk to any medical doctor or
nurse, such as
those types listed on this card? (Please include
telephone
calls or visits where {you/he/she} received advice,
prescriptions,
or test results.)
YES .................................... 1 {LOOP_10}
NO ..................................... 2 {PP19}
REF ................................... -7 {PP19}
DK .................................... -8 {PP19}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_10
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_12 - END_LP10.
LOOP DEFINITION: LOOP_10 COLLECTS ALL MEDICAL
PROVIDER VISIT (MV) EVENTS NOT ALREADY RECORDED
FOR PERSON BEING ASKED ABOUT.
THE RESPONSE TO PP18 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP18 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP18
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_12
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP18
PP18
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-7.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, did
{you/{PERSON}} see or talk to any other type of
medical professional,
such as the types listed on this card (other than what
you’ve
already told me about)?
YES .................................... 1 {END_LP10}
NO ..................................... 2 {END_LP10}
REF ................................... -7 {END_LP10}
DK .................................... -8 {END_LP10}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
END_LP10
IF PP18 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP18 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_10 AND CONTINUE WITH PP19
PP19
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-8.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, {were/was}
{you/PERSON}} a patient in a hospital or did
{you/he/she} receive care
in a hospital emergency room or hospital outpatient
department?
YES .................................... 1 {LOOP_11}
NO ..................................... 2 {PP21}
REF ................................... -7 {PP21}
DK .................................... -8 {PP21}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_11
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_13 - END_LP11.
LOOP DEFINITION: LOOP_11 COLLECTS ALL HOSPITAL-
BASED EVENTS (I.E., HS, ER, AND OP EVENTS) NOT
ALREADY RECORDED FOR PERSON BEING ASKED ABOUT.
THE RESPONSE TO PP20 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP20 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP20
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_13
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP20
PP20
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-8.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, did
{you/{PERSON}} receive any other care as a
patient in a hospital or
from a hospital emergency room or outpatient
department (other
than what you’ve already told me about)?
YES .................................... 1 {END_LP11}
NO ..................................... 2 {END_LP11}
REF ................................... -7 {END_LP11}
DK .................................... -8 {END_LP11}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
END_LP11
IF PP20 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP20 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_11 AND CONTINUE WITH PP21
PP21
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-9.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, did
{you/{PERSON}} see or talk to any of the health care
providers listed
on this card?
YES .................................... 1 {LOOP_12}
NO ..................................... 2 {PP22A}
REF ................................... -7 {PP22A}
DK .................................... -8 {PP22A}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_12
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_14 - END_LP12.
LOOP DEFINITION: LOOP_12 COLLECTS ALL MEDICAL
PROVIDER VISIT (MV) EVENTS NOT ALREADY RECORDED
FOR PERSON BEING ASKED ABOUT.
THE RESPONSE TO PP22 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP22 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_14
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP22
PP22
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-9.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, did
{you/{PERSON}} see or talk to any other type of
health care provider,
such as the types listed on this card (other than what
you’ve
already told me about)?
YES .................................... 1 {END_LP12}
NO ..................................... 2 {END_LP12}
REF ................................... -7 {END_LP12}
DK .................................... -8 {END_LP12}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
END_LP12
IF PP22 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP22 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_12 AND CONTINUE WITH PP22A
PP22A
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{Since {START DATE}/Between {START DATE} and {END
DATE}},
did {you/{PERSON}} have any visits to an independent
lab or
testing facility for x-rays or other tests?
YES .................................... 1 {LOOP_12A}
NO ..................................... 2 {PP22B}
REF ................................... -7 {PP22B}
DK .................................... -8 {PP22B}
HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR
TESTING FACILITY.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_12A
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_14A - END_LP12A.
LOOP DEFINITION: LOOP_12A COLLECTS ALL LAB EVENTS
(I.E., OP, OR MV EVENTS) NOT ALREADY RECORDED.
THE RESPONSE TO PP22AA DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP22AA IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22AA
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_14A
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP22AA
PP22AA
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
Since {START DATE}/Between {START DATE} and {END
DATE}},
did {you/(PERSON}} have any other visits to an
independent lab
or testing facility (other than what you’ve already
told
me about)?
YES .................................... 1 {END_LP12A}
NO ..................................... 2 {END_LP12A}
REF ................................... -7 {END_LP12A}
DK .................................... -8 {END_LP12A}
HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR
TESTING FACILITY.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
END_LP12A
IF PP22AA IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.
IF PP22AA IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_12A AND CONTINUE WITH
PP22B
PP22B
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{Since {START DATE}/Between {START DATE} and {END
DATE}},
did {you/{PERSON}} have any visits to someone who
practices
alternative care such as acupuncture, massage therapy,
hypnosis, or other treatments?
YES .................................... 1 {LOOP_12B}
NO ..................................... 2 {PP23}
REF ................................... -7 {PP23}
DK .................................... -8 {PP23}
HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE
PROVIDER.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_12B
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_14B - END_LP12B.
LOOP DEFINITION: LOOP_12B COLLECTS ALL
ALTERNATIVE CARE EVENTS (I.E., MV EVENTS) NOT
ALREADY RECORDED.
THE RESPONSE TO PP22BB DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP22BB IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22BB
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_14B
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION,
CONTINUE WITH PP22BB
PP22BB
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
{Since {START DATE}/Between {START DATE} and {END
DATE}},
did {you/{PERSON}} have any other visits to
someone who practices
alternative care (other than what you’ve already told
me
about)?
YES .................................... 1 {END_LP12B}
NO ..................................... 2 {END_LP12B}
REF ................................... -7 {END_LP12B}
DK .................................... -8 {END_LP12B}
HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE
PROVIDER.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
END_LP12B
IF PP22BB IS CODED ‘1’ (YES), CYCLE TO COLLECT
NEXT EVENT.
IF PP22BB IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR
‘-8’ (DON’T KNOW), END LOOP_12B AND CONTINUE WITH
PP23
PP23
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-10
{Since {START DATE}/Between {START DATE} and {END
DATE}},
because of a health problem, did {you/{PERSON}}
receive any home care
services such as the types listed on this card? Please
include
home care services received for medical care, personal
care,
supervision, and household help.
YES .................................... 1 {LOOP_13}
NO ..................................... 2 {PP25}
REF ................................... -7 {PP25}
DK .................................... -8 {PP25}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_13
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_15 - END_LP13.
LOOP DEFINITION: LOOP_13 COLLECTS ALL HOME
HEALTH (HH) EVENTS NOT ALREADY RECORDED FOR PERSON
BEING ASKED ABOUT.
THE RESPONSE TO PP24 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP24 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP24
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_15
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP24
PP24
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-10.
{Since {START DATE}/Between {START DATE} and {END
DATE}},
because of a health problem, did {you/{PERSON}}
receive home care
services such as the types listed on this card (other
than what
you’ve already told me about)?
YES .................................... 1 {END_LP13}
NO ..................................... 2 {END_LP13}
REF ................................... -7 {END_LP13}
DK .................................... -8 {END_LP13}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
END_LP13
IF PP24 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP24 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_13 AND CONTINUE WITH PP25
PP25
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-11.
{Since {START DATE}/Between {START DATE} and {END
DATE}},
{were/was} {you/{PERSON}} a patient in any long term
care facility,
such as the types of places listed on this card?
YES .................................... 1 {LOOP_14}
NO ..................................... 2 {PP27}
REF ................................... -7 {PP27}
DK .................................... -8 {PP27}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_14
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_16 - END_LP14.
LOOP DEFINITION: LOOP_14 COLLECTS ALL
INSTITUTIONAL (IC) EVENTS NOT ALREADY RECORDED FOR
PERSON BEING ASKED ABOUT.
THE RESPONSE TO PP26 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP26 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP26
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_16
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP26
PP26
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-11.
{Since {START DATE}/Between {START DATE} and {END
DATE}},
{were/was} {you/{PERSON}} a patient in any other
long term care
facility, such as the types of places listed on this
card
(other than what you’ve already told me about)?
YES .................................... 1 {END_LP14}
NO ..................................... 2 {END_LP14}
REF ................................... -7 {END_LP14}
DK .................................... -8 {END_LP14}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
END_LP14
IF PP26 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP26 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_14 AND CONTINUE WITH PP27
PP27
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-12.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, did
{you/{PERSON}} obtain eyeglasses, contact lenses, or
diabetic equipment
or supplies?
YES .................................... 1 {LOOP_15}
NO ..................................... 2 {BOX_17A}
REF ................................... -7 {BOX_17A}
DK .................................... -8 {BOX_17A}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
LOOP_15
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_17 - END_LP15.
LOOP DEFINITION: LOOP_15 COLLECTS ALL OTHER
MEDICAL EXPENSE (OM) EVENTS NOT ALREADY RECORDED
FOR PERSON BEING ASKED ABOUT.
THE RESPONSE TO PP28 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP28 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP28
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_17
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP28
PP28
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-12.
{Since {START DATE}/Between {START DATE} and {END
DATE}}, did
{you/{PERSON}} obtain any other medical
supplies listed on this card
(other than what you’ve already told me about)?
YES .................................... 1 {END_LP15}
NO ..................................... 2 {END_LP15}
REF ................................... -7 {END_LP15}
DK .................................... -8 {END_LP15}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
DISPLAY ‘Since {START DATE}’ IF NOT ROUND 5.
DISPLAY ‘Between {START DATE} and {END DATE}’ IF
ROUND 5.
END_LP15
IF PP28 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP28 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_15 AND CONTINUE WITH
BOX_17A
BOX_17A
IF ROUND 3 OR ROUND 5, CONTINUE WITH PP29
OTHERWISE, GO TO END_LP08
PP29
{PERSON’S FIRST MIDDLE AND LAST NAME} JAN 01 DEC 31
SHOW CARD PP-13.
Now I would like you to think about the entire
calendar year
{YEAR}, that is from January 1, {YEAR} until December
31, {YEAR}.
During {YEAR}, did {you/{PERSON}} have expenses for
any of the types of
things listed on this card?
PROBE: These could include ambulance services, canes,
wheelchairs, corrective shoes, hearing aids or
amplifiers for a
telephone, artificial limbs, raised toilet seats, a
modification to the house or a car because of some
illness or
injury, for example ramps or handrails, etc.
YES .................................... 1 {LOOP_16}
NO ..................................... 2 {END_LP08}
REF ................................... -7 {END_LP08}
DK .................................... -8 {END_LP08}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN
PROGRAM IS AUTOMATICALLY SET.)
IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR
‘YEAR’.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR
‘YEAR’.
LOOP_16
For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
ask BOX_17B - END_LP16.
LOOP DEFINITION: LOOP_16 COLLECTS ALL OTHER
TYPES OF MEDICAL EXPENSE (OM) EVENTS THAT ARE NOT
ALREADY RECORDED FOR THE CALENDAR YEAR. IF ROUND
3, THE YEAR IS THE FIRST CALENDAR YEAR OF THE
PANEL. IF ROUND 5, THE YEAR IS THE SECOND CALENDAR
YEAR OF THE PANEL.
THE RESPONSE TO PP30 DETERMINES WHETHER THE LOOP
CYCLES AGAIN. IF PP30 IS CODED ‘1’ (YES), THE
LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP30
IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T
KNOW), THE LOOP ENDS.
BOX_17B
ASK THE EVENT ROSTER (EV) SECTION
AT COMPLETION OF THE EV SECTION, CONTINUE WITH
PP30
PP30
{PERSON’S FIRST MIDDLE AND LAST NAME} JAN 01 DEC 31
SHOW CARD PP-13.
During the calendar year {YEAR}, {have/has}
{you/{PERSON}} obtained,
purchased, or rented any of the types of other medical
expenses
listed on this card (other than what we have already
talked
about)?
YES .................................... 1 {END_LP16}
NO ..................................... 2 {END_LP16}
REF ................................... -7 {END_LP16}
DK .................................... -8 {END_LP16}
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN
PROGRAM IS AUTOMATICALLY SET.)
IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR
‘YEAR’.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR
‘YEAR’.
END_LP16
IF PP30 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT
EVENT.
IF PP30 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’
(DON’T KNOW), END LOOP_16 AND CONTINUE WITH
END_LP08
END_LP08
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER
WHO MEETS THE CONDITIONS STATED IN THE LOOP
DEFINITION.
IF NO OTHER PERSONS MEET THE STATED CONDITIONS,
END LOOP_08 AND CONTINUE WITH BOX_18
BOX_18
GO TO NEXT QUESTIONNAIRE SECTION.
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