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BOX_00A
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.PROVNAME,
EVPV.EVNTTYPE, EVPV.EVNTBEGM, EVPV.EVNTBEGD,
EVPV.EVNTBEGY, EVPV.EVNTENDM, EVPV.EVNTENDD,
EVPV.EVNTENDY, FFEE.FFEENAME
IF OMTYPE = 4-11, 91 USE "JAN 01" FOR START DATE.
BOX_01
IF NO FLAT FEE GROUPS ALREADY ON PERSONS-FLAT-FEE-
GROUPS-ROSTER, GO TO FF02
OTHERWISE, CONTINUE WITH FF01
FF01
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER.} {EV} {EVN-DT}
Let me review the groups of health care events I have
recorded for
{you/{PERSON}}. Please tell me if any of these groups
include the
charge that covered {this hospital stay/this visit/the
{OME ITEM
GROUP NAME}/the services received at home}.
REVIEW FLAT FEE GROUPS WITH RESPONDENT.
SELECT FLAT FEE GROUP COVERED BY SAME CHARGE AS EVENT
BEING ASKED
ABOUT.
[1. Flat Fee Group] ....................
[2. Flat Fee Group] ....................
[3. Flat Fee Group] ....................
[Code One]
DISPLAY ‘this hospital stay’ IF EVENT TYPE IS HS.
DISPLAY ‘this visit’ IF EVENT TYPE IS ER, OP, MV,
OR DN.
DISPLAY ‘the {OME ITEM GROUP NAME}’ IF EVENT TYPE
IS OM.
DISPLAY ‘the services received at home’ IF EVENT
TYPE IS HH.
FOR {OME ITEM GROUP NAME}, DISPLAY THE NAME OF
THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED
ABOUT FOR THIS EVENT:
DISPLAY ‘glasses or contact lenses’ IF EVENT
TYPE IS OM AND THE OM ITEM GROUP IS ‘1’ (GLASSES
OR CONTACT LENSES).
DISPLAY ‘ambulance services’ IF THE OM ITEM
GROUP IS ‘4’ (AMBULANCE SERVICES).
DISPLAY ‘orthopedic items’ IF THE OM ITEM GROUP
IS ‘5’ (ORTHOPEDIC ITEMS).
DISPLAY ‘hearing devices’ IF THE OM ITEM GROUP
IS ‘6’ (HEARING DEVICES).
DISPLAY ‘prostheses’ IF THE OM ITEM GROUP IS ‘7’
(PROSTHESES).
DISPLAY ‘bathroom aids’ IF THE OM ITEM GROUP IS
‘8’ (BATHROOM AIDS).
DISPLAY ‘medical equipment’ IF THE OM ITEM GROUP
IS ‘9’ (MEDICAL EQUIPMENT).
DISPLAY ‘disposable supplies’ IF THE OM ITEM
GROUP IS ‘10’ (DISPOSABLE SUPPLIES).
DISPLAY ‘alterations or modifications’ IF THE OM
ITEM GROUP IS ‘11’ (ALTERATIONS/MODIFICATIONS).
DISPLAY {TEXT FROM OTHER SPECIFY} IF THE OM ITEM
GROUP IS ‘91’ (OTHER).
FOR ‘TEXT FROM OTHER SPECIFY’, DISPLAY THE
TEXT CATEGORY ENTERED IN THE OTHER SPECIFY
FIELD FOR OM EVENTS.
FOR ‘{START DATE}’, DISPLAYED IN THE CONTEXT
HEADER, DISPLAY THE START DATE OF THE CURRENT
ROUND FOR OM EVENTS THAT ARE ‘REGULAR’ GROUP TYPE
(EV02A=1 OR NOT ASKED) AND DISPLAY ‘JAN 01 {YEAR}’
FOR OM EVENTS THAT ARE ‘ADDITIONAL’ GROUP TYPE
(EV02A=2).
(FOR SPECIFICATION PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY): ‘YEAR’ IN CONTEXT HEADER IS FIRST
CALENDAR YEAR OF PANEL IF ROUND 3. ‘YEAR’ IS
SECOND CALENDAR YEAR OF PANEL IF ROUND 5.
SINCE THIS ROSTER WILL INCLUDE ALL FLAT FEE
GROUPS, CURRENT ROUND SINGLE EVENTS CAN BE ADDED
TO ANY FLAT FEE GROUP CREATED DURING THE CURRENT
ROUND OR A PREVIOUS ROUND.
DISPLAY AN 'ADD GROUP' OPTION ON THIS SCREEN.
IF A FLAT FEE GROUP IS SELECTED, GO TO BOX_02
IF ‘ADD GROUP’ IS SELECTED, CONTINUE WITH FF02
ROSTER DETAILS:
TITLE: PERS_FFEE_GROUPS_1
COL # 1 HEADER: FLAT FEE GROUP
INSTRUCTIONS: DISPLAY FLAT FEE GROUP NAME
(FFEE.FFEENAME)
ROSTER DEFINITION:
DISPLAY THE PERSON’S-FLAT-FEE-GROUPS-ROSTER FOR
SELECTION.
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. ADD ALLOWED.
3. MULTIPLE SELECT, MULTIPLE ADD, DELETE, AND EDIT
DISALLOWED.
ROSTER FILTER:
NO FILTER; DISPLAY ALL.
FF02
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER.} {EV} {EVN-DT}
Let me review the list of health care events I have
recorded for
{you/{PERSON}}. Please tell me which of these were
included in the
same charge that covered {this hospital stay/this
visit/the {OME
ITEM GROUP NAME}/the services received at home}.
REVIEW EVENTS WITH RESPONDENT.
SELECT EVENTS COVERED BY SAME CHARGE AS EVENT BEING
ASKED ABOUT.
| ROSTER. PROVIDER |
FF02_02. EVENT TYPE |
FF02_03. ADMIT DATE |
FF02_04 DISCH DATE |
[Display Medical
Provider-35]
|
[Display Event Code] |
[Display Month
Day Year-4] |
[Display Month
Day Year-4] |
[Display Medical
Provider-35] |
[Display Event Code] |
[Display Month
Day Year-4] |
[Display Month
Day Year-4] |
[Display Medical
Provider-35] |
[Display Event Code] |
[Display Month
Day Year-4] |
[Display Month
Day Year-4] |
DISPLAY ‘this hospital stay’ IF EVENT TYPE IS HS.
DISPLAY ‘this visit’ IF EVENT TYPE IS ER, OP, MV,
OR DN.
DISPLAY ‘the {OME ITEM GROUP NAME}’ IF EVENT TYPE
IS OM.
DISPLAY ‘the services received at home’ IF EVENT
TYPE IS HH.
FOR {OME ITEM GROUP NAME}, DISPLAY THE NAME OF
THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED
ABOUT FOR THIS EVENT:
DISPLAY ‘glasses or contact lenses’ IF EVENT
TYPE IS OM AND THE OM ITEM GROUP IS ‘1’ (GLASSES
OR CONTACT LENSES).
DISPLAY ‘ambulance services’ IF THE OM ITEM
GROUP IS ‘4’ (AMBULANCE SERVICES).
DISPLAY ‘orthopedic items’ IF THE OM ITEM GROUP
IS ‘5’ (ORTHOPEDIC ITEMS).
DISPLAY ‘hearing devices’ IF THE OM ITEM GROUP
IS ‘6’ (HEARING DEVICES).
DISPLAY ‘prostheses’ IF THE OM ITEM GROUP IS ‘7’
(PROSTHESES).
DISPLAY ‘bathroom aids’ IF THE OM ITEM GROUP IS
‘8’ (BATHROOM AIDS).
DISPLAY ‘medical equipment’ IF THE OM ITEM GROUP
IS ‘9’ (MEDICAL EQUIPMENT).
DISPLAY ‘disposable supplies’ IF THE OM ITEM
GROUP IS ‘10’ (DISPOSABLE SUPPLIES).
DISPLAY ‘alterations or modifications’ IF THE OM
ITEM GROUP IS ‘11’ (ALTERATIONS/MODIFICATIONS).
DISPLAY {TEXT FROM OTHER SPECIFY} IF THE OM ITEM
GROUP IS ‘91’ (OTHER).
FOR ‘TEXT FROM OTHER SPECIFY’, DISPLAY THE
TEXT CATEGORY ENTERED IN THE OTHER SPECIFY
FIELD FOR OM EVENTS.
FOR ‘{START DATE}’, DISPLAYED IN THE CONTEXT
HEADER, DISPLAY THE START DATE OF THE CURRENT
ROUND FOR OM EVENTS THAT ARE ‘REGULAR’ GROUP TYPE
(EV02A=1 OR NOT ASKED) AND DISPLAY ‘JAN 01 {YEAR}’
FOR OM EVENTS THAT ARE ‘ADDITIONAL’ GROUP TYPE
(EV02A=2).
(FOR SPECIFICATION PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY): ‘YEAR’ IN CONTEXT HEADER IS FIRST
CALENDAR YEAR OF PANEL IF ROUND 3. ‘YEAR’ IS
SECOND CALENDAR YEAR OF PANEL IF ROUND 5.
ROSTER DETAILS:
TITLE: PERS_MED_EVNT_1
COL # 1 HEADER: PROVIDER
INSTRUCTIONS: DISPLAY THE NAME OF PROVIDER
ASSOCIATED WITH THIS EVENT (EVNT.LORPNAME)
COL # 2 HEADER: EVENT TYPE
INSTRUCTIONS: DISPLAY THE TWO-LETTER EVENT
ABBREVIATION (EVNT.EVNTTYPE)
COL # 3 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY THE MONTH, DAY, AND YEAR OF
MEDICAL EVENTS (EVNT.EVNTBEGM, EVNT.EVNTBEGD,
EVNT.EVNTBEGY)
COL # 4 HEADER: DISCHARGE DATE
INSTRUCTIONS: DISPLAY THE DISCHARGE DATE FOR
HOSPITAL STAY EVENTS (EVNT.EVNTENDM,
EVNT.EVNTENDD, EVNT.EVNTENDY)
ROSTER DEFINITION:
THIS ITEM DISPLAYS ALL MEDICAL EVENTS ON PERSON’S-
MEDICAL-EVENTS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER:
1. EVENT HAS CP STATUS OF ‘PROCESSED’ OR
‘UNPROCESSED’ (DISPLAY EVENT REGARDLESS OF CP
STATUS).
2. EVENT IS NOT ALREADY INCLUDED IN A FLAT FEE
GROUP OR A REPEAT VISIT GROUP.
3. EVENT IS NOT ALREADY CODED (VERIFIED) AS A
COPAYMENT.
4. EVENT TYPE IS NOT PM, IC, OM TYPE 2 (INSULIN),
OR OM TYPE 3 (OTHER DIABETIC SUPPLIES OR
EQUIPMENT).
5. EVENT IS NOT AN HS EVENT WITH A DISCHARGE DATE
CODED ‘95’ (STILL IN HOSPITAL).
6. EVENT IS NOT AN MV OR OP EVENT THAT WAS A
TELEPHONE CALL (OP02 OR MV01 CODED ‘2’).
7. EVENT IS NOT A HH EVENT WITH EVENT DATE =
INTERVIEW MONTH.
8. DISPLAY 'EVENT OUTSIDE REFERENCE PERIOD' AS THE
LAST ENTRY IN THE ‘PROVIDER’ COLUMN.
FF03
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE
PROVIDER.} {EV} {EVN-DT}
INTERVIEWER: RECORD 'NAME OF FLAT FEE GROUP' FOR
EVENTS
SELECTED IN PREVIOUS QUESTION:
[Enter Flat Fee Group]
WRITE FLAT FEE GROUP TO PERSON’S-FLAT-FEE-GROUPS-
ROSTER.
IF ROUND 1, CONTINUE WITH FF04
IF ROUND 5, GO TO FF09
OTHERWISE, GO TO BOX_02
FF04
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
Did the charge which included the services for {FLAT
FEE GROUP}
cover any visits before {START DATE}?
YES .................................... 1 {FF05}
NO ..................................... 2 {FF06}
REF ................................... -7 {FF06}
DK .................................... -8 {FF06}
FOR {FLAT FEE GROUP}, DISPLAY THE NAME OF THE FLAT
FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.
FF05
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
How many visits did {you/{PERSON}} have before {START
DATE}?
NUMBER OF VISITS:
[Enter Number] ......................... {FF06}
REF ................................... -7 {FF06}
DK .................................... -8 {FF06}
FF06
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
Did the charge that included the services for {FLAT
FEE GROUP} cover
any surgical procedures before {START DATE}?
YES .................................... 1 {FF07}
NO ..................................... 2 {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
HELP AVAILABLE FOR DEFINITION OF SURGICAL PROCEDURE.
FOR {FLAT FEE GROUP}, DISPLAY THE NAME OF THE FLAT
FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.
FF07
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
INTERVIEWER: IS THE VISIT THAT INCLUDES SURGERY
ALREADY
PART OF THE FLAT FEE GROUP?
YES .................................... 1 {BOX_02}
NO ..................................... 2
REF ................................... -7
DK .................................... -8
FF08
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
Was this the kind of surgery for which {you/{PERSON}}
had to stay
in the hospital at least one night or {were/was}
{you/he/she}
allowed to go home the same day of the surgery?
AT LEAST ONE NIGHT ..................... 1 {BOX_02}
SAME DAY ............................... 2 {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
[Code One]
FF09
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
Will the charge which includes the services for {FLAT
FEE GROUP}
cover any visits after December 31, {YEAR}?
YES .................................... 1 {FF10}
NO ..................................... 2 {FF11}
REF ................................... -7 {FF11}
DK .................................... -8 {FF11}
FOR {FLAT FEE GROUP}, DISPLAY THE NAME OF THE FLAT
FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY): FOR ‘YEAR’ IN QUESTION TEXT,
DISPLAY THE SECOND YEAR OF THE PANEL.
FF10
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
Approximately, how many visits will {you/{PERSON}}
have after
December 31, {YEAR}?
NUMBER OF VISITS:
[Enter Number] ......................... {FF11}
REF ................................... -7 {FF11}
DK .................................... -8 {FF11}
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY): FOR ‘YEAR’ IN QUESTION TEXT,
DISPLAY THE SECOND YEAR OF THE PANEL.
FF11
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
Will the charge that includes the services for {FLAT
FEE GROUP}
cover any surgical procedures after December 31,
{YEAR}?
YES .................................... 1 {FF12}
NO ..................................... 2 {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
HELP AVAILABLE FOR DEFINITION OF SURGICAL PROCEDURE.
FOR {FLAT FEE GROUP}, DISPLAY THE NAME OF THE FLAT
FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY): FOR ‘YEAR’ IN QUESTION TEXT,
DISPLAY THE SECOND YEAR OF THE PANEL.
FF12
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
INTERVIEWER: IS THE VISIT THAT INCLUDES SURGERY
ALREADY PART OF
THE FLAT FEE GROUP?
YES .................................... 1 {BOX_02}
NO ..................................... 2 {FF13}
REF ................................... -7 {FF13}
DK .................................... -8 {FF13}
FF13
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}
Will this be the kind of surgery for which
{you/{PERSON}} {have/has}
to stay in the hospital at least one night or will
{you/he/she} be
allowed to go home the same day of the surgery?
AT LEAST ONE NIGHT ..................... 1 {BOX_02}
SAME DAY ............................... 2 {BOX_02}
REF ................................... -7 {BOX_02}
DK .................................... -8 {BOX_02}
[Code One]
BOX_02
RETURN TO THE EVENT DRIVER FOR THIS EVENT-PROVIDER
PAIR. IF EVENT-PROVIDER PAIR BEING ASKED ABOUT WAS
PART OF AN EXISTING FLAT FEE GROUP (A NAME WAS
SELECTED AT FF01), FLAG THE CP STATUS OF THE
EVENT-PROVIDER PAIR AS 'PROCESSED'. IF A NEW FLAT
FEE GROUP WAS FORMED AT FF02, THE COMPLETE (FROM
THE BEGINNING) CP SECTION WILL BE ASKED FOR THIS
FLAT FEE GROUP.
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