Closing (CL) SectionSubsection 1: MPC Authorization Forms (Round 1 through Round 5) BOX_00
CONTEXT HEADER DISPLAY INSTRUCTIONS: DISPLAY PERS.FULLNAME BOX_01
IF: AT LEAST ONE PERSON-PROVIDER-PAIR ELIGIBLE (SEE SAMPLING BOXES BELOW) FOR AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND, OR AT LEAST ONE PERSON-PROVIDER-PAIR ELIGIBLE FOR AUTHORIZATION FORM COLLECTION DURING THE PREVIOUS ROUND AND CL04 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’ (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PROVIDER-PAIR IN PREVIOUS ROUND, CONTINUE WITH CL01
OTHERWISE, GO TO BOX_02
NOTE: RECEIPT CONTROL WILL UPDATE CAPI INTER- ROUND, USING THE CODE STRUCTURE AT CL04. UPDATES CAN BE EITHER POSITIVE OR NEGATIVE. THIS MEANS THAT INTER-ROUND AN AUTHORIZATION FORM’S STATUS CAN EITHER GET UPDATED TO A HIGHER STATUS CODE (FROM UNSIGNED TO SIGNED) OR TO A LOWER STATUS CODE (FROM SIGNED TO UNSIGNED -- I.E., IT WAS NOT SIGNED BY THE RIGHT PERSON). SEE MAPPING SPECIFICATIONS FOR EXACT UPDATES TO STATUS CODES.
NOTE: DUE TO LEGISLATION THAT WENT INTO EFFECT IN APRIL 2003, MEPS CHANGED TO NEW HIPAA- COMPLIANT AUTHORIZATION FORMS.
NOTEBOX THERE ARE 6 PERSON TYPES (AND TWO SUB-TYPES) IN THE MEPS RU TYPE PRSLT DECEASED/ELIGIBLE FOR PART OF REF PERIOD 41 INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD 51 IN A HEALTHCARE FACILITY (INSTTTYPE 1 OR 2) IN A NON-HEALTHCARE FACILITY (INSTTYPE 3) MEPS STUDENT/ELIGIBLE ALL OF REF PERIOD 71 LIVING OUTSIDE US/ELIGIBLE PT OF REF PERIOD 75 LIVING-MILITARY BASE/ELIGIBLE PT REF PERIOD 76 ELIGIBLE FOR ALL OF REFERENCE PERIOD 99 THE FOLLOWING PERSON TYPES (AND SUB-TYPES) ARE ELIGIBLE FOR AUTHORIZATION FORM COLLECTION: - PRSLT 41 - DECEASED/ELIGIBLE FOR PART OF REF PERIOD - PRSLT 51 SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A HEALTHCARE FACILITY (INSTTYPE 1 OR 2) - PRSLT 71 - MEPS STUDENT/ELIGIBLE ALL OF REF PERIOD - PRSLT 99 - ELIGIBLE FOR ALL OF REFERENCE PERIOD THERE ARE TWO TYPES OF OUT OF SCOPE RU MEMBERS THAT ARE ELIGIBLE FOR AUTHORIZATION FORM COLLECTION (NOTE: OUT OF SCOPE REFERS TO RU MEMBERS WHO HAD PARTIAL ELIGIBILITY IN THE PREVIOUS ROUND AND NO ELIGIBILITY IN THE CURRENT ROUND): - PRSLT 41 - DECEASED/ELIGIBLE FOR PART OF REF PERIOD - PRSLT 51 SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A HEALTHCARE FACILITY (INSTTYPE 1 OR 2) 2 PERSON TYPES AND 1 SUB-TYPE ARE NOT ELIGIBLE FOR AUTHORIZATION FORM COLLECTION: - PRSLT 51 SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A NON-HEALTHCARE FACILITY (INSTTYPE 3) - PRSLT 75 - LIVING OUTSIDE US/ELIGIBLE PT OF REF PERIOD - PRSLT 76 - LIVING-MILITARY BASE/ELIGIBLE PT REF PERIOD PERSON-PROVIDER-PAIRS WHERE THE PROVIDER LOCATION IS IN A FOREIGN COUNTRY I.E., ‘FC’ IS ENTERED IN THE STATE FIELD OF PROVIDER’S ADDRESS ARE NOT ELIGIBLE FOR MPC AUTHORIZATION FORM COLLECTION)
SAMPLING BOX PERSON-PROVIDER-PAIRS ELIGIBLE FOR MPC AUTHORIZATION FORM COLLECTION: NOTE: PERSON IS A KEY, ELIGIBLE RU MEMBER (AT TIME OF EVENT). ROUND 1: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE: - PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL EVENTS (HS) BOTH OPEN AND CLOSED. - PERSON-PROVIDER PAIRS ASSOCIATED WITH EMERGENCY ROOM EVENTS (ER). - PERSON-PROVIDER PAIRS ASSOCIATED WITH OUTPATIENT EVENTS (OP). ROUND 2: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE: - PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL TYPE EVENTS (HS, ER AND OP) AS IN ROUND 1. - PERSON-PROVIDER PAIRS ASSOCIATED WITH MEDICAL EVENTS (MV) WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY (MV03=1) OR WORKS AT A MEDICAL FACILITY (MV06=1). - PERSON-PROVIDER PAIRS ASSOCIATED WITH HOME HEALTH EVENTS (HH) WHERE THE HHTYPE IS AN AGENCY, BOTH OPEN AND CLOSED. - PERSON-PROVIDER PAIRS ASSOCIATED WITH INSTITUTIONAL CARE EVENTS (IC), BOTH OPEN AND CLOSED. - ANY OUTSTANDING PERSON-PROVIDER PAIRS FROM ROUND 1 ARE ALSO REQUESTED FOR THE HOSPITAL RELATED PROVIDERS (EVENT TYPES HS, ER, OP), IC, HH (WHERE THE HHTYPE IS AN AGENCY) OR MV EVENTS WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY OR WORKS AT A MEDICAL FACILITY). ROUND 3: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE: - PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL TYPE EVENTS (HS, ER AND OP) AS IN OTHER ROUNDS. - PERSON-PROVIDER PAIRS ASSOCIATED WITH MEDICAL EVENTS (MV) WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY (MV03=1) OR WORKS AT A MEDICAL FACILITY (MV06=1). - PERSON-PROVIDER PAIRS ASSOCIATED WITH HOME HEALTH EVENTS (HH) WHERE THE HHTYPE IS AN AGENCY, BOTH OPEN AND CLOSED. - PERSON-PROVIDER PAIRS ASSOCIATED WITH INSTITUTIONAL CARE EVENTS (IC), BOTH OPEN AND CLOSED. - ANY OUTSTANDING PERSON-PROVIDER PAIRS FROM ROUND 1 AND ROUND 2 ARE REQUESTED.
ROUND 4: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE: - PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL TYPE EVENTS (HS, ER AND OP) AS IN OTHER ROUNDS. - PERSON-PROVIDER PAIRS ASSOCIATED WITH MEDICAL EVENTS (MV) WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY (MV03=1) OR WORKS AT A MEDICAL FACILITY (MV06=1). - PERSON-PROVIDER PAIRS ASSOCIATED WITH HOME HEALTH EVENTS (HH) WHERE THE HHTYPE IS AN AGENCY, BOTH OPEN AND CLOSED. - PERSON-PROVIDER PAIRS ASSOCIATED WITH INSTITUTIONAL CARE EVENTS (IC), BOTH OPEN AND CLOSED. - ANY OUTSTANDING PERSON-PROVIDER PAIRS ASSOCIATED WITH EVENTS OCCURRING (OR ENDING) IN REFERENCE YEAR 2 ARE ALSO REQUESTED.? NOTE: FOR HS AND IC EVENTS THIS MEANS THE PERSON LEFT THE INSTITUTION/HOSPITAL DURING REFERENCE YEAR 2 (I.E., THE EVENT’S END DATE IS REFERENCE YEAR 2).? FOR OTHER EVENT TYPES, ANY WITH DATE OF SERVICE WITH A REFERENCE YEAR 1 ARE NO LONGER REQUESTED
ROUND 5: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE: - PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL TYPE EVENTS (HS, ER AND OP) AS IN OTHER ROUNDS. - PERSON-PROVIDER PAIRS ASSOCIATED WITH MEDICAL EVENTS (MV) WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY (MV03=1) OR WORKS AT A MEDICAL FACILITY (MV06=1). - PERSON-PROVIDER PAIRS ASSOCIATED WITH HOME HEALTH EVENTS (HH) WHERE THE HHTYPE IS AN AGENCY, BOTH OPEN AND CLOSED. - PERSON-PROVIDER PAIRS ASSOCIATED WITH INSTITUTIONAL CARE EVENTS (IC), BOTH OPEN AND CLOSED. - ANY OUTSTANDING PERSON-PROVIDER PAIRS ASSOCIATED WITH EVENTS OCCURRING (OR ENDING) IN REFERENCE YEAR 2 ARE ALSO REQUESTED. NOTE: FOR HS AND IC EVENTS THIS MEANS THE PERSON LEFT THE INSTITUTION/HOSPITAL DURING REFERENCE YEAR 2 (I.E., THE EVENT’S END DATE IS REFERENCE YEAR 2).
SAMPLING BOX (FOR ROUNDS 2-5) CONT’D: WHEN DETERMINING IF THE MV EVENTS FOR AN RU REQUIRE AUTHORIZATION FORMS, AN RU IS SELECTED FOR THE MPC SAMPLE AT THE TIME OF THE ROUND 1 INTERVIEW USING THE FOLLOWING RATES: - 100% OF RUs WITH AT LEAST ONE RU MEMBER COVERED BY MEDICAID OR GOV’T HOSPITAL (PHYSICIAN) INSURANCE AT ANY TIME DURING THE REFERENCE PERIOD - 100% OF THE REMAINING RUs (THAT IS, RUs WITH NO RU MEMBER COVERED BY MEDICAID OR GOV’T- HOSPITAL/PHYSICIAN INSURANCE AT ANY TIME DURING THE REFERENCE PERIOD) WITH AT LEAST ONE RU MEMBER WITH HMO COVERAGE AT ANY TIME DURING THE REFERENCE PERIOD. HMO COVERAGE IS DEFINED AS: IF AT LEAST ONE PRIVATE INSURANCE PLAN IN RU MEETS THE FOLLOWING CONDITIONS: - FLAGGED AS ‘PROVIDING HOSPITAL/PHYSICIAN BENEFITS’ (EXCLUDE INSURERS WHERE HOSPITAL/PHYSICIAN BENEFITS ARE PROVIDED SOLELY THROUGH MEDIGAP) - ESTABLISHMENT OR INSURER IS FLAGGED AS ‘HMO’ OR INSURER IS AN HMO (MC01 IS CODED ‘1’ (YES)) OR INSURER REQUIRES PERSONS TO SIGN UP WITH PRIMARY PHYSICIAN (MC02 IS CODED ‘1’ (YES) - 100% OF THE REMAINING RUs (THAT IS, RUs WITH NO RU MEMBER COVERED BY MEDICAID OR GOV’T- HOSPITAL/PHYSICIAN INSURANCE AND HMO COVERAGE AT ANY TIME DURING THE REFERENCE PERIOD).
NOTE: IF THE SAME PROVIDER IS ASSOCIATED MORE THAN ONCE WITH A PARTICULAR PERSON, ONLY ONE AUTHORIZATION FORM IS CREATED FOR THAT PAIR. IF THE SAME PROVIDER IS ASSOCIATED WITH MORE THAN ONE PERSON, AN AUTHORIZATION FORM IS CREATED FOR EACH UNIQUE PERSON-PROVIDER-PAIR.
NOTE: IF THE PERSON-PROVIDER-PAIR IS OUTSTANDING FROM A PREVIOUS ROUND AND THERE IS A NEW ELIGIBLE EVENT FOR THIS PAIR IN THE CURRENT ROUND, THE PAIR WILL NOT BE TREATED AS IF IT IS OUTSTANDING. THAT IS, THE DISPLAYS FOR PREVIOUS ROUND STATUS WILL NOT BE SHOWN, ETC. CL01 {[As I mentioned during the last interview], we/We}
request written
DISPLAY ‘[As I mentioned during the last interview], we’ IF NOT ROUND 1 AND AT LEAST ONE PERSON-PROVIDER-PAIR WAS ELIGIBLE FOR MPC AUTHORIZATION FORM COLLECTION DURING THE PREVIOUS ROUND. OTHERWISE, DISPLAY ‘We’.
DISPLAY EACH UNIQUE ELIGIBLE PERSON NAME ONLY ONCE.
CONTINUE WITH LOOP_01
ROSTER DETAILS: TITLE: RU_ESTB_PERS_PAIRS_1 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
ROSTER DEFINITION: DISPLAY THE RU_PERSON_ESTABLISHMENT_PAIRS_ROSTER FOR DISPLAY OF RU MEMBERS ONLY.
ROSTER BEHAVIOR: 1. DISPLAY ONLY. 2. SELECT, ADD, DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITION(S): - PERSON IS ELIGIBLE FOR MPC AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_01 SAMPLING SPECIFICATIONS) OR - PERSON WAS ASSOCIATED WITH A PERSON-PROVIDER- PAIR ELIGIBLE FOR AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND, AND - CL04 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’ (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PROVIDER-PAIR IN PREVIOUS ROUND LOOP_01
FOR EACH ELEMENT ON THE RU-PERSON-PROVIDER-PAIRS- ROSTER, ASK CL03 - END_LP01
LOOP DEFINITION: LOOP_01 PRESENTS EACH UNIQUE PERSON-PROVIDER-PAIR ELIGIBLE FOR AUTHORIZATION FORM COLLECTION (THIS INCLUDES NEW AND OUTSTANDING FORMS) FOR THE INTERVIEWER TO COMPLETE THE AUTHORIZATION FORM. THIS LOOP CYCLES ON RU- PERSON-PROVIDER-PAIRS WITH AN EVENT-PROVIDER- PAIR THAT MEET THE FOLLOWING CONDITION(S): - PAIR IS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_01 SAMPLING SPECIFICATIONS) OR - PAIR WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND, AND - CL04 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’ (ADDED BY COMMENT REVIEW) FOR THIS PAIR IN THE PREVIOUS ROUND
NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON- PROVIDER-PAIR. CL03 INTERVIEWER: {COMPLETE A NEW MPC AF FOR THIS
PAIR./CHECK FIRST FOR
DISPLAY ‘COMPLETE A NEW MPC AF FOR THIS PAIR.’ IF ROUND 1. OTHERWISE, (I.E., ROUND 2-5) DISPLAY ‘CHECK...MPC AF.’ DISPLAY ‘AF STATUS ... -40’ IF CURRENT PERSON- PROVIDER-PAIR IS OUTSTANDING FROM THE PREVIOUS ROUND AND NO ELIGIBLE EVENT WAS CREATED FOR THIS PAIR IN THE CURRENT ROUND. FOR ‘DISPLAY PREVIOUS...-40’, DISPLAY THE CATEGORY ENTRY ASSOCIATED WITH THE PREVIOUS ROUND (OR RECEIPT CONTROL UPDATED) CL04 OUTSTANDING STATUS. THAT IS, IF CL04 WAS CODED ‘3’, DISPLAY ‘LEFT WITH R’; IF CL04 WAS CODED ‘4’, DISPLAY ‘MAILED TO R’; IF CL04 WAS CODED ‘5’, DISPLAY ‘REFUSED’; AND IF CL04 WAS CODED ‘91’ OR ‘-1’, DISPLAY THE FIRST 40 CHARACTERS FROM THE OTHER SPECIFY ENTRY FIELD (OR THE RECEIPT CONTROL UPDATE TEXT GENERATED FOR THE ‘91’ AND ‘-1’ CODES). DISPLAY ‘BLUE’ IF PANEL 20 INTERVIEW. DISPLAY ‘GREEN’ IF PANEL 21 INTERVIEW. DISPLAY ‘WHITE’ IF PANEL 22 INTERVIEW. DISPLAY THE INTERVIEW DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR ‘MM/DD/YYYY’. END_LP01
CYCLE ON NEXT PAIR ON THE RU-PERSON-PROVIDER- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH LOOP_02 LOOP_02
FOR EACH ELEMENT ON THE RU-PERSON-PROVIDER-PAIRS- ROSTER, ASK CL04 - END_LP02 LOOP DEFINITION: LOOP_02 COLLECTS THE STATUS OF PERSON-PROVIDER AUTHORIZATION FORMS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION (THIS INCLUDES NEW AND OUTSTANDING FORMS). THIS LOOP CYCLES ON RU-PERSON-PROVIDER-PAIRS WITH AN EVENT-PROVIDER- PAIR THAT MEET THE FOLLOWING CONDITION(S): - PAIR IS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_01 SAMPLING SPECIFICATIONS) OR - PAIR WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND, AND - CL04 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’ (ADDED BY COMMENT REVIEW) FOR THIS PAIR IN THE PREVIOUS ROUND NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON- PROVIDER-PAIR. CL04 INTERVIEWER: ASK APPROPRIATE PERSON(S) TO SIGN
AUTHORIZATION FORM. FOR ‘MM/DD/YYYY’, DISPLAY THE RU END REFERENCE DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION. DISPLAY ‘BLUE’ IF PANEL 20 INTERVIEW. DISPLAY ‘GREEN’ IF PANEL 21 INTERVIEW. DISPLAY ‘WHITE’ IF PANEL 22 INTERVIEW. SOFT CHECK: CODE ‘4’ (MAILED TO R) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE ‘4’ SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: ‘UNLIKELY RESPONSE. VERIFY AND RE-ENTER.’ CL04OV1 PROBLEM: CL04OV2 SPECIFY: CL05 FOR PANEL [PANEL-2], THE MPC AF COLOR IS
{WHITE/BLUE/GREEN}. FOR ‘MM/DD/YYYY’, DISPLAY THE RU END REFERENCE DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION. DISPLAY ‘BLUE’ IF PANEL 20 INTERVIEW. DISPLAY ‘GREEN’ IF PANEL 21 INTERVIEW. DISPLAY ‘WHITE’ IF PANEL 22 INTERVIEW. NOTE: EACH AUTHORIZATION FORM HAS A PRE-ASSIGNED AUTHORIZATION FORM NUMBER. HARD CHECK PANEL 20 MPC AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN AND END WITH AN ALPHA CHARACTER. PANEL 20 MPC AUTHORIZATION FORMS ARE PRINTED ON BLUE PAPER.
HARD CHECK PANEL 21 MPC AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN AND END WITH AN ALPHA CHARACTER. PANEL 21 MPC AUTHORIZATION FORMS ARE PRINTED ON GREEN PAPER.
HARD CHECK PANEL 22 MPC AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN WITH AN ALPHA CHARACTER AND END WITH AN ALPHA CHARACTER. PANEL 22 MPC AUTHORIZATION FORMS ARE PRINTED ON WHITE PAPER.
SOME IMPORTANT POINTS TO REMEMBER ABOUT MPC AUTHORIZATION FORMS: - THE PREFIX LETTER CHANGES BASED ON THE TYPE OF AUTHORIZATION FORM AND THE ORIGIN OF THE FORM. THIS MEANS THAT A PRE-PRINTED OR FIELD GENERATED MPC AUTHORIZATION FORM WILL DRAW FROM THE SAME LETTER OR RANGE OF LETTERS IN EACH PANEL. - THE 5-NUMBER SEQUENCE REPEATS ITSELF FOR EACH PANEL. - THE CHECK-DIGIT ALWAYS REMAINS CONSTANT. - THE ROUND IDENTIFIER IS DIFFERENT FOR EACH PANEL. THE ROUND IDENTIFIER WILL REMAIN THE SAME FOR ALL AUTHORIZATION FORMS COLLECTED WITHIN A PANEL, BUT CHANGES BASED ON THE ROUND. FOR EXAMPLE: AUTHORIZATION FORMS GENERATED FOR PANEL 19, ROUND 1 WILL USE THE ROUND IDENTIFIER “M”; “M” OR “N” FOR ROUND 2; “M”, “N”, OR “P” FOR ROUND 3; “M”, “N”, “P” OR “Q” FOR ROUND 4; AND “M”, “N”, “P”, “Q” OR “R” FOR ROUND 5. CL05OV MPC AUTHORIZATION FORM SIGNATURE DATE: NOTE: INTERVIEWERS WILL BE INSTRUCTED TO COLLECT SIGNED MPC AUTHORIZATION FORMS WITH DATES EARLIER THAN THE ONE DISPLAYED, BUT WILL NOT ENTER THE NUMBER IN CAPI SINCE THE CURRENT STATUS FOR THE AUTHORIZATION FORM WITH THE CORRECT DATE MAY BE SOMETHING ELSE. THE CAPI STATUS OF THE MPC AUTHORIZATION FORM SHOULD REFLECT THE FORM WITH THE MOST RECENT DATE. HARD CHECK: DATE ENTERED MUST BE ON OR AFTER THE INTERVIEW DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH THE PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION, BUT CANNOT BE AFTER ‘TODAY’S’ DATE (THE CURRENT DATE SET ON THE LAPTOP. IF DATE IS BEFORE CORRECT DATE, DISPLAY THE FOLLOWING MESSAGE: ‘MPC AF MUST BE SIGNED ON OR AFTER ABOVE DATE. VERIFY AND RE-ENTER DATE OR COMPLETE NEW AF.’ CL06 PID: [PID-3] PERSON: [First, [Middle], Last Name-35] CL06OV OTHER REASON FOR REFUSAL: END_LP02
CYCLE ON NEXT PAIR ON THE RU-PERSON-PROVIDER- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH BOX_02 BOX_02
IF NOT ROUND 1 AND ANY KEY RU MEMBER HAD A STATUS OF INSTITUTIONALIZED (IN A HEALTH CARE INSTITUTION) AT THE PREVIOUS ROUND’S INTERVIEW DATE, BUT HAS A DIFFERENT STATUS AS OF THE CURRENT ROUND’S INTERVIEW DATE, CONTINUE WITH LOOP_02A
OTHERWISE, GO TO BOX_03 LOOP_02A
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV_CL02A - END_LP02A
LOOP DEFINITION: LOOP_02A INSTRUCTS THE INTERVIEWER TO COLLECT THE HEALTH CARE INSTITUTION HISTORY AND THE APPROPRIATE NUMBER OF MEDICAL PROVIDER AUTHORIZATION FORMS FOR ALL RU MEMBERS WHO HAD A STATUS OF INSTITUTIONALIZED (IN A HEALTH CARE INSTITUTION) IN ANY PREVIOUS ROUND BUT WHO REJOINED THE COMMUNITY (OR CHANGED STATUS) DURING THE CURRENT ROUND. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS: - PERSON IS AN RU MEMBER - PERSON IS KEY - PERSON DOES NOT HAVE A STATUS OF INSTITUTIONALIZED AS OF THE CURRENT ROUND’S INTERVIEW DATE (RE19A = 1, 3, -7, -8 IN THE CURRENT ROUND) - PERSON HAD A STATUS OF INSTITUTIONALIZED IN ANY PREVIOUS ROUND
NAVIGATOR DETAILS: LOOP_02A USES NAV_CL02A TO CONTROL THE FLOW OF THE LOOP. NAV_CL02A SERIES: Complete the Institutionalized Health History
Worksheet
ROSTER DETAILS: COL # 1 HEADER: RU MEMBER INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: EMPTY INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
ROSTER DEFINITION: THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR: 1. SELECT ALLOWED. 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER: DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_02A DEFINITION.
CONTINUE WITH CL06A FOR SELECTED RU MEMBER. CL06A PID: [PID-3] PERSON: [First,[Middle],Last Name-35]
DISPLAY THE INTERVIEW DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR ‘MM/DD/YYYY’.
DISPLAY ‘We request ... prepare the forms.]’ IF CL01 WAS NOT ASKED FOR THE CURRENT ROUND. OTHERWISE, USE A NULL DISPLAY.
CONTINUE WITH END_LP02A END_LP02A
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_02A AND CONTINUE WITH BOX_03 BOX_03
Subsection 2: HIPS AUTHORIZATION FORMS (BEGINNING WITH THE SECOND YEAR OF PANEL 2 AND THE FIRST YEAR OF PANEL 3 (1998), SAMPLING CONTINUES BUT AUTHORIZATION FORMS ARE NOT COLLECTED). SAMPLING BOX FOR ROUNDS 2 AND 3: (TO BASE ON ROUND 1 CRITERIA FOR COLLECTION OF AFs IN ROUND 2 AND ROUND 3): RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION: - ALL PAIRS WHERE THE PERSON IS THE POLICYHOLDER OF THIS INSURANCE ON THE DATE OF THE ROUND 1 INTERVIEW AND THE ESTABLISHMENT IS A PRIVATE SOURCE OF INSURANCE (DEFINED LATER) HELD ON THE DATE OF THE ROUND 1 INTERVIEW (DEFINED LATER) WITH FOUR EXCEPTIONS: 1. ESTABLISHMENT IS FLAGGED AS ‘EMPLOYER’ AND EMPLOYER IS THE FEDERAL GOVERNMENT (EM96=2 OR HP13=1) 2. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF- EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2) 3. PERSON IS THE POLICYHOLDER OF THIS INSURANCE AND IS FLAGGED AS ‘POLICYHOLDER NOT LISTED IN RU’ 4. ESTABLISHMENT ONLY PROVIDES LONG TERM CARE IN A NURSING HOME, EXTRA CASH FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD DISEASE, DISABILITY, WORKER’S COMPENSATION, OR ACCIDENT INSURANCE (HX48 IS CODED ONLY COMBINATIONS OF CODES ‘6’, ‘7’, ‘8’, ‘9’, ‘10’, AND ‘11’).
SAMPLING BOX FOR ROUNDS 2 AND 3: (TO BASE ON ROUND 1 CRITERIA FOR COLLECTION OF AFs IN ROUND 2 AND ROUND 3): RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION: - ALL PAIRS WHERE THE ESTABLISHMENT IS FLAGGED AS ‘EMPLOYER’ AND THE JOB SUBTYPE OF THAT EMPLOYER IS FLAGGED AS ‘CURRENT MAIN’ AND THE JOB IS NOT FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ (PERSON IS THE JOBHOLDER OF THIS CURRENT MAIN JOB ON THE DATE OF THE ROUND 1 INTERVIEW) AS OF THE ROUND 1 INTERVIEW DATE WITH THREE EXCEPTIONS: 1. ESTABLISHMENT IS THE FEDERAL GOVERNMENT (EM96 = 2) 2. ESTABLISHMENT IS FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE=1 3. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF- EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2)
SAMPLING BOX FOR ROUNDS 4 AND 5: RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION: - ALL PAIRS WHERE THE ESTABLISHMENT IS FLAGGED AS ‘EMPLOYER’ AND THE JOB SUBTYPE OF THAT EMPLOYER IS FLAGGED AS ‘CURRENT MAIN’ AND THE JOB IS NOT FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ (PERSON IS THE JOBHOLDER OF THIS CURRENT MAIN JOB ON THE DATE OF THE ROUND 1 INTERVIEW) AS OF THE ROUND 1 INTERVIEW DATE WITH THREE EXCEPTIONS: 1. ESTABLISHMENT IS THE FEDERAL GOVERNMENT (EM96 = 2) 2. ESTABLISHMENT IS FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE=1 3. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF- EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2)
NOTE: PRIVATE INSURANCE IS DEFINED AS: - ESTABLISHMENTS FLAGGED AS ‘EMPLOYER’ AND FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ (ESTABLISHMENTS FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1 ARE TREATED AS DIRECT PURCHASED, SEE NOTE BELOW) - DIRECT PURCHASED INSURANCE, THAT IS, ESTABLISHMENTS CREATED FROM THE HX23 SERIES
NOTE: HELD ON THE DATE OF THE ROUND 1 INTERVIEW: - FOR PRIVATE SOURCES -- POLICYHOLDER HELD INSURANCE AT THE TIME OF THE ROUND 1 INTERVIEW DATE (HQ01 IS CODED ‘1’ (WHOLE TIME) OR HQ02 IS CODED ‘1’ (YES, COVERED NOW) FOR THE POLICYHOLDER) - FOR PRIVATE SOURCES WHERE POLICYHOLDER IS DECEASED -- AT LEAST ONE DEPENDENT (SELECTED AT HP16) IS COVERED BY THE INSURANCE AT THE TIME OF THE ROUND 1 INTERVIEW DATE (HQ01 IS CODED ‘1’ (WHOLE TIME) OR HQ02 IS CODED ‘1’ (YES, COVERED NOW) FOR THE COVERED PERSON)
NOTE: ESTABLISHMENTS WHICH ARE EMPLOYERS AND PROVIDE HEALTH INSURANCE AND ARE FLAGGED AS ‘SELF- EMPLOYED’ WITH A FIRM-SIZE=1 ARE TREATED AS DIRECT PURCHASED INSURANCE, THAT IS, HIPS WILL CONTACT THE ESTABLISHMENT PROVIDING THE INSURANCE, (I.E., CREATED FROM THE HX03 SERIES) NOT THE EMPLOYER.
NOTE: FOR ESTABLISHMENTS WHICH ARE CURRENT MAIN EMPLOYERS (ON THE ROUND 1 INTERVIEW DATE) AND PROVIDE HEALTH INSURANCE, WHERE THE HEALTH INSURANCE IS ONLY FROM A UNION (EM117=2), A HIPS AUTHORIZATION FORM IS REQUIRED FOR BOTH THE EMPLOYER AND THE UNION. IN THESE CASES, BOTH ESTABLISHMENT-PERSON-PAIRS ARE ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION.
NOTE: IF A CURRENT MAIN JOB IS FLAGGED AS ‘PREVIOUS HEALTH INSURANCE’ BUT THAT INSURANCE IS ONLY LONG TERM CARE IN A NURSING HOME, EXTRA CASH FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD DISEASE, DISABILITY, WORKER’S COMPENSATION, AND/OR ACCIDENT INSURANCE, THE JOB IS PROCESSED AS IF IT DOES NOT PROVIDE HEALTH INSURANCE BUT IS ELIGIBLE FOR HEALTH INSURANCE PROVIDER AUTHORIZATION FORM COLLECTION (AS LONG AS OTHER REQUIREMENTS ARE MET).
NOTE: A ‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW) RESPONSE AT ANY QUESTION LISTED ABOVE DOES NOT MEET THE CRITERIA.
NOTE: IN ROUND 4, A NEW HIPS FLAG WILL BE SET AND NEW HIPS AUTHORIZATION FORMS WILL BE COLLECTED FOR ALL ESTABLISHMENT-PERSON-PAIRS BASED ON THE ABOVE SAMPLING CRITERIA, BUT USING ROUND 3 DATA.
SAMPLING BOX (TO BASE ON ROUND 3 CRITERIA, FOR COLLECTION OF AFs IN ROUNDS 4 AND 5): RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION: - ALL PAIRS WHERE THE PERSON IS THE POLICYHOLDER OF THIS INSURANCE ON THE DATE OF THE ROUND 3 INTERVIEW AND THE ESTABLISHMENT IS A PRIVATE SOURCE OF INSURANCE (DEFINED LATER) HELD ON THE DATE OF THE ROUND 3 INTERVIEW (DEFINED LATER) WITH FOUR EXCEPTIONS: 1. ESTABLISHMENT IS FLAGGED AS ‘EMPLOYER’ AND EMPLOYER IS THE FEDERAL GOVERNMENT (EM96=2 OR HP13=1) 2. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF- EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2) 3. PERSON IS THE POLICYHOLDER OF THIS INSURANCE AND IS FLAGGED AS ‘POLICYHOLDER NOT LISTED IN DU’ 4. ESTABLISHMENT PROVIDES ONLY LONG TERM CARE IN A NURSING HOME, EXTRA CASH FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD DISEASE, DISABILITY, WORKER’S COMPENSATION, OR ACCIDENT INSURANCE (HX48, OE10, OE24, OR OE37 IS CODED ONLY COMBINATIONS OF CODES ‘6’, ‘7’, ‘8’, ‘9’, ‘10’, AND ‘11’).
SAMPLING BOX FOR ROUNDS 4 AND 5: (TO BASE ON ROUND 3 CRITERIA, FOR COLLECTION OF AFs IN ROUNDS 4 AND 5): RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION: - ALL PAIRS WHERE THE ESTABLISHMENT IS FLAGGED AS ‘EMPLOYER’ AND THE JOB SUBTYPE OF THAT EMPLOYER IS FLAGGED AS ‘CURRENT MAIN’ AND THE JOB IS NOT FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ (PERSON IS THE JOBHOLDER OF THIS CURRENT MAIN JOB ON THE DATE OF THE ROUND 3 INTERVIEW) AS OF THE ROUND 3 INTERVIEW DATE WITH THREE EXCEPTIONS: 1. ESTABLISHMENT IS THE FEDERAL GOVERNMENT (EM96 = 2) 2. ESTABLISHMENT IS FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE=1 3. ESTABLISHMENT IS FLAGGED AS ‘NOT SELF- EMPLOYED’ WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2)
NOTE: PRIVATE INSURANCE IS DEFINED AS: - ESTABLISHMENTS FLAGGED AS ‘EMPLOYER’ AND FLAGGED AS ‘PROVIDES HEALTH INSURANCE’ (ESTABLISHMENTS FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE-1 ARE TREATED AS DIRECT PURCHASED, SEE NOTE BELOW) - DIRECT PURCHASED INSURANCE, THAT IS, ESTABLISHMENTS CREATED FROM THE HX23 SERIES
NOTE: HELD ON THE DATE OF THE ROUND 3 INTERVIEW: - FOR PRIVATE SOURCES -- POLICYHOLDER HELD INSURANCE AT THE TIME OF THE ROUND 3 INTERVIEW DATE [(HQ01 IS CODED ‘1’ (WHOLE TIME) OR HQ02 IS CODED ‘1’ (YES, COVERED NOW) FOR THE POLICYHOLDER) OR (OE01, OE12, OE26 IS CODED ‘1’ (YES) FOR THE POLICYHOLDER) - FOR PRIVATE SOURCES WHERE POLICYHOLDER IS DECEASED -- AT LEAST ONE DEPENDENT [(SELECTED AT HP16 OR OE45) OR (CONFIRMED AS STILL COVERED AT OE29 OR OE30)] IS COVERED BY THE INSURANCE AT THE TIME OF THE ROUND 3 INTERVIEW DATE [(HQ01 IS CODED ‘1’ (WHOLE TIME) OR HQ02 IS CODED ‘1’ (YES, COVERED NOW) FOR THE COVERED PERSON) OR (OE26 IS CODED ‘1’ (YES) FOR THE COVERED PERSON)]
NOTE: ESTABLISHMENTS WHICH ARE EMPLOYERS AND PROVIDE HEALTH INSURANCE AND ARE FLAGGED AS ‘SELF-EMPLOYED’ WITH A FIRM-SIZE=1 ARE TREATED AS DIRECT PURCHASED INSURANCE, THAT IS, HIPS WILL CONTACT THE ESTABLISHMENT PROVIDING THE INSURANCE, (I.E., CREATED FROM THE HX03 SERIES) NOT THE EMPLOYER.
NOTE: FOR ESTABLISHMENTS WHICH ARE CURRENT MAIN EMPLOYERS (ON THE ROUND 3 INTERVIEW DATE) AND PROVIDE HEALTH INSURANCE, WHERE THE HEALTH INSURANCE IS ONLY FROM A UNION (EM117=2), A HIPS AUTHORIZATION FORM IS REQUIRED FOR BOTH THE EMPLOYER AND THE UNION. IN THESE CASES, BOTH ESTABLISHMENT-PERSON-PAIRS ARE ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION.
NOTE: IF A CURRENT MAIN JOB IS FLAGGED AS ‘PREVIOUS HEALTH INSURANCE’ BUT THAT INSURANCE IS ONLY LONG TERM CARE IN A NURSING HOME, EXTRA CASH FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD DISEASE, DISABILITY, WORKER’S COMPENSATION, AND/OR ACCIDENT INSURANCE, THE JOB IS PROCESSED AS IF IT DOES NOT PROVIDE HEALTH INSURANCE BUT IS ELIGIBLE FOR HEALTH INSURANCE PROVIDER AUTHORIZATION FORM COLLECTION (AS LONG AS OTHER REQUIREMENTS ARE MET).
NOTE: A ‘-7’ (REFUSED) AND ‘-8’ (DON’T KNOW) RESPONSE AT ANY QUESTION LISTED ABOVE DOES NOT MEET THE CRITERIA.
GO TO BOX_10 BOX_10
Subsection 4: Pharmacy Requests and Authorization Forms (Rounds 2-5) AS A PHARMACY WAS ENTERED OR SELECTED DURING THE PRESCRIBED MEDICINES SECTION, THE PERSON-PHARMACY- PAIR WAS FLAGGED WITH THE CURRENT ROUND (I.E., THE MOST RECENT ROUND IT WAS ENTERED/SELECTED). THIS ROUND FLAG IS USED TO DETERMINE WHETHER THE PHARMACY IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THIS RU MEMBER.
IF ROUND 1, GO TO BOX_14
OTHERWISE (I.E., IF ROUNDS 2-5), CONTINUE WITH BOX_11
NOTE: PANELS 1 THROUGH 12 INCLUDED PHARMACY AF COLLECTION ONLY IN ROUNDS 3 AND 5. PANEL 13 INCLUDES PHARMACY AF COLLECTION IN ROUNDS 3, 4, AND 5. BEGINNING IN PANEL 14, AND ALL SUBSEQUENT PANELS, PHARMACY AF COLLECTION OCCURS IN ROUNDS 2-5. BOX_11
IF AT LEAST ONE PERSON-PHARMACY-PAIR ELIGIBLE (SEE SAMPLING BOX BELOW) FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND, OR AT LEAST ONE PERSON-PHARMACY-PAIR ELIGIBLE FOR AUTHORIZATION FORM COLLECTION DURING THE PREVIOUS ROUND AND CL32 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER), OR ‘-1’ (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PHARMACY-PAIR IN PREVIOUS ROUND, CONTINUE WITH CL30
OTHERWISE, GO TO BOX_14
NOTE: RECEIPT CONTROL WILL UPDATE CAPI INTER- ROUND, USING THE CODE STRUCTURE AT CL32. UPDATES CAN BE EITHER POSITIVE OR NEGATIVE. THIS MEANS THAT INTER-ROUND AN AUTHORIZATION FORM’S STATUS CAN EITHER GET UPDATED TO A HIGHER STATUS CODE (FROM UNSIGNED TO SIGNED) OR TO A LOWER STATUS CODE (FROM SIGNED TO UNSIGNED -- I.E., IT WAS NOT SIGNED BY THE RIGHT PERSON). SEE MPC MAPPING SPECIFICATIONS FOR EXACT UPDATES TO STATUS CODES.
NOTE BOX THERE ARE 6 PERSON TYPES (AND TWO SUB-TYPES) IN THE MEPS RU TYPE PRSLT DECEASED/ELIGIBLE FOR PART OF REF PERIOD 41 INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD 51 IN A HEALTHCARE FACILITY (INSTTTYPE 1 OR 2) IN A NON-HEALTHCARE FACILITY (INSTTYPE 3) MEPS STUDENT/ELIGIBLE ALL OF REF PERIOD 71 LIVING OUTSIDE US/ELIGIBLE PT OF REF PERIOD 75 LIVING-MILITARY BASE/ELIGIBLE PT REF PERIOD 76 ELIGIBLE FOR ALL OF REFERENCE PERIOD 99 THE FOLLOWING PERSON TYPES (AND SUB-TYPES) ARE ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION: - PRSLT 41 - DECEASED/ELIGIBLE FOR PART OF REF PERIOD - PRSLT 51 SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A HEALTHCARE FACILITY (INSTTYPE 1 OR 2) - PRSLT 71 - MEPS STUDENT/ELIGIBLE ALL OF REF PERIOD - PRSLT 99 - ELIGIBLE FOR ALL OF REFERENCE PERIOD THERE ARE TWO TYPES OF OUT OF SCOPE RU MEMBERS THAT ARE ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION (NOTE: OUT OF SCOPE REFERS TO RU MEMBERS WHO HAD PARTIAL ELIGIBILITY IN THE PREVIOUS ROUND AND NO ELIGIBILITY IN THE CURRENT ROUND): - PRSLT 41 - DECEASED/ELIGIBLE FOR PART OF REF PERIOD - PRSLT 51 SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A HEALTHCARE FACILITY (INSTTYPE 1 OR 2) 2 PERSON TYPES AND 1 SUB-TYPE ARE NOT ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION: - PRSLT 51 SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A NON-HEALTHCARE FACILITY (INSTTYPE 3) - PRSLT 75 - LIVING OUTSIDE US/ELIGIBLE PT OF REF PERIOD - PRSLT 76 - LIVING-MILITARY BASE/ELIGIBLE PT REF PERIOD PERSON-PHARMACY-PAIRS WHERE THE PHARMACY LOCATION IS IN A FOREIGN COUNTRY (I.E., ‘FC’ IS ENTERED IN THE STATE FIELD OF PHARMACY’S ADDRESS ARE NOT ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION)
NOTE: PHARMACY AUTHORIZATION FORMS ARE NOT EVENT DEPENDENT, ARE NOT LINKED TO ANY SPECIFIC YEAR IN ROUND 3 AND ARE ASKED AS TWO SEPARATE SAMPLES. FOR THE FIRST SAMPLE, CAPI REQUESTS AUTHORIZATION FORMS FROM ROUNDS 1, 2 AND 3. FOR THE SECOND SAMPLE, CAPI REQUESTS AUTHORIZATION FORMS FROM ROUNDS 3, 4 AND 5. REQUESTS FOR OUTSTANDING AUTHORIZATION FORMS FROM ROUNDS 1 AND 2 SHOULD NOT BE CONTINUED IN ROUND 4, INCLUDING AUTHORIZATION FORMS FOR DECEASED AND INSTITUTIONALIZED PERSONS.
SAMPLING BOX PERSON-PHARMACY-PAIRS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION: NOTE: PERSON IS A KEY, ELIGIBLE RU MEMBER (AT TIME OF EVENT). ROUND 1: - AUTHORIZATION FORMS (AFS) ARE NOT REQUESTED IN ROUND 1 BUT PHARMACY RECORDS ARE CREATED. ROUND 2: - PERSON-PHARMACY PAIRS CREATED IN THE CURRENT ROUND. - PERSON-PHARMACY PAIRS CREATED IN THE PREVIOUS ROUND. ROUND 3: - PERSON-PHARMACY PAIRS CREATED IN THE CURRENT ROUND. - PERSON-PHARMACY PAIRS OUTSTANDING FROM THE PREVIOUS ROUND. - PERSON-PHARMACY PAIRS CREATED IN PREVIOUS ROUNDS BUT SELECTED IN THE CURRENT ROUND. ROUND 4: - PERSON-PHARMACY PAIRS CREATED IN THE CURRENT ROUND. - PERSON-PHARMACY PAIRS OUTSTANDING FROM THE PREVIOUS ROUND IF THEY WERE CREATED IN ROUND 3. - PERSON-PHARMACY PAIRS CREATED IN PREVIOUS ROUNDS BUT SELECTED IN THE CURRENT ROUND. ROUND 5: - PERSON-PHARMACY PAIRS CREATED IN THE CURRENT ROUND. - PERSON-PHARMACY PAIRS OUTSTANDING FROM THE PREVIOUS ROUND IF THEY WERE CREATED IN ROUND 3 OR 4. - PERSON-PHARMACY PAIRS CREATED IN PREVIOUS ROUNDS BUT SELECTED IN THE CURRENT ROUND.
NOTE: IF THE SAME PHARMACY IS ASSOCIATED MORE THAN ONCE WITH A PARTICULAR PERSON, ONLY ONE AUTHORIZATION FORM IS ASKED ABOUT FOR THAT PAIR. IF THE SAME PHARMACY IS ASSOCIATED WITH MORE THAN ONE PERSON, AN AUTHORIZATION FORM IS ASKED FOR EACH UNIQUE PERSON-PHARMACY-PAIR.
NOTE: IF THE PERSON-PHARMACY-PAIR IS OUTSTANDING FROM A PREVIOUS ROUND AND THE SAME PHARMACY IS SELECTED FOR THAT PERSON IN THE CURRENT ROUND, THE PAIR WILL NOT BE TREATED AS IF IT IS OUTSTANDING. THAT IS, THE DISPLAYS FOR PREVIOUS ROUND STATUS WILL NOT BE SHOWN, ETC. CL30 To obtain complete and accurate information about
health care use
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
ROSTER DETAILS: TITLE: RU_PERS_PHAR_PAIR_1 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: PHARMACY INSTRUCTIONS: DISPLAY PHARMACY NAME (PHAR.PHARNAME)
ROSTER DEFINITION: DISPLAY EACH UNIQUE PAIR ON THE RU-PERSON- PHARMACY-PAIRS-ROSTER.
ROSTER BEHAVIOR: 1. DISPLAY ONLY. 2. SELECT, EDIT, ADD, AND DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ONLY THOSE PAIRS THAT MEET THE FOLLOWING CONDITION(S): - PAIR IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_11 SAMPLING SPECIFICATIONS) OR - PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND, AND - CL32 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’ (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PHARMACY-PAIR IN PREVIOUS ROUND
NOTE: DISPLAY EACH UNIQUE ELIGIBLE PERSON- PHARMACY-PAIR ONLY ONCE. LOOP_07
FOR EACH ELEMENT ON THE RU-PERSON-PHARMACY-PAIRS- ROSTER, ASK CL31 - END_LP07
LOOP DEFINITION: LOOP_07 PRESENTS EACH UNIQUE PERSON-PHARMACY-PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE INTERVIEWER TO COMPLETE THE AUTHORIZATION FORM. THIS LOOP CYCLES ON THE RU-PERSON-PHARMACY-PAIRS THAT MEET THE FOLLOWING CONDITIONS: - PAIR IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_11 SAMPLING SPECIFICATIONS) OR - PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND, AND - CL32 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’ (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PHARMACY-PAIR IN PREVIOUS ROUND
NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON- PHARMACY-PAIR. CL31 INTERVIEWER: CHECK FIRST FOR PREPRINTED PHARMACY AF
FOR THIS PAIR.
DISPLAY ‘PHARMACY AF STATUS ... -40}’ IF CURRENT PERSON-PHARMACY-PAIR IS OUTSTANDING FROM THE PREVIOUS ROUND. FOR ‘DISPLAY PREVIOUS ROUND STATUS-40’, DISPLAY THE CATEGORY ENTRY ASSOCIATED WITH THE PREVIOUS ROUND (OR RECEIPT CONTROL UPDATED) CL32 OUTSTANDING STATUS. THAT IS, IF CL32 WAS CODED ‘3’, DISPLAY ‘LEFT WITH R’; IF CL32 WAS CODED ‘4’, DISPLAY ‘MAILED TO R’; IF CL32 WAS CODED ‘5’, DISPLAY ‘REFUSED’; AND IF CL32 WAS CODED ‘91’ OR ‘-1’, DISPLAY THE FIRST 40 CHARACTERS FROM THE OTHER SPECIFY ENTRY FIELD (OR THE RECEIPT CONTROL UPDATE TEXT GENERATED FOR THE ‘91’ OR ‘-1’ CODES) DISPLAY THE INTERVIEW DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR ‘MM/DD/YYYY’.
DISPLAY ‘22’ AND ‘ORCHID’ IF PANEL 22 INTERVIEW. DISPLAY ‘20’ AND ‘PINK’ IF PANEL 20 INTERVIEW. DISPLAY ‘21’ AND ‘GRAY’ IF PANEL 21 INTERVIEW. END_LP07
CYCLE ON NEXT PAIR ON THE RU-PERSON-PHARMACY- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_07 AND CONTINUE WITH LOOP_08 LOOP_08
FOR EACH ELEMENT ON THE RU-PERSON-PHARMACY-PAIRS- ROSTER, ASK CL32 - END_LP08
LOOP DEFINITION: LOOP_08 PRESENTS EACH UNIQUE PERSON-PHARMACY-PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE INTERVIEWER TO RECORD THE STATUS OF THE AUTHORIZATION FORM. THIS LOOP CYCLES ON THE RU-PERSON-PHARMACY-PAIRS THAT MEET THE FOLLOWING CONDITIONS: - PAIR IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_11 SAMPLING SPECIFICATIONS) OR - PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND, AND - CL32 WAS CODED '3' (LEFT WITH R), ‘4’ (MAILED TO R), ‘5’ (REFUSED), ‘91’ (OTHER) OR ‘-1’ (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PHARMACY-PAIR IN PREVIOUS ROUND
NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON- PHARMACY-PAIR. CL32 INTERVIEWER: ASK APPROPRIATE PERSON(S) TO SIGN
AUTHORIZATION FORM.
FOR ‘MM/DD/YYY’, DISPLAY THE RU END REFERENCE DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION
DISPLAY ‘22’ AND ‘ORCHID’ IF PANEL 22 INTERVIEW. DISPLAY ‘20’ AND ‘PINK’ IF PANEL 20 INTERVIEW. DISPLAY ‘21’ AND ‘GRAY’ IF PANEL 21 INTERVIEW.
SOFT CHECK: CODE ‘4’ (MAILED TO R) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE ‘4’ SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: ‘UNLIKELY RESPONSE. VERIFY AND RE-ENTER.’ CL32OV1 PROBLEM: CL32OV2 SPECIFY: CL33 FOR PANEL [PANEL-2], THE PHARMACY AF COLOR IS
{ORCHID/PINK/GRAY}.
FOR ‘MM/DD/YYYY’, DISPLAY THE RU END REFERENCE DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION.
DISPLAY ‘22’ AND ‘ORCHID’ IF PANEL 22 INTERVIEW. DISPLAY ‘20’ AND ‘PINK’ IF PANEL 20 INTERVIEW. DISPLAY ‘21’ AND ‘GRAY’ IF PANEL 21 INTERVIEW.
NOTE: EACH PHARMACY AUTHORIZATION FORM HAS A PRE-ASSIGNED PHARMACY AUTHORIZATION FORM NUMBER.
HARD CHECKPANEL 20 PHARMACY AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN AND END WITH AN ALPHA CHARACTER. PANEL 20 PHARMACY AUTHORIZATION FORMS ARE PRINTED ON PINK PAPER.
HARD CHECKPANEL 21 PHARMACY AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN AND END WITH AN ALPHA CHARACTER. PANEL 21 PHARMACY AUTHORIZATION FORMS ARE PRINTED ON GRAY PAPER.
HARD CHECKPANEL 22 PHARMACY AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN WITH AN ALPHA CHARACTER AND END WITH AN ALPHA CHARACTER. PANEL 22 PHARMACY AUTHORIZATION FORMS ARE PRINTED ON ORCHID PAPER.
SOME IMPORTANT POINTS TO REMEMBER ABOUT PHARMACY AUTHORIZATION FORMS: - THE PREFIX LETTER CHANGES BASED ON THE TYPE OF AUTHORIZATION FORM AND THE ORIGIN OF THE FORM. THIS MEANS THAT A PRE-PRINTED OR FIELD GENERATED AUTHORIZATION FORM WILL DRAW FROM THE SAME LETTER OR RANGE OF LETTERS IN EACH PANEL. THE EXCEPTION IS PANEL 14 PHARMACY AUTHORIZATION FORMS WHICH WILL DRAW FROM AN EXPANDED LIST OF PREFIX LETTERS TO ACCOMMODATE A CHANGE IN COLLECTION PROCEDURES. - THE 5-NUMBER SEQUENCE REPEATS ITSELF FOR EACH PANEL. - THE CHECK-DIGIT ALWAYS REMAINS CONSTANT. - THE ROUND IDENTIFIER IS DIFFERENT FOR EACH PANEL. THE ROUND IDENTIFIER WILL REMAIN THE SAME FOR ALL AUTHORIZATION FORMS COLLECTED WITHIN A PANEL, BUT CHANGES BASED ON THE ROUND. FOR EXAMPLE: AUTHORIZATION FORMS GENERATED FOR PANEL 19, ROUND 1 WILL USE THE ROUND IDENTIFIER “M”; “M” OR “N” FOR ROUND 2; “M”, “N”, OR “P” FOR ROUND 3; “M”, “N”, “P” OR “Q” FOR ROUND 4; AND “M”, “N”, “P”, “Q” OR “R” FOR ROUND 5. CL33OV PHARMACY AUTHORIZATION FORM SIGNATURE DATE:
NOTE: INTERVIEWERS WILL BE INSTRUCTED TO COLLECT SIGNED PHARMACY AUTHORIZATION FORMS WITH DATES EARLIER THAN THE ONE DISPLAYED, BUT WILL NOT ENTER THE NUMBER IN CAPI SINCE THE CURRENT STATUS FOR THE AUTHORIZATION FORM WITH THE CORRECT DATE MAY BE SOMETHING ELSE. THE CAPI STATUS OF THE PHARMACY AUTHORIZATION FORM SHOULD REFLECT THE FORM WITH THE MOST RECENT DATE.
HARD CHECK: DATE ENTERED MUST BE ON OR AFTER THE INTERVIEW DATE OF THE MOST RECENT ROUND’S INTERVIEW FOR WHICH THE PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION BUT CANNOT BE AFTER ‘TODAY’S DATE’ (THE CURRENT DATE SET ON THE LAPTOP). IF DATE IS BEFORE CORRECT DATE, DISPLAY THE FOLLOWING MESSAGE: ‘PHARMACY AF MUST BE SIGNED ON OR AFTER ABOVE DATE. VERIFY AND RE-ENTER DATE OR COMPLETE NEW AF.’ CL34 PID: [PID] PERSON: [First,[Middle],Last Name-35] CL34OV OTHER REASON FOR REFUSAL: END_LP08
CYCLE ON NEXT PAIR ON THE RU-PERSON-PHARMACY- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_08 AND CONTINUE WITH BOX_14 BOX_14
SUBSECTION 5: SELF-ADMINISTERED QUESTIONNAIRE (ROUNDS 2 THROUGH 5)
IF ROUND 2 OR 4, CONTINUE WITH BOX_15
IF ROUND 3 OR 5, GO TO BOX_16
OTHERWISE, GO TO BOX_16A BOX_15
IF ROUND 2 OR 4 AND AT LEAST ONE KEY RU MEMBER ELIGIBLE FOR SAQ (I.E., AT LEAST ONE CURRENT RU MEMBER WHO IS KEY AND WHO IS NOT DECEASED OR INSTITUTIONALIZED AND IS IN THE RU AT THE ROUND 2 OR 4 INTERVIEW DATE AND IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2 OR ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2, OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 4, CONTINUE WITH CL35
OTHERWISE, GO TO BOX_16A
NOTE: DETERMINING WHICH ADULTS IN THE RU RECEIVE AN SAQ AND WHICH ADULTS ARE FOLLOWED-UP IN ROUND 3 OR 5 WILL BE BASED ONLY ON ROUND 2 OR 4 INFORMATION. THAT IS, NO RU MEMBERS ADDED IN ROUND 3 OR 5 WILL BE ASKED TO COMPLETE AN SAQ. CL35 Now I would like to ask (READ PERSON NAMES BELOW) to
complete
AS APPROPRIATE, PREPARE AN SAQ FOR EACH PERSON LISTED
ABOVE.
ROSTER DETAILS: TITLE: RU-MEMBERS_7 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: PID INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID (PERS.PID)
ROSTER DEFINITION: DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
ROSTER BEHAVIOR: 1. DISPLAY ONLY. 2. SELECT, EDIT, ADD, DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ALL PERSONS WHO MEET THE FOLLOWING CONDITIONS: - PERSON IS KEY - PERSON DOES NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE - PERSON CURRENTLY IN RU ON ROUND 2 OR 4 INTERVIEW DATE - PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2, OR ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2 OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL AND THE DATE OF THE INTERVIEW IF ROUND 4. LOOP_09
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV_CL09 END_LP09
LOOP DEFINITION: LOOP_09 COLLECTS THE SAQ STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THE SAQ. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS- ROSTER WHO MEETS THE FOLLOWING CONDITIONS: - PERSON IS KEY - PERSON DOES NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE - PERSON CURRENTLY IN RU ON ROUND 2 OR 4 INTERVIEW DATE - PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2, OR ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2 OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL AND THE DATE OF THE INTERVIEW IF ROUND 4.
NAVIGATOR DETAILS: LOOP_09 USES NAV_CL09 TO CONTROL THE FLOW OF THE LOOP. NAV_CL09 SERIES: Collect and Record the Status of Each SAQ.
ROSTER DETAILS: COL # 1 HEADER: RU MEMBER INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: EMPTY INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
ROSTER DEFINITION: THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR: 1. SELECT ALLOWED. 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER: DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_09 DEFINITION.
CONTINUE WITH CL36 FOR SELECTED RU MEMBER. CL36 {PERSON’S FIRST MIDDLE AND LAST NAME}
DISPLAY THE PERSON’S 3-DIGIT PID FOR ‘PID’. DISPLAY ‘AND EXPLAIN...SAQ’ IF PANEL 17, ROUND 4. OTHERWISE, USE A NULL DISPLAY.
NOTE: STARTING IN PANEL 18, PAYMENT WILL NO LONGER BE MADE FOR COMPLETED SAQ. FORMS.
SOFT CHECK: CODE ‘4’ (MAILED TO SAQ RESPONDENT) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE ‘4’ SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: ‘UNLIKELY RESPONSE. VERIFY AND RE-ENTER.’ CL36OV SPECIFY: CL37 {PERSON’S FIRST MIDDLE AND LAST NAME} CL37OV OTHER REASON FOR REFUSAL: END_LP09
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_09 AND GO TO BOX_16A BOX_16
IF AT LEAST ONE PERSON WITH AN SAQ DISPOSITION IN THE PREVIOUS ROUND (SAQSTAT) OF ‘5’ (REFUSED TO COMPLETE SAQ) OR [‘91’ (OTHER) AND UPDATED BY RECEIPT CONTROL (RCFLG) to 0, 1, or 3] DURING ROUND 2 OR 4 AND NOT UPDATED BY RECEIPT, CONTINUE WITH CL38
OTHERWISE, GO TO BOX_16A CL38 During the last interview a short booklet about health
and
1. COLLECT SAQs, IF AVAILABLE.
ROSTER DETAILS: TITLE: RU-MEMBERS_7 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: PID INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID (PERS.PID)
ROSTER DEFINITION: DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
ROSTER BEHAVIOR: 1. DISPLAY ONLY. 2. SELECT, EDIT, ADD, DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS: - PERSON IS KEY - PERSON DID NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE - PERSON WAS CURRENTLY IN RU ON ROUND 2 OR 4 INTERVIEW DATE - PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2, OR ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2 OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL AND THE DATE OF THE INTERVIEW IF ROUND 4. - CL36 WAS CODED ‘1’ (COMPLETED AND GIVEN TO INTERVIEWER), ‘2’ (NOT COMPLETED, WILL PICK UP AT LATER DATE), ‘3’ (NOT COMPLETED, WILL MAIL TO OFFICE),‘4’ (MAILED TO SAQ RESPONDENT), ‘5’ (REFUSED TO COMPLETE SAQ), OR ‘91’ (OTHER) DURING ROUND 2 OR 4 FOR PERSON AND NOT UPDATED BY RECEIPT CONTROL TO ‘1’ (COMPLETE), ‘2’ (PARTIAL COMPLETE), ‘4’ (PROBLEM), OR ‘6’ (WRONG SAQ TYPE) ((I.E., RECEIPT CONTROL IS EQUAL TO ‘3’ (REFUSED) OR ‘5’ (NOT HERE/BLANK)) LOOP_10
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV_CL10 - END_LP10
LOOP DEFINITION: LOOP_10 COLLECTS THE SAQ STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THE SAQ. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS- ROSTER WHO MEETS THE FOLLOWING CONDITIONS: - PERSON IS KEY - PERSON DID NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE - PERSON WAS CURRENTLY IN RU ON ROUND 2 OR 4 INTERVIEW DATE - PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2, OR ON JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2 OR JULY 1, {YEAR}, WHERE ‘YEAR’ IS THE SECOND CALENDAR YEAR OF THE PANEL AND THE DATE OF THE INTERVIEW IF ROUND 4. - CL36 WAS CODED ‘1’ (COMPLETED AND GIVEN TO INTERVIEWER), ‘2’ (NOT COMPLETED, WILL PICK UP AT LATER DATE), ‘3’ (NOT COMPLETED, WILL MAIL TO OFFICE),‘4’ (MAILED TO SAQ RESPONDENT), ‘5’ (REFUSED TO COMPLETE SAQ), OR ‘91’ (OTHER) DURING ROUND 2 OR 4 FOR PERSON AND NOT UPDATED BY RECEIPT CONTROL TO ‘1’ (COMPLETE), ‘2’ (PARTIAL COMPLETE), ‘4’ (PROBLEM), OR ‘6’ (WRONG SAQ TYPE) ((I.E., RECEIPT CONTROL IS EQUAL TO ‘3’ (REFUSED) OR ‘5’ (NOT HERE/BLANK))
NAVIGATOR DETAILS: LOOP_10 USES NAV_CL10 TO CONTROL THE FLOW OF THE LOOP. NAV_CL10 SERIES: SAQ Forms.
ROSTER DETAILS: COL # 1 HEADER: SAQ FORMS INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: EMPTY INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
ROSTER DEFINITION: THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR: 1. SELECT ALLOWED. 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER: DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_10 DEFINITION.
CONTINUE WITH CL39 FOR SELECTED RU MEMBER. CL39 {PERSON’S FIRST MIDDLE AND LAST NAME}
DISPLAY THE PERSON’S 3-DIGIT PID FOR ‘PID’.
DISPLAY ‘SAQ STATUS FROM PREVIOUS ROUND’ {PREVIOUS ROUND STATUS -40}’. OTHERWISE, USE A NULL DISPLAY. FOR ‘PREVIOUS ROUND STATUS-40’, DISPLAY THE TEXT ASSOCIATED WITH THE ROUND 2 OR 4 (OR RECEIPT CONTROL UPDATED STATUS) STATUS ENTERED AT CL36. OTHERWISE, USE A NULL DISPLAY. DISPLAY ‘AND EXPLAIN...SAQ’ IF PANEL 17, ROUND 5. OTHERWISE, USE A NULL DISPLAY.
NOTE: STARTING IN PANEL 18, PAYMENT WILL NO LONGER BE MADE FOR COMPLETED SAQ FORMS. CL39OV SPECIFY: CL40 {PERSON’S FIRST MIDDLE AND LAST NAME} CL40OV OTHER REASON FOR REFUSAL: END_LP10
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_10 AND CONTINUE WITH BOX_16A BOX_16A
SUBSECTION 5A: DIABETES CARE SUPPLEMENT (DCS) QUESTIONNAIRE (ROUNDS 3 AND 5 ONLY)
IF ROUND 3 OR 5, CONTINUE WITH BOX_16B
OTHERWISE, GO TO CL41 BOX_16B
IF ROUND 3 OR 5 AND AT LEAST ONE RU MEMBER ELIGIBLE FOR DIABETES CARE SUPPLEMENT (I.E., AT LEAST ONE RU MEMBER WHO IS CONFIRMED AS HAVING DIABETES AT PC02A), CONTINUE WITH CL40A
OTHERWISE, GO TO BOX_16C CL40A SELF DIABETES CARE SUPPLEMENT (DCS):
AS APPROPRIATE, COLLECT A DCS FOR EACH PERSON LISTED
ABOVE.
DISPLAY THE ROW PERSON’S PID FOR ‘PID’.
DISPLAY THE TYPE OF DCS FOR THE PERSON FOR ‘SELF/PROXY’. IF PC03 FOR THE ROW PERSON IS CODED ‘1’ (SELF), DISPLAY ‘SELF.’ IF PC03 FOR THE ROW PERSON IS CODED ‘2’ (PROXY), DISPLAY ‘PROXY.’
ROSTER DETAILS: TITLE: RU-MEMBERS_9 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: PID INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID (PERS.PID)
ROSTER DEFINITION: DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
ROSTER BEHAVIOR: 1. DISPLAY ONLY. 2. SELECT, ADD, EDIT, DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ALL PERSONS WHO MEET THE FOLLOWING CONDITION: - PC02A IS CODED ‘1’ (CONTINUE) FOR THE PERSON LOOP_10A
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV-CL10A END_LP10A
LOOP DEFINITION: LOOP_10A COLLECTS THE DCS STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THE DCS. THIS LOOP CYCLES ON EACH PERSON ON THE RU- MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITION: - PC02A IS CODED ‘1’ (CONTINUE) FOR THE PERSON
NAVIGATOR DETAILS: LOOP_10A USES NAV_CL10A TO CONTROL THE FLOW OF THE LOOP. NAV_CL10A SERIES: DCS Forms.
ROSTER DETAILS: COL # 1 HEADER: DCS FORMS INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: EMPTY INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
ROSTER DEFINITION: THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR: 1. SELECT ALLOWED. 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER: DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_10A DEFINITION.
CONTINUE WITH CL40B FOR SELECTED RU MEMBER. CL40B {PERSON’S FIRST MIDDLE AND LAST NAME}
DISPLAY THE PERSON’S 3-DIGIT PID FOR ‘PID’.
FOR ‘SELF/PROXY’, DISPLAY ‘SELF’ IF THE PERSON BEING LOOPED ON IS CODED ‘1’ (SELF) AT PC03. DISPLAY ‘PROXY’ IF THE PERSON BEING LOOPED ON IS CODED ‘2’ (PROXY) AT PC03.
SOFT CHECK: CODE ‘4’ (MAILED TO DCS RESPONDENT) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE ‘4’ SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: ‘UNLIKELY RESPONSE. VERIFY AND RE-ENTER.’ CL40BOV SPECIFY: CL40C {PERSON’S FIRST MIDDLE AND LAST NAME} CL40COV OTHER REASON FOR REFUSAL: END_LP10A
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITION STATED IN THE LOOP DEFINITION
IF NO OTHER PERSONS MEET THE STATED CONDITION, END LOOP_10A AND CONTINUE WITH BOX_16C BOX_16C
SUBSECTION 5B: CANCER SAQ QUESTIONNAIRE (ROUNDS 1, 3, AND 5 ONLY)
IF PANEL 22 ROUND 1 OR PANEL 21 ROUND 3, CONTINUE WITH BOX_16D
OTHERWISE, GO TO BOX_16E
NOTE: THE DISTRIBUTION AND COLLECTION OF THE CANCER SAQ OCCURS ONLY DURING PANEL 16 ROUND 3, PANEL 15 ROUND 5, PANEL 21 ROUND 1, PANEL 20 ROUND 3, PANEL 22 ROUND 1, AND PANEL 21 ROUND 3 (BUT ONLY FOR NEWLY IDENTIFIED CANCER). BOX_16D
IF PANEL 22 ROUND 1 OR PANEL 21 ROUND 3 AND AT LEAST ONE RU MEMBER ELIGIBLE FOR CANCER SAQ (I.E., AT LEAST ONE RU MEMBER WHO IS CONFIRMED AS HAVING CANCER AT PC04 DURING THE CURRENT ROUND), CONTINUE WITH CL40D
OTHERWISE, GO TO BOX_16E CL40D CANCER SAQ FOLLOW-UP:
AS APPROPRIATE, COLLECT A CANCER SAQ FOR EACH PERSON
LISTED ABOVE.
ROSTER DETAILS: TITLE: RU-MEMBERS_9 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: PID INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID (PERS.PID)
ROSTER DEFINITION: DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
ROSTER BEHAVIOR: 1. DISPLAY ONLY. 2. SELECT, ADD, EDIT, DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ALL PERSONS WHO MEET THE FOLLOWING CONDITION: - PC04 IS CODED ‘1’ (CONTINUE) FOR THE PERSON LOOP_10B
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV-CL10B END_LP10B
LOOP DEFINITION: LOOP_10B COLLECTS THE CANCER SAQ STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THE CANCER SAQ. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITION: - PC04 IS CODED ‘1’ (CONTINUE) FOR THE PERSON
NAVIGATOR DETAILS: LOOP_10B USES NAV_CL10B TO CONTROL THE FLOW OF THE LOOP. NAV_CL10B SERIES: Cancer SAQ Forms.
ROSTER DETAILS: COL # 1 HEADER: CANCER SAQ FORMS INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: EMPTY INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
ROSTER DEFINITION: THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR: 1. SELECT ALLOWED. 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER: DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_10B DEFINITION.
CONTINUE WITH CL40E FOR SELECTED RU MEMBER. CL40E {PERSON’S FIRST MIDDLE AND LAST NAME}
DISPLAY THE PERSON’S 3-DIGIT PID FOR ‘PID’.
SOFT CHECK: CODE ‘4’ (MAILED TO CANCER SAQ RESPONDENT) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE ‘4’ SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: ‘UNLIKELY RESPONSE. VERIFY AND RE-ENTER.’ CL40EOV SPECIFY:[Enter Other Specify-45] ............... {END_LP10B} CL40F {PERSON’S FIRST MIDDLE AND LAST NAME} CL40FOV OTHER REASON FOR REFUSAL: END_LP10B
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITION STATED IN THE LOOP DEFINITION
IF NO OTHER PERSONS MEET THE STATED CONDITION, END LOOP_10B AND GO TO BOX_16E
BOX_16E BEGINS SUBSECTION 5B: COLLECTING/UPDATING PREVENTIVE CARE SAQ STATUS (ROUND 5) BOX_16E
SUBSECTION 5B: PREVENTIVE CARE SELF-ADMINISTERED QUESTIONNAIRE (ROUND 5)
IF PANEL 18 ROUND 5 AND AT LEAST ONE RU MEMBER ELIGIBLE FOR PREVENTIVE CARE SAQ (I.E., AT LEAST ONE CURRENT RU MEMBER WHO DOES NOT HAVE ROUND 5 STATUS OF DECEASED OR INSTITUTIONALIZED WAS SAMPLED), CONTINUE WITH CL40AA
OTHERWISE, GO TO CL41
NOTE: THERE WILL BE NO FOLLOW-UP ON THE PREVENTIVE CARE SAQS. COLLECTION INFORMATION IN ROUND 5 WILL BE BASED ONLY ON PRELOADED SAMPLE INFORMATION. THAT IS, NO RU MEMBERS ADDED IN ROUND 5 WILL BE ASKED TO COMPLETE A PREVENTIVE CARE SAQ. THE PREVENTIVE SAQ WAS ONLY ADMINISTERED IN PANEL 18, ROUND 5. CL40AA (Not long ago), we mailed a short {blue/purple}
questionnaire about
1. COLLECT BLUE PREVENTIVE CARE SAQ FROM MALES.
DISPLAY ‘blue’ IF PERSON BEING ASKED ABOUT IS MALE. DISPLAY ‘purple’ IF PERSON BEING ASKED ABOUT IS FEMALE. IF MULTIPLE PERSONS OF DIFFERENT SEXES ARE BEING ASKED ABOUT, USE A NULL DISPLAY.
ROSTER DETAILS: TITLE: RU-MEMBERS_7 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: PID INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID (PERS.PID) COL # 3 HEADER: SEX INSTRUCTIONS: DISPLAY RU MEMBERS’ SEX (PERS.SMPSEXR)
ROSTER DEFINITION: DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
ROSTER BEHAVIOR: 1. DISPLAY ONLY. 2. SELECT, EDIT, ADD, DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS: - PERSON MARKED WITH THE IN-SAMPLE INDICATOR - PERSON CURRENTLY IN RU ON ROUND 5 INTERVIEW DATE - PERSON DOES NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 5 INTERVIEW DATE LOOP_10C
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV_CL10C - END_LP10C
LOOP DEFINITION: LOOP_10C COLLECTS THE YOUR CHOICES ABOUT YOUR HEALTH SAQ STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THIS SAQ. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS: - RU MEMBER MARKED WITH THE IN-SAMPLE INDICATOR - PERSON CURRENTLY IN RU ON ROUND 5 INTERVIEW DATE - PERSON DOES NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 5 INTERVIEW DATE
NAVIGATOR DETAILS: LOOP_10C USES NAV_CL10C TO CONTROL THE FLOW OF THE LOOP. NAV_CL10C SERIES: Your Choices About Your Health SAQ.
ROSTER DETAILS: COL # 1 HEADER: YOUR CHOICES ABOUT YOUR HEALTH SAQ FORMS INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 2 HEADER: EMPTY INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
ROSTER DEFINITION: THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR: 1. SELECT ALLOWED. 2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
ROSTER FILTER: DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_10C DEFINITION.
CONTINUE WITH CL40AAA FOR SELECTED RU MEMBER. CL40AAA {PERSON’S FIRST MIDDLE AND LAST NAME}
DISPLAY THE PERSON’S 3-DIGIT PID FOR ‘PID’.
DISPLAY ‘MALE=BLUE’ AND ‘HIM’ IF PERSON BEING ASKED ABOUT IS MALE. DISPLAY ‘FEMALE=PURPLE’ AND ‘HER’ IF PERSON BEING ASKED ABOUT IS FEMALE.
SOFT CHECK: CODE ‘4’ (MAILED TO SAQ RESPONDENT) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE ‘4’ SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: ‘UNLIKELY RESPONSE. VERIFY AND RE-ENTER.’ CL40AAAOV SPECIFY: CL40AAAA {PERSON’S FIRST MIDDLE AND LAST NAME} CL40_4OV OTHER REASON FOR REFUSAL: END_LP10C
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_10C AND GO TO CL41
CL41 BEGINS SUBSECTION 6: COLLECTING/UPDATING LOCATING INFORMATION (ROUND 1 THROUGH ROUND 5) CL41 {In the coming months, we will be contacting you again
to collect
DISPLAY ‘In the coming months, ... use and expenses.’ IF ROUNDS 1, 2, 3, OR 4. OTHERWISE, DISPLAY ‘We are nearing ... correctly.’ DISPLAY ‘Just ... move.’ IF ROUND 1. OTHERWISE, DISPLAY ‘Let ... interview.’
IF NOT ROUND 5, CONTINUE WITH CL42
OTHERWISE (I.E., IF ROUND 5), GO TO BOX_17 CL42 What is the best time of day and day of the week to
get in touch CL42OV1 SELECT WHO BEST TIME RECORDED FOR:
NOTE: CL42OV1 IS ALWAYS DISPLAYED ON THE SCREEN WITH CL42. IT IS NOT A TRUE ‘OVERLAY’. CL42OV2 SPECIFY: BOX_17
IF NO CURRENT RU MEMBER PART OF THE RU ON THE CURRENT INTERVIEW DATE (I.E., ALL RU MEMBERS DECEASED, INSTITUTIONALIZED, OR OUT OF THE COUNTRY ON CURRENT INTERVIEW DATE), GO TO BOX_18
OTHERWISE, CONTINUE WITH BOX_17AA BOX_17AA
IF ROUND 1, GO TO CL42B
IF ROUNDS 2-5, AND THERE IS AN EMAIL ADDRESS LINKED TO THE PID OF THE CURRENT RESPONDENT, CONTINUE WITH CL42A
OTHERWISE (I.E., IF ROUNDS 2-5 AND THE CURRENT RESPONDENT DOES NOT HAVE AN EMAIL LINKED TO THEIR PID), GO TO CL42B
NOTE: PROXY RESPONDENTS DO NOT HAVE A PID. NO PREVIOUS EMAIL ADDRESS IS LINKED TO THEM. CL42A Is this still the best email address to contact you to
FOR ‘EMAIL_ADDRESS’ DISPLAY THE EMAIL ADDRESS ASSOCIATED WITH THE PID OF THE CURRENT RESPONDENT.
IF CODED ‘3’ (NO, NO EMAIL ADDRESS), ‘-7’ (REF) OR ‘-8’ (DK), DELETE THE EMAIL ADDRESS ASSOCIATED WITH THE PID OF THE CURRENT RESPONDENT. CL42B Do you send or receive emails CL42C {What is your new email address?/We’d like to contact
you by email
DISPLAY ‘What is your new email address?’ IF CL42A IS CODED ‘2’ (NO, UPDATE EMAIL ADDRESS). DISPLAY ‘We’d like to ... your email address?’ IF CL42B IS CODED ‘1’ (YES).
ALLOW A 50 CHARACTER ENTRY INCLUDING ALPHA AND NUMERIC CHARACTERS AS WELL AS SYMBOLS.
HARD CHECK: EDITS: EMAIL ADDRESS MUST CONTAIN AN ‘@’ SYMBOL. IF ENTRY DOES NOT INCLUDE THIS SYMBOL, DISPLAY THE FOLLOWING MESSAGE: “EMAIL ADDRESS MUST CONTAIN AN ‘@’ SYMBOL. VERIFY AND RE-ENTER.” EMAIL ADDRESS MUST NOT CONTAIN ANY SPACES. IF ENTRY INCLUDES A SPACE, DISPLAY THE FOLLOWING MESSAGE: “EMAIL ADDRESS CANNOT CONTAIN BLANK SPACES. VERIFY AND RE-ENTER.”
LINK EMAIL ADDRESS COLLECTED TO PID OF RESPONDENT SELECTED AT RE06/RE08 OR PROXY SELECTED AT RE07/RE08 FOR THE CURRENT ROUND. CL42D Is that your personal e-mail, work e-mail, a family or
shared e-mail CL42DOV SPECIFY TYPE OF EMAIL ACCOUNT: CL42E How often do you check this email account CL42EOV1 PER PERIOD: CL43 Do you have a second phone number where you can be
reached such as
ASSUMPTION: THE QUESTIONS IN CLOSING IN WHICH CONTACT AND LOCATING INFORMATION IS PRE-RECORDED IN CAPI (CL43-CL64) ARE SPECIFIED WITH THE FOLLOWING BASIC ASSUMPTIONS: 1. LOCATING AND CONTACTING INFORMATION WILL NOT BE WRITTEN OVER FROM ROUND TO ROUND. 2. ONLY THE MOST CURRENT INFORMATION WILL APPEAR IN THE TEXT OF THESE QUESTIONS AND NO HISTORY OF CONTACT AND LOCATING INFORMATION WILL APPEAR ON THE CAPI SCREEN FOR THE INTERVIEWER. 3. IF INFORMATION STAYS THE SAME, IT WILL BE CARRIED FORWARD. 4. WHETHER OR NOT PREVIOUS ROUND’S INFORMATION OR ANY CONTACT HISTORY WILL BE PRINTED ON THE FACE SHEET FOR ANY OF THE CONTACTING AND LOCATING QUESTIONS IS STILL NOT KNOWN.
HARD CHECK: CODES ‘2’ (YES, SECOND PHONE ABOVE CORRECT) AND ‘3’ (YES, SECOND PHONE ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT SECOND PHONE INFORMATION AVAILABLE. IF CODES ‘2’ OR ‘3’ SELECTED WHEN NO CURRENT SECOND PHONE, DISPLAY THE FOLLOWING MESSAGE: ‘CODE NOT AVAILABLE. NO CURRENT SECOND PHONE. VERIFY AND RE-ENTER.’ CL44 [What is that telephone number?]
FLAG SECOND PHONE INFORMATION FOR THE RU WITH THE NUMBER ENTERED OR CORRECTED AT CL44 FOR THE CURRENT ROUND.
HARD CHECK: DISALLOW LEADING ZEROES AS AN ENTRY. AN ENTRY MUST BE MADE FOR EVERY FIELD (REF AND DK ARE ALLOWED). CL44_2 [What is that telephone number?]
FLAG SECOND PHONE INFORMATION FOR THE RU WITH THE NUMBER ENTERED OR CORRECTED AT CL44 FOR THE CURRENT ROUND.
HARD CHECK: DISALLOW LEADING ZEROS AS AN ENTRY. CL45 Where is that telephone located CL45OV1 SPECIFY: CL45OV2 ENTER NAME AND/OR DESCRIPTION OF SECOND PHONE. ALSO,
INCLUDE
ALLOW 2 LINES OF 45 CHARACTERS FOR DESCRIPTION. CL46 Do you receive your mail at an address different from
your home
HARD CHECK: CODES ‘2’ (YES, MAILING ADDRESS ABOVE CORRECT) AND ‘3’ (YES, MAILING ADDRESS ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT MAILING ADDRESS INFORMATION AVAILABLE. IF CODES ‘2’ OR ‘3’ SELECTED WHEN NO CURRENT MAILING ADDRESS, DISPLAY THE FOLLOWING MESSAGE: ‘CODE NOT AVAILABLE. NO CURRENT MAILING ADDRESS. VERIFY AND RE-ENTER.’ CL47 [What is that address?]
CONTINUE WITH BOX_17A
HARD CHECK: AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED). CL47_2 [What is that address?] BOX_17A
IF NOT ROUND 5, CONTINUE WITH CL48
OTHERWISE (I.E., IF ROUND 5), GO TO BOX_18 CL48 Do you have a second home, such as a vacation home,
where we could
HARD CHECK: CODES ‘2’ (YES, SECOND HOME ADDRESS AND TELEPHONE ABOVE CORRECT) AND ‘3’ (YES, SECOND HOME ADDRESS OR TELEPHONE ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT SECOND HOME ADDRESS INFORMATION AVAILABLE. IF CODES ‘2’ OR ‘3’ SELECTED WHEN NO CURRENT SECOND HOME ADDRESS, DISPLAY THE FOLLOWING MESSAGE: ‘CODE NOT AVAILABLE. NO CURRENT SECOND HOME ADDRESS. VERIFY AND RE-ENTER.’ CL49 [What is the address and phone number of that home?]
HARD CHECK: AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED). CL49_2 [What is the address and phone number of that home?] CL50 Do you have a friend or relative who does not live
here who will
HARD CHECK: CODES ‘2’ (YES, CONTACT PERSON/ADDRESS ABOVE CORRECT) AND ‘3’ (YES, CONTACT PERSON/ADDRESS ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT CONTACT PERSON INFORMATION AVAILABLE. IF CODES ‘2’ OR ‘3’ SELECTED WHEN NO CURRENT CONTACT INFORMATION, DISPLAY THE FOLLOWING MESSAGE: ‘CODE NOT AVAILABLE. NO CURRENT CONTACT INFORMATION. VERIFY AND RE-ENTER.’
NOTE: BEGINNING IN PANEL 17 ROUND 1, PANEL 16 ROUND 3, AND PANEL 14 ROUND 5 AND FOR ALL FUTURE ROUNDS MEPS NO LONGER COLLECTS OR DISPLAYS THE CONTACT PERSON’S MIDDLE NAME (HOME.CONTMNAM) IN CAPI OR IN THE IMS. CL51 [What is the name, address, and phone number of that
person?]
DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE RU FOR ‘NAME OF REFERENCE PERSON’.
GO TO CL53
HARD CHECK: AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED). CL51_2 [What is the name, address, and phone number of that
person?]
DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE RU FOR ‘NAME OF REFERENCE PERSON’.
CONTINUE WITH CL53 CL53 If you are not available for the next interview, who
would be the best
IF CURRENT ALTERNATE RESPONDENT IS A DU MEMBER, DO NOT DISPLAY CURRENT ADDRESS AND PHONE INFORMATION. ONLY DISPLAY CURRENT ADDRESS AND PHONE INFORMATION IF CURRENT ALTERNATE RESPONDENT IS OUTSIDE OF THE DU.
HARD CHECK: CODES ‘2’ (ALTERNATE RESPONDENT INFORMATION CORRECT) AND ‘3’ (ALTERNATE RESPONDENT INFORMATION NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT ALTERNATE RESPONDENT INFORMATION AVAILABLE. IF CODES ‘2’ OR ‘3’ SELECTED WHEN NO CURRENT ALTERNATE RESPONDENT INFORMATION, DISPLAY THE FOLLOWING MESSAGE: ‘RESPONSE NOT AVAILABLE. NO NO CURRENT ALTERNATE INFORMATION. VERIFY AND RE-ENTER.’ CL54 INTERVIEWER: SELECT PERSON NAMED FROM ROSTER.
IF ‘SOMEONE OUTSIDE DU’ SELECTED AND CL53 IS ‘ENTER NEW ALTERNATE RESPONDENT INFORMATION, CONTINUE WITH CL55. ELSE IF ‘SOMEONE OUTSIDE DU’ SELECTED AND CL53 IS ‘ALTERNATE RESPONDENT INFORMATION NEEDS CORRECTION’, CONTINUE WITH CL55_2.
OTHERWISE, GO TO CL57
ROSTER DETAILS: TITLE: DU_MEMBERS_1 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY DU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
ROSTER DEFINITION: DISPLAY PERSONS ON THE DU-MEMBERS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR: 1. SELECT ONE ALLOWED. 2. MULTIPLE SELECT, EDIT, ADD, DELETE DISALLOWED. 3. DISPLAY ‘SOMEONE OUTSIDE DU’ AS LAST ENTRY ON ROSTER.
ROSTER FILTER: DISPLAY THOSE DU MEMBERS WHO MEET THE FOLLOWING CONDITIONS: - PERSON IS NOT CURRENT RESPONDENT - PERSON IS NOT DECEASED CL55 [What is the name, address, and phone number of that
person?]
IF THERE IS NO CURRENT ALTERNATE RELATIONSHIP, PROCEED TO CL56. OTHERWISE, PROCEED TO CL56_2.
HARD CHECK: AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED). CL55_2 [What is the name, address, and phone number of that
person?]
IF THERE IS NO CURRENT ALTERNATE RELATIONSHIP, PROCEED TO CL56. OTHERWISE, PROCEED TO CL56_2. CL56 What is {NAME OF ALTERNATE RESPONDENT CL55}’s
relationship to
DISPLAY THE NAME ENTERED AT CL55 FOR ‘NAME OF ALTERNATE RESPONDENT CL55’. DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE RU FOR ‘NAME OF REFERENCE PERSON’.
HARD CHECK: AN ENTRY MUST BE MADE (REF AND DK ARE ALLOWED). CL56_2 [What is {NAME OF ALTERNATE RESPONDENT CL55}’s
relationship to
DISPLAY THE NAME ENTERED AT CL55 FOR ‘NAME OF ALTERNATE RESPONDENT CL55’. DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE RU FOR ‘NAME OF REFERENCE PERSON’. CL57 Is anyone in the family planning to move within the
next 3 CL58 Who is that?
CONTINUE WITH LOOP_11
ROSTER DETAILS: TITLE: RU_MEMBERS_1 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
ROSTER DEFINITION: DISPLAY THE RU-MEMBERS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR: 1. MULTIPLE SELECT ALLOWED. 2. ADD, EDIT, DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ALL PERSONS WHO ARE CURRENT RU MEMBERS (I.E., A MEMBER OF THE RU ON THE INTERVIEW DATE) LOOP_11
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK CL59 - END_LP11
LOOP DEFINITION: LOOP_11 COLLECTS ADDRESS INFORMATION FOR POTENTIAL FUTURE MOVERS. THIS LOOP CYCLES ON PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS: - PERSON IS A CURRENT RU MEMBER (I.E., PERSON PART OF THE RU ON INTERVIEW DATE) - PERSON SELECTED AS A FUTURE MOVER (I.E., SELECTED AT CL58) - PERSON NOT FLAGGED AS ‘PROCESSED FUTURE MOVER’ (I.E., PERSON HAS NOT YET BEEN PROCESSED THROUGH THIS LOOP OR SELECTED AT CL61) CL59 {PERSON’S FIRST MIDDLE AND LAST NAME}
REFUSED AND DON’T KNOW ALLOWED FOR EACH FIELD.
FLAG PERSON AS ‘PROCESSED FUTURE MOVER’.
IF ALL PERSONS SELECTED AS FUTURE MOVERS (I.E., SELECTED AT CL58) ARE FLAGGED AS ‘PROCESSED FUTURE MOVER’, GO TO END_LP11
OTHERWISE, CONTINUE WITH CL60
HARD CHECK: CAPI REQUIRES AN ENTRY IN ALL FIELDS EXCEPT SECOND STREET ADDRESS. CL60 {PERSON’S FIRST MIDDLE AND LAST NAME} CL61 {PERSON’S FIRST MIDDLE AND LAST NAME}
FLAG ALL SELECTED PERSONS AS ‘PROCESSED FUTURE MOVER’.
CONTINUE WITH END_LP11
ROSTER DETAILS: TITLE: RU_MEMBERS_1 COL # 1 HEADER: NAME INSTRUCTIONS: DISPLAY RU MEMBER’S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
ROSTER DEFINITION: DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR SELECTION.
ROSTER BEHAVIOR: 1. MULTIPLE SELECT ALLOWED. 2. ADD, EDIT, DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ALL PERSONS IN THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS: - PERSON IS A CURRENT RU MEMBER (I.E., PERSON PART OF THE RU ON INTERVIEW DATE) - PERSON SELECTED AS A FUTURE MOVER (I.E., SELECTED AT CL58) - PERSON NOT FLAGGED AS ‘PROCESSED FUTURE MOVER’ END_LP11
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_11 AND CONTINUE WITH BOX_18 BOX_18
IF CURRENT RESPONDENT IS A PROXY, CONTINUE WITH CL61A
OTHERWISE, GO TO BOX_18A CL61A FOR PROXY RESPONDENT: May I please have your
address and
HARD CHECK: CODES ‘2’ (YES, PROXY ADDRESS AND TELEPHONE ABOVE CORRECT) AND ‘3’ (YES, PROXY ADDRESS OR TELEPHONE ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT PROXY ADDRESS INFORMATION AVAILABLE. IF CODES ‘2’ OR ‘3’ SELECTED WHEN NO CURRENT PROXY ADDRESS, DISPLAY THE FOLLOWING MESSAGE: ‘CODE NOT AVAILABLE. NO CURRENT PROXY ADDRESS. VERIFY AND RE-ENTER.’ CL61B What is your address and phone number?
FLAG PROXY ADDRESS INFORMATION FOR THE RU WITH THE ADDRESS AND PHONE ENTERED OR CORRECTED AT CL61B FOR THE CURRENT ROUND.
CONTINUE WITH BOX_18A
HARD CHECK: AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED). CL61B_2 [What is your address and phone number?]
FLAG PROXY ADDRESS INFORMATION FOR THE RU WITH THE ADDRESS AND PHONE ENTERED OR CORRECTED AT CL61B FOR THE CURRENT ROUND.
CONTINUE WITH BOX_18A BOX_18A
IF ROUND 1, GO TO CL67
OTHERWISE, CONTINUE WITH BOX_18B BOX_18B
IF AT LEAST ONE RU MEMBER COMPLETED THE SAQ [CL36 IS CODED ‘1’ (COMPLETED AND GIVEN TO INTERVIEWER) FOR AT LEAST ONE RU MEMBER AND IF PANEL 17, ROUND 4 OR CL39 IS CODED ‘1’ (COMPLETED AND GIVEN TO INTERVIEWER) FOR AT LEAST ONE RU MEMBER AND IF PANEL 17, ROUND 5], CONTINUE WITH CL64A
OTHERWISE, GO TO CL67
NOTE: STARTING IN PANEL 18, PAYMENT WILL NO LONGER BE MADE FOR COMPLETED SAQ FORMS. CL64A INTERVIEWER: FILL OUT SAQ CHECK(S) WITH SAQ RESPONDENT
NAME(S).
ROSTER DETAILS: TITLE: RU_MEMBERS COL # 1 HEADER: PID INSTRUCTIONS: DISPLAY RU MEMBERS’ 3-DIGIT ID (PERS.PID) COL # 2 HEADER: RU MEMBER INSTRUCTIONS: DISPLAY RU MEMBERS’ FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME) COL # 3 HEADER: PAYMENT TYPE INSTRUCTIONS: SELECT PAYMENT TYPE COL # 4 HEADER: CHECK NUMBER INSTRUCTIONS: ENTER CHECK NUMBER
ROSTER DEFINITION: DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
ROSTER BEHAVIOR: 1. THE PID COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED. 2. THE NAME COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED. 3. THE PAYMENT TYPE COLUMN IS A DROP DOWN SELECTION BOX WITH TWO CHOICES: CHECK AND CASH. 4. THE CHECK NUMBER COLUMN IS A 7 DIGIT NUMERIC ENTRY FIELD. 5. THE CHECK NUMBER COLUMN SHOULD BE INACTIVE OR “GRAYED OUT” UNTIL A SELECTION IS MADE IN THE PAYMENT TYPE COLUMN. IF ‘CHECK’ IS SELECTED, THE CURSOR MOVES TO THE CHECK NUMBER COLUMN FOR COMPLETION. IF ‘CASH’ IS SELECTED THE CHECK NUMBER COLUMN REMAINS INACTIVE AND THE CURSOR MOVES TO THE PAYMENT TYPE COLUMN FOR THE NEXT RU MEMBER ON THE ROSTER. 6. SELECT, ADD, AND DELETE DISALLOWED.
ROSTER FILTER: DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER THAT HAVE COMPLETED AN SAQ FOR THIS ROUND. THAT IS, DISPLAY ALL RU MEMBERS THAT MEET THE FOLLOWING CONDITION: - IF ROUNDS 2 OR 4: CL36 IS CODED ‘1’ (COMPLETED AND GIVEN TO INTERVIEWER) FOR THIS PERSON OR - IF ROUNDS 3 OR 5: CL39 IS CODED ‘1’ (COMPLETED AND GIVEN TO INTERVIEWER) FOR THIS PERSON CL67 READ IF RESPONDENT REFERRED TO RECORDS DURING THE
INTERVIEW: CL67_01 CALENDAR YES NO CL67_03 ELECTRONIC RECORDS YES NO CL67_04 INSURANCE PAYMENT CL67_05 BILL/STATEMENT CL67_06 PHARMACY PATIENT CL67_07 MEDICINE BOTTLE/ CL67_08 CHECK BOOK YES NO CL67_09 DOCTOR’S CARD OR CL67_10 TELEPHONE BOOK YES NO CL67_11 TAX RETURN/ CL67_12 INSURANCE CARDS YES NO CL67_13 OTHER YES NO
IF CL67_13 IS CODED ‘1’ (YES), CONTINUE WITH CL67OV
OTHERWISE, GO TO CL65 CL67OV OTHER: CL65 INTERVIEWER: FILL OUT INTERVIEW CHECK WITH
RESPONDENT’S NAME. CL65OV CHECK NUMBER:
DISPLAY ‘The next interview will take place in about six months.’ IF ROUNDS 1 OR 2 OR 3 OR 4. IF ROUND 5, USE A NULL DISPLAY. DISPLAY ‘GIVE RESPONDENT GIFT.’ IF ROUND 1. DISPLAY ‘GIVE RESPONDENT ... Panel Survey.’ IF ROUND 5. IF ROUNDS 2 OR 3 OR 4, USE A NULL DISPLAY.
CL65OV SHOULD ALWAYS BE DISPLAYED AT CL65 (NOT AN OVERLAY), BUT IT SHOULD BE INACTIVE OR “GRAYED OUT”. IF CL65 IS CODED ‘1’ (CHECK), CL65OV SHOULD BECOME ACTIVE. IF CL65 IS CODED ‘2’ (CASH), CL65OV REMAINS INACTIVE. BOX_20
END INTERVIEW. |