Other Medical Expenses (OM) SectionBOX_00 (OM1005) Route Details: 01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60 02 Loop = LOOP_10 03 End Loop = END_LP10 04 Single Select = OM10, OM30, OM40, OM50, OM60, OM70 10 Multiple Select with Fill in Answer Text = OM80 23 Text Field = OM90 24 Information Screen = OM20 Grid Type 1 = OM80 BOX_10 (OM1010) Route Details: Context header display instructions: Display PERS.FULLNAME, PRND.BEGREFMM, PRND.BEGREFDD, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY If PRND dates are missing, use RU dates: RUBEGMM, RUBEGDD, RUENDMM, RUENDDD BOX_20 (OM1015) Route Details: If person currently looping on has been asked EE40 or EE50, or has a record for GLASSES OR CONTACT LENSES created at EV20, where EV20=8 go to BOX_30. Otherwise, if RU member has not been asked about glasses/contact purchases at EE40 or EE50 and does not have GLASSES OR CONTACT LENSES record created, go to OM10. OM10 (OM1020) BLAISE NAME: Glasses Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: Did {you/{PERSON}} purchase eyeglasses or contact lenses {since {START DATE}/between {START DATE} and {END DATE}}? Responses: YES 1 BOX_30 (OM1025) NO 2 BOX_30 (OM1025) REFUSED RF BOX_30 (OM1025) DON'T KNOW DK BOX_30 (OM1025) Programmer Instructions: If OM10 coded ‘1’ (YES), create a record as OM-record for ‘GLASSES OR CONTACT LENSES’, go to BOX_30. Display Instructions: Display ‘since {START DATE}’ if not round 5. Display ‘between {START DATE} and {END DATE}’ if round 5. BOX_30 (OM1025) Route Details: If CA30_01-CA30_N has at least 1 record for this person and this person is selected at EV10 and EV20 and coded ‘9’ (OTHER MEDICAL EXPENSES), go to OM20. Otherwise, go to OM30. OM20 (OM1030) BLAISE NAME: HCareRec Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: Health care records were reported for {you/{PERSON}}. Please look at these records while answering the next set of questions. {Earlier, you mentioned {you/PERSON} } had medical purchases you wanted to talk about. This is the place where I can record that information. } PRESS 1 AND ENTER TO CONTINUE. Responses: CONTINUE 1 OM30 (OM1035) Display Instructions: If a person level variable was previously set at EV25 for the person currently looping on, display "Earlier you had mentioned {you/{PERSON} } had medical purchases..." Otherwise, use a null display. OM30 (OM1035) BLAISE NAME: Ambulance Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: {Since {START DATE}/Between {START DATE} and {END DATE}}, {have/has} {you/{PERSON}} used any ambulance services? HELP:F1 Responses: YES 1 NO 2 REFUSED RF DON'T KNOW DK Programmer Instructions: If coded ‘1’, (YES) create OM-record for "AMBULANCE SERVICES". Display Instructions: Display ‘Since {START DATE}’ if not round 5. Display ‘Between {START DATE} and {END DATE}’ if round 5. OM40 (OM1040) BLAISE NAME: DisposSupplies Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: & OM-1 Please look at card OM-1, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {you/{PERSON}} purchased any disposable supplies {that we haven’t already talked about as related to {your/{PERSON}’s} diabetes}? Responses: YES 1 NO 2 REFUSED RF DON'T KNOW DK Programmer Instructions: If coded ‘1’ (YES), create OM-record for "DISPOSABLE SUPPLIES". Display Instructions: Display ‘since {START DATE}’ if not round 5. Display ‘between {START DATE} and {END DATE}’ if round 5. Display ‘that we haven’t already talked about as related…’ if PM20 or PM40 is coded ‘1’ (YES) for this person during the current round. Otherwise, use a null display. OM50 (OM1045) BLAISE NAME: MedEquip Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: & OM-2 Please look at card OM-2, {since {START DATE}/between {START DATE} and {END DATE}}, {have/has} {you/{PERSON}} purchased any long term medical equipment {that we haven’t already talked about as related to {your/{PERSON}’s} diabetes}? Responses: YES 1 BOX_40 (OM1050) NO 2 BOX_40 (OM1050) REFUSED RF BOX_40 (OM1050) DON'T KNOW DK BOX_40 (OM1050) Programmer Instructions: If OM50 coded ‘1’ (YES), create OM-record for "LONG-TERM MEDICAL EQUIPMENT", go to BOX_40 . Display Instructions: Display ‘since {START DATE}’ if not round 5. Display ‘between {START DATE} and {END DATE}’ if round 5. Display ‘that we haven’t already talked about as related...’ if PM20 or PM40 is coded ‘1’ (YES) for this person during the current round. Otherwise, use a null display. BOX_40 (OM1050) Route Details: If at least one OM-record has been reported for this person (GLASSES/CONTACT LENSES record created at EE40, EE50 or OM10 or OM30=1 ‘AMBULANCE SERVICES’, OM40= 1 ‘DISPOSABLE SUPPLIES’, or OM50=1 ‘LONG- TERM MEDICAL EQUIPMENT’), go to LOOP_10. Otherwise, go to OM80. LOOP_10 (OM1055) Route Details: For each OM- record reported, ask BOX_50-END_LP10. Loop definition: LOOP_10 collects information on if glasses/contacts, ambulance services, disposable supplies, or long-term medical equipment were obtained at all during panel year 1 or 2, and collects charge payment information. This loop cycles on OM-record who meet the following condition: -RU member reported any OM record type at OM30= ‘1’ (AMBULANCE SERVICES), OM40=‘1’ (DISPOSABLE SUPPLIES), OM50=‘3’ (LONG-TERM MEDICAL EQUIPMENT) OR RU member has an OM-record for “GLASSES/CONTACTS” created, at EE40, EE50, or OM10. Loop by OM-record type in the following order: GLASSES OR CONTACT LENSES, AMBULANCE SERVICES, DISPOSABLE SUPPLIES, THEN LONG-TERM MEDICAL EQUIPMENT. BOX_50 (OM1060) Route Details: If round 3 and persons reference period crosses between panel year 1 and panel year 2, continue with OM60. Otherwise, go to BOX_60. OM60 (OM1065) BLAISE NAME: OMEYear1 Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {OME ITEM GROUP} Question Text: Did {you/{PERSON}} {obtain/use} {eyeglasses or contact lenses/ambulance services/long-term medical equipment/disposable supplies} in {PANEL YEAR 1}? Responses: YES 1 OM70 (OM1070) NO 2 OM70 (OM1070) REFUSED RF OM70 (OM1070) DON'T KNOW DK OM70 (OM1070) Display Instructions: If PERSON’s current OM-record being looped on is glasses/contacts, display ‘eyeglasses or contact lenses’. If PERSON’s current OM-record being looped on is ambulance services, display ‘ambulance services’. If PERSON’s current OM-record being looped on is disposable supplies, display ‘disposable supplies’. If PERSON’s current OM-record being looped on is long-term medical equipment, display ‘long-term medical equipment’. If PERSON’s current OM-record being looped on is ambulance services, display ‘use’. Otherwise, display ‘obtain’. For ‘PANEL YEAR 1’ display the first calendar year of the panel. OM70 (OM1070) BLAISE NAME: OMEYear2 Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {OME ITEM GROUP} Question Text: Did {you/{PERSON}} {obtain/use} {eyeglasses or contact lenses/ambulance services/long-term medical equipment/disposable supplies} in {PANEL YEAR 2}? Responses: YES 1 BOX_60 (OM1075) NO 2 BOX_60 (OM1075) REFUSED RF BOX_60 (OM1075) DON'T KNOW DK BOX_60 (OM1075) Display Instructions: If PERSON’s current OM-record being looped on is glasses/contacts, display ‘eyeglasses or contact lenses’. If PERSON’s current OM-record being looped on is ambulance services, display ‘ambulance services’. If PERSON’s current OM-record being looped on is disposable supplies, display ‘disposable supplies’. If PERSON’s current OM-record being looped on is long-term medical equipment, display ‘long-term medical equipment’. If PERSON’s current OM-record being looped on is ambulance services, display ‘use’. Otherwise, display ‘obtain’. For ‘PANEL YEAR 2’ display the second calendar year of the panel. BOX_60 (OM1075) Route Details: Go to the Charge Payment section for this person-OM record pair. When the Charge Payment section is complete, go to END_LP10. END_LP10 (OM1080) Route Details: If there are more OM records to loop on for this person, return to LOOP_10. Otherwise, if there are no more OM records to loop on for this person, go to OM80. OM80 (OM1085) BLAISE NAME: CodeAllOMRec Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: PLEASE INDICATE ANY {ADDITIONAL} RECORDS USED FOR {PERSON} DURING UTILIZATION, CHARGE/PAYMENT, PRESCRIBED MEDICINES, AND OTHER MEDICAL EXPENSES. ENTER ALL THAT APPLY. Responses: CALENDAR WITH HEALTH CARE ENTRIES FOR {PERSON} 1 BOX_70 (OM1091) PROVIDER/INSURANCE STATEMENT 2 BOX_70 (OM1091) PATIENT PORTAL 3 BOX_70 (OM1091) PAYMENT RECORDS 4 BOX_70 (OM1091) PRESCRIPTION MEDICINE BOTTLES, TUBES, CONTAINERS, ETC 5 BOX_70 (OM1091) OTHER TYPE OF RECORD 7 OM90 (OM1090) NO OTHER RECORDS USED 8 BOX_70 (OM1091) REFUSED RF BOX_70 (OM1091) DON'T KNOW DK BOX_70 (OM1091) Programmer Instructions: Preloaded grid type 1 Display "ADDITIONAL" if CA30_01= 1, CA30_02=1, CA30_03=1, CA30_04=1, CA30_05=1, or CA_30_07=1. Otherwise, use a null display. Display Instructions: Col #1 Header: CA30 Responses Instructions: Display the responses entered at the records grid CA30_01, CA30_02, CA30_03, CA30_04, CA30_05, and CA30_07. Do not display CA30_06. Display these previously recorded responses as prefilled values but not editable. Display the number associated with the event type: if CA30_01= 1, display “1”, if CA30_02=1, display “2”, if CA30_03=1, display “3”, if CA30_04=1, display “4”, if CA30_05=1, display “5”, if CA_30_07=1, display “7”, if no records coded at CA30_01-CA30_07, use a null display. Display these numbers with a hyphen separating them for example: 1-3-5. Col#2 Header: Additional Records Instructions: Display the responses entered at OM80 (CodeAllOMRec). Hard checks: Cannot code OM80 (CodeAllOMRec) as 8 (NO OTHER RECORDS USED) in combination with any other codes. Display the following error message: “CANNOT CHOOSE "NO OTHER RECORDS USED" IN COMBINATION WITH OTHER RESPONSES. REVIEW YOUR RESPONSES AND MAKE ANOTHER SELECTION.” OM90 (OM1090) BLAISE NAME: OthOMRec Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: ENTER OTHER RECORD. NOTE: BE AS SPECIFIC AS POSSIBLE. Responses: 1 BOX_70 (OM1091) REFUSED RF BOX_70 (OM1091) DON'T KNOW DK BOX_70 (OM1091) Display Instructions: BOX_70 (OM1091) Route Details: Go to next section of the questionnaire. |