Prescribed Medicines (PM) SectionBOX_00 (PM1000) Route Details: 01 Box = BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100, BOX_110 02 Loop = LOOP_10 03 End Loop = END_LP10 04 Single Select = PM20, PM40, PM50, PM70, PM90, PM110, PM190 05 Single Select with Display Roster = PM180 06 Single Select with Fill in Answer Text = PM10 07_Single Select with Add/Edit/Delete = PM200 11 Multiple Select with Add/Edit/Delete = PM30, PM60, PM80, PM100, PM120 12 Address - Newly Collected = PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06, PM170_07 15 Regular Date Entry with Skips = PM130_01, PM130_02 19 Numeric Field = PM140, PM150 28 Trigram Lookup = PM160LU Roster 3 = PM30, PM60, PM80, PM100, PM120, PM160LU, PM200 BOX_05 (PM1005) Route Details: All sections starting with and including PM that precede Employment in rounds 1, 3, 5 or precede Access in rounds 2 and 4, function as a single person level loop (e.g., ask PM, OM, AH, and CS, for person 1, then loop through those sections for person 2, then person 3, and person N.) CAPI will allow the interviewer to select CTRL-S at any time during the person loop, and select another RU member to loop on (including starting with someone other than the respondent/reference person). For sections PM, OM, and AH, all current RU members, including those who are deceased and institutionalized should be asked these sections. For the CS section, all RU members < or = 17 years of age including those who are institutionalized, but excluding those RU members that are deceased. The order of these sections follows the same ones specified in the GL section; respondent/reference person if the respondent is a proxy followed by RU members in PID order. PMIntro (PM1006) BLAISE NAME: PMIntro Question Text: PRESCRIBED MEDICINES (PM), OTHER MEDICAL (OM), {AND} ADDITIONAL HEALTHCARE (AH){, AND CHILD HEALTH (CS)} SECTIONS - ASKED FOR EACH RU MEMBER AS A LOOP. CTRL-S: SWITCH TO A DIFFERENT RU MEMBER. PRESS 1 AND ENTER TO CONTINUE. Responses: CONTINUE 1 BOX_10 (PM1010) Programmer Instructions: This item is presented only for the first person that goes through the PM, OM, AH and CS loop. Skip PMIntroduction for all other RU members. Display Instructions: Display "AND" if rounds 1, 3, or 5. Otherwise, use a null display. Display ", AND CHILD HEALTH (CS)" if round 2 or round 4. Otherwise, use a null display. BOX_10 (PM1010) Route Details: Context header display instructions: Display PERS.FULLNAME, PRND.BEGREFMM,DD,YY and PRND.ENDREFMM,DD,YY. Continue with PM10 (even if PM10 is prefilled with a response). PM10 (PM1020) BLAISE NAME: HasPmedRecords Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: {Earlier you mentioned that {you/{PERSON}} had prescription medicine bottles, containers, tubes, or bags available.} For these next questions, please have any bottles, containers, tubes, or bags, a pharmacy print out or patient portal information available for each of {your/PERSON}'s medicines we will be talking about. Responses: HAS PRESCRIPTION MEDICINE BOTTLES/RECORDS FOR {PERSON} 1 BOX_20 (PM1030) DOES NOT HAVE ANY PRESCRIPTION MEDICINE BOTTLES/RECORDS FOR {PERSON} 2 BOX_20 (PM1030) REFUSED TO USE ANY PRESCRIPTION MEDICINE BOTTLES/RECORDS FOR {PERSON} 3 BOX_20 (PM1030) Programmer Instructions: Refused and Don't Know are disallowed. If CA30_05 is coded '1' (YES, HAS PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR {PERSON}), prefill the response entry field with '1' (HAS PRESCRIPTION MEDICINE BOTTLES/RECORDS) as selected, but the field should be editable. Display Instructions: Display 'Earlier you mentioned that {you/{PERSON}} had prescription medicine bottles, containers, tubes, or bags available.' If CA30_5 is coded '1' (YES, HAS PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR {PERSON}. Otherwise, use a null display. BOX_20 (PM1030) Route Details: If person has 'DIABETES' on Persons-Medical-Conditions-Roster, created in PE in any round, continue with PM20. Otherwise, go to BOX_30. PM20 (PM1040) BLAISE NAME: PmedDiab 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}} obtained insulin or any other prescribed medicines related to {your/his/her} diabetes? HELP:F1 Responses: YES 1 PM30 (PM1050) NO 2 PM40 (PM1060) REFUSED RF PM40 (PM1060) DON'T KNOW DK PM40 (PM1060) Programmer Instructions: Display Instructions: Display 'since {START DATE}' if not round 5. Display 'between {START DATE} and {END DATE}' if round 5. PM30 (PM1050) BLAISE NAME: PmedDiabRoster Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: What are the names of these medicines related to {your/his/her} diabetes? PROBE: Any other medicines related to {your/his/her} diabetes? ENTER ALL THAT APPLY. CTRL-A: ADD CTRL-E: EDIT CTRL-D: DELETE Responses: {PRESCRIBED MEDICINE}1 1 PM40 (PM1060) {PRESCRIBED MEDICINE}2 2 PM40 (PM1060) {PRESCRIBED MEDICINE}3 3 PM40 (PM1060) {PRESCRIBED MEDICINE}4 4 PM40 (PM1060) {PRESCRIBED MEDICINE}N 5 PM40 (PM1060) Programmer Instructions: Roster Behavior:
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster. When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed. When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name. General flag rules for medicines: -Round medicine first created (by definition a medicine is selected the same time it is created) -Question number medicine first created -Round medicine selected Display Instructions: Roster 3- Add/Edit/Delete Allowed. Roster Definition: This item displays the person's-prescribed-medicines-roster for selection/addition. Display name of prescribed medicine (DRUG.DRUGNAME). Roster Filter: Display all; no filter. PM40 (PM1060) BLAISE NAME: DiabEquip Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: {Other than what we just listed, did/Did} {you/{PERSON}} obtain any other diabetic equipment or supplies, typically prescribed by a physician; for example, syringes, a blood glucose monitor machine, glucose meter, insulin pumps, lancets, alcohol swabs or control solution {since {START DATE}/between {START DATE} and {END DATE}}? Responses: YES 1 BOX_30 (PM1070) NO 2 BOX_30 (PM1070) REFUSED RF BOX_30 (PM1070) DON'T KNOW DK BOX_30 (PM1070) Programmer Instructions: If PM40 is coded '1' (YES), automatically select the entry 'OTHER DIABETIC EQUIPMENT/SUPPLIES' on person's-prescribed-medicines-roster. If 'OTHER DIABETIC EQUIPMENT/SUPPLIES' is not already on roster, create the entry and select it. General flag rules for medicines: - Round medicine first created (by definition a medicine is selected the same time it is created) - Question number medicine first created - Round medicine selected Display Instructions: Display 'Other than what we just listed, did' if PM20 was coded '1' (YES). Otherwise, display 'Did'. Display 'since {START DATE}' if not round 5. Display 'between {START DATE} and {END DATE}' if round 5. BOX_30 (PM1070) Route Details: If person has 'ASTHMA' on Persons-Medical-Conditions-Roster, created in PE in any round, continue with PM50. Otherwise, go to PM70. PM50 (PM1080) BLAISE NAME: PmedAsthma Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: Including any medicines for quick relief of asthma symptoms, such as inhalers, and those that prevent symptoms over the long term, {have/has} {you/{PERSON}} obtained any prescribed medicines related to {your/his/her} asthma {since {START DATE}/between {START DATE} and {END DATE}}? HELP:F1 Responses: YES 1 PM60 (PM1090) NO 2 PM70 (PM1100) REFUSED RF PM70 (PM1100) DON'T KNOW DK PM70 (PM1100) Display Instructions: Display 'since {START DATE}' if not round 5. Display 'between {START DATE} and {END DATE}' if round 5. PM60 (PM1090) BLAISE NAME: PmedAsthmaRoster Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: What are the names of these medicines related to {your/his/her} asthma? PROBE: Any other medicines related to {your/his/her} asthma? ENTER ALL THAT APPLY CTRL-A: ADD CTRL-E: EDIT CTRL-D: DELETE Responses: {PRESCRIBED MEDICINE}1 1 PM70 (PM1100) {PRESCRIBED MEDICINE}2 2 PM70 (PM1100) {PRESCRIBED MEDICINE}3 3 PM70 (PM1100) {PRESCRIBED MEDICINE}4 4 PM70 (PM1100) {PRESCRIBED MEDICINE}N 5 PM70 (PM1100) Programmer Instructions: Roster Behavior:
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster. When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed. When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name. General flag rules for medicines: -Round medicine first created (by definition a medicine is selected the same time it is created) -Question number medicine first created -Round medicine selected Display Instructions: Roster 3- Add/Edit/Delete Allowed. Roster Definition: This item displays the person's-prescribed-medicines-roster for selection/addition. Display name of prescribed medicine (DRUG.DRUGNAME). Roster Filter: Display all; no filter. PM70 (PM1100) BLAISE NAME: NewMeds Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: In answering the next couple of questions, remember to think about prescriptions obtained at any pharmacy, including mail-order or on-line. {Since {START DATE}/Between {START DATE} and {END DATE}}, {have/has} {you/{PERSON}} obtained any new prescription medicines or any refills {we have not yet talked about}? HELP: F1 Responses: YES 1 PM80 (PM1110) NO 2 PM90 (PM1120) REFUSED RF PM90 (PM1120) DON'T KNOW DK PM90 (PM1120) Display Instructions: DISPLAY 'Since {START DATE}' IF NOT ROUND 5. DISPLAY 'Between {START DATE} and {END DATE}' IF ROUND 5. Display "we have not yet talked about" if 1 or more medicines have been selected during this round. Otherwise use a null display. PM80 (PM1110) BLAISE NAME: NewMedsRoster Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: What were the names of these medicines? PROBE: Any other medicines? ENTER ALL THAT APPLY CTRL-A: ADD CTRL-E: EDIT CTRL-D: DELETE Responses: {PRESCRIBED MEDICINE}1 1 PM90 (PM1120) {PRESCRIBED MEDICINE}2 2 PM90 (PM1120) {PRESCRIBED MEDICINE}3 3 PM90 (PM1120) {PRESCRIBED MEDICINE}4 4 PM90 (PM1120) {PRESCRIBED MEDICINE}N 5 PM90 (PM1120) Programmer Instructions: Roster Behavior:
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster. When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed. When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name. General flag rules for medicines: - Round medicine first created (by definition a medicine is selected the same time it is created) - Question number medicine first created - Round medicine selected Display Instructions: Roster 3- Add/Edit/Delete Allowed. Roster Definition: This item displays the person's-prescribed-medicines-roster for selection/addition. Display name of prescribed medicine (DRUG.DRUGNAME). Roster Filter: Display all; no filter. PM90 (PM1120) BLAISE NAME: PmedAsNeeded Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: {Since {START DATE}/Between {START DATE} and {END DATE}}, did {you/{PERSON}} obtain any {other} prescriptions, even if {you/{PERSON}} {are/is} no longer taking the medicine or only take it as-needed? HELP: F1 Responses: YES 1 PM100 (PM1130) NO 2 BOX_40 (PM1140) REFUSED RF BOX_40 (PM1140) DON'T KNOW DK BOX_40 (PM1140) Display Instructions: Display 'Since {START DATE}' if not round 5. Display 'Between {START DATE} and {END DATE}' if round 5. Display 'other' if at least one medicine is flagged as selected for the current round (that is, at least one medicine was selected at HS100, ER70, OP100, MV120, PM30, PM60, or PM80 in the current round or PM40 was coded '1' (YES) in the current round). Otherwise, use a null display. PM100 (PM1130) BLAISE NAME: PmedAsNeededRoster Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: What were the names of these medicines? PROBE: Any other medicines? ENTER ALL THAT APPLY. CTRL-A: ADD CTRL-E: EDIT CTRL-D: DELETE Responses: {PRESCRIBED MEDICINE}1 1 BOX_40 (PM1140) {PRESCRIBED MEDICINE}2 2 BOX_40 (PM1140) {PRESCRIBED MEDICINE}3 3 BOX_40 (PM1140) {PRESCRIBED MEDICINE}4 4 BOX_40 (PM1140) {PRESCRIBED MEDICINE}N 5 BOX_40 (PM1140) Programmer Instructions: Roster Behavior:
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster. When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed. When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name. General flag rules for medicines: - Round medicine first created (by definition a medicine is selected the same time it is created) - Question number medicine first created - Round medicine selected Display Instructions: Roster 3- Add/Edit/Delete Allowed. Roster Definition: This item displays the person's-prescribed-medicines-roster for selection/addition. Display name of prescribed medicine (DRUG.DRUGNAME). Roster Filter: Display all; no filter. BOX_40 (PM1140) Context Header: Route Details: Check person's-prescribed-medicines-roster for selections. If at least one medicine is flagged as selected for the current round (that is, at least one medicine was selected at HS100, ER70, OP100, MV120, PM30, PM60, PM80 or PM100 in the current round or PM40 was coded '1' (YES) in the current round), continue with LOOP_10. Otherwise, go to BOX_110. LOOP 10 (PM1150) Context Header: Route Details: For each element in person's-prescribed-medicines-roster flagged as selected, ask BOX_50 -END_LP10. Loop Definition: LOOP_10 collects information about each prescribed medicine selected during the current round. This loop cycles on prescribed medicines that meet one of the following conditions: - Prescribed medicine was selected at HS100, ER70, OP100, MV120, PM30, PM60, PM80 or PM100 in the current round for this person or - PM40 is coded '1' (YES) and "OTHER DIABETIC EQUIPMENT/SUPPLIES' is flagged as selected for the current round BOX_50 (PM1180) Route Details: If medicine being looped on was linked to a condition in a prior round (preload.PrescribedMed.PMedSpecCondFlag=Yes), go to BOX_60. If medicine being looped on was selected at PM30 in the current round, autocode PM110 to '1' (YES) and autocode 'DIABETES' at PM120 and then go to BOX_60. If looping on "OTHER DIABETIC EQUIPMENT/SUPPLIES", autocode PM110 to '1' (YES) and autocode 'DIABETES' at PM120 and then go to PM140. If medicine being looped on was selected at PM60 in the current roundautocode PM110 to '1' (YES) and autocode 'ASTHMA' at PM120 and then go to BOX_60. Otherwise (medicine created this round and related to neither diabetes nor asthma), continue with PM110. PM110 (PM1190) BLAISE NAME: PmedSpecCond Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT} Question Text: Now, let's talk about {MEDICINE}. Is {MEDICINE} used for a specific health problem? Responses: YES 1 PM120 (PM1200) NO 2 BOX_60 (PM1210) REFUSED RF BOX_60 (PM1210) DON'T KNOW DK BOX_60 (PM1210) Display Instructions: PM120 (PM1200) BLAISE NAME: PmedCondRoster Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT} Question Text: {Now, let's talk about {MEDICINE}.} What health problem is {MEDICINE} prescribed for? PROBE: Any other health problems? ENTER ALL THAT APPLY CTRL-A: ADD CTRL-E: EDIT CTRL-D: DELETE HELP:F1 Responses: {MEDICAL CONDITION} 1 1 BOX_60 (PM1210) {MEDICAL CONDITION} 2 2 BOX_60 (PM1210) {MEDICAL CONDITION} 3 3 BOX_60 (PM1210) {MEDICAL CONDITION} 4 4 BOX_60 (PM1210) {MEDICAL CONDITION}N 5 BOX_60 (PM1210) Programmer Instructions: Roster Behavior:
Display Instructions: Roster 3- Add/Edit/Delete allowed. Roster Definition: Display the person-medical-conditions-roster for the selection and addition of one or many medical condition(s) associated with this medicine. Roster Filter: Display all conditions on person's roster; no filter. Display 'Now let's talk about {MEDICINE}.' if this is the first question presented in LOOP_10, otherwise, use a null display. BOX_60 (PM1210) Context Header: Route Details: If medicine being asked about is flagged as 'CREATED' during the current round, continue with PM130_01. Otherwise, go to PM140. PM130_01 (PM1220) BLAISE NAME: PMedStartYYYY Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT} Question Text: {Now, let's talk about {MEDICINE}.} In what year did {you/{PERSON} first use {MEDICINE}? ENTER ' XXXX' IF PERSON HAS NOT YET TAKEN/USED MEDICINE. ENTER 4- DIGIT YEAR Responses: 1 REFUSED RF PM140 (PM1240) DON'T KNOW DK PM140 (PM1240) Programmer Instructions: If ' XXXX' (HAS NOT YET TAKEN/USED) entered, go to PM140. If Rounds 1-3 and year entered is equal to or greater than person's begin reference period year or FirstPanYear minus 1, continue with PM130_02. If Rounds 4-5 and year entered is equal to or greater than person's begin reference period year or SecondPanYear minus 1, continue with PM130_02. Otherwise, go to PM140. Range Check: Year = 1900 - 2100. Display Instructions: Display PM130_01 and PM130_02, on the same form pane. Display 'Now let's talk about {MEDICINE}.' if this is the first question presented in LOOP_10, otherwise, use a null display. PM130_02 (PM1230) BLAISE NAME: PMedStartMM Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} {NAME OF PRESCRIPTION MEDICINE.} Question Text: [In what year did {you/{PERSON} first use {MEDICINE}?] What month did {you/he/she} first use {MEDICINE}? ENTER MONTH Responses: 1 PM140 (PM1240) REFUSED RF PM140 (PM1240) DON'T KNOW DK PM140 (PM1240) Programmer Instructions: For specifications purposes only (CAPI handles automatically): allowable values for month are 1-12. The complete date cannot be before the person's date of birth or after the reference period end date for this person. Display Instructions: Display PM130_01 and PM130_02, on the same form pane. Display bracketed question text in lighter "grayed-out" text. PM140 (PM1240) BLAISE NAME: PmedXFill Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT} Question Text: {Now, let's talk about {MEDICINE}.} How many times was {MEDICINE} obtained or purchased for {you/{PERSON}} {since {START DATE} /between {START DATE} and {END DATE}}? ENTER NUMBER OF TIMES Responses: 1 BOX_70 (PM1250) REFUSED RF BOX_70 (PM1250) DON'T KNOW DK BOX_70 (PM1250) Display Instructions: DISPLAY 'since {START DATE}' if not Round 5. DISPLAY 'between {START DATE} and {END DATE}' if Round 5. Display 'Now let's talk about {MEDICINE}.' if this is the first question presented in LOOP_10, otherwise, use a null display. BOX_70 (PM1250) Context Header: Route Details: If Round 3 and PM140 is not RF or DK, continue with BOX_80. Otherwise, go to END_LP10. BOX_80 (PM1260) Route Details: If person being looped on has a begin reference period date of YEAR 2, auto-code PM150 with '0' and then go to END_LP10. If person being looped on has an end reference period date of YEAR 1, auto-code PM150 with the response entered at PM140 and then go to END_LP10. Otherwise, continue with PM150. PM150 (PM1270) BLAISE NAME: PmedXFillLYr Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF PRESCRIPTION MEDICINE.} {STR-DT} {END-DT} Question Text: NUMBER OF TIMES OBTAINED/PURCHASED SINCE {START DATE}: {NUMBER OF TIMES} Of these times, how many were in {YEAR}? ENTER NUMBER OF TIMES Responses: 1 END_LP10 (PM1280) REFUSED RF END_LP10 (PM1280) DON'T KNOW DK END_LP10 (PM1280) Programmer Instructions: Display the first year of the panel for 'YEAR'. Hard Check: Number of times must be <= number of times obtained/purchased at PM140 (PmedXFill). Display Instructions: For 'NUMBER OF TIMES,' display the number entered at PM140 (PmedXFill). END_LP10 (PM1280) Context Header: Route Details: Cycle on next medicine in person's-prescribed-medicines-roster that meets the conditions stated in the loop definition. If no other medicines meet the stated conditions, end LOOP_10 and continue with PM160LU. PM160LU (PM1290) BLAISE NAME: PharmRoster Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: Please tell me the name of the pharmacy or pharmacies that filled the prescription(s) for {you/{PERSON}} {since {START DATE}/between {START DATE} and {END DATE}} PROBE: Any other pharmacy? PRESS ENTER WHEN DONE SELECTING OR ADDING PHARMACIES. CTRL-A: ADD CTRL-E: EDIT CTRL-D: DELETE HELP:F1 Responses: {{PHARMACY}, {STREET ADDRESS}, {CITY}, {ST}}1 1 BOX_90 (PM1300) {{PHARMACY}, {STREET ADDRESS }, {CITY}, {ST}}2 2 BOX_90 (PM1300) {{PHARMACY}, {STREET ADDRESS}, {CITY}, {ST}}3 3 BOX_90 (PM1300) {{PHARMACY}, {STREET ADDRESS}, {CITY}, {ST}}4 4 BOX_90 (PM1300) {{PHARMACY}, {STREET ADDRESS}, {CITY}, {ST}}N 5 BOX_90 (PM1300) PHARMACY NOT IN LOOKUP 91 BOX_90 (PM1300) Programmer Instructions: Roster behavior:
General flag rules for pharmacies: - Round pharmacy first created (by definition a pharmacy is selected the same time it is created) - Round pharmacy selected for this RU member - RU member pharmacy is linked to (however, this is known by virtue that the medicine was selected at PM160 for this person). NOTE: The round flag and which RU member the pharmacy is linked to, also known as a person-pharmacy-pair, is key for the collection of pharmacy authorization forms. Display Instructions: Roster 3- add/edit/delete allowed. Roster Definition: This item displays the RU-pharmacies-roster for selection/addition. Display pharmacy name (PHAR.PHARNAME), street address, city, and state. Roster Filter: Display all; no filter. Display the roster in non-proportional text. The allowable characters for each field should be as follow before truncation: Pharmacy: 40 characters Street Address: 35 characters City: 23 characters State: 2 characters Phone: 10 characters - stored with pharmacy info but not displayed at PM160LU. NOTE: When a pharmacy is selected from the lookup, the name of the pharmacy saved to the pharmacy array and will display on this roster under the 'Pharmacy' column header be pulled from the PharmName1 column in the NPI database. DISPLAY 'since {START DATE}' if not Round 5. DISPLAY 'between {START DATE} and {END DATE}' if Round 5. Display only one column of pharmacy response option categories. Each response category should have pharmacy name, address, city, and state separated by commas. Upon return to PM160LU, after CTRL-A has been launched at least once, display the question text "Please tell me the name of the pharmacy or pharmacies that filled the prescription(s) for {you/{PERSON}} {since {START DATE}/between {START DATE} and {END DATE}}" in brackets and "grayed out" text. The instruction "PROBE: Any other pharmacy?" remains in bold black text. BOX_90 (PM1300) Route Details: If 'PHARMACY NOT IN LOOKUP' selected, continue with PM170_01. If a pharmacy is selected from the look-up, add that pharmacy to the roster at PM160LU and select it. Return to PM160LU for interviewer to continue to select pharmacies. Otherwise, go to BOX_100. PM170_01 (PM1310) BLAISE NAME: PharmName Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}? ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED. ENTER WEB ADDRESS ON STREET ADDRESS LINE(S). [What is the pharmacy name?] HELP:F1 Responses: 1 PM170_02 (PM1320) Programmer Instructions: Refused and Don't Know are disallowed. Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane. PM170_02 (PM1320) BLAISE NAME: PharmStrt1 Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: [What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?] ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED. ENTER WEB ADDRESS ON STREET ADDRESS LINE(S). What is the address? Responses: 1 PM170_03 (PM1330) REFUSED RF PM170_03 (PM1330) DON'T KNOW DK PM170_03 (PM1330) Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane. Display question text "[What is the name...{you/{PERSON}}?]" and interviewer instruction "ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED." in lighter "grayed-out" text. PM170_03 (PM1330) BLAISE NAME: PharmStrt2 Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: [What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?] ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED. ENTER WEB ADDRESS ON STREET ADDRESS LINE(S). ENTER SECOND STREET ADDRESS, IF AVAILABLE. IF NONE, PRESS ENTER TO CONTINUE. Responses: 1 PM170_04 (PM1340) EMPTY Empty PM170_04 (PM1340) REFUSED RF PM170_04 (PM1340) DON'T KNOW DK PM170_04 (PM1340) Programmer Instructions: Allow empty. Display Instructions: Display question text "[What is the name...{you/{PERSON}}?]" and interviewer instruction "ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED." in lighter "grayed-out" text. PM170_04 (PM1340) BLAISE NAME: PharmCity Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: [What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?] What is the city? Responses: 1 PM170_05 (PM1350) REFUSED RF PM170_05 (PM1350) DON'T KNOW DK PM170_05 (PM1350) Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane. Display question text "[What is the name...{you/{PERSON}}?]" in lighter "grayed-out" text. PM170_05 (PM1350) BLAISE NAME: PharmSt Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: [What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?] What is the state? TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND PRESS ENTER TO SELECT. Responses: 1 PM170_06 (PM1360) REFUSED RF PM170_06 (PM1360) DON'T KNOW DK PM170_06 (PM1360) Programmer Instructions: Use state look-up file. NOTE: The entry Foreign Country (FC) is allowed. Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane. Display question text "[What is the name...{you/{PERSON}}?]" in lighter "grayed-out" text. PM170_06 (PM1360) BLAISE NAME: PharmZip Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: [What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?] What is the zip code? Responses: 1 PM170_07 (PM1370) REFUSED RF PM170_07 (PM1370) DON'T KNOW DK PM170_07 (PM1370) Programmer Instructions: Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered in PM170_06 (PharmZip) or any characters entered that are not numeric, display the following message: "ZIP CODE ENTRY REQUIRES EXACTLY 5 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL ZIP CODE IS NOT KNOWN." Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane. Display question text "[What is the name...{you/{PERSON}}?]" in lighter "grayed-out" text. PM170_07 (PM1370) BLAISE NAME: PharmPhone Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: [What is the name and address of the pharmacy that filled the prescription(s) for {you/{PERSON}}?] What is the telephone number? IF NO TELEPHONE, ENTER DK. Responses: 1 REFUSED RF DON'T KNOW DK Programmer Instructions: Ten digit entry required for this field. Display hard check if less than 10 digits are entered in PM170_07 (PharmPhone) : "PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN." Use number input mask (XXX-XXX-XXXX) in the response field. Add the pharmacy created at PM170_01 through PM170_07 to the roster at PM160LU and select it. Return to PM160LU for interviewer to continue to select pharmacies. Display Instructions: Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane. Display question text "[What is the name...{you/{PERSON}}?]" in lighter "grayed-out" text. BOX_100 (PM1380) Context Header: Route Details: If at least one pharmacy selected at PM160LUfor this person where PharmTp is missing [(Preload.PharmTp=RF, DK, or Empty) and (PharmTp=Empty for the current round)], continue with PM180. Otherwise, go to PM190. PM180 (PM1390) BLAISE NAME: PharmTp Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {PHARMACY NAME} {STR-DT} {END-DT} Question Text: What type of pharmacy is {PHARMACY}? Is it a mail-order pharmacy; a pharmacy located in another store such as a grocery or department store; a pharmacy located in an HMO, clinic, or hospital; a drug store that is not located within another facility; or is it an on-line pharmacy? HELP: F1 Responses: MAIL-ORDER 1 IN ANOTHER STORE 2 IN HMO/CLINIC/HOSPITAL 3 DRUG STORE 4 ON-LINE 5 REFUSED RF DON'T KNOW DK Programmer Instructions: Preloaded Grid Type 1 including question PM180. Continue with PM190 once grid is complete. Display Instructions: Roster 1 - Report Roster Definition: This item displays the RU-pharmacies-roster as the first two columns of the grid. Display only pharmacy name and first street address in these columns. These columns are protected and cannot be changed. Roster Filter: Display only pharmacies that are newly added to the roster (do not have a pharmacy type associated with them). When on grid rows, 2-n, display the text "Is it a mail-order…on-line pharmacy?" in grayed out text. The question "What type of pharmacy is {PHARMACY}?" will stay in bold black when on every row of the grid. Display the actual pharmacy name for the row the cursor is on for "PHARMACY". PM190 (PM1400) BLAISE NAME: PMed3Part Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: Now I'd like to ask you about the charges for {your/{PERSON}'s} prescription medicine(s). Has {your/{PERSON}'s} health insurance or another source of coverage helped pay for any of {your/his/her} prescription medications {since {START DATE}/between {START DATE} and {END DATE}}? SELECT 'NO' IF PERSON REPORTS NO HEALTH INSURANCE OR ANOTHER SOURCE OF COVERAGE. HELP: F1 Responses: YES 1 PM200 (PM1410) NO 2 BOX_110 (PM1420) REFUSED RF BOX_110 (PM1420) DON'T KNOW DK BOX_110 (PM1420) Display Instructions: Display Instructions: DISPLAY 'since {START DATE}' IF NOT ROUND 5. DISPLAY 'between {START DATE} and {END DATE}' IF ROUND 5. PM200 (PM1410) BLAISE NAME: PMed3Roster Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT} Question Text: Who usually helps pay? CTRL-A: ADD CTRL-E: EDIT CTRL-D: DELETE Responses: {NAME OF SOURCE OF DIRECT PAYMENT}1 1 BOX_110 (PM1420) {NAME OF SOURCE OF DIRECT PAYMENT}2 2 BOX_110 (PM1420) {NAME OF SOURCE OF DIRECT PAYMENT}3 3 BOX_110 (PM1420) {NAME OF SOURCE OF DIRECT PAYMENT}4 4 BOX_110 (PM1420) {NAME OF SOURCE OF DIRECT PAYMENT}N 5 BOX_110 (PM1420) Programmer Instructions: Write sources selected to the sources-of-payment roster. If at least one source is added or selected during the current round, the flag SOPFlag should be set to YES. Roster Behavior:
Display Instructions: Roster 3 - Add/Edit/Delete allowed Roster Definition: Display the RU-Sources-Of-Payment-Roster for selection. Roster Filter: Display all sources of payment that are not "PERSON/FAMILY". BOX_110 (PM1420) Route Details: Go to next questionnaire section. |