Fall 2021
BOX_00 (IC1000)
Route Details: 01 Box = BOX_00, BOX_10
04 Single Select = IC10, IC20
11 Multiple Select with Add/Edit/Delete = IC30
Roster 3 = IC30
BOX_05 (IC1005)
Programmer Instructions: If provider already has IC10 (provider type) recorded for this round (for any RU member) or in a previous round (for any RU member) (preload.ICPlaceTp=1) go to IC20, otherwise, continue with IC10.
IC10 (IC1010)
BLAISE NAME: ICPlaceTP
Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER......} {ADM-DT}
{DIS-DT}
Question Text:
&IC-1.
Looking at card IC-1, what kind of place is {PROVIDER}?
HELP: F1
Responses: INPATIENT REHABILITATION FACILITY OR CONVALESCENT HOME 1 IC20 (IC1015)
NURSING HOME 2 IC20 (IC1015)
RESIDENTIAL MENTAL HEALTH TREATMENT CENTER 3 IC20 (IC1015)
RESIDENTIAL EATING DISORDER TREATMENT CENTER 4 IC20 (IC1015)
RESIDENTIAL DRUG AND ALCOHOL OR ADDICTION TREATMENT CENTER 5 IC20 (IC1015)
RESIDENTIAL HOSPICE CARE 6 IC20 (IC1015)
RESIDENTIAL RESPITE CARE 7 IC20 (IC1015)
OTHER 91 IC20 (IC1015)
REFUSED RF IC20 (IC1015)
DON'T KNOW DK IC20 (IC1015)
Display Instructions:
IC20 (IC1015)
BLAISE NAME: ICRelCond
Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER......} {ADM-DT}
{DIS-DT}
Question Text:
Was {your/{PERSON}’s} stay at {PROVIDER} related to any specific health condition or were any conditions discovered during this stay?
Responses: YES 1 IC30 (IC1020)
NO 2 BOX_10 (IC1025)
REFUSED RF BOX_10 (IC1025)
DON'T KNOW DK BOX_10 (IC1025)
Display Instructions:
IC30 (IC1020)
BLAISE NAME: ICCondRoster
Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE PROVIDER......} {ADM-DT}
{DIS-DT}
Question Text:
What conditions were discovered or led {you/{PERSON}} to enter {PROVIDER}?
PROBE: Any other condition?
ENTER ALL THAT APPLY
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1
Responses: {MEDICAL CONDITION} 1 1 BOX_10 (IC1025)
{MEDICAL CONDITION} 2 2 BOX_10 (IC1025)
{MEDICAL CONDITION} 3 3 BOX_10 (IC1025)
{MEDICAL CONDITION} 4 4 BOX_10 (IC1025)
{MEDICAL CONDITION}N 5 BOX_10 (IC1025)
Programmer Instructions: Roster behavior:
1. Multiple select allowed.
2. Multiple add allowed.
3. Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
4. Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event.
The link is created when the collection of utilization and/or charge/payment data is complete.
Display Instructions: Roster 3 – add/edit/delete allowed
Roster definition:
This item displays Person-Medical-Conditions-Roster for selection and addition of one or many medical conditions associated with this event. Display name of medical condition (COND.CONDNAM)
Roster filter:
Display all conditions on person's roster; display all.
BOX_10 (IC1025)
Route Details: The Charge/Payment (CP) section is not required for this Institutional Care Stay (IC) event.
Go to the Event Driver (ED) section.