Fall 2021
BOX_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:
SEE CONTEXT HEADER SPEC
If PRND dates are missing, use RU dates:
RUBEGMM, RUBEGDD, RUENDMM, RUENDDD
OM10 (OM1020)
BLAISE NAME: Glasses
Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
Question Text:
Earlier we talked about obtaining eyeglasses or contact lenses. Just to verify, did {you/{PERSON}} purchase eyeglasses or contact lenses {since {START DATE}/between {START DATE} and {END DATE}}? / 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 “Earlier we talked about obtaining eyeglasses or contact lenses. Just to verify, did {you/{PERSON}} purchase eyeglasses or contact lenses {since {START DATE}/between {START DATE} and {END DATE}}?” If a person level variable was stored at EV20, where EV20=8 (GLASSES OR CONTACTS) or if a person level variable was stored at either EE40 or EE50.
Otherwise, display “Did {you/{PERSON} purchase eyeglasses or contact lenses {since {START DATE}/between {START DATE} and {END DATE}?
Display ‘since {START DATE}’ if current round is not the final round of the panel (RndType<>Final). Display ‘between {START DATE} and {END DATE}’ if current round is the final round of the panel (RndType=Final).
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 current round is not the final round of the panel (RndType<>Final).
Display ‘Between {START DATE} and {END DATE}’ if current round is the final round of the panel (RndType=Final).
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 current round is not the final round of the panel (RndType<>Final).
Display ‘between {START DATE} and {END DATE}’ if current round is the final round of the panel (RndType=Final).
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 current round is not the final round of the panel (RndType<>Final).
Display ‘between {START DATE} and {END DATE}’ if current round is the final round of the panel (RndType=Final).
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 current round is a round that crosses two calendar years (RndType=Cross), 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’.
If Rd. 3 for ‘PANEL YEAR 1’ display the first calendar year of the panel (FirstPanYear).
If Rd. 5 for ‘PANEL YEAR 1’ display the second calendar year of the panel (SecondPanYear).
If Rd. 7 for ‘PANEL YEAR 1’ display the third calendar year of the panel (ThirdPanYear).
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}?
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’.
If Rd. 3 for ‘PANEL YEAR 2’ display the second calendar year of the panel (SecondPanYear).
If Rd. 5 for ‘PANEL YEAR 2’ display the third calendar year of the panel (ThirdPanYear).
If Rd. 7 for ‘PANEL YEAR 2’ display the fourth calendar year of the panel (FourthPanYear).
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)
MEPS RECORD KEEPER 9 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_01A=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_01A, 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_01A=1, display "9", 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.