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2022

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2018
Survey form view entire document:  text  image
AC210 (AC1185)
BLAISE NAME: DelayCare
Question Text:
The following questions are about the use of health care. Do not include dental care or prescription medicines.
Please think about the last 12 months, that is, between [MONTH YEAR-1] and today. [[Have you/Has [PERSON]] delayed seeking medical care/Has medical care been delayed for anyone in the household] because of worry about the cost?
Responses:
> YES 1 AC220 (AC1186)
NO 2 AC230 (AC1187)
REFUSED RF AC230 (AC1187)
DON'T KNOW DK AC230 (AC1187)
Programmer Instructions:

 

If coded ?1? (YES) and a MULTI-PERSON RU, continue with AC220. If coded ?1? (YES) and a SINGLE-PERSON RU, automatically code person at AC220, and go to AC230.
Display Instructions:

 

For ?MONTH YEAR-1? display the month of the current interview and the current interview year minus 1.
Display ?[Have you/Has [PERSON]] delayed seeking medical care? if SINGLE-PERSON RU. Otherwise, display ?Has medical care been delayed for anyone in the household?.
AC220 (AC1186)
BLAISE NAME: DelayWho
Question Text:
Who was that?
PROBE: Did anyone else delay seeking medical care because of worry about the cost?
ENTER ALL THAT APPLY.
Responses:
> [FIRST NAME [MIDDLE NAME] LAST NAME]1 1
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5
Programmer Instructions: 
Go to AC230.
Display Instructions: 
Roster 2 - no add/edit/delete
Roster definition:
This item displays RU members roster for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster filter:
No filter; display all.