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Reenumeration (RE) Section Subsection A


BOX_01
======

----------------------------------------------------
RU CLASSIFICATIONS:

THE FOLLOWING RU CLASSIFICATIONS ARE USED THROUGHOUT THE REENUMERATION SECTION IN SKIP AND WORD FILL SPECIFICATIONS:

STANDARD RU - AN RU (OTHER THAN A STUDENT RU) THAT EXISTED IN THE PREVIOUS ROUND. DURING THE INTERVIEW WITH THE STANDARD RU, INFORMATION MAY BE OBTAINED THAT IDENTIFIES A 'NEW RU' OR A 'STUDENT RU' AND A NEW CASE IS CREATED. SEE DEFINITIONS BELOW.

NEW RU - WHEN ONE OR MORE RU MEMBERS ARE IDENTIFIED AS HAVING LEFT THE RU AND FORMED ONE OR MORE NEW RUs, A NEW CASE IS CREATED FOR EACH OF THE NEW RUs WHERE AT LEAST ONE KEY RU MEMBER LIVES. IN THE CURRENT ROUND, THE CASE IS CLASSIFIED AS A 'NEW RU' UNLESS IT SATISFIES THE CONDITIONS FOR A 'STUDENT RU' (SEE DEFINITION BELOW). IN THE NEXT ROUND, THE NEW RU WILL BE RECLASSIFIED AS A 'STANDARD RU' SINCE IT EXISTED IN THE PREVIOUS ROUND.

STUDENT RU - WHEN AN RU MEMBER IS IDENTIFIED IN A STANDARD OR NEW RU AS BEING AGE 17-23 (INCLUSIVE), NEVER MARRIED, NON-MILITARY, AND LIVING AWAY FROM THE STANDARD/NEW RU AT POST-SECONDARY SCHOOL WITHIN THE U.S., AN RU IS CREATED AND CLASSIFIED AS A 'STUDENT RU'. THE 'STUDENT RU' REMAINS CLASSIFIED AS A 'STUDENT RU' UNTIL ONE OF THE CRITERIA FOR A STUDENT RU CLASSIFICATION IS VIOLATED (E.G., AGE RANGE OR MARITAL STATUS). (NOTE: A STUDENT RU IS ALWAYS A SINGLE-PERSON RU.)
----------------------------------------------------
----------------------------------------------------
NOTE: THE NHIS ORIGINAL RUs ARE DETERMINED FROM IN-HOUSE PRE-PROCESSING AND ARE CLASSIFIED AS STANDARD RUs.
----------------------------------------------------
----------------------------------------------------
NOTE: REFERENCES TO THE RU-MEMBERS-ROSTER AND 'RU MEMBERS' IN THESE SPECIFICATIONS INDICATE THE ROSTER IN ITS CURRENT STATE; THAT IS, INCLUDING ALL ADDITIONS TO AND DELETIONS FROM THE ROSTER THAT OCCUR UP TO THE POINT AT WHICH THE REFERENCE IS MADE.

THEREFORE, IF ROUND 1, THE FIRST TIME A CASE IS WORKED DURING THE ROUND, AT THE BEGINNING OF THE RE SECTION, THE ROSTER INCLUDES ALL ORIGINAL NHIS RU MEMBERS. IF NOT ROUND 1, THE FIRST TIME A CASE IS WORKED IN THE ROUND, AT THE BEGINNING OF THE RE SECTION, THE ROSTER INCLUDES ALL RU MEMBERS WHO WERE ELIGIBLE OR INSTITUTIONALIZED ON THE DATE OF THE PREVIOUS ROUND INTERVIEW.

IN ALL ROUNDS, FOR A CASE THAT HAS HAD A BREAKOFF, THE ROSTER INCLUDES PERSONS ELIGIBLE OR INSTITUTIONALIZED AT THE END OF RE. FOR A SPLIT RU, THE ROSTER INCLUDES RU MEMBERS WHO SPLIT FROM THE ORIGINAL RU.
----------------------------------------------------

RE01
====

YOU HAVE SELECTED THE [STUDENT RU] CASE FOR [FULL NAME OF REFERENCE PERSON]. THE RU MEMBERS ARE LISTED BELOW.
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[1. First Name,[Middle Name],LastName-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
HAVE YOU SELECTED THE CORRECT CASE?
YES .................................... 1
NO ..................................... 2
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'STUDENT RU' IF STUDENT RU. OTHERWISE, USE NULL DISPLAY.

FOR '[FULL NAME OF REFERENCE PERSON]' DISPLAY THE FULL NAME OF PREVIOUS ROUND REFERENCE PERSON IF STANDARD RU OR STUDENT RU. DISPLAY FULL NAME OF OLDEST PERSON IN RU, IF NEW RU.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), DISPLAY THE FOLLOWING MESSAGE: 'PRESS ENTER TO RETURN TO 'ENTER ID' SCREEN.'
----------------------------------------------------
----------------------------------------------------
OTHERWISE (CORRECT CASE SELECTED), CONTINUE WITH RE02
----------------------------------------------------

RE02
====

[INTERVIEWER: READ INTRODUCTION JOB AID BEFORE CODING.] [PLEASE NOTE: THIS IS A ROUND 5 INTERVIEW. QUESTIONS ARE ASKED AS OF DEC 31, 1998 RATHER THAN 'TODAY'.]
[THE RESPONDENT MUST HAVE BEEN LIVING IN THE RU ON DEC 31, 1998 TO BE CODED AS AN RU MEMBER RESPONDENT. OTHERWISE, CODE AS A PROXY.]
IS RESPONDENT: ...
RU MEMBER OR ........................... 1
PROXY APPROVED BY SUPERVISOR? .......... 2
[Code One]
PRESS F1 FOR RESPONDENT RULES.
----------------------------------------------------
DISPLAY 'INTERVIEWER: READ INTRODUCTION JOB AID BEFORE CODING.' IF NOT ROUND 1. OTHERWISE, USE NULL DISPLAY.

DISPLAY 'PLEASE NOTE: THIS IS A ROUND 5 INTERVIEW. QUESTIONS ARE ASKED AS OF DEC 31, 1998 RATHER THAN 'TODAY'.' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND CODED '1' (RU MEMBER) AND STANDARD RU, GO TO RE05
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND CODED '1' (RU MEMBER) AND NEW RU, GO TO RE05A
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND CODED '1' (RU MEMBER) AND STUDENT RU, GO TO RE05B
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1 AND CODED '1' (RU MEMBER) AND STUDENT RU, GO TO RE06 AND SELECT STUDENT AUTOMATICALLY BY CAPI, THEN GO TO RE09
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1 AND CODED '1' (RU MEMBER) AND STANDARD OR NEW RU, GO TO RE06
----------------------------------------------------
----------------------------------------------------
OTHERWISE (PROXY APPROVED BY SUPERVISOR), CONTINUE WITH RE03
----------------------------------------------------

BOX_01A
=======

OMITTED.

BOX_01B
=======

OMITTED.

RE03
====

INTERVIEWER: SINCE THIS IS AN INTERVIEW WITH A PROXY, PLEASE EXPLAIN THE REASON(S) AN RU MEMBER CANNOT BE THE RESPONDENT.
[Enter Text]
----------------------------------------------------
IF ROUND 1 AND STANDARD RU, GO TO RE05
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND NEW RU, GO TO RE05A
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND STUDENT RU, GO TO RE05B
----------------------------------------------------
----------------------------------------------------
OTHERWISE (NOT ROUND 1), GO TO RE07
----------------------------------------------------

LOOP_01
=======

OMITTED.

RE04
====

OMITTED.

END_LP01
========

OMITTED.

BOX_02
=======

OMITTED.

RE05
====

[REFERENCE PERSON'S FIRST MIDDLE AND LAST NAME]
(As I mentioned earlier,) my records show that (PERSON)'s household took part in the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW] and, at that time, the Census Bureau interviewer mentioned that (PERSON)'s family might be contacted again for another health related survey.
IF NEEDED, READ ALL OR PART OF THE FOLLOWING:
This survey, the Medical Expenditure Panel Survey, is also for the U.S. Public Health Service [specifically, the Agency for Health Care Policy and Research and the National Center for Health Statistics]. The information you provide will be kept completely confidential and private as required by law.
PRESS ENTER TO CONTINUE.
---------------------------------------------------
NOTE: IN ROUND 1, THE NAME IN THE CONTEXT HEADER IS THE FULL NAME OF THE NHIS REFERENCE PERSON.
---------------------------------------------------
---------------------------------------------------
IF RE02 CODED '1' (RU MEMBER), GO TO RE06
---------------------------------------------------
---------------------------------------------------
IF RE02 CODED '2' (PROXY APPROVED BY SUPERVISOR), GO TO RE08
---------------------------------------------------

RE05A
=====

[REFERENCE PERSON'S FIRST MIDDLE AND LAST NAME]
(As I mentioned earlier,) my records show that (PERSON) (were/was) a member of a household that took part in the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW] and, at that time, the Census Bureau interviewer mentioned that members of that household might be contacted again for another health related survey. Since (PERSON) (are/is) no longer living with that household, we will interview this new household separately.
IF NEEDED, READ ALL OR PART OF THE FOLLOWING:
This survey, the Medical Expenditure Panel Survey, is also for the U.S. Public Health Service [specifically, the Agency for Health Care Policy and Research and the National Center for Health Statistics]. The information you provide will be kept completely confidential and private as required by law.
PRESS ENTER TO CONTINUE.
---------------------------------------------------
NOTE: THE NAME OF THE REFERENCE PERSON DISPLAYED IN THE CONTEXT HEADER IS THE FULL NAME OF THE OLDEST RU MEMBER.
---------------------------------------------------
---------------------------------------------------
IF RE02 CODED '1' (RU MEMBER), GO TO RE06
---------------------------------------------------
---------------------------------------------------
IF RE02 CODED '2' (PROXY APPROVED BY SUPERVISOR), GO TO RE08
---------------------------------------------------

RE05B
=====

[REFERENCE PERSON'S FIRST MIDDLE AND LAST NAME]
(As I mentioned earlier,) my records show that (PERSON] (were/was] a member of a household that took part in the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW] and, at that time, the Census Bureau interviewer mentioned that members of that household might be contacted again for another health related survey. Since (PERSON] (are/is) now a student and no longer living with that household, we will interview (PERSON) separately.
IF NEEDED, READ ALL OR PART OF THE FOLLOWING:
This survey, the Medical Expenditure Panel Survey, is also for the U.S. Public Health Service [specifically, the Agency for Health Care Policy and Research and the National Center for Health Statistics]. The information you provide will be kept completely confidential and private as required by law.
PRESS ENTER TO CONTINUE.
---------------------------------------------------
NOTE: THE NAME OF THE REFERENCE PERSON DISPLAYED IN THE CONTEXT HEADER IS THE FULL NAME OF THE STUDENT.
---------------------------------------------------
---------------------------------------------------
IF RE02 CODED '1' (RU MEMBER), SELECT STUDENT AT RE06 AUTOMATICALLY BY CAPI, THEN GO TO RE09
---------------------------------------------------
---------------------------------------------------
IF RE02 CODED '2' (PROXY APPROVED BY SUPERVISOR), GO TO RE08
---------------------------------------------------

RE06
====

SELECT THE RESPONDENT.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. DU MEMBERS
RE06_02. RUID
RE06_03. GENDER
RE06_04. AGE
RE06_05. INTERVIEW COMPLETED THIS ROUND
1. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
2. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
3. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
PRESS F1 FOR RESPONDENT RULES.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NEW RU MEMBER NOT YET LISTED' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
2. THE MATRIX COLUMNS ARE DISPLAY-ONLY. THAT IS, NO CHANGES ARE ALLOWED TO THE INFORMATION.
3. THE 'INTERVIEW COMPLETED THIS ROUND' COLUMN DISPLAYS AN 'X' FOR EACH PERSON WHO HAS ALREADY BEEN INTERVIEWED THIS ROUND IN THE STANDARD RU OR ANOTHER RU IN THIS DU.
4. IF PERSON WITH AN 'X' IN 'INTERVIEW COMPLETED THIS ROUND' COLUMN IS SELECTED, DISPLAY MESSAGE: 'PERSON CANNOT BE SELECTED. HAS ALREADY BEEN INTERVIEWED WITH ANOTHER RU.'
5. IF AN RU MEMBER UNDER 18 IS SELECTED AS THE RESPONDENT, DISPLAY MESSAGE 'RESPONDENT ( 18. S/HE MUST BE APPROVED BY SUPERVISOR. RESELECT TO VERIFY.'
6. IF INTERVIEWER SELECTS A PERSON FROM ANOTHER RU, DISPLAY THE MESSAGE: 'PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION.'
----------------------------------------------------
----------------------------------------------------
IF PERSON FROM ANOTHER RU IS SELECTED AND VERIFIED AS THE RESPONDENT, ADD PERSON TO RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'NEW RU MEMBER NOT YET LISTED' IS SELECTED, CONTINUE WITH RE08
----------------------------------------------------
----------------------------------------------------
OTHERWISE (PERSON SELECTED AS RESPONDENT WAS ALREADY IN DU IN THE PREVIOUS ROUND), GO TO RE09
----------------------------------------------------

BOX_03
======

OMITTED.

RE07
====

SELECT PROXY.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65] ...............................
[2. First Name,[Middle Name],Last Name-65] ...............................
[3. First Name,[Middle Name],Last Name-65] ...............................
[Code One]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE PERSONS IN THE PERSONS-ROSTER (RU-LEVEL) THAT MEET THE FOLLOWING CONDITION:
- PERSON WAS PROXY IN PREVIOUS ROUND
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NEW PROXY APPROVED BY SUPERVISOR' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A PERSON(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD NOT BE ABLE TO EDIT ANY OF THE NAMES.
3. INTERVIEWER SHOULD NOT BE ABLE TO ADD NEW PERSONS.
4. INTERVIEWER SHOULD NOT BE ABLE TO DELETE ANY PERSONS.
----------------------------------------------------
----------------------------------------------------
IF 'NEW PROXY APPROVED BY SUPERVISOR' IS SELECTED, CONTINUE WITH RE08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO RE09
----------------------------------------------------

RE08
====

ENTER NAME OF [RU MEMBER/PROXY] RESPONDENT.
May I have your full name?
VERIFY SPELLING.
IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.
[Enter First Name,[Middle Name],Last Name-65] .....
----------------------------------------------------
REFUSED AND DON'T KNOW DISALLOWED AT ALL FIELDS.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'RU MEMBER' IF RE02 CODED '1' (RU MEMBER).

DISPLAY 'PROXY' IF RE02 CODED '2' (PROXY APPROVED BY SUPERVISOR).
----------------------------------------------------
----------------------------------------------------
IF 'NEW RU MEMBER NOT YET LISTED' SELECTED AT RE06, ADD PERSON ENTERED AT RE08 TO RU-MEMBERS-ROSTER
AND
FLAG PERSON AS 'RU MEMBER ADDED AT RE08'.
----------------------------------------------------
----------------------------------------------------
IF 'NEW PROXY APPROVED BY SUPERVISOR' CODED AT RE07, ADD PERSON ENTERED AT RE08 TO PERSONS-ROSTER
AND
FLAG PERSON AS 'PROXY ADDED AT RE08'.
----------------------------------------------------

RE09
====

VERIFY LOCATING ADDRESS BELOW WITH RESPONDENT.
STREET ADDRESS1: [RU'S MOST RECENT ST. ADDRESS1]
STREET ADDRESS2: [RU'S MOST RECENT ST. ADDRESS2]
CITY: [RU'S MOST RECENT CITY]
STATE: [ST]
ZIP CODE: [ZIP CODE]
CORRECT ADDRESS ........................ 1 [RE10A]
SAME ADDRESS - MINOR CORRECTIONS ....... 2
NEW ADDRESS ............................ 3
[Code One]
PRESS F1 FOR DEFINITION OF LOCATING ADDRESS.

RE10
====

MAKE CORRECTIONS TO LOCATING ADDRESS BELOW.
IF NO CORRECTION TO A FIELD IS NECESSARY, PRESS ENTER.
IF CORRECTION TO A FIELD IS NECESSARY, RE-TYPE ENTIRE FIELD.
Current Info: [STREET ADDRESS1]
[STREET ADDRESS2]
[CITY]
[STATE]
[ZIP CODE]
STREET ADDRESS1 (RE10_01): [_____________]
STREET ADDRESS2 (RE10_02): [_____________]
CITY (RE10_03): [_____________]
STATE (RE10_04): [_____________]
ZIP CODE (RE10_05): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED AT ALL FIELDS.
----------------------------------------------------

RE10A
=====

RECORD THE NAME OF THE COUNTY WHERE THIS RU IS LOCATED.
[Enter County Name -25] .........................
REF ............................................. -7
DK .............................................. -8

RE11
====

VERIFY TELEPHONE NUMBER BELOW WITH RESPONDENT.
IF NO CORRECTION TO A FIELD IS NECESSARY, PRESS ENTER.
IF CORRECTION TO A FIELD IS NECESSARY, RE-TYPE ENTIRE FIELD.
IF NO TELEPHONE, ENTER '000'.
Current Info: [TELEPHONE NUMBER]
TELEPHONE NUMBER: [ ]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF CURRENT INFO IS NOT AVAILABLE, ENTRY IS REQUIRED FOR TELEPHONE NUMBER. (REFUSED AND DON'T KNOW ARE ALLOWED AT ALL FIELDS.)
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND STANDARD SINGLE-PERSON RU OR NEW SINGLE-PERSON RU (THAT IS, ANY NON-STUDENT SINGLE-PERSON RU),
AND
RE02 CODED '1' (RESPONDENT IS AN RU MEMBER), GO TO RE47
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND STANDARD SINGLE-PERSON RU OR NEW SINGLE-PERSON RU (THAT IS, ANY NON-STUDENT SINGLE-PERSON RU)
AND
RE02 CODED '2' (RESPONDENT IS A PROXY APPROVED BY SUPERVISOR), GO TO RE20
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND MULTI-PERSON RU (WHETHER STANDARD OR NEW), GO TO RE20
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1 AND NOT A STUDENT RU, GO TO BOX_09
----------------------------------------------------
----------------------------------------------------
IF STUDENT RU, CONTINUE WITH RE11A
----------------------------------------------------

RE11A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
My records show that (PERSON) (are/is) a student at post-secondary school. (Are/Is) (PERSON) attending school full-time or part-time?
PART-TIME .............................. 1
FULL-TIME .............................. 2
NOT ATTENDING SCHOOL ................... 3
REF ................................... -7
DK .................................... -8
[Code One]

BOX_03A
=======

----------------------------------------------------
IF STUDENT RU NOT CREATED IN CURRENT ROUND AND RE11A CODED '3' (NOT ATTENDING SCHOOL), CONTINUE WITH BOX_03B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO RE12
----------------------------------------------------

BOX_03B
=======

----------------------------------------------------
RU CLASSIFICATION CHANGE: CHANGE RU CLASSIFICATION FROM STUDENT RU TO STANDARD RU SINCE PERSON IS NO LONGER ATTENDING SCHOOL.
----------------------------------------------------
----------------------------------------------------
GO TO RE47
----------------------------------------------------

RE12
====

VERIFY INFORMATION WITH RESPONDENT. CORRECT IF NECESSARY.
GENDER: 1 = MALE, 2 = FEMALE
IF AGE IS INCORRECT AND DATE OF BIRTH KNOWN, RE-ENTER DATE OF BIRTH.
IF AGE IS INCORRECT AND DATE OF BIRTH NOT KNOWN, PROBE FOR AGE AND
ENTER IF KNOWN.
[NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, 1998.]

TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
ROSTER. RU MEMBER
RE12_01. GENDER
RE12_02. DATE OF BIRTH
RE12_03. AGE
1. First Name Middle Name Last Name-35 [Display/Correct Selection] [Display/ Correct Date] [Verify/Enter Age]
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED IN ALL COLUMNS EXCEPT 'RU MEMBER' COLUMN.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, 1998.' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE LEFT AND RIGHT ARROW KEYS TO MOVE CURSOR AMONG CELLS.
2. ALLOW INTERVIEWERS TO CORRECT GENDER, DATE OF BIRTH, AND AGE (WHEN AGE NOT CALCULATED BY CAPI). THE NAME CANNOT BE EDITED.
3. INTERVIEWERS SHOULD NOT BE ALLOWED TO CHANGE 'REAL' DATA TO '-7' (REFUSED) OR '-8' (DON'T KNOW). IF INTERVIEWER TRIES TO DO SO, DISPLAY MESSAGE 'DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON'T KNOW.'
4. IF DATE OF BIRTH IS CHANGED, CALCULATE AGE AUTOMATICALLY BY CAPI USING NEW DATE OF BIRTH AND DISPLAY CALCULATED AGE IN AGE COLUMN.
----------------------------------------------------
----------------------------------------------------
NOTE: BECAUSE THIS IS A STUDENT RU, THERE IS ONLY ONE RU MEMBER AND ONLY ONE ROW IN THE MATRIX.
----------------------------------------------------
----------------------------------------------------
NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DECEMBER 31, 1998. ALL AGE SKIPS (THROUGHOUT THE QUESTIONNAIRE) WILL BE BASED ON THIS AGE.
----------------------------------------------------

BOX_04
=======

----------------------------------------------------
IF STUDENT RU NOT CREATED THIS ROUND AND AGE ) 23, CONTINUE WITH BOX_05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO RE13
----------------------------------------------------

BOX_05
=======

----------------------------------------------------
RU CLASSIFICATION CHANGE: CHANGE RU CLASSIFICATION FROM STUDENT RU TO STANDARD RU SINCE STUDENT IS OUTSIDE OF DESIGNATED STUDENT RU AGE RANGE.
----------------------------------------------------
----------------------------------------------------
GO TO RE47
----------------------------------------------------

RE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
My records show that [as of December 31, 1998] (PERSON) [(have/has)/had] never been married.
Is that correct?
YES .................................... 1 [RE14]
NO ..................................... 2
REF ................................... -7 [RE14)
DK .................................... -8 [RE14]
---------------------------------------------------
DISPLAY 'as of December 31, 1998' IF ROUND 5. OTHERWISE, USE NULL DISPLAY.
DISPLAY (have/has) IF NOT ROUND 5. IF ROUND 5, DISPLAY 'had'.
---------------------------------------------------

RE13OV
======

[(Are/Is)/On December 31, 1998, (were/was)] (PERSON) [now] married, widowed, divorced, or separated?
MARRIED ................................ 1
WIDOWED ................................ 2
DIVORCED ............................... 3
SEPARATED .............................. 4
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY 'On December 31, 1998, (were/was)' IF ROUND 5.
DISPLAY 'now' IF NOT ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

BOX_06
======

----------------------------------------------------
RU CLASSIFICATION CHANGE: CHANGE RU CLASSIFICATION FROM STUDENT RU TO STANDARD RU SINCE STUDENT'S MARITAL STATUS IS NO LONGER 'NEVER MARRIED'.
----------------------------------------------------
----------------------------------------------------
GO TO RE47
----------------------------------------------------

RE14
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[(Are/Is)/(Were/Was)] (PERSON) on full-time active duty with the Armed Forces of the United States [on December 31, 1998]?
YES .................................... 1
NO ..................................... 2 [RE18]
REF ................................... -7 [RE18)
DK .................................... -8 [RE18]
PRESS F1 FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY '(Were/Was)' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

RE15
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) enter full-time active duty service in the Armed Forces?
[Enter Month, Day, Year-2] ............
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
REMOVE PERSON FROM THE RU-MEMBERS-ROSTER AND FLAG PERSON AS REMOVED AT RE15. PERSON IS INELIGIBLE FOR DATA COLLECTION IN THIS ROUND.
----------------------------------------------------

BOX_07
======

OMITTED.

RE16
====

At this time, we are only collecting information about persons who are not on full-time active duty with the Armed Forces of the United States. Therefore, that is all the information we need.
PRESS ENTER TO CONTINUE.

RE17
====

Thank you for your participation in this important study.
PRESS ENTER TO CONTINUE.

RE17A
=====

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS ENTER TO END THE INTERVIEW.

RE17B
=====

INTERVIEWER: DID YOU COMPLETE THIS INTERVIEW IN-PERSON OR BY TELEPHONE? (YOU MUST HAVE SUPERVISOR APPROVAL PRIOR TO INTERVIEWING BY TELEPHONE.)
IN-PERSON ............................. 1
TELEPHONE ............................. 2
(Code One)
----------------------------------------------------
GO TO BOX_27
----------------------------------------------------

RE18
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever served on active duty in the Armed Forces of the United States?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
GO TO BOX_27
----------------------------------------------------

BOX_08
======

---------------------------------------------------
IF ROUND 1, GO TO RE20
---------------------------------------------------
---------------------------------------------------
OTHERWISE (NOT ROUND 1), CONTINUE WITH BOX_09
---------------------------------------------------

BOX_09
======

----------------------------------------------------
IF ON DATE OF PREVIOUS ROUND INTERVIEW AT LEAST ONE KEY RU MEMBER WAS CODED AS INSTITUTIONALIZED IN A HEALTH CARE FACILITY (RE36 = 1 OR 2 -OR- RE19 = 1), CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
IF STANDARD SINGLE-PERSON RU OR NEW SINGLE-PERSON RU (THAT IS, ANY NON-STUDENT SINGLE-PERSON RU), AND RE02 CODED '1' (RESPONDENT IS AN RU MEMBER), GO TO RE47
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO RE20
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK BOX_09A-END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION TO DETERMINE THE LOCATION AND ELIGIBILITY OF KEY RU MEMBERS WERE INSTITUTIONALIZED AT A HEALTH CARE FACILITY ON THE DATE OF THE PREVIOUS ROUND INTERVIEW. THIS LOOP CYCLES ON RU MEMBERS WHO MEET ALL OF THE FOLLOWING CONDITIONS:
- PERSON IS KEY
- PERSON WAS INSTITUTIONALIZED AT A HEALTH CARE FACILITY ON THE DATE OF THE PREVIOUS ROUND INTERVIEW (RE36 = 1 OR 2 -OR- RE19 = 1).
----------------------------------------------------

BOX_09A
=======

----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS AN RU MEMBER RESPONDENT (RE02 = 1), CODE 'NO' AT RE19 AUTOMATICALLY BY CAPI, THEN CONTINUE WITH BOX_09B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH RE19
----------------------------------------------------

RE19
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
My records indicate that (PERSON) was institutionalized in a health care facility at the time of the last interview. [Is/On December 31, 1998, was] (PERSON) still institutionalized in a health care facility?
YES .................................... 1 [END_LP02]
NO ..................................... 2
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
PRESS F1 FOR DEFINITION OF INSTITUTIONALIZED IN A HEALTH CARE FACILITY.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'On December 31, 1998, was' IF ROUND 5.
----------------------------------------------------

BOX_09B
=======

----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS AN RU MEMBER RESPONDENT (RE02 = 1), CODE 'LIVING WITH THIS FAMILY' AT RE19A AUTOMATICALLY BY CAPI, THEN CONTINUE WITH RE19B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH RE19A
----------------------------------------------------
----------------------------------------------------
NOTE: SINCE THE NUMBER OF PEOPLE WHO ENTER AND LEAVE AN INSTITUTION IS SO SMALL, WE WILL INSTRUCT THE INTERVIEWER TO MAKE A COMMENT ABOUT INDIVIDUALS WHO ARE NOT ACCOMMODATED BY THIS SERIES (E.G., PERSON IS THE RESPONDENT, BUT LEFT INSTITUTION AFTER 12/31/98).
----------------------------------------------------

RE19A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
IF RESPONDENT VOLUNTEERS THAT PERSON IS DECEASED, CODE '3' WITHOUT ASKING.
[Is/On December 31, 1998, was] (PERSON) [now] living here with this family, or [does/did] (PERSON) have a usual place of residence somewhere else?
LIVING WITH THIS FAMILY ................ 1
USUAL PLACE OF RESIDENCE SOMEWHERE ELSE ....................... 2 [RE19D]
DECEASED ............................... 3 [RE19C]
REF ................................... -7 [RE19D]
DK .................................... -8 [RE19D]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Is' AND 'does' IF NOT ROUND 5. DISPLAY 'On December 31, 1998, was' AND 'did' IF ROUND 5.
DISPLAY 'now' IF NOT ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (LIVING WITH THIS FAMILY), FLAG PERSON WITH THE NUMBER OF THE ROUND PERSON REJOINED RU, THEN CONTINUE WITH RE19B
----------------------------------------------------

RE19B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) leave the health care facility?
[Enter Month Day Year-2]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.
----------------------------------------------------
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/98. IF A DATE AFTER 12/31/98 IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'DATE MUST BE ON OR BEFORE 12/31/98. IF LEFT INSTITUTION AFTER 12/31/98, USE CTRL/B TO BACK-UP AND RE-CODE RE19 TO 'YES'.'
----------------------------------------------------
----------------------------------------------------
NOTE: THE DATE ENTERED HERE DETERMINES THE START OF THE REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------

RE19BOV
=======

On what date did (PERSON) return to live with this family?
[Enter Month Day Year-2]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/98. IF A DATE AFTER 12/31/98 IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'DATE MUST BE ON OR BEFORE 12/31/98. IF JOINED RU AFTER 12/31/98, USE CTRL/B TO BACK-UP AND RE-CODE RE19A.'
----------------------------------------------------
----------------------------------------------------
GO TO END_LP02
----------------------------------------------------

RE19C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) leave the health care facility?
[Enter Month Day Year-2]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.
----------------------------------------------------
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/98. IF A DATE AFTER 12/31/98 IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'DATE MUST BE ON OR BEFORE 12/31/98. IF LEFT INSTITUTION AFTER 12/31/98, USE CTRL/B TO BACK-UP AND RE-CODE RE19 TO 'YES'.'
----------------------------------------------------
----------------------------------------------------
NOTE: THE DATE ENTERED HERE DETERMINES THE START OF THE REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------

RE19COV
=======

On what date did (PERSON) die?
[Enter Month Day Year-2]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/98. IF A DATE AFTER 12/31/98 IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'DATE MUST BE ON OR BEFORE 12/31/98. IF DIED AFTER 12/31/98, USE CTRL/B TO BACK-UP AND RE-CODE RE19A.'
----------------------------------------------------
----------------------------------------------------
GO TO END_LP02
----------------------------------------------------

RE19D
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) leave the health care facility?
[Enter Month Day Year-2]
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.
----------------------------------------------------
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/98. IF A DATE AFTER 12/31/98 IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'DATE MUST BE ON OR BEFORE 12/31/98. IF LEFT INSTITUTION AFTER 12/31/98, USE CTRL/B TO BACK-UP AND RE-CODE RE19 TO 'YES'.'
----------------------------------------------------
----------------------------------------------------
NOTE: THE DATE ENTERED HERE DETERMINES THE START OF THE REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------

RE19E
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Where [is (PERSON) now/was (PERSON) on December 31, 1998]?
INSTITUTIONALIZED IN A HEALTH CARE FACILITY ............................. 1
INSTITUTIONALIZED IN A NON-HEALTH CARE FACILITY ............................. 2 [RE19I]
STUDENT UNDER 24 LIVING AWAY AT SCHOOL IN GRADES 1-12 ....................... 3 [RE19I]
STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL ................ 4
ANOTHER HOUSEHOLD - CURRENTLY NOT FULL- TIME MILITARY ........................ 5
ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME MILITARY ......... 6 [RE19H]
REF .................................... -7
DK ..................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'is (PERSON) now' IF NOT ROUND 5. DISPLAY 'was (PERSON) on December 31, 1998' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISALLOW FINAL ENTRY OF CODE '1' (INSTITUTIONALIZED IN HEALTH CARE FACILITY). IF INTERVIEWER ENTERS CODE '1', DISPLAY THE FOLLOWING MESSAGE 'VERIFY FACILITY TYPE. IF HEALTH CARE FACILITY USE CTRL/J TO CORRECT RE19 TO YES.'
----------------------------------------------------

RE19F
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Is/Was] (PERSON) living within the U.S. or outside the U.S. [on December 31, 1998]?
WITHIN U.S. .......................... 1
OUTSIDE U.S. ......................... 2
REF ................................. -7
DK .................................. -8
PRESS F1 FOR DEFINITION OF LIVING WITHIN/OUTSIDE U.S.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
-----------------------------------------------------
IF PERSON CODED '4' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL AT RE19E), CONTINUE WITH RE19G
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO RE19I
-----------------------------------------------------

RE19G
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[(Are/Is)/On December 31, 1998, (were/was)] (PERSON) attending ...
grades 1-12, ........................... 1
a college or university, or ............ 2
some other training school after high school? .............................. 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY 'On 'December 31, 1998, (were/was)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISALLOW FINAL ENTRY OF CODE '1' (GRADES 1-12). IF INTERVIEWER TRIES TO ENTERS CODE '1', DISPLAY THE FOLLOWING MESSAGE: 'USE CTRL/J TO CORRECT RE19E TO STUDENT ( 24 LIVING AWAY AT SCHOOL GRADES 1-12).'
----------------------------------------------------
----------------------------------------------------
GO TO RE19I
----------------------------------------------------

RE19H
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Is/Was] (PERSON) living in another household or in a military facility [on December 31, 1998]?
ANOTHER HOUSEHOLD ................... 1
MILITARY FACILITY ................... 2
REF ................................ -7
DK ................................. -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

RE19HOV
=======

[Is/Was] (PERSON) living within the U.S. or outside the U.S. [on December 31, 1998]?
WITHIN U.S. ......................... 1
OUTSIDE U.S. ........................ 2
REF ................................ -7
DK ................................. -8
[Code One]
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

RE19I
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) [enter the non-health care facility/start living away at school/start living in another household/start living at a military facility/leave the United States]?
[Enter Month,Day,Year-2] ...............
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'enter the non-health care facility' IF RE19E CODED '2' (INSTITUTIONALIZED IN NON-HEALTH CARE FACILITY).

DISPLAY 'start living away at school' IF RE19E CODED '3' (STUDENT UNDER 24 LIVING AWAY AT SCHOOL IN GRADES 1-12) OR IF RE19E CODED '4' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) AND RE19F CODED '1' (WITHIN U.S.), '-7' (REF), OR '-8' (DK).

DISPLAY 'start living in another household' IF RE19E CODED '5' (ANOTHER HOUSEHOLD – CURRENTLY NOT FT MILITARY) AND RE19F CODED '1' (WITHIN U.S.), '-7' (REF), OR '-8' (DK) OR IF RE19E CODED '6' (ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME MILITARY AND RE19H CODED '1' (ANOTHER HOUSEHOLD), '-7' (REF), OR '-8' (DK) AND RE19HOV CODED '1' (WITHIN U.S.), '-7' (REF), OR '-8' (DK).

DISPLAY 'start living at a military facility' IF RE19E CODED '6' (ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME MILITARY AND RE19H CODED '2' (MILITARY FACILITY) AND RE19HOV CODED '1' (WITHIN U.S.), '-7' (REF), OR '-8' (DK).

DISPLAY 'leave the U.S.' IF RE19E CODED '4' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) AND RE19F CODED '2' (OUTSIDE U.S.) OR IF RE19E CODED '5' (ANOTHER HOUSEHOLD – CURRENTLY NOT FULL-TIME MILITARY) AND RE19F CODED '2' (OUTSIDE U.S.) OR IF RE19E CODED '6' (ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME MILITARY) AND RE19HOV CODED '2' (OUTSIDE U.S.).
----------------------------------------------------
----------------------------------------------------
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/98. IF A DATE AFTER 12/31/98 IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'DATE MUST BE ON OR BEFORE 12/31/98. IF DATE IS AFTER 12/31/98, USE CTRL/B TO BACK-UP AND RE-CODE RE19A.'
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH RE20
----------------------------------------------------

RE20
====

[INTERVIEWER: IF ALL RU MEMBERS DEAD OR INSTITUTIONALIZED, CODE NO WITHOUT ASKING.]
Before we begin the health interview, [I'd like to ask some questions about this household./I'd like you think about the people living here on December 31, 1998, regardless of whether they are living here now.]
My records indicate that [on [DATE OF PREVIOUS ROUND INTERVIEW],] the people listed on the top of this form (HAND HOUSEHOLD SUMMARY) [were/are] living together as a family. [Do/Did] (READ NAMES BELOW) still live together as a family [on December 31, 1998]?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY INTERVIEWER INSTRUCTION IF RESPONDENT IS A PROXY. OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'I'd like to ... this household.' IF NOT ROUND 5. DISPLAY 'I'd like you ... here now.' IF ROUND 5.

DISPLAY 'on [DATE OF PREVIOUS ROUND INTERVIEW]' IF STANDARD RU. OTHERWISE, USE NULL DISPLAY.

FOR '[DATE OF PREVIOUS ROUND INTERVIEW]', DISPLAY DATE OF NHIS INTERVIEW IF ROUND 1. OTHERWISE, DISPLAY DATE OF PREVIOUS ROUND MEPS INTERVIEW.

DISPLAY 'were' IF STANDARD RU. OTHERWISE, DISPLAY 'are'.

DISPLAY 'Do' IF NOT ROUND 5. DISPLAY 'Did' IF ROUND 5.

DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
IF ROUND 1, THIS ITEM USES THE RU-MEMBERS-ROSTER TO DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITION:
- PERSON NOT ADDED TO RU-MEMBERS-ROSTER THIS ROUND

IF NOT ROUND 1, THIS ITEM USES THE RU-MEMBERS-ROSTER TO DISPLAY ALL RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- PERSON NOT ADDED TO RU-MEMBERS-ROSTER THIS ROUND
- PERSON NOT INSTITUTIONALIZED ON DATE OF PREVIOUS ROUND INTERVIEW
----------------------------------------------------
----------------------------------------------------
IF RE20 CODED '1' (YES), '-7' (REFUSED), OR '-8' (DON'T KNOW), CODE RE21_02 AS '1' (IN RU) FOR ALL RU MEMBERS AUTOMATICALLY BY CAPI, AND GO TO RE42
----------------------------------------------------
----------------------------------------------------
OTHERWISE (RE20 CODED '2' (NO)), CONTINUE WITH RE21
----------------------------------------------------

BOX_10
======

OMITTED.

BOX_11
======

OMITTED.

RE21
====

Who [is/was] not living here with the family [on December 31, 1998]?
CHANGE RU STATUS AS NECESSARY. 1 = IN RU, 2 = LEFT RU, 3 = INCORRECTLY LISTED IN RU DURING [NHIS/PREVIOUS ROUND]
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
ROSTER. RU MEMBER
RE21_02. RU STATUS
1. First Name Middle Name Last Name-35 [Enter RU Status]
2. First Name Middle Name Last Name-35 [Enter RU Status]
3. First Name Middle Name Last Name-35 [Enter RU Status]
PRESS F1 FOR HH MEMBERSHIP RULES.
----------------------------------------------------
REFUSED AND DON'T KNOW DISALLOWED.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
-----------------------------------------------------
DISPLAY 'NHIS' IF ROUND 1. OTHERWISE, DISPLAY 'PREVIOUS ROUND'.
-----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-MEMBERS-ROSTER TO DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITION:
- PERSON NOT ADDED TO RU-MEMBERS-ROSTER THIS ROUND
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. DISPLAY CODE '1' (IN RU) AT RE21_02 FOR EACH RU MEMBER.
2. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
3. RU MEMBERS COLUMN IS PROTECTED. CURSOR WILL NOT ENTER THIS COLUMN, SO NO CHANGES ARE ALLOWED TO RU MEMBERS AT THIS SCREEN.
4. INTERVIEWERS SHOULD NOT BE ALLOWED TO LEAVE SCREEN IF ALL PERSONS CODED '1' (IN RU) AT RE21_02. IF THE INTERVIEWER ATTEMPTS TO LEAVE SCREEN WITH RE21_02 CODED '1' FOR ALL RU MEMBERS, DISPLAY THE MESSAGE: 'IF EVERYONE IS STILL IN RU, USE CTRL/B TO CORRECT PREVIOUS SCREEN.'
----------------------------------------------------
----------------------------------------------------
IF PERSON IS CODED '3' (INCORRECTLY LISTED IN RU DURING [NHIS/PREVIOUS INTERVIEW]) AT RE21_02, REMOVE PERSON FROM RU-MEMBERS-ROSTER AND IF ROUND 1, FLAG PERSON AS 'NOT IN RU – INCORRECTLY LISTED IN RU DURING NHIS.' OTHERWISE FLAG AS 'NOT IN RU - INCORRECTLY LISTED IN RU DURING PREVIOUS INTERVIEW.' PERSON IS INELIGIBLE AND OUT-OF-SCOPE. NO FURTHER INFORMATION WILL BE COLLECTED FOR PERSON.
----------------------------------------------------
----------------------------------------------------
IF RE21_02 CODED '2' (LEFT RU) FOR AT LEAST ONE RU MEMBER, CONTINUE WITH LOOP_04
----------------------------------------------------
----------------------------------------------------
OTHERWISE (NO RU MEMBER CODED '2' (LEFT RU) AND AT LEAST ONE RU MEMBER CODED '3' (INCORRECTLY LISTED IN RU DURING NHIS)), GO TO BOX_22
----------------------------------------------------

BOX_11A
======

OMITTED.

BOX_12
======

OMITTED.

RE22
====

OMITTED.

RE23
====

OMITTED.

BOX_13
======

OMITTED.

LOOP_02
=======

USED ELSEWHERE.

RE24
====

OMITTED.

RE25
====

OMITTED.

END_LP02
========

USED ELSEWHERE.

BOX_14
======

OMITTED.

RE26
====

OMITTED.

RE27
=====

OMITTED.

BOX_15
======

OMITTED.

RE28
====

OMITTED.

RE29
====

OMITTED.

BOX_16
======

OMITTED.

RE30
====

OMITTED.

RE31
====

OMITTED.

BOX_17
======

OMITTED.

LOOP_03
=======

OMITTED.

RE32
====

OMITTED.

RE33
====

OMITTED.

BOX_18
======

OMITTED.

RE34
====

OMITTED.

END_LP03
========

OMITTED.

BOX_19
======

OMITTED.

LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK RE35-END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 DETERMINES THE LOCATION OF RU MEMBERS WHO HAVE LEFT THE RU AND THE DATE SUCH PERSONS LEFT. THIS INFORMATION IS USED TO DETERMINE WHETHER SUCH PERSONS ARE ELIGIBLE FOR THIS INTERVIEW (THAT IS, REMAIN ON THE RU-MEMBERS- ROSTER) AND TO DEFINE THE REFERENCE PERIOD, I ANY, FOR SUCH PERSONS. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITION:
- PERSON LEFT RU (RE21_02 CODED '2')
----------------------------------------------------

BOX_20
======

OMITTED.

RE35
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Why [(are/is)/was] (PERSON) no longer living here with this family [on December 31, 1998]?
DECEASED ................................ 1 [RE41]
INSTITUTIONALIZED ....................... 2
STUDENT UNDER 24 LIVING AWAY AT SCHOOL IN GRADES 1-12 ....................... 3 [RE41]
STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL ................ 4 [RE37]
MOVED - CURRENTLY NOT IN MILITARY ....... 5 [RE37]
MOVED - CURRENTLY ON FULL-TIME ACTIVE DUTY IN ARMED FORCES ................. 6 [RE38]
REF .................................... -7 [RE41]
DK ..................................... -8 [RE41]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(are/is)' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

RE36
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What type of institution [is/was] (PERSON) living in [now/on December 31, 1998]?
NURSING HOME ........................ 1 [RE40]
OTHER LONG-TERM HEALTH CARE INSTITUTION (EXCLUDE COMMUNITY BASED HOSPITAL) ................... 2 [RE40]
OTHER NON-HEALTH CARE INSTITUTION ... 3 [RE41]
REF ................................ -7 [RE40]
DK ................................. -8 [RE40]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'now' IF NOT ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5.
----------------------------------------------------

RE37
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Is/Was] (PERSON) living within the U.S. or outside the U.S. [on December 31, 1998]?
WITHIN U.S. .......................... 1 [RE41]
OUTSIDE U.S. ......................... 2 [RE41]
REF ................................. -7 [RE41]
DK .................................. -8 [RE41]
[Code One]
PRESS F1 FOR DEFINITION OF LIVING WITHIN/OUTSIDE U.S.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF RE35 CODED '4' (STUDENT AWAY AT POST-SECONDARY SCHOOL)
AND
RE37 CODED '1' (WITHIN U.S.), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG PERSON AS A 'NEW STUDENT'.
----------------------------------------------------
----------------------------------------------------
IF RE35 CODED '5' (MOVED - CURRENTLY NOT IN MILITARY)
AND
RE37 CODED '1' (WITHIN U.S.), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG PERSON AS A 'NON-MILITARY MOVER IN U.S.'
----------------------------------------------------

RE38
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Is/Was] (PERSON) living in another household or in a military facility [on December 31, 1998]?
ANOTHER HOUSEHOLD ................... 1
MILITARY FACILITY ................... 2 [RE41]
REF ................................ -7
DK ................................. -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

RE38OV
======

[Is/Was] (PERSON) living within the U.S. or outside the U.S. [on December 31, 1998]?
WITHIN U.S. ......................... 1 [RE41]
OUTSIDE U.S. ........................ 2 [RE41]
REF ................................ -7 [RE41]
DK ................................. -8 [RE41]
[Code One]
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (WITHIN U.S.), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG PERSON AS 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY'
----------------------------------------------------

BOX_21
======

OMITTED.

RE39
====

OMITTED.

RE40
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the name and address of the nursing home or long term care facility where (PERSON) [is/was] living [now/on December 31, 1998].
PLACE NAME (RE40_01): [_____________]
STREET ADDRESS1 (RE40_02): [_____________]
STREET ADDRESS2 (RE40_03): [_____________]
CITY (RE40_04): [_____________]
STATE (RE40_05): [_____________]
ZIP CODE (RE40_06): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'now' IF NOT ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
CODES '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON EACH FORM ITEM.
----------------------------------------------------

RE41
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) [die/enter the institution/start living away at school/move/leave the United States/leave the household]?
[Enter Month,Day,Year-2] ..............
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'die' IF RE35 CODED '1' (DECEASED).

DISPLAY 'enter the institution' IF RE35 CODED '2' (INSTITUTIONALIZED).

DISPLAY 'start living away at school' IF RE35 CODED '3' (STUDENT UNDER 24 LIVING AWAY AT SCHOOL IN GRADES 1-12) OR '4' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL).

DISPLAY 'move' IF RE35 CODED '5' (MOVED - CURRENTLY NOT IN MILITARY) AND RE37 CODED '1' (WITHIN U.S.), '-7' (REF), OR '-8' (DK) OR IF RE35 CODED '6' (MOVED - CURRENTLY FULL-TIME ACTIVE DUTY IN THE ARMED FORCES.

DISPLAY 'leave the U.S.' IF RE35 CODED 5' (MOVED - CURRENTLY NOT IN MILITARY) AND RE37 CODED '2' (OUTSIDE U.S.).

DISPLAY 'leave the household' IF RE35 CODED '-7' (REF) OR '-8' (DK).
----------------------------------------------------
----------------------------------------------------
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/98. IF A DATE AFTER 12/31/98 IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'DATE MUST BE ON OR BEFORE 12/31/98. IF LEFT RU AFTER 12/31/98, USE CTRL/J TO BACK-UP AND RE-CODE RE21.'
----------------------------------------------------
----------------------------------------------------
IF DATE IS PRIOR TO 01/01/97 AND PERSON MEETS ONE OF THE FOLLOWING SETS OF CONDITIONS:
- RE35 CODED '1' (DECEASED), '2' (INSTITUTIONALIZED), '-7' (REFUSED), OR '-8' (DON'T KNOW)
OR
- (RE35 CODED '4' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) OR '5' (MOVED - CURRENTLY NOT IN MILITARY))
AND
RE37 CODED '2' (OUTSIDE U.S.)
OR
- RE35 CODED '6' (MOVED - CURRENTLY ON FULL-TIME ACTIVE DUTY IN ARMED FORCES)
AND
RE38 CODED '2' (MILITARY FACILITY)
OR
- RE35 CODED '6' (MOVED - CURRENTLY ON FULL-TIME ACTIVE DUTY IN ARMED FORCES)
AND
(RE38 CODED '1' (ANOTHER HOUSEHOLD), '-7' (REFUSED), OR '-8' (DON'T KNOW))
AND
RE38OV CODED '2' (OUTSIDE U.S.)

REMOVE PERSON FROM THE RU-MEMBERS-ROSTER AND FLAG PERSON AS REMOVED AT RE41. PERSON IS OUT 0F SCOPE AND INELIGIBLE. INFORMATION WILL NOT BE COLLECTED FOR THIS PERSON.
----------------------------------------------------
-----------------------------------------------------
IF PERSON IS FLAGGED DURING THIS INTERVIEW AS ONE OF THE FOLLOWING:
- 'NEW STUDENT' (THAT IS, RE35 CODED '4' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) AND (RE37 CODED '1' (WITHIN U.S.), '-7' (REFUSED), OR '-8' (DON'T KNOW)))
OR
- 'NON-MILITARY MOVER IN U.S.' (THAT IS, RE35 CODED '5' (MOVED - CURRENTLY NOT IN MILITARY) AND (RE37 CODED '1' (WITHIN U.S.), '-7' (REFUSED), OR '-8' (DON'T KNOW)))
OR
- 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY' (THAT IS, RE35 CODED '6' (MOVED - CURRENTLY ON FULL-TIME ACTIVE DUTY IN ARMED FORCES) AND (RE38 CODED '2' (ANOTHER HOUSEHOLD), '-7' (REFUSED), OR '-8' (DON'T KNOW)) AND (RE38OV CODED '1' (WITHIN U.S.), '-7' (REFUSED), OR '-8'(DON'T KNOW))),

REMOVE PERSON FROM RU-MEMBERS-ROSTER AND FLAG PERSON AS REMOVED AT RE41. THE RE SECTION WILL COLLECT LOCATING AND OTHER PERTINENT INFORMATION FOR PERSON BUT PERSON WILL NOT BE INCLUDED IN THIS INTERVIEW AFTER THE RE SECTION. INFORMATION FOR PERSON MAY BE COLLECTED AS PART OF ANOTHER RU.
-----------------------------------------------------
----------------------------------------------------
IF DATE IS = OR AFTER 01/01/97 AND PERSON MEETS ONE OF THE FOLLOWING SETS OF CONDITIONS:
- RE35 CODED '1' (DECEASED)
OR
- RE35 CODED '2' (INSTITUTIONALIZED)
OR
- (RE35 CODED '4' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) OR '5' (MOVED - CURRENTLY NOT IN MILITARY))
AND
RE37 CODED '2' (OUTSIDE U.S.)
OR
- RE35 CODED '6' (MOVED - CURRENTLY ON FULL-TIME ACTIVE DUTY IN ARMED FORCES)
AND
RE38 CODED '2' (MILITARY FACILITY)
OR
- RE35 CODED '6' (MOVED - CURRENTLY ON FULL-TIME ACTIVE DUTY IN ARMED FORCES)
AND
(RE38 CODED '1' (ANOTHER HOUSEHOLD), '-7' (REFUSED), OR '-8' (DON'T KNOW))
AND
RE38OV CODED '2' (OUTSIDE U.S.)
OR
- RE35 CODED '-7' (REFUSED) OR '-8' (DON'T KNOW)

FLAG PERSON AS 'REMOVE FROM RU BEFORE NEXT ROUND'. INFORMATION MAY BE COLLECTED FOR PERSON DURING THIS ROUND UP UNTIL THE DATE PERSON LEFT THE RU. (PERSON'S REFERENCE PERIOD WILL END ON DATE PERSON LEFT THE RU.) CAPI DETERMINES WHETHER OR NOT TO INCLUDE PERSON IN THE INTERVIEW BASED ON PERSON'S ELIGIBILITY WHICH IS ASSESSED BEFORE RE85.
----------------------------------------------------

END_LP04
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_04 AND CONTINUE WITH BOX_22
----------------------------------------------------

BOX_22
======

----------------------------------------------------
IF ALL RU MEMBERS LEFT THE RU AND ARE NOT ELIGIBLE FOR THE STUDY AS PART OF ANY RU (THEREFORE, LOCATING INFORMATION IS NOT REQUIRED); THAT IS:
- IF THE RU-MEMBERS-ROSTER IS EMPTY
AND
- NO ONE IS FLAGGED AS A 'NEW STUDENT' THIS INTERVIEW
AND
- NO ONE IS FLAGGED AS A 'NON-MILITARY MOVER IN U.S.' THIS INTERVIEW
AND
- NO ONE IS FLAGGED AS 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY' THIS INTERVIEW,
CONTINUE WITH RE42A
----------------------------------------------------
----------------------------------------------------
IF AT LEAST ONE RU MEMBER IS CURRENTLY LIVING IN THE RU (THAT IS, IF AT LEAST ONE PERSON ON THE CURRENT RU-MEMBERS-ROSTER MEETS ALL OF THE FOLLOWING CONDITIONS:
- NOT DECEASED (RE35 IS NOT CODED '1')
AND
- NOT INSTITUTIONALIZED (RE35 IS NOT CODED '2')
AND
- NOT A STUDENT OR NON-MILITARY MOVER LIVING OUTSIDE THE U.S. (RE37 IS NOT CODED '2')
AND
- NOT ON FULL-TIME ACTIVE DUTY AND LIVING AT A MILITARY FACILITY (RE38 IS NOT CODED '2')
AND
- NOT ON FULL-TIME ACTIVE DUTY AND LIVING OUTSIDE THE U.S. (RE38OV IS NOT CODED '2')
AND
- NOT LEFT RU FOR UNKNOWN REASON (RE35 IS NOT CODED '-7' OR '-8'),
GO TO RE42
----------------------------------------------------
----------------------------------------------------
OTHERWISE (THAT IS, EITHER THE RU-MEMBERS-ROSTER INCLUDES ONLY PERSONS WHO HAVE LEFT THE RU SINCE START DATE OR (THE RU-MEMBERS-ROSTER IS EMPTY AND AT LEAST ONE REMOVED PERSON IN FLAGGED AS 'NEW STUDENT' OR 'NON-MILITARY MOVER IN U.S.' OR 'FULL- TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY')), GO TO BOX_25A
----------------------------------------------------

RE42A
=====

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS ENTER TO END THE INTERVIEW.

RE42B
=====

INTERVIEWER: DID YOU COMPLETE THIS INTERVIEW IN-PERSON OR BY TELEPHONE? (YOU MUST HAVE SUPERVISOR APPROVAL PRIOR TO INTERVIEWING BY TELEPHONE.)
IN-PERSON ............................. 1
TELEPHONE ............................. 2
(Code One)
----------------------------------------------------
GO TO BOX_27
----------------------------------------------------

RE42
====

[At the time this household participated in the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW]/At the time of the last interview], [PREVIOUS ROUND REFERENCE PERSON] was listed as the person who owns or rents this home. [Is/Was] that still true [as of December 31, 1998]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF OWNS/RENTS HOME.
----------------------------------------------------
DISPLAY 'At the time this household participated in the National Health Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW]' IF ROUND 1. OTHERWISE, DISPLAY 'At the time of the last interview'.

FOR '[PREVIOUS ROUND REFERENCE PERSON]', DISPLAY NHIS REFERENCE PERSON IF ROUND 1. OTHERWISE, DISPLAY PREVIOUS ROUND MEPS REFERENCE PERSON.

DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5.

DISPLAY 'as of December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND PREVIOUS ROUND REFERENCE PERSON MEETS ANY OF THE FOLLOWING CONDITIONS:
- DELETED FROM THE RU-MEMBERS-ROSTER THIS ROUND
OR
- DECEASED OR INSTITUTIONALIZED (RE35 CODED '1' OR '2')
OR
- STUDENT OR NON-MILITARY LIVING OUTSIDE THE U.S. (RE37 CODED '2')
OR
- CURRENTLY ON FULL-TIME ACTIVE DUTY AND LIVING AT A MILITARY FACILITY (RE38 CODED '2')
OR
- CURRENTLY ON FULL-TIME ACTIVE DUTY AND LIVING OUTSIDE U.S. (RE38OV CODED '2')
OR
- LEFT RU FOR UNKNOWN REASON (RE35 CODED '-7' OR '-8'),
GO TO RE44
----------------------------------------------------
---------------------------------------------------
IF CODED '2' (NO), CONTINUE WITH RE43
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_22AA
----------------------------------------------------

RE43
====

Of the people in this family who [live/lived] here [now/on December 31, 1998], who [owns/owned] or [rents/rented] this home?
IF NAME GIVEN NOT LISTED, PROBE TO DETERMINE IF NEW RU MEMBER (I.E., RELATED) OR PERSON NOT IN RU.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
[Code One]
PRESS F1 FOR DEFINITION OF OWNS/RENTS HOME.
----------------------------------------------------
DISPLAY 'live' AND 'now' AND 'owns' AND 'rents' IF NOT ROUND 5. DISPLAY 'lived' AND 'on December 31, 1998' AND 'owned' AND 'rented' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-MEMBERS-ROSTER TO DISPLAY ALL RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- PERSON = ) 16 YEARS OLD OR AGE CATEGORY 4-9
AND
- STILL LIVING IN THE RU AT THE DATE OF THE CURRENT INTERVIEW (THAT IS, NOT CODED ANY OF THE FOLLOWING:
- DECEASED OR INSTITUTIONALIZED (RE35 CODED '1' OR '2')
OR
- STUDENT OR NON-MILITARY LIVING OUTSIDE THE U.S. (RE37 CODED '2')
OR
- CURRENTLY ON FULL-TIME ACTIVE DUTY AND LIVING AT A MILITARY FACILITY (RE38 CODED '2')
OR
- CURRENTLY ON FULL-TIME ACTIVE DUTY AND LIVING OUTSIDE U.S. (RE38OV CODED '2')
OR
- LEFT RU FOR UNKNOWN REASON (RE35 CODED '-7' OR '-8')
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PERSON NOT IN RU' AS THE LAST ENTRY ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'PERSON NOT IN RU' IS SELECTED, CONTINUE WITH RE44
----------------------------------------------------
----------------------------------------------------
OTHERWISE (CURRENT RU MEMBER SELECTED), GO TO BOX_22AA
----------------------------------------------------

RE44
====

Of all the people in this family who [live/lived] here [now/on December 31, 1998], who [is/was] considered the head of household?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. DU MEMBERS
RE51_02. RUID
RE51_03. GENDER
RE51_04. AGE
RE51_05. INTERVIEW COMPLETED THIS ROUND
1. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
2. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
3. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
[Code One]
PRESS F1 FOR DEFINITION OF HEAD OF HOUSEHOLD.
----------------------------------------------------
DISPLAY 'live' AND 'now' AND 'is' IF NOT ROUND 5.
DISPLAY 'lived' AND 'on December 31, 1998' AND 'was' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NEW RU MEMBER NOT YET LISTED' AS LAST ENTRY ON ROSTER.
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
2. THE MATRIX COLUMNS ARE DISPLAY-ONLY. THAT IS, NO CHANGES ARE ALLOWED TO THE INFORMATION.
3. THE 'INTERVIEW COMPLETED THIS ROUND' COLUMN DISPLAYS AN 'X' FOR EACH PERSON WHO HAS ALREADY BEEN INTERVIEWED THIS ROUND IN THE STANDARD RU OR ANOTHER RU IN THIS DU.
4. IF PERSON WITH AN 'X' IN 'INTERVIEW COMPLETED THIS ROUND' COLUMN IS SELECTED, DISPLAY MESSAGE: 'PERSON CANNOT BE SELECTED. HAS ALREADY BEEN INTERVIEWED WITH ANOTHER RU.'
5. IF AN RU MEMBER UNDER 16 SELECTED AS HEAD OF HOUSEHOLD, DISPLAY MESSAGE 'RESPONDENT ( 16. S/HE MUST BE APPROVED BY SUPERVISOR. RESELECT TO VERIFY.'
6. IF INTERVIEWER SELECTS A PERSON FROM ANOTHER RU, DISPLAY THE MESSAGE: 'PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION.'
7. IF INTERVIEWER SELECTS PERSON WHO HAS LEFT THE RU, DISPLAY THE MESSAGE: 'SELECTION IS INAPPROPRIATE. MAKE ANOTHER SELECTION.'
----------------------------------------------------
----------------------------------------------------
IF PERSON FROM ANOTHER RU SELECTED AND VERIFIED AS THE HEAD OF HOUSEHOLD, ADD PERSON TO RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'NEW RU MEMBER NOT YET LISTED' SELECTED, CONTINUE WITH RE45
----------------------------------------------------
----------------------------------------------------
OTHERWISE (CURRENT DU MEMBER SELECTED), GO TO BOX_22AA
----------------------------------------------------

RE45
====

ENTER NAME OF NEW RU MEMBER WHO OWNS OR RENTS HOME OR IS HEAD OF HOUSEHOLD.
VERIFY SPELLING.
IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.
[Enter First Name,[Middle Name],Last Name-65]
----------------------------------------------------
REFUSED AND DON'T KNOW DISALLOWED AT ALL FIELDS.
----------------------------------------------------
----------------------------------------------------
ADD PERSON TO RU-MEMBERS-ROSTER AND FLAG PERSON AS 'NEW RU MEMBER ADDED AT RE45'.
----------------------------------------------------

BOX_22AA
========

----------------------------------------------------
IF AT LEAST ONE PERSON ON THE RU-MEMBERS-ROSTER IS AN ORIGINAL RU MEMBER WHO IS STILL LIVING IN THE RU AT THE TIME OF THE CURRENT INTERVIEW; THAT IS, IF AT LEAST ONE RU MEMBER MEETS THE FOLLOWING CONDITIONS:
- NOT ADDED TO THE RU THIS ROUND
AND
- NOT CODED ANY OF THE FOLLOWING:
- DECEASED OR INSTITUTIONALIZED (RE35 CODED '1' OR '2')
OR
- STUDENT OR NON-MILITARY LIVING OUTSIDE THE U.S. (RE37 CODED '2')
OR
- CURRENTLY ON FULL-TIME ACTIVE DUTY AND LIVING AT A MILITARY FACILITY (RE38 CODED '2')
OR
- CURRENTLY ON FULL-TIME ACTIVE DUTY AND LIVING OUTSIDE U.S. (RE38OV CODED '2')
OR
- LEFT RU FOR UNKNOWN REASON (RE35 CODED '-7' OR '-8'),
CONTINUE WITH RE46
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_24A
----------------------------------------------------

RE46
====

[REFERENCE PERSON'S FIRST MIDDLE AND LAST NAME]
[Please think about the household composition as of December 31, 1998 for the next few questions.] [Is/Was] there anyone else [other than you] related to (REFERENCE PERSON) who [is/was] living here [now/on December 31, 1998] as part of this family and who is not listed on top of this form? (HAND HOUSEHOLD SUMMARY) That is, other than (READ NAMES BELOW)? Do not include anyone who was staying here temporarily who usually lived somewhere else. By related we mean by blood, marriage, living together as married, adoption or foster care relationship.
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1 [RE48]
NO ..................................... 2 [RE50]
REF ................................... -7 [RE50]
DK .................................... -8 [RE50]
PRESS F1 FOR DEFINITION OF LIVING TOGETHER AS MARRIED/PARTNER RELATIONSHIPS.
----------------------------------------------------
DISPLAY 'Please .. questions.' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'Is' AND 'is' AND 'now' IF NOT ROUND 5.
DISPLAY 'Was' AND 'was' AND 'on December 31, 1998' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-MEMBERS-ROSTER TO DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITION:
- PERSON NOT ADDED TO RU-MEMBERS-ROSTER THIS ROUND
----------------------------------------------------
----------------------------------------------------
DISPLAY 'other than you' IF RESPONDENT FLAGGED AS 'NEW RU MEMBER ADDED AT RE08'. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

RE47
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
We would like to include the other members of (PERSON)'s household who are related to (PERSON) in this interview.
[Is/Was] there anyone else related to (PERSON) living here [now/on December 31, 1998]? Do not include anyone staying here temporarily who usually lives somewhere else. By related we mean by blood, marriage, living together as married, adoption, or foster care relationship.
YES .................................... 1
NO ..................................... 2 [RE50]
REF ................................... -7 [RE50]
DK .................................... -8 [RE50]
PRESS F1 FOR DEFINITION OF LIVING TOGETHER AS MARRIED.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'now' IF NOT ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5.
----------------------------------------------------

RE48
====

[INTERVIEWER: IF ALL PERSONS WHO HAVE JOINED THE RU ARE ALREADY SELECTED, USE CTRL/B TO CHANGE PREVIOUS SCREEN TO 'NO'.]
Who else [is/was] related and living here [now/on December 31, 1998]?
PROBE: Anyone else?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. DU MEMBERS
RE48_02. RUID
RE48_03. GENDER
RE48_04. AGE
RE48_05. INTERVIEW COMPLETED THIS ROUND
1. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
2. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
3. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'now' IF NOT ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'INTERVIEWER: IF ALL PERSONS WHO HAVE JOINED THE RU ARE ALREADY SELECTED, USE CTRL/B TO CHANGE PREVIOUS SCREEN TO 'NO'.' IF NOT ROUND 1. OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ANY NEW RU MEMBERS NOT LISTED' AS THE LAST ENTRY ON ROSTER.
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
2. ALL COLUMNS ARE PROTECTED. CURSOR WILL NOT ENTER THESE COLUMNS, SO NO CHANGES ARE ALLOWED.
3. IF NEW RU, AN 'X' WILL BE DISPLAYED IN THE INTERVIEW COMPLETED THIS ROUND COLUMN FOR EACH PERSON WHO HAS ALREADY BEEN INTERVIEWED IN ANOTHER RU IN THE DU
4. IF PERSON WITH AN 'X' IN 'INTERVIEW COMPLETED THIS ROUND' COLUMN IS SELECTED, DISPLAY MESSAGE: 'PERSON CANNOT BE SELECTED. HAS BEEN INCLUDED IN INTERVIEW WITH ANOTHER RU.'
5. IF INTERVIEWER SELECTS A PERSON FROM ANOTHER RU FOR WHOM AN INTERVIEW HAS NOT BEEN COMPLETED, DISPLAY THE MESSAGE: 'PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION.'
6. IF INTERVIEWER SELECTS A PERSON WHO HAS LEFT THIS RU OR A CURRENT RU MEMBER, DISPLAY THE MESSAGE: 'SELECTION IS INAPPROPRIATE. MAKE ANOTHER SELECTION.'
7. IF INTERVIEWER PRESSES ESC KEY TO LEAVE SCREEN WITHOUT MAKING A SELECTION, DISPLAY THE MESSAGE: 'IF NO NEW PERSON HAS JOINED RU, USE CTRL/B TO CORRECT PREVIOUS SCREEN(S).'
----------------------------------------------------
----------------------------------------------------
IF A PERSON FROM ANOTHER RU VERIFIED AND SELECTED AS THE RESPONDENT, ADD THAT PERSON TO THE RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'ANY NEW RU MEMBERS NOT LISTED' IS SELECTED, CONTINUE WITH RE49
----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO RE50
----------------------------------------------------

RE49
====

Please give me the name of each new related person who [is/was] living with this household [on December 31, 1998].
PROBE: Anyone else?

ENTER NAMES. VERIFY SPELLING. IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.
TO MOVE CURSOR, USE ARROW KEYS.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
ROSTER. RU MEMBER
RE49_02. IN RU NOW?
1. First Name Middle Name Last Name-35 [Display Selection]
2. First Name Middle Name Last Name-35 [Display Selection]
3. First Name Middle Name Last Name-35 [Display Selection]
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
2. ALLOW INTERVIEWERS TO ADD A PERSON(S) TO THE ROSTER.
3. ALLOW INTERVIEWERS TO DELETE ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.
4. ALLOW INTERVIEWERS TO EDIT ONLY THOSE PERSONS
WHO WERE ADDED AT THIS SCREEN.
5. WHEN SCREEN IS DISPLAYED, DISPLAY 'YES' IN RE49_02 FOR EACH PERSON CODED '1' (IN RU) AT RE21_02 OR ADDED TO RU DURING THIS INTERVIEW.
6. DO NOT ALLOW INTERVIEWERS TO CHANGE CODES IN RE49_02.
7. AUTOMATICALLY DISPLAY 'YES' AT RE49_02 FOR PERSON ADDED AT THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF PERSON IS ADDED AT RE49, ADD PERSON TO RU-MEMBERS-ROSTER AND FLAG PERSON AS ADDED AT RE49
----------------------------------------------------

RE50
====

Have we missed anyone? For example, babies born or adopted [since/between] [DATE OF PREVIOUS ROUND INTERVIEW] [and December 31, 1998], anyone related who usually [lives/lived] here but [is/was] traveling, away on business, or in the hospital?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'since' AND 'lives' AND 'is' IF NOT ROUND 5. DISPLAY 'between' AND 'lived' AND 'was' IF ROUND 5.

FOR '[DATE OF PREVIOUS ROUND INTERVIEW]' DISPLAY DATE OF NHIS INTERVIEW IF ROUND 1. OTHERWISE, DISPLAY DATE OF PREVIOUS ROUND MEPS INTERVIEW.

DISPLAY 'and December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND RE50 CODED '2' (NO), '-7' (REF), OR '-8' (DK), GO TO RE53
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1 AND RE50 CODED '2' (NO), '-7' (REF), OR '-8' (DK), GO TO BOX_24A
----------------------------------------------------
----------------------------------------------------
OTHERWISE (RE50 CODED '1' (YES)), CONTINUE WITH RE51
----------------------------------------------------

RE51
====

Who else [is/was] related and living here [now/on December 31, 1998]?
PROBE: Anyone else?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. DU MEMBERS
RE51_02. RUID
RE51_03. GENDER
RE51_04. AGE
RE51_05. INTERVIEW COMPLETED THIS ROUND
1. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
2. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
3. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'now' IF NOT ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ANY NEW RU MEMBERS NOT LISTED' AS THE LAST ENTRY ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
2. ALL COLUMNS ARE PROTECTED. CURSOR WILL NOT ENTER THESE COLUMNS, SO NO CHANGES ARE ALLOWED IN ANY OF THESE COLUMNS.
3. IF NEW RU, AN 'X' WILL BE DISPLAYED IN THE INTERVIEW COMPLETED THIS ROUND COLUMN FOR EACH PERSON WHO HAS ALREADY BEEN INTERVIEWED IN ANOTHER RU IN THE DU.
4. IF PERSON WITH AN 'X' IN INTERVIEW COMPLETED THIS ROUND COLUMN IS SELECTED, DISPLAY MESSAGE: 'PERSON CANNOT BE SELECTED. HAS BEEN INCLUDED IN INTERVIEW WITH ANOTHER RU.'
5. IF INTERVIEWER SELECTS A PERSON WHO HAS LEFT THIS RU OR A CURRENT RU MEMBER, DISPLAY THE MESSAGE: 'SELECTION IS INAPPROPRIATE. MAKE ANOTHER SELECTION.'
----------------------------------------------------
----------------------------------------------------
ADD EACH PERSON SUCCESSFULLY SELECTED TO THE RU-MEMBERS-ROSTER AND FLAG PERSON AS ADDED AT RE51.
----------------------------------------------------
----------------------------------------------------
IF 'ANY NEW RU MEMBERS NOT LISTED' SELECTED, CONTINUE WITH RE52
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND 'ANY NEW RU MEMBERS NOT LISTED' NOT SELECTED, GO TO RE53
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_24A
----------------------------------------------------

RE52
====

Please give me the name of each new related person who [is/was] living with this household [on December 31, 1998].
PROBE: Anyone else?

ENTER NAMES. VERIFY SPELLING. IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.
TO MOVE CURSOR, USE ARROW KEYS.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
ROSTER. RU MEMBER
RE52_02. IN RU NOW?
1. First Name Middle Name Last Name-35 [Display Selection]
2. First Name Middle Name Last Name-35 [Display Selection]
3. First Name Middle Name Last Name-35 [Display Selection]
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
2. ALLOW INTERVIEWERS TO ADD A PERSON(S) TO THE ROSTER.
3. ALLOW INTERVIEWERS TO DELETE ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.
4. ALLOW INTERVIEWERS TO EDIT ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.
5. WHEN SCREEN IS DISPLAYED, DISPLAY 'YES' IN RE52_02 FOR EACH PERSON CODED '1' (IN RU) AT RE49_02 OR ADDED TO RU THIS ROUND.
6. DO NOT ALLOW INTERVIEWERS TO CHANGE CODES IN RE52_02.
7. AUTOMATICALLY DISPLAY 'YES' AT RE52_02 FOR PERSON ADDED AT THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ADD ENTERED PERSONS TO RU-MEMBERS-ROSTER AND FLAG PERSONS AS ADDED AT RE52.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1, CONTINUE WITH RE53
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_24A
----------------------------------------------------

RE53
====

[REFERENCE PERSON'S FIRST MIDDLE AND LAST NAME]
Are there any children or young people under 24 years of age related to (REFERENCE PERSON) who are not listed on this form (HAND HOUSEHOLD SUMMARY) and who usually live here but are currently living away from home in the U.S., never married, going to school? Please include any new member you may have just mentioned who is under 24, never married, and living away from home going to school in the U.S.
YES .................................... 1
NO ..................................... 2 [BOX_24]
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
----------------------------------------------------
FOR CONTEXT HEADER, DISPLAY NHIS REFERENCE PERSON IF RE42 CODED '1' (YES), '-7' (REF), OR '-8' (DK). OTHERWISE, DISPLAY PERSON SELECTED AT RE43 OR RE44 OR NAME ENTERED AT RE45.
----------------------------------------------------

RE54
====

Who is under 24, never married, and living away at school in the U.S.?
PROBE: Anyone else?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. DU MEMBERS
RE54_02. RUID
RE54_03. GENDER
RE54_04. AGE
RE54_05. INTERVIEW COMPLETED THIS ROUND
1. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
2. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
3. First Name Middle Name Last Name-35 [Display RUID] [Display Selection] [Display Age] [Display Selection]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ANY NEW RU MEMBERS NOT LISTED' AS THE LAST ENTRY ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
2. RU MEMBERS, RUID, GENDER, AND AGE COLUMNS ARE PROTECTED. CURSOR WILL NOT ENTER THESE COLUMNS, SO NO CHANGES ARE ALLOWED INFORMATION IN ANY OF THESE COLUMNS.
3. IF NEW RU, AN 'X' WILL BE DISPLAYED IN THE INTERVIEW COMPLETED THIS ROUND COLUMN FOR EACH PERSON WHO HAS ALREADY BEEN INTERVIEWED IN THE STANDARD RU OR ANOTHER NEW RU IN THE DU.
4. IF PERSON WITH AN 'X' IN 'INTERVIEW COMPLETED THIS ROUND' COLUMN IS SELECTED, DISPLAY MESSAGE: 'PERSON CANNOT BE SELECTED. HAS BEEN INCLUDED IN INTERVIEW WITH ANOTHER RU.'
5. IF GENDER OR AGE NOT YET COLLECTED, DISPLAY '--' IN APPROPRIATE CELL(S).
6. IF INTERVIEWER SELECTS A PERSON WHO HAS LEFT THIS RU OR A CURRENT RU MEMBER, DISPLAY THE MESSAGE: 'SELECTION IS INAPPROPRIATE. MAKE ANOTHER SELECTION.'
----------------------------------------------------
----------------------------------------------------
ADD EACH SUCCESSFULLY SELECTED PERSON TO THE RU-MEMBERS-ROSTER AND FLAG PERSON AS ADDED AT RE54.
----------------------------------------------------
----------------------------------------------------
IF 'ANY NEW RU MEMBERS NOT LISTED' SELECTED, CONTINUE WITH RE55
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_22A
----------------------------------------------------

RE55
====

Please give me the name of each new related person who is a student, under 24, never married, and living away at school.
PROBE: Anyone else?

ENTER NAMES. VERIFY SPELLING. IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.
TO MOVE CURSOR, USE ARROW KEYS.
TO ADD, PRESS CTRL/A. TO DELETES, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
ROSTER. RU MEMBER
RE55_02. IN RU NOW?
1. First Name Middle Name Last Name-35 [Display Selection]
2. First Name Middle Name Last Name-35 [Display Selection]
3. First Name Middle Name Last Name-35 [Display Selection]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
2. ALLOW INTERVIEWERS TO ADD A PERSON(S) TO THE ROSTER.
3. ALLOW INTERVIEWERS TO DELETE ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.
4. ALLOW INTERVIEWERS TO EDIT ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.
5. DISPLAY 'YES' IN RE55_02 FOR EACH PERSON CODED '1' (IN RU) AT RE52_02 WHEN SCREEN IS DISPLAYED.
6. DO NOT ALLOW INTERVIEWERS TO CHANGE CODES IN RE55_02.
7. AUTOMATICALLY DISPLAY 'YES' AT RE55_02 FOR PERSON ADDED AT THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ADD PERSONS TO THE RU-MEMBERS-ROSTER AND FLAG PERSONS AS ADDED AT RE55.
----------------------------------------------------

BOX_22A
=======

----------------------------------------------------
IF AT LEAST ONE PERSON ADDED TO THE RU-MEMBERS-ROSTER AT RE54 OR RE55, CONTINUE WITH LOOP_05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_24
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK RE56-END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS INFORMATION THAT CAPI REQUIRES TO DETERMINE THE KEYNESS AND ELIGIBILITY OF PERSONS WHO WERE ADDED TO THE RU AT RE54 OR RE55. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITION:
- NEW RU MEMBER ( 24, NEVER MARRIED, LIVING AWAY AT SCHOOL (SELECTED AT RE54 OR ADDED AT RE55)
----------------------------------------------------
----------------------------------------------------
NOTE: AT THE END OF THE LOOP, CAPI REMOVES FROM THE RU-MEMBERS-ROSTER ANY NEW RU MEMBER WHO IS ADDED AT RE54 OR RE55 AND WHO IS FLAGGED AS 'NEW STUDENT' OR 'NON-MILITARY MOVER IN U.S.' DURING THE COURSE OF THE LOOP. THE RE SECTION WILL COLLECT LOCATING AND OTHER PERTINENT INFORMATION FOR SUCH PERSONS BUT THEY WILL NOT BE INCLUDED IN THIS INTERVIEW BEYOND THE RE SECTION.

IMMEDIATELY AFTER LOOP_05 ENDS, CAPI WILL REMOVE FROM THE RU-MEMBERS-ROSTER ANY NEW RU MEMBER WHO IS FLAGGED AS 'SAMPLEABLE AT NHIS' DURING THE COURSE OF THE LOOP. NO INFORMATION WILL BE COLLECTED FOR SUCH PERSONS.

NEW RU MEMBERS WHO ARE NOT 'NEW STUDENT', 'NON-MILITARY MOVER IN U.S.', OR 'SAMPLEABLE AT NHIS' REMAIN ON THE RU-MEMBERS-ROSTER AFTER LOOP_05.
----------------------------------------------------

RE56
====

[PERSON'S FIRST MIDDLE AND LAST NAMES]
(Are/Is) (PERSON) attending ...
grades 1-12, ........................... 1
a college or university, or ............ 2
some other training school after high school? .................. 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

RE56A
=====

[PERSON'S FIRST MIDDLE AND LAST NAMES]
Where (were/was) (PERSON) living when this household participated in the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW]?
PERSON WAS ...
INSTITUTIONALIZED ................. 1 [BOX_23A]
STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL ......... 2
PERSON WAS NOT FT MILITARY AT TIME OF NHIS AND WAS ...
LIVING IN U.S. .................... 3
LIVING OUTSIDE U.S. ............... 4 [BOX_23A]
PERSON WAS FT MILITARY AT TIME OF NHIS AND WAS ...
LIVING AT A MILITARY FACILITY ..... 5 [BOX_23A]
LIVING OUTSIDE U.S................. 6 [BOX_23A]
LIVING IN ANOTHER HOUSEHOLD IN U.S. 7 PERSON WAS ...
LIVING WITH THIS FAMILY (PERSON LEFT OFF NHIS ROSTER) .............. 8 [BOX_23A]
OTHER ............................ 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
NOTE: THE RESPONSE CATEGORY 'LIVING WITH THIS FAMILY (PERSON LEFT OFF NHIS ROSTER)' INCLUDES PERSONS WHO WERE LIVING AWAY AT SCHOOL IN GRADES 1 - 12.
----------------------------------------------------
----------------------------------------------------
IF CODED ONE OF THE FOLLOWING:
- '1' (INSTITUTIONALIZED),
OR
- '4' (NOT FT MILITARY AT TIME OF NHIS AND LIVING OUTSIDE U.S.),
OR
- '5' (FT MILITARY AT TIME OF NHIS AND LIVING AT A MILITARY FACILITY),
OR
- '6' (FT MILITARY AT TIME OF NHIS AND LIVING OUTSIDE U.S.),
OR
- '8' (LIVING WITH THIS FAMILY BUT LEFT OFF NHIS ROSTER), FLAG PERSON AS 'NOT SAMPLEABLE AT NHIS' (PERSON HAD NO POSSIBILITY OF BEING INCLUDED IN THE NHIS SAMPLE).

IF CODED ANY OTHER CODE (INCLUDING '-7' (REFUSED) AND '-8' (DON'T KNOW), FLAG PERSON AS 'SAMPLEABLE AT NHIS.' (PERSON HAD POSSIBILITY OF BEING INCLUDED IN THE NHIS SAMPLE.)
----------------------------------------------------
----------------------------------------------------
IF PERSON MEETS BOTH OF THE FOLLOWING CONDITIONS:
- PERSON IS FLAGGED AS 'NOT SAMPLEABLE AT NHIS' (SEE PREVIOUS BOX)
AND
- PERSON IS ATTENDING (COLLEGE OR UNIVERSITY) OR (SOME OTHER TRAINING SCHOOL AFTER HIGH SCHOOL) (THAT IS, RE56 IS CODED '2' OR '3' FOR PERSON), FLAG PERSON AS A 'NEW STUDENT'.
----------------------------------------------------
----------------------------------------------------
IF PERSON MEETS BOTH OF THE FOLLOWING CONDITIONS:
- PERSON IS FLAGGED AS 'NOT SAMPLEABLE AT NHIS' (SEE BOX ABOVE)
AND
- RE56 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) FOR PERSON, FLAG PERSON AS 'NON-MILITARY MOVER IN U.S.'
----------------------------------------------------

RE56B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
At the time of the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW], (were/was) (PERSON) 17 to 23 years old?
YES .................................... 1
NO ..................................... 2 [END_LP05]
REF ................................... -7 [END_LP05]
DK .................................... -8 [END_LP05]
----------------------------------------------------
IF CODED '1' (YES)
AND
RE56A CODED '2' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL), CONTINUE WITH RE56C
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES)
AND
RE56A NOT CODED '2' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL), GO TO BOX_23A
----------------------------------------------------

RE56C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
At the time of the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW] were either of (PERSON)'s parents living in this household?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON AS 'A NEW STUDENT'.
----------------------------------------------------

BOX_23A
=======

----------------------------------------------------
IF PERSON MEETS EITHER OF THE FOLLOWING CONDITIONS:
- FLAGGED AS A 'NEW STUDENT' (SEE BOX ON RE56A AND RE56C)
OR
- FLAGGED AS 'NON-MILITARY MOVER IN U.S.' (SEE BOX ON RE56A)

REMOVE PERSON FROM RU-MEMBERS-ROSTER. THE RE SECTION WILL COLLECT LOCATING AND OTHER PERTINENT INFORMATION FOR PERSON BUT PERSON WILL NOT BE INCLUDED IN THIS INTERVIEW AFTER THE RE SECTION. INFORMATION FOR PERSON MAY BE COLLECTED AS PART OF ANOTHER RU.
----------------------------------------------------

END_LP05
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_05 AND CONTINUE WITH BOX_23
----------------------------------------------------

BOX_23
======

----------------------------------------------------
IF NO ONE ON THE RU-MEMBERS-ROSTER IS FLAGGED AS 'SAMPLEABLE AT NHIS', GO TO BOX_24
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH RE56D
----------------------------------------------------

RE56D
=====

[PERSON'S FIRST MIDDLE LAST NAME]
At the time we are only collecting information about some of the students you just now identified. Therefore, the remaining questions will not be asked about (READ NAMES BELOW).
TO SCROLL, USE ARROW KEYS. TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO ARE FLAGGED AS 'SAMPLEABLE AT NHIS'. (SEE BOX ON RE56A)
----------------------------------------------------
----------------------------------------------------
REMOVE ALL PERSONS WHO ARE FLAGGED AS 'SAMPLEABLE AT NHIS' (THAT IS, ALL RU MEMBERS DISPLAYED AT RE56D) FROM THE RU-MEMBERS-ROSTER. SUCH PERSONS ARE NOT ELIGIBLE FOR THIS INTERVIEW AND ARE NOT KEY. INFORMATION WILL NOT BE COLLECTED FOR SUCH PERSONS AS PART OF THIS OR ANY OTHER RU.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_24
----------------------------------------------------

BOX_24A
=======

----------------------------------------------------
IF NOT ROUND 1, CONTINUE WITH RE57A.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_26
----------------------------------------------------

RE57A
=====

VERIFY DISPLAYED INFORMATION.
ASK APPROPRIATE QUESTION FOR EACH BLANK FIELD.
ENTER GENDER. 1 = MALE, 2 = FEMALE
IF NOT OBVIOUS, ASK: Is (READ NAME BELOW) male or female?
What is (READ NAME BELOW)'s date of birth?

ENTER MM/DD/YYYY.
VERIFY AGE - IF AGE IS INCORRECT, RE-ENTER DATE OF BIRTH. IF DATE OF BIRTH UNKNOWN, PROBE FOR AGE AND ENTER IF KNOWN. [NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, 1998.]
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
ROSTER. RU MEMBER
RE57A_02. GENDER
RE57A_03. DATE OF BIRTH
RE57A_04. AGE
1. First Name Middle Name Last Name-35 [Enter Selection] [Enter Month Day Year-4] [Verify/Enter Age]
2. First Name Middle Name Last Name-35 [Enter Selection] [Enter Month Day Year-4] [Verify/Enter Age]
3. First Name Middle Name Last Name-35 [Enter Selection] [Enter Month Day Year-4] [Verify/Enter Age]
----------------------------------------------------
DISPLAY 'NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, 1998.' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE RU-MEMBERS-ROSTER
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. FOR ALL PERSONS ON ROSTER, PRESENT BLANK FIELDS FOR THE MISSING DATA ITEMS.
2. PLACE CURSOR ON FIRST BLANK FIELD. AFTER ENTRY, MOVE CURSOR TO NEXT BLANK CELL ON THAT ROW.
3. COMPUTE AGE FROM DATE OF BIRTH AND DISPLAY IN RE57A_04. IF UNABLE TO CALCULATE AGE BECAUSE OF MISSING DATA, DISPLAY '?' IN RE57A_04.
4. ALLOW INTERVIEWERS TO USE ALL ARROW KEYS TO MOVE CURSOR AMONG ROWS AND COLUMNS.
5. INTERVIEWERS SHOULD NOT BE ALLOWED TO ADD NEW PERSONS.
6. INTERVIEWERS SHOULD NOT BE ALLOWED TO EDIT NAMES OF ANY RU MEMBER ON ROSTER.
----------------------------------------------------
----------------------------------------------------
IF AGE MISSING FOR ANY RU MEMBER, CONTINUE WITH LOOP_06A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_26
----------------------------------------------------
----------------------------------------------------
NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DECEMBER 31, 1998. ALL AGE SKIPS (THROUGHOUT THE QUESTIONNAIRE) WILL BE BASED ON THIS AGE.
----------------------------------------------------

LOOP_06A
========

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK RE57B-END_LP06A
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06A COLLECTS AGE ESTIMATE FOR RU MEMBERS WHOSE AGE IS MISSING. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITION:
- PERSON'S AGE MISSING FROM RE57A_04
----------------------------------------------------

RE57B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
PROBE FOR RESPONDENT'S BEST ESTIMATE OF AGE.
[(Are/Is)/As of December 31, 1998, (were/was)] (PERSON)...
Less than 1 year old, .................. 1 [END_LP06A]
1 - 4, ................................. 2 [END_LP06A]
5 - 15, ................................ 3 [END_LP06A]
16 - 23, ............................... 4 [END_LP06A]
24 - 34, ............................... 5 [END_LP06A]
35 - 44, ............................... 6 [END_LP06A]
45 - 54, ............................... 7 [END_LP06A]
55 - 64, or ............................ 8 [END_LP06A]
65 years or older? ..................... 9 [END_LP06A]
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY 'As of December 31, 1998, (were/was)' IF ROUND 5.
----------------------------------------------------

RE57C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
ENTER YOUR BEST GUESS FOR (PERSON)'S AGE [AS OF DECEMBER 31, 1998].
Less than 1 year old, .................. 1
1 - 4, ................................ 2
5 - 15, ............................... 3
16 - 23, ............................... 4
24 - 34, ............................... 5
35 - 44, ............................... 6
45 - 54, ............................... 7
55 - 64, or ............................ 8
65 years or older? ..................... 9
[Code One]
----------------------------------------------------
DISPLAY 'AS OF DECEMBER 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW DISALLOWED.
----------------------------------------------------

END_LP06A
=========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_06A AND GO TO BOX_26
----------------------------------------------------

BOX_24
======

---------------------------------------------------
IF AT LEAST ONE PERSON IN THE RU-MEMBERS-ROSTER MEETS BOTH OF THE FOLLOWING CONDITIONS:
- ADDED TO THE RU THIS ROUND
AND
- NOT A DU MEMBER AT THE TIME OF NHIS (THAT IS, A NEW RU MEMBER NOT SELECTED FROM THE DU-MEMBERS-ROSTER), CONTINUE WITH RE57
---------------------------------------------------
---------------------------------------------------
OTHERWISE, GO TO BOX_25A
---------------------------------------------------

BOX_25
======

OMITTED.

RE57
====

ASK APPROPRIATE QUESTION FOR EACH BLANK FIELD.
ENTER GENDER. 1 = MALE, 2 = FEMALE
IF NOT OBVIOUS, ASK: Is (READ NAME BELOW) male or female?
What is (READ NAME BELOW)'s date of birth?

ENTER MM/DD/YYYY.
VERIFY AGE - IF AGE IS INCORRECT, RE-ENTER DATE OF BIRTH. IF DATE OF BIRTH UNKNOWN, PROBE FOR AGE AND ENTER IF KNOWN.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
ROSTER. RU MEMBER
RE57_02. GENDER
RE57_03. DATE OF BIRTH
RE57_04. AGE
1. First Name Middle Name Last Name-35 [Enter Selection] [Enter Month Day Year-4] [Verify/Enter Age]
2. First Name Middle Name Last Name-35 [Enter Selection] [Enter Month Day Year-4] [Verify/Enter Age]
3. First Name Middle Name Last Name-35 [Enter Selection] [Enter Month Day Year-4] [Verify/Enter Age]
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED IN ALL FIELDS.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITION:
- PERSON IS A NEW RU MEMBER ADDED IN CURRENT ROUND WHO WAS NOT SELECTED FROM THE DU-MEMBERS- ROSTER
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. FOR ALL PERSONS ON ROSTER, PRESENT BLANK FIELDS FOR THE MISSING DATA ITEMS (EITHER NOT YET COLLECTED OR MISSING FROM PREVIOUS ROUNDS)
2. PLACE CURSOR ON FIRST BLANK FIELD. AFTER ENTRY, MOVE CURSOR TO NEXT BLANK CELL ON THAT ROW.
3. COMPUTE AGE FROM DATE OF BIRTH AND DISPLAY IN RE57_04. IF UNABLE TO CALCULATE AGE BECAUSE OF MISSING DATA, DISPLAY '?' IN RE57_04.
4. ALLOW INTERVIEWERS TO USE ALL ARROW KEYS TO MOVE CURSOR AMONG ROWS AND COLUMNS.
5. INTERVIEWERS SHOULD NOT BE ALLOWED TO ADD NEW PERSONS.
6. INTERVIEWERS SHOULD NOT BE ALLOWED TO EDIT NAMES OF ANY RU MEMBER ON ROSTER.
----------------------------------------------------
----------------------------------------------------
IF AGE NOT MISSING FOR ANY NEW RU MEMBER WHO WAS NOT A DU MEMBER IN PREVIOUS ROUND (THAT IS, AGE NOT MISSING AT RE57_04)), GO TO BOX_25A
----------------------------------------------------
----------------------------------------------------
OTHERWISE (AGE IS MISSING FOR ANY NEW RU MEMBER WHO WAS NOT A DU MEMBER IN PREVIOUS ROUND (THAT IS, AGE IS MISSING AT RE57_04)), CONTINUE WITH LOOP_06
----------------------------------------------------

LOOP_06
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK RE58-END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS AN AGE ESTIMATE FOR NEW RU MEMBERS WHOSE AGE IS MISSING. THIS LOOP CYCLES ON ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITION:
- PERSON'S AGE IS MISSING AT RE57_04
----------------------------------------------------

RE58
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
PROBE FOR RESPONDENT'S BEST ESTIMATE OF AGE.
(Are/Is) (PERSON)...
Less than 1 year old, .................. 1 [END_LP06]
1 - 4, ................................. 2 [END_LP06]
5 - 15, ................................ 3 [END_LP06]
16 - 23, ............................... 4 [END_LP06]
24 - 34, ............................... 5 [END_LP06]
35 - 44, ............................... 6 [END_LP06]
45 - 54, ............................... 7 [END_LP06]
55 - 64, or ............................ 8 [END_LP06]
65 years or older? ..................... 9 [END_LP06]
REF ................................... -7
DK .................................... -8
[Code One]

RE59
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
ENTER YOUR BEST GUESS FOR (PERSON)'S AGE.
Less than 1 year old, .................. 1
1 - 4, ................................ 2
5 - 15, ............................... 3
16 - 23, ............................... 4
24 - 34, ............................... 5
35 - 44, ............................... 6
45 - 54, ............................... 7
55 - 64, or ............................ 8
65 years or older? ..................... 9
[Code One]

END_LP06
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH BOX_25A
----------------------------------------------------

BOX_25A
=======

----------------------------------------------------
IF ROUND 1 AND AT LEAST ONE PERSON ON THE RU-MEMBERS-ROSTER WAS A MEMBER OF THE RU OR DU AT THE DATE OF THE NHIS INTERVIEW,
OR
IF AT LEAST ONE PERSON REMOVED FROM THE RU- MEMBERS-ROSTER THIS ROUND MEETS BOTH OF THE FOLLOWING CONDITIONS:
- PERSON WAS A MEMBER OF THE RU OR DU AT THE DATE OF THE NHIS INTERVIEW
AND
- PERSON IS FLAGGED AS A 'NEW STUDENT', CONTINUE WITH LOOP_07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_26
----------------------------------------------------

LOOP_07
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE DU MEMBERS-ROSTER, ASK RE60-END_LP07
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07 UPDATES NAME, GENDER, BIRTH DATE, AND AGE OF BOTH CURRENT RU MEMBERS WHO WERE MEMBERS OF THE RU OR DU AT THE TIME OF NHIS AND PERSONS WHO ARE FLAGGED AS 'NEW STUDENT'. THIS LOOP CYCLES ON ALL DU MEMBERS WHO MEET ANY ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT MEMBER OF THIS RU AND WAS A MEMBER OF THIS RU AT THE TIME OF NHIS
OR
- PERSON IS A CURRENT MEMBER OF THIS RU AND WAS A MEMBER OF THE DU AT THE TIME OF NHIS
OR
- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW AND IS FLAGGED AS A 'NEW STUDENT'
----------------------------------------------------

RE60
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Let's review some information about (PERSON). Please look at this form (HAND HOUSEHOLD SUMMARY) and tell me if (PERSON)'s name is spelled correctly.
MAKE CORRECTIONS TO NAME BELOW.
IF NO CORRECTION TO A FIELD IS NECESSARY, PRESS ENTER. IF CORRECTION TO A FIELD IS NECESSARY, RE-TYPE ENTIRE FIELD.
IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.
Current Info: [NHIS FIRST NAME]
[NHIS MIDDLE NAME]
[NHIS LAST NAME]
FIRST NAME (RE60_01): [_________________]
MIDDLE NAME (RE60_02): [_________________]
LAST NAME (RE60_03): [_________________]
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED AT ALL FIELDS. HOWEVER, DO NOT ALLOW INTERVIEWER TO CHANGE 'REAL DATA' TO '-7' (REFUSED) OR '-8' (DON'T KNOW).
----------------------------------------------------

RE61
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
ASK IF NOT OBVIOUS: I have (PERSON) recorded as (READ GENDER BELOW). Is that correct?
MAKE CORRECTIONS TO GENDER BELOW.
IF NO CORRECTION IS NECESSARY, PRESS ENTER. IF CORRECTION IS NECESSARY, ENTER APPROPRIATE CODE.
1 = MALE 2 = FEMALE
Current Info: [NHIS GENDER]
[Enter Gender]........................
REF .................................. -7
DK ................................... -8
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED. HOWEVER, DO NOT ALLOW INTERVIEWER TO CHANGE 'REAL DATA' TO '-7' (REFUSED) OR '-8' (DON'T KNOW).
----------------------------------------------------

RE62
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
I have recorded that (PERSON) was born on (READ DATE BELOW). Is that correct?
MAKE CORRECTIONS TO DATE OF BIRTH BELOW.
IF NO CORRECTION TO A FIELD IS NECESSARY, PRESS ENTER. IF CORRECTION TO A FIELD IS NECESSARY, RE-TYPE ENTIRE FIELD.
Current Info: [NHIS DATE OF BIRTH]
[Enter Month,Day,Year-4] ............
REF ................................. -7
DK .................................. -8
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED. HOWEVER, DO NOT ALLOW INTERVIEWER TO CHANGE 'REAL DATA' TO '-7' (REFUSED) OR '-8' (DON'T KNOW).
----------------------------------------------------
----------------------------------------------------
IF CURRENT INFO IS NOT AVAILABLE, ENTRY FOR DATE OF BIRTH IS REQUIRED. (REF AND DK ARE ALLOWED.)
----------------------------------------------------
----------------------------------------------------
IF ANY FIELD IN DATE OF BIRTH CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO RE64
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH RE63
----------------------------------------------------

RE63
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
So (PERSON) is [AGE CALCULATED FROM DATE OF BIRTH AT RE62] years old. Is that correct?
YES ..................................... 1 [END_LP07]
NO ...................................... 2
REF .................................... -7 [RE65]
DK ..................................... -8 [RE65]
----------------------------------------------------
IF CODED '2' (NO), DISPLAY MESSAGE: 'IF AGE INCORRECT, USE CTRL/B AND CORRECT DATE OF BIRTH AT PREVIOUS SCREEN.'
----------------------------------------------------

RE64
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (are/is) (PERSON)?
[Enter Age] ........................... [END_LP07]
REF ................................... -7
DK .................................... -8

RE65
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
PROBE FOR RESPONDENT'S BEST ESTIMATE OF AGE.
(Are/Is) (PERSON)...
Less than 1 year old, .................. 1 [END_LP07]
1 - 4, ................................ 2 [END_LP07]
5 - 15, ............................... 3 [END_LP07]
16 - 23, ............................... 4 [END_LP07]
24 - 34, ............................... 5 [END_LP07]
35 - 44, ............................... 6 [END_LP07]
45 - 54, ............................... 7 [END_LP07]
55 - 64, or ............................ 8 [END_LP07]
65 years or older? ..................... 9 [END_LP07]
REF ................................... -7
DK .................................... -8
[Code One]

RE66
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
ENTER YOUR BEST GUESS FOR (PERSON)'S AGE.
Less than 1 year old, .................. 1
1 - 4, ................................ 2
5 - 15, ............................... 3
16 - 23, ............................... 4
24 - 34, ............................... 5
35 - 44, ............................... 6
45 - 54, ............................... 7
55 - 64, or ............................ 8
65 years or older? ..................... 9
[Code One]

END_LP07
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_07 AND CONTINUE WITH BOX_26
----------------------------------------------------

BOX_26
======

----------------------------------------------------
IF ROUND 1 AND AT LEAST ONE RU MEMBER MEETS ALL THE FOLLOWING CONDITIONS:
- ADDED TO THE RU THIS ROUND
AND
- NOT A NEWBORN (THAT IS, NOT BORN BETWEEN NHIS INTERVIEW DATE AND DATE OF THE CURRENT INTERVIEW), GO TO LOOP_08
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1 AND AT LEAST ONE RU MEMBER MEETS ALL OF THE FOLLOWING CONDITIONS:
- ADDED TO THE RU THIS ROUND
AND
- NOT IN ANOTHER RU AT THE END OF THE PREVIOUS ROUND
AND
- NOT A NEWBORN (THAT IS, NOT BORN BETWEEN 1/1/97 AND THE DATE OF THE CURRENT INTERVIEW), CONTINUE WITH LOOP_07A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_27
----------------------------------------------------

LOOP_07A
========

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK RE66A-END_LP07A
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07A COLLECTS INFORMATION ON THE LOCATION OF NEW RU MEMBERS ON 1/1/97 TO DETERMINE THEIR KEYNESS AND ELIGIBILITY. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- ADDED TO RU IN CURRENT ROUND
AND
- NOT IN ANOTHER RU AT THE END OF THE PREVIOUS ROUND
AND
- NOT NEWBORN (THAT IS, NOT BORN BETWEEN 1/1/97 AND THE DATE OF THE CURRENT INTERVIEW)
----------------------------------------------------

RE66A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) start living with the family?
[Enter Month,Day,Year-2] ..............
REF ................................... -7
DK .................................... -8
----------------------------------------------------
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/98. IF A DATE AFTER 12/31/98 IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'DATE MUST BE ON OR BEFORE 12/31/98. IF PERSON JOINED RU AFTER 12/31/98, USE CTRL/B TO BACK-UP RE49/RE52 AND REVIEW ENTRIES.'
----------------------------------------------------
----------------------------------------------------
IF DATE ≤ PREVIOUS ROUND INTERVIEW DATE, CONTINUE WITH RE66B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO RE66C
----------------------------------------------------

RE66B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Let me make sure that I have entered this date correctly. I have recorded that (PERSON) began living with this family on [RE66A DATE.]. That is before the interview on [DATE OF PREVIOUS ROUND INTERVIEW]. Is that correct?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
FOR DATE OF PREVIOUS ROUND INTERVIEW, DISPLAY DATE OF PREVIOUS ROUND MEPS INTERVIEW.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), DISPLAY MESSAGE: 'USE CTRL/B AND CORRECT DATE PERSON JOINED RU AT PREVIOUS SCREEN.'
----------------------------------------------------

BOX_26A
=======

OMITTED.

RE66C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On January 1, 1997, was (PERSON) living in an institution?
YES .................................... 1 [RE66G]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION FOR LIVING IN AN INSTITUTION.

RE66D
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On January 1, 1997, was (PERSON) living outside the United States?
YES .................................... 1 [END_LP07A]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF LIVING OUTSIDE U.S.
----------------------------------------------------
IF PERSON ( 18 YEARS OLD, GO TO RE66F
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH RE66E
----------------------------------------------------

RE66E
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On January 1, 1997, was (PERSON) serving on full-time active duty in the Armed Forces?
YES .................................... 1 [END_LP07A]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FULL-TIME MILITARY.

RE66F
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Where (were/was) (PERSON) living on January 1, 1997?
NOT YET BORN ............................ 1 [END_LP07A]
INSTITUTIONALIZED ....................... 2 [RE66G]
STUDENT UNDER 24 LIVING AWAY AT SCHOOL IN GRADES 1-12 ....................... 3 [END_LP07A]
STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL ................ 4 [RE66J]
ANOTHER HOUSEHOLD - NOT FULL-TIME MILITARY ON 1/1/97 ................... 5 [END_LP07A]
ANOTHER HOUSEHOLD/MILITARY FACILITY - FULL-TIME MILITARY ON 1/1/97 ......... 6 [RE66K]
LIVING WITH THIS FAMILY (PERSON LEFT OFF ROSTER LAST INTERVIEW) ........... 7 [END_LP07A]
OTHER .................................. 91
REF .................................... -7 [END_LP07A]
DK ..................................... -8 [END_LP07A]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

RE66FOV
=======

ENTER OTHER:
[Enter Other Specify] ................. [END_LP07A]
REF ................................... -7 [END_LP07A]
DK .................................... -8 [END_LP07A]

RE66G
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What type of institution (were/was) (PERSON) living in on January 1, 1997?
NURSING HOME ........................ 1
OTHER LONG-TERM HEALTH CARE INSTITUTION (EXCLUDE COMMUNITY BASED HOSPITAL) ................... 2
OTHER NON-HEALTH CARE INSTITUTION ... 3 [END_LP07A]
REF ................................ -7
DK ................................. -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

RE66H
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the name and address of the nursing home or long term care facility where (PERSON) (were/was) on January 1, 1997?
NAME (RE66H_01): [_____________]
STREET ADDRESS1 (RE66H_02): [_____________]
STREET ADDRESS2 (RE66H_03): [_____________]
CITY (RE66H_04): [_____________]
STATE (RE66H_05): [_____________]
ZIP CODE (RE66H_06): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
CODES '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON EACH FORM ITEM.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP07A
----------------------------------------------------

RE66I
=====

OMITTED.

RE66J
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Were either of (PERSON)'S parents living in this household on January 1, 1997?
YES .................................... 1 [END_LP07A]
NO ..................................... 2 [END_LP07A]
REF ................................... -7 [END_LP07A]
DK .................................... -8 [END_LP07A]

RE66K
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Were/Was) (PERSON) living in another household or in a military facility on January 1, 1997?
ANOTHER HOUSEHOLD ................... 1
MILITARY FACILITY ................... 2
REF ................................ -7
DK ................................. -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

RE66KOV
=======

OMITTED.

END_LP07A
=========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_07A AND CONTINUE WITH BOX_27
----------------------------------------------------

LOOP_08
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK RE67-END_LP08
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_08 COLLECTS INFORMATION ON THE LOCATION AT THE TIME OF NHIS OF NEW RU MEMBERS WHO ARE NOT NEWBORN TO DETERMINE THEIR KEYNESS AND ELIGIBILITY. THIS LOOP CYCLES ON RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- ADDED TO RU IN CURRENT ROUND
AND
- NOT NEWBORN (THAT IS, NOT BORN BETWEEN THE NHIS INTERVIEW DATE AND THE DATE OF THE CURRENT INTERVIEW)
----------------------------------------------------

RE67
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) start living with the family [before leaving to live at school]?
[Enter Month,Day,Year-2] ..............
REF ................................... -7 [RE73]
DK .................................... -8 [RE73]
----------------------------------------------------
DISPLAY 'before leaving to live at school' IF PERSON IS A STUDENT LIVING AWAY AT SCHOOL (SELECTED AT RE54 OR ADDED AT RE55). OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF DATE ( PREVIOUS ROUND INTERVIEW DATE, CONTINUE WITH RE68
----------------------------------------------------
----------------------------------------------------
IF DATE = OR ) PREVIOUS ROUND INTERVIEW DATE, GO TO RE73
----------------------------------------------------

RE68
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Let me make sure that I have entered this date correctly. I have recorded that (PERSON) began living with this family on [RE67 DATE.]. That is before the interview on [MONTH, DAY, YEAR OF NHIS INTERVIEW]. Is that correct?
YES .................................... 1
NO ..................................... 2
REF ................................... -7 [RE73]
DK .................................... -8 [RE73]
[Code One]
----------------------------------------------------
IF RE68 CODED '1' (YES), CODE RE73 '7' (LIVING WITH THIS FAMILY (PERSON LEFT OFF NHIS ROSTER)) AUTOMATICALLY BY CAPI, THEN GO TO END_LP08
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), DISPLAY MESSAGE: 'USE CTRL/B AND CORRECT DATE PERSON JOINED RU AT PREVIOUS SCREEN.'
----------------------------------------------------

BOX_26A
=======

USED ELSEWHERE.

RE69
====

OMITTED.

RE70
====

OMITTED.

RE71
====

OMITTED.

RE72
====

OMITTED.

RE73
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Where (were/was) (PERSON) living when this household participated in the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW]?
NOT YET BORN ............................ 1 [END_LP08]
INSTITUTIONALIZED ....................... 2 [RE73A]
STUDENT UNDER 24 LIVING AWAY AT SCHOOL GRADES 1-12 ...... .......... 3 [END_LP08]
STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL ................ 4 [RE73B]
ANOTHER HH - NOT FT MILITARY AT NHIS .... 5 [RE73B]
ANOTHER HH/MILITARY FACILITY – FT MILITARY AT NHIS ...... .......... 6 (RE73C)
LIVING WITH THIS FAMILY - PERSON LEFT OFF NHIS ROSTER .................... 7 [END_LP08]
OTHER .................................. 91
REF .................................... -7 [END_LP08]
DK ..................................... -8 [END_LP08]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

RE73OV
======

ENTER OTHER:
[Enter Other Specify] ................. [END_LP08]
REF ................................... -7 [END_LP08]
DK .................................... -8 [END_LP08]

RE73A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What type of institution (were/was) (PERSON) living in on [MONTH, DAY, YEAR OF NHIS INTERVIEW]?
NURSING HOME ........................ 1 [RE74]
OTHER LONG-TERM HEALTH CARE INSTITUTION (EXCLUDE COMMUNITY BASED HOSPITAL) ................... 2 [RE74]
OTHER NON-HEALTH CARE INSTITUTION ... 3 [END_LP08]
REF ................................ -7 [RE74]
DK ................................. -8 [RE74]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

RE73B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Were/Was) (PERSON) living within the U.S. or outside the U.S. on [MONTH, DAY, YEAR OF NHIS INTERVIEW]?
WITHIN U.S. .......................... 1
OUTSIDE U.S. ......................... 2
REF ................................. -7
DK .................................. -8
PRESS F1 FOR DEFINITION OF LIVING WITHIN/OUTSIDE U.S.
----------------------------------------------------
IF RE73 CODED '4' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL), GO TO RE75
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP08
----------------------------------------------------

RE73C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Were/Was) (PERSON) living in another household or in a military facility on [MONTH, DAY, YEAR OF NHIS INTERVIEW]?
ANOTHER HOUSEHOLD ................... 1
MILITARY FACILITY ................... 2 [END_LP08]
REF ................................ -7
DK ................................. -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

RE73COV
=======

Was that household within the U.S. or outside the U.S.?
WITHIN U.S. ......................... 1 [END_LP08]
OUTSIDE U.S. ........................ 2 [END_LP08]
REF ................................ -7 [END_LP08]
DK ................................. -8 [END_LP08]
[Code One]

RE74
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the name and address of the nursing home or long term care facility where (PERSON) (were/was) living at the time of the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW]?
NAME (RE74_01): [_____________]
STREET ADDRESS1 (RE74_02): [_____________]
STREET ADDRESS2 (RE74_03): [_____________]
CITY (RE74_04): [_____________]
STATE (RE74_05): [_____________]
ZIP CODE (RE74_06): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
CODES '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON EACH FORM ITEM.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP08
----------------------------------------------------

RE75
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
At the time of the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW], were either of (PERSON)'s parents living in this household?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8

END_LP08
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_08 AND CONTINUE WITH BOX_27
----------------------------------------------------

BOX_27
======

----------------------------------------------------
CONTINUE WITH REENUMERATION-B (RE-B) SUBSECTION
----------------------------------------------------


Reenumeration (RE) Section Subsection B


BOX_28AA
========

----------------------------------------------------
NOTE: THE RU-MEMBERS-ROSTER HAS BEEN UPDATED THROUGHOUT THE RE-A SECTION AS FOLLOWS:
- NEW RU MEMBERS RECORDED AT RE08, RE45, RE49, RE52, AND RE55 HAVE BEEN ADDED
- DU MEMBERS SELECTED AT RE06, RE44, RE48, RE51, AND RE54 HAVE BEEN ADDED
- RU MEMBERS WHO MEET ANY ONE OF THE FOLLOWING CONDITIONS HAVE BEEN REMOVED:
- PERSONS IN STUDENT RUs IDENTIFIED AS FULL-TIME MILITARY (RE14 CODED '1' (YES))
OR
- INCORRECTLY LISTED IN RU DURING [NHIS/ PREVIOUS INTERVIEW] (RE21_02 CODED '3')
OR
- LEFT THE RU BEFORE 01/01/97 FOR ANY REASON OTHER THAN STUDENT LIVING AWAY AT SCHOOL IN GRADES 1-12 (DATE AT RE41)
OR
- FLAGGED AS 'NON-MILITARY MOVER IN U.S.'
OR
- FLAGGED AS 'NEW STUDENT'
OR
- FLAGGED AS 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY'
OR
- ADDED TO THE RU AT RE54 OR RE55 AND FLAGGED AS 'SAMPLEABLE AT NHIS' AT RE56A

REFERENCES IN THE RE-B SUBSECTION TO RU MEMBERS OR TO THE RU-MEMBERS-ROSTER POINT TO THE CURRENT STATUS OF THAT ROSTER, INCLUDING THE ADDITIONS AND DELETIONS, IF ANY, THAT OCCURRED IN RE-A.
----------------------------------------------------

BOX_28
======

----------------------------------------------------
IF STUDENT RU AND RU-MEMBERS-ROSTER IS EMPTY, GO TO BOX_44
----------------------------------------------------
----------------------------------------------------
IF STUDENT RU AND RU-MEMBERS-ROSTER IS NOT EMPTY, GO TO BOX_37
----------------------------------------------------
----------------------------------------------------
IF STANDARD OR NEW RU
AND
RU-MEMBERS-ROSTER IS EMPTY
AND
NO PERSON WHO WAS REMOVED FROM THE RU-MEMBERS- ROSTER DURING THIS INTERVIEW IS FLAGGED AS ONE OF THE FOLLOWING:
- 'NEW STUDENT'
OR
- 'NON-MILITARY MOVER IN U.S.'
OR
- 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY',
GO TO BOX_44
----------------------------------------------------
----------------------------------------------------
IF STANDARD OR NEW RU
AND
RU-MEMBERS-ROSTER IS EMPTY
AND
AT LEAST ONE PERSON WHO WAS AN ORIGINAL RU MEMBER (THAT IS, ON THE RU-MEMBERS-ROSTER AT THE TIME OF NHIS) WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW AND FLAGGED AS A 'NEW STUDENT', GO TO LOOP_09
----------------------------------------------------
----------------------------------------------------
IF STANDARD OR NEW RU
AND
RU-MEMBERS-ROSTER IS EMPTY
AND
AT LEAST ONE PERSON WHO WAS ADDED TO THE RU DURING THIS INTERVIEW AT RE54 OR RE55 WAS SUBSEQUENTLY REMOVED FROM THE RU-MEMBERS-ROSTER AND IS FLAGGED AS A 'NEW STUDENT', GO TO LOOP_13
----------------------------------------------------
----------------------------------------------------
IF STANDARD OR NEW RU
AND
RU-MEMBERS-ROSTER IS EMPTY
AND
NO ONE WHO WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW IS FLAGGED AS A 'NEW STUDENT',
AND
AT LEAST ONE PERSON WHO WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW IS FLAGGED AS EITHER OF THE FOLLOWING:
- 'NON-MILITARY MOVER IN U.S.'
OR
- 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY',
GO TO RE85A
----------------------------------------------------
----------------------------------------------------
IF STANDARD OR NEW SINGLE-PERSON RU
AND
NO ONE WHO WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW IS FLAGGED AS A 'NEW STUDENT',
GO TO BOX_29
----------------------------------------------------
----------------------------------------------------
IF MULTI-PERSON RU
OR
(IF STANDARD OR NEW SINGLE-PERSON RU
AND
AT LEAST ONE PERSON WHO WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW IS FLAGGED AS A 'NEW STUDENT'),
CONTINUE WITH RE76
----------------------------------------------------

RE76
====

ASK RELATIONSHIP FOR EACH BLANK FIELD.
[What [is/was] the EXACT relationship of [ROW PERSON'S NAME] to [COLUMN PERSON'S NAME]?/We have recorded that [ROW PERSON'S NAME] [is/was] [COLUMN PERSON'S NAME] [COLUMN PERSON'S RELATIONSHIP].]
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
ROSTER. DU MEMBER NAME
RE76_01. DU MEMBER 1
RE76_02. DU MEMBER 2
RE76_03. DU MEMBER 3
1. First Name-15 [Enter Selection] [Enter Selection] [Enter Selection]
2. First Name-15 [Enter Selection] [Enter Selection] [Enter Selection]
3. First Name-15 [Enter Selection] [Enter Selection] [Enter Selection]
1 = MOTHER 5 = DAUGHTER/ADOPTED DAUGHTER
2 = FATHER 6 = SON/ADOPTED SON
3 = SISTER/STEP-/HALF- 7 = WIFE/SPOUSE
4 = BROTHER/STEP-/HALF- 8 = HUSBAND/SPOUSE
PRESS F1 FOR COMPLETE LIST OF RELATIONSHIP CODES.
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE DU-MEMBERS-ROSTER TO DISPLAY ALL DU MEMBERS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
- PERSON IS A MEMBER OF THE RU FOR THIS CASE
OR
- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW AND IS FLAGGED AS A 'NEW STUDENT'
----------------------------------------------------
-----------------------------------------------------
DISPLAY 'What [is/was] the EXACT relationship of [ROW PERSON'S NAME] to [COLUMN PERSON'S NAME]?' IF CELL WHERE CURSOR IS LOCATED IS BLANK. DISPLAY 'is' IF BOTH PERSONS ARE LIVING. DISPLAY 'was' IF EITHER OR BOTH PERSONS ARE DECEASED.

DISPLAY 'We have recorded that [ROW PERSON'S NAME] [is/was] [COLUMN PERSON'S NAME] [COLUMN PERSON'S RELATIONSHIP].' IF CELL CONTAINS A CODE. DISPLAY 'is' IF BOTH PERSONS ARE LIVING. DISPLAY 'was' IF EITHER OR BOTH PERSONS ARE DECEASED. FOR '[COLUMN PERSON'S RELATIONSHIP]', DISPLAY 'UNKNOWN' IF RELATIONSHIP CODED '-7' (REF) OR '-8' (DK). OTHERWISE, DISPLAY TEXT FOR CODE.
-----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:
1. ALLOW HORIZONTAL AND VERTICAL SCROLLING TO COLLECT RELATIONSHIPS AMONG ALL PERSONS IN THE MATRIX.
2. THE COLUMN HEADINGS 'DU MEMBER 1', 'DU MEMBER 2' AND 'DU MEMBER 3' ARE FILLED WITH THE NAMES OF DU MEMBERS IN THE ORDER PRESENTED IN THE ROSTER.
3. DISPLAY RELATIONSHIPS THAT WERE CODED IN PREVIOUS ROUND AND ARE STILL APPLICABLE.
4. DISPLAY BLANK FIELDS FOR RELATIONSHIPS NOT YET COLLECTED OR WHERE RELATIONSHIP WAS CODED '-7' (REF) OR '-8' (DK) IN PREVIOUS ROUND.
5. PLACE CURSOR ON FIRST BLANK FIELD. AFTER ENTRY, MOVE CURSOR TO NEXT BLANK CELL ON THAT ROW.
6. ALLOW INTERVIEWERS TO USE ALL ARROW KEYS TO MOVE CURSOR AMONG ROWS AND COLUMNS.
7. INTERVIEWERS SHOULD NOT BE ALLOWED TO ADD NEW PERSONS.
8. INTERVIEWERS SHOULD NOT BE ALLOWED TO DELETE ANY PERSON(S).
9. INTERVIEWERS SHOULD NOT BE ALLOWED TO EDIT NAMES OF ANY PERSON ON MATRIX.
----------------------------------------------------
----------------------------------------------------
EDITS: IF CODE 1 (MOTHER) OR CODE 2 (FATHER) WITH CODES 5 OR 6 (CHILDREN) WHERE THE AGE OF THE PERSON ASSOCIATED WITH CODE 1/2 IS ( 12 OR ) 55 YEARS FROM THE AGE ASSOCIATED WITH CODE 5/6, DISPLAY THE FOLLOWING MESSAGE: 'UNLIKELY RESPONSE DUE TO AGE.'

IF CODES 1 OR 2 OR 7 OR 8 IS USED MORE THAN ONCE, DISPLAY THE FOLLOWING MESSAGE: 'UNLIKELY RESPONSE – CODE ALREADY USED.'
----------------------------------------------------
----------------------------------------------------
IF ANY RELATIONSHIP IS CODED '99' (NOT RELATED), CONTINUE WITH RE77
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_29
----------------------------------------------------

RE77
====

REVIEW RELATIONSHIPS BELOW. USE CODES 28-33 IF MORE DESCRIPTIVE.
28 = FEMALE PARTNER 32 = PARTNER'S DAUGHTER
29 = MALE PARTNER 33 = PARTNER'S SON
30 = MOTHER'S PARTNER 91 = OTHER RELATED, SPECIFY
31 = FATHER'S PARTNER
USE OTHER RELATIONSHIP CODES IF APPROPRIATE.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
ROSTER UNRELATED MEMBER
RE77_01. DU MEMBER 1
RE77_02. DU MEMBER 2
RE77_03. SPECIFICATION
1. First Name-15 [Enter Selection] [Enter Selection] [Enter Other Specify]
2. First Name-15 [Enter Selection] [Enter Selection] [Enter Other Specify]
3. First Name-15 [Enter Selection] [Enter Selection] [Enter Other Specify]
PRESS F1 FOR COMPLETE LIST OF RELATIONSHIP CODES.
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITION:
- PERSON IS CODED '99' (NOT RELATED) AT RE76 IN AT LEAST ONE CELL IN ROW WITH PERSON'S NAME
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW HORIZONTAL AND VERTICAL SCROLLING TO COLLECT RELATIONSHIPS AMONG ALL MEMBERS IN THE MATRIX.
2. THE FIRST COLUMN DISPLAYS THE NAMES OF ROW PERSONS CODED '99' (NOT RELATED) AT RE76 FOR AT LEAST ONE RELATIONSHIP. THE COLUMN HEADINGS 'DU MEMBER 1', 'DU MEMBER 2', ETC. ARE FILLED WITH THE NAMES OF THE DU MEMBERS.
3. DISPLAY RELATIONSHIPS THAT WERE CODED IN RE76.
4. ALLOW INTERVIEWERS TO USE ALL ARROW KEYS TO MOVE CURSOR AMONG ROWS AND COLUMNS.
5. INTERVIEWERS SHOULD NOT BE ALLOWED TO ADD NEW PERSONS.
6. INTERVIEWERS SHOULD NOT BE ALLOWED TO DELETE ANY PERSON(S).
7. INTERVIEWERS SHOULD NOT BE ALLOWED TO EDIT NAMES OF ANY PERSON ON MATRIX.
----------------------------------------------------
----------------------------------------------------
IF AT LEAST ONE RU MEMBER OR 'NEW STUDENT' MEETS THE FOLLOWING CONDITION:
- CODED '99' (NOT RELATED) FOR RELATIONSHIP WITH REFERENCE PERSON AT RE77,
CONTINUE WITH RE78
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_29
----------------------------------------------------

BOX_28A
=======

OMITTED.

RE78
====

At this time, we are only collecting information about the people in this family. Therefore, that is all the information we will need about the non-related people who live here. We will not collect any additional information about (READ NAMES BELOW).
TO SCROLL, USE ARROW KEYS. TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- AN RU MEMBER OR 'NEW STUDENT' DISPLAYED AT RE76
AND
- NOT RELATED TO REFERENCE PERSON (RELATIONSHIP TO REFERENCE PERSON CODED '99' AT RE77)
----------------------------------------------------
----------------------------------------------------
REMOVE ALL RU MEMBERS DISPLAYED AT RE78 FROM THE RU-MEMBERS-ROSTER AND FLAG SUCH PERSONS AS REMOVED FROM THE ROSTER AT RE78. (NOTE THAT 'NEW STUDENTS' HAVE BEEN REMOVED FROM THE RU- MEMBERS-ROSTER EARLIER IN THE RE SECTION.)
----------------------------------------------------
----------------------------------------------------
IF PERSON DISPLAYED AT RE78 MEETS BOTH OF THE FOLLOWING CONDITIONS:
- ADDED TO THE RU DURING THIS INTERVIEW
AND
- FLAGGED AS A 'NEW STUDENT',
TURN OFF THE 'NEW STUDENT' FLAG. PERSON IS NOT RELATED TO REFERENCE PERSON AND, THEREFORE, DOES NOT MEET THE REQUIREMENTS FOR A 'NEW STUDENT' ASSOCIATED WITH THIS RU. PERSON IS NOT KEY AND IS OUT OF SCOPE FOR THIS STUDY. NO INFORMATION WILL BE COLLECTED FOR PERSON.
----------------------------------------------------

BOX_28B
=======

OMITTED.

LOOP_08A
========

OMITTED.

END_LP08A
=========

OMITTED.

BOX_29
======

----------------------------------------------------
IF ROUND 1 AND AT LEAST ONE PERSON ON THE DU-MEMBERS-ROSTER MEETS EITHER OF THE FOLLOWING SETS OF CONDITIONS:

PERSON IS:
- CURRENTLY ON THE RU-MEMBERS-ROSTER
AND
- AGE 17 - 23, INCLUSIVE, AT THE TIME OF NHIS
AND
- AN ORIGINAL RU OR DU MEMBER (THAT IS, ON THE RU-MEMBERS-ROSTER OR THE DU-MEMBERS-ROSTER AT THE START OF THIS ROUND)
AND
- PERSON'S KEYNESS HAS NOT YET BEEN DETERMINED DURING THIS INTERVIEW OR IN A PREVIOUS INTERVIEW WITHIN THIS ROUND

OR PERSON IS:
- FLAGGED AS A 'NEW STUDENT'
AND
- AN ORIGINAL RU MEMBER (THAT IS, ON THE RU-MEMBERS-ROSTER AT THE START OF THIS ROUND),

CONTINUE WITH LOOP_09
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_30A
----------------------------------------------------

LOOP_09
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE DU-MEMBERS-ROSTER, ASK RE79-END_LP09
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_09 COLLECTS INFORMATION TO IDENTIFY THE FOLLOWING TYPES OF STUDENTS:
- STUDENTS SAMPLED BY NHIS APART FROM THEIR PARENTS
AND
- STUDENTS WHO ARE LIVING 'PERMANENTLY' APART FROM THEIR PARENTS AND WHO DO NOT RECEIVE HEALTH CARE BENEFITS THROUGH THE CURRENT RU

THIS LOOP CYCLES ON PERSONS ON THE DU-MEMBERS-ROSTER WHO MEET EITHER OF THE FOLLOWING SETS OF CONDITIONS:

PERSON IS:
- CURRENTLY ON THE RU-MEMBERS-ROSTER
AND
- AGE 17 - 23, INCLUSIVE, AT THE TIME OF NHIS
AND
- AN ORIGINAL RU OR DU MEMBER (THAT IS, ON THE RU-MEMBERS-ROSTER OR THE DU-MEMBERS-ROSTER AT THE START OF THIS ROUND)
AND
- PERSON'S KEYNESS HAS NOT YET BEEN DETERMINED DURING THIS INTERVIEW OR IN A PREVIOUS INTERVIEW WITHIN THIS ROUND

OR PERSON IS:
- FLAGGED AS A 'NEW STUDENT'
AND
- AN ORIGINAL RU MEMBER (THAT IS, ON THE RU- MEMBERS-ROSTER AT THE START OF THIS ROUND).

----------------------------------------------------

RE79
====

[PERSON'S FIRST MIDDLE LAST NAME]
At the time of the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW] (were/was) (PERSON) attending school?
YES .................................... 1
NO ..................................... 2 [END_LP09]
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]

RE80
====

[PERSON'S FIRST MIDDLE LAST NAME]
(Were/Was) (PERSON) attending ...
grades 1-12, ............................1 [END_LP09]
a college or university, or .............2
some other training school after high school? ..........................3
REF ....................................-7 [END_LP09]
DK .....................................-8 [END_LP09]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
IF CODED '2' (COLLEGE) OR '3' (OTHER TRAINING SCHOOL)
AND
PERSON WAS NOT CODED 'NEVER MARRIED' AT NHIS INTERVIEW,
GO TO END_LP09
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (COLLEGE) OR '3' (OTHER TRAINING SCHOOL)
AND
PERSON WAS CODED 'NEVER MARRIED' AT NHIS INTERVIEW,
CONTINUE WITH RE80A
----------------------------------------------------

RE80A
=====

[PERSON'S FIRST MIDDLE LAST NAME]
At the time of the National Health Interview Survey in [MONTH, DAY, YEAR OF NHIS INTERVIEW] were either of (PERSON)'s parents living in this household?
YES .................................... 1 [END_LP09]
NO ..................................... 2
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]

RE81
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does)(PERSON) have parents who live somewhere else?
YES .................................... 1
NO ..................................... 2 [END_LP09]
REF ................................... -7
DK .................................... -8

BOX_29A
=======

OMITTED.

RE82
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is this (PERSON)'s usual year-round place of residence or is this (PERSON)'s place of residence only during the school year?
USUAL YEAR-ROUND PLACE OF RESIDENCE .... 1 [END_LP09]
RESIDENCE ONLY DURING SCHOOL YEAR ...... 2 [END_LP09]
SOME OTHER ARRANGEMENT ................ 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
IF RE82 CODED '2' (RESIDENCE ONLY DURING SCHOOL YEAR)
AND
PERSON IS FLAGGED AS A 'NEW STUDENT', TURN OFF THE 'NEW STUDENT' FLAG. PERSON DOES NOT MEET THE REQUIREMENTS FOR A 'NEW STUDENT' ASSOCIATED WITH THIS RU. PERSON IS NOT KEY AND IS OUT OF SCOPE FOR THIS STUDY. NO INFORMATION WILL BE COLLECTED FOR PERSON.
----------------------------------------------------

BOX_29B
=======

OMITTED.

RE83
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does someone in this household have primary responsibility for (PERSON)'s health and health care?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF PRIMARY RESPONSIBILITY.
----------------------------------------------------
IF RE83 CODED '2' (NO), '-7' (DON'T KNOW), OR '-8' (REFUSED)
AND
PERSON IS FLAGGED AS A 'NEW STUDENT', TURN OFF THE 'NEW STUDENT' FLAG. PERSON DOES NOT MEET THE REQUIREMENTS FOR A 'NEW STUDENT' ASSOCIATED WITH THIS RU. PERSON IS NOT KEY AND IS OUT OF SCOPE FOR THIS STUDY. NO INFORMATION WILL BE COLLECTED FOR PERSON.
----------------------------------------------------

END_LP09
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_09 AND CONTINUE WITH BOX_30
----------------------------------------------------

BOX_30
======

----------------------------------------------------
IF AT LEAST ONE PERSON BECAME NON-KEY IN THE COURSE OF LOOP_09, THAT IS, IF AT LEAST ONE PERSON WHOSE KEYNESS WAS EVALUATED IN LOOP_09 MEETS EITHER OF THE FOLLOWING CONDITIONS:

PERSON IS:
- AGE 17 - 23, INCLUSIVE, AND LIVES IN RU ONLY DURING SCHOOL YEAR (RE82 CODED '2')

OR PERSON IS:
- AGE 17-23, INCLUSIVE, AND RU IS NOT PERSON'S YEAR-ROUND RESIDENCE, AND PERSON'S HEALTH CARE IS NOT THE PRIMARY RESPONSIBILITY OF AN RU MEMBER (RE83 CODED '2', '-7', OR '-8'),

CONTINUE WITH RE84
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_30A
----------------------------------------------------

RE84
====

At this time, we are only collecting information about persons who are usual year-round residents of this household and for whom we can collect health care information. Therefore, the remaining questions will not be asked about (READ NAMES BELOW).
TO SCROLL, USE ARROW KEYS. TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITION:
- PERSON'S KEYNESS WAS EVALUATED IN LOOP_09
AND EITHER OF THE FOLLOWING CONDITIONS:
- PERSON LIVES IN THE RU ONLY DURING THE SCHOOL YEAR (RE82 CODED '2')
OR
- RU IS NOT PERSON'S YEAR-ROUND RESIDENCE AND PERSON'S HEALTH CARE IS NOT THE PRIMARY RESPONSIBILITY OF ANOTHER RU MEMBER RE83 CODED '2', '-7', OR '-8')
----------------------------------------------------
----------------------------------------------------
IF ANY PERSON MEETS EITHER OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER
AND
- PERSON WAS DETERMINED TO BE NON-KEY IN THE COURSE OF LOOP_09 (THAT IS, PERSON WAS DISPLAYED AT RE84)
REMOVE PERSON FROM THE RU-MEMBERS-ROSTER AND FLAG PERSON AS REMOVED FROM RU-MEMBERS-ROSTER AT RE84.

NO FURTHER INFORMATION WILL BE COLLECTED FOR SUCH PERSONS OR FOR THE 'NEW STUDENTS' WHO HAD THE 'NEW STUDENT' FLAG TURNED OFF DURING THE COURSE OF LOOP_09. THESE PERSONS ARE NON-KEY AND OUT-OF- SCOPE (INELIGIBLE FOR REST OF SURVEY).
----------------------------------------------------

BOX_30A
=======

-----------------------------------------------------
DETERMINE THE KEYNESS AND ELIGIBILITY OF ALL PERSONS ON THE RU-MEMBERS-ROSTER.

THE DETERMINATION OF KEYNESS AND ELIGIBILITY IS BASED ON DEFINED CRITERIA AND IS DETERMINED IN THE FOLLOWING ORDER:
1. DETERMINE THE KEYNESS OF PERSONS WHO ARE NOT NEWBORN
2. DETERMINE THE KEYNESS OF PERSONS WHO ARE NEWBORN
3. DETERMINE THE ELIGIBILITY OF ALL PERSONS ON THE RU-MEMBERS-ROSTER

KEYNESS AND ELIGIBILITY FOR PERSONS WHO HAVE BEEN REMOVED FROM THE RU-MEMBERS-ROSTER IS DETERMINED ELSEWHERE IN THE REENUMERATION (RE) SECTION OF THE INSTRUMENT.
-----------------------------------------------------
-----------------------------------------------------
DELETE ANY RU MEMBERS WHO ARE DETERMINED TO BE INELIGIBLE FROM THE RU-MEMBERS-ROSTER.
-----------------------------------------------------
-----------------------------------------------------
IF THE RU-MEMBERS-ROSTER IS NOT EMPTY (THAT IS, IF AT LEAST ONE RU MEMBER REMAINS ELIGIBLE FOR THE SURVEY IN THE CURRENT ROUND, CONTINUE WITH RE85
-----------------------------------------------------
-----------------------------------------------------
IF THE RU-MEMBERS-ROSTER IS EMPTY (THAT IS NO RU MEMBER REMAINS ELIGIBLE FOR THE SURVEY IN THE CURRENT ROUND),
GO TO RE85A
-----------------------------------------------------

RE85
====

THESE ARE NOW THE MEMBERS OF THE RU WHO WILL BE INCLUDED IN THIS INTERVIEW.
TO SCROLL, USE ARROW KEYS. TO LEAVE, PRESS ESC.
[FULL NAME OF REFERENCE PERSON......]'S FAMILY:
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER (THAT IS, ALL PERSONS WHO ARE ELIGIBLE FOR THE SURVEY IN THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_34
----------------------------------------------------

RE85A
=====

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS ENTER TO END THE INTERVIEW.

RE85B
=====

INTERVIEWER: DID YOU COMPLETE THIS INTERVIEW IN-PERSON OR BY TELEPHONE? (YOU MUST HAVE SUPERVISOR APPROVAL PRIOR TO INTERVIEWING BY TELEPHONE.)
IN-PERSON ............................. 1
TELEPHONE ............................. 2
(Code One)
----------------------------------------------------
IF AT LEAST ONE PERSON REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW IS FLAGGED AS A 'NEW STUDENT', GO TO BOX_37
----------------------------------------------------
----------------------------------------------------
IF NO PERSON WHO WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW IS FLAGGED AS A 'NEW STUDENT'
AND
AT LEAST ONE PERSON WHO WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW IS FLAGGED AS EITHER OF THE FOLLOWING:
- 'NON-MILITARY MOVER IN U.S.'
OR
- 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY',
GO TO RE111
----------------------------------------------------
----------------------------------------------------
OTHERWISE (NO 'NEW STUDENT', 'NON-MILITARY MOVER IN U.S.', OR 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY'), GO TO BOX_44
----------------------------------------------------

BOX_31
======

OMITTED.

RE86
====

OMITTED.

RE87
====

OMITTED.

LOOP_10
=======

OMITTED.

RE88
====

OMITTED.

END_LP10
========

OMITTED.

BOX_32
======

OMITTED.

RE89
====

OMITTED.

RE90
====

OMITTED.

LOOP_11
=======

OMITTED.

RE91
====

OMITTED.

END_LP11
========

OMITTED.

BOX_33
======

OMITTED.

RE92
====

OMITTED.

RE93
====

OMITTED.

RE93A
=====

OMITTED.

RE93B
=====

OMITTED.

BOX_34
======

----------------------------------------------------
IF ROUND 1
AND
AT LEAST ONE PERSON ON THE RU-MEMBERS-ROSTER IS ) 16 YEARS OLD AND NOT CODED 'FULL TIME ACTIVE DUTY IN THE MILITARY',
CONTINUE WITH RE94A
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1
AND
AT LEAST ONE PERSON ON THE RU-MEMBERS-ROSTER IS ) 16 YEARS OLD AND ( 60 YEARS OLD,
GO TO LOOP_12A0
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_35
----------------------------------------------------

BOX_35AA
========

OMITTED.

BOX_34A
=======

OMITTED.

RE94
====

OMITTED (INTEGRATED WITH RE94A).

RE94A
=====

[In addition to (READ NAMES BELOW),has/Has] anyone in the family ever served on active duty in the Armed Forces of the United States?
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES .................................... 1
NO ..................................... 2 [BOX_35]
REF ................................... -7 [BOX_35]
DK .................................... -8 [BOX_35]
PRESS F1 FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
IF AT LEAST ONE PERSON ON THE RU-MEMBERS-ROSTER IS CODED AS ON FULL-TIME ACTIVE DUTY IN THE MILITARY (RE35 CODED '6') IN ANY INTERVIEW DURING THIS ROUND, DISPLAY THE INTRODUCTORY PHRASE 'In addition to ...' AND THE SCREEN INSTRUCTIONS AND ROSTER. OTHERWISE, DISPLAY 'Has' AND DO NOT DISPLAY THE SCREEN INSTRUCTIONS AND ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITION:
- CODED AS ON FULL-TIME ACTIVE DUTY IN THE MILITARY (RE35 CODED '6') IN ANY INTERVIEW DURING THIS ROUND,
----------------------------------------------------

RE95
====

Who [else] has served on active duty in the Armed Forces?
PROBE: Anyone else?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
PRESS F1 FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- AGE ) 16 YEARS OLD
AND
- NOT CODED AS ON FULL-TIME ACTIVE DUTY IN THE MILITARY (RE35 CODED '6') IN ANY INTERVIEW DURING THIS ROUND
----------------------------------------------------
----------------------------------------------------
DISPLAY 'else' IF A ROSTER WAS DISPLAYED AT RE94. OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY NUMBER OF PERSON(S) LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD NOT BE ABLE TO EDIT ANY OF THE NAMES.
3. INTERVIEWER SHOULD NOT BE ABLE TO ADD NEW PERSONS.
4. INTERVIEWER SHOULD NOT BE ABLE TO DELETE ANY PERSONS.
----------------------------------------------------

LOOP_12
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBER-ROSTER, ASK RE96-END_LP12
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_12 COLLECTS INFORMATION ON WHEN PERSON SERVED IN THE ARMED FORCES AND WHETHER PERSON IS CURRENTLY ON FULL-TIME ACTIVE DUTY. THIS LOOP CYCLES ON RU MEMBERS SELECTED AT RE95.
----------------------------------------------------

RE96
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON) serve in the Armed Forces?
World War I (April 1917 - Nov. 1918) ... 1
World War II (Sept. 1940 - July 1947) .. 2
Korean War (June 1950 - Jan. 1955) ..... 3
Vietnam Era (Aug. 1964 - April 1975) ... 4
Post-Vietnam (May 1975 - Present) ...... 5
Other service (all other periods) ...... 6
REF ................................... -7
DK .................................... -8
[Code All That Apply]
----------------------------------------------------
IF PERSON IS ( 60 YEARS OF AGE, CONTINUE WITH RE96A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP12
----------------------------------------------------

RE96A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is (PERSON) now on full-time active duty service with the Armed Forces of the United States?
YES .................................... 1
NO ..................................... 2 [END_LP12]
REF ................................... -7 [END_LP12]
DK .................................... -8 [END_LP12]
PRESS F1 FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON AS 'FULL-TIME MILITARY AND LIVING IN RU'.
----------------------------------------------------

RE96B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) enter full-time active duty service in the Armed Forces?
[Enter Month, Day, Year -2] ............
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FULL-TIME ACTIVE DUTY.

END_LP12
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_12 AND CONTINUE WITH BOX_35A
----------------------------------------------------

LOOP_12A0
=========

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK RE96B1-END_LP12A0
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_12A0 COLLECTS INFORMATION TO DETERMINE WHETHER PERSON IS CURRENTLY ON FULL-TIME ACTIVE DUTY IN THE MILITARY. THIS LOOP CYCLES ON RU MEMBERS WHO ARE ) 16 YEARS OLD AND ( 60 YEARS OLD.
----------------------------------------------------

RE96B1
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Is/Was] (PERSON) [now] on full-time active duty service with the Armed Forces of the United States [on December 31, 1998]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5.

DISPLAY 'now' IF NOT ROUND 5. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON AS 'FULL-TIME MILITARY AND LIVING IN RU'.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), AND PREVIOUS ROUND STATUS NOT FULL-TIME MILITARY LIVING IN THE RU/FULL-TIME MILITARY IN U.S. AND NOT ON A MILITARY FACILITY, CONTINUE WITH RE96B2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP12A0
----------------------------------------------------

RE96B2
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) enter full-time active duty service in the Armed Forces?
[Enter Month, Day, Year -2] ............
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
EDIT (FOR ROUND 5): DATE MUST BE ON OR BEFORE 12/31/98. IF A DATE AFTER 12/31/98 IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'DATE MUST BE ON OR BEFORE 12/31/98. IF PERSON WAS ONLY FULL-TIME MILITARY AFTER 12/31/98, USE CTRL/B TO BACK-UP AND CHANGE RESPONSE TO RE96B1.'
----------------------------------------------------

END_LP12A0
==========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_12A0 AND CONTINUE WITH BOX_35A
----------------------------------------------------

BOX_35AA
========

OMITTED.

BOX_35A
=======

----------------------------------------------------
IF AT LEAST ONE RU MEMBER IS KEY AND NOT FULL-TIME MILITARY (THAT IS, KEY AND NOT FLAGGED AS EITHER:
- 'FULL-TIME MILITARY AND LIVING IN RU'
OR
- 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY',
PERSONS FLAGGED DURING LOOP_12 OR LOOP_12A0 AS 'FULL-TIME MILITARY LIVING IN RU' ARE ELIGIBLE FOR THIS INTERVIEW.
----------------------------------------------------
----------------------------------------------------
IF NO RU MEMBER IS KEY AND NOT FULL-TIME MILITARY (THAT IS, KEY AND NOT FLAGGED AS EITHER:
- 'FULL-TIME MILITARY AND LIVING IN RU'
OR
- 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY',
PERSONS FLAGGED DURING LOOP_12 OR LOOP_12A0 AS 'FULL-TIME MILITARY LIVING IN RU' ARE NOT ELIGIBLE FOR THIS INTERVIEW. REMOVE ALL PERSONS FLAGGED AS 'FULL-TIME MILITARY LIVING IN RU' FROM THE RU-MEMBERS-ROSTER AND FLAG PERSONS AS REMOVED AT LOOP_12 OR LOOP_12A0.
----------------------------------------------------
----------------------------------------------------
IF NO ONE WAS REMOVED FROM THE RU-MEMBERS-ROSTER AT LOOP_12 OR LOOP_12A0, GO TO BOX_35
----------------------------------------------------
----------------------------------------------------
IF AT LEAST ONE PERSON WAS REMOVED FROM THE RU- MEMBERS-ROSTER AT LOOP_12 OR LOOP_12A0
AND
AT LEAST ONE PERSON REMAINS ELIGIBLE FOR THE THE INTERVIEW (THAT IS, THE RU-MEMBERS-ROSTER IS NOT EMPTY),
GO TO RE96E
----------------------------------------------------
----------------------------------------------------
IF THE RU-MEMBERS-ROSTER IS EMPTY (THAT IS, ALL REMAINING RU MEMBERS WERE REMOVED AT LOOP_12 OR LOOP_12A0), CONTINUE WITH RE96C
----------------------------------------------------

RE96C
=====

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS ENTER TO END THE INTERVIEW.

RE96D
=====

INTERVIEWER: DID YOU COMPLETE THIS INTERVIEW IN-PERSON OR BY TELEPHONE? (YOU MUST HAVE SUPERVISOR APPROVAL PRIOR TO INTERVIEWING BY TELEPHONE.)
IN-PERSON ............................. 1
TELEPHONE ............................. 2
(Code One)
----------------------------------------------------
GO TO BOX_37
----------------------------------------------------

RE96E
=====

At this time, we are collecting information only about some of the people in this family. Therefore, we will not collect any additional information about (READ NAMES BELOW).
TO SCROLL, USE ARROW KEYS. TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE DU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- FLAGGED AS 'FULL-TIME MILITARY LIVING IN RU'
AND
- REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW
----------------------------------------------------

BOX_35
======

----------------------------------------------------
IF ANY PERSONS ON THE RU-MEMBERS-ROSTER MEET THE FOLLOWING CONDITION:
- AGE = OR ) 16,
CONTINUE WITH RE97
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_37
----------------------------------------------------

BOX_36
======

OMITTED.

RE97
====

[(Are/Is) (PERSON) now/As of December 31, 1998, (were/was) (PERSON)] married, widowed, divorced, separated, or never married?
1 = MARRIED 2 = WIDOWED 3 = DIVORCED 4 = SEPARATED
5 = NEVER MARRIED.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
ROSTER. FIRST MIDDLE LAST NAME
RE97_02. MARITAL STATUS
1. First Name Middle Name Last Name-35 [Enter Selection]
2. First Name Middle Name Last Name-35 [Enter Selection]
3. First Name Middle Name Last Name-35 [Enter Selection]
PRESS F1 FOR DEFINITIONS OF MARITAL STATUS CODES.
----------------------------------------------------
DISPLAY '(Are/Is) (PERSON) now' IF NOT ROUND 5. DISPLAY 'As of December 31, 1998, (were/was) (PERSON)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITION:
- AGE = OR ) 16
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
2. RU MEMBERS COLUMN IS PROTECTED. CURSOR WILL NOT ENTER THIS COLUMN, SO NO CHANGES ARE ALLOWED TO RU MEMBERS AT THIS SCREEN.
----------------------------------------------------

BOX_37
======

----------------------------------------------------
IF ANY PERSON ON THE DU-MEMBERS-ROSTER MEETS ANY ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER AND ETHNICITY DATA IS MISSING
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATED WITH THIS RU AND ETHNICITY DATA IS MISSING,
CONTINUE WITH LOOP_13
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_38
----------------------------------------------------

LOOP_13
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE DU-MEMBERS-ROSTER, ASK RE98-END_LP13
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_13 COLLECTS ETHNICITY FOR RU MEMBERS AND NEW STUDENTS WHOSE ETHNICITY DATA IS MISSING. THIS LOOP CYCLES ON DU MEMBERS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER AND ETHNICITY DATA IS MISSING
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATED WITH THIS RU AND ETHNICITY DATA IS MISSING
----------------------------------------------------

RE98
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD RE-1.
Do any of the groups on this card represent (PERSON)'s main national origin or ancestry?
YES .................................... 1
NO ..................................... 2 [END_LP13]
REF ................................... -7 [END_LP13]
DK .................................... -8 [END_LP13]
PRESS F1 FOR DEFINITIONS OF GROUPS LISTED ON CARD.

RE99
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD RE-1.
Which group represents (PERSON)'s main national origin or ancestry?
IF RESPONDENT CANNOT CHOOSE ONE NATIONAL ORIGIN, PRESS F1 FOR APPROPRIATE PROBES.
PUERTO RICAN ........................... 1 [END_LP13]
CUBAN .................................. 2 [END_LP13]
MEXICAN, MEXICAN-AMERICAN, MEXICANO, CHICANO ................................ 3 [END_LP13]
OTHER LATIN AMERICAN ................... 4
OTHER SPANISH .......................... 5
OTHER ................................. 91 [END_LP13]
REF ................................... -7 [END_LP13]
DK .................................... -8 [END_LP13]
[Code One]
ALSO PRESS F1 FOR DEFINITIONS OF NATIONAL ORIGIN/ANCESTRY.

RE100
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What country would that be?
IF NECESSARY, PROBE: Which country best represents (PERSON)'s main national origin or ancestry?

IF RESPONDENT CANNOT CHOOSE ONE COUNTRY, PRESS F1 FOR APPROPRIATE PROBES.
ARGENTINA .............................. 1 [END_LP13]
BOLIVIA ................................ 2 [END_LP13]
BRAZIL ................................. 3 [END_LP13]
CHILE .................................. 4 [END_LP13]
COLOMBIA ............................... 5 [END_LP13]
COSTA RICA ............................. 6 [END_LP13]
ECUADOR ................................ 7 [END_LP13]
DOMINICAN REPUBLIC ..................... 8 [END_LP13]
EL SALVADOR ............................ 9 [END_LP13]
GUATEMALA ............................. 10 [END_LP13]
HONDURAS .............................. 11 [END_LP13]
NICARAGUA ............................. 12 [END_LP13]
PANAMA ................................ 13 [END_LP13]
PARAGUAY .............................. 14 [END_LP13]
PERU .................................. 15 [END_LP13]
PORTUGAL .............................. 16 [END_LP13]
URUGUAY ............................... 17 [END_LP13]
VENEZUELA ............................. 18 [END_LP13]
SPAIN ................................. 19 [END_LP13]
OTHER ................................. 91
REF ................................... -7 [END_LP13]
DK .................................... -8 [END_LP13]
[Code One]

RE100OV
=======

ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

END_LP13
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE DU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_13 AND CONTINUE WITH BOX_38
----------------------------------------------------

BOX_38
======

----------------------------------------------------
IF ANY PERSON ON THE DU-MEMBERS-ROSTER MEETS ANY ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER AND RACE DATA IS MISSING
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATED WITH THIS RU AND RACE DATA IS MISSING,
CONTINUE WITH LOOP_14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LOOP_15
----------------------------------------------------

LOOP_14
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE DU-MEMBERS-ROSTER, ASK RE101-END_LP14
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_14 COLLECTS RACE DATA FOR RU MEMBERS AND NEW STUDENTS WHOSE RACE DATA IS IS MISSING. THIS LOOP CYCLES ON DU MEMBERS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER AND RACE DATA IS MISSING
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATED WITH THIS RU AND RACE DATA IS MISSING,
----------------------------------------------------

RE101
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD RE-2.
Please look at this card and tell me the group which best describes (PERSON)'s racial background.
PROBE: Which group best represents (PERSON)'s race ...

IF RESPONDENT CANNOT CHOOSE ONE RACE, PRESS F1 FOR APPROPRIATE PROBES.
AMERICAN INDIAN ........................ 1 [END_LP14]
ALEUT, ESKIMO .......................... 2 [END_LP14]
ASIAN OR PACIFIC ISLANDER .............. 3 [END_LP14]
BLACK .................................. 4 [END_LP14]
WHITE .................................. 5 [END_LP14]
OTHER ................................. 91
REF ................................... -7 [END_LP14]
DK .................................... -8 [END_LP14]
[Code One]
ALSO PRESS F1 FOR RACE DEFINITIONS.

RE102
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
ENTER CODE TO SPECIFY 'OTHER' RACIAL BACKGROUND.
IF RESPONDENT CANNOT CHOOSE ONE RACE, PRESS F1 FOR APPROPRIATE PROBES.
AFRICAN AMERICAN ....................... 1 [END_LP14]
ASIAN INDIAN ........................... 2 [END_LP14]
CHINESE ................................ 3 [END_LP14]
FILIPINO ............................... 4 [END_LP14]
GUAMANIAN .............................. 5 [END_LP14]
HAWAIIAN ............................... 6 [END_LP14]
JAPANESE ............................... 7 [END_LP14]
KOREAN ................................. 8 [END_LP14]
SAMOAN ................................. 9 [END_LP14]
VIETNAMESE ............................ 10 [END_LP14]
OTHER ................................. 91
REF ................................... -7 [END_LP14]
DK .................................... -8 [END_LP14]
[Code One]

RE102OV
=======

ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

END_LP14
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE DU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_14 AND CONTINUE WITH LOOP_15
----------------------------------------------------

LOOP_15
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK BOX_39-END_LP15
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_15 COLLECTS INFORMATION ON EDUCATION LEVEL OF ALL RU MEMBERS AND NEW STUDENTS. THIS LOOP CYCLES ON RU MEMBERS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER (THAT IS, CURRENTLY ON THE RU-MEMBERS-ROSTER FOR THIS RU)
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATED WITH THIS RU
----------------------------------------------------

BOX_39
======

----------------------------------------------------
IF PERSON'S AGE (= 4 YEARS, CODE RE103 AS '0' (NEVER ATTENDED SCHOOL/KINDERGARTEN ONLY) AUTOMATICALLY BY CAPI, THEN GO TO END_LP15
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH RE103
----------------------------------------------------

RE103
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[As of December 31, 1998, what/What] is the highest grade or year of regular school (PERSON) ever completed?
NEVER ATTENDED SCHOOL/KINDERGARTEN ONLY ...................................... 0
ELEMENTARY
FIRST GRADE ............................ 1
SECOND GRADE ........................... 2
THIRD GRADE ............................ 3
FOURTH GRADE ........................... 4
FIFTH GRADE ............................ 5
SIXTH GRADE ............................ 6
SEVENTH GRADE .......................... 7
EIGHTH GRADE ........................... 8
HIGH SCHOOL
NINTH GRADE ............................ 9
TENTH GRADE ........................... 10
ELEVENTH GRADE ........................ 11
TWELFTH GRADE (HIGH SCHOOL DIPLOMA) ... 12
COLLEGE
FIRST YEAR ............................ 13
SECOND YEAR ........................... 14
THIRD YEAR ............................ 15
FOURTH YEAR (BACHELOR'S DEGREE) ....... 16
FIVE OR MORE YEARS (GRADUATE DEGREE) .. 17
REF ...................................... -7
DK ....................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF REGULAR SCHOOL AND GRADE OR YEAR.
----------------------------------------------------
DISPLAY 'What' IF NOT ROUND 5. DISPLAY 'As of December 31, 1998, what' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '0' (NEVER ATTENDED SCHOOL/KINDERGARTEN ONLY) - '12' (TWELFTH GRADE (HIGH SCHOOL DIPLOMA)) AND PERSON = OR ) 16, CONTINUE WITH RE104
----------------------------------------------------
----------------------------------------------------
IF CODED '13' THROUGH '17' (COLLEGE LEVEL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO RE105
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP15
----------------------------------------------------

RE104
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[[Do/Does/Did]/As of December 31, 1998 did] (PERSON) have a high school diploma or [[have/has/had]/had] (PERSON) passed the GED equivalency test?
HAVE HIGH SCHOOL DIPLOMA ............... 1 [END_LP15]
PASSED GED ............................. 2 [END_LP15]
NEITHER HIGH SCHOOL DIPLOMA OR GED ..... 3 [END_LP15]
REF ................................... -7 [END_LP15]
DK .................................... -8 [END_LP15]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Do' AND 'have' IF PERSON IS RESPONDENT. DISPLAY 'Does' AND 'has' IF PERSON IS NOT RESPONDENT AND LIVING. DISPLAY 'Did' AND 'had' IF PERSON IS DECEASED.
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 5, DISPLAY '(Do/Does/Did)'. IF ROUND 5, DISPLAY 'As of December 31, 1998, did'. IF NOT ROUND 5, DISPLAY [have/has/had]. IF ROUND 5, DISPLAY 'had'.
----------------------------------------------------

BOX_40
======

OMITTED.

RE105
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What is the highest educational degree (PERSON) obtained [as of December 31, 1998]?
BACHELOR'S DEGREE ....................... 1
MASTER'S DEGREE ......................... 2
DOCTORATE DEGREE ........................ 3
NO DEGREE ............................... 4
OTHER .................................. 91
REF .................................... -7
DK ..................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'as of December 31, 1998' IF ROUND 5. OTHERWISE, USE NULL A DISPLAY.
----------------------------------------------------

END_LP15
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE DU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_15 AND CONTINUE WITH BOX_41
----------------------------------------------------

BOX_41
======

----------------------------------------------------
IF RU TYPE IS STANDARD OR NEW (NOT A STUDENT RU)
AND
IF ANY PERSON ON THE RU-MEMBERS-ROSTER MEETS BOTH OF THE FOLLOWING CONDITIONS:
- AGE 17-23, INCLUSIVE
AND
- NOT CODED AS LIVING AWAY AT SCHOOL IN GRADES
1-12,
CONTINUE WITH RE106
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_41A
----------------------------------------------------

RE106
=====

[(Is/Are)/As of December 31, 1998, (were/was)] (READ NAMES BELOW) attending school either part-time or full-time?
CODE '1' (YES) IF ANY PERSON ATTENDING SCHOOL.
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES ..................................... 1
NO ...................................... 2 [BOX_41A]
REF .................................... -7 [BOX_41A]
DK ..................................... -8 [BOX_41A]
PRESS F1 FOR DEFINITIONS OF PART-TIME/FULL-TIME.
----------------------------------------------------
DISPLAY '(Is/Are)' IF NOT ROUND 5. DISPLAY 'As of December 31, 1998, (were/was)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET ALL OF THE FOLLOWING CONDITIONS:
- AGE 17-23, INCLUSIVE
AND
- NOT CODED AS LIVING AWAY AT SCHOOL IN GRADES 1-12
----------------------------------------------------

RE107
=====

Who [is/was] attending school either part-time or full-time [on December 31, 1998]?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- AGE 17-23, INCLUSIVE
AND
- NOT CODED AS LIVING AWAY AT SCHOOL IN GRADES 1-12
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A PERSON(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD NOT BE ABLE TO EDIT ANY OF THE NAMES.
3. INTERVIEWER SHOULD NOT BE ABLE TO ADD NEW PERSONS.
4. INTERVIEWER SHOULD NOT BE ABLE TO DELETE ANY PERSONS.
----------------------------------------------------

BOX_41A
=======

----------------------------------------------------
IF ANY RU MEMBERS MEET EITHER OF THE FOLLOWING CONDITIONS:
- SELECTED AT RE107
OR
- CODED AS LIVING AWAY AT SCHOOL IN GRADES 1-12,
CONTINUE WITH RE108
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_42
----------------------------------------------------

RE108
=====

[[Earlier you mentioned (PERSON) was living away at school in grades 1-12.] ][Is/Was] (PERSON) attending school part-time or full-time?
1 = PART-TIME 2 = FULL-TIME
ROSTER. RU MEMBERS
RE108_02. PART-TIME/FULL-TIME STATUS
1. First Name Middle Name Last Name-35 [Enter Selection]
2. First Name Middle Name Last Name-35 [Enter Selection]
3. First Name Middle Name Last Name-35 [Enter Selection]
PRESS F1 FOR DEFINITIONS OF PART-TIME/FULL-TIME.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS ATTENDING SCHOOL PART-TIME OR FULL-TIME (I.E., SELECTED AT RE107)
OR
- PERSON IS PREVIOUSLY CODED AS LIVING AWAY AT SCHOOL GRADES 1-12
----------------------------------------------------
---------------------------------------------------
DISPLAY '[Earlier you mentioned (PERSON) was living away at school in grades 1-12. ] IF PERSON BEING ASKED ABOUT IS CODED AS LIVING AWAY AT SCHOOL IN GRADES 1-12. OTHERWISE, USE NULL DISPLAY.
---------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. DISPLAY PERSONS WHO ARE AGE 17-23 (INCLUSIVE), ATTENDING SCHOOL PART-TIME OR FULL-TIME (I.E., SELECTED AT RE107) FIRST ON THE ROSTER. THEN DISPLAY PERSONS CODED AS LIVING AWAY AT SCHOOL GRADES 1-12.
2. ALLOW INTERVIEWER TO USE UP AND DOWN ARROW KEYS TO MOVE CURSOR AMONG ROWS.
3. RU MEMBERS COLUMN IS PROTECTED. CURSOR WILL NOT ENTER THIS COLUMN, SO NO CHANGES ARE ALLOWED TO RU MEMBERS AT THIS SCREEN.
----------------------------------------------------

BOX_42
======

----------------------------------------------------
IF AT LEAST ONE DU MEMBER WAS REMOVED FROM THE RU-MEMBERS-ROSTER THIS ROUND AND IS FLAGGED AS A 'NEW STUDENT', CONTINUE WITH RE109
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_43
----------------------------------------------------

RE109
=====

We may conduct a separate interview with (READ NAMES BELOW) so I will remove (READ NAMES BELOW) from this form.
TO SCROLL, USE ARROW KEYS. TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
LINE THROUGH STUDENT NAMES ON HOUSEHOLD SUMMARY.
------------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER THIS ROUND
AND
- PERSON IS FLAGGED AS A 'NEW STUDENT'
------------------------------------------------------
----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2 QUESTION WAS WORDED, "We will conduct..."
----------------------------------------------------

LOOP_16
=======

------------------------------------------------------
FOR EACH ELEMENT IN DU-MEMBERS-ROSTER, ASK RE110-END_LP16
------------------------------------------------------
------------------------------------------------------
LOOP DEFINITION: LOOP_16 COLLECTS LOCATING ADDRESS AND PHONE NUMBER FOR EACH STUDENT RU. THIS LOOP CYCLES ON PERSONS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER THIS ROUND
AND
- PERSON IS FLAGGED AS A 'NEW STUDENT'
------------------------------------------------------

RE110
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the address and telephone number where (PERSON) can be reached at school.
IF NO TELEPHONE, ENTER '000'.
STREET_ADDRESS1 (RE110_01): [_______________]
STREET_ADDRESS2 (RE110_02): [_______________]
CITY (RE110_03): [_______________]
STATE (RE110_04): [_______________]
ZIP CODE (RE110_05): [_______________]
TELEPHONE (RE110_06): [_______________]
RECORD ADDRESS AND TELEPHONE ABOVE AND ON SPLIT/STUDENT MOVING FORM.

END_LP16
========

--------------------------------------------------------
CYCLE ON THE NEXT PERSON IN THE DU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
--------------------------------------------------------
--------------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_16 AND CONTINUE WITH BOX_43
--------------------------------------------------------

BOX_43
======

----------------------------------------------------
IF ANY PERSON ON THE DU-MEMBERS-ROSTER MEETS EITHER OF THE FOLLOWING CONDITIONS:
- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND IS FLAGGED AS 'NON-MILITARY MOVER IN U.S.'
OR
- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND IS FLAGGED AS 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY',
CONTINUE WITH RE111
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_44
----------------------------------------------------

RE111
=====

We may (also) conduct a separate interview with (READ NAMES BELOW) so I will remove (READ NAMES BELOW) from this form.
TO SCROLL, USE ARROW KEYS. TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
LINE THROUGH NAMES LISTED ABOVE ON HOUSEHOLD SUMMARY SHEET.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND IS FLAGGED AS 'NON-MILITARY MOVER IN U.S.'
OR
- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND IS FLAGGED AS 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY',
----------------------------------------------------

LOOP_17
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE DU-MEMBERS-ROSTER, ASK RE111A-END_LP17
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_17 COLLECTS LOCATING INFORMATION FOR EACH PERSON WHO HAS LEFT THE RU AND MOVED TO ANOTHER HOUSEHOLD IN THE U.S. THIS LOOP CYCLES ON DU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- PERSON NOT FLAGGED AS 'PROCESSED MOVER'
AND
- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND EITHER OF THE FOLLOWING CONDITIONS:
- FLAGGED AS 'NON-MILITARY MOVER IN U.S.'
OR
- FLAGGED AS 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY'
----------------------------------------------------

RE111A
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the address and telephone number where (PERSON) has moved.
IF NO TELEPHONE, ENTER '000'.
STREET_ADDRESS1 (RE111A_1): [_____________]
STREET_ADDRESS2 (RE111A_2): [_____________]
CITY (RE111A_3): [_____________]
STATE (RE111A_4): [_____________]
ZIP CODE (RE111A_5): [_____________]
TELEPHONE (RE111A_6): [_____________]
RECORD ADDRESS AND TELEPHONE ABOVE AND ON SPLIT/STUDENT MOVING FORM.
----------------------------------------------------
FLAG PERSON AS 'PROCESSED MOVER'.
----------------------------------------------------
----------------------------------------------------
IF ALL PERSONS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
- REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND FLAGGED AS 'NON- MILITARY MOVER IN U.S.'
OR
- REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND FLAGGED AS 'FULL- TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY'
ARE FLAGGED AS 'PROCESSED MOVER',
GO TO END_LP17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH RE111B
----------------------------------------------------

RE111B
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
IF KNOWN, CODE WITHOUT ASKING.
Is (PERSON) living with any of the following family members?
(READ NAMES BELOW)
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES ..................................... 1
NO ...................................... 2 [END_LP17]
REF .................................... -7 [END_LP17]
DK ..................................... -8 [END_LP17]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- NOT FLAGGED AS 'PROCESSED MOVER'
AND
- REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU
AND EITHER OF THE FOLLOWING CONDITIONS:
- FLAGGED AS 'NON-MILITARY MOVER IN U.S.'
OR
- FLAGGED AS 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY'
----------------------------------------------------

RE112
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Who lives with (PERSON)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
[Code All That Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE DU-MEMBERS-ROSTER WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- NOT FLAGGED AS 'PROCESSED MOVER'
AND
- REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU
AND EITHER OF THE FOLLOWING CONDITIONS:
- FLAGGED AS 'NON-MILITARY MOVER IN U.S.'
OR
- FLAGGED AS 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY'
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS AS 'PROCESSED MOVER'.
----------------------------------------------------

END_LP17
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE DU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_17 AND CONTINUE WITH BOX_44A
----------------------------------------------------

BOX_44A
=======

----------------------------------------------------
THE PROGRAM DETERMINES THE ELIGIBILITY OF PERSONS WHO HAVE MOVED TO ANOTHER HOUSEHOLD IN THE U.S. AND HAVE THEREFORE BEEN REMOVED FROM THE RU-MEMBERS-ROSTER FOR THE CURRENT CASE. THE ELIGIBILITY OF SUCH PERSONS IS BASED ON WHETHER THEY ARE KEY AND/OR MOVED WITH A KEY PERSON. IF A PERSON WHO HAS MOVED TO A HOUSEHOLD WITHIN THE U.S. IS DETERMINED TO BE ELIGIBLE, THAT PERSON WILL BE INTERVIEWED AS PART OF A NEW RU.
-----------------------------------------------------

BOX_44
======

-----------------------------------------------------
IF NO PERSONS ARE ELIGIBLE AS PART OF THIS RU FOR THE SURVEY THIS ROUND (THAT IS, IF THE RU-MEMBERS-ROSTER IS EMPTY), EXIT INTERVIEW.
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, CONTINUE WITH NEXT QUESTIONNAIRE SECTION
-----------------------------------------------------


Condition Enumeration (CE) Section


BOX_01
======

----------------------------------------------------
AS A CONDITION IS ENTERED (IN THIS SECTION AS WELL AS IN LATER SECTIONS), FLAG THE CONDITION WITH THE ROUND IN WHICH THE CONDITION WAS FIRST CREATED. THIS ROUND FLAG IS USED TO DETERMINE WHETHER THE CONDITION IS ELIGIBLE FOR THE CN SECTION. (A CONDITION IS ELIGIBLE ONLY IN THE ROUND IN WHICH IT WAS CREATED.)
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK CE01-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS GENERAL HEALTH RATINGS AND ENUMERATES THE MEDICAL CONDITIONS OF EACH PERSON IN THE RU. THIS LOOP CYCLES ON EACH PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT OR INSTITUTIONALIZED RU MEMBER
AND
- PERSON IS NOT DECEASED
----------------------------------------------------

CE01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
I'd like to talk about (PERSON)'s health.
In general, compared to other people of (PERSON)'s age, would you say that (PERSON)'s health is excellent, very good, good, fair, or poor?
EXCELLENT .............................. 1
VERY GOOD .............................. 2
GOOD ................................... 3
FAIR ................................... 4
POOR ................................... 5
REF ................................... -7
DK .................................... -8
[Code One]

CE01OV
======

INTERVIEWER: WHO ANSWERED THIS QUESTION?
(PERSON) .............................. 1
SOMEONE ELSE .......................... 2
[Code One]
----------------------------------------------------
FLAG RESPONSE TO CE01 AS 'SELF-REPORT' IF CE01OV IS CODED '1' ((PERSON)) AND AS 'PROXY REPORT' IF CE01OV IS CODED '2' (SOMEONE ELSE).
----------------------------------------------------

CE02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
In general, would you say that (PERSON)'s mental health is excellent, very good, good, fair, or poor?
EXCELLENT .............................. 1
VERY GOOD .............................. 2
GOOD ................................... 3
FAIR ................................... 4
POOR ................................... 5
REF ................................... -7
DK .................................... -8
[Code One]

CE02OV
======

INTERVIEWER: WHO ANSWERED THIS QUESTION?
(PERSON) .............................. 1
SOMEONE ELSE .......................... 2
[Code One]
----------------------------------------------------
FLAG RESPONSE TO CE02 AS 'SELF-REPORT' IF CE02OV IS CODED '1' ((PERSON)) AND AS 'PROXY REPORT' IF CE02OV IS CODED '2' (SOMEONE ELSE).
----------------------------------------------------
----------------------------------------------------
IF FIRST CYCLE OF LOOP, CONTINUE WITH CE03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CE04
----------------------------------------------------

CE03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
We're interested in learning about health problems that may have bothered (PERSON) [since (START DATE)/between (START DATE) and (END DATE)]. Health problems include physical conditions, accidents, or injuries that affect any part of the body as well as mental or emotional health conditions, such as feeling sad, blue, or anxious about something.
PRESS ENTER TO CONTINUE.
PRESS F1 FOR DEFINITION OF HEALTH PROBLEM.
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

CE04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[At the time (PERSON) entered the institution, did (PERSON) have any physical or mental health problems, or had (PERSON) experienced any accidents or injuries?/Between (START DATE) and (END DATE), did (PERSON) have any physical or mental health problems, accidents, or injuries?]
[Please include all of (PERSON)'s conditions, accidents or injuries regardless of whether (PERSON) saw a medical provider, received treatment, or took medications [since (START DATE)/between (START DATE) and (END DATE)]. [Also include health problems that may have been mentioned during a previous interview, but have also bothered (PERSON) [since (START DATE)/between (START DATE) and (END DATE)].]]
YES .................................... 1
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF HEALTH PROBLEM.
----------------------------------------------------
DISPLAY 'At the time (PERSON) entered the institution, did (PERSON) have any physical or mental health problems, or had (PERSON) experienced any accidents or injuries?' IF PERSON CODED AS BEING INSTITUTIONALIZED.

OTHERWISE, DISPLAY 'Between (START DATE) and (END DATE), did (PERSON) have any physical or mental health problems, accidents, or injuries?'
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Also include health problems that may have been mentioned during a previous interview, but have also bothered (PERSON) [since (START DATE)/between (START DATE) and (END DATE)].' IF NOT ROUND 1. IF ROUND 1, USE A NULL DISPLAY.

DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2, THE SECOND PARAGRAPH OF THE QUESTION DID NOT HAVE BRACKETS AND WAS WORDED, "Please include all conditions, accidents or injuries for which (PERSON) saw a medical provider or took medications. Also include other physical or mental health problems affecting (PERSON) since (START DATE), even if no treatment or medications were received for the problems during this period.
[Also...(START DATE).]"
----------------------------------------------------

CE05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What did (PERSON) have?
PROBE: Did (PERSON) have any other health problems, accidents, or injuries?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
FLAG RESPONSE(S) AS COLLECTED IN CE SECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
4. ANY CONDITION ADDED TO THE ROSTER SHOULD BE FLAGGED AS 'CREATED' THIS ROUND (WITH THE ROUND STATUS). ANY CONDITION SELECTED AT THE ROSTER SHOULD BE FLAGGED AS 'SELECTED' THIS ROUND (WITH THE ROUND STATUS). THIS FLAGGING SHOULD OCCUR, AT ALL OF THE PERSON'S-MEDICAL- CONDITIONS-ROSTERS THROUGHOUT THE INSTRUMENT, THE FIRST TIME THE CONDITION IS ADDED OR SELECTED DURING THE ROUND. FOR EXAMPLE, IF IT IS ROUND 1, ALL CONDITIONS ON THE ROSTER WOULD HAVE THE FLAG 'CREATED - ROUND 1'. IF A CONDITION IS CREATED IN CE, BUT SELECTED IN MV, ALL DURING ROUND 1, IT WOULD ONLY HAVE THE FLAG 'CREATED - ROUND 1'. THUS, FOR ANY ONE ROUND, A CONDITION CAN ONLY BE FLAGGED AS 'CREATED' OR 'SELECTED'. IF IT IS ROUND 2 AND A CONDITION THAT WAS CREATED IN ROUND 1 IS SELECTED, IT SHOULD BE FLAGGED AS 'SELECTED - ROUND 2'.
THIS FLAG IS IN ADDITION TO THE ORIGINAL 'CREATED - ROUND 1' FLAG.
----------------------------------------------------

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
CHECK HOUSEHOLD ENUMERATION. IF ANY FEMALES AGED 15-45 YEARS, INCLUSIVE, (OR AGE CATEGORIES 4-6) IN THE RU, CONTINUE WITH BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF NOT ROUND 1 AND IF ANY PERSON IN RU CODED AS 'STILL PREGNANT' (PG01 WAS CODED '1' (YES)) DURING PREVIOUS ROUND, CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_06
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK LOOP_03-END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION ABOUT THE PREGNANCIES OF RU MEMBERS WHO WERE 'STILL PREGNANT' DURING THE PREVIOUS ROUND. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:

- PERSON IS FEMALE AND 15-45 YEARS OF AGE, INCLUSIVE, OR IN AGE CATEGORIES 4-6
AND
- PERSON WAS FLAGGED AS 'STILL PREGNANT' (PG01 CODED '1' (YES)) DURING THE PREVIOUS ROUND
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

PREVIOUS ROUND PREGNANCY
PREGNANCY 1
PREGNANCY 2
PREGNANCY 3

ASK BOX_04-END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS DETAILED INFORMATION ABOUT EACH PREGNANCY OF EACH PERSON CYCLED ON IN LOOP_02. THE FIRST LOOP CYCLE COLLECTS INFORMATION ABOUT THE PREGNANCY NOT ENDED DURING THE PREVIOUS ROUND. THE RESPONSE TO CE06 DETERMINES WHETHER THE LOOP CYCLES AGAIN.
SUBSEQUENT CYCLES, IF ANY, COLLECT INFORMATION ABOUT PREGNANCIES SINCE THE PERSON'S START DATE, STARTING WITH THE MOST RECENT PREGNANCY.
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF LOOPING ON PREGNANCY 1 AND PG01 IS CODED '1' (YES) FOR THIS PREGNANCY, ADD 'PREGNANCY (1)- STARTED-RD[n]' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.

IF LOOPING ON PREGNANCY 1 AND PG01 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS PREGNANCY, ADD 'PREGNANCY (1)-ENDED-RD[n]' TO PERSON'S MEDICAL-CONDITIONS-ROSTER.

IF LOOPING ON PREGNANCY 2, ADD 'PREGNANCY (2)- ENDED-RD[n]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER

IF LOOPING ON PREGNANCY 3, ADD 'PREGNANCY (3)- ENDED-RD[n]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER

NOTE: NO FLAG IS ADDED TO PERSON'S-MEDICAL- CONDITIONS-ROSTER FOR THE PREVIOUS ROUND PREGNANCY SINCE THIS PREGNANCY WOULD ALREADY HAVE A FLAG SET FOR IT IN THE PREVIOUS ROUND. ONCE A PREGNANCY IS ADDED TO PERSON'S-MEDICAL-CONDITIONS-ROSTER THAT IS 'STARTED', IT WILL NEVER BE CHANGED TO 'ENDED'.
THAT IS, THE FLAGS ON THE ROSTER NEVER CHANGE FOR PREGNANCY. INTERVIEWERS WILL BE TRAINED ON THIS.
----------------------------------------------------

CE06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was this/Were these] (PERSON)'s only [pregnancy/pregnancies] [since (START DATE)/between (START DATE) and (END DATE)]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'Was this' AND 'pregnancy' IF FIRST TIME THROUGH LOOP_03. OTHERWISE, DISPLAY 'Were these' AND 'pregnancies' IF NOT FIRST TIME THROUGH LOOP_03.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP03
========

----------------------------------------------------
IF CE06 IS CODED '2' (NO), CYCLE ON NEXT PREGNANCY.
----------------------------------------------------
----------------------------------------------------
IF CE06 IS CODED '1' (YES), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_03 AND CONTINUE WITH END_LP02
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH BOX_06
----------------------------------------------------

BOX_06
======

----------------------------------------------------
CHECK HOUSEHOLD ENUMERATION. IF ANY FEMALES AGE 15-45 (OR AGE CATEGORIES 4-6) IN THE RU WHO WERE NOT FLAGGED AS 'STILL PREGNANT' DURING PREVIOUS ROUND, CONTINUE WITH CE07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

CE07
====

[STR-DT] [END-DT]
[Besides the pregnancies we've already talked about, [since/ between]/[Since/Between]] (START DATE)[ and (END DATE)], was anyone [else] in the family pregnant at any time?
YES .................................... 1
NO ..................................... 2 [BOX_09]
REF ................................... -7 [BOX_09]
DK .................................... -8 [BOX_09]
----------------------------------------------------
DISPLAY 'Besides the pregnancies we've already talked about, [since/between]' IF SOMEONE IN THE RU WAS FLAGGED AS 'STILL PREGNANT' AT TIME OF LAST INTERVIEW. OTHERWISE, DISPLAY '[Since/Between]'.

DISPLAY 'since' AND 'Since' IF NOT ROUND 5.
DISPLAY 'between' AND 'Between' IF ROUND 5.

DISPLAY ' and (END DATE)' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'else' IF SOMEONE IN THE RU WAS FLAGGED AS 'STILL PREGNANT' AT TIME OF LAST INTERVIEW.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

CE08
====

[STR-DT] [END-DT]
Who was pregnant [since (START DATE)/between (START DATE) and (END DATE)]?
PROBE: Anyone else pregnant at any time [since (START DATE)/ between (START DATE) and (END DATE)]?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS
IN THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:

- PERSON IS FEMALE AND 15-45 YEARS OF AGE, INCLUSIVE, OR IN AGE CATEGORIES 4-6
AND
- PERSON WAS NOT FLAGGED AS 'STILL PREGNANT' (PG01 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)) DURING THE PREVIOUS ROUND FOR ALL PREGNANCIES
----------------------------------------------------
----------------------------------------------------
NOTE: THIS ROSTER SHOULD NOT EXCLUDE PEOPLE WHO ARE CURRENTLY OUT-OF-SCOPE (I.E., DECEASED, INSTITUTIONALIZED, ETC.).
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK LOOP_05-END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 COLLECTS INFORMATION ABOUT THE PREGNANCIES OF RU MEMBERS DURING THIS ROUND WHO WERE NOT 'STILL PREGNANT' DURING THE PREVIOUS ROUND. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:

- PERSON IS FEMALE AND 15-45 YEARS OF AGE, INCLUSIVE, OR IN AGE CATEGORIES 4-6
AND
- PERSON WAS NOT FLAGGED AS 'STILL PREGNANT' (PG01 CODED '2' (NO), '-7' (REFUSED), OR '8' (DON'T KNOW) OR NOT ASKED FOR ALL PREGNANCIES DURING THE PREVIOUS ROUND)
AND
- PERSON WAS SELECTED AT CE08 (PREGNANT SINCE START DATE)
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

PREGNANCY 1
PREGNANCY 2
PREGNANCY 3

ASK BOX_07-END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS DETAILED INFORMATION ABOUT EACH PREGNANCY OF EACH PERSON CYCLED ON IN LOOP_04. THE FIRST LOOP CYCLE COLLECTS INFORMATION ABOUT THE FIRST MOST RECENT NEW PREGNANCY SINCE START DATE. THE RESPONSE TO CE09 DETERMINES WHETHER THE LOOP CYCLES AGAIN.
SUBSEQUENT CYCLES, IF ANY, COLLECT INFORMATION ABOUT ADDITIONAL PREGNANCIES SINCE START DATE, STARTING WITH THE NEXT MOST RECENT PREGNANCY.
----------------------------------------------------

BOX_07
======

----------------------------------------------------
ASK THE PREGNANCY DETAIL (PG) SECTION.

WHEN PG SECTION COMPLETED, CONTINUE WITH BOX_08
----------------------------------------------------

BOX_08
======

----------------------------------------------------
IF LOOPING ON PREGNANCY 1 AND PG01 IS CODED '1' (YES) FOR THIS PREGNANCY, ADD 'PREGNANCY (1)- STARTED-RD[n]' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.

IF LOOPING ON PREGNANCY 1 AND PG01 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS PREGNANCY, ADD 'PREGNANCY (1)-ENDED-RD[n]' TO PERSON'S MEDICAL-CONDITIONS-ROSTER.

IF LOOPING ON PREGNANCY 2, ADD 'PREGNANCY (2)- ENDED-RD[n]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER

IF LOOPING ON PREGNANCY 3, ADD 'PREGNANCY (3)- ENDED-RD[n]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER
----------------------------------------------------

CE09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was this/Were these] (PERSON)'s only [pregnancy/pregnancies] [since (START DATE)/between (START DATE) and (END DATE)]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'Was this' AND 'pregnancy' IF FIRST TIME THROUGH LOOP_05. OTHERWISE, DISPLAY 'Were these' AND 'pregnancies' IF NOT FIRST TIME THROUGH LOOP_05.

DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP05
========

----------------------------------------------------
IF CE09 IS CODED '2' (NO), CYCLE ON NEXT PREGNANCY.
----------------------------------------------------
----------------------------------------------------
IF CE09 IS CODED '1' (YES), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_05 AND CONTINUE WITH END_LP04
----------------------------------------------------

END_LP04
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_04 AND CONTINUE WITH BOX_09
----------------------------------------------------

BOX_09
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------


Pregnancy Detail (PG) Section


BOX_01
======

----------------------------------------------------
IF LOOPING ON 'PREVIOUS ROUND PREGNANCY' OR 'PREGNANCY 1' (FROM CURRENT ROUND), CONTINUE WITH PG01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO PG02
----------------------------------------------------

PG01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
[We recorded that (PERSON) (were/was) pregnant at the time of our last interview on [PREV RD INTV DATE].]
[(Are/Is)/(Were/Was)] (PERSON) [currently] pregnant [with that pregnancy] [on December 31, 1998]?

[CODE 3 IF RESPONDENT SAYS PERSON WAS NOT PREGNANT AT LAST INTERVIEW.]
YES .................................... 1 [PG03]
NO ..................................... 2
[NOT PREGNANT AT LAST INTERVIEW ........ 3 [BOX_02]]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]
----------------------------------------------------
DISPLAY 'We recorded that (PERSON) (were/was) pregnant at the time of our last interview on [PREV RD INTV DATE].'; 'with that pregnancy'; 'CODE 3 IF RESPONDENT SAYS PERSON WAS NOT PREGNANT AT LAST INTERVIEW.'; AND 'NOT PREGNANT AT LAST INTERVIEW ...... 3 [BOX_02]' IF PERSON CODED AS 'STILL PREGNANT' AT LAST INTERVIEW AND LOOPING ON 'PREVIOUS ROUND PREGNANCY' FOR THIS PERSON. OTHERWISE, USE A NULL DISPLAY.

DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY '(Were/Was)' IF ROUND 5.

DISPLAY 'currently' IF NOT ROUND 5. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'on December 31, 1998' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NOT PREGNANT AT LAST INTERVIEW), FLAG ITEM FOR EVENT CLEANUP.
----------------------------------------------------

PG02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Did (PERSON)'s [most recent pregnancy/next most recent pregnancy/pregnancy that we talked about last time] end in a live birth?
[IF MORE THAN ONE PREGNANCY SINCE (START DATE), PROBE FOR OUTCOME OF (NEXT) MOST RECENT PREGNANCY.]
IF RESPONDENT VOLUNTEERS STILLBIRTH, MISCARRIAGE, OR ABORTION, CODE AS APPROPRIATE.
DO NOT PROBE A 'NO' RESPONSE. CODE 5, 'NO, OUTCOME NOT VOLUNTEERED.'
YES, ENDED IN A LIVE BIRTH ............. 1
NO, ENDED IN MISCARRIAGE ............... 2 [BOX_02]
NO, ENDED IN STILLBIRTH ................ 3 [BOX_02]
NO, ENDED IN ABORTION .................. 4 [BOX_02]
NO, OUTCOME NOT VOLUNTEERED ............ 5 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]
----------------------------------------------------
DISPLAY 'most recent pregnancy' IF LOOPING ON FIRST PREGNANCY OF CURRENT REFERENCE PERIOD.

DISPLAY 'next most recent pregnancy' IF LOOPING ON ANY PREGNANCY, AFTER THE FIRST PREGNANCY, OF CURRENT REFERENCE PERIOD.

DISPLAY 'pregnancy that we talked about last time' IF LOOPING ON PREGNANCY FROM PREVIOUS ROUND.

DISPLAY 'IF MORE THAN ONE PREGNANCY SINCE (START DATE), PROBE FOR OUTCOME OF (NEXT) MOST RECENT PREGNANCY.' IF NOT LOOPING ON FIRST PREGNANCY OF CURRENT ROUND OR PREGNANCY FROM PREVIOUS ROUND.
----------------------------------------------------

PG03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PG-1.
Looking at this card, which of these complications, if any, did (PERSON) experience during this pregnancy?
CODE ALL THAT APPLY.
HIGH BLOOD PRESSURE, TOXEMIA, PRE-ECLAMPSIA, OR ECLAMPSIA ......... 1
ANEMIA ................................ 2
DIABETES, GESTATIONAL DIABETES, OR HIGH BLOOD SUGAR .................... 3
LOW LYING PLACENTA (PLACENTA PREVIA) .. 4
VAGINAL BLEEDING ...................... 5
PREMATURE LABOR ....................... 6
NONE OF THESE COMPLICATIONS ........... 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF SELECTED CONDITIONS.
---------------------------------------------------
NOTE: CODE '95' (NONE OF THESE COMPLICATIONS) WILL NOT APPEAR ON THE SHOW CARD.
---------------------------------------------------
----------------------------------------------------
IF PG01 IS CODED '1' (YES), GO TO PG11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PG04
----------------------------------------------------

PG04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
How many babies did (PERSON) deliver?
[Enter Small Number] ...................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
NOTE: IF PG04 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), ASK ITEMS LOOP_01 TO END_LP01 ONCE.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: 1 TO 6 BABIES.
----------------------------------------------------

PG05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Where was the delivery - in a hospital, a birthing center separate from a hospital, at home, or some other place?
HOSPITAL ............................... 1 [PG06]
BIRTHING CENTER ........................ 2 [LOOP_01]
HOME ................................... 3 [LOOP_01]
SOME OTHER PLACE ...................... 91
REF ................................... -7 [LOOP_01]
DK .................................... -8 [LOOP_01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

PG05OV
======

ENTER OTHER:
[Enter Other Specify] .................. [LOOP_01]
REF ................................... -7 [LOOP_01]
DK .................................... -8 [LOOP_01]

PG06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
What kind of delivery did (PERSON) have? Was it a vaginal delivery or a caesarean section?
VAGINAL DELIVERY ....................... 1
CAESAREAN SECTION ...................... 2 [LOOP_01]
REF ................................... -7 [LOOP_01]
DK .................................... -8 [LOOP_01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

PG07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Were forceps used for the delivery?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FORCEPS.

PG08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Did (PERSON) receive an epidural or a 'spinal' for pain?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF EPIDURAL/SPINAL.

LOOP_01
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

BABY #1
BABY #2
BABY #3
BABY #4
BABY #5

ASK PG09-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT EACH BABY BORN AS A RESULT OF THE PREGNANCY BEING ASKED ABOUT. THE NUMBER OF LOOP CYCLES IS DETERMINED BY THE RESPONSE TO PG04. LOOP_01 CYCLES THE NUMBER OF TIMES AS THE NUMBER CODED IN PG04. IF PG04 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), TREAT AS A '1' RESPONSE TO PG04; THAT IS, CYCLE THROUGH LOOP_01 ONCE.
----------------------------------------------------

PG09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
[BABY #[n]]
How much did the (first/next) baby weigh at birth?
POUNDS AND OUNCES ...................... 1 [PG09OV1]
GRAMS .................................. 2 [PG09OV3]
REF ................................... -7 [PG10]
DK .................................... -8 [PG10]
[Code One]
----------------------------------------------------
DISPLAY 'BABY #[n]' IF PG04 IS NOT CODED '1', '-7' (REFUSED), OR '-8' (DON'T KNOW).
DISPLAY THE NUMBER OF THE CURRENT LOOP CYCLE (FOR LOOP_01) FOR 'n'.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 2-15 FOR POUNDS; 0-15 FOR OUNCES; 500-6800 FOR GRAMS.
----------------------------------------------------

PG09OV1
=======

ENTER POUNDS:
[Enter Pounds] .........................
REF ................................... -7 [PG10]
DK .................................... -8 [PG10]

PG09OV2
=======

PROBE FOR OUNCES IF NOT REPORTED.
ENTER OUNCES:
[Enter Ounces] .........................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF THE RESPONSE TO PG09OV1 IS '5' FOR THE NUMBER OF POUNDS AND PG09OV2 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO PG10
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

PG09OV3
=======

ENTER GRAMS:
[Enter Grams] .......................... [END_LP01]
REF ................................... -7
DK .................................... -8

PG10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
[BABY #[n]]
Did the (first/next) baby weigh less than five and a half pounds (2500 grams), five and a half to nine pounds (2500 to 4100 grams), or more than 9 pounds (4100 grams)?
LESS THAN 5-1/2 POUNDS/2500 GRAMS ...... 1
5-1/2 TO 9 POUNDS/2500 TO 4100 GRAMS ... 2
MORE THAN 9 POUNDS/4100 GRAMS .......... 3
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'BABY #[n]' IF PG04 IS NOT CODED '1', '-7' (REFUSED), OR '-8' (DON'T KNOW). DISPLAY THE NUMBER OF THE CURRENT LOOP CYCLE (FOR LOOP_01) FOR 'n'.
----------------------------------------------------
-----------------------------------------------------
EDIT: IF CODED '3' (MORE THAN 9 POUNDS/4100 GRAMS) AND THE RESPONSE TO PG09OV1 IS '5' FOR THE NUMBER OF POUNDS, DISPLAY THE FOLLOWING MESSAGE: 'CODE NOT AVAILABLE. R REPORTED BABY WEIGHED 5 LBS. VERIFY AND RE-ENTER.'
-----------------------------------------------------

END_LP01
========

-----------------------------------------------------
IF NUMBER OF BABIES DELIVERED (PG04) ( NUMBER OF LOOP CYCLES COMPLETED, THEN CYCLE ON NEXT BABY.
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, END LOOP_01 AND GO TO BOX_02
-----------------------------------------------------

PG11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
[How/As of December 31, 1998, how] many weeks or months pregnant [(are/is)/(were/was)] (PERSON)?
[Enter Number of Weeks/Months] .........
REF ................................... -7 [PG12]
DK .................................... -8 [PG12]
----------------------------------------------------
DISPLAY 'How' AND '(are/is)' IF NOT ROUND 5.
DISPLAY 'As of December 31, 1998, how' AND '(were/was)' IF ROUND 5.
----------------------------------------------------

PG11OV
======

ENTER UNIT:
WEEKS .................................. 1 [BOX_02]
MONTHS ................................. 2 [BOX_02]
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
EDIT CHECK: 1-42 FOR WEEKS; 1-10 FOR MONTHS.
----------------------------------------------------

PG12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
[(Are/Is)/As of December 31, 1998, (were/was)] (PERSON) less than 3 months pregnant, 3-6 months pregnant, or more than 6 months pregnant?
LESS THAN 3 MONTHS ..................... 1
3 TO 6 MONTHS .......................... 2
MORE THAN 6 MONTHS ..................... 3
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY 'As of December 31, 1998, (were/was)' IF ROUND 5.
----------------------------------------------------

BOX_02
======

----------------------------------------------------
RETURN TO THE CE SECTION.
----------------------------------------------------


Health Status (HE) Section


BOX_01
=======

----------------------------------------------------
NOTE: THIS SECTION IS ASKED FOR ALL CURRENT RU MEMBERS AND INSTITUTIONALIZED PERSONS. DO NOT ASK THIS SECTION FOR DECEASED PERSONS.
----------------------------------------------------
----------------------------------------------------
NOTE: QUESTIONS HE01 THROUGH HE06 ARE ASKED EVERY ROUND.
----------------------------------------------------
----------------------------------------------------
NOTE: THROUGHOUT THE HEALTH STATUS (HE) SECTION, AGE CATEGORIES ARE REFERENCED WHEN A TRUE AGE WAS NOT OBTAINED. THE AGES FOR THESE AGE CATEGORIES ARE AS FOLLOWS:
1 = LESS THAN 1 YEAR OLD
2 = 1-4
3 = 5-15
4 = 16-23
5 = 24-34
6 = 35-44
7 = 45-54
8 = 55-64
9 = 65 YEARS OLD OR OLDER
----------------------------------------------------

HE01
====

[STR-DT] [END-DT]
The next few questions are about difficulties people may have with everyday activities such as getting around, bathing or taking medications. We are interested in difficulties due to an impairment or a physical or mental health problem.
[Also, please keep in mind that we are only interested in difficulties family members may have had between (START DATE) and (END DATE).]
Does anyone in the family receive help or supervision using the telephone, paying bills, taking medications, preparing light meals, doing laundry, or going shopping?
YES .................................... 1
NO ..................................... 2 [HE04]
REF ................................... -7 [HE04]
DK .................................... -8 [HE04]
PRESS F1 FOR DEFINITION OF IMPAIRMENT AND HELP/SUPERVISION.
----------------------------------------------------
DISPLAY 'Also, please keep in mind that we are only interested in difficulties family members may have had between (START DATE)and (END DATE).' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVES HELP' AT HE02 BY CAPI AND GO TO HE04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE02
----------------------------------------------------

HE02
====

[STR-DT] [END-DT]
HELP OR SUPERVISION USING THE TELEPHONE, PAYING BILLS, TAKING MEDICATIONS, PREPARING LIGHT MEALS, DOING LAUNDRY, OR GOING SHOPPING.
Who is that?
PROBE: Does anyone else receive help or supervision doing these types of activities?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU- MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 13 YEARS OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: IADL SECTION.
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE03 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 DETERMINES IF PERSONS ( 13 YEARS OF AGE RECEIVE HELP OR SUPERVISION WITH INSTRUMENTAL ACTIVITIES OF DAILY LIVING BECAUSE OF AN IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP WITH INSTRUMENTAL ACTIVITIES OF DAILY LIVING (I.E., PERSON SELECTED AT HE02)
- PERSON ( 13 YEARS OF AGE OR IN AGE CATEGORY 1-3
----------------------------------------------------

HE03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
(Do/Does) (PERSON) receive help or supervision using the telephone, paying bills, taking medications, preparing light meals, doing laundry or going shopping because of an impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION AND IMPAIRMENT.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: IADL SECTION.
----------------------------------------------------

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH HE04
----------------------------------------------------

HE04
====

[STR-DT] [END-DT]
Does anyone in the family receive help or supervision with personal care such as bathing, dressing, or getting around the house?
YES .................................... 1
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION.
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVES HELP' AT HE05 BY CAPI AND GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HE05
----------------------------------------------------

HE05
====

[STR-DT] [END-DT]
HELP OR SUPERVISION WITH PERSONAL CARE SUCH AS BATHING, DRESSING OR GETTING AROUND THE HOUSE.
Who is that?
PROBE: Does anyone else receive help or supervision with personal care?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE RU-MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 13 YEARS OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: ADL SECTION.
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE06 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 DETERMINES IF PERSONS ( 13 YEARS OF AGE RECEIVE HELP OR SUPERVISION WITH PERSONAL CARE (I.E., ACTIVITIES OF DAILY LIVING) BECAUSE OF AN IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP OR SUPERVISION WITH PERSONAL CARE (I.E., ACTIVITIES OF DAILY LIVING, THAT IS, THE PERSON IS SELECTED AT HE05)
- PERSON (13 YEARS OF AGE OR IN AGE CATEGORIES 1-3
----------------------------------------------------

HE06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
(Do/Does) (PERSON) receive help or supervision with personal care such as bathing, dressing or getting around the house because of an impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION AND IMPAIRMENT.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: ADL SECTION.
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF ROUND 1 OR ROUND 3 OR ROUND 5, CONTINUE WITH HE07
----------------------------------------------------
----------------------------------------------------
IF ROUND 2 OR ROUND 4, GO TO HE26
----------------------------------------------------

HE07
====

[STR-DT] [END-DT]
Does anyone in the family use any aids such as a walker, grab bars in the bathtub or any other special equipment for personal care or everyday activities?
YES .................................... 1
NO ..................................... 2 [HE09]
REF ................................... -7 [HE09]
DK .................................... -8 [HE09]
PRESS F1 FOR EXAMPLES OF AIDS/SPECIAL EQUIPMENT.
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'USES AIDS' AT HE08 BY CAPI AND GO TO HE09
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE08
----------------------------------------------------

HE08
====

[STR-DT] [END-DT]
USE ANY AIDS SUCH AS A WALKER, GRAB BARS IN THE BATHTUB OR ANY OTHER SPECIAL EQUIPMENT FOR PERSONAL CARE OR EVERYDAY ACTIVITIES.
Who is that?
PROBE: Does anyone else use any aids for personal care or everyday activities?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU- MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS FOR THE LTC SUPPLEMENT:
AIDS/SPECIAL EQUIPMENT SECTION.
----------------------------------------------------

HE09
====

[STR-DT] [END-DT]
Does anyone in the family have difficulties walking, climbing stairs, grasping objects, reaching overhead, lifting, bending or stooping, or standing for long periods of time?
YES .................................... 1
NO ..................................... 2 [HE19]
REF ................................... -7 [HE19]
DK .................................... -8 [HE19]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'HAVING DIFFICULTY' AT HE10 BY CAPI AND GO TO LOOP_03
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE10
----------------------------------------------------

HE10
====

[STR-DT] [END-DT]
DIFFICULTIES WALKING, CLIMBING STAIRS, GRASPING OBJECTS, REACHING OVERHEAD, LIFTING, BENDING OR STOOPING, OR STANDING FOR LONG PERIODS OF TIME.
Who is that?
PROBE: Does anyone else have difficulties doing these types of activities?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU- MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 13 YEARS OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: FUNCTIONAL LIMITATIONS SECTION.
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE11 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS INFORMATION ON THE LEVEL OF FUNCTIONAL LIMITATION WITH VARIOUS PHYSICAL ACTIVITIES FOR PERSONS = OR ) 13 YEARS OF AGE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS FUNCTIONAL LIMITATIONS (I.E., PERSON SELECTED AT HE10)
- PERSON = OR ) 13 YEARS OF AGE OR IN AGE CATEGORIES 4-9
----------------------------------------------------

BOX_03
======

OMITTED.

HE11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-1.
[For these next questions, I would like you to think about the time when (PERSON) entered the institution and what (PERSON) was able to do at that time.]
Please look at this card and tell me how much difficulty (do/does) (PERSON) have lifting something as heavy as 10 pounds, such as a full bag of groceries? Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1
SOME DIFFICULTY ........................ 2
A LOT OF DIFFICULTY .................... 3
COMPLETELY UNABLE TO DO IT ............. 4
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'For these next questions, I would like you to think about the time when (PERSON) entered the institution and what (PERSON) was able to do at that time.]' IF PERSON BEING ASKED ABOUT CODED AS BEING INSTITUTIONALIZED AT END DATE. IF PERSON BEING ASKED ABOUT IS A CURRENT RU MEMBER LIVING IN THE RU, USE A NULL DISPLAY.
----------------------------------------------------

HE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have walking up 10 steps without resting?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

IF RESPONDENT VOLUNTEERS THAT PERSON IS COMPLETELY UNABLE TO WALK, CODE 5.
NO DIFFICULTY .......................... 1
SOME DIFFICULTY ........................ 2
A LOT OF DIFFICULTY .................... 3
COMPLETELY UNABLE TO DO IT ............. 4
COMPLETELY UNABLE TO WALK .............. 5
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
IF CODED '5' (COMPLETELY UNABLE TO WALK), AUTOMATICALLY CODE HE13, HE14, HE15, AND HE16 AS '4' (COMPLETELY UNABLE TO DO IT) BY CAPI, AND GO TO HE17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HE13
----------------------------------------------------

HE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have walking about 3 city blocks or about a quarter of a mile?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1
SOME DIFFICULTY ........................ 2
A LOT OF DIFFICULTY .................... 3
COMPLETELY UNABLE TO DO IT ............. 4
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
IF CODED '4' (COMPLETELY UNABLE TO DO IT), AUTOMATICALLY CODE HE14 AS '4' (COMPLETELY UNABLE TO DO IT) BY CAPI, AND GO TO HE15
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HE14
----------------------------------------------------

HE14
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have walking a mile?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1
SOME DIFFICULTY ........................ 2
A LOT OF DIFFICULTY .................... 3
COMPLETELY UNABLE TO DO IT ............. 4
REF ................................... -7
DK .................................... -8
[Code One]

HE15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have standing for about 20 minutes?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1
SOME DIFFICULTY ........................ 2
A LOT OF DIFFICULTY .................... 3
COMPLETELY UNABLE TO DO IT ............. 4
REF ................................... -7
DK .................................... -8
[Code One]

HE16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have bending down or stooping from a standing position to pick up an object from the floor or tie a shoe?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1
SOME DIFFICULTY ........................ 2
A LOT OF DIFFICULTY .................... 3
COMPLETELY UNABLE TO DO IT ............. 4
REF ................................... -7
DK .................................... -8
[Code One]

HE17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have reaching up overhead, for example to remove something from a shelf?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1
SOME DIFFICULTY ........................ 2
A LOT OF DIFFICULTY .................... 3
COMPLETELY UNABLE TO DO IT ............. 4
REF ................................... -7
DK .................................... -8
[Code One]

HE18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-1.
How much difficulty (do/does) (PERSON) have using fingers to grasp or handle something such as picking up a glass from a table or using a pencil to write?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?
NO DIFFICULTY .......................... 1
SOME DIFFICULTY ........................ 2
A LOT OF DIFFICULTY .................... 3
COMPLETELY UNABLE TO DO IT ............. 4
REF ................................... -7
DK .................................... -8
[Code One]

END_LP03
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_03 AND CONTINUE WITH HE19
----------------------------------------------------

HE19
====

[STR-DT] [END-DT]
Is anyone in the family limited in any way in the ability to work at a job, do housework, or go to school because of an impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2 [HE22]
REF ................................... -7 [HE22]
DK .................................... -8 [HE22]
PRESS F1 FOR DEFINITION OF LIMITED ABILITY AND IMPAIRMENT.
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'LIMITED ABILITY' AT HE20 BY CAPI AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE20
----------------------------------------------------

HE20
====

[STR-DT] [END-DT]
LIMITED ABILITY TO WORK AT A JOB, DO HOUSEWORK OR GO TO SCHOOL BECAUSE OF AN IMPAIRMENT OR A PHYSICAL OR MENTAL HEALTH PROBLEM.
Who is that?
PROBE: Is anyone else limited in the ability to work at a job, do housework, or go to school because of an impairment or a physical or mental health problem?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU- MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 5 YEARS OLD OR IN AGE CATEGORIES 3-9 FOR THE LTC SUPPLEMENT: WORK-HOUSEWORK-SCHOOL LIMITATIONS SECTION.
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE20A - END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS INFORMATION ON WORK/HOUSEWORK/SCHOOL LIMITATIONS BECAUSE OF AN IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM FOR PERSONS = OR ) 5 YEARS OF AGE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS LIMITED IN ABILITY TO WORK AT A JOB, DO HOUSEWORK, OR GO TO SCHOOL (I.E., PERSON SELECTED AT HE20)
- PERSON = OR ) 5 YEARS OF AGE OR IN AGE CATEGORIES 3-9
----------------------------------------------------

BOX_04
======

OMITTED.

HE20A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Which activities is (PERSON) limited in doing because of an impairment or a physical or mental health problem - working at a job, doing housework, or going to school?
CODE ALL THAT APPLY.
WORKING AT A JOB ...................... 1
DOING HOUSEWORK ....................... 2
GOING TO SCHOOL ....................... 3
REF ................................... -7
DK .................................... -8
[Code All That Apply]

HE21
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT][END-DT]
[At the time (PERSON) entered the institution, was/(Are/Is)] (PERSON) completely unable to [work at a job][,/ and] [ do housework][ and][ go to school]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'At the time (PERSON) entered the institution, was'. IF PERSON BEING ASKED ABOUT CODED AS BEING INSTITUTIONALIZED AT END DATE.
DISPLAY '(Are/Is)' IF PERSON BEING ASKED ABOUT IS A CURRENT RU MEMBER LIVING IN THE RU.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'work at a job' IF HE20A IS CODED '1' (WORKING AT A JOB), EITHER ALONE OR IN COMBINATION WITH OTHER CODES OR IF HE20A IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW). IF HE20A IS NOT CODED '1', '-7', OR '-8', USE A NULL DISPLAY.

DISPLAY ',' IF HE20A IS CODED '1', '2', AND '3' OR IF HE20A IS CODED EITHER '-7' OR '-8'.
DISPLAY ' and' IF HE20A IS CODED '1' AND EITHER '2' OR '3'. OTHERWISE, USE A NULL DISPLAY.

DISPLAY ' do housework' IF HE20A IS CODED '2' (DOING HOUSEWORK), EITHER ALONE OR IN COMBINATION WITH OTHER CODES OR IF HE20A IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW). IF HE20A IS NOT CODED '2', '-7', OR '-8', USE A NULL DISPLAY.

DISPLAY ' and' IF ONLY CODES '2' AND '3' ARE SELECTED AT HE20A OR IF CODES '1', '2', AND '3' ARE ALL SELECTED AT HE20A OR IF CODED EITHER '-7' OR '-8' AT HE20A. OTHERWISE, USE A NULL DISPLAY.

DISPLAY ' go to school' IF HE20A IS CODED '3' (GOING TO SCHOOL), EITHER ALONE OR IN COMBINATION WITH OTHER CODES OR IF HE20A IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW). IF HE20A IS NOT CODED '3', '-7', OR '-8', USE A NULL DISPLAY.
----------------------------------------------------

END_LP04
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_04 AND CONTINUE WITH HE22
----------------------------------------------------

HE22
====

[STR-DT] [END-DT]
Besides the limitations we just talked about, is anyone in the family limited in participating in social, recreational or family activities because of an impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2 [HE24]
REF ................................... -7 [HE24]
DK .................................... -8 [HE24]
PRESS F1 FOR DEFINITION OF LIMITED IN PARTICIPATING.
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'LIMITED IN PARTICIPATION' AT HE23 BY CAPI AND GO TO HE24
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE23
----------------------------------------------------

HE23
====

[STR-DT] [END-DT]
LIMITED IN PARTICIPATION IN SOCIAL, RECREATIONAL OR FAMILY ACTIVITIES BECAUSE OF AN IMPAIRMENT OR A PHYSICAL OR MENTAL HEALTH PROBLEM.
Who is that?
PROBE: Is anyone else limited in participation in activities because of an impairment or a physical or mental health problem?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU- MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 5 YEARS OLD OR IN AGE CATEGORIES 3-9 FOR THE LTC SUPPLEMENT: SOCIAL LIMITATIONS SECTION.
----------------------------------------------------

HE24
====

[STR-DT] [END-DT]
Do any of the adults in the family...
(1= YES, 2= NO)
YES NO REF DK

HE24_01
=======

Experience confusion or memory loss such that it interferes with daily activities? 1 2 -7 -8

HE24_02
=======

Have problems making decisions to the point that it interferes with daily activities? 1 2 -7 -8

HE24_03
=======

Require supervision for their own safety? 1 2 -7 -8
----------------------------------------------------
IF HE24_01, HE24_02, OR HE24_03 IS CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE AS 'EXPERIENCES CONFUSION' AT HE25 BY CAPI AND GO TO BOX_05
----------------------------------------------------
----------------------------------------------------
IF HE24_01, HE24_02, AND HE24_03 ARE ALL CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HE25
----------------------------------------------------

HE25
====

[STR-DT] [END-DT]
[EXPERIENCE CONFUSION OR MEMORY LOSS SUCH THAT IT INTERFERES WITH DAILY ACTIVITIES][[/]HAVE PROBLEMS MAKING DECISIONS TO THE POINT THAT IT INTERFERES WITH DAILY ACTIVITIES][[/]REQUIRE SUPERVISION FOR THEIR OWN SAFETY]
Who is that?
PROBE: Does anyone else [experience confusion or memory loss such that it interferes with daily activities] [[or ]have problems making decisions to the point that it interferes with daily activities] [[or ]require supervision for their own safety]?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS
IN THE RU-MEMBERS-ROSTER, EXCLUDING DECEASED RU
MEMBERS
----------------------------------------------------
----------------------------------------------------
DISPLAY 'EXPERIENCE CONFUSION OR MEMORY LOSS SUCH THAT IT INTERFERES WITH DAILY ACTIVITIES' IF HE24_01 CODED '1' (YES).

DISPLAY '[/]HAVE PROBLEMS MAKING DECISIONS TO THE POINT THAT IT INTERFERES WITH DAILY ACTIVITIES' IF HE24_02 CODED '1' (YES). DISPLAY THE '/' ONLY IF HE24_01 IS ALSO CODED '1' (YES).

DISPLAY '[/]REQUIRE SUPERVISION FOR THEIR OWN SAFETY' IF HE24_03 IS CODED '1' (YES). DISPLAY THE '/' ONLY IF HE24_01 AND/OR HE24_02 ARE ALSO CODED '1' (YES).

DISPLAY 'experience confusion or memory loss such that it interferes with daily activities' IF HE24_01 CODED '1' (YES).

DISPLAY '[or ]have problems making decisions to the point that it interferes with daily activities' IF HE24_02 CODED '1' (YES). DISPLAY THE 'or ' ONLY IF HE24_01 IS ALSO CODED '1' (YES).

DISPLAY '[or ]require supervision for their own safety' IF HE24_03 IS CODED '1' (YES). DISPLAY 'or ' ONLY IF HE24_01 AND/OR HE24_02 ARE ALSO CODED '1' (YES).
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 18 YEARS OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: COGNITIVE LIMITATIONS SECTION.
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF ROUND 1 OR 3, GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
IF ROUND 5, CONTINUE WITH BOX_05A
----------------------------------------------------

BOX_05A
=======

----------------------------------------------------
IF ANY CURRENT RU MEMBERS (NOT DECEASED OR INSTITUTIONALIZED) ( OR = 15 YEARS OF AGE OR IN AGE CATEGORIES 1 - 3, CONTINUE WITH HE25A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------

HE25A
=====

JAN 01 98 DEC 31 98
Parents use different types of child care for their children while they are working, such as a day care center or care provided by a relative.
During 1998, did any of the children living here, who are 15 years of age or younger, require child care arrangements, other than school attendance, because the child's parents were working?
YES .................................... 1
NO ..................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]

HE25B
=====

JAN 01 98 DEC 31 98
During 1998, was this child usually cared for by a relative or by a non-relative?
IF NECESSARY SAY, Please consider only the care provided to the youngest child.
RELATIVE ............................... 1 [BOX_10]
NON-RELATIVE ........................... 2
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
[Code One]

HE25C
=====

JAN 01 98 DEC 31 98
Where was this care usually provided?
IF NECESSARY SAY, Please consider only the care provided to the youngest child.
CHILD'S HOME ........................... 1 [BOX_10]
OTHER PRIVATE HOME ..................... 2 [BOX_10]
NURSERY, PRESCHOOL ..................... 3 [BOX_10]
ORGANIZED (BEFORE/AFTER) SCHOOL ACTIVITIES .......................... 4 [BOX_10]
DAY CARE CENTER, NOT AT PARENT'S WORKPLACE ........................... 5 [BOX_10]
DAY CARE CENTER, AT PARENT'S WORKPLACE . 6 [BOX_10]
PARENT WATCHES CHILD AT WORK ........... 7 [BOX_10]
SOME OTHER ARRANGEMENT ................ 91 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
[Code One]

HE26
====

[STR-DT] [END-DT]
Does anyone in the family wear eyeglasses or contact lenses?
YES ................................... 1
NO .................................... 2 [HE28]
REF ................................... -7 [HE28]
DK .................................... -8 [HE28]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AT HE27 BY CAPI AND GO TO HE28
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE27
----------------------------------------------------

HE27
====

[STR-DT] [END-DT]
Who is that?
PROBE: Does anyone else wear eyeglasses or contact lenses?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU- MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

HE28
====

[STR-DT] [END-DT]
Does anyone in the family have any difficulty seeing[ [with glasses or contacts, if they use them]]?
YES ................................... 1
NO .................................... 2 [HE33]
REF ................................... -7 [HE33]
DK .................................... -8 [HE33]
----------------------------------------------------
DISPLAY '[with glasses or contacts, if they use them]' IF HE26 IS CODED '1' (YES). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'VISION IMPAIRED' AT HE29 BY CAPI AND GO TO LOOP_05
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE29
----------------------------------------------------

HE29
====

[STR-DT] [END-DT]
DIFFICULTY SEEING [[WITH GLASSES OR CONTACTS, IF THEY USE THEM]].
Who is that?
PROBE: Does anyone else have any difficulty seeing[ [with glasses or contacts, if they use them]]?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU- MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
DISPLAY '[WITH GLASSES OR CONTACTS, IF THEY USE THEM]' IF HE26 IS CODED '1' (YES). OTHERWISE, USE A NULL DISPLAY. Display '[with glasses or contacts, if they use them]' IF HE26 IS CODED '1' (YES). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE30 - END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS VISION IMPAIRMENT DETAILS FOR PERSONS HAVING DIFFICULTY SEEING. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY SEEING (I.E., PERSON SELECTED AT HE29)
----------------------------------------------------

HE30
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Can (PERSON) not see anything at all, that is, (are/is) (PERSON) blind?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF BLIND.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: VISION SECTION AND GO TO END_LP05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HE31
----------------------------------------------------

HE31
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[With glasses or contacts, can/Can] (PERSON) see well enough to read ordinary newspaper print, even if (PERSON) cannot read?
YES ................................... 1 [END_LP05)
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'With glasses or contacts, can' IF PERSON BEING ASKED ABOUT WAS SELECTED AT HE27, OTHERWISE (PERSON NOT SELECTED AT HE27), DISPLAY 'Can'.
----------------------------------------------------

HE32
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[With glasses or contacts, can/Can] (PERSON) see well enough to recognize familiar people if they are two or three feet away?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'With glasses or contacts, can' IF PERSON BEING ASKED ABOUT WAS SELECTED AT HE27, OTHERWISE (PERSON NOT SELECTED AT HE27), DISPLAY 'Can'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), FLAG PERSON FOR THE LTC SUPPLEMENT: VISION SECTION.
----------------------------------------------------

END_LP05
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_05 AND CONTINUE WITH HE33
----------------------------------------------------

HE33
====

[STR-DT] [END-DT]
Does anyone in the family wear a hearing aid?
YES ................................... 1
NO .................................... 2 [HE35]
REF ................................... -7 [HE35]
DK .................................... -8 [HE35]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AT HE34 BY CAPI AND GOTO HE35
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE34
----------------------------------------------------

HE34
====

[STR-DT] [END-DT]
Who is that?
PROBE: Does anyone else wear a hearing aid?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU- MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED PERSONS FOR THE LTC SUPPLEMENT:
HEARING SECTION.
----------------------------------------------------

HE35
====

[STR-DT] [END-DT]
Does anyone in the family have any difficulty hearing[ [with a hearing aid, if they use one]]?
YES ................................... 1
NO .................................... 2 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
----------------------------------------------------
DISPLAY '[with a hearing aid, if they use one]' IF HE33 IS CODED '1' (YES). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'HEARING IMPAIRED' AT HE36 BY CAPI AND GO TO LOOP_06
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE36
----------------------------------------------------

HE36
====

[STR-DT] [END-DT]
DIFFICULTY HEARING [[WITH A HEARING AID, IF THEY USE ONE]].
Who is that?
PROBE: Does anyone else have any difficulty hearing[ [with a hearing aid, if they use one]]?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU- MEMBERS-ROSTER, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
DISPLAY '[WITH A HEARING AID, IF THEY USE ONE]' IF HE33 IS CODED '1' (YES). OTHERWISE USE A NULL DISPLAY. DISPLAY '[with a hearing aid, if they use one]' IF HE33 IS CODED '1' (YES). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

LOOP_06
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE37 - END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS HEARING IMPAIRMENT DETAILS FOR PERSONS HAVING DIFFICULTY HEARING. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY HEARING (I.E., PERSON SELECTED AT HE36)
----------------------------------------------------

HE37
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Can (PERSON) not hear any speech at all, that is, (are/is) (PERSON) deaf?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF DEAF.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: HEARING SECTION AND GO TO END_LP06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HE38
----------------------------------------------------

HE38
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[With a hearing aid, can/Can] (PERSON) hear most of the things people say?
YES ................................... 1 [END_LP06]
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'With a hearing aid, can' IF PERSON BEING ASKED ABOUT WAS SELECTED AT HE34. OTHERWISE (PERSON NOT SELECTED AT HE34), DISPLAY 'Can'.
----------------------------------------------------

HE39
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[With a hearing aid, can/Can] (PERSON) hear some of the things people say?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'With a hearing aid, can' IF PERSON BEING ASKED ABOUT WAS SELECTED AT HE34. OTHERWISE (PERSON NOT SELECTED AT HE34), DISPLAY 'Can'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), FLAG PERSON FOR THE LTC SUPPLEMENT: HEARING SECTION.
----------------------------------------------------

END_LP06
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH BOX_06
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF ANY RU MEMBERS ( OR = 4 YEARS OF AGE OR IN AGE CATEGORIES 1 OR 2, CONTINUE WITH HE40
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

HE40
====

[STR-DT] [END-DT]
The following questions are about some aspects of children's health. We will begin with some questions for children who are 4 years old or younger.
(Is/Are) (READ NAMES FROM BELOW) limited in any way in any activities, including play activities, because of an impairment or a physical or mental health problem?

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
YES ................................... 1
NO .................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
PRESS F1 FOR DEFINITION OF LIMITED ACTIVITIES AND IMPAIRMENT.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER WHO ARE ( OR = 4 YEARS OF AGE OR IN AGE CATEGORIES 1 OR 2, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND ONLY 1 RU MEMBER ( OR = 4 YEARS OF AGE OR IN AGE CATEGORIES 1 OR 2, AUTOMATICALLY CODE PERSON AS '( = 4 AND LIMITED ACTIVITIES' AT HE41 BY CAPI. ALSO FLAG THAT PERSON FOR THE LTC SUPPLEMENT: CHILD ( = 4 LIMITED ACTIVITIES, AND GO TO LOOP_07
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MORE THAN 1 RU MEMBER ( OR = 4 YEARS OF AGE OR IN AGE CATEGORIES 1 OR 2, CONTINUE WITH HE41
----------------------------------------------------

HE41
====

[STR-DT] [END-DT]
LIMITED IN ACTIVITIES BECAUSE OF AN IMPAIRMENT OR A PHYSICAL OR MENTAL HEALTH PROBLEM.
Who is that?
PROBE: Is any other child, age 4 years or younger, limited in any activities because of an impairment or a physical or mental health problem?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS IN THE RU-MEMBERS-ROSTER WHO ARE ( OR = 4 YEARS OF AGE OR IN AGE CATEGORIES 1 OR 2, EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
FLAG SELECTED PERSONS FOR THE LTC SUPPLEMENT:
CHILD ( = 4 LIMITED ACTIVITIES.
----------------------------------------------------

LOOP_07
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE42 - END_LP07
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07 COLLECTS INFORMATION ON PLAY ACTIVITY LIMITATIONS BECAUSE OF AN IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM FOR PERSONS ( OR = 4 YEARS OF AGE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS LIMITED IN PLAY ACTIVITIES (I.E., PERSON SELECTED AT HE41)
- PERSON ( OR = 4 YEARS OF AGE OR IN AGE CATEGORIES 1-2
----------------------------------------------------

HE42
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Is (PERSON) limited in the kind or amount of play activities (PERSON) can do because of any impairment or physical or mental health problem?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF LIMITED ACTIVITIES AND IMPAIRMENT.

HE43
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Does (PERSON)'s impairment or physical or mental health problem keep (PERSON) from being able to take any part in the usual kind of play activities done by most children of this age?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF IMPAIRMENT AND LIMITED ACTIVITIES.
----------------------------------------------------
IF HE42 OR IF HE43 IS CODED '1' (YES), CONTINUE WITH HE44
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP07
----------------------------------------------------

HE44
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Does (PERSON) participate in any special program or receive any early intervention services aimed at improving (PERSON)'s ability to participate in play activities?
YES, SPECIAL PROGRAM .................. 1 [END_LP07]
YES, EARLY INTERVENTION SERVICES ...... 2 [END_LP07]
YES, BOTH ............................. 3 [END_LP07]
NO .................................... 4 [END_LP07]
OTHER ................................. 91
REF ................................... -7 [END_LP07]
DK .................................... -8 [END_LP07]
PRESS F1 FOR DEFINITION OF INTERVENTION SERVICES AND IMPROVING ABILITIES.
[Code One]

HE44OV
======

ENTER OTHER:
[Enter Other Specify] .................
REF ................................... -7
DK .................................... -8

END_LP07
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_07 AND CONTINUE WITH BOX_07
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF ANY RU MEMBERS ( OR = 6 YEARS OF AGE OR IN AGE CATEGORIES 1-3, CONTINUE WITH LOOP_08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

LOOP_08
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE45 - END_LP08
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_08 COLLECTS INFORMATION ON IMMUNIZATIONS FOR PERSONS ( OR = 6 YEARS OF AGE.
THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON ( OR = 6 YEARS OF AGE OR IN AGE CATEGORIES 1-3
----------------------------------------------------

HE45
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[The following questions are about some aspects of children's health.]
Has (PERSON) ever been immunized for certain diseases, that is, received any shots or drops to prevent the following diseases:
Diphtheria, whooping cough and tetanus [DPT or DTP shots]?
YES ................................... 1
NO .................................... 2 [HE47]
REF ................................... -7 [HE47]
DK .................................... -8 [HE47]
----------------------------------------------------
DISPLAY 'The following questions are about some aspects of children's health.' IF HE40 WAS NOT ASKED. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

HE46
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Was this once or several times?
PROBE: Was (PERSON) immunized for diphtheria, whooping cough and tetanus [DPT or DTP] once or several times?
ONCE ................................. 1
SEVERAL TIMES ........................ 2
REF .................................. -7
DK ................................... -8
[Code One]

HE47
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Polio [drops by mouth]?
PROBE: Has (PERSON) ever been immunized for polio, that is, received any shots or drops to prevent this disease?
YES ...................................... 1
NO ....................................... 2 [HE49]
REF ...................................... -7 [HE49]
DK ....................................... -8 [HE49]

HE48
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Was this once or several times?
PROBE: Was (PERSON) immunized for polio once or several times?
ONCE ..................................... 1
SEVERAL TIMES ............................ 2
REF ...................................... -7
DK ....................................... -8
[Code One]

HE49
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Measles or MMR [Measles, Mumps, Rubella or German Measles]?
PROBE: Has (PERSON) ever been immunized for measles or MMR [Measles, Mumps, Rubella or German Measles], that is, received any shots or drops to prevent these diseases?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8

HE49A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Hepatitis B?
PROBE: Has (PERSON) ever been immunized for hepatitis B, that is, received any shots or drops to prevent this disease?
YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8

END_LP08
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_08 AND CONTINUE WITH BOX_08
----------------------------------------------------

BOX_08
======

----------------------------------------------------
IF ANY RU MEMBERS AGED 5 - 17 YEARS, INCLUSIVE, OR IN AGE CATEGORY 3, CONTINUE WITH LOOP_09
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

LOOP_09
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE50 - END_LP09
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_09 COLLECTS INFORMATION ON ACTIVITIES, LIMITATIONS, AND SPECIAL PROGRAMS FOR PERSONS 5-17 YEARS OF AGE, INCLUSIVE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS AGED 5-17 YEARS, INCLUSIVE, OR IN AGE CATEGORY 3
----------------------------------------------------

HE50
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-2.
[The following questions are about some aspects of children's health.]
In this series of questions, please rate (PERSON) on a scale of 0 to 4 where 0 indicates no problem and 4 indicates a very big problem.
In general, how much of a problem do you think (PERSON) has with:
PROBE: Please rate on a scale of 0 to 4 where 0 indicates no problem and 4 indicates a very big problem, how much of a problem you think (PERSON) has with (ACTIVITY).

CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.

HE50_01. a. Getting along with mother? ( )

HE50_02. b. Getting along with father? ( )

HE50_03. c. Feeling unhappy or sad? ( )

HE50_04. d. (His/Her) behavior at school? ( )

HE50_05. e. Having fun? ( )

HE50_06. f. Getting along with other adults? ( )

HE50_07. g. Feeling nervous or afraid? ( )

HE50_08. h. Getting along with brothers and sisters? ( )

HE50_09. i. Getting along with other kids? ( )

HE50_10. j. Getting involved in activities like sports or hobbies? ( )

HE50_11. k. (His/Her) schoolwork? ( )

HE50_12. l. (His/Her) behavior at home? ( )

HE50_13. m. Staying out of trouble? ( )
----------------------------------------------------
DISPLAY 'The following questions are about some aspects of children's health.' IF HE40 AND HE45 WERE NOT ASKED.
----------------------------------------------------
----------------------------------------------------
ONLY THE VALUES OF 0 AND 4 WILL BE DEFINED IN THE TEXT OF THE QUESTION. HOWEVER, THE VALUES OF ALL THE ANSWER CATEGORIES ARE:

0 = NO PROBLEM
1 = LITTLE PROBLEM
2 = MEDIUM PROBLEM
3 = BIG PROBLEM
4 = VERY BIG PROBLEM
-7 = REF
-8 = DK
99 = INAPPLICABLE
----------------------------------------------------
----------------------------------------------------
NOTE: THIS SCREEN WILL BE SPLIT INTO TWO SCREENS IN CAPI. THE FIRST SCREEN (HE50A) WILL CONTAIN THE FOLLOWING PARTS OF THE QUESTION AS SPECIFIED BELOW:
- THE SHOW CARD LINE
- THE FILL: [The following...]
- THE FIRST TWO BLOCKS TEXT
- THE INTERVIEWER INSTRUCTION: 'CODE 99...'
- HE50_01 (a.) THROUGH HE50_08 (h.) DISPLAYED IN TWO COLUMNS, WITH HE50_01, HE50_02, HE50_03, HE50_04 IN THE FIRST COLUMN AND HE50_05, HE50_06, HE50_07, AND HE50_08 IN THE SECOND COLUMN

THE SECOND SCREEN (HE50B) WILL CONTAIN THE FOLLOWING PARTS OF THE QUESTION AS SPECIFIED BELOW:
- THE SHOW CARD LINE
- THE PROBE
- THE INTERVIEWER INSTRUCTION: 'CODE 99...'
- HE50_09 (i.) THROUGH HE50_13 (m.) DISPLAYED IN TWO COLUMNS, WITH HE50_09 AND HE50_10 IN THE FIRST COLUMN AND HE50_11, HE50_12, AND HE50_13 IN THE SECOND COLUMN
----------------------------------------------------

HE51
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Does (PERSON) have an impairment or a physical or mental health problem which limits (PERSON)'s school attendance or which requires a special school program?
YES ................................... 1
NO .................................... 2 [HE54]
REF ................................... -7 [HE54]
DK .................................... -8 [HE54]
PRESS F1 FOR DEFINITION OF IMPAIRMENT, LIMITED ATTENDANCE, AND SPECIAL SCHOOL PROGRAM.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: SCHOOL ATTENDANCE LIMITED SECTION.
----------------------------------------------------

HE52
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Is (PERSON) enrolled in any type of special education or does (PERSON) receive related services aimed at improving (PERSON)'s ability to participate in school or recreational activities?
YES, ENROLLED IN SPECIAL EDUCATION .... 1 [HE52A]
YES, RELATED SERVICES ................. 2 [HE52B]
YES, BOTH ............................. 3 [HE52A]
NO .................................... 4 [HE53]
OTHER ................................. 91
REF ................................... -7 [HE53]
DK .................................... -8 [HE53]
PRESS F1 FOR DEFINITION OF SPECIAL EDUCATION AND IMPROVING ABILITIES.
[Code One]

HE52OV
======

ENTER OTHER:
[Enter Other Specify] ................. [HE53]
REF ................................... -7 [HE53]
DK .................................... -8 [HE53]

HE52A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Can you please tell me the name of this program or give me a description of what type of program this is?
[Enter Text] ..........................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HE52 IS CODED '3' (YES, BOTH), CONTINUE WITH HE52B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HE53
----------------------------------------------------

HE52B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What are the types of other related services?
CODE ALL THAT APPLY.
SPEECH THERAPY ......................... 1
PSYCHOLOGICAL COUNSELING ............... 2
OCCUPATIONAL THERAPY ................... 3
VOCATIONAL SERVICES .................... 4
TUTORING ............................... 5
READER OR INTERPRETER .................. 6
PHYSICAL THERAPY/MOBILITY TRAINING ..... 7
LIFE SKILLS TRAINING/SELF-HELP TRAINING 8
FAMILY TRAINING/COUNSELING ............. 9
THERAPEUTIC RECREATION ................. 10
OTHER .................................. 91
REF .................................... -7
DK ..................................... -8
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH HE52BOV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HE53
----------------------------------------------------

HE52BOV
=======

ENTER OTHER:
[Enter Other Specify] .................
REF ................................... -7
DK .................................... -8

HE53
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Is (PERSON) limited in attendance or unable to attend school because of (PERSON)'s impairment or physical or mental health problem?
LIMITED IN ATTENDANCE ................. 1
UNABLE TO ATTEND ...................... 2
NEITHER ............................... 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF LIMITED ATTENDANCE AND IMPAIRMENT.

HE54
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Is (PERSON) limited in any way in activities other than school because of an impairment or a physical or mental health problem?
YES ................................... 1
NO .................................... 2 [END_LP09]
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]
PRESS F1 FOR DEFINITION OF LIMITED ACTIVITIES AND IMPAIRMENT.

HE54OV
======
What type of limitation is that?
[Enter Text] ..........................
REF ................................... -7
DK .................................... -8

END_LP09
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_09 AND CONTINUE WITH BOX_09
----------------------------------------------------

BOX_09
======

----------------------------------------------------
IF ANY RU MEMBERS AGED 0 - 17 YEARS, INCLUSIVE, OR IN AGE CATEGORIES 1-3, CONTINUE WITH LOOP_10
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------

LOOP_10
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE55 - END_LP10
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_10 COLLECTS INFORMATION ON THE GENERAL HEALTH STATUS FOR PERSONS 0-17 YEARS OF AGE, INCLUSIVE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS AGED 0-17 YEARS, INCLUSIVE, OR IN AGE CATEGORIES 1-3
----------------------------------------------------

HE55
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HE-3.
[The following are statements that give us an indication of children's general health status.]
Please indicate how true or false the statements are for (PERSON).
PROBE: Is that statement definitely false, mostly false, mostly true, or definitely true.
1 = DEFINITELY FALSE 3 = MOSTLY TRUE
2 = MOSTLY FALSE 4 = DEFINITELY TRUE

HE55_01
=======

(PERSON) seems to resist illness very well. ( )

HE55_02
=======

(PERSON) seems to be less healthy than other children of (PERSON)'s age that I know. ( )

HE55_03
=======

When there is something going around, (PERSON) seems to catch it. ( )
----------------------------------------------------
DISPLAY 'The following....status.' IF FIRST CYCLE THROUGH LOOP_10. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

HE56
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
About how tall is (PERSON) without shoes?
PROBE FOR INCHES IF NOT REPORTED.

HE56_01
=======

ENTER FEET:
[Enter Feet] ..........................
REF ................................... -7 [HE57]
DK .................................... -8 [HE57]
----------------------------------------------------
SOFT RANGE CHECK: 0 TO 7
----------------------------------------------------

HE56_02
=======

ENTER INCHES:
[Enter Inches] ........................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 0-12 (INCLUDING 1/4, 1/2, AND 3/4 UNITS)
----------------------------------------------------
----------------------------------------------------
EDIT: IF FEET (HE56_01) = 0, INCHES (HE56_02) MUST BE 1-30. IF FEET (HE56_01) ) 0, INCHES (HE56_02) MUST BE 0-12.
----------------------------------------------------

HE57
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
About how much does (PERSON) weigh without shoes?
PROBE FOR OUNCES IF NOT REPORTED.

HE57_01
=======

ENTER POUNDS:
[Enter Pounds] ........................
REF ................................... -7 [END_LP10]
DK .................................... -8 [END_LP10]
----------------------------------------------------
SOFT RANGE CHECK: 1 TO 300
----------------------------------------------------

HE57_02
=======

ENTER OUNCES:
[Enter Ounces] ........................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 0-15
----------------------------------------------------
----------------------------------------------------
EDIT: IF POUNDS (HE57_01) = 0, THEN OUNCES MUST BE 1-16.
----------------------------------------------------

END_LP10
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_10 AND CONTINUE WITH BOX_10
----------------------------------------------------

BOX_10
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------


Calendar (CA) Section


BOX_01
======

----------------------------------------------------
IF ROUND 1 OR IF RESPONDENT FOR THIS ROUND IS NOT THE SAME AS THE RESPONDENT FOR THE PREVIOUS ROUND GO TO CA01
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1 AND IF RESPONDENT FOR THIS ROUND IS SAME AS RESPONDENT FOR THE PREVIOUS ROUND, CONTINUE WITH BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF NOT ROUND 1 AND RESPONDENT USED ANY CALENDAR DURING THE PREVIOUS ROUND'S INTERVIEW - CL67_01 CL67_02, CL67_03, OR CL67_05 IS CODED '1' (YES), GO TO CA02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CA01
----------------------------------------------------

CA01
====

We've talked about health conditions for the family. The next set of questions is about health care received [in the last few months/between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]]. Some of these questions ask for information which may be difficult to remember. Because it is important to the U.S. Public Health Service to get complete and accurate information, please take your time in answering these questions.
ASK RESPONDENT TO GET HEALTH EVENTS RECORD (CALENDAR) IF NOT ALREADY OUT.
HAS HEALTH EVENTS RECORD ............... 1 [CA03]
HAS CALENDAR OTHER THAN HEALTH EVENTS RECORD .......................... 2 [CA03]
DOES NOT HAVE CALENDAR ................. 3 [CA04]
WILL NOT USE CALENDAR .................. 4 [CA04]
[Code One]
----------------------------------------------------
DISPLAY 'in the last few months' IF NOT ROUND 5.
DISPLAY 'between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]' IF ROUND 5.

FOR 'START DATE OF REFERENCE PERIOD', DISPLAY THE DATE OF THE ROUND 4 INTERVIEW AS MM/DD/YY. FOR 'END DATE OF REFERENCE PERIOD', DISPLAY THE RU END DATE FOR ROUND 5 AS MM/DD/YY.
----------------------------------------------------

CA02
====

We've talked about health conditions for the family. The next set of questions is about health care received [in the last few months/between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]]. As you may remember from the last interview, some of these questions ask for information which may be difficult to remember.
THANK RESPONDENT FOR USING CALENDAR DURING THE PREVIOUS INTERVIEW.
ASK RESPONDENT TO GET CALENDAR IF NOT ALREADY OUT.
HAS HEALTH EVENTS RECORD ............... 1
HAS CALENDAR OTHER THAN HEALTH EVENTS RECORD .......................... 2
DOES NOT HAVE CALENDAR ................. 3 [CA04]
WILL NOT USE CALENDAR .................. 4 [CA04]
[Code One]
----------------------------------------------------
DISPLAY 'in the last few months' IF NOT ROUND 5.
DISPLAY 'between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]' IF ROUND 5.

FOR 'START DATE OF REFERENCE PERIOD', DISPLAY THE DATE OF THE ROUND 4 INTERVIEW AS MM/DD/YY. FOR 'END DATE OF REFERENCE PERIOD', DISPLAY THE RU END DATE FOR ROUND 5 AS MM/DD/YY.
----------------------------------------------------

CA03
====

CODE WITHOUT ASKING IF RESPONDENT HAS ALREADY ANSWERED.
Has anyone in the family been using the calendar to record all visits to medical providers and medical places, most of the visits, only some of the visits, or has the calendar not been used?
ALL VISITS RECORDED .................... 1 [BOX_03]
MOST VISITS RECORDED ................... 2 [BOX_03]
SOME VISITS RECORDED ................... 3
DID NOT USE ............................ 4
VOLUNTEERED: NO EVENTS TO RECORD ...... 5 [BOX_03]
REF ................................... -7
DK .................................... -8
[Code One]

CA04
====

GIVE RESPONDENT A HEALTH EVENTS RECORD (CALENDAR) IF RESPONDENT DOES NOT HAVE ONE, OR A CALENDAR WORKSHEET IF RESPONDENT WILL NOT USE CALENDAR.
Through the rest of the interview, there are questions that will ask for dates. When you do not remember the date, we can refer to this calendar for help.
CIRCLE [TODAY'S DATE/12/31/98] [AND DATE OF LAST INTERVIEW].
PRESS ENTER TO CONTINUE.
----------------------------------------------------
DISPLAY 'TODAY'S DATE' IF NOT ROUND 5. DISPLAY
'12/31/98' IF ROUND 5.

DISPLAY 'AND DATE OF LAST INTERVIEW' IF NOT
ROUND 1. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF ROUND 1, GO TO BOX_05
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1, CONTINUE WITH BOX_04
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF ANY EVENTS (INCLUDING PRESCRIBED MEDICINES) RECORDED DURING PREVIOUS ROUND, CONTINUE WITH CA05
----------------------------------------------------
----------------------------------------------------
IF NO EVENTS (INCLUDING PRESCRIBED MEDICINES) RECORDED DURING PREVIOUS ROUND, GO TO BOX_05
----------------------------------------------------

CA05
====

If at any point it would help you to look at information from the last interview, I have a computer printed summary of the health care received during that period. This summary includes any hospital stays; visits to medical providers; names of doctors, hospitals, and other providers; and prescribed medicines that were talked about during the last interview. If you need to refer to a past visit, date, or provider name, we can use this summary.
HOLD UP SUMMARY OF HEALTH CARE EVENTS FOR THIS RU.
PRESS ENTER TO CONTINUE.

BOX_05
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------


Provider Probes (PP) Section


BOX_01A
=======

----------------------------------------------------
THE PROVIDER PROBES (PP) SECTION (INCLUDING THE EVENT ROSTER (EV) AND PROVIDER ROSTER (PV) SECTIONS WHICH ARE CALLED IN THE COURSE OF PP) COLLECTS THE INFORMATION REQUIRED TO CREATE AN EVENT. THIS INFORMATION INCLUDES THE EVENT TYPE, PERSON, PROVIDER, AND DATE OR DATE RANGE. ONCE THE EV SECTION IS COMPLETED FOR AN EVENT, THE INTERVIEWER CANNOT BACK UP TO EDIT THAT EVENT OR ANY OTHER EVENTS THAT WERE CREATED PREVIOUSLY. HOWEVER, EVENTS CAN BE EDITED IN THE EVENT DRIVER (ED) SECTION OF THE QUESTIONNAIRE.
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF DISCHARGE DATE CODED '95' (STILL IN HOSPITAL) FOR ANY HOSPITAL STAY (HS) EVENT REPORTED IN PREVIOUS ROUND FOR ANY RU MEMBER, CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_02
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK PP01 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS THE DISCHARGE DATE OF A HOSPITAL STAY FOR ANY PERSON STILL IN THE HOSPITAL AT THE END OF THE PREVIOUS ROUND. THIS LOOP CYCLES ON PERSONS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- PERSON HAD AN HS EVENT DURING THE PREVIOUS ROUND
AND
- ONE OF PERSON'S HS EVENTS HAD A DISCHARGE DATE CODED '95' (STILL IN HOSPITAL).
----------------------------------------------------

PP01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE
PROVIDER......] [ADM-DT]
Last time, we recorded that (PERSON) entered (PROVIDER) on (ADMIT DATE) and was still in the hospital at the time of our interview on [PREV RD INTV DT].
On what date was (PERSON) discharged from (PROVIDER)?

IF STILL IN HOSPITAL [OR RELEASED IN 1999], ENTER 95 IN MONTH FOR DISCHARGE DATE.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
[Display Month,Day,Year-2] - [Enter Month,Day,Year-2] ..
[Display Month,Day,Year-2] - [Enter Month,Day,Year-2] ..
[Display Month,Day,Year-2] - [Enter Month,Day,Year-2] ...
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES PERSON'S-MEDICAL-EVENTS-ROSTER TO DISPLAY ALL HS EVENTS THAT WERE CODED '95' (STILL IN HOSPITAL) DURING THE PREVIOUS ROUND.
----------------------------------------------------
----------------------------------------------------
PERSON'S EVENT ROSTER BEHAVIOR SPECIFICATIONS:

ADMIT DATE IS A PROTECTED FIELD. INTERVIEWER CAN ENTER DISCHARGE DATE ONLY.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE DATE OF THE PREVIOUS ROUND'S INTERVIEW FOR '[PREV RD INTV DT]'.
DISPLAY 'OR RELEASED IN 1999' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
FOR 'Display Month,Day,Year-2', DISPLAY THE ADMIT DATE OF THE HS EVENT WITH A DISCHARGE DATE OF '95' (STILL IN HOSPITAL) FOR THIS PERSON.
----------------------------------------------------

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF DISCHARGE DATE CODED '95' (STILL IN INSTITUTION) FOR ANY INSTITUTIONAL STAY (IC) EVENT REPORTED IN PREVIOUS ROUND FOR ANY RU MEMBER, CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_03
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK PP02 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS THE DISCHARGE DATE OF AN INSTITUTIONAL STAY FOR ANY PERSON STILL IN THE INSTITUTION AT THE END OF THE PREVIOUS ROUND. THIS LOOP CYCLES ON PERSONS THAT MEET THE FOLLOWING CONDITIONS:
- PERSON HAD AT LEAST ONE IC EVENT DURING THE PREVIOUS ROUND
AND
- ONE OF PERSON'S IC EVENTS HAD A DISCHARGE DATE CODED '95' (STILL IN INSTITUTION).
----------------------------------------------------

PP02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE
PROVIDER......] [ADM-DT]
Last time we recorded that (PERSON) entered (PROVIDER) on (ADMIT DATE) and was still there at the time of our interview on [PREV RD INTV DT].
On what date was (PERSON) discharged from (PROVIDER)?

IF STILL IN INSTITUTION [OR RELEASED IN 1999], ENTER 95 IN MONTH FOR DISCHARGE DATE.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
[Display Month,Day,Year-2] - [Enter Month,Day,Year-2] ....
[Display Month,Day,Year-2] - [Enter Month,Day,Year-2] ....
[Display Month,Day,Year-2] - [Enter Month,Day,Year-2] ....
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES PERSON'S-MEDICAL-EVENTS-ROSTER TO DISPLAY ALL IC EVENTS THAT WERE CODED '95' (STILL IN INSTITUTION) DURING THE PREVIOUS ROUND.
----------------------------------------------------
----------------------------------------------------
PERSON'S EVENT ROSTER BEHAVIOR SPECIFICATIONS:

ADMIT DATE IS A PROTECTED FIELD. INTERVIEWER CAN ENTER DISCHARGE DATE ONLY.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE DATE OF THE PREVIOUS ROUND'S INTERVIEW FOR '[PREV RD INTV DT]'.
DISPLAY 'OR RELEASED IN 1999' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
FOR 'Display Month,Day,Year-2', DISPLAY THE ADMIT DATE OF THE IC EVENT WITH A DISCHARGE DATE OF '95' (STILL IN INSTITUTION) FOR THIS PERSON.
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH BOX_03
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF CA03 IS CODED '5' (VOLUNTEERED NO EVENTS TO RECORD), GO TO PP03A
----------------------------------------------------
----------------------------------------------------
IF CA03 IS CODED '3' (SOME VISITS RECORDED), '4' (DID NOT USE), '-7' (REFUSED), '-8' (DON'T KNOW), OR IS NOT ASKED (CALENDAR NEVER USED), GO TO PP14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_03
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_04 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 ASKS THE EVENT ROSTER (EV) SECTION FOR EACH EVENT RECORDED ON THE CALENDAR. THE RESPONSE TO PP03 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP03 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP03 IS CODED '2' (NO) OR '3' (NO EVENTS ON CALENDAR TO RECORD), THE LOOP ENDS.
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF FIRST CYCLE OF LOOP_03, GO TO PP03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_05
----------------------------------------------------

BOX_05
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP03
----------------------------------------------------

PP03
====

INTERVIEWER: ADD (AN/ANOTHER) EVENT?
YES .................................... 1
NO ..................................... 2
[NO EVENTS ON CALENDAR TO RECORD ........ 3]
----------------------------------------------------
DISPLAY CODE 3 (NO EVENTS ON CALENDAR TO RECORD), ONLY IF FIRST CYCLE OF LOOP_03. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

END_LP03
========

----------------------------------------------------
IF PP03 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP03 IS CODED '2' (NO) OR '3' (NO EVENTS ON CALENDAR TO RECORD), END LOOP_03 AND CONTINUE WITH PP03A
----------------------------------------------------

PP03A
=====

[STR-DT]
[END-DT]
As you know, it is important for us to get complete and accurate information of all of the family's health care events. I'd like you to take a few minutes to look at several lists of health care providers, to be sure we haven't missed any visits or calls, including those made just for advice, prescriptions, tests, shots, or x-rays.
PRESS ENTER TO CONTINUE.

PP04
====

[STR-DT]
[END-DT]
SHOW CARD PP-1.
[Since (START DATE)/Between (START DATE) and (END DATE)], has anyone in the family seen or spoken with a medical or mental health professional, dentist, or other health care provider listed on this card [other than what we have already talked about]?
YES .................................... 1
NO ..................................... 2 [PP06]
REF ................................... -7 [PP06]
DK .................................... -8 [PP06]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2 THE PHRASE "[Other than what we have already talked about]" WAS NOT INCLUDED AS PART OF THE QUESTION TEXT
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_06 - END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 COLLECTS ALL DENTAL (DN) AND MEDICAL PROVIDER VISIT (MV) EVENTS NOT ALREADY RECORDED.

THE RESPONSE TO PP05 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP05 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP05 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_06
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP05
----------------------------------------------------

PP05
====

[STR-DT]
[END-DT]
SHOW CARD PP-1.
Has [PERSON'S FIRST MIDDLE AND LAST NAME] had any other visits or calls to health care providers listed on this card? Or has anyone else in the family visited or called a health care provider listed here? [Please include any visits or calls we have not yet talked about.]
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT WAS JUST ADDED FOR '[PERSON'S FIRST MIDDLE AND LAST NAME]'.
----------------------------------------------------
----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2 THE SENTENCE "[Please include any visits or calls we have not yet talked about.]" WAS NOT INCLUDED AS PART OF THE QUESTION TEXT.
----------------------------------------------------

END_LP04
========

----------------------------------------------------
IF PP05 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP05 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_04 AND CONTINUE WITH PP06
----------------------------------------------------

PP06
====

[STR-DT]
[END-DT]
SHOW CARD PP-2.
[Has/Between (START DATE) and (END DATE), has] anyone in the family been a patient in a hospital or been seen in a hospital emergency room or outpatient department? Or has anyone been a patient in any type of long term care facility? [Please include any hospital care we have not yet talked about.]
YES .................................... 1
NO ..................................... 2 [PP08]
REF ................................... -7 [PP08]
DK .................................... -8 [PP08]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Has' IF NOT ROUND 5. DISPLAY 'Between (START DATE) and (END DATE), has' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2 THE SENTENCE "[Please include any hospital care we have not yet talked about.]" WAS NOT INCLUDED AS PART OF THE QUESTION TEXT.
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_07 - END_LP05.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS ALL HOSPITAL BASED AND INSTITUTIONAL STAY EVENTS (I.E., HS, ER, OP, AND IC EVENTS) NOT ALREADY RECORDED.

THE RESPONSE TO PP07 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP07 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_07
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP07
----------------------------------------------------

PP07
====

[STR-DT]
[END-DT]
SHOW CARD PP-2.
Has [PERSON'S FIRST MIDDLE AND LAST NAME] had any other visits to a hospital or long term care facility? Or has anyone else in the family been a patient in or seen at a hospital or long term care facility? [Please include any hospital care we have not yet talked about.]
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT WAS JUST ADDED FOR '[PERSON'S FIRST MIDDLE AND LAST NAME]'.
----------------------------------------------------
----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2 THE SENTENCE "[Please include any hospital care we have not yet talked about.]" WAS NOT INCLUDED AS PART OF THE QUESTION TEXT.
----------------------------------------------------

END_LP05
========

----------------------------------------------------
IF PP07 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP07 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_05 AND CONTINUE WITH PP08
----------------------------------------------------

PP08
====

[STR-DT]
[END-DT]
SHOW CARD PP-3.
What about visits to the home because of a health problem for any of these services [between (START DATE) and (END DATE)]? [Please include any home care services we have not yet talked about.]
YES .................................... 1
NO ..................................... 2 [PP12]
REF ................................... -7 [PP12]
DK .................................... -8 [PP12]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

LOOP_06
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_08 - END_LP06.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS ALL HOME HEALTH (HH) EVENTS NOT ALREADY RECORDED.

THE RESPONSE TO PP09 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP09 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP09 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_08
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP09
----------------------------------------------------

PP09
====

[STR-DT]
[END-DT]
SHOW CARD PP-3.
Because of a health problem, has [PERSON'S FIRST MIDDLE AND LAST NAME] received any other home care services? Or has anyone else in the family received home care services such as those listed on this card? [Please include any home care services we have not yet talked about.]
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT WAS JUST ADDED FOR '[PERSON'S FIRST MIDDLE AND LAST NAME]'.
----------------------------------------------------

END_LP06
========

----------------------------------------------------
IF PP09 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP09 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_06 AND CONTINUE WITH PP12
----------------------------------------------------

PP12
====

[STR-DT]
[END-DT]
SHOW CARD PP-4.
[And finally/Between (START DATE) and (END DATE)], did anyone in the family obtain eyeglasses, contact lenses, or diabetic equipment [since (START DATE)] [other than what we have already talked about]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'And finally' IF NOT ROUND 5. DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.

DISPLAY 'since (START DATE)' IF NOT ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF PP12 IS CODED '1' (YES), CONTINUE WITH LOOP_07
----------------------------------------------------
----------------------------------------------------
IF PP12 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND CURRENT ROUND IS ROUND 3 OR ROUND 5, GO TO PP13A
----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO BOX_10
-----------------------------------------------------

LOOP_07
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_09 - END_LP07.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07 COLLECTS ALL OTHER MEDICAL EXPENSE (OM) EVENTS NOT ALREADY RECORDED.

THE RESPONSE TO PP13 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP13 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP13 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_09
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP13
----------------------------------------------------

PP13
====

[STR-DT]
[END-DT]
SHOW CARD PP-4.
Has anyone else in the family obtained eyeglasses, contact lenses, or diabetic equipment [other than what we have already talked about]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]

END_LP07
========

----------------------------------------------------
IF PP13 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP13 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_07 AND CONTINUE WITH BOX_09A
----------------------------------------------------

BOX_09A
=======

----------------------------------------------------
IF ROUND 3 OR ROUND 5, CONTINUE WITH PP13A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------

PP13A
=====

JAN 01
DEC 31
SHOW CARD PP-4A.
Now I would like you to think about the entire calendar year 1998, that is from January 1, 1998 until December 31, 1998.
Please look at the types of other medical expenses listed on this card. Did anyone in the family obtain any of these types of other medical expenses during the year 1998?
PROBE: These could include ambulance services, canes, wheelchairs, corrective shoes, hearing aids or amplifiers for a telephone, artificial limbs, raised toilet seats, a modification to the house or a car because of some illness or injury, for example ramps or handrails, etc.
YES .................................... 1
NO ..................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
NOTE: IN ROUND 3, QUESTION REFERRED TO '1997', NOT '1998'.
----------------------------------------------------

LOOP_07A
========

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_09B - END_LP07A.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07A COLLECTS ALL OTHER TYPES OF MEDICAL EXPENSE (OM) EVENTS FOR THE YEAR 1997 NOT ALREADY RECORDED.

THE RESPONSE TO PP13B DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP13B IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP13B IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_09B
=======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP13B
----------------------------------------------------

PP13B
=====

JAN 01
DEC 31
SHOW CARD PP-4A.
During the calendar year 1998, has anyone else in the family obtained, purchased, or rented any of the types of other medical expenses listed on this card [other than what we have already talked about]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
NOTE: IN ROUND 3, QUESTION REFERRED TO '1997', NOT '1998'.
----------------------------------------------------

END_LP07A
=========

----------------------------------------------------
IF PP13B IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP13B IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_07A AND CONTINUE WITH BOX_10
----------------------------------------------------

BOX_10
======

----------------------------------------------------
GO TO BOX_18
----------------------------------------------------

PP14
====

[STR-DT]
[END-DT]
These next questions ask about the different medical and dental care anyone in the family has received [since (START DATE)/between (START DATE) and (END DATE)]. It is sometimes hard to remember dates accurately so take your time. You might want to look at any calendar you may keep, checkbook, or receipts to help you remember. We are interested in any type of visit or call, including those made just for advice, prescriptions, tests, shots, or x-rays.
PRESS ENTER TO CONTINUE.
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_08
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK PP15 - END_LP08.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_08 COLLECTS ALL EVENTS FOR EACH RU MEMBER WHEN THE CALENDAR IS INCOMPLETE OR WAS NOT USED. THIS LOOP CYCLES ON ALL RU MEMBERS INCLUDING PERSONS WHO WERE DECEASED OR INSTITUTIONALIZED AFTER THE REFERENCE PERIOD START DATE.
----------------------------------------------------

PP15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-5.
Now think about the health care (PERSON) has received [since (START DATE)/between (START DATE) and (END DATE)].
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) see or talk to any type of dental care provider, such as the types listed on this card, for dental care or a dental check-up?
YES .................................... 1
NO ..................................... 2 [PP17]
REF ................................... -7 [PP17]
DK .................................... -8 [PP17]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'since (START DATE)' AND 'Since (START DATE) IF NOT ROUND 5. DISPLAY 'between (START DATE) and (END DATE)' AND 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_09
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_11- END_LP09.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_09 COLLECTS ALL DENTAL (DN) EVENTS NOT ALREADY RECORDED FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP16 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP16 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP16 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_11
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP16
----------------------------------------------------

PP16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-5.
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) see or talk to any other type of dental care provider, such as the types listed on this card (other than what you've already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP09
========

----------------------------------------------------
IF PP16 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP16 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_09 AND CONTINUE WITH PP17
----------------------------------------------------

PP17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-6.
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) see or talk to any medical doctor or nurse, such as those types listed on this card? [Please include telephone calls or visits where (PERSON) received advice, prescriptions, or test results.]
YES .................................... 1
NO ..................................... 2 [PP19]
REF ................................... -7 [PP19]
DK .................................... -8 [PP19]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_10
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_12 - END_LP10.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_10 COLLECTS ALL MEDICAL PROVIDER VISIT (MV) EVENTS NOT ALREADY RECORDED FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP18 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP18 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP18 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_12
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP18
----------------------------------------------------

PP18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-6.
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) see or talk to any other type of medical professional, such as the types listed on this card (other than what you've already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP10
========

----------------------------------------------------
IF PP18 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP18 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_10 AND CONTINUE WITH PP19
----------------------------------------------------

PP19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-7.
[Since (START DATE)/Between (START DATE) and (END DATE)], was (PERSON) a patient in a hospital or receive care in a hospital emergency room or hospital outpatient department?
YES .................................... 1
NO ..................................... 2 [PP21]
REF ................................... -7 [PP21]
DK .................................... -8 [PP21]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5. DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_11
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_13 - END_LP11.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_11 COLLECTS ALL HOSPITAL BASED EVENTS (I.E., HS, ER, AND OP EVENTS) NOT ALREADY RECORDED FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP20 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP20 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP20 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_13
======

---------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP20
----------------------------------------------------

PP20
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-7.
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) receive any other care as a patient in a hospital or from a hospital emergency room or outpatient department (other than what you've already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP11
========

----------------------------------------------------
IF PP20 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP20 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_11 AND CONTINUE WITH PP21
----------------------------------------------------

PP21
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-8.
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) see or talk to any of the health care providers listed on this card?
YES .................................... 1
NO ..................................... 2 [PP23]
REF ................................... -7 [PP23]
DK .................................... -8 [PP23]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_12
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_14 - END_LP12.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_12 COLLECTS ALL MEDICAL PROVIDER VISIT (MV) EVENTS NOT ALREADY RECORDED FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP22 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP22 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_14
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP22
----------------------------------------------------

PP22
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-8.
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) see or talk to any other type of health care provider, such as the types listed on this card (other than what you've already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP12
========

----------------------------------------------------
IF PP22 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP22 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_12 AND CONTINUE WITH PP23
----------------------------------------------------

PP23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-9.
[Since (START DATE)/Between (START DATE) and (END DATE)], because of a health problem, did (PERSON) receive any home care services such as the types listed on this card? Please include home care services received for medical care, personal care, supervision, and household help.
YES .................................... 1
NO ..................................... 2 [PP25]
REF ................................... -7 [PP25]
DK .................................... -8 [PP25]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_13
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_15 - END_LP13.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_13 COLLECTS ALL HOME HEALTH (HH) EVENTS NOT ALREADY RECORDED FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP24 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP24 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP24 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_15
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP24
----------------------------------------------------

PP24
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-9.
[Since (START DATE)/Between (START DATE) and (END DATE)], because of a health problem, did (PERSON) receive home care services such as the types listed on this card (other than what you've already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP13
========

----------------------------------------------------
IF PP24 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP24 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_13 AND CONTINUE WITH PP25
----------------------------------------------------

PP25
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-10.
[Since (START DATE)/Between (START DATE) and (END DATE)], (were/was) (PERSON) a patient in any long term care facility, such as the types of places listed on this card?
YES .................................... 1
NO ..................................... 2 [PP27]
REF ................................... -7 [PP27]
DK .................................... -8 [PP27]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_14
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_16 - END_LP14.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_14 COLLECTS ALL INSTITUTIONAL (IC) EVENTS NOT ALREADY RECORDED FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP26 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP26 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP26 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_16
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP26
----------------------------------------------------

PP26
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-10.
[Since (START DATE)/Between (START DATE) and (END DATE)], (were/was) (PERSON) a patient in any other long term care facility, such as the types of places listed on this card (other than what you've already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP14
========

----------------------------------------------------
IF PP26 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP26 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_14 AND CONTINUE WITH PP27
----------------------------------------------------

PP27
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-11.
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) obtain eyeglasses, contact lenses, or diabetic equipment?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
-----------------------------------------------------
IF PP27 IS CODED '1' (YES), CONTINUE WITH LOOP_15
-----------------------------------------------------
-----------------------------------------------------
IF PP27 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND CURRENT ROUND IS ROUND 3 OR ROUND 5, GO TO PP29
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO END_LP08
-----------------------------------------------------

LOOP_15
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_17 - END_LP15.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_15 COLLECTS ALL OTHER MEDICAL EXPENSE (OM) EVENTS NOT ALREADY RECORDED FOR PERSON BEING ASKED ABOUT.

THE RESPONSE TO PP28 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP28 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP28 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_17
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP28
----------------------------------------------------

PP28
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SHOW CARD PP-11.
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) obtain any other medical supplies listed on this card (other than what you've already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP15
========

----------------------------------------------------
IF PP28 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP28 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_15 AND CONTINUE WITH BOX_17A
----------------------------------------------------

BOX_17A
=======

-----------------------------------------------------
IF ROUND 3 OR ROUND 5, CONTINUE WITH PP29
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO END_LP08
-----------------------------------------------------

PP29
====

[PERSON'S FIRST MIDDLE AND LAST NAME] JAN 01
DEC 31
SHOW CARD PP-12.
Now I would like you to think about the entire calendar year 1998, that is from January 1, 1998 until December 31, 1998.
Please look at the types of other medical expenses listed on this card. Did (PERSON) obtain any of these types of other medical expenses during the year 1998?
PROBE: These could include ambulance services, canes, wheelchairs, corrective shoes, hearing aids or amplifiers for a telephone, artificial limbs, raised toilet seats, a modification to the house or a car because of some illness or injury, for example ramps or handrails, etc.
YES .................................... 1
NO ..................................... 2 [END_LP08]
REF ................................... -7 [END_LP08]
DK .................................... -8 [END_LP08]
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
NOTE: IN ROUND 3, QUESTION REFERRED TO '1997', NOT '1998'.
----------------------------------------------------

LOOP_16
=======

----------------------------------------------------
For each of the following:

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_17B - END_LP16.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_16 COLLECTS ALL OTHER TYPES OF MEDICAL EXPENSE (OM) EVENTS FOR THE YEAR 1997 NOT ALREADY RECORDED.

THE RESPONSE TO PP30 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP30 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP30 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_17B
=======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP30
----------------------------------------------------

PP30
====

[PERSON'S FIRST MIDDLE AND LAST NAME] JAN 01
DEC 31
SHOW CARD PP-12.
During the calendar year 1998, (have/has) (PERSON) obtained, purchased, or rented any of the types of other medical expenses listed on this card [other than what we have already talked about]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
NOTE: IN ROUND 3, QUESTION REFERRED TO '1997', NOT '1998'.
----------------------------------------------------

END_LP16
========

----------------------------------------------------
IF PP30 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP30 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_16 AND CONTINUE WITH END_LP08
----------------------------------------------------

END_LP08
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_08 AND CONTINUE WITH BOX_18
----------------------------------------------------

BOX_18
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION.
----------------------------------------------------


Event Roster (EV) Section


BOX_01
======

----------------------------------------------------
IF COMING FROM WITHIN PERSON LOOP IN PROVIDER PROBES, CODE EV01 AUTOMATICALLY BY CAPI WITH THE CORRECT PERSON NAME AND GO TO EV02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH EV01
----------------------------------------------------

EV01
====

INTERVIEWER: SELECT CORRECT PERSON FOR THIS EVENT.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65] ...
[2. First Name,[Middle Name],Last Name-65] ...
[3. First Name,[Middle Name],Last Name-65] ...
[Code One]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER.
----------------------------------------------------

EV02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER: WHAT TYPE OF EVENT IS IT?
HOSPITAL STAY ......................... HS
HOSPITAL EMERGENCY ROOM ............... ER
HOSPITAL OUTPATIENT DEPARTMENT ........ OP
MEDICAL PROVIDER VISIT ................ MV
DENTAL CARE ........................... DN
HOME HEALTH ........................... HH [EV06]
OTHER MEDICAL EXPENSES ................ OM
INSTITUTIONAL/LONG TERM CARE STAY ..... IC
PRESS F1 FOR DEFINITION OF EVENT TYPES.
[Code One]
----------------------------------------------------
IF ROUNDS 3 OR 5 AND EV02 IS CODED 'OM', GO TO EV02A
----------------------------------------------------
----------------------------------------------------
IF ROUNDS 1, 2, OR 4 AND EV02 IS CODED 'OM', GO TO EV03
----------------------------------------------------

BOX_02
======

----------------------------------------------------
ASK PROVIDER ROSTER (PV) SECTION FOR THIS EVENT
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE PV SECTION, GO TO BOX_03
----------------------------------------------------

EV02A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV]
INTERVIEWER: SELECT GROUP TYPE OF OTHER MEDICAL EXPENSE (OM) EVENT YOU NEED TO ADD:
NOTE: ONLY ONE OM GROUP TYPE MAY BE ADDED AT THIS SCREEN.
REGULAR (GLASSES OR CONTACTS, INSULIN, OTHER DIABETIC SUPPLIES) .............. 1 [EV03]
ADDITIONAL (E.G., AMBULANCE SERVICES, ORTHOPEDIC ITEMS, HEARING DEVICES, MEDICAL EQUIPMENT, ETC.) .............. 2 [EV03A]
[Code One]

EV03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
IF KNOWN, SELECT CORRECT OME ITEM GROUP.
OTHERWISE, ASK: Did (PERSON) obtain glasses or contact lenses, insulin, or other diabetic equipment or supplies since (START DATE)?
GLASSES OR CONTACT LENSES .............. 1
INSULIN ................................ 2
OTHER DIABETIC EQUIPMENT OR SUPPLIES ... 3
[Code All That Apply]
----------------------------------------------------
IF CODED '2' (INSULIN), ADD 'INSULIN' TO PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (OTHER DIABETIC EQUIPMENT OR SUPPLIES), ADD 'OTHER DIABETIC EQUIP/SUPPLIES' TO PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_06
----------------------------------------------------

EV03A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] JAN 01 DEC 31
SHOW CARD PP-4A OR PP-12
IF KNOWN, SELECT CORRECT ADDITIONAL OME ITEM GROUP
OTHERWISE, ASK: Looking at this card, what type of other medical expenses did (PERSON) obtain, purchase or rent during the calendar year 1998?
AMBULANCE SERVICES ....................... 1
ORTHOPEDIC ITEMS ......................... 2
HEARING DEVICES .......................... 3
PROSTHESES ............................... 4
BATHROOM AIDS ............................ 5
MEDICAL EQUIPMENT ........................ 6
DISPOSABLE SUPPLIES ...................... 7
ALTERATIONS/MODIFICATIONS ................ 8
OTHER ................................... 91
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER) ALONE OR IN COMBINATION WITH ANY OTHER CODES, CONTINUE WITH EV03AOV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_06
----------------------------------------------------

EV03AOV
=======

ENTER OTHER GROUPING OF OTHER MEDICAL EXPENSES:
[Enter Other Specify] ................ [BOX_06]
REF .................................. -7 [BOX_06]
DK ................................... -8 [BOX_06]

BOX_03
======

----------------------------------------------------
IF EVENT TYPE IS HS OR IC, CONTINUE WITH EV04
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EV05
----------------------------------------------------

EV04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [STR-DT] [END-DT]
IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS PERSON-PROVIDER
PAIR WITH THE EVENT TYPE (EV).
IF DATES NOT KNOWN, ASK: When (were/was) (PERSON) admitted to and discharged from (PROVIDER)? Please tell me the dates of all stays between (START DATE) and (END DATE).
IF NECESSARY, PROBE: On what date did (PERSON) enter (PROVIDER)? On what date did (PERSON) leave (PROVIDER)?

IF STILL IN (PROVIDER) [OR RELEASED IN 1999], ENTER 95 IN MONTH FOR DISCHARGE DATE.
PROBE: Any other stays?
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[Enter Month,Day,Year-2] - [Enter Month,Day,Year-2] .....
[Enter Month,Day,Year-2] - [Enter Month,Day,Year-2] .....
[Enter Month,Day,Year-2] - [Enter Month,Day,Year-2] .....
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES PERSON'S- MEDICAL-EVENTS-ROSTER TO COLLECT ALL EVENTS (DATE RANGES) THAT ARE EVENT TYPE HS OR EVENT TYPE IC, DEPENDING ON THE TYPE OF EVENT BEING ASKED ABOUT.
----------------------------------------------------
----------------------------------------------------
PERSON'S EVENT ROSTER BEHAVIOR SPECIFICATIONS:

1. THIS ROSTER WILL APPEAR BLANK WHEN DISPLAYED.
INTERVIEWER CAN ADD ANY NUMBER OF EVENTS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF EVENTS).
2. INTERVIEWER CAN DELETE AN EVENT THAT WAS ENTERED ON THE SCREEN WHERE DELETE IS USED.
THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE AN EVENT ENTERED IN ERROR.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'OR RELEASED IN 1999' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
REF AND DK ARE ALLOWED IN THE DAY AND YEAR FIELDS BUT ARE DISALLOWED IN THE MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_06
----------------------------------------------------

EV05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [STR-DT] [END-DT]
IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS PERSON-PROVIDER PAIR WITH THE EVENT TYPE (EV).
IF DATES NOT KNOWN, ASK: When did (PERSON) visit (PROVIDER)?
Please tell me all the dates between (START DATE) and (END DATE).
PROBE: Any other dates?

TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[Enter Month,Day,Year-2] ...............
[Enter Month,Day,Year-2] ...............
[Enter Month,Day,Year-2] ...............
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES PERSON'S- MEDICAL-EVENTS-ROSTER TO COLLECT ALL EVENTS (DATES) THAT ARE THE SAME EVENT TYPE AND SAME PROVIDER AS THE EVENT BEING ASKED ABOUT.
----------------------------------------------------
----------------------------------------------------
PERSON'S EVENT ROSTER BEHAVIOR SPECIFICATIONS:

1. THIS ROSTER WILL APPEAR BLANK WHEN DISPLAYED.
INTERVIEWER CAN ADD ANY NUMBER OF EVENTS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF EVENTS).
2. INTERVIEWER CAN DELETE AN EVENT THAT WAS ENTERED ON THE SCREEN WHERE DELETE IS USED.
THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE AN EVENT ENTERED IN ERROR.
----------------------------------------------------
----------------------------------------------------
REF AND DK ARE ALLOWED IN THE DAY AND YEAR FIELDS BUT ARE DISALLOWED IN THE MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_06
----------------------------------------------------

EV06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Thinking about the health care (PERSON) received at home, was the person who provided the care a friend or neighbor, a relative, a volunteer, or some type of provider who was paid?
Please do not include health care received from friends or relatives living here.
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?

NOTE: SELECT ONLY ONE TYPE OF PROVIDER AT THIS TIME.
FRIEND/NEIGHBOR ........................ 1 [EV08]
RELATIVE ............................... 2 [EV07]
VOLUNTEER .............................. 3 [EV08]
OTHER-PAID ............................. 4
VOLUNTEERED: MEAL DELIVERY SERVICE .... 5 [BOX_06]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code One]
----------------------------------------------------
IF CODED '5' (VOLUNTEERED: MEAL DELIVERY SERVICE), DO NOT CREATE AN EVENT RECORD.
----------------------------------------------------

EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [BOX_04]
WORKED FOR SELF ........................ 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
[Code One]

EV07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
What is the relationship of the relative who provided home care services to (PERSON)?
IF MORE THAN ONE DAUGHTER/DAUGHTER-IN-LAW/SON/SON-IN-LAW, CODE ONLY ONE AT THIS TIME AND TREAT EACH AS A SEPARATE HOME HEALTH EVENT.
INCLUDE ALL OTHER TYPES OF RELATIVES AS ONE GROUP AND CODE 'OTHER-RELATIVE' ONLY ONE TIME.
DAUGHTER ............................... 1 [BOX_04]
DAUGHTER-IN-LAW ........................ 2 [BOX_04]
SON .................................... 3 (BOX_04]
SON-IN-LAW ............................. 4 [BOX_04]
OTHER RELATIVE ......................... 5
[Code One]

EV07OV1
=======

CODE RELATIONSHIPS OF ALL DIFFERENT TYPES OF RELATIVES WHO PROVIDED HOME CARE SERVICES SINCE (START DATE) TO (PERSON).
MOTHER ................................. 1
FATHER ................................. 2
SISTER ................................. 3
BROTHER ................................ 4
GRANDPARENT ............................ 5
GRANDCHILD ............................. 6
AUNT/UNCLE ............................. 7
NIECE/NEPHEW ........................... 8
COUSIN ................................. 9
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF EV07OV1 IS CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODES, CONTINUE WITH EV07OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EV08
----------------------------------------------------

EV07OV2
=======

ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

EV08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
How many different [friends or neighbors/volunteers/relatives, other than daughters, daughters-in-law, sons, and sons-in-law] provided home care services for (PERSON) since (START DATE)?
[Enter Number-2] .......................
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'friends or neighbors' IF EV06 IS CODED '1' (FRIEND/NEIGHBOR). DISPLAY 'volunteers' IF EV06 IS CODED '3' (VOLUNTEER). DISPLAY 'relatives, other than daughters, daughters-in-law, sons, and sons-in-law' IF EV07 IS CODED '5' (OTHER-RELATIVE).
----------------------------------------------------
----------------------------------------------------
IF EV06 IS CODED '1' (FRIEND/NEIGHBOR):

- ADD 'FRIEND/NEIGHBOR' TO THE RU-MEDICAL-PROVIDERS-ROSTER, PERSON-TYPE- PROVIDER NAME COLUMN. NO ADDRESS INFORMATION IS NECESSARY.

- FLAG PROVIDER AS 'INFORMAL'.
----------------------------------------------------
----------------------------------------------------
IF EV06 IS CODED '3' (VOLUNTEER):

- ADD 'VOLUNTEER' TO THE RU-MEDICAL-PROVIDERS-ROSTER, PERSON-TYPE- PROVIDER NAME COLUMN. NO ADDRESS INFORMATION IS NECESSARY.

- FLAG PROVIDER AS 'INFORMAL'.
----------------------------------------------------
----------------------------------------------------
IF EV07 IS CODED '5' (OTHER RELATIVE):

- ADD 'OTHER RELATIVE' TO THE RU-MEDICAL-PROVIDERS-ROSTER, PERSON-TYPE- PROVIDER NAME COLUMN. NO ADDRESS INFORMATION IS NECESSARY.

- FLAG PROVIDER AS 'INFORMAL'.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_05
----------------------------------------------------

BOX_04
======

----------------------------------------------------
ASK PROVIDER ROSTER (PV) SECTION FOR THIS EVENT
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE PV SECTION, CONTINUE WITH BOX_05
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF EV06 IS CODED '1' (FRIEND/NEIGHBOR) OR '3' (VOLUNTEER) AND ROUND 1, GO TO EV12
----------------------------------------------------
----------------------------------------------------
IF EV06 IS CODED '1' (FRIEND/NEIGHBOR) OR '3' (VOLUNTEER) AND NOT ROUND 1, GO TO EV13
----------------------------------------------------
----------------------------------------------------
IF EV06 IS CODED '2' (RELATIVE), FLAG PROVIDER JUST COLLECTED IN PV SECTION AS 'INFORMAL' AND THEN GO TO EV13
----------------------------------------------------
----------------------------------------------------
IF EV06A IS CODED '2' (WORKED FOR SELF), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG PROVIDER JUST COLLECTED IN PV SECTION AS 'PAID INDEPENDENT' AND THEN GO TO EV10
----------------------------------------------------
----------------------------------------------------
IF EV06A IS CODED '1' (WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME), FLAG PROVIDER JUST COLLECTED IN PV SECTION AS 'AGENCY' AND THEN CONTINUE WITH EV09
----------------------------------------------------

EV09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [STR-DT] [END-DT]
How many people from (PROVIDER) provided home care services for (PERSON)?
[Enter Number-2] ......................
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
IF ROUND 1, GO TO EV12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EV13
----------------------------------------------------

EV10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [STR-DT] [END-DT]
Is (PROVIDER) a companion, a professional homemaker, a home health or nurse's aide, a health professional, or something else?
PROBE: Health professionals include people like nurses, social workers, therapists of any type.
COMPANION .............................. 1
DOMESTIC WORKER/HOUSE CLEANER .......... 2
HEALTH PROFESSIONAL .................... 3
HOMEMAKER .............................. 4
HOME HEALTH AIDE ....................... 5
NURSE'S AIDE ........................... 6
PERSONAL CARE ATTENDANT ................ 7
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code One]
----------------------------------------------------
IF EV10 CODED '3' (HEALTH PROFESSIONAL), GO TO EV11 IF EV10 IS CODED '91' (OTHER), CONTINUE WITH EV10OV IF EV10 NOT CODED '3' (HEALTH PROFESSIONAL), OR '91' (OTHER), AND ROUND 1, GO TO EV12 OTHERWISE, GO TO EV13
----------------------------------------------------

EV10OV
======

ENTER OTHER:
[Enter Other Specify] .................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF ROUND 1, GO TO EV12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EV13
----------------------------------------------------

EV11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [STR-DT] [END-DT]
What type of health professional is (PROVIDER)?
DIETITIAN/NUTRITIONIST ................. 1
HOME HEALTH AIDE ....................... 2
HOSPICE WORKER ......................... 3
I.V./INFUSION THERAPIST ................ 4
MEDICAL DOCTOR ......................... 5
NURSE/NURSE PRACTITIONER ............... 6
NURSE'S AIDE ........................... 7
OCCUPATIONAL THERAPIST ................. 8
PERSONAL CARE ATTENDANT ................ 9
PHYSICAL THERAPIST .................... 10
RESPIRATORY THERAPIST ................. 11
SOCIAL WORKER ......................... 12
SPEECH THERAPIST ...................... 13
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code One]
----------------------------------------------------
IF EV11 CODED '91' (OTHER), CONTINUE WITH EV11OV
----------------------------------------------------
----------------------------------------------------
IF EV11 NOT CODED '91' (OTHER), AND ROUND 1, GO TO EV12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EV13
----------------------------------------------------

EV11OV
======

ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF ROUND 1, CONTINUE WITH EV12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EV13
----------------------------------------------------

EV12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [STR-DT] [END-DT]
Did [someone from] (PROVIDER) ever provide home care services for (PERSON) before January 1, 1997?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS A FACILITY.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
NOTE: EV12 SHOULD ONLY BE ASKED IF ROUND 1. IT WAS, HOWEVER, ASKED IN ROUND 2, BUT NOT IN ROUND 3 AND BEYOND.
----------------------------------------------------

EV13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [STR-DT] [END-DT]
[Last time we recorded that (PERSON) received home care services from (PROVIDER) during some part of [PRV RD INTV MTH].
Did (PERSON) continue to receive home care services from (PROVIDER) during the rest of [PRV RD INTV MTH]?]
Did [someone from] (PROVIDER) provide home care services for (PERSON) during the month of (MONTH)?
How about in (MONTH)?
Yes No REF DK

EV13_01
=======

[MONTH] 1 2 -7 -8

EV13_02
=======

[MONTH] 1 2 -7 -8

EV13_03
=======

[MONTH] 1 2 -7 -8

EV13_04
=======

[MONTH] 1 2 -7 -8
----------------------------------------------------
EV13 SCREEN DISPLAY SPECIFICATIONS:

1. THE NUMBER AND NAMES OF THE MONTHS LISTED ARE DETERMINED BY THE NUMBER OF MONTHS BETWEEN THE MONTH OF THE START DATE AND THE MONTH OF THE END DATE FOR THIS PERSON. FOR EXAMPLE, IF THE START DATE IS JANUARY 1 AND THE END DATE IS APRIL 10 FOR THIS PERSON'S REFERENCE PERIOD, 'JANUARY', 'FEBRUARY', 'MARCH', AND 'APRIL' ARE DISPLAYED. THAT IS, THE MONTHS ARE ALL THE MONTHS OF THE PERSON'S REFERENCE PERIOD.
2. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED FOR EV13_01, EV13_02, EV13_03, AND EV13_04. HOWEVER, THEY WILL BE TREATED AS A 'NO' WHEN CREATING EVENTS.
----------------------------------------------------
----------------------------------------------------
NOTE: THE SCREEN LAYOUT SHOULD ACCOMMODATE AS MANY MONTHS AS POSSIBLE.
----------------------------------------------------
----------------------------------------------------
DISPLAY FIRST PARAGRAPH IF A HOME HEALTH EVENT FOR THE MONTH OF THE PREVIOUS ROUND'S INTERVIEW DATE FOR THIS PERSON-PROVIDER PAIR WAS CREATED DURING THE PREVIOUS ROUND (HOWEVER, IT WOULD NOT HAVE BEEN ASKED ABOUT). OTHERWISE, USE A NULL DISPLAY.

DISPLAY THE MONTH OF THE PREVIOUS ROUND'S INTERVIEW DATE FOR '[PRV RD INTV MTH]'.

DISPLAY 'someone from' IF PROVIDER IS A FACILITY.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
EDIT: ALL MONTHS DURING THE REFERENCE PERIOD CANNOT BE CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF ALL ARE, DISPLAY THE FOLLOWING MESSAGE: 'MUST RECEIVE HOME CARE DURING AT LEAST ONE MONTH.'
----------------------------------------------------
----------------------------------------------------
MESSAGE: IF CURRENT INTERVIEW MONTH IS CODED '1' (YES), DISPLAY THE FOLLOWING MESSAGE: 'HOME HEALTH UTILIZATION SEC FOR [INT MONTH] WILL NOT BE ASKED UNTIL NEXT ROUND.'
----------------------------------------------------
----------------------------------------------------
EACH MONTH CODED '1' (YES) BECOMES A SEPARATE HOME HEALTH EVENT FOR THIS PERSON-PROVIDER PAIR.
HOWEVER, IF THE CURRENT INTERVIEW MONTH IS CODED '1' (YES), IT WILL NOT BE ASKED ABOUT UNTIL THE NEXT ROUND. IF THE MONTH OF THE PREVIOUS ROUND'S INTERVIEW DATE IS CODED '1' (YES), IT IS ONLY ASKED ABOUT ONE TIME. THAT IS, IT IS NOT A SEPARATE EVENT FOR BOTH THE PREVIOUS ROUND AND THIS ROUND, IT IS ONLY ONE EVENT.

NOTE: A SEAM MONTH WILL BE ASKED ONLY ONE HOME HEALTH UTILIZATION SECTION WHENEVER IT RECEIVES (OR RECEIVED) A CODE OF '1' (YES) IN EITHER THE CURRENT ROUND OR THE PREVIOUS ROUND.
----------------------------------------------------

BOX_06
======

----------------------------------------------------
RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN PP OR ED.
----------------------------------------------------


Provider Roster (PV) Section


PV01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV]
[[What is the name of the person or place that provided health care to (PERSON)?]]
INTERVIEWER: IS THE PROVIDER [ASSOCIATED WITH THIS EVENT] A PERSON OR A FACILITY (INCLUDING GROUP PRACTICES AND HMOs)?
PERSON ................................. 1
FACILITY ............................... 2 [BOX_01]
PRESS F1 FOR DEFINITION OF PERSON/FACILITY.
----------------------------------------------------
DISPLAY '[What is ... (PERSON)?]' AND 'ASSOCIATED WITH THIS EVENT' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLED FROM THE ACCESS TO CARE (AC) SECTION. IF THE PV SECTION WAS CALLED FROM THE AC SECTION, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (PERSON), SET PROVIDER TYPE TO 'PERSON-TYPE-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (FACILITY), SET PROVIDER TYPE TO 'FACILITY-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (PERSON) AND NO PROVIDERS THAT ARE TYPE 'PERSON-TYPE-PROVIDER' ON RU-MEDICAL-PROVIDERS-ROSTER, GO TO PV04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (PERSON) AND AT LEAST ONE PROVIDER THAT IS TYPE 'PERSON-TYPE-PROVIDER' ON RU-MEDICAL-PROVIDERS-ROSTER, CONTINUE WITH PV02
----------------------------------------------------
----------------------------------------------------
EDIT: IF EVENT TYPE IS HS, ER, OP, OR IC, PV01 CANNOT BE CODED '1' (PERSON). IF PV01 IS CODED '1' (PERSON) FOR AN HS, ER, OP, OR IC EVENT, DISPLAY THE FOLLOWING MESSAGE: 'A FACILITY MUST BE ASSOCIATED WITH [EV] TYPE. VERIFY PROVIDER AND RE-ENTER.'
----------------------------------------------------

PV02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV]
SELECT CORRECT [USUAL SOURCE OF CARE] PROVIDER [ASSOCIATED WITH THE EVENT].
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. PERSON-TYPE-PROVIDER
PV02_02. FACILITY
PV02_03. STREET
1. [Display Truncated Person-Provider-25] [Display Truncated Facility-Provider-30] [Display Truncated Street Address-15]
2. [Display Truncated Person-Provider-25] [Display Truncated Facility-Provider-30] [Display Truncated Street Address-15]
3. [Display Truncated Person-Provider-25] [Display Truncated Facility-Provider-30] [Display Truncated Street Address-15]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE PROVIDERS ON THE RU-MEDICAL-PROVIDERS-ROSTER THAT ARE OF THE TYPE PERSON-TYPE-PROVIDER, WHICH INCLUDES THE SUBGROUP FLAGGED AS 'PERSON-IN-FACILITY-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'USUAL SOURCE OF CARE' IF THE PROVIDER ROSTER (PV) SECTION WAS CALLED FROM THE ACCESS TO CARE (AC) SECTION. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'ASSOCIATED WITH THE EVENT' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLED FROM THE ACCESS TO CARE (AC) SECTION. IF THE PV SECTION WAS CALLED FROM THE AC SECTION, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY PROVIDER ALREADY LISTED OR SELECT 'NONE OF THE ABOVE.'
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. PROVIDERS ARE 'ADDED' BY USING THE 'NONE OF THE ABOVE' SELECTION.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
5. IF NO FACILITY IS ASSOCIATED WITH THE PERSON-PROVIDER, LEAVE THE FACILITY COLUMN BLANK FOR THAT PERSON-TYPE-PROVIDER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED, GO TO PV04
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PV03
----------------------------------------------------

PV03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV]
Is the address of (READ NAME AND ADDRESS OF PROVIDER BELOW)...
[PERSON-TYPE-PROVIDER NAME SELECTED AT PV02]
[FACILITY-PROVIDER W/ PERSON-TYPE-PROVIDER.]
[PERSON-TYPE-PROVIDER STREET ADDRESS LINE1.]
[PERSON-TYPE-PROVIDER STREET ADDRESS LINE2.]
ADDRESS [and FACILITY NAME] CORRECT ...... 1 [BOX_02]
ADD NEW ADDRESS FOR PROVIDER ........... 2 [PV06]
ADD NEW/DIFFERENT FACILITY FOR PROVIDER ............................. 3 [BOX_01]
ABOVE PROVIDER NAME/ADDRESS [OR FACILITY NAME] NEEDS SPELLING OR MINOR CORRECTION .................. 4 [PV07]
SELECTED WRONG PROVIDER/ADDRESS ........ 5
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]
----------------------------------------------------
FOR: [PERSON-TYPE-PROVIDER NAME SELECTED AT PV02], DISPLAY THE PERSON-TYPE-PROVIDER NAME SELECTED AT PV02.
FOR: [FACILITY-PROVIDER W/ PERSON-TYPE-PROVIDER.], DISPLAY THE FACILITY-PROVIDER NAME ASSOCIATED WITH THE PERSON-TYPE-PROVIDER SELECTED AT PV02. IF NO FACILITY-PROVIDER NAME ASSOCIATED WITH THIS PERSON-TYPE-PROVIDER, USE A NULL DISPLAY.
FOR: [PERSON-TYPE-PROVIDER STREET ADDRESS LINE1.] AND [PERSON-TYPE-PROVIDER STREET ADDRESS LINE2.], DISPLAY LINES 1 and 2 OF THE PERSON-TYPE-PROVIDER'S ADDRESS FOR THE PERSON-TYPE-PROVIDER SELECTED AT PV02.

DISPLAY 'and FACILITY NAME' AND 'OR FACILITY NAME' IF FACILITY-PROVIDER NAME ASSOCIATED WITH THE PERSON-TYPE-PROVIDER SELECTED AT PV02. IF NO FACILITY-PROVIDER NAME ASSOCIATED WITH THIS PERSON-TYPE-PROVIDER, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '5' (SELECTED WRONG PROVIDER/ADDRESS), CAPI REDISPLAYS PV02 TO ALLOW INTERVIEWER TO SELECT CORRECT PROVIDER.
----------------------------------------------------

PV04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV]
ENTER NAME OF PROVIDER [ASSOCIATED WITH EVENT].
ENTER COMPLETE PROVIDER NAME AND VERIFY SPELLING.
[Enter Provider Name-65] ...............
----------------------------------------------------
DISPLAY 'ASSOCIATED WITH EVENT' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLED FROM THE ACCESS TO CARE (AC) SECTION. IF THE PV SECTION WAS CALLED FROM THE AC SECTION, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
WRITE PROVIDER NAME TO THE PERSON-TYPE-PROVIDER COLUMN OF THE RU-MEDICAL-PROVIDERS-ROSTER.
----------------------------------------------------

PV05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV]
Is (PROVIDER) in a group practice, that is, do other doctors practice at the same office (or are part of an HMO)?
YES .................................... 1 [BOX_01]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON-TYPE-PROVIDER AS 'PERSON-IN-FACILITY-PROVIDER'.
----------------------------------------------------

PV06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV]
ENTER [NEW] STREET ADDRESS FOR (PROVIDER).
ENTER STREET ADDRESS AND VERIFY SPELLING. IF PROVIDER HAS MORE THAN ONE LOCATION, RECORD LOCATION PERSON VISITED.
PROVIDER_STR1 (PV06_01): [_____________]
PROVIDER_STR2 (PV06_02): [_____________]
----------------------------------------------------
DISPLAY 'NEW' IF PV03 IS CODED '2' (ADD NEW ADDRESS FOR PROVIDER). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
CODES '-7' (REF) AND '-8' (DK) ARE ALLOWED ON EACH FORM ITEM.
----------------------------------------------------
----------------------------------------------------
IF PV04 WAS ASKED, ASSOCIATE ADDRESS WITH PERSON-TYPE-PROVIDER ENTERED AT PV04.
----------------------------------------------------
----------------------------------------------------
IF PV03 WAS CODED '2' (ADD NEW ADDRESS FOR PROVIDER), WRITE ANOTHER RECORD FOR PROVIDER IN RU-MEDICAL-PROVIDERS-ROSTER AND ASSOCIATE ADDRESS WITH THAT NEW PROVIDER RECORD. SET PROVIDER TYPE TO 'PERSON-TYPE-PROVIDER'.

IF A FACILITY WAS DISPLAYED AS PART OF PROVIDER'S ADDRESS AT PV03, ASSOCIATE THAT FACILITY WITH THE NEW PROVIDER RECORD AND FLAG THE PERSON-TYPE-PROVIDER AS A 'PERSON-IN-FACILITY-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------

PV07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV]
CORRECT SPELLING OR ADDRESS FOR: (PROVIDER)
TO VERIFY CURRENT INFORMATION OR TO LEAVE A FIELD BLANK, PRESS ENTER. TO CORRECT OR ENTER INFORMATION, TYPE ENTIRE FIELD.
Current Info: [PROVIDER_NAME]
[FACILITY_NAME]
[PROVIDER_STR1]
[PROVIDER_STR2]
PROVIDER_NAME (PV07_01): [_____________]
FACILITY_NAME (PV07_02): [_____________]
PROVIDER_STR1 (PV07_03): [_____________]
PROVIDER_STR2 (PV07_04): [_____________]
----------------------------------------------------
WRITE CORRECTIONS TO RU-MEDICAL-PROVIDERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF NO FACILITY-PROVIDER ASSOCIATED WITH THIS PERSON-TYPE-PROVIDER, PV07_02 SHOULD NOT BE COLLECTED OR DISPLAYED. '[FACILITY_NAME]' AS PART OF THE CURRENT INFO SHOULD ALSO BE LEFT BLANK IF NO FACILITY-PROVIDER ASSOCIATED WITH THIS PERSON-TYPE-PROVIDER.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF NO PROVIDERS THAT ARE TYPE 'FACILITY-PROVIDERS' ON RU-MEDICAL-PROVIDERS-ROSTER, GO TO PV10
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PV08
----------------------------------------------------

PV08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV]
SELECT CORRECT [USUAL SOURCE OF CARE] [PROVIDER/FACILITY] [ASSOCIATED WITH THE EVENT].
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. FACILITY-PROVIDERS
PV08_02. STREET
[Display Truncated Facility-Provider-30] [Display Truncated Street Address-15]
[Display Truncated Facility-Provider-30] [Display Truncated Street Address-15]
[Display Truncated Facility-Provider-30] [Display Truncated Street Address-15]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE PROVIDERS ON THE RU-MEDICAL-PROVIDERS-ROSTER THAT ARE TYPE FACILITY-PROVIDERS.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'USUAL SOURCE OF CARE' IF THE PROVIDER ROSTER (PV) SECTION WAS CALLED FROM THE ACCESS TO CARE (AC) SECTION. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'PROVIDER' IF PV01 IS CODED '2' (FACILITY). DISPLAY 'FACILITY' IF PV01 IS CODED '1' (PERSON).

DISPLAY 'ASSOCIATED WITH THE EVENT' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLED FROM THE ACCESS TO CARE (AC) SECTION. IF THE PV SECTION WAS CALLED FROM THE AC SECTION, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY PROVIDER ALREADY LISTED OR SELECT 'NONE OF THE ABOVE.'
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CANNOT ADD AT THIS SCREEN. PROVIDERS ARE 'ADDED' BY USING THE 'NONE OF THE ABOVE' SELECTION.
4. INTERVIEWER CANNOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED, GO TO PV10
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PV09
----------------------------------------------------

PV09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV]
Is the address of (READ NAME AND ADDRESS OF ([PROVIDER/FACILITY]) BELOW)...
[FACILITY NAME SELECTED AT PV08]
[FACILITY STREET ADDRESS LINE1.]
[FACILITY STREET ADDRESS LINE2.]
FACILITY NAME AND ADDRESS CORRECT ...... 1 [BOX_02]
ADD NEW ADDRESS FOR FACILITY ........... 2
ABOVE NAME/ADDRESS NEEDS SPELLING OR MINOR CORRECTION ..................... 3 [PV11]
SELECTED WRONG FACILITY/ADDRESS ........ 4
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]
----------------------------------------------------
DISPLAY 'PROVIDER' IF PV01 IS CODED '2' (FACILITY). DISPLAY 'FACILITY' IF PV01 IS CODED '1' (PERSON).

FOR: [FACILITY NAME SELECTED AT PV08], DISPLAY THE FACILITY-PROVIDER NAME SELECTED AT PV08. FOR: [FACILITY STREET ADDRESS LINE1.] AND [FACILITY STREET ADDRESS LINE2.], DISPLAY LINES 1 AND 2 OF THE FACILITY-PROVIDER'S ADDRESS FOR THE FACILITY-PROVIDER SELECTED AT PV08.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (FACILITY NAME AND ADDRESS CORRECT) OR '3' (ABOVE NAME/ADDRESS FOR FACILITY NEEDS SPELLING OR MINOR CORRECTION) AND PV01 IS CODED '1' (PERSON), LINK THE FACILITY SELECTED AT PV08 TO THE PERSON-TYPE-PROVIDER FLAGGED AS 'PERSON-IN-FACILITY-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
IF CODED '4' (SELECTED WRONG FACILITY/ADDRESS), CAPI REDISPLAYS PV08 TO ALLOW INTERVIEWER TO SELECT CORRECT FACILITY.
----------------------------------------------------

PV10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV]
ENTER [NEW] [NAME AND] ADDRESS OF ([PROVIDER/FACILITY]).
ENTER [NAME AND] STREET ADDRESS AND VERIFY SPELLING. IF ([PROVIDER/FACILITY]) HAS MORE THAN ONE LOCATION, RECORD LOCATION PERSON VISITED.
FACILITY_NAME (PV10_01): [_____________]
FACILITY_STR1 (PV10_02): [_____________]
FACILITY_STR2 (PV10_03): [_____________]
----------------------------------------------------
DISPLAY 'NEW' IF PV09 IS CODED '2' (ADD NEW ADDRESS FOR FACILITY). OTHERWISE, USE A NULL DISPLAY. DISPLAY 'PROVIDER' IF PV01 IS CODED '2' (FACILITY). DISPLAY 'FACILITY' IF PV01 IS CODED '1' (PERSON). DISPLAY 'NAME AND' IF 'NONE OF THE ABOVE' WAS SELECTED AT PV08 OR PV08 WAS NOT ASKED. IF 'NONE OF THE ABOVE' WAS SELECTED AT PV08 OR PV08 WAS NOT ASKED, THE CONTEXT HEADER WILL NOT DISPLAY THE NAME OF THE MEDICAL CARE PROVIDER. THE CONTEXT HEADER WILL ONLY HAVE THE NAME OF THE PROVIDER(S) ASSOCIATED WITH THE EVENT IF PV09 WAS CODED '2' (ADD NEW ADDRESS FOR FACILITY).
----------------------------------------------------
----------------------------------------------------
CODES '-7' (REF) AND '-8' (DK) ARE ALLOWED ON PV10_02 AND PV10_03 ONLY.
----------------------------------------------------
----------------------------------------------------
IF PV09 IS CODED '2' (ADD NEW ADDRESS FOR FACILITY), PV10 WILL NOT COLLECT THE FACILITY NAME.
----------------------------------------------------
----------------------------------------------------
IF FACILITY-PROVIDER NOT SELECTED AT PV08 (I.E., PV08 WAS NOT ASKED OR 'NONE OF THE ABOVE' WAS SELECTED), WRITE NAME AND ADDRESS ENTERED ABOVE TO FACILITY-PROVIDER NAME COLUMN AND ADDRESS COLUMN OF THE RU-MEDICAL-PROVIDERS-ROSTER.

IF FACILITY-PROVIDER SELECTED AT PV08 AND PV09 WAS CODED '2' (ADD NEW ADDRESS FOR FACILITY), WRITE ANOTHER RECORD FOR THE FACILITY-PROVIDER TO THE RU-MEDICAL-PROVIDERS-ROSTER AND ASSOCIATE ADDRESS WITH THAT NEW PROVIDER RECORD.

IF PV01 IS CODED '1' (PERSON), LINK THE FACILITY TO THE PERSON-TYPE-PROVIDER FLAGGED AS 'PERSON-IN-FACILITY-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------

PV11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV]
CORRECT SPELLING OR ADDRESS FOR: ([PROVIDER/FACILITY])
TO VERIFY CURRENT INFORMATION OR TO LEAVE A FIELD BLANK, PRESS ENTER. TO CORRECT OR ENTER INFORMATION, TYPE ENTIRE FIELD.
Current Info: [FACILITY_NAME]
[FACILITY_STR1]
[FACILITY_STR2]
FACILITY_NAME (PV11_01): [_____________]
FACILITY_STR1 (PV11_02): [_____________]
FACILITY_STR2 (PV11_03): [_____________]
----------------------------------------------------
DISPLAY 'PROVIDER' IF PV01 IS CODED '2' (FACILITY). DISPLAY 'FACILITY' IF PV01 IS CODED '1' (PERSON).
----------------------------------------------------
----------------------------------------------------
WRITE CORRECTIONS TO RU-MEDICAL-PROVIDERS-ROSTER.
----------------------------------------------------

BOX_02
======

----------------------------------------------------
RETURN TO QUESTIONNAIRE SECTION FROM WHICH THE PROVIDER ROSTER (PV) SECTION WAS CALLED.
----------------------------------------------------


Event Driver (ED) Section


BOX_01
======

----------------------------------------------------
DISPLAY EVENTS BY PERSON THEN BY THE ORDER OF ENTRY - THAT IS, IN THE ORDER BY PROVIDER PROBES, AND THEN ANY ADDITIONS.
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN PERSON'S-MEDICAL-EVENTS- ROSTER, ASK ED01 - END_LP01.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 CORRECTS EVENT INFORMATION, IF NECESSARY, AND CALLS THE APPROPRIATE UTILIZATION SECTION FOR THE EVENT.
THIS LOOP CYCLES ON EVENTS THAT MEET THE FOLLOWING CONDITIONS:
- EVENT TYPE IS NOT PM OR IC
- EVENT IS NOT YET FLAGGED AS PROCESSED IN UTILIZATION
----------------------------------------------------

ED01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[The next questions ask detail about each of the times (PERSON) received medical or dental care.]
THERE [IS/ARE] [NUMBER] [EVENT/EVENTS] REMAINING TO BE PROCESSED FOR (PERSON).
PRESS ENTER TO CONTINUE.
----------------------------------------------------
DISPLAY 'The....care.' IF FIRST EVENT TO BE ASKED ABOUT FOR THIS PERSON.

DISPLAY 'IS' IF ONLY ONE EVENT LEFT TO BE ASKED ABOUT FOR THIS PERSON. DISPLAY 'ARE' IF MORE THAN ONE EVENT LEFT TO BE ASKED ABOUT FOR THIS PERSON.

DISPLAY THE ACTUAL NUMBER OF EVENTS LEFT TO BE ASKED ABOUT FOR THIS PERSON FOR '[NUMBER]'.

DISPLAY 'EVENT' IF ONLY ONE EVENT LEFT TO BE ASKED ABOUT FOR THIS PERSON. DISPLAY 'EVENTS' IF MORE THAN ONE EVENT LEFT TO BE ASKED ABOUT FOR THIS PERSON.
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
For each of the following:

EVENT NOT YET CODED AS 'INFORMATION OK' AT ED02

ask ED02 - END_LP02
----------------------------------------------------

ED02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
Let's talk about [the hospital stay for (PERSON) at (PROVIDER) that began on (ADMIT DATE)/when (PERSON) visited the emergency room at (PROVIDER) on (VISIT DATE)/when (PERSON) received medical care from an outpatient department at (PROVIDER) on (VISIT DATE)/when (PERSON) received medical care from (PROVIDER) on (VISIT DATE)/when (PERSON) received dental care from (PROVIDER) on (VISIT DATE)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/the services (PERSON) received at home from (PROVIDER) during (MONTH)].
CODE '1' UNLESS RESPONDENT VOLUNTEERS CORRECTION.
INFORMATION OK ......................... 1 [END_LP02]
CORRECTIONS NEEDED:
PROVIDER MISSPELLED/INCOMPLETE ......... 2
DATE(S) INCORRECT ...................... 3
WRONG EVENT TYPE ....................... 4
WRONG PROVIDER ......................... 5
WRONG OME ITEM GROUP ................... 6
EVENT NOT FOR THIS PERSON .............. 7
EVENT ENTERED IN ERROR ................. 8
WANT TO REVIEW (PERSON)'S EVENTS OR ADD EVENT FOR ANY RU MEMBER ............ 9 [ED09]
[Code One]
----------------------------------------------------
DISPLAY 'the hospital....(ADMIT DATE)' IF EVENT TYPE IS HS. DISPLAY 'when...emergency...(VISIT DATE)' IF EVENT TYPE IS ER. DISPLAY 'when...outpatient...(VISIT DATE)' IF EVENT TYPE IS OP. DISPLAY 'when...medical...(VISIT DATE)' IF EVENT TYPE IS MV. DISPLAY 'when...dental...(VISIT DATE)' IF EVENT TYPE IS DN. DISPLAY 'the [OME ITEM GROUP NAME]...(START DATE)' IF EVENT TYPE IS OM. DISPLAY 'the...home...(MONTH)' IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (PROVIDER MISSPELLED/INCOMPLETE) AND EVENT TYPE IS OM, DISPLAY THE FOLLOWING MESSAGE:
'THIS CODE NOT AVAILABLE FOR OM EVENTS. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (PROVIDER MISSPELLED/INCOMPLETE) AND EVENT TYPE IS NOT OM, CONTINUE WITH ED03
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (DATE(S) INCORRECT), '4' (WRONG EVENT TYPE), OR '5' (WRONG PROVIDER) AND EVENT TYPE IS HH, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE NOT AVAILABLE FOR HH EVENTS. IF CORRECTION NECESSARY, DELETE AND RE-ADD THIS HH EVENT. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (DATE(S) INCORRECT), '4' (WRONG EVENT TYPE), OR '5' (WRONG PROVIDER) AND EVENT TYPE IS OM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE NOT AVAILABLE FOR OM EVENTS. IF CORRECTION NECESSARY, DELETE AND RE-ADD THIS OM EVENT. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (DATE(S)) INCORRECT AND EVENT TYPE IS NOT HH OR OM, GO TO ED04
----------------------------------------------------
----------------------------------------------------
IF CODED '4' (WRONG EVENT TYPE) AND EVENT TYPE IS NOT HH OR OM, GO TO ED07
----------------------------------------------------
----------------------------------------------------
IF CODED '5' (WRONG PROVIDER) AND EVENT IS ALREADY LINKED TO A FLAT FEE BUNDLE, DISPLAY THE FOLLOWING MESSAGE: 'CHANGE OF PROVIDER DISALLOWED. RECORD ALREADY LINKED TO OTHER EVENTS.'
----------------------------------------------------
----------------------------------------------------
IF CODED '5' (WRONG PROVIDER), AND EVENT TYPE IS NOT HH OR OM, AND EVENT IS NOT ALREADY LINKED TO A FLAT FEE BUNDLE, GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
IF CODED '6' (WRONG OME ITEM GROUP) AND EVENT TYPE IS NOT OM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE ONLY AVAILABLE FOR OM EVENTS. ENTER NEW CODE. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '6' (WRONG OME ITEM GROUP) AND EVENT TYPE IS OM, AND OM GROUP TYPE IS 'REGULAR' (EV02A=1 OR NOT ASKED), GO TO ED06
----------------------------------------------------
----------------------------------------------------
IF CODED '6' (WRONG OME ITEM GROUP) AND EVENT TYPE IS OM, AND OM GROUP TYPE IS 'ADDITIONAL' (EV02A=2), GO TO ED06A
----------------------------------------------------
----------------------------------------------------
IF CODED '7' (EVENT NOT FOR THIS PERSON) AND SINGLE-PERSON RU, DISPLAY THE FOLLOWING MESSAGE:
'THIS CODE NOT AVAILABLE FOR SINGLE-PERSON RU.
ENTER NEW CODE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '7' (EVENT NOT FOR THIS PERSON) AND EVENT IS ALREADY LINKED TO A FLAT FEE BUNDLE, DISPLAY THE FOLLOWING MESSAGE: 'TRANSFER DISALLOWED. RECORD ALREADY LINKED TO OTHER EVENTS.'
----------------------------------------------------
----------------------------------------------------
IF CODED '7' (EVENT NOT FOR THIS PERSON), AND MULTI-PERSON RU, AND EVENT IS NOT ALREADY LINKED TO A FLAT FEE BUNDLE, GO TO ED05
----------------------------------------------------
----------------------------------------------------
IF CODED '8' (EVENT ENTERED IN ERROR), AND EVENT IS NOT ALREADY LINKED TO A FLAT FEE BUNDLE, FLAG EVENT FOR DELETION AND GO TO END_LP02
----------------------------------------------------
----------------------------------------------------
IF CODED '8' (EVENT ENTERED IN ERROR) AND EVENT IS ALREADY LINKED TO A FLAT FEE BUNDLE, DISPLAY THE FOLLOWING MESSAGE: 'DELETION DISALLOWED. RECORD ALREADY LINKED TO OTHER EVENTS.'
----------------------------------------------------

ED03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
INTERVIEWER: RE-TYPE THE ENTIRE PROVIDER NAME TO CORRECT.
[Enter Person-Type-Provider-85]
[Enter Facility-Provider-45]
----------------------------------------------------
DISPLAY PERSON-TYPE-PROVIDER AND FACILITY-PROVIDER AS APPLICABLE FOR THE PROVIDER(S) ASSOCIATED WITH THIS EVENT-PROVIDER PAIR. THAT IS, DISPLAY AND ALLOW CORRECTIONS TO THE PERSON-TYPE-PROVIDER IF PV01 WAS CODED '1' (PERSON). DISPLAY AND ALLOW CORRECTIONS TO THE FACILITY-PROVIDER IF PV01 WAS CODED '2' (FACILITY), OR IF PV03 WAS CODED '3' (ADD NEW/DIFFERENT FACILITY FOR PROVIDER), OR IF PV05 WAS CODED '1' (YES) FOR THIS EVENT-PROVIDER PAIR FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
WRITE CORRECTION TO RU-MEDICAL-PROVIDERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP02
----------------------------------------------------

ED04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
INTERVIEWER: RE-TYPE THE ENTIRE EVENT DATE(S) TO CORRECT.
[Enter Month,Day,Year-2] - [Enter Month,Day,Year-2]
-----------------------------------------------------
REFUSED AND DON'T KNOW ARE ALLOWED IN THE DAY AND YEAR FIELDS BUT ARE DISALLOWED IN THE MONTH FIELD.
-----------------------------------------------------
-----------------------------------------------------
COLLECT DISCHARGE DATE ONLY IF EVENT TYPE IS HS.
-----------------------------------------------------
-----------------------------------------------------
WRITE CORRECTION TO PERSON'S-MEDICAL-EVENTS-ROSTER.
-----------------------------------------------------
-----------------------------------------------------
GO TO END_LP02
-----------------------------------------------------

ED05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
INTERVIEWER: SELECT CORRECT PERSON FOR THIS EVENT.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-35] ...............................
[2. First Name,[Middle Name],Last Name-35] ...............................
[3. First Name,[Middle Name],Last Name-35] ...............................
[Code One]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
FLAG EVENT FOR DELETION FROM PERSON'S-MEDICAL- EVENTS-ROSTER FOR PERSON ORIGINALLY ASSOCIATED WITH EVENT AND ADD EVENT TO PERSON'S-MEDICAL- EVENTS-ROSTER FOR PERSON SELECTED IN ED05.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
ASK THE PROVIDER ROSTER (PV) SECTION FOR THIS EVENT.
AT COMPLETION OF PROVIDER ROSTER (PV) SECTION, CONTINUE WITH BOX_03
----------------------------------------------------

BOX_03
======

----------------------------------------------------
WRITE PROVIDER CORRECTION TO PERSON'S-EVENT- PROVIDER-PAIRS-ROSTER.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP02
----------------------------------------------------

ED06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV]
INTERVIEWER: SELECT CORRECT OME ITEM GROUP.
GLASSES OR CONTACT LENSES .............. 1
INSULIN ................................ 2
OTHER DIABETIC EQUIPMENT OR SUPPLIES ... 3
[Code One]
----------------------------------------------------
IF CODED '2' (INSULIN), ADD 'INSULIN' TO PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (OTHER DIABETIC EQUIPMENT OR SUPPLIES), ADD 'OTHER DIABETIC EQUIP/SUPPLIES' TO PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
CHANGE THE OME GROUP ORIGINALLY ASSOCIATED WITH THE EVENT BEING ASKED ABOUT TO THE OME ITEM GROUP SELECTED IN ED06.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP02
----------------------------------------------------

ED06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV]
INTERVIEWER: SELECT CORRECT OME ITEM GROUP.
AMBULANCE SERVICES ..................... 1 [BOX_ED06A]
ORTHOPEDIC ITEMS ....................... 2 [BOX_ED06A]
HEARING DEVICES ........................ 3 [BOX_ED06A]
PROSTHESES ............................. 4 [BOX_ED06A]
BATHROOM AIDS .......................... 5 [BOX_ED06A]
MEDICAL EQUIPMENT ...................... 6 [BOX_ED06A]
DISPOSABLE SUPPLIES .................... 7 [BOX_ED06A]
ALTERATIONS/MODIFICATIONS .............. 8 [BOX_ED06A]
OTHER ................................. 91
[Code One]

ED06AOV
=======

ENTER OTHER GROUPING OF OTHER MEDICAL EXPENSES:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

BOX_ED06A
=========

----------------------------------------------------
CHANGE THE OME GROUP ORIGINALLY ASSOCIATED WITH THE EVENT BEING ASKED ABOUT TO THE OME ITEM GROUP SELECTED IN ED06A OR ENTERED IN ED06AOV.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP02
----------------------------------------------------

ED07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
INTERVIEWER: SELECT CORRECT EVENT TYPE.
HOSPITAL STAY ......................... HS
HOSPITAL EMERGENCY ROOM ............... ER [END_LP02]
HOSPITAL OUTPATIENT DEPARTMENT ........ OP [END_LP02]
MEDICAL PROVIDER VISIT ................ MV [END_LP02]
DENTAL CARE ........................... DN [END_LP02]
[Code One]
PRESS F1 FOR DEFINITIONS OF EVENT TYPES.
-----------------------------------------------------
CHANGE THE EVENT TYPE ORIGINALLY ASSOCIATED WITH THE EVENT BEING ASKED ABOUT TO THE EVENT TYPE SELECTED IN ED07. IF EVENT TYPE WAS HOSPITAL STAY, THE NEW EVENT DATE WILL BE THE ADMIT DATE COLLECTED FOR THE HOSPITAL STAY.
-----------------------------------------------------

ED08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
INTERVIEWER: RE-TYPE ENTIRE EVENT DATE(S) TO CORRECT.
[Enter Month,Day,Year-2] - [Enter Month,Day,Year-2]
-----------------------------------------------------
WRITE CORRECTION TO PERSON'S-MEDICAL-EVENTS-ROSTER.
-----------------------------------------------------
-----------------------------------------------------
GO TO END_LP02
-----------------------------------------------------
-----------------------------------------------------
REFUSED AND DON'T KNOW ARE ALLOWED IN THE DAY AND YEAR FIELDS BUT ARE DISALLOWED IN THE MONTH FIELD.
-----------------------------------------------------

ED09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
[OME ITEM GROUP: [NAME OF OME ITEM GROUP......]]
INTERVIEWER: SO FAR, THE FOLLOWING EVENTS HAVE BEEN RECORDED FOR (PERSON):
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
ED09_01. NAME MEDICAL PROVIDER
ED09_02. EVENT TYPE
ROSTER.
DATE-DATE
ED09_04. UTIL
ED09_05. C/P
1. [Display Medical Provider-35] [Display Event Code] [Display Month Day Year-4] [Display Selection] [Display Selection]
2. [Display Medical Provider-35] [Display Event Code] [Display Month Day Year-4] [Display Selection] [Display Selection]
3. [Display Medical Provider-35] [Display Event Code] [Display Month Day Year-4] [Display Selection] [Display Selection]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL CURRENT ROUND EVENTS AND ALL EVENTS HELD OVER FROM THE PREVIOUS ROUND (I.E., UTILIZATION AND CHARGE/ PAYMENT WERE NOT MARKED AS PROCESSED) ON PERSON'S- MEDICAL-EVENTS-ROSTER EXCEPT EVENTS WITH EVENT TYPE 'PM'. THE ROSTER IS DISPLAYED IN THE THIRD COLUMN OF THE GRID. THE FIRST COLUMN OF THE GRID WILL DISPLAY THE PROVIDER ASSOCIATED WITH THAT PARTICULAR ROW ENTRY OF PERSON'S-MEDICAL-EVENTS- ROSTER. THE SECOND COLUMN OF THE GRID WILL DISPLAY THE EVENT TYPE ASSOCIATED WITH THAT PARTICULAR ROW ENTRY OF PERSON'S-MEDICAL-EVENTS- ROSTER.
----------------------------------------------------
----------------------------------------------------
CAPI DISPLAYS A CHECK MARK IN THE 'UTIL' COLUMN IF THE EVENT BEING ASKED ABOUT HAS COMPLETED THE APPROPRIATE UTILIZATION SECTION.
----------------------------------------------------
----------------------------------------------------
CAPI DISPLAYS A CHECK MARK IN THE 'C/P' COLUMN IF THE EVENT BEING ASKED ABOUT HAS COMPLETED THE CHARGE/PAYMENT (CP) SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH ED09OV1
----------------------------------------------------

ED09OV1
=======

ADD AN EVENT?
YES .................................... 1
NO ..................................... 2 [END_LP02]
----------------------------------------------------
ED09OV1 IS DISPLAYED BENEATH THE GRID ON ED09 WHENEVER ED09 IS DISPLAYED.
----------------------------------------------------

BOX_04
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION FOR THIS EVENT.
AT COMPLETION OF EVENT ROSTER (EV) SECTION, CONTINUE WITH END_LP02
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI CONTINUES THE LOOP FOR THE EVENT THAT WAS IN PROCESS WHEN ANOTHER EVENT WAS ADDED.
ADDED EVENTS ARE PROCESSED IN THE ED SECTION AFTER EVENTS THAT WERE RECORDED IN THE PROVIDER PROBES (PP) SECTION.
----------------------------------------------------

END_LP02
========

----------------------------------------------------
IF ED02 IS CODED '1' (INFORMATION OK), CONTINUE WITH END_LP01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CYCLE ON THE SAME EVENT TO COLLECT ANY ADDITIONAL CORRECTION.
----------------------------------------------------

END_LP01
========

-----------------------------------------------------
ASK APPROPRIATE UTILIZATION SECTION FOR THIS EVENT.
WHEN UTILIZATION IS COMPLETED FOR THIS EVENT, CYCLE ON NEXT EVENT IN PERSON'S-MEDICAL-EVENTS- ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
-----------------------------------------------------
-----------------------------------------------------
IF NO MORE EVENTS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_05
-----------------------------------------------------

BOX_05
======

-----------------------------------------------------
GO TO THE NEXT QUESTIONNAIRE SECTION
-----------------------------------------------------


Hospital Stay (HS) Section


BOX_01
======

----------------------------------------------------
IF HOSPITAL STAY DISCHARGE DATE IS '95' (STILL IN HOSPITAL) [OR IF ROUND 5, CODE '95' INDICATES 'STILL IN HOSPITAL' AND 'RELEASED IN 1999'], DO NOT ASK THE HOSPITAL STAY (HS) SECTION OR THE CHARGE/PAYMENT (CP) SECTION FOR THIS EVENT.
(WE WILL FOLLOW UP WITH THESE EVENTS NEXT ROUND.
IF ROUND 5, WE WILL OBTAIN NECESSARY INFORMATION DURING MPS FOLLOW-UP.)
----------------------------------------------------
----------------------------------------------------
IF THE MONTH OR DAY FOR THE HOSPITAL STAY ADMIT DATE OR DISCHARGE DATE IS '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH HS01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HS02
----------------------------------------------------

HS01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
How many nights did (PERSON) stay in (PROVIDER)?
[Enter Number of Nights] ...............
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 1 TO 30.
----------------------------------------------------

HS02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Did this hospital stay begin with a visit to an emergency room?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF EMERGENCY ROOM.

HS03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Was this hospital stay related to any specific health condition or were any conditions discovered during this hospital stay?
YES .................................... 1
NO ..................................... 2 [HS05]
REF ................................... -7 [HS05]
DK .................................... -8 [HS05]

HS04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
What conditions were discovered or led (PERSON) to enter the hospital? PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
----------------------------------------------------

HS05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
SHOW CARD HS-1.
Please look at this card and tell me which category best describes the reason (PERSON) entered (PROVIDER) on (ADMIT DATE)?
IF NECESSARY, PROBE: What was the main reason (PERSON) entered (PROVIDER)?
OPERATION OR SURGICAL PROCEDURE ........ 1
TREATMENT OR THERAPY, NOT INCLUDING SURGERY .............................. 2
DIAGNOSTIC TESTS ONLY .................. 3
GIVE BIRTH TO A BABY - NORMAL OR
CAESAREAN SECTION (MOTHER) ........... 4
TO BE BORN (BABY) ...................... 5
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '4' (GIVE BIRTH TO A BABY) ONLY IF PERSON IS FEMALE. ALLOW CODE '5' (TO BE BORN) ONLY IF PERSON IS ( OR = 1 YEAR OLD (OR AGE CATEGORY 1).
----------------------------------------------------
----------------------------------------------------
IF HS05 IS CODED '1' (OPERATION OR SURGICAL PROCEDURE), AUTOMATICALLY CODE HS06 AS '1' (YES) BY CAPI AND GO TO HS07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HS06
----------------------------------------------------

HS06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Were any operations or surgical procedures performed on (PERSON) during this stay?
YES .................................... 1
NO ..................................... 2 [HS08]
REF ................................... -7 [HS08]
DK .................................... -8 [HS08]
PRESS F1 FOR DEFINITION OF OPERATIONS/SURGICAL PROCEDURES.

HS07
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[NAME OF MEDICAL CARE PROVIDER....] [ADM-DT] [DIS-DT]
What was the name of the main surgical procedure?
APPENDECTOMY ........................... 1
ARTHROSCOPIC (VISUALIZATION OF JOINTS) SURGERY ...................... 2
CARDIAC CATHETERIZATION ................ 3
CATARACT SURGERY ....................... 4
CIRCUMCISION ........................... 5
CORONARY BYPASS ........................ 6
D AND C (DILATATION AND CURETTAGE) ....... 7
DENTAL SURGERY ......................... 8
GALLBLADDER SURGERY (CHOLECYSTECTOMY) .. 9
HERNIA REPAIR ......................... 10
HYSTERECTOMY .......................... 11
JOINT (HIP/KNEE) REPLACEMENT SURGERY .. 12
MASTECTOMY/LUMPECTOMY ................. 13
PACEMAKER INSERTION ................... 14
PLASTIC/RECONSTRUCTIVE SURGERY ........ 15
PROSTATE SURGERY (PROSTATECTOMY) ...... 16
SPINAL DISC SURGERY (SLIPPED DISC/ PROLAPSED DISC) ..................... 17
SURGICAL SETTING OF BROKEN BONE (FRACTURE REDUCTION) ................ 18
THYROID SURGERY (THYROIDECTOMY) ....... 19
TISSUE BIOPSY ......................... 20
TONSILLECTOMY ......................... 21
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
EDITS: IF HS07 IS CODED '5 (CIRCUMCISION) OR CODE '16' [PROSTATE SURGERY (PROSTATECTOMY)], CHECK THAT PERSON IS MALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: CODE UNAVAILABLE FOR FEMALES.
VERIFY AND RE-ENTER.

IF HS07 IS CODED '7' [D AND C (DILATATION AND CURETTAGE)] OR CODE '11' (HYSTERECTOMY), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: CODE NOT AVAILABLE FOR MALES.
VERIFY AND RE-ENTER.
----------------------------------------------------

HS08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
At the time (PERSON) (were/was) discharged, were any medicines prescribed for (PERSON)? Please do not include medications received while (PERSON) (were/was) a patient in the hospital.
YES .................................... 1
NO ..................................... 2 [HS10]
REF ................................... -7 [HS10]
DK .................................... -8 [HS10]
PRESS F1 FOR DEFINITION OF PRESCRIBED MEDICINE.

HS09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Please tell me the names of the prescribed medicines from this stay that were filled.
PROBE: Any other prescribed medicines from this stay that were filled?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Prescribed Medicine] ...............
[2. Prescribed Medicine] ...............
[3. Prescribed Medicine] ...............
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS

1. INTERVIEWER MAY SELECT A MEDICINE(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF MEDICINES AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF MEDICINES).
3. INTERVIEWER SHOULD BE ABLE TO DELETE A MEDICINE THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A MEDICINE ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST ENTERED.'
----------------------------------------------------

HS10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Now I would like to ask about the physicians and surgeons who treated (PERSON) during this hospital stay. (Have/Has) (PERSON) seen any of these doctors or surgeons at a place of practice outside of (PROVIDER)?
YES .................................... 1
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
-----------------------------------------------------------
NOTE: IN ROUNDS 1 AND 2, THE SECOND SENTENCE OF THE QUESTION WAS WORDED, "Do any of these doctors or surgeons have a place of practice outside of (PROVIDER) where (PERSON) (was/were) seen as a patient?"
-----------------------------------------------------------

HS11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Please give me the names of the medical places or private doctor's office where (PERSON) saw each of these doctors or surgeons outside of (PROVIDER).
PRESS ENTER TO CONTINUE.

LOOP_01
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

PROVIDER 1
PROVIDER 2
PROVIDER 3
PROVIDER 4

ASK BOX_02_END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS NAMES AND INFORMATION ABOUT EACH SEPARATELY BILLING PROVIDER. THE RESPONSE TO HS12 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF HS12 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT SEPARATELY BILLING PROVIDER. IF HS12 IS CODED '2'(NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_02
======

----------------------------------------------------
ASK THE PROVIDER ROSTER (PV) SECTION.
AT COMPLETION OF THE PROVIDER ROSTER (PV) SECTION, CONTINUE WITH BOX_03
----------------------------------------------------

BOX_03
======

----------------------------------------------------
FOR EACH PROVIDER ADDED OR SELECTED, ADD A PAIR TO THE PERSON'S-EVENT-PROVIDER-PAIRS ROSTER.
----------------------------------------------------
----------------------------------------------------
FLAG EACH PROVIDER ADDED OR SELECTED AS A 'SEPARATELY BILLING DOCTOR' RELATED TO THE HOSPITAL STAY EVENT BEING ASKED ABOUT.
----------------------------------------------------

HS12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.....] [ADM-DT] [DIS-DT]
Was there anyone else?
PROBE: Were there any other doctors or surgeons who treated (PERSON) during the hospital stay and who (PERSON) (have/has) seen at a place of practice outside of (PROVIDER)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2, THE PROBE PART OF THE QUESTION WAS WORDED, "...and who have a place of practice outside of (PROVIDER) where (PERSON) (was/were) seen as a patient?"
----------------------------------------------------

END_LP01
========

----------------------------------------------------
IF HS12 IS CODED '1' (YES), CYCLE TO COLLECT NEXT PROVIDER.
----------------------------------------------------
----------------------------------------------------
IF HS12 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_01 AND CONTINUE WITH BOX_04
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF THE CHARGE/PAYMENT (CP) SECTION FOR THIS HOSPITAL STAY IS NOT COMPLETED, ASK THE CHARGE/ PAYMENT (CP) SECTION.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION.
----------------------------------------------------


Emergency Room (ER) Section


ER01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Did (PERSON) see a medical doctor during this particular visit?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

ER02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
SHOW CARD ER-1.
Please look at this card and tell me which category best describes the care (PERSON) received during the visit to (PROVIDER) emergency room on (VISIT DATE)?
DIAGNOSIS OR TREATMENT ................. 1
EMERGENCY (E.G., ACCIDENT OR INJURY) ... 2
PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING ............................. 3
FOLLOW-UP OR POST-OPERATIVE VISIT ...... 4
IMMUNIZATIONS OR SHOTS ................. 5
MATERNITY CARE (PRE/POSTNATAL). ........ 6
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
IF CODED '6' (MATERNITY CARE (PRE/POSTNATAL)), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: 'CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER.'
----------------------------------------------------

ER03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was this visit related to any specific health condition or were any conditions discovered during this visit?
YES .................................... 1
NO ..................................... 2 [ER05]
REF ................................... -7 [ER05]
DK .................................... -8 [ER05]

ER04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What conditions were discovered or led (PERSON) to make this visit? PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
----------------------------------------------------

ER05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER....] [EVN-DT]
SHOW CARD ER-2.
Looking at this card, which of these services, if any, did (PERSON) have during this visit?
CODE '95' IF NO SERVICES WERE RECEIVED.
CODE ALL THAT APPLY.
LABORATORY TESTS ....................... 1
SONOGRAM OR ULTRASOUND ................. 2
X-RAYS ................................. 3
MAMMOGRAM .............................. 4
MRI OR CATSCAN ......................... 5
EKG OR ECG ............................. 6
EEG .................................... 7
VACCINATION ............................ 8
ANESTHESIA ............................. 9
OTHER DIAGNOSTIC TEST ................. 10
NO SERVICES RECEIVED .................. 95
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
ALLOW CODE '4' (MAMMOGRAM) ONLY IF PERSON IS FEMALE AND AGE IS ) 17 YEARS (OR AGE CATEGORIES 4 THROUGH 9).
----------------------------------------------------
----------------------------------------------------
ALLOW CODE '95' (NO SERVICES RECEIVED), '-7' (REFUSED), AND '-8' (DON'T KNOW) AS ENTRIES IN THE FIRST ENTRY FIELD ONLY. ALL OTHER RESPONSE CODES MAY BE ENTERED IN ANY ENTRY FIELD, IN ANY ORDER. CODE '95' WILL NOT APPEAR AS A RESPONSE CATEGORY ON THE SCREEN.
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '95' (NO SERVICES RECEIVED), NO OTHER SERVICE CATEGORIES SHOULD BE CODED. IF A SECOND CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------
----------------------------------------------------
WHEN AN ANSWER CATEGORY IS ENTERED IN AN ENTRY FIELD, CAPI WILL DISPLAY AN ANSWER CATEGORY ABBREVIATION BELOW THE ENTRY FIELD. THE FOLLOWING ANSWER CATEGORY ABBREVIATIONS SHOULD BE USED FOR THIS DISPLAY:

CODE '1' = 'LAB'
CODE '2' = 'ULTRA'
CODE '3' = 'XRAY'
CODE '4' = 'MAMMO'
CODE '5' = 'MRI'
CODE '6' = 'EKG'
CODE '7' = 'EEG'
CODE '8' = 'VACIN'
CODE '9' = 'ANEST'
CODE '10'= 'OTHER'
CODE '95'= 'NONE'
----------------------------------------------------
----------------------------------------------------
NOTE: 'OTHER DIAGNOSTIC TESTS' AND 'NO SERVICES RECEIVED' ARE NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------

ER06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was a surgical procedure performed on (PERSON) during this visit?
YES .................................... 1
NO ..................................... 2 [ER08]
REF ................................... -7 [ER08]
DK .................................... -8 [ER08]
PRESS F1 FOR DEFINITION OF SURGICAL PROCEDURE.

ER07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What was the name of the main surgical procedure?
CLEANING OR MEDICAL TREATMENT OF WOUND, INFECTION, OR BURN ............ 1
STITCHES (WOUND SUTURE) ................ 2
SURGICAL SETTING OF BROKEN BONE (FRACTURE REDUCTION) ................. 3
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

ER08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
During this visit, were any medicines prescribed for (PERSON)? Please include only prescriptions which were filled.
YES .................................... 1
NO ..................................... 2 [ER10]
REF ................................... -7 [ER10]
DK .................................... -8 [ER10]
PRESS F1 FOR DEFINITION OF PRESCRIBED MEDICINE.

ER09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Please tell me the names of the prescriptions from this visit that were filled.
PROBE: Any other prescribed medicines from this visit that were filled?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Prescribed Medicine] ...............
[2. Prescribed Medicine] ...............
[3. Prescribed Medicine] ...............
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A MEDICINE(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF MEDICINES AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF MEDICINES).
3. INTERVIEWER SHOULD BE ABLE TO DELETE A MEDICINE THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A MEDICINE ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST ENTERED.'
----------------------------------------------------

ER10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Now I would like to ask about the physicians and surgeons who treated (PERSON) during this emergency room visit. (Have/Has) (PERSON) seen any of these doctors or surgeons at a place of practice outside of (PROVIDER)?
YES .................................... 1
NO ..................................... 2 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
--------------------------------------------------------
NOTE: IN ROUNDS 1 AND 2, THE SECOND SENTENCE OF THE QUESTION WAS WORDED, "Do any of these doctors or surgeons have a place of practice outside of (PROVIDER) where (PERSON) (was/were) seen as a patient?"
--------------------------------------------------------

ER11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Please give me the names of the medical places or private doctor's office where (PERSON) saw each of these doctors or surgeons outside of (PROVIDER).
PRESS ENTER TO CONTINUE.

LOOP_01
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

PROVIDER 1
PROVIDER 2
PROVIDER 3
PROVIDER 4

ASK BOX_01 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS NAMES AND INFORMATION ABOUT EACH SEPARATELY BILLING PROVIDER. THE RESPONSE TO ER12 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF ER12 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT SEPARATELY BILLING PROVIDER. IF ER12 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_01
======

----------------------------------------------------
ASK THE PROVIDER ROSTER (PV) SECTION. AT THE COMPLETION OF THE PROVIDER ROSTER (PV) SECTION, CONTINUE WITH BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
FOR EACH PROVIDER ADDED OR SELECTED, ADD A PAIR TO THE PERSON'S-EVENT-PROVIDER-PAIRS-ROSTER.
----------------------------------------------------
----------------------------------------------------
FLAG EACH PROVIDER ADDED OR SELECTED AS A 'SEPARATELY BILLING DOCTOR' RELATED TO THE EMERGENCY ROOM EVENT BEING ASKED ABOUT.
----------------------------------------------------

ER12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was there anyone else?
PROBE: Were there any other doctors or surgeons who treated (PERSON) during the emergency room visit and who (PERSON) (have/has) seen at a place of practice outside of (PROVIDER)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2 THE PROBE PART OF THE QUESTION WAS WORDED, "...and who have a place of practice outside of (PROVIDER) where (PERSON) (was/were) seen as a patient?"
----------------------------------------------------

END_LP01
========

----------------------------------------------------
IF ER12 IS CODED '1' (YES), CYCLE TO COLLECT NEXT SEPARATELY BILLING PROVIDER.
----------------------------------------------------
----------------------------------------------------
IF ER12 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_01 AND CONTINUE WITH BOX_03
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF THE CHARGE/PAYMENT (CP) SECTION FOR THIS EMERGENCY ROOM EVENT IS NOT COMPLETED, ASK THE CHARGE/PAYMENT (CP) SECTION
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION
----------------------------------------------------


Outpatient Department (OP) Section


OP01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What is the name of the outpatient department?
[Enter Department Name] ................

OP02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
OUTPATIENT DEPT. NAME: [OUTPATIENT DEPT NAME FROM OP01]
Did (PERSON) visit the (OUTPATIENT DEPARTMENT) at (PROVIDER) on (VISIT DATE) in person or was this a telephone call?
SAW PROVIDER ........................... 1
TELEPHONE CALL ......................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY THE TEXT ENTRY FROM OP01 FOR 'OUTPATIENT DEPT NAME FROM OP01'.
----------------------------------------------------
----------------------------------------------------
IF OP02 IS CODED '1' (SAW PROVIDER), FLAG EVENT AS 'OP-IN-PERSON'.
----------------------------------------------------
----------------------------------------------------
IF OP02 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW) FLAG EVENT AS 'OP-TELEPHONE'.
----------------------------------------------------

OP03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
(Were/Was) (PERSON) referred for this particular [visit/telephone call] by another physician or medical person?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF REFERRED.
----------------------------------------------------
DISPLAY 'visit' IF OP02 CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW). DISPLAY 'telephone call' IF OP02 CODED '2' (TELEPHONE CALL).
----------------------------------------------------

OP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
[Did (PERSON) see a medical doctor during this particular visit?/Was this telephone call about (PERSON)'s health with a medical doctor?]
YES .................................... 1
NO ..................................... 2 [OP05]
REF ................................... -7 [OP05]
DK .................................... -8 [OP05]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.
----------------------------------------------------
DISPLAY 'Did (PERSON) see a medical doctor during this particular visit?' IF OP02 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT.

DISPLAY 'Was this telephone call about (PERSON)'s health with a medical doctor?' IF OP02 IS CODED '2' (TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND OP02 IS CODED '1' (SAW PROVIDER), GO TO OP06
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND OP02 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_01
----------------------------------------------------

OP05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What type of medical person did (PERSON) talk to on (VISIT DATE)?
IF TALKED TO MORE THAN ONE MEDICAL PERSON, PROBE FOR MAIN PROVIDER.
CHIROPRACTOR .......................... 1
DENTIST/DENTAL CARE PERSON ............ 2
MIDWIFE ............................... 3
NURSE/NURSE PRACTITIONER .............. 4
OPTOMETRIST ........................... 5
PODIATRIST ............................ 6
PHYSICIAN'S ASSISTANT ................. 7
PHYSICAL THERAPIST .................... 8
OCCUPATIONAL THERAPIST ................ 9
PSYCHOLOGIST .......................... 10
SOCIAL WORKER ......................... 11
TECHNICIAN ............................ 12
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
IF OP02 IS CODED '1' (SAW PROVIDER), CONTINUE WITH OP06
----------------------------------------------------
----------------------------------------------------
IF OP02 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_01
----------------------------------------------------

OP06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Approximately how much time did (PERSON) actually spend with [the doctor/that medical person]?
Would you say ...
5 minutes or less, ..................... 1
6 - 10 minutes, ........................ 2
11 - 15 minutes, ....................... 3
16 - 25 minutes, ....................... 4
26 - 40 minutes, or .................... 5
41 minutes or more? .................... 6
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'the doctor' IF OP04 IS CODED '1' (YES). DISPLAY 'that medical person' IF OP04 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW).
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF OP02 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO OP08
----------------------------------------------------
----------------------------------------------------
IF OP02 IS CODED '1' (SAW PROVIDER), CONTINUE WITH OP07
----------------------------------------------------

OP07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
OUTPATIENT DEPT. NAME: [OUTPATIENT DEPT NAME FROM OP01]
SHOW CARD OP-1.
Please look at this card and tell me which category best describes the care (PERSON) received during the visit to (OUTPATIENT DEPARTMENT) at (PROVIDER) on (VISIT DATE)?
GENERAL CHECKUP ........................ 1
DIAGNOSIS OR TREATMENT ................. 2
EMERGENCY (E.G., ACCIDENT OR INJURY) ... 3
PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING ............................. 4
FOLLOW-UP OR POST-OPERATIVE VISIT ...... 5
IMMUNIZATIONS OR SHOTS ................. 6
VISION EXAM ............................ 7
MATERNITY CARE (PRE/POSTNATAL) ......... 8
WELL CHILD EXAM ........................ 9
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY THE TEXT ENTRY FROM OP01 FOR 'OUTPATIENT DEPT NAME FROM OP01'.
----------------------------------------------------
----------------------------------------------------
IF CODED '8' (MATERNITY CARE (PRE/POSTNATAL)), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: 'CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
IF CODED '9' (WELL CHILD EXAM), CHECK THAT PERSON IS (7 YEARS OLD (OR AGE CATEGORIES 1 TO 3). IF NOT, DISPLAY THE FOLLOWING MESSAGE: 'CODE UNAVAILABLE FOR PERSONS 7 AND OLDER. VERIFY AND RE-ENTER.'
----------------------------------------------------

OP08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was this [visit/telephone call] related to any specific health condition or were any conditions discovered during this [visit/ telephone call]?
YES .................................... 1
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
----------------------------------------------------
DISPLAY 'visit' IF OP02 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT. DISPLAY 'telephone call' IF OP02 IS CODED '2'(TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------

OP09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What conditions were discovered or led (PERSON) to make this [visit/telephone call]?
PROBE: Any other condition?

IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?
IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
OTHER SPECIFY: (__________) ........... 91
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'visit' IF OP02 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT. DISPLAY 'telephone call' IF OP02 IS CODED '2'(TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF OP02 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO OP14
----------------------------------------------------
----------------------------------------------------
IF OP02 IS CODED '1' (SAW PROVIDER), CONTINUE WITH BOX_03
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF OP05 IS CODED '2' (DENTIST/DENTAL CARE PERSON), '3' (MIDWIFE), OR '5' (OPTOMETRIST), GO TO OP11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OP10
----------------------------------------------------

OP10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
SHOW CARD OP-2.
Looking at this card, which of these treatments, if any, did (PERSON) receive during this visit?
CODE '95' IF NO TREATMENTS WERE RECEIVED.
CODE ALL THAT APPLY.
PHYSICAL THERAPY ....................... 1
OCCUPATIONAL THERAPY ................... 2
SPEECH THERAPY ......................... 3
CHEMOTHERAPY ........................... 4
RADIATION THERAPY ...................... 5
KIDNEY DIALYSIS ........................ 6
IV THERAPY ............................. 7
DRUG OR ALCOHOL TREATMENT .............. 8
ALLERGY SHOT ........................... 9
PSYCHOTHERAPY/COUNSELING .............. 10
NO TREATMENTS RECEIVED ................ 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '95' (NO TREATMENTS RECEIVED), '-7' (REFUSED), AND '-8' (DON'T KNOW) AS ENTRIES IN THE FIRST FIELD ONLY. ALL OTHER RESPONSE CODES MAY BE ENTERED IN ANY ENTRY FIELD, IN ANY ORDER. CODE '95' WILL NOT APPEAR AS A RESPONSE CATEGORY ON THE SCREEN.
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '95' (NO TREATMENTS RECEIVED), NO OTHER TREATMENT CATEGORIES SHOULD BE CODED. IF A SECOND CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------
----------------------------------------------------
WHEN AN ANSWER CATEGORY IS ENTERED IN AN ENTRY FIELD, CAPI WILL DISPLAY AN ANSWER CATEGORY ABBREVIATION BELOW THE ENTRY FIELD. THE FOLLOWING ANSWER CATEGORY ABBREVIATIONS SHOULD BE USED FOR THIS DISPLAY:

CODE '1' = 'PHYS'
CODE '2' = 'OCCPT'
CODE '3' = 'SPCH'
CODE '4' = 'CHEMO'
CODE '5' = 'RADIA'
CODE '6' = 'KIDNY'
CODE '7' = 'IV'
CODE '8' = 'DRUG'
CODE '9' = 'ALRGY'
CODE '10'= 'PSYCH'
CODE '95'= 'NONE'
----------------------------------------------------
----------------------------------------------------
NOTE: 'NO TREATMENTS RECEIVED' IS NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------

OP11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
SHOW CARD OP-3.
Looking at this card, which of these services, if any, did (PERSON) have during this visit?
CODE '95' IF NO SERVICES WERE RECEIVED.
CODE ALL THAT APPLY.
LABORATORY TESTS ....................... 1
SONOGRAM OR ULTRASOUND ................. 2
X-RAYS ................................. 3
MAMMOGRAM .............................. 4
MRI OR CATSCAN ......................... 5
EKG OR ECG ............................. 6
EEG .................................... 7
VACCINATION ............................ 8
ANESTHESIA ............................. 9
OTHER DIAGNOSTIC TEST ................. 10
NO SERVICES RECEIVED .................. 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '4' (MAMMOGRAM) ONLY IF PERSON IS FEMALE AND AGE IS ) 17 YEARS (OR AGE CATEGORIES 4 THROUGH 9).
----------------------------------------------------
----------------------------------------------------
ALLOW CODE '95' (NO SERVICES RECEIVED), '-7' (REFUSED), AND '-8' (DON'T KNOW) AS ENTRIES IN THE FIRST FIELD ONLY. ALL OTHER RESPONSE CODES MAY BE ENTERED IN ANY ENTRY FIELD, IN ANY ORDER. CODE '95' WILL NOT APPEAR AS A RESPONSE CATEGORY ON THE SCREEN.
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '95' (NO SERVICES RECEIVED), NO OTHER SERVICE CATEGORIES SHOULD BE CODED. IF A SECOND CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------
----------------------------------------------------
WHEN AN ANSWER CATEGORY IS ENTERED IN AN ENTRY FIELD, CAPI WILL DISPLAY AN ANSWER CATEGORY ABBREVIATION BELOW THE ENTRY FIELD. THE FOLLOWING ANSWER CATEGORY ABBREVIATIONS SHOULD BE USED FOR THIS DISPLAY:

CODE '1' = 'LAB'
CODE '2' = 'ULTRA'
CODE '3' = 'X-RAYS'
CODE '4' = 'MAMMO'
CODE '5' = 'MRI'
CODE '6' = 'EKG'
CODE '7' = 'EEG'
CODE '8' = 'VACIN'
CODE '9' = 'ANEST'
CODE '10'= 'OTHER'
CODE '95'= 'NONE'
----------------------------------------------------
----------------------------------------------------
NOTE: 'OTHER DIAGNOSTIC TEST' AND 'NO SERVICES RECEIVED' ARE NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------

OP12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was a surgical procedure performed on (PERSON) during this visit?
YES .................................... 1
NO ..................................... 2 [OP14]
REF ................................... -7 [OP14]
DK .................................... -8 [OP14]
PRESS F1 FOR DEFINITION OF SURGICAL PROCEDURE.

OP13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What was the name of the main surgical procedure?
ARTHROSCOPIC (VISUALIZATION OF JOINTS) SURGERY ...................... 1
CATARACT SURGERY ....................... 2
CLEANING OR MEDICAL TREATMENT OF WOUND, INFECTION, OR BURN ............ 3
D and C (DILATATION AND CURETTAGE) ....... 4
STITCHES (WOUND SUTURE) ................ 5
TISSUE BIOPSY .......................... 6
TONSILLECTOMY .......................... 7
ADENOIDECTOMY .......................... 8
CARDIAC CATHETERIZATION ................ 9
EAR TUBES (TYMPANOSTOMY TUBES) ........ 10
PACEMAKER INSERTION ................... 11
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
EDIT: IF OP13 CODED '4' [D and C (DILATATION AND CURETTAGE)], CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER.
----------------------------------------------------
----------------------------------------------------
NOTE: CODES '8' (ADENOIDECTOMY), '9' (CARDIAC CATHETERIZATION), '10' [EAR TUBES (TYMPANOSTOMY TUBES)], AND '11' (PACEMAKER INSERTION) WERE NOT AVAILABLE IN ROUND 1.
----------------------------------------------------

OP14
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
During this [visit/telephone call], were any medicines prescribed for (PERSON)? Please include only prescriptions which were filled.
YES .................................... 1
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
PRESS F1 FOR DEFINITION OF PRESCRIBED MEDICINE.
----------------------------------------------------
DISPLAY 'visit' IF OP02 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT. DISPLAY 'telephone call' IF OP02 IS CODED '2'(TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------

OP15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Please tell me the names of the prescriptions from this visit that were filled.
PROBE: Any other prescribed medicines from this visit that were filled?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Prescribed Medicine] ...............
[2. Prescribed Medicine] ...............
[3. Prescribed Medicine] ...............
OTHER SPECIFY: (__________) ........... 91
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A MEDICINE(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF MEDICINES AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF MEDICINES).
3. INTERVIEWER SHOULD BE ABLE TO DELETE A MEDICINE THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A MEDICINE ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST ENTERED.'
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF OP02 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
IF OP02 IS CODED '1' (SAW PROVIDER), CONTINUE WITH OP16
----------------------------------------------------

OP16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
OUTPATIENT DEPT. NAME: [OUTPATIENT DEPT NAME FROM OP01]
Now I would like to ask about the physicians and surgeons who treated (PERSON) during this visit to (OUTPATIENT DEPARTMENT). (Have/Has) (PERSON) seen any of these doctors or surgeons at a place of practice outside of (PROVIDER)?
YES .................................... 1
NO ..................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
DISPLAY THE TEXT ENTRY FROM OP01 FOR 'OUTPATIENT DEPT NAME FROM OP01'.
----------------------------------------------------
----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2, THE SECOND SENTENCE OF THE QUESTION WAS WORDED, "Do any of these doctors or surgeons have a place of practice outside of (PROVIDER) where (PERSON) (was/were) seen as a patient?"
----------------------------------------------------

OP17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Please give me the names of the medical places or private doctor's office where (PERSON) saw each of these doctors or surgeons outside of (PROVIDER).
PRESS ENTER TO CONTINUE.

LOOP_01
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

PROVIDER 1
PROVIDER 2
PROVIDER 3
PROVIDER 4

ASK BOX_05 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS NAMES AND INFORMATION ABOUT EACH SEPARATELY BILLING PROVIDER ASSOCIATED WITH THIS EVENT. THE RESPONSE TO OP18 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF OP18 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT SEPARATELY BILLING PROVIDER. IF OP18 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_05
======

----------------------------------------------------
ASK THE PROVIDER ROSTER (PV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE PROVIDER ROSTER (PV) SECTION, CONTINUE WITH BOX_06
----------------------------------------------------

BOX_06
======

----------------------------------------------------
FOR EACH PROVIDER ADDED OR SELECTED, ADD A PAIR TO THE PERSON'S-EVENT-PROVIDER-PAIRS-ROSTER.
----------------------------------------------------
----------------------------------------------------
FLAG EACH PROVIDER ADDED OR SELECTED AS A 'SEPARATELY BILLING DOCTOR' RELATED TO THE OUTPATIENT DEPARTMENT EVENT BEING ASKED ABOUT.
----------------------------------------------------

OP18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
OUTPATIENT DEPT. NAME: [OUTPATIENT DEPT NAME FROM OP01]
Was there anyone else?
PROBE: Were there any other doctors or surgeons who treated (PERSON) during the visit to (OUTPATIENT DEPARTMENT) and who (PERSON) (have/has) seen at a place of practice outside of (PROVIDER)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY THE TEXT ENTRY FROM OP01 FOR 'OUTPATIENT DEPT NAME FROM OP01'.
----------------------------------------------------
-----------------------------------------------------
NOTE: IN ROUNDS 1 AND 2 THE PROBE PART OF THE QUESTION WAS WORDED, "...and who have a place of practice outside of (PROVIDER) where (PERSON) (was/were) seen as a patient?"
-----------------------------------------------------

END_LP01
========

----------------------------------------------------
IF OP18 IS CODED '1' (YES), CYCLE TO COLLECT NEXT PROVIDER.
----------------------------------------------------
----------------------------------------------------
IF OP18 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_01 AND CONTINUE WITH BOX_07
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF NO CONDITION IS ASSOCIATED WITH THIS VISIT TO THIS PROVIDER FOR THIS PERSON, GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_08
----------------------------------------------------

BOX_08
======

----------------------------------------------------
IF 2 OR MORE VISITS TO THIS PROVIDER FOR THIS PERSON HAVE NOT COMPLETED THE OUTPATIENT DEPARTMENT (OP) UTILIZATION SECTION, CONTINUE WITH BOX_09
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------

BOX_09
======

----------------------------------------------------
IF THIS EVENT IS NOT PART OF A FLAT FEE GROUP, CONTINUE WITH OP19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------

OP19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Earlier I recorded that (PERSON) had some other visits to an outpatient department at (PROVIDER). Were any of these visits related to any condition associated with (PERSON)'s visit on (VISIT DATE)? That is, were any of the other visits for the (READ CONDITIONS BELOW) and did (PERSON) receive [(READ SERVICES BELOW)/the same services]?
CONDITIONS SERVICES
[PERSON'S OP MEDICAL CONDITION.] [SERVICES RECEIVED..]
[PERSON'S OP MEDICAL CONDITION.] [SERVICES RECEIVED..]
[PERSON'S OP MEDICAL CONDITION.] [SERVICES RECEIVED..]
YES .................................... 1
NO ..................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
PRESS F1 FOR DEFINITION OF REPEAT VISITS.
----------------------------------------------------
DISPLAY '(READ SERVICES BELOW)' IF OP11 IS NOT CODED '95' (NO SERVICES), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF OP11 IS CODED '95' (NO SERVICES), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY 'the same services'.
----------------------------------------------------
----------------------------------------------------
FOR 'PERSON'S OP MEDICAL CONDITION.', DISPLAY ALL CONDITIONS SELECTED OR ADDED TO PERSON'S-MEDICAL-CONDITIONS-ROSTER AT OP09.

FOR 'SERVICES RECEIVED..', DISPLAY THE FOLLOWING TEXT FOR EACH CODE ENTERED AT OP11:

CODE '1' = LABORATORY TESTS
CODE '2' = SONOGRAM/ULTRASOUND
CODE '3' = X-RAYS
CODE '4' = MAMMOGRAM
CODE '5' = MRI/CATSCAN
CODE '6' = EKG/ECG
CODE '7' = EEG
CODE '8' = VACCINATION
CODE '9' = ANESTHESIA
CODE '10' = OTHER SERVICES
----------------------------------------------------

OP20
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Did any of these visits or calls cost the same amount as (PERSON)'s visit on (VISIT DATE)?
YES .................................... 1
NO ..................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
PRESS F1 FOR DEFINITION OF COST THE SAME AMOUNT.
----------------------------------------------------
NOTE: THE ISSUE OF COST WHEN THE PERSON HAS A COPAY AND DOES NOT KNOW THE TOTAL CHARGE WILL BE HANDLED IN THE F1 DEFINITION.
----------------------------------------------------

OP21
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Which of the following visits were related to the (READ CONDITIONS BELOW) and [(READ SERVICES BELOW)/the same services] and cost the same amount as the (VISIT DATE) visit we've just talked about?
PROBE: Any other visits related to this condition and cost the same amount?

CONDITIONS SERVICES
[PERSON'S OP MEDICAL CONDITION.] [SERVICES RECEIVED..]
[PERSON'S OP MEDICAL CONDITION.] [SERVICES RECEIVED..]
[PERSON'S OP MEDICAL CONDITION.] [SERVICES RECEIVED..]
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. Month,Day,Year-2]
[2. Month,Day,Year-2]
[3. Month,Day,Year-2]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL EVENTS (DATES) IN PERSON'S-MEDICAL-EVENTS-ROSTER THAT WERE CREATED THIS ROUND, ARE NOT YET PROCESSED IN UTILIZATION, HAVE EVENT TYPE 'OP', AND ARE ASSOCIATED WITH THE SAME PROVIDER AS THE EVENT BEING ASKED ABOUT.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(READ SERVICES BELOW)' IF OP11 IS NOT CODED '95' (NO SERVICES), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF OP11 IS CODED '95' (NO SERVICES), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY 'the same services'.
----------------------------------------------------
----------------------------------------------------
FOR 'PERSON'S OP MEDICAL CONDITIONS.', DISPLAY ALL CONDITIONS SELECTED OR ADDED TO PERSON'S-MEDICAL- CONDITIONS-ROSTER AT OP09.

FOR 'SERVICES RECEIVED..', DISPLAY THE FOLLOWING TEXT FOR EACH CODE ENTERED AT OP11:

CODE '1' = LABORATORY TESTS
CODE '2' = SONOGRAM/ULTRASOUND
CODE '3' = X-RAY
CODE '4' = MAMMOGRAM
CODE '5' = MRI/CATSCAN
CODE '6' = EKG/ECG
CODE '7' = EEG
CODE '8' = VACCINATION
CODE '9' = ANESTHESIA
CODE '10' = OTHER SERVICES
----------------------------------------------------
----------------------------------------------------
FLAG EACH VISIT SELECTED AT OP21 AS A REPEAT VISIT RELATED TO THE EVENT BEING ASKED ABOUT.

FLAG THE CHARGE PAYMENT (CP) STATUS OF EACH REPEAT VISIT AS 'PROCESSED'.

LINK CONDITION(S) AND SERVICE(S) ASSOCIATED WITH THE EVENT BEING ASKED ABOUT WITH EACH REPEAT VISIT.

THE EVENT DRIVER WILL NOT SERVE THESE REPEAT VISITS FOR THE OP SECTION.
----------------------------------------------------

OP22
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
INTERVIEWER: RECORD 'NAME OF REPEAT VISIT GROUP' FOR EVENTS SELECTED IN PREVIOUS QUESTION:
[Enter Repeat Visit Group] .............

BOX_10
======

----------------------------------------------------
IF CHARGE/PAYMENT (CP) SECTION IS NOT COMPLETED FOR THIS OUTPATIENT EVENT, ASK THE CHARGE/PAYMENT (CP) SECTION
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EVENT DRIVER (ED) SECTION
----------------------------------------------------


Medical Provider Visits (MV) Section


MV01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Did (PERSON) visit (PROVIDER) on (VISIT DATE) in person or was this a telephone call?
SAW PROVIDER ........................... 1
TELEPHONE CALL ......................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
IF MV01 IS CODED '1' (SAW PROVIDER), FLAG EVENT AS 'MV-IN-PERSON.'
----------------------------------------------------
----------------------------------------------------
IF MV01 IS CODED '2' (TELEPHONE CALL), '-7', (REFUSED), OR '-8' (DON'T KNOW), FLAG EVENT AS 'MV-TELEPHONE.'
----------------------------------------------------

MV02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
(Were/Was) (PERSON) referred for this particular [visit/telephone call] by another physician or medical person?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF REFERRED.
----------------------------------------------------
DISPLAY 'visit' IF MV01 CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW). DISPLAY 'telephone call' IF MV01 CODED '2' (TELEPHONE CALL).
----------------------------------------------------

MV03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
[Did (PERSON) see a medical doctor during this particular visit?/Was this telephone call about (PERSON)'s health with a medical doctor?]
YES .................................... 1
NO ..................................... 2 [MV04]
REF ................................... -7 [MV04]
DK .................................... -8 [MV04]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.
----------------------------------------------------
DISPLAY 'Did (PERSON) see a medical doctor during this particular visit?' IF MV01 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT.

DISPLAY 'Was this telephone call about (PERSON)'s health with a medical doctor?' IF MV01 IS CODED '2' (TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MV01 IS CODED '1' (SAW PROVIDER), GO TO MV05
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MV01 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_01
----------------------------------------------------

MV04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What type of medical person did (PERSON) talk to on (VISIT DATE)?
IF TALKED TO MORE THAN ONE MEDICAL PERSON, PROBE FOR MAIN PROVIDER.
CHIROPRACTOR .......................... 1
DENTIST/DENTAL CARE PERSON ............ 2
MIDWIFE ............................... 3
NURSE/NURSE PRACTITIONER .............. 4
OPTOMETRIST ........................... 5
PODIATRIST ............................ 6
PHYSICIAN'S ASSISTANT ................. 7
PHYSICAL THERAPIST .................... 8
OCCUPATIONAL THERAPIST ................ 9
PSYCHOLOGIST .......................... 10
SOCIAL WORKER ......................... 11
TECHNICIAN ............................ 12
RECEPTIONIST, CLERK, SECRETARY ........ 13
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
IF MV01 IS CODED '1' (SAW PROVIDER), CONTINUE WITH MV05
----------------------------------------------------
----------------------------------------------------
IF MV01 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_01
----------------------------------------------------

MV05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Approximately how much time did (PERSON) actually spend with [the doctor/that medical person]?
Would you say ...
5 minutes or less, ..................... 1
6 to 10 minutes, ....................... 2
11 - 15 minutes, ....................... 3
16 - 25 minutes, ....................... 4
26 - 40 minutes, or .................... 5
41 minutes or more? .................... 6
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'the doctor' IF MV03 IS CODED '1' (YES).
DISPLAY 'that medical person' IF MV03 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW).
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF MV01 IS CODED '1' (SAW PROVIDER) AND MV03 IS CODED '1' (YES), GO TO MV07
----------------------------------------------------
----------------------------------------------------
IF MV01 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND MV03 IS CODED '1' (YES), GO TO MV08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH MV06
----------------------------------------------------

MV06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
TYPE OF PERSON HAD CONTACT: [MEDICAL PERSON TYPE FROM MV04]
CODE WITHOUT ASKING IF OBVIOUS. OTHERWISE, ASK:
Do any medical doctors work at [the same location as (PROVIDER)/(PROVIDER)]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.
----------------------------------------------------
DISPLAY 'the same location as (PROVIDER)' IF PROVIDER IS FLAGGED AS 'PERSON-TYPE-PROVIDER'.
DISPLAY '(PROVIDER)' IF PROVIDER IS FLAGGED AS 'FACILITY-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
FOR 'MEDICAL PERSON TYPE FROM MV04', DISPLAY THE
FOLLOWING TEXT FOR EACH CODE ENTERED AT MV04:

CODE '1' = CHIROPRACTOR
CODE '2' = DENTIST/DENTAL CARE PERSON
CODE '3' = MIDWIFE
CODE '4' = NURSE/NURSE PRACTITIONER
CODE '5' = OPTOMETRIST
CODE '6' = PODIATRIST
CODE '7' = PHYSICIAN'S ASSISTANT
CODE '8' = PHYSICAL THERAPIST
CODE '9' = OCCUPATIONAL THERAPIST
CODE '10'= PSYCHOLOGIST
CODE '11'= SOCIAL WORKER
CODE '12'= TECHNICIAN
CODE '13'= RECEPTIONIST/CLERK/SECRETARY
CODE '91'= OTHER
CODE '-7'= REFUSED PROVIDER TYPE
CODE '-8'= DON'T KNOW PROVIDER TYPE
----------------------------------------------------
----------------------------------------------------
IF MV01 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO MV08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH MV07
----------------------------------------------------

MV07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
SHOW CARD MV-1.
Please look at this card and tell me which category best describes the care (PERSON) received during the visit to (PROVIDER) on (VISIT DATE)?
GENERAL CHECKUP ........................ 1
DIAGNOSIS OR TREATMENT ................. 2
EMERGENCY (E.G., ACCIDENT OR INJURY) ... 3
PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING ............................. 4
FOLLOW-UP OR POST-OPERATIVE VISIT ...... 5
IMMUNIZATIONS OR SHOTS ................. 6
VISION EXAM ............................ 7
MATERNITY CARE (PRE/POSTNATAL) ......... 8
WELL CHILD EXAM ........................ 9
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
EDITS: IF MVO7 IS CODED '8' (MATERNITY CARE (PRE/POSTNATAL)), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER.

IF MV07 IS CODED '9' (WELL CHILD EXAM), CHECK THAT PERSON IS ( 7 YEARS OLD (OR AGE CATEGORIES 1 THROUGH 3). IF NOT, DISPLAY THE FOLLOWING MESSAGE: CODE UNAVAILABLE FOR PERSONS 7 AND OLDER. VERIFY AND RE-ENTER.
----------------------------------------------------

MV08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was this [visit/telephone call] related to any specific health condition or were any conditions discovered during this [visit/ telephone call]?
YES .................................... 1
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
----------------------------------------------------
DISPLAY 'visit' IF MV01 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT. DISPLAY 'telephone call' IF MV01 IS CODED '2'(TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------

MV09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What conditions were discovered or led (PERSON) to make this [visit/telephone call]?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'visit' IF MV01 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT. DISPLAY 'telephone call' IF MV01 IS CODED '2'(TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF MV01 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO MV14
----------------------------------------------------
----------------------------------------------------
IF MV01 IS CODED '1' (SAW PROVIDER), CONTINUE WITH BOX_03
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF MV04 IS CODED '2' (DENTIST/DENTAL CARE PERSON), '3' (MIDWIFE), '5' (OPTOMETRIST), OR '13' (RECEPTIONIST, CLERK, SECRETARY), GO TO MV11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH MV10
----------------------------------------------------

MV10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
SHOW CARD MV-2.
Looking at this card, which of these treatments, if any, did (PERSON) receive during this visit?
CODE '95' IF NO TREATMENTS WERE RECEIVED.
CODE ALL THAT APPLY.
PHYSICAL THERAPY ....................... 1
OCCUPATIONAL THERAPY ................... 2
SPEECH THERAPY ......................... 3
CHEMOTHERAPY ........................... 4
RADIATION THERAPY ...................... 5
KIDNEY DIALYSIS ........................ 6
IV THERAPY ............................. 7
DRUG OR ALCOHOL TREATMENT .............. 8
ALLERGY SHOT ........................... 9
PSYCHOTHERAPY/COUNSELING .............. 10
NO TREATMENTS RECEIVED ................ 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '95' (NO TREATMENTS RECEIVED), '-7' (REFUSED), AND '-8' (DON'T KNOW) AS ENTRIES IN THE FIRST FIELD ONLY. ALL OTHER RESPONSE CODES MAY BE ENTERED IN ANY ENTRY FIELD, IN ANY ORDER. CODE '95' WILL NOT APPEAR AS A RESPONSE CATEGORY ON THE SCREEN.
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '95' (NO TREATMENTS RECEIVED), NO OTHER TREATMENT CATEGORIES SHOULD BE CODED. IF A SECOND CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------
----------------------------------------------------
WHEN AN ANSWER CATEGORY IS ENTERED IN AN ENTRY FIELD, CAPI WILL DISPLAY AN ANSWER CATEGORY ABBREVIATION BELOW THE ENTRY FIELD. THE FOLLOWING ANSWER CATEGORY ABBREVIATIONS SHOULD BE USED FOR THIS DISPLAY:

CODE '1' = 'PHYS'
CODE '2' = 'OCCPT'
CODE '3' = 'SPCH'
CODE '4' = 'CHEMO'
CODE '5' = 'RADIA'
CODE '6' = 'KIDNY'
CODE '7' = 'IV'
CODE '8' = 'DRUG'
CODE '9' = 'ALRGY'
CODE '10'= 'PSYCH'
CODE '95'= 'NONE'
----------------------------------------------------
----------------------------------------------------
NOTE: 'NO TREATMENT RECEIVED' IS NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------

MV11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
SHOW CARD MV-3.
Looking at this card, which of these services, if any, did (PERSON) have during this visit?
CODE '95' IF NO SERVICES WERE RECEIVED.
CODE ALL THAT APPLY.
LABORATORY TESTS ....................... 1
SONOGRAM OR ULTRASOUND ................. 2
X-RAYS ................................. 3
MAMMOGRAM .............................. 4
MRI OR CATSCAN ......................... 5
EKG OR ECG ............................. 6
EEG .................................... 7
VACCINATION ............................ 8
ANESTHESIA ............................. 9
OTHER DIAGNOSTIC TEST ................. 10
NO SERVICES RECEIVED .................. 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '4' (MAMMOGRAM) ONLY IF PERSON IS FEMALE AND AGE IS ) 17 YEARS (OR AGE CATEGORIES 4 THROUGH 9).
----------------------------------------------------
----------------------------------------------------
ALLOW CODE '95' (NO SERVICES RECEIVED), '-7' (REFUSED), AND '-8' (DON'T KNOW) AS ENTRIES IN THE FIRST FIELD ONLY. ALL OTHER RESPONSE CODES MAY BE ENTERED IN ANY ENTRY FIELD, IN ANY ORDER. CODE '95' WILL NOT APPEAR AS A RESPONSE CATEGORY ON THE SCREEN.
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '95' (NO SERVICES RECEIVED), NO OTHER SERVICE CATEGORIES SHOULD BE CODED. IF A SECOND CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------
----------------------------------------------------
WHEN AN ANSWER CATEGORY IS ENTERED IN AN ENTRY FIELD, CAPI WILL DISPLAY AN ANSWER CATEGORY ABBREVIATION BELOW THE ENTRY FIELD. THE FOLLOWING ANSWER CATEGORY ABBREVIATIONS SHOULD BE USED FOR THIS DISPLAY:

CODE '1' = 'LAB'
CODE '2' = 'ULTRA'
CODE '3' = 'X-RAYS'
CODE '4' = 'MAMMO'
CODE '5' = 'MRI'
CODE '6' = 'EKG'
CODE '7' = 'EEG'
CODE '8' = 'VACIN'
CODE '9' = 'ANEST'
CODE '10'= 'OTHER'
CODE '95'= 'NONE'
----------------------------------------------------
----------------------------------------------------
NOTE: 'NO SERVICES RECEIVED' IS NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------

MV12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was a surgical procedure performed on (PERSON) during this visit?
YES .................................... 1
NO ..................................... 2 [MV14]
REF ................................... -7 [MV14]
DK .................................... -8 [MV14]
PRESS F1 FOR DEFINITION OF SURGICAL PROCEDURE.

MV13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What was the name of the main surgical procedure?
ARTHROSCOPIC (VISUALIZATION OF JOINTS) SURGERY ...................... 1
CLEANING OR MEDICAL TREATMENT OF WOUND, INFECTION, OR BURN ............ 2
REMOVAL OF DISEASED TISSUE (EXCISION OF LESION) ........................... 3
STITCHES (WOUND SUTURE) ................ 4
EAR TUBES (TYMPANOSTOMY TUBES) ......... 5
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

MV14
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
During this [visit/telephone call], were any medicines prescribed for (PERSON)? Please include only prescriptions which were filled.
YES .................................... 1
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
PRESS F1 FOR DEFINITION OF PRESCRIBED MEDICINE.
----------------------------------------------------
DISPLAY 'visit' IF MV01 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT. DISPLAY 'telephone call' IF MV01 IS CODED '2'(TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------

MV15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Please tell me the names of the prescriptions from this visit that were filled.
PROBE: Any other prescribed medicines from this visit that were filled?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Prescribed Medicine] ...............
[2. Prescribed Medicine] ...............
[3. Prescribed Medicine] ...............
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A MEDICINE(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF MEDICINES AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF MEDICINES).
3. INTERVIEWER SHOULD BE ABLE TO DELETE A MEDICINE THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A MEDICINE ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST ENTERED.'
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF MV01 IS CODED '1' (SAW PROVIDER), CONTINUE WITH BOX_05
----------------------------------------------------
----------------------------------------------------
IF MV01 IS CODED '2' (TELEPHONE CALL), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_07
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF NO CONDITION IS ASSOCIATED WITH THIS VISIT TO THIS PROVIDER FOR THIS PERSON, GO TO BOX_07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_06
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF 2 OR MORE VISITS TO THIS PROVIDER FOR THIS PERSON HAVE NOT COMPLETED THE MEDICAL PROVIDER VISITS UTILIZATION MODULE AND IF THIS EVENT IS NOT PART OF A FLAT FEE GROUP, CONTINUE WITH MV16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

MV16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Earlier I recorded that (PERSON) had some other visits to (PROVIDER). Were any of these visits related to any condition associated with (PERSON)'s visit on (VISIT DATE)? That is, were any of the other visits for the (READ CONDITIONS BELOW) and did (PERSON) receive [(READ SERVICES BELOW)/the same services]?
CONDITIONS SERVICES
[PERSON'S MV MEDICAL CONDITION.] [SERVICES RECEIVED..]
[PERSON'S MV MEDICAL CONDITION.] [SERVICES RECEIVED..]
[PERSON'S MV MEDICAL CONDITION.] [SERVICES RECEIVED..]
YES .................................... 1
NO ..................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
PRESS F1 FOR DEFINITION OF REPEAT VISITS.
----------------------------------------------------
DISPLAY '(READ SERVICES BELOW)' IF MV11 IS NOT CODED '95' (NO SERVICES), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF MV11 IS CODED '95' (NO SERVICES), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY 'the same services'.
----------------------------------------------------
----------------------------------------------------
FOR 'PERSON'S MV MEDICAL CONDITION.', DISPLAY ALL CONDITIONS SELECTED OR ADDED TO PERSON'S-MEDICAL- CONDITIONS ROSTER AT MV09.

FOR 'SERVICES RECEIVED..', DISPLAY THE FOLLOWING TEXT FOR EACH CODE ENTERED AT MV11:

CODE '1' = LABORATORY TESTS
CODE '2' = SONOGRAM/ULTRASOUND
CODE '3' = X-RAYS
CODE '4' = MAMMOGRAM
CODE '5' = MRI/CATSCAN
CODE '6' = EKG/ECG
CODE '7' = EEG
CODE '8' = VACCINATION
CODE '9' = ANESTHESIA
CODE '10' = OTHER SERVICES
----------------------------------------------------

MV17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Did any of these visits or calls cost the same amount as (PERSON)'s visit on (VISIT DATE)?
YES .................................... 1
NO ..................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
PRESS F1 FOR DEFINITION OF COST THE SAME AMOUNT.
----------------------------------------------------
NOTE: THE ISSUES OF COST WHEN THE PERSON HAS A COPAY AND DOES NOT KNOW THE TOTAL CHARGE WILL BE HANDLED IN THE F1 DEFINITION.
----------------------------------------------------

MV18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Which of the following visits were related to the (READ CONDITIONS BELOW) and [(READ SERVICES BELOW)/the same services] and cost the same amount as the (VISIT DATE) visit we've just talked about?
PROBE: Any other visits related to this condition and cost the same amount?

CONDITIONS SERVICES
[PERSON'S MV MEDICAL CONDITION.] [SERVICES RECEIVED..]
[PERSON'S MV MEDICAL CONDITION.] [SERVICES RECEIVED..]
[PERSON'S MV MEDICAL CONDITION.] [SERVICES RECEIVED..]
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. Month,Day,Year-2]
[2. Month,Day,Year-2]
[3. Month,Day,Year-2]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL EVENTS (DATES) IN PERSON'S-MEDICAL-EVENTS-ROSTER THAT WERE CREATED THIS ROUND, ARE NOT YET PROCESSED IN UTILIZATION, HAVE EVENT TYPE 'MV', AND ARE ASSOCIATED WITH THE SAME PROVIDER AS THE EVENT BEING ASKED ABOUT.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(READ SERVICES BELOW)' IF MV11 IS NOT CODED '95' (NO SERVICES), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF MV11 IS CODED '95' (NO SERVICES), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY 'the same services'.
----------------------------------------------------
----------------------------------------------------
FOR 'PERSON'S MV MEDICAL CONDITION.', DISPLAY ALL CONDITIONS SELECTED OR ADDED TO PERSON'S-MEDICAL-CONDITIONS-ROSTER AT MV09.

FOR 'SERVICES RECEIVED..', DISPLAY THE FOLLOWING TEXT FOR EACH CODE ENTERED AT MV11:

CODE '1' = LABORATORY TESTS
CODE '2' = SONOGRAM/ULTRASOUND
CODE '3' = X-RAYS
CODE '4' = MAMMOGRAM
CODE '5' = MRI/CATSCAN
CODE '6' = EKG/ECG
CODE '7' = EEG
CODE '8' = VACCINATION
CODE '9' = ANESTHESIA
CODE '10' = OTHER SERVICES
----------------------------------------------------
----------------------------------------------------
FLAG EACH VISIT SELECTED AT MV18 AS A REPEAT VISIT RELATED TO THE EVENT BEING ASKED ABOUT.

FLAG THE CHARGE PAYMENT (CP) STATUS OF EACH REPEAT VISIT AS 'PROCESSED'.

LINK CONDITION(S) AND SERVICE(S) ASSOCIATED WITH THE EVENT BEING ASKED ABOUT WITH EACH REPEAT VISIT.

THE EVENT DRIVER WILL NOT SERVE THESE REPEAT VISITS FOR THE MV SECTION.
----------------------------------------------------

MV19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
INTERVIEWER: RECORD 'NAME OF REPEAT VISIT GROUP' FOR EVENTS SELECTED IN PREVIOUS QUESTION:
[Enter Repeat Visit Group] .............

BOX_07
======

----------------------------------------------------
IF THE CHARGE/PAYMENT (CP) SECTION IS NOT COMPLETED FOR THIS MEDICAL PROVIDER VISIT (MV) EVENT, GO TO THE CHARGE/PAYMENT (CP) SECTION
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION
----------------------------------------------------


Dental Care (DN) Section


DN01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was this visit because of an accident or injury?
YES .................................... 1
NO ..................................... 2 [DN03]
REF ................................... -7 [DN03]
DK .................................... -8 [DN03]
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY.

DN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What kind of dental injury did (PERSON) have?
PROBE: Any other injury?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO THE CONDITION ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
----------------------------------------------------
----------------------------------------------------
EACH CONDITION SELECTED OR ADDED AT DN02 SHOULD BE FLAGGED AS 'DUE TO ACCIDENT/INJURY'. THIS WILL BE USED TO PRECODE THE RESPONSE TO CN02_02 ('Was this due to an accident/injury?') AS '1' (YES).
----------------------------------------------------

DN03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
What type of dental care provider did (PERSON) see during this visit?
PROBE: Any other type of dental care person?

CODE ALL THAT APPLY.
GENERAL DENTIST ........................ 1
DENTAL HYGIENIST ....................... 2
DENTAL TECHNICIAN ...................... 3
DENTAL SURGEON ......................... 4
ORTHODONTIST ........................... 5
ENDODONTIST ............................ 6
PERIODONTIST ........................... 7
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

DN04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
SHOW CARD DN-1.
What did (PERSON) have done during this visit?
PROBE: What else was done?

CODE ALL THAT APPLY.
FOR DEFINITIONS OF ANSWER CATEGORIES, PRESS F1.
*DIAGNOSTIC OR PREVENTATIVE
GENERAL EXAM, CHECKUP OR CONSULTATION .. 1
CLEANING, PROPHYLAXIS, OR POLISHING .... 2
X-RAYS, RADIOGRAPHS, OR BITEWINGS ...... 3
FLUORIDE TREATMENT ..................... 4
SEALANT (PLASTIC COATINGS ON BACK TEETH) ................................. 5
*RESTORATIVE OR ENDODONTIC
FILLINGS ............................... 6
INLAYS ................................. 7
CROWNS OR CAPS ......................... 8
ROOT CANAL ............................. 9
*PERIODONTIC (GUM TREATMENT)
PERIODONTAL SCALING, ROOT PLANING, OR GUM SURGERY ............................ 10
PERIODONTAL RECALL VISIT (PERIODIC OR REGULAR) ............................... 11
*ORAL SURGERY
EXTRACTION, TOOTH PULLED ............... 12
IMPLANTS ............................... 13
ABSCESS OR INFECTION TREATMENT ......... 14
OTHER ORAL SURGERY ..................... 15
*PROSTHETICS
FIXED BRIDGES .......................... 16
DENTURES OR REMOVABLE PARTIAL DENTURES . 17
RELINING OR REPAIR OF BRIDGES OR DENTURES ............................... 18
*ORTHODONTICS
ORTHODONTIA, BRACES, OR RETAINERS ...... 19
*ADDITIONAL PROCEDURES
BOND, WHITEN, OR BLEACH ................ 20
TREATMENT FOR TMD OR TMJ ............... 21
OTHER .................................. 91
REF .................................... -7
DK ..................................... -8
[Code All That Apply]
----------------------------------------------------
IF CODE '91' (OTHER) ENTERED ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH DN04OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO DN05
----------------------------------------------------
----------------------------------------------------
HEADINGS AND CODE CATEGORIES WILL NOT FIT ON ONE SCREEN. THEREFORE, HEADINGS WILL ONLY APPEAR ON F1 SCREEN AND SHOW CARD DN-1. HEADINGS SHOULD BE ASSOCIATED WITH CODES AS FOLLOWS:
*DIAGNOSTIC OR PREVENTATIVE = CODES 1-5
*RESTORATIVE OR ENDODONTIC = CODES 6-9
*PERIODONTIC (GUM TREATMENT) = CODES 10-11
*ORAL SURGERY = CODES 12-15
*PROSTHETICS = CODES 16-18
*ORTHODONTICS = CODE 19
*ADDITIONAL PROCEDURES = CODES 20-21 AND 91
----------------------------------------------------

DN04OV
======

ENTER OTHER TYPE OF DENTAL CARE:
[Enter Other Specify]..................
REF ................................... -7
DK .................................... -8

DN05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
During this visit, were any medicines prescribed for (PERSON)? Please include only prescriptions which were filled.
YES .................................... 1
NO ..................................... 2 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
PRESS F1 FOR DEFINITION OF PRESCRIBED MEDICINE.

DN06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Please tell me the names of the prescriptions from this visit that were filled.
PROBE: Any other prescriptions from this visit filled?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Prescribed Medicine] ...............
[2. Prescribed Medicine] ...............
[3. Prescribed Medicine] ...............
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS

1. INTERVIEWER MAY SELECT A MEDICINE(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF MEDICINES AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF MEDICINES).
3. INTERVIEWER SHOULD BE ABLE TO DELETE A MEDICINE THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A MEDICINE ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST ENTERED.'
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF THE CHARGE/PAYMENT SECTION HAS NOT BEEN ASKED FOR THE EVENT-PROVIDER PAIR BEING ASKED ABOUT, GO TO THE CHARGE/PAYMENT SECTION.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION.
----------------------------------------------------


Home Health (HH) Section


BOX_00
======

----------------------------------------------------
IF EVENT MONTH IS INTERVIEW MONTH, GO TO BOX_05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_01
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF PROVIDER IS FLAGGED AS 'AGENCY', CONTINUE WITH HH01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA) ...... 1
COMPANION .............................. 2
DIETITIAN/NUTRITIONIST ................. 3
HOME HEALTH/HOME CARE AIDE ............. 4
HOSPICE WORKER ......................... 5
HOMEMAKER .............................. 6
I.V. OR INFUSION THERAPIST ............. 7
MEDICAL DOCTOR ......................... 8
NURSE/NURSE PRACTITIONER ............... 9
NURSE'S AIDE .......................... 10
OCCUPATIONAL THERAPIST ................ 11
PERSONAL CARE ATTENDANT ............... 12
PHYSICAL THERAPIST .................... 13
RESPIRATORY THERAPIST ................. 14
SOCIAL WORKER ......................... 15
SPEECH THERAPIST ...................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER . 91
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN: 'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

HH02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
What type of health care worker was it?
CODE ALL THAT APPLY.
NONSKILLED WORKER (ANY TYPE OF WORKER WHO PROVIDES HOME CARE SERVICES WHICH GENERALLY FALL INTO COMPANION, HOMEMAKER, PERSONAL CARE CATEGORIES. THESE WORKERS MAY ALSO PERFORM MINOR HEALTH CARE ACTIVITIES SUCH AS
ADMINISTERING MEDICATIONS)............ 1
SKILLED WORKER.......................... 2
OTHER TYPE OF HEALTH CARE WORKER....... 91
REF.................................... -7
DK..................................... -8
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN: 'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (NONSKILLED WORKER) ALONE, OR IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (SKILLED WORKER) ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HH02OV1
----------------------------------------------------
----------------------------------------------------
IF NOT CODED '2' BUT CODED '91' (ALONE OR IN COMBINATION WITH ANY CODE EXCEPT '2'), GO TO HH02OV2
----------------------------------------------------

HH02OV1
=======

SPECIFY TYPE OF SKILLED WORKER:
[Enter Other Specify]...................
REF.................................... -7
DK..................................... -8
----------------------------------------------------
IF HH02 INCLUDES CODE '91', CONTINUE WITH HH02OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

HH02OV2
=======

ENTER OTHER TYPE OF HEALTH CARE WORKER:
[Enter Other Specify]...................
REF.................................... -7
DK..................................... -8

HH03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
Thinking about the home care services (PERSON) (have/has) received from [someone from] (PROVIDER) during (VISIT MONTH), were any of these home care services because of a hospitalization, either before or after [PERSON'S STR-DT]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF HOSPITALIZATION.
[Code One]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE REFERENCE PERIOD START DATE FOR THE PERSON BEING ASKED ABOUT FOR 'PERSON'S STR-DT'.
----------------------------------------------------

HH04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
Thinking about all of the home care services (PERSON) (have/has) received from [someone from] (PROVIDER) during (VISIT MONTH), were any of these home care services related to any specific health problem?
IF OLD AGE MENTIONED, CODE 1 FOR YES AND ENTER 'OLD AGE' AS CONDITION.
YES .................................... 1
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
PRESS F1 FOR DEFINITION OF HEALTH PROBLEM.
[Code One]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------

HH05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
What health condition led (PERSON) to receive home health care services from [someone from] (PROVIDER) during (VISIT MONTH)?
PROBE: Any other health condition?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEMS DISPLAYS PERSON'S-MEDICAL-CONDITIONS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
4. ANY CONDITION ADDED TO THE CONDITION ROSTER SHOULD BE FLAGGED AS 'CREATED' THIS ROUND (WITH THE ROUND STATUS). ANY CONDITION SELECTED AT THE CONDITION ROSTER SHOULD BE FLAGGED AS 'SELECTED' THIS ROUND (WITH THE ROUND STATUS). THIS FLAGGING SHOULD OCCUR, AT ALL CONDITION ROSTERS THROUGHOUT THE INSTRUMENT, THE FIRST TIME THE CONDITION IS ADDED OR SELECTED DURING THE ROUND. FOR EXAMPLE, IF IT IS ROUND 1, ALL CONDITIONS ON THE ROSTER WOULD HAVE THE FLAG 'CREATED - ROUND 1'. IF A CONDITION IS CREATED IN CE, BUT SELECTED IN MV, ALL DURING ROUND 1, IT WOULD ONLY HAVE THE FLAG 'CREATED- ROUND 1'. THUS, FOR ANY ONE ROUND, A CONDITION CAN ONLY BE FLAGGED AS 'CREATED' OR 'SELECTED'. IF IT IS ROUND 2 AND A CONDITION THAT WAS CREATED IN ROUND 1 IS SELECTED, IT SHOULD BE FLAGGED AS 'SELECTED - ROUND 2'. THIS FLAG IS IN ADDITION TO THE ORIGINAL 'CREATED - ROUND 1' FLAG.
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF PROVIDER FLAGGED AS 'INFORMAL', GO TO HH08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HH06
----------------------------------------------------

HH06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-2.
Please look at the top of this card.
During (VISIT MONTH), did [someone from] (PROVIDER) help (PERSON) by providing medical treatments or any type of therapy?
PROBE: Medical treatments include things like changing bandages, wound care, giving medication, taking blood pressure, or giving shots or injections. Therapy includes physical, occupational, and speech therapy.
YES, AT LEAST ONCE ..................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR OTHER EXAMPLES OF MEDICAL TREATMENTS AND THERAPY.
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------

HH07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-2.
Now look at the gray area in the middle of the card.
During (VISIT MONTH), did [someone from] (PROVIDER) provide or teach (PERSON) or a friend or relative how to use any medical equipment or assistive device, such as the items listed on this card?
PROBE: For example, an oxygen tank, a wheelchair, a walker, a hospital bed, a tub seat, or a special railing or commode.
YES, AT LEAST ONCE ..................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------

HH08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
[SHOW CARD HH-2. Now look at the bottom of this card./SHOW CARD HH-3.]
During (VISIT MONTH), did [someone from] (PROVIDER) help (PERSON) with daily activities or personal care tasks, such as those listed on this card?
PROBE: For example, using the telephone, paying bills, shopping, driving, doing housework, preparing meals, bathing, dressing, using the toilet, getting in or out of a bed or chair, walking or eating.
YES, AT LEAST ONCE ..................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'SHOW CARD HH-2.' AND 'Now look at the bottom of this card.' IF PROVIDER IS FLAGGED AS 'AGENCY' OR 'PAID INDEPENDENT'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'SHOW CARD HH-3.' IF PROVIDER IS FLAGGED AS 'INFORMAL'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------

HH09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
During (VISIT MONTH), did [someone from] (PROVIDER) provide companionship or company for (PERSON)?
PROBE: For example, reading, watching T.V., playing games, going for a walk or to a restaurant, or just being together.
YES, AT LEAST ONCE ..................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------

HH10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
Did [someone from] (PROVIDER) provide (PERSON) with any other home care services we have not yet talked about?
YES, AT LEAST ONCE ..................... 1
NO ..................................... 2 [HH11]
REF ................................... -7 [HH11]
DK .................................... -8 [HH11]
[Code One]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------

HH10OV
======

What other services?
[IF MEDICAL TREATMENT OR THERAPY MENTIONED, CTRL/B TO HH06 TO BE SURE CODE 1 IS ENTERED.
IF MEDICAL EQUIPMENT OR ASSISTIVE DEVICE MENTIONED, CTRL/B TO HH07 TO BE SURE CODE 1 IS ENTERED.]
IF DAILY ACTIVITIES OR PERSONAL CARE TASKS MENTIONED, CTRL/B TO HH08 TO BE SURE CODE 1 IS ENTERED.
IF COMPANIONSHIP MENTIONED, CTRL/B TO HH09 TO BE SURE CODE 1 IS ENTERED.
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'IF MEDICAL TREATMENT OR THERAPY MENTIONED, CTRL/B...' IF PROVIDER IS FLAGGED AS 'AGENCY' OR 'PAID INDEPENDENT'.
----------------------------------------------------

HH11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
Generally speaking, during (VISIT MONTH), did [someone from] (PROVIDER) come to the home to help (PERSON) every week or only during some weeks?
EVERY WEEK ............................. 1
SOME WEEKS ............................. 2 [HH13]
ONLY CAME ONCE ......................... 3 [HH16]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
[Code One]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------

HH12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
During (VISIT MONTH), about how many days per week did [someone from] (PROVIDER) come?
PROBE: We just need to know in general.
[Enter Number of Days Per Week] ....... [HH14]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 1-7 FOR NUMBER OF DAYS.
----------------------------------------------------

HH13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
About how many days during (VISIT MONTH) did [someone from] (PROVIDER) come?
PROBE: We just need to know in general.
[Enter Number of Days Per Month] .......
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK:
IF (VISIT MONTH) IS: JANUARY, MARCH, MAY, JULY, AUGUST, OCTOBER OR DECEMBER: 1-31 FOR NUMBER OF DAYS.
IF (VISIT MONTH) IS: APRIL, JUNE, SEPTEMBER OR NOVEMBER: 1-30 FOR NUMBER OF DAYS.
IF (VISIT MONTH) IS: FEBRUARY: 1-29 FOR NUMBER OF DAYS.
----------------------------------------------------

HH14
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
During (VISIT MONTH), did [someone from] (PROVIDER) come once per day or more than once per day?
PROBE: We just need to know in general.
ONCE PER DAY ........................... 1 [HH16]
MORE THAN ONCE PER DAY ................. 2
24 HOURS PER DAY ....................... 3 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
[Code One]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------

HH15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
During (VISIT MONTH), how many times per day did [someone from] (PROVIDER) come to the home to help (PERSON)?
PROBE: We just need to know in general.
[Enter Number of Times Per Day] .......
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 2-6 FOR NUMBER OF TIMES.
----------------------------------------------------

HH16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
How long did [each visit usually/the visit] last?
PROBE: We just need to know in general.

IF RESPONSE IS LESS THAN ONE HOUR, ENTER '0' FOR HOURS.

HH16_01
=======

ENTER HOURS:
[Enter Hours] ......................
REF ................................. -7 [BOX_03]
DK .................................. -8 [BOX_03]

HH16_02
=======

ENTER MINUTES:
[Enter Minutes] .....................
REF ................................. -7
DK .................................. -8
----------------------------------------------------
DISPLAY 'each visit usually' IF HH11 IS NOT CODED '3' (ONLY CAME ONCE). DISPLAY 'the visit' IF HH11 IS CODED '3' (ONLY CAME ONCE).
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 0-24 IF NUMBER OF HOURS. 0-59 IF NUMBER OF MINUTES.
----------------------------------------------------
----------------------------------------------------
EDIT CHECK: IF '0' ENTERED IN BOTH HH16_01 AND HH16_02 DISPLAY MESSAGE: NUMBER MUST BE ENTERED IN EITHER HOURS OR MINUTES.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF 2 OR MORE MONTHS, EXCLUDING INTERVIEW MONTH, FOR THIS PROVIDER FOR THIS PERSON HAVE NOT COMPLETED THE HOME HEALTH (HH) UTILIZATION SECTION AND IF THIS EVENT IS NOT PART OF A FLAT FEE GROUP, CONTINUE WITH HH17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_04
----------------------------------------------------

HH17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
I have recorded that (PERSON) received services from (PROVIDER) during other months. Were the services received from (PROVIDER) during the other months similar to the services received during (VISIT MONTH). That is, in the other months, did (PROVIDER) visit [the same number of times/(READ FREQUENCY BELOW)] and provide [the same services/(READ SERVICES BELOW)]?
FREQUENCY SERVICES
[FREQUENCY OF SERVICES...] [DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
[DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
[DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
[DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
[DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
YES .................................... 1
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
[Code One]
----------------------------------------------------
DISPLAY 'the same number of times' IF HH12 AND HH13 WERE NOT ASKED OR WERE CODED '-7' (REFUSED) OR '-8' (DON'T KNOW). OTHERWISE, DISPLAY '(READ FREQUENCY BELOW)'.

IF HH06 - HH10 ARE ALL CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), OR ANY COMBINATION OF ONLY THESE CODES, DISPLAY 'the same services'. OTHERWISE, DISPLAY '(READ SERVICES BELOW)'.
----------------------------------------------------
----------------------------------------------------
FREQUENCY =
DISPLAY NUMBER AND 'DAYS PER WEEK' IF A RESPONSE WAS RECORDED AT HH12.
DISPLAY NUMBER AND 'DAYS PER MONTH' IF A RESPONSE WAS RECORDED AT HH13.
DISPLAY 'THE SAME NUMBER OF TIMES' IF HH12 AND HH13 WERE NOT ASKED OR WERE CODED '-7' (REFUSED) OR '-8' (DON'T KNOW).
----------------------------------------------------
----------------------------------------------------
SERVICES =
FOR EACH CODE 1 RECORDED AT HH06, HH07, HH08, HH09, AND HH10, DISPLAY THE FOLLOWING SERVICE ABBREVIATIONS FOR 'DESCRIPTION OF SERVICE':

IF HH06 = 1, DISPLAY 'MEDICAL TREATMENT OR THERAPY'
IF HH07 = 1, DISPLAY 'MEDICAL EQUIPMENT OR ASSISTIVE DEVICE INSTRUCTION.'
IF HH08 = 1, DISPLAY 'HELP WITH DAILY ACTIVITIES OR PERSONAL CARE'
IF HH09 = 1, DISPLAY 'COMPANIONSHIP'
IF HH10 = 1, DISPLAY TEXT ENTERED AT HH10OV
IF HH06 - HH10 ARE ALL CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), OR ANY COMBINATION OF ONLY THESE CODES, DISPLAY 'THE SAME SERVICES'.
----------------------------------------------------

HH18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
During which of the following months did (PROVIDER) visit [the same number of times/(READ FREQUENCY BELOW)] and provide [the same services/(READ SERVICES BELOW)]?
PROBE: Any other months with the same number of visits and the same services?

FREQUENCY SERVICES
[FREQUENCY OF SERVICES...] [DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
[DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
[DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
[DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
[DESCRIPTION OF HOME HEALTH SERVICES RECEIVED]
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. Month, Year-2]
[2. Month, Year-2]
[3. Month, Year-2]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL EVENTS (MONTHS) IN PERSON'S-MEDICAL-EVENTS-ROSTER THAT WERE CREATED THIS ROUND, EXCLUDING INTERVIEW MONTH, HAVE NOT YET BEEN PROCESSED THROUGH UTILIZATION, HAVE EVENT TYPE 'HH', AND ARE ASSOCIATED WITH THE SAME PROVIDER AS THE EVENT BEING ASKED ABOUT DURING THIS ROUND.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'the same number of times' IF HH12 AND HH13 WERE NOT ASKED OR WERE CODED '-7' (REFUSED) OR '-8' (DON'T KNOW). OTHERWISE, DISPLAY '(READ FREQUENCY BELOW)'.

IF HH06 - HH10 ARE ALL CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), OR ANY COMBINATION OF ONLY THESE CODES, DISPLAY 'the same services'. OTHERWISE, DISPLAY '(READ SERVICES BELOW)'.
----------------------------------------------------
----------------------------------------------------
FREQUENCY =
DISPLAY NUMBER AND 'DAYS PER WEEK' IF A RESPONSE WAS RECORDED AT HH12.
DISPLAY NUMBER AND 'DAYS PER MONTH' IF A RESPONSE WAS RECORDED AT HH13.
DISPLAY 'THE SAME NUMBER OF TIMES' IF HH12 AND HH13 WERE NOT ASKED OR WERE CODED '-7' (REFUSED) OR '-8' (DON'T KNOW).
----------------------------------------------------
----------------------------------------------------
SERVICES =
FOR EACH CODE 1 RECORDED AT HH06, HH07, HH08, HH09, AND HH10, DISPLAY THE FOLLOWING SERVICE ABBREVIATIONS FOR 'DESCRIPTION OF SERVICE':

IF HH06 = 1, DISPLAY 'MEDICAL TREATMENT OR THERAPY'
IF HH07 = 1, DISPLAY 'MEDICAL EQUIPMENT OR ASSISTIVE DEVICE INSTRUCTION.'
IF HH08 = 1, DISPLAY 'HELP WITH DAILY ACTIVITIES OR PERSONAL CARE'
IF HH09 = 1, DISPLAY 'COMPANIONSHIP'
IF HH10 = 1, DISPLAY TEXT ENTERED AT HH10OV
IF HH06 - HH10 ARE ALL CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), OR ANY COMBINATION OF ONLY THESE CODES, DISPLAY 'THE SAME SERVICES'.
----------------------------------------------------
----------------------------------------------------
FLAG EACH MONTH SELECTED AT HH18 AS A REPEAT VISIT RELATED TO THE EVENT BEING ASKED ABOUT. FLAG THE CHARGE PAYMENT (CP)STATUS OF EACH REPEAT VISIT AS 'PROCESSED.'
----------------------------------------------------
----------------------------------------------------
LINK FREQUENCY AND SERVICE(S) ASSOCIATED WITH THE EVENT BEING ASKED ABOUT WITH EACH REPEAT VISIT. FLAG EVENT AS PROCESSED SO THAT THE EVENT DRIVER WILL NOT SERVE THESE REPEAT VISITS FOR THE HH SECTION.
----------------------------------------------------

HH19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
INTERVIEWER: RECORD 'NAME OF REPEAT VISIT GROUP' FOR MONTHS SELECTED IN PREVIOUS QUESTION.
[Enter Repeat Month Group].............

BOX_04
======

----------------------------------------------------
IF THE CHARGE/PAYMENT (CP) SECTION IS NOT COMPLETED FOR THIS HOME HEALTH EVENT, ASK THE CHARGE/PAYMENT (CP) SECTION
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_05
----------------------------------------------------

BOX_05
======

----------------------------------------------------
GO TO THE EVENT DRIVER (ED) SECTION
----------------------------------------------------


Other Medical Expenses (OM) Section


BOX_01
======

----------------------------------------------------
IF THE OM ITEM TYPE IS NOT INSULIN OR OTHER DIABETIC EQUIPMENT OR SUPPLIES, CONTINUE WITH OM01
----------------------------------------------------
----------------------------------------------------
IF THE OM ITEM TYPE IS INSULIN OR OTHER DIABETIC EQUIPMENT OR SUPPLIES, GO TO OM02
----------------------------------------------------

OM01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
NOTE:
NO UTILIZATION SECTION IS REQUIRED FOR [GLASSES OR CONTACT LENSES/AMBULANCE SERVICES/ORTHOPEDIC ITEMS/HEARING DEVICES/ PROSTHESES/BATHROOM AIDS/MEDICAL EQUIPMENT/DISPOSABLE SUPPLIES/ ALTERATIONS OR MODIFICATIONS/[TEXT FROM OTHER SPECIFY]].
PRESS ENTER TO CONTINUE.
----------------------------------------------------
DISPLAY 'GLASSES OR CONTACT LENSES' IF EVENT TYPE IS OM AND ITEM TYPE IS CODED '1' (GLASSES OR CONTACT LENSES.) DISPLAY 'AMBULANCE SERVICES' IF EVENT TYPE IS OM AND ITEM TYPE IS CODED '4' (AMBULANCE SERVICES). DISPLAY 'ORTHOPEDIC ITEMS' IF EVENT TYPE IS OM AND ITEM TYPE IS CODED '5' (ORTHOPEDIC ITEMS). DISPLAY 'HEARING DEVICES' IF EVENT TYPE IS OM AND ITEM TYPE IS CODED '6' (HEARING DEVICES). DISPLAY 'PROSTHESES' IF EVENT TYPE IS OM AND ITEM TYPE IS CODED '7' (PROSTHESES). DISPLAY 'BATHROOM AIDS' IF EVENT TYPE IS OM AND ITEM TYPE IS CODED '8' (BATHROOM AIDS). DISPLAY 'MEDICAL EQUIPMENT' IF EVENT TYPE IS OM AND ITEM TYPE IS CODED '9' (MEDICAL EQUIPMENT). DISPLAY 'DISPOSABLE SUPPLIES' IS EVENT TYPE IS OM AND ITEM TYPE IS CODED '10' (DISPOSABLE SUPPLIES). DISPLAY 'ALTERATIONS OR MODIFICATIONS' IF EVENT TYPE IS OM AND ITEM TYPE IS CODED '11' (ALTERATIONS/MODIFICATIONS). FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS WHEN OM ITEM TYPE IS CODED '91' (OTHER).
----------------------------------------------------
----------------------------------------------------
IF THE CHARGE/PAYMENT (CP) SECTION HAS NOT BEEN ASKED FOR THE EVENT BEING ASKED ABOUT, GO TO THE CP SECTION
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION
----------------------------------------------------

OM02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
NOTE:
[INSULIN/OTHER DIABETIC EQUIPMENT OR SUPPLIES] WILL BE PROCESSED LIKE A PRESCRIBED MEDICINE.
AT THIS TIME, NO UTILIZATION OR CHARGE/PAYMENT SECTION WILL BE ASKED.
PRESCRIBED MEDICINE QUESTIONS AND CHARGE/PAYMENT DATA WILL BE COLLECTED LATER.
PRESS ENTER TO CONTINUE.
----------------------------------------------------
DISPLAY 'INSULIN' IF OM ITEM TYPE BEING ASKED ABOUT IS INSULIN. DISPLAY 'OTHER DIABETIC EQUIPMENT OR SUPPLIES' IF OM TYPE BEING ASKED ABOUT IS OTHER DIABETIC EQUIPMENT OR SUPPLIES.
----------------------------------------------------
----------------------------------------------------
FLAG THE OM CHARGE/PAYMENT (CP) SECTION AS 'PROCESSED'. INSULIN AND OTHER DIABETIC EQUIPMENT AND SUPPLIES WILL BE PROCESSED THROUGH CP AS PRESCRIBED MEDICINES.
----------------------------------------------------

BOX_02
======

----------------------------------------------------
GO TO THE EVENT DRIVER (ED) SECTION
----------------------------------------------------


Charge Payment (CP) Section


BOX_00
======

----------------------------------------------------
NOTE: THROUGHOUT THE CHARGE/PAYMENT (CP) SECTION, ENTRY OF ALL DOLLAR AMOUNTS WILL INCLUDE ONLY WHOLE DOLLARS. ENTRY OF CENTS WILL BE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
IF EVENT TYPE IS HH AND HH PROVIDER ASSOCIATED WITH THE EVENT BEING ASKED ABOUT IS FLAGGED AS 'AGENCY' OR 'INFORMAL', GO TO BOX_26
----------------------------------------------------
----------------------------------------------------
IF EVENT TYPE IS MV AND MV01 IS CODED '2'(TELEPHONE CALL)
OR
IF EVENT TYPE IS OP AND OP02 IS CODED '2' (TELEPHONE CALL), GO TO BOX_26
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_01
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF EVENT TYPE IS PM, CONTINUE WITH BOX_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_03
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF PERSON ALREADY FLAGGED AS 'NO CP INFORMATION FOR PM EVENTS NECESSARY' FOR THE CURRENT ROUND, GO TO BOX_26
----------------------------------------------------
----------------------------------------------------
IF PERSON ALREADY FLAGGED AS 'CP INFORMATION FOR PM EVENTS NECESSARY' FOR THE CURRENT ROUND, GO TO CP03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CP01
----------------------------------------------------

CP01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) (or someone in the family) send in a claim form to the insurance company for (PERSON)'s prescription medicines or does the pharmacy automatically do this for (PERSON)'s prescription medicines?
FAMILY SENDS IN CLAIM FORMS ............ 1 [CP03]
PHARMACY AUTOMATICALLY FILES CLAIM ..... 2 [BOX_26]
NOT EITHER TYPE OF SITUATION ........... 3 [BOX_26]
REF ................................... -7 [CP03]
DK .................................... -8 [CP03]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code One]
----------------------------------------------------
IF CODED '2' (PHARMACY AUTOMATICALLY FILES CLAIM), OR '3' (NOT EITHER TYPE OF SITUATION), FLAG THIS PERSON AS 'NO CP INFORMATION FOR PM EVENTS NECESSARY' FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (FAMILY SENDS IN CLAIM FORMS), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG THIS PERSON AS 'CP INFORMATION FOR PM EVENTS NECESSARY' FOR THE CURRENT ROUND.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF FIRST TIME THROUGH CHARGE PAYMENT FOR THIS PERSON-PROVIDER PAIR AND PAIR WAS FLAGGED AS 'COPAYMENT SITUATION' DURING THE PREVIOUS ROUND, CONTINUE WITH CP02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CP03
----------------------------------------------------

CP02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Before we talk about the charges for [(PERSON)'S visit to (PROVIDER) on (VISIT DATE)/(PROVIDER)'s services as a part of the visit made on (VISIT DATE)], let me take a moment to verify some information.
Last time we recorded that (PERSON) (or someone in the family) usually pay(s) a [$ AMT COPAY] copayment to (PROVIDER). Is this still the correct copayment amount?
YES .................................... 1 [CP03]
NO ..................................... 2
NOT A COPAYMENT SITUATION ANYMORE ..... 99 [CP03]
REF ................................... -7 [CP03]
DK .................................... -8 [CP03]
[Code One]
PRESS F1 FOR DEFINITION OF COPAYMENT.
----------------------------------------------------
IF CODED '99' (NOT A COPAYMENT SITUATION ANYMORE), DO NOT FLAG THIS PERSON-PROVIDER AS 'COPAYMENT SITUATION' FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG THIS PERSON-PROVIDER PAIR AS 'COPAYMENT SITUATION' FOR THE CURRENT ROUND AND SET COPAYMENT AMOUNT FROM THE PREVIOUS ROUND AS THE COPAYMENT AMOUNT FOR THE CURRENT ROUND.
----------------------------------------------------

CP02OV
======
What is the correct copayment amount?
[Enter $ Amount] ......................
NOT A COPAYMENT SITUATION ANYMORE ..... 99
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SET SMALL DOLLAR AMOUNT ENTERED AT CP02OV AS THE NEW COPAYMENT AMOUNT FOR THIS PERSON-PROVIDER PAIR FOR THE CURRENT ROUND. USE THIS AMOUNT IN CP04.
----------------------------------------------------
----------------------------------------------------
IF CODED '99' (NOT A COPAYMENT SITUATION ANYMORE), DO NOT FLAG THIS PERSON-PROVIDER AS 'COPAYMENT SITUATION' FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG THIS PERSON-PROVIDER PAIR AS 'COPAYMENT SITUATION' FOR THE CURRENT ROUND AND SET COPAYMENT AMOUNT FROM PREVIOUS ROUND AS COPAYMENT AMOUNT FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: DOLLAR AMOUNT MUST BE WHOLE DOLLAR AMOUNT ( OR = $50.
----------------------------------------------------

CP03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Now I'd like to ask you about the charges for [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the last purchase of [NAME OF PRESCRIBED MEDICINE...] for (PERSON)/the services for (FLAT FEE GROUP) for (PERSON)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)].
[Let's begin with the charges from the hospital itself, not including any separate physician services or lab tests.]
PRESS ENTER TO CONTINUE.
PRESS F1 FOR DEFINITION OF CHARGE.
----------------------------------------------------
IF PERSON-PROVIDER PAIR FLAGGED AS 'COPAYMENT SITUATION' FOR THE CURRENT ROUND, AND THIS EVENT- PROVIDER PAIR DOES NOT REPRESENT A FLAT FEE GROUP, GO TO CP04
----------------------------------------------------
----------------------------------------------------
IF EVENT TYPE IS OM AND OM GROUP TYPE IS 'ADDITIONAL' (EV02A=2), CONTINUE WITH CP03A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CP05
----------------------------------------------------

CP03A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Did (PERSON) (or anyone in the family) purchase or rent the [OME ITEM GROUP NAME] used by (PERSON)?
CODE '95' IF RESPONDENT VOLUNTEERS OME ITEM GROUP HAD NO CHARGE BECAUSE IT WAS BORROWED OR FREE FROM A CHARITY, ETC.
PURCHASED .............................. 1 [CP05]
RENTED ................................. 2 [CP05]
NO CHARGE: BORROWED, FREE FROM CHARITY/ORGANIZATION, ETC. .......... 95 [BOX_26]
REF ................................... -7 [CP05]
DK .................................... -8 [CP05]
[Code One]

CP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Is this the type of situation where (PERSON) (or someone in the family) only paid the [$ AMT COPAY] copayment for [this visit/these services] and (PERSON) (do/does) not know the total charge?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF COPAYMENT AND TOTAL CHARGE.
----------------------------------------------------
IF CODED '1' (YES), COPY ALL PREVIOUS COPAYMENT CHARGE PAYMENT DATA FOR THE PERSON-PROVIDER PAIR TO THIS EVENT-PROVIDER-PAIR. THEN GO TO CP37
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), IGNORE 'COPAYMENT SITUATION' FLAG FOR THIS PERSON-PROVIDER PAIR FOR THIS EVENT (THAT IS, COLLECT CHARGE/PAYMENT INFORMATION FOR THIS EVENT- PROVIDER PAIR) AND CONTINUE WITH CP05
----------------------------------------------------

CP05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
(Have/Has) (PERSON) (or anyone in the family) received anything in writing, such as a bill, receipt, or statement, for [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/ (PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the last purchase of [NAME OF PRESCRIBED MEDICINE...] for (PERSON)/the services for (FLAT FEE GROUP) for (PERSON)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)]?
PROBE: Include anything in writing received by family members living with (PERSON) as well as those living somewhere else.
YES, AND DOCUMENTATION AVAILABLE ....... 1 [CP08]
YES, BUT DOCUMENTATION NOT AVAILABLE ... 2 [CP08]
NO ..................................... 3
NO, FREE SAMPLE ........................ 4 [CP37]
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF ANYTHING IN WRITING.
----------------------------------------------------
NOTE: CAPI DISPLAYS CODE '4' (NO, FREE SAMPLE) ONLY IF THE EVENT TYPE OF THE EVENT-PROVIDER PAIR IS PM.
----------------------------------------------------

CP06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
SHOW CARD CP-1.
Why (have/has) (PERSON) (or anyone in the family) not received anything in writing?
[CODE '95' IF THIS IS A FLAT FEE SITUATION.]
PAID AT TIME OF VISIT ................... 1 [CP08]
MADE A COPAYMENT ........................ 2 [CP08]
BILL SENT DIRECTLY TO OTHER SOURCE ...... 3
BILL HAS NOT ARRIVED .................... 4 [CP08]
NO BILL SENT:
HMO PLAN .............................. 5 [BOX_04]
VA .................................... 6 [BOX_04]
MILITARY FACILITY ..................... 7 [BOX_04]
WELFARE/MEDICAID ...................... 8 [BOX_04]
WORKER'S COMPENSATION ................. 9 [BOX_04]
PRIVATE HEALTH CENTER/CLINIC .......... 10 [BOX_04]
PUBLIC CLINIC/HEALTH CENTER OR PRIVATE CHARITY ............................ 11 [B0X_04]
NO CHARGE: TELEPHONE CALL ............. 12 [CP37]
FREE FROM PROVIDER ..................... 13 [CP37]
GOVERNMENT-FINANCED RESEARCH AND CLINICAL TRIALS ........................ 14 [CP37]
INCLUDED WITH OTHER CHARGES ............ 95
REF .................................... -7 [CP08]
DK ..................................... -8 [CP08]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES AND FLAT FEE.
----------------------------------------------------
NOTE: SHOW CARD FOR CODE '10' WILL READ: 'SCHOOL, EMPLOYER, OR OTHER PRIVATE HEALTH CENTER/CLINIC'.
THE SHOW CARD FOR CODE '11' WILL INCLUDE THE FOLLOWING: '(INCLUDE COMMUNITY AND MIGRANT HEALTH CENTER, FEDERALLY QUALIFIED HEALTH CENTER, INDIAN HEALTH SERVICES)'. THE SHOW CARD FOR CODE '13' WILL INCLUDE THE FOLLOWING: '(PROFESSIONAL COURTESY/FREE SAMPLE)'. THESE CODES HAVE BEEN ABBREVIATED TO CONSERVE SPACE ON THE SCREEN.
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT TYPE OF THE EVENT-PROVIDER PAIR IS PM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A PM EVENT. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A FLAT FEE GROUP. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT-PROVIDER PAIR REPRESENTS A REPEAT VISIT STEM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A REPEAT VISIT GROUP. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT TYPE OF THE EVENT-PROVIDER PAIR IS NOT PM AND THE EVENT-PROVIDER PAIR DOES NOT REPRESENT A FLAT FEE GROUP OR A REPEAT VISIT GROUP, ASK THE FLAT FEE (FF) SECTION.
----------------------------------------------------

CP07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
To whom was the bill sent?
RECORD VERBATIM:
[Enter Text]

CP07OV1
=======

INTERVIEWER: ENTER CODE FOR TYPE OF ORGANIZATION TO WHOM BILL WAS SENT:
HMO .................................... 1
VA ..................................... 2
CHAMPUS/CHAMPVA ........................ 3 [CP08]
OTHER MILITARY ......................... 4
WELFARE/MEDICAID ....................... 5
WORKER'S COMPENSATION .................. 6
PRIVATE INSURANCE COMPANY .............. 7
OTHER ................................. 91 [CP08]
REF ................................... -7 [CP08]
DK .................................... -8 [CP08]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

BOX_04
======

----------------------------------------------------
IF:
- EVENT TYPE IS OM, HH, OR PM
OR
- EVENT TYPE IS HS AND THE EVENT-PROVIDER PAIR IS NOT FLAGGED AS 'SEPARATELY BILLING'
OR
- THIS EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP, GO TO CP11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CP10
----------------------------------------------------

CP08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Do you know the total charge for [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the last purchase of [NAME OF PRESCRIBED MEDICINE...] for (PERSON)/the services for (FLAT FEE GROUP) for (PERSON)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)]?
[CODE '95' IF THIS IS A FLAT FEE SITUATION.]
YES .................................... 1 [CP09]
NO ..................................... 2
INCLUDED WITH OTHER CHARGES ........... 95
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF TOTAL CHARGE AND FLAT FEE.
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT TYPE OF THE EVENT-PROVIDER PAIR IS PM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A PM EVENT. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A FLAT FEE GROUP. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT-PROVIDER PAIR REPRESENTS A REPEAT VISIT STEM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A REPEAT VISIT GROUP. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT TYPE IS NOT PM AND THE EVENT-PROVIDER PAIR DOES NOT REPRESENT A FLAT FEE GROUP OR A REPEAT VISIT GROUP, ASK THE FLAT FEE (FF) SECTION.
----------------------------------------------------
----------------------------------------------------
IF:
CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)
AND
(EVENT TYPE IS OM, HH, OR PM
OR
EVENT TYPE IS HS AND THE EVENT-PROVIDER PAIR IS NOT FLAGGED AS 'SEPARATELY BILLING'
OR
THIS EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP), GO TO CP11
----------------------------------------------------
----------------------------------------------------
IF:
CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)
AND
EVENT TYPE IS ER, OP, MV, DN, OR EVENT-PROVIDER PAIR IS FLAGGED AS 'SEPARATELY BILLING', GO TO CP10
----------------------------------------------------

CP09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
How much was the total charge for [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the last purchase of [NAME OF PRESCRIBED MEDICINE...] for (PERSON)/the services for (FLAT FEE GROUP) for (PERSON)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)]?
Please include any amounts that may be paid by health insurance or other sources. [However, please do not include any services billed for separately such as physician charges or other services.]
[If charges for procedures such as x-rays, lab tests, or diagnostic procedures are listed separately on the bill or statement, include those in the total charge.]

IF WORKING FROM DOCUMENTATION, ENTER TOTAL CHARGES. DO NOT DEDUCT DISCOUNTS OR DISALLOWED OR DENIED CHARGES.
[CODE '95' IF THIS IS A FLAT FEE SITUATION.]
AMOUNT ................................. 1
INCLUDED WITH OTHER CHARGES ........... 95
[Code One]
PRESS F1 FOR DEFINITION OF WHAT MAKES UP TOTAL CHARGE AND FLAT FEE.
----------------------------------------------------
DISPLAY 'However, please do not include any services billed for separately such as physician charges or other services.' IF EVENT TYPE IS HS, ER, OR OP. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'If charges for procedures such as x-rays, lab tests, or diagnostic procedures are listed separately on the bill or statement, include those in the total charge.' IF CP05 IS CODED '1' (YES, AND DOCUMENTATION AVAILABLE). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT TYPE OF THE EVENT-PROVIDER PAIR IS PM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A PM EVENT. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODEIS NOT AVAILABLE FOR A FLAT FEE GROUP. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT-PROVIDER PAIR REPRESENTS A REPEAT VISIT STEM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A REPEAT VISIT GROUP. PRESS ENTER TO CONTINUE.'
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (INCLUDED WITH OTHER CHARGES) AND THE EVENT TYPE IS NOT PM AND THE EVENT-PROVIDER PAIR DOES NOT REPRESENT A FLAT FEE GROUP OR A REPEAT VISIT GROUP, ASK THE FLAT FEE (FF) SECTION.
----------------------------------------------------

CP09OV
======

ENTER $ AMOUNT:
[Enter $ Amount] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
POSSIBLE SOFT RANGE CHECK: $0 - $100,000
----------------------------------------------------
----------------------------------------------------
IF THE AMOUNT IS $0, GO TO CP37
----------------------------------------------------
----------------------------------------------------
IF THE AMOUNT IS NOT $0
AND
(EVENT TYPE IS OM OR PM
OR
THE EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP
OR
(EVENT TYPE IS HS AND THE EVENT-PROVIDER PAIR IS NOT FLAGGED AS 'SEPARATELY BILLING')) GO TO CP11
----------------------------------------------------
----------------------------------------------------
IF:
EVENT TYPE IS ER, OP, MV, DN, OR EVENT-PROVIDER PAIR IS FLAGGED AS 'SEPARATELY BILLING'
AND
TOTAL CHARGE IS A NON-ZERO WHOLE NUMBER ( OR = $50.00 OR CP090V IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO CP10
----------------------------------------------------
----------------------------------------------------
IF THE AMOUNT IS NOT $0, DK, OR REF AND THE EVENT TYPE IS HH, CONTINUE WITH CPO9A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CP11
----------------------------------------------------

CP09A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Let me be sure I recorded this correctly. The total charge for the services received at home from (PROVIDER) during (MONTH) for (PERSON) was [$ AMOUNT].
Is that correct?
YES .................................... 1 [CP11]
NO ..................................... 2
REF ................................... -7 [CP11]
DK .................................... -8 [CP11]
----------------------------------------------------
IF CODED '2' (NO), DISPLAY THE FOLLOWING MESSAGE:
'USE CTRL/B TO CORRECT TOTAL CHARGE FOR THIS MONTH. PRESS ENTER TO CONTINUE.'
----------------------------------------------------

CP10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Is this a situation in which (PERSON) (are/is) required to pay a certain set amount each time [(PERSON) (visit/visits) (PROVIDER) regardless of what happens during the visit/(PERSON) (receive/receives) services of this type]?
PROBE: For example, is this the type of situation in which (PERSON) always (make/makes) the same set dollar amount copayment?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF SET AMOUNT AND COPAYMENT.

CP11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
How much of the [[AMT TOT CH]/total charge] did anyone in the family pay for [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the last purchase of [NAME OF PRESCRIBED MEDICINE...] for (PERSON)/ the services for (FLAT FEE GROUP) for (PERSON)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON) /(PROVIDER)'s services as part of the visit made on (VISIT DATE)]?
Please include all amounts paid 'out-of-pocket,' that is, amounts paid before any reimbursements.

IF AMOUNT PAID IS NOTHING, DK, OR REF, ENTER 1 FOR DOLLARS, THEN RESPONSE.
IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1
PERCENT ................................ 2 [CP11OV2]
[Code One]
PRESS F1 FOR INFORMATION ON AMOUNTS TO INCLUDE.

CP11OV1
=======

ENTER DOLLARS:
[Enter $ Amount] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: $0 - $10,000
----------------------------------------------------
----------------------------------------------------
WRITE 'PERSON/FAMILY' TO THE RU-SOURCES-OF- PAYMENT-ROSTER.
----------------------------------------------------
----------------------------------------------------
WRITE 'PERSON/FAMILY' TO THE EVENT'S-SOURCES-OF- PAYMENT-ROSTER.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_05
----------------------------------------------------

CP11OV2
=======

ENTER PERCENT:
[Enter Percent %] ......................
----------------------------------------------------
SOFT RANGE CHECK: 1% - 100%
----------------------------------------------------
----------------------------------------------------
MULTIPLY THE PERCENTAGE ENTERED BY THE TOTAL CHARGE ENTERED AT CP09 TO CALCULATE THE AMOUNT PAID BY THE FAMILY AT CP11.
----------------------------------------------------
----------------------------------------------------
IF CP09 IS CODED '-7' (REFUSED), OR '-8' (DON'T KNOW), DOLLAR AMOUNT PAID BY FAMILY CANNOT BE CALCULATED. RECORD DOLLAR AMOUNT PAID BY PERSON/FAMILY AS 'DK' OR'REF' AS APPROPRIATE.
----------------------------------------------------
----------------------------------------------------
WRITE 'PERSON/FAMILY' TO THE RU-SOURCES-OF- PAYMENT-ROSTER.
----------------------------------------------------
----------------------------------------------------
WRITE 'PERSON/FAMILY' TO THE EVENT'S-SOURCES-OF- PAYMENT-ROSTER.
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF:
CP11OV1 OR CP11OV2 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW)
AND
CP08 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)
AND
CP10 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY THE FOLLOWING MESSAGE: 'NO CHARGE-PAYMENT RESOLUTION WILL BE NEEDED FOR THIS CASE. PRESS ENTER TO CONTINUE.' THEN GO TO CP37
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_01
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

SOURCE OF DIRECT PAYMENT 1
SOURCE OF DIRECT PAYMENT 2
SOURCE OF DIRECT PAYMENT 3
SOURCE OF DIRECT PAYMENT 4

ASK BOX_LP01-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ON SOURCES OF DIRECT PAYMENTS AND ASSOCIATED PAYMENT AMOUNTS, OTHER THAN PERSON/FAMILY. THE RESPONSE TO CP13OV DETERMINES WHETHER THE LOOP CYCLES AGAIN.
SUBSEQUENT CYCLES, IF ANY, COLLECT ADDITIONAL SOURCES OF DIRECT PAYMENT AND ASSOCIATED AMOUNTS.
IF CP13OV IS CODED '1' (YES), THE LOOP CYCLES AGAIN. IF CP13OV IS NOT ASKED OR IS CODED '2' (NO), THE LOOP ENDS.
----------------------------------------------------

BOX_LP01
========

----------------------------------------------------
IF FIRST CYCLE OF LOOP_01, CONTINUE WITH CP12
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ANY CYCLE SUBSEQUENT TO THE FIRST CYCLE OF LOOP_01), GO TO CP12A
----------------------------------------------------

CP12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Has any [other] source already paid [(PROVIDER)] for any of the charges for [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the last purchase of [NAME OF PRESCRIBED MEDICINE...] for (PERSON)/ the services for (FLAT FEE GROUP) for (PERSON)/the [OME ITEM GROUP NAME...........] used by (PERSON) since (START DATE)/for services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)]?
YES .................................... 1
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
PRESS F1 FOR A DEFINITION OF SOURCE AND 'ALREADY PAID'.
----------------------------------------------------
DISPLAY 'OTHER' IN THE QUESTION TEXT IF AN AMOUNT WAS PAID BY PERSON/FAMILY; THAT IS, AN AMOUNT ) $0 WAS ENTERED AT CP11OV1 OR CP11OV2
----------------------------------------------------
----------------------------------------------------
DISPLAY '(PROVIDER)' IN THE QUESTION TEXT IF EVENT TYPE IS NOT PM OR OM.
----------------------------------------------------

CP12A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
Who else paid? PROBE: Anyone else?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Name of Source of Direct Payment-35]
[2. Name of Source of Direct Payment-35]
[3. Name of Source of Direct Payment-35]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE RU-SOURCES-OF-PAYMENT-ROSTER.
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF- PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
SOURCE ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A SOURCE(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF SOURCES AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF SOURCES).
3. INTERVIEWER SHOULD BE ABLE TO DELETE A SOURCE THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A SOURCE ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN SOURCE IS FIRST ENTERED.'
----------------------------------------------------

CP13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
How much did (SOURCE) pay?
ENTER AMOUNT PAID TO COLUMN 2 OR COLUMN 3.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
TOTAL CHARGE: [$XXXXXXXXX]
ROSTER. SOURCE OF PAYMENT
CP13_02. DOLLAR AMOUNT PAID
CP13_03. PERCENT AMOUNT PAID
PERSON/Family [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER, THAT IS, ALL SOURCES SELECTED AT CP12A FOR THIS EVENT- PROVIDER PAIR AND THE 'PERSON/FAMILY' RECORD.
----------------------------------------------------
----------------------------------------------------
TOTAL CHARGE: DISPLAY AMOUNT ENTERED AT CP09.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SOURCES AND ASSOCIATED AMOUNTS AS 'DIRECT PAYMENT'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PERSON/FAMILY' AS THE FIRST SOURCE OF PAYMENT.

DISPLAY THE RESPONSE TO CP11 IN THE 'AMOUNT PAID' COLUMN FOR PERSON/FAMILY. THAT IS, IF THE RESPONSE TO CP11OV1 IS AN AMOUNT, DISPLAY THE DOLLAR AMOUNT IN CP13_02, 'DOLLAR AMOUNT PAID'.
IF THE RESPONSE TO CP11OV2 IS A PERCENTAGE, DISPLAY THE PERCENTAGE AMOUNT IN CP13_03, 'PERCENT AMOUNT PAID'. IF CP11OV1 OR CP11OV2 IS CODED '-8' (DON'T KNOW), DISPLAY 'DK' FOR THE AMOUNT IN BOTH CP13_02 AND CP13_03. IF CP11OV1 OR CP11OV2 IS CODED '-7' (REFUSED), DISPLAY 'REF' FOR THE AMOUNT IN BOTH CP13_02 AND CP13_03.
----------------------------------------------------
----------------------------------------------------
NOTE: FEATURES OF THE SOURCE OF PAYMENT MATRIX.

1. INTERVIEWER USES RIGHT AND LEFT ARROW KEYS TO MOVE TO EITHER THE PERCENT OR DOLLAR AMOUNT COLUMN ASSOCIATED WITH THAT SOURCE.
INTERVIEWER USES THE UP AND DOWN ARROW KEYS TO MOVE BETWEEN AMOUNT PAID COLUMNS FOR DIFFERENT SOURCES.
2. SOURCE COLUMN IS PROTECTED. CURSOR WILL NOT ENTER THIS COLUMN, SO NO CHANGES ARE ALLOWED TO SOURCES AT THIS SCREEN.
3. INTERVIEWER ENTERS EITHER A DOLLAR OR A PERCENTAGE AMOUNT FOR EACH SOURCE DISPLAYED.
AMOUNTS CAN BE CHANGED AS MANY TIMES AS NECESSARY BEFORE THE INTERVIEWER LEAVES THE SCREEN.
4. THE PERSON/FAMILY AMOUNT PAID COLUMNS MAY BE CHANGED OR CORRECTED.
5. WHEN CURSOR LEAVES THE CELL AND A DOLLAR OR PERCENTAGE AMOUNT HAS BEEN ENTERED AND THERE IS A TOTAL CHARGE, THE RECIPROCAL AMOUNT WILL BE DISPLAYED. FOR EXAMPLE, IF THE INTERVIEWER ENTERS A PERCENTAGE, THE DOLLAR AMOUNT WILL BE CALCULATED USING THE TOTAL CHARGE. THIS DOLLAR AMOUNT WOULD THEN BE DISPLAYED IN THE DOLLAR AMOUNT PAID COLUMN (NEXT TO THE PERCENT AMOUNT PAID COLUMN).
6. IF A SOURCE IS ENTERED IN ERROR, THE INTERVIEWER WILL ZERO OUT THE AMOUNT PAID.
7. INTERVIEWERS WILL BE INSTRUCTED TO ONLY ENTER DIRECT PAYMENTS MADE TO THE PROVIDER AT THIS SCREEN.
8. THE CURSOR SHOULD FIRST APPEAR IN THE DOLLAR AMOUNT PAID COLUMN FOR THE FIRST SOURCE ADDED/ SELECTED AT THE PREVIOUS SCREEN (NOT IN THE PERSON/FAMILY COLUMN).
----------------------------------------------------

CP13OV
======

DID ANY OTHER SOURCES MAKE ANY PAYMENTS DIRECTLY TO THE PROVIDER?
YES .................................... 1
NO ..................................... 2
PRESS F1 FOR A DEFINITION OF PAYMENTS MADE DIRECTLY TO PROVIDER.

END_LP01
========

----------------------------------------------------
IF CP13OV IS CODED '1' (YES), CYCLE TO COLLECT NEXT SOURCE OF PAYMENT.
----------------------------------------------------
----------------------------------------------------
IF CP13OV IS NOT ASKED OR IS CODED '2' (NO), END LOOP_01 AND CONTINUE WITH BOX_06
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF 'AMOUNT PAID' BY PERSON/FAMILY ) $0, CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

SOURCE OF REIMBURSEMENT 1
SOURCE OF REIMBURSEMENT 2
SOURCE OF REIMBURSEMENT 3
SOURCE OF REIMBURSEMENT 4

ASK BOX_LP02-END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION ON SOURCES OF REIMBURSEMENT TO PERSON/FAMILY AND ASSOCIATED REIMBURSEMENT AMOUNTS. THE RESPONSE TO CP15OV DETERMINES WHETHER THE LOOP CYCLES AGAIN.
SUBSEQUENT CYCLES, IF ANY, COLLECT ADDITIONAL SOURCES OF REIMBURSEMENT AND ASSOCIATED AMOUNTS.
IF CP15OV IS CODED '1' (YES), THE LOOP CYCLES AGAIN. IF CP15OV IS NOT ASKED OR IS CODED '2' (NO), THE LOOP ENDS.
----------------------------------------------------

BOX_LP02
========

----------------------------------------------------
IF FIRST CYCLE OF LOOP_02, CONTINUE WITH CP14
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ANY CYCLE SUBSEQUENT TO THE FIRST CYCLE OF LOOP_02), GO TO CP14A
----------------------------------------------------

CP14
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
Has any source reimbursed or paid back anything to (PERSON) (or anyone in the family) for the amount paid 'out-of-pocket'?
That is, has any source reimbursed any of the [$/% FAMILY PAID] paid?
YES .................................... 1
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
PRESS F1 FOR DEFINITION OF SOURCE AND REIMBURSEMENT.

CP14A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
Who reimbursed or paid anyone in the family back?
PROBE: Anyone else?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Name of Source of Reimbursement-35]
[2. Name of Source of Reimbursement-35]
[3. Name of Source of Reimbursement-35]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE RU-SOURCES-OF-PAYMENT-ROSTER EXCLUDING THE 'PERSON/FAMILY' RECORD.
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF- PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
NOTE: SOURCES OF PAYMENTS AND SOURCES OF REIMBURSEMENTS ARE SELECTED FROM THE SAME RU LEVEL ROSTER OF SOURCES AND ROSTER BEHAVIOR IS THE SAME.
----------------------------------------------------

CP15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
How much did (SOURCE) reimburse or pay anyone in the family back?
ENTER THE AMOUNT REIMBURSED IN COLUMN 2 OR COLUMN 3.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
PERSON/FAMILY PAYMENT: [$XXXXXXXXX] TOTAL CHARGE: [$XXXXXXXXX]
ROSTER. SOURCE OF REIMBURSEMENT
CP15_02. DOLLAR AMOUNT REIMBURSED
CP15_03. PERCENT AMOUNT REIMBURSED
[Display Source of Reimbursement] [Enter $ Amount] [Enter % Amount]
[Display Source of Reimbursement] [Enter $ Amount] [Enter % Amount]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER, THAT IS, ALL SOURCES SELECTED AT CP14A FOR THIS EVENT- PROVIDER PAIR.
----------------------------------------------------
----------------------------------------------------
TOTAL CHARGE: DISPLAY AMOUNT ENTERED AT CP09.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SOURCES AND ASSOCIATED AMOUNTS AS 'REIMBURSEMENT'.
----------------------------------------------------
----------------------------------------------------
NOTE: FEATURES OF THE REIMBURSEMENT MATRIX.

1. INTERVIEWER USES RIGHT AND LEFT ARROW KEYS TO MOVE TO EITHER THE PERCENT OR DOLLAR AMOUNT COLUMN ASSOCIATED WITH THAT SOURCE.
INTERVIEWER USES THE UP AND DOWN ARROW KEYS TO MOVE BETWEEN AMOUNT PAID COLUMNS FOR DIFFERENT SOURCES.
2. SOURCE COLUMN IS PROTECTED. CURSOR WILL NOT ENTER THIS COLUMN, SO NO CHANGES ARE ALLOWED TO SOURCES AT THIS SCREEN.
3. INTERVIEWER ENTERS EITHER A DOLLAR OR A PERCENTAGE AMOUNT FOR EACH SOURCE DISPLAYED.
AMOUNTS CAN BE CHANGED AS MANY TIMES AS NECESSARY BEFORE THE INTERVIEWER LEAVES THE SCREEN.
4. WHEN CURSOR LEAVES THE CELL AND A DOLLAR OR PERCENTAGE AMOUNT HAS BEEN ENTERED AND THERE IS A TOTAL CHARGE, THE RECIPROCAL AMOUNT WILL BE DISPLAYED. FOR EXAMPLE, IF THE INTERVIEWER ENTERS A PERCENTAGE, THE DOLLAR AMOUNT WILL BE CALCULATED USING THE TOTAL CHARGE. THIS DOLLAR AMOUNT WOULD THEN BE DISPLAYED IN THE DOLLAR AMOUNT REIMBURSED COLUMN (NEXT TO PERCENT AMOUNT REIMBURSED).
5. IF A SOURCE IS ENTERED IN ERROR, THE INTERVIEWER WILL ZERO OUT THE AMOUNT REIMBURSED.
6. INTERVIEWERS WILL BE INSTRUCTED TO ONLY ENTER REIMBURSEMENTS MADE TO THE FAMILY AT THIS SCREEN.
7. IF THE TOTAL AMOUNT REIMBURSED BY ALL SOURCES EXCEEDS THE AMOUNT PAID BY THE PERSON/FAMILY, CAPI DISPLAYS THE MESSAGE: 'REIMBURSED AMOUNT GREATER THAN FAMILY PAYMENT. VERIFY REIMBURSED AMOUNT AND RE-ENTER. IF NEED TO CORRECT FAMILY PAYMENT, JUMPBACK TO CP13.' IF INTERVIEWER RE-ENTERS THE SAME AMOUNTS, CAPI WILL ACCEPT. THAT IS, WE WILL INFORM THE INTERVIEWER OF THE DISCREPANCY, BUT NOT FORCE HER TO RECONCILE IT.
8. THE SAME SOURCE CAN BE FLAGGED AS BOTH A REIMBURSEMENT AND A DIRECT PAYMENT. ONLY THE AMOUNT ASSOCIATED WITH THE DIRECT PAYMENT WILL PLAY INTO THE RESOLUTION PROCESS.
9. POST DATA COLLECTION EDITING WILL BE NECESSARY TO DETERMINE THE NET PAYMENTS OF SOURCES.
----------------------------------------------------

CP15OV
======

ARE THERE ANY OTHER SOURCES OF REIMBURSEMENT?
YES .................................... 1
NO ..................................... 2
PRESS F1 FOR DEFINITION OF REIMBURSEMENT.

END_LP02
========

----------------------------------------------------
IF CP15OV CODED '1' (YES), CYCLE TO COLLECT NEXT SOURCE OF REIMBURSEMENT
----------------------------------------------------
----------------------------------------------------
IF CP15OV IS NOT ASKED OR IS CODED '2' (NO), END LOOP_02 AND CONTINUE WITH BOX_07
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF A TOTAL CHARGE IS ENTERED AT CP09 AND IF 'AMOUNT PAID' BY EVERY SOURCE OF DIRECT PAYMENT (INCLUDING PERSON/FAMILY PAYMENT, BUT EXCLUDING REIMBURSEMENTS) HAS A CALCULATED DOLLAR AMOUNT, CONTINUE WITH BOX_08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_11
----------------------------------------------------

BOX_08
======

----------------------------------------------------
IF:
THE TOTAL CHARGE IS KNOWN (CP08 CODED '1' (YES))
AND
A PERCENT WAS ENTERED FOR THE FAMILY PAYMENT (CP11 CODED '2' (PERCENT) AND AMOUNT CODED AT CP11OV2), CONTINUE WITH CP16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_11
----------------------------------------------------

CP16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
ROSTER. SOURCE OF PAYMENT
DOLLAR AMOUNT PAID
PERCENT AMOUNT PAID
PERSON/Family [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
TOTAL CHARGE: [$XXXXXXXXX]
[ Did (PROVIDER) discount any portion of the total charges/ Was any portion of the total charges discounted]?
YES .................................... 1
NO ..................................... 2 [BOX_11]
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
PRESS F1 FOR DEFINITION OF DISCOUNTED.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER THAT ARE FLAGGED AS 'DIRECT PAYMENT' AND THE ASSOCIATED DIRECT PAYMENT AMOUNTS.
----------------------------------------------------
----------------------------------------------------
SOURCE OF PAYMENT MATRIX IS READ ONLY.
DISPLAY '(PROVIDER) DISCOUNTED ANY PORTION OF THE TOTAL CHARGES' IN THE QUESTION TEXT IF EVENT TYPE IS NOT PM OR OM. DISPLAY 'ANY PORTION OF THE CHARGE WAS DISCOUNTED' IN THE QUESTION TEXT IF THE EVENT TYPE IS PM OR OM.
----------------------------------------------------

CP17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
How much was the discount?
IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1
PERCENT ................................ 2 [CP17OV2]

CP17OV1
=======

ENTER DOLLARS:
[Enter $ Amount] ....................... [BOX_11]
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
----------------------------------------------------
SOFT RANGE CHECK: $0 - $10,000
----------------------------------------------------

CP17OV2
=======

ENTER PERCENT:
[Enter % Amount] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 1% - 100%
----------------------------------------------------

BOX_11
======

----------------------------------------------------
IF CP14 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND CP10 IS CODED '1' (YES), GO TO BOX_09
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_10
----------------------------------------------------
----------------------------------------------------
NOTE: THIS BOX SKIPS PEOPLE OVER CP18 (EXPECT ANY REIMBURSEMENT) FOR INDIVIDUALS WHO HAVE ALREADY TOLD US THAT THE PAYMENT WAS A COPAYMENT (CP10 IS CODED '1') AND THEY HAVE NOT BEEN REIMBURSED FOR ANY AMOUNT PAID (CP14 IS CODED '2', '-7', OR '-8').
----------------------------------------------------

BOX_10
======

----------------------------------------------------
IF AMOUNT PAID BY PERSON/FAMILY IS ) $0, CONTINUE WITH CP18
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

CP18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Do you expect any [other] source to reimburse anyone in the family for what has been paid?
YES .................................... 1
NO ..................................... 2 [BOX_09]
REF ................................... -7 [BOX_09]
DK .................................... -8 [BOX_09]
PRESS F1 FOR DEFINITION OF REIMBURSEMENT.
----------------------------------------------------
DISPLAY 'OTHER' IN THE QUESTION TEXT IF CP14 IS CODED '1' (YES).
----------------------------------------------------

CP19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
How much does anyone in the family expect to be reimbursed?
PROBE: Include amounts to be reimbursed from all sources.

IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1
PERCENT ................................ 2 [CP19OV2]

CP19OV1
=======

ENTER DOLLARS:
[Enter $ Amount] ....................... [CP20]
REF ................................... -7 [CP20]
DK .................................... -8 [CP20]
----------------------------------------------------
SOFT RANGE CHECK: $0 - $10,000
----------------------------------------------------

CP19OV2
=======

ENTER PERCENT:
[Enter % Amount] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 1% - 100%
----------------------------------------------------

CP20
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
From whom do you expect these reimbursements to come?
IF MORE THAN ONE SOURCE OF REIMBURSEMENT, PROBE FOR THE MAIN SOURCE (I.E., THE SOURCE REIMBURSING THE MOST).
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Name of Source of Direct Payment-35]
[2. Name of Source of Direct Payment-35]
[3. Name of Source of Direct Payment-35]
[Code One]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE RU-SOURCES-OF-PAYMENT-ROSTER EXCLUDING THE 'PERSON/FAMILY' RECORD.
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF- PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
REFER TO CP12 FOR SOURCE OF PAYMENT ROSTER BEHAVIOR SPECIFICATIONS.
----------------------------------------------------

BOX_09
======

----------------------------------------------------
DETERMINE IF THERE IS AN OVERPAYMENT OR UNDERPAYMENT: SUBTRACT THE TOTAL PAYMENT FROM THE TOTAL CHARGE AT CP09. IF THE ABSOLUTE VALUE OF THE REMAINDER IS ) 3% OR $5 (WHICHEVER IS HIGHER) OF THE TOTAL CHARGE, CONTINUE WITH BOX_12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, DISPLAY THE FOLLOWING MESSAGE: 'NO CHARGE-PAYMENT RESOLUTION NEEDED FOR THIS CASE.
PRESS ENTER TO CONTINUE.' THEN GO TO CP37
----------------------------------------------------

BOX_12
======

----------------------------------------------------
IF CP09 (TOTAL CHARGE) OR 'AMOUNT PAID' BY ANY SOURCE OF DIRECT PAYMENT (INCLUDING PERSON/FAMILY, BUT EXCLUDING REIMBURSEMENTS) IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY THE FOLLOWING MESSAGE: 'NO CHARGE-PAYMENT RESOLUTION NEEDED FOR THIS CASE. PRESS ENTER TO CONTINUE.'
THEN GO TO CP37
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_13
----------------------------------------------------

BOX_13
======

----------------------------------------------------
IF THE UNDERPAYMENT IS ) 3% OR $5 (WHICHEVER IS HIGHER) OF THE TOTAL CHARGE, CONTINUE WITH CP21
----------------------------------------------------
----------------------------------------------------
IF THE OVERPAYMENT IS ) 3% OR $5 (WHICHEVER IS HIGHER) OF THE TOTAL CHARGE, GO TO LOOP_04
----------------------------------------------------

CP21
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Does anyone in the family or any other source expect to make additional payments for [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the last purchase of [NAME OF PRESCRIBED MEDICINE...] for (PERSON)/the services for (FLAT FEE GROUP) for (PERSON)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/ (PROVIDER)'s services as part of the visit made on (VISIT DATE)]?
YES .................................... 1
NO ..................................... 2 [LOOP_03]
REF ................................... -7 [LOOP_03]
DK .................................... -8 [LOOP_03]

CP22
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
How much more does anyone in the family or any other source expect to pay?
IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1
PERCENT ................................ 2 [CP22OV2]

CP22OV1
=======

ENTER DOLLARS:
[Enter $ Amount] ....................... [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX_14]
----------------------------------------------------
SOFT RANGE CHECK: $0 - $10,000
----------------------------------------------------

CP22OV2
=======

ENTER PERCENT:
[Enter % Amount] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 1% - 100%
----------------------------------------------------

BOX_14
======

----------------------------------------------------
IF AN AMOUNT IS ENTERED AT CP22OV1 OR AT CP22OV2 OR IF CP22OV1 OR CP22OV2 ARE CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY THE FOLLOWING MESSAGE: 'NO CHARGE-PAYMENT RESOLUTION NEEDED FOR THIS CASE. PRESS ENTER TO CONTINUE.' THEN GO TO CP37
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

SOURCE OF DIRECT PAYMENT 1
SOURCE OF DIRECT PAYMENT 2
SOURCE OF DIRECT PAYMENT 3
SOURCE OF DIRECT PAYMENT 4

ASK BOX_LP03-END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 REVIEWS PAYMENT INFORMATION WHERE AN UNDERPAYMENT HAS BEEN REPORTED AND EITHER VERIFIES THE UNDERPAYMENT OR COLLECTS CORRECTIONS AND ADDITIONAL PAYMENT INFORMATION TO RESOLVE THE UNDERPAYMENT. THE FIRST CYCLE OF THIS LOOP COLLECTS CORRECTIONS OF ERRONEOUS INFORMATION ON DIRECT PAYMENTS AND THE ASSOCIATED AMOUNTS PAID. SUBSEQUENT LOOP CYCLES, IF ANY, COLLECT ADDITIONAL SOURCES OF DIRECT PAYMENT AND ASSOCIATED AMOUNTS. THE RESPONSE TO CP24OV DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF CP24OV IS CODED '1' (YES), THE LOOP CYCLES AGAIN. IF CP24OV IS CODED '2' (NO), THE LOOP ENDS.
----------------------------------------------------

BOX_LP03
========

----------------------------------------------------
IF FIRST CYCLE OF LOOP_03, GO TO CP24
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ANY CYCLE SUBSEQUENT TO THE FIRST CYCLE OF LOOP_03), CONTINUE WITH CP23
----------------------------------------------------

CP23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
Who else paid? PROBE: Anyone else?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Name of Source of Direct Payment-35]
[2. Name of Source of Direct Payment-35]
[3. Name of Source of Direct Payment-35]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE RU-SOURCES-OF-PAYMENT-ROSTER.
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF- PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
REFER TO CP12A FOR SOURCE OF PAYMENT ROSTER BEHAVIOR SPECIFICATIONS.
----------------------------------------------------

CP24
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
At the moment, it appears that [AMOUNT REMAINING] of the total charge for [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the last purchase of [NAME OF PRESCRIBED MEDICINE...] for (PERSON)/the services for (FLAT FEE GROUP) for (PERSON)/the [OME ITEM GROUP NAME............] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)] is still unpaid. Let me be sure I have entered everything correctly.
REVIEW CHARGES AND PAYMENTS WITH RESPONDENT. WORK WITH RESPONDENT TO CORRECT ERRONEOUS INFORMATION, IF ANY.
IF TOTAL CHARGE NEEDS CORRECTION, JUMPBACK TO CP09.
IF TOTAL CHARGE WAS DISCOUNTED, WAIT TO RECORD AT CP27.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
UNDERPAYMENT: [$XXXXXXXXX] TOTAL CHARGE: [$XXXXXXXXX]
ROSTER. SOURCE OF PAYMENT
CP24_02. DOLLAR AMOUNT PAID
CP24_03. PERCENT AMOUNT PAID
PERSON/Family [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER THAT ARE FLAGGED AS 'DIRECT PAYMENT' AND THE ASSOCIATED DIRECT PAYMENT AMOUNTS.
----------------------------------------------------
----------------------------------------------------
TOTAL CHARGE: DISPLAY AMOUNT ENTERED AT CP09.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PERSON/FAMILY' AS THE FIRST SOURCE OF PAYMENT.

IF THE AMOUNT PAID BY PERSON/FAMILY WAS ADJUSTED AT CP13, DISPLAY ADJUSTED AMOUNT. IF AMOUNT PAID BY PERSON/FAMILY WAS NOT ADJUSTED, DISPLAY THE RESPONSE TO CP11 IN THE 'AMOUNT PAID' COLUMN FOR PERSON/FAMILY. THAT IS, IF THE RESPONSE TO CP11OV1 IS AN AMOUNT, DISPLAY THE DOLLAR AMOUNT IN CP24_02, 'DOLLAR AMOUNT PAID'.
IF THE RESPONSE TO CP11OV2 IS A PERCENTAGE, DISPLAY THE PERCENTAGE AMOUNT IN CP24_03, 'PERCENT AMOUNT PAID'. IF CP11OV1 OR CP11OV2 IS CODED '-8' (DON'T KNOW), DISPLAY 'DK' FOR THE AMOUNT IN BOTH CP24_02 AND CP24_03. IF CP11OV1 OR CP11OV2 IS CODED '-7' (REFUSED), DISPLAY 'REF' FOR THE AMOUNT IN BOTH CP24_02 AND CP24_03.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SOURCES AND ASSOCIATED AMOUNTS AS 'DIRECT PAYMENTS'.
----------------------------------------------------
----------------------------------------------------
NOTE: FEATURES OF THE SOURCE OF PAYMENT MATRIX.

1. THIS MATRIX WILL WORK JUST LIKE THE SOURCE OF PAYMENT MATRIX AT CP13. HOWEVER IN THIS FIRST STAGE RESOLUTION PROCESS, ONLY CORRECTIONS TO DIRECT PAYMENTS CAN BE MADE. AS WELL, ONLY NEW SOURCES OF DIRECT PAYMENTS MAY BE ADDED.
AT NO TIME IN THIS FIRST STAGE RESOLUTION PROCESS CAN ANY CORRECTIONS OR UPDATES BE MADE TO SOURCE NAMES OR AMOUNTS OF REIMBURSEMENTS.
----------------------------------------------------

CP24OV
======

DID ANY OTHER SOURCES MAKE ANY PAYMENTS DIRECTLY TO THE PROVIDER?
YES .................................... 1
NO ..................................... 2
PRESS F1 FOR A DEFINITION OF PAYMENTS MADE DIRECTLY TO PROVIDER.

END_LP03
========

----------------------------------------------------
IF CP24OV IS CODED '1' (YES), CYCLE TO COLLECT ADDITIONAL SOURCES OF PAYMENT.
----------------------------------------------------
----------------------------------------------------
IF CP24OV IS CODED '2' (NO), END LOOP_03 AND GO TO BOX_15
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

SOURCE OF DIRECT PAYMENT 1
SOURCE OF DIRECT PAYMENT 2
SOURCE OF DIRECT PAYMENT 3
SOURCE OF DIRECT PAYMENT 4

ASK BOX_LP04-END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 REVIEWS PAYMENT INFORMATION WHERE AN OVERPAYMENT HAS BEEN REPORTED AND EITHER VERIFIES THE OVERPAYMENT OR COLLECTS CORRECTIONS AND ADDITIONAL PAYMENT INFORMATION TO RESOLVE THE OVERPAYMENT. THE FIRST CYCLE OF THIS LOOP COLLECTS CORRECTIONS OF ERRONEOUS INFORMATION ON DIRECT PAYMENTS AND ASSOCIATED AMOUNTS PAID.
SUBSEQUENT LOOP CYCLES, IF ANY, COLLECT ADDITIONAL SOURCES OF DIRECT PAYMENT AND ASSOCIATED AMOUNTS.
THE RESPONSE TO CP26OV DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF CP26OV IS CODED '1' (YES), THE LOOP CYCLES AGAIN. IF CP26OV IS CODED '2' (NO), THE LOOP ENDS.
----------------------------------------------------

BOX_LP04
========

----------------------------------------------------
IF FIRST CYCLE OF LOOP_04, GO TO CP26
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ANY CYCLE SUBSEQUENT TO THE FIRST CYCLE OF LOOP_04), CONTINUE WITH CP25
----------------------------------------------------

CP25
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
Who else paid? PROBE: Anyone else?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Name of Source of Direct Payment-35]
[2. Name of Source of Direct Payment-35]
[3. Name of Source of Direct Payment-35]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE RU-SOURCES-OF-PAYMENT-ROSTER.
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF-PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
REFER TO CP12 FOR SOURCE OF PAYMENT ROSTER BEHAVIOR SPECIFICATIONS.
----------------------------------------------------

CP26
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
The payments you reported for [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the last purchase of [NAME OF PRESCRIBED MEDICINE...] for (PERSON)/the services for (FLAT FEE GROUP) for (PERSON)/the [OME ITEM GROUP NAME............] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)] exceed the charge I have recorded by [$ DISCREPANCY].
Let me be sure I have all the information recorded correctly.

REVIEW CHARGES AND PAYMENTS WITH RESPONDENT. WORK WITH RESPONDENT TO CORRECT ERRONEOUS INFORMATION, IF ANY.
IF TOTAL CHARGE NEEDS CORRECTION, JUMPBACK TO CP09.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
OVERPAYMENT: [$XXXXXXXXX] TOTAL CHARGE: [$XXXXXXXXX]
ROSTER. SOURCE OF PAYMENT
CP26_02. DOLLAR AMOUNT PAID
CP26_03. PERCENT AMOUNT PAID
PERSON/Family [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER THAT ARE FLAGGED AS 'DIRECT PAYMENT' AND THE ASSOCIATED DIRECT PAYMENT AMOUNTS.
----------------------------------------------------
----------------------------------------------------
TOTAL CHARGE: DISPLAY AMOUNT ENTERED AT CP09.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PERSON/FAMILY' AS THE FIRST SOURCE OF PAYMENT.

IF THE AMOUNT PAID BY PERSON/FAMILY WAS ADJUSTED AT CP13, DISPLAY ADJUSTED AMOUNT. IF AMOUNT PAID BY PERSON/FAMILY WAS NOT ADJUSTED, DISPLAY THE RESPONSE TO CP11 IN THE 'AMOUNT PAID' COLUMN FOR PERSON/FAMILY. THAT IS, IF THE RESPONSE TO CP11OV1 IS AN AMOUNT, DISPLAY THE DOLLAR AMOUNT IN CP26_02, 'DOLLAR AMOUNT PAID'.
IF THE RESPONSE TO CP11OV2 IS A PERCENTAGE, DISPLAY THE PERCENTAGE AMOUNT IN CP26_03, 'PERCENT AMOUNT PAID'. IF CP11OV1 OR CP11OV2 IS CODED '-8' (DON'T KNOW), DISPLAY 'DK' FOR THE AMOUNT IN BOTH CP26_02 AND CP26_03. IF CP11OV1 OR CP11OV2 IS CODED '-7' (REFUSED), DISPLAY 'REF' FOR THE AMOUNT IN BOTH CP26_02 AND CP26_03.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SOURCES AND ASSOCIATED AMOUNTS AS 'DIRECT PAYMENTS'.
----------------------------------------------------
----------------------------------------------------
NOTE: FEATURES OF THE SOURCE OF PAYMENT MATRIX.

1. THIS MATRIX WILL WORK JUST LIKE THE SOURCE OF PAYMENT MATRIX AT CP13. HOWEVER IN THIS FIRST STAGE RESOLUTION PROCESS, ONLY CORRECTIONS TO DIRECT PAYMENTS CAN BE MADE. AS WELL, ONLY NEW SOURCES OF DIRECT PAYMENTS MAY BE ADDED.
AT NO TIME IN THIS FIRST STAGE RESOLUTION PROCESS CAN ANY CORRECTIONS OR UPDATES BE MADE TO SOURCE NAMES OR AMOUNTS OF REIMBURSEMENTS.
----------------------------------------------------

CP26OV
======

DID ANY OTHER SOURCES MAKE ANY PAYMENTS DIRECTLY TO THE PROVIDER?
YES .................................... 1
NO ..................................... 2
PRESS F1 FOR A DEFINITION OF PAYMENTS MADE DIRECTLY TO PROVIDER.

END_LP04
========

----------------------------------------------------
IF CP26OV IS CODED '1' (YES), CYCLE TO COLLECT ADDITIONAL SOURCES OF PAYMENT
----------------------------------------------------
----------------------------------------------------
IF CP26OV IS CODED '2' (NO), END LOOP_04 AND CONTINUE WITH BOX_15
----------------------------------------------------

BOX_15
======

----------------------------------------------------
RECALCULATE AMOUNT OF UNDERPAYMENT OR OVERPAYMENT.
----------------------------------------------------
----------------------------------------------------
IF UNDERPAYMENT IS ) 3% OR $5 (WHICHEVER IS HIGHER) OF TOTAL CHARGE, CONTINUE WITH BOX_16
----------------------------------------------------
----------------------------------------------------
IF OVERPAYMENT IS ) 3% % OR $5 (WHICHEVER IS HIGHER) OF TOTAL CHARGE, GO TO BOX_21
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CP37
----------------------------------------------------

BOX_16
======

----------------------------------------------------
IF CP16 HAS BEEN ASKED, GO TO BOX_17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CP27
----------------------------------------------------

CP27
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
ROSTER. SOURCE OF PAYMENT
DOLLAR AMOUNT PAID
PERCENT AMOUNT PAID
PERSON/Family [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
TOTAL CHARGE: [$XXXXXXXXX] DIFFERENCE: [$XXXXXXXXX]
[Did (PROVIDER) discount any portion of the total charges/Was any portion of the total charges discounted]?
YES .................................... 1
NO ..................................... 2 [BOX_17]
REF ................................... -7 [BOX_17]
DK .................................... -8 [BOX_17]
PRESS F1 FOR DEFINITION OF DISCOUNTED.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER THAT ARE FLAGGED AS 'DIRECT PAYMENT' AND THE ASSOCIATED DIRECT PAYMENT AMOUNTS.
----------------------------------------------------
----------------------------------------------------
SOURCE OF PAYMENT MATRIX IS READ ONLY.
DISPLAY '(PROVIDER) DISCOUNTED ANY PORTION OF THE TOTAL CHARGES' IN THE QUESTION TEXT IF EVENT TYPE IS NOT PM OR OM. DISPLAY 'ANY PORTION OF THE CHARGE WAS DISCOUNTED' IN THE QUESTION TEXT IF THE EVENT TYPE IS PM OR OM.
----------------------------------------------------

CP28
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
How much was the discount?
IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1
PERCENT ................................ 2 [CP28OV2]

CP28OV1
=======

ENTER DOLLARS:
[Enter $ Amount] ....................... [BOX_17]
REF ................................... -7 [BOX_17]
DK .................................... -8 [BOX_17]
----------------------------------------------------
SOFT RANGE CHECK: $0 - $10,000
----------------------------------------------------

CP28OV2
=======

ENTER PERCENT:
[Enter % Amount] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 1% - 100%
----------------------------------------------------

BOX_17
======

----------------------------------------------------
IF ANY SOURCE OF DIRECT PAYMENT OTHER THAN PERSON/ FAMILY, CONTINUE WITH BOX_18
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_19
----------------------------------------------------

BOX_18
======

----------------------------------------------------
RECALCULATE UNDERPAYMENT TAKING INTO ACCOUNT CP28 (DISCOUNT). IF UNDERPAYMENT IS STILL ) 3% OR $5 (WHICH EVER IS HIGHER) OF TOTAL CHARGE, CONTINUE WITH CP29 USING THE NEW DIFFERENCE IN THE DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF UNDERPAYMENT IS NOT ) 3% OR $5 (WHICHEVER IS HIGHER) OF THE TOTAL CHARGE, GO TO BOX_22
----------------------------------------------------

CP29
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
ROSTER. SOURCE OF PAYMENT
DOLLAR AMOUNT PAID
PERCENT AMOUNT PAID
PERSON/Family [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
TOTAL CHARGE: [$XXXXXXXXX] DIFFERENCE: [$XXXXXXXXX]
Do you know if any portion of the total charge was disallowed or disapproved by (PERSON)'s insurance, Medicare, or Medicaid?
YES .................................... 1
NO ..................................... 2 [BOX_19]
REF ................................... -7 [BOX_19]
DK .................................... -8 [BOX_19]
PRESS F1 FOR DEFINITION OF DISALLOWED/DISAPPROVED.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER THAT ARE FLAGGED AS 'DIRECT PAYMENT' AND THE ASSOCIATED DIRECT PAYMENT AMOUNTS.
----------------------------------------------------
----------------------------------------------------
SOURCE OF PAYMENT MATRIX IS READ ONLY.
----------------------------------------------------

CP30
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
How much was disallowed or disapproved?
IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1
PERCENT ................................ 2 [CP30OV2]

CP30OV1
=======

ENTER DOLLARS:
[Enter $ Amount] ....................... [BOX_19]
REF ................................... -7 [BOX_19]
DK .................................... -8 [BOX_19]
----------------------------------------------------
SOFT RANGE CHECK: $0 - $10,000
----------------------------------------------------

CP30OV2
=======

ENTER PERCENT:
[Enter % Amount] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 1% - 100%
----------------------------------------------------

BOX_19
======

----------------------------------------------------
IF CP21 WAS ASKED, GO TO BOX_22
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_20
----------------------------------------------------

BOX_20
======

----------------------------------------------------
RECALCULATE UNDERPAYMENT TAKING INTO ACCOUNT CP30 (DISALLOWED CHARGES). IF UNDERPAYMENT IS STILL ) 3% OR $5 (WHICHEVER IS HIGHER) OF TOTAL CHARGE, CONTINUE WITH CP31 USING THE NEW DIFFERENCE IN THE DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF UNDERPAYMENT IS NOT ) 3% OR $5 (WHICHEVER IS HIGHER) OF THE TOTAL CHARGE, GO TO BOX_22
----------------------------------------------------

CP31
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
ROSTER. SOURCE OF PAYMENT
DOLLAR AMOUNT PAID
PERCENT AMOUNT PAID
PERSON/Family [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
TOTAL CHARGE: [$XXXXXXXXX] DIFFERENCE: [$XXXXXXXXX]
Do you expect anyone in the family to pay any [amount/more]?
YES .................................... 1
NO ..................................... 2 [BOX_22]
REF ................................... -7 [BOX_22]
DK .................................... -8 [BOX_22]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER THAT ARE FLAGGED AS 'DIRECT PAYMENT' AND THE ASSOCIATED DIRECT PAYMENT AMOUNTS.
----------------------------------------------------
----------------------------------------------------
SOURCE OF PAYMENT MATRIX IS READ ONLY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'AMOUNT' IF PERSON FAMILY PAYMENT IS $0/0%. DISPLAY 'MORE' IF PERSON/FAMILY PAYMENT IS NOT EQUAL TO $0/0%
----------------------------------------------------

CP32
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
How much do you expect anyone in the family to pay?
IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1
PERCENT ................................ 2 [CP32OV2]

CP32OV1
=======

ENTER DOLLARS:
[Enter $ Amount] ....................... [BOX_22]
REF ................................... -7 [BOX_22]
DK .................................... -8 [BOX_22]
----------------------------------------------------
SOFT RANGE CHECK: $0 - $10,000
----------------------------------------------------

CP32OV2
=======

ENTER PERCENT:
[Enter % Amount] ....................... [BOX_22]
REF ................................... -7 [BOX_22]
DK .................................... -8 [BOX_22]
----------------------------------------------------
SOFT RANGE CHECK: 1% - 100%
----------------------------------------------------

BOX_21
======

----------------------------------------------------
IF AMOUNT PAID BY PERSON/FAMILY IS ) $0, CONTINUE WITH CP33
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_22
----------------------------------------------------

CP33
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
ROSTER. SOURCE OF PAYMENT
DOLLAR AMOUNT PAID
PERCENT AMOUNT PAID
PERSON/Family [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Display $ Amount] [Display % Amount]
TOTAL CHARGE: [$XXXXXXXXX] DIFFERENCE: [$XXXXXXXXX]
Is anyone in the family expecting any reimbursement for this overpayment?
YES .................................... 1
NO ..................................... 2 [BOX_22]
REF ................................... -7 [BOX_22]
DK .................................... -8 [BOX_22]
PRESS F1 FOR DEFINITION OF REIMBURSEMENT.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL SOURCES ON THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER THAT ARE FLAGGED AS 'DIRECT PAYMENT' AND THE ASSOCIATED DIRECT PAYMENT AMOUNTS.
----------------------------------------------------
----------------------------------------------------
SOURCE OF PAYMENT MATRIX IS READ ONLY.
----------------------------------------------------

CP34
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
How much of a reimbursement does anyone in the family expect?
IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1
PERCENT ................................ 2 [CP34OV2]

CP34OV1
=======

ENTER DOLLARS:
[Enter $ Amount] ....................... [BOX_22]
REF ................................... -7 [BOX_22]
DK .................................... -8 [BOX_22]
----------------------------------------------------
SOFT RANGE CHECK: $0 - $10,000
----------------------------------------------------

CP34OV2
=======

ENTER PERCENT:
[Enter % Amount] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 1% - 100%
----------------------------------------------------

BOX_22
======

----------------------------------------------------
RECALCULATE UNDERPAYMENT OR OVERPAYMENT TAKING INTO ACCOUNT ANY AMOUNTS ENTERED AT CP28, CP30, OR CP32.
----------------------------------------------------
----------------------------------------------------
IF UNDERPAYMENT IS ) 3% OR $5 (WHICHEVER IS HIGHER) OF TOTAL CHARGE (WHETHER OR NOT ANY NEW AMOUNTS WERE ENTERED), CONTINUE WITH CP35
----------------------------------------------------
----------------------------------------------------
IF OVERPAYMENT IS ) 3% OR $5 (WHICHEVER IS HIGHER) OF TOTAL CHARGE (WHETHER OR NOT ANY NEW AMOUNTS WERE ENTERED), GO TO CP36
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CP37
----------------------------------------------------

CP35
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Can you think of any other reason why there is still an amount remaining?
RECORD ANSWER VERBATIM:
[Enter Text]
----------------------------------------------------
GO TO CP37
----------------------------------------------------
----------------------------------------------------
NOTE: MULTIPLE LINES ARE NECESSARY FOR TEXT ENTRY.
----------------------------------------------------

CP36
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
Can you think of any other reason why more than the total charge has been paid?
RECORD ANSWER VERBATIM:
[Enter Text]
----------------------------------------------------
NOTE: MULTIPLE LINES ARE NECESSARY FOR TEXT ENTRY.
----------------------------------------------------

CP37
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
INTERVIEWER: WHAT RECORDS WERE USED IN COMPLETING THE CHARGE/PAYMENT INFORMATION FOR THE VISIT TO (PROVIDER) ON (VISIT DATE)/THE VISITS FOR (FLAT FEE GROUP)/THE LAST PURCHASE OF [NAME OF PRESCRIBED MEDICINE...]/THE [OME ITEM GROUP NAME] USED BY (PERSON) SINCE (START DATE)/SERVICES RECEIVED AT HOME FROM (PROVIDER) DURING (MONTH) FOR (PERSON)/(PROVIDER)'S SERVICES AS PART OF THE VISIT MADE ON (VISIT DATE)]?
RESPONDENT'S/FAMILY MEMBER'S MEMORY .... 1
RESPONDENT'S/FAMILY MEMBER'S CHECK BOOK. 2
STATEMENT, BILL OR RECEIPT FROM PROVIDER'S OFFICE ...................... 3
EXPLANATION OF BENEFITS FROM:
MEDICARE ............................. 4
PRIVATE INSURANCE CARRIER ............ 5
CALENDAR ............................... 6
PRESCRIBED MEDICINE BOTTLE, BAG, OR CONTAINER ............................ 7
OTHER ................................. 91
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH CP37OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_23
----------------------------------------------------

CP37OV
======

ENTER OTHER:
[Enter Other Specify] ..................

BOX_23
======

----------------------------------------------------
IF CP37 IS CODED '3' (PROVIDER'S OFFICE), '4' (EXPLANATION OF BENEFITS FROM MEDICARE), OR '5' (EXPLANATION OF BENEFITS FROM PRIVATE INSURANCE CARRIER) AND EVENT TYPE IS NOT PM OR OM, CONTINUE WITH CP38
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_24
----------------------------------------------------

CP38
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
INTERVIEWER: DOES THE PAPERWORK SHOW THAT (PROVIDER) HAS ANOTHER NAME?
YES .................................... 1
NO ..................................... 2 [BOX_24]
PRESS F1 FOR DEFINITION OF PROVIDER NAME.

CP39
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
INTERVIEWER: ENTER OTHER NAME FOR (PROVIDER).
[Enter Medical-Provider-65]

BOX_24
======

----------------------------------------------------
IF:
EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP,
OR
EVENT TYPE IS PM, HS, OM, OR HH,
OR
PERSON-PROVIDER PAIR ALREADY FLAGGED AS 'COPAYMENT SITUATION', GO TO BOX_26
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_25
----------------------------------------------------

BOX_25
======

----------------------------------------------------
IF [CP08 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)] OR [THE AMOUNT IN CP09 IS SET TO THE COPAYMENT AMOUNT] OR [CP08 AND CP09 WERE NOT ASKED AND CP06 IS CODED '5' (NO BILL SENT:
HMO PLAN), '6' (NO BILL SENT: VA), OR '8' (NO BILL SENT: WELFARE/MEDICAID)]
AND
CP10 IS CODED '1' (YES)
AND
CP11 IS CODED '1' (DOLLARS) AND A WHOLE DOLLAR AMOUNT GREATER ()) THAN $0 AND LESS THAN OR EQUAL ((=) TO $50 IS ENTERED IN CP11OV1, FLAG THIS PERSON-PROVIDER PAIR AS A 'COPAYMENT SITUATION', THEN CONTINUE WITH BOX_26
----------------------------------------------------
----------------------------------------------------
OTHERWISE, DO NOT SET ANY FLAGS AND THEN CONTINUE WITH BOX_26
----------------------------------------------------

BOX_26
======

----------------------------------------------------
FLAG CP STATUS OF EVENT-PROVIDER PAIR AS 'PROCESSED'.
----------------------------------------------------
----------------------------------------------------
END OF CHARGE PAYMENT (CP) SECTION.
----------------------------------------------------


Flat Fee (FF) Section


BOX_01
======

----------------------------------------------------
IF NO FLAT FEE GROUPS ALREADY ON PERSONS-FLAT-FEE-GROUPS-ROSTER, GO TO FF02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH FF01
----------------------------------------------------

FF01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
Let me review the groups of health care events I have recorded for (PERSON). Please tell me if any of these groups include the charge that covered [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)].
REVIEW FLAT FEE GROUPS WITH RESPONDENT.
SELECT FLAT FEE GROUP COVERED BY SAME CHARGE AS EVENT BEING nASKED ABOUT.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. Flat Fee Group] ....................
[2. Flat Fee Group] ....................
[3. Flat Fee Group] ....................
[Code One]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL FLAT FEE GROUPS ON THE PERSON'S-FLAT-FEE-GROUPS-ROSTER CREATED IN THIS ROUND AND IN THE PREVIOUS ROUNDS.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
IF A FLAT FEE GROUP IS SELECTED, GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED, CONTINUE WITH FF02
----------------------------------------------------
----------------------------------------------------
NOTE: SINCE THIS ROSTER WILL INCLUDE ALL FLAT FEE GROUPS, CURRENT ROUND SINGLE EVENTS CAN BE ADDED TO ANY FLAT FEE GROUP CREATED DURING THE CURRENT ROUND OR A PREVIOUS ROUND.
----------------------------------------------------

FF02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
Let me review the list of health care events I have recorded for (PERSON). Please tell me which of these were included in the same charge that covered [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)].
REVIEW EVENTS WITH RESPONDENT.
SELECT EVENTS COVERED BY SAME CHARGE AS EVENT BEING ASKED ABOUT.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. PROVIDER
FF02_02. STAY TYPE
FF02_03. ADMIT DATE
FF02_04 DISCH DATE
[Display Medical Provider-35] [Display Event Code] [Display Month Day Year-4] [Display Month Day Year-4]
[Display Medical Provider-35] [Display Event Code] [Display Month Day Year-4] [Display Month Day Year-4]
[Display Medical Provider-35] [Display Event Code] [Display Month Day Year-4] [Display Month Day Year-4]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL EVENTS ON PERSON'S-MEDICAL-EVENTS-ROSTER THAT MEET THE FOLLOWING CONDITIONS:

- EVENT HAS CP STATUS OF 'PROCESSED' OR 'UNPROCESSED'
- EVENT IS NOT ALREADY INCLUDED IN A FLAT FEE GROUP OR A REPEAT VISIT GROUP
- EVENT IS NOT ALREADY CODED (VERIFIED) AS A COPAYMENT
- EVENT TYPE IS NOT PM, IC, OM TYPE 2 (INSULIN), OR OM TYPE 3 (OTHER DIABETIC SUPPLIES OR EQUIPMENT)
- EVENT IS NOT AN HS EVENT WITH A DISCHARGE DATE CODED '95' (STILL IN HOSPITAL)
- EVENT IS NOT AN MV OR OP EVENT THAT WAS A TELEPHONE CALL (OP02 OR MV01 CODED '2')
- EVENT IS NOT A HH EVENT WITH EVENT DATE = INTERVIEW MONTH
----------------------------------------------------
----------------------------------------------------
DISPLAY 'OUTSIDE REFERENCE PERIOD' AS THE LAST ENTRY IN THE 'EVENT DATE' COLUMN.
----------------------------------------------------

FF03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
INTERVIEWER: RECORD 'NAME OF FLAT FEE GROUP' FOR EVENTS SELECTED IN PREVIOUS QUESTION:
[Enter Flat Fee Group]
----------------------------------------------------
WRITE FLAT FEE GROUP TO PERSON'S-FLAT-FEE-GROUPS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1, CONTINUE WITH FF04
----------------------------------------------------
----------------------------------------------------
IF ROUND 5, GO TO FF09
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_02
----------------------------------------------------

FF04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
Did the charge which included the services for (FLAT FEE GROUP) cover any visits before (START DATE)?
YES .................................... 1
NO ..................................... 2 [FF06]
REF ................................... -7 [FF06]
DK .................................... -8 [FF06]

FF05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
How many visits did (PERSON) have before (START DATE)?
[Enter Number] .........................
REF ................................... -7
DK .................................... -8

FF06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
Did the charge that included the services for (FLAT FEE GROUP) cover any surgical procedures before (START DATE)?
YES .................................... 1
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
PRESS F1 FOR DEFINITION OF SURGICAL PROCEDURE.

FF07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
INTERVIEWER: IS THE VISIT THAT INCLUDES SURGERY ALREADY PART OF THE FLAT FEE GROUP?
YES .................................... 1 [BOX_02]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]

FF08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
Was this the kind of surgery for which (PERSON) had to stay in the hospital at least one night or (were/was) (PERSON) allowed to go home the same day of the surgery?
AT LEAST ONE NIGHT ..................... 1 [BOX_02]
SAME DAY ............................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]

FF09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
Will the charge which includes the services for (FLAT FEE GROUP) cover any visits after December 31, 1998?
YES .................................... 1
NO ..................................... 2 [FF11]
REF ................................... -7 [FF11]
DK .................................... -8 [FF11]

FF10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
Approximately, how many visits will (PERSON) have after December 31, 1998?
[Enter Number] .........................
REF ................................... -7
DK .................................... -8

FF11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
Will the charge that includes the services for (FLAT FEE GROUP) cover any surgical procedures after December 31, 1998?
YES .................................... 1
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
PRESS F1 FOR DEFINITION OF SURGICAL PROCEDURE.

FF12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
INTERVIEWER: IS THE VISIT THAT INCLUDES SURGERY ALREADY PART OF THE FLAT FEE GROUP?
YES .................................... 1 [BOX_02]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]

FF13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
Will this be the kind of surgery for which (PERSON) has to stay in the hospital at least one night or will (PERSON) be allowed to go home the same day of the surgery?
AT LEAST ONE NIGHT ..................... 1
SAME DAY ............................... 2
REF ................................... -7
DK .................................... -8
[Code One]

BOX_02
======

----------------------------------------------------
RETURN TO THE EVENT DRIVER FOR THIS EVENT-PROVIDER PAIR. IF EVENT-PROVIDER PAIR BEING ASKED ABOUT WAS PART OF AN EXISTING FLAT FEE GROUP (A NAME WAS SELECTED AT FF01), FLAG THE CP STATUS OF THE EVENT-PROVIDER PAIR AS 'PROCESSED'. IF A NEW FLAT FEE GROUP WAS FORMED AT FF02, THE COMPLETE (FROM THE BEGINNING) CP SECTION WILL BE ASKED FOR THIS FLAT FEE GROUP.
----------------------------------------------------


Long Term Care (LC) Section


BOX_01
======

----------------------------------------------------
IF AT LEAST ONE CURRENT OR INSTITUTIONALIZED (NOT DECEASED) RU MEMBER IS FLAGGED FOR:
- LTC SUPPLEMENT: ADL SECTION
AND/OR
- LTC SUPPLEMENT: IADL SECTION
AND/OR
- LTC SUPPLEMENT: AIDS/SPECIAL EQUIPMENT SECTION
AND/OR
- LTC SUPPLEMENT: FUNCTIONAL LIMITATIONS SECTION
AND/OR
- LTC SUPPLEMENT: WORK-HOUSEWORK-SCHOOL LIMITATIONS SECTION
AND/OR
- LTC SUPPLEMENT: SOCIAL LIMITATIONS SECTION
AND/OR
- LTC SUPPLEMENT: COGNITIVE LIMITATIONS SECTION
AND/OR
- LTC SUPPLEMENT: VISION SECTION
AND/OR
- LTC SUPPLEMENT: HEARING SECTION
AND/OR
- LTC SUPPLEMENT: CHILD (=4 LIMITED ACTIVITIES SECTION
AND/OR
- LTC SUPPLEMENT: SCHOOL ATTENDANCE LIMITED SECTION
DURING ROUNDS 1, 2, 3, OR 4, CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_18
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL ONLY LOOK AT LTC SUPPLEMENT FLAGS THAT HAVE NOT YET BEEN CONSIDERED. FOR EXAMPLE, FOR PANEL 1, ROUND 4, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 1-4. FOR PANEL 2, ROUND 2, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 1 AND 2. FOR PANEL 2, ROUND 4, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 3 AND 4.
----------------------------------------------------
----------------------------------------------------
NOTE: THIS SECTION IS NOT ASKED FOR RU MEMBERS WHO ARE DECEASED.
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK BOX_02 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 CYCLES PERSONS THROUGH THE DIFFERENT SERIES OF LONG TERM CARE QUESTIONS. THIS LOOP CYCLES ON EACH CURRENT OR INSTITUTIONALIZED (NOT DECEASED) PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS ONE OF THE FOLLOWING CONDITIONS:

PERSON IS FLAGGED FOR:
- LTC SUPPLEMENT: ADL SECTION
AND/OR
- LTC SUPPLEMENT: IADL SECTION
AND/OR
- LTC SUPPLEMENT: AIDS/SPECIAL EQUIPMENT SECTION
AND/OR
- LTC SUPPLEMENT: FUNCTIONAL LIMITATIONS SECTION
AND/OR
- LTC SUPPLEMENT: WORK-HOUSEWORK-SCHOOL LIMITATIONS SECTION
AND/OR
- LTC SUPPLEMENT: SOCIAL LIMITATIONS SECTION
AND/OR
- LTC SUPPLEMENT: COGNITIVE LIMITATIONS SECTION
AND/OR
- LTC SUPPLEMENT: VISION SECTION
AND/OR
- LTC SUPPLEMENT: HEARING SECTION
AND/OR
- LTC SUPPLEMENT: CHILD (=4 LIMITED ACTIVITIES SECTION
AND/OR
- LTC SUPPLEMENT: SCHOOL ATTENDANCE LIMITED SECTION
DURING ROUNDS 1, 2, 3, OR 4.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL ONLY LOOK AT LTC SUPPLEMENT FLAGS THAT HAVE NOT YET BEEN CONSIDERED. FOR EXAMPLE, FOR PANEL 1, ROUND 4, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 1-4. FOR PANEL 2, ROUND 2, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 1 AND 2. FOR PANEL 2, ROUND 4, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 3 AND 4.
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF PERSON IS FLAGGED FOR LTC SUPPLEMENT: ADL SECTION, CONTINUE WITH BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF PERSON IS = OR ) 6 YEARS OLD OR IN AGE CATEGORIES 3-9, CONTINUE WITH LC01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

LC01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
We have some questions about everyday activities such as bathing and eating. We are interested in the kinds of help people receive, not just hands on help but instructing or prompting or being there just in case help is needed.
Because of an impairment or a physical or mental health problem, did (PERSON) receive help bathing or showering (including getting to the bath or shower and turning on the water) in the past month?

CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DID NOT DO THIS ACTIVITY IN THE PAST MONTH.
YES .................................... 1
NO ..................................... 2 [LC03]
DID NOT DO ACTIVITY .................... 3 [LC03]
REF ................................... -7 [LC03]
DK .................................... -8 [LC03]
[Code One]
PRESS F1 FOR DEFINITION OF HELP BATHING OR SHOWERING.

LC02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD LC-1.
HELP BATHING OR SHOWERING, INCLUDING GETTING TO THE BATH OR SHOWER AND TURNING ON THE WATER, IN THE PAST MONTH.
Please look at this card and tell me which types of help (PERSON) received. Include help getting to and from the bath or shower as well as help with bathing.
PROBE: Any other type of help?

CODE ALL THAT APPLY.
HANDS ON ............................... 1
INSTRUCTION OR PROMPTING ............... 2
STAYING IN ROOM IN CASE HELP IS NEEDED . 3
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF HELP BATHING OR SHOWERING AND ANSWER CATEGORIES.

LC03
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Because of an impairment or a physical or mental health problem, did (PERSON) receive help dressing (that is, getting clothes and putting them on) in the past month?
CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DID NOT DO THIS ACTIVITY IN THE PAST MONTH, INCLUDING STAYING IN BEDCLOTHES OR ONLY PARTIALLY DRESSING.
YES .................................... 1
NO ..................................... 2 [LC05]
DID NOT DO ACTIVITY .................... 3 [LC05]
REF ................................... -7 [LC05]
DK .................................... -8 [LC05]
[Code One]
PRESS F1 FOR DEFINITION OF HELP DRESSING.

LC04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD LC-1.
HELP DRESSING, INCLUDING GETTING THE CLOTHES AND PUTTING THEM ON, IN THE PAST MONTH.
Please look at this card and tell me which types of help (PERSON) received.
PROBE: Any other type of help?

CODE ALL THAT APPLY.
HANDS ON ............................... 1
INSTRUCTION OR PROMPTING ............... 2
STAYING IN ROOM IN CASE HELP IS NEEDED . 3
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF HELP DRESSING AND ANSWER CATEGORIES.

LC05
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Because of an impairment or a physical or mental health problem, did (PERSON) receive help getting to the toilet or using the toilet in the past month?
IF NEEDED SAY, Independence in toileting includes getting to the toilet, arranging clothes and cleaning organs.

CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DID NOT DO THIS ACTIVITY IN THE PAST MONTH.
YES .................................... 1
NO ..................................... 2 [LC07]
DID NOT DO ACTIVITY .................... 3 [LC07]
REF ................................... -7 [LC07]
DK .................................... -8 [LC07]
[Code One]
PRESS F1 FOR DEFINITION OF HELP GETTING TO/USING TOILET.

LC06
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD LC-1.
HELP GETTING TO THE TOILET AND USING TOILET, IN THE PAST MONTH.
Please look at this card and tell me which types of help (PERSON) received. Include help getting to the toilet or using the toilet.
PROBE: Any other type of help?

CODE ALL THAT APPLY.
HANDS ON ............................... 1
INSTRUCTION OR PROMPTING ............... 2
STAYING IN ROOM IN CASE HELP IS NEEDED . 3
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF HELP GETTING TO/USING TOILET AND ANSWER CATEGORIES.

LC07
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Because of an impairment or a physical or mental health problem, did (PERSON) receive help getting out of bed or a chair in the past month?
CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DID NOT DO THIS ACTIVITY IN THE PAST MONTH OR PERSON IS BED BOUND.
YES .................................... 1
NO ..................................... 2 [LC09]
DID NOT DO ACTIVITY .................... 3 [LC09]
REF ................................... -7 [LC09]
DK .................................... -8 [LC09]
[Code One]
PRESS F1 FOR DEFINITION OF HELP GETTING OUT OF BED OR A CHAIR.

LC08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD LC-1.
HELP GETTING OUT OF BED OR A CHAIR IN THE PAST MONTH.
Please look at this card and tell me which types of help (PERSON) received.
PROBE: Any other type of help?

CODE ALL THAT APPLY.
HANDS ON ............................... 1
INSTRUCTION OR PROMPTING ............... 2
STAYING IN ROOM IN CASE HELP IS NEEDED . 3
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF HELP GETTING OUT OF BED OR A CHAIR AND ANSWER CATEGORIES.

LC09
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Because of an impairment or a physical or mental health problem, did (PERSON) receive help eating (not including meal preparation) in the past month?
CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DID NOT DO THIS ACTIVITY IN THE PAST MONTH.
YES .................................... 1
NO ..................................... 2 [BOX_04]
DID NOT DO ACTIVITY .................... 3 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
[Code One]
PRESS F1 FOR DEFINITION OF HELP EATING.

LC10
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD LC-1.
HELP EATING, NOT INCLUDING MEAL PREPARATION, IN THE PAST MONTH.
Please look at this card and tell me which types of help (PERSON) received.
PROBE: Any other type of help?

CODE ALL THAT APPLY.
HANDS ON ............................... 1
INSTRUCTION OR PROMPTING ............... 2
STAYING IN ROOM IN CASE HELP IS NEEDED . 3
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF HELP EATING AND ANSWER CATEGORIES.

BOX_04
======

----------------------------------------------------
IF CODED '1' (YES) AT LC01, LC03, LC05, LC07, OR LC09 (I.E., PERSON RECEIVED HELP WITH AN ADL IN PAST MONTH), CONTINUE WITH LC11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

LC11
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
You told me (PERSON) received help with some everyday activities in the past month. (Have/Has) (PERSON) received help with any of those activities for more than three months?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8

BOX_05
======

----------------------------------------------------
IF PERSON IS FLAGGED FOR LTC SUPPLEMENT: IADL SECTION, CONTINUE WITH BOX_06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF PERSON IS = OR ) 16 YEARS OLD OR IN AGE CATEGORIES 4-9, CONTINUE WITH LC12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

LC12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Now I would like to ask about a few [more] daily activities which some people have difficulty with.
(Do/Does) (PERSON) receive help or supervision shopping for groceries because of an impairment or a physical or mental health problem? Please do not include help in getting to or from the store.

CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DOES NOT DO THIS ACTIVITY.
YES .................................... 1
NO ..................................... 2
DOES NOT DO ACTIVITY ................... 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION SHOPPING FOR GROCERIES.
----------------------------------------------------
DISPLAY 'more' IF PERSON FLAGGED FOR LTC SUPPLEMENT: ADL SECTION. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

LC13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) receive help or supervision getting around the community outside of walking distance because of an impairment or a physical or mental health problem? Please include help or supervision with taking cabs, using public transportation, or driving.
CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DOES NOT DO THIS ACTIVITY.
YES .................................... 1
NO ..................................... 2
DOES NOT DO ACTIVITY ................... 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION GETTING AROUND IN COMMUNITY OUTSIDE OF WALKING DISTANCE.

LC14
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) receive help or supervision preparing meals because of an impairment or a physical or mental health problem?
CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DOES NOT DO THIS ACTIVITY.
YES .................................... 1
NO ..................................... 2
DOES NOT DO ACTIVITY ................... 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION PREPARING MEALS.

LC15
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) receive help or supervision taking medications because of an impairment or a physical or mental health problem? Please include pouring, counting pills, and remembering when and how often to take medications.
CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DOES NOT DO THIS ACTIVITY.
YES .................................... 1
NO ..................................... 2
DOES NOT DO ACTIVITY ................... 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION TAKING MEDICATIONS.

LC16
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) receive help or supervision managing money, such as keeping track of expenses or paying bills because of an impairment or a physical or mental health problem?
CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DOES NOT DO THIS ACTIVITY.
YES .................................... 1
NO ..................................... 2
DOES NOT DO ACTIVITY ................... 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION MANAGING MONEY.

LC17
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) receive help or supervision doing laundry because of an impairment or a physical or mental health problem?
CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DOES NOT DO THIS ACTIVITY.
YES .................................... 1
NO ..................................... 2
DOES NOT DO ACTIVITY ................... 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION DOING LAUNDRY.

LC18
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) receive help or supervision doing light housework, such as straightening up, putting things away or washing dishes because of an impairment or a physical or mental health problem?
CODE '3' IF RESPONDENT VOLUNTEERS THAT PERSON DOES NOT DO THIS ACTIVITY.
YES .................................... 1
NO ..................................... 2
DOES NOT DO ACTIVITY ................... 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF HELP/SUPERVISION DOING LIGHT HOUSEWORK.

BOX_07
======

----------------------------------------------------
IF CODED '1' (YES) AT LC12, LC13, LC14, LC15, LC16, LC17, OR LC18 (I.E., PERSON RECEIVES HELP OR SUPERVISION WITH AN IADL), CONTINUE WITH LC19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

LC19
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
You told me (PERSON) (receive/receives) help or supervision with some daily activities. (Have/Has) (PERSON) received help or supervision with any of these activities for more than three months?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8

BOX_08
======

----------------------------------------------------
IF PERSON IS FLAGGED FOR LTC SUPPLEMENT: COGNITIVE LIMITATIONS SECTION, CONTINUE WITH LC20
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

LC20
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
We are interested in learning about people's memory and how they think about things. First, how would you rate (PERSON)'s memory at the present time?
Would you say it is...
excellent, ............................. 1
very good, ............................. 2
good, .................................. 3
fair, or ............................... 4
poor? .................................. 5
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF MEMORY.

LC21
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Compared with two years ago, would you say (PERSON)'s memory is better now, about the same, or worse than it was then?
BETTER ................................. 1
SAME ................................... 2
WORSE .................................. 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF MEMORY.

BOX_09
======

----------------------------------------------------
IF PERSON IS ( OR = 17 YEARS OF AGE OR IN AGE CATEGORIES 1-3, CONTINUE WITH LC22
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------

LC22
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[The next few questions ask about [other] types of difficulties (PERSON) may have because of an impairment or a physical or mental health problem.]
Has a doctor or medical person ever said that (PERSON) has problems or delays in understanding things, that is, delays in cognitive or mental development?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF DELAYS IN COGNITIVE OR MENTAL DEVELOPMENT.
----------------------------------------------------
DISPLAY "other" IF LC01 AND/OR LC12 WERE ASKED. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

LC23
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or medical person ever said that (PERSON) has problems or delays in speech or language development?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF DELAYS IN SPEECH OR LANGUAGE DEVELOPMENT.

LC24
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or medical person ever said that (PERSON) has problems or delays in emotional or behavioral development?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DELAYS IN EMOTIONAL OR BEHAVIORAL DEVELOPMENT.

LC25
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does (PERSON) follow a special diet ordered by a doctor because of an impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF SPECIAL DIET.
----------------------------------------------------
IF PERSON IS ( 6 YEARS OLD OR IN AGE CATEGORIES 1 OR 2, CONTINUE WITH LC26
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LC27
----------------------------------------------------

LC26
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Because of an impairment or a physical or mental health problem, does (PERSON) need more help than usual for a child of (PERSON)'s age with eating, dressing, bathing, or using the toilet?
YES .................................... 1 [BOX_10]
NO ..................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
PRESS F1 FOR DEFINITION OF HELP WITH EATING, DRESSING, BATHING, OR USING THE TOILET.

LC27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Because of an impairment or a physical or mental health problem, does (PERSON) have any difficulty participating in strenuous activity, such as running or jumping, compared to other children of (PERSON)'s age?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF DIFFICULTY PARTICIPATING IN STRENUOUS ACTIVITY.

LC28
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does (PERSON) have significant problems at school with...
1 = YES
2 = NO
3 = CANNOT DO OR DOES NOT APPLY BECAUSE OF LIMITATION
LC28_01. a. Understanding instructional materials? ( )
LC28_02. b. Paying attention in class? ( )
LC28_03. c. Communicating with teachers and other students? ( )
-----------------------------------------------------
REFUSED (-7) AND DON'T KNOW (-8) ALLOWED ON ALL FORM ITEMS.
-----------------------------------------------------
-----------------------------------------------------
IF PERSON IS 6 - 13 YEARS OLD, INCLUSIVE, OR IN AGE CATEGORY 3, CONTINUE WITH LC29
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO BOX_10
-----------------------------------------------------

LC29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does (PERSON) have trouble either walking several blocks or climbing stairs because of an impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8

BOX_10
======

----------------------------------------------------
IF PERSON IS FLAGGED FOR LTC SUPPLEMENT: IADL SECTION, ADL SECTION, WORK-HOUSEWORK-SCHOOL LIMITATION SECTION, SOCIAL LIMITATIONS SECTION, COGNITIVE LIMITATIONS SECTION, HEARING SECTION, CHILD (=4 LIMITED ACTIVITIES SECTION, OR SCHOOL ATTENDANCE LIMITED SECTION, CONTINUE WITH BOX_11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

BOX_11
======

----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS NOT THE RESPONDENT, CONTINUE WITH LC30
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

LC30
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[The next few questions ask about difficulties (PERSON) may have communicating because of an impairment or a physical or mental health problem.]
Does (PERSON) have difficulty understanding ordinary conversation (in (PERSON)'s native language)?
IF NEEDED SAY, If (PERSON) wears a hearing aid, please think about when (PERSON) is wearing the hearing aid.
YES .................................... 1
NO ..................................... 2 [LC32]
REF ................................... -7 [LC32]
DK .................................... -8 [LC32]
PRESS F1 FOR DEFINITION OF DIFFICULTY UNDERSTANDING.

LC31
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How do people usually communicate with (PERSON)?
PROBE: Any other ways?

CODE '95' IF PERSON CANNOT UNDERSTAND ANY KIND OF COMMUNICATION.
CODE ALL THAT APPLY.
TALKING ............................... 1
SIGN LANGUAGE ......................... 2
PRINTING OR WRITING ................... 3
SYMBOL SYSTEM OR PICTURES/COMMUNICATION BOARD/COMPUTER ........ 4
POINTING OR USING GESTURES/FACIAL EXPRESSIONS ......................... 5
OTHER ................................. 91
PERSON CANNOT UNDERSTAND ANY KIND OF COMMUNICATION .......... 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '95' (PERSON CANNOT UNDERSTAND ANY KIND OF COMMUNICATION), '-7' (REFUSED), AND '-8' (DON'T KNOW) AS ENTRIES IN THE FIRST FIELD ONLY. ALL OTHER RESPONSE CODES MAY BE ENTERED IN ANY ENTRY FIELD, IN ANY ORDER. CODE '95' WILL NOT APPEAR AS A RESPONSE CATEGORY ON THE SCREEN.
----------------------------------------------------

LC32
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does (PERSON) have difficulty talking?
YES .................................... 1
NO ..................................... 2 [BOX_12]
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]
PRESS F1 FOR DEFINITION OF DIFFICULTY TALKING.

LC33
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How does (PERSON) communicate with other people?
PROBE: Any other ways?

CODE '95' IF PERSON UNABLE TO COMMUNICATE AT ALL.
CODE ALL THAT APPLY.
TALKING ............................... 1
SIGN LANGUAGE ......................... 2
PRINTING OR WRITING ................... 3
SYMBOL SYSTEM OR PICTURES/COMMUNICATION BOARD/COMPUTER ........ 4
POINTING OR USING GESTURES/FACIAL EXPRESSIONS ......................... 5
OTHER ................................. 91
PERSON UNABLE TO COMMUNICATE AT ALL ................. 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '95' (PERSON UNABLE TO COMMUNICATE AT ALL), '-7' (REFUSED), AND '-8' (DON'T KNOW) AS ENTRIES IN THE FIRST FIELD ONLY. ALL OTHER RESPONSE CODES MAY BE ENTERED IN ANY ENTRY FIELD, IN ANY ORDER. CODE '95' WILL NOT APPEAR AS A RESPONSE CATEGORY ON THE SCREEN.
----------------------------------------------------

BOX_12
======

----------------------------------------------------
IF PERSON IS FLAGGED FOR LTC SUPPLEMENT: AIDS/SPECIAL EQUIPMENT SECTION, FUNCTIONAL LIMITATION SECTION, WORK-HOUSEWORK-SCHOOL LIMITATION SECTION, VISION SECTION, OR HEARING SECTION, CONTINUE WITH BOX_13
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_14
----------------------------------------------------

BOX_13
======

----------------------------------------------------
IF PERSON IS = OR ) 16 YEARS OF AGE OR IN AGE CATEGORIES 4-9, CONTINUE WITH LC34
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_14
----------------------------------------------------

LC34
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Now I would like to ask a few questions about accommodations (PERSON)'s employer may have made because of (PERSON)'s impairment or physical or mental health problem.]
(Are/Is) (PERSON) currently working?
YES .................................... 1
NO ..................................... 2 [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX_14]
PRESS F1 FOR DEFINITION OF WORKING.

LC35
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD LC-2.
What kind of accommodations, if any, has (PERSON)'s employer made so that (PERSON) can work?
PROBE: Any other accommodations?

CODE '95' IF NO ACCOMMODATIONS HAVE BEEN MADE.
CODE ALL THAT APPLY.
HANDRAILS OR RAMPS ..................... 1
AN ELEVATOR ............................ 2
WORK STATION ADAPTATION SUCH AS RAISED DESK ......................... 3
ACCESSIBLE RESTROOMS ................... 4
AUTOMATIC DOOR(S) ...................... 5
VOICE SYNTHESIZER, TELECOMMUNICATIONS
DEVICE FOR THE DEAF (TDD) ........... 6
BRAILLE, ENLARGED PRINT, AUDIO TAPE, OR SPECIAL LIGHTING ................. 7
JOB COACH .............................. 8
PERSONAL ASSISTANT/INTERPRETER ......... 9
SPECIAL PENS, PENCILS, OR OTHER OFFICE SUPPLIES .................... 10
JOB REDESIGN, ALTERNATIVE RESPONSIBILITIES, OPTIONS .......... 11
MODIFIED WORK HOURS OR DAYS ........... 12
OTHER EQUIPMENT ....................... 13
NO ACCOMMODATIONS HAVE BEEN MADE ...... 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '95' (NO ACCOMMODATIONS HAVE BEEN MADE) '-7' (REFUSED), AND '-8' (DON'T KNOW) AS ENTRIES IN THE FIRST FIELD ONLY. ALL OTHER RESPONSE CODES MAY BE ENTERED IN ANY ENTRY FIELD, IN ANY ORDER. CODE '95' WILL NOT APPEAR AS A RESPONSE CATEGORY ON THE SCREEN.
----------------------------------------------------

LC36
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Did (PERSON) change the kind of work (PERSON) (do/does) due to an impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8

BOX_14
======

----------------------------------------------------
IF PERSON IS FLAGGED FOR LTC SUPPLEMENT: AIDS/SPECIAL EQUIPMENT SECTION, FUNCTIONAL LIMITATION SECTION, WORK-HOUSEWORK-SCHOOL LIMITATION SECTION, SOCIAL LIMITATION SECTION, VISION SECTION, HEARING SECTION, CONTINUE WITH BOX_15
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LC41
----------------------------------------------------

BOX_15
======

----------------------------------------------------
IF PERSON IS = OR ) 16 YEARS OF AGE OR IN AGE CATEGORIES 4-9, CONTINUE WITH BOX_16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LC39
----------------------------------------------------

BOX_16
======

----------------------------------------------------
IF PERSON IS NOT FLAGGED FOR LTC SUPPLEMENT:
VISION SECTION, CONTINUE WITH LC37
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LC39
----------------------------------------------------

LC37
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does an impairment or a physical or mental health problem prevent (PERSON) from driving?
YES .................................... 1 [LC39]
NO ..................................... 2
REF ................................... -7 [LC39]
DK .................................... -8 [LC39]

LC38
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) use special equipment or have a modified vehicle that enables (PERSON) to drive?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF SPECIAL EQUIPMENT OR MODIFIED VEHICLE.

LC39
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Do family or friends provide (PERSON) with transportation on a regular basis because of an impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8

LC40
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) receive other special transportation services from any other source?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF SPECIAL TRANSPORTATION SERVICES.

LC41
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) use any special equipment or technology because of an impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2 [BOX_16A]
REF ................................... -7 [BOX_16A]
DK .................................... -8 [BOX_16A]
PRESS F1 FOR DEFINITION OF SPECIAL EQUIPMENT OR TECHNOLOGY.

LC42
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD LC-3.
What types of special equipment or technology (do/does) (PERSON) use?
PROBE: Anything else?

CODE ALL THAT APPLY.
RAILINGS, RAMPS ........................ 1
WALKERS, CANES, CRUTCHES ............... 2
ORTHOPEDIC SHOES, ORTHOTICS ............ 3
BRACES FOR ARM, LEG, OR BACK ........... 4
PROSTHESES, E.G., ARTIFICIAL ARM, HAND, LEG, FOOT ........................... 5
REACHER ................................ 6
BATHING AIDS, E.G., TUB OR SHOWER BENCH, HAND HELD SHOWER ............. 7
TOILETING AIDS, E.G., RAISED TOILET SEAT, HAND RAILS, BED PANS .......... 8
WHEELCHAIR OR SCOOTER .................. 9
DRESSING AIDS, E.G., ZIPPER PULL ...... 10
OXYGEN OR RESPIRATOR .................. 11
LIFT .................................. 12
GUIDE DOGS OR OTHER ANIMAL ASSISTANTS . 13
COMMUNICATION EQUIPMENT, E.G., TTY/TDD, COMMUNICATION BOARD, SPEECH SYNTHESIZER ........................ 14
OTHER SPECIAL EQUIPMENT OR TECHNOLOGY . 15
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.

BOX_16A
=======

----------------------------------------------------
IF PERSON:
- HAS RECEIVED HELP WITH ADLs,
OR
- HAS RECEIVED HELP WITH IADLs,
OR
- IS A CHILD WITH LIMITATIONS,
OR
- HAS DIFFICULTY COMMUNICATING,
OR
- HAS CHANGED JOBS DUE TO LIMITATIONS, THAT IS,
IF LC01, LC03, LC05, LC07, LC09, LC12, LC13, LC14, LC15, LC16, LC17, LC18, LC22, LC23, LC24, LC25, LC26, LC27, LC28_01, LC28_02, LC28_03, LC29, LC30, OR LC36 IS CODED '1' (YES),

CONTINUE WITH LC43
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

LC43
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Thinking of all the limitations we have talked about, when did (PERSON)'s limitation(s) start?
ENTER A 4 DIGIT YEAR.
[Enter Year-4] .........................
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
EDIT: START DATE OF LIMITATION MUST BE ) = BIRTH DATE AND ( = INTERVIEW DATE.
----------------------------------------------------
----------------------------------------------------
IF YEAR ENTERED IS REFERENCE YEAR, CONTINUE WITH LC43OV1
----------------------------------------------------
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO BOX_17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LC45
----------------------------------------------------
----------------------------------------------------
NOTE: 1996/1997 IS THE REFERENCE YEAR FOR PANEL 1, ROUND 4. 1997 IS THE REFERENCE YEAR FOR PANEL 2, ROUND 2. 1997/1998 IS THE REFERENCE YEAR FOR PANEL 2, ROUND 4.
----------------------------------------------------

LC43OV1
=======

[Enter Month-2] .......................
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH BOX_17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LC45
----------------------------------------------------

BOX_17
======

----------------------------------------------------
IF PERSON IS ) 22 YEARS OLD OR IN AGE CATEGORIES CATEGORIES 5-9, CONTINUE WITH LC44
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LC45
----------------------------------------------------

LC44
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Did the limitations start before (PERSON) (were/was) 22 years old?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8

LC45
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
We have talked about different kinds of help (PERSON) might receive and different types of problems or limitations (PERSON) might have. What health conditions led (PERSON) to need this help or to have these problems and limitations?
PROBE: Any other conditions associated with (PERSON)'s limitations?

IF OLD AGE MENTIONED, RECORD 'OLD AGE' AS A CONDITION.
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?
IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition]..................
[2. Medical Condition]..................
[3. Medical Condition]..................
-----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-MEDICAL-CONDITIONS-ROSTER.
-----------------------------------------------------
----------------------------------------------------
NOTE: THERE IS NO "DIRECT" LINK BETWEEN CONDITIONS AND LIMITATIONS.
----------------------------------------------------

LC46
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD LC-4.
Please look at this card and tell me which types of community services, if any, (PERSON) (use/uses) because of (PERSON)'s impairment or a physical or mental health problem.
PROBE: Any other services?

CODE '95' IF NO SERVICES ARE USED.
CODE ALL THAT APPLY.
ADULT DAY CARE ......................... 1
MEALS DELIVERED TO THE HOME (INCLUDING MEALS ON WHEELS) .......... 2
SENIOR CENTER .......................... 3
VOCATIONAL REHABILITATION .............. 4
FAMILY SUPPORT SERVICES OR RESPITE CARE ......................... 5
SPECIAL TRANSPORTATION SERVICES ........ 6
CASE MANAGEMENT ........................ 7
SHELTERED WORKSHOP/SUPPORTED EMPLOYMENT ........................... 8
OTHER ................................. 91
NO SERVICES ARE USED .................. 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '95' (NO SERVICES ARE USED), '-7' (REFUSED), AND '-8' (DON'T KNOW) AS ENTRIES IN THE FIRST FIELD ONLY. ALL OTHER RESPONSE CODES MAY BE ENTERED IN ANY ENTRY FIELD, IN ANY ORDER. CODE '95' WILL NOT APPEAR AS A RESPONSE CATEGORY ON THE SCREEN.
----------------------------------------------------
-----------------------------------------------------
IF PERSON IS = OR ) 18 YEARS OLD OR IN AGE CATEGORIES 4-9, CONTINUE WITH LC47
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO END_LP01
-----------------------------------------------------

LC47
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
We have talked about different types of help (PERSON) might receive and different types of problems and limitations (PERSON) might have.
Is the help (PERSON) (receive/receives) or the problems and limitations (PERSON) (have/has) related to service in the Armed Forces of the United States?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF SERVICE IN THE ARMED FORCES OF THE UNITED STATES.

END_LP01
========

-----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
-----------------------------------------------------
-----------------------------------------------------
IF NO MORE PERSONS MEETS THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_18
-----------------------------------------------------

BOX_18
======

-----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION.
-----------------------------------------------------


Caregiver (CG) Section


BOX_01
======

----------------------------------------------------
IF ANY CURRENT OR INSTITUTIONALIZED (NOT DECEASED) RU MEMBER MEETS AT LEAST ONE OF THE FOLLOWING CONDITIONS:
(LC43 WAS ASKED (NOT CODED '-1' MISSING) FOR PERSON AND PERSON IS FLAGGED FOR:
- LTC SUPPLEMENT: ADL SECTION (DURING ROUNDS 1, 2, 3, OR 4)
AND/OR
- LTC SUPPLEMENT: IADL SECTION (DURING ROUNDS 1, 2, 3, OR 4)
AND/OR
- LTC SUPPLEMENT: CHILD (=4 LIMITED ACTIVITIES SECTION (DURING ROUNDS 2 OR 4)
AND/OR
- LTC SUPPLEMENT: SCHOOL ATTENDANCE LIMITED SECTION (DURING ROUNDS 2 OR 4))
OR
PERSON IS FLAGGED FOR THE LTC SUPPLEMENT:
COGNITIVE LIMITATIONS SECTION (DURING ROUNDS 1 OR 3)
OR
PERSON HAS A HOME HEALTH EVENT IN THE CURRENT ROUND, CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL ONLY LOOK AT LTC SUPPLEMENT FLAGS THAT HAVE NOT YET BEEN CONSIDERED. FOR EXAMPLE, FOR PANEL 1, ROUND 4, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 1-4. FOR PANEL 2, ROUND 2, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 1 AND 2. FOR PANEL 2, ROUND 4, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 3 AND 4.
----------------------------------------------------
----------------------------------------------------
NOTE: THIS SECTION IS NOT ASKED FOR RU MEMBERS WHO ARE DECEASED.
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK BOX_02 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ON POTENTIAL CAREGIVERS BOTH IN AND OUTSIDE OF THE RU. THIS LOOP CYCLES ON EACH CURRENT OR INSTITUTIONALIZED (NOT DECEASED) PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS AT LEAST ONE OF THE FOLLOWING CONDITIONS:

(LC43 WAS ASKED FOR PERSON (NOT CODED '-1' (MISSING) AND PERSON IS FLAGGED FOR:
- LTC SUPPLEMENT: ADL SECTION (DURING ROUNDS 1, 2, 3, OR 4)
AND/OR
- LTC SUPPLEMENT: IADL SECTION (DURING ROUNDS 1, 2, 3, OR 4)
AND/OR
- LTC SUPPLEMENT: CHILD (=4 LIMITED ACTIVITIES SECTION (DURING ROUNDS 2 OR 4)
AND/OR
- LTC SUPPLEMENT: SCHOOL ATTENDANCE LIMITED SECTION (DURING ROUNDS 2 OR 4))
OR
PERSON IS FLAGGED FOR LTC SUPPLEMENT: COGNITIVE LIMITATIONS SECTION (DURING ROUNDS 1 OR 3)
OR
PERSON HAS A HOME HEALTH EVENT IN THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL ONLY LOOK AT LTC SUPPLEMENT FLAGS THAT HAVE NOT YET BEEN CONSIDERED. FOR EXAMPLE, FOR PANEL 1, ROUND 4, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 1-4. FOR PANEL 2, ROUND 2, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 1 AND 2. FOR PANEL 2, ROUND 4, CAPI WILL LOOK AT ALL LTC SUPPLEMENT FLAGS SET IN ROUNDS 3 AND 4.
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF MULTI-PERSON RU, CONTINUE WITH CG01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_03
----------------------------------------------------

CG01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Now we would like to talk about the help or assistance (PERSON) (receive/receives) from other household members due to an impairment or a physical or mental health problem.
During the past month, (have/has) (PERSON) received any help or assistance from a household member due to (PERSON)'s impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
PRESS F1 FOR DEFINITION OF HELP AND ASSISTANCE.

CG02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Who was that?
PROBE: Who else helped or assisted (PERSON) because of (PERSON)'s impairment or a physical or mental health problem?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
[Code All That Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM USES THE RU-MEMBERS- ROSTER TO DISPLAY PERSONS WHO MEET THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON IS NOT THE RU MEMBER CURRENTLY BEING ASKED ABOUT
----------------------------------------------------
----------------------------------------------------
FLAG SELECTED PERSONS AS 'RU CAREGIVER' FOR PERSON BEING ASKED ABOUT.
----------------------------------------------------

CG03
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Did anyone move or change their residence so that care could be more easily given to (PERSON)?
YES .................................... 1
NO ..................................... 2 [LOOP_02]
REF ................................... -7 [LOOP_02]
DK .................................... -8 [LOOP_02]

CG04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Who was that?
PROBE: Who else moved so that care could be more easily given to (PERSON)?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
[Code All That Apply]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET ONE OF THE FOLLOWING CONDITIONS:

- PERSON PROVIDES CARE, THAT IS PERSON WAS SELECTED AT CG02 (FLAGGED AS 'RU CAREGIVER' FOR THIS PERSON)
OR
- PERSON IS THE RU MEMBER BEING LOOPED ON
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK CG05 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 DETERMINES WHICH ACTIVITIES PERSON BEING LOOPED ON IN LOOP_01 HAS HAD HELP WITH DURING THE PAST MONTH FROM RU MEMBERS WHO HAVE PROVIDED CARE. THIS LOOP CYCLES ON EACH PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:

- PERSON IS FLAGGED AS AN 'RU CAREGIVER' FOR THE PERSON CURRENTLY BEING ASKED ABOUT (I.E., SELECTED AT CG02)
----------------------------------------------------

CG05
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
SHOW CARD CG-1.
During the past month, which of the activities listed on this card did (CAREGIVER) help (PERSON) with because of (PERSON)'s impairment or a physical or mental health problem?
PROBE: Any other activities?

CODE ALL THAT APPLY.
MEDICAL TREATMENTS ..................... 1
HELP WITH DAILY ACTIVITIES ............. 2
HELP WITH PERSONAL CARE ................ 3
HELP WITH OTHER ACTIVITY................ 4
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF RESPONSE CATEGORIES.
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE RU-CAREGIVER BEING LOOPED ON FOR LOOP_02 (I.E., SELECTED AT CG02).
----------------------------------------------------

CG06
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
How long (have/has) (PERSON) been receiving help from (CAREGIVER)?
Would you say ...
a month or less; ....................... 1
more than a month, but less than 3 months; ............................ 2
more than 3 months, but less than a year; .............................. 3
about a year; or ....................... 4
more than a year? ...................... 5
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE RU-CAREGIVER BEING LOOPED ON FOR LOOP_02 (I.E., SELECTED AT CG02).
----------------------------------------------------

CG07
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
During the past month, how much extra time did (CAREGIVER) spend helping (PERSON) because of an impairment or a physical or mental health problem? Please tell me the number of hours in a typical week.
ENTER THE NUMBER OF EXTRA HOURS IN A TYPICAL WEEK:
IF LESS THAN 1 HOUR PER WEEK, CODE '995'.
[Enter Number of Hours Per Week-3] ....
LESS THAN 1 HOUR PER WEEK ............ 995
REF ................................... -7
DK .................................... -8
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE RU-CAREGIVER BEING LOOPED ON FOR LOOP_02 (I.E., SELECTED AT CG02).
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 1-168 FOR THE NUMBER OF HOURS PER WEEK.
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT RU-CAREGIVER IN THE RU-MEMBERS- ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER RU-CAREGIVERS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH BOX_03
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF PERSON IS = OR ) 50 YEARS OF AGE OR IN AGE CATEGORIES 8 OR 9, CONTINUE WITH CG08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_04
----------------------------------------------------

CG08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Now we'd like to talk about other family members outside the household that (PERSON) could rely on for help or assistance if needed.
(Do/Does) (PERSON) have any children, 18 years of age or older, living elsewhere?
YES .................................... 1
NO ..................................... 2 [CG10]
REF ................................... -7 [CG10]
DK .................................... -8 [CG10]
PRESS F1 FOR DEFINITION OF HELP AND ASSISTANCE.

CG09
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the first and last name of all (PERSON)'s children, 18 years of age or older, who live elsewhere.
PROBE: (Do/Does) (PERSON) have any other children, 18 years of age or older, who live elsewhere?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Name of Caregiver] .................
[2. Name of Caregiver] .................
[3. Name of Caregiver] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-POTENTIAL-CAREGIVER-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CAREGIVER(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CAREGIVERS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CAREGIVERS). AS CAREGIVERS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NAME OF THE PERSON WHO THEY POTENTIALLY PROVIDE CARE TO.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CAREGIVER THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CAREGIVER ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CAREGIVER IS FIRST ENTERED.'
----------------------------------------------------
----------------------------------------------------
FLAG ADDED OR SELECTED PERSONS AS 'NON-RU POTENTIAL CAREGIVER'.
----------------------------------------------------

CG10
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How many living sisters (do/does) (PERSON) have?
[Number-2] .............................
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF SISTER.
----------------------------------------------------
SOFT RANGE CHECK: 0-10
----------------------------------------------------

CG11
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How many living brothers (do/does) (PERSON) have?
[Number-2] .............................
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF BROTHER.
----------------------------------------------------
SOFT RANGE CHECK: 0-10
----------------------------------------------------

CG12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is (PERSON)'s mother living?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MOTHER.

CG13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is (PERSON)'s father living?
YES .................................... 1 [BOX_08]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
PRESS F1 FOR DEFINITION OF FATHER.
----------------------------------------------------
NOTE: THE DEFINITION OF MOTHER AND FATHER WILL BE THE SAME AS THAT USED IN OTHER SECTIONS OF THE QUESTIONNAIRE FOR PURPOSES OF THE F1 SCREEN.
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF PERSON IS BETWEEN THE AGES OF 35-49, INCLUSIVE OR IN AGE CATEGORIES 6 OR 7, CONTINUE WITH CG14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

CG14
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Now we'd like to talk about other family members outside the household that (PERSON) could rely on for help or assistance if needed.
(Do/Does) (PERSON) have any children, 18 years of age or older, living elsewhere?
YES .................................... 1
NO ..................................... 2 [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
PRESS F1 FOR DEFINITION OF HELP AND ASSISTANCE.

CG15
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the first and last name of all (PERSON)'s children, 18 years of age or older, who live elsewhere.
PROBE: (Do/Does) (PERSON) have any other children, 18 years of age or older, who live elsewhere?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Name of Caregiver] .................
[2. Name of Caregiver] .................
[3. Name of Caregiver] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-POTENTIAL-CAREGIVER-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CAREGIVER(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CAREGIVERS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CAREGIVERS). AS CAREGIVERS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NAME OF THE PERSON WHO THEY POTENTIALLY PROVIDE CARE TO.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CAREGIVER THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CAREGIVER ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CAREGIVER IS FIRST ENTERED.'
----------------------------------------------------
----------------------------------------------------
FLAG ADDED OR SELECTED PERSONS AS 'NON-RU POTENTIAL CAREGIVER'.
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF PERSON IS ( 50 YEARS OF AGE OR IN AGE CATEGORIES 1 THROUGH 7, CONTINUE WITH CG16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

CG16
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Now we'd like to talk about other family members outside the household that (PERSON) could rely on for help or assistance if needed.]
(Do/Does) (PERSON) have any brothers or sisters, 18 years of age or older, living elsewhere?
YES .................................... 1
NO ..................................... 2 [CG18]
REF ................................... -7 [CG18]
DK .................................... -8 [CG18]
[PRESS F1 FOR DEFINITION OF HELP AND ASSISTANCE.]
----------------------------------------------------
DISPLAY 'Now we'd ... if needed.' AND 'PRESS F1 ... ASSISTANCE.' IF PERSON BEING ASKED ABOUT IS ( 35 YEARS OF AGE OR IN AGE CATEGORIES 1-5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

CG17
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the first and last name of all (PERSON)'s brothers and sisters, 18 years of age or older, who live elsewhere.
PROBE: (Do/Does) (PERSON) have any other brothers or sisters, 18 years of age or older, who live elsewhere?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Name of Caregiver] .................
[2. Name of Caregiver] .................
[3. Name of Caregiver] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-POTENTIAL-CAREGIVER-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CAREGIVER(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CAREGIVERS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CAREGIVERS). AS CAREGIVERS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NAME OF THE PERSON WHO THEY POTENTIALLY PROVIDE CARE TO.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CAREGIVER THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CAREGIVER ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CAREGIVER IS FIRST ENTERED.'
----------------------------------------------------
----------------------------------------------------
FLAG ADDED OR SELECTED PERSONS AS 'NON-RU POTENTIAL CAREGIVER'.
----------------------------------------------------

CG18
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) have a mother or father living elsewhere?
CODE '95' IF RESPONDENT VOLUNTEERS THAT PERSON LIVES WITH BOTH PARENTS.
YES .................................... 1
NO ..................................... 2 [BOX_06]
LIVES WITH BOTH PARENTS ............... 95 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
PRESS F1 FOR DEFINITIONS OF MOTHER AND FATHER.
[Code One]
----------------------------------------------------
NOTE: THE DEFINITION OF MOTHER AND FATHER WILL BE THE SAME AS THAT USED IN OTHER SECTIONS OF THE QUESTIONNAIRE FOR PURPOSES OF THE F1 SCREEN.
----------------------------------------------------

CG19
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the first and last name of (PERSON)'s mother and/or father who live elsewhere.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Name of Caregiver] .................
[2. Name of Caregiver] .................
[3. Name of Caregiver] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-POTENTIAL-CAREGIVER-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CAREGIVER(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CAREGIVERS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CAREGIVERS). AS CAREGIVERS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NAME OF THE PERSON WHO THEY POTENTIALLY PROVIDE CARE TO.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CAREGIVER THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CAREGIVER ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CAREGIVER IS FIRST ENTERED.'
----------------------------------------------------
----------------------------------------------------
FLAG ADDED OR SELECTED PERSONS AS 'NON-RU POTENTIAL CAREGIVER'.
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF PERSON IS MARRIED (RE97=1 (MARRIED) FOR THIS PERSON FOR THE CURRENT ROUND), CONTINUE WITH CG20
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

CG20
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is (PERSON)'s mother-in-law living?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MOTHER-IN-LAW.

CG21
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is (PERSON)'s father-in-law living?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FATHER-IN-LAW.

BOX_07
======

----------------------------------------------------
IF PERSON IS ( OR = 35 YEARS OF AGE OR IN AGE CATEGORIES 1-5, CONTINUE WITH CG22
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

CG22
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How many living grandparents (do/does) (PERSON) have?
[Number-2] .............................
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF GRANDPARENT.
----------------------------------------------------
SOFT RANGE CHECK: 0-10
----------------------------------------------------

BOX_08
======

----------------------------------------------------
IF AT LEAST ONE NON-RU POTENTIAL CAREGIVER ENUMERATED FOR PERSON, CONTINUE WITH LOOP_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-POTENTIAL-CAREGIVER- ROSTER, ASK BOX_09 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 ASKS THE CAREGIVER ROSTER DETAIL (CR) SECTION FOR EACH NON-RU POTENTIAL CAREGIVER ENUMERATED FOR THE PERSON BEING LOOPED ON. THIS LOOP CYCLES ON EACH NON-RU POTENTIAL CAREGIVER IN THE RU-POTENTIAL-CAREGIVER- ROSTER WHO MEETS THE FOLLOWING CONDITIONS:

- NON-RU POTENTIAL CAREGIVER ADDED OR SELECTED FOR PERSON BEING ASKED ABOUT
----------------------------------------------------

BOX_09
======

----------------------------------------------------
ASK THE CAREGIVER ROSTER DETAIL (CR) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE CR SECTION, CONTINUE WITH END_LP03
----------------------------------------------------

END_LP03
========

----------------------------------------------------
CYCLE ON NEXT NON-RU POTENTIAL CAREGIVER IN THE RU-POTENTIAL-CAREGIVER-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER NON-RU POTENTIAL CAREGIVERS MEET THE STATED CONDITIONS, END LOOP_03 AND CONTINUE WITH END_LP01
----------------------------------------------------

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_10
----------------------------------------------------

BOX_10
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------


Caregiver Roster Detail (CR) Section


BOX_01
======

----------------------------------------------------
IF CAREGIVER IS NOT FLAGGED AS 'DETAIL COLLECTED', CONTINUE WITH CR01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CR13
----------------------------------------------------

CR01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
How old is (CAREGIVER)?
[Enter Age-3] ......................... [CR03]
REF ................................... -7 [CR03]
DK .................................... -8
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: 18-80
----------------------------------------------------

CR02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
Is (CAREGIVER)...
18 to 64 years old or ................. 1
65 years of age or older? ............. 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR03
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
Is (CAREGIVER) married?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MARRIED.
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
IF OBVIOUS, CODE WITHOUT ASKING.
OTHERWISE ASK, Is (CAREGIVER) male or female?
MALE ................................... 1
FEMALE ................................. 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR05
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
What is the highest grade or year (CAREGIVER) completed in school?
NO FORMAL SCHOOLING .................... 1
ELEMENTARY SCHOOL (GRADES 1-8) ......... 2
SOME HIGH SCHOOL (GRADES 9-12) ......... 3
COMPLETED HIGH SCHOOL, NO COLLEGE ...... 4
TECHNICAL OR TRADE SCHOOL .............. 5
SOME COLLEGE ........................... 6
COLLEGE GRADUATE ....................... 7
GRADUATE DEGREE ........................ 8
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF RESPONSE CATEGORIES.
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR06
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
How many children does (CAREGIVER) have?
[Enter Number-2] ......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: 0-10
----------------------------------------------------
----------------------------------------------------
IF CR06 IS = OR ) 1, CONTINUE WITH CR07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CR08
----------------------------------------------------

CR07
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
How many of (CAREGIVER)'s children are under 6 years of age?
[Enter Number-2] ......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------
----------------------------------------------------
EDIT: NUMBER ENTERED AT CR07 MUST BE ( = THE NUMBER ENTERED AT CR06.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: 0-10
----------------------------------------------------

CR08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
In general, compared to other people of (CAREGIVER)'s age, would you say (CAREGIVER)'s health is good to excellent or is it poor to fair?
EXCELLENT, VERY GOOD, OR GOOD .......... 1
FAIR OR POOR ........................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR09
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
How many minutes does (CAREGIVER) live from (PERSON)?
10 MINUTES OR LESS ..................... 1
11-30 MINUTES .......................... 2
31-59 MINUTES .......................... 3
1-2 HOURS .............................. 4
MORE THAN 2 HOURS ...................... 5
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR10
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
Does (CAREGIVER) work full-time, part-time, or not at all?
FULL-TIME .............................. 1
PART-TIME .............................. 2
NOT AT ALL ............................. 3 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR11
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
SHOW CARD CR-1.
Looking at this card, please tell me which category best describes (CAREGIVER)'s main job or occupation.
EXECUTIVE, ADMINISTRATIVE, AND MANAGERIAL OCCUPATIONS ............... 1 [BOX_02]
PROFESSIONAL SPECIALTY OCCUPATIONS ..... 2 [BOX_02]
TECHNICIANS AND RELATED SUPPORT OCCUPATIONS .......................... 3 [BOX_02]
MARKETING AND SALES OCCUPATIONS ........ 4 [BOX_02]
ADMINISTRATIVE SUPPORT OCCUPATIONS, INCLUDING CLERICAL ................... 5 [BOX_02]
SERVICE OCCUPATIONS .................... 6 [BOX_02]
AGRICULTURE, FORESTRY, FISHING, AND RELATED OCCUPATIONS .................. 7 [BOX_02]
MECHANICS, INSTALLERS, AND REPAIRERS ... 8 [BOX_02]
CONSTRUCTION TRADES AND EXTRACTIVE OCCUPATIONS .......................... 9 [BOX_02]
PRODUCTION OCCUPATIONS ................ 10 [BOX_02]
TRANSPORTATION AND MATERIAL MOVING OCCUPATIONS ......................... 11 [BOX_02]
HANDLERS, EQUIPMENT CLEANERS, HELPERS, AND LABORERS ........................ 12 [BOX_02]
MILITARY OCCUPATIONS .................. 13 [BOX_02]
OTHER ................................. 91
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]
PRESS F1 FOR DEFINITION OF RESPONSE CATEGORIES.
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR11OV
======

ENTER OTHER:
[Enter Other Specify] .................
REF ................................... -7
DK .................................... -8

BOX_02
======

----------------------------------------------------
IF CR03 IS CODED '1' (YES) AND CR04 IS CODED '1' (MALE), CONTINUE WITH CR12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_03
----------------------------------------------------

CR12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
Does (CAREGIVER)'s wife work full-time, part-time, or not at all?
FULL-TIME .............................. 1
PART-TIME .............................. 2
NOT AT ALL ............................. 3
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
FLAG CAREGIVER AS 'DETAIL COLLECTED'.
----------------------------------------------------
----------------------------------------------------
THEN CONTINUE WITH CR13
----------------------------------------------------

CR13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
SHOW CARD CR-2.
During the past month did (CAREGIVER) help or assist (PERSON) with any of the activities listed on this card because of (PERSON)'s impairment or a physical or mental health problem?
YES .................................... 1
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
PRESS F1 FOR DEFINITION OF HELP OR ASSISTANCE.
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR14
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
SHOW CARD CR-2.
During the past month, which of the activities listed on this card did (CAREGIVER) help (PERSON) with [because of (PERSON)'s impairment or a physical or mental health problem]?
PROBE: Any other activities?

CODE ALL THAT APPLY.
MEDICAL TREATMENTS ..................... 1
HELP WITH DAILY ACTIVITIES ............. 2
HELP WITH PERSONAL CARE ................ 3
HELP WITH OTHER ACTIVITY ............... 4
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF RESPONSE CATEGORIES.
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR15
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
Generally speaking, during the past month, did (CAREGIVER) come to the home to help (PERSON) every week or only during some weeks?
EVERY WEEK ............................. 1
SOME WEEKS ............................. 2 [CR17]
REF ................................... -7 [CR17]
DK .................................... -8 [CR17]
[Code One]
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------

CR16
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
During the past month, about how many days per week did (CAREGIVER) come?
PROBE: We just need to know in general.
[Enter Number of Days Per Week-1] ..... [CR18]
REF ................................... -7 [CR18]
DK .................................... -8 [CR18]
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 1-7 FOR NUMBER OF DAYS.
----------------------------------------------------

CR17
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
About how many days, during the past month, did (CAREGIVER) come?
PROBE: We just need to know in general.
[Enter Number of Days Per Month-2] ....
REF ................................... -7
DK .................................... -8
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 1-31 FOR NUMBER OF DAYS.
----------------------------------------------------

CR18
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
CAREGIVER: [CAREGIVER'S FIRST AND LAST NAME....]
How long did each visit usually last?
PROBE: We just need to know in general.

IF RESPONSE IS LESS THAN ONE HOUR, ENTER '0' FOR HOURS.

CR18_01
=======

ENTER HOURS:
[Enter Hours].......................
REF.................................. -7 [BOX_04]
DK................................... -8 [BOX_04]

CR18_02
=======

ENTER MINUTES:
[Enter Minutes]......................
REF.................................. -7
DK................................... -8
----------------------------------------------------
FOR 'CAREGIVER'S FIRST AND LAST NAME....', DISPLAY THE FIRST AND LAST NAME OF THE CAREGIVER BEING LOOPED ON IN LOOP_03 OF THE CG SECTION.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 0-24 IF NUMBER OF HOURS. 0-59 IF NUMBER OF MINUTES.
----------------------------------------------------
----------------------------------------------------
EDIT CHECK: IF '0' ENTERED IN BOTH CR18_01 AND CR18_02 DISPLAY MESSAGE: NUMBER MUST BE ENTERED IN EITHER HOURS OR MINUTES.
----------------------------------------------------

BOX_04
======

----------------------------------------------------
RETURN TO CAREGIVER (CG) SECTION
----------------------------------------------------


Prescribed Medicines (PM) Section


PM01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
The next questions are about prescription medicines (PERSON) purchased or received [since (START DATE)/between (START DATE) and (END DATE)].
[It would be very helpful for the following questions if we could look at the bottles, containers, tubes, or bags for each of the medicines we will be talking about.]

PRESS ENTER TO CONTINUE.
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF PERSON HAS NO MEDICINES CREATED OR SELECTED DURING THE CURRENT ROUND (ON PERSON'S-PRESCRIBED-MEDICINES-ROSTER), GO TO PM04
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PM02
----------------------------------------------------
----------------------------------------------------
NOTE: MEDICINES ARE FLAGGED AS 'CREATED' ONLY ONCE (I.E., DURING THE ROUND WHERE THE MEDICINE IS INITIALLY REPORTED). MEDICINES ARE FLAGGED AS 'SELECTED' WHEN CHOSEN DURING SUBSEQUENT ROUNDS. THUS, FOR ONE ROUND, A MEDICINE CAN ONLY BE FLAGGED AS EITHER 'CREATED' OR 'SELECTED'.
----------------------------------------------------

PM02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
While we were talking about (PERSON)'s medical care, we listed the following prescription(s) as purchased or received [since (START DATE)/between (START DATE) and (END DATE)]. (READ MEDICINES BELOW.)
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[NAME OF PRESCRIPTION MEDICINE.]
[NAME OF PRESCRIPTION MEDICINE.]
[NAME OF PRESCRIPTION MEDICINE.]
INFORMATION OKAY ....................... 1 [PM04]
AT LEAST ONE MEDICINE INCORRECT ........ 2
[Code One]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICINES IN THE PERSON'S-PRESCRIBED-MEDICINES-ROSTER THAT ARE FLAGGED AS EITHER 'CREATED' OR 'SELECTED' DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (AT LEAST ONE MEDICINE INCORRECT) AND THERE IS ONLY ONE MEDICINE ON PERSON'S-PRESCRIBED-MEDICINES-ROSTER, SELECT THAT MEDICINE AUTOMATICALLY BY CAPI AT PM03 AND GO TO PM04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (AT LEAST ONE MEDICINE INCORRECT) AND THERE IS MORE THAN ONE MEDICINE ON PERSON'S-PRESCRIBED-MEDICINES-ROSTER, CONTINUE WITH PM03
----------------------------------------------------

PM03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
SELECT MEDICINE(S) THAT WERE RECORDED INCORRECTLY.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICINES IN THE PERSON'S-PRESCRIBED-MEDICINES-ROSTER THAT ARE FLAGGED AS EITHER 'CREATED' OR 'SELECTED' DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A MEDICINE(S) ALREADY LISTED ON THE ROSTER.
2. DO NOT ALLOW MEDICINES TO BE ADDED, EDITED OR DELETED.
----------------------------------------------------
----------------------------------------------------
FLAG SELECTED MEDICINES AS 'INCORRECT'. THESE MEDICINES WILL NOT BE ELIGIBLE FOR LOOP_01 (I.E., NOT 'CREATED' OR 'SELECTED' THIS ROUND).
----------------------------------------------------

PM04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], (have/has) (PERSON) obtained any medicines [we have not yet talked about]? For example, (have/has) (PERSON) had any new prescriptions or a refill of a prescription?
YES .................................... 1
NO ..................................... 2 [PM06]
REF ................................... -7 [PM06]
DK .................................... -8 [PM06]
PRESS F1 FOR DEFINITION OF PRESCRIPTIONS AND REFILLS.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5. DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

PM05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
What were the names of these medicines?
PROBE: Any other medicines?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Prescribed Medicine] ...............
[2. Prescribed Medicine] ...............
[3. Prescribed Medicine] ...............
OTHER SPECIFY: (__________) ........... 91
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A MEDICINE(S) ALREADY LISTED ON THE ROSTER.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF MEDICINES AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF MEDICINES).
3. INTERVIEWER SHOULD BE ABLE TO DELETE A MEDICINE THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A MEDICINE ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST ENTERED.'
4. ANY MEDICINE ADDED TO THE ROSTER SHOULD BE FLAGGED AS 'CREATED' THIS ROUND (WITH THE ROUND STATUS). ANY MEDICINE SELECTED AT THE ROSTER SHOULD BE FLAGGED AS 'SELECTED' THIS ROUND (WITH THE ROUND STATUS). THIS FLAGGING SHOULD OCCUR, AT EACH PERSON'S-PRESCRIBED-MEDICINES-ROSTER THROUGHOUT THE INSTRUMENT (UNLESS OTHERWISE SPECIFIED), THE FIRST TIME THE MEDICINE IS ADDED OR SELECTED DURING THE ROUND. FOR EXAMPLE, IF IT IS ROUND 1, ALL MEDICINES ON THE ROSTER WOULD HAVE THE FLAG 'CREATED -ROUND 1'. IF A MEDICINE IS CREATED IN HS, BUT SELECTED IN MV, ALL DURING ROUND 1, IT WOULD ONLY HAVE THE FLAG 'CREATED - ROUND 1'. THUS, FOR ANY ONE ROUND, A MEDICINE CAN ONLY BE FLAGGED AS 'CREATED' OR 'SELECTED'. IF IT IS ROUND 2 AND A MEDICINE THAT WAS CREATED IN ROUND 1 IS SELECTED, IT SHOULD BE FLAGGED AS 'SELECTED - ROUND 2'. THIS FLAG IS IN ADDITION TO THE ORIGINAL 'CREATED - ROUND 1' FLAG.
----------------------------------------------------
----------------------------------------------------
THE PERSON'S-PRESCRIBED-MEDICINES-ROSTER WILL CONTAIN ALL PREVIOUSLY CREATED PRESCRIBED MEDICINES FROM ALL PREVIOUS ROUNDS, AS WELL AS MEDICINES FROM THE CURRENT ROUND. WHEN A MEDICINE FROM A PREVIOUS ROUND IS SELECTED, A NEW EVENT IS CREATED SINCE IT INVOLVES A NEW PURCHASE. A NEW PURCHASE REQUIRES ASKING CP AND WHAT PHARMACY. THE REASON FOR INCLUDING ALL OF THE PRESCRIBED MEDICINES ON THE ROSTER IS SIMPLY TO AVOID THE INTERVIEWER HAVING TO TYPE THEM IN AGAIN (IF THE PERSON IS GETTING REFILLS OF THE SAME MEDICINE EVERY ROUND).
----------------------------------------------------

PM06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) get any free samples of prescribed medicines from a medical or dental provider that we have not yet talked about?
YES .................................... 1
NO ..................................... 2 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
PRESS F1 FOR DEFINITION OF FREE SAMPLES.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

PM07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
What are the names of the medicines (PERSON) got as free samples?
PROBE: Any other free samples?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Prescribed Medicine] ...............
[2. Prescribed Medicine] ...............
[3. Prescribed Medicine] ...............
OTHER SPECIFY: (__________) ........... 91
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
----------------------------------------------------
----------------------------------------------------
SEE PM05 FOR PRESCRIBED MEDICINE ROSTER BEHAVIOR SPECIFICATIONS.
----------------------------------------------------
----------------------------------------------------
ONLY MEDICINES CREATED AT PM07 DURING THE CURRENT ROUND SHOULD BE FLAGGED AS 'FREE SAMPLE'.
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF NO MEDICINES FLAGGED AS 'CREATED' OR 'SELECTED' DURING THE CURRENT ROUND, GO TO BOX_06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_01
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN PERSON'S-PRESCRIBED-MEDICINES-ROSTER, ASK BOX_01A-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT EACH PRESCRIBED MEDICINE CREATED OR SELECTED DURING THE CURRENT ROUND. THIS LOOP CYCLES ON PRESCRIBED MEDICINES THAT MEET ONE OF THE FOLLOWING CONDITIONS:

- PRESCRIBED MEDICINE IS FLAGGED AS 'CREATED' DURING THE CURRENT ROUND.
OR
- PRESCRIBED MEDICINE IS FLAGGED AS 'SELECTED' DURING THE CURRENT ROUND.
----------------------------------------------------

BOX_01A
=======

----------------------------------------------------
IF ROUND 5, CONTINUE WITH PM07A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO PM08
----------------------------------------------------

PM07A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF PRESCRIPTION MEDICINE.] [STR-DT]
[END-DT]
Now, let's talk about (MEDICINE).
Was (MEDICINE) purchased or obtained sometime between (START DATE) and (END DATE)?
YES .................................... 1
NO ..................................... 2 [END_LP01]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF CODED '2' (NO), FLAG MEDICINE AS 'INCORRECT'. THIS MEDICINE SHOULD NOT BE FLAGGED AS 'CREATED' OR 'SELECTED' FOR ROUND 5.
----------------------------------------------------

PM08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF PRESCRIPTION MEDICINE.] [STR-DT]
[END-DT]
[Now, let's talk about (MEDICINE).]
Is (MEDICINE) used for a specific health problem?
YES .................................... 1
NO ..................................... 2 [PM10]
REF ................................... -7 [PM10]
DK .................................... -8 [PM10]
----------------------------------------------------
DISPLAY 'Now let's talk about (MEDICINE).' IF NOT ROUND 5. IF ROUND 5, USE A NULL DISPLAY.
----------------------------------------------------

PM09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF PRESCRIPTION MEDICINE.] [STR-DT]
[END-DT]
What health problem is (MEDICINE) prescribed for?
PROBE: Any other health problems?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
OTHER SPECIFY: (__________) ........... 91
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
----------------------------------------------------

PM10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF PRESCRIPTION MEDICINE.] [STR-DT]
[END-DT]
How many times was (MEDICINE) obtained or purchased for (PERSON) [since (START DATE)/between (START DATE) and (END DATE)]?
[Enter Number of Times] ................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF MEDICINE BEING ASKED ABOUT IS FLAGGED AS 'SELECTED' DURING THE CURRENT ROUND, GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
IF MEDICINE BEING ASKED ABOUT IS FLAGGED AS 'CREATED' DURING THE CURRENT ROUND, CONTINUE WITH PM11
----------------------------------------------------

PM11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF PRESCRIPTION MEDICINE.] [STR-DT]
[END-DT]
In what year did (PERSON) first use (MEDICINE)?
[Enter Year-2] ........................
HAS NOT YET TAKEN/USED ................ XX
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH PM11OV1
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR MINUS 1, GO TO PM11OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_02
----------------------------------------------------

PM11OV1
=======

[Enter Month, Day-2] .................. [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]

PM11OV2
=======

[Enter Month-2] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
EDIT/RANGE CHECK:

ENTRIES FOR MONTH AND DAY FIELDS MUST CORRESPOND TO CALENDAR MONTHS AND DAYS. THAT IS,
- IF MONTH, ALLOWABLE VALUES = 01 - 12.
- IF DAY:
- ALLOWABLE VALUES = 01 - 31 IF MONTH CODED '01', '03', '05', '07', '08', '10', '12';
- ALLOWABLE VALUES = 01 - 30 IF MONTH CODED '04', '06', '09', '11';
- ALLOWABLE VALUES = 01 - 29 IF MONTH CODED '02' AND YEAR IS 1996 (LEAP YEAR);
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT 1996 (I.E., NOT LEAP YEAR).

MISSING VALUES = -7 AND -8 ALLOWED FOR MONTH AND DAY FIELDS.
----------------------------------------------------
----------------------------------------------------
THE COMPLETE DATE CANNOT BE BEFORE THE PERSON'S DATE OF BIRTH OR AFTER THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF THE CHARGE/PAYMENT (CP) SECTION HAS NOT BEEN ASKED FOR THIS MEDICINE, ASK THE CHARGE/PAYMENT (CP) SECTION
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH END_LP01
----------------------------------------------------

END_LP01
========

----------------------------------------------------
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_01 AND CONTINUE WITH BOX_03
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF ALL PRESCRIBED MEDICINES FOR THIS PERSON ARE FLAGGED AS 'FREE SAMPLES' (IN BOTH PM AND CP) DURING THE CURRENT ROUND, GO TO BOX_06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_02
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH OF THE FOLLOWING:

PHARMACY 1
PHARMACY 2
PHARMACY 3
PHARMACY 4

ASK BOX_04A-END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 ENUMERATES PHARMACIES USED BY PERSON FOR PRESCRIBED MEDICINES THAT WERE CREATED OR SELECTED DURING THE CURRENT ROUND. THE RESPONSE TO PM17 DETERMINES IF THE LOOP CYCLES AGAIN. IF PM17 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT PHARMACY USED BY PERSON. IF PM17 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_04A
=======

----------------------------------------------------
AS A PHARMACY IS ENTERED OR SELECTED, FLAG THE PHARMACY WITH THE CURRENT ROUND (I.E., THE MOST RECENT ROUND IT WAS ENTERED/SELECTED). THIS ROUND FLAG IS USED TO DETERMINE WHETHER THE PHARMACY IS ELIGIBLE FOR PHARMACY PERMISSION FORM COLLECTION FOR THIS RU MEMBER.
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF THERE ARE NO PHARMACIES ON THE RU-PHARMACIES-ROSTER, GO TO PM14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PM12
----------------------------------------------------

PM12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
What is the name of the (next) pharmacy that filled the prescription(s) for (PERSON)?
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
ROSTER. PHARMACY
PM12_02. STREET
PM12_03. CITY
1. Pharmacy [Display Truncated Street Address] [Display Truncated City]
2. Pharmacy [Display Truncated Street Address] [Display Truncated City]
3. Pharmacy [Display Truncated Street Address] [Display Truncated City]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-PHARMACIES-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT ANY PHARMACY ALREADY LISTED OR SELECT 'NONE OF THE ABOVE.'
2. ONLY ONE SELECTION MAY BE MADE.
3. INTERVIEWER CAN NOT ADD AT THIS SCREEN. PHARMACIES ARE 'ADDED' BY USING THE 'NONE OF THE ABOVE' SELECTION.
4. INTERVIEWER CAN NOT DELETE AT THIS SCREEN (I.E., CTRL/D).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY.
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED, GO TO PM14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PM13
----------------------------------------------------

PM13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Is the address of (READ NAME AND ADDRESS OF PHARMACY BELOW)...
[PHARMACY NAME SELECTED AT PM12]
[PHARMACY STREET ADDRESS LINE1.]
[PHARMACY STREET ADDRESS LINE2.]
[PHARMACY CITY..,ST,ZIPCODE...]
[PHRM PHONE]
ADDRESS AND TELEPHONE CORRECT .......... 1 [BOX_05]
ADD NEW ADDRESS FOR PHARMACY ........... 2
ABOVE ADDRESS/TELEPHONE NEEDS
CORRECTION ............................. 3 [PM15]
SELECTED WRONG PHARMACY/ADDRESS ........ 4
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
[Code One]
----------------------------------------------------
IF CODED '4' (SELECTED WRONG PHARMACY/ADDRESS), CAPI REDISPLAYS PM12 TO ALLOW INTERVIEWER TO SELECT CORRECT PHARMACY.
----------------------------------------------------

PM14
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
What is the name and address of the (next) pharmacy that filled the prescription(s) for (PERSON)?
ENTER COMPLETE (NAME AND) ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED.
PHARMACY_NAME (PM14_01): [_____________]
PHARMACY_STR1 (PM14_02): [_____________]
PHARMACY_STR2 (PM14_03): [_____________]
PHARMACY_CITY (PM14_04): [_____________]
PHARMACY_STATE (PM14_05): [_____________]
PHARMACY_ZIPCDE (PM14_06): [_____________]
PHARMACY_PHONE (PM14_07): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
CODES '-7' (REF) AND '-8' (DK) ARE ALLOWED ON EACH FORM ITEM EXCEPT FOR PHARMACY NAME (PM14_01).
----------------------------------------------------
----------------------------------------------------
EDIT: CHECK THAT STATE ABBREVIATION IS VALID.
----------------------------------------------------
----------------------------------------------------
IF PM13 IS CODED '2' (ADD NEW ADDRESS FOR PHARMACY), PM14 WILL NOT COLLECT THE PHARMACY NAME, PM14_01 WILL DISPLAY THE PHARMACY NAME AND CANNOT BE EDITED.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_05
----------------------------------------------------

PM15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
CORRECT ADDRESS OR TELEPHONE FOR: [PHARMACY NAME W/WRONG ADDRESS.]
TO VERIFY CURRENT INFORMATION OR TO LEAVE A FIELD BLANK, PRESS ENTER. TO CORRECT OR ENTER INFORMATION, TYPE ENTIRE FIELD.
Current Info: [PHARMACY_STR1]
[PHARMACY_STR2]
[PHARMACY_CITY]
[PHARMACY_STATE]
[PHARMACY_ZIPCDE]
[PHARMACY_PHONE]
PHARMACY_STR1 (PM15_01): [_____________]
PHARMACY_STR2 (PM15_02): [_____________]
PHARMACY_CITY (PM15_03): [_____________]
PHARMACY_STATE (PM15_04): [_____________]
PHARMACY_ZIPCDE (PM15_05): [_____________]
PHARMACY_PHONE (PM15_06): [_____________]
PRESS F1 FOR LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
EDIT: CHECK THAT STATE ABBREVIATION IS VALID.
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF THE NAME OR ADDRESS FIELDS WERE COMPLETED IN PM14 FOR THE PHARMACY BEING ASKED ABOUT (THAT IS, THE PHARMACY WAS ADDED TO THE RU-PHARMACIES-ROSTER OR A NEW ADDRESS WAS ENTERED FOR AN EXISTING PHARMACY), CONTINUE WITH PM16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO PM17
----------------------------------------------------

PM16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
What type of pharmacy is that? 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; or is it a drug store that is not located within another facility?
MAIL-ORDER ............................. 1
IN ANOTHER STORE ....................... 2
IN HMO/CLINIC/HOSPITAL ................. 3
DRUG STORE ............................. 4
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code One]

PM17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Did (PERSON) use another pharmacy [since (START DATE)/between (START DATE) and (END DATE)]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP02
========

----------------------------------------------------
IF PM17 IS CODED '1' (YES), CYCLE TO COLLECT INFORMATION ABOUT THE NEXT PHARMACY USED BY PERSON.
----------------------------------------------------
----------------------------------------------------
IF PM17 IS CODED '2' (NO), '-7 (REFUSED), OR '-8' (DON'T KNOW), END LOOP_02 AND CONTINUE WITH BOX_06
----------------------------------------------------

BOX_06
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------


Alternative/Preventive Care (AP) Section


AP01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD AP-1.
In order to get as complete a picture as possible of all sources of health care, we would also like to ask about the use of other forms of health care, including treatment you may have previously told me about, such as the treatments shown on this card.
Frequently this type of care is referred to as complementary or alternative care.
During the calendar year 1998, for health reasons, did (PERSON) consult someone who provides these types of treatments?
YES .................................... 1
NO ..................................... 2 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
PRESS F1 FOR DEFINITION OF COMPLEMENTARY/ALTERNATIVE CARE.

AP02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD AP-1.
What type of treatment did (PERSON) receive?
PROBE: Any other types of treatments received?

CODE ALL THAT APPLY.
ACUPUNCTURE ............................ 1
NUTRITIONAL ADVICE OR LIFESTYLE DIETS .. 2
MASSAGE THERAPY ........................ 3
HERBAL REMEDIES PURCHASED .............. 4
BIO-FEEDBACK TRAINING .................. 5
TRAINING OR PRACTICE OF MEDITATION, IMAGERY, OR RELAXATION TECHNIQUES .... 6
HOMEOPATHIC TREATMENT .................. 7
SPIRITUAL HEALING OR PRAYER ............ 8
HYPNOSIS ............................... 9
TRADITIONAL MEDICINE, SUCH AS CHINESE, AYURVEDIC, AMERICAN INDIAN, ETC. .... 10
OTHER TREATMENT ....................... 91
REF ................................... -7
DK .................................... -8
[Code All That Apply.]
PRESS F1 FOR DEFINITIONS OF RESPONSE CATEGORIES.
----------------------------------------------------
IF CODED '91' (OTHER TREATMENT) ALONE OR IN COMBINATION WITH ANY OTHER CODES, CONTINUE WITH AP02OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AP03
----------------------------------------------------

AP02OV
======

ENTER OTHER:
[Enter Other Specify] .................
REF ................................... -7
DK .................................... -8

AP03
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
You told me that (PERSON) consulted someone who practices alternative care. What type of practitioner(s) (was/were) used?
PROBE: Any other types of practitioners consulted?

CODE ALL THAT APPLY.
MASSAGE THERAPIST ...................... 1
ACUPUNCTURIST .......................... 2
PHYSICIAN .............................. 3
NURSE .................................. 4
HOMEOPATHIC OR NATUROPATHIC DOCTOR ..... 5
CHIROPRACTOR ........................... 6
CLERGY, SPIRITUALIST, OR CHANNELER ..... 7
HERBALIST .............................. 8
OTHER ................................. 91
REF ................................... -7
DK .................................... -8
[Code All That Apply.]
PRESS F1 FOR DEFINITIONS OF RESPONSE CATEGORIES.
----------------------------------------------------
IF CODED '91' (OTHER) ALONE OR IN COMBINATION WITH ANY OTHER CODES, CONTINUE WITH AP03OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AP04
----------------------------------------------------

AP03OV
======

ENTER OTHER:
[Enter Other Specify] .................
REF ................................... -7
DK .................................... -8

AP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Approximately how many times in 1998 did (PERSON) actually visit these types of practitioners?
[Enter Number-3] ....................... [AP05]
REF ................................... -7 [AP05]
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: 1-100
----------------------------------------------------

AP04A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Would you say (PERSON) visited these types of practitioners ...
1 time, ................................ 1
2 - 4 times, ........................... 2
5 - 10 times, .......................... 3
11 - 20 times, ......................... 4
21 - 30 times, or ...................... 5
31 or more times? ...................... 6
REF ................................... -7
DK .................................... -8
[Code One.]

AP05
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Did (PERSON) consult the alternative or complementary care practitioner(s) for a specific physical or mental health problem?
YES .................................... 1
NO ..................................... 2 [AP07]
REF ................................... -7 [AP07]
DK .................................... -8 [AP07]

AP06
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
For what health problems was/were the alternative care practitioner(s) consulted?
PROBE: Did (PERSON) have any other health problems for which (PERSON) consulted an alternative care practitioner?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
OTHER SPECIFY: (__________) ........... 91
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
4. ANY CONDITION ADDED TO THE ROSTER SHOULD BE FLAGGED AS 'CREATED' THIS ROUND (WITH THE ROUND STATUS). ANY CONDITION SELECTED AT THE ROSTER SHOULD BE FLAGGED AS 'SELECTED' THIS ROUND (WITH THE ROUND STATUS). THIS FLAGGING SHOULD OCCUR, AT ALL OF THE PERSON'S-MEDICAL- CONDITIONS-ROSTERS THROUGHOUT THE INSTRUMENT, THE FIRST TIME THE CONDITION IS ADDED OR SELECTED DURING THE ROUND. FOR EXAMPLE, IF IT IS ROUND 1, ALL CONDITIONS ON THE ROSTER WOULD HAVE THE FLAG 'CREATED - ROUND 1'. IF A CONDITION IS CREATED IN CE, BUT SELECTED IN MV, ALL DURING ROUND 1, IT WOULD ONLY HAVE THE FLAG 'CREATED - ROUND 1'. THUS, FOR ANY ONE ROUND, A CONDITION CAN ONLY BE FLAGGED AS 'CREATED' OR 'SELECTED'. IF IT IS ROUND 2 AND A CONDITION THAT WAS CREATED IN ROUND 1 IS SELECTED, IT SHOULD BE FLAGGED AS 'SELECTED - ROUND 2'.
THIS FLAG IS IN ADDITION TO THE ORIGINAL 'CREATED - ROUND 1' FLAG.
----------------------------------------------------

AP07
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Was the use of complementary or alternative care ever discussed with (PERSON)'s regular doctor?
YES .................................... 1
NO ..................................... 2
HAVE NO REGULAR DOCTOR ................. 3
ALTERNATIVE CARE PRACTITIONER IS REGULAR DOCTOR ...................... 4
REF ................................... -7
DK .................................... -8
[Code One.]

AP08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Were/Was) (PERSON) ever referred for alternative care by a physician or any other medical provider?
CODE '95' IF ALTERNATIVE CARE PROVIDED BY REGULAR PROVIDER (NOT PHYSICIAN).
YES .................................... 1
NO ..................................... 2
CARE PROVIDED BY REGULAR PROVIDER ..... 95
REF ................................... -7
DK .................................... -8
[Code One.]

AP09
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Thinking about all of (PERSON)'s alternative or complementary care visits, please give me your best estimate of the total amount spent by (PERSON) (or the family) and insurance, for (PERSON)'s care in calendar year 1998?
[$ Amount] ............................. [AP11]
REF ................................... -7 [AP11]
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: $0-$100,000. WHOLE DOLLAR AMOUNTS ONLY.
----------------------------------------------------

AP10
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Would you say (PERSON) (and the family) and insurance spent...
$1 - $100, ............................. 1
$101 - $500, ........................... 2
$501 - $1500, .......................... 3
$1501 - $3000, ......................... 4
$3001 - $5000, or ...................... 5
$5001 or more? ......................... 6
REF ................................... -7
DK .................................... -8
[Code One.]

AP11
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Did (PERSON)'s health insurance pay for any of (PERSON)'s complementary or alternative care?
CODE '95' IF PERSON DOES NOT HAVE HEALTH INSURANCE.
YES .................................... 1
NO ..................................... 2 [AP11B]
DOES NOT HAVE HEALTH INSURANCE ....... 95 [AP11B]
REF ................................... -7 [AP11B]
DK .................................... -8 [AP11B]
[Code One.]

AP11A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Thinking about the total amount (PERSON) (and the family) and insurance spent on alternative or complementary care visits, please give me your best estimate of the percent paid by insurance.
[% Amount] .............................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
RANGE CHECK: 0%-100%
----------------------------------------------------

AP11B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Thinking about all the products or remedies used that are associated with alternative or complementary care, please give me your best estimate of the total amount spent for these products and remedies by (PERSON) (and the family) in the calendar year 1998?
[$ Amount] ............................. [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8
----------------------------------------------------
SOFT RANGE CHECK: $0-$10,000. WHOLE DOLLAR AMOUNTS ONLY.
----------------------------------------------------

AP11C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Would you say (PERSON) (and the family) spent...
$1 - $50, .............................. 1
$51 - $100, ............................ 2
$101 - $200, ........................... 3
$201 - $500, or ........................ 4
$501 or more? .......................... 5
REF ................................... -7
DK .................................... -8
[Code One.]

BOX_01
======

----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS DECEASED, GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH AP12
----------------------------------------------------

AP12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
The next few questions ask about the amounts and types of preventive care (PERSON) may receive.
On average, how often (do/does) (PERSON) receive a dental check-up?
TWICE A YEAR OR MORE ................... 1
ONCE A YEAR ............................ 2
LESS THAN ONCE A YEAR .................. 3
NEVER GO TO DENTIST .................... 4
REF ................................... -7
DK .................................... -8
[Code One.]
PRESS F1 FOR DEFINITION OF DENTAL CHECK-UP.
----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9), CONTINUE WITH AP15
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_02
----------------------------------------------------

AP13
====

OMITTED. (MOVED AND RENUMBERED)

AP14
====

OMITTED. (MOVED AND RENUMBERED)

AP15
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since (PERSON) had (PERSON)'s blood pressure taken by a doctor, nurse, or other health professional?
WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 5 YEARS .................... 3
MORE THAN 5 YEARS ...................... 4
NEVER .................................. 5
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF BLOOD PRESSURE CHECK.
[Code One.]

AP16
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since (PERSON) had (PERSON)'s cholesterol levels checked?
WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 5 YEARS .................... 3
MORE THAN 5 YEARS ...................... 4
NEVER .................................. 5
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF CHOLESTEROL LEVEL CHECK.
[Code One.]

AP17
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since (PERSON) had a complete physical?
WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 5 YEARS .................... 3
MORE THAN 5 YEARS ...................... 4
NEVER .................................. 5
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF COMPLETE PHYSICAL.
[Code One.]

AP18
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since (PERSON) had a flu shot?
WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 5 YEARS .................... 3
MORE THAN 5 YEARS ...................... 4
NEVER .................................. 5
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF FLU SHOT.
[Code One.]
----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS 35 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 6-9), CONTINUE WITH AP18A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_01A
----------------------------------------------------

AP18A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does) (PERSON) wear dentures?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF DENTURES.

AP18B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) lost all of (PERSON)'s adult teeth?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8

BOX_01A
=======

----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS MALE, CONTINUE WITH AP19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AP20
----------------------------------------------------

AP19
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since (PERSON) had a prostate exam?
WITHIN PAST YEAR ....................... 1 [BOX_02]
WITHIN PAST 2 YEARS .................... 2 [BOX_02]
WITHIN PAST 5 YEARS .................... 3 [BOX_02]
MORE THAN 5 YEARS ...................... 4 [BOX_02]
NEVER .................................. 5 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
PRESS F1 FOR DEFINITION OF PROSTATE EXAM.
[Code One.]

AP20
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since (PERSON) had a pap smear test?
WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 5 YEARS .................... 3
MORE THAN 5 YEARS ...................... 4
NEVER .................................. 5
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF PAP SMEAR TEST.
[Code One.]

AP21
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since (PERSON) had a breast exam?
WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 5 YEARS .................... 3
MORE THAN 5 YEARS ...................... 4
NEVER .................................. 5
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF BREAST EXAM.
[Code One.]
----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS 40 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 6-9), CONTINUE WITH AP22
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_02
----------------------------------------------------

AP22
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since (PERSON) had a mammogram?
WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 5 YEARS .................... 3
MORE THAN 5 YEARS ...................... 4
NEVER .................................. 5
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF MAMMOGRAM.
[Code One.]

BOX_02
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION.
----------------------------------------------------


Disability Days (DD) Section


BOX_01
======

----------------------------------------------------
IF PERSON IS LESS THAN 1 YEAR OF AGE (OR AGE CATEGORY 1), GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH DD01
----------------------------------------------------

DD01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
The next questions ask about time when (PERSON) may have missed a half day or more from work or school or spent a half day or more in bed [since (START DATE)/between (START DATE) and (END DATE)]. In answering these questions, please include any time when this occurred because of (PERSON)'s physical illness or injury, or a mental or emotional problem such as stress or depression.
PRESS ENTER TO CONTINUE.
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF PERSON IS = OR ) 1 YEAR OLD AND ( 3 YEARS OLD (OR AGE CATEGORY 2), GO TO DD08
----------------------------------------------------
----------------------------------------------------
IF PERSON IS = OR ) 3 YEARS OLD AND ( OR = 15 YEARS OLD (OR AGE CATEGORY 3), GO TO DD05
----------------------------------------------------
----------------------------------------------------
IF PERSON IS = OR ) 16 YEARS OLD (OR AGE CATEGORIES 4-9), CONTINUE WITH DD02
----------------------------------------------------
----------------------------------------------------
NOTE: THERE IS NO UPPER AGE LIMIT RESTRICTION FOR PERSONS WHO ARE ASKED THE WORK-LOSS DISABILITY DAYS QUESTION.
----------------------------------------------------

DD02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[NUMBER OF DAYS IN HOSPITAL: [NUMBER OF DAYS]]
Let's start with work. [Including the time (PERSON) (were/was) in the hospital, how/How] many days did (PERSON) miss a half day or more from work [since (START DATE)/between (START DATE) and (END DATE)]? Please do not include work around the house.
PROBE: Include any time when a half day or more was missed because of a physical illness or injury, or a mental or emotional problem.

IF NO DAYS MISSED FROM WORK, CODE '995'.
IF PERSON DOES NOT WORK, CODE '996'.
[Enter Number of Days] .................
NONE ................................... 995
DOES NOT WORK (OTHER THAN AROUND THE HOUSE) ................................. 996
REF .................................... -7
DK ..................................... -8
PRESS F1 FOR DEFINITION OF HALF DAY OR MORE.
----------------------------------------------------
DISPLAY 'NUMBER OF DAYS IN HOSPITAL: [ ]' IF PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDEDIN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)).
----------------------------------------------------
----------------------------------------------------
FOR 'NUMBER OF DAYS', DISPLAY TOTAL NUMBER OF DAYS PERSON WAS IN HOSPITAL FOR ALL HOSPITAL STAYS THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Including the time..., how' IF PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)).
OTHERWISE, DISPLAY 'How'.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 1 THROUGH NUMBER OF DAYS IN REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
IF '0' ENTERED, DISPLAY THE FOLLOWING ERROR MESSAGE: 'IF NO WORK DAYS MISSED, CODE '995'.'
----------------------------------------------------
----------------------------------------------------
IF NUMBER ENTERED ) NUMBER OF DAYS IN REFERENCE PERIOD, DISPLAY THE FOLLOWING ERROR MESSAGE:
'NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER IN REFERENCE PERIOD.'
----------------------------------------------------
----------------------------------------------------
IF CODED '995' (NONE), '996' (DOES NOT WORK), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND PERSON IS 16 THROUGH 22 YEARS OF AGE INCLUSIVE (OR AGE CATEGORY 4), GO TO DD05
----------------------------------------------------
----------------------------------------------------
IF CODED '995' (NONE), '996' (DOES NOT WORK), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND PERSON IS 23 YEARS OF AGE OR OLDER (OR AGE CATEGORIES 5-9), GO TO DD08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH DD03
----------------------------------------------------
----------------------------------------------------
NOTE: THE AGE RANGE FOR PERSONS GOING TO THE SCHOOL-LOSS DISABILITY DAYS QUESTION HAS BEEN EXTENDED TO INCLUDE INDIVIDUALS WHO MAY BE ATTENDING POST-SECONDARY INSTITUTIONS.
----------------------------------------------------

DD03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What are the health problems that caused (PERSON) to miss work on those days?
PROBE: Any other health problems?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
OTHER SPECIFY: (____________)..........91
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.'
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS SELECTED OR ADDED AS BEING ASSOCIATED WITH MISSED WORK DAYS IN THIS ROUND.
----------------------------------------------------

DD04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
NUMBER OF DAYS MISSED WORK: [NUMBER OF DAYS]
Of those days, how many did (PERSON) stay in bed for half a day or more?
[Enter Number of Days] .................
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF STAY IN BED.
----------------------------------------------------
IF PERSON IS 16 THROUGH 22 YEARS OF AGE INCLUSIVE (OR AGE CATEGORY 4), CONTINUE WITH DD05
----------------------------------------------------
----------------------------------------------------
IF PERSON IS 23 YEARS OF AGE OR OLDER (OR AGE CATEGORIES 5-9), GO TO DD08
----------------------------------------------------
----------------------------------------------------
EDIT: DAYS IN BED ( DAYS MISSED FROM WORK.
----------------------------------------------------
----------------------------------------------------
FOR 'NUMBER OF DAYS', DISPLAY THE NUMBER ENTERED AT DD02.
----------------------------------------------------

DD05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[NUMBER OF DAYS IN HOSPITAL: [NUMBER OF DAYS]]
Let's talk about school (and day care). [Including the time (PERSON) (were/was) in the hospital, how/How] many days did (PERSON) miss a half day or more of school (or day care) [since (START DATE)/between (START DATE) and (END DATE)]?
PROBE: Include any time when a half day or more of school (or day care) was missed because of a physical illness or injury, or a mental or emotional problem.

IF NO DAYS MISSED FROM SCHOOL, CODE '995'.
IF PERSON DOES NOT ATTEND SCHOOL, CODE '996'.
[Enter Number of Days] .................
NONE ................................... 995 [DD08]
DOES NOT ATTEND SCHOOL ................. 996 [DD08]
REF .................................... -7 [DD08]
DK ..................................... -8 [DD08]
PRESS F1 FOR DEFINITION OF HALF DAY OR MORE.
[Code One]
----------------------------------------------------
DISPLAY 'NUMBER OF DAYS IN HOSPITAL: [ ]' IF PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)).
----------------------------------------------------
----------------------------------------------------
FOR 'NUMBER OF DAYS', DISPLAY TOTAL NUMBER OF DAYS PERSON WAS IN HOSPITAL FOR ALL HOSPITAL STAYS THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Including the time..., how' IF PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)).
OTHERWISE, DISPLAY 'How'.
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 1 THROUGH NUMBER OF DAYS IN REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
IF '0' ENTERED, DISPLAY THE FOLLOWING ERROR MESSAGE: 'IF NO SCHOOL DAYS MISSED, CODE '995'.'
----------------------------------------------------
----------------------------------------------------
IF NUMBER ENTERED ) NUMBER OF DAYS IN REFERENCE PERIOD, DISPLAY THE FOLLOWING ERROR MESSAGE:
'NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER IN REFERENCE PERIOD.'
----------------------------------------------------

DD06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What are the health problems that caused (PERSON) to miss school on those days?
PROBE: Any other health problems?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
OTHER SPECIFY: (____________)..........91
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- MEDICAL-CONDITIONS-ROSTER.
---------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: "DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED."
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS SELECTED OR ADDED AS BEING ASSOCIATED WITH MISSED SCHOOL DAYS IN THIS ROUND.
----------------------------------------------------

DD07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
NUMBER OF DAYS MISSED SCHOOL: [NUMBER OF DAYS]
Of those days, how many did (PERSON) stay in bed a half day or more?
[Enter Number of Days] .................
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF STAY IN BED.
----------------------------------------------------
DISPLAY NUMBER RECORDED IN DD05 FOR 'NUMBER OF DAYS'.
----------------------------------------------------
----------------------------------------------------
EDIT: DAYS IN BED AT DD07 ( DAYS MISSED FROM SCHOOL.
----------------------------------------------------
----------------------------------------------------
EDIT: TOTAL BED DAYS (SUM OF ENTRY AT DD04 PLUS ENTRY AT DD07) MUST BE ( NUMBER OF DAYS IN REFERENCE PERIOD FOR PERSON.
----------------------------------------------------

DD08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[NUMBER OF DAYS IN HOSPITAL: [NUMBER OF DAYS]]
[Besides the days in bed you just told me about, how/How] many [additional] days did (PERSON) spend a half day or more in bed [since (START DATE)/between (START DATE) and (END DATE)] because of a physical illness or injury, or mental or emotional problem?
[Please include the time (PERSON) (were/was) in the hospital.]

IF NO [ADDITIONAL] BED DAYS, CODE '995'.
[Enter Number of Days] .................
NONE ................................... 995 [BOX_02]
REF .................................... -7 [BOX_02]
DK ..................................... -8 [BOX_02]
PRESS F1 FOR DEFINITION OF HALF DAY OR MORE AND STAY IN BED.
----------------------------------------------------
DISPLAY 'NUMBER OF DAYS IN HOSPITAL: [ ]' IF PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)).
----------------------------------------------------
----------------------------------------------------
FOR 'NUMBER OF DAYS', DISPLAY TOTAL NUMBER OF DAYS PERSON WAS IN HOSPITAL FOR ALL HOSPITAL STAYS THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Besides the days...how', 'additional', AND 'ADDITIONAL' IF ANY BED DAYS RECORDED FOR THIS PERSON IN EITHER DD04 OR DD07. IF NO BED DAYS RECORDED AT DD04 AND DD07, DISPLAY, 'How'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Please include...' IF PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)).
----------------------------------------------------
----------------------------------------------------
RANGE CHECK: 1 THROUGH NUMBER OF DAYS IN REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
IF '0' ENTERED, DISPLAY THE FOLLOWING ERROR MESSAGE: 'IF NO ADDITIONAL BED DAYS, CODE '995'.'
----------------------------------------------------
----------------------------------------------------
EDIT: TOTAL BED DAYS (SUM OF ENTRY AT DD04 PLUS ENTRY AT DD07 PLUS ENTRY AT DD08) MUST BE LESS THAN OR EQUAL TO NUMBER OF DAYS IN REFERENCE PERIOD FOR PERSON.
----------------------------------------------------

DD09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What are the health problems that caused (PERSON) to spend half day or more in bed on those days?
PROBE: Any other health problems?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF CONDITION) that we have already talked about before?

IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
OTHER SPECIFY: (____________)..........91
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. INTERVIEWER MAY SELECT A CONDITION(S) ALREADY LISTED ON THE ROSTER. DOING SO SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. INTERVIEWER SHOULD BE ABLE TO ADD ANY NUMBER OF CONDITIONS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF CONDITIONS). AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
3. INTERVIEWER SHOULD BE ABLE TO DELETE CONDITION THAT WAS RECORDED ON THE SCREEN WHERE DELETE IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE A CONDITION ENTERED IN ERROR. IF DELETE IS ATTEMPTED AT A TIME WHEN IT IS NOT ALLOWED (I.E., AFTER THE LINK IS ESTABLISHED), DISPLAY THE FOLLOWING ERROR MESSAGE: "DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED."
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS SELECTED OR ADDED AS BEING ASSOCIATED WITH BED DAYS IN THIS ROUND.
----------------------------------------------------

BOX_02
======

----------------------------------------------------
CHECK AGE AND WORK STATUS:
IF LESS THAN 16 YEARS OF AGE OR AGE CATEGORIES 1-3), GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
IF 16 YEARS OF AGE OR OLDER (OR AGE CATEGORIES 4-9) AND DD02 IS NOT CODED '996' (DOES NOT WORK OTHER THAN AROUND THE HOUSE), CONTINUE WITH DD10
----------------------------------------------------
----------------------------------------------------
IF 16 YEARS OF AGE OR OLDER (OR AGE CATEGORIES 4-9) AND DD02 IS CODED '996' (DOES NOT WORK OTHER THAN AROUND THE HOUSE), GO TO BOX_03
----------------------------------------------------

DD10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Besides the [NUMBER MISSED WORK DAYS] days (PERSON) missed a half day or more from work because of (PERSON)'s own illness or injury, did/Did] (PERSON) miss more than a half day from work [between (START DATE) and (END DATE)] because of someone else's illness, injury, or health care needs, for example, to take care of a sick child or a relative?
YES .................................... 1
NO/DO NOT WORK.......................... 2 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
PRESS F1 FOR DEFINITION OF HALF DAY OR MORE.
----------------------------------------------------
DISPLAY 'Besides the ..., did' IF ANY BED DAYS RECORDED FOR THIS PERSON IN DD02. DISPLAY 'Did' IF NO BED DAYS RECORDED FOR THIS PERSON IN DD02.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY NUMBER RECORDED IN DD02 FOR 'NUMBER MISSED WORK DAYS' IF DD02 ≠ '-7' (REFUSED) OR '-8' DON'T KNOW). IF DD02 = '-7' (REFUSED) OR '-8' DON'T KNOW), USE A NULL DISPLAY.
----------------------------------------------------

DD11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
How many days did (PERSON) miss a half day or more from work because of someone else's illness, injury, or health care needs?
[Enter Number of Days] .................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
EDIT: DAYS ENTERED ( NUMBER OF DAYS IN REFERENCE PERIOD
----------------------------------------------------
----------------------------------------------------
IF '0' ENTERED, DISPLAY THE FOLLOWING ERROR MESSAGE: 'IF NO WORK DAYS MISSED, USE CTRL/B TO CORRECT PREVIOUS ANSWER.'
----------------------------------------------------
----------------------------------------------------
IF NUMBER ENTERED ) NUMBER OF DAYS IN REFERENCE PERIOD, DISPLAY THE FOLLOWING ERROR MESSAGE:
'NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER IN REFERENCE PERIOD.'
----------------------------------------------------

BOX_03
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------


Conditions (CN) Section


BOX_01
======

-----------------------------------------------------
IF AT LEAST ONE CONDITION ON PERSON'S-MEDICAL-CONDITIONS-ROSTER FLAGGED AS 'CREATED' DURING THE CURRENT ROUND, CONTINUE WITH BOX_02
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO BOX_07
-----------------------------------------------------
-----------------------------------------------------
NOTE: FOR THE PURPOSE OF HARD COPY SPECIFICATIONS, CONDITIONS CAN ONLY BE FLAGGED AS 'CREATED' OR 'SELECTED' DURING A PARTICULAR ROUND.
-----------------------------------------------------

BOX_02
======

-----------------------------------------------------
IF 'PREGNANCY' ONLY CONDITION FLAGGED AS 'CREATED' FOR THIS PERSON DURING THE CURRENT ROUND, GO TO BOX_07
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, CONTINUE WITH CN01
-----------------------------------------------------

CN01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Now I would like to ask you some questions about the health conditions we have listed for (PERSON).
PRESS ENTER TO CONTINUE.

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO
ROSTER. CONDITION
CN02_02. ACCIDENT/INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS-ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'. WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF ANY CONDITIONS FLAGGED AS 'DUE TO ACCIDENT/INJURY' OR FLAGGED AS 'ON PRIORITY LIST', CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN PERSON'S-MEDICAL-CONDITIONS-ROSTER, ASK BOX_04-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT MEDICAL CONDITIONS CREATED DURING THE CURRENT ROUND THAT ARE DUE TO AN ACCIDENT OR INJURY AND/OR ARE ON THE PRIORITY LIST. THIS LOOP CYCLES ON MEDICAL CONDITIONS THAT MEET EITHER OR BOTH OF THE FOLLOWING CONDITIONS:

- MEDICAL CONDITION IS DUE TO AN ACCIDENT OR INJURY (CN02_02 IS CODED '1' (YES))
- MEDICAL CONDITION IS ON LIST OF PRIORITY CONDITIONS (CN02_03 IS CODED '1' (YES))

AND ALSO MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' DURING THE CURRENT ROUND
----------------------------------------------------

BOX_04
======

----------------------------------------------------
CHECK CONDITION LINKS TO MEDICAL PROVIDER VISIT (MV) EVENTS, EMERGENCY ROOM (ER) EVENTS, OUTPATIENT DEPARTMENT (OP) EVENTS, HOSPITAL STAY (HS) EVENTS, AND DENTAL (DN) EVENTS TO DETERMINE WHETHER THE RU MEMBER HAS SEEN OR TALKED WITH A MEDICAL PERSON ABOUT THE CONDITION BETWEEN START DATE AND END DATE.
----------------------------------------------------
----------------------------------------------------
NOTE: CONDITION LINKS TO HOME HEALTH EVENTS WILL NOT BE CHECKED FOR HERE. IN MANY HOME HEALTH EVENTS, THE SERVICES PROVIDED AND PROVIDER ARE NOT ALWAYS MEDICAL. THERE IS NO CONTROL OR CHECKS DONE TO ASCERTAIN A STRAIGHT-FORWARD LINK TO A HOME HEALTH EVENT RELATED TO MEDICAL SERVICES OR A MEDICAL PROVIDER. THUS ALL CONDITIONS ONLY LINKED TO A HOME HEALTH EVENT WILL CONTINUE WITH CN03.
----------------------------------------------------
----------------------------------------------------
IF CONDITION FLAGGED AS BOTH 'DUE TO ACCIDENT/INJURY' AND 'ON PRIORITY LIST' AND THERE IS AN EVENT-PROVIDER PAIR ASSOCIATED WITH THE CONDITION, AUTOMATICALLY CODE CN03 AS '1' (YES) BY CAPI AND GO TO CN06
----------------------------------------------------
----------------------------------------------------
IF CONDITION FLAGGED ONLY AS 'DUE TO ACCIDENT/INJURY' AND THERE IS AN EVENT-PROVIDER PAIR ASSOCIATED WITH THE CONDITION, AUTOMATICALLY CODE CN03 AS '1' (YES) BY CAPI AND GO TO CN06
----------------------------------------------------
----------------------------------------------------
IF CONDITION FLAGGED ONLY AS 'ON PRIORITY LIST' AND THERE IS AN EVENT-PROVIDER PAIR ASSOCIATED WITH THE CONDITION, AUTOMATICALLY CODE CN03 AS '1'(YES) BY CAPI AND GO TO CN05
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., NO EVENT-PROVIDER PAIR ASSOCIATED WITH THE CONDITION), CONTINUE WITH CN03
----------------------------------------------------

CN03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
Did (PERSON) ever see or talk to a doctor or other medical person about the (CONDITION)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF [CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) OR IF NOT ROUND 1 AND CN03 IS CODED '1' (YES)] AND CONDITION FLAGGED AS BOTH 'DUE TO ACCIDENT/INJURY' AND 'ON PRIORITY LIST', GO TO CN06
----------------------------------------------------
----------------------------------------------------
IF [CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) OR IF NOT ROUND 1 AND CN03 IS CODED '1' (YES)] AND CONDITION FLAGGED ONLY AS 'DUE TO ACCIDENT/INJURY', GO TO CN06
----------------------------------------------------
----------------------------------------------------
IF [CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) OR IF NOT ROUND 1 AND CN03 IS CODED '1' (YES)] AND CONDITION FLAGGED ONLY AS 'ON PRIORITY LIST', GO TO CN05
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ROUND 1 AND CN03 IS CODED '1' (YES)), CONTINUE WITH CN04
----------------------------------------------------
----------------------------------------------------
NOTE: ROUND BASED CRITERIA IN SKIPS WERE NOT ADDED UNTIL ROUND 4.
----------------------------------------------------

CN04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
Was the last time (PERSON) saw or talked with a doctor or medical person about the (CONDITION) before or after (START DATE)?
BEFORE START DATE ...................... 1
AFTER START DATE ....................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
IF CONDITION FLAGGED AS BOTH 'DUE TO ACCIDENT/INJURY' AND 'ON PRIORITY LIST', GO TO CN06
----------------------------------------------------
----------------------------------------------------
IF CONDITION FLAGGED ONLY AS 'DUE TO ACCIDENT/INJURY', GO TO CN06
----------------------------------------------------
----------------------------------------------------
IF CONDITION FLAGGED ONLY AS 'ON PRIORITY LIST', CONTINUE WITH CN05
----------------------------------------------------
----------------------------------------------------
NOTE: CN04 SHOULD ONLY BE ASKED IN ROUND 1. HOWEVER, FOR PANEL 1, IT WAS ALSO ASKED IN ROUNDS 2 AND 3, BUT NOT IN ROUNDS 4 AND 5.
----------------------------------------------------

CN05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
When did (PERSON) first notice or find out that (PERSON) had (CONDITION)?
[PROBE IF ANY EVENTS LISTED: The dates we have recorded for the medical care for (CONDITION) include (READ EVENT DATES BELOW).]

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
CN05_01. PROVIDER
ROSTER. EVENT DATE
CN05_03. EVENT TYPE
1. Medical Provider-35 [Display Month Day Year-4] [Display Event Code]
2. Medical Provider-35 [Display Month Day Year-4] [Display Event Code]
3. Medical Provider-35 [Display Month Day Year-4] [Display Event Code]
[Enter Year-2] .........................
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS EVENTS ON THE PERSON'S-MEDICAL-EVENTS-ROSTER THAT MEET THE FOLLOWING CONDITIONS:

- EVENT IS LINKED TO THE CONDITION BEING ASKED ABOUT
AND
- EVENT OCCURRED DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

1. THE ROSTER DEFINED ABOVE WILL BE DISPLAYED IN COLUMN 2. THE ASSOCIATED MEDICAL PROVIDER AND EVENT TYPE WILL BE DISPLAYED FOR EACH EVENT IN COLUMN 1 (CN05_01) AND COLUMN 2 (CN05_03), RESPECTIVELY.
2. INFORMATION IN THE MATRIX IS FOR DISPLAY ONLY.
----------------------------------------------------
----------------------------------------------------
IF THERE ARE NO EVENTS RELATED TO THE CONDITION BEING ASKED ABOUT, DO NOT DISPLAY THE PROBE OR EVENT GRID.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH CN05OV1
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR MINUS 1, GO TO CN05OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_06
----------------------------------------------------

CN05OV1
=======

ENTER MONTH AND DAY:
[Enter Month-2, Day-2] ................. [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]

CN05OV2
=======

ENTER MONTH:
[Enter Month-2] ........................ [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
----------------------------------------------------
EDIT/RANGE CHECK:

ENTRIES FOR MONTH AND DAY FIELDS MUST CORRESPOND TO CALENDAR MONTHS AND DAYS. THAT IS,
- IF MONTH, ALLOWABLE VALUES = 01 - 12.
- IF DAY:
- ALLOWABLE VALUES = 01 - 31 IF MONTH CODED '01', '03', '05', '07', '08', '10', '12';
- ALLOWABLE VALUES = 01 - 30 IF MONTH CODED '04', '06', '09', '11';
- ALLOWABLE VALUES = 01 - 29 IF MONTH CODED '02' AND YEAR IS 1996 (LEAP YEAR);
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT 1996 (I.E., NOT LEAP YEAR).

MISSING VALUES = -7 AND -8 ALLOWED FOR MONTH AND DAY FIELDS.
----------------------------------------------------
----------------------------------------------------
EDIT: THE COMPLETE DATE CANNOT BE BEFORE THE PERSON'S DATE OF BIRTH OR AFTER THE CURRENT REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

CN06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
When did the accident or injury happen?
[PROBE IF ANY EVENTS LISTED: The dates we have recorded for the medical care for (CONDITION) include (READ EVENT DATES BELOW).]

TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
CN06_01. PROVIDER
ROSTER. EVENT DATE
CN06_03. EVENT TYPE
1. Medical Provider-35 [Display Month Day Year-4] [Display Event Code]
2. Medical Provider-35 [Display Month Day Year-4] [Display Event Code]
3. Medical Provider-35 [Display Month Day Year-4] [Display Event Code]
[Enter Year-2] .........................
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS EVENTS ON THE PERSON'S-MEDICAL-EVENTS-ROSTER THAT MEET THE FOLLOWING CONDITIONS:

- EVENT IS LINKED TO THE CONDITION BEING ASKED ABOUT
AND
- EVENT OCCURRED DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
MATRIX BEHAVIOR SPECIFICATIONS:

SEE SPECIFICATIONS AT CN05.
----------------------------------------------------
----------------------------------------------------
IF THERE ARE NO EVENTS RELATED TO THE CONDITION BEING ASKED ABOUT, DO NOT DISPLAY THE PROBE OR EVENT GRID.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH CN06OV1
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR MINUS 1, GO TO CN06OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

CN06OV1
=======

ENTER MONTH AND DAY:
[Enter Month-2, Day-2] ................. [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]

CN06OV2
=======

ENTER MONTH:
[Enter Month-2] ........................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
EDIT/RANGE CHECK:

ENTRIES FOR MONTH AND DAY FIELDS MUST CORRESPOND TO CALENDAR MONTHS AND DAYS. THAT IS,
- IF MONTH, ALLOWABLE VALUES = 01 - 12.
- IF DAY:
- ALLOWABLE VALUES = 01 - 31 IF MONTH CODED '01', '03', '05', '07', '08', '10', '12';
- ALLOWABLE VALUES = 01 - 30 IF MONTH CODED '04', '06', '09', '11';
- ALLOWABLE VALUES = 01 - 29 IF MONTH CODED '02' AND YEAR IS 1996 (LEAP YEAR);
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT 1996 (I.E., NOT LEAP YEAR).

MISSING VALUES = -7 AND -8 ALLOWED FOR MONTH AND DAY FIELDS.
----------------------------------------------------
----------------------------------------------------
EDIT: THE COMPLETE DATE CANNOT BE BEFORE THE PERSON'S DATE OF BIRTH OR AFTER THE CURRENT REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

BOX_05
======

---------------------------------------------------
IF PERSON IS = OR ) 16 YEARS OF AGE OR IN AGE CATEGORIES 4-9, CONTINUE WITH CN07
---------------------------------------------------
---------------------------------------------------
OTHERWISE, GO TO CN08
---------------------------------------------------

CN07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
Did the accident or injury happen while (PERSON) (were/was) at work?
YES .................................... 1
NO ..................................... 2
DOES NOT WORK .......................... 3
REF ................................... -7
DK .................................... -8
[Code One]

CN08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
Where did the accident or injury happen?
LISTEN TO RESPONSE AND SELECT OPTION FROM CODE LIST.
VERIFY SELECTION WITH RESPONDENT.
AT HOME (OWN OR SOMEONE ELSE'S) ........ 1
ON PUBLIC STREET, ROAD, HIGHWAY, SIDEWALK ............................... 2 [CN10]
ON FARM (OWN OR SOMEONE ELSE'S) ........ 3 [CN10]
SCHOOL (IN BUILDING, ON GROUNDS, INCLUDING PLAYING FIELDS) .............. 4 [CN10]
STORE OR RESTAURANT (INCLUDING MALLS) .. 5 [CN10]
OFFICE (ANY PART OF BUILDING) .......... 6 [CN10]
FACTORY, INDUSTRY SITE ................. 7 [CN10]
MILITARY FACILITY ...................... 8 [CN10]
RECREATIONAL PLACE OR FACILITY ......... 9 [CN10]
OTHER ................................. 91 [CN10]
REF ................................... -7 [CN10]
DK .................................... -8 [CN10]
[Code One]
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.

CN09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
Was it inside or outside the house?
INSIDE ................................. 1
OUTSIDE ................................ 2
REF ................................... -7
DK .................................... -8
[Code One]

CN10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
SHOW CARD CN-1.
Did the accident or injury involve any of the things listed on this card?
CODE ALL THAT APPLY.
MOTOR VEHICLE .......................... 1
GUN .................................... 2
WEAPON OTHER THAN GUN .................. 3
POISON OR SOMETHING THAT CAN POISON (LIKE GASOLINE OR A CLEANING FLUID OR CHEMICAL) .............................. 4
FIRE OR SOMETHING HOT THAT WOULD CAUSE A BURN ........................... 5
DROWNING OR NEAR-DROWNING .............. 6
SPORTS INJURY .......................... 7
FALL (EXCLUDE FALLS RELATED TO SPORTS) . 8
SOMETHING ELSE/NOTHING ................ 95
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

BOX_06
======

----------------------------------------------------
IF CONDITION FLAGGED AS BOTH 'DUE TO ACCIDENT/INJURY' AND 'ON PRIORITY LIST' AND CN03 IS CODED '2' (NO-PERSON HAS NEVER SEEN A DOCTOR OR OTHER MEDICAL PERSON ABOUT THE CONDITION), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO CN12
----------------------------------------------------
----------------------------------------------------
IF CONDITION FLAGGED ONLY AS 'DUE TO ACCIDENT/INJURY' AND CN03 IS CODED '2' (NO-PERSON HAS NEVER SEEN A DOCTOR OR OTHER MEDICAL PERSON ABOUT THE CONDITION), '-7' (REFUSED), OR '-8' (DON'T KNOW) GO TO CN12
----------------------------------------------------
----------------------------------------------------
IF CONDITION FLAGGED ONLY AS 'ON PRIORITY LIST' AND CN03 IS CODED '2' (NO-PERSON HAS NEVER SEEN A DOCTOR OR OTHER MEDICAL PERSON ABOUT THE CONDITION), '-7' (REFUSED), OR '-8' (DON'T KNOW) GO TO CN13
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CN11
----------------------------------------------------

CN11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
[(Are/Is)/Was] (PERSON) still being treated for (CONDITION) [at (END DATE)]? That is, [(are/is)/was] (PERSON) still receiving care or taking medicine for (CONDITION)?
YES .................................... 1 [CN13]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF STILL BEING TREATED.
----------------------------------------------------
DISPLAY '(Are/Is)' AND '(are/is)' IF PERSON BEING ASKED ABOUT IS CURRENTLY IN THE RU. DISPLAY 'Was', 'was' AND 'at (END DATE)' IF PERSON BEING ASKED ABOUT IS NO LONGER IN THE RU OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND CONDITION IS FLAGGED ONLY AS 'ON PRIORITY LIST', GO TO CN13
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CN12
----------------------------------------------------

CN12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
ASK IF APPROPRIATE. IF INAPPROPRIATE TO ASK, CODE '3' TO SHOW THAT THE CONDITION IS PERSISTENT OR PERMANENT.
[(Have/Has)/Had] (PERSON) fully recovered from (CONDITION), or [(do/does)/did] (PERSON) still have it?
FULLY RECOVERED ........................ 1
STILL HAVE IT .......................... 2
DID NOT ASK: STILL HAS (CONDITION IS PERSISTENT/PERMANENT) .................. 3
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF RECOVERED.
----------------------------------------------------
DISPLAY '(Have/Has)' AND '(do/does)' IF PERSON BEING ASKED ABOUT IS CURRENTLY IN THE RU. DISPLAY 'Had' AND 'did' IF PERSON BEING ASKED ABOUT IS NO LONGER IN THE RU OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

CN13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
How seriously did the (CONDITION) affect (PERSON)'s overall health and well-being [since/between] [(START DATE)[and (END DATE)]/that accident or injury]? Would you say it affected (PERSON)'s health ...
very seriously, ........................ 1
somewhat seriously, .................... 2
not very seriously, or ................. 3
not at all? ............................ 4
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'since' IF NOT ROUND 5. DISPLAY 'between' IF ROUND 5.

DISPLAY '(START DATE)[and (END DATE)]' IF NOT ACCIDENT OR INJURY. DISPLAY 'that accident or injury' IF ACCIDENT OR INJURY (CN02_02 CODED '1' (YES) FOR CONDITION).

DISPLAY 'and (END DATE)' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

CN13OV
======

INTERVIEWER: WHO ANSWERED THIS QUESTION?
(PERSON) .............................. 1
SOMEONE ELSE .......................... 2
[Code One]
----------------------------------------------------
FLAG RESPONSE TO CN13 AS SELF-REPORT IF CN13OV IS CODED '1' ((PERSON)) AND AS PROXY REPORT IF CN13OV IS CODED '2' (SOMEONE ELSE).
----------------------------------------------------
----------------------------------------------------
IF CN03 IS CODED '1' (YES) AND CN04 IS CODED '1' (BEFORE START DATE) (THAT IS, PERSON HAS SEEN A DOCTOR OR MEDICAL PERSON BUT NOT SINCE START DATE) OR IF CN03 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CN14
----------------------------------------------------

CN14
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
Earlier you told me about the health care (PERSON) received for the (CONDITION). Did the health care provider recommend further treatment or consultation?
YES .................................... 1
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF FURTHER TREATMENT/CONSULTATION.

CN15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
[How/As of December 31, 1998, how] much of the follow-up care did (PERSON) receive for (CONDITION)? Did (PERSON) receive all of the follow-up care, some of it, none of it, or is (PERSON) still being treated?
ALL FOLLOW-UP CARE RECEIVED ............ 1
SOME FOLLOW-UP CARE RECEIVED ........... 2
NO FOLLOW-UP CARE RECEIVED ............. 3
STILL BEING TREATED .................... 4
REF ................................... -7
DK .................................... -8
[Code One]
PRESS F1 FOR DEFINITIONS OF FOLLOW-UP CARE AND ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'How' IF NOT ROUND 5. DISPLAY 'As of December 31, 1998, how' IF ROUND 5.
----------------------------------------------------

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT CONDITION IN PERSON'S-MEDICAL-CONDITIONS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER CONDITIONS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_07
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF AT LEAST ONE CONDITION ON PERSON'S-MEDICAL-CONDITIONS-ROSTER FLAGGED AS 'SELECTED' DURING THE CURRENT ROUND, CONTINUE WITH BOX_08
----------------------------------------------------
----------------------------------------------------
NOTE: 'SELECTED' HERE REFERS TO CONDITIONS PICKED DURING A ROUND AFTER THE ROUND IN WHICH THEY WERE CREATED.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

BOX_08
======

----------------------------------------------------
CHECK CONDITIONS FLAGGED AS 'SELECTED' DURING THE CURRENT ROUND. IF AT LEAST ONE CONDITION FLAGGED AS 'SELECTED' AND FLAGGED AS 'ON PRIORITY LIST', CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

LOOP_02
=======

-----------------------------------------------------
FOR EACH ELEMENT IN PERSON'S-MEDICAL-CONDITIONS-ROSTER, ASK CN16-END_LP02
-----------------------------------------------------
-----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS 'FOLLOW-UP' INFORMATION ABOUT MEDICAL CONDITIONS THAT WERE NOT CREATED BUT WERE SELECTED DURING THE CURRENT ROUND, AND WERE FLAGGED AS 'ON PRIORITY LIST' DURING A PREVIOUS ROUND. THIS LOOP CYCLES ON MEDICAL CONDITIONS THAT MEET THE FOLLOWING CONDITIONS:

- MEDICAL CONDITION IS FLAGGED AS 'SELECTED' DURING THE CURRENT ROUND (NOTE THAT CONDITIONS 'CREATED' DURING THE CURRENT ROUND ARE EXCLUDED FROM THIS LOOP BUT ARE ASKED ABOUT IN LOOP_01)
AND
- MEDICAL CONDITION WAS FLAGGED AS 'ON PRIORITY LIST' (CN02_03 CODED '1' (YES)) DURING A PREVIOUS ROUND
-----------------------------------------------------

CN16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
Today, (PERSON)'s (CONDITION) was mentioned. We talked about this condition [another/last] time I was here. I'd just like to ask a few questions about it.
PRESS ENTER TO CONTINUE.
----------------------------------------------------
DISPLAY 'another' IF CONDITION CREATED ANY ROUND PRIOR TO PREVIOUS ROUND. DISPLAY 'last' IF CONDITION CREATED PREVIOUS ROUND.
----------------------------------------------------
----------------------------------------------------
CHECK CONDITION LINKS TO MEDICAL PROVIDER VISIT (MV) EVENTS, EMERGENCY ROOM (ER) EVENTS, OUTPATIENT DEPARTMENT (OP) EVENTS, HOSPITAL STAY (HS) EVENTS, AND DENTAL (DN) EVENTS TO DETERMINE WHETHER THE RU MEMBER HAS SEEN OR TALKED WITH A MEDICAL PERSON ABOUT THE CONDITION BETWEEN CURRENT START DATE AND END DATE.
----------------------------------------------------
----------------------------------------------------
NOTE: CONDITION LINKS TO HOME HEALTH EVENTS WILL NOT BE CHECKED FOR HERE. IN MANY HOME HEALTH EVENTS, THE SERVICES PROVIDED AND PROVIDER ARE NOT ALWAYS MEDICAL. THERE IS NO CONTROL OR CHECKS DONE TO ASCERTAIN A STRAIGHT-FORWARD LINK TO A HOME HEALTH EVENT RELATED TO MEDICAL SERVICES OR A MEDICAL PROVIDER. THUS ALL CONDITIONS ONLY LINKED TO A HOME HEALTH EVENT WILL CONTINUE WITH CN17.
----------------------------------------------------
----------------------------------------------------
IF THERE IS AN EVENT-PROVIDER PAIR FROM THE CURRENT ROUND ASSOCIATED WITH THE CONDITION, AUTOMATICALLY CODE CN17 AS '1' (YES) BY CAPI AND GO TO CN18
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., NO EVENT-PROVIDER PAIR FROM THE CURRENT ROUND ASSOCIATED WITH THE CONDITION), CONTINUE WITH CN17
----------------------------------------------------

CN17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], (have/has) (PERSON) seen or talked with a doctor or other medical person about the (CONDITION)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), AND CN03 WAS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS CONDITION DURING THE ROUND IN WHICH THE CONDITION WAS CREATED, GO TO CN19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CN18
----------------------------------------------------

CN18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
[(Are/Is)/Was] (PERSON) still being treated for (CONDITION) [at (END DATE)]? That is, [(are/is)/was] (PERSON) still receiving care or taking medicine for (CONDITION)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF STILL BEING TREATED.
----------------------------------------------------
DISPLAY '(Are/Is)' AND '(are/is)' IF PERSON BEING ASKED ABOUT IS CURRENTLY IN THE RU. DISPLAY 'Was', 'was', AND 'at (END DATE)' IF PERSON BEING ASKED ABOUT IS NO LONGER IN THE RU OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

CN19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT]
[END-DT]
How seriously did the (CONDITION) affect (PERSON)'s overall health and well-being [since (START DATE)/between (START DATE) and (END DATE)]? Would you say it affected (PERSON)'s health ...
very seriously, ........................ 1
somewhat seriously, .................... 2
not very seriously, .................... 3
or not at all? ......................... 4
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

CN19OV
======

INTERVIEWER: WHO ANSWERED THIS QUESTION?
(PERSON) .............................. 1
SOMEONE ELSE .......................... 2
[Code One]
----------------------------------------------------
FLAG RESPONSE TO CN19 AS SELF-REPORT IF CN19OV IS CODED '1' ((PERSON)) AND AS PROXY REPORT IF CN19OV IS CODED '2' (SOMEONE ELSE).
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT CONDITION IN PERSON'S-MEDICAL-CONDITIONS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER CONDITIONS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH BOX_09
----------------------------------------------------

BOX_09
======

----------------------------------------------------
IF ROUND 5, CONTINUE WITH BOX_10
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

BOX_10
======

----------------------------------------------------
IF PERSON IS 18 YEARS OF AGE OR OLDER (OR AGE CATEGORIES 4-9), CONTINUE WITH BOX_11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

BOX_11
======

----------------------------------------------------
IF AT LEAST ONE CONDITION ON PERSON'S-MEDICAL-CONDITIONS-ROSTER, CONTINUE WITH CN20
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

CN20
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Are any of the health conditions, accidents, and injuries we have listed for (PERSON) [(READ CONDITION NAMES BELOW, IF NECESSARY)] related to service in the Armed Forces of the United States?
CODE '3' IF RESPONDENT VOLUNTEERS NEVER IN ARMED FORCES.
TO SCROLL, USE ARROW KEYS.
TO LEAVE BOX AND GO TO ENTRY FIELD, PRESS ESC.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
YES .................................... 1
NO ..................................... 2 [BOX_12]
NEVER IN ARMED FORCES .................. 3 [BOX_12]
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]
[Code One]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

CN21
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Which of the health conditions, accidents, and injuries we have listed for (PERSON) are related to service in the Armed Forces of the United States?
PROBE: Any other health conditions related to service in the Armed Forces?

TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR SPECIFICATIONS:

1. AT LEAST ONE CONDITION SHOULD BE SELECTED.
2. CONDITIONS MAY NOT BE ADDED OR DELETED.
3. SELECTION OF CONDITIONS AT THIS QUESTION SHOULD NOT FLAG THE CONDITION AS 'SELECTED' OR 'CREATED' FOR THIS ROUND.
----------------------------------------------------

BOX_12
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------


Over-the-Counter Medicines (OC) Section


OC01
====

[STR-DT] [END-DT]
SHOW CARD OC-1.
Looking at this card, has anyone in the family purchased any of these types of over-the-counter medications [since (START DATE)/between (START DATE) and (END DATE)]?
YES .................................... 1
NO ..................................... 2 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
PRESS F1 FOR DESCRIPTION OF OTC CATEGORIES LISTED ON CARD.
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

OC02
====

[STR-DT] [END-DT]
SHOW CARD OC-1.
Which of the categories on this card best describe the types of over-the-counter medications anyone in the family has purchased [since (START DATE)/between (START DATE) and (END DATE)]?
PROBE: Any others?
CODE ALL THAT APPLY.
DIGESTIVE SYSTEM PROBLEMS .............. 1
RESPIRATORY PROBLEMS ................... 2
PAIN PROBLEMS .......................... 3
SKIN PROBLEMS .......................... 4
EYE/EAR/MOUTH PROBLEMS ................. 5
FEMININE PROBLEMS ...................... 6
GENERAL WELL-BEING PROBLEMS ............ 7
REF ................................... -7
DK .................................... -8
[Code All That Apply]
PRESS F1 FOR DESCRIPTION OF OTC CATEGORIES LISTED ON CARD.
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

OC03
====

[STR-DT] [END-DT]
[OTC CATEGORIES: [DIGESTIVE SYSTEM PROBLEMS] [RESPIRATORY PROBLEMS]
[PAIN PROBLEMS] [SKIN PROBLEMS] [EYE/EAR/MOUTH PROBLEMS]
[FEMININE PROBLEMS] [GENERAL WELL-BEING PROBLEMS]]
Thinking about all purchases of over-the-counter medications [for (READ OTC CATEGORIES)], please give me your best estimate of how much the family has spent [since (START DATE)/between (START DATE) and (END DATE)].
PROBE: Is that [since (START DATE)/between (START DATE) and (END DATE)], per month, per week, or what?
[Enter $ Amount] ......................
REF ................................... -7 [OC04]
DK .................................... -8 [OC04]
----------------------------------------------------
DISPLAY 'OTC CATEGORIES:...' AND 'FOR (READ OTC CATEGORIES)' ONLY IF OC02 ≠ '-7' (REFUSED) OR '-8' (DON'T KNOW). IF OC02 = '-7' (REFUSED) OR '-8' (DON'T KNOW), USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'DIGESTIVE SYSTEM PROBLEMS' IF OC02 IS CODED 1. DISPLAY 'RESPIRATORY PROBLEMS' IF OC02 IS CODED 2. DISPLAY 'PAIN PROBLEMS' IF OC02 IS CODED 3. DISPLAY 'SKIN PROBLEMS' IF OC02 IS CODED 4. DISPLAY 'EYE/EAR/MOUTH PROBLEMS' IF OC02 IS CODED 5. DISPLAY 'FEMININE PROBLEMS' IF OC02 IS CODED 6. DISPLAY 'GENERAL WELL-BEING PROBLEMS' IF OC02 IS CODED 7.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

OC03OV1
=======

ENTER UNIT:
[SINCE (START DATE)/BETWEEN (START DATE) AND (END DATE)] ............... 1 [BOX_01]
PER MONTH .............................. 2 [BOX_01]
EVERY OTHER WEEK (2 TIMES PER MONTH) ... 3 [BOX_01]
PER WEEK ............................... 4 [BOX_01]
OTHER ................................. 91
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
----------------------------------------------------
DISPLAY 'SINCE (START DATE)' IF NOT ROUND 5.
DISPLAY 'BETWEEN (START DATE) AND (END DATE)' IF ROUND 5.
----------------------------------------------------

OC03OV2
=======

ENTER OTHER:
[Enter Other Specify] .................. [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]

OC04
====

[STR-DT] [END-DT]
[About how much has the family spent on all purchases of over-the-counter medications [since (START DATE)/between (START DATE) and (END DATE)]?]
Would you say $5 to $10, $10 to $25, or what?

OC04_01
=======

ENTER DOLLAR AMOUNT OF LOWER RANGE:
[Enter $ Amount] ......................
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]

OC04_02
=======

TO -
ENTER DOLLAR AMOUNT OF UPPER RANGE:
[Enter $ Amount] ......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
EDIT: LOWER RANGE OF ESTIMATE MUST BE LESS THAN OR EQUAL TO UPPER RANGE OF ESTIMATE.
----------------------------------------------------

BOX_01
======

----------------------------------------------------
GO TO NEXT QUESTIONNAIRE SECTION
----------------------------------------------------


Access to Care (AC) Section


LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK AC01-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS THE NAME OF THE USUAL SOURCE OF CARE PROVIDER, IF ANY, FOR EACH CURRENT RU MEMBER. THIS LOOP CYCLES ON PERSONS WHO MEET THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
----------------------------------------------------

AC01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is there a particular doctor's office, clinic, health center, or other place that (PERSON) usually (go/goes) if (PERSON) (are/is) sick or (need/needs) advice about (PERSON)'s health?
YES ..................................... 1 [AC05]
NO ...................................... 2 [AC03]
MORE THAN ONE PLACE ..................... 3
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITION OF USUAL SOURCE OF HEALTH CARE.

AC02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Would (PERSON) go to one of these places first or most often if (PERSON) (are/is) sick?
YES ..................................... 1 [AC05]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]

AC03
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What is the main reason (PERSON) (do/does) not have a usual source of health care?
SELDOM OR NEVER GETS SICK ............... 1 [AC04]
RECENTLY MOVED INTO AREA ................ 2 [AC04]
DON'T KNOW WHERE TO GO FOR CARE ......... 3 [AC04]
USUAL SOURCE OF MEDICAL CARE IN THIS AREA IS NO LONGER AVAILABLE ........... 4 [AC04]
CAN'T FIND A PROVIDER WHO SPEAKS (PERSON)'S LANGUAGE ................... 5 [AC04]
LIKES TO GO TO DIFFERENT PLACES FOR DIFFERENT HEALTH NEEDS ................ 6 [AC04]
JUST CHANGED INSURANCE PLANS ............ 7 [AC04]
DON'T USE DOCTORS/TREAT MYSELF .......... 8 [AC04]
COST OF MEDICAL CARE .................... 9 [AC04]
OTHER REASON ............................ 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITION OF USUAL SOURCE OF HEALTH CARE.

AC03OV
======

ENTER OTHER REASON:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

AC04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What are the other reasons (PERSON) (do/does) not have a usual source of health care?
CODE ALL THAT APPLY.
NO OTHER REASONS ........................ 0
SELDOM OR NEVER GETS SICK ............... 1
RECENTLY MOVED INTO AREA ................ 2
DON'T KNOW WHERE TO GO FOR CARE ......... 3
USUAL SOURCE OF MEDICAL CARE IN THIS AREA IS NO LONGER AVAILABLE ........... 4
CAN'T FIND A PROVIDER WHO SPEAKS (PERSON)'S LANGUAGE ................... 5
LIKES TO GO TO DIFFERENT PLACES FOR DIFFERENT HEALTH NEEDS ................ 6
JUST CHANGED INSURANCE PLANS ............ 7
DON'T USE DOCTORS/TREAT MYSELF .......... 8
COST OF MEDICAL CARE .................... 9
OTHER REASON ............................ 91
REF ..................................... -7
DK ...................................... -8
[Code All That Apply]
PRESS F1 FOR DEFINITION OF USUAL SOURCE OF HEALTH CARE.
----------------------------------------------------
IF CODED '91' (OTHER REASON) ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH AC04OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8 (DON'T KNOW) IN THE FIRST FIELD, NO OTHER REASON CATEGORY CAN BE CODED. IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8' (DON'T KNOW), IN A FIELD OTHER THAN THE FIRST FIELD AND A SUBSEQUENT CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------

AC04OV
======

ENTER OTHER REASON:
[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

AC05
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the name of the medical person, doctor's office, clinic, health center, or other place that (PERSON) usually (go/goes) if (PERSON) (are/is) sick or (need/needs) advice about (PERSON)'s health.
PRESS ENTER TO CONTINUE.
PRESS F1 FOR DEFINITION OF USUAL SOURCE OF HEALTH CARE.

BOX_01
======

----------------------------------------------------
ASK THE PROVIDER ROSTER (PV) SECTION
----------------------------------------------------
----------------------------------------------------
AT THE COMPLETION OF THE PROVIDER ROSTER (PV)
SECTION, CONTINUE WITH BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
FLAG THE PROVIDER ADDED OR SELECTED AS THE 'USC (USUAL SOURCE OF CARE) PROVIDER' FOR THIS PERSON FOR THIS PARTICULAR ROUND.
----------------------------------------------------
----------------------------------------------------
IF THIS USC PROVIDER IS FLAGGED AS 'FACILITY- TYPE-PROVIDER' OR 'PERSON-IN-FACILITY-PROVIDER' AND AC06 WAS NOT ALREADY ASKED FOR THIS USC PROVIDER IN AN EARLIER LOOP, CONTINUE WITH AC06
----------------------------------------------------
----------------------------------------------------
IF THIS USC PROVIDER IS FLAGGED AS 'PERSON-TYPE- PROVIDER', GO TO AC09A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_03
----------------------------------------------------

AC06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
ASK IF NOT OBVIOUS.
[Is (PROVIDER)/Does (PROVIDER) work at] a clinic in a hospital, a hospital outpatient department, an emergency room at a hospital, or some other kind of place?
HOSPITAL CLINIC OR OUTPATIENT DEPARTMENT ............................ 1
HOSPITAL EMERGENCY ROOM ................. 2 [BOX_03]
OTHER KIND OF PLACE ..................... 3 [BOX_03]
REF ..................................... -7 [BOX_03]
DK ...................................... -8 [BOX_03]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Is (PROVIDER)' IF USC PROVIDER IS FLAGGED AS 'FACILITY-TYPE-PROVIDER'. DISPLAY 'Does (PROVIDER) work at' IF USC PROVIDER IS FLAGGED AS 'PERSON-IN-FACILITY-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (HOSPITAL EMERGENCY ROOM), FLAG THIS USC PROVIDER AS 'HOSPITAL BASED'.
----------------------------------------------------
----------------------------------------------------
NOTE: FOR QUESTIONS AC06 - AC12, THE CONTEXT HEADER WILL DISPLAY THE PERSON-PROVIDER NAME IF THE USC PROVIDER BEING ASKED ABOUT IS FLAGGED AS 'PERSON-TYPE-PROVIDER' OR 'PERSON-IN-FACILITY- PROVIDER'. IF THE USC PROVIDER BEING ASKED ABOUT IS FLAGGED AS 'FACILITY-TYPE-PROVIDER', THE CONTEXT HEADER WILL DISPLAY THE FACILITY-PROVIDER NAME.
----------------------------------------------------

AC07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is this clinic or outpatient department owned and operated by the hospital or is this a private doctor's office located at the hospital?
OWNED AND OPERATED BY HOSPITAL .......... 1
PRIVATE DOCTOR'S OFFICE ................. 2
REF ..................................... -7
DK ...................................... -8
[Code One]
----------------------------------------------------
IF CODED '1' (OWNED AND OPERATED BY HOSPITAL) OR '-8' (DON'T KNOW), FLAG THIS USC PROVIDER AS 'HOSPITAL BASED'.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF THIS USC PROVIDER IS FLAGGED AS 'HOSPITAL BASED', CONTINUE WITH AC08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC09A
----------------------------------------------------

AC08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is the main reason (PERSON) usually (go/goes) to (PROVIDER), that is, [someone who works at] a [hospital emergency room/hospital clinic or outpatient department], for health care?
PREFERS/LIKES THIS AS A SOURCE OF CARE .. 1 [AC09]
DON'T KNOW WHERE ELSE TO GO ............. 2 [AC09]
CAN'T AFFORD TO GO ELSEWHERE ............ 3 [AC09]
MY DOCTOR HAS AN OFFICE AT THE OUTPATIENT DEPARTMENT/CLINIC ........ ............ 4 [AC09]
ONLY CARE AVAILABLE WHEN (PERSON) HAS TIME TO GO ............................ 5 [AC09]
CONVENIENCE ............................. 6 [AC09]
BEST PLACE TO GET CARE FOR MY HEALTH CONDITION ............................. 7 [AC09]
OTHER REASON ............................ 91
REF ..................................... -7 [AC09A]
DK ...................................... -8 [AC09A]
[Code One]
----------------------------------------------------
DISPLAY 'someone who works at' IF THIS USC PROVIDER IS FLAGGED AS 'PERSON-IN-FACILITY- PROVIDER'. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'hospital emergency room' IF AC06 WAS CODED '2' (HOSPITAL EMERGENCY ROOM) DURING ANY LOOP FOR THIS USC PROVIDER. DISPLAY 'hospital clinic or outpatient department' IF AC07 WAS CODED '1' (OWNED AND OPERATED BY HOSPITAL) OR '-8' (DON'T KNOW) DURING ANY LOOP FOR THIS USC PROVIDER.
----------------------------------------------------

AC08OV
======

ENTER OTHER REASON:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

AC09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What are the other reasons (PERSON) usually (go/goes) to (PROVIDER) for health care?
CODE ALL THAT APPLY.
NO OTHER REASONS ........................ 0
PREFERS/LIKES THIS AS A SOURCE OF CARE .. 1
DON'T KNOW WHERE ELSE TO GO ............. 2
CAN'T AFFORD TO GO ELSEWHERE ............ 3
MY DOCTOR HAS AN OFFICE AT THE OUTPATIENT DEPARTMENT/CLINIC ..................... 4
ONLY CARE AVAILABLE WHEN (PERSON) HAS TIME TO GO ............................ 5
CONVENIENCE ............................. 6
BEST PLACE TO GET CARE FOR MY HEALTH CONDITION ............................. 7
OTHER REASON ............................ 91
REF ..................................... -7
DK ...................................... -8
[Code All That Apply]
----------------------------------------------------
IF CODED '91' (OTHER REASON) ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH AC09OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC09A
----------------------------------------------------
----------------------------------------------------
EDIT: IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8 (DON'T KNOW) IN THE FIRST FIELD, NO OTHER REASON CATEGORY CAN BE CODED. IF CODED '0' (NO OTHER REASONS), '-7' (REFUSED), OR '-8' (DON'T KNOW), IN A FIELD OTHER THAN THE FIRST FIELD AND A SUBSEQUENT CODE IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 'INVALID RESPONSE. PRESS ENTER ON A BLANK FIELD.'
----------------------------------------------------

AC09OV
======

ENTER OTHER REASON:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

AC09A
=====

How does (PERSON) usually get to (PROVIDER)?
DRIVE/IS DRIVEN ...................... 1
TAXI, BUS, TRAIN, OTHER
PUBLIC TRANSPORTATION .............. 2
WALKS ................................ 3
REF .................................. -7
DK ................................... -8

BOX_04
======

----------------------------------------------------
IF THIS USC PROVIDER IS FLAGGED AS 'PERSON- TYPE-PROVIDER' OR 'PERSON-IN-FACILITY-PROVIDER' AND AC10 WAS NOT ALREADY ASKED FOR THIS USC PROVIDER IN AN EARLIER LOOP, CONTINUE WITH AC10
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

AC10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a medical doctor?
YES ..................................... 1 [AC12]
NO ...................................... 2
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
PRESS F1 FOR DEFINITION OF MEDICAL DOCTOR.

AC11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
CODE '5' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.
NURSE ................................... 1 [END_LP01]
NURSE PRACTITIONER ...................... 2 [END_LP01]
PHYSICIAN'S ASSISTANT ................... 3 [END_LP01]
MIDWIFE ................................. 4 [END_LP01]
CHIROPRACTOR ............................ 5 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.

AC11OV
======

ENTER OTHER:
[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

AC12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is (PROVIDER)'s specialty?
GENERAL/FAMILY PRACTICE ................. 1 [END_LP01]
INTERNAL MEDICINE ....................... 2 [END_LP01]
PEDIATRICS .............................. 3 [END_LP01]
OB/GYN .................................. 4 [END_LP01]
SURGERY ................................. 5 [END_LP01]
CHIROPRACTOR ............................ 6 [END_LP01]
OTHER ................................... 91
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]

AC12OV
======

ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_05
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF AT LEAST ONE PROVIDER FLAGGED AS 'USC PROVIDER' ON THE RU-MEDICAL-PROVIDERS-ROSTER, CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC22
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEDICAL-PROVIDERS- ROSTER, ASK AC13-END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS DETAILED INFORMATION ON EACH UNIQUE USUAL SOURCE OF CARE PROVIDER IDENTIFIED FOR THIS RU. THIS LOOP CYCLES ON PROVIDERS WHO MEET THE FOLLOWING CONDITION:

- PROVIDER FLAGGED AS 'USC PROVIDER' DURING THE CURRENT ROUND FOR A CURRENT RU MEMBER.
----------------------------------------------------
----------------------------------------------------
NOTE: IF THE USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'PERSON-TYPE-PROVIDER' OR 'PERSON-IN- FACILITY-PROVIDER' THE CONTEXT HEADER IN LOOP_02 WILL DISPLAY THE PERSON-PROVIDER NAME. IF THE USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY- TYPE-PROVIDER' THE CONTEXT HEADER IN LOOP_02 WILL DISPLAY THE FACILITY-PROVIDER NAME.
----------------------------------------------------

AC13
====

[NAME OF MEDICAL CARE PROVIDER......]
The next few questions ask about the experience (READ NAME(S) BELOW) have had with (PROVIDER). Please think about their overall experiences when answering the following questions.
TO SCROLL, USE ARROW KEYS. TO LEAVE SCREEN, PRESS ESC.
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITION:
- PERSON IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND
----------------------------------------------------

AC14
====

[NAME OF MEDICAL CARE PROVIDER......]
Is (PROVIDER) the [person/place] they would go to for ...
YES = 1
NO = 2
AC14_01 a. New health problems? ( )
AC14_02 b. Preventive health care, such as general checkups, examinations, and immunizations? ( )
AC14_03 c. Referrals to other health professionals when needed? ( )
PRESS F1 FOR DEFINITION OF PREVENTIVE HEALTH CARE AND REFERRAL.
----------------------------------------------------
DISPLAY 'person' IF THE USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'PERSON-TYPE-PROVIDER' OR 'PERSON-IN-FACILITY-PROVIDER'. DISPLAY 'place' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
ALLOW '-7' (REFUSED) AND '-8' (DON'T KNOW) ON ALL FORM ITEMS.
----------------------------------------------------
----------------------------------------------------
IF AC06 WAS CODED '2' (HOSPITAL EMERGENCY ROOM) FOR THIS USC PROVIDER, GO TO AC19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH AC15
----------------------------------------------------

AC15
====

[NAME OF MEDICAL CARE PROVIDER......]
Does (PROVIDER) have office hours at night or on weekends?
YES ..................................... 1
NO ...................................... 2
REF ..................................... -7
DK ...................................... -8

AC16
====

[NAME OF MEDICAL CARE PROVIDER......]
When they go to (PROVIDER), do they usually have an appointment ahead of time, just walk in, or sometimes have an appointment and sometimes not?
HAVE APPOINTMENT ........................ 1
JUST WALKS IN ........................... 2 [AC19]
SOMETIMES APPOINTMENT, SOMETIMES WALKS IN .............................. 3
REF ..................................... -7 [AC19]
DK ...................................... -8 [AC19]
[Code One]

AC17
====

[NAME OF MEDICAL CARE PROVIDER......]
How difficult is it to get appointments with (PROVIDER) on short notice, for example, within one or two days?
Would you say it is ...

[IF ASKED WHAT IS MEANT BY 'APPOINTMENTS WITH (PROVIDER)', SAY:
This refers to appointments with any medical person at (PROVIDER), not necessarily a specific medical person.]
very difficult, ......................... 1
somewhat difficult, ..................... 2
not too difficult, or ................... 3
not at all difficult? ................... 4
REF ..................................... -7
DK ...................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'IF ASKED ... person.' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS A 'FACILITY-TYPE- PROVIDER'. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

AC18
====

[NAME OF MEDICAL CARE PROVIDER......]
If they arrive on time for an appointment, about how long do they usually have to wait before seeing [a medical person at] (PROVIDER)?
LESS THAN 5 MINUTES ..................... 1
5 TO 15 MINUTES ......................... 2
16 TO 30 MINUTES ........................ 3
31 MINUTES TO 59 MINUTES ................ 4
1 TO 2 HOURS ............................ 5
MORE THAN 2 HOURS ....................... 6
REF ..................................... -7
DK ...................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'a medical person at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE- PROVIDER'. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

AC19
====

[NAME OF MEDICAL CARE PROVIDER......]
How difficult is it to contact [a medical person at] (PROVIDER) over the telephone about a health problem?
Would you say it is ...
very difficult, ......................... 1
somewhat difficult, ..................... 2
not too difficult, or ................... 3
not at all difficult? ................... 4
REF ..................................... -7
DK ...................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'a medical person at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE- PROVIDER'. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

AC19A
=====

[NAME OF MEDICAL CARE PROVIDER......]
Does (PROVIDER) generally listen to them and give them the information needed about health and health care?
YES ..................................... 1
NO ...................................... 2
REF ..................................... -7
DK ...................................... -8

AC19B
=====

[NAME OF MEDICAL CARE PROVIDER......]
Does (PROVIDER) usually ask about prescription medications and treatments other doctors may give them?
YES ..................................... 1
NO ...................................... 2
REF ..................................... -7
DK ...................................... -8

AC19C
=====

[NAME OF MEDICAL CARE PROVIDER......]
Are they confident in (PROVIDER)'s ability to help when they have a medical problem?
YES ..................................... 1
NO ...................................... 2
REF ..................................... -7
DK ...................................... -8

AC19D
=====

[NAME OF MEDICAL CARE PROVIDER......]
How satisfied are they with the professional staff at [(PROVIDER)/(PROVIDER)'s office]?
Would you say ...
very satisfied, ......................... 1
somewhat satisfied, ..................... 2
not too satisfied, or ................... 3
not at all satisfied? ................... 4
REF ..................................... -7
DK ...................................... -8
[Code One]
PRESS F1 FOR DEFINITION OF PROFESSIONAL STAFF.
----------------------------------------------------
DISPLAY '(PROVIDER)' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER'.
OTHERWISE, DISPLAY '(PROVIDER)'s office'.
----------------------------------------------------

AC19E
=====

[NAME OF MEDICAL CARE PROVIDER......]
Overall, how satisfied are they with the quality of care received from (PROVIDER)?
Would you say ...
very satisfied, ......................... 1
somewhat satisfied, ..................... 2
not too satisfied, or ................... 3
not at all satisfied? ................... 4
REF ..................................... -7
DK ...................................... -8
[Code One]
----------------------------------------------------
DISPLAY '(PROVIDER)' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER'.
OTHERWISE, DISPLAY '(PROVIDER)'s office'.
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PROVIDER IN THE RU-MEDICAL- PROVIDERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PROVIDERS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH AC20
----------------------------------------------------

AC20
====

Over the last year, has anyone in the family changed the person or place they usually go if they are sick or need advice about their health?
YES ..................................... 1
NO ...................................... 2 [AC24]
REF ..................................... -7 [AC24]
DK ...................................... -8 [AC24]

AC21
====

Why did this change occur?
FAMILY/PERSON CHANGED INSURANCE PLANS ... 1 [AC24]
INSURANCE PLAN CHANGED DOCTORS IT COVERS ................................ 2 [AC24]
DISSATISFIED WITH QUALITY OF CARE ....... 3 [AC24]
HEALTH CARE NEEDS CHANGED................ 4 [AC24]
TOO FAR AWAY ............................ 5 [AC24]
MOVED TO NEW AREA ....................... 6 [AC24]
OLD PROVIDER NO LONGER AVAILABLE ........ 7 [AC24]
OTHER ................................... 91
REF ..................................... -7 [AC24]
DK ...................................... -8 [AC24]
[Code One]

AC21OV
======

ENTER OTHER:
[Enter Other Specify] .................. [AC24]
REF ................................... -7 [AC24]
DK .................................... -8 [AC24]

AC22
====

Within the last year, has anyone in the family had a person or place they usually go if they are sick or need advice about their health?
YES ..................................... 1
NO ...................................... 2 [AC24]
REF ..................................... -7 [AC24]
DK ...................................... -8 [AC24]

AC23
====

Why do they not have a usual source of health care any more?
FAMILY/PERSON CHANGED INSURANCE PLANS ... 1 [AC24]
INSURANCE PLAN CHANGED DOCTORS IT COVERS ................................ 2 [AC24]
DISSATISFIED WITH QUALITY OF CARE ....... 3 [AC24]
HEALTH CARE NEEDS CHANGED................ 4 [AC24]
TOO FAR AWAY ............................ 5 [AC24]
MOVED TO NEW AREA ....................... 6 [AC24]
OLD PROVIDER NO LONGER AVAILABLE ........ 7 [AC24]
OTHER ................................... 91
REF ..................................... -7 [AC24]
DK ...................................... -8 [AC24]
[Code One]

AC23OV
======

ENTER OTHER:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8

AC24
====

During the last year, did any family member not receive a doctor's care or prescription medications because the family needed the money to buy food, clothing, or pay for housing?
YES ..................................... 1
NO ...................................... 2
REF ..................................... -7
DK ...................................... -8

AC24A
=====

Overall, how satisfied are you that members of your family can get health care if they need it?
Would you say ...
very satisfied, ......................... 1
somewhat satisfied, ..................... 2
not too satisfied, or ................... 3
not at all satisfied? ................... 4
REF ..................................... -7
DK ...................................... -8
[Code One]

AC25
====

SHOW CARD AC-1.
In the last 12 months, did anyone in the family experience difficulty in obtaining any type of health care, delay obtaining care, or not receive health care they thought they needed due to any of the reasons listed on this card?
YES ..................................... 1
NO ...................................... 2 [BOX_06]
REF ..................................... -7 [BOX_06]
DK ...................................... -8 [BOX_06]

AC25A
=====

SHOW CARD AC-1.
Which of these is the main problem that caused family members' difficulty, delay, or not receiving needed health care?
COULDN'T AFFORD CARE .................... 1
INSURANCE COMPANY WOULDN'T APPROVE, COVER, OR PAY FOR CARE ................ 2
PRE-EXISTING CONDITION .................. 3
INSURANCE REQUIRED A REFERRAL, BUT COULDN'T GET ONE ...................... 4
DOCTOR REFUSED TO ACCEPT FAMILY'S INSURANCE PLAN ........................ 5
MEDICAL CARE TOO FAR AWAY ............... 6
CAN'T DRIVE/DON'T HAVE CAR/NO PUBLIC TRANSPORTATION AVAILABLE .............. 7
TOO EXPENSIVE TO GET THERE .............. 8
HEARING IMPAIRMENT OR LOSS .............. 9
DIFFERENT LANGUAGE ...................... 10
HARD TO GET INTO BUILDING ............... 11
HARD TO GET AROUND INSIDE BUILDING ...... 12
NO APPROPRIATE EQUIPMENT IN OFFICE ...... 13
COULDN'T GET TIME OFF WORK .............. 14
DIDN'T KNOW WHERE TO GO TO GET CARE ..... 15
WAS REFUSED SERVICES .................... 16
COULDN'T GET CHILD CARE ................. 17
DIDN'T HAVE TIME OR TOOK TOO LONG ....... 18
OTHER ................................... 91
REF ..................................... -7 [BOX_06]
DK ...................................... -8 [BOX_06]
[Code One]
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