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Reenumeration (RE) Section Subsection A


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME
----------------------------------------------------

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.
[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 [RE02]
IF YOU HAVE SELECTED THE WRONG CASE, CLICK ON THE BREAKOFF LINK AT THE TOP OF THE SCREEN TO RETURN TO THE IMS.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
START RE_ENUM MAIN BLOCK OTHERWISE (CORRECT CASE SELECTED), CONTINUE WITH RE02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL RU MEMBERS
----------------------------------------------------

RE02
====

[INTERVIEWER: READ INTRODUCTION JOB AID BEFORE CODING.]
[PLEASE NOTE: THIS IS A ROUND 5 INTERVIEW. QUESTIONS ARE ASKED AS OF DEC 31, [YEAR] RATHER THAN 'TODAY'.]
THE RESPONDENT MUST HAVE BEEN LIVING IN THE RU ON DEC 31, [YEAR] TO BE CODED AS AN RU MEMBER RESPONDENT. OTHERWISE, CODE AS A PROXY.]

IS RESPONDENT:
RU MEMBER OR ........................... 1
PROXY APPROVED BY SUPERVISOR? .......... 2 [RE03]
[Code One]
HELP AVAILABLE 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, [YEAR] RATHER THAN 'TODAY'.' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'THE RESPONDENT...' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
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 on [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 Healthcare Research and Quality and the National Center for Health Statistics]. The information you provide will be kept completely confidential and private as required by law.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
---------------------------------------------------
DISPLAY THE DATE OF NHIS INTERVIEW FOR [MONTH, DAY, YEAR OF NHIS INTERVIEW].
---------------------------------------------------
---------------------------------------------------
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 on [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 Healthcare Research and Quality and the National Center for Health Statistics]. The information you provide will be kept completely confidential and private as required by law.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
---------------------------------------------------
DISPLAY THE DATE OF NHIS INTERVIEW FOR [MONTH, DAY, YEAR OF NHIS INTERVIEW].
---------------------------------------------------
---------------------------------------------------
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 on [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 Healthcare Research and Quality and the National Center for Health Statistics]. The information you provide will be kept completely confidential and private as required by law.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
---------------------------------------------------
DISPLAY THE DATE OF NHIS INTERVIEW FOR [MONTH, DAY, YEAR OF NHIS INTERVIEW].
---------------------------------------------------
---------------------------------------------------
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.
----------------------------------------------------------------------
ROSTER. RE06_02. RE06_03. RE06_04. AGE RE06_05. DU MEMBER'S RUID GENDER INTERVIEW NAME COMPLETED THIS ROUND
----------------------------------------------------------------------
1. First [Display [Display [Display Age] [Display Name Middle RUNTID] Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
2. First [Display [Display [Display Age] [Display Name Middle RUNTID] Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
3. First [Display [Display [Display Age] [Display Name Middle RUNTID] Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
HELP AVAILABLE FOR RESPONDENT RULES.
----------------------------------------------------
IF PERSON FROM ANOTHER RU IS SELECTED AND VERIFIED AS THE RESPONDENT, ADD PERSON TO RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY AN 'ADD PERSON' OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD PERSON' IS SELECTED, GO TO RE08
----------------------------------------------------
----------------------------------------------------
OTHERWISE (PERSON SELECTED AS RESPONDENT WAS ALREADY IN DU IN THE PREVIOUS ROUND), GO TO RE09
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_2

COL # 1 HEADER: SELECT DU MEMBER
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: RUID
INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID)

COL # 3 HEADER: GENDER
INSTRUCTIONS: DISPLAY DU MEMBERS' SEX (PERS.SMPSEXR)

COL # 4 HEADER: AGE
INSTRUCTIONS: DISPLAY DU MEMBERS' AGES (PRND.AGE)

COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND
INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS ALREADY FINISHED THE INTERVIEW THIS ROUND (TEMPORARY VARIABLE)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. ALL COLUMNS ARE PROTECTED; NO CHANGES ARE ALLOWED AT THIS SCREEN, EXCEPT TO ADD A PERSON AT THE POP-UP (RE08).

2. 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.

3. 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."

4. 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."

5. IF INTERVIEWER SELECTS A PERSON FROM ANOTHER RU, DISPLAY THE MESSAGE: "PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL.
----------------------------------------------------

BOX_03
======

OMITTED.

RE07
====

SELECT PROXY.
[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]
----------------------------------------------------
DISPLAY A 'NEW PROXY APPROVED BY SUPERVISOR' OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'NEW PROXY APPROVED BY SUPERVISOR' IS SELECTED, CONTINUE WITH RE08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO RE09
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION OF PROXY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY THE PROXY FROM THE PREVIOUS ROUND ONLY.
----------------------------------------------------

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] .....
----------------------------------------------------
DISPLAY 'RU MEMBER' IF RE02 CODED '1' (RU MEMBER).

DISPLAY 'PROXY' IF RE02 CODED '2' (PROXY APPROVED BY SUPERVISOR).
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW DISALLOWED AT ALL FIELDS.
----------------------------------------------------
----------------------------------------------------
IF 'ADD RU MEMBER' 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 [RE10]
NEW ADDRESS ............................ 3 [RE10]
[Code One]
HELP AVAILABLE FOR DEFINITION OF LOCATING ADDRESS.
----------------------------------------------------
FOR RU'S MOST RECENT ADDRESS FIELDS, DISPLAY ADDRESS INFORMATION FROM HOME TABLE.
----------------------------------------------------

RE10
====

MAKE CORRECTIONS TO LOCATING ADDRESS BELOW.
USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH NEED CORRECTION. TYPE THREE Xs (XXX) TO DELETE 2ND STREET ADDRESS.
Current Info: [STREET ADDRESS1]
[STREET ADDRESS2]
[CITY]
[STATE]
[ZIP CODE]
STREET ADDRESS1: [_____________]
STREET ADDRESS2: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINE.
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED AT ALL FIELDS EXCEPT STATE.
----------------------------------------------------
----------------------------------------------------
GO TO RE10A
----------------------------------------------------

RE10A
=====

RECORD THE NAME OF THE COUNTY WHERE THIS RU IS LOCATED.
[Enter County Name -25] ......................... [RE11]
REF ............................................. -7 [RE11]
DK .............................................. -8 [RE11]

RE11
====

VERIFY TELEPHONE NUMBER BELOW WITH RESPONDENT.
USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH NEED CORRECTION.
IF NO TELEPHONE, ENTER '000'.
Current Info: [TELEPHONE NUMBER]
TELEPHONE NUMBER: [ ]
REF ................................... -7
DK .................................... -8
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
FOR 'TELEPHONE NUMBER', DISPLAY THE CURRENT TELEPHONE NUMBER.
----------------------------------------------------
----------------------------------------------------
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 [BOX_03A]
FULL-TIME .............................. 2 [BOX_03A]
NOT ATTENDING SCHOOL ................... 3 [BOX_03A]
REF ................................... -7 [BOX_03A]
DK .................................... -8 [BOX_03A]
[Code One]

BOX_03A
=======

----------------------------------------------------
IF [ROUND 1] OR [STUDENT RU CREATED IN THE CURRENT ROUND] OR [RE11A CODED '1' (PART-TIME), '2' (FULL-TIME), '-8' (DON'T KNOW), OR '-7' (REFUSED)] THEN GO TO RE12

OTHERWISE [ROUNDS 2-5, AND RE11A CODED '3' (NOT ATTENDING SCHOOL) AND RU IS A STUDENT RU CREATED IN A PREVIOUS ROUND], CONTINUE WITH BOX_03B
----------------------------------------------------

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, [YEAR].]
------------------------------------------------------------------
ROSTER. RU RE12_01. GENDER RE12_02. DATE RE12_03. AGE MEMBER OF BIRTH
------------------------------------------------------------------
1. First Name [Display/Correct [Display/ [Verify/Enter Middle Name Selection] Correct Date] Age] Last Name-35
------------------------------ -----------------------------------
----------------------------------------------------
DISPLAY 'NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, [YEAR].' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
'REFUSED' AND 'DON'T KNOW' ALLOWED IN ALL COLUMNS
XCEPT 'RU MEMBER' COLUMN.
----------------------------------------------------
----------------------------------------------------
BECAUSE THIS IS A STUDENT RU, THERE IS ONLY ONE RU MEMBER AND ONLY ONE ROW IN THE MATRIX.
---------------------------------------------------
----------------------------------------------------
FOR ROUND 5, AGE IS CALCULATED AS OF DECEMBER 31, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. ALL AGE SKIPS (THROUGHOUT THE QUESTIONNAIRE) WILL BE BASED ON THIS AGE.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_2

COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: GENDER
INSTRUCTIONS: DISPLAY RU MEMBERS' SEX (PERS.SMPSEXR)

COL # 3 HEADER: DATE OF BIRTH
INSTRUCTIONS: DISPLAY RU MEMBERS' DATES OF BIRTH (PERS.SMPDOBMM, PERS.SMPDOBDD, PERS.SMPDOBYY)

COL # 4 HEADER: AGE
INSTRUCTIONS: DISPLAY RU MEMBERS' AGES (PRND.AGE)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR VERIFICATION AND CORRECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. THE NAME COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED.

2. GENDER, DATE OF BIRTH, AND AGE (WHEN AGE IS NOT CALCULATED BY CAPI) CAN BE EDITED.

3. REPLACING 'REAL' DATA WITH -7 OR -8 IS DISALLOWED. IF THE INTERVIEWER TRIES TO DO SO, DISPLAY THE MESSAGE "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON'T KNOW."

4. IF DATE OF BIRTH IS CHANGED, CAPI WILL CALCULATE THE NEW AGE AUTOMATICALLY AND DISPLAY THE AGE IN THE AGE COLUMN.

5. SELECT, ADD, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER FOR THIS STUDENT; NO FILTER.
----------------------------------------------------

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, [YEAR]] (PERSON) [(have/has)/had] never been married. Is that correct?
YES .................................... 1 [RE14]
NO ..................................... 2 [RE13OV]
REF ................................... -7 [RE14)
DK .................................... -8 [RE14]
---------------------------------------------------
DISPLAY 'as of December 31, [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. OTHERWISE, USE A NULL DISPLAY.
DISPLAY (have/has) IF NOT ROUND 5. IF ROUND 5, DISPLAY 'had'.
---------------------------------------------------

RE13OV
======
[(Are/Is)/On December 31, [YEAR], (were/was)] (PERSON) [now] married, widowed, divorced, or separated?
MARRIED ................................ 1 [BOX_06]
WIDOWED ................................ 2 [BOX_06]
DIVORCED ............................... 3 [BOX_06]
SEPARATED .............................. 4 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY 'On December 31, [YEAR], (were/was)' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
DISPLAY 'now' IF NOT ROUND 5. OTHERWISE, (IF ROUND 5), USE A NULL DISPLAY.
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF ROUND 1, OR IF ROUND 2-5 AND STUDENT RU WAS IDENTIFIED DURING ANOTHER INTERVIEW IN THIS ROUND, CONTINUE WITH RE14
----------------------------------------------------
----------------------------------------------------
IF ROUND 2-5, AND STUDENT RU WAS IDENTIFIED IN PREVIOUS ROUND, THEN RU CLASSIFICATION CHANGE:
CHANGE RU CLASSIFICATION FROM STUDENT RU TO STANDARD RU SINCE STUDENT'S MARITAL STATUS HAS CHANGED SINCE PREVIOUS ROUND AND IS NO LONGER 'NEVER MARRIED'. THEN 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, [YEAR]]?
YES .................................... 1 [RE15]
NO ..................................... 2 [RE18A]
REF ................................... -7 [RE18A)
DK .................................... -8 [RE18A]
HELP AVAILABLE FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY '(Were/Was)' IF ROUND 5. DISPLAY 'on December 31, [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. 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-4] ............ [RE16]
REF ................................... -7 [RE16]
DK .................................... -8 [RE16]
HELP AVAILABLE 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 OR SELECT NEXT PAGE TO CONTINUE.

RE17
====
Thank you for your participation in this important study.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

RE17A
=====

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS ENTER OR SELECT NEXT PAGE 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 [BOX_27]
TELEPHONE ............................. 2 [BOX_27]
[Code One]

RE18
====

OMITTED.

RE18A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been honorably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard?
YES .................................... 1 [BOX_27]
NO ..................................... 2 [BOX_27]
REF ................................... -7 [BOX_27]
DK .................................... -8 [BOX_27]

BOX_08
======

OMITTED.

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 WHO 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, [YEAR], was] (PERSON) still institutionalized in a health care facility?
YES .................................... 1 [END_LP02]
NO ..................................... 2 [BOX_09B]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
HELP AVAILABLE FOR DEFINITION OF INSTITUTIONALIZED IN A HEALTH CARE FACILITY.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'On December 31, [YEAR], was' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
----------------------------------------------------

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
----------------------------------------------------
----------------------------------------------------
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/[YEAR]), WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
----------------------------------------------------

RE19A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
IF RESPONDENT VOLUNTEERS THAT PERSON IS DECEASED, CODE '3' WITHOUT ASKING.
[Is/On December 31, [YEAR], 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 [RE19B]
USUAL PLACE OF RESIDENCE SOMEWHERE ELSE ....................... 2 [RE19D]
DECEASED ............................... 3 [RE19C]
REF ................................... -7 [RE19D]
DK .................................... -8 [RE19D]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Is' AND 'does' IF NOT ROUND 5. DISPLAY 'On December 31, [YEAR], was' AND 'did' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. 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-4] .............. [RE19BOV]
REF ................................... -7 [RE19BOV]
DK .................................... -8 [RE19BOV]
HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.
----------------------------------------------------
NOTE: THE DATE ENTERED HERE DETERMINES THE START OF THE REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR].
IF LEFT INSTITUTION AFTER 12/31/[YEAR], BACK-UP AND RE-CODE RE19 TO 'YES'."
----------------------------------------------------

RE19BOV
=======

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) return to live with this family?
[Enter Month Day Year-4] .............. [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR].
IF JOINED RU AFTER 12/31/[YEAR], BACK-UP AND RE-CODE RE19A."
----------------------------------------------------

RE19C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) leave the health care facility?
[Enter Month Day Year-4] .............. [RE19COV]
REF ................................... -7 [RE19COV]
DK .................................... -8 [RE19COV]
HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.
----------------------------------------------------
NOTE: THE DATE ENTERED HERE DETERMINES THE START OF THE REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR].
IF LEFT INSTITUTION AFTER 12/31/[YEAR], BACK-UP AND RE-CODE RE19 TO 'YES'."
----------------------------------------------------

RE19COV
=======

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) die?
[Enter Month Day Year-4] .............. [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR].
IF DIED AFTER 12/31/[YEAR], BACK-UP AND RE-CODE RE19A."
----------------------------------------------------

RE19D
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On what date did (PERSON) leave the health care facility?
[Enter Month Day Year-4] .............. [RE19E]
REF ................................... -7 [RE19E]
DK .................................... -8 [RE19E]
HELP AVAILABLE FOR DEFINITION OF LEAVE THE HEALTH CARE FACILITY.
----------------------------------------------------
THE DATE ENTERED HERE DETERMINES THE START OF THE REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR].
IF LEFT INSTITUTION AFTER 12/31/[YEAR], BACK-UP AND RE-CODE RE19 TO 'YES'."
----------------------------------------------------

RE19E
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Where [is (PERSON) now/was (PERSON) on December 31, [YEAR]]?
INSTITUTIONALIZED IN A HEALTH CARE FACILITY ............................. 1 [RE19F]
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 [RE19F]
ANOTHER HOUSEHOLD - CURRENTLY NOT FULLTIME MILITARY ........................ 5 [RE19F]
ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME MILITARY ......... 6 [RE19H]
REF .................................... -7 [RE19F]
DK ..................................... -8 [RE19F]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'is (PERSON) now' IF NOT ROUND 5. DISPLAY 'was (PERSON) on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
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 BACK UP 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, [YEAR]]?
WITHIN U.S. .......................... 1
OUTSIDE U.S. ......................... 2
REF ................................. -7
DK .................................. -8
HELP AVAILABLE FOR DEFINITION OF LIVING WITHIN/OUTSIDE U.S.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, 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, [YEAR], (were/was)] (PERSON) attending ...
grades 1-12, ........................... 1
a college or university, or ............ 2 [RE19I]
some other training school after high school? .............................. 3 [RE19I]
REF ................................... -7 [RE19I]
DK .................................... -8 [RE19I]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY 'On 'December 31, [YEAR], (were/was)' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DISALLOW FINAL ENTRY OF CODE '1' (GRADES 1-12). IF INTERVIEWER ENTERS CODE '1', DISPLAY THE FOLLOWING MESSAGE: "JUMPBACK TO CORRECT RE19E TO STUDENT ] 24 LIVING AWAY AT SCHOOL GRADES 1-12)."
----------------------------------------------------

RE19H
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Is/Was] (PERSON) living in another household or in a military facility [on December 31, [YEAR]]?
ANOTHER HOUSEHOLD ................... 1 [RE19HOV]
MILITARY FACILITY ................... 2 [RE19HOV]
REF ................................ -7 [RE19HOV]
DK ................................. -8 [RE19HOV]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

RE19HOV
=======
[Is/Was] (PERSON) living within the U.S. or outside the U.S. [on December 31, [YEAR]]?
WITHIN U.S. ......................... 1 [RE19I]
OUTSIDE U.S. ........................ 2 [RE19I]
REF ................................ -7 [RE19I]
DK ................................. -8 [RE19I]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. 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-4] .............. [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
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' (REFUSED), OR '-8' (DON'T KNOW).

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

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' (REFUSED), OR '-8' (DON'T KNOW).

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.).
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR].
IF DATE IS AFTER 12/31/[YEAR], 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 BOX_09C
----------------------------------------------------

BOX_09C
=======

----------------------------------------------------
IF STANDARD SINGLE-PERSON RU (THAT IS NON-STUDENT) AND RE02 IS CODED '1' (RU MEMBER), GO TO RE47
----------------------------------------------------
----------------------------------------------------
OTHERWISE, 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 to think about the people living here on December 31, [YEAR], regardless of whether they are living here now.]
My records indicate that [on [DATE OF PREVIOUS ROUND INTERVIEW],] the people listed on 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, [YEAR]]?
[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 [BOX_22AAA]
NO ..................................... 2 [RE21]
REF ................................... -7 [BOX_22AAA]
DK .................................... -8 [BOX_22AAA]
----------------------------------------------------
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.', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, 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, [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF RE20 CODED '1' (YES), '-7' (REFUSED), OR '-8' (DON'T KNOW), CODE RE21 AS '1' (IN RU) FOR ALL RU MEMBERS AUTOMATICALLY BY CAPI, AND GO TO BOX_22AAA
----------------------------------------------------
----------------------------------------------------
OTHERWISE (RE20 CODED '2' (NO)), CONTINUE WITH RE21
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
IF ROUND 1, DISPLAY PERSONS WHO WERE NOT ADDED TO THE ROSTER THIS ROUND. IF NOT ROUND 1, DISPLAY PERSONS WHO WERE NOT ADDED TO THE ROSTER THIS ROUND AND PERSONS WHO WERE NOT INSTITUTIONALIZED ON DATE OF PREVIOUS ROUND'S INTERVIEW.
----------------------------------------------------

BOX_10
======

OMITTED.

BOX_11
======

OMITTED.

RE21
====

Who [is/was] not living here with the family [on December 31, [YEAR]]?
CHANGE RU STATUS AS NECESSARY TO: IN RU, LEFT RU, INCORRECTLY LISTED IN RU DURING [NHIS/PREVIOUS ROUND].
------------------------------------------------------------------------
ROSTER. RU MEMBER RE21_02. RU STATUS
------------------------------------------------------------------------
1. First Name Middle Name Last [Enter RU Status] Name-35
------------------------------------------------------------------------
2. First Name Middle Name Last [Enter RU Status] Name-35
------------------------------------------------------------------------
3. First Name Middle Name Last [Enter RU Status] Name-35
------------------------------------------------------------------------
HELP AVAILABLE FOR HH MEMBERSHIP RULES.
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
-----------------------------------------------------
DISPLAY 'NHIS' IF ROUND 1. OTHERWISE, DISPLAY 'PREVIOUS ROUND'.
-----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW DISALLOWED.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND PERSON'S RU STATUS CODED '3' (INCORRECTLY LISTED IN RU DURING [NHIS/PREVIOUS INTERVIEW]) AT RE21, REMOVE PERSON FROM RU- MEMBERS-ROSTER AND FLAG PERSON AS 'NOT IN RU - INCORRECTLY LISTED IN RU DURING NHIS.' IF NOT ROUND 1 AND PERSON'S RU STATUS CODED '3' AT RE21, FLAG PERSON 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 RU STATUS 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/PREVIOUS INTERVIEW)), GO TO BOX_22
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
IF RESPONDENT IS SELECTED, DISPLAY THE FOLLOWING ERROR MESSAGE: "THE RESPONDENT CANNOT BE MARKED HERE AS HAVING LEFT THE RU."
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_3

COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: RU STATUS
INSTRUCTIONS: DISPLAY THE RU MEMBERS' RU STATUS (PRND.INRUSTAT)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. THE RU MEMBERS COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED.

2. EACH ROW INITIALLY HAS RU STATUS SET TO '1'.

3. SELECT, ADD, EDIT, AND DELETE OF PERSONS DISALLOWED.

4. INTERVIEWERS SHOULD NOT BE ALLOWED TO LEAVE THE SCREEN IF NO PERSON'S RU STATUS IS UPDATED FROM '1'. IF THE INTERVIEWER ATTEMPTS TO LEAVE THE SCREEN WITHOUT MAKING ANY UPDATES, DISPLAY THE MESSAGE "IF EVERYONE IS STILL IN RU, BACKUP TO CORRECT PREVIOUS SCREEN."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS NOT ADDED THIS ROUND.
----------------------------------------------------

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, IF ANY, FOR SUCH PERSONS. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITION:
- PERSON LEFT RU (RU STATUS 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, [YEAR]]?
DECEASED ................................ 1 [RE41]
INSTITUTIONALIZED ....................... 2 [RE36]
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]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY '(are/is)' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. 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, [YEAR]]?
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]
HELP AVAILABLE 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, [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
----------------------------------------------------

RE37
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Is/Was] (PERSON) living within the U.S. or outside the U.S. [on December 31, [YEAR]]?
WITHIN U.S. .......................... 1 [RE41]
OUTSIDE U.S. ......................... 2 [RE41]
REF ................................. -7 [RE41]
DK .................................. -8 [RE41]
[Code One]
HELP AVAILABLE FOR DEFINITION OF LIVING WITHIN/OUTSIDE U.S.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, 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, [YEAR]]?
ANOTHER HOUSEHOLD ................... 1 [RE38OV]
MILITARY FACILITY ................... 2 [RE41]
REF ................................ -7 [RE38OV]
DK ................................. -8 [RE38OV]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, 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, [YEAR]]?
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, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, 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, [YEAR]].
PLACE NAME: [_____________]
STREET ADDRESS1: [_____________]
STREET ADDRESS2: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
USE HELP TO VIEW 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, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
CODES '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON EACH FORM ITEM.
----------------------------------------------------
----------------------------------------------------
GO TO RE41
----------------------------------------------------

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 U.S./leave the household]?
[Enter Month,Day,Year-4] .............. [END_LP04]
REF ................................... -7 [END_LP04]
DK .................................... -8 [END_LP04]
----------------------------------------------------
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' (REFUSED), OR '-8' (DON'T KNOW) 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' (REFUSED) OR '-8' (DON'T KNOW).
----------------------------------------------------
----------------------------------------------------
IF DATE IS PRIOR TO 01/01/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, 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/[YEAR] 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.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR].
IF LEFT RU AFTER 12/31/[YEAR], BACK-UP AND RE-CODE RE21."
----------------------------------------------------

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 BOX_22AAA
----------------------------------------------------
----------------------------------------------------
OTHERWISE, IF ROUND 1 (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 IS 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_24A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, IF NOT ROUND 1 (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 RE57A
----------------------------------------------------

RE42A
=====

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS ENTER OR SELECT NEXT PAGE 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 [BOX_27]
TELEPHONE ............................. 2 [BOX_27]
[Code One]

BOX_22AAA
=========

----------------------------------------------------
IF PREVIOUS ROUND REFERENCE PERSON (OR NHIS REFERENCE PERSON IF ROUND 1) IS STILL IN RU ON DATE OF INTERVIEW (OR AS OF DECEMBER 31, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5), THAT IS IF PREVIOUS ROUND REFERENCE PERSON MEETS 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')

THEN FLAG PREVIOUS ROUND REFERENCE PERSON (OR NHIS REFERENCE PERSON IF ROUND 1) AS CURRENT ROUND REFERENCE PERSON AND GO TO BOX_22AA
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH RE42
----------------------------------------------------

RE42
====
Of all the people who [live/lived] in this household [on December 31, [YEAR]], [does/did] anyone own or rent this home?
YES .................................... 1 [RE43]
NO ..................................... 2 [RE44]
REF ................................... -7 [RE44]
DK .................................... -8 [RE44]
HELP AVAILABLE FOR DEFINITION OF OWNS/RENTS HOME.
----------------------------------------------------
DISPLAY 'live' IF NOT ROUND 5. DISPLAY 'lived' IF ROUND 5.
DISPLAY 'does' IF NOT ROUND 5. DISPLAY 'did' IF ROUND 5.
DISLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

RE43
====

Of the people in this family who [live/lived] here [now/on December 31, [YEAR]], 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]
HELP AVAILABLE FOR DEFINITION OF OWNS/RENTS HOME.
----------------------------------------------------
DISPLAY 'live' AND 'now' AND 'owns' AND 'rents' IF NOT ROUND 5. DISPLAY 'lived' AND 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5 AND 'owned' AND 'rented' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PERSON NOT IN RU' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'PERSON NOT IN RU' SELECTED, CONTINUE WITH RE44
----------------------------------------------------
----------------------------------------------------
OTHERWISE (CURRENT RU MEMBER SELECTED), GO TO BOX_22AA
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER FOR SELECTION OF THE PERSON WHO OWNS OR RENTS THE HOME.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CRITERIA:

PERSON )= 16 YEARS OLD OR AGE CATEGORY 4-9 INCLUSIVE
AND
PERSON IS STILL LIVING IN THE RU AT THE DATE OF THE CURRENT INTERVIEW. THAT IS, THE PERSON 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 THE U.S. (RE38OV CODED '2')
OR
- LEFT RU FOR UNKNOWN REASON (RE35 CODED '-7' OR '-8')
----------------------------------------------------

RE44
====
Of all the people in this family who [live/lived] here [now/on December 31, [YEAR]], who [is/was] considered the head of household?
----------------------------------------------------------------------
ROSTER. RE51_02. RE51_03. RE51_04. AGE RE51_05. DU MEMBER RUID GENDER INTERVIEW COMPLETED THIS ROUND
----------------------------------------------------------------------
1. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
2. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
3. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
[Code One]
HELP AVAILABLE FOR DEFINITION OF HEAD OF HOUSEHOLD.
----------------------------------------------------
DISPLAY 'live' AND 'now' AND 'is' IF NOT ROUND 5.
DISPLAY 'lived' AND 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, AND 'was' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD RU MEMBER' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF PERSON FROM ANOTHER RU SELECTED AND VERIFIED AS THE HEAD OF HOUSEHOLD, ADD PERSON TO RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'ADD RU MEMBER' SELECTED, CONTINUE WITH RE45 (NOTE THAT RE45 IS ACTUALLY A POP-UP ON RE44.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (CURRENT DU MEMBER SELECTED), GO TO BOX_22AA
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_2

COL # 1 HEADER: SELECT DU MEMBER
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: RUID
INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID)

COL # 3 HEADER: GENDER
INSTRUCTIONS: DISPLAY THE DU MEMBERS' SEX (PERS.SMPSEXR)

COL # 4 HEADER: AGE
INSTRUCTIONS: DISPLAY DU MEMBERS' AGES (PRND.AGE)

COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND
INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS ALREADY FINISHED THE INTERVIEW THIS ROUND (TEMPORARY VARIABLE)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION OF HEAD OF HOUSEHOLD.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. ALL COLUMNS ARE PROTECTED; NO CHANGES ARE ALLOWED AT THIS SCREEN.

2. 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.

3. 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."

4. IF AN RU MEMBER UNDER 16 IS SELECTED AS THE HEAD OF HOUSEHOLD, DISPLAY MESSAGE "HEAD OF HOUSEHOLD ] 16. S/HE MUST BE APPROVED BY SUPERVISOR. RESELECT TO VERIFY."

5. IF INTERVIEWER SELECTS A PERSON FROM ANOTHER RU, DISPLAY THE MESSAGE: "PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION."

6. IF INTERVIEWER SELECTS PERSON WHO HAS LEFT THE RU, DISPLAY THE MESSAGE: "SELECTION IS INAPPROPRIATE. MAKE ANOTHER SELECTION."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL DU MEMBERS.
----------------------------------------------------

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] [BOX_22AA]
----------------------------------------------------
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, [YEAR] 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, [YEAR]] as part of this family and who is not listed on this form? (HAND HOUSEHOLD SUMMARY) That is, other than (READ NAMES BELOW)? Do not include anyone [who was] staying here temporarily who usually [lives/lived] somewhere else. By related we mean by blood, marriage, living together as married, adoption or foster care relationship.
[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]
HELP AVAILABLE FOR DEFINITION OF LIVING TOGETHER AS MARRIED/PARTNER RELATIONSHIPS.
----------------------------------------------------
DISPLAY 'Please .. questions.' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'Is' AND 'is' AND 'now' IF NOT ROUND 5.
DISPLAY 'Was' AND 'was' AND 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.

DISPLAY 'who was' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'lives' IF ROUND 1-4. DISPLAY 'lived' IF ROUND 5.

DISPLAY 'other than you' IF RESPONDENT FLAGGED AS 'NEW RU MEMBER ADDED AT RE08 (RE06 POP-UP)' OR IF A PREVIOUS ROUND INSTITUTIONALIZED RU MEMBER HAS RETURNED TO THE RU AND IS THE RESPONDENT.
OTHERWISE, USE A NULL DISPLAY.

FOR CONTEXT HEADER, DISPLAY CURRENT ROUND REFERENCE PERSON.
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1 AND CE05A WAS CODED '1' (YES) IN THE PREVIOUS ROUND, DISPLAY THE FOLLOWING MESSAGE:
"SOMEONE IN RU WAS PREGNANT DURING THE PREVIOUS ROUND. IF BABY WAS BORN AND IS LIVING IN THE RU, PLEASE BE SURE TO ADD HIM/HER."
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.

2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO WERE NOT ADDED TO THE ROSTER THIS ROUND.
----------------------------------------------------

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, [YEAR]]? 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 [RE48]
NO ..................................... 2 [RE50]
REF ................................... -7 [RE50]
DK .................................... -8 [RE50]
HELP AVAILABLE 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, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1 AND CE05A WAS CODED '1' (YES) IN THE PREVIOUS ROUND, DISPLAY THE FOLLOWING MESSAGE:
"SOMEONE IN RU WAS PREGNANT DURING THE PREVIOUS ROUND. IF BABY WAS BORN AND IS LIVING IN THE RU, PLEASE BE SURE TO ADD HIM/HER."
----------------------------------------------------

RE48
====

[INTERVIEWER: IF ALL PERSONS WHO HAVE JOINED THE RU ARE ALREADY SELECTED, BACKUP AND CHANGE PREVIOUS SCREEN TO 'NO'.]
Who else [is/was] related and living here [now/on December 31, [YEAR]]?
PROBE: Anyone else?
----------------------------------------------------------------------
ROSTER. RE48_02. RE48_03. RE48_04. AGE RE48_05. SELECT RUID GENDER INTERVIEW DU MEMBER COMPLETED THIS ROUND
----------------------------------------------------------------------
1. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
2. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
3. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
----------------------------------------------------
DISPLAY AN 'ANY NEW RU MEMBERS NOT LISTED' OPTION AS THE LAST SELECTABLE ROW ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'now' IF NOT ROUND 5. DISPLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'INTERVIEWER...' IF NOT ROUND 1.
OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_2

COL # 1 HEADER: SELECT DU MEMBER
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: RUID
INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID)

COL # 3 HEADER: GENDER
INSTRUCTIONS: DISPLAY THE DU MEMBERS' SEX (PERS.SMPSEXR)

COL # 4 HEADER: AGE
INSTRUCTIONS: DISPLAY DU MEMBERS' AGES (PRND.AGE)

COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND
INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS ALREADY FINISHED THE INTERVIEW THIS ROUND (TEMPORARY VARIABLE)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. ALL COLUMNS ARE PROTECTED; NO CHANGES ARE ALLOWED AT THIS SCREEN, EXCEPT TO ADD AN RU MEMBER AT THE POP-UP (RE49).

2. 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.

3. 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."

4. IF INTERVIEWER SELECTS A PERSON FROM ANOTHER RU FOR WHOM AN INTERVIEW HAS NOT YET BEEN COMPLETED, DISPLAY THE MESSAGE: "PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION."

5. IF INTERVIEWER SELECTS PERSON WHO HAS LEFT THE RU, DISPLAY THE MESSAGE: "SELECTION IS INAPPROPRIATE. MAKE ANOTHER SELECTION."

6. IF INTERVIEWER TRIES TO LEAVE THE SCREEN WITHOUT MAKING A SELECTION, DISPLAY THE MESSAGE:
"IF NO NEW PERSON HAS JOINED THE RU, BACKUP TO CORRECT PREVIOUS SCREENS."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL DU MEMBERS; NO FILTER.
----------------------------------------------------

RE49
====

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

ENTER NAMES. VERIFY SPELLING. IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.
------------------------------------------------------------------------
ROSTER. RU MEMBER RE49_02. IN RU NOW?
------------------------------------------------------------------------
1. First Name Middle Name Last [Display Selection] Name-35
------------------------------------------------------------------------
2. First Name Middle Name Last [Display Selection] Name-35
------------------------------------------------------------------------
3. First Name Middle Name Last [Display Selection] Name-35
------------------------------------------------------------------------
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY AN 'ADD RU MEMBER' OPTION AT THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF PERSON IS ADDED AT RE49, ADD PERSON TO RU- MEMBERS-ROSTER AND FLAG PERSON AS ADDED AT RE49
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH RE50
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_4

COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: IN RU NOW?
INSTRUCTIONS: DISPLAY THE RU MEMBERS' RU STATUS (PRND.INRUSTAT)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE ADD ALLOWED.

2. LIMITED DELETE ALLOWED. ALLOW INTERVIEWERS TO DELETE ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.

3. LIMITED EDIT ALLOWED. ALLOW INTERVIEWERS TO EDIT ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.

4. EACH ROW INITIALLY HAS 'IN RU NOW?' SET TO 'YES' FOR EACH PERSON CODED '1' (IN RU) AT RE21 OR ADDED TO RU DURING THIS INTERVIEW.

5. 'IN RU NOW?' COLUMN IS PROTECTED.

6. AUTOMATICALLY DISPLAY 'YES' FOR 'IN RU NOW?' FOR PERSON(S) ADDED AT THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL MEMBERS OF THE RU; NO FILTER.
----------------------------------------------------

RE50
====
Have we missed anyone? For example, babies born or adopted [since/between] [DATE OF PREVIOUS ROUND INTERVIEW] [and December 31, [YEAR]], anyone related who usually [lives/lived] here but [is/was] traveling, away on business, or in the hospital?
YES .................................... 1 [RE51]
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, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND RE50 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO RE53
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1 AND RE50 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), 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, [YEAR]]?
PROBE: Anyone else?
----------------------------------------------------------------------
ROSTER. RE51_02. RE51_03. RE51_04. AGE RE51_05. DU MEMBER RUID GENDER INTERVIEW COMPLETED THIS ROUND
----------------------------------------------------------------------
1. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
2. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
3. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
----------------------------------------------------
DISPLAY 'ANY NEW RU MEMBERS NOT LISTED' AS THE LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'now' IF NOT ROUND 5. DISPLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
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 'ADD RU MEMBER' NOT SELECTED, GO TO RE53
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_24A
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_2

COL # 1 HEADER: SELECT DU MEMBER
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: RUID
INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID)

COL # 3 HEADER: GENDER
INSTRUCTIONS: DISPLAY THE DU MEMBERS' SEX (PERS.SMPSEXR)

COL # 4 HEADER: AGE
INSTRUCTIONS: DISPLAY DU MEMBERS' AGES (PRND.AGE)

COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND
INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS ALREADY FINISHED THE INTERVIEW THIS ROUND (TEMPORARY VARIABLE)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. ALL COLUMNS ARE PROTECTED; NO CHANGES ARE ALLOWED AT THIS SCREEN.

2. 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.

3. 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."

4. IF INTERVIEWER SELECTS A PERSON WHO HAS LEFT THE RU OR A CURRENT RU MEMBER, DISPLAY THE MESSAGE: "SELECTION IS INAPPROPRIATE. MAKE ANOTHER SELECTION."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS; NO FILTER.
----------------------------------------------------

RE52
====

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

ENTER NAMES. VERIFY SPELLING. IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.
------------------------------------------------------------------------
ROSTER. RU MEMBER RE52_02. IN RU NOW?
------------------------------------------------------------------------
1. First Name Middle Name Last [Display Selection] Name-35
------------------------------------------------------------------------
2. First Name Middle Name Last [Display Selection] Name-35
------------------------------------------------------------------------
3. First Name Middle Name Last [Display Selection] Name-35
------------------------------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD RU MEMBER' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ADD ENTERED PERSONS TO RU-MEMBERS-ROSTER AND FLAG ERSONS AS ADDED TO RU AT RE52.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1, CONTINUE WITH RE53
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_24A
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_4

COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: IN RU NOW?
INSTRUCTIONS: DISPLAY THE RU MEMBERS' RU STATUS (PRND.INRUSTAT)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY OF NEW RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE ADD ALLOWED.

2. LIMITED DELETE ALLOWED. ALLOW INTERVIEWERS TO DELETE ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.

3. LIMITED EDIT ALLOWED. ALLOW INTERVIEWERS TO EDIT ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.

4. EACH ROW INITIALLY HAS 'IN RU NOW?' SET TO 'YES' FOR EACH PERSON CODED '1' (IN RU) AT RE21 OR ADDED TO RU DURING THIS INTERVIEW.

5. 'IN RU NOW?' COLUMN IS PROTECTED.

6. AUTOMATICALLY DISPLAY 'YES' FOR 'IN RU NOW?' FOR PERSON(S) ADDED AT THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS; NO FILTER.
----------------------------------------------------

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 [RE54]
NO ..................................... 2 [BOX_24]
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
----------------------------------------------------
FOR CONTEXT HEADER, DISPLAY CURRENT ROUND REFERENCE PERSON.
----------------------------------------------------

RE54
====
Who is under 24, never married, and living away at school in the U.S.?
PROBE: Anyone else?
----------------------------------------------------------------------
ROSTER. RE54_02. RE54_03. RE54_04. RE54_05. DU MEMBER RUID GENDER AGE INTERVIEW COMPLETED THIS ROUND
----------------------------------------------------------------------
1. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
2. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
3. First [Display RUID] [Display [Display Age] [Display Name Middle Selection] Selection] Name Last Name-35
----------------------------------------------------------------------
----------------------------------------------------
DISPLAY 'ANY NEW RU MEMBERS NOT LISTED' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ADD EACH SUCCESSFULLY SELECTED PERSON TO THE RU- MEMBERS-ROSTER AND FLAG PERSON AS ADDED TO THE RU AT RE54.
----------------------------------------------------
----------------------------------------------------
IF 'ANY NEW RU MEMBERS NOT LISTED' SELECTED, CONTINUE WITH RE55
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_22A
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_2

COL # 1 HEADER: SELECT DU MEMBER
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: RUID
INSTRUCTIONS: DISPLAY RU ID (RUNT.RUNTID)

COL # 3 HEADER: GENDER
INSTRUCTIONS: DISPLAY THE DU MEMBERS' SEX (PERS.SMPSEXR)

COL # 4 HEADER: AGE
INSTRUCTIONS: DISPLAY DU MEMBERS' AGES (PRND.AGE)

COL # 5 HEADER: INTERVIEW COMPLETED THIS ROUND
INSTRUCTIONS: DISPLAY WHETHER THE DU MEMBER HAS ALREADY FINISHED THE INTERVIEW THIS ROUND (TEMPORARY VARIABLE)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE DU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. RU MEMBERS, RUID, GENDER, AND AGE COLUMNS ARE PROTECTED; NO CHANGES ARE ALLOWED.

2. IF NEW RU, AN 'X' WILL BE DISPLAYED IN THE INTERVIEW COMPLETED THIS ROUND FOR EACH PERSON WHO HAS ALREADY BEEN INTERVIEWED IN ANOTHER RU IN THE DU.

3. 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."

4. IF INTERVIEWER SELECTS A PERSON WHO HAS LEFT THIS RU OR A CURRENT RU MEMBER, DISPLAY THE MESSAGE: "SELECTION IS INAPPROPRIATE. MAKE ANOTHER SELECTION."

5. IF GENDER OR AGE HAS NOT BEEN COLLECTED, DISPLAY '--' IN APPROPRIATE CELLS.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL DU MEMBERS; NO FILTER.
----------------------------------------------------

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'.
------------------------------------------------------------------------
ROSTER. RU MEMBER RE55_02. IN RU NOW?
------------------------------------------------------------------------
1. First Name Middle Name Last [Display Selection] Name-35
------------------------------------------------------------------------
2. First Name Middle Name Last [Display Selection] Name-35
------------------------------------------------------------------------
3. First Name Middle Name Last [Display Selection] Name-35
------------------------------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD RU MEMBER' AS AN OPTION ON THIS
SCREEN.
----------------------------------------------------
----------------------------------------------------
ADD PERSONS TO THE RU-MEMBERS-ROSTER AND FLAG PERSONS AS ADDED TO THE RU AT RE55.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_4

COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: IN RU NOW?
INSTRUCTIONS: DISPLAY THE RU MEMBERS' RU STATUS (PRND.INRUSTAT)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY OF NEW RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE ADD ALLOWED.

2. LIMITED DELETE ALLOWED. ALLOW INTERVIEWERS TO DELETE ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.

3. LIMITED EDIT ALLOWED. ALLOW INTERVIEWERS TO EDIT ONLY THOSE PERSONS WHO WERE ADDED AT THIS SCREEN.

4. EACH ROW INITIALLY HAS 'IN RU NOW?' SET TO 'YES' FOR EACH PERSON CODED '1' (IN RU) AT RE21 OR ADDED TO RU DURING THIS INTERVIEW.

5. 'IN RU NOW?' COLUMN IS PROTECTED.

6. AUTOMATICALLY DISPLAY 'YES' FOR 'IN RU NOW?' FOR PERSON(S) ADDED AT THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS; NO FILTER.
----------------------------------------------------

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 [RE56A]
a college or university, or ............ 2 [RE56A]
some other training school
after high school? .................. 3 [RE56A]
REF ................................... -7 [RE56A]
DK .................................... -8 [RE56A]
[Code One]
HELP AVAILABLE 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 on [MONTH, DAY, YEAR OF NHIS INTERVIEW]?
PERSON WAS ...
INSTITUTIONALIZED ................. 1 [BOX_23A]
STUDENT ] 24, LIVING AWAY, POST-SECONDARY SCHOOL.......... 2 [RE56B]
PERSON WAS NOT FT MILITARY AT TIME OF NHIS AND WAS ...
LIVING IN U.S. .................... 3 [RE56B]
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 [RE56B]
PERSON WAS ...
LIVING WITH THIS FAMILY (PERSON LEFT
OFF NHIS ROSTER) .............. 8 [BOX_23A]
OTHER ............................ 91 [RE56B]
REF ................................... -7 [RE56B]
DK .................................... -8 [RE56B]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
FOR [MONTH...], DISPLAY THE NHIS INTERVIEW DATE.
----------------------------------------------------
----------------------------------------------------
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 on [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]
----------------------------------------------------
FOR [MONTH...], DISPLAY THE NHIS INTERVIEW DATE.
----------------------------------------------------
----------------------------------------------------
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 on [MONTH, DAY, YEAR OF NHIS INTERVIEW] were either of (PERSON)'s parents living in this household?
YES .................................... 1 [BOX_23A]
NO ..................................... 2 [BOX_23A]
REF ................................... -7 [BOX_23A]
DK .................................... –8 [BOX_23A]
----------------------------------------------------
FOR [MONTH...], DISPLAY THE NHIS INTERVIEW DATE.
----------------------------------------------------
----------------------------------------------------
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).
[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 ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.

2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO ARE FLAGGED AS 'SAMPLEABLE AT NHIS'. SEE BOX ON RE56A.
----------------------------------------------------

BOX_24A
=======

-------------------------------------------------
IF ROUND 1, GO TO BOX_25A
-------------------------------------------------
-------------------------------------------------
OTHERWISE (ROUNDS 2 – 5), CONTINUE WITH RE57A
-------------------------------------------------

RE57A
=====

VERIFY DISPLAYED INFORMATION. ASK APPROPRIATE QUESTION FOR EACH BLANK FIELD.
SELECT GENDER. 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, [YEAR].]
----------------------------------------------------------------------
ROSTER. RU RE57A_02. RE57A_03. DATE RE57_04A. AGE MEMBER GENDER OF BIRTH
--------------------------------------------------------------------
1. First Name [Enter [Enter Month [Verify/Enter Age] Middle Name Selection] Day Year-4] Last Name-35
----------------------------------------------------------------------
2. First Name [Enter [Enter Month [Verify/Enter Age] Middle Name Selection] Day Year-4] Last Name-35
----------------------------------------------------------------------
3. First Name [Enter [Enter Month [Verify/Enter Age] Middle Name Selection] Day Year-4] Last Name-35
----------------------------------------------------------------------
----------------------------------------------------
DISPLAY 'NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, [YEAR].', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED.
----------------------------------------------------
----------------------------------------------------
FOR ROUND 5, AGE IS CALCULATED AS OF DECEMBER 31, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. ALL AGE SKIPS (THROUGHOUT THE QUESTIONNAIRE) WILL BE BASED ON THIS AGE.
----------------------------------------------------
----------------------------------------------------
IF THE INTERVIEWER ENTERS AN AGE THAT CONTRADICTS THE DOB, CAPI WILL STILL CALCULATE THE AGE BASED ON DOB WHEN THE INTERVIEWER LEAVES THE SCREEN. NO ERROR MESSAGE IS DISPLAYED.
----------------------------------------------------
----------------------------------------------------
IF AGE MISSING FOR ANY RU MEMBER, CONTINUE WITH LOOP_06A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_26
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_2

COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: GENDER
INSTRUCTIONS: DISPLAY RU MEMBERS' SEX (PERS.SMPSEXR)

COL # 3 HEADER: DATE OF BIRTH
INSTRUCTIONS: DISPLAY RU MEMBERS' DATES OF BIRTH (PERS.SMPDOBMM, PERS.SMPDOBDD, PERS.SMPDOBYY)

COL # 4 HEADER: AGE
INSTRUCTIONS: DISPLAY RU MEMBERS' AGES (PRND.AGE)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR VERIFICATION AND CORRECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. PRESENT BLANK FIELDS FOR ALL MISSING DATA ITEMS. ENABLE MOVEMENT ON SCREEN SO THAT INTERVIEWER CAN ENTER/UPDATE GENDER, DATE OF BIRTH AND AGE FOR ALL PERSONS BY ROW.

2. THE NAME COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED.

3. GENDER, DATE OF BIRTH, AND AGE (WHEN AGE IS NOT CALCULATED BY CAPI) CAN BE EDITED.

4. REPLACING 'REAL' DATA WITH -7 OR -8 IS DISALLOWED. IF THE INTERVIEWER TRIES TO DO SO, DISPLAY THE MESSAGE "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON'T KNOW."

5. IF DATE OF BIRTH IS CHANGED, CAPI WILL CALCULATE THE NEW AGE AUTOMATICALLY AND DISPLAY THE AGE IN THE AGE COLUMN.

6. SELECT, ADD, AND DELETE DISALLOWED IN ALL COLUMNS.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS; NO FILTER.
----------------------------------------------------

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

RE57B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
PROBE FOR RESPONDENT'S BEST ESTIMATE OF AGE.
[(Are/Is)/As of December 31, [YEAR], (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 [RE57C]
DK .................................... -8 [RE57C]
[Code One]
----------------------------------------------------
DISPLAY '(Are/Is)' IF NOT ROUND 5. DISPLAY 'As of December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, AND '(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, [YEAR]].
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 ................................ 8 [END_LP06A]
65 YEARS OR OLDER ...................... 9 [END_LP06A]
[Code One]
----------------------------------------------------
DISPLAY 'As of December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, 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.
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.
----------------------------------------------------------------------
ROSTER. RU RE57_02. GENDER RE57_03. DATE RE57_04. AGE MEMBER OF BIRTH
--------------------------------------------------------------------
1. First Name [Select [Enter Month [Verify/Enter Age] Middle Name Gender] Day Year-4] Last Name-35
----------------------------------------------------------------------
2. First Name [Select [Enter Month [Verify/Enter Age] Middle Name Gender] Day Year-4] Last Name-35
----------------------------------------------------------------------
3. First Name [Select [Enter Month [Verify/Enter Age] Middle Name Gender] Day Year-4] Last Name-35
----------------------------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED IN ALL FIELDS.
----------------------------------------------------
----------------------------------------------------
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)), 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)), CONTINUE WITH LOOP_06
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_2

COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: GENDER
INSTRUCTIONS: DISPLAY RU MEMBERS' SEX (PERS.SMPSEXR)

COL # 3 HEADER: DATE OF BIRTH
INSTRUCTIONS: DISPLAY RU MEMBERS' DATES OF BIRTH (PERS.SMPDOBMM, PERS.SMPDOBDD, PERS.SMPDOBYY)

COL # 4 HEADER: AGE
INSTRUCTIONS: DISPLAY RU MEMBERS' AGES (PRND.AGE)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY OF MISSING DATA.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. PRESENT BLANK FIELDS FOR ALL MISSING DATA ITEMS. ENABLE MOVEMENT ON SCREEN SO THAT INTERVIEWER CAN ENTER/UPDATE GENDER, DATE OF BIRTH AND AGE FOR ALL PERSONS BY ROW.

2. THE NAME COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED.

3. GENDER, DATE OF BIRTH, AND AGE (WHEN AGE IS NOT CALCULATED BY CAPI) CAN BE EDITED.

4. REPLACING 'REAL' DATA WITH -7 OR -8 IS DISALLOWED. IF THE INTERVIEWER TRIES TO DO SO, DISPLAY THE MESSAGE "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON'T KNOW."

5. IF DATE OF BIRTH IS CHANGED, CAPI WILL CALCULATE THE NEW AGE AUTOMATICALLY AND DISPLAY THE AGE IN THE AGE COLUMN.

6. SELECT, ADD, AND DELETE DISALLOWED IN ALL COLUMNS.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY NEW RU MEMBERS ADDED IN THE CURRENT ROUND WHO WERE NOT SELECTED FROM THE DU-MEMBERS-ROSTER.
----------------------------------------------------

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

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 [RE59]
DK .................................... -8 [RE59]
[Code One]

RE59
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
ENTER YOUR BEST GUESS FOR (PERSON)'S AGE.
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 ................................ 8 [END_LP06]
65 YEARS OR OLDER ...................... 9 [END_LP06]
[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.
VERIFY FULL NAME BELOW WITH RESPONDENT.
USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH NEED CORRECTION.
IF NO MIDDLE NAME OR INITIAL, ENTER 'NMN'.
Current Info: [NHIS FIRST NAME]
[NHIS MIDDLE NAME]
[NHIS LAST NAME]
FIRST NAME[_________________]
MIDDLE NAME[_________________]
LAST NAME[_________________]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
FOR NHIS FIRST NAME, MIDDLE NAME, AND LAST NAME, DISPLAY THE PERSON'S NAME AS RECORDED IN THE NHIS.
----------------------------------------------------
----------------------------------------------------
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).
----------------------------------------------------
----------------------------------------------------
GO TO RE61
----------------------------------------------------

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 CORRECTION IS NECESSARY, SELECT APPROPRIATE CODE. IF NO CORRECTION IS NECESSARY, PRESS ENTER.
Current Info: [NHIS GENDER]
MALE ................................. 1 [RE62]
FEMALE ............................... 2 [RE62]
REF .................................. -7 [RE62]
DK ................................... -8 [RE62]
----------------------------------------------------
FOR 'NHIS GENDER', DISPLAY THE PERSON'S GENDER AS RECORDED IN THE NHIS.
----------------------------------------------------
----------------------------------------------------
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?
VERIFY BIRTHDATE BELOW WITH RESPONDENT.
USE TAB TO MOVE THROUGH FIELDS. IF ANY CORRECTIONS ARE NEEDED, RETYPE ENTIRE DATE.
Current Info: [NHIS DATE OF BIRTH]
[Enter Month,Day,Year-4] ............ [RE63]
REF ................................. -7 [RE64]
DK .................................. -8 [RE64]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
FOR 'NHIS DATE OF BIRTH', DISPLAY THE PERSON'S DATE OF BIRTH AS RECORDED IN THE NHIS.
----------------------------------------------------
----------------------------------------------------
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, BACKUP 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 [RE65]
DK .................................... -8 [RE65]

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 [RE66]
DK .................................... -8 [RE66]
[Code One]

RE66
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
ENTER YOUR BEST GUESS FOR (PERSON)'S AGE.
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 ................................ 8 [END_LP07]
65 YEARS OR OLDER ...................... 9 [END_LP07]
[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/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, 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/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, 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/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, 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-4] ..............
REF ................................... -7 [RE66C]
DK .................................... -8 [RE66C]
----------------------------------------------------
IF DATE IS LESS THAN OR EQUAL TO THE PREVIOUS ROUND INTERVIEW DATE, CONTINUE WITH RE66B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO RE66C
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE ENTERED MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR].
IF PERSON JOINED RU AFTER 12/31/[YEAR], BACKUP TO RE49/RE52 AND REVIEW ENTRIES."
----------------------------------------------------

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 [RE66C]
NO ..................................... 2
REF ................................... -7 [RE66C]
DK .................................... -8 [RE66C]
[Code One]
----------------------------------------------------
FOR 'DATE OF PREVIOUS ROUND INTERVIEW', DISPLAY DATE OF PREVIOUS ROUND MEPS INTERVIEW.
----------------------------------------------------
----------------------------------------------------
FOR 'RE66A DATE', DISPLAY DATE ENTERED AT RE66A.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), DISPLAY MESSAGE: "BACKUP AND CORRECT DATE PERSON JOINED RU AT PREVIOUS SCREEN."
----------------------------------------------------

BOX_26A
=======

OMITTED.

RE66C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On January 1, [YEAR], was (PERSON) living in an institution?
YES .................................... 1 [RE66G]
NO ..................................... 2 [RE66D]
REF ................................... -7 [RE66D]
DK .................................... -8 [RE66D]
HELP AVAILABLE FOR DEFINITION FOR LIVING IN AN INSTITUTION.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): DISPLAY FIRST CALENDAR YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

RE66D
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On January 1, [YEAR], was (PERSON) living outside the United States?
YES .................................... 1 [END_LP07A]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF LIVING OUTSIDE U.S.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): DISPLAY FIRST CALENDAR YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND PERSON ] 18 YEARS OLD, GO TO RE66F
----------------------------------------------------
----------------------------------------------------
OTHERWISE, (I.E., CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND PERSON ) OR = 18 YEARS OLD) CONTINUE WITH RE66E
----------------------------------------------------

RE66E
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On January 1, [YEAR], was (PERSON) serving on full-time active duty in the Armed Forces?
YES .................................... 1 [END_LP07A]
NO ..................................... 2 [RE66F]
REF ................................... -7 [RE66F]
DK .................................... -8 [RE66F]
HELP AVAILABLE FOR DEFINITION OF FULL-TIME MILITARY.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): DISPLAY FIRST CALENDAR YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

RE66F
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Where (were/was) (PERSON) living on January 1, [YEAR]?
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/[YEAR] ............... 5 [END_LP07A]
ANOTHER HOUSEHOLD/MILITARY FACILITY - FULL-TIME MILITARY ON 1/1/[YEAR] ..... 6 [RE66K]
LIVING WITH THIS FAMILY (PERSON LEFT OFF ROSTER LAST INTERVIEW) ........... 7 [END_LP07A]
OTHER .................................. 91 [RE66FOV]
REF .................................... -7 [END_LP07A]
DK ..................................... -8 [END_LP07A]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): DISPLAY FIRST CALENDAR YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

RE66FOV
=======
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, [YEAR]?
NURSING HOME ........................ 1 [RE66H]
OTHER LONG-TERM HEALTH CARE INSTITUTION (EXCLUDE COMMUNITY BASED HOSPITAL) ................... 2 [RE66H]
OTHER NON-HEALTH CARE INSTITUTION ... 3 [END_LP07A]
REF ................................ -7 [RE66H]
DK ................................. -8 [RE66H]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): DISPLAY THE FIRST CALENDAR YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

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, [YEAR]?
NAME: [_____________]
STREET ADDRESS1: [_____________]
STREET ADDRESS2: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): DISPLAY THE FIRST CALENDAR YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------
----------------------------------------------------
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, [YEAR]?
YES .................................... 1 [END_LP07A]
NO ..................................... 2 [END_LP07A]
REF ................................... -7 [END_LP07A]
DK .................................... -8 [END_LP07A]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): DISPLAY THE FIRST CALENDAR YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

RE66K
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Were/Was) (PERSON) living in another household or in a military facility on January 1, [YEAR]?
ANOTHER HOUSEHOLD ................... 1 [END_LP07A]
MILITARY FACILITY ................... 2 [END_LP07A]
REF ................................ -7 [END_LP07A]
DK ................................. -8 [END_LP07A]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): DISPLAY THE FIRST CALENDAR YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

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 GO TO 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-4] ..............
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]
----------------------------------------------------
FOR 'RE67 DATE', DISPLAY DATE ENTERED AT RE67.

FOR 'MONTH...', DISPLAY DATE OF NHIS INTERVIEW.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), DISPLAY MESSAGE: "BACKUP AND CORRECT DATE PERSON JOINED RU AT PREVIOUS SCREEN."
----------------------------------------------------
----------------------------------------------------
IF RE68 CODED '1' (YES), CODE RE73 '7' (LIVING WITH THIS FAMILY (PERSON LEFT OFF NHIS ROSTER)) AUTOMATICALLY BY CAPI AND GO TO END_LP08
----------------------------------------------------

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 on [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 [RE73OV]
REF .................................... -7 [END_LP08]
DK ..................................... -8 [END_LP08]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
OR 'MONTH...', DISPLAY DATE OF NHIS INTERVIEW.
----------------------------------------------------

RE73OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
OTHER:
[Enter Other Specify] ................. [END_LP08]
REF ................................... -7 [END_LP08]
DK .................................... -8 [END_LP08]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

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]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
FOR 'MONTH...', DISPLAY DATE OF NHIS INTERVIEW.
----------------------------------------------------

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
HELP AVAILABLE FOR DEFINITION OF LIVING WITHIN/OUTSIDE U.S.
----------------------------------------------------
FOR 'MONTH...', DISPLAY DATE OF NHIS INTERVIEW.
----------------------------------------------------
----------------------------------------------------
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 [RE73COV]
MILITARY FACILITY ................... 2 [END_LP08]
REF ................................ -7 [RE73COV]
DK ................................. -8 [RE73COV]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
FOR 'MONTH...', DISPLAY DATE OF NHIS INTERVIEW.
----------------------------------------------------

RE73COV
=======

[PERSON'S FIRST MIDDLE AND LAST NAME]
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 on [MONTH, DAY, YEAR OF NHIS INTERVIEW]?
NAME: [_____________]
STREET ADDRESS1: [_____________]
STREET ADDRESS2: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
FOR 'MONTH...', DISPLAY DATE OF NHIS INTERVIEW.
----------------------------------------------------
----------------------------------------------------
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 on [MONTH, DAY, YEAR OF NHIS INTERVIEW], were either of (PERSON)'s parents living in this household?
YES .................................... 1 [END_LP08]
NO ..................................... 2 [END_LP08]
REF ................................... -7 [END_LP08]
DK .................................... -8 [END_LP08]
----------------------------------------------------
FOR 'MONTH...', DISPLAY DATE OF NHIS INTERVIEW.
----------------------------------------------------

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 CODED '3')
OR
- LEFT THE RU BEFORE 01/01/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, 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 SECTION 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 SINGLE-PERSON RU (EITHER STANDARD OR NEW (SPLIT))
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
(SINGLE-PERSON RU (EITHER STANDARD OR NEW (SPLIT))
AND
AT LEAST ONE PERSON WHO WAS REMOVED FROM THE RU- MEMBERS-ROSTER DURING THIS INTERVIEW IS FLAGGED AS A 'NEW STUDENT'), CONTINUE WITH BOX_28AAA
----------------------------------------------------

BOX_28AAA
=========

----------------------------------------------------
IF NOT ROUND 1
AND
IF NO NEW RU MEMBERS HAVE BEEN ADDED THIS ROUND
AND
IF NO RELATIONSHIPS ARE CODED '-7' (REFUSED), '-8' (DON'T KNOW), OR MISSING FROM THE PREVIOUS ROUND CONTINUE WITH RE75B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO RE76_1
----------------------------------------------------

RE75B
=====

[STR-DT]
INTERVIEWER: HAND HOUSEHOLD COMPOSITION SHEET(S) TO RESPONDENT.
Please look at this sheet listing the relationships of the people living here. [Since (START DATE)/Between (START DATE) and December 31, [YEAR]], have any of the relationships between members of this household changed?
YES .................................... 1 [RE76_1]
NO ..................................... 2 [BOX_29]
REF ................................... -7 [BOX_29]
DK .................................... -8 [BOX_29]
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
----------------------------------------------------

RE76_1
======

[Now I would like to collect information about how the [new] members of this household are related [to the family]./Please tell me whose relationships have changed./INTERVIEWER: FILL IN MISSING RELATIONSHIPS.]
[READ GRID STARTING FROM LEFT. EXAMPLE: "(NAME ON LEFT) IS (NAME ON TOP)'S ______________ (RELATIONSHIP)."]
--------------------------------------------------------------------
MEMBER NAME RE76_1_01. DU RE76_1_02. DU RE76_1_03. DU MEMBER 1 MEMBER 2 MEMBER 3
--------------------------------------------------------------------
1. First [Display [Display [Display Name-15 Relationship] Relationship] Relationship]
--------------------------------------------------------------------
2. First [Display [Display [Display Name-15 Relationship] Relationship] Relationship]
--------------------------------------------------------------------
3. First [Display [Display [Display Name-15 Relationship] Relationship] Relationship]
--------------------------------------------------------------------
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE
----------------------------------------------------
Display 'Now I would like to collect information about how the [new] members of this household are related [to the family].' if Round 1 or if Rounds 2-5 and at least one new RU member was added this round.

Display 'new' if Rounds 2-5 and at least one new RU member was added this round. Otherwise, use a null display.

Display 'to the family' if Rounds 2-5 and at least one new RU member was added this round. Otherwise, use a null display.

Display 'Please tell me whose relationships have changed.' if Rounds 2-5 and RE75B was coded '1' (YES).

Display 'INTERVIEWER: FILL IN MISSING RELATIONSHIPS.' if Rounds 2-5 and no new RU members have been added this round, and at least one relationship is coded '-7' (REFUSED) or '-8' (DON'T KNOW) from a previous round.

Display 'READ GRID STARTING...' IF ROUNDS 2-5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_08B
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_3

COL # 1 HEADER: MEMBER NAME
INSTRUCTIONS: DISPLAY DU MEMBER'S FIRST NAME (PERS.SMPFNAMR)

COL # 2 HEADER: DU MEMBER ""
INSTRUCTIONS: DISPLAY DU MEMBER'S NAME NOTE THAT THERE WILL BE AS MANY COLUMNS AS NECESSARY TO ACCOMMODATE ALL DU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE DU-MEMBERS-ROSTER FOR DISPLAY OF DU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.

2. THE COLUMN HEADINGS 'DU MEMBER N' ARE FILLED WITH THE NAMES OF DU MEMBERS IN ORDER FROM YOUNGEST TO OLDEST. IF AGES OF ANY RU MEMBERS ARE UNKNOWN, AND RU MEMBERS ARE IN AGE CATEGORIES 1-4, LIST THESE RU MEMBERS FIRST, FOLLOWED BY RU MEMBERS WITH KNOWN AGES IN ORDER FROM YOUNGEST TO OLDEST IN ALL OTHER AGE CATEGORIES.

3. DISPLAY RELATIONSHIPS THAT WERE CODED IN THE PREVIOUS ROUND AND ARE STILL APPLICABLE. NOTE THAT THE RELATIONSHIPS COLLECTED IN THE NHIS WILL NOT BE PRE-FILLED IN THE ROUND 1 CAPI.

4. DISPLAY QUESTION MARK FOR RELATIONSHIPS NOT YET CODED OR WHERE RELATIONSHIP WAS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) IN PREVIOUS ROUND.

5. FOR EACH CYCLE THROUGH THE LOOP, THE MATRIX SHOULD DISPLAY TEXT LABELS FOR ALL RELATIONSHIPS CODED UP TO THAT POINT, INCLUDING RECIPROCAL RELATIONSHIPS.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
1. PERSON IS A MEMBER OF THE RU
OR
2. PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW AND FLAGGED AS A 'NEW STUDENT'.
----------------------------------------------------

LOOP_08B
========

----------------------------------------------------
FOR EACH ELEMENT IN DU-MEMBERS-ROSTER, ASK RE76A-END_LP08B
----------------------------------------------------
----------------------------------------------------
LOOP DEFINTION: LOOP_08B COLLECTS RELATIONSHIPS BETWEEN RU MEMBERS. THE LOOP BEGINS WITH THE YOUNGEST RU MEMBER AND CONTINUES TO LOOP ON THE NEXT YOUNGEST RU MEMBER. THE LOOP CYCLES ON 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'
----------------------------------------------------

RE76
====

OMITTED.

RE76A
=====

[PERSON'S FIRST, MIDDLE AND LAST NAME]
I would like to know how everyone in this household is related to (PERSON).
[DU MEMBER 1 First, Middle and Last Name] [is/was] (PERSON)'s [[Relation]]
[DU MEMBER 2 First, Middle and Last Name] [is/was] (PERSON)'s [[Relation]]
[DU MEMBER 3 First, Middle and Last Name] [is/was] (PERSON)'s [[Relation]]
[DU MEMBER 4 First, Middle and Last Name] [is/was] (PERSON)'s [[Relation]]
----------------------------------------------------
DISPLAY 'is' IF BOTH PERSONS ARE LIVING. DISPLAY 'was' IF BOTH ARE OR EITHER PERSON IS DECEASED.

DISPLAY NAME OF PERSON BEING LOOPED ON FOR 'PERSON' IN EACH ROW OF GRID.

DISPLAY THE NAME OF A DU MEMBER WHO MEETS THE FOLLOWING CONDITIONS IN EACH ROW OF THE GRID:
1. PERSON IS A MEMBER OF THE RU
2. PERSON WAS REMOVED FROM THE RU_MEMBERS_ROSTER DURING THIS INTERVIEW AND FLAGGED AS 'NEW STUDENT'

DISPLAY NAME OF THE SELECTED RELATIONSHIP FOR 'RELATION' IN EACH ROW OF THE GRID.
----------------------------------------------------
----------------------------------------------------
QUESTION BEHAVIOR SPECIFICATIONS:

1. FOR EACH PERSON BEING LOOPED ON, DISPLAY A LIST OF QUESTIONS THAT ASKS THE RELATIONSHIP TO EVERY DU MEMBER ON THE RELATIONSHIP MATRIX AT RE76_1.
2. ALL RELATIONSHIPS THAT HAVE ALREADY BEEN ESTABLISHED BETWEEN THE PERSON BEING LOOPED ON AND THE DU MEMBER SHOULD BE FILLED IN. ALL FIELDS CONTAINING RELATIONSHIPS ARE INPUT FIELDS. EACH INPUT FIELD CAN DISPLAY A DROP DOWN LIST OF SELECTABLE RELATIONSHIP CODES AND LABELS. ALL RELATIONSHIPS CAN BE EDITED. IF NO CHANGES NEEDED, THE INTERVIEWER CAN MOVE TO THE NEXT FIELD.
3. IF CODE '91' (OTHER RELATED, SPECIFY) IS SELECTED, MOVE INTERVIEWER TO TYPE THE RELATIONSHIP IN THE OTHER SPECIFY FIELD.
4. IF CODE '99' (NOT RELATED) IS SELECTED, DISPLAY THE FOLLOWING MESSAGE: "THIS PERSON HAS BEEN CODED AS NOT RELATED. PROBE RESPONDENT AND REVIEW CODES. IF APPLICABLE, USE A MORE DESCRIPTIVE CODE OR USE CODE 91 (OTHER RELATED, SPECIFY). IF RESPONDENT CONFIRMS PERSON IS NOT RELATED, CONTINUE ENTERING OTHER RELATIONSHIPS."
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED IN ALL RELATIONSHIP FIELDS.
----------------------------------------------------
----------------------------------------------------
THE LIST OF RELATIONSHIP CODES AND LABELS (IN ORDER OF PRESENTATION IN LIST) IS AS FOLLOWS:

21 = AUNT
4 = BROTHER/STEP-/HALF-
12 = BROTHER-IN-LAW
25 = COUSIN
5 = DAUGHTER/ADOPTED DAUGHTER
13 = DAUGHTER-IN-LAW
32 = DAUGHTER OF PARTNER
2 = FATHER (BIOLOGICAL/ADOPTIVE)
10 = FATHER-IN-LAW
31 = FATHER'S PARTNER
28 = FEMALE PARTNER
47 = FOSTER BROTHER
45 = FOSTER DAUGHTER
44 = FOSTER FATHER
43 = FOSTER MOTHER
48 = FOSTER SISTER
46 = FOSTER SON
20 = GRANDFATHER
19 = GRANDMOTHER
26 = GRANDSON
27 = GRANDDAUGHTER
36 = GREAT GRANDFATHER
35 = GREAT GRANDMOTHER
38 = GREAT GRANDSON
37 = GREAT GRANDDAUGHTER
39 = GREAT AUNT
40 = GREAT UNCLE
42 = GREAT NEPHEW
41 = GREAT NEICE
8 = HUSBAND
1 = MOTHER (BIOLOGICAL/ADOPTIVE)
9 = MOTHER-IN-LAW
30 = MOTHER'S PARTNER
29 = MALE PARTNER
24 = NEPHEW
23 = NIECE
99 = NOT RELATED
91 = OTHER RELATED, SPECIFY
3 = SISTER/STEP-/HALF-
6 = SON/ADOPTED SON
33 = SON OF PARTNER
11 = SISTER-IN-LAW
14 = SON-IN-LAW
16 = STEPFATHER
15 = STEPMOTHER
18 = STEPSON
17 = STEPDAUGHTER
----------------------------------------------------
----------------------------------------------------
22 = UNCLE
7 = WIFE
----------------------------------------------------
----------------------------------------------------
THE LEGAL GUARDIAN ITEMS (BOX_RE76A1 – RE76F) WERE INTRODUCED IN PANEL 12 ROUND 2. STARTING IN PANEL 13, THESE ITEMS WILL BE INCORPORATED IN ALL ROUNDS.
----------------------------------------------------
----------------------------------------------------
IF PANEL 12 ROUND 1, GO TO END_LP08B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_RE76A1
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
IF CODE '1' (MOTHER) OR '2' (FATHER) IS USED MORE THAN ONCE, DISPLAY THE FOLLOWING MESSAGE:
"UNLIKELY RESPONSE – RELATIONSHIP ALREADY USED.
VERIFY AND RE-ENTER."

IF CODE '15' (STEPMOTHER) OR '16' (STEPFATHER) AND THE AGE OF PERSON ASSOCIATED WITH CODE IS YOUNGER THAN PERSON BEING LOOPED ON, DISPLAY THE FOLLOWING MESSAGE: "UNLIKELY RESPONSE DUE TO AGE. VERIFY AND RE-ENTER."

HARD CHECK:
IF CODE '1' (MOTHER), '2' (FATHER), '19' (GRANDMOTHER), '20' (GRANDFATHER), '35' (GREAT GRANDMOTHER), '36' (GREAT GRANDFATHER) '43' (FOSTER MOTHER), OR '44' (FOSTER FATHER), THE AGE OF PERSON ASSOCIATED WITH THE CODE MUST BE OLDER THAN THE PERSON BEING LOOPED ON.
----------------------------------------------------

BOX_RE76A1
==========

----------------------------------------------------
IF PERSON BEING LOOPED ON IS AGE 18 OR UNDER OR IN AGE CATEGORIES 1-4, CONTINUE WITH BOX_RE76A2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP08B
----------------------------------------------------

BOX_RE76A2
==========

----------------------------------------------------
IF THERE IS NO ENTRY FOR MOTHER (CODE 1), STEP- MOTHER (CODE 15), FOSTER MOTHER (CODE 43), FATHER (CODE 2), STEP-FATHER (CODE 16), FOSTER FATHER (CODE 44), WIFE/SPOUSE (CODE 7), OR HUSBAND/SPOUSE (CODE 8), CONTINUE WITH BOX_RE76D
----------------------------------------------------
----------------------------------------------------
OTHERWISE, (AT LEAST ONE OF THESE RELATIONSHIPS IS CODED), GO TO END_LP08B
----------------------------------------------------

RE76C
=====

OMITTED.

RE76COV
=======

OMITTED.

BOX_RE76C
=========

OMITTED.

BOX_RE76D
=========

----------------------------------------------------
CHECK TO DETERMINE IF ELIGIBLE GUARDIAN:
IF AT LEAST ONE RU MEMBER WHO IS:
-NOT PERSON BEING LOOPED ON
AND
-IS 18 YEARS OF AGE OR OLDER OR IS IN AGE CATEGORIES 4-9
AND
-IS NOT DECEASED, CONTINUE WITH RE76E
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP08B
----------------------------------------------------

RE76DOV
=======

OMITTED.

BOX_RE76D
=========

OMITTED.

RE76E
=====

[PERSON'S FIRST, MIDDLE AND LAST NAME]
I have recorded that (PERSON) does not have a mother or father living in this household. Does (PERSON) have a legal guardian living in this household?
YES .................................... 1 [RE76F]
NO ..................................... 2 [END_LP08B]
REF ................................... -7 [END_LP08B]
DK .................................... -8 [END_LP08B]
HELP AVAILABLE FOR DEFINITION OF LEGAL GUARDIAN.

RE76F
=====

[PERSON'S FIRST, MIDDLE AND LAST NAME]
Who is (PERSON)'s legal guardian?
[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 DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION OF LEGAL GUARDIAN.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO ARE 18 YEARS OF AGE OR OLDER OR IN AGE CATEGORIES 4-9 AND WHO ARE NOT DECEASED AND DO NOT DISPLAY THE PERSON BEING LOOPED ON.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH END_LP08B
----------------------------------------------------

END_LP08B
=========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE DU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, THEN END LOOP_08B AND CONTINUE WITH RE76_2
----------------------------------------------------

RE77
====

OMITTED.

RE76_2
======

INTERVIEWER: REVIEW THE RELATIONSHIPS BELOW.
READ GRID STARTING FROM LEFT.
EXAMPLE: "(NAME ON LEFT) IS (NAME ALONG TOP)'S (RELATIONSHIP)."
--------------------------------------------------------------------
MEMBER NAME RE76_2_01. DU RE76_2_02. DU RE76_2_03. DU MEMBER 1 MEMBER 2 MEMBER 3
--------------------------------------------------------------------
1. First [Display [Display [Display Name-15 Relationship] Relationship] Relationship]
--------------------------------------------------------------------
2. First [Display [Display [Display Name-15 Relationship] Relationship] Relationship]
--------------------------------------------------------------------
3. First [Display [Display [Display Name-15 Relationship] Relationship] Relationship]
--------------------------------------------------------------------
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE
----------------------------------------------------
CONTINUE WITH BOX_28AAAA
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_3

COL # 1 HEADER: MEMBER NAME
INSTRUCTIONS: DISPLAY DU MEMBER'S FIRST NAME (PERS.SMPFNAMR)

COL # 2 HEADER: DU MEMBER "n"
INSTRUCTIONS: DISPLAY DU MEMBER'S NAME NOTE THAT THERE WILL BE AS MANY COLUMNS AS NECESSARY TO ACCOMMODATE ALL DU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS DU-MEMBERS-ROSTER FOR DISPLAY OF DU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.

2. THE COLUMN HEADINGS 'DU MEMBER' ARE FILLED WITH THE NAMES OF DU MEMBERS IN ORDER FROM YOUNGEST TO OLDEST. IF AGES OF ANY RU MEMBERS ARE UNKNOWN, AND RU MEMBERS ARE IN AGE CATEGORIES 1-4, LIST THESE RU MEMBERS FIRST, FOLLOWED BY RU MEMBERS WITH KNOWN AGES IN ORDER FROM YOUNGEST TO OLDEST IN ALL OTHER AGE CATEGORIES.

3. DISPLAY ALL RELATIONSHIPS CODED PREVIOUSLY.

4. DISPLAY RF OR DK FOR RELATIONSHIPS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW).
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
1. PERSON IS A MEMBER OF THE RU
OR
2. PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THIS INTERVIEW AND FLAGGED AS A 'NEW STUDENT'.
----------------------------------------------------

BOX_28AAAA
==========

----------------------------------------------------
IF AT LEAST ONE RU MEMBER OR 'NEW STUDENT' MEETS THE FOLLOWING CONDITION:
- CODED NOT RELATED FOR RELATIONSHIP WITH REFERENCE PERSON AT RE76A, 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).
[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 ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSONS IN THE DU-MEMBERS- ROSTER FOR DISPLAY ONLY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.

2. SELECT, ADD, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE DU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER OR 'NEW STUDENT' DISPLAYED AT RE76_2
AND
- PERSON IS NOT RELATED TO REFERENCE PERSON (RELATIONSHIP TO REFERENCE PERSON CODED 'NOT RELATED' AT RE76A
----------------------------------------------------

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 on [MONTH, DAY, YEAR OF NHIS INTERVIEW] (were/was) (PERSON) attending school?
YES .................................... 1 [RE80]
NO ..................................... 2 [END_LP09]
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]
----------------------------------------------------
FOR (MONTH...) DISPLAY THE NHIS INTERVIEW DATE.
----------------------------------------------------

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]
HELP AVAILABLE 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 on [MONTH, DAY, YEAR OF NHIS INTERVIEW] were either of (PERSON)'s parents living in this household?
YES .................................... 1 [END_LP09]
NO ..................................... 2 [RE81]
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]
----------------------------------------------------
FOR (MONTH...) DISPLAY THE NHIS INTERVIEW DATE.
----------------------------------------------------

RE81
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Do/Does)(PERSON) have parents who live somewhere else?
YES .................................... 1 [RE82]
NO ..................................... 2 [END_LP09]
REF ................................... -7 [RE82]
DK .................................... -8 [RE82]

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 [RE83]
REF ................................... -7 [RE83]
DK .................................... -8 [RE83]
[Code One]
HELP AVAILABLE 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 AND CLEAN UP ALL RELATED VARIABLES. 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 [END_LP09]
NO ..................................... 2 [END_LP09]
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]
HELP AVAILABLE FOR DEFINITION OF PRIMARY RESPONSIBILITY.
----------------------------------------------------
IF RE83 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)
AND
PERSON IS FLAGGED AS A 'NEW STUDENT', TURN OFF THE 'NEW STUDENT' FLAG AND CLEAN UP ALL RELATED VARIABLES. 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).
[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 ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
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).
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS DU-MEMBERS-ROSTER FOR DISPLAY OF DU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO MEET THE FOLLOWING CONDITIONS:

- 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')
----------------------------------------------------

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.
[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]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
FOR 'FULL...' DISPLAY THE REFERENCE PERSON'S FULL NAME.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_34
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO ARE ELIGIBLE FOR THE SURVEY IN THE CURRENT ROUND.
----------------------------------------------------

RE85A
=====

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS ENTER OR SELECT NEXT PAGE 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 ( 60 YEARS OLD
AND
- NOT CODED 'FULL TIME ACTIVE DUTY IN THE MILITARY' (RE35 CODED '6'), 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
AND
- ADDED TO THE RU THIS ROUND, GO TO RE95A
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1
AND
AT LEAST ONE PERSON ON THE RU-MEMBERS-ROSTER
- IS ) 16 YEARS OLD AND ( 60 YEARS OLD
AND
- NOT ADDED TO THE RU THIS ROUND, GO TO LOOP_12A0
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_35B
----------------------------------------------------

BOX_35AA
========

OMITTED.

BOX_34A
=======

OMITTED.

RE94
====

OMITTED. (INTEGRATED WITH RE94A).

RE94A
=====

[In addition to (READ NAMES BELOW),is/Is] anyone in the family currently serving on active duty in the Armed Forces of the United States?
[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 [RE95]
NO ..................................... 2 [BOX_35B]
REF ................................... -7 [BOX_35B]
DK .................................... -8 [BOX_35B]
HELP AVAILABLE 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 'Is' AND DO NOT DISPLAY THE SCREEN INSTRUCTIONS AND ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO ARE CODED AS ON FULL-TIME ACTIVE DUTY IN THE MILITARY (RE35 CODED '6') IN ANY INTERVIEW DURING THIS ROUND.
----------------------------------------------------

RE95
====

Who [else] is currently serving on active duty in the Armed Forces?
PROBE: Anyone else?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
HELP AVAILABLE FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
DISPLAY 'else' IF A ROSTER WAS DISPLAYED AT RE94A.
OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
[PERSON-LEVEL CONTROL VARIABLE SET HERE. STATUS (FULL-TIME MILITARY LIVING IN RU)] FOR THOSE SELECTED AT RE95.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_12
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE PERSONS WHO ARE OLDER THAN 16 YEARS AND YOUNGER THAN 60 YEARS AND WHO ARE NOT CODED AS ON FULL-TIME ACTIVE DUTY IN THE MILITARY (RE35 CODED '6') IN ANY INTERVIEW DURING THIS ROUND.
----------------------------------------------------

LOOP_12
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBER-ROSTER, ASK BOX_34B-END_LP12
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_12 COLLECTS INFORMATION ON WHEN PERSON ENTERED FULL-TIME ACTIVE DUTY IN THE ARMED FORCES. THIS LOOP CYCLES ON RU MEMBERS SELECTED AT RE95.
----------------------------------------------------

BOX_34B
=======

----------------------------------------------------
IF PERSON FIRST IDENTIFIED AS CURRENTLY SERVING IN ARMED FORCES DURING PREVIOUS ROUND, GO TO END_LP12
----------------------------------------------------
----------------------------------------------------
IF ROUND 1
OR
IF PERSON FIRST IDENTIFIED AS CURRENTLY SERVING IN ARMED FORCES DURING CURRENT ROUND, CONTINUE WITH RE96B
----------------------------------------------------

RE96
====

OMITTED.

RE96A
=====

OMITTED.

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 -4] ............ [END_LP12]
REF ................................... -7 [END_LP12]
DK .................................... -8 [END_LP12]
HELP AVAILABLE 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_35B
----------------------------------------------------

RE95A
=====

(Is/Are) (READ NAMES BELOW) currently serving on active duty in the Armed Forces of the United States?
[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 [RE95B]
NO ..................................... 2 [BOX_34AA]
REF ................................... -7 [BOX_34AA]
DK .................................... -8 [BOX_34AA]
HELP AVAILABLE FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE PERSONS WHO ARE OLDER THAN 16 YEARS AND YOUNGER THAN 60 YEARS OF AGE AND WHO WERE ADDED TO THE RU THIS ROUND.
----------------------------------------------------

RE95B
=====

Who is currently serving on active duty in the Armed Forces?
PROBE: Anyone else?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
HELP AVAILABLE FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
[PERSON-LEVEL CONTROL VARIABLE SET HERE. STATUS (FULL-TIME MILITARY LIVING IN RU)] FOR THOSE SELECTED AT RE95B.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_12B
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE PERSONS WHO ARE OLDER THAN 16 YEARS AND YOUNGER THAN 60 YEARS OF AGE AND WHO WERE ADDED TO THE RU THIS ROUND.
----------------------------------------------------

LOOP_12B
========

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBER-ROSTER, ASK RE95E-END_LP12B
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_12B COLLECTS INFORMATION ON WHEN PERSON ENTERED FULL-TIME ACTIVE DUTY IN THE ARMED FORCES. THIS LOOP CYCLES ON RU MEMBERS SELECTED AT RE95B.
----------------------------------------------------

RE95C
=====

OMITTED.

RE95D
=====

OMITTED.

RE95E
=====

[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 -4] ............ [END_LP12B]
REF ................................... -7 [END_LP12B]
DK .................................... -8 [END_LP12B]
HELP AVAILABLE FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR]. IF PERSON WAS ONLY FULL-TIME MILITARY AFTER 12/31/[YEAR], BACK-UP AND CHANGE RESPONSE TO RE95B."
----------------------------------------------------

END_LP12B
=========

----------------------------------------------------
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_12B AND CONTINUE WITH BOX_34AA
----------------------------------------------------

BOX_34AA
========

----------------------------------------------------
IF NOT ROUND 1
AND
AT LEAST ONE PERSON ON THE RU-MEMBERS-ROSTER:
- IS ) 16 YEARS OLD AND ( 60 YEARS OLD
AND
- NOT ADDED TO THE RU THIS ROUND, GO TO LOOP_12A0
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_35B
----------------------------------------------------

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 AND IF "YES" WHEN PERSON ENTERED ACTIVE DUTY IN THE ARMED FORCES. THIS LOOP CYCLES ON RU MEMBERS WHO ARE ) 16 YEARS OLD AND ( 60 YEARS OLD AND NOT ADDED TO THE RU THIS ROUND.
----------------------------------------------------

RE96B1
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Is/Was] (PERSON) currently serving on full-time active duty in the Armed Forces of the United States [on December 31, [YEAR]]?
YES .................................... 1
NO ..................................... 2 [END_LP12A0]
REF ................................... -7 [END_LP12A0]
DK .................................... -8 [END_LP12A0]
HELP AVAILABLE FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5.

DISPLAY 'on December 31, [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, 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 -4] ............ [END_LP12A0]
REF ................................... -7 [END_LP12A0]
DK .................................... -8 [END_LP12A0]
HELP AVAILABLE FOR DEFINITION OF FULL-TIME ACTIVE DUTY.
----------------------------------------------------
HARD CHECK:
EDIT (FOR ROUND 5): DATE MUST BE ON OR BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. IF A DATE AFTER 12/31/[YEAR] IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "DATE MUST BE ON OR BEFORE 12/31/[YEAR]. IF PERSON WAS ONLY FULL-TIME MILITARY AFTER 12/31/[YEAR], 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_35B
----------------------------------------------------

BOX_35AA
========

OMITTED.

BOX_35B
=======

----------------------------------------------------
IF AT LEAST ONE RU MEMBER MEETS ALL OF THE FOLLOWING CONDITIONS, CONTINUE WITH RE96F:

IF ROUND 1:
- AGE ) 16
AND
- RE35 IS NOT CODED '6' THAT IS NOT CODED AS 'FULL TIME ACTIVE DUTY IN THE MILITARY'
AND
- IS NOT CODED AS 'CURRENTLY SERVING ON ACTIVE DUTY IN THE MILITARY AND LIVING IN THE RU' (BOTH [NOT SELECTED AT RE95 AND RE95B] AND [RE96B1 NOT CODED '1'])

IF ROUND 2-5:
AND
- [PERSON ADDED TO THE RU THIS ROUND OR PERSON'S STATUS IN THE PREVIOUS ROUND WAS 'FULL TIME MILITARY AND LIVING IN THE RU']
AND
- AGE ) 16
AND
- IS NOT CODED AS 'CURRENTLY SERVING ON ACTIVE DUTY IN THE MILITARY AND LIVING IN THE RU' (BOTH [NOT SELECTED AT RE95 AND RE95B] AND [RE96B1 NOT CODED '1'])
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_35A
----------------------------------------------------

RE96F
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (READ NAMES BELOW) ever been honorably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Corps or Coast Guard?
[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 [RE96G]
NO ..................................... 2 [BOX_35A]
REF ................................... -7 [BOX_35A]
DK .................................... -8 [BOX_35A]
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
THIS ITEM DISPLAYS ALL PERSONS ON THE RU-MEMBERS- ROSTER WHO MEET ALL OF THE FOLLOWING CONDITIONS:

IF ROUND 1:
- AGE ) 16
AND
- RE35 IS NOT CODED '6' THAT IS NOT CODED AS 'FULL TIME ACTIVE DUTY IN THE MILITARY'
AND
- IS NOT CODED AS 'CURRENTLY SERVING ON ACTIVE DUTY IN THE MILITARY AND LIVING IN THE RU' (BOTH [NOT SELECTED AT RE95 AND RE95B] AND [RE96B1 NOT CODED '1'])

IF ROUND 2-5:
AND
- [PERSON ADDED TO THE RU THIS ROUND OR PERSON'S STATUS IN THE PREVIOUS ROUND WAS 'FULL TIME MILITARY AND LIVING IN THE RU']
AND
- AGE ) 16
AND
- IS NOT CODED AS 'CURRENTLY SERVING ON ACTIVE DUTY IN THE MILITARY AND LIVING IN THE RU' (BOTH [NOT SELECTED AT RE95 AND RE95B] AND [RE96B1 NOT CODED '1'])
----------------------------------------------------

RE96G
=====

Who was this?
PROBE: Anyone else?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
CONTINUE WITH BOX_35A
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
MULTIPLE SELECT ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
THIS ITEM DISPLAYS ALL PERSONS ON THE RU-MEMBERS- ROSTER WHO MEET ALL OF THE FOLLOWING CONDITIONS:

IF ROUND 1:
- AGE ) 16
AND
- RE35 IS NOT CODED '6' THAT IS NOT CODED AS 'FULL TIME ACTIVE DUTY IN THE MILITARY'
AND
- IS NOT CODED AS 'CURRENTLY SERVING ON ACTIVE DUTY IN THE MILITARY AND LIVING IN THE RU' (BOTH [NOT SELECTED AT RE95 AND RE95B] AND [RE96B1 NOT CODED '1'])

IF ROUND 2-5:
AND
- [PERSON ADDED TO THE RU THIS ROUND OR PERSON'S STATUS IN THE PREVIOUS ROUND WAS 'FULL TIME MILITARY AND LIVING IN THE RU']
AND
- AGE ) 16
AND
- IS NOT CODED AS 'CURRENTLY SERVING ON ACTIVE DUTY IN THE MILITARY AND LIVING IN THE RU' (BOTH [NOT SELECTED AT RE95 AND RE95B] AND [RE96B1 NOT CODED '1'])
----------------------------------------------------

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 SELECTED AT RE95 OR IN 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 SELECTED AT RE95 OR IN 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 RE95 OR LOOP_12A0.
----------------------------------------------------
----------------------------------------------------
IF NO ONE WAS REMOVED FROM THE RU-MEMBERS-ROSTER AT RE95 OR LOOP_12A0, GO TO BOX_35
----------------------------------------------------
----------------------------------------------------
IF AT LEAST ONE PERSON WAS REMOVED FROM THE RU- MEMBERS-ROSTER AT RE95 OR LOOP_12A0
AND
AT LEAST ONE PERSON REMAINS ELIGIBLE FOR 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 RE95 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 OR SELECT NEXT PAGE 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 [BOX_37]
TELEPHONE ............................. 2 [BOX_37]
[Code One]

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).
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
CONTINUE WITH BOX_35
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS DU-MEMBERS-ROSTER FOR DISPLAY OF DU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO ARE FLAGGED AS 'FULL-TIME MILITARY LIVING IN RU' AND WHO WERE 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, [YEAR], (were/was) (PERSON)] married, widowed, divorced, separated, or never married?
------------------------------------------------------------------------
ROSTER. NAME RE97_02. MARITAL STATUS
------------------------------------------------------------------------
1. First Name Middle Name Last [Enter Selection] Name-35
------------------------------------------------------------------------
2. First Name Middle Name Last [Enter Selection] Name-35
------------------------------------------------------------------------
3. First Name Middle Name Last [Enter Selection] Name-35
------------------------------------------------------------------------
HELP AVAILABLE FOR DEFINITIONS OF MARITAL STATUS CODES.
----------------------------------------------------
DISPLAY '(Are/Is) (PERSON) now' IF NOT ROUND 5.
DISPLAY 'As of December 31, [YEAR], (were/was) (PERSON)', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_5

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: MARITAL STATUS
INSTRUCTIONS: DISPLAY RU MEMBER'S MARITAL STATUS (PRND.MARISTAT)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR ENTRY OF MARITAL STATUS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. THE RU MEMBERS COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED.

2. THE MARITAL STATUS COLUMN PROVIDES A DROP-DOWN LIST OF STATUS INCLUDING: MARRIED, WIDOWED, DIVORCED, SEPARATED, NEVER MARRIED, RF, DK.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS AGE 16 OR OLDER.
----------------------------------------------------

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 ARE MISSING
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATED WITH THIS RU AND ETHNICITY DATA ARE MISSING, CONTINUE WITH LOOP_13
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_38
----------------------------------------------------

LOOP_13
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE DU-MEMBERS-ROSTER, ASK RE98A-END_LP13
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_13 COLLECTS ETHNICITY FOR RU MEMBERS AND NEW STUDENTS WHOSE ETHNICITY DATA ARE MISSING. THIS LOOP CYCLES ON DU MEMBERS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER AND ETHNICITY DATA ARE MISSING
OR
PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATED WITH THIS RU AND ETHNICITY DATA ARE MISSING
----------------------------------------------------

BOX_37A
=======

OMITTED.

RE98
====

OMITTED.

RE99
====

OMITTED.

RE100
=====

OMITTED.

RE100OV
=======

OMITTED.

RE98A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD RE-1B.
(Do/Does) (PERSON) consider (yourself/himself/herself) Hispanic or Latino?
YES .................................... 1 [RE100A]
NO ..................................... 2 [END_LP13]
REF ................................... -7 [END_LP13]
DK .................................... -8 [END_LP13]

RE100A
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD RE-1B.
Please look at this card and tell me which group best describes (PERSON)'s ethnic background.
PUERTO RICAN ........................... 1 [END_LP13]
CUBAN/CUBAN AMERICAN ................... 2 [END_LP13]
DOMINICAN .............................. 3 [END_LP13]
MEXICAN ................................ 4 [END_LP13]
MEXICAN-AMERICAN ....................... 5 [END_LP13]
CENTRAL OR SOUTH AMERICAN .............. 6 [END_LP13]
OTHER LATIN AMERICAN .................. 91 [END_LP13]
OTHER HISPANIC/LATINO ................. 92 [END_LP13]
REF ................................... -7 [END_LP13]
DK .................................... -8 [END_LP13]
[Code One]

RE100AOV1
=========

OMITTED.

RE100AOV2
=========

OMITTED.

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 ARE MISSING
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATED WITH THIS RU AND RACE DATA ARE MISSING, CONTINUE WITH LOOP_14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LOOP_15
----------------------------------------------------

LOOP_14
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE DU-MEMBERS-ROSTER, ASK RE101A-END_LP14
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_14 COLLECTS RACE DATA FOR RU MEMBERS AND NEW STUDENTS WHOSE RACE DATA ARE IS MISSING. THIS LOOP CYCLES ON DU MEMBERS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER AND RACE DATA ARE MISSING
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATED WITH THIS RU AND RACE DATA ARE MISSING
----------------------------------------------------

BOX_37B
=======

OMITTED.

RE101
=====

OMITTED.

RE102
=====

OMITTED.

RE102OV
=======

OMITTED.

RE101A
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD RE-2B.
Please look at this card and tell me which race or races best describes (PERSON).
CHECK ALL THAT APPLY.
WHITE .................................. 1
BLACK/AFRICAN AMERICAN ................. 2
AMERICAN INDIAN OR ALASKA NATIVE ....... 3
ASIAN .................................. 4
NATIVE HAWAIIAN OR OTHER PACIFIC
ISLANDER ............................. 5
OTHER: SPECIFY ........................ 91
REF ................................... -7 [BOX_38A]
DK .................................... -8 [BOX_38A]
[Code All That Apply]
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES AUTOMATICALLY): '-7' (REFUSED) AND '-8' (DON'T KNOW) NOT ALLOWED IN COMBINATION WITH ANY OTHER CODES.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER: SPECIFY) ALONE OR IN COMBINATION W/ OTHER CODES, CONTINUE WITH RE101AOV3
----------------------------------------------------
----------------------------------------------------
IF CODED '4' (ASIAN) ALONE OR IN COMBINATION WITH OTHER CODES EXCEPT '91', GO TO RE101B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_38A
----------------------------------------------------

101AOV3
=======

OTHER RACE:
[Enter Other Specify] ..................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF RE101A CODED '4' (ASIAN) IN COMBINATION WITH CODE '91' (OTHER: SPECIFY), CONTINUE WITH RE101B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_38A
----------------------------------------------------

101AOV1
=======

OMITTED.

101AOV2
=======

OMITTED.

RE101B
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD RE-2C.
Please look at this card and tell me which group best describes (PERSON)'s ethnic background.
ASIAN INDIAN ........................... 1 [BOX_38A]
CHINESE ................................ 2 [BOX_38A]
FILIPINO ............................... 3 [BOX_38A]
JAPANESE ............................... 4 [BOX_38A]
KOREAN ................................. 5 [BOX_38A]
VIETNAMESE ............................. 6 [BOX_38A]
OTHER ASIAN: SPECIFY .................. 91 [RE101BOV]
REF ................................... -7 [BOX_38A]
DK .................................... -8 [BOX_38A]

RE101BOV
========

OTHER ASIAN:
[Enter Other Asian Specify] ............. [BOX_38A]
REF ................................... -7 [BOX_38A]
DK .................................... -8 [BOX_38A]

BOX_38A
=======

----------------------------------------------------
GO TO END_LP14
----------------------------------------------------

RE102A
======

OMITTED.

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
----------------------------------------------------
----------------------------------------------------
IF ROUND 1, CONTINUE WITH RE103
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1
AND
PERSON WAS ADDED TO THE RU THIS ROUND (I.E., NEW U MEMBER), CONTINUE WITH RE103
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., NOT ROUND 1 AND PERSON WAS NOT ADDED TO THE RU THIS ROUND (NOT NEW RU MEMBER)), GO TO END_LP15
----------------------------------------------------

RE103
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[As of December 31, [YEAR], 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 [RE105]
SECOND YEAR ........................... 14 [RE105]
THIRD YEAR ............................ 15 [RE105]
FOURTH YEAR (BACHELOR'S DEGREE) ....... 16 [RE105]
FIVE OR MORE YEARS (GRADUATE DEGREE) .. 17 [RE105]
REF ...................................... -7 [RE105]
DK ....................................... -8 [RE105]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF REGULAR SCHOOL AND GRADE OR YEAR.
----------------------------------------------------
DISPLAY 'What' IF NOT ROUND 5. DISPLAY 'As of December 31, [YEAR], what' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
----------------------------------------------------
----------------------------------------------------
IF CODED '0' (NEVER ATTENDED SCHOOL/KINDERGARTEN ONLY) THROUGH '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, [YEAR] 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]
HELP AVAILABLE 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, [YEAR], did', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL.
----------------------------------------------------
----------------------------------------------------
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, [YEAR]]?
BACHELOR'S DEGREE ....................... 1 [END_LP15]
MASTER'S DEGREE ......................... 2 [END_LP15]
DOCTORATE DEGREE ........................ 3 [END_LP15]
NO DEGREE ............................... 4 [END_LP15]
OTHER .................................. 91 [END_LP15]
REF .................................... -7 [END_LP15]
DK ..................................... -8 [END_LP15]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'as of December 31, [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. 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, [YEAR], (were/was)] (READ NAMES BELOW) attending school either part-time or full-time?
SELECT 'YES' IF ANY PERSON ATTENDING SCHOOL.
[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 [RE107]
NO ...................................... 2 [BOX_41A]
REF .................................... -7 [BOX_41A]
DK ..................................... -8 [BOX_41A]
HELP AVAILABLE FOR DEFINITIONS OF PART-TIME/FULL-TIME.
----------------------------------------------------
DISPLAY '(Is/Are)' IF NOT ROUND 5. DISPLAY 'As of December 31, [YEAR], (were/was)', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS AGE 17 TO 23 INCLUSIVE AND WHO ARE 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, [YEAR]]?
[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, [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_41A
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS AGE 17 TO 23 INCLUSIVE AND WHO ARE NOT CODED AS LIVING AWAY AT SCHOOL IN GRADES 1-12.
----------------------------------------------------

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_41B
----------------------------------------------------

RE108
=====

[[Earlier you mentioned (PERSON) was living away at school in grades 1-12.]] [Is/Was] (PERSON) attending school part-time or full-time?
-------------------------------------------------------------------------
ROSTER. NAME RE108_02. PART-TIME/FULL-TIME STATUS
-------------------------------------------------------------------------
1. First Name Middle Name Last [Enter Selection] Name-35
-------------------------------------------------------------------------
2. First Name Middle Name Last [Enter Selection] Name-35
-------------------------------------------------------------------------
3. First Name Middle Name Last [Enter Selection] Name-35
-------------------------------------------------------------------------
HELP AVAILABLE FOR DEFINITIONS OF PART-TIME/FULL-TIME.
---------------------------------------------------
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.
---------------------------------------------------
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_6

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 2 HEADER: PART-TIME/FULL-TIME STATUS
INSTRUCTIONS: DISPLAY RU MEMBERS' STUDENT STATUS (PRND.STUDTIME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY OF SCHOOL STATUS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.

3. 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.

4. THE STATUS COLUMN PROVIDES A DROP-DOWN LIST OF CHOICES INCLUDING: PART-TIME, FULL-TIME, -7, AND -8.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO MEET ONE OF THE FOLLOWING CONDITIONS:
- AGE 17-23 AND ATTENDING SCHOOL PART-TIME OR FULL-TIME (I.E., SELECTED AT RE107)
OR
- PREVIOUSLY CODED AS LIVING AWAY AT SCHOOL GRADES 1-12
----------------------------------------------------

BOX_41B
=======

----------------------------------------------------
IF ROUND 1 OR ROUND 3
AND
IF AT LEAST ONE ELIGIBLE RU MEMBER, THEN GO TO BOX_41BB
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_42
----------------------------------------------------

BOX_41BB
========

----------------------------------------------------
IF HOUSEHOLD CONSISTS OF EITHER ONE OR TWO MEMBERS, GO TO RE108A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO RE108B
----------------------------------------------------

RE108A
======

INTERVIEWER: REFER TO HOUSEHOLD SUMMARY.
IS REFERENCE PERSON LESS THAN 65 YEARS OLD, OR AGE 65 AND OLDER?
LESS THAN 65 YEARS OLD .................. 1 [RE108B]
AGE 65 OR OLDER ......................... 2 [RE108B]
[Code One]

RE108B
======

[SHOWCARD RE-]
Please look at the various sources of income listed on the top of this card and think for a moment about the income received from these sources by all household members during the calendar year [YEAR]. Please tell me the letter on the bottom of the card that corresponds to your household's total income from these sources during [YEAR].
IF RESPONDENT WILL NOT ANSWER WITH A YEARLY INCOME AND MONTHLY INCOME VARIES, PROBE: Please pick the typical or average or most recent monthly amount.
A. [( 100%) ............................. 1 [BOX_42]
B. [100% - 150%] ........................ 2 [BOX_42]
C. [150% - 200%] ........................ 3 [BOX_42]
D. [200% - 300%] ........................ 4 [BOX_42]
E. [) 300%] ............................. 5 [BOX_42]
REF .................................... -7 [BOX_42]
DK ..................................... -8 [BOX_42]
[Code One]
----------------------------------------------------
(FOR SPECIFICATIONS ONLY; 'YEAR' IN PROGRAM IS HARD-CODED.) IF ROUND 1, DISPLAY THE YEAR PRIOR TO THE FIRST YEAR OF THE PANEL FOR 'YEAR'. IF ROUND 3, DISPLAY THE FIRST YEAR OF THE PANEL FOR 'YEAR'.
----------------------------------------------------
----------------------------------------------------
FOR 'SHOWCARD RE-' DISPLAY THE FOLLOWING:

- IF RE-108A IS CODED '1' (LESS THAN 65 YEARS OLD), AND HOUSEHOLD ROSTER LISTS ONE RU MEMBER, DISPLAY 'SHOWCARD RE-3A'

- IF RE-108A IS CODED '1' (LESS THAN 65 YEARS OLD), AND HOUSEHOLD ROSTER LISTS TWO RU MEMBERS, DISPLAY 'SHOWCARD RE-3B'

- IF RE-108A IS CODED '2' (AGE 65 OR OLDER), AND HOUSEHOLD ROSTER LISTS ONE RU MEMBER, DISPLAY 'SHOWCARD RE-3C'

- IF RE-108A IS CODED '2' (AGE 65 OR OLDER), AND HOUSEHOLD ROSTER LISTS TWO RU MEMBERS, DISPLAY 'SHOWCARD RE-3D'
----------------------------------------------------
----------------------------------------------------
FOR ALL HOUSEHOLD ROSTERS WITH MORE THAN TWO RU MEMBERS,

IF RU MEMBERSHIP = 3, DISPLAY 'SHOWCARD RE-3E'
IF RU MEMBERSHIP = 4, DISPLAY 'SHOWCARD RE-3F'
IF RU MEMBERSHIP = 5, DISPLAY 'SHOWCARD RE-3G'
IF RU MEMBERSHIP = 6, DISPLAY 'SHOWCARD RE-3H'
IF RU MEMBERSHIP = 7, DISPLAY 'SHOWCARD RE-3I'
IF RU MEMBERSHIP = 8, DISPLAY 'SHOWCARD RE-3J'
IF RU MEMBERSHIP = )9, DISPLAY 'SHOWCARD RE-3K'
----------------------------------------------------
----------------------------------------------------
FOR ANSWER CATEGORY DISPLAYS:

IF RE-108A IS CODED '1' (LESS THAN 65 YEARS OLD) AND HOUSEHOLD ROSTER LISTS ONE RU MEMBER,

FOR [( 100%], DISPLAY 'less than $11,300'
FOR [100%-150%], DISPLAY '$11,300-$17,000'
FOR [150%-200%], DISPLAY '$17,001-$22,700'
FOR [200%-300%], DISPLAY '$22,701-$34,000'
FOR [) 300%], DISPLAY 'more than $34,000'

IF RE-108A IS CODED '1' (LESS THAN 65 YEARS OLD) AND HOUSEHOLD ROSTER LISTS TWO RU MEMBERS,

FOR [( 100%], DISPLAY 'less than $14,700'
FOR [100%-150%], DISPLAY '$14,700-$22,000'
FOR [150%-200%], DISPLAY '$22,001-$29,300'
FOR [200%-300%], DISPLAY '$29,301-$44,000'
FOR [) 300%], DISPLAY 'more than $44,000'

IF RE-108A IS CODED '2' (AGE 65 OR OLDER) AND HOUSEHOLD ROSTER LISTS ONE RU MEMBER,

FOR [( 100%], DISPLAY 'less than $10,400'
FOR [100%-150%], DISPLAY '$10,400-$15,700'
FOR [150%-200%], DISPLAY '$15,701-$20,900'
FOR [200%-300%], DISPLAY '$20,901-$31,300'
FOR [) 300%], DISPLAY 'more than $31,300'

IF RE-108A IS CODED '2' (AGE 65 OR OLDER) AND HOUSEHOLD ROSTER LISTS TWO RU MEMBERS,

FOR [( 100%], DISPLAY 'less than $13,200'
FOR [100%-150%], DISPLAY '$13,200-$19,800'
FOR [150%-200%], DISPLAY '$19,801-$26,400'
FOR [200%-300%], DISPLAY '$26,401-$39,500'
FOR [) 300%], DISPLAY 'more than $39,500'
----------------------------------------------------
----------------------------------------------------
IF RU ROSTER LISTS THREE HOUSEHOLD MEMBERS,

FOR [( 100%], DISPLAY 'less than $17,400'
FOR [100%-150%], DISPLAY '$17,400-$26,000'
FOR [150%-200%], DISPLAY '$26,001-$34,700'
FOR [200%-300%], DISPLAY '$34,701-$52,100'
FOR [) 300%], DISPLAY 'more than $52,100'

IF RU ROSTER LISTS FOUR HOUSEHOLD MEMBERS,

FOR [( 100%], DISPLAY 'less than $22,300'
FOR [100%-150%], DISPLAY '$22,300-$33,400'
FOR [150%-200%], DISPLAY '$33,401-$44,500'
FOR [200%-300%], DISPLAY '$44,501-$66,800'
FOR [) 300%], DISPLAY 'more than $66,800'

IF RU ROSTER LISTS FIVE HOUSEHOLD MEMBERS,

FOR [( 100%], DISPLAY 'less than $26,300'
FOR [100%-150%], DISPLAY '$26,300-$39,500'
FOR [150%-200%], DISPLAY '$39,501-$52,700'
FOR [200%-300%], DISPLAY '$52,701-$79,000'
FOR [) 300%], DISPLAY 'more than $79,000'

IF RU ROSTER LISTS SIX HOUSEHOLD MEMBERS,

FOR [( 100%], DISPLAY 'less than $29,800'
FOR [100%-150%], DISPLAY '$29,800-$44,600'
FOR [150%-200%], DISPLAY '$44,601-$59,500'
FOR [200%-300%], DISPLAY '$59,501-$89,300'
FOR [) 300%], DISPLAY 'more than $89,300'

IF RU ROSTER LISTS SEVEN HOUSEHOLD MEMBERS,

FOR [( 100%], DISPLAY 'less than $33,700'
FOR [100%-150%], DISPLAY '$33,700-$50,500'
FOR [150%-200%], DISPLAY '$50,501-$67,400'
FOR [200%-300%], DISPLAY '$67,401-$101,100'
FOR [) 300%], DISPLAY 'more than $101,100'

IF RU ROSTER LISTS EIGHT HOUSEHOLD MEMBERS,

FOR [( 100%], DISPLAY 'less than $37,500'
FOR [100%-150%], DISPLAY '$37,500-$56,300'
FOR [150%-200%], DISPLAY '$56,301-$75,100'
FOR [200%-300%], DISPLAY '$75,101-$112,600'
FOR [) 300%], DISPLAY 'more than $112,600'
----------------------------------------------------
----------------------------------------------------
IF RU ROSTER LISTS NINE OR MORE HOUSEHOLD MEMBERS,

FOR [( 100%], DISPLAY 'less than $44,800'
FOR [100%-150%], DISPLAY '$44,800-$67,200'
FOR [150%-200%], DISPLAY '$67,201-$89,600'
FOR [200%-300%], DISPLAY '$89,601-$134,400'
FOR [) 300%], DISPLAY 'more than $134,400'
----------------------------------------------------

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.
[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 DETAILS:
TITLE: DU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO WERE REMOVED FROM THE RU- MEMBERS-ROSTER THIS ROUND AND WHO WERE FLAGGED AS A 'NEW STUDENT'.
----------------------------------------------------

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: [_______________]
STREET_ADDRESS2: [_______________]
CITY: [_______________]
STATE: [_______________]
ZIP CODE: [_______________]
TELEPHONE: [_______________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
--------------------------------------------------------
DISPLAY THE FOLLOWING MESSAGE IN RED UPON EXITING RE110: "RECORD ADDRESS AND TELEPHONE ABOVE ON SPLIT/ STUDENT MOVING FORM NOW."
--------------------------------------------------------
--------------------------------------------------------
CONTINUE WITH END_LP16
--------------------------------------------------------

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.
[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 DETAILS:
TITLE: DU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS DU-MEMBERS-ROSTER FOR DISPLAY OF DU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS 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 US'.

- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND IS FLAGGED AS 'FULL-TIME MILITARY IN US 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: [_____________]
STREET_ADDRESS2: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
TELEPHONE: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
DISPLAY THE FOLLOWING MESSAGE IN RED UPON EXITING RE111A: "RECORD ADDRESS AND TELEPHONE ABOVE ON SPLIT/STUDENT MOVING FORM NOW."
----------------------------------------------------
----------------------------------------------------
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)
[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 [RE112]
NO ...................................... 2 [END_LP17]
REF .................................... -7 [END_LP17]
DK ..................................... -8 [END_LP17]
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS DU-MEMBERS-ROSTER FOR DISPLAY OF DU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO WERE NOT FLAGGED AS 'PROCESSED MOVERS' AND WHO WERE REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND MEET EITHER OF THE FOLLOWING CONDITIONS:

- FLAGGED AS 'NON-MILITARY MOVER IN US'.
- FLAGGED AS 'FULL-TIME MILITARY IN US AND NOT ON MILITARY FACILITY'.
----------------------------------------------------

RE112
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Who lives with (PERSON)?
[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]
----------------------------------------------------
FLAG ALL SELECTED PERSONS AS 'PROCESSED MOVER'.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH END_LP17
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY DU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS DU-MEMBERS-ROSTER FOR DISPLAY OF DU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO WERE NOT FLAGGED AS 'PROCESSED MOVERS' AND WHO WERE REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND MEET EITHER OF THE FOLLOWING CONDITIONS:

- FLAGGED AS 'NON-MILITARY MOVER IN US'.
- FLAGGED AS 'FULL-TIME MILITARY IN US AND NOT ON MILITARY FACILITY'.
----------------------------------------------------

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


Priority Conditions Enumeration (PE) Section


BOX_00A
=======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, [PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY].
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK PE00A-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS GENERAL HEALTH RATINGS AND ENUMERATES THE PRIORITY HEALTH 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
- PERSON IS NOT DECEASED
----------------------------------------------------

PE00A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Please think about (PERSON)'s health between (START DATE) and (END DATE). 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 [PE00B]
VERY GOOD .............................. 2 [PE00B]
GOOD ................................... 3 [PE00B]
FAIR ................................... 4 [PE00B]
POOR ................................... 5 [PE00B]
REF ................................... -7 [PE00B]
DK .................................... -8 [PE00B]
[Code One]

PE00B
=====

[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 [BOX_00]
VERY GOOD .............................. 2 [BOX_00]
GOOD ................................... 3 [BOX_00]
FAIR ................................... 4 [BOX_00]
POOR ................................... 5 [BOX_00]
REF ................................... -7 [BOX_00]
DK .................................... -8 [BOX_00]
[Code One]

BOX_00
======

----------------------------------------------------
IF:
- ROUND 1, 3 OR 5
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND

CONTINUE WITH PE01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

PE01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Now I'm going to ask you about certain medical conditions (PERSON) may have had. For these questions, please think about (PERSON)'s health over (his/her) lifetime.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

BOX_01
======

----------------------------------------------------
IF PERSON IS ) OR = 18 YEARS OF AGE OR IN AGE CATEGORIES 4-9, CONTINUE WITH BOX_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_14
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'HYPERTENSION - HI BLOOD PRESSURE' IN THE PE SECTION,

CONTINUE WITH PE02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_03
----------------------------------------------------

PE02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Other than during pregnancy, (have/has)/(Have/Has)] (PERSON) ever been told by a doctor or other health professional that (PERSON) had hypertension, also called high blood pressure?
YES .................................... 1 [PE03]
NO ..................................... 2 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
HELP AVAILABLE FOR DEFINITION OF HYPERTENSION.
----------------------------------------------------
DISPLAY 'Other than during pregnancy, (have/has)' IF PERSON BEING ASKED ABOUT IS FEMALE. DISPLAY '(Have/Has)' IF PERSON BEING ASKED ABOUT IS MALE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'HYPERTENSION - HI BLOOD PRESSURE' TO PERSON'S- MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

PE03
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the hypertension, also called high blood pressure, was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE04]
REF ................................... -7 [PE04]
DK .................................... -8 [PE04]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

PE04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Were/Was) (PERSON) told on two or more different visits that (PERSON) had hypertension, also called high blood pressure?
YES .................................... 1 [BOX_03]
NO ..................................... 2 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]

BOX_03
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'CORONARY HEART DISEASE' IN THE PE SECTION,

CONTINUE WITH PE05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_04
----------------------------------------------------

PE05
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had coronary heart disease?
YES .................................... 1 [PE06]
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'CORONARY HEART DISEASE' TO PERSON'S-MEDICAL- CONDITIONS-ROSTER.
----------------------------------------------------

PE06
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the coronary heart disease was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'ANGINA' IN THE PE SECTION,

CONTINUE WITH PE07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

PE07
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had angina, also called angina pectoris?
YES .................................... 1 [PE08]
NO ..................................... 2 [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'ANGINA' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

PE08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the angina, also called angina pectoris, was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'HEART ATTACK - MYOCARDIAL INFARC' IN THE PE SECTION,

CONTINUE WITH PE09
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_06
----------------------------------------------------

PE09
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had a heart attack, also called myocardial infarction or MI?
YES .................................... 1 [PE10]
NO ..................................... 2 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'HEART ATTACK - MYOCARDIAL INFARC' TO PERSON'S- MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

PE10
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the heart attack, also called myocardial infarction or MI, was first diagnosed?
IF MORE THAN ONE HEART ATTACK, PROBE FOR AGE WHEN FIRST HEART ATTACK DIAGNOSED.
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'OTHER HRT COND – [SPECIFY TEXT]' IN THE PE SECTION,

CONTINUE WITH PE11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

PE11
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had any other kind of heart condition or heart disease, other than coronary heart disease, angina, or heart attack?
YES .................................... 1 [PE11OV]
NO ..................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]

PE11OV
======

What did the doctor or other health professional call it?
[Enter Other Specify-45] ............... [PE12]
REF .................................... -7 [PE12]
DK ..................................... -8 [PE12]
----------------------------------------------------
IF CODED '1' (YES) AT PE11, ADD THE PRIORITY CONDITION 'OTH HRT COND - [SPECIFY TEXT.....]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER. USE THE FIRST 17 CHARACTERS OF THE OTHER SPECIFY TEXT ENTERED AT PE11OV AS PART OF THE CONDITION NAME.
----------------------------------------------------

PE12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the other kind of heart condition, that is the [OTHER HEART CONDITION SPECIFY TEXT], was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
FOR 'OTHER HEART CONDITION SPECIFY TEXT', DISPLAY THE TEXT ENTERED AT PE11OV.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'STROKE-TIA' IN THE PE SECTION,

CONTINUE WITH PE13
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

PE13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had a stoke or TIA? A TIA is a transient ischemic attack which is sometimes referred to as a ministroke.
YES .................................... 1 [PE14]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'STROKE-TIA' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------

PE14
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the stroke or TIA was first diagnosed?
IF MORE THAN ONE STROKE, PROBE FOR AGE WHEN FIRST STROKE DIAGNOSED.
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_08
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'EMPHYSEMA' IN THE PE SECTION,

CONTINUE WITH PE15
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

PE15
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had emphysema?
YES .................................... 1 [PE16]
NO ..................................... 2 [BOX_09]
REF ................................... RF [BOX_09]
DK .................................... -8 [BOX_09]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'EMPHYSEMA' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

PE16
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the emphysema was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_09]
REF ................................... -7 [BOX_09]
DK .................................... -8 [BOX_09]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_09
======

----------------------------------------------------
IF:
- ROUND 1, 3 OR 5
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND

CONTINUE WITH PE17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
NOTE THAT WHETHER THE PERSON HAS BEEN DIAGNOSED WITH 'CHRONIC BRONCHITIS' IN THE PAST 12 MONTHS IS ASKED IN ROUNDS 3 AND 5 EVEN IF PERSON REPORTED 'CHRONIC BRONCHITIS' IN A PREVIOUS ROUND.
----------------------------------------------------

PE17
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
During the past 12 months, (have/has) (PERSON) been told by a doctor or other health professional that (PERSON) had chronic bronchitis? Please do not include isolated instances of acute bronchitis.
YES .................................... 1
NO ..................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
HELP AVAILABLE FOR DEFINITION OF ACUTE AND CHRONIC BRONCHITIS.
----------------------------------------------------
IF CODED '1 (YES) AND:
- ROUND 1, 2, OR 4
OR
- THE PRIORITY CONDITION 'CHRONIC BRONICHITIS' NOT REPORTED IN A PREVIOUS ROUND IN THE PE SECTION, ADD THE PRIORITY CONDITION 'CHRONIC BRONCHITIS' TO PERSON'S-MEDICAL-CONDITIONS ROSTER.

IF CODED '1' (YES) AND:
- ROUND 3 OR 5
AND
- THE PRIORITY CONDITION 'CHRONIC BRONCHITIS' REPORTED IN A PREVIOUS ROUND IN THE PE SECTION, THE PRIORITY CONDITION 'CHRONIC BRONCHITIS' SHOULD BE FLAGGED AS 'SELECTED' THIS ROUND (WITH THE ROUND STATUS).
----------------------------------------------------
----------------------------------------------------
IF:
- PE17 IS CODED '1' (YES)
AND
- ROUND 1 OR [NOT ROUND 1 AND PE18 NOT ASKED IN A PREVIOUS ROUND]

CONTINUE WITH PE18
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------

PE18
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the chronic bronchitis was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_10
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'HIGH CHOLESTEROL' IN THE PE SECTION,

CONTINUE WITH PE19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_11
----------------------------------------------------

PE19
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had high cholesterol?
YES .................................... 1 [PE20]
NO ..................................... 2 [BOX_11]
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'HIGH CHOLESTEROL' TO PERSON'S-MEDICAL-CONDITIONS- ROSTER.
----------------------------------------------------

PE20
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the high cholesterol was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_11]
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_11
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'CANCER – [ANY TYPE]' AT PE22 OR PE22OV,

CONTINUE WITH PE21
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

PE21
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had cancer or a malignancy of any kind?
YES .................................... 1 [PE22]
NO ..................................... 2 [BOX_12]
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]

PE22
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What kind of cancer was it?
IF RESPONDENT DOESN'T KNOW OR REFUSES THE KIND OF CANCER, SELECT 'OTHER' AND THEN SELECT 'DON'T KNOW' OR 'REFUSAL.'
CHECK ALL THAT APPLY.
BLADDER ................................ 1
BLOOD .................................. 2
BONE ................................... 3
BRAIN .................................. 4
BREAST ................................. 5
CERVIX ................................. 6
COLON .................................. 7
ESOPHAGUS .............................. 8
GALLBLADDER ............................ 9
KIDNEY ................................ 10
LARYNX-WINDPIPE ....................... 11
LEUKEMIA .............................. 12
LIVER ................................. 13
LUNG .................................. 14
LYMPHOMA .............................. 15
MELANOMA .............................. 16
MOUTH/TONGUE/LIP ...................... 17
OVARY ................................. 18
PANCREAS .............................. 19
PROSTATE .............................. 20
RECTUM ................................ 21
SKIN NON-MELANOMA ..................... 22
SKIN DK WHAT KIND ..................... 23
SOFT TISSUE MUSCLE OR FAT ............. 24
STOMACH ............................... 25
TESTIS ................................ 26
THROAT-PHARYNX ........................ 27
THYROID ............................... 28
UTERUS ................................ 29
OTHER ................................. 91 [PE22OV]
[Code All That Apply]
----------------------------------------------------
HARD CHECK:
EDITS: IF PE22 IS CODED '6' (CERVIX), '18' (OVARY), OR '29' (UTERUS), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE:
"CODE UNAVAILABLE FOR MALES. VERIFY AND RE-ENTER."

IF PE22 IS CODED '20' (PROSTATE) OR '26' (TESTIS), CHECK THAT PERSON IS MALE. IF NOT, DISPLAY THE FOLLOWING MESSAGE: "CODE UNAVAILABLE FOR FEMALES.
VERIFY AND RE-ENTER."
----------------------------------------------------
----------------------------------------------------
FOR EACH TYPE OF CANCER SELECTED AT PE22, ADD THE PRIORITY CONDITION 'CANCER-[SPECIFY TYPE........]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER, WHERE 'SPECIFY TYPE' IS THE NAME OF THE CANCER TYPE SELECTED. SINCE THE LENGTH OF THE CONDNAM IS LIMITED TO 30 CHARACTERS, ABBREVIATE 'SOFT TISSUE' OPTION TO 'CANCER - SOFT TISSUE MUSCL/FAT'. FOR EACH TYPE OF CANCER SELECTED, CREATE A CONDITION AND CONDITION-BY-ROUND RECORD.

REFUSED AND DON'T KNOW DISALLOWED. INTERVIEWER MUST SELECT '91' (OTHER) AND ENTER THE APPROPRIATE TEXT STRING.
----------------------------------------------------
----------------------------------------------------
IF 'OTHER' SELECTED ALONE OR IN COMBINATION WITH ANY OTHER RESPONSE, CONTINUE WITH PE22OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LOOP_02
----------------------------------------------------

PE22OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
SPECIFY OTHER TYPE OF CANCER:
[Enter Other Specify-23] .............. [LOOP_02]
REF ................................... -7 [LOOP_02]
DK .................................... -8 [LOOP_02]
----------------------------------------------------
ALLOW UP TO 23 CHARACTERS FOR THIS FIELD.
----------------------------------------------------
----------------------------------------------------
ADD THE PRIORITY CONDITION 'CANCER - [OTHER SPECIFY]' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN PERSON'S-MEDICAL-CONDITIONS ROSTER, ASK PE23-END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 CYCLES ON EACH TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV FOR PERSON.
LOOP_02 COLLECTS THE AGE THE CANCER WAS DIAGNOSED AND WHETHER IT IS IN REMISSION. THIS LOOP CYCLES ON EACH CONDITION IN PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEETS THE FOLLOWING CONDITIONS:

- CONDITION WAS CREATED AT PE22 OR PE22OV IN THE CURRENT ROUND
----------------------------------------------------

PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old (were/was) (PERSON) when the (CONDITION) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [PE25]
REF ................................... -7 [PE25]
DK .................................... -8 [PE25]
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

PE24
====

OMITTED.

PE25
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
Is (PERSON)'s (CONDITION) in remission, that is, the (CONDITION) is under control?
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
HELP AVAILABLE FOR DEFINITION OF REMISSION.
----------------------------------------------------
[PERSON'S MEDICAL CONDITION]: IN THE HEADER, DISPLAY THE TYPE OF CANCER ENUMERATED AT PE22 OR PE22OV THAT IS CURRENTLY BEING CYCLED ON IN LOOP_02.
----------------------------------------------------

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_12
----------------------------------------------------

BOX_12
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'DIABETES' IN THE PE SECTION,

CONTINUE WITH PE26
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_13
----------------------------------------------------

PE26
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Other than during pregnancy, (have/has)/(Have/Has)] (PERSON) ever been told by a doctor or other health professional that (PERSON) had diabetes or sugar diabetes?
YES .................................... 1 [PE27]
NO ..................................... 2 [BOX_13]
REF ................................... -7 [BOX_13]
DK .................................... -8 [BOX_13]
HELP AVAILABLE FOR DEFINITION OF DIABETES.
----------------------------------------------------
DISPLAY 'Other than during pregnancy, (have/has)' IF PERSON BEING ASKED ABOUT IS FEMALE. DISPLAY '(Have/Has)' IF PERSON BEING ASKED ABOUT IS MALE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'DIABETES' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

PE27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the diabetes or sugar diabetes was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_13]
REF ................................... -7 [BOX_13]
DK .................................... -8 [BOX_13]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_13
======

----------------------------------------------------
IF:
- ROUND 1, 3 OR 5
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- OSTER DURING THE CURRENT ROUND

CONTINUE WITH PE28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_14
----------------------------------------------------
----------------------------------------------------
NOTE THAT WHETHER THE PERSON HAS HAD JOINT PAIN IN THE LAST 12 MONTHS IS ASKED IN ROUNDS 3 AND 5 EVEN IF PERSON REPORTED JOINT PAIN IN THE PE SECTION IN A PREVIOUS ROUND.
----------------------------------------------------

PE28
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) had pain, aching, stiffness or swelling around a joint in the past 12 months?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF:
- ROUND 1, 2, OR 4
OR
- ROUND 3 OR 5 AND THE PRIORITY CONDITION 'ARTHRITIS' (OF ANY KIND) NOT REPORTED IN A PREVIOUS ROUND IN THE PE SECTION,

CONTINUE WITH PE29
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_14
----------------------------------------------------

PE29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) had arthritis?
YES .................................... 1 [PE30]
NO ..................................... 2 [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX_14]
----------------------------------------------------
IF PE28 IS CODED '1' (YES) AND PE29 IS CODED '2' (NO), 'RF' (REFUSED), OR 'DK' (DON'T KNOW) AND ONE OF THE FOLLOWING IS TRUE:
- ROUND 1, 2, OR 4
OR
- ROUND 3 OR 5 AND THE PRIORITY CONDITION 'JOINT PAIN' NOT REPORTED IN A PREVIOUS ROUND IN THE PE SECTION ADD THE PRIORITY CONDITION 'JOINT PAIN' TO THE PERSON'S-MEDICAL-CONDITIONS-ROSTER

IF PE28 IS CODED '1' (YES) AND PE29 IS CODED '2' (NO), 'RF' (REFUSED), OR 'DK' (DON'T KNOW) IN ROUND 3 OR 5 AND THE PRIORITY CONDITION 'JOINT PAIN' REPORTED IN A PREVIOUS ROUND IN THE PE SECTION, THE PRIORITY CONDITION 'JOINT PAIN' SHOULD BE FLAGGGED AS 'SELECTED' THIS ROUND (WITH ROUND STATUS).

(NOTE THAT CONDITION RECORD FOR ARTHRITIS IS NOT CREATED HERE BUT AT PE30.)
----------------------------------------------------

PE30
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What type of arthritis was that?
PROBE: (Were/Was) (PERSON) diagnosed with rheumatoid arthritis or osteoarthritis?

CODE 'NOT SPECIFIED' IF RESPONDENT DOES NOT KNOW THE TYPE OF ARTHRITIS.
RHEUMATOID ARTHRITIS ................... 1 [PE31]
OSTEOARTHRITIS ......................... 2 [PE31]
NOT SPECIFIED .......................... 3 [PE31]
REF ................................... -7 [PE31]
[Code One]
HELP AVAILAIBLE FOR DEFINITION OF RHEUMATOID ARTHRITIS AND OSTEOARTHRITIS.
----------------------------------------------------
IF CODED '1' (RHEUMATOID ARTHRITIS), ADD THE PRIORITY CONDITION 'RHEUMATOID ARTHRITIS' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (OSTEOARTHRITIS), ADD THE PRIORITY CONDITION 'OSTEOARTHRITIS' TO PERSON'S-MEDICAL- CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NOT SPECIFIED) OR '-7' (REFUSED), ADD THE PRIORITY CONDITION 'ARTHRITIS (NOT SPECIFIED)' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------
----------------------------------------------------
CODE '-8' (DON'T KNOW) DISALLOWED.
----------------------------------------------------

PE31
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the [rheumatoid arthritis/ osteoarthritis/arthritis] was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX_14]
----------------------------------------------------
DISPLAY 'rheumatoid arthritis' IF PE30 IS CODED '1' (RHEUMATOID ARTHRITIS). DISPLAY 'osteoarthritis' IF PE30 IS CODED '2' (OSTEOARTHRITIS). DISPLAY 'arthritis' IF PE30 IS CODED '3' (NOT SPECIFIED) OR '-7' (REFUSED).
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_14
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'ASTHMA' IN THE PE SECTION,

CONTINUE WITH PE32
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_15
----------------------------------------------------

PE32
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
(Have/Has) (PERSON) ever been told by a doctor or other health professional that (PERSON) (have/has) asthma?
YES .................................... 1 [PE33]
NO ..................................... 2 [BOX_15]
REF ................................... -7 [BOX_15]
DK .................................... -8 [BOX_15]
HELP AVAILABLE FOR DEFINITION OF ASTHMA.
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'ASTHMA' TO PERSON'S-MEDICAL-CONDITIONS-ROSTER.
----------------------------------------------------

PE33
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the asthma was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [BOX_15]
REF ................................... -7 [BOX_15]
DK .................................... -8 [BOX_15]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

BOX_15
======

----------------------------------------------------
IF:
- ROUND 1, 3 OR 5
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND

CONTINUE WITH BOX_16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_17
----------------------------------------------------

BOX_16
======

----------------------------------------------------
IF 'ASTHMA' (COLLECTED IN PE SECTION IN ANY ROUND) ON PERSON'S-MEDICAL-CONDITIONS-ROSTER, CONTINUE WITH PE33A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_17
----------------------------------------------------

PE33A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[During an earlier interview, it was mentioned that (PERSON) (have/has) asthma.] (Do/Does) (PERSON) still have asthma?
YES .................................... 1 [PE34]
NO ..................................... 2 [PE34]
REF ................................... -7 [PE34]
DK .................................... -8 [PE34]
----------------------------------------------------
DISPLAY 'During an earlier interview, it…' IF ASTHMA WAS ADDED DURING A PREVIOUS ROUND.
OTHERWISE (ASTHMA ADDED FOR PERSON IN THE CURRENT ROUND), USE A NULL DISPLAY.
----------------------------------------------------

PE34
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
During the past 12 months, (have/has) (PERSON) had an episode of asthma or an asthma attack?
YES .................................... 1 [BOX_17]
NO ..................................... 2
REF ................................... -7 [BOX_17]
DK .................................... -8 [BOX_17]
HELP AVAILABLE FOR DEFINITION OF ASTHMA ATTACK.
----------------------------------------------------
IF:
- PE34 IS CODED '2' (NO)
AND
- ROUND 1 OR NOT ROUND 1 AND PE35 NOT ASKED IN A PREVIOUS ROUND

CONTINUE WITH PE35
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_17
----------------------------------------------------

PE35
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did (PERSON) last have an episode of asthma or an asthma attack?
WITHIN PAST 2 YEARS .................... 1 [BOX_17]
WITHIN PAST 3 YEARS .................... 2 [BOX_17]
WITHIN PAST 5 YEARS .................... 3 [BOX_17]
MORE THAN 5 YEARS ...................... 4 [BOX_17]
NEVER .................................. 5 [BOX_17]
REF ................................... -7 [BOX_17]
DK .................................... -8 [BOX_17]
[Code One]

BOX_17
======

----------------------------------------------------
IF PERSON IS 5 - 17 YEARS OF AGE INCLUSIVE OR IN AGE CATEGORIES 3 OR 4, CONTINUE WITH BOX_18
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

BOX_18
======

----------------------------------------------------
IF:
- ROUND 1
OR
- ROUND 2 OR 4 AND PERSON ADDED TO DU-MEMBERS- ROSTER DURING THE CURRENT ROUND
OR
- ROUND 3 OR 5 AND PERSON DID NOT REPORT IN A PREVIOUS ROUND EVER HAVING BEEN DIAGNOSED WITH 'ATTEN DEFICIT/HYPERACTIVITY' IN THE PE SECTION,

CONTINUE WITH PE36
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

PE36
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Have you or (PERSON) ever been told by a doctor or other health professional that (PERSON) had Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD)?
YES .................................... 1 [PE37]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
----------------------------------------------------
IF CODED '1' (YES), ADD THE PRIORITY CONDITION 'ATTEN DEFICIT/HYPERACTIVITY' TO PERSON'S-MEDICAL- CONDITIONS-ROSTER.
----------------------------------------------------

PE37
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How old (were/was) (PERSON) when the Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder (ADD) was first diagnosed?
IF LESS THAN ONE YEAR OLD WHEN DIAGNOSED, ENTER 0 FOR AGE.
[Enter Age-3] ......................... [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0 TO PERSON'S CURRENT AGE
----------------------------------------------------

END_LP01
========

----------------------------------------------------
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_01 AND CONTINUE WITH BOX_19
----------------------------------------------------

BOX_19
======

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


Condition Enumeration (CE) Section


BOX_00
======

-----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY
-----------------------------------------------------

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 BOX_01A-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 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
====

OMITTED.

CE01OV
======

OMITTED.

CE02
====

OMITTED.

CE02OV
======

OMITTED.

BOX_01A
=======

----------------------------------------------------
IF FIRST CYCLE OF LOOP, CONTINUE WITH CE03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CE04
----------------------------------------------------

CE03
====

Now we are going to focus on health problems that have actually bothered anyone in the family [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 OR SELECT NEXT PAGE TO CONTINUE.
HELP AVAILABLE FOR DEFINITION OF HEALTH PROBLEM.
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5.
- DISPLAY 'January 1, [YEAR]' FOR 'START DATE' WHERE 'YEAR' IS THE FIRST YEAR OF THE PANEL IF ROUND 1 AND A MULTI-PERSON RU.
- DISPLAY THE ACTUAL START DATE FOR 'START DATE' IF ROUND 1 AND A SINGLE-PERSON RU.
- DISPLAY THE PREVIOUS ROUND'S INTERVIEW DATE FOR 'START DATE' IF ROUND 2, 3, OR 4.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5 AND DISPLAY THE PREVIOUS ROUND'S INTERVIEW DATE FOR 'START DATE'.
- DISPLAY 'December 31, [YEAR]' FOR 'END DATE' WHERE 'YEAR' IS THE SECOND YEAR OF THE PANEL IF A MULTI-PERSON RU.
- DISPLAY THE ACTUAL END DATE FOR 'END DATE' IF A SINGLE-PERSON RU.
----------------------------------------------------
----------------------------------------------------
ALTHOUGH THIS IS A PERSON-LEVEL LOOP, CE03 OCCURS ONLY IN THE FIRST CYCLE OF THE LOOP AND ASKS ABOUT THE WHOLE FAMILY. THEREFORE, DO NOT INCLUDE A PERSON NAME IN THE CONTEXT HEADER FOR CE03.
----------------------------------------------------

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 [CE05]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HELP AVAILABLE 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.
----------------------------------------------------

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, SELECT ENTRY ON ROSTER.
[Medical Condition]
[Medical Condition]
[Medical Condition] [END_LP01]
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1

COL #1 HEADER: CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.

2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE CONDITION NAME.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET "RECORDED" THE CONDITION.

4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET "RECORDED" THE CONDITION.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL CONDITIONS ON PERSON'S ROSTER.
----------------------------------------------------

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 15-55 YEARS, INCLUSIVE, (OR AGE CATEGORIES 4-8) IN THE RU, CONTINUE WITH CE05A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

CE05A
=====

[STR-DT] [END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], has anyone in the family been pregnant at any time?
YES .................................... 1
NO ..................................... 2 [BOX_09]
REF ................................... -7 [BOX_09]
DK .................................... -8 [BOX_09]
----------------------------------------------------
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5. OTHERWISE, DISPLAY 'Since (START DATE)'.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AT CE05B BY CAPI AND GO TO BOX_09
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH CE05B
----------------------------------------------------

CE05B
=====

[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)]?
[First Name,[Middle Name],Last Name-65]
[First Name,[Middle Name],Last Name-65]
[First Name,[Middle Name],Last Name-65] [BOX_09]
----------------------------------------------------
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5. OTHERWISE, DISPLAY 'since (START DATE)'.
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PREGNANCIES ARE NO LONGER ADDED TO THE PERSON'S CONDITIONS ROSTER BASED ON THE RESPONSE TO THIS QUESTION, CE05B. (IN EARLIER PANELS AND ROUNDS, THIS SAME QUESTION WAS ASKED AS CE08.) THEREFORE, PERSONS WHO ARE SELECTED AT CE05B WILL HAVE A PREGNANCY CONDITION ON THEIR ROSTER ONLY IF PREGNANCY IS REPORTED ELSEWHERE IN CAPI (THE DD SECTION, CE05, OR THE EVENT SECTIONS). ALSO, PERSONS WHO HAVE A PREGNANCY REPORTED IN CAPI MAY NOT BE SELECTED AT CE05B (THE PRND VARIABLE MIGHT NOT BE SET FOR PERSON); THERE IS NO LINK BETWEEN CE05B AND REPORTS OF PREGNANCY FOR PERSON ELSEWHERE IN CAPI.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY FEMALES AGE 15-55 YEARS INCLUSIVE, OR IN AGE CATEGORIES 4-8.

NOTE: THIS ROSTER SHOULD NOT EXCLUDE PEOPLE WHO ARE CURRENTLY OUT-OF-SCOPE (E.G., DECEASED, INSTITUTIONALIZED, ETC.).
----------------------------------------------------

BOX_03
======

OMITTED.

LOOP_02
=======

OMITTED.

LOOP_03
=======

OMITTED.

BOX_04
======

OMITTED.

BOX_05
======

OMITTED.

CE06
====

OMITTED.

END_LP03
========

OMITTED.

END_LP02
========

OMITTED.

BOX_06
======

OMITTED.

CE07
====

OMITTED.

CE08
====

OMITTED.

LOOP_04
=======

OMITTED.

LOOP_05
=======

OMITTED.

BOX_07
======

OMITTED.

BOX_08
======

OMITTED.

CE09
====

OMITTED.

END_LP05
========

OMITTED.

END_LP04
========

OMITTED.

BOX_09
======

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


Health Status (HE) Section


BOX_00
=======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY [HOME.RUSTRTMM, HOME.RUSTRTDD, HOME.RUSTRTYY, HOME.RUENDMM, HOME.RUENDDD, HOME.RUENDYY/PERS.FULLNAME, PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY]
----------------------------------------------------

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]
HELP AVAILABLE 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 LOOP_01
----------------------------------------------------
----------------------------------------------------
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?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 13 YEARS OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: IADL SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK BOX_01A - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 DETERMINES IF PERSONS 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)
----------------------------------------------------

BOX_01A
=======

----------------------------------------------------
IF RU MEMBER BEING LOOPED ON IS ( 13 YEARS OF AGE OR IN CATEGORIES 1-3, CONTINUE WITH HE03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HE03A
----------------------------------------------------

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 [HE03A]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION AND IMPAIRMENT.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: IADL SECTION.
----------------------------------------------------

HE03A
=====

[PERSON'S FIRST NAME AND LAST NAME] [STR-DT] [END-DT]
Do you expect that (PERSON) will need help or supervision with these activities for at least three more months?
YES .................................... 1 [END_LP01]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [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 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]
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION.
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVES HELP' AT HE05 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_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?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 13 YEARS OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: ADL SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK BOX_01B - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 DETERMINES IF PERSONS 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)
----------------------------------------------------

BOX_01B
=======

----------------------------------------------------
IF THE RU MEMBER BEING LOOPED ON IS ( 13 YEARS OF AGE OR IN AGE CATEGORIES 1-3, CONTINUE WITH HE06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HE06A
----------------------------------------------------

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 [HE06A]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION AND IMPAIRMENT.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: ADL SECTION.
----------------------------------------------------

HE06A
=====

[PERSON'S FIRST NAME AND LAST NAME] [STR-DT] [END-DT]
Do you expect that (PERSON) will need help or supervision with personal care for at least three more months?
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]

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]
HELP AVAILABLE FOR EXAMPLES OF AIDS/SPECIAL EQUIPMENT.
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, UTOMATICALLY CODE PERSON AS 'USES AIDS' AT HE08 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, 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?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS FOR THE LTC SUPPLEMENT:
AIDS/SPECIAL EQUIPMENT SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE09
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

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.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, 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?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 13 YEARS OLD OR IN AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: FUNCTIONAL LIMITATIONS SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_03
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

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 [HE12]
SOME DIFFICULTY ........................ 2 [HE12]
A LOT OF DIFFICULTY .................... 3 [HE12]
COMPLETELY UNABLE TO DO IT ............. 4 [HE12]
REF ................................... -7 [HE12]
DK .................................... -8 [HE12]
[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, SELECT 'COMPLETELY UNABLE TO WALK'.
NO DIFFICULTY .......................... 1 [HE13]
SOME DIFFICULTY ........................ 2 [HE13]
A LOT OF DIFFICULTY .................... 3 [HE13]
COMPLETELY UNABLE TO DO IT ............. 4 [HE13]
COMPLETELY UNABLE TO WALK .............. 5 [HE17]
REF ................................... -7 [HE13]
DK .................................... -8 [HE13]
[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.
----------------------------------------------------

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 [HE14]
SOME DIFFICULTY ........................ 2 [HE14]
A LOT OF DIFFICULTY .................... 3 [HE14]
COMPLETELY UNABLE TO DO IT ............. 4 [HE15]
REF ................................... -7 [HE14]
DK .................................... -8 [HE14]
[Code One]
----------------------------------------------------
IF CODED '4' (COMPLETELY UNABLE TO DO IT), AUTOMATICALLY CODE HE14 AS '4' (COMPLETELY UNABLE TO DO IT) BY CAPI.
----------------------------------------------------

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 [HE15]
SOME DIFFICULTY ........................ 2 [HE15]
A LOT OF DIFFICULTY .................... 3 [HE15]
COMPLETELY UNABLE TO DO IT ............. 4 [HE15]
REF ................................... -7 [HE15]
DK .................................... -8 [HE15]
[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 [HE16]
SOME DIFFICULTY ........................ 2 [HE16]
A LOT OF DIFFICULTY .................... 3 [HE16]
COMPLETELY UNABLE TO DO IT ............. 4 [HE16]
REF ................................... -7 [HE16]
DK .................................... -8 [HE16]
[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 [HE17]
SOME DIFFICULTY ........................ 2 [HE17]
A LOT OF DIFFICULTY .................... 3 [HE17]
COMPLETELY UNABLE TO DO IT ............. 4 [HE17]
REF ................................... -7 [HE17]
DK .................................... -8 [HE17]
[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 [HE18]
SOME DIFFICULTY ........................ 2 [HE18]
A LOT OF DIFFICULTY .................... 3 [HE18]
COMPLETELY UNABLE TO DO IT ............. 4 [HE18]
REF ................................... -7 [HE18]
DK .................................... -8 [HE18]
[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 [HE18A]
SOME DIFFICULTY ........................ 2 [HE18A]
A LOT OF DIFFICULTY .................... 3 [HE18A]
COMPLETELY UNABLE TO DO IT ............. 4 [HE18A]
REF ................................... -7 [HE18A]
DK .................................... -8 [HE18A]
[Code One]

HE18A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
(Are/Is) (PERSON) expected to have difficulty with any of these activities for at least three more months?
YES .................................... 1 [END_LP03]
NO ..................................... 2 [END_LP03]
REF ................................... -7 [END_LP03]
DK .................................... -8 [END_LP03]

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]
HELP AVAILABLE 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.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, 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?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_04
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE20A - END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 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?
CHECK ALL THAT APPLY.
WORKING AT A JOB ...................... 1 [HE21]
DOING HOUSEWORK ....................... 2 [HE21]
GOING TO SCHOOL ....................... 3 [HE21]
REF ................................... -7 [HE21]
DK .................................... -8 [HE21]
[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 [END_LP04]
NO ..................................... 2 [END_LP04]
REF ................................... -7 [END_LP04]
DK .................................... -8 [END_LP04]
----------------------------------------------------
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]
HELP AVAILABLE 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.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, 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?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS WHO ARE = OR ) 5 YEARS OLD OR IN AGE CATEGORIES 3-9 FOR THE LTC SUPPLEMENT: SOCIAL LIMITATIONS SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE24
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

HE24
====

[STR-DT][END-DT]
Do any of the adults in the family...
YES NO

HE24_01
=======

Experience confusion or memory loss such that it interferes with daily activities? 1 2
----------------------------------------------------
REFUSED (-7) AND DON'T KNOW (-8) ALLOWED.
----------------------------------------------------

HE24_02
=======

Have problems making decisions to the point that it interferes with daily activities? 1 2
----------------------------------------------------
REFUSED (-7) AND DON'T KNOW (-8) ALLOWED.
----------------------------------------------------

HE24_03
=======

Require supervision for their own safety? 1 2
----------------------------------------------------
REFUSED (-7) AND DON'T KNOW (-8) ALLOWED.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
IF HE24_01, HE24_02, OR HE24_03 IS CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
IF HE24_01, HE24_02, AND HE24_03 ARE ALL CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
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]?
[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 '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.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

BOX_05
======

OMITTED.

BOX_05A
=======

OMITTED.

HE25A
=====

OMITTED.

HE25B
=====

OMITTED.

HE25C
=====

OMITTED.

HE26
====

[STR-DT] [END-DT]
Does anyone in the family wear eyeglasses or contact lenses?
YES ................................... 1 [HE27]
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.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, 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?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
CONTINUE WITH HE28
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS 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.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, 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]]?
[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 '[with glasses or contacts, if they use them]' IF HE26 IS CODED '1' (YES). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_05
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

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 [END_LP05]
NO .................................... 2 [HE31]
REF ................................... -7 [HE31]
DK .................................... -8 [HE31]
HELP AVAILABLE FOR DEFINITION OF BLIND.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: VISION SECTION.
----------------------------------------------------

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 [HE32]
REF ................................... -7 [HE32]
DK .................................... -8 [HE32]
----------------------------------------------------
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 [END_LP05]
NO .................................... 2 [END_LP05]
REF ................................... -7 [END_LP05]
DK .................................... -8 [END_LP05]
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO 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?
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS FOR THE LTC SUPPLEMENT:
HEARING SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE35
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU EMBERS.
----------------------------------------------------

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_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, 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]]?
[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 '[WITH A HEARING AID, IF THEY USE ONE]' IF HE33 IS CODED '1' (YES). OTHERWISE USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_06
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------

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 [END_LP06]
NO .................................... 2 [HE38]
REF ................................... -7 [HE38]
DK .................................... -8 [HE38]
HELP AVAILABLE FOR DEFINITION OF DEAF.
----------------------------------------------------
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: HEARING SECTION.
----------------------------------------------------

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 [HE39]
REF ................................... -7 [HE39]
DK .................................... -8 [HE39]
----------------------------------------------------
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 [END_LP06]
NO .................................... 2 [END_LP06]
REF ................................... -7 [END_LP06]
DK .................................... -8 [END_LP06]
----------------------------------------------------
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 GO TO BOX_10
----------------------------------------------------

BOX_06A
=======

OMITTED.

BOX_06
======

OMITTED.

HE40
====

OMITTED.

HE41
====

OMITTED.

LOOP_07
=======

OMITTED.

HE42
====

OMITTED.

HE43
====

OMITTED.

HE44
====

OMITTED.

HE44OV
======

OMITTED.

END_LP07
========

OMITTED.

BOX_07
======

OMITTED.

LOOP_08
=======

OMITTED.

HE45
====

OMITTED.

HE46
====

OMITTED.

HE47
====

OMITTED.

HE48
====

OMITTED.

HE49
====

OMITTED.

HE49A
=====

OMITTED.

END_LP08
========

OMITTED.

BOX_08
======

OMITTED.

LOOP_09
=======

OMITTED.

HE50
====

OMITTED.

HE51
====

OMITTED.

HE52
====

OMITTED.

HE52OV
======

OMITTED.

HE52A
=====

OMITTED.

HE52B
=====

OMITTED.

HE52BOV
=======

OMITTED.

HE53
====

OMITTED.

HE54
====

OMITTED.

HE54OV
======

OMITTED.

END_LP09
========

OMITTED.

BOX_09
======

OMITTED.

LOOP_10
=======

OMITTED.

HE55
====

OMITTED.

HE55_01
=======

OMITTED.

HE55_02
=======

OMITTED.

HE55_03
=======

OMITTED.

HE56
====

OMITTED.

HE56_01
=======

OMITTED.

HE56_02
=======

OMITTED.

HE57
====

OMITTED.

HE57_01
=======

OMITTED.

HE57_02
=======

OMITTED.

END_LP10
========

OMITTED.

BOX_10
======

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


Child Preventive Health Supplement (CS) Section


BOX_00A
=======

----------------------------------------------------
THE CS SECTION IS ASKED IN ROUNDS 2 AND 4 ONLY. IF IT IS ROUND 1, 3, OR 5, CONTINUE TO THE NEXT SECTION.
----------------------------------------------------

BOX_00
======

-----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME.
-----------------------------------------------------

BOX_01
======

-----------------------------------------------------
IF ANY RU MEMBERS ( OR = 17 YEARS OF AGE OR IN AGE CATEGORIES 1 THROUGH 4, CONTINUE WITH LOOP_01
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO BOX_08
-----------------------------------------------------

LOOP_01
=======

-----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK CS01-END_LP01
-----------------------------------------------------
-----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT A CHILD'S RESISTANCE TO ILLNESS, HEALTH NEEDS A CHILD MAY HAVE BECAUSE OF A HEALTH CONDITION (LWIM), RATINGS ON THE CHILD'S BEHAVIOR AND RELATIONSHIPS (CIS), HEALTH CARE THE CHILD RECEIVED IN THE LAST YEAR (CAHPS), AND INFORMATION ABOUT THE CHILD'S USE OF CLINICAL PREVENTIVE SERVICES. 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
AND
- PERSON IS ( OR = 17 YEARS OF AGE OR IN AGE CATEGORIES 1 THROUGH 4
-----------------------------------------------------

CS01
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-1.
[Now I'd like to talk about (PERSON).] The following are statements about (PERSON)'s general health status. How true or false is each of these statements for (PERSON)?
1 = DEFINITELY TRUE
2 = MOSTLY TRUE
3 = DON'T KNOW
4 = MOSTLY FALSE
5 = DEFINITELY FALSE

CS01_01
=======

a. (PERSON) seems to be less healthy than other children that I know. ( )

CS01_02
=======

b. (PERSON) has never been seriously ill. ( )

CS01_03
=======

c. When there is something going around, (PERSON) usually catches it. ( )

CS01_04
=======

d. I expect (PERSON) will have a very healthy life. ( )

CS01_05
=======

e. I worry more about (PERSON)'s health than other people worry about their children's health. ( )
----------------------------------------------------
DISPLAY "Now I'd like to talk about (PERSON)." IF NOT FIRST CYCLE THROUGH LOOP_01. OTHERWISE (THAT IS, IF IT IS THE FIRST CYCLE THROUGH LOOP_01), USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
OPTIONS 1-5 ARE RADIO BUTTONS IN EACH ROW TO THE RIGHT OF THE QUESTION TEXT, CS01_01 THROUGH CS01_05. CS01_01 THROUGH CS01_05 ARE DISPLAYED ON THE SCREEN TOGETHER.
----------------------------------------------------
----------------------------------------------------
REFUSED (-7) ALLOWED ON ALL ENTRY FIELDS.
----------------------------------------------------

CS02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
The next questions are about (PERSON)'s health needs and whether (PERSON) has a health condition. A health condition can be physical, mental or behavioral. Health conditions may affect a child's development, daily functioning or need for services.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

CS03
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does (PERSON) currently need or use medicine prescribed by a doctor, other than vitamins?
YES .................................... 1 [CS03OV1]
NO ..................................... 2 [CS04]
REF ................................... -7 [CS04]
DK .................................... -8 [CS04]

CS03OV1
=======

Is this because of any medical, behavioral or other health condition?
YES .................................... 1 [CS03OV2]
NO ..................................... 2 [CS04]
REF ................................... -7 [CS04]
DK .................................... -8 [CS04]

CS03OV2
=======

Is this a condition that has lasted or is expected to last for at least 12 months?
YES .................................... 1 [CS04]
NO ..................................... 2 [CS04]
REF ................................... -7 [CS04]
DK .................................... -8 [CS04]

CS04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does (PERSON) need or use more medical care, mental health or educational services than is usual for most children of the same age?
YES .................................... 1 [CS04OV1]
NO ..................................... 2 [CS05]
REF ................................... -7 [CS05]
DK .................................... -8 [CS05]

CS04OV1
=======

Is this because of any medical, behavioral or other health condition?
YES .................................... 1 [CS04OV2]
NO ..................................... 2 [CS05]
REF ................................... -7 [CS05]
DK .................................... -8 [CS05]

CS04OV2
=======

Is this a condition that has lasted or is expected to last for at least 12 months?
YES .................................... 1 [CS05]
NO ..................................... 2 [CS05]
REF ................................... -7 [CS05]
DK .................................... -8 [CS05]

CS05
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is (PERSON) limited or prevented in any way in (his/her) ability to do the things most children of the same age can do?
YES .................................... 1 [CS05OV1]
NO ..................................... 2 [CS06]
REF ................................... -7 [CS06]
DK .................................... -8 [CS06]

CS05OV1
=======

Is this because of any medical, behavioral or other health condition?
YES .................................... 1 [CS05OV2]
NO ..................................... 2 [CS06]
REF ................................... -7 [CS06]
DK .................................... -8 [CS06]

CS05OV2
=======

Is this a condition that has lasted or is expected to last for at least 12 months?
YES .................................... 1 [CS06]
NO ..................................... 2 [CS06]
REF ................................... -7 [CS06]
DK .................................... -8 [CS06]

CS06
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does (PERSON) need or get special therapy such as physical, occupational or speech therapy?
YES .................................... 1 [CS06OV1]
NO ..................................... 2 [CS07]
REF ................................... -7 [CS07]
DK .................................... -8 [CS07]

CS06OV1
=======

Is this because of any medical, behavioral or other health condition?
YES .................................... 1 [CS06OV2]
NO ..................................... 2 [CS07]
REF ................................... -7 [CS07]
DK .................................... -8 [CS07]

CS06OV2
=======

Is this a condition that has lasted or is expected to last for at least 12 months?
YES .................................... 1 [CS07]
NO ..................................... 2 [CS07]
REF ................................... -7 [CS07]
DK .................................... -8 [CS07]

CS07
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Does (PERSON) have any kind of emotional, developmental or behavioral problem for which (he/she) needs or gets treatment or counseling?
YES .................................... 1 [CS07OV]
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]

CS07OV
======

Is this a condition that has lasted or is expected to last for at least 12 months?
YES .................................... 1 [BOX_02]
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]

BOX_02
======

----------------------------------------------------
IF RU MEMBER BEING ASKED ABOUT IS AGED 5-17 YEARS, INCLUSIVE, OR IN AGE CATEGORIES 3 OR 4, CONTINUE WITH CS08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CS09A
----------------------------------------------------

CS08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-2.
The following questions are about some aspects of (PERSON)'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.

CS08_01. a. Getting along with (his/her) mother? ( )

CS08_02. b. Getting along with (his/her) father? ( )

CS08_03. c. Feeling unhappy or sad? ( )

CS08_04. d. (His/Her) behavior at school? ( )

CS08_05. e. Having fun? ( )

CS08_06. f. Getting along with other adults? ( )

CS08_07. g. Feeling nervous or afraid? ( )

CS08_08. h. Getting along with brothers and sisters? ( )

CS08_09. i. Getting along with other kids? ( )

CS08_10. j. Getting involved in activities like sports or hobbies? ( )

CS08_11. k. (His/Her) schoolwork? ( )

CS08_12. l. (His/Her) behavior at home? ( )

CS08_13. m. Staying out of trouble? ( )
----------------------------------------------------
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
2 = SOME PROBLEM
3
4 = VERY BIG PROBLEM
-7 = REF
-8 = DK
99 = INAPPLICABLE
----------------------------------------------------
----------------------------------------------------
NOTE: THIS SCREEN WILL BE SPLIT INTO TWO SCREENS IN CAPI. THE FIRST SCREEN (CS08A) WILL CONTAIN THE FOLLOWING PARTS OF THE QUESTION AS SPECIFIED BELOW:
- THE SHOW CARD LINE
- THE FIRST THREE BLOCKS OF TEXT
- THE INTERVIEWER INSTRUCTION: 'CODE 99...'
- CS08_01 (a.) THROUGH CS08_08 (h.) DISPLAYED IN MULTIPLE ROWS, WITH CS08_01 AND CS08_02 IN THE FIRST ROW, CS08_03 AND CS08_04 IN THE SECOND ROW, CS08_05 AND CS08_06 IN THE THIRD ROW, AND CS08_07 AND CS08_08 IN THE LAST ROW.

THE SECOND SCREEN (CS08B) WILL CONTAIN THE FOLLOWING PARTS OF THE QUESTION AS SPECIFIED BELOW:
- THE SHOW CARD LINE
- THE PROBE
- THE INTERVIEWER INSTRUCTION: 'CODE 99...'
- CS08_09 (i.) THROUGH CS08_13 (m.) DISPLAYED IN MULTIPLE ROWS, WITH CS08_09 AND CS08_10 IN THE FIRST ROW, CS08_11 AND CS08_12 IN THE SECOND ROW, AND CS08_13 IN THE LAST ROW.
----------------------------------------------------
----------------------------------------------------
SPECIAL CHECK:
THE VALUES FOR MOTHPROB, FATHPROB, UNHAPSAD, BEHVSCHL, HAVFUNPR, ADULPROB, NERVAFRD, SIBSPROB, KIDSPROB, SPORTHOB, SCHLWORK, BEHVHOME AND TROUBLE SHOULD BE BETWEEN 0 AND 4 AND SHOULD ALSO INCLUDE 99. A CHECK SHOULD BE CONDUCTED TO ENSURE THAT ANY VALUES OUTSIDE OF THOSE DEFINED PRODUCE AN ERROR AND PROHIBIT THE INTERVIEWER FROM CONTINUING UNTIL CORRECTED.
----------------------------------------------------

CS09
====

OMITTED.

CS10
====

OMITTED.

CS11
====

OMITTED.

CS09A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
The following questions are about the health care (PERSON) received in the last 12 months. In the last 12 months, did (PERSON) have an illness, injury or condition that needed care right away in a clinic, emergency room, or doctor's office?
YES .................................... 1 [CS10A]
NO ..................................... 2 [CS11A]
REF ................................... -7 [CS11A]
DK .................................... -8 [CS11A]

CS12
====

OMITTED.

CS10A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-3.
In the last 12 months, when (PERSON) needed care right away, how often did (PERSON) get care as soon as you thought (he/she) needed?
NEVER .................................. 1 [CS11A]
SOMETIMES .............................. 2 [CS11A]
USUALLY ................................ 3 [CS11A]
ALWAYS ................................. 4 [CS11A]
REF ................................... -7 [CS11A]
DK .................................... -8 [CS11A]
[Code One]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS10A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------

CS11A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, not counting the times (PERSON) needed health care right away, did you make any appointments for (PERSON)'s health care at a doctor's office or clinic?
YES .................................... 1 [CS12A]
NO ..................................... 2 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS11A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------

CS12A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-3.
In the last 12 months, not counting times (PERSON) needed health care right away, how often did (PERSON) get an appointment for health care at a doctor's office or clinic as soon as you thought (he/she) needed?
NEVER .................................. 1 [CS13]
SOMETIMES .............................. 2 [CS13]
USUALLY ................................ 3 [CS13]
ALWAYS ................................. 4 [CS13]
REF ................................... -7 [CS13]
DK .................................... -8 [CS13]
[Code One]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS12A WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------

CS13
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-3A.
In the last 12 months, not counting times (PERSON) went to an emergency room, how many times did (PERSON) go to a doctor's office or clinic to get health care?
NONE ................................... 0 [CS20]
1 TIME ................................. 1 [CS14A]
2 TIMES ................................ 2 [CS14A]
3 TIMES ................................ 3 [CS14A]
4 TIMES ................................ 4 [CS14A]
5 TO 9 TIMES............................ 5 [CS14A]
10 OR MORE TIMES ....................... 6 [CS14A]
REF ................................... -7 [CS20]
DK .................................... -8 [CS20]
[Code One]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS13 WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING.
----------------------------------------------------

CS14A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
In the last 12 months, did you or a doctor believe (PERSON) needed any care, tests, or treatment?
YES .................................... 1 [CS14]
NO ..................................... 2 [CS15]
REF ................................... -7 [CS15]
DK .................................... -8 [CS15]

CS14
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-3.
In the last 12 months, how often was it easy to get the care, tests, or treatments you or a doctor believed necessary?
NEVER .................................. 1 [CS15]
SOMETIMES .............................. 2 [CS15]
USUALLY ................................ 3 [CS15]
ALWAYS ................................. 4 [CS15]
REF ................................... -7 [CS15]
DK .................................... -8 [CS15]
[Code One]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AND RESPONSE CATEGORIES AT CS14 WERE CHANGED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING AND RESPONSE CATEGORIES. THE RESPONSE SCALE CHANGED FROM A PROBLEM SCALE TO A TIME FRAME SCALE
----------------------------------------------------

CS15
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-3.
In the last 12 months, how often did (PERSON)'s doctors or other health providers listen carefully to you?
NEVER .................................. 1 [CS16]
SOMETIMES .............................. 2 [CS16]
USUALLY ................................ 3 [CS16]
ALWAYS ................................. 4 [CS16]
REF ................................... -7 [CS16]
DK .................................... -8 [CS16]
[Code One]

CS16
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-3.
In the last 12 months, how often did (PERSON)'s doctors or other health providers explain things in a way that was easy to understand?
NEVER .................................. 1 [CS17]
SOMETIMES .............................. 2 [CS17]
USUALLY ................................ 3 [CS17]
ALWAYS ................................. 4 [CS17]
REF ................................... -7 [CS17]
DK .................................... -8 [CS17]
[Code One]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AT CS16 WAS UPDATED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING
----------------------------------------------------

CS17
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-3.
In the last 12 months, how often did (PERSON)'s doctors or other health providers show respect for what you had to say?
NEVER .................................. 1 [CS18]
SOMETIMES .............................. 2 [CS18]
USUALLY ................................ 3 [CS18]
ALWAYS ................................. 4 [CS18]
REF ................................... -7 [CS18]
DK .................................... -8 [CS18]
[Code One]

CS18
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-3.
In the last 12 months, how often did doctors or other health providers spend enough time with (PERSON)?
NEVER .................................. 1 [CS19]
SOMETIMES .............................. 2 [CS19]
USUALLY ................................ 3 [CS19]
ALWAYS ................................. 4 [CS19]
REF ................................... -7 [CS19]
DK .................................... -8 [CS19]
[Code One]

CS19
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-5.
Using any number from 0 to 10 where 0 is the worst health care possible, and 10 is the best health care possible, what number would you use to rate all (PERSON)'s health care in the last 12 months?
RATING FROM 0-10:
[Enter Number] ........................
REF ................................... -7 [CS20]
DK .................................... -8 [CS20]
----------------------------------------------------
HARD CHECK: 0-10
----------------------------------------------------

CS20
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When you answer the next questions, do not include dental visits. Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and others who specialize in one area of health care. In the last 12 months, did you or a doctor think (PERSON) needed to see a specialist?
YES .................................... 1 [CS21]
NO ..................................... 2 [CS22]
REF ................................... -7 [CS22]
DK .................................... -8 [CS22]

CS21
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD CS-3.
In the last 12 months, how often was it easy to see a specialist that (PERSON) needed to see?
NEVER .................................. 1 [CS22]
SOMETIMES .............................. 2 [CS22]
USUALLY ................................ 3 [CS22]
ALWAYS ................................. 4 [CS22]
REF ................................... -7 [CS22]
DK .................................... -8 [CS22]
[Code One]
----------------------------------------------------
IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, THE QUESTION WORDING AND RESPONSE CATEGORIES AT CS21 WERE CHANGED TO BE MORE CONSISTENT WITH CAHPS VERSION 4.0 QUESTION WORDING AND RESPONSE CATEGORIES. THE RESPONSE SCALE CHANGED FROM A PROBLEM SCALE TO A TIME FRAME SCALE.
----------------------------------------------------

CS22
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
The following questions are about amounts and types of preventive care (PERSON) may receive when (he/she) goes to see a doctor or other health provider. Has a doctor or other health provider ever measured (PERSON)'s height?
YES .................................... 1 [CS22OV]
NO ..................................... 2 [CS23_01]
REF ................................... -7 [CS23_01]
DK .................................... -8 [CS23_01]

CS22OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [CS23_01]
WITHIN PAST 2 YEARS .................... 2 [CS23_01]
MORE THAN 2 YEARS ...................... 3 [CS23_01]
REF ................................... -7 [CS23_01]
DK .................................... -8 [CS23_01]
[Code One]

CS23_01
=======

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how tall is (PERSON) without shoes?
PROBE FOR INCHES IF NOT REPORTED.
FEET:
[Enter Feet] .......................... [CS23_02]
REF ................................... -7 [CS24]
DK .................................... -8 [CS24]
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0 TO 7
----------------------------------------------------
----------------------------------------------------
NOTE THAT CS23_02 IS AN OVERLAY ON CS23_01.
----------------------------------------------------

CS23_02
=======

INCHES:
[Enter Inches] ........................ [CS24]
REF ................................... –7 [CS24]
DK .................................... –8 [CS24]
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-12
----------------------------------------------------
----------------------------------------------------
EDIT: IF FEET (CS23_01) = 0, INCHES (CS23_02) MUST BE 1-30. IF FEET (CS23_01) ) 0, INCHES (CS23_02) MUST BE 0-12.
----------------------------------------------------

CS24
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever measured (PERSON)'s weight?
YES .................................... 1 [CS24OV]
NO ..................................... 2 [CS25_01]
REF ................................... -7 [CS25_01]
DK .................................... -8 [CS25_01]

CS24OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [CS25_01]
WITHIN PAST 2 YEARS .................... 2 [CS25_01]
MORE THAN 2 YEARS ...................... 3 [CS25_01]
REF ................................... -7 [CS25_01]
DK .................................... -8 [CS25_01]
[Code One]

CS25_01
=======

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how much does (PERSON) weigh without shoes?
POUNDS:
[Enter Pounds] ........................
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
IF CS25_01 IS ( OR = 20 POUNDS, CONTINUE WITH CS25_02
----------------------------------------------------
----------------------------------------------------
IF CS25_01 IS ) 20 POUNDS, GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 1 TO 300
----------------------------------------------------
----------------------------------------------------
NOTE THAT CS25_02 IS AN OVERLAY ON CS25_01.
----------------------------------------------------

CS25_02
=======

OUNCES:
[Enter Ounces] ........................ [BOX_03]
REF ................................... –7 [BOX_03]
DK .................................... –8 [BOX_03]
PROBE FOR OUNCES IF NOT REPORTED.
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-15
----------------------------------------------------
----------------------------------------------------
EDIT: IF POUNDS (CS25_01) = 0, THEN OUNCES MUST BE 1-16.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF RU MEMBER BEING ASKED ABOUT IS AGED 3-6 YEARS, INCLUSIVE, OR IN AGE CATEGORIES 2 OR 3, CONTINUE WITH CS26
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_04
----------------------------------------------------

CS26
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever checked (PERSON)'s vision?
YES .................................... 1 [BOX_04]
NO ..................................... 2 [BOX_04]
TRIED, BUT (PERSON) WAS UNCOOPERATIVE .. 3 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
----------------------------------------------------
'(PERSON)' IN THE TEXT FOR CATEGORY 3 SHOULD BE IN PURPLE.
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF RU MEMBER BEING ASKED ABOUT IS ) OR = 2 YEARS OF AGE OR IN AGE CATEGORIES 2 THROUGH 4, CONTINUE WITH CS27
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

CS27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever measured (PERSON)'s blood pressure?
YES .................................... 1 [CS27OV]
NO ..................................... 2 [CS28]
TRIED, BUT (PERSON) WAS UNCOOPERATIVE .. 3 [CS27OV]
REF ................................... -7 [CS28]
DK .................................... -8 [CS28]
----------------------------------------------------
'(PERSON)' IN THE TEXT FOR CATEGORY 3 SHOULD BE IN PURPLE.
----------------------------------------------------

CS27OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [CS28]
WITHIN PAST 2 YEARS .................... 2 [CS28]
MORE THAN 2 YEARS ...................... 3 [CS28]
REF ................................... -7 [CS28]
DK .................................... -8 [CS28]
[Code One]

CS28
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever given you or (PERSON) advice about (PERSON) having regular dental check-ups?
YES .................................... 1 [CS28OV]
NO ..................................... 2 [CS29]
REF ................................... -7 [CS29]
DK .................................... -8 [CS29]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS28OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [CS29]
WITHIN PAST 2 YEARS .................... 2 [CS29]
MORE THAN 2 YEARS ...................... 3 [CS29]
REF ................................... -7 [CS29]
DK .................................... -8 [CS29]
[Code One]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever given you or (PERSON) advice about (PERSON) eating healthy?
YES .................................... 1 [CS29OV]
NO ..................................... 2 [CS30]
REF ................................... -7 [CS30]
DK .................................... -8 [CS30]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS29OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [CS30]
WITHIN PAST 2 YEARS .................... 2 [CS30]
MORE THAN 2 YEARS ...................... 3 [CS30]
REF ................................... -7 [CS30]
DK .................................... -8 [CS30]
[Code One]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS30
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever given you or (PERSON) advice about the amount and kind of exercise, sports, or physically active hobbies (PERSON) should have?
YES .................................... 1 [CS30OV]
NO ..................................... 2 [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS30OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [BOX_05]
WITHIN PAST 2 YEARS .................... 2 [BOX_05]
MORE THAN 2 YEARS ...................... 3 [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
[Code One]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

BOX_05
======

----------------------------------------------------
IF RU MEMBER BEING ASKED ABOUT:
- HAS A WEIGHT AT CS25_01 ( OR = 40 POUNDS,
OR
- IF CS25_01 IS CODED 'REF' OR 'DK'
AND
- PERSON ( OR = 4 YEARS OF AGE (OR IN AGE CATEGORIES 1 OR 2), CONTINUE WITH CS31
----------------------------------------------------
----------------------------------------------------
IF RU MEMBER BEING ASKED ABOUT:
- HAS A WEIGHT AT CS25_01 ) 40 AND ( OR = 80 POUNDS
OR
- IF CS25_01 IS CODED 'REF' OR 'DK'
AND
- PERSON ) 4 AND ( OR = 9 YEARS OF AGE (OR IN AGE CATEGORY 3), GO TO CS32
----------------------------------------------------
----------------------------------------------------
IF RU MEMBER BEING ASKED ABOUT:
- HAS A WEIGHT AT CS25_01 ) 80 POUNDS,
OR
- IF CS25_01 IS CODED 'REF' OR 'DK'
AND
- PERSON ) 9 YEARS OF AGE (OR IN AGE CATEGORY 4), GO TO CS33
----------------------------------------------------

CS31
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever given you or (PERSON) advice about (PERSON) using a child safety seat while riding in the car?
YES .................................... 1 [CS31OV]
NO ..................................... 2 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS31OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [BOX_06]
WITHIN PAST 2 YEARS .................... 2 [BOX_06]
MORE THAN 2 YEARS ...................... 3 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
[Code One]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS32
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever given you or (PERSON) advice about (PERSON) using a booster seat when riding in the car?
YES .................................... 1 [CS32OV]
NO ..................................... 2 [BOX_05A]
REF ................................... -7 [BOX_05A]
DK .................................... -8 [BOX_05A]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS32OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [BOX_05A]
WITHIN PAST 2 YEARS .................... 2 [BOX_05A]
MORE THAN 2 YEARS ...................... 3 [BOX_05A]
REF ................................... -7 [BOX_05A]
DK .................................... -8 [BOX_05A]
[Code One]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

BOX_05A
=======

----------------------------------------------------
IF CS25_01 IS CODED 'REF' OR 'DK' FOR RU MEMBER BEING ASKED ABOUT AND PERSON IS IN AGE CATEGORY 3 (AGE IS UNKNOWN), CONTINUE WITH CS33
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_06
----------------------------------------------------

CS33
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever given you or (PERSON) advice about (PERSON) using lap and shoulder belts when driving or riding in a car?
YES .................................... 1 [CS33OV]
NO ..................................... 2 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS33OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [BOX_06]
WITHIN PAST 2 YEARS .................... 2 [BOX_06]
MORE THAN 2 YEARS ...................... 3 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
[Code One]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

BOX_06
======

----------------------------------------------------
IF RU MEMBER BEING ASKED ABOUT IS ) OR = 2 YEARS OF AGE OR IN AGE CATEGORIES 2 THROUGH 4, CONTINUE WITH CS34
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CS35
----------------------------------------------------

CS34
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever given you or (PERSON) advice about (PERSON) using a helmet when riding a bicycle or motorcycle?
YES .................................... 1 [CS34OV]
NO ..................................... 2 [CS35]
REF ................................... -7 [CS35]
DK .................................... -8 [CS35]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU (ABOUT HELMETS)."

CS34OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [CS35]
WITHIN PAST 2 YEARS .................... 2 [CS35]
MORE THAN 2 YEARS ...................... 3 [CS35]
REF ................................... -7 [CS35]
DK .................................... -8 [CS35]
[Code One]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU (ABOUT HELMETS)."

CS35
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever given you advice about how smoking in the house can be bad for (PERSON)'s health?
YES .................................... 1 [CS35OV]
NO ..................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

CS35OV
======

When was that?
WITHIN PAST YEAR ....................... 1 [BOX_07]
WITHIN PAST 2 YEARS .................... 2 [BOX_07]
MORE THAN 2 YEARS ...................... 3 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
[Code One]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."

BOX_07
======

----------------------------------------------------
IF RU MEMBER BEING ASKED ABOUT IS ) OR = 12 YEARS OF AGE OR IN AGE CATEGORY 4, CONTINUE WITH CS36
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

CS36
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
The last time (PERSON) had a health care visit, did a doctor or other health provider spend any time alone with (PERSON) without a parent, relative or guardian in the room?
YES .................................... 1 [END_LP01]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [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_08
----------------------------------------------------

BOX_08
======

---------------------------------------------------
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 IS CODED '1' (YES) FOR USE OF MONTHLY PLANNER, HEALTH EVENTS WORKSHEET, RECORD FILE, OR OTHER CALENDAR, 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 MONTHLY PLANNER (CALENDAR) IF NOT ALREADY OUT.
HAS MONTHLY PLANNER .................... 1 [CA03]
HAS CALENDAR OTHER THAN
MONTHLY PLANNER ........................ 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/YYYY. FOR 'END DATE OF REFERENCE PERIOD', DISPLAY THE RU END DATE FOR ROUND 5 AS MM/DD/YYYY.
----------------------------------------------------

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 MONTHLY PLANNER .................... 1 [CA03]
HAS CALENDAR OTHER THAN
MONTHLY PLANNER ........................ 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/YYYY. FOR 'END DATE OF REFERENCE PERIOD', DISPLAY THE RU END DATE FOR ROUND 5 AS MM/DD/YYYY.
----------------------------------------------------

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_05]
MOST VISITS RECORDED ................... 2 [BOX_05]
SOME VISITS RECORDED ................... 3 [CA04]
DID NOT USE ............................ 4 [CA04]
VOLUNTEERED: NO EVENTS TO RECORD ...... 5 [BOX_05]
REF ................................... -7 [CA04]
DK .................................... -8 [CA04]
[Code One]
----------------------------------------------------
THE COMPUTER SUMMARY ITEMS (BOX_03 – CA05) WERE REMOVED IN PANEL 12 ROUND 2. STARTING IN PANEL 13, THESE ITEMS WILL BE OMITTED IN ALL ROUNDS.
----------------------------------------------------

CA04
====

GIVE RESPONDENT A MONTHLY PLANNER (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/[YEAR]] [AND DATE OF LAST INTERVIEW].
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY 'TODAY'S DATE' IF NOT ROUND 5. DISPLAY '12/31/[YEAR]' IF ROUND 5. FOR [YEAR] DISPLAY SECOND YEAR OF PANEL.

DISPLAY 'AND DATE OF LAST INTERVIEW' IF NOT ROUND 1. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
THE COMPUTER SUMMARY ITEMS (BOX_03 – CA05) WERE REMOVED IN PANEL 12 ROUND 2. STARTING IN PANEL 13, THESE ITEMS WILL BE OMITTED IN ALL ROUNDS.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_05
----------------------------------------------------

BOX_03
======

OMITTED.

BOX_04
======

OMITTED.

CA05
====

OMITTED.

BOX_05
======

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


Provider Probes (PP) Section


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PRND.BEGREFMM,DD,YY AND PRND.ENDREFMM,DD,YY.
----------------------------------------------------

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 2009], SELECT EVENT AND CONTINUE INTERVIEW.
---------------------------------------------------------
[Display Month,Day,Year-4] [Enter Month,Day,Year-4]
--------------------------------------------------------
[Display Month,Day,Year-4] [Enter Month,Day,Year-4]
--------------------------------------------------------
[Display Month,Day,Year-4] [Enter Month,Day,Year-4]
---------------------------------------------------------
----------------------------------------------------
DISPLAY THE DATE OF THE PREVIOUS ROUND'S INTERVIEW FOR '[PREV RD INTV DT]'.
DISPLAY 'OR RELEASED IN 2009' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_EVNT_EDIT_1

COL #1 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE (EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)

COL #2 HEADER: DISCHARGE DATE
INSTRUCTIONS: ENTER EVENT END DATE (EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-MEDICAL-EVENTS-ROSTER FOR ENTERING THE DISCHARGE DATE FOR ALL OPEN-ENDED HOSPITAL STAYS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, AND DELETE DISALLOWED.

2. LIMITED EDIT ALLOWED. ADMIT DATE IS A PROTECTED FIELD. INTERVIEWER CAN UPDATE DISCHARGE DATE.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAYS ALL HS EVENTS THAT WERE CODED '95' (STILL IN HOSPITAL) IN THE PREVIOUS ROUND.
----------------------------------------------------

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 AN INSTITUTION OR LONG-TERM CARE FACILITY, [OR RELEASED IN 2009], SELECT EVENT AND CONTINUE INTERVIEW.
---------------------------------------------------------
[Display Month,Day,Year-4] [Enter Month,Day,Year-4]
--------------------------------------------------------
[Display Month,Day,Year-4] [Enter Month,Day,Year-4]
--------------------------------------------------------
[Display Month,Day,Year-4] [Enter Month,Day,Year-4]
---------------------------------------------------------
----------------------------------------------------
DISPLAY THE DATE OF THE PREVIOUS ROUND'S INTERVIEW FOR '[PREV RD INTV DT]'.
DISPLAY 'OR RELEASED IN 2009' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_EVNT_EDIT_2

COL #1 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE (EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)

COL #2 HEADER: DISCHARGE DATE
INSTRUCTIONS: ENTER EVENT END DATE (EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-MEDICAL-EVENTS-ROSTER FOR ENTERING THE DISCHARGE DATE FOR ALL OPEN-ENDED STAYS IN INSTITUTIONS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, AND DELETE DISALLOWED.

2. LIMITED EDIT ALLOWED. ADMIT DATE IS A PROTECTED FIELD. INTERVIEWER CAN UPDATE DISCHARGE DATE.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAYS ALL IC EVENTS THAT WERE CODED '95' (STILL IN INSTITUTION) IN THE PREVIOUS ROUND.
----------------------------------------------------

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 [END_LP03)
NO ..................................... 2 [END_LP03)
[NO EVENTS ON CALENDAR TO RECORD ........ 3] [END_LP03)
----------------------------------------------------
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. Please be sure to include any visits or phone calls to a health care provider that you haven't told me about that were related to any health conditions we may have already discussed.
PRESS ENTER OR SELECT NEXT PAGE 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 [LOOP_04]
NO ..................................... 2 [PP06]
REF ................................... -7 [PP06]
DK .................................... -8 [PP06]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

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 [END_LP04]
NO ..................................... 2 [END_LP04]
REF ................................... -7 [END_LP04]
DK .................................... -8 [END_LP04]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT WAS JUST ADDED FOR '[PERSON'S FIRST MIDDLE AND LAST NAME]'.
----------------------------------------------------

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 [LOOP_05]
NO ..................................... 2 [PP07A]
REF ................................... -7 [PP07A]
DK .................................... -8 [PP07A]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
DISPLAY 'Has' IF NOT ROUND 5. DISPLAY 'Between (START DATE) and (END DATE), has' IF ROUND 5.
----------------------------------------------------

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 [END_LP05]
NO ..................................... 2 [END_LP05]
REF ................................... -7 [END_LP05]
DK .................................... -8 [END_LP05]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT WAS JUST ADDED FOR '[PERSON'S FIRST MIDDLE AND LAST NAME]'.
----------------------------------------------------

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 PP07A
----------------------------------------------------

PP07A
=====

[STR-DT] [END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], has anyone in the family had any visits to an independent lab or testing facility for x-rays or other tests? [Please include any care we have not yet talked about.]
YES .................................... 1 [LOOP_05A]
NO ..................................... 2 [PP07B]
REF ................................... -7 [PP07B]
DK .................................... -8 [PP07B]
HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR TESTING FACILITY.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_05A
========

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

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_07A - END_LP05A.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05A COLLECTS ALL LAB EVENTS (I.E., OP, OR MV EVENTS) NOT ALREADY RECORDED.

THE RESPONSE TO PP07AA DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP07AA IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07AA IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_07A
=======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP07AA
----------------------------------------------------

PP07AA
======

[STR-DT] [END-DT]
Has [PERSON'S FIRST MIDDLE AND LAST NAME] had any other visits to an independent lab or testing facility? Or has anyone else in the family been seen at an independent lab or testing facility? [Please include any care we have not yet talked about.]
YES .................................... 1 [END_LP05A]
NO ..................................... 2 [END_LP05A]
REF ................................... -7 [END_LP05A]
DK .................................... -8 [END_LP05A]
HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR TESTING FACILITY.
----------------------------------------------------
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT WAS JUST ADDED FOR '[PERSON'S FIRST MIDDLE AND LAST NAME]'.
----------------------------------------------------

END_LP05A
=========

----------------------------------------------------
IF PP07AA IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP07AA IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_05A AND CONTINUE WITH PP07B
----------------------------------------------------

PP07B
=====

[STR-DT] [END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], has anyone in the family had any visits to someone who practices alternative care such as acupuncture, massage therapy, hypnosis, or other treatments? [Please include any alternative care we have not yet talked about.]
YES .................................... 1 [LOOP_05B]
NO ..................................... 2 [PP08]
REF ................................... -7 [PP08]
DK .................................... -8 [PP08]
HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE PROVIDER.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_05B
========

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

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_07B - END_LP05B.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05B COLLECTS ALL ALTERNATIVE CARE EVENTS (I.E., MV EVENTS) NOT ALREADY RECORDED.

THE RESPONSE TO PP07BB DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP07BB IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07BB IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_07B
=======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP07BB
----------------------------------------------------

PP07BB
======

[STR-DT][END-DT]
Has [PERSON'S FIRST MIDDLE AND LAST NAME] had any other visits to someone who practices alternative care? Or has anyone else in the family been seen by someone who practices alternative care? [Please include any alternative care we have not yet talked about.]
YES .................................... 1 [END_LP05B]
NO ..................................... 2 [END_LP05B]
REF ................................... -7 [END_LP05B]
DK .................................... -8 [END_LP05B]
HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE PROVIDER.
----------------------------------------------------
DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT WAS JUST ADDED FOR '[PERSON'S FIRST MIDDLE AND LAST NAME]'.
----------------------------------------------------

END_LP05B
=========

----------------------------------------------------
IF PP07BB IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP07BB IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_05B 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 [LOOP_06]
NO ..................................... 2 [PP12]
REF ................................... -7 [PP12]
DK .................................... -8 [PP12]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [END_LP06]
NO ..................................... 2 [END_LP06]
REF ................................... -7 [END_LP06]
DK .................................... -8 [END_LP06]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [LOOP_07]
NO ..................................... 2 [BOX_09A]
REF ................................... -7 [BOX_09A]
DK .................................... -8 [BOX_09A]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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.
----------------------------------------------------

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 [END_LP07]
NO ..................................... 2 [END_LP07]
REF ................................... -7 [END_LP07]
DK .................................... -8 [END_LP07]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.

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 [YEAR], that is from January 1, [YEAR] until December 31, [YEAR]. 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 [YEAR]? 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 [LOOP_07A]
NO ..................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN PROGRAM IS AUTOMATICALLY SET.)

IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR 'YEAR'.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

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 CALENDAR YEAR. IF ROUND 3, THE YEAR IS THE FIRST CALENDAR YEAR OF THE PANEL. IF ROUND 5, THE YEAR IS THE SECOND CALENDAR YEAR OF THE PANEL 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 [YEAR], 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 [END_LP07A]
NO ..................................... 2 [END_LP07A]
REF ................................... -7 [END_LP07A]
DK .................................... -8 [END_LP07A]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN PROGRAM IS AUTOMATICALLY SET.)

IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR 'YEAR'.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

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. Also include any visits or phone calls to a health care provider that were related to any conditions we may have already discussed.
PRESS ENTER OR SELECT NEXT PAGE 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 ELIGIBLE 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 [LOOP_09]
NO ..................................... 2 [PP17]
REF ................................... -7 [PP17]
DK .................................... -8 [PP17]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [END_LP09]
NO ..................................... 2 [END_LP09]
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [LOOP_10]
NO ..................................... 2 [PP19]
REF ................................... -7 [PP19]
DK .................................... -8 [PP19]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [END_LP10]
NO ..................................... 2 [END_LP10]
REF ................................... -7 [END_LP10]
DK .................................... -8 [END_LP10]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 did (PERSON) receive care in a hospital emergency room or hospital outpatient department?
YES .................................... 1 [LOOP_11]
NO ..................................... 2 [PP21]
REF ................................... -7 [PP21]
DK .................................... -8 [PP21]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [END_LP11]
NO ..................................... 2 [END_LP11]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [LOOP_12]
NO ..................................... 2 [PP22A]
REF ................................... -7 [PP22A]
DK .................................... -8 [PP22A]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [END_LP12]
NO ..................................... 2 [END_LP12]
REF ................................... -7 [END_LP12]
DK .................................... -8 [END_LP12]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 PP22A
----------------------------------------------------

PP22A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) have any visits to an independent lab or testing facility for x-rays or other tests?
YES .................................... 1 [LOOP_12A]
NO ..................................... 2 [PP22B]
REF ................................... -7 [PP22B]
DK .................................... -8 [PP22B]
HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR TESTING FACILITY.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_12A
========

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

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_14A - END_LP12A.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_12A COLLECTS ALL LAB EVENTS (I.E., OP, OR MV EVENTS) NOT ALREADY RECORDED.

THE RESPONSE TO PP22AA DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP22AA IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22AA IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_14A
=======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP22AA
----------------------------------------------------

PP22AA
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) have any other visits to an independent lab or testing facility (other than what you've already told me about)?
YES .................................... 1 [END_LP12A]
NO ..................................... 2 [END_LP12A]
REF ................................... -7 [END_LP12A]
DK .................................... -8 [END_LP12A]
HELP AVAILABLE FOR DEFINITION OF INDEPENDENT LAB OR TESTING FACILITY.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP12A
=========

----------------------------------------------------
IF PP22AA IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP22AA IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_12A AND CONTINUE WITH PP22B
----------------------------------------------------

PP22B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) have any visits to someone who practices alternative care such as acupuncture, massage therapy, hypnosis, or other treatments?
YES .................................... 1 [LOOP_12B]
NO ..................................... 2 [PP23]
REF ................................... -7 [PP23]
DK .................................... -8 [PP23]
HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE PROVIDER.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

LOOP_12B
========

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

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_14B - END_LP12B.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_12B COLLECTS ALL ALTERNATIVE CARE EVENTS (I.E., MV EVENTS) NOT ALREADY RECORDED.

THE RESPONSE TO PP22BB DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP22BB IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22BB IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_14B
=======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP22BB
----------------------------------------------------

PP22BB
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Since (START DATE)/Between (START DATE) and (END DATE)], did (PERSON) have any other visits to someone who practices alternative care (other than what you've already told me about)?
YES .................................... 1 [END_LP12B]
NO ..................................... 2 [END_LP12B]
REF ................................... -7 [END_LP12B]
DK .................................... -8 [END_LP12B]
HELP AVAILABLE FOR DEFINITION OF ALTERNATIVE CARE PROVIDER.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

END_LP12B
=========

----------------------------------------------------
IF PP22BB IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP22BB IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_12B 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 [LOOP_13]
NO ..................................... 2 [PP25]
REF ................................... -7 [PP25]
DK .................................... -8 [PP25]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [END_LP13]
NO ..................................... 2 [END_LP13]
REF ................................... -7 [END_LP13]
DK .................................... -8 [END_LP13]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [LOOP_14]
NO ..................................... 2 [PP27]
REF ................................... -7 [PP27]
DK .................................... -8 [PP27]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [END_LP14]
NO ..................................... 2 [END_LP14]
REF ................................... -7 [END_LP14]
DK .................................... -8 [END_LP14]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [LOOP_15]
NO ..................................... 2 [BOX_17A]
REF ................................... -7 [BOX_17A]
DK .................................... -8 [BOX_17A]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
DISPLAY 'Since (START DATE)' IF NOT ROUND 5.
DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

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 [END_LP15]
NO ..................................... 2 [END_LP15]
REF ................................... -7 [END_LP15]
DK .................................... -8 [END_LP15]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
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 [YEAR], that is from January 1, [YEAR] until December 31, [YEAR]. 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 [YEAR]?
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 [LOOP_16]
NO ..................................... 2 [END_LP08]
REF ................................... -7 [END_LP08]
DK .................................... -8 [END_LP08]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN PROGRAM IS AUTOMATICALLY SET.)

IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR 'YEAR'.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

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 THAT ARE NOT ALREADY RECORDED FOR THE CALENDAR YEAR. IF ROUND 3, THE YEAR IS THE FIRST CALENDAR YEAR OF THE PANEL. IF ROUND 5, THE YEAR IS THE SECOND CALENDAR YEAR OF THE PANEL.

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 [YEAR], (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 [END_LP16]
NO ..................................... 2 [END_LP16]
REF ................................... -7 [END_LP16]
DK .................................... -8 [END_LP16]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSE ONLY, YEAR IN PROGRAM IS AUTOMATICALLY SET.)

IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR 'YEAR'.
IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR 'YEAR'.
----------------------------------------------------

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_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.DRFNAM, PROV.LORPNAME (IF EVNT.PROVNUM ^= -1), EVNT.EVNTTYPE (IF SET), EVNT.EVNTBEGM,D (EVNTBEGM ONLY FOR HH), (PRND.BEGREFMM, DD FOR OM), EVNT.EVNTENDM, D (IF EVNT = HS), (PRND.ENDREFMM, DD FOR OM).
----------------------------------------------------

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.
[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 DETAILS:
TITLE: RU_MEMBERS_SELECTONE

COL # 1 HEADER: PERSON-TYPE-PROVIDER
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER FOR SELECTION OF RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED. INTERVIEWER MAY SELECT ONE FROM THE LISTED MEMBERS.

2. MULTIPLE SELECT DISALLOWED.

3. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL.
----------------------------------------------------

EV02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
INTERVIEWER: WHAT TYPE OF EVENT IS IT?
HOSPITAL STAY ......................... HS [BOX_02]
HOSPITAL EMERGENCY ROOM ............... ER [BOX_02]
HOSPITAL OUTPATIENT DEPARTMENT ........ OP [BOX_02]
MEDICAL PROVIDER VISIT ................ MV [BOX_02]
DENTAL CARE ........................... DN [BOX_02]
HOME HEALTH ........................... HH [EV06]
OTHER MEDICAL EXPENSES ................ OM
INSTITUTIONAL/LONG TERM CARE STAY ..... IC [BOX_02]
HELP AVAILABLE 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 [BOX_06]
INSULIN ................................ 2 [BOX_06]
OTHER DIABETIC EQUIPMENT OR SUPPLIES ... 3 [BOX_06]
[Code All That Apply]
----------------------------------------------------
IF CODED '2' (INSULIN), ADD 'INSULIN' TO PERSON'S-PRESCRIBED-MEDICINES-ROSTER, CREATING NECESSARY RECORDS FOR INSULIN.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (OTHER DIABETIC EQUIPMENT OR SUPPLIES), ADD 'OTHER DIABETIC EQUIP/SUPPLIES' TO PERSON'S-PRESCRIBED-MEDICINES-ROSTER, CREATING NECESSARY RECORDS FOR 'OTHER DIABETIC EQUIP/SUPPLIES'.
----------------------------------------------------

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 [YEAR]?
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]
----------------------------------------------------
(FOR SPECIFICATIONS ONLY, 'YEAR' IN PROGRAM IS HARD-CODED.) IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER) ALONE OR IN COMBINATION WITH ANY OTHER CODES, CONTINUE WITH EV03AOV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_06
----------------------------------------------------

EV03AOV
=======
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)?
PROBE: Any other stays?
-------------------------------------------------------
[Enter Month,Day,Year-4] [Enter Month,Day,Year-4]
------------------------------------------------------
[Enter Month,Day,Year-4] [Enter Month,Day,Year-4]
------------------------------------------------------
[Enter Month,Day,Year-4] [Enter Month,Day,Year-4]
-------------------------------------------------------
----------------------------------------------------
DISPLAY 'OR RELEASED IN [YEAR]' IF ROUND 5, WHERE 'YEAR' IS THE CALENDAR YEAR SUBSEQUENT TO THE SECOND YEAR OF THE PANEL. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY A RADIO BUTTON ON THE DATE ENTRY SCREEN LABELED 'CHECK IF STILL IN PROVIDER [OR RELEASED IN [YEAR]].
----------------------------------------------------
----------------------------------------------------
ALLOW RF AND DK FOR THE DAY AND YEAR BUT NOT FOR THE MONTH.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT CHECK:

IN ROUND 1 ONLY, ALLOW AN ADMIT DATE ONE YEAR PRIOR TO THE RU MEMBER'S REFERENCE PERIOD START DATE.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_06
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS_EVNT_ADD_1

COL # 1 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE (EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)

COL # 2 HEADER: DISCHARGE DATE
INSTRUCTIONS: DISPLAY EVENT END DATE (EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY)

----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-MEDICAL-EVENTS- ROSTER FOR ADDING BEGIN AND END DATES.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. EDIT AND SELECT DISALLOWED.

2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE EVENT BEGIN AND END DATES.

3. LIMITED DELETE ALLOWED. 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, THEY SHOULD BE ABLE TO DELETE AN EVENT ENTERED IN ERROR.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY NO EVENTS ON ROSTER INITIALLY. THIS SCREEN RELATES TO HS AND IC EVENT TYPES (EVNT.EVNTTYPE) ONLY.
----------------------------------------------------

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?
----------------------------
[Enter Month,Day,Year-4]
----------------------------
[Enter Month,Day,Year-4]
----------------------------
[Enter Month,Day,Year-4]
----------------------------
----------------------------------------------------
DISPLAY 'ADD EVENT DATE', 'EDIT EVENT DATE', AND 'DELETE EVENT DATE' BUTTONS ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ALLOW RF AND DK FOR THE DAY AND YEAR BUT NOT FOR THE MONTH.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_06
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS_EVNT_ADD_2

COL # 1 HEADER: EVENT DATE
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE (EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS PERSON'S- MEDICAL-EVENTS-ROSTER FOR ADDING EVENT BEGIN DATES.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
THIS ITEM CAN COLLECT ONLY THOSE EVENTS THAT ARE THE SAME PROVIDER, PERSON, AND EVENT TYPE AS THE EVENT BEING ASKED ABOUT.

1. SELECT DISALLOWED.

2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE EVENT BEGIN DATES.

3. LIMITED DELETE ALLOWED. 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, THEY SHOULD BE ABLE TO DELETE AN EVENT ENTERED IN ERROR.

4. LIMITED EDIT ALLOWED. INTERVIEWER CAN EDIT AN EVENT THAT WAS ENTERED ON THE SCREEN WHERE EDIT IS USED. THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, THEY SHOULD BE ABLE TO EDIT AN EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY NO EVENTS ON ROSTER INITIALLY.
----------------------------------------------------

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 [EV06A]
VOLUNTEERED: MEAL DELIVERY SERVICE .... 5 [BOX_06]
HELP AVAILABLE 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 [EV07OV1]
[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
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
FOR SPECIFICATION PURPOSES ONLY: CAPI DOES NOT ALLOW 'RF' OR 'DK' IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF EV07OV1 IS CODED '91' (OTHER) ALONE OR IN COMBINATION WITH ANY OTHER CODES, CONTINUE WITH EV07OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EV08
----------------------------------------------------

EV07OV2
=======
OTHER:
[Enter Other Specify] .................. [EV08]
REF ................................... -7 [EV08]
DK .................................... -8 [EV08]

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] ....................... [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
----------------------------------------------------
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'.
----------------------------------------------------

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 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 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 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
----------------------------------------------------
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 [EV11]
HOMEMAKER .............................. 4
HOME HEALTH AIDE ....................... 5
NURSE'S AIDE ........................... 6
PERSONAL CARE ATTENDANT ................ 7
OTHER ................................. 91 [EV10OV]
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
IF EV10 NOT CODED '3' (HEALTH PROFESSIONAL), OR '91' (OTHER), AND ROUND 1, GO TO EV12 OTHERWISE, GO TO EV13
----------------------------------------------------

EV10OV
======
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 [EV11OV]
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
----------------------------------------------------
IF EV11 NOT CODED '91' (OTHER), AND ROUND 1, GO TO EV12
----------------------------------------------------
----------------------------------------------------
IF EV11 NOT CODED '91' (OTHER), AND ROUNDS 2-5, GO TO EV13
----------------------------------------------------

EV11OV
======
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, [YEAR]?
YES .................................... 1 [EV13]
NO ..................................... 2 [EV13]
REF ................................... -7 [EV13]
DK .................................... -8 [EV13]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS A FACILITY.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN QUESTION TEXT IS FIRST CALENDAR YEAR OF PANEL.
----------------------------------------------------

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
----------------------------------------------------
DISPLAY FIRST PARAGRAPH IF A HOME HEALTH EVENT FOR THE MONTH OF THE PREVIOUS ROUND'S INTERVIEW 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.
----------------------------------------------------
----------------------------------------------------
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.

3. THE MONTHS ARE DISPLAYED IN GRID FORMAT WITH YES/NO/DK/RF RADIO BUTTONS.

4. EV13 HAS TO ACCOMMODATE AT LEAST 10 MONTHS.

5. 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.

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 ASKED ONE TIME. THAT IS, IT IS NOT A SEPARATE EVENT FOR BOTH THE PREVIOUS ROUND AND THIS ROUND, IT IS ONLY ONE EVENT.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: CAPI REQUIRES A RESPONSE FOR EACH MONTH DISPLAYED. ALL MONTHS DURING THE REFERENCE PERIOD CANNOT BE CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF ALL ARE, WVS ERROR HANDLER WILL FORCE THE INTERVIEWER TO RECTIFY THE DATA.
----------------------------------------------------

BOX_06
======

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


Provider Roster (PV) Section


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME AND EVNT.EVNTTYPE.
----------------------------------------------------

BOX_00A
=======

----------------------------------------------------
CAPI SETS PROV.PROVTYPE USING DATA FROM MULTIPLE QUESTIONS, NOT JUST PV01. ULTIMATELY, THE VALUES ARE AS FOLLOWS:
1 – FACILITY
2 – PERSON
3 – PERSON IN FACILITY
----------------------------------------------------

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)?
[IF FACILITY NAMED, PROBE: If (PERSON) usually (see/sees) a particular person at this place, please give me the name of that person first.]
PERSON ................................. 1
FACILITY ............................... 2 [BOX_01]
HELP AVAILABLE 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.

DISPLAY 'IF FACILITY NAMED, PROBE: ... person first.' IF THE PV SECTION WAS CALLED FROM THE AC SECTION. IF THE PV SECTION WAS NOT 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 NO PERSON-PROVIDERS ON RU-MEDICAL-PROVIDERS- ROSTER AND PV01 IS CODED '1', THEN CREATE A NEW PROV RECORD.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (PERSON) AND NO PROVIDERS THAT ARE TYPE 'PERSON-PROVIDER' ON RU-MEDICAL-PROVIDERS- ROSTER, GO TO PV04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (PERSON) AND AT LEAST ONE PROVIDER THAT IS TYPE 'PERSON-PROVIDER' ON RU-MEDICAL- PROVIDERS-ROSTER, CONTINUE WITH PV02
----------------------------------------------------
----------------------------------------------------
HARD CHECK: 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, THE ERROR HANDLER WILL FORCE THE INTERVIEWER TO RECTIFY THE DATA.
----------------------------------------------------

PV02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV]
What is the name of the person that [provided health care to (PERSON)/(PERSON) usually (go/goes) to if (PERSON) (is/are) sick]?
SELECT CORRECT [USUAL SOURCE OF CARE] PROVIDER [ASSOCIATED WITH THE EVENT].
------------------------------------------------------------------------
ROSTER. PV02_02. FACILITY PV02_03. STREET PERSON-TYPE-PROVIDER
------------------------------------------------------------------------
1. [Display Truncated [Display Truncated [Display Truncated Person-Provider-25] Facility-Provider-30] Street Address-15]
------------------------------------------------------------------------
2. [Display Truncated [Display Truncated [Display Truncated Person-Provider-25] Facility-Provider-30] Street Address-15]
------------------------------------------------------------------------
3. [Display Truncated [Display Truncated [Display Truncated Person-Provider-25] Facility-Provider-30] Street Address-15]
------------------------------------------------------------------------
----------------------------------------------------
DISPLAY 'provided health care to (PERSON)' 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, DISPLAY '(PERSON) usually (go/goes) to if (PERSON) (is/are) sick'.
----------------------------------------------------
----------------------------------------------------
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.

DISPLAY AN 'ADD PROVIDER' OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD NEW PROVIDER' IS SELECTED, GO TO PV04
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PV03
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_PROV_SELECTONE_1

COL # 1 HEADER: PERSON-TYPE-PROVIDER
INSTRUCTIONS: DISPLAY TRUNCATED PERSON-PROVIDER NAME (PROV.DRFNAME (10), PROV.LORPNAME (15))

COL # 2 HEADER: FACILITY
INSTRUCTIONS: DISPLAY FACILITY-PROVIDER NAME (PROV.PVASSOC (30)) (IF NO FACILITY, USE NULL
DISPLAY)

COL # 3 HEADER: STREET
INSTRUCTIONS: DISPLAY TRUNCATED STREET ADDRESS (PROV.PVSTRT1, PROV.PVSTRT2 (15))
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEDICAL-PROVIDERS-ROSTER FOR SELECTING ONE MEDICAL PROVIDER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED. INTERVIEWER MAY SELECT ONE FROM THE LISTED MEDICAL PROVIDERS.

2. MULTIPLE SELECT DISALLOWED.

3. ADD ALLOWED USING THE 'ADD PROVIDER' BUTTON.

4. DELETE AND EDIT ARE NOT ALLOWED.

5. IF PROVIDER IS A PERSON-PROVIDER NOT ASSOCIATED WITH A FACILITY (PROV.PROVTYPE=2), THE FACILITY COLUMN IS EMPTY FOR THAT ROW.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSON PROVIDERS (PROV.PROVTYPE = 2) AND PERSON-IN-FACILITY PROVIDERS (PROV.PROVTYPE = 3).
----------------------------------------------------

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 ASSOC 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]
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 ASSOC W/ PERSON-TYPE- PROVIDER.], DISPLAY THE FACILITY PROVIDER NAME ASSOCIATED WITH THE PERSON-PROVIDER SELECTED AT PV02. IF NO FACILITY ASSOCIATED WITH THIS PERSON 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 ADDRESS FOR THE PERSON PROVIDER SELECTED AT PV02.

DISPLAY 'and FACILITY NAME' IF THERE IS A FACILITY- PROVIDER NAME ASSOCIATED WITH THE PERSON PROVIDER SELECTED AT PV02. IF NO FACILITY ASSOCIATED WITH THIS PROVIDER, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF "ADD NEW ADDRESS FOR PROVIDER" SELECTED, CREATE A NEW PROVIDER RECORD FOR THIS PROVIDER. SET PROVIDER TYPE AS 'PERSON-TYPE-PROVIDER' (PROVTYPE=2).
----------------------------------------------------
----------------------------------------------------
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]
What is the first and last name of the person that [provided health care to (PERSON)/(PERSON) usually (go/goes) to if (PERSON) (is/are) sick]?
ENTER COMPLETE PROVIDER NAME [ASSOCIATED WITH THIS EVENT] AND VERIFY SPELLING.
[Enter Provider Name-65] ............... [PV05]
----------------------------------------------------
DISPLAY 'provided health care to (PERSON)' 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, DISPLAY '(PERSON) usually (go/goes) to if (PERSON) (is/are) sick'.
----------------------------------------------------
----------------------------------------------------
DISPLAY '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.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'CLICK 'ADD PROVIDER' TO ADD A NEW PROVIDER.' IF THERE ARE NO RECORDS IN THE ROSTER.
----------------------------------------------------
----------------------------------------------------
CREATE A NEW PERSON-PROVIDER ON 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 [PV06]
REF ................................... -7 [PV06]
DK .................................... -8 [PV06]
----------------------------------------------------
IF CODED '1' (YES), FLAG PROVIDER AS 'PERSON-IN- FACILITY-PROVIDER' (PROVTYPE=3).
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), FLAG PROVIDER AS 'PERSON- PROVIDER' (PROVTYPE=2).
----------------------------------------------------

PV06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV]
What is the [new] street address for (PROVIDER)?
ENTER STREET ADDRESS AND VERIFY SPELLING. IF PROVIDER HAS MORE THAN ONE LOCATION, RECORD LOCATION PERSON VISITED.
PROVIDER_STR1: [_____________]
PROVIDER_STR2: [_____________]
----------------------------------------------------
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 ADDRESS FIELD.
----------------------------------------------------
----------------------------------------------------
IF PV04 WAS ASKED, ASSOCIATE ADDRESS WITH PERSON-TYPE-PROVIDER ENTERED AT PV04.
----------------------------------------------------
----------------------------------------------------
IF PV03 WAS CODED '2' (ADD NEW ADDRESS PROVIDER), RECORD ADDRESS IN THE NEW PROVIDER RECORD CREATED AT PV03.

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 PROVIDER AS A 'PERSON-IN-FACILITY-PROVIDER' (PROVTYPE=3).
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------

PV07
====

OMITTED.

BOX_01
======

----------------------------------------------------
IF NO PROVIDERS THAT ARE 'FACILITY-PROVIDER' (PROVTYPE=1) ON RU-MEDICAL-PROVIDERS-ROSTER, GO TO PV10
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PV08
----------------------------------------------------

PV08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV]
What is the name of the place that [provided health care to (PERSON)/(PERSON) usually (go/goes) to if (PERSON) (is/are) sick]?
SELECT CORRECT [USUAL SOURCE OF CARE] [PROVIDER/FACILITY]
[ASSOCIATED WITH THE EVENT].
--------------------------------------------------------
ROSTER. FACILITY-PROVIDERS PV08_02. STREET
--------------------------------------------------------
[Display Truncated [Display Truncated Facility-Provider-30] Street Address-15]
--------------------------------------------------------
[Display Truncated [Display Truncated Facility-Provider-30] Street Address-15]
--------------------------------------------------------
[Display Truncated [Display Truncated Facility-Provider-30] Street Address-15]
--------------------------------------------------------
----------------------------------------------------
DISPLAY 'provided health care to (PERSON)' 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, DISPLAY '(PERSON) usually (go/goes) to if (PERSON) (is/are) sick'.
----------------------------------------------------
----------------------------------------------------
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 '1' (PERSON). DISPLAY 'FACILITY' IF PV01 IS CODED '2' (FACILITY).

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.

DISPLAY AN 'ADD PROVIDER' OR 'ADD NEW FACILITY' OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD PROVIDER' IS SELECTED, GO TO PV10 (NOTE THAT PV10 IS ACTUALLY A POPUP ON PV08 AND PV09)
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PV09
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_PROV_SELECTONE_2

COL # 1 HEADER: FACILITY-PROVIDER
INSTRUCTIONS: DISPLAY TRUNCATED FACILITY-PROVIDER (PROV.LORPNAME)

COL # 2 HEADER: STREET
INSTRUCTIONS: DISPLAY TRUNCATED STREET ADDRESS (PROV.PVSTRT1, PROV.PVSTRT2)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEDICAL-PROVIDERS-ROSTER FOR SELECTING ONE FACILITY TYPE MEDICAL PROVIDER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED. INTERVIEWER MAY SELECT ONE FROM THE LISTED MEDICAL PROVIDERS.

2. MULTIPLE SELECT DISALLOWED.

3. DELETE AND EDIT ARE NOT ALLOWED.

4. ADD ALLOWED. INTERVIEWER CAN SELECT THE 'ADD PROVIDER' BUTTON.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY FACILITY TYPE (PROV.PROVTYPE = 1) PROVIDERS.
----------------------------------------------------

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 [PV10]
SELECTED WRONG FACILITY/ADDRESS ........ 4
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]
----------------------------------------------------
DISPLAY 'PROVIDER' IF PV01 IS CODED '1' (PERSON). DISPLAY 'FACILITY' IF PV01 IS CODED '2' (FACILITY).

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 ADDRESS FOR THE FACILITY-PROVIDER SELECTED AT PV08.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (FACILITY NAME AND ADDRESS CORRECT) AND PV01 IS CODED '1' (PERSON), LINK THE FACILITY SELECTED AT PV08 TO THE PERSON PROVIDER FLAGGED AS 'PERSON-IN-FACILITY-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
IF FACILITY-PROVIDER WAS SELECTED AT PV08 AND PV09 WAS CODED '2' (ADD NEW ADDRESS FOR FACILITY), CREATE ANOTHER RECORD FOR THE FACILITY-PROVIDER ON THE RU-MEDICAL-PROVIDERS-ROSTER AND ASSOCIATE ADDRESS THAT WILL BE ENTERED AT PV10 WITH THAT NEW PROVIDER RECORD. FLAG NEW PROVIDER AS FACILITY (PROVTYPE=1).
----------------------------------------------------
----------------------------------------------------
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]
What is the [new] name and street address of the place that [provided health care to (PERSON)/(PERSON) usually (go/goes) to if (PERSON) (is/are) sick]?
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): [_____________] [BOX_02]
FACILITY_STR2 (PV10_03): [_____________] [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
----------------------------------------------------
DISPLAY 'provided health care to (PERSON)' 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, DISPLAY '(PERSON) usually (go/goes) to if (PERSON) (is/are) sick'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'new' IF PV09 IS CODED '2' (ADD NEW ADDRESS FOR FACILITY). OTHERWISE, USE A NULL DISPLAY. DISPLAY 'PROVIDER' IF PV01 IS CODED '1' (PERSON). DISPLAY 'FACILITY' IF PV01 IS CODED '2' (FACILITY). DISPLAY 'NAME AND' IF 'ADD PROVIDER' WAS SELECTED AT PV08 OR PV08 WAS NOT ASKED.
IF 'ADD PROVIDER' 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 DISPLAY THE NAME OF THE PROVIDER(S) ASSOCIATED WITH THE EVENT ONLY IF PV09 WAS CODED '2' (ADD NEW ADDRESS FOR FACILITY).
----------------------------------------------------
----------------------------------------------------
CODES '-7' (REF) AND '-8' (DK) ARE ALLOWED ON THE STREET ADDRESS FIELDS ONLY.
----------------------------------------------------
----------------------------------------------------
IF PV09 IS CODED '2' (ADD NEW ADDRESS FOR FACILITY), PV10 WILL NOT COLLECT THE FACILITY NAME. THE NEW PROVIDER RECORD FOR THIS FACILITY WAS ALREADY CREATED AT PV09 AND THE ADDRESS WILL BE RECORDED AT PV10.
----------------------------------------------------
----------------------------------------------------
IF FACILITY-PROVIDER NOT SELECTED AT PV08 (I.E., PV08 WAS NOT ASKED OR 'NONE OF THE ABOVE' WAS SELECTED), ADD A FACILITY-PROVIDER TO THE RU-MEDICAL-PROVIDERS-ROSTER. FLAG NEW PROVIDER AS FACILITY (PROVTYPE=1).

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

PV11
====

OMITTED.

BOX_02
======

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


Event Driver (ED) Section


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.LORPNAME, EVPV.EVNTTYPE, EVPV.EVNTBEGM, EVPV.EVNTBEGD, AND EVPV.EVNTBEGY.
----------------------------------------------------

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 OR SELECT NEXT PAGE 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
=======

----------------------------------------------------
LOOP DEFINITION: LOOP_02 CORRECTS CURRENT ROUND EVENT INFORMATION COLLECTED IN THE EVENT ROSTER SECTION, AS NEEDED. THE 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
- EVENT IS 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 INFORMATION OK ('1') UNLESS RESPONDENT VOLUNTEERS CORRECTION.
INFORMATION OK ......................... 1 [END_LP02]
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 NAME OF THE MEDICAL PROVIDER AND THE EVENT DATE IN THE HEADER ONLY IF THE EVENT TYPE IS NOT 'OM'.
----------------------------------------------------
----------------------------------------------------
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 NAME OF THE OME GROUP BEING LOOPED ON FOR 'OME ITEM GROUP NAME'.
DISPLAY 'the...home...(MONTH)' IF EVENT TYPE IS HH
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.
----------------------------------------------------
----------------------------------------------------
IF POSSIBLE ON SCREEN, INSERT A COLUMN HEADER BEFORE THE VALUE OF '2', READING "CORRECTIONS NEEDED" AS SHOWN ON CAPI SCREEN.
IN LABEL FOR ANSWER CATEGORY 9, DISPLAY "(PERSON)" IN PURPLE (TO BE READ FROM HEADER).
----------------------------------------------------
----------------------------------------------------
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.'
----------------------------------------------------
----------------------------------------------------
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.'
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (DATE(S)) INCORRECT AND EVENT TYPE IS DN, ER, OP, OR MV, CONTINUE WITH ED04A
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (DATE(S)) INCORRECT AND EVENT TYPE IS HS, GO TO ED04B
----------------------------------------------------
----------------------------------------------------
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.'
----------------------------------------------------
----------------------------------------------------
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
====

OMITTED.

ED04
====

OMITTED.

ED04A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
INTERVIEWER: TO CORRECT DATE, SELECT DATE, THEN CLICK THE EDIT DATE LINK.
[Enter MM/DD/YYYY-4]
-----------------------------------------------------
REFUSED AND DON'T KNOW ARE ALLOWED IN THE DAY AND YEAR FIELDS BUT ARE DISALLOWED IN THE MONTH FIELD.
-----------------------------------------------------
-----------------------------------------------------
WRITE CORRECTION TO PERSON'S-MEDICAL-EVENTS-ROSTER.
-----------------------------------------------------
-----------------------------------------------------
GO TO END_LP02
-----------------------------------------------------

ED04B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
INTERVIEWER: TO CORRECT DATE, SELECT DATE, THEN CLICK THE EDIT DATE LINK.
[Enter MM/DD/YYYY-4] - [Enter MM/DD/YYYY-4]
-----------------------------------------------------
REFUSED AND DON'T KNOW ARE ALLOWED IN THE DAY AND YEAR FIELDS BUT ARE DISALLOWED IN THE MONTH FIELD.
-----------------------------------------------------
-----------------------------------------------------
IF DISCHARGE DATE IS '95' (STILL IN FACILITY), THIS HS EVENT IS NOT CLOSED IN THE CURRENT ROUND.
FLAG EVENT AS PROCESSED AND FLAG CHARGE PAYMENT AS PROCESSED.
-----------------------------------------------------
-----------------------------------------------------
WRITE CORRECTION TO PERSON'S-MEDICAL-EVENTS-ROSTER.
-----------------------------------------------------
-----------------------------------------------------
GO TO END_LP02
-----------------------------------------------------

ED05
====

[NAME OF MEDICAL CARE PROVIDER......] [EV] [EVN-DT]
INTERVIEWER: SELECT CORRECT PERSON FOR THIS EVENT.
[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 DETAILS:
TITLE: RU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT ARE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
EXCLUDE THE PERSON CURRENTLY BEING LOOPED ON WHEN DISPLAYING THE RU MEMBERS ROSTER.
----------------------------------------------------
----------------------------------------------------
DELETE EVENT FROM PERSON'S-MEDICAL-EVENTS-ROSTER FOR PERSON ORIGINALLY ASSOCIATED WITH EVENT AND ADD EVENT TO PERSON'S-MEDICAL-EVENT-ROSTER FOR SELECTED PERSON.
----------------------------------------------------
----------------------------------------------------
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] [EV]
INTERVIEWER: SELECT CORRECT OME ITEM GROUP.
GLASSES OR CONTACT LENSES .............. 1 [END_LP02]
INSULIN ................................ 2 [END_LP02]
OTHER DIABETIC EQUIPMENT OR SUPPLIES ... 3 [END_LP02]
[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]
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 [ED06AOV]
[Code One]
----------------------------------------------------
IF THE SELECTED OME ITEM GROUP EXISTS, DISPLAY THE FOLLOWING MESSAGE: 'OM OF THIS TYPE ALREADY EXISTS. PLEASE RE-SELECT OME GROUP.'
----------------------------------------------------

ED06AOV
=======
OTHER GROUP OF OTHER MEDICAL EXPENSES (OME) ITEMS:
[Enter Other Specify] ................. [BOX_ED06A]
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 [ED08]
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]
HELP AVAILABLE 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.
-----------------------------------------------------
----------------------------------------------------
IF CHANGE TO HS, ER, OR OP AND PROVIDER IS A PERSON-TYPE-PROVIDER, DISPLAY THE FOLLOWING MESSAGE: 'YOU MUST CHANGE TO A FACILITY PROVIDER BEFORE CHANGING THE EVENT TYPE.'
----------------------------------------------------
----------------------------------------------------
IF THE SELECTED EVENT TYPE MATCHES THE EVENT TYPE ORIGINALLY ASSOCIATED WITH THE EVENT BEING ASKED ABOUT, DISPLAY THE FOLLOWING MESSAGE: 'YOU MUST CHANGE THE EVENT TYPE. PLEASE RESELECT.'
----------------------------------------------------

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 MM/DD/YYYY-4] - [Enter MM/DD/YYYY-4]
-----------------------------------------------------
WHEN SCREEN IS DISPLAYED, DISPLAY THE EVENT DATE AS THE ADMIT DATE AND LEAVE THE DISCHARGE DATE BLANK. BOTH DATES CAN BE CORRECTED.
-----------------------------------------------------
-----------------------------------------------------
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):
----------------------------------------------------------------------
ED09_01. NAME ED09_02. ROSTER. ED09_04. ED09_05. C/P MEDICAL EVENT TYPE DATE-DATE UTIL PROVIDER
----------------------------------------------------------------------
1. [Display [Display [Display [Display [Display Medical Event Code] Month Selection] Selection] Provider-35] Day Year-4]
----------------------------------------------------------------------
2. [Display [Display [Display [Display [Display Medical Event Code] Month Selection] Selection] Provider-35] Day Year-4]
----------------------------------------------------------------------
3. [Display [Display [Display [Display [Display Medical Event Code] Month Selection] Selection] Provider-35] Day Year-4]
----------------------------------------------------------------------
----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
ADD TEXT FOR EVNT.OMTYPE CODE
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS_EVNT_DISPLAY_1

COL # 1 NAME MEDICAL PROVIDER
DISPLAY MEDICAL PROVIDER
EVPV.LORPNAME, EVPV.DRFNAM, EVPV.DRMNAM

COL # 2 EVENT TYPE
DISPLAY EVENT TYPE
EVNT.EVNTTYPE

COL # 3 EVENT DATE
DISPLAY EVENT DATE
EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY
EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY

COL # 4 UTIL
DISPLAY SELECTION
EVNT.UTFLAG

COL # 5 C/P
DISPLAY SELECTION
EVNT.PROCFLAG
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE PERSON'S-MEDICAL-EVENTS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
2. CAPI DISPLAYS A CHECK MARK IN THE 'UTIL' COLUMN IF THE EVENT HAS COMPLETED THE APPROPRIATE UTILIZATION SECTION.
3. CAPI DISPLAYS A CHECK MARK IN THE 'C/P' COLUMN IF THE EVENT HAS COMPLETED THE CHARGE/PAYMENT (CP) SECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
THIS ITEM DISPLAYS ALL EVENTS ON THE PERSON'S- MEDICAL-EVENTS_ROSTER THAT WERE CREATED IN THE CURRENT ROUND OR HELD OVER FROM THE PREVIOUS ROUND (I.E., UTIL AND THE CHARGE/PAYMENT (CP) SECTION WERE NOT MARKED AS PROCESSED, EXCEPT EVENTS WITH THE EVENT TYPE (EVPV.EVNTTYPE) 'PM'.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH ED09OV1
----------------------------------------------------

ED09OV1
=======
ADD AN EVENT?
YES .................................... 1 [BOX_04]
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 2009'], 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 OR YEAR 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] ............... [HS02]
REF ................................... -7 [HS02]
DK .................................... -8 [HS02]
----------------------------------------------------
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 [HS03]
NO ..................................... 2 [HS03]
REF ................................... -7 [HS03]
DK .................................... -8 [HS03]
HELP AVAILABLE FOR DEFINITION OF EMERGENCY ROOM.
----------------------------------------------------
IF CODED '1' (YES), DISPLAY THE FOLLOWING MESSAGE: "PLEASE BE SURE YOU HAVE ENTERED THIS EMERGENCY ROOM VISIT FOR THIS PERSON."
----------------------------------------------------

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 [HS04]
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, SELECT ENTRY ON ROSTER.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS-COND-1

COL #1 HEADER: MEDICAL CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON-MEDICAL-CONDITIONS- ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITIONS ASSOCIATED WITH THIS EVENT
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. MULTIPLE ADD ALLOWED.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER;
DISPLAY ALL.
----------------------------------------------------

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 [HS08]
TREATMENT OR THERAPY, NOT INCLUDING SURGERY .............................. 2 [HS06]
DIAGNOSTIC TESTS ONLY .................. 3 [HS06]
GIVE BIRTH TO A BABY - NORMAL OR CAESAREAN SECTION (MOTHER) ........... 4 [HS06]
TO BE BORN (BABY) ...................... 5 [HS06]
PREGNANCY-RELATED COMPLICATIONS ........ 6 [HS06]
OTHER ................................. 91 [HS06]
REF ................................... -7 [HS06]
DK .................................... -8 [HS06]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '4' (GIVE BIRTH TO A BABY) AND CODE '6' (PREGNANCY-RELATED COMPLICATIONS) ONLY IF PERSON IS FEMALE. ALLOW CODE '5' (TO BE BORN) ONLY IF PERSON IS ( OR = 1 YEAR OLD (OR AGE CATEGORY 1).
----------------------------------------------------
----------------------------------------------------
IF CODED '4' (GIVE BIRTH TO A BABY), DISPLAY THE FOLLOWING MESSAGE: "PLEASE BE SURE YOU HAVE ALSO ENTERED A HOSPITAL STAY EVENT FOR THE BABY." IF CODED '5' (TO BE BORN), DISPLAY THE FOLLOWING MESSAGE: "PLEASE BE SURE YOU HAVE ALSO ENTERED A HOSPITAL STAY EVENT FOR THE MOTHER."
----------------------------------------------------
----------------------------------------------------
IF HS05 IS CODED '1' (OPERATION OR SURGICAL PROCEDURE), AUTOMATICALLY CODE HS06 AS '1' (YES) BY CAPI
----------------------------------------------------

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 [BOX_01A]
NO ..................................... 2 [BOX_01A]
REF ................................... -7 [BOX_01A]
DK .................................... -8 [BOX_01A]
HELP AVAILABLE FOR DEFINITION OF OPERATIONS/SURGICAL PROCEDURES.

BOX_01A
=======

----------------------------------------------------
IF HS05 IS CODED '4' (GIVE BIRTH TO A BABY), CONTINUE WITH HS06A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HS08
----------------------------------------------------

HS06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
What kind of delivery did (PERSON) have? Was it vaginal delivery or caesarean section?
VAGINAL DELIVERY ....................... 1 [HS06B]
CAESAREAN SECTION ...................... 2 [HS06B]
REF ................................... -7 [HS06B]
DK .................................... -8 [HS06B]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

HS06B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Did (PERSON) receive an epidural or a 'spinal' for pain?
YES .................................... 1 [HS08]
NO ..................................... 2 [HS08]
REF ................................... -7 [HS08]
DK .................................... -8 [HS08]
HELP AVAILABLE FOR DEFINITION OF EPIDURAL/SPINAL.

HS07
====

OMITTED.

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 [HS09]
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
HELP AVAILABLE 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?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
----------------------------------------------------
DISPLAY 'ADD MEDICINE' AS AN OPTION ON THIS SCREEN
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERSON'S-PRESCRIBED-MEDICINES_1.

COL # 1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE (DRUG.DRUGNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES- ROSTER FOR SELECTION AND ADDITION OF PRESCRIBED MEDICINES.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT AND ADD ALLOWED.

2. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE MEDICINES ADDED AT THE SECCTION AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS MEDICINE AND THE EVENT.

3. EDIT DISALLOWED.

4. ANY MEDICINE ADDED TO THE ROSTER SHOULD BE FLAGGED AS 'CREATED' THIS ROUND. ANY MEDICINE SELECTED AT THE ROSTER SHOULD BE FLAGGED AS 'SELECTED' THIS ROUND. 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 BE FLAGGED ONLY AS EITHER '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.

5. WHEN A MEDICINE FROM A PREVIOUS ROUND IS SELECTED, A NEW EVENT IS CREATED SINCE IT INVOLVES A NEW PURCHASE OF THE MEDICINE. A NEW PURCHASE REQUIRES ASKING CP AND THE 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).
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL MEDICINES ON PERSON'S ROSTER;
NO FILTER.
----------------------------------------------------

HS10
====

OMITTED.

HS11
====

OMITTED.

LOOP_01
=======

OMITTED.

BOX_02
======

OMITTED.

BOX_03
======

OMITTED.

HS12
====

OMITTED.

END_LP01
========

OMITTED.

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


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.LORPNAME, EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY
----------------------------------------------------

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 [ER02]
NO ..................................... 2 [ER02]
REF ................................... -7 [ER02]
DK .................................... -8 [ER02]
HELP AVAILABLE 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 [ER03]
EMERGENCY (E.G., ACCIDENT OR INJURY) ... 2 [ER03]
PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING ............................. 3 [ER03]
FOLLOW-UP OR POST-OPERATIVE VISIT ...... 4 [ER03]
IMMUNIZATIONS OR SHOTS ................. 5 [ER03]
PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY) ............ 6 [ER03]
OTHER ................................. 91 [ER03]
REF ................................... -7 [ER03]
DK .................................... -8 [ER03]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
IF CODED '6' (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)), 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 [ER04]
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, SELECT ENTRY ON ROSTER.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
GO TO ER05
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1

COL #1 HEADER: MEDICAL CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.

2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE CONDITION NAME.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT. IF THE INTERVIEWER ATTEMPTS TO DELETE A CONDITION WHEN DELETE IS NOT ALLOWED, DISPLAY THE FOLLOWING MESSAGE:
"DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED."

4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT. IF THE INTERVIEWER ATTEMPTS TO EDIT A CONDITION WHEN EDIT IS NOT ALLOWED, DISPLAY THE FOLLOWING MESSAGE: "EDIT ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

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?
CHECK ALL THAT APPLY.
LABORATORY TESTS ....................... 1 [ER06]
SONOGRAM OR ULTRASOUND ................. 2 [ER06]
X-RAYS ................................. 3 [ER06]
MAMMOGRAM .............................. 4 [ER06]
MRI OR CATSCAN ......................... 5 [ER06]
EKG OR ECG ............................. 6 [ER06]
EEG .................................... 7 [ER06]
VACCINATION ............................ 8 [ER06]
ANESTHESIA ............................. 9 [ER06]
OTHER DIAGNOSTIC TEST ................. 10 [ER06]
THROAT SWAB ........................... 11 [ER06]
NO SERVICES RECEIVED .................. 95 [ER06]
REF ................................... -7 [ER06]
DK .................................... -8 [ER06]
HELP AVAILABLE 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) ALONE ONLY; THESE RESPONSES MAY NOT BE SELECTED WITH ANY OTHER RESPONSE.
----------------------------------------------------
----------------------------------------------------
NOTE: 'OTHER DIAGNOSTIC TESTS' AND 'NO SERVICES RECEIVED' ARE NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: IF CODED '95' (NO SERVICES RECEIVED), NO OTHER SERVICE CATEGORIES CAN BE CODED. IF INTERVIEWER SELECTS ANOTHER CODE WITH 'NO SERVICES', DISPLAY THE FOLLOWING MESSAGE: "NO SERVICES RECEIVED CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE-ENTER."
----------------------------------------------------

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 [ER08]
NO ..................................... 2 [ER08]
REF ................................... -7 [ER08]
DK .................................... -8 [ER08]
HELP AVAILABLE FOR DEFINITION OF SURGICAL PROCEDURE.

ER07
====

OMITTED.

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 [ER09]
NO ..................................... 2 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
HELP AVAILABLE 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?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
----------------------------------------------------
DISPLAY 'ADD MEDICINE' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERSON'S_PRESCRIBED_MEDICINES_1

COL # 1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE (DRUG.DRUGNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-PRESCRIPTION- MEDICINES-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. MULTIPLE ADD ALLOWED.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A MEDICINE ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS MEDICINE AND THE EVENT.

4. EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL MEDICINES ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

ER10
====

OMITTED.

ER11
====

OMITTED.

LOOP_01
=======

OMITTED.

BOX_01
======

OMITTED.

BOX_02
======

OMITTED.

ER12
====

OMITTED.

END_LP01
========

OMITTED.

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


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.LORPNAME, EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY
----------------------------------------------------

OP01
====

OMITTED.

OP02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Did (PERSON) visit the outpatient department at (PROVIDER) on (VISIT DATE) in person or was this a telephone call?
SAW PROVIDER ........................... 1 [OP04]
TELEPHONE CALL ......................... 2 [OP04]
REF ................................... -7 [OP04]
DK .................................... -8 [OP04]
[Code One]
----------------------------------------------------
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'. (THIS EVENT IS FLAGGED IN SUCH A WAY FOR PURPOSES OF SKIPS IN THE C/P SECTION.
HOWEVER, 'RF' AND 'DK' WILL USE THE SAME QUESTION WORDING AS 'OP-IN-PERSON' EVENTS DURING THE ADMINISTRATION OF THE OP SECTION.
----------------------------------------------------

OP03
====

OMITTED.

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 [OP04A]
NO ..................................... 2 [OP05]
REF ................................... -7 [OP05]
DK .................................... -8 [OP05]
HELP AVAILABLE 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.
----------------------------------------------------

OP04A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE
PROVIDER] [EVN-DT]
What was the doctor's specialty?
IF TALKED TO MORE THAN ONE DOCTOR, PROBE FOR MAIN PROVIDER.
ALLERGY/IMMUNOLOGY .................... 1 [BOX_01]
ANESTHESIOLOGY ........................ 2 [BOX_01]
CARDIOLOGY (HEART) .................... 3 [BOX_01]
DERMATOLOGY (SKIN) .................... 4 [BOX_01]
ENDOCRINOLOGY/METABOLISM (DIABETES, THYROID) ................. 5 [BOX_01]
FAMILY PRACTICE ....................... 6 [BOX_01]
GASTROENTEROLOGY ...................... 7 [BOX_01]
GENERAL PRACTICE ...................... 8 [BOX_01]
GENERAL SURGERY ....................... 9 [BOX_01]
GERIATRICS (ELDERLY) .................. 10 [BOX_01]
GYNECOLOGY/OBSTETRICS ................. 11 [BOX_01]
HEMATOLOGY (BLOOD) .................... 12 [BOX_01]
HOSPITAL RESIDENCE .................... 13 [BOX_01]
INTERNAL MEDICINE (INTERNIST) ......................... 14 [BOX_01]
NEPHROLOGY (KIDNEYS) .................. 15 [BOX_01]
NEUROLOGY ............................. 16 [BOX_01]
NUCLEAR MEDICINE ...................... 17 [BOX_01]
ONCOLOGY (TUMORS, CANCER) ............. 18 [BOX_01]
OPHTHALMOLOGY (EYES) .................. 19 [BOX_01]
ORTHOPEDICS ........................... 20 [BOX_01]
OSTEOPATHY (DO) ....................... 21 [BOX_01]
OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT) ................. 22 [BOX_01]
PATHOLOGY ............................. 23 [BOX_01]
PEDIATRICIAN .......................... 24 [BOX_01]
PHYSICAL MEDICINE/REHAB ............... 25 [BOX_01]
PLASTIC SURGERY ....................... 26 [BOX_01]
PROCTOLOGY ............................ 27 [BOX_01]
PSYCHIATRY/PSYCHIATRIST ............... 28 [BOX_01]
PULMONARY ............................. 29 [BOX_01]
RADIOLOGY ............................. 30 [BOX_01]
RHEUMATOLOGY (ARTHRITIS) .............. 31 [BOX_01]
THORACIC SURGERY (CHEST) .............. 32 [BOX_01]
UROLOGY ............................... 33 [BOX_01]
OTHER DR SPECIALTY .................... 91 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

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 [BOX_01]
DENTIST/DENTAL CARE PERSON ............ 2 [BOX_01]
MIDWIFE ............................... 3 [BOX_01]
NURSE/NURSE PRACTITIONER .............. 4 [BOX_01]
OPTOMETRIST ........................... 5 [BOX_01]
PODIATRIST ............................ 6 [BOX_01]
PHYSICIAN'S ASSISTANT ................. 7 [BOX_01]
PHYSICAL THERAPIST .................... 8 [BOX_01]
OCCUPATIONAL THERAPIST ................ 9 [BOX_01]
PSYCHOLOGIST .......................... 10 [BOX_01]
SOCIAL WORKER ......................... 11 [BOX_01]
TECHNICIAN ............................ 12 [BOX_01]
ACUPUNCTURIST ......................... 14 [BOX_01]
MASSAGE THERAPIST ..................... 15 [BOX_01]
HOMEOPATHIC/NATUROPATHIC/HERBALIST .... 16 [BOX_01]
OTHER ALTERNATIVE/COMPLEMENTARY CARE PROVIDER ....................... 17 [BOX_01]
OTHER ................................. 91 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

OP06
====

OMITTED.

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]
SHOW CARD OP-1.
Please look at this card and tell me which category best describes the care (PERSON) received during the visit to the outpatient department at (PROVIDER) on (VISIT DATE).
GENERAL CHECKUP ........................ 1 [OP08]
DIAGNOSIS OR TREATMENT ................. 2 [OP08]
EMERGENCY (E.G., ACCIDENT OR INJURY) ... 3 [OP08]
PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING ............................. 4 [OP08]
FOLLOW-UP OR POST-OPERATIVE VISIT ...... 5 [OP08]
IMMUNIZATIONS OR SHOTS ................. 6 [OP08]
VISION EXAM ............................ 7 [OP08]
PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY) ................... 8 [OP08]
WELL CHILD EXAM ........................ 9 [OP08]
LASER EYE SURGERY ..................... 10 [OP08]
OTHER ................................. 91 [OP08]
REF ................................... -7 [OP08]
DK .................................... -8 [OP08]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
IF CODED '8' (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)), 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 [OP09]
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, SELECT ENTRY ON ROSTER.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1

COL #1 HEADER: MEDICAL CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. MULTIPLE ADD ALLOWED.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

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?
CHECK ALL THAT APPLY.
PHYSICAL THERAPY ....................... 1 [OP11]
OCCUPATIONAL THERAPY ................... 2 [OP11]
SPEECH THERAPY ......................... 3 [OP11]
CHEMOTHERAPY ........................... 4 [OP11]
RADIATION THERAPY ...................... 5 [OP11]
KIDNEY DIALYSIS ........................ 6 [OP11]
IV THERAPY ............................. 7 [OP11]
DRUG OR ALCOHOL TREATMENT .............. 8 [OP11]
ALLERGY SHOT ........................... 9 [OP11]
PSYCHOTHERAPY/COUNSELING .............. 10 [OP11]
SHOTS, OTHER THAN ALLERGY ............. 11 [OP11]
NO TREATMENTS RECEIVED ................ 95 [OP11]
REF ................................... -7 [OP11]
DK .................................... -8 [OP11]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '95' (NO TREATMENTS RECEIVED), '-7' (REFUSED), AND '-8' (DON'T KNOW) ALONE ONLY.
THESE RESPONSES MAY NOT BE SELECTED WITH ANY OTHER RESPONSE.
----------------------------------------------------
----------------------------------------------------
'NO TREATMENTS RECEIVED' IS NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: IF CODED '95' (NO TREATMENTS RECEIVED), NO OTHER TREATMENT CATEGORIES CAN BE CODED. IF INTERVIEWER SELECTS ANOTHER CODE WITH 'NO TREATMENTS', DISPLAY THE FOLLOWING MESSAGE: "NO TREATMENTS RECEIVED CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE-ENTER."
----------------------------------------------------

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?
CHECK ALL THAT APPLY.
LABORATORY TESTS ....................... 1 [OP12]
SONOGRAM OR ULTRASOUND ................. 2 [OP12]
X-RAYS ................................. 3 [OP12]
MAMMOGRAM .............................. 4 [OP12]
MRI OR CATSCAN ......................... 5 [OP12]
EKG OR ECG ............................. 6 [OP12]
EEG .................................... 7 [OP12]
VACCINATION ............................ 8 [OP12]
ANESTHESIA ............................. 9 [OP12]
OTHER DIAGNOSTIC TEST ................. 10 [OP12]
THROAT SWAB ........................... 11 [OP12]
NO SERVICES RECEIVED .................. 95 [OP12]
REF ................................... -7 [OP12]
DK .................................... -8 [OP12]
[Code All That Apply]
HELP AVAILABLE 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) ALONE ONLY.
THESE RESPONSES MAY NOT BE SELECTED WITH ANY OTHER RESPONSE.
----------------------------------------------------
----------------------------------------------------
'OTHER DIAGNOSTIC TEST' AND 'NO SERVICES RECEIVED' ARE NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: IF CODED '95' (NO SERVICES RECEIVED), NO OTHER TREATMENT CATEGORIES CAN BE CODED. IF INTERVIEWER SELECTS ANOTHER CODE WITH 'NO SERVICES', DISPLAY THE FOLLOWING MESSAGE: "NO SERVICES RECEIVED CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE-ENTER."
----------------------------------------------------
----------------------------------------------------
NOTE: CODE '11' (THROAT SWAB) IS DISPLAYED ON THE SCREEN AND ON THE SHOW CARD BETWEEN CODES '1' (LABORATORY TESTS) AND '2' (SONOGRAM OR ULTRASOUND).
----------------------------------------------------

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 [OP14]
NO ..................................... 2 [OP14]
REF ................................... -7 [OP14]
DK .................................... -8 [OP14]
HELP AVAILABLE FOR DEFINITION OF SURGICAL PROCEDURE.

OP13
====

OMITTED.

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 [OP15]
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
HELP AVAILABLE 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/ telephone call] that were filled.
PROBE: Any other prescribed medicines from this [visit/telephone call] that were filled?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
----------------------------------------------------
DISPLAY 'ADD MEDICINE' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_04
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERSON'S_PRESCRIBED_MEDICINES_1

COL # 1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE (DRUG.DRUGNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-PRESCRIPTION- MEDICINES-ROSTER FOR SELECTION AND ADDITION OF PRESCRIBED MEDICINES.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED AND ADD ALLOWED.

2. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A PMED ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS PMED AND THE EVENT.

3. EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL MEDICINES ON PERSON'S' ROSTER; NO FILTER.
----------------------------------------------------

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), GO TO BOX_07
----------------------------------------------------

OP16
====

OMITTED.

OP17
====

OMITTED.

LOOP_01
=======

OMITTED.

BOX_05
======

OMITTED.

BOX_06
======

OMITTED.

OP18
====

OMITTED.

END_LP01
========

OMITTED.

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 [OP20]
NO ..................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
HELP AVAILABLE FOR DEFINITION OF REPEAT VISITS.
----------------------------------------------------
DISPLAY '(READ SERVICES BELOW)' IF OP11 IS NOT CODED '95' (NO SERVICES RECEIVED), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF OP11 IS CODED '95' (NO SERVICES RECEIVED), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY 'the same services'.
----------------------------------------------------
----------------------------------------------------
FOR 'PERSON'S OP MEDICAL CONDITION', DISPLAY ALL CONDITIONS SELECTED FROM 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
CODE '11' = THROAT SWAB
----------------------------------------------------

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 [OP21]
NO ..................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
HELP AVAILABLE 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 HELP FILE 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]
[1. Month,Day,Year-4]
[2. Month,Day,Year-4]
[3. Month,Day,Year-4]
----------------------------------------------------
DISPLAY '(READ SERVICES BELOW)' IF OP11 IS NOT CODED '95' (NO SERVICES RECEIVED), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF OP11 IS CODED '95' (NO SERVICES RECEIVED), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY 'the same services'.
----------------------------------------------------
----------------------------------------------------
FOR 'PERSON'S OP MEDICAL CONDITION', DISPLAY ALL CONDITIONS SELECTED FROM OR ADDED TO PERSON'S- MEDICAL-CONDITIONS-ROSTER AT OP09.

FOR 'SERVICES RECEIVED', DISPLAY THE FOLLOWING TEXT FOR EACH SERVICE 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
CODE '11' = THROAT SWAB
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
GO TO OP22
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS_EVNT_1

COL # 1 HEADER: MONTH/DAY/YEAR
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE (EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS ALL MEDICAL EVENTS (DATES) ON PERSON'S-MEDICAL-EVENTS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE EVENTS WITH THE FOLLOWING CHARACTERISTICS:
1. EVENT WAS CREATED THIS ROUND.
2. EVENT HAS NOT BEEN PROCESSED IN UTILIZATION.
3. EVENT HAS EVENT TYPE 'OP'.
4. EVENT IS ASSOCIATED WITH THE SAME PROVIDER AS THE EVENT BEING ASKED ABOUT.
----------------------------------------------------

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]

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


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.LORPNAME, EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY
----------------------------------------------------

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 [MV02A]
TELEPHONE CALL ......................... 2 [MV03]
REF ................................... -7 [MV03]
DK .................................... -8 [MV03]
[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'. (THIS EVENT IS FLAGGED FOR PURPOSES OF SKIPS IN THE C/P SECTION. HOWEVER '-7' AND '-8' WILL USE THE SAME QUESTION WORDING AS IN 'MV-IN-PERSON' EVENTS DURING THE ADMINISTRATION OF THE MV SECTION.)
----------------------------------------------------

MV02
====

OMITTED.

MV02A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
What kind of place is that -- a managed care plan center or HMO, a clinic, a doctor's office, or some other place?
DOCTOR'S OFFICE OR GROUP PRACTICE ..... 1 [MV03]
MEDICAL CLINIC ........................ 2 [MV03]
MANAGED CARE PLAN CENTER/HMO .......... 3 [MV03]
NEIGHBORHOOD/FAMILY HEALTH CENTER ..... 4 [MV03]
LASER EYE SURGERY CENTER .............. 5 [MV03]
OTHER FREESTANDING SURGICAL CENTER .... 6 [MV03]
RURAL HEALTH CLINIC ................... 7 [MV03]
COMPANY CLINIC ........................ 8 [MV03]
SCHOOL CLINIC ......................... 9 [MV03]
OTHER CLINIC .......................... 10 [MV03]
WALK-IN URGENT CARE ................... 11 [MV03]
VA FACILITY ........................... 12 [MV03]
COMMUNITY HEALTH CENTER ............... 13 [MV03]
LABORATORY/X-RAY FACILITY ............. 14 [MV03]
BIRTHING CENTER ....................... 15 [MV03]
INDIAN HEALTH SERVICE (IHS) FACILITY .. 16 [MV03]
SOME OTHER PLACE ...................... 91 [MV03]
REF ................................... -7 [MV03]
DK .................................... -8 [MV03]
[Code One]
----------------------------------------------------
CODE '16' (IHS FACILITY) WAS INTRODUCED IN PANEL 12 ROUND 3 AND WILL BE INCLUDED IN ALL FUTURE PANELS AND ROUNDS. '16' WAS NOT AVAILABLE IN PANEL 12 ROUNDS 1 AND 2.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: IF CODED '15' BIRTHING CENTER, AND PERSON IS NOT FEMALE, DISPLAY THE FOLLOWING MESSAGE:
"'BIRTHING CENTER' CAN BE SELECTED ONLY IF PERSON IS FEMALE. VERIFY AND RE-ENTER."
----------------------------------------------------

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 [MV03A]
NO ..................................... 2 [MV04]
REF ................................... -7 [MV04]
DK .................................... -8 [MV04]
HELP AVAILABLE 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.
----------------------------------------------------

MV03A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
What was the doctor's specialty?
IF TALKED TO MORE THAN ONE DOCTOR, PROBE FOR MAIN PROVIDER.
ALLERGY/IMMUNOLOGY .................... 1 [BOX_01]
ANESTHESIOLOGY ........................ 2 [BOX_01]
CARDIOLOGY (HEART) .................... 3 [BOX_01]
DERMATOLOGY (SKIN) .................... 4 [BOX_01]
ENDOCRINOLOGY/METABOLISM (DIABETES, THYROID) ................. 5 [BOX_01]
FAMILY PRACTICE ....................... 6 [BOX_01]
GASTROENTEROLOGY ...................... 7 [BOX_01]
GENERAL PRACTICE ...................... 8 [BOX_01]
GENERAL SURGERY ....................... 9 [BOX_01]
GERIATRICS (ELDERLY) .................. 10 [BOX_01]
GYNECOLOGY/OBSTETRICS ................. 11 [BOX_01]
HEMATOLOGY (BLOOD) .................... 12 [BOX_01]
HOSPITAL RESIDENCE .................... 13 [BOX_01]
INTERNAL MEDICINE (INTERNIST) ......................... 14 [BOX_01]
NEPHROLOGY (KIDNEYS) .................. 15 [BOX_01]
NEUROLOGY ............................. 16 [BOX_01]
NUCLEAR MEDICINE ...................... 17 [BOX_01]
ONCOLOGY (TUMORS, CANCER) ............. 18 [BOX_01]
OPHTHALMOLOGY (EYES) .................. 19 [BOX_01]
ORTHOPEDICS ........................... 20 [BOX_01]
OSTEOPATHY (DO) ....................... 21 [BOX_01]
OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT) ................. 22 [BOX_01]
PATHOLOGY ............................. 23 [BOX_01]
PEDIATRICIAN .......................... 24 [BOX_01]
PHYSICAL MEDICINE/REHAB ............... 25 [BOX_01]
PLASTIC SURGERY ....................... 26 [BOX_01]
PROCTOLOGY ............................ 27 [BOX_01]
PSYCHIATRY/PSYCHIATRIST................ 28 [BOX_01]
PULMONARY ............................. 29 [BOX_01]
RADIOLOGY ............................. 30 [BOX_01]
RHEUMATOLOGY (ARTHRITIS) .............. 31 [BOX_01]
THORACIC SURGERY (CHEST) .............. 32 [BOX_01]
UROLOGY ............................... 33 [BOX_01]
OTHER DR SPECIALTY .................... 91 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

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 [BOX_01]
DENTIST/DENTAL CARE PERSON ............ 2 [BOX_01]
MIDWIFE ............................... 3 [BOX_01]
NURSE/NURSE PRACTITIONER .............. 4 [BOX_01]
OPTOMETRIST ........................... 5 [BOX_01]
PODIATRIST ............................ 6 [BOX_01]
PHYSICIAN'S ASSISTANT ................. 7 [BOX_01]
PHYSICAL THERAPIST .................... 8 [BOX_01]
OCCUPATIONAL THERAPIST ................ 9 [BOX_01]
PSYCHOLOGIST .......................... 10 [BOX_01]
SOCIAL WORKER ......................... 11 [BOX_01]
TECHNICIAN ............................ 12 [BOX_01]
RECEPTIONIST, CLERK, SECRETARY ........ 13 [BOX_01]
ACUPUNCTURIST ......................... 14 [BOX_01]
MASSAGE THERAPIST ..................... 15 [BOX_01]
HOMEOPATHIC/NATUROPATHIC/HERBALIST .... 16 [BOX_01]
OTHER ALTERNATIVE/COMPLEMENTARY
CARE PROVIDER ....................... 17 [BOX_01]
OTHER ................................. 91 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

MV05
====

OMITTED.

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
HELP AVAILABLE 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 SELECTED 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 '14'= ACUPUNCTURIST
CODE '15'= MASSAGE THERAPIST
CODE '16'= HOMEOPATHIC/NATUROPATHIC/HERBALIST
CODE '17'= OTHER ALTERNATIVE/COMPLEMENTARY CARE PROVIDER
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 [MV08]
DIAGNOSIS OR TREATMENT ................. 2 [MV08]
EMERGENCY (E.G., ACCIDENT OR INJURY) ... 3 [MV08]
PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING ............................. 4 [MV08]
FOLLOW-UP OR POST-OPERATIVE VISIT ...... 5 [MV08]
IMMUNIZATIONS OR SHOTS ................. 6 [MV08]
VISION EXAM ............................ 7 [MV08]
PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY) ................... 8 [MV08]
WELL CHILD EXAM ........................ 9 [MV08]
LASER EYE SURGERY ..................... 10 [MV08]
OTHER ................................. 91 [MV08]
REF ................................... -7 [MV08]
DK .................................... -8 [MV08]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
HARD CHECK:
EDITS: IF MV07 IS CODED '8' (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)), 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 [MV09]
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, SELECT ENTRY ON ROSTER.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1

COL #1 HEADER: MEDICAL CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. MULTIPLE ADD ALLOWED.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.

4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

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?
CHECK ALL THAT APPLY.
PHYSICAL THERAPY ....................... 1 [MV11]
OCCUPATIONAL THERAPY ................... 2 [MV11]
SPEECH THERAPY ......................... 3 [MV11]
CHEMOTHERAPY ........................... 4 [MV11]
RADIATION THERAPY ...................... 5 [MV11]
KIDNEY DIALYSIS ........................ 6 [MV11]
IV THERAPY ............................. 7 [MV11]
DRUG OR ALCOHOL TREATMENT .............. 8 [MV11]
ALLERGY SHOT ........................... 9 [MV11]
PSYCHOTHERAPY/COUNSELING .............. 10 [MV11]
SHOTS, OTHER THAN ALLERGY ............. 11 [MV11]
NO TREATMENTS RECEIVED ................ 95 [MV11]
REF ................................... -7 [MV11]
DK .................................... -8 [MV11]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
ALLOW CODE '95' (NO TREATMENTS RECEIVED), '-7' (REFUSED), AND '-8' (DON'T KNOW) ALONE ONLY.
THESE RESPONSES MAY NOT BE SELECTED WITH ANY OTHER RESPONSE.
----------------------------------------------------
----------------------------------------------------
'NO TREATMENTS RECEIVED' IS NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: IF CODED '95' (NO TREATMENTS RECEIVED), NO OTHER TREATMENT CATEGORIES CAN BE CODED. IF INTERVIEWER SELECTS ANOTHER CODE WITH 'NO TREATMENTS' DISPLAY THE FOLLOWING MESSAGE: "NO TREATMENTS RECEIVED CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE-ENTER."
----------------------------------------------------

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?
CHECK ALL THAT APPLY.
LABORATORY TESTS ....................... 1 [MV12]
SONOGRAM OR ULTRASOUND ................. 2 [MV12]
X-RAYS ................................. 3 [MV12]
MAMMOGRAM .............................. 4 [MV12]
MRI OR CATSCAN ......................... 5 [MV12]
EKG OR ECG ............................. 6 [MV12]
EEG .................................... 7 [MV12]
VACCINATION ............................ 8 [MV12]
ANESTHESIA ............................. 9 [MV12]
OTHER DIAGNOSTIC TEST ................. 10 [MV12]
THROAT SWAB ........................... 11 [MV12]
NO SERVICES RECEIVED .................. 95 [MV12]
REF ................................... -7 [MV12]
DK .................................... -8 [MV12]
[Code All That Apply]
HELP AVAILABLE 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) ALONE ONLY.
THESE RESPONSES MAY NOT BE SELECTED WITH ANY OTHER RESPONSE.
----------------------------------------------------
----------------------------------------------------
'NO SERVICES RECEIVED' IS NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: IF CODED '95' (NO SERVICES RECEIVED), NO OTHER TREATMENT CATEGORIES CAN BE CODED. IF INTERVIEWER SELECTS ANOTHER CODE WITH 'NO SERVICES' DISPLAY THE FOLLOWING MESSAGE: "NO SERVICES RECEIVED CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE-ENTER."
----------------------------------------------------
----------------------------------------------------
NOTE: CODE '11' (THROAT SWAB) IS DISPLAYED ON THE SCREEN AND ON THE SHOW CARD BETWEEN CODES '1' (LABORATORY TESTS) AND '2' (SONOGRAM OR ULTRASOUND).
----------------------------------------------------

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 [MV14]
NO ..................................... 2 [MV14]
REF ................................... -7 [MV14]
DK .................................... -8 [MV14]
HELP AVAILABLE FOR DEFINITION OF SURGICAL PROCEDURE.

MV13
====

OMITTED.

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 [MV15]
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
HELP AVAILABLE 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/ telephone call] that were filled.
PROBE: Any other prescribed medicines from this [visit/telephone call] that were filled?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
----------------------------------------------------
DISPLAY 'ADD MEDICINE' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_04
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERSON'S_PRESCRIBED_MEDICINES_1

COL # 1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE (DRUG.DRUGNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-PRESCRIPTION- MEDICINES-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT AND ADD ALLOWED.

2. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A PMED ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS PMED AND THE EVENT.

3. EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL MEDICINES IN PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

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 [MV17]
NO ..................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
HELP AVAILABLE FOR DEFINITION OF REPEAT VISITS.
----------------------------------------------------
DISPLAY '(READ SERVICES BELOW)' IF MV11 IS NOT CODED '95' (NO SERVICES RECEIVED), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF MV11 IS CODED '95' (NO SERVICES RECEIVED), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY 'the same services'.
----------------------------------------------------
----------------------------------------------------
FOR 'PERSON'S MV MEDICAL CONDITION', DISPLAY ALL CONDITIONS SELECTED FROM OR ADDED TO PERSON'S- MEDICAL-CONDITIONS-ROSTER AT MV09.

FOR 'SERVICES RECEIVED', DISPLAY THE FOLLOWING TEXT FOR EACH SERVICE SELECTED 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
CODE '11' = THROAT SWAB
----------------------------------------------------

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 [MV18]
NO ..................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
HELP AVAILABLE 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 HELP 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)/and 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]
[1. Month,Day,Year-4]
[2. Month,Day,Year-4]
[3. Month,Day,Year-4]
----------------------------------------------------
DISPLAY 'and (READ SERVICES BELOW)' IF MV11 IS NOT CODED '95' (NO SERVICES RECEIVED), '-7' (REFUSED), OR '-8' (DON'T KNOW). IF MV11 IS CODED '95' (NO SERVICES RECEIVED), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY 'and 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 SERVICE SELECTED 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
CODE '11' = 'THROAT SWAB'
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
GO TO MV19
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS_EVNT_1

COL # 1 HEADER: MONTH/DAY/YEAR
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE (EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS ALL MEDICAL EVENTS (DATES) ON ERSON'S MEDICAL-EVENTS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE EVENTS WITH THE FOLLOWING CHARACTERISTICS.
1. EVENT WAS CREATED THIS ROUND.
2. EVENT HAS NOT BEEN PROCESSED IN UTILIZATION.
3. EVENT HAS EVENT TYPE 'MV'.
4. EVENT IS ASSOCIATED WITH THE SAME PROVIDER AS THE EVENT BEING ASKED ABOUT.
----------------------------------------------------

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]

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
====

OMITTED.

DN02
====

OMITTED.

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?
CHECK ALL THAT APPLY.
GENERAL DENTIST ........................ 1 [DN04]
DENTAL HYGIENIST ....................... 2 [DN04]
DENTAL TECHNICIAN ...................... 3 [DN04]
DENTAL SURGEON ......................... 4 [DN04]
ORTHODONTIST ........................... 5 [DN04]
ENDODONTIST ............................ 6 [DN04]
PERIODONTIST ........................... 7 [DN04]
OTHER ................................. 91 [DN04]
REF ................................... -7 [DN04]
DK .................................... -8 [DN04]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES AUTOMATICALLY): CAPI DOES NOT ALLOW -7 OR -8 IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------

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?
CHECK ALL THAT APPLY.
*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 [DN04OV]
REF .................................... -7
DK ..................................... -8
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
HEADINGS AND CODE CATEGORIES WILL NOT FIT ON ONE SCREEN. THEREFORE, HEADINGS WILL ONLY APPEAR ON HELP 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
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES AUTOMATICALLY): CAPI DOES NOT ALLOW -7 OR -8 IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODE '91' (OTHER) ENTERED ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH DN04OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO DN05
----------------------------------------------------

DN04OV
======
OTHER TYPE OF DENTAL CARE:
[Enter Other Specify].................. [DN05]
REF ................................... -7 [DN05]
DK .................................... -8 [DN05]

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 [DN06]
NO ..................................... 2 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
HELP AVAILABLE 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?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERSON'S-PRESCRIBED-MEDICINES_1.

COL # 1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY PMED NAME (PMED.PMEDNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES- ROSTER FOR SELECTION AND ADDITION OF PRESCRIBED MEDICINES.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT AND ADD ALLOWED.

2. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A PMED ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS PMED AND THE EVENT.

3. EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF THE CHARGE/PAYMENT MODULE HAS NOT BEEN ASKED FOR THE EVENT-PROVIDER PAIR BEING ASKED ABOUT, GO TO THE CHARGE/PAYMENT (CP) SECTION.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION.
----------------------------------------------------


Home Health (HH) Section


BOX_00A
=======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY EVNT.EVENTBEGM AS THREE LETTERS.
----------------------------------------------------

BOX_00
======

----------------------------------------------------
IF NOT ROUND 5 AND EVENT MONTH IS INTERVIEW MONTH, O 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)?
CHECK 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 [HH02]
REF ................................... -7 [HH03]
DK .................................... -8 [HH03]
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
'SOME OTHER TYPE OF HEALTH CARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (THIS CHECK IS AUTOMATIC): CAPI DOES NOT ALLOW -7 OR -8 IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
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?
CHECK 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 (TRAINED, CERTIFIED, OR
LICENSED MEDICAL PERSONNEL WHO PERFORM SERVICES OR OTHER MEDICAL PROCEDURES INCLUDING: NURSE/NURSE PRACTITIONER, ANY TYPE OF THERAPIST, HOSPICE WORKER, MEDICAL DOCTOR, DIETICIAN/NUTRITIONIST, AND SOCIAL WORKER.).................... 2
OTHER TYPE OF HEALTH CARE WORKER ....... 91
REF .................................... -7 [HH03]
DK ..................................... -8 [HH03]
[Code All That Apply]
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (THIS CHECK IS AUTOMATIC): CAPI DOES NOT ALLOW -7 OR -8 IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (NONSKILLED WORKER) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (SKILLED WORKER) ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HH02OV1
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY CODE EXCEPT '2'), GO TO HH02OV2
----------------------------------------------------
----------------------------------------------------
HARD CHECK: REFUSED AND DON'T KNOW CANNOT BE ENTERED IN CONJUNCTION WITH ANY OTHER CODE.
----------------------------------------------------

HH02OV1
=======

TYPE OF SKILLED WORKER:
[Enter Other Specify]...................
REF.................................... -7
DK..................................... -8
----------------------------------------------------
IF RESPONSE TO HH02 INCLUDES CODE '91', CONTINUE WITH HH02OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

HH02OV2
=======

OTHER TYPE OF HEALTH CARE WORKER:
[Enter Other Specify]................... [HH03]
REF.................................... -7 [HH03]
DK..................................... -8 [HH03]

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 [HH04]
NO ..................................... 2 [HH04]
REF ................................... -7 [HH04]
DK .................................... -8 [HH04]
HELP AVAILABLE FOR DEFINITION OF HOSPITALIZATION.
----------------------------------------------------
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, SELECT 'YES' AND ENTER 'OLD AGE' AS CONDITION.
YES .................................... 1 [HH05]
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
HELP AVAILABLE FOR DEFINITION OF HEALTH PROBLEM.
----------------------------------------------------
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, SELECT ENTRY ON ROSTER.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS-COND-1

COL #1 HEADER: MEDICAL CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON'S-MEDICAL-CONDITIONS ROSTER FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.

2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE CONDITION NAME.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT. IF THE INTERVIEWER ATTEMPTS TO DELETE A CONDITION WHEN DELETE IS NOT ALLOWED, DISPLAY THE FOLLOWING MESSAGE:
"DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED."

4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

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 [HH07]
NO ..................................... 2 [HH07]
REF ................................... -7 [HH07]
DK .................................... -8 [HH07]
[Code One]
HELP AVAILABLE 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 [HH08]
NO ..................................... 2 [HH08]
REF ................................... -7 [HH08]
DK .................................... -8 [HH08]
[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/SHOW CARD HH-3.]
[Now look at the bottom of this card.] 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 [HH09]
NO ..................................... 2 [HH09]
REF ................................... -7 [HH09]
DK .................................... -8 [HH09]
[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 [HH10]
NO ..................................... 2 [HH10]
REF ................................... -7 [HH10]
DK .................................... -8 [HH10]
[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 [HH10OV]
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, BACKUP TO HH06 TO BE SURE 'YES' IS CODED.
IF MEDICAL EQUIPMENT OR ASSISTIVE DEVICE MENTIONED, BACKUP TO HH07 TO BE SURE 'YES' IS CODED.]
IF DAILY ACTIVITIES OR PERSONAL CARE TASKS MENTIONED, BACKUP TO HH08 TO BE SURE 'YES' IS CODED.
IF COMPANIONSHIP MENTIONED, BACKUP TO HH09 TO BE SURE 'YES' IS CODED.
[Enter Other Specify] .................. [HH11]
REF ................................... -7 [HH11]
DK .................................... -8 [HH11]
----------------------------------------------------
DISPLAY 'IF MEDICAL TREATMENT OR THERAPY MENTIONED, BACKUP TO BE SURE 'YES' IS CODED...' 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 [HH12]
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'.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (RANGE IS DETERMINED IN PROGRAM): ALLOW RESPONSES 1-7 ONLY.
----------------------------------------------------

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] ....... [HH14]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
WVS ERROR HANDLER WILL DISPLAY AN ERROR MESSAGE AND FORCE THE INTERVIEWER TO RECTIFY THE DATA IF ANY OF THE FOLLOWING SITUATIONS OCCUR:

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 IF 2008. OTHERWISE, 1-28 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 [HH15]
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] ....... [HH16]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
ALLOW ONLY 2-6 FOR NUMBER OF TIMES PER DAY.
----------------------------------------------------

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
=======

HOURS:
[Enter Hours] .......................
REF ................................. -7 [BOX_03]
DK .................................. -8 [BOX_03]

HH16_02
=======

MINUTES:
[Enter Minutes] ..................... [BOX_03]
REF ................................. -7 [BOX_03]
DK .................................. -8 [BOX_03]
----------------------------------------------------
DISPLAY 'each visit usually' IF HH11 IS NOT CODED '3' (ONLY CAME ONCE). DISPLAY 'the visit' IF HH11 IS CODED '3' (ONLY CAME ONCE).
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES THIS AUTOMATICALLY): ALLOW 0-24 FOR HOURS AND 0-59 FOR MINUTES.
----------------------------------------------------
----------------------------------------------------
IF '-7' (REFUSED), '-8' (DON'T KNOW), OR '24' ENTERED FOR HOURS, GO TO BOX_03.
----------------------------------------------------
----------------------------------------------------
HARD CHECK: IF '0' ENTERED IN BOTH HOURS AND MINUTES, THE WVS ERROR HANDLER WILL FORCE THE INTERVIEWER TO RECTIFY THE DATA.
----------------------------------------------------

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 SERVICES RECEIVED]
[DESCRIPTION OF SERVICES RECEIVED]
[DESCRIPTION OF SERVICES RECEIVED]
[DESCRIPTION OF SERVICES RECEIVED]
[DESCRIPTION OF SERVICES RECEIVED]
YES .................................... 1 [HH18]
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
----------------------------------------------------
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 SERVICES RECEIVED]
[DESCRIPTION OF SERVICES RECEIVED]
[DESCRIPTION OF SERVICES RECEIVED]
[DESCRIPTION OF SERVICES RECEIVED]
[DESCRIPTION OF SERVICES RECEIVED]
[1. Month, Year-4]
[2. Month, Year-4]
[3. Month, Year-4]
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_EVNT_1

COL #1 HEADER: MONTH/YEAR
INSTRUCTIONS: DISPLAY EVENT BEGIN DATE (EVNT.EVNTBEGM, EVNT.EVNTBEGY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON'S MEDICAL-EVENTS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL EVENTS (DATES) IN PERSON'S MEDICAL- EVENTS-ROSTER THAT MEET THE FOLLOWING CRITERIA:
- CREATED THIS ROUND, EXCLUDING THE INTERVIEW MONTH

- HAVE NOT BEEN PROCESSED THROUGH UTILIZATION

- HAVE EVENT TYPE 'HH'

- ARE ASSOCIATED WITH THE SAME PROVIDER AS THE EVENT BEING ASKED ABOUT DURING THIS ROUND
----------------------------------------------------

HH19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
INTERVIEWER: RECORD 'NAME OF REPEAT VISIT GROUP' FOR MONTHS SELECTED IN PREVIOUS QUESTION.
[Enter Repeat Month Group] .......... [BOX_04]

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_01A
=======

----------------------------------------------------
IF ROUND 3, CONTINUE WITH BOX_01B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_01
----------------------------------------------------

BOX_01B
=======

----------------------------------------------------
IF OM ITEM TYPE IS GLASSES/CONTACT LENSES, CONTINUE WITH OM01A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_01
----------------------------------------------------

OM01A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT][END-DT]
Of the times (PERSON) obtained glasses or contact lenses since (START DATE), how many were during [YEAR]?
[Enter Number of Times]................ [OM01B]
REF.................................... -7 [OM01B]
DK..................................... -8 [OM01B]
----------------------------------------------------
(FOR SPECIFICATIONS ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN QUESTION TEXT IS FIRST CALENDAR YEAR OF PANEL.
----------------------------------------------------

OM01B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT][END-DT]
Of the times (PERSON) obtained glasses or contact lenses since (START DATE), how many were during [YEAR]?
[Enter Number of Times]................
REF.................................... -7
DK..................................... -8
----------------------------------------------------
(FOR SPECIFICATIONS ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN QUESTION TEXT IS SECOND CALENDAR YEAR OF PANEL.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF THE OM ITEM TYPE IS INSULIN OR OTHER DIABETIC EQUIPMENT OR SUPPLIES, GO TO OM02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OM01
----------------------------------------------------

OM01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT][END-DT] 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 OR SELECT NEXT PAGE 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] [STR-DT][END-DT]
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 OR SELECT NEXT PAGE 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.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
GO TO THE EVENT DRIVER (ED) SECTION
----------------------------------------------------


Charge Payment (CP) Section


BOX_00A
=======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PROV.PROVNAME, EVPV.EVNTTYPE, EVPV.EVNTBEGM, EVPV.EVNTBEGD, EVPV.EVNTBEGY, EVPV.EVNTENDM, EVPV.EVNTENDD, EVPV.EVNTENDY, PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY, EVPV.RVNAME, FFEE.FFEENAME
----------------------------------------------------
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.

FOR '[EVN - DT]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).
----------------------------------------------------

BOX_00
======

----------------------------------------------------
THROUGHOUT THE CHARGE/PAYMENT (CP) SECTION, ENTRY OF ALL DOLLAR AMOUNTS WILL INCLUDE ONLY WHOLE DOLLARS. ENTRY OF CENTS WILL BE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
SOME ITEMS (CP01B, CP12A, CP14A, CP20, CP23, AND CP25) IN THIS SECTION ALLOW THE ADDITION OF A SOURCE OF PAYMENT FOR THE RU. WHEN THE INTERVIEWER SELECTS THE "ADD" LINK, CAPI DISPLAYS A POP-UP WITH A BLANK ENTRY FIELD AND A SELECTABLE PICK LIST OF SOME COMMON SOURCES AS FOLLOWS:

GOVERNMENT SOURCES
- 'MEDICARE'
- 'MEDICAID/[STATE NAME FOR MEDICAID]'
- 'SCHIP/[STATE NAME FOR CHIP]'
- 'VA/(VETERAN'S ADMINISTRATION)/CHAMPVA'
- 'TRICARE'
- 'MILITARY FACILITY'
- 'INDIAN HEALTH SERVICE'
- 'WORKER'S COMPENSATION' PRIVATE SOURCES
- 'AARP'
- 'AETNA'
- 'BLUE CROSS/BLUE SHIELD'
- 'CIGNA'
- 'DELTA DENTAL'
- 'KAISER/KAISER PERMANENTE'
- 'UNITED HEALTHCARE'

THE PICK LIST EXPEDITES THE ENTRY OF ONE OF THESE COMMON SOURCES. ONCE THE INTERVIEWER SELECTS FROM THE PICK LIST (OR TYPES AN ENTRY) AND RETURNS TO THE MAIN SCREEN, THE ADDED SOURCE OF PAYMENT APPEARS IN THE ROSTER AS SELECTED.
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 13, ROUND 1, THE SOURCE OF PAYMENT PICK LIST GROUPS VA AND CHAMPVA TOGETHER RATHER THAN TRICARE AND CHAMPVA AS PAST ROUNDS HAVE DONE.

THE SOP PICK LIST FOR ALL ROUNDS OF PANEL 12 READS:

'VA/VETERAN'S ADMINISTRATION' 'TRICARE/CHAMPVA'

THE PICK LIST FOR ALL ROUNDS OF PANEL 13 READS:
'VA (VETERAN'S ADMINISTRATION)/CHAMPVA' 'TRICARE'
----------------------------------------------------
----------------------------------------------------
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 AND IS OM TYPE 2 OR 3, GO TO CP03
----------------------------------------------------
----------------------------------------------------
IF EVENT TYPE IS PM AND IS NOT OM TYPE 2 OR 3, 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 CP01A
----------------------------------------------------

CP01A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
Now I'd like to ask you about the charges for (PERSON)'s prescription medicine.
Has (PERSON)'s health insurance or another source of coverage helped pay for any of (PERSON)'s prescription medications since (START DATE)?

CODE "NO" IF PERSON REPORTS NO HEALTH INSURANCE OR ANOTHER SOURCE OF COVERAGE.
YES .................................... 1 [CP01B]
NO ..................................... 2 [CP01C]
REF ................................... -7 [CP01C]
DK .................................... -8 [CP01C]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE OR ANOTHER SOURCE OF COVERAGE.
----------------------------------------------------
QUESTIONS CP01A THROUGH CP01C WERE REVISED IN PANEL 12 ROUND 3. STARTING IN PANEL 13, THESE ITEMS WILL BE INCORPORATED IN ALL ROUNDS.
----------------------------------------------------

CP01B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [EVN-DT]
Who usually helps pay?
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]
HELP AVAILABLE FOR DEFINITION OF SOURCE OF PAYMENT.
[Code One]
----------------------------------------------------
WRITE SOURCES SELECTED TO THE SOURCES-OF-PAYMENT ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CP01C
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_SOP_2

COL # 1 HEADER: REIMBURSEMENT SOURCE
INSTRUCTIONS: DISPLAY REIMBURSEMENT SOURCE NAME (SRCS.SRCNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-SOURCES-OF-PAYMENT-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE ADD AND MULTIPLE SELECT ALLOWED.

2. ADD ALLOWED. THE SCREEN DISPLAYS A LINK "ADD A SOURCE OF PAYMENT" THAT THE INTERVIEWER CAN SELECT. SELECTING THE LINK DISPLAYS A POP-UP WITH A TEXT ENTRY FIELD AND A SELECTABLE LIST OF 15 COMMON SOURCES OF PAYMENT. (SEE BOX_00 FOR A DETAILED LIST). THE INTERVIEWER CAN TYPE A NEW SOURCE OR SELECT ONE FROM THE LIST. UPON RETURN TO CP01B, THE ADDED SOURCE WILL APPEAR ON THE ROSTER AS SELECTED.

3. SELECT ONE. INTERVIEWER MAY SELECT ONLY ONE SOURCE OF PAYMENT.

4. LIMITED DELETE ALLOWED. IF INTERVIEWER ADDS A SOURCE OF PAYMENT, DELETE IS POSSIBLE FOR THAT SOURCE ONLY, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN. IF DELETE IS ATTEMPTED WHEN IT IS NOT ALLOWED, CAPI DISPLAYS THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN SOURCE IS FIRST ENTERED.'

5. LIMITED EDIT ALLOWED. IF INTERVIEWER ADDS A SOURCE OF PAYMENT, EDITING IS POSSIBLE FOR THAT SOURCE ONLY, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN. IF EDIT IS ATTEMPTED WHEN IT IS NOT ALLOWED, CAPI DISPLAYS THE FOLLOWING ERROR MESSAGE: 'EDIT ALLOWED ONLY WHEN SOURCE FIRST ENTERED.'

6. IF ROSTER IS EMPTY WHEN CAPI DISPLAYS SCREEN, DISPLAY THE STANDARD WVS INSTRUCTION: "EITHER THE ROSTER IS EMPTY OR YOUR SEARCH HAS NOT TURNED UP ANY CHOICES."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL SOURCES OF PAYMENT THAT ARE NOT PERSON/FAMILY.
----------------------------------------------------

CP01C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How much did (PERSON) pay out-of-pocket for (PERSON)'s last prescription?
IF AMOUNT PAID IS NOTHING, ENTER 0.
IF AMOUNT PAID VARIES DEPENDING ON TYPE OF MEDICATION, ENTER THE OUT-OF-POCKET COST FOR THE LAST PRESCRIPTION FILLED DURING THE REFERENCE PERIOD.
IF MORE THAN ONE PRESCRIPTION WAS FILLED AT THE SAME TIME, ENTER THE AMOUNT FOR THE LAST PRESCRIPTION ON RECEIPT.
[Enter $ Amount] ....................... [CP01]
REF ................................... -7 [CP01]
DK .................................... -8 [CP01]
----------------------------------------------------
HARD RANGE CHECK: $0 - $999,999
----------------------------------------------------

CP01COV2
========

OMITTED.
PERCENT:
----------------------------------------------------
BEGINNING IN PANEL 13 ROUND 2 AND PANEL 12 ROUND 4, CP01C IS ASKED OF ALL PERSONS ASKED CP01A.
PERCENT WAS REMOVED FROM CP01 AT THE SAME TIME.
----------------------------------------------------

CP01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [EVN-DT]
(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]
HELP AVAILABLE 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/REF-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), 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 [CP02OV]
NOT A COPAYMENT SITUATION ANYMORE ..... 99 [CP03]
REF ................................... -7 [CP03]
DK .................................... -8 [CP03]
[Code One]
HELP AVAILABLE FOR DEFINITION OF COPAYMENT.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.

[$ AMT COPAY]: DISPLAY THE CP11OV1 AMOUNT FLAGGED AS 'COPAYMENT SITUATION' DURING THE PREVIOUS ROUND FOR THIS PERSON-PROVIDER PAIR.
----------------------------------------------------
----------------------------------------------------
IF CODED '99' (NOT A COPAYMENT SITUATION ANYMORE), FLAG THIS PERSON-PROVIDER AND THIS PERSON AS 'NOT A COPAYMENT SITUATION' FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG THIS PERSON-PROVIDER PAIR AND THIS PERSON AS 'COPAYMENT SITUATION' FOR THE CURRENT ROUND AND SET COPAYMENT AMOUNT FROM THE PREVIOUS ROUND AS THE PERSON'S COPAYMENT AMOUNT FOR THE CURRENT ROUND.
----------------------------------------------------

CP02OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
What is the correct copayment amount?
[Enter $ Amount] ...................... [CP03]
NOT A COPAYMENT SITUATION ANYMORE ..... 99 [CP03]
REF ................................... -7 [CP03]
DK .................................... -8 [CP03]
HELP AVAILABLE FOR DEFINITION OF COPAYMENT.
----------------------------------------------------
SET 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.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
$1 - $50.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
COPAYMENT 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/REF-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)].
[Let's begin with the charges from the hospital itself, not including any separate physician services or lab tests.]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
HELP AVAILABLE FOR DEFINITION OF CHARGE.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)' IF EVENT TYPE IS HS.

DISPLAY '(PERSON)'s visit to (PROVIDER) on (VISIT DATE)' IF EVENT TYPE IS ER, OP, MV, OR DN.

DISPLAY 'the last purchase of [NAME OF PRESCRIBED MEDICINE] for (PERSON)' IF EVENT TYPE IS PM.

FOR '[NAME OF PRESCRIBED MEDICINE]', DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'the services for (FLAT FEE GROUP) for (PERSON)' IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

DISPLAY 'the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)' IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
FOR [OME ITEM GROUP NAME], DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT, AS FOLLOWS:

DISPLAY 'glasses or contact lenses' IF THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR THE OM EVENT BEING ASKED ABOUT.
----------------------------------------------------
----------------------------------------------------
FOR '[EVN - DT]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

DISPLAY 'services received at home from (PROVIDER) during (MONTH) for (PERSON)' IF EVENT TYPE IS HH.

DISPLAY '[Let's begin with the charges from the hospital itself, not including any separate physician services or lab tests.]' IF EVENT TYPE IS HS.
----------------------------------------------------
----------------------------------------------------
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 ROUND 3 OR 5 AND IF EVENT TYPE IS OM AND OM GROUP TYPE IS 'ADDITIONAL' (EV02A=2), CONTINUE WITH CP03A. (NOTE THAT ADDITIONAL OM EVENTS CAN BE ENTERED IN ROUNDS 3 AND 5 ONLY.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CP05
----------------------------------------------------

CP03A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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)?
SELECT 'NO CHARGE' 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/REF-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 and (PERSON) (do/does) not know the total charge?
YES .................................... 1 [CP37]
NO ..................................... 2 [CP05]
REF ................................... -7 [CP05]
DK .................................... -8 [CP05]
HELP AVAILABLE FOR DEFINITION OF COPAYMENT AND TOTAL CHARGE.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.

[$ AMT COPAY]: DISPLAY THE CP02OV OR CP11OV1 AMOUNT FLAGGED AS 'COPAYMENT SITUATION' FOR THE CURRENT ROUND FOR THIS PERSON-PROVIDER PAIR.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), COPY ALL PREVIOUS COPAYMENT CHARGE PAYMENT DATA FOR THE PERSON-PROVIDER PAIR TO THIS EVENT-PROVIDER-PAIR.
----------------------------------------------------
----------------------------------------------------
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).
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), GO TO CP37
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), CONTINUE WITH CP05
----------------------------------------------------

CP05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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)]?
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 [CP06]
NO, FREE SAMPLE ........................ 4 [CP37]
REF ................................... -7 [CP06]
DK .................................... -8 [CP06]
[Code One]
HELP AVAILABLE FOR DEFINITION OF ANYTHING IN WRITING.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE): DISPLAY IF EVENT TYPE IS HS.

(PERSON)'s visit to (PROVIDER) on (VISIT DATE):
DISPLAY IF EVENT TYPE IS ER, OP, MV, OR DN.

the last purchase of [NAME OF PRESCRIBED MEDICINE] for (PERSON): DISPLAY IF EVENT TYPE IS PM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

the services for (FLAT FEE GROUP) for (PERSON):
DISPLAY IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE): DISPLAY IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

services received at home from (PROVIDER) during (MONTH) for (PERSON): DISPLAY IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
'NO, FREE SAMPLE' IS A RADIO BUTTON BELOW THE ENTRY FIELD.
----------------------------------------------------
----------------------------------------------------
DISPLAY NO, FREE SAMPLE RESPONSE CATEGORY AND THE CORRESPONDING RADIO BUTTON 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/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
SHOW CARD CP-1.
[NAME OF PRESCRIBED MEDICINE] [OME ITEM GROUP NAME]
Why (have/has) (PERSON) (or anyone in the family) not received anything in writing?
[SELECT 'INCLUDED WITH OTHER CHARGES' 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 [CP07]
BILL HAS NOT ARRIVED .................... 4 [CP08]
NO BILL SENT:
HMO PLAN .............................. 5 [BOX_04]
VA (VETERANS ADMINISTRATION)/CHAMPVA... 6 [BOX_04]
INDIAN HEALTH SERVICE (IHS) .......... 15 [BOX_04]
MILITARY FACILITY ..................... 7 [BOX_04]
PUBLIC ASSISTANCE/MEDICAID/SCHIP ...... 8 [BOX_04]
WORKER'S COMPENSATION ................. 9 [BOX_04]
PRIVATE HEALTH CENTER/CLINIC .......... 10 [BOX_04]
PUBLIC CLINIC/HEALTH CENTER OR PRIVATE CHARITY ............................ 11 [BOX_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]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES AND FLAT FEE.
----------------------------------------------------
BEGINNING IN PANEL 13, ROUND 1, RESPONSE CATEGORY 6 AT CP06 GROUPS VA AND CHAMPVA TOGETHER.

CATEGORY 6 AT CP06 FOR ALL ROUNDS OF PANEL 12 READS:

'VA (VETERANS ADMINISTRATION)'

CATEGORY 6 AT CP06 FOR ALL ROUNDS OF PANEL 13 AND BEYOND READS:

'VA (VETERANS ADMINISTRATION)/CHAMPVA'
----------------------------------------------------
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.

DISPLAY THE INTERVIEWER INSTRUCTION 'SELECT "INCLUDED WITH OTHER CHARGES" IF THIS IS A FLAT FEE SITUATION' IF EVENT-PROVIDER PAIR DOES NOT REPRESENT A FLAT FEE. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
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 SERVICE)'. 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 'INCLUDED WITH OTHER CHARGES' IS SELECTED AND THE EVENT TYPE OF THE EVENT-PROVIDER PAIR IS PM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A PM EVENT.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED AND THE EVENT-PROVIDER PAIR REPRESENTS A REPEAT VISIT STEM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A REPEAT VISIT GROUP.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED AND THE EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A FLAT FEE GROUP.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED, AND THE EVENT TYPE IS NOT PM AND EVENT-PROVIDER PAIR DOES NOT REPRESENT A FLAT FEE GROUP OR A REPEAT VISIT GROUP, ASK THE FLAT FEE (FF) SECTION.
----------------------------------------------------
----------------------------------------------------
INDIAN HEALTH SERVICE (IHS) WAS INTRODUCED IN PANEL 12 ROUND 3. STARTING IN PANEL 13, IT WILL BE AVAILABLE IN ALL ROUNDS.
----------------------------------------------------

CP07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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. TO CONTINUE PRESS TAB AND THEN ENTER, OR SELECT NEXT PAGE.
[Enter Text] ........................... [CP07OV1]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------

CP07OV1
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
INTERVIEWER: SELECT TYPE OF ORGANIZATION TO WHOM BILL WAS SENT:
HMO .................................... 1 [BOX_04]
VA (VETERANS ADMINISTRATION)/CHAMPVA.... 2 [BOX_04]
TRICARE ................................ 3 [CP08]
OTHER MILITARY ......................... 4 [BOX_04]
PUBLIC ASSISTANCE/MEDICAID/SCHIP ....... 5 [BOX_04]
WORKER'S COMPENSATION .................. 6 [BOX_04]
PRIVATE INSURANCE COMPANY .............. 7 [BOX_04]
INDIAN HEALTH SERVICE (IHS) ............ 8 [BOX_04]
OTHER ................................. 91 [CP08]
REF ................................... -7 [CP08]
DK .................................... -8 [CP08]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
INDIAN HEALTH SERVICE (IHS) WAS INTRODUCED IN PANEL 12 ROUND 3. STARTING IN PANEL 13, IT WILL BE AVAILABLE IN ALL ROUNDS. IT IS DISPLAYED ON THE PICK LIST BETWEEN VA/CHAMPVA AND TRICARE.
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 13, ROUND 1, THE RESPONSE CATEGORIES AT CP07OV1 GROUP VA AND CHAMPVA TOGETHER RATHER THAN TRICARE AND CHAMPVA AS PAST ROUNDS HAVE DONE.

CATEGORIES 2 AND 3 AT CP07OV1 FOR ALL ROUNDS OF PANEL 12 READ:

'VA (VETERANS ADMINISTRATION)' 'TRICARE/CHAMPVA'

CATEGORIES 2 AND 3 AT CP07OV1 FOR ALL ROUNDS OF PANEL 13 AND BEYOND READ:

'VA (VETERANS ADMINISTRATION)/CHAMPVA' 'TRICARE'
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF:
- EVENT TYPE IS OM, HH, OR PM
OR
- EVENT TYPE IS HS
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/REF-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)]?
[SELECT 'INCLUDED WITH OTHER CHARGES' IF THIS IS A FLAT FEE SITUATION.]
YES .................................... 1 [CP09]
NO ..................................... 2
INCLUDED WITH OTHER CHARGES ........... 95
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITIONS OF TOTAL CHARGE AND FLAT FEE.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)' IF EVENT TYPE IS HS.

DISPLAY '(PERSON)'s visit to (PROVIDER) on (VISIT DATE)' IF EVENT TYPE IS ER, OP, MV, OR DN.

DISPLAY 'the last purchase of [NAME OF PRESCRIBED MEDICINE] for (PERSON)' IF EVENT TYPE IS PM.

FOR '[NAME OF PRESCRIBED MEDICINE]', DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'the services for (FLAT FEE GROUP) for (PERSON)' IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

DISPLAY 'the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)' IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
FOR [OME ITEM GROUP NAME], DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT AS FOLLOWS:

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR THE OM EVENT BEING ASKED ABOUT.
----------------------------------------------------
----------------------------------------------------
FOR '[START DATE]', IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

services received at home from (PROVIDER) during (MONTH) for (PERSON): DISPLAY IF EVENT TYPE IS HH.

DISPLAY THE INTERVIEWER INSTRUCTION 'SELECT "INCLUDED WITH OTHER CHARGES" IF THIS IS A FLAT FEE SITUATION' IF EVENT-PROVIDER PAIR DOES NOT REPRESENT A FLAT FEE. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED AND THE EVENT TYPE OF THE EVENT-PROVIDER PAIR IS PM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A PM EVENT.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED AND THE EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A FLAT FEE GROUP.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED AND THE EVENT-PROVIDER PAIR REPRESENTS A REPEAT VISIT STEM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A REPEAT VISIT GROUP.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED 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
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, OR DN GO TO CP10
----------------------------------------------------

CP09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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)]?
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.
[SELECT 'INCLUDED WITH OTHER CHARGES' IF THIS IS A FLAT FEE SITUATION.]
AMOUNT ................................. 1 [CP09OV]
INCLUDED WITH OTHER CHARGES ........... 95
[Code One]
HELP AVAILABLE FOR DEFINITION OF WHAT MAKES UP TOTAL CHARGE AND FLAT FEE.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE): DISPLAY IF EVENT TYPE IS HS.

(PERSON)'s visit to (PROVIDER) on (VISIT DATE):
DISPLAY IF EVENT TYPE IS ER, OP, MV, OR DN.

the last purchase of [NAME OF PRESCRIBED MEDICINE] for (PERSON): DISPLAY IF EVENT TYPE IS PM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

the services for (FLAT FEE GROUP) for (PERSON):
DISPLAY IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE): DISPLAY IF EVENT TYPE IS OM.

services received at home from (PROVIDER) during (MONTH) for (PERSON): DISPLAY IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.
----------------------------------------------------
----------------------------------------------------
FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

DISPLAY INTERVIEWER INSTRUCTION 'SELECT "INCLUDED WITH OTHER CHARGES" IF THIS IS A FLAT FEE SITUATION' IF EVENT-PROVIDER PAIR DOES NOT REPRESENT A FLAT FEE GROUP. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A PM EVENT.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED AND THE EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A FLAT FEE GROUP.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED AND THE EVENT-PROVIDER PAIR REPRESENTS A REPEAT VISIT STEM, DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A REPEAT VISIT GROUP.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES' IS SELECTED 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
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
$ AMOUNT:
[Enter $ Amount] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
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, OR DN
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
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: $0 - $100,000

HARD CHECK:
AMOUNT CANNOT BE ( 0
----------------------------------------------------

CP09A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.

[$ AMOUNT]: DISPLAY AMOUNT ENTERED AT CP09OV.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), DISPLAY THE FOLLOWING MESSAGE:
'USE BACKUP TO CORRECT TOTAL CHARGE FOR THIS MONTH.'
----------------------------------------------------

CP10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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?
PROBE: For example, is this the type of situation in which (PERSON) always (make/makes) the same set dollar amount copayment?
YES .................................... 1 [CP11]
NO ..................................... 2 [CP11]
REF ................................... -7 [CP11]
DK .................................... -8 [CP11]
HELP AVAILABLE FOR DEFINITION OF SET AMOUNT AND COPAYMENT.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------

CP11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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)]? Please include all amounts paid 'out-of-pocket,' that is, amounts paid before any reimbursements.
IF AMOUNT PAID IS NOTHING, DK, OR REF, SELECT 'DOLLARS', THEN ENTER 0, DK, OR RF.
IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1 [CP11OV1]
PERCENT ................................ 2 [CP11OV2]
[Code One]
HELP AVAILABLE FOR INFORMATION ON AMOUNTS TO INCLUDE.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.

[[AMT TOT CH]/total charge]: DISPLAY '[AMT TOT CH]' IF AN AMOUNT IS GIVEN FOR THE TOTAL CHARGE AT CP09OV. DISPLAY 'total charge' IF CP08 IS CODED '2' (NO), '-7' (REFUSED), '-8' (DON'T KNOW), OR IS NOT ASKED.

[AMT TOT CH]: DISPLAY THE DOLLAR AMOUNT ENTERED AT CP09OV.
----------------------------------------------------
----------------------------------------------------
(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE): DISPLAY IF EVENT TYPE IS HS.

(PERSON)'s visit to (PROVIDER) on (VISIT DATE):
DISPLAY IF EVENT TYPE IS ER, OP, MV, OR DN.

the last purchase of [NAME OF PRESCRIBED MEDICINE] for (PERSON): DISPLAY IF EVENT TYPE IS PM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

the services for (FLAT FEE GROUP) for (PERSON):
DISPLAY IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE): DISPLAY IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

services received at home from (PROVIDER) during
(MONTH) for (PERSON): DISPLAY IF EVENT TYPE IS HH.
----------------------------------------------------

CP11OV1
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
DOLLARS:
[Enter $ Amount] ....................... [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
HELP AVAILABLE FOR INFORMATION ON AMOUNTS TO INCLUDE.
----------------------------------------------------
WRITE 'PERSON/FAMILY' TO THE RU-SOURCES-OF- PAYMENT-ROSTER.
----------------------------------------------------
----------------------------------------------------
WRITE 'PERSON/FAMILY' TO THE EVENT'S-SOURCES-OF- PAYMENT-ROSTER.
----------------------------------------------------
----------------------------------------------------
HARD RANGE CHECK:
$0 - $999,999
----------------------------------------------------

CP11OV2
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
PERCENT:
[Enter Percent %] ...................... [BOX_05]
HELP AVAILABLE FOR INFORMATION ON AMOUNTS TO INCLUDE.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK: 1% - 100%.

HARD CHECK:
IF 0, DK OR RF IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: 0, DK, RF ARE NOT ALLOWED ON THIS SCREEN. SELECT 'DOLLARS', THEN ENTER 0, DK, OR RF.
----------------------------------------------------

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.
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/REF-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)]?
YES .................................... 1 [CP12A]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HELP AVAILABLE FOR A DEFINITION OF SOURCE AND 'ALREADY PAID'.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'OTHER' IN THE QUESTION TEXT IF AN AMOUNT WAS PAID BY PERSON/FAMILY; THAT IS, AN AMOUNT ) $0 OR 0% WAS ENTERED AT CP11OV1 OR CP11OV2. OTHERWISE USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(PROVIDER)' IN THE QUESTION TEXT IF EVENT TYPE IS NOT PM OR OM. IF EVENT TYPE IS PM OR OM, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)' IF EVENT TYPE IS HS.

DISPLAY '(PERSON)'s visit to (PROVIDER) on (VISIT DATE)' IF EVENT TYPE IS ER, OP, MV, OR DN.

DISPLAY 'the last purchase of [NAME OF PRESCRIBED MEDICINE] for (PERSON)' IF EVENT TYPE IS PM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'the services for (FLAT FEE GROUP) for (PERSON)' IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

DISPLAY 'the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)' IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

services received at home from (PROVIDER) during (MONTH) for (PERSON): DISPLAY IF EVENT TYPE IS HH.
----------------------------------------------------

CP12A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF- PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CP13
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_SOP_2

COL # 1 HEADER: REIMBURSEMENT SOURCE
INSTRUCTIONS: DISPLAY REIMBURSEMENT SOURCE NAME (SRCS.SRCNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-SOURCES-OF-PAYMENT-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. MULTIPLE ADD ALLOWED. THE SCREEN DISPLAYS A LINK "ADD A SOURCE OF PAYMENT" THAT THE INTERVIEWER CAN SELECT. SELECTING THE LINK DISPLAYS A POP-UP WITH A TEXT ENTRY FIELD AND A SELECTABLE LIST OF 15 COMMON SOURCES OF PAYMENT.
(SEE BOX_00 FOR A DETAILED LIST). THE INTERVIEWER CAN TYPE A NEW SOURCE OR SELECT ONE FROM THE LIST. UPON RETURN TO CP12A, THE ADDED SOURCE WILL APPEAR ON THE ROSTER AS SELECTED.

3. LIMITED DELETE ALLOWED. IF INTERVIEWER ADDS A SOURCE OF PAYMENT, DELETE IS POSSIBLE FOR THAT SOURCE ONLY, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN. IF DELETE IS ATTEMPTED WHEN IT IS NOT ALLOWED, CAPI DISPLAYS THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN SOURCE IS FIRST ENTERED.'

4. IF ROSTER IS EMPTY WHEN CAPI DISPLAYS SCREEN, DISPLAY THE STANDARD WVS INSTRUCTION: "EITHER THE ROSTER IS EMPTY OR YOUR SEARCH HAS NOT TURNED UP ANY CHOICES."

5. PERSON/FAMILY IS FOR DISPLAY ONLY. THIS SOURCE IS AUTOMATICALLY SELECTED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL SOURCES OF PAYMENT.
----------------------------------------------------

CP13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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.
TOTAL CHARGE: [$XXXXXXXXX]
--------------------------------------------------------------------
ROSTER. SOURCE OF PAYMENT CP13_02. DOLLAR CP13_03. PERCENT AMOUNT PAID AMOUNT PAID
--------------------------------------------------------------------
PERSON/Family [Display $ Amount] [Display % Amount]
--------------------------------------------------------------------
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
--------------------------------------------------------------------
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
---------------------------------------------------------------------
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
TOTAL CHARGE: DISPLAY AMOUNT ENTERED AT CP09.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PERSON/FAMILY' AS THE FIRST SOURCE OF PAYMENT.

DISPLAY THE RESPONSE TO CP11 IN THE 'DOLLAR AMOUNT PAID' OR 'PERCENT AMOUNT PAID' COLUMN FOR PERSON/FAMILY. THAT IS, IF THE RESPONSE TO CP11 IS AN AMOUNT, DISPLAY THE DOLLAR AMOUNT IN THE 'DOLLAR AMOUNT PAID' COLUMN. IF THE RESPONSE TO CP11 IS A PERCENTAGE, DISPLAY THE PERCENTAGE AMOUNT IN THE 'PERCENT AMOUNT PAID' COLUMN. IF THE DOLLAR AMOUNT AT CP11 IS CODED '-8' (DON'T KNOW), DISPLAY 'DK' FOR THE AMOUNT IN BOTH COLUMNS. IF DOLLAR AMOUNT AT CP11 IS CODED '-7' (REFUSED), DISPLAY 'REF' FOR THE AMOUNT IN BOTH COLUMNS.
----------------------------------------------------
----------------------------------------------------
[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).
----------------------------------------------------
----------------------------------------------------
FLAG ALL SOURCES AND ASSOCIATED AMOUNTS AS 'DIRECT PAYMENT'.
----------------------------------------------------
----------------------------------------------------
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 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. NOTE THAT THE SCREEN WILL REQUIRE AN AMOUNT FOR PERSON/FAMILY IN THE DOLLAR COLUMN IN ORDER TO PROCEED. THIS DOLLAR AMOUNT MAY BE ENTERED BY THE INTERVIEWER OR CALCULATED BY CAPI BASED ON % OF TOTAL CHARGE WHERE TOTAL CHARGE IS KNOWN.
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.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
$0 - $10,000
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CP13OV
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: EVNT_SOP_1

COL # 1 HEADER: SOURCE OF PAYMENT
INSTRUCTIONS: DISPLAY PAYMENT SOURCE NAME (PAYM.REIMNAM/PAYF.REIMNAM)

COL # 2 HEADER: DOLLAR AMOUNT PAID
INSTRUCTIONS: ENTER $ AMOUNT PAID (PAYM.AMTPAID/PAYF.AMTPAID)

COL # 3 HEADER: PERCENT AMOUNT PAID
INSTRUCTIONS: ENTER % AMOUNT PAID (PAYM.PCTPAID/PAYF.PCTPAID)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER FOR ENTRY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SOURCE COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED TO SOURCES AT THIS SCREEN.

2. THE PERSON/FAMILY AMOUNT MAY BE CHANGED OR CORRECTED.

3. THE INTERVIEWER CAN ENTER A DOLLAR OR A PERCENTAGE AMOUNT FOR EACH SOURCE DISPLAYED.

4. THE AMOUNT PAID COLUMNS CAN BE CHANGED AS MANY TIMES AS NECESSARY BEFORE THE INTERVIEWER LEAVES THE SCREEN.

5. WHEN THE 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.

6. IF A SOURCE IS ENTERED IN ERROR, THE INTERVIEWER WILL ZERO OUT THE AMOUNT PAID.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL SOURCES SELECTED AT CP12A FOR THIS EVENT-PROVIDER PAIR AND THE 'PERSON/FAMILY' RECORD.
----------------------------------------------------

CP13OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
DID ANY OTHER SOURCES MAKE ANY PAYMENTS DIRECTLY TO THE PROVIDER?
YES .................................... 1 [END_LP01]
NO ..................................... 2 [END_LP01]
HELP AVAILABLE 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/REF-DT] [NAME OF PMED] [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 [CP14A]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
HELP AVAILABLE FOR DEFINITION OF SOURCE AND REIMBURSEMENT.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS OM EVENT.

DISPLAY 'glasses or contact lenses' IF THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

[$/% FAMILY PAID]: DISPLAY THE FAMILY DOLLAR AMOUNT PAID IF CP11 IS CODED '1' (DOLLARS).
DISPLAY THE FAMILY PERCENT AMOUNT PAID IF CP11 IS CODED '2' (PERCENT).
----------------------------------------------------

CP14A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS OM EVENT.

DISPLAY 'glasses or contact lenses' IF THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CP15
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_SOP_2

COL # 1 HEADER: REIMBURSEMENT SOURCE
INSTRUCTIONS: DISPLAY REIMBURSEMENT SOURCE NAME (SRCS.SRCNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-SOURCES-OF-PAYMENT-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE ADD AND MULTIPLE SELECT ALLOWED.

2. ADD ALLOWED. THE SCREEN DISPLAYS A LINK "ADD A SOURCE OF PAYMENT" THAT THE INTERVIEWER CAN SELECT. SELECTING THE LINK DISPLAYS A POP-UP WITH A TEXT ENTRY FIELD AND A SELECTABLE LIST OF 15 COMMON SOURCES OF PAYMENT. (SEE BOX_00 FOR A DETAILED LIST). THE INTERVIEWER CAN TYPE A NEW SOURCE OR SELECT ONE FROM THE LIST. UPON RETURN TO CP14A, THE ADDED SOURCE WILL APPEAR ON THE ROSTER AS SELECTED.

3. SELECT ONE. INTERVIEWER MAY SELECT ONLY ONE SOURCE OF PAYMENT.

4. LIMITED DELETE ALLOWED. IF INTERVIEWER ADDS A SOURCE OF PAYMENT, DELETE IS POSSIBLE FOR THAT SOURCE ONLY, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN. IF DELETE IS ATTEMPTED WHEN IT IS NOT ALLOWED, CAPI DISPLAYS THE FOLLOWING ERROR MESSAGE: 'DELETE ALLOWED ONLY WHEN SOURCE IS FIRST ENTERED.'

5. LIMITED EDIT ALLOWED. IF INTERVIEWER ADDS A SOURCE OF PAYMENT, EDITING IS POSSIBLE FOR THAT SOURCE ONLY, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN. IF EDIT IS ATTEMPTED WHEN IT IS NOT ALLOWED, CAPI DISPLAYS THE FOLLOWING ERROR MESSAGE: 'EDIT ALLOWED ONLY WHEN SOURCE FIRST ENTERED.'

6. IF ROSTER IS EMPTY WHEN CAPI DISPLAYS SCREEN, DISPLAY THE STANDARD WVS INSTRUCTION: "EITHER THE ROSTER IS EMPTY OR YOUR SEARCH HAS NOT TURNED UP ANY CHOICES."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL SOURCES OF PAYMENT ON THE ROSTER EXCEPT PERSON/FAMILY.
----------------------------------------------------

CP15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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.
PERSON/FAMILY PAYMENT: [$XXXXXXXXX] TOTAL CHARGE: [$XXXXXXXXX]
--------------------------------------------------------------------
ROSTER. SOURCE OF CP15_02. DOLLAR CP15_03. PERCENT REIMBURSEMENT AMOUNT REIMBURSED AMOUNT REIMBURSED
--------------------------------------------------------------------
[Display Source of [Enter $ Amount] [Enter % Amount] Reimbursement]
--------------------------------------------------------------------
[Display Source of [Enter $ Amount] [Enter % Amount] Reimbursement]
---------------------------------------------------------------------
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
TOTAL CHARGE: DISPLAY AMOUNT ENTERED AT CP09.
----------------------------------------------------
----------------------------------------------------
[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS OM EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).
----------------------------------------------------
----------------------------------------------------
PERSON/FAMILY PAYMENT: [$XXXXXXXXX]: DISPLAY THE DOLLAR AMOUNT ENTERED AT CP11OV1 IF CP11 IS CODED '1' (DOLLARS). DISPLAY THE PERCENT AMOUNT ENTERED AT CP11OV2 IF CP11 IS CODED '2' (PERCENT).
----------------------------------------------------
----------------------------------------------------
TOTAL CHARGE: [$XXXXXXXXX]: DISPLAY THE AMOUNT ENTERED AT CP09OV. IF CP08 IS CODED '2' (NO), '-8' (DON'T KNOW), OR IF CP09 IS CODED '-8' (DON'T KNOW), DISPLAY 'UNKNOWN' FOR [$XXXXXXXXX]. IF CP08 IS CODED '-7' (REFUSED) OR IF CP09 IS CODED '-7' (REFUSED), DISPLAY 'REFUSED' FOR [$XXXXXXXXX].
----------------------------------------------------
----------------------------------------------------
FLAG ALL SOURCES AND ASSOCIATED AMOUNTS AS 'REIMBURSEMENT'.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
0 – 999999
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: EVNT_SOP_1

COL # 1 HEADER: SOURCE OF PAYMENT
INSTRUCTIONS: DISPLAY PAYMENT SOURCE NAME (PAYM.REIMNAM/PAYF.REIMNAM)

COL # 2 HEADER: DOLLAR AMOUNT PAID
INSTRUCTIONS: ENTER $ AMOUNT PAID (PAYM.AMTPAID/PAYF.AMTPAID)

COL # 3 HEADER: PERCENT AMOUNT PAID
INSTRUCTIONS: ENTER % AMOUNT PAID (PAYM.PCTPAID/PAYF.PCTPAID)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SOURCE COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED TO SOURCES AT THIS SCREEN.

2. THE INTERVIEWER CAN ENTER A DOLLAR OR A PERCENTAGE AMOUNT FOR EACH SOURCE DISPLAYED.

3. THE AMOUNT PAID COLUMNS CAN BE CHANGED AS MANY TIMES AS NECESSARY BEFORE THE INTERVIEWER LEAVES THE SCREEN.

4. WHEN THE 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.

5. IF A SOURCE IS ENTERED IN ERROR, THE INTERVIEWER WILL ZERO OUT THE AMOUNT PAID. IF THE TOTAL AMOUNT REIMBURSED BY ALL SOURCES EXCEEDS THE AMOUNT PAID BY THE PERSON/FAMILY, CAPI DISPLAYS THE MESSAGE 'SHOULD THIS ANSWER BE ACCEPTED OR CHANGED?' IF THE INTERVIEWER REENTERS THE SAME AMOUNTS, CAPI WILL ACCEPT IT.

6. INTERVIEWERS WILL BE INSTRUCTED TO ENTER ONLY REIMBURSEMENTS MADE TO THE FAMILY AT THIS SCREEN.

7. THE SAME SOURCE CAN BE FLAGGED AS BOTH A REIMBURSEMENT AND A DIRECT PAYMENT. ONLY THE AMOUNT OF THE DIRECT PAYMENT WILL PLAY INTO THE RESOLUTION PROCESS.

8. POST DATA COLLECTION EDITING WILL BE NECESSARY TO DETERMINE THE NET PAYMENTS OF SOURCES.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL SOURCES SELECTED AT CP14A FOR THIS EVENT-PROVIDER PAIR.
----------------------------------------------------

CP15OV
======
ARE THERE ANY OTHER SOURCES OF REIMBURSEMENT?
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
HELP AVAILABLE 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
======

----------------------------------------------------
GO TO BOX_11
----------------------------------------------------

BOX_08
======

OMITTED.

CP16
====

OMITTED.

CP17
====

OMITTED.

CP17OV1
=======

OMITTED.

CP17OV2
=======

OMITTED.

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/REF-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 [CP19]
NO ..................................... 2 [BOX_09]
REF ................................... -7 [BOX_09]
DK .................................... -8 [BOX_09]
HELP AVAILABLE FOR DEFINITION OF REIMBURSEMENT.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.

DISPLAY 'OTHER' IF CP14 IS CODED '1' (YES).
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

CP19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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 [CP19OV1]
PERCENT ................................ 2 [CP19OV2]
[Code One]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------

CP19OV1
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
DOLLARS:
[Enter $ Amount] ....................... [CP20]
REF ................................... -7 [CP20]
DK .................................... -8 [CP20]
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: $0 - $10,000
----------------------------------------------------

CP19OV2
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
PERCENT:
[Enter % Amount] ....................... [CP20]
REF ................................... -7 [CP20]
DK .................................... -8 [CP20]
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 1% - 100%
----------------------------------------------------

CP20
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF- PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_09
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_SOP_2

COL # 1 HEADER: REIMBURSEMENT SOURCE
INSTRUCTIONS: DISPLAY REIMBURSEMENT SOURCE NAME (SRCS.SRCNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-SOURCES-OF-PAYMENT-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:

1. MULTIPLE ADD ALLOWED. THE SCREEN DISPLAYS AN "ADD SOURCES" OPTION. SELECTING THE OPTION DISPLAYS A POP-UP WITH A TEXT ENTRY FIELD AND A SELECTABLE LIST OF 15COMMON SOURCES OF PAYMENT.
(SEE BOX_00 FOR A DETAILED LIST). THE INTERVIEWER CAN TYPE A NEW SOURCE OR SELECT ONE FROM THE LIST.
UPON RETURN TO CP20, THE ADDED SOURCE WILL APPEAR ON THE ROSTER AS SELECTED.

2. SELECT ONE. INTERVIEWER MAY SELECT ONLY ONE SOURCE OF PAYMENT.

3. LIMITED DELETE ALLOWED. IF INTERVIEWER ADDS A SOURCE OF PAYMENT, DELETE IS POSSIBLE FOR THAT SOURCE ONLY, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN.

4. IF ROSTER IS EMPTY WHEN CAPI DISPLAYS SCREEN, DISPLAY THE STANDARD WVS INSTRUCTION: "EITHER THE ROSTER IS EMPTY OR YOUR SEARCH HAS NOT TURNED UP ANY CHOICES."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL SOURCES OF PAYMENT ON THE ROSTER EXCEPT PERSON/FAMILY.
----------------------------------------------------

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 CP09OV (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/REF-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)]?
YES .................................... 1 [CP22]
NO ..................................... 2 [LOOP_03]
REF ................................... -7 [LOOP_03]
DK .................................... -8 [LOOP_03]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE): DISPLAY IF EVENT TYPE IS HS.

(PERSON)'s visit to (PROVIDER) on (VISIT DATE):
DISPLAY IF EVENT TYPE IS ER, OP, MV, OR DN.

the last purchase of [NAME OF PRESCRIBED MEDICINE] for (PERSON): DISPLAY IF EVENT TYPE IS PM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

the services for (FLAT FEE GROUP) for (PERSON):
DISPLAY IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE): DISPLAY IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

services received at home from (PROVIDER) during (MONTH) for (PERSON): DISPLAY IF EVENT TYPE IS HH.
----------------------------------------------------

CP22
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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 [CP22OV1]
PERCENT ................................ 2 [CP22OV2]
[Code One]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------

CP22OV1
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
DOLLARS:
[Enter $ Amount] ....................... [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX_14]
----------------------------------------------------
HARD RANGE CHECK:
$0 - $999,9999
----------------------------------------------------

CP22OV2
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
PERCENT:
[Enter % Amount] ....................... [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX_14]
----------------------------------------------------
HARD RANGE: 1% - 100%.

HARD CHECK:
IF 0, DK OR RF IS ENTERED, DISPLAY THE FOLLOWING MESSAGE: "0, DK, RF NOT ALLOWED ON THIS SCREEN. SELECT 'DOLLARS', THEN ENTER 0, DK, OR RF."
----------------------------------------------------

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. 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/REF-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?
[1. Name of Source of Direct Payment-35]
[2. Name of Source of Direct Payment-35]
[3. Name of Source of Direct Payment-35]
----------------------------------------------------
[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF- PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CP24
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_SOP_2

COL # 1 HEADER: REIMBURSEMENT SOURCE
INSTRUCTIONS: DISPLAY REIMBURSEMENT SOURCE NAME (SRCS.SRCNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-SOURCES-OF-PAYMENT-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. MULTIPLE ADD ALLOWED. THE SCREEN DISPLAYS AN "ADD SOURCES OF PAYMENT" OPTION. SELECTING THE OPTION DISPLAYS A POP-UP WITH A TEXT ENTRY FIELD AND A SELECTABLE LIST OF 15 COMMON SOURCES OF PAYMENT. (SEE BOX_00 FOR A DETAILED LIST). THE INTERVIEWER CAN TYPE A NEW SOURCE OR SELECT ONE FROM THE LIST. UPON RETURN TO CP23, THE ADDED SOURCE WILL APPEAR ON THE ROSTER AS SELECTED.

3. LIMITED DELETE ALLOWED. IF INTERVIEWER ADDS A SOURCE OF PAYMENT" THAT SOURCE ONLY, AS SELECTED.

4. IF ROSTER IS EMPTY WHEN CAPI DISPLAYS SCREEN, DISPLAY THE STANDARD WVS INSTRUCTION: "EITHER THE ROSTER IS EMPTY OR YOUR SEARCH HAS NOT TURNED UP ANY CHOICES."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE; DISPLAY ALL.
----------------------------------------------------

CP24
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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)] 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, BACK UP TO CP09.
UNDERPAYMENT: [$XXXXXXXXX] TOTAL CHARGE: [$XXXXXXXXX]
--------------------------------------------------------------------
ROSTER. SOURCE OF PAYMENT CP24_02. DOLLAR CP24_03. PERCENT AMOUNT PAID AMOUNT PAID
--------------------------------------------------------------------
PERSON/Family [Display $ Amount] [Display % Amount]
--------------------------------------------------------------------
[Display Source of Payment] [Display $ Amount] [Display % Amount]
--------------------------------------------------------------------
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
--------------------------------------------------------------------
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
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 CP11 IS A DOLLAR AMOUNT, DISPLAY THE DOLLAR AMOUNT IN THE 'DOLLAR AMOUNT PAID' COLUMN.
IF THE RESPONSE TO CP11 IS A PERCENTAGE, DISPLAY THE PERCENTAGE AMOUNT IN THE 'PERCENT AMOUNT PAID' COLUMN. IF THE DOLLAR AMOUNT OR PERCENT AT CP11 IS CODED '-8' (DON'T KNOW), DISPLAY 'DK' FOR THE AMOUNT IN BOTH COLUMNS. IF THE DOLLAR AMOUNT OR PERCENT IS CODED '-7' (REFUSED), DISPLAY 'REF' FOR THE AMOUNT IN BOTH COLUMNS.
----------------------------------------------------
----------------------------------------------------
[AMOUNT REMAINING]: DISPLAY THE AMOUNT OF THE CALCULATED UNDERPAYMENT.

(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE): DISPLAY IF EVENT TYPE IS HS.

(PERSON)'s visit to (PROVIDER) on (VISIT DATE):
DISPLAY IF EVENT TYPE IS ER, OP, MV, OR DN.

the last purchase of [NAME OF PRESCRIBED MEDICINE] for (PERSON): DISPLAY IF EVENT TYPE IS PM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

the services for (FLAT FEE GROUP) for (PERSON):
DISPLAY IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE): DISPLAY IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

services received at home from (PROVIDER) during (MONTH) for (PERSON): DISPLAY IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
UNDERPAYMENT: [$XXXXXXXXX]: DISPLAY THE AMOUNT OF THE CALCULATED UNDERPAYMENT.

TOTAL CHARGE: [$XXXXXXXXX]: DISPLAY THE AMOUNT ENTERED AT CP09OV.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SOURCES AND ASSOCIATED AMOUNTS AS 'DIRECT PAYMENTS'.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
WHOLE DOLLAR AMOUNT (INTEGER): 0 - $100,000
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: EVNT_SOP_1

COL # 1 HEADER: SOURCE OF PAYMENT
INSTRUCTIONS: DISPLAY PAYMENT SOURCE NAME (PAYM.REIMNAM/PAYF.REIMNAM)

COL # 2 HEADER: DOLLAR AMOUNT PAID
INSTRUCTIONS: ENTER $ AMOUNT PAID (PAYM.AMTPAID/PAYF.AMTPAID)

COL # 3 HEADER: PERCENT AMOUNT PAID
INSTRUCTIONS: ENTER % AMOUNT PAID (PAYM.PCTPAID/PAYF.PCTPAID)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER FOR ENTRY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SOURCE COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED TO SOURCES AT THIS SCREEN.

2. THE INTERVIEWER CAN ENTER A DOLLAR OR A PERCENTAGE AMOUNT FOR EACH SOURCE DISPLAYED.

3. NO CORRECTIONS OR UPDATES MAY BE MADE TO SOURCE NAMES OR AMOUNTS OF REIMBURSEMENT.

4. WHEN THE 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.

5. IF A SOURCE IS ENTERED IN ERROR, THE INTERVIEWER WILL ZERO OUT THE AMOUNT PAID.

6. ONLY NEW SOURCES OF DIRECT PAYMENTS MAY BE ADDED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL SOURCES FLAGGED AS 'DIRECT PAYMENT' FOR THIS EVENT.
----------------------------------------------------

CP24OV
======
DID ANY OTHER SOURCES MAKE ANY PAYMENTS DIRECTLY TO THE PROVIDER?
YES .................................... 1 [END_LP03]
NO ..................................... 2 [END_LP03]
HELP AVAILABLE 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/REF-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?
[1. Name of Source of Direct Payment-35]
[2. Name of Source of Direct Payment-35]
[3. Name of Source of Direct Payment-35]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS OM EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF- PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
GO TO CP26
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_SOP_2

COL # 1 HEADER: REIMBURSEMENT SOURCE
INSTRUCTIONS: DISPLAY REIMBURSEMENT SOURCE NAME (SRCS.SRCNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-SOURCES-OF-PAYMENT-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE ADD ALLOWED. THE SCREEN DISPLAYS AN "ADD SOURCES OF PAYMENT" OPTION. SELECTING THE LINK DISPLAYS A POP-UP WITH A TEXT ENTRY FIELD AND A SELECTABLE LIST OF 15 COMMON SOURCES OF PAYMENT.
(SEE BOX_00 FOR A DETAILED LIST). THE INTERVIEWER CAN TYPE A NEW SOURCE OR SELECT ONE FROM THE LIST.
UPON RETURN TO CP25, THE ADDED SOURCE WILL APPEAR ON THE ROSTER AS SELECTED.

2. SELECT ONE. INTERVIEWER MAY SELECT ONLY ONE SOURCE OF PAYMENT.

3. LIMITED DELETE ALLOWED. IF INTERVIEWER ADDS A SOURCE OF PAYMENT, DELETE IS POSSIBLE FOR THAT SOURCE ONLY, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN.

4. IF ROSTER IS EMPTY WHEN CAPI DISPLAYS SCREEN, DISPLAY THE STANDARD WVS INSTRUCTION: "EITHER THE ROSTER IS EMPTY OR YOUR SEARCH HAS NOT TURNED UP ANY CHOICES."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------

CP26
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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)] 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, BACK UP TO CP09.
OVERPAYMENT: [$XXXXXXXXX] TOTAL CHARGE: [$XXXXXXXXX]
--------------------------------------------------------------------
ROSTER. SOURCE OF PAYMENT CP26_02. DOLLAR CP26_03. PERCENT AMOUNT PAID AMOUNT PAID
-------------------------------------------------------------------
PERSON/Family [Display $ Amount] [Display % Amount]
--------------------------------------------------------------------
[Display Source of Payment] [Display $ Amount] [Display % Amount]
--------------------------------------------------------------------
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
--------------------------------------------------------------------
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE CONTEXT HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES). OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE CONTEXT HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE CONTEXT HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
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 CP11 IS A DOLLAR AMOUNT, DISPLAY THE DOLLAR AMOUNT IN THE 'DOLLAR AMOUNT PAID' COLUMN.
IF THE RESPONSE TO CP11 IS A PERCENTAGE, DISPLAY THE PERCENTAGE AMOUNT IN THE 'PERCENT AMOUNT PAID' COLUMN. IF THE DOLLAR AMOUNT OR PERCENT AT CP11 IS CODED '-8' (DON'T KNOW), DISPLAY 'DK' FOR THE AMOUNT IN BOTH COLUMNS. IF THE DOLLAR AMOUNT OR PERCENT IS CODED '-7' (REFUSED), DISPLAY 'REF' FOR THE AMOUNT IN BOTH COLUMNS.
----------------------------------------------------
----------------------------------------------------
(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE): DISPLAY IF EVENT TYPE IS HS.

(PERSON)'s visit to (PROVIDER) on (VISIT DATE):
DISPLAY IF EVENT TYPE IS ER, OP, MV, OR DN.

the last purchase of [NAME OF PRESCRIBED MEDICINE] for (PERSON): DISPLAY IF EVENT TYPE IS PM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

the services for (FLAT FEE GROUP) for (PERSON):
DISPLAY IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE): DISPLAY IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

services received at home from (PROVIDER) during (MONTH) for (PERSON): DISPLAY IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
[$ DISCREPANCY]: DISPLAY THE AMOUNT OF THE CALCULATED OVERPAYMENT.

OVERPAYMENT: [$XXXXXXXXX]: DISPLAY THE AMOUNT OF THE CALCULATED OVERPAYMENT.

TOTAL CHARGE: [$XXXXXXXXX]: DISPLAY THE AMOUNT ENTERED AT CP09OV.
----------------------------------------------------
----------------------------------------------------
FLAG ALL SOURCES AND ASSOCIATED AMOUNTS AS 'DIRECT PAYMENTS'.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
WHOLE DOLLAR AMOUNT (INTEGER): 0 - $100,000
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: EVNT_SOP_1

COL # 1 HEADER: SOURCE OF PAYMENT
INSTRUCTIONS: DISPLAY PAYMENT SOURCE NAME (PAYM.REIMNAM/PAYF.REIMNAM)

COL # 2 HEADER: DOLLAR AMOUNT PAID
INSTRUCTIONS: ENTER $ AMOUNT PAID (PAYM.AMTPAID/PAYF.AMTPAID)

COL # 3 HEADER: PERCENT AMOUNT PAID
INSTRUCTIONS: ENTER % AMOUNT PAID (PAYM.PCTPAID/PAYF.PCTPAID)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER FOR ENTRY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SOURCE COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED TO SOURCES AT THIS SCREEN.

2. THE INTERVIEWER CAN ENTER A DOLLAR OR A PERCENTAGE AMOUNT FOR EACH SOURCE DISPLAYED.

3. WHEN THE 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.

4. IF A SOURCE IS ENTERED IN ERROR, THE INTERVIEWER WILL ZERO OUT THE AMOUNT PAID.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL SOURCES FLAGGED AS 'DIRECT PAYMENT'.
----------------------------------------------------

CP26OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
DID ANY OTHER SOURCES MAKE ANY PAYMENTS DIRECTLY TO THE PROVIDER?
YES .................................... 1 [END_LP04]
NO ..................................... 2 [END_LP04]
HELP AVAILABLE 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_19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CP37
----------------------------------------------------

BOX_16
======

OMITTED.

CP27
====

OMITTED.

CP28
====

OMITTED.

CP28OV1
=======

OMITTED.

CP28OV2
=======

OMITTED.

BOX_17
======

OMITTED.

BOX_18
======

OMITTED.

CP29
====

OMITTED.

CP30
====

OMITTED.

CP30OV1
=======

OMITTED.

CP30OV2
=======

OMITTED.

BOX_19
======

----------------------------------------------------
IF CP21 WAS ASKED, GO TO CP37
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_20
----------------------------------------------------

BOX_20
======

----------------------------------------------------
IF UNDERPAYMENT IS STILL ) 3% OR $5 (WHICHEVER IS HIGHER) OF TOTAL CHARGE, CONTINUE WITH CP31 USING THE DIFFERENCE IN THE DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF UNDERPAYMENT IS NOT ) 3% OR $5 (WHICHEVER IS HIGHER) OF THE TOTAL CHARGE, GO TO CP37
----------------------------------------------------

CP31
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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]
--------------------------------------------------------------------
ROSTER. SOURCE OF PAYMENT DOLLAR PERCENT AMOUNT PAID 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 [CP32]
NO ..................................... 2 [CP37]
REF ................................... -7 [CP37]
DK .................................... -8 [CP37]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.
----------------------------------------------------
----------------------------------------------------
[amount/more]: DISPLAY 'amount' IF PERSON FAMILY PAYMENT IS $0/0%. DISPLAY 'more' IF PERSON/FAMILY PAYMENT IS NOT EQUAL TO $0/0% (INCLUDING DON'T KNOW AND REFUSED RESPONSES).

TOTAL CHARGE: [$XXXXXXXXX]: DISPLAY THE AMOUNT ENTERED AT CP09OV.

DIFFERENCE: [$XXXXXXXXX]: DISPLAY THE AMOUNT OF THE RE-CALCULATED UNDERPAYMENT.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: EVNT_SOP_1

COL # 1 HEADER: SOURCE OF PAYMENT
INSTRUCTIONS: DISPLAY PAYMENT SOURCE NAME (PAYM.REIMNAM/PAYF.REIMNAM)

COL # 2 HEADER: DOLLAR AMOUNT PAID
INSTRUCTIONS: ENTER $ AMOUNT PAID (PAYM.AMTPAID/PAYF.AMTPAID)

COL # 3 HEADER: PERCENT AMOUNT PAID
INSTRUCTIONS: ENTER % AMOUNT PAID (PAYM.PCTPAID/PAYF.PCTPAID)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE EVENT'S-SOURCES-OF-PAYMENT-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. THIS MATRIX IS READ-ONLY.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL SOURCES FLAGGED AS 'DIRECT PAYMENT'.
----------------------------------------------------

CP32
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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 do you expect anyone in the family to pay?
IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1 [CP32OV1]
PERCENT ................................ 2 [CP32OV2]
[Code One]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.
----------------------------------------------------

CP32OV1
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
DOLLARS:
[Enter $ Amount] ....................... [CP37]
REF ................................... -7 [CP37]
DK .................................... -8 [CP37]
----------------------------------------------------
SOFT CHECK:
WHOLE DOLLAR AMOUNT (INTEGER): $0 - $10,000
----------------------------------------------------

CP32OV2
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]/FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]]
PERCENT:
[Enter % Amount] ....................... [CP37]
REF ................................... -7 [CP37]
DK .................................... -8 [CP37]
----------------------------------------------------
SOFT CHECK:
1% - 100%
----------------------------------------------------

BOX_21
======

OMITTED.

CP33
====

OMITTED.

CP34
====

OMITTED.

CP34OV1
=======

OMITTED.

CP34OV2
=======

OMITTED.

BOX_22
======

OMITTED.

CP35
====

OMITTED.

CP36
====

OMITTED.

CP37
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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)]?
CHECK ALL THAT APPLY.
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 [CP37OV]
[Code All That Apply]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------
----------------------------------------------------
THE VISIT TO (PROVIDER) ON (VISIT DATE): DISPLAY IF EVENT TYPE IS HS, OP, ER, MV, OR DN.

THE VISITS FOR (FLAT FEE GROUP): DISPLAY IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

THE LAST PURCHASE OF [NAME OF PRESCRIBED MEDICINE]: DISPLAY IF EVENT TYPE IS PM.

[NAME OF PRESCRIBED MEDICINE]: DISPLAY THE NAME OF THE PRESCRIPTION MEDICINE BEING ASKED ABOUT FOR THIS EVENT.

THE [OME ITEM GROUP NAME] USED BY (PERSON) SINCE (START DATE): DISPLAY IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

SERVICES RECEIVED AT HOME FROM (PROVIDER) DURING (MONTH) FOR (PERSON): DISPLAY IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH CP37OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_23
----------------------------------------------------

CP37OV
======
OTHER SPECIFY:
[Enter Other Specify] .................. [BOX_23]

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/REF-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 [CP39]
NO ..................................... 2 [BOX_24]
HELP AVAILABLE FOR DEFINITION OF PROVIDER NAME.
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------

CP39
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-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]
----------------------------------------------------
DISPLAY [NAME OF MEDICAL CARE PROVIDER] IN THE HEADER IF THE EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).
OTHERWISE, USE NULL VALUE.

DISPLAY [EVN-DT] IN THE HEADER IF EVENT TYPE IS NOT 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY [REF-DT] IN THE HEADER IF EVENT TYPE IS 'PM' (PRESCRIBED MEDICINES) OR 'OM' (OTHER MEDICAL EXPENSES).

DISPLAY 'REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]' IN THE HEADER IF THIS EVENT IS A REPEAT VISIT STEM.

DISPLAY 'FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]' IN THE HEADER IF THIS EVENT IS A FLAT FEE STEM.
----------------------------------------------------

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), '8' (NO BILL SENT: PUBLIC ASSISTANCE/MEDICAID/SCHIP) OR '15' (NO BILL SENT: INDIAN HEALTH SERVICE)]
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_00A
=======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PROV.PROVNAME, EVPV.EVNTTYPE, EVPV.EVNTBEGM, EVPV.EVNTBEGD, EVPV.EVNTBEGY, EVPV.EVNTENDM, EVPV.EVNTENDD, EVPV.EVNTENDY, FFEE.FFEENAME
----------------------------------------------------
----------------------------------------------------
IF OMTYPE = 4-11, 91 USE "JAN 01" FOR START DATE.
----------------------------------------------------

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)].
REVIEW FLAT FEE GROUPS WITH RESPONDENT. SELECT FLAT FEE GROUP COVERED BY SAME CHARGE AS EVENT BEING ASKED ABOUT.
[1. Flat Fee Group] ....................
[2. Flat Fee Group] ....................
[3. Flat Fee Group] ....................
[Code One]
----------------------------------------------------
DISPLAY '(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)' IF EVENT TYPE IS HS.

DISPLAY '(PERSON)'s visit to (PROVIDER) on (VISIT DATE)' IF EVENT TYPE IS ER, OP, MV, OR DN.

DISPLAY 'the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)' IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
FOR [OME ITEM GROUP NAME], DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT:

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

DISPLAY 'services received at home from (PROVIDER) during (MONTH) for (PERSON)' IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
DISPLAY AN 'ADD GROUP' OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF A FLAT FEE GROUP IS SELECTED, GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
IF 'ADD GROUP' IS SELECTED, CONTINUE WITH FF02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS_FFEE_GROUPS_1

COL # 1 HEADER: FLAT FEE GROUP
INSTRUCTIONS: DISPLAY FLAT FEE GROUP NAME (FFEE.FFEENAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON'S-FLAT-FEE-GROUPS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED.

3. MULTIPLE SELECT, MULTIPLE ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL.
----------------------------------------------------

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)].
REVIEW EVENTS WITH RESPONDENT. SELECT EVENTS COVERED BY SAME CHARGE AS EVENT BEING ASKED ABOUT.
------------------------------------------------------------------------------------
ROSTER. PROVIDER FF02_02. EVENT TYPE FF02_03. ADMIT DATE FF02_04 DISCH DATE
------------------------------------------------------------------------------------
[Display Medical [Display Event Code] [Display Month [Display Month Provider-35] Day Year-4] Day Year-4]
------------------------------------------------------------------------------------
[Display Medical [Display Event Code] [Display Month [Display Month Provider-35] Day Year-4] Day Year-4]
------------------------------------------------------------------------------------
[Display Medical [Display Event Code] [Display Month [Display Month Provider-35] Day Year-4] Day Year-4]
------------------------------------------------------------------------------------
----------------------------------------------------
DISPLAY '(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)' IF EVENT TYPE IS HS.

DISPLAY '(PERSON)'s visit to (PROVIDER) on (VISIT DATE)' IF EVENT TYPE IS ER, OP, MV, OR DN.

DISPLAY 'the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)' IF EVENT TYPE IS OM.
----------------------------------------------------
----------------------------------------------------
FOR [OME ITEM GROUP NAME], DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT:

DISPLAY 'glasses or contact lenses' IF EVENT TYPE IS OM AND THE OM ITEM GROUP IS '1' (GLASSES OR CONTACT LENSES).

DISPLAY 'ambulance services' IF THE OM ITEM GROUP IS '4' (AMBULANCE SERVICES).

DISPLAY 'orthopedic items' IF THE OM ITEM GROUP IS '5' (ORTHOPEDIC ITEMS).

DISPLAY 'hearing devices' IF THE OM ITEM GROUP IS '6' (HEARING DEVICES).

DISPLAY 'prostheses' IF THE OM ITEM GROUP IS '7' (PROSTHESES).

DISPLAY 'bathroom aids' IF THE OM ITEM GROUP IS '8' (BATHROOM AIDS).

DISPLAY 'medical equipment' IF THE OM ITEM GROUP IS '9' (MEDICAL EQUIPMENT).

DISPLAY 'disposable supplies' IF THE OM ITEM GROUP IS '10' (DISPOSABLE SUPPLIES).

DISPLAY 'alterations or modifications' IF THE OM ITEM GROUP IS '11' (ALTERATIONS/MODIFICATIONS).

DISPLAY [TEXT FROM OTHER SPECIFY] IF THE OM ITEM GROUP IS '91' (OTHER).

FOR 'TEXT FROM OTHER SPECIFY', DISPLAY THE TEXT CATEGORY ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS.

FOR '[START DATE]', DISPLAYED IN THE CONTEXT HEADER, DISPLAY THE START DATE OF THE CURRENT ROUND FOR OM EVENTS THAT ARE 'REGULAR' GROUP TYPE (EV02A=1 OR NOT ASKED) AND DISPLAY 'JAN 01' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).

DISPLAY 'services received at home from (PROVIDER) during (MONTH) for (PERSON)' IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS_MED_EVNT_1

COL # 1 HEADER: PROVIDER
INSTRUCTIONS: DISPLAY THE NAME OF PROVIDER ASSOCIATED WITH THIS EVENT (EVNT.LORPNAME)

COL # 2 HEADER: EVENT TYPE
INSTRUCTIONS: DISPLAY THE TWO-LETTER EVENT ABBREVIATION (EVNT.EVNTTYPE)

COL # 3 HEADER: ADMIT DATE
INSTRUCTIONS: DISPLAY THE MONTH, DAY, AND YEAR OF MEDICAL EVENTS (EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY)

COL # 4 HEADER: DISCHARGE DATE
INSTRUCTIONS: DISPLAY THE DISCHARGE DATE FOR HOSPITAL STAY EVENTS (EVNT.EVNTENDM, EVNT.EVNTENDD, EVNT.EVNTENDY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS ALL MEDICAL EVENTS ON PERSON'S-MEDICAL-EVENTS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. EVENT HAS CP STATUS OF 'PROCESSED' OR 'UNPROCESSED' (DISPLAY EVENT REGARDLESS OF CP STATUS).

2. EVENT IS NOT ALREADY INCLUDED IN A FLAT FEE GROUP OR A REPEAT VISIT GROUP.

3. EVENT IS NOT ALREADY CODED (VERIFIED) AS A COPAYMENT.

4. EVENT TYPE IS NOT PM, IC, OM TYPE 2 (INSULIN), OR OM TYPE 3 (OTHER DIABETIC SUPPLIES OR EQUIPMENT).

5. EVENT IS NOT AN HS EVENT WITH A DISCHARGE DATE CODED '95' (STILL IN HOSPITAL).

6. EVENT IS NOT AN MV OR OP EVENT THAT WAS A TELEPHONE CALL (OP02 OR MV01 CODED '2').

7. EVENT IS NOT A HH EVENT WITH EVENT DATE = INTERVIEW MONTH.

8. DISPLAY 'EVENT OUTSIDE REFERENCE PERIOD' AS THE LAST ENTRY IN THE 'PROVIDER' 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 [FF05]
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] ......................... [FF06]
REF ................................... -7 [FF06]
DK .................................... -8 [FF06]

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 [FF07]
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
HELP AVAILABLE 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

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, [YEAR]?
YES .................................... 1 [FF10]
NO ..................................... 2 [FF11]
REF ................................... -7 [FF11]
DK .................................... -8 [FF11]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR 'YEAR', DISPLAY THE SECOND YEAR OF THE PANEL.
----------------------------------------------------

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, [YEAR]?
[Enter Number] ......................... [FF11]
REF ................................... -7 [FF11]
DK .................................... -8 [FF11]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR 'YEAR', DISPLAY THE SECOND YEAR OF THE PANEL.
----------------------------------------------------

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, [YEAR]?
YES .................................... 1 [FF12]
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
HELP AVAILABLE FOR DEFINITION OF SURGICAL PROCEDURE.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR 'YEAR', DISPLAY THE SECOND YEAR OF THE PANEL.
----------------------------------------------------

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 [FF13]
REF ................................... -7 [FF13]
DK .................................... -8 [FF13]

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 [BOX_02]
SAME DAY ............................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[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.
----------------------------------------------------


Prescribed Medicines (PM) Section


BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, PRND.BEGREFMM,DD,YY AND PRND.ENDREFMM,DD,YY.
----------------------------------------------------

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 OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
MEDICINES ARE FLAGGED AS 'CREATED' ONLY ONCE (I.E., THE ROUND IN WHICH THE MEDICINE IS INITIALLY REPORTED). MEDICINES ARE FLAGGED AS 'SELECTED' WHEN CHOSEN IN SUBSEQUENT ROUNDS.
THUS, FOR ONE ROUND, A MEDICINE CAN ONLY BE FLAGGED AS EITHER 'CREATED' OR 'SELECTED', BUT NOT BOTH.
----------------------------------------------------
----------------------------------------------------
IF PERSON HAS NO MEDICINES CREATED OR SELECTED ON PERSON'S-PRESCRIBED-MEDICINES-ROSTER DURING THE CURRENT ROUND, GO TO PM04
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PM02
----------------------------------------------------

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.)
[NAME OF PRESCRIPTION MEDICINE]
[NAME OF PRESCRIPTION MEDICINE]
[NAME OF PRESCRIPTION MEDICINE]
INFORMATION OKAY ....................... 1 [PM04]
AT LEAST ONE MEDICINE INCORRECT ........ 2
[Code One]
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERSON'S_PRESCRIBED-MEDICINES_1

COL #1 HEADER: DRUG NAME
INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE (DRUG.DRUGNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-PRESCRIBED- MEDICINES-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.

2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE PRESCRIBED MEDICINES THAT ARE FLAGGED AS EITHER 'CREATED' OR 'SELECTED' DURING THE CURRENT ROUND.
----------------------------------------------------

PM03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SELECT MEDICINE(S) THAT WERE RECORDED INCORRECTLY.
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
----------------------------------------------------
FLAG SELECTED MEDICINES AS 'INCORRECT'. THESE MEDICINES WILL NOT BE ELIGIBLE FOR LOOP_01 (I.E., NOT 'CREATED' OR 'SELECTED' THIS ROUND).
----------------------------------------------------
----------------------------------------------------
GO TO PM04
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERSON'S_PRESCRIBED-MEDICINES_1

COL #1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE (DRUG.DRUGNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-PRESCRIBED- MEDICINES-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE PRESCRIBED MEDICINES THAT ARE FLAGGED AS EITHER 'CREATED' OR 'SELECTED' DURING THE CURRENT 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?
Please include any on-line prescriptions.
YES .................................... 1 [PM05]
NO ..................................... 2 [PM06]
REF ................................... -7 [PM06]
DK .................................... -8 [PM06]
HELP AVAILABLE 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?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
-----------------------------------------------------
FLAG ANY MEDICINE ADDED TO THE ROSTER AS 'CREATED' IN THIS ROUND.

FLAG ANY MEDICINE SELECTED FROM THE ROSTER AS 'SELECTED' IN THIS ROUND, IF THIS IS THE FIRST TIME THAT THE MEDICINE IS SELECTED IN CAPI IN THIS ROUND. FOR ANY ONE ROUND, A MEDICINE CAN BE FLAGGED ONLY AS 'CREATED' OR 'SELECTED', BUT NOT BOTH IN THAT SAME ROUND.

AT THIS ITEM, THE ROSTER WILL DISPLAY ALL MEDICINES IN PERSON'S-PRESCRIBED-MEDICINES-ROSTER.
THAT DISPLAY WILL INCLUDE ALL MEDICINES CREATED IN PREVIOUS ROUNDS AND IN THE CURRENT ROUND. WHEN A MEDICINE CREATED IN A PREVIOUS ROUND IS SELECTED, CREATE A NEW EVENT FOR THAT MEDICINE. FOR SUCH MEDICINES, (AND FOR ADDED MEDICINES), CAPI WILL ASK THE CP SECTION AND THE PHARMACY OF THE PURCHASE.

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.

WHEN A MEDICINE FROM A PREVIOUS ROUND IS SELECTED, CREATE A NEW EVENT SINCE IT INVOLVES A NEW PURCHASE. A NEW PURCHASE REQUIRES ASKING THE CHARGE/PAYMENT (CP) SECTION AND PHARMACY OF THE PURCHASE. 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).
----------------------------------------------------
----------------------------------------------------
GO TO PM06
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERSON'S_PRESCRIBED-MEDICINES_1

COL # 1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE (DRUG.DRUGNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES- ROSTER FOR SELECTION/ADDITION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. MULTIPLE ADD ALLOWED.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A PMED ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS PMED AND THE EVENT.

4. EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL; NO FILTER.
----------------------------------------------------

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 [PM07]
NO ..................................... 2 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
HELP AVAILABLE 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?
[1. Prescribed Medicine]
[2. Prescribed Medicine]
[3. Prescribed Medicine]
----------------------------------------------------
FLAG MEDICINES AS 'FREE SAMPLE' ON IF MEDICINE WAS CREATED AT PM07 DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_01
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERSON'S_PRESCRIBED-MEDICINES_1

COL # 1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY NAME OF PRESCRIBED MEDICINE (DRUG.DRUGNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-PRESCRIPTION- MEDICINES-ROSTER FOR SELECTION/ADDITION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. MULTIPLE ADD ALLOWED.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A PMED ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS PMED AND THE EVENT.

4. EDIT DISALLOWED.

5. 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.

6. 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 THE CHARGE/PAYMENT (CP) SECTION AND THE PHARMACY OF THE PURCHASE. 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).
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL; NO FILTER.
----------------------------------------------------

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 [PM08]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [PM08]
DK .................................... -8 [PM08]
----------------------------------------------------
IF CODED '2' (NO), FLAG MEDICINE AS 'INCORRECT'.
THIS MEDICINE SHOULD NOT BE FLAGGED AS 'CREATED' OR 'SELECTED' FOR ROUND 5 AND THE ROUND 5 RECORDS SHOULD BE DELETED.
----------------------------------------------------

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 [PM09]
NO ..................................... 2 [BOX_02A]
REF ................................... -7 [BOX_02A]
DK .................................... -8 [BOX_02A]
----------------------------------------------------
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, SELECT ENTRY ON ROSTER.
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
GO TO BOX_02A
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1

COL #1 HEADER: MEDICAL CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.

2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD CONDITION NAME.

3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.

4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

BOX_02A
=======

----------------------------------------------------
IF MEDICINE BEING ASKED ABOUT IS FLAGGED AS 'SELECTED' DURING THE CURRENT ROUND, GO TO PM10
----------------------------------------------------
----------------------------------------------------
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)?
XXXX HAS NOT YET TAKEN/USED
[Enter Year-4] ........................
REF ................................... -7 [PM10]
DK .................................... -8 [PM10]
----------------------------------------------------
IF XXXX (HAS NOT YET TAKEN/USED) ENTERED, GO TO PM10
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH PM11OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO PM10
----------------------------------------------------

PM11OV1
=======
MONTH:
[Enter Month-2] .......................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES AUTOMATICALLY): ALLOWABLE VALUES FOR MONTH ARE 1-12.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH PM11OV2

OTHERWISE, GO TO PM10
----------------------------------------------------

PM11OV2
=======
DAY:
[Enter Day-2] ......................... [PM10]
REF ................................... -7 [PM10]
DK .................................... -8 [PM10]
----------------------------------------------------
HARD CHECK:

ENTRIES FOR DAY MUST CORRESPOND TO CALENDAR MONTHS AND DAYS. THAT IS,
- 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 2008 (LEAP YEAR);
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT 2008 (I.E., NOT LEAP YEAR).
----------------------------------------------------
----------------------------------------------------
THE COMPLETE DATE CANNOT BE BEFORE THE PERSON'S DATE OF BIRTH OR AFTER THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

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] ................ [BOX_02B]
REF ................................... -7 [BOX_02B]
DK .................................... -8 [BOX_02B]
----------------------------------------------------
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.
----------------------------------------------------

BOX_02B
=======

----------------------------------------------------
IF ROUND 3 AND PM10 IS NOT -7 OR –8, CONTINUE WITH PM10A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_02
----------------------------------------------------

PM10A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF PRESCRIPTION MEDICINE.] [STR-DT] [END-DT]
NUMBER OF TIMES OBTAINED/PURCHASED SINCE (START DATE): [NUMBER OF TIMES]
Of these times, how many were in [YEAR]?
[Enter Number of Times] ................ [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
----------------------------------------------------
FOR 'NUMBER OF TIMES,' DISPLAY THE NUMBER ENTERED AT PM10.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES AUTOMATICALLY): FOR 'YEAR', DISPLAY THE YEAR THAT IS THE FIRST YEAR OF THE GIVEN PANEL.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
NUMBER OF TIMES MUST BE (= NUMBER OF TIMES OBTAINED/PURCHASED AT PM10.
----------------------------------------------------

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 PERSON-PHARMACY PAIR 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)?
[1. Pharmacy] [STREET ADDRESS] [CITY]
[2. Pharmacy] [STREET ADDRESS] [CITY]
[3. Pharmacy] [STREET ADDRESS] [CITY]
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'ADD PHARMACY' AND 'DELETE PHARMACY' BUTTONS AS OPTIONS ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD PHARMACY' IS SELECTED, GO TO PM14 (NOTE THAT PM14 IS ACTUALLY A POPUP ON PM12).
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PM13
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: RU_PHAR_1

COL #1 HEADER: PHARMACY
INSTRUCTIONS: DISPLAY PHARMACY NAME (PHAR.PHARNAME)

COL #2 HEADER: STREET ADDRESS
INSTRUCTIONS: DISPLAY TRUNCATED STREET ADDRESS (PHAR.PHARADR1)

COL #3 HEADER: CITY
INSTRUCTIONS: DISPLAY TRUNCATED CITY (PHAR.PHARCITY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-PHARMACIES-ROSTER FOR SELECTION/ADDITION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:

1. SELECT ONE ALLOWED. INTERVIEWER MUST SELECT ONE ONLY FROM THE LIST OF PROVIDERS OR MAY SELECT 'ADD PHARMACY'

2. ADD ALLOWED.

3. EDITS ARE NOT ALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL; NO FILTER.
----------------------------------------------------

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 [PM14]
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.
ENTER WEB ADDRESS ON STREET ADDRESS LINE(S).
PHARMACY_NAME: [_____________]
PHARMACY_STR1: [_____________]
PHARMACY_STR2: [_____________]
PHARMACY_CITY: [_____________]
PHARMACY_STATE: [_____________]
PHARMACY_ZIPCDE: [_____________]
PHARMACY_PHONE: [_____________]
REF .................................. -7 [BOX_05]
DK ................................... -8 [BOX_05]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
CODES '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON EACH FORM ITEM EXCEPT FOR PHARMACY NAME (PM14_01).
----------------------------------------------------
----------------------------------------------------
HARD CHECK: CHECK THAT STATE ABBREVIATION IS VALID.
----------------------------------------------------

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 ANY INNACURATE FIELDS, TYPE ENTIRE FIELD.
PHARMACY_STR1: [_____________] [BOX_05]
PHARMACY_STR2: [_____________]
PHARMACY_CITY: [_____________]
PHARMACY_STATE: [_____________]
PHARMACY_ZIPCDE: [_____________]
PHARMACY_PHONE: [_____________]
RF ................................... -7 [BOX_05]
DK ................................... -8 [BOX_05]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
ADDRESS FIELDS CONTAIN PREVIOUSLY COLLECTED INFORMATION WHICH CAN BE UPDATED.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: CHECK THAT STATE ABBREVIATION