Reenumeration (RE) Section Subsection A

BOX_00
======

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CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME
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BOX_01
======

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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.)
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NOTE: THE NHIS ORIGINAL RUs ARE DETERMINED FROM IN-HOUSE PRE-PROCESSING AND ARE CLASSIFIED AS STANDARD RUs.
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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.
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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.
----------------------------------------------------
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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)
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ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
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ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
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ROSTER FILTER:
NONE. DISPLAY ALL RU MEMBERS
----------------------------------------------------

RE02
====

[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 '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.
----------------------------------------------------
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IF CODED '2' (PROXY APPROVED BY SUPERVISOR), FLAG CASE AS ELIGIBLE FOR PROXY ITEMS IN CLOSING. THIS INCLUDES WHEN RESPONDENT IS A PROXY SELECTED DURING A RE-START.
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IF ROUND 1 AND CODED '1' (RU MEMBER) AND STANDARD RU, GO TO RE05
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IF ROUND 1 AND CODED '1' (RU MEMBER) AND NEW RU, GO TO RE05A
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IF ROUND 1 AND CODED '1' (RU MEMBER) AND STUDENT RU, GO TO RE05B
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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
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IF NOT ROUND 1 AND CODED '1' (RU MEMBER) AND STANDARD OR NEW RU, GO TO RE06
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OTHERWISE (PROXY APPROVED BY SUPERVISOR), CONTINUE WITH RE03
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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]
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IF ROUND 1 AND STANDARD RU, GO TO RE05
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IF ROUND 1 AND NEW RU, GO TO RE05A
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IF ROUND 1 AND STUDENT RU, GO TO RE05B
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OTHERWISE (NOT ROUND 1), GO TO RE07
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LOOP_01
=======

OMITTED.

RE04
====

OMITTED.

END_LP01
========

OMITTED.

RE05
====

[REFERENCE PERSON'S FIRST MIDDLE AND LAST NAME]
(As I mentioned earlier,) [your family/[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 [you/[his/her] 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 Department of Health and Human Services [specifically, the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention (CDC)]. The information you provide will be kept completely confidential and private as required by law.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

---------------------------------------------------
DISPLAY 'your family' AND 'you' IF RE02 IS CODED '1' (RU MEMBER). DISPLAY '[PERSON]'s household' AND '[his/her] family' IF RE02 IS CODED '2' (PROXY APPROVED BY SUPERVISOR).
---------------------------------------------------
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DISPLAY THE DATE OF NHIS INTERVIEW FOR [MONTH, DAY, YEAR OF NHIS INTERVIEW].
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IN ROUND 1, THE NAME IN THE CONTEXT HEADER IS THE FULL NAME OF THE NHIS REFERENCE PERSON.
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IF RE02 CODED '1' (RU MEMBER), GO TO RE06
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IF RE02 CODED '2' (PROXY APPROVED BY SUPERVISOR),GO TO RE08
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RE05A
=====

[REFERENCE PERSON'S FIRST MIDDLE AND LAST NAME]
(As I mentioned earlier,) [you/[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 [you/he/she] [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 Department of Health and Human Services [specifically, the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention (CDC)]. 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
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---------------------------------------------------
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 you were 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 you might be contacted again for another health related survey. Since you are now a student and no longer living with that household, we will interview you separately.
IF NEEDED, READ ALL OR PART OF THE FOLLOWING:
This survey, the Medical Expenditure Panel Survey, is also for the Department of Health and Human Services [specifically, the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention (CDC)]. 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].
---------------------------------------------------
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NOTE: THE NAME OF THE REFERENCE PERSON DISPLAYEDIN THE CONTEXT HEADER IS THE FULL NAME OF THE STUDENT.
---------------------------------------------------
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IF RE02 CODED '1' (RU MEMBER), SELECT STUDENT AT RE06 AUTOMATICALLY BY CAPI, THEN GO TO RE09
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---------------------------------------------------
IF RE02 CODED '2' (PROXY APPROVED BY SUPERVISOR),GO TO RE08
---------------------------------------------------

RE06
====

SELECT THE RESPONDENT.

ROSTER.
DU MEMBER'S
NAME
RE06_02.
RUNTID
RE06_03.
SEX
RE06_04. AGE RE06_05.
INTERVIEW
COMPLETED
THIS ROUND
1. First Name Middle Name Last Name-35[DisplayRUNTID][DisplaySelection][Display Age] [DisplaySelection]
2. First Name Middle Name Last Name- 35[DisplayRUNTID][DisplaySelection][Display Age] [DisplaySelection]
3. First Name Middle Name Last Name-35[DisplayRUNTID][DisplaySelection] [Display Age] [DisplaySelection]
HELP AVAILABLE FOR RESPONDENT RULES.
----------------------------------------------------
IF PERSON FROM ANOTHER RU IS SELECTED AND VERIFIEDAS THE RESPONDENT, ADD PERSON TO RU-MEMBERS-ROSTER.
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DISPLAY AN 'ADD PERSON' OPTION ON THIS SCREEN.
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IF 'ADD PERSON' IS SELECTED, GO TO RE08
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OTHERWISE (PERSON SELECTED AS RESPONDENT WAS ALREADY IN DU IN THE PREVIOUS ROUND), GO TO RE09
----------------------------------------------------
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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: SEX
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)
----------------------------------------------------
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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.
----------------------------------------------------

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.
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----------------------------------------------------
IF 'NEW PROXY APPROVED BY SUPERVISOR' IS SELECTED, CONTINUE WITH RE08
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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 SELECTIONOF 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).
----------------------------------------------------
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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 [, COUNTY] AND PHONE NUMBER 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]
[COUNTY: [COUNTY]]
PHONE NUMBER: [TELEPHONE NUMBER]

CORRECT ADDRESS AND PHONE NUMBER ....... 1 [BOX_02]
SAME ADDRESS/PHONE NUMBER ? MINOR CORRECTIONS .......................... 2 [RE10]
NEW ADDRESS OR PHONE NUMBER ............ 3 [RE10]
[Code One]
HELP AVAILABLE FOR DEFINITION OF LOCATING ADDRESS.
----------------------------------------------------
FOR RU'S MOST RECENT ADDRESS FIELDS, DISPLAY ADDRESS INFORMATION FROM HOME TABLE.
----------------------------------------------------
----------------------------------------------------
DISPLAY ', COUNTY' AND 'COUNTY: [COUNTY]' ONLY IF ONE IS AVAILABLE FOR THIS RU FROM THE PREVIOUS ROUND. OTHERWISE, USE A NULL DISPLAY. FOR 'COUNTY', DISPLAY THE CURRENT COUNTY FOR THIS RU (HOME.CURRCNTY).
----------------------------------------------------
----------------------------------------------------
FOR 'TELEPHONE NUMBER', DISPLAY THE CURRENT TELEPHONE NUMBER.
----------------------------------------------------

RE10
====

MAKE CORRECTIONS 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]
[[COUNTY]]
[TELEPHONE NUMBER]
STREET ADDRESS1: [_____________]
STREET ADDRESS2: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
[COUNTY: [_____________]]
PHONE NUMBER: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED AT ALL FIELDS EXCEPT STATE.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'COUNTY: [COUNTY]' ONLY IF ONE IS AVAILABLE FOR THIS RU FROM THE PREVIOUS ROUND.
OTHERWISE, USE A NULL DISPLAY. FOR 'COUNTY', DISPLAY THE CURRENT COUNTY FOR THIS RU (HOME.CURRCNTY).
----------------------------------------------------
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GO TO BOX_02
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BOX_02
======

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IF COUNTY (HOME.CURRCNTY) MISSING FOR THIS RU, CONTINUE WITH RE10A
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OTHERWISE, GO TO RE11
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RE10A
=====

RECORD THE NAME OF THE COUNTY WHERE THIS RU IS LOCATED.

[Enter County Name -25] ......................... [RE11]
REF ............................................. -7 [RE11]
DK .............................................. -8 [RE11]

RE11
====

Some of this interview will be recorded for quality control purposes. I'd like to continue now, unless you have any questions.
IF THE RESPONDENT HAS QUESTIONS, PLEASE PRESS F1 TO REFER TO THE FAQS IN THE HELP SCREEN.
CONTINUE WITH RECORDING .......................... 1 [BOX_03]
CONTINUE, RECORDING REFUSED ...................... 2 [BOX_03]

HELP AVAILABLE FOR RECORDING FREQUENTLY ASKED QUESTIONS.
[Code One]

BOX_03
======

----------------------------------------------------
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
----------------------------------------------------
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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 [you/[PERSON]] [are/is] a student at post-secondary school. [Are/Is] [you/he/she] 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.
SEX: 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
MEMBER
RE12_01. SEX RE12_02. DATE
OF BIRTH
RE12_03. AGE
1. First Name
Middle Name
Last Name-35
[Display/Correct
Selection]
[Display/
Correct Date]
[Verify/Enter
Age]
----------------------------------------------------
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 EXCEPT '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: SEX
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 ANDCORRECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. THE NAME COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED.

2. SEX, 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]] [you/[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]] [you/[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]] [you/[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 [you/[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] [you/[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] [he/she] 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 December31, [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, SELECT 'DECEASED' WITHOUT ASKING.
[Is/On December 31, [YEAR], was] [PERSON] [now] living here with this family, or [does/did] [he/she] 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 THEPANEL. 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 [you/[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 [you/[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 FOLLOWINGMESSAGE "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
-----------------------------------------------------
----------------------------------------------------
IF RE19E IS CODED '5' (ANOTHER HOUSEHOLD ? CURRENTLY NOT FULL-TIME MILITARY) AND RE19F IS CODED '1' (WITHIN U.S.), '-7' (REF), OR '-8' (DK),REMOVE PERSON FROM RU-MEMBERS-ROSTER AND FLAG PERSON AS 'NON-MILITARY MOVER IN U.S.'. THE RE SECTION WILL COLLECT LOCATING INFORMATION FOR PERSON, BUT PERSON WILL NOT BE INCLUDED IN THIS INTERVIEW AFTER THE RE SECTION. INFORMATION FOR PERSON WILL BE COLLECTED AS PART OF ANOTHER RU.
----------------------------------------------------

RE19G
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Is/On December 31, [YEAR], 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 'Is' IF NOT ROUND 5. DISPLAY 'On 'December 31, [YEAR], 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). IFINTERVIEWER ENTERS CODE '1', DISPLAY THE FOLLOWINGMESSAGE: "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.
----------------------------------------------------
----------------------------------------------------
IF RE19E IS CODED '6' (ANOTHER HOUSEHOLD/MILITARY FACILITY ? CURRENTLY FULL-TIME MILITARY) AND RE19HIS CODED '1' (ANOTHER HOUSEHOLD), '-7' (REF), OR '-8' (DK) AND RE19HOV IS CODED '1' (WITHIN U.S.), '-7' (REF), OR '-8' (DK), REMOVE PERSON FROM RU- MEMBERS-ROSTER AND FLAG PERSON AS 'FULL-TIME MILITARY IN U.S. AND NOT ON MILITARY FACILITY'. THE RE SECTION WILL COLLECT LOCATING INFORMATION FOR PERSON, BUT PERSON WILL NOT BE INCLUDED IN THIS INTERVIEW AFTER THE RE SECTION. INFORMATION FOR PERSON WILL BE COLLECTED AS PART OF ANOTHER RU.
----------------------------------------------------

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 RE19HCODED '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-CODERE19A."
----------------------------------------------------

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.]
[INTERVIEWER: IF ONLY RU MEMBER LISTED IS RESPONDENT, CODE YES WITHOUT ASKING.]
[Think about the people living here on December 31, [YEAR], regardless of whether they are living here now.] [Are/Were] (READ NAMES BELOW) still living 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 'INTERVIEWER: IF ALL RU MEMBERS...' IF RESPONDENT IS A PROXY. OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY INTERVIEWER INSTRUCTION 'INTERVIEWER: IF ONLY RU MEMBER...' IF AT LEAST ONE KEY RU MEMBER WAS INSTITUTIONALIZED AT A HEALTH CARE FACILITY ON THE DATE OF THE PREVIOUS ROUND INTERVIEW (RE36 = 1 OR 2 OR RE19 = 1) AND ONLY ONE RU MEMBERIS LISTED ON THE RU-MEMBERS-ROSTER AS NOT ADDED TO THE ROSTER THIS ROUND.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Think about ... here now.', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'Are' IF ROUNDS 1-4.
DISPLAY 'Were' 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].
COMMENT FIELD REQUIRED FOR INCORRECTLY LISTED CODE.
USE ARROW/DELETE KEYS FOR TEXT CORRECTIONS.

ROSTER. RU MEMBER RE21_02. KEYNESS RE21_03. RU STATUS RE21_04. COMMENT
1. First Name Middle
Name Last Name-35
[Display
Selection]
[Enter RU Status] [Enter Comment]
2. First Name Middle
Name Last Name-35
[Display
Selection]
[Enter RU Status] [Enter Comment]
3. First Name Middle
Name Last Name-35
[Display
Selection]
[Enter RU Status] [Enter Comment]
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) 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)), 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: KEYNESS
INSTRUCTIONS: DISPLAY THE RU MEMBER'S KEYNESS AS EITHER 'KEY' OR 'NON-KEY' OR 'NOT DETERMINED' (IF KEYNESS IS MISSING) (PERS.KEYNESS)

COL # 3 HEADER: RU STATUS
INSTRUCTIONS: DISPLAY THE RU MEMBERS' RU STATUS. THE CHOICES IN THE DROP DOWN BOX ARE IN RU, LEFT RU, AND INCORRECTLY LISTED. (PRND.INRUSTAT)

COL # 4 HEADER: COMMENT
INSTRUCTIONS: ENTER TEXT DESCRIBING USE OF INCORRECTLY LISTED CODE.
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE RU-MEMBERS-ROSTER FOR ENTRY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. THE RU MEMBERS COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED.

2. THE KEYNESS COLUMN IS PROTECTED; NO CHANGES AREALLOWED.

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

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

5. INTERVIEWERS SHOULD NOT BE ALLOWED TO LEAVE THESCREEN 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."

6. IF ANY RU MEMBER IS CODED "INCORRECTLY LISTED,"MOVE CURSOR TO COMMENT FIELD FOR INTERVIEWER TO TYPE IN THE REASON FOR THE INCORRECTLY LISTED CODE.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS NOT ADDED THIS ROUND.
----------------------------------------------------

BOX_11A
======

OMITTED.

BOX_12
======

OMITTED.

RE22
====

OMITTED.

RE23
====

OMITTED.

BOX_13
======

OMITTED.

LOOP_02
=======

OMITTED. USED ELSEWHERE.

RE24
====

OMITTED.

RE25
====

OMITTED.

END_LP02
========

OMITTED. 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 [is/was] [PERSON] no longer living here with this family [on December 31, [YEAR]]?

DECEASED ................................ 1 [RE41]
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]
INSTITUTIONALIZED ....................... 2 [RE35A]
REF .................................... -7 [RE41]
DK ..................................... -8 [RE41]
[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.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
IF CODED '3' (STUDENT UNDER 24 LIVING AWAY AT SCHOOL IN GRADES 1-12)) OR '4' (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) AND PERSON BEING ASKED ABOUT IS 24 YEAR OF AGE OR OLDER, DISPLAY THE FOLLOWING MESSAGE: "STUDENT CODES UNAVAILABLE FOR RU MEMBERS 24 YEARS AND OLDER.
VERIFY AND RE-ENTER. (NOTE: RU MEMBERS 24+ CAN BE CODED AS REGULAR MOVERS.)"
----------------------------------------------------

RE35A
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is [PERSON] expected to stay in the institution 100 days or less or more than 100 days?

100 DAYS OR LESS........................... 1 [END_LP04]
MORE THAN 100 DAYS......................... 2 [RE36]
REF ...................................... -7 [END_LP04]
DK ....................................... -8 [END_LP04]
----------------------------------------------------
IF CODED '1' (100 DAYS OR LESS), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE RU MEMBER STATUS SHOULD BE RESET TO "IN RU" FOR THE ENTIRE REFERENCE PERIOD.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (100 DAYS OR LESS), '-7' (REFUSED), OR '-8' (DON'T KNOW), DISPLAY THE FOLLOWING MESSAGE: "[PERSON'S FIRST MIDDLE AND LAST NAME] WILL BE CONSIDERED "IN RU" AND INCLUDED AS PART OF THIS INTERVIEW FOR ENTIRE REFERENCE PERIOD. PRESS ENTER TO CONTINUE."
----------------------------------------------------

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 (MUST PROVIDE 24 HR SKILLED NURSING CARE) ............. 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.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
IF CODED '1' (NURSING HOME) OR '2' (OTHER LONG- TERM HEALTH CARE INSTITUTION), DISPLAY THE FOLLOWING MESSAGE: "CONFIRM THAT [PERSON'S FIRST MIDDLE AND LAST NAME] IS RESIDING IN A FACILITY THAT PROVIDES 24 HOUR SKILLED NURSING CARE. IF NOT, BACK-UP TO RE35 AND CODE THE PERSON AS MOVED.
----------------------------------------------------

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 PERSONLEFT 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 ELIGIBLEFOR 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 OUTSIDETHE 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.

[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.
DU MEMBER
RE44_02.
RUID
RE44_03.
SEX
RE44_04. AGE RE44_05.
INTERVIEW
COMPLETED
THIS ROUND
1. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
2. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
3. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
[Code One]
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: SEX
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
====

[Please think about the people living here as of December 31, [YEAR] for the next few questions.] [Is/Was] there anyone else [other than you] related to [you/[REFERENCE PERSON]] who [is/was] living here [now/on December 31, [YEAR]] as part of this family, other than (READ NAMES BELOW)? By related we mean by blood, marriage, living together as married, adoption or foster care relationship. Do not include anyone [who was] staying here temporarily who usually [lives/lived] somewhere 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]
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.
----------------------------------------------------
----------------------------------------------------
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
====

We would like to include the other members of [your/[REFERENCE PERSON]'s] household who are related to [you/him/her] in this interview.
[Is/Was] there anyone else related to [you/him/her] living here [now/on December 31, [YEAR]]? By related we mean by blood, marriage, living together as married, adoption, or foster care relationship. Do not include anyone staying here temporarily who usually lives somewhere else.

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.
SELECT
DU MEMBER
RE48_02.
RUID
RE48_03.
SEX
RE48_04. AGE RE48_05.
INTERVIEW
COMPLETED
THIS ROUND
1. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
2. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
3. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
----------------------------------------------------
DISPLAY 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: SEX
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 MEMBERAT 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
Name-35
[Display Selection]
2. First Name Middle Name Last
Name-35
[Display Selection]
3. First Name Middle Name Last
Name-35
[Display Selection]
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on December 31, [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' ISTHE 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.
DU MEMBER
RE51_02.
RUID
RE51_03.
SEX
RE51_04. AGE RE51_05.
INTERVIEW
COMPLETED
THIS ROUND
1. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
2. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
3. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
----------------------------------------------------
DISPLAY '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: SEX
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. ANY PERSON WITH AN 'X' IN 'INTERVIEW COMPLETED THIS ROUND' COLUMN IS GRAYED OUT AND CANNOT BE SELECTED.

4. CURRENT RU MEMBERS AND RU MEMBERS WHO HAVE LEFT THE RU ARE ALSO GRAYED OUT AND CANNOT BE SELECTED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS; NO FILTER.
----------------------------------------------------

RE52
====

ROSTER. RU MEMBER RE52_02. IN RU NOW?
1. First Name Middle Name Last
Name-35
[Display Selection]
2. First Name Middle Name Last
Name-35
[Display Selection]
3. First Name Middle Name Last
Name-35
[Display Selection]
----------------------------------------------------
DISPLAY '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 PERSONS 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
====

Are there any children or young people under 24 years of age related to [you/[REFERENCE PERSON]] 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]

RE54
====

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

ROSTER.
DU MEMBER
RE54_02.
RUID
RE54_03.
SEX
RE54_04. AGE RE54_05.
INTERVIEW
COMPLETED
THIS ROUND
1. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
2. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
3. First
Name Middle
Name Last
Name-35
[Display RUID] [Display
Selection]
[Display Age] [Display
Selection]
----------------------------------------------------
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: SEX
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, SEX, 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. ANY PERSON WITH AN 'X' IN 'INTERVIEW COMPLETED THIS ROUND' COLUMN IS GRAYED OUT AND CANNOT BE SELECTED.

4. CURRENT RU MEMBERS AND RU MEMBERS WHO HAVE LEFT THE RU ARE ALSO GRAYED OUT AND CANNOT BE SELECTED.

5. IF SEX 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
Name-35
[Display Selection]
2. First Name Middle Name Last
Name-35
[Display Selection]
3. First Name Middle Name Last
Name-35
[Display Selection]
----------------------------------------------------
DISPLAY '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] [you/[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] [you/[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 LIVINGOUTSIDE 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), LAG 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] [you/[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 [your/[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
=====

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 SEX. IF NOT OBVIOUS, ASK: What is (READ NAME BELOW)'s sex?
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
MEMBER
RE57A_02. SEX RE57A_03. DATE
OF BIRTH
RE57A_04. AGE
1. First Name
Middle Name
Last Name-35
[Enter
Selection]
[Enter Month
Day Year-4]
[Verify/Enter Age]
2. First Name
Middle Name
Last Name-35
[Enter
Selection]
[Enter Month
Day Year-4]
[Verify/Enter Age]
3. First Name
Middle Name
Last Name-35
[Enter
Selection]
[Enter Month
Day Year-4]
[Verify/Enter Age]
----------------------------------------------------
DISPLAY 'NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, [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: SEX
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 ANDCORRECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. PRESENT BLANK FIELDS FOR ALL MISSING DATA ITEMS. ENABLE MOVEMENT ON SCREEN SO THAT INTERVIEWER CAN ENTER/UPDATE SEX, DATE OF BIRTH AND AGE FOR ALL PERSONS BY ROW.

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

3. SEX, 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]] [you/[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.
SELECT SEX. IF NOT OBVIOUS, ASK: What is (READ NAME BELOW)'s sex?
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
MEMBER
RE57_02. SEX RE57_03. DATE
OF BIRTH
RE57_04. AGE
1. First Name
Middle Name
Last Name-35
[Select SEX] [Enter Month
Day Year-4]
[Verify/Enter Age]
2. First Name
Middle Name
Last Name-35
[Select SEX] [Enter Month
Day Year-4]
[Verify/Enter Age]
3. First Name
Middle Name
Last Name-35
[Select SEX] [Enter Month
Day Year-4]
[Verify/Enter Age]
----------------------------------------------------
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: SEX
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 SEX, DATE OF BIRTH AND AGE FOR ALL PERSONS BY ROW.

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

3. SEX, 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 ESTIMATEFOR 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] [you/[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 DATEOF 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, SEX, BIRTH DATE, AND AGE OF BOTH CURRENT RU MEMBERS WHOWERE 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 AMEMBER 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 [you/[PERSON]], starting with the name.
VERIFY FULL NAME AND SPELLING.
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: So [you/[PERSON]] [are/is] (READ SEX BELOW).
Is that correct?
MAKE CORRECTIONS TO SEX BELOW.
IF CORRECTION IS NECESSARY, SELECT APPROPRIATE CODE.
IF NO CORRECTION IS NECESSARY, PRESS ENTER.

Current Info: [NHIS SEX]
MALE ................................. 1 [RE62]
FEMALE ............................... 2 [RE62]
REF .................................. -7 [RE62]
DK ................................... -8 [RE62]
----------------------------------------------------
FOR 'NHIS SEX', DISPLAY THE PERSON'S SEX 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 [you/[PERSON]] [were/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 [you/[PERSON]] [are/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] [you/[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] [you/[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 [you/[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 [you/[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], [were/was] [you/[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], [were/was] [you/[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], [were/was] [you/[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] [you/[PERSON]] living on January 1, [YEAR]?

NOT YET BORN ............................ 1 [END_LP07A]
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]
INSTITUTIONALIZED ....................... 2 [RE66G]
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
=======

SPECIFY:

[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] [you/[PERSON]] living in on January 1, [YEAR]?

NURSING HOME ........................ 1 [RE66H]
OTHER LONG-TERM HEALTH CARE INSTITUTION (MUST PROVIDE 24 HR SKILLED NURSING CARE) ............. 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 [you/[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 [your/[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] [you/[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 OFPANEL 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 [you/[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 [you/[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
=======

OMITTED. USED ELSEWHERE.

RE69
====

OMITTED.

RE70
====

OMITTED.

RE71
====

OMITTED.

RE72
====

OMITTED.

RE73
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Where [were/was] [you/[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]
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]
INSTITUTIONALIZED ....................... 2 [RE73A]
OTHER .................................. 91 [RE73OV]
REF .................................... -7 [END_LP08]
DK ..................................... -8 [END_LP08]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
FOR 'MONTH...', DISPLAY DATE OF NHIS INTERVIEW.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
IF CODED '7' (LIVING WITH THIS FAMILY ? PERSON LEFT OFF NHIS ROSTER), DISPLAY THE FOLLOWING MESSAGE: "CONFIRM THAT [PERSON'S FIRST MIDDLE AND LAST NAME] WAS PHYSICALLY LIVING IN THE SAME HOUSEHOLD WITH [NHIS REFERENCE PERSON'S FIRST MIDDLE AND LAST NAME]'S FAMILY ON [MONTH, DAY, YEAR OF NHIS INTERVIEW].
----------------------------------------------------

RE73OV
======

SPECIFY:

[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] [you/[PERSON]] living in on [MONTH, DAY, YEAR OF NHIS INTERVIEW]?

NURSING HOME ........................ 1 [RE74]
OTHER LONG-TERM HEALTH CARE INSTITUTION (MUST PROVIDE 24 HR SKILLED NURSING CARE) ............. 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] [you/[PERSON]] living within the U.S. or outside the U.S. on [MONTH, DAY, YEAR OF NHIS INTERVIEW]?

RE73C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Were/Was] [you/[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 [you/[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 [your/[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 TOTHE 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 DURINGTHIS 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]
[Since [START DATE]/Between [START DATE] and December 31, [YEAR]], have any of the relationships between members of this household changed?

IF NECESSARY, REVIEW RELATIONSHIP GRID WITH RESPONDENT BY
SHOWING OR READING FROM SCREEN.
[READ GRID STARTING FROM LEFT. EXAMPLE: "(NAME ON LEFT) IS
(NAME ON TOP)'S ______________ (RELATIONSHIP)."]
MEMBER NAME RE75B_01. DU
MEMBER 1
RE75B_02. DU
MEMBER 2
RE75B_03. DU
MEMBER 3
1. First
Name-15
[Display
Relationship]
[Display
Relationship]
[Display
Relationship]
2. First
Name-15
[Display
Relationship]
[Display
Relationship]
[Display
Relationship]
3. First
Name-15
[Display
Relationship]
[Display
Relationship]
[Display
Relationship]
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.
----------------------------------------------------
----------------------------------------------------
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 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 ORDERFROM 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 YETCODED OR WHERE RELATIONSHIP WAS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) IN PREVIOUS ROUND.
----------------------------------------------------
----------------------------------------------------
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'.
----------------------------------------------------

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
MEMBER 1
RE76_1_02. DU
MEMBER 2
RE76_1_03. DU
MEMBER 3
1. First
Name-15
[Display
Relationship]
[Display
Relationship]
[Display
Relationship]
2. First
Name-15
[Display
Relationship]
[Display
Relationship]
[Display
Relationship]
3. First
Name-15
[Display
Relationship]
[Display
Relationship]
[Display
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 "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 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 YETCODED 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 [you/[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 THENEXT 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) WEREINTRODUCED 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) ANDTHE AGE OF PERSON ASSOCIATED WITH CODE IS YOUNGER THAN PERSON BEING LOOPED ON, DISPLAY THE FOLLOWINGMESSAGE: "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.
IF CODE '45' (FOSTER DAUGHTER) OR '46' (FOSTER SON), THE AGE OF PERSON ASSOCIATED WITH THE CODE MUST BE 18 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-4.
----------------------------------------------------

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

RE76D
=====

OMITTED.

RE76DOV
=======

OMITTED.

BOX_RE76D
=========

OMITTED.

RE76E
=====

[PERSON'S FIRST, MIDDLE AND LAST NAME]
I have recorded that [you/[PERSON]] [do/does] not have a mother or father living in this household. [Do/Does] [you/he/she] 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 [your/[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
MEMBER 1
RE76_2_02. DU
MEMBER 2
RE76_2_03. DU
MEMBER 3
1. First
Name-15
[Display
Relationship]
[Display
Relationship]
[Display
Relationship]
2. First
Name-15
[Display
Relationship]
[Display
Relationship]
[Display
Relationship]
3. First
Name-15
[Display
Relationship]
[Display
Relationship]
[Display
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 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 ORDERFROM 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 THEFOLLOWING 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] [you/[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] [you/[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 [you/[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] [you/[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 [your/[PERSON]'s] usual year-round place of residence or is this [your/his/her] 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 FORTHIS 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 [your/[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 PERSONWHOSE 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 OFLOOP_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:
ROSTER. RU MEMBER RE85_02. KEYNESS RE85_03. ESTIMATED
REF PERIOD
BEGIN DATE
RE85_04. REF PERIOD
END DATE
1. First Name Middle
Name Last Name-35
[Display
Selection]
[Display Begin
Date]
[Display End
Date]
2. First Name Middle
Name Last Name-35
[Display
Selection]
[Display Begin
Date]
[Display End
Date]
3. First Name Middle
Name Last Name-35
[Display
Selection]
[Display Begin
Date]
[Display End
Date]
----------------------------------------------------
FOR 'FULL...' DISPLAY THE REFERENCE PERSON'S FULL NAME.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_34
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_1

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

COL # 2 HEADER: KEYNESS
INSTRUCTIONS: DISPLAY THE RU MEMBER'S KEYNESS AS EITHER 'KEY' OR 'NON-KEY' OR 'NOT DETERMINED' (IF KEYNESS IS MISSING) (PERS.KEYNESS)

COL # 3 HEADER: ESTIMATED REF PERIOD BEGIN DATE
INSTRUCTIONS: DISPLAY THE RU MEMBER'S ESTIMATED REFERENCE PERIOD BEGIN DATE AS '[MONTH-3] [DD], [YY]'

COL # 4 HEADER: ESTIMATED REF PERIOD END DATE
INSTRUCTIONS: DISPLAY THE RU MEMBER'S ESTIMATED REFERENCE PERIOD END DATE AS '[MONTH-3] [DD], [YY]'
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.

2. ALL COLUMN ARE PROTECTED; NO CHANGES ARE ALLOWED.
----------------------------------------------------
----------------------------------------------------
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'),
AND
- IS A CURRENT RU MEMBER (NOT DECEASED OR INSTITUTIONALIZED)
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,
AND
- IS A CURRENT RU MEMBER (NOT DECEASED OR INSTITUTIONALIZED)
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,
AND
- IS A CURRENT RU MEMBER (NOT DECEASED OR INSTITUTIONALIZED)
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?

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 CURRENT RU MEMBERS (NOT DECEASED OR INSTITUTIONALIZED) 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 [you/[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?

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 AND WHO ARE CURRENT RU MEMBERS (NOT DECEASED OR INSITUTIONALIZED.
----------------------------------------------------

LOOP_12B
========

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBER-ROSTER, ASK RE95E-END_LP12B
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_12B COLLECTS INFORMATION ONWHEN 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 [you/[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] ISENTERED, 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
AND
- IS A CURRENT RU MEMBER (NOT DECEASED OR INSITUTIONALIZED)
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 TOTHE RU THIS ROUND AND IS A CURRENT RU MEMBER (NOT DECEASED OR INSTITUTILIZED).
----------------------------------------------------

RE96B1
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
[[Is/Are]/[Was/Were]] [you/[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/Are)' IF NOT ROUND 5. DISPLAY '(Was/Were)' 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 [you/[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] ISENTERED, 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'SSTATUS 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
=====

(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?

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'SSTATUS 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-TIMEMILITARY (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 MILITARYFACILITY', 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 MILITARYFACILITY', 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 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
=====

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] [you/[PERSON]] now/As of December 31, [YEAR], [were/was] [you/[PERSON]]] married, widowed, divorced, separated, or never married? IF R SAYS 'SINGLE', PROBE: [[Are/Is]/[Were/Was]] [you/he/she] married, widowed, divorced, separated, or never married?

IF MARITAL STATUS CHANGES TO 'NEVER MARRIED', MAKE A COMMENT
EXPLAINING SITUATION.
ROSTER. RU MEMBER RE97_02. PREVIOUS
ROUND MARITAL
STATUS
RE97_03. MARITAL
STATUS
1. First Name Middle Name Last
Name-35
[Display Selection] [ENTER MARITAL
STATUS]
2. First Name Middle Name Last
Name-35
[Display Selection] [ENTER MARITAL
STATUS]
3. First Name Middle Name Last
Name-35
[Display Selection] [ENTER MARITAL
STATUS]
HELP AVAILABLE FOR DEFINITIONS OF MARITAL STATUS CODES.
----------------------------------------------------
DISPLAY '[Are/Is] [you/[PERSON]] now' AND '[Are/Is]' IF NOT ROUND 5. DISPLAY 'As of December 31, [YEAR], [were/was] [you/[PERSON]]' AND '[Were/Was]', 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: PREVIOUS ROUND MARITAL STATUS
INSTRUCTIONS: DISPLAY RU MEMBER'S PREVIOUS ROUND MARITAL STATUS (PRND.MARISTAT). IF PREVIOUS ROUND MARITAL STATUS IS MISSING, REFUSED, DON'T KNOW, OR NOT ASCERTAINED, DISPLAY "UNAVAILABLE".

COL # 3 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 PREVIOUS ROUND MARITAL STATUS COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED

3. 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' ASSOCIATEDWITH 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' ASSOCIATEDWITH 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-1.
[Are/Is] [you/[PERSON]] Hispanic, Latino, or Spanish origin?

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-1.
Please look at this card and tell me which group or groups best describes [your/[PERSON]'s] ethnic background.

CHECK ALL THAT APPLY.
MEXICAN ................................ 1 [END_LP13]
MEXICAN-AMERICAN/CHICANO ............... 2 [END_LP13]
PUERTO RICAN ........................... 3 [END_LP13]
CUBAN/CUBAN AMERICAN ................... 4 [END_LP13]
DOMINICAN .............................. 5 [END_LP13]
CENTRAL OR SOUTH AMERICAN .............. 6 [END_LP13]
OTHER LATIN AMERICAN ................... 7 [END_LP13]
OTHER HISPANIC, LATINO, OR SPANISH
ORIGIN ............................... 8 [END_LP13]
REF ................................... -7 [END_LP13]
DK .................................... -8 [END_LP13]
[Code All That Apply]
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW '-7' (REFUSED) OR '-8' (DON'T KNOW) IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------

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' ASSOCIATEDWITH 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.

RE101A
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD RE-2.
For this survey, Hispanic origins are not races. What is [your/[PERSON]'s] race? Please select one or more of the categories on this card.

CHECK ALL THAT APPLY.
WHITE .................................. 1
BLACK OR AFRICAN AMERICAN .............. 2
AMERICAN INDIAN OR ALASKA NATIVE ....... 3
ASIAN INDIAN ........................... 4
CHINESE ................................ 5
FILIPINO ............................... 6
JAPANESE ............................... 7
KOREAN ................................. 8
VIETNAMESE ............................. 9
OTHER ASIAN ........................... 10
NATIVE HAWAIIAN ....................... 11
GUAMANIAN OR CHAMORRO ................. 12
SOMOAN ................................ 13
OTHER PACIFIC ISLANDER ................ 14
OTHER: SPECIFY ........................ 91
REF ................................... -7 [END_LP14]
DK .................................... -8 [END_LP14]
[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
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP14
----------------------------------------------------

RE101AOV3
=========

OTHER RACE:
[Enter Other Specify] .................. [END_LP14]
REF ................................... -7 [END_LP14]
DK .................................... -8 [END_LP14]

RE101AOV1
=========

OMITTED.

RE101AOV2
=========

OMITTED.

RE101B
======

OMITTED.

RE101BOV
========

OMITTED.

BOX_38A
=======

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 BOX_38B
----------------------------------------------------

BOX_38B
=======

----------------------------------------------------
IF ROUND 1, CONTINUE WITH RE102
----------------------------------------------------
----------------------------------------------------
IF ROUNDS 2 ? 5 AND IF AT LEAST ONE PERSON:
- = OR ) 5 YEARS OF AGE (OR IN AGE CATEGORIES 3?9)
AND
- WAS ADDED TO THE DU IN THE CURRENT ROUND
AND
- IS AN RU MEMBER (NOT DECEASED OR INSTITUTIONALIZED)
CONTINUE WITH RE102
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LOOP_14B
----------------------------------------------------

RE102
=====

[Does anyone in your family [ages 5 or older]/[(Do/Does) (READ NAMES BELOW)]] speak a language other than English at home?

RE102A
======

What is this language?

SPANISH ................................ 1 [LOOP_14A]
ANOTHER LANGUAGE ....................... 2 [LOOP_14A]
REF ................................... -7 [LOOP_14A]
DK .................................... -8 [LOOP_14A]
[Code One]

LOOP_14A
========

----------------------------------------------------
FOR EACH ELEMENT IN THE DU-MEMBERS-ROSTER, ASK BOX_38C-END_LP14A
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_14A COLLECTS INFORMATION ON THE ENGLISH PROFICIENCY OF ALL RU MEMBERS AND NEW STUDENTS 5 YEARS OF AGE AND OLDER. THIS LOOP CYCLES ON RU MEMBERS WHO MEET EITHER OF THE FOLLOWING CONDITIONS:

IF ROUND 1:
- PERSON IS AN RU MEMBER (NOT DECEASED OR INSTITUTIONALIZED)
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATEDWITH THIS RU

IF ROUNDS 2 ? 5:
- PERSON WAS ADDED TO THE DU IN THE CURRENT ROUND
AND
- PERSON IS AN RU MEMBER (NOT DECEASED OR INSTITUTIONALIZED)
----------------------------------------------------

BOX_38C
=======

----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS ( OR = 4 YEARS OF AGE OR IN AGE CATEGORIES 1 OR 2, GO TO END_LP14A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH RE102B
----------------------------------------------------

RE102B
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
How well [do/does] [you/[PERSON]] speak English? Would you say...
Very well, ............................. 1 [END_LP14A]
Well, .................................. 2 [END_LP14A]
Not Well, or ........................... 3 [END_LP14A]
Not at all? ............................ 4 [END_LP14A]

REF ................................... -7 [END_LP14A]
DK .................................... -8 [END_LP14A]
[Code One]

END_LP14A
=========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE DU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITION, END LOOP_14A AND CONTINUE WITH LOOP_14B
----------------------------------------------------

LOOP_14B
========

----------------------------------------------------
FOR EACH ELEMENT IN THE DU-MEMBERS-ROSTER, ASK BOX_38D-END_LP14B
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_14B COLLECTS WHETHER OR NOT PERSON WAS BORN IN THE U.S., AND IF NOT, WHAT YEARPERSON CAME TO THE U.S. TO STAY. THIS LOOP CYCLESON PERSONS THAT MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (NOT DECEASED OR INSTITUTIONALIZED)
OR
- PERSON IS FLAGGED AS A 'NEW STUDENT' ASSOCIATEDWITH THIS RU
----------------------------------------------------

BOX_38D
=======

----------------------------------------------------
IF ROUND 1, CONTINUE WITH RE102C
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1
AND
- PERSON WAS ADDED TO THE DU IN THE CURRENT ROUND
AND
- PERSON IS AN RU MEMBER
CONTINUE WITH RE102C
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., NOT ROUND 1 AND PERSON IS NOT A NEW DU MEMBER), GO TO END_LP14B
----------------------------------------------------

RE102C
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Were/Was] [you/[PERSON]] born in the United States?

YES .................................... 1 [END_LP14B]
NO ..................................... 2 [RE102D]
REF ................................... -7 [END_LP14B]
DK .................................... -8 [END_LP14B]
----------------------------------------------------
NOTE: IN PANEL 6 ROUND 4 THROUGH PANEL 17 ROUND 2,RE102C AND RE102E(FOREIGN BORN STATUS) WERE COLLECTED IN THE ACCESS TO CARE SECTION IN BOTH ROUNDS 2 AND 4 OF A PANEL. BEGINNING IN P18R1, P17R3, P16R5, THIS QUESTION WILL BE ASKED OF ALL RU MEMBERS IN ROUND 1 ONLY OR IN ROUNDS 2-5 IF A NEW RU MEMBER.
----------------------------------------------------

RE102D
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
In what year did [you/[PERSON]] come to the United States to stay? IF NEEDED SAY: Please give me only the most recent year that [you/[PERSON]] came to the United States to stay.

[Enter Year-4] ......................... [END_LP14B]
REF ................................... -7 [END_LP14B]
DK .................................... -8 [RE102E]
[Code One]
----------------------------------------------------
HARD CHECK:
EDIT: IF ROUNDS 1-4, THE YEAR ENTERED MUST BE LESS THAN OR EQUAL TO THE CURRENT YEAR AND MUST BE GREATER THAN OR EQUAL TO THE PERSON'S BIRTH YEAR, IF KNOWN. IF ROUND 5, YEAR MUST BE LESS THAN OR EQUAL TO THE SECOND CALENDAR YEAR OF THE PANEL AND MUST BE GREATER THAN OR EQUAL TO THE PERSON'S BIRTH YEAR, EQUAL TO THE PERSON'S BIRTH YEAR, IF KNOWN. IF YEAR ENTERED IS GREATER THAN THE CURRENT YEAR OR THE SECOND CALENDAR YEAR OF THE PANEL (IF ROUND 5), DISPLAY THE FOLLOWING MESSAGE: "YEAR CANNOT BE AFTER [CURRENT YEAR/ YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL IF ROUND 5. VERIFY AND RE-ENTER."
IF YEAR ENTERED IS LESS THAN PERSON'S YEAR OF BIRTH, DISPLAY THE FOLLOWING MESSAGE: "YEAR CANNOTBE BEFORE PERSON'S YEAR OF BIRTH. VERIFY AND RE-ENTER."
----------------------------------------------------

RE102E
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long [have/has] [you/[PERSON]] lived in United States?

IF LESS THAN 1 YEAR, CODE 0.
YEARS:
[Enter years] .......................... [END_LP14B]
REF ................................... -7 [END_LP14B]
DK .................................... -8 [END_LP14B]
[Code One]
----------------------------------------------------
HARD CHECK:
EDIT: NUMBER OF YEARS ENTERED MUST BE LESS THAN OR EQUAL TO PERSON'S AGE. IF PERSON'S AGE IS REPRESENTED BY AN AGE CATEGORY, THE NUMBER OF YEARS ENTERED MUST BE LESS THAN OR EQUAL TO THE TOP AGE LIMIT FOR THAT CATEGORY. IF NUMBER OF YEARS ENTERED IS GREATER THAN PERSON'S AGE, DISPLAY THE FOLLOWING MESSAGE: "PERSON IS [XXX] YEARS OLD. NUMBER OF YEARS LIVING IN THE U.S. CANNOT BE MORE THAN PERSON'S AGE. VERIFY AND RE-ENTER."
----------------------------------------------------

END_LP14B
=========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE DU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITION, END LOOP_14B AND CONTINUE WITH LOOP_15
----------------------------------------------------

LOOP_15
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE DU-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' ASSOCIATEDWITH 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 DU IN THE CURRENT ROUND
AND
- PERSON IS AN RU MEMBER CONTINUE WITH RE103
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., NOT ROUND 1 AND PERSON IS NOT A NEW DU MEMBER), GO TO END_LP15
----------------------------------------------------

BOX_40
======

OMITTED.

RE103
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[As of December 31, [YEAR], what/What] is the highest grade or year of regular school [you/[PERSON]] ever completed?

KINDERGARTEN OR LESS:
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
----------------------------------------------------
----------------------------------------------------
SOFT CHECK: IF CODED '16' (FOURTH YEAR (BACHELOR'S DEGREE)) OR '17' (FIVE OR MORE YEARS (GRADUATE DEGREE)) AND PERSON IS ( = 18 YEARS OF AGE (OR IN AGE CATEGORIES 1-3), DISPLAY THE FOLLOWING MESSAGE: "UNLIKELY RESPONSE DUE TO AGE.VERIFY AND RE-ENTER."
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 20 ROUND 1, PANEL 19 ROUND 3, AND PANEL 18 ROUND 5, THE MEPS EDUCATION ITEMS WERE RETURNED TO THE TWO-TIER QUESTION STYLE USED PRIOR TO PANEL 17 ROUND 1, PANEL 16 ROUND 3, AND PANEL 15 ROUND 5 WHEN THE SINGLE EDUCATION ITEM WAS FIRST IMPLEMENTED. ITEMS RE104 AND RE105 ARE NOW REINSTATED.
----------------------------------------------------
----------------------------------------------------
NOTE: CODE '0' (NEVER ... ONLY) IS DISPLAYED ON THE SCREEN AFTER CODE '17' (FIVE OR MORE YEARS)
----------------------------------------------------

RE104
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[[Do/Does/Did]/As of December 31, [YEAR] did] [you/[PERSON]] have a high school diploma or [[have/has/had]/had] [you/[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'.
----------------------------------------------------

RE105
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What is the highest educational degree [you/[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 A NULL 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 THE FOLLOWING CONDITIONS:
- AGE 17-23, INCLUSIVE
OR
- CODED AS LIVING AWAY AT SCHOOL IN GRADES 1-12, CONTINUE WITH RE108
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_42
----------------------------------------------------

RE106
=====

OMITTED.

RE107
=====

OMITTED.

BOX_41A
=======

OMITTED.

RE108
=====

[[Earlier you mentioned [you/[PERSON]] [were/was] living away at school in grades 1-12.]] [[Are/Is]]/As of December 31, [YEAR], [were/was]] [you/[PERSON]] attending school full-time, part-time, or not attending school at all?

ROSTER. NAME RE108_02. SCHOOL STATUS
1. First Name Middle Name Last
Name-35
[Enter Selection]
2. First Name Middle Name Last
Name-35
[Enter Selection]
3. First Name Middle Name Last
Name-35
[Enter Selection]
HELP AVAILABLE FOR DEFINITIONS OF PART-TIME/FULL-TIME.
---------------------------------------------------
DISPLAY '[Earlier you mentioned [you/[PERSON]] [were/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 '[Are/Is]' 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.
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS_XX

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

COL # 2 HEADER: SCHOOL 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 FIRST ON THE ROSTER. THEN DISPLAY PERSONS CODEDAS LIVING AWAY AT SCHOOL GRADES 1-12.

4. THE STATUS COLUMN PROVIDES A DROP-DOWN LIST OF CHOICES INCLUDING: PART-TIME, FULL-TIME, NOT IN SCHOOL, -7, AND -8.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO MEET ONE OF THE FOLLOWING CONDITIONS:
- AGE 17-23 INCLUSIVE
OR
- PREVIOUSLY CODED AS LIVING AWAY AT SCHOOL GRADES 1-12
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_42
----------------------------------------------------

BOX_41B
=======

OMITTED.

BOX_41BB
========

OMITTED.

RE108A
======

OMITTED.

RE108B
======

OMITTED.

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 not ask any further questions about them today.

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER 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 'DK-DK-DK'.
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: "REMEMBER TO WRITE DOWN ADDRESS AND TELEPHONE NUMBER."
--------------------------------------------------------
--------------------------------------------------------
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 not ask any further questions about them today.

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
ROSTER 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 FLAGGEDAS 'NON-MILITARY MOVER IN US'.

- PERSON WAS REMOVED FROM THE RU-MEMBERS-ROSTER DURING THE INTERVIEW WITH THIS RU AND IS FLAGGEDAS '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]
[INTERVIEWER: IF [PERSON] IS A FOSTER CHILD WHO HAS MOVED TO ANOTHER
FOSTER HOME, RECORD 'DON'T KNOW' FOR ADDRESS WITHOUT ASKING.]
Please give me the address and telephone number where [PERSON] has moved.

IF NO TELEPHONE, ENTER 'DK-DK-DK'.
STREET_ADDRESS1: [_____________]
STREET_ADDRESS2: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
TELEPHONE: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
DISPLAY 'INTERVIEWER: IF (PERSON) IS A FOSTER CHILD ...' IF PERSON IS LESS THAN 18 YEARS OF AGE OR IN AGE CATEGORIES 1-4.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE FOLLOWING MESSAGE IN RED UPON EXITING RE111A: "REMEMBER TO WRITE DOWN ADDRESS AND TELEPHONE NUMBER."
----------------------------------------------------
----------------------------------------------------
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 [your/[PERSON]'s] health between [START DATE] and [END DATE].
In general, compared to other people of [your/his/her] age, would you say that [your/his/her] 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 [your/[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 [you/[PERSON]] may have had. For these questions, please think about [your/his/her] health over [your/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]] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] 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] [you/[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] [you/[PERSON]] told on two or more different visits that [you/he/she] 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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] 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] [you/[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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] 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] [you/[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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] 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] [you/[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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] 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]
HELP AVAILABLE FOR DEFINITION OF OTHER HEART CONDITION.

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] [you/[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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] had a stroke 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]
HELP AVAILABLE FOR DEFINITION OF TIA.
----------------------------------------------------
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] [you/[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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] had emphysema?

YES .................................... 1 [PE16]
NO ..................................... 2 [BOX_09]
REF ................................... -7 [BOX_09]
DK .................................... -8 [BOX_09]
HELP AVAILABLE FOR DEFINITION OF EMPHYSEMA.
----------------------------------------------------
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] [you/[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 ISASKED 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] [you/[PERSON]] been told by a doctor or other health professional that [you/he/she] 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' SHOULDBE 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] [you/[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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] 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] [you/[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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] 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]
SHOW CARD PE-1.
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 (UNKNOWN TYPE) ................... 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:
"AT LEAST ONE 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: "AT LESAT ONE 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 APPROPRIATETEXT 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 PERSON'S-MEDICAL-CONDITIONS ROSTER, ASK NAV_PE02 - 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
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_02 USES NAV_PE02 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_PE02
========

SERIES: Cancer Detail
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

Cancer Type
[1. Person's Medical Condition-30] [Status-25]
[2. Person's Medical Condition-30] [Status-25]
[3. Person's Medical Condition-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: CANCER TYPE
INSTRUCTIONS: DISPLAY PERSON'S MEDICAL CONDITION
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH CONDITION EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-MEDICAL-CONDITION ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY EACH CONDITION IN PERSON'S-MEDICAL- CONDITIONS-ROSTER THAT MEETS THE FOLLOWING CONDITIONS:

- CONDITION WAS CREATED AT PE22 OR PE22OV IN THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH PE23 FOR SELECTED CONDITION
----------------------------------------------------

PE23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S MEDICAL CONDITION.]
How old [were/was] [you/[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 [your/[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
====

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] [you/[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- ROSTER 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] [you/[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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] 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 ONEOF 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 FLAGGED 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] [you/[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] [you/[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] [you/[PERSON]] ever been told by a doctor or other health professional that [you/he/she] [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] [you/[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 [you/[PERSON]] [have/has] asthma.] [Do/Does] [you/[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] [you/[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 [you/[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/Have you or [PERSON]] ever been told by a doctor or other health professional that [you/he/she] 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]
----------------------------------------------------
DISPLAY 'Have you' IF PERSON BEING ASKED ABOUT IS SELECTED AS THE RESPONDENT.

OTHERWISE, DISPLAY 'Have you or [PERSON]'.
----------------------------------------------------
----------------------------------------------------
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] [you/[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 NAV_CE01 - 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
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_CE01 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_CE01
========

SERIES: Conditions
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS EXCLUDING DECEASED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_01A FOR SELECTED RU MEMBER.
----------------------------------------------------

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 [you/[PERSON]] entered the institution, did [you/he/she] have any physical or mental health problems, or had [you/he/she] experienced any accidents or injuries?/Between [START DATE] and [END DATE], did [you/[PERSON]] have any physical or mental health problems, accidents, or injuries?] [Please include all of [your/his/her] conditions, accidents or injuries regardless of whether [you/he/she] 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 [you/ [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 [you/[PERSON]] entered the institution, did [you/he/she] have any physical or mental health problems, or had [you/he/she] experienced any accidents or injuries?' IF PERSON CODED AS BEING INSTITUTIONALIZED.

OTHERWISE, DISPLAY 'Between [START DATE] and [END DATE], did [you/[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 [you/[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 [you/[PERSON]] have? PROBE: Did [you/he/she] 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 SELECTEDIN 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.RUBEGMM, HOME.RUBEGDD, HOME.RUBEGYY, 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 HE25 ARE ASKED IN ROUNDS 1, 3, AND 5. QUESTIONS HE26 THROUGH HE43 ARE ASKED IN ROUNDS 2 AND 4.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 OR ROUND 3 OR ROUND 5, CONTINUE WITH HE01
----------------------------------------------------
----------------------------------------------------
IF ROUND 2 OR ROUND 4, GO TO HE26
----------------------------------------------------

HE01
====

[STR-DT] [END-DT]
[Between [START DATE] and [END DATE], did/Does] anyone in the family receive help or supervision using the telephone, paying bills, taking medications, preparing light meals, doing laundry, or going shopping (because of an impairment or a physical or mental health problem)?

YES .................................... 1
NO ..................................... 2 [HE04]
REF ................................... -7 [HE04]
DK .................................... -8 [HE04]
HELP AVAILABLE FOR DEFINITION OF IMPAIRMENT AND HELP/SUPERVISION.
----------------------------------------------------
DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5. OTHERWISE, DISPLAY 'Does'.
----------------------------------------------------
----------------------------------------------------
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]
Who is that?
PROBE: Does anyone else receive help or supervision doing these types of activities [such as using the telephone, paying bills, taking medications, preparing light meals, doing laundry, or going shopping]?

[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 NAV_HE01 - 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)
- PERSON IS (13 YEARS OF AGE OR IN AGE CATEGORIES 1-3
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_HE01 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HE01
========

SERIES: Help with Daily Activities (e.g., using phone, paying bills, taking medication, etc.)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP WITH INSTRUMENTAL ACTIVITIES OF DAILY LIVING (I.E., PERSON SELECTED AT HE02)
- PERSON IS (13 YEARS OF AGE OR IN AGE CATEGORIES 1-3
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE03 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_01A
=======

OMITTED.

HE03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Do/Does] [you/[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 [END_LP01]
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
=====

OMITTED.

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]
[Between [START DATE] and [END DATE], did/Does] anyone in the family receive help or supervision with personal care such as bathing, dressing, or getting around the house (because of an impairment or a physical or mental health problem)?

YES .................................... 1
NO ..................................... 2 [HE07]
REF ................................... -7 [HE07]
DK .................................... -8 [HE07]
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION.
----------------------------------------------------
DISPLAY 'between [START DATE] and [END DATE], did' IF ROUND 5. OTHERWISE, DISPLAY 'Does'.
----------------------------------------------------
----------------------------------------------------
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]
Who is that?
PROBE: Does anyone else receive help or supervision with personal care [such as bathing, dressing, or getting around the house]?

[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 NAV_HE02 - 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)
- PERSON IS (13 YEARS OF AGE OR IN AGE CATEGORIES 1-3
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_02 USES NAV_HE02 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HE02
========

SERIES: Help with Personal Care (e.g., bathing, dressing, getting around the house)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP OR SUPERVISION WITH PERSONAL CARE (I.E., ACTIVITIES OF DAILY LIVING,THAT IS, THE PERSON IS SELECTED AT HE05)
- PERSON IS (13 YEARS OF AGE OR IN AGE CATEGORIES 1-3
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE06 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_01B
=======

OMITTED.

HE06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Do/Does] [you/[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 [END_LP02]
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
=====

OMITTED.

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 HE07
----------------------------------------------------

BOX_02
======

OMITTED.

HE07
====

[STR-DT] [END-DT]
[Between [START DATE] and [END DATE], did/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 (because of an impairment or a physical or mental health problem)?

YES .................................... 1
NO ..................................... 2 [HE09]
REF ................................... -7 [HE09]
DK .................................... -8 [HE09]
HELP AVAILABLE FOR EXAMPLES OF AIDS/SPECIAL EQUIPMENT.
----------------------------------------------------
DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5. OTHERWISE, DISPLAY 'Does'.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY 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]
Who is that?
PROBE: Does anyone else use any aids [such as a walker, grab bars in the bathtub or any other special equipment] 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]
[Between [START DATE] and [END DATE], did/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 (because of an impairment or a physical or mental health problem)?

YES .................................... 1
NO ..................................... 2 [HE19]
REF ................................... -7 [HE19]
DK .................................... -8 [HE19]
----------------------------------------------------
DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5. OTHERWISE, DISPLAY 'Does'.
----------------------------------------------------
----------------------------------------------------
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]
Who is that?
PROBE: Does anyone else have difficulties [walking, climbing stairs, grasping objects, reaching overhead, lifting, bending or stooping, or standing for long periods of time]?

[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 NAV_HE03 - 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
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_03 USES NAV_HE03 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HE03
========

SERIES: Difficulty Moving (e.g., walking, climbing stairs, grasping, reaching overhead, etc.)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL 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
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE11 FOR SELECTED RU MEMBER.
----------------------------------------------------

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 [you/[PERSON]] entered the institution and what [you/he/she] was able to do at that time.]
Please look at this card and tell me how much difficulty [do/does] [you/[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 [you/[PERSON]] entered the institution and what [you/he/she] 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] [you/[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] [you/[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] [you/[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] [you/[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] [you/[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] [you/[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] [you/[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 [END_LP03]
SOME DIFFICULTY ........................ 2 [END_LP03]
A LOT OF DIFFICULTY .................... 3 [END_LP03]
COMPLETELY UNABLE TO DO IT ............. 4 [END_LP03]
REF ................................... -7 [END_LP03]
DK .................................... -8 [END_LP03]
[Code One]

HE18A
=====

OMITTED.

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]
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 NAV_HE04 - 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
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_04 USES NAV_HE04 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HE04
========

SERIES: Limited Ability in Working, Doing Housework, Going to School
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL 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
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE20A FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_04
======

OMITTED.

HE20A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Which activities [are/is] [you/[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 [you/[PERSON]] entered the institution, was/[Are/Is]] [you/[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 [you/[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]
Who is that?
PROBE: Is anyone else limited in participating in social, recreational, or family 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]
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 '[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
====

With this next set of questions we want to learn about people who have physical, mental, or emotional conditions that cause serious difficulties with their daily activities.
[Please answer the next few questions for family members age 1 or older.]
Is anyone in the family deaf or does anyone have serious difficulty hearing?

YES ................................... 1
NO .................................... 2 [HE29]
REF ................................... -7 [HE29]
DK .................................... -8 [HE29]
----------------------------------------------------
DISPLAY THE SENTENCE 'Please answer ... age 1 or older.' IF ANY RU MEMBERS ARE ( 1 YEAR OF AGE OR IN AGE CATEGORY 1. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
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 LOOP_05
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE27
----------------------------------------------------

HE27
====

Who is that?
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 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 ONLY RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS ) OR = 1 YEAR OF AGE OR IN AGE CATEGORIES 2-9
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_HE05 - END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 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 HE27)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_05 USES NAV_HE05 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HE05
========

SERIES: Hearing Impairment Details (e.g., deaf?)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY HEARING (I.E., PERSON SELECTED AT HE27)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE28 FOR SELECTED RU MEMBER
----------------------------------------------------

HE28
====

Can [you/[PERSON]] not hear any speech at all, that is, [are/is] [you/[PERSON]] deaf?

YES ................................... 1 [END_LP05]
NO .................................... 2 [END_LP05]
REF ................................... -7 [END_LP05]
DK .................................... -8 [END_LP05]
HELP AVAILABLE FOR DEFINITION OF DEAF.

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 HE29
----------------------------------------------------

HE29
====

Is anyone in the family blind or does anyone have serious difficulty seeing, even when wearing glasses?

YES ................................... 1
NO .................................... 2 [HE32]
REF ................................... -7 [HE32]
DK .................................... -8 [HE32]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AT HE30 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 HE30
----------------------------------------------------

HE30
====

Who is that?
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 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 ONLY RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS ) OR = 1 YEAR OF AGE OR IN AGE CATEGORIES 2-9
----------------------------------------------------

LOOP_06
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_HE06 - END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 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 HE30)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_06 USES NAV_HE06 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HE06
========

SERIES: Vision Impairment Details (e.g., blind?)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY SEEING (I.E., PERSON SELECTED AT HE30)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HE31 FOR SELECTED RU MEMBER
----------------------------------------------------

HE31
====

Can [you/[PERSON]] not see anything at all, that is, [are/is] [you/[PERSON]] blind?

YES ................................... 1 [END_LP06]
NO .................................... 2 [END_LP06]
REF ................................... -7 [END_LP06]
DK .................................... -8 [END_LP06]
HELP AVAILABLE FOR DEFINITION OF BLIND.

END_LP06
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH HE32
----------------------------------------------------

HE32
====

[Please answer the next few questions for family members age 5 or older.]
Because of a physical, mental, or emotional condition, does anyone in the family have serious difficulty concentrating, remembering, or making decisions?

YES ................................... 1
NO .................................... 2 [HE34]
REF ................................... -7 [HE34]
DK .................................... -8 [HE34]
----------------------------------------------------
DISPLAY THE SENTENCE 'Please answer ... age 5 or older.' IF ANY RU MEMBERS ARE ( 5 YEARS OF AGE OR IN AGE CATEGORIES 1 OR 2. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AT HE33 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO HE34
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE33
----------------------------------------------------

HE33
====

Who is that?
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 HE34
----------------------------------------------------
----------------------------------------------------
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 RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS ) OR = 5 YEARS OF AGE OR IN AGE CATEGORIES 3-9
----------------------------------------------------

HE34
====

Does anyone in the family have serious difficulty walking or climbing stairs?

YES ................................... 1
NO .................................... 2 [HE36]
REF ................................... -7 [HE36]
DK .................................... -8 [HE36]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AT HE35 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO HE36
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE35
----------------------------------------------------

HE35
====

Who is that?
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 HE36
----------------------------------------------------
----------------------------------------------------
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 RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
PERSON IS ) OR = 5 YEARS OF AGE OR IN AGE CATEGORIES 3-9
----------------------------------------------------

HE36
====

Does anyone in the family have difficulty dressing or bathing?

YES ................................... 1
NO .................................... 2 [HE38]
REF ................................... -7 [HE38]
DK .................................... -8 [HE38]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AT HE37 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO HE38
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE37
----------------------------------------------------

HE37
====

Who is that?
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 HE38
----------------------------------------------------
----------------------------------------------------
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 RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS ) OR = 5 YEARS OF AGE OR IN AGE CATEGORIES 3-9
----------------------------------------------------

HE38
====

[Please answer the next few questions for family members age 15 or older.] Because of a physical, mental, or emotional condition, does anyone in the family have difficulty doing errands alone such as visiting a doctor's office or shopping?

YES ................................... 1
NO .................................... 2 [HE40]
REF ................................... -7 [HE40]
DK .................................... -8 [HE40]
----------------------------------------------------
DISPLAY THE SENTENCE 'Please answer ... age 15 or older.' IF ANY RU MEMBERS ARE ( 15 YEARS OF AGE OR IN AGE CATEGORIES 1 - 3. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AT HE39 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO HE40
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE39
----------------------------------------------------

HE39
====

Who is that?
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 HE40
----------------------------------------------------
----------------------------------------------------
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 RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS ) OR = 15 YEARS OF AGE OR IN AGE CATEGORIES 4-9
----------------------------------------------------

HE40
====

[Please answer the next few questions for family members of all ages.]
Does anyone in the family wear a hearing aid?

YES ................................... 1
NO .................................... 2 [HE42]
REF ................................... -7 [HE42]
DK .................................... -8 [HE42]
----------------------------------------------------
DISPLAY THE SENTENCE 'Please answer ... of all ages.' IF ANY RU MEMBERS ARE (15 YEARS OF AGE OR IN AGE CATEGORIES 1-3. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AT HE41 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO HE42
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE41
----------------------------------------------------

HE41
====

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]
----------------------------------------------------
CONTINUE WITH HE42
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------

HE42
====

Does anyone in the family wear eyeglasses or contact lenses?

YES ................................... 1
NO .................................... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AT HE43 BY CAPI.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE43
----------------------------------------------------

HE43
====

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 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_06A
=======

OMITTED.

BOX_06
======

OMITTED.

LOOP_07
=======

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 NAV_CS01 - END_LP01
-----------------------------------------------------
-----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT 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
-----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_CS01 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_CS01
========

SERIES: All Child Preventive Health Questions (i.e., child's health needs, behavioral ratings, etc.)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET 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
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_01A FOR SELECTED RU MEMBER
----------------------------------------------------

CS01
====

OMITTED.

CS01_01
=======

OMITTED.

CS01_02
=======

OMITTED.

CS01_03
=======

OMITTED.

CS01_04
=======

OMITTED.

CS01_05
=======

OMITTED.

BOX_01A
=======

----------------------------------------------------
IF FIRST CYCLE OF LOOP, CONTINUE WITH CS02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CS03
----------------------------------------------------

CS02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
The next questions are about [your/[PERSON]'s] health needs and whether [you/he/she] [have/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]
[Now I'd like to talk about [you/[PERSON]].] [Do/Does] [you/[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]
----------------------------------------------------
DISPLAY 'Now I'd like to talk about [you/ [PERSON]].' IF NOT FIRST CYCLE THROUGH LOOP_01.
OTHERWISE (THAT IS, IF IT IS THE FIRST CYCLE THROUGH LOOP_01), USE A NULL DISPLAY.
----------------------------------------------------

CS04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Do/Does] [you/[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]
[Are/Is] [you/PERSON]] limited or prevented in any way in [your/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]
[Do/Does] [you/[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]
[Do/Does] [you/[PERSON]] have any kind of emotional, developmental or behavioral problem for which [you/he/she] need[s] or get[s] 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 [your/[PERSON]'s]
health. In this series of questions, please rate [yourself/him/her] 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 [you/[PERSON]] [have/has] [have/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 [you/he/she] [have/has] with (ACTIVITY).

CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.

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

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

CS08_03. c. Feeling unhappy or sad? ( )

CS08_04. d. [Your/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. [Your/His/Her] schoolwork? ( )

CS08_12. l. [Your/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]
In the last 12 months, did [you/[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 [you/[PERSON]] needed care right away, how often did [you/he/she] get care as soon as you thought [you/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 [you/[PERSON]] needed health care right away, did you make any appointments for [your/his/her] 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 [you/[PERSON]] needed health care right away, how often did [you/he/she] get an appointment for health care at a doctor's office or clinic as soon as you thought [you/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-4.
In the last 12 months, not counting times [you/[PERSON]] went to an emergency room, how many times did [you/he/she] 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 [you/[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 [your/[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 [your/[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 [your/[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 [you/[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 [your/[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 [you/[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 [you/[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]
Has a doctor or other health provider ever measured [your/[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 [are/is] [you/[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
----------------------------------------------------

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 0-11.
----------------------------------------------------

CS24
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health provider ever measured [your/[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 [do/does] [you/[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
=======

[PROBE FOR OUNCES IF NOT REPORTED.]
OUNCES:
[Enter Ounces] ........................ [BOX_03]
REF ................................... ?7 [BOX_03]
DK .................................... ?8 [BOX_03]
----------------------------------------------------
DISPLAY 'PROBE FOR OUNCES IF NOT REPORTED.' IF CS25_01 IS ( OR = 20 POUNDS.
----------------------------------------------------
----------------------------------------------------
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 [your/[PERSON]'s] vision?

YES .................................... 1 [BOX_04]
NO ..................................... 2 [BOX_04]
TRIED, BUT [YOU/HE/SHE] [WERE/WAS]
UNCOOPERATIVE .......................... 3 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
[Code One]

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 [your/[PERSON]'s] blood pressure?

YES .................................... 1 [CS27OV]
NO ..................................... 2 [CS28]
TRIED, BUT [YOU/HE/SHE] [WERE/WAS] ..... 3 [CS27OV]
REF ................................... -7 [CS28]
DK .................................... -8 [CS28]
[Code One]

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 [[him/her]] 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."
----------------------------------------------------
DISPLAY 'or [PERSON]' AND '[him/her]' IF PERSON BEING ASKED ABOUT IS NOT SELECTED AS THE RESPONDENT. OTHERWISE, (PERSON BEING ASKED ABOUT IS SELECTED AS THE RESPONDENT), USE A NULL DISPLAY.
----------------------------------------------------

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 [[him/her]] eating healthy?

YES .................................... 1 [CS29OV]
NO ..................................... 2 [CS30]
REF ................................... -7 [CS30]
DK .................................... -8 [CS30]
HELP AVAILABLE FOR DEFINITION OF "ADVICE TO YOU."
----------------------------------------------------
DISPLAY 'or [PERSON]' AND '[him/her]' IF PERSON BEING ASKED ABOUT IS NOT SELECTED AS THE RESPONDENT. OTHERWISE, (PERSON BEING ASKED ABOUT IS SELECTED AS THE RESPONDENT), USE A NULL ISPLAY.
----------------------------------------------------

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 [you/he/she] 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 [[him/her]] 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."
----------------------------------------------------
DISPLAY 'or [PERSON]' AND '[him/her]' IF PERSON BEING ASKED ABOUT IS NOT SELECTED AS THE RESPONDENT. OTHERWISE, (PERSON BEING ASKED ABOUT IS SELECTED AS THE RESPONDENT), USE A NULL DISPLAY.
----------------------------------------------------

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 [[him/her]] 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."
----------------------------------------------------
DISPLAY 'or [PERSON]' AND '[him/her]' IF PERSON BEING ASKED ABOUT IS NOT SELECTED AS THE RESPONDENT. OTHERWISE, (PERSON BEING ASKED ABOUT IS SELECTED AS THE RESPONDENT), USE A NULL DISPLAY.
----------------------------------------------------

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 [[him/her]] 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."
---------------------------------------------------
DISPLAY 'or [PERSON]' AND '[him/her]' IF PERSON BEING ASKED ABOUT IS NOT SELECTED AS THE RESPONDENT. OTHERWISE, (PERSON BEING ASKED ABOUT IS SELECTED AS THE RESPONDENT), USE A NULL DISPLAY.
----------------------------------------------------

CS33OV
======

When was that?

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 [[him/her]] 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)."
----------------------------------------------------
DISPLAY 'or [PERSON]' AND '[him/her]' IF PERSON BEING ASKED ABOUT IS NOT SELECTED AS THE RESPONDENT. OTHERWISE, (PERSON BEING ASKED ABOUT IS SELECTED AS THE RESPONDENT), USE A NULL DISPLAY.
----------------------------------------------------

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 [your/[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 [you/[PERSON]] had a health care visit, did a doctor or other health provider spend any time alone with [you/him/her] without a parent, relative or guardian in the room?

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, HEALTHEVENTS WORKSHEET, RECORD FILE, OR OTHER CALENDAR, GO TO CA02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CA01
----------------------------------------------------

CA01
====

The next questions are about health care received [since [START DATE OF REFERENCE PERIOD]/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. It is important to get complete and accurate information, so please take your time and feel free to refer to any records you may have. TYPES OF RECORDS THAT ARE HELPFUL (USE RECORDS JOB AID IN QUICK REFERENCE GUIDE AS NEEDED): - Any kind of calendar or electronic calendar that you regularly use to keep track of health care appointments. (If you wrote things down on the monthly planner we mailed you, we can use that.) - Any records that might help you remember health care received without an appointment, such as a health insurance statement, or a payment record like a credit card statement or checkbook log.

ASK RESPONDENT TO GET RECORD KEEPING MATERIALS IF NOT ALREADY OUT.
HAS MEPS RECORD KEEPING MATERIALS ..... 1 [CA03]
HAS SOME OTHER TYPE OF RECORD KEEPING
MATERIALS ............................. 2 [CA03]
DOES NOT HAVE RECORDS ................. 3 [CA04]
WILL NOT USE RECORDS .................. 4 [CA04]
[Code One]
----------------------------------------------------
DISPLAY 'since [START DATE OF REFERENCE PERIOD]' 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 START DATE OF THE CURRENT INTERVIEW AS MM/DD/YYYY.FOR 'END DATE OF REFERENCE PERIOD', DISPLAY THE RUEND DATE FOR ROUND 5 AS MM/DD/YYYY.
----------------------------------------------------

CA02
====

The next questions are about health care received [since [START DATE OF REFERENCE PERIOD]/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. TYPES OF RECORDS THAT ARE HELPFUL (USE RECORDS JOB AID IN QUICK REFERENCE GUIDE AS NEEDED): - Any kind of calendar or electronic calendar that you regularly use to keep track of health care appointments. (If you wrote things down on the monthly planner we mailed you, we can use that.) - Any records that might help you remember health care received without an appointment, such as a health insurance statement, or a payment record like a credit card statement or checkbook log.

THANK RESPONDENT FOR USING RECORDS DURING THE PREVIOUS INTERVIEW.
ASK RESPONDENT TO GET RECORD KEEPING MATERIALS IF NOT ALREADY OUT.
HAS MEPS RECORD KEEPING MATERIALS...... 1 [CA03]
HAS SOME OTHER TYPE OF RECORD KEEPING MATERIALS ............................. 2 [CA03]
DOES NOT HAVE RECORDS ................. 3 [CA04]
WILL NOT USE RECORDS .................. 4 [CA04]
[Code One]
----------------------------------------------------
DISPLAY 'since [START DATE OF REFERENCE PERIOD]' 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 START DATE OF THE CURRENT INTERVIEW AS MM/DD/YYYY.FOR 'END DATE OF REFERENCE PERIOD', DISPLAY THE RUEND DATE FOR ROUND 5 AS MM/DD/YYYY.
----------------------------------------------------

CA03
====

Has anyone in the family been keeping records of all visits to medical providers and medical places, most of the visits, only some of the visits, or have no records been kept? IF MORE THAN ONE PERSON IN RU: Do you have records that cover health care received for each person (in your family)?

PROBE AS NEEDED TO ESTABLISH HOW WELL THE RESPONDENT'S RECORDS COVER THE
HEALTH CARE VISITS FOR ALL FAMILY MEMBERS.
ALL VISITS RECORDED .................... 1 [BOX_05]
MOST VISITS RECORDED ................... 2 [BOX_05]
SOME VISITS RECORDED ................... 3 [CA04]
NO RECORDS KEPT......................... 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
======

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 [you/[PERSON]] entered [PROVIDER] on [ADMIT DATE] and [were/was] still in the hospital at the time of our interview on [PREV RD INTV DT]. On what date [were/was] [you/he/she] discharged from [PROVIDER]?

IF STILL IN HOSPITAL [OR RELEASED IN [YEAR], SELECT EVENT AND
CONTINUE INTERVIEW.
PP01_01.ADMIT DATE PP01_02.DISCHARGE DATE
[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 INTERVIEWFOR '[PREV RD INTV DT]'.
DISPLAY 'OR RELEASED IN [YEAR]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATION PURPOSES ONLY, YEAR IN PROGRAM IS AUTOMATICALLY SET): DISPLAY THE YEAR SUBSEQUENTTO THE SECOND CALENDAR YEAR OF THE PANEL.
----------------------------------------------------
----------------------------------------------------
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-ENDEDHOSPITAL STAYS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, AND DELETE DISALLOWED.

2. LIMITED EDIT ALLOWED. ADMIT DATE IS A PROTECTEDFIELD. INTERVIEWER CAN UPDATE DISCHARGE DATE.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAYS ALL HS EVENTS THAT WERE CODED '95' (STILLIN 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) EVENTREPORTED 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 STILLIN 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 [you/[PERSON]] entered [PROVIDER] on [ADMIT DATE] and [were/was] still there at the time of our interview on [PREV RD INTV DT]. On what date [were/was] [you/he/she] discharged from [PROVIDER]?

IF STILL IN AN INSTITUTION OR LONG-TERM CARE FACILITY, [OR
RELEASED IN [YEAR], SELECT EVENT AND CONTINUE INTERVIEW.
PP02_01.ADMIT DATE PP02_02.DISCHARGE DATE
[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 INTERVIEWFOR '[PREV RD INTV DT]'.
DISPLAY 'OR RELEASED IN [YEAR]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATION PURPOSES ONLY, YEAR IN PROGRAM IS AUTOMATICALLY SET): DISPLAY THE YEAR SUBSEQUENTTO THE SECOND CALENDAR YEAR OF THE PANEL.
----------------------------------------------------
----------------------------------------------------
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 PROTECTEDFIELD. INTERVIEWER CAN UPDATE DISCHARGE DATE.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAYS ALL IC EVENTS THAT WERE CODED '95' (STILLIN 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 ROUND 1 AND IF CA03 IS CODED '5' (VOLUNTEERED NO EVENTS TO RECORD), GO TO PP14
----------------------------------------------------
----------------------------------------------------
IF ROUNDS 2-5 AND CA03 IS CODED '5', 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 WHETHERTHE 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)

END_LP03
========

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

PP03A
=====

[STR-DT]
[END-DT]
Next, I am going to show you several lists of health care providers to be sure we haven't missed any visits or phone calls, including those made just for advice, prescriptions, tests, shots, or x-rays.

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 ALREADYRECORDED.

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 ISCODED '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.
[Have/Has] [you/[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. READ ALL THREE PROBES BELOW.
[Since [START DATE]/Between [START DATE] and [END DATE]], has anyone in the family received any type of care...
... in a hospital?
... in a hospital emergency room?
... in a hospital outpatient department?
[Please include any hospital care we have not yet talked about.]

CODE 'YES' IF R SAYS 'YES' TO ANY PROBE ABOVE.
YES .................................... 1 [LOOP_05]
NO ..................................... 2 [PP07A]
REF ................................... -7 [PP07A]
DK .................................... -8 [PP07A]
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_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 ISCODED '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. READ ALL THREE PROBES BELOW.
[Have/Has] [you/[PERSON'S FIRST MIDDLE AND LAST NAME]] or has anyone in the family received any (other) type of care...
... in a hospital?
... in a hospital emergency room?
... in a hospital outpatient department?
[Please include any hospital care we have not yet talked about.]

CODE 'YES' IF R SAYS 'YES' TO ANY PROBE ABOVE.
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 LOOPCYCLES 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]
[Have/Has] [you/[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 LOOPCYCLES 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]
[Have/Has] [you/[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 [PP10]
REF ................................... -7 [PP10]
DK .................................... -8 [PP10]
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, [have/has] [you/[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 PP10
----------------------------------------------------

PP10
====

[STR-DT]
[END-DT]
SHOW CARD PP-3A.
[Since [START DATE]/Between [START DATE] and [END DATE]], has anyone in the family received health care in a place like those listed on this card, where they stayed overnight? IF NECESSARY, SAY: Do not include assisted living or other permanent residences.

YES .................................... 1 [LOOP_06A]
NO ..................................... 2 [PP12]
REF ................................... -7 [PP12]
DK .................................... -8 [PP12]
HELP AVAILABLE FOR DEFINITION OF ITEMS ON SHOW CARD.
----------------------------------------------------
DISPLAY 'Since [START DATE]' IF ROUNDS 1-4. DISPLAY 'Between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
SOFT ERROR:
IF CODED '2' (NO) AND IF RE35A CODED '1' (100 DAYS OR LESS) AND NO HOSPITAL STAY (HS) EVENTS HAVE BEEN RECORDED, DISPLAY THE FOLLOWING MESSAGE: "SOMEONE IN RU WAS RECORDED AS BEING INSTITUTIONALIZED FOR 100 DAYS OR LESS IN THE REENUMERATION SECTION. PLEASE RECORD ANY REMAININGLONG TERM HEALTH CARE EVENTS."
----------------------------------------------------
----------------------------------------------------
SOFT ERROR:
IF CODED '2' (NO) AND IF RE35A CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND NO HOSPITAL STAY (HS) EVENTS HAVE BEEN RECORDED, DISPLAY THE FOLLOWING MESSAGE: "SOMEONE IN RU WAS RECORDED AS BEING INSTITUTIONALIZED FOR A PERIOD OF TIME IN THE REENUMERATION SECTION. PLEASE RECORD ANY REMAINING LONG TERM HEALTH CARE EVENTS."
----------------------------------------------------

LOOP_06A
=======

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

EVENT 1
EVENT 2
EVENT 3
EVENT 4

ask BOX_08A - END_LP06A.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06A COLLECTS ALL LONG TERM CARE FACILITY EVENTS NOT ALREADY RECORDED.

THE RESPONSE TO PP11 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF PP11 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP11 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_08A
=======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP11
----------------------------------------------------

PP11
====

[STR-DT] [END-DT]
SHOW CARD PP-3A.
[Have/Has] [you/[PERSON'S FIRST MIDDLE AND LAST NAME]] received any other health care where [you/he/she] stayed overnight? Or has anyone in the family received health care in a place like those listed on this card where they stayed overnight? [Please include any health care we have not yet talked about.]

YES .................................... 1 [END_LP06A]
NO ..................................... 2 [END_LP06A]
REF ................................... -7 [END_LP06A]
DK .................................... -8 [END_LP06A]
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_LP06A
========

----------------------------------------------------
IF PP11 IS CODED '1' (YES), CYCLE TO COLLECT NEXT EVENT.
----------------------------------------------------
----------------------------------------------------
IF PP11 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_06A AND CONTINUE WITH PP12
----------------------------------------------------

PP12
====

[STR-DT] [END-DT]
SHOW CARD PP-4.
[And finally, did/Did/Between [START DATE] and [END DATE], did] anyone in the family obtain eyeglasses, contact lenses, or diabetic equipment or supplies [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, did' IF ROUNDS 1, 2, OR 4. DISPLAY 'Did' IF ROUND 3. DISPLAY 'Between [START DATE] and [END DATE], did' 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 or supplies [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-5.
Now I would like you to think about the entire calendar year [YEAR], that is from January 1, [YEAR] until December 31, [YEAR]. During [YEAR], did anyone in the family have expenses for any of the types of things listed on this card? 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-5.
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 medical and dental care each family member received [since [START DATE]/between [START DATE] and [END DATE]]. You can use your calendar, electronic records, checkbook, or receipts to help you remember. We are interested in any type of visit or phone call, including those made just for advice, prescriptions, tests, shots, or x-rays.

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 STARTDATE.
----------------------------------------------------

PP15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD PP-6.
Now think about the health care [you/[PERSON]] [have/has] received [since [START DATE]/between [START DATE] and [END DATE]]. [Since [START DATE]/Between [START DATE] and [END DATE]], did [you/he/she] 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-6.
[Since [START DATE]/Between [START DATE] and [END DATE]], did [you/[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)?

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-7.
[Since [START DATE]/Between [START DATE] and [END DATE]], did [you/[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 [you/he/she] 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-7.
[Since [START DATE]/Between [START DATE] and [END DATE]], did [you/[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-8. READ ALL THREE PROBES BELOW.
[Since [START DATE]/Between [START DATE] and [END DATE]], did [you/PERSON]] receive any type of care...
... in a hospital?
... in a hospital emergency room?
... in a hospital outpatient department?

CODE 'YES' IF R SAYS 'YES' TO ANY PROBE ABOVE.
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-8. READ ALL THREE PROBES BELOW.
[Other than what you've already told me about,] [since [START DATE]/between [START DATE] and [END DATE]], did [you/[PERSON]] receive any other type of care ...
... in a hospital?
... in a hospital emergency room?
... in a hospital outpatient department?

CODE 'YES' IF R SAYS 'YES' TO ANY PROBE ABOVE.
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-9.
[Since [START DATE]/Between [START DATE] and [END DATE]], did [you/[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-9.
[Since [START DATE]/Between [START DATE] and [END DATE]], did [you/[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 [you/[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 LOOPCYCLES 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 [you/(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 [you/[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 LOOPCYCLES 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 [you/[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-10
[Since [START DATE]/Between [START DATE] and [END DATE]], because of a health problem, did [you/[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 PERSONBEING 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-10.
[Since [START DATE]/Between [START DATE] and [END DATE]], because of a health problem, did [you/[PERSON]] receive home care services such as the types listed on this card (other than what you've already told me about)?

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-11.
[Since [STATE DATE]/Between [START DATE] and [END DATE]], did [you/[PERSON]] receive health care in a place like those listed on this card, where [you/he/she] stayed overnight? IF NECESSARY, SAY: Do not include assisted living or other permanent residences.

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.
----------------------------------------------------
----------------------------------------------------
SOFT ERROR:
IF CODED '2' (NO) AND IF RE35A CODED '1' (100 DAYSOR LESS) FOR [PERSON] AND NO HOSPITAL STAY (HS) EVENTS HAVE BEEN RECORDED FOR [PERSON], DISPLAY THE FOLLOWING MESSAGE: "[PERSON] WAS RECORDED AS AS BEING INSTITUTIONALIZED FOR 100 DAYS OR LESS IN THE REENUMERATION SECTION. PLEASE RECORD ANY REMAINING LONG TERM HEALTH CARE EVENTS FOR [PERSON]."
----------------------------------------------------
----------------------------------------------------
SOFT ERROR:
IF CODED '2' (NO) AND IF RE35A CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) FOR [PERSON] AND NOHOSPITAL STAY (HS) EVENTS HAVE BEEN RECORDED FOR [PERSON], DISPLAY THE FOLLOWING MESSAGE: "[PERSON] WAS RECORDED AS BEING INSTITUTIONALIZED FOR FOR A PERIOD OF TIME IN THE REENUMERATION SECTION.
PLEASE RECORD ANY REMAINING LONG TERM HEALTH CARE EVENTS FOR [PERSON]."
----------------------------------------------------

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 FORPERSON 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-11.
(Other than what you've already told me about,)[since [START DATE]/between [START DATE] and [END DATE]], did [you/[PERSON]] receive any other health care in a place like those listed on this card, where [you/he/she] stayed overnight?

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-12.
[Since [START DATE]/Between [START DATE] and [END DATE]], did [you/[PERSON]] obtain eyeglasses, contact lenses, or diabetic equipment or supplies?

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-12.
[Since [START DATE]/Between [START DATE] and [END DATE]], did [you/[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-13.
Now I would like you to think about the entire calendar year [YEAR], that is from January 1, [YEAR] until December 31, [YEAR]. During [YEAR], did [you/[PERSON]] have expenses for any of the types of things listed on this card? 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-13.
During the calendar year [YEAR], [have/has] [you/[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]
SHOW CARD [EV-1A/EV-1B].
Where did [you/[PERSON]] receive the care?
REFER TO TAB 7 OF QUICK REFERENCE GUIDE FOR EVENT TYPE FOLLOW-UP PROBES.

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]
----------------------------------------------------
| DISPLAY 'EV-1A' IF ROUND 1, 2, OR 4. |
| DISPLAY 'EV-1B' IF ROUND 3 OR 5. |
----------------------------------------------------
----------------------------------------------------
| 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 [you/[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-5 OR PP-13
IF KNOWN, SELECT CORRECT ADDITIONAL OME ITEM GROUP
OTHERWISE ASK: Looking at this card, what type of other medical expenses did [you/[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
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
[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] [you/[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 [you/he/she] enter [PROVIDER]? On what date did [you/he/she] leave [PROVIDER]?
PROBE: Any other stays?

EV04_01.ADMIT DATE EV04_02.DISCHARGE DATE
[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 [you/[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 [you/[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 [you/[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].

CHECK ALL THAT APPLY.
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
=======

SPECIFY:

[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 [you/[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 [you/[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
======

SPECIFY:

[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
======

SPECIFY:

[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] [friends or neighbors/volunteers/relatives, other than daughters, daughters-in-law, sons, and sons-in-law/[PROVIDER] ever provide home care services for [you/[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. |
----------------------------------------------------
----------------------------------------------------
| IF PROVIDER BEING ASKED ABOUT IS NOT FLAGGED AS |
| 'INFORMAL' AT EV08, DISPLAY ACTUAL PROVIDER NAME |
| FOR '[PROVIDER]'. |
| IF PROVIDER BEING ASKED ABOUT IS FLAGGED AS |
| 'INFORMAL' AT EV08, DISPLAY 'friends or |
| neighbors/volunteers/relatives, other than |
| daughters, daughters-in-law, sons, and |
| sons-in-law'. DISPLAY 'friends or neighbors' IF |
| 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). |
----------------------------------------------------
----------------------------------------------------
| (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 [you/[PERSON]] received home care services from [PROVIDER] during some part of [PRV RD INTV MTH]. Did [you/he/she] 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 [you/[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 [you/[PERSON]]?]] INTERVIEWER: IS THE PROVIDER [ASSOCIATED WITH THIS EVENT] A PERSON OR A FACILITY (INCLUDING GROUP PRACTICES AND HMOs)? [IF FACILITY NAMED, PROBE: If [you/[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 ... [you/[PERSON]]?]' AND 'ASSOCIATED WITH THIS EVENT' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLED FROM THE ACCESSTO 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 [you/[PERSON]]/[you/[PERSON]] usually [go/goes] to if [you/he/she] [are/is] sick]?

SELECT CORRECT [USUAL SOURCE OF CARE] PROVIDER [ASSOCIATED WITH THE EVENT].
ROSTER.
PERSON-TYPE-PROVIDER
PV02_02. FACILITY PV02_03. STREET
1. [Display Truncated
Person-Provider-25]
[Display Truncated
Facility-Provider-30]
[Display Truncated
Street Address-15]
2. [Display Truncated
Person-Provider-25]
[Display Truncated
Facility-Provider-30]
[Display Truncated
Street Address-15]
3. [Display Truncated
Person-Provider-25]
[Display Truncated
Facility-Provider-30]
[Display Truncated
Street Address-15]
----------------------------------------------------
DISPLAY 'provided health care to [you/[PERSON]]' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLEDFROM THE ACCESS TO CARE (AC) SECTION. IF THE PV SECTION WAS CALLED FROM THE AC SECTION, DISPLAY '[you/[PERSON]] usually [go/goes] to if [you/he/ she] (are/is) 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 NEW 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 NEW 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]
TO MAKE CORRECTIONS OR ADDITIONS TO ADDRESS, MAKE A COMMENT. ADDRESS [AND FACILITY NAME] CORRECT ...... 1 [BOX_02]
ADD NEW ADDRESS (2ND LOCATION) FOR PROVIDER ABOVE........................ 2 [PV06]
ADD NEW/DIFFERENT FACILITY (GROUP PRACTICE) FOR PROVIDER ABOVE ......... 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, CREATEA 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 [you/[PERSON]]/[you/[PERSON]] usually [go/goes] to if [you/he/she] [are/is] sick]?

ENTER COMPLETE PROVIDER NAME [ASSOCIATED WITH THIS EVENT]
AND VERIFY SPELLING.
[Enter Provider Name-65] ............... [PV05]
----------------------------------------------------
DISPLAY 'provided health care to [you/[PERSON]]' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLEDFROM THE ACCESS TO CARE (AC) SECTION. IF THE PV SECTION WAS CALLED FROM THE AC SECTION, DISPLAY '[you/[PERSON]] usually [go/goes] to if [you/he/ she] [are/is] 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 [you/[PERSON]]/[you/[PERSON]] usually [go/goes] to if [you/he/she] [are/is] sick]?

SELECT CORRECT [USUAL SOURCE OF CARE] [PROVIDER/FACILITY]
[ASSOCIATED WITH THE EVENT].
ROSTER. FACILITY-PROVIDERS PV08_02. STREET
[Display Truncated
Facility-Provider-30]
[Display Truncated
Street Address-15]
[Display Truncated
Facility-Provider-30]
[Display Truncated
Street Address-15]
[Display Truncated
Facility-Provider-30]
[Display Truncated
Street Address-15]
----------------------------------------------------
DISPLAY 'provided health care to [you/[PERSON]]' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLEDFROM THE ACCESS TO CARE (AC) SECTION. IF THE PV SECTION WAS CALLED FROM THE AC SECTION, DISPLAY '[you/[PERSON]] usually [go/goes] to if [you/he/ she] [are/is] 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 NEW PROVIDER' OR 'ADD NEW FACILITY' OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD NEW PROVIDER' OR 'ADD NEW FACILITY' 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 NEW PROVIDER' OR 'ADD NEW FACILITY 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]
TO MAKE CORRECTIONS OR ADDITIONS TO ADDRESS, MAKE A COMMENT.
FACILITY NAME AND ADDRESS CORRECT ...... 1 [BOX_02]
ADD NEW ADDRESS FOR FACILITY ........... 2 [PV10A]
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 PV10A 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 [you/[PERSON]]/[you/[PERSON]] usually [go/goes] to if [you/he/she] [are/is] 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 [you/[PERSON]]' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLEDFROM THE ACCESS TO CARE (AC) SECTION. IF THE PV SECTION WAS CALLED FROM THE AC SECTION, DISPLAY '[you/[PERSON]] usually [go/goes] to if [you/he/ she] [are/is] 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 PV09WAS CODED '2' (ADD NEW ADDRESS FOR FACILITY).
----------------------------------------------------
----------------------------------------------------
DISPLAY AN 'ADD NEW PROVIDER' OR 'ADD NEW FACILITY' OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
CODES '-7' (REF) AND '-8' (DK) ARE ALLOWED ON THE STREET ADDRESS FIELDS ONLY.
----------------------------------------------------
----------------------------------------------------
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'.
----------------------------------------------------

PV10A
=====

ENTER STREET ADDRESS AND VERIFY SPELLING. IF ([PROVIDER/FACILITY])
HAS MORE THAN ONE LOCATION, RECORD LOCATION PERSON VISITED.
FACILITY_STR1 (PV10a): [_____________] [BOX_02]
FACILITY_STR2 (PV10b): [_____________] [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
----------------------------------------------------
DISPLAY 'provided health care to [you/[PERSON]]' IF THE PROVIDER ROSTER (PV) SECTION WAS NOT CALLEDFROM THE ACCESS TO CARE (AC) SECTION. IF THE PV SECTION WAS CALLED FROM THE AC SECTION, DISPLAY '[you/[PERSON]] usually [go/goes] to if [you/he/ she] [are/is] 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). THE CONTEXT HEADER DISPLAYS THE NAME OF THE PROVIDER(S) ASSOCIATED WITH THE EVENT IF PV09 WAS CODED '2' (ADD NEW ADDRESS FOR FACILITY).
----------------------------------------------------
----------------------------------------------------
CODES '-7' (REF) AND '-8' (DK) ARE ALLOWED ON THE STREET ADDRESS FIELDS ONLY.
----------------------------------------------------
---------------------------------------------------
NOTE: PV10A DOES NOT COLLECT THE FACILITY NAME BUT COLLECTS ONLY NEW ADDRESSES ASSOCIATED WITH EXISTING FACILITY NAMES. THE NEW PROVIDER RECORD FOR THIS FACILITY WAS ALREADY CREATED AT PV09.
----------------------------------------------------

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 LOOP_02 - 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
====

OMITTED.

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]
[The next questions ask detail about each of the times [you/[PERSON]] received medical or dental care.] Let's talk about [the hospital stay for [you/[PERSON]] at [PROVIDER] that began on [ADMIT DATE]/when [you/[PERSON]] visited the emergency room at [PROVIDER] on [VISIT DATE]/when [you/[PERSON]] received medical care from an outpatient department at [PROVIDER] on [VISIT DATE]/when [you/[PERSON]] received medical care from [PROVIDER] on [VISIT DATE]/when [you/[PERSON]] received dental care from [PROVIDER] on [VISIT DATE]/the [OME ITEM GROUP NAME] used by [you/[PERSON]] since [START DATE]/the services [you/[PERSON]] received at home from [PROVIDER] during [MONTH]].

[THIS IS AN OPEN EVENT. EVENT DATA WILL BE COLLECTED NEXT ROUND./EVENT WILL BE PROCESSED AS A PRESCRIBED MEDICINE.]
THERE [IS/ARE] [NUMBER] [EVENT/EVENTS] REMAINING FOR [PERSON].
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....care.' IF FIRST EVENT TO BE ASKED ABOUT FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------
----------------------------------------------------
DISPLAY 'THIS IS AN OPEN EVENT. EVENT DATA WILL BE COLLECTED NEXT ROUND.' IF THE EVENT TYPE IS HS AND THE DISCHARGE DATE IS CODED AS 'STILL IN THE HOSPITAL' OR IF EVENT TYPE IS HH AND EV13 FOR THE INTERVIEW MONTH IS CODED '1' (YES). DO NOT DISPLAY IF EVENT TYPE IS HH AND ROUND 5. THERE CANNOT BE AN OPEN HH EVENT IN ROUND 5. DISPLAY 'EVENT WILL BE PROCESSED AS A PRESCRIBED MEDICINE.' IF EVENT TYPE IS OM AND ITEM TYPE IS INSULIN OR OTHER DIABETIC EQUIPMENT OR SUPPLIES.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
[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 H, 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
=====

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]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
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 TAY, 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
MEDICAL
PROVIDER
ED09_02.
EVENT TYPE
ROSTER.
DATE-DATE
ED09_04.
UTIL
ED09_05. C/P
1. [Display Medical Provider-35]
[Display Event Code]
[Display Month Day Year-4]
[Display Selection]
[Display Selection]
2. [Display Medical Provider-35]
[Display Event Code]
[Display Month Day Year-4]
[Display Selection]
[Display Selection]
3. [Display Medical Provider-35]
[Display Event Code]
[Display Month Day Year-4]
[Display Selection]
[Display Selection]
----------------------------------------------------
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 ITH 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 [you/[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 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 [you/[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 API 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 [you/[PERSON]] entered [PROVIDER] on [ADMIT DATE].
IF NECESSARY, PROBE: What was the main reason [you/he/she] entered [PROVIDER]?

OPERATION OR SURGICAL PROCEDURE ........ 1 [HS06AA]
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 IN RED: "PLEASE BE SURE YOU HAVE ALSO ENTERED A HOSPITAL STAY EVENT FOR THE BABY." IF CODED '5' (TO BE BORN), DISPLAY THE FOLLOWING MESSAGE IN RED: "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 [you/[PERSON]] during this stay?

YES .................................... 1 [HS06AA]
NO ..................................... 2 [HS06AA]
REF ................................... -7 [HS06AA]
DK .................................... -8 [HS06AA]
HELP AVAILABLE FOR DEFINITION OF OPERATIONS/SURGICAL PROCEDURES.

HS06AA
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Did [you/[PERSON] spend any time in an intensive or critical care unit (ICU) during this stay?

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 [you/[PERSON]] have? Was it a vaginal delivery or caesarean section?

VAGINAL DELIVERY ....................... 1 [HS08]
CAESAREAN SECTION ...................... 2 [HS08]
REF ................................... -7 [HS08]
DK .................................... -8 [HS08]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

HS06B
=====

OMITTED.

HS07
====

OMITTED.

HS08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
At the time [you/[PERSON]] [were/was] discharged, were any medicines prescribed for [you/him/her]? Please do not include medications received while [you/he/she] [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 ONTHE 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
====

OMITTED.

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 [you/[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 ISFEMALE. 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 [you/[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."
----------------------------------------------------
----------------------------------------------------
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 [you/[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; THESERESPONSES 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."
----------------------------------------------------
----------------------------------------------------
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).
----------------------------------------------------

ER06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Was a surgical procedure performed on [you/[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 [you/[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?

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
======

OP01
====

OMITTED.

OP02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Did [you/(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 [you/[PERSON]] see a medical doctor during this particular visit?/Was this telephone call about [your/[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 [you/[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 [your/ [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 [you/[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 [you/[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 [you/[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 OP11
----------------------------------------------------

BOX_03
======

OMITTED.

OP10
====

OMITTED.

OP11
====

[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 services, if any, did [you/[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 [you/[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 [you/[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?

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 [you/[PERSON]] had some other visits to an outpatient department at [PROVIDER]. Were any of these visits related to any condition associated with [your/his/her] visit on [VISIT DATE]? That is, were any of the other visits for the (READ CONDITIONS BELOW) and did [you/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 [your/[PERSON]'s] visit on [VISIT DATE]?

IF R SAYS 'DON'T KNOW' ? PROBE ABOUT COPAYMENTS. IF ANY OF THESE VISITS OR CALLS HAD THE SAME COPAYMENT OR PERSON DID NOT PAY ANYTHING, CODE 'YES'.
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
======

MV01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Did [you/[PERSON]] visit [PROVIDER] on [VISIT DATE] in person or was this a telephone call?

SAW PROVIDER ........................... 1 [MV03]
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
=====

OMITTED.

MV03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE
PROVIDER] [EVN-DT]
[Did [you/[PERSON]] see a medical doctor during this particular visit?/Was this telephone call about [your/[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 [you/[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 [your/ [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 [you/[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 [you/[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 THATPERSON 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 [you/[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 MV11
----------------------------------------------------

BOX_03
======

OMITTED.

MV10
====

OMITTED.

MV11
====

[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 services, if any, did [you/[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 [you/[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 [you/[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?

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 [you/[PERSON]] had some other visits to [PROVIDER]. Were any of these visits related to any condition associated with [your/his/her] visit on [VISIT DATE]? That is, were any of the other visits for the (READ CONDITIONS BELOW) and did [you/[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 [your/[PERSON]'s] visit on [VISIT DATE]?

IF R SAYS 'DON'T KNOW' ? PROBE ABOUT COPAYMENTS. IF ANY OF THESE VISITS OR CALLS HAD THE SAME COPAYMENT OR PERSON DID NOT PAY ANYTHING, CODE 'YES'.
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 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 'MV'.
4. EVENT IS ASSOCIATED WITH THE SAME PROVIDER AS THE EVENT BEING ASKED ABOUT.
----------------------------------------------------

MV19
====

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]
SHOW CARD DN-1.
What type of dental care provider did [you/[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-2.
What did [you/[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 [you/[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.EVNTBEGM AS THREE LETTERS.
----------------------------------------------------

BOX_00
======

----------------------------------------------------
IF NOT ROUND 5 AND EVENT MONTH IS INTERVIEW MONTH, GO TO BOX_05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_01
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF PROVIDER IS FLAGGED AS 'AGENCY', CONTINUE WITH HH01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During [VISIT MONTH], what types of health care workers from [PROVIDER] provided home care services for [you/[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 [you/[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 [you/[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 [you/[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 [you/[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 [you/[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 [you/[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 [you/[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 [you/[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...' F 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 [you/[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.
NUMBER OF DAYS PER WEEK:

[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.
NUMBER OF DAYS PER MONTH:

[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 [you/[PERSON]]?
PROBE: We just need to know in general.
NUMBER OF TIMES PER DAY:

[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
DK .................................. -8

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.
----------------------------------------------------
----------------------------------------------------
HARD CHECK: IF '0' ENTERED IN BOTH HOURS AND MINUTES, THE WVS ERROR HANDLER WILL FORCE THE INTERVIEWER TO RECTIFY THE DATA.
----------------------------------------------------
----------------------------------------------------
HARD CHECK: IF '24' ENTERED IN HOURS AND AN ENTRY )0 FOR 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 [you/[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 ACTIVITIESOR 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]?

NUMBER OF TIMES
[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]?

NUMBER OF TIMES
[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 BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_02
----------------------------------------------------

OM01
====

OMITTED.

BOX_02
======

----------------------------------------------------
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
====

OMITTED.

BOX_03
======

----------------------------------------------------
FLAG THE OM CHARGE/PAYMENT (CP) SECTION AS 'PROCESSED'. INSULIN AND OTHER DIABETIC EQUIPMENTAND SUPPLIES WILL BE PROCESSED THROUGH CP AS PRESCRIBED MEDICINES.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_04
----------------------------------------------------

BOX_04
======

----------------------------------------------------
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 [YEAR]' 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 [YEAR]' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATION PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN CONTEXT HEADER IS FIRST CALENDAR YEAR OF PANEL IF ROUND 3. 'YEAR' IS SECOND CALENDAR YEAR OF PANEL IF ROUND 5.
----------------------------------------------------

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, AND CP20) 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 AND ALL SUBSEQUENT PANELS 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 (INCLUDING 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 [your/[PERSON]'s] prescription medicine(s). Has [your/[PERSON]'s] health insurance or another source of coverage helped pay for any of [your/his/her] prescription medications since [START DATE]?

SELECT 'NO' IF PERSON REPORTS NO HEALTH INSURANCE OR ANOTHER SOURCE OF COVERAGE.
YES .................................... 1 [CP01B]
NO ..................................... 2 [CP01]
REF ................................... -7 [CP01]
DK .................................... -8 [CP01]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE OR ANOTHER SOURCE OF COVERAGE.

CP01B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [EVN-DT]
Who usually helps pay?

[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 CP01
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_SOP_2

COL # 1 HEADER: SELECT PAYMENT 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
=====

OMITTED.

CP01COV2
========

OMITTED.

CP01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [EVN-DT]
[Do/Does] [you/[PERSON]] (or someone in the family) send in a claim form to the insurance company for [your/his/her] prescription medicines or does the pharmacy automatically file the claim forms?

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 [your/[PERSON]'s] visit to [PROVIDER] on [VISIT DATE], let me take a moment to verify some information. Last time we recorded that [you/he/she] (or someone in the family) [usually pay(s) a [$ AMT COPAY] copayment/usually pay(s) nothing for visits] to [PROVIDER]. Is this still correct?

YES .................................... 1 [CP03]
NO [- PAYS A COPAYMENT AMOUNT NOW] ..... 2 [CP02OV]
NOT [A COPAYMENT/THE SAME] SITUATION
ANYMORE ............................. 99 [CP03]
REF ................................... -7 [CP03]
DK .................................... -8 [CP03]
[Code One]
HELP AVAILABLE FOR DEFINITION OF COPAYMENT.
----------------------------------------------------
DISPLAY 'usually pay(s) [$ AMT COPAY] copayment' AND 'A COPAYMENT' IN RESPONSE CATEGORY 99 IF THE CP11OV1 AMOUNT FLAGGED AS 'COPAYMENT SITUATION' DOES NOT EQUAL ZERO. DISPLAY 'usually pay(s) nothing for visits', 'PAYS A COPAYMENT AMOUNT NOW' IN RESPONSE CATEGORY 2, AND 'THE SAME' IN RESPONSE CATEGORY 99 IF THE CP11OV1 AMOUNT FLAGGED AS 'COPAYMENT SITUATION' EQUALS ZERO.

FOR '$ 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/THE SAME] 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
======

[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:
$0 - $50.
----------------------------------------------------
----------------------------------------------------
HARD CHECK MESSAGE:
"ENTER A DOLLAR AMOUNT ( OR = $50, DK, RF OR CHECK 'NOT A COPAYMENT SITUATION ANYMORE.' IF COPAYMENT IS ACTUALLY ) $50, ENTER 'DK' FOR AMOUNT AND ENTER THE ACTUAL COPAYMENT AMOUNT IN A COMMENT."
----------------------------------------------------

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 [your/[PERSON]'s] stay at [HOSPITAL] that began on [ADMIT DATE]/[your/[PERSON]'s] visit to [PROVIDER] on [VISIT DATE]/the last purchase of [NAME OF PRESCRIBED MEDICINE] for [you/[PERSON]]/the services for [FLAT FEE GROUP] for [you/[PERSON]]/the [OME ITEM GROUP NAME] used by [you/[PERSON]] since [START DATE]/services received at home from [PROVIDER] during [MONTH] for [you/[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 '[your/[PERSON]'s] stay at [HOSPITAL] that began on [ADMIT DATE]' IF EVENT TYPE IS HS.

DISPLAY '[your/[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 [you/[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 [you/[PERSON]]' IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

FOR '[FLAT FEE GROUP]' DISPLAY THE NAME OF THE FLAT FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.

DISPLAY 'the [OME ITEM GROUP NAME] used by [you/ [PERSON]] since [START DATE]' IF EVENT TYPE IS OM.

DISPLAY 'services received at home from [PROVIDER] during [MONTH] for [you/[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.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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
=====

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]
----------------------------------------------------
[OME ITEM GROUP NAME]: DISPLAY THE NAME OF THE OTHER MEDICAL EXPENSES ITEM GROUP BEING ASKED ABOUT FOR THIS EVENT.

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

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 [you/[PERSON]] (or someone in the family) [only paid the [$ AMT COPAY] copayment/paid nothing] for this visit and [you/he/she] [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 'only paid the [$ AMT COPAY] copayment' IF THE CP11OV1 AMOUNT FLAGGED AS 'COPAYMENT SITUATION' DOES NOT EQUAL ZERO ($0).

FOR '$ AMT COPAY' DISPLAY THE CP02OV OR CP11OV1 AMOUNT FLAGGED AS 'COPAYMENT SITUATION' FOR THE CURRENT ROUND FOR THIS PERSON-PROVIDER PAIR.

DISPLAY 'paid nothing' IF THE CP11OV1 AMOUNT FLAGGED AS 'COPAYMENT SITUATION' EQUALS ZERO ($0).
----------------------------------------------------
----------------------------------------------------
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] [you/[PERSON]] (or anyone in the family) received anything in writing, such as a bill, receipt, or statement, for [this hospital stay/this visit/the last purchase of [NAME OF PRESCRIBED MEDICINE]/the services for [FLAT FEE GROUP]/the [OME ITEM GROUP NAME]/the services received at home]?

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.
----------------------------------------------------
this hospital stay: DISPLAY IF EVENT TYPE IS HS.

this visit: DISPLAY IF EVENT TYPE IS ER, OP, MV, OR DN.

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 services for [FLAT FEE GROUP]: DISPLAY IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

FOR [FLAT FEE GROUP], DISPLAY THE NAME OF THE FLAT FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.

the [OME ITEM GROUP NAME]: DISPLAY IF EVENT TYPE IS OM.

the services received at home: DISPLAY 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.
----------------------------------------------------
----------------------------------------------------
'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]]
[NAME OF PRESCRIBED MEDICINE] [OME ITEM GROUP NAME]
SHOW CARD CP-1.
Why [have/has] [you/[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]
NO BILL SENT: VA (VETERANS
ADMINISTRATION)/CHAMPVA ............... 6 [BOX_04]
NO BILL SENT: MILITARY FACILITY ......... 7 [BOX_04]
NO BILL SENT: PUBLIC ASSISTANCE/
MEDICAID/SCHIP ........................ 8 [BOX_04]
NO BILL SENT: INDIAN HEALTH SERVICE
(IHS) ................................. 15 [BOX_04]
NO BILL SENT: WORKER'S COMPENSATION ..... 9 [BOX_04]
NO BILL SENT: PRIVATE HEALTH CENTER/
CLINIC ................................ 10 [BOX_04]
NO BILL SENT: 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 (E.G. FLAT
FEE) .................................. 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'
----------------------------------------------------
----------------------------------------------------
[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.
----------------------------------------------------
----------------------------------------------------
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 (E.G. FLAT FEE)' 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 (E.G. FLAT FEE)' 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 (E.G. FLAT FEE)' 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(E.G. FLAT FEE)' 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
====

RECORD VERBATIM. TO CONTINUE PRESS TAB AND THEN ENTER, OR SELECT NEXT PAGE.
[Enter Text] ........................... [CP07OV1]
----------------------------------------------------
[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.
----------------------------------------------------

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]]
[NAME OF PRESCRIBED MEDICINE] [OME ITEM GROUP NAME]
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]
INDIAN HEALTH SERVICE (IHS) ............ 8 [BOX_04]
WORKER'S COMPENSATION .................. 6 [BOX_04]
PRIVATE INSURANCE COMPANY .............. 7 [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 PUBLIC ASSISTANCE AND WORKER'S COMPENSATION.
----------------------------------------------------
----------------------------------------------------
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 [this hospital stay/this visit/the last purchase of [NAME OF PRESCRIBED MEDICINE]/the services for [FLAT FEE GROUP]/the [OME ITEM GROUP NAME]/the services received at home]?

[SELECT 'INCLUDED WITH OTHER CHARGES' IF THIS IS A FLAT FEE
SITUATION.]
YES .................................... 1 [CP09]
NO ..................................... 2
INCLUDED WITH OTHER CHARGES (E.G. FLAT
FEE) ................................ 95
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITIONS OF TOTAL CHARGE AND FLAT FEE.
----------------------------------------------------
DISPLAY 'this hospital stay' IF EVENT TYPE IS HS.

DISPLAY 'this visit' IF EVENT TYPE IS ER, OP, MV, OR DN.

DISPLAY 'the last purchase of [NAME OF PRESCRIBED MEDICINE]' 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]' IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

FOR [FLAT FEE GROUP], DISPLAY THE NAME OF THE FLAT FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.

DISPLAY 'the [OME ITEM GROUP NAME]' IF EVENT TYPE IS OM.

DISPLAY 'the services received at home' 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.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)' 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 (E.G. FLAT FEE)' 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 (E.G. FLAT FEE)' 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 (E.G. FLAT FEE)' 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]]
[NAME OF PRESCRIBED MEDICINE] [OME ITEM GROUP NAME]
How much was the total charge, including any amounts that may be paid by health insurance or other sources? [Do not include any services billed for separately such as physician charges or other services.] [Include charges for procedures such as x-rays, lab tests, or diagnostic procedures that are listed separately on the [hospital] bill [or statement].]

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 (E.G. FLAT
FEE)................................. 95
[Code One]
HELP AVAILABLE FOR DEFINITION OF WHAT MAKES UP TOTAL CHARGE AND FLAT FEE.
----------------------------------------------------
DISPLAY 'Do not include any services billed for billed for separately such as physician charges or other services.' IF EVENT TYPE IS HS, ER, OR OP. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'Include charges for procedures such as x-rays, lab tests, or diagnostic procedures that are listed separately on the [hospital] bill [or statement]'. IF CP05 IS CODED '1' (YES, AND DOCUMENTATION AVAILABLE) AND EVENT TYPE IS NOT PM. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'hospital' IF EVENT TYPE IS HS, ER, OR OP.OTHERWISE, USE A NULL DISPLAY. DISPLAY 'or statement' IF EVENT TYPE IS MV, DN, OM, HH OR EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
[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 'INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)' DISPLAY THE FOLLOWING MESSAGE: 'THIS CODE IS NOT AVAILABLE FOR A PM EVENT.'
----------------------------------------------------
----------------------------------------------------
IF 'INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)' 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 (E.G. FLAT FEE)' 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 (E.G. FLAT FEE)' 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:
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 CP09A
----------------------------------------------------
----------------------------------------------------
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 during [MONTH] was [$ AMOUNT]. Is that correct?

YES .................................... 1 [CP11]
NO ..................................... 2
REF ................................... -7 [CP11]
DK .................................... -8 [CP11]
----------------------------------------------------
[$ 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 [you/[PERSON]] [are/is] required to pay a certain set amount each time [you/he/she] [visit/visits] [PROVIDER] regardless of what happens during the visit? PROBE: For example, is this the type of situation in which [you/he/she] always [make/makes] the same set dollar amount copayment?

YES .................................... 1 [CP11]
NO ..................................... 2 [CP11]
USUALLY PAYS $0 (REGARDLESS OF SERVICE). 3 [CP11]
REF ................................... -7 [CP11]
DK .................................... -8 [CP11]
HELP AVAILABLE FOR DEFINITION OF SET AMOUNT AND COPAYMENT.

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]]
[NAME OF PRESCRIBED MEDICINE] [OME ITEM GROUP NAME]
How much of the [[AMT TOT CH]/total charge] did anyone in the family pay 'out-of-pocket,' that is, 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.
----------------------------------------------------
[[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.
----------------------------------------------------
----------------------------------------------------
[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.
----------------------------------------------------

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]]
$
[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]]
%
[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), GO TO CP37
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CP12
----------------------------------------------------

LOOP_01
=======

OMITTED.

BOX_LP01
========

OMITTED.

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 for any of the charges for [this hospital stay/this visit/the last purchase of [NAME OF PRESCRIBED MEDICINE]/the services for [FLAT FEE GROUP]/the [OME ITEM GROUP NAME]/ the services received at home]? By other source, we mean a private insurance company, an HMO, Medicare, Medicaid, or any other public program that may have paid.

YES .................................... 1 [CP12A]
NO ..................................... 2 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
HELP AVAILABLE FOR A DEFINITION OF SOURCE AND 'ALREADY PAID'.
----------------------------------------------------
DISPLAY 'OTHER' IN THE QUESTION TEXT IF AN AMOUNT WAS PAID BY PERSON/FAMILY; THAT IS, AN AMOUNT ) $0 OR 0% WAS ENTERED AT CP11OV1 OR CP11OV2. OTHERWISE USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'this hospital stay' IF EVENT TYPE IS HS.

DISPLAY 'this visit' IF EVENT TYPE IS ER, OP, MV, OR DN.

DISPLAY 'the last purchase of [NAME OF PRESCRIBED MEDICINE]' 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]' IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

FOR [FLAT FEE GROUP], DISPLAY THE NAME OF THE FLAT FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.

DISPLAY 'the [OME ITEM GROUP NAME]' IF EVENT TYPE IS OM.

DISPLAY 'the services received at home' 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.
----------------------------------------------------

CP12A
=====

[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.
----------------------------------------------------
----------------------------------------------------
WRITE SOURCES SELECTED TO THE EVENT'S-SOURCES-OF- PAYMENTS-ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CP13
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_SOP_2

COL # 1 HEADER: SELECT PAYMENT SOURCE
INSTRUCTIONS: DISPLAY PAYMENT 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
====

ENTER AMOUNT PAID TO COLUMN 2 OR COLUMN 3.
IF ONLY PERCENT KNOWN, ENTER F5 FOR DOLLAR AMOUNT PAID AND THEN ENTER PERCENT.
TOTAL CHARGE: [$XXXXXXXXX]
ROSTER. SOURCE OF PAYMENT CP13_02. DOLLAR
AMOUNT PAID
CP13_03. PERCENT
AMOUNT PAID
PERSON/Family [Display $ Amount] [Display % Amount]
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
[Display Source of Payment] [Enter $ Amount] [Enter % Amount]
HELP AVAILABLE FOR A DEFINITION OF PAYMENTS MADE DIRECTLY TO PROVIDER.
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
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 TOMOVE 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 BOX_06
----------------------------------------------------
----------------------------------------------------
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
======

OMITTED.

END_LP01
========

OMITTED.

BOX_06
======

----------------------------------------------------
IF 'AMOUNT PAID' BY PERSON/FAMILY ) $0, CONTINUE WITH CP14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

LOOP_02
=======

OMITTED.

BOX_LP02
========

OMITTED.

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 paid back any of the [$/% FAMILY PAID] paid 'out-of-pocket'?

YES .................................... 1 [CP14A]
NO ..................................... 2 [BOX_09]
REF ................................... -7 [BOX_09]
DK .................................... -8 [BOX_09]
HELP AVAILABLE FOR DEFINITION OF SOURCE AND REIMBURSEMENT.
----------------------------------------------------
[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.
----------------------------------------------------
----------------------------------------------------
[$/% 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
=====

[1. Name of Source of Reimbursement-35]
[2. Name of Source of Reimbursement-35]
[3. Name of Source of Reimbursement-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.
----------------------------------------------------
----------------------------------------------------
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: SELECT 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
====

ENTER THE AMOUNT REIMBURSED IN COLUMN 2 OR COLUMN 3.
IF ONLY PERCENT KNOWN, ENTER F5 FOR DOLLAR AMOUNT PAID AND THEN ENTER PERCENT.
PERSON/FAMILY PAYMENT: [$XXXXXXXXX] TOTAL CHARGE: [$XXXXXXXXX]
ROSTER. SOURCE OF
REIMBURSEMENT
CP15_02. DOLLAR
AMOUNT REIMBURSED
CP15_03. PERCENT
AMOUNT REIMBURSED
[Display Source of Reimbursement]
[Enter $ Amount]
[Enter % Amount]
[Display Source of Reimbursement]
[Enter $ Amount]
[Enter % Amount]
HELP AVAILABLE FOR DEFINITION OF REIMBURSEMENT.
----------------------------------------------------
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 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.
----------------------------------------------------
----------------------------------------------------
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 'IF THE VALUE IS OK, CLICK ACCEPT. IF YOU WANT TO CHANGE THE VALUE, CLICK CHANGE.'

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.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_09
----------------------------------------------------

CP15OV
======

OMITTED.

END_LP02
========

OMITTED.

BOX_07
======

OMITTED.

BOX_08
======

OMITTED.

CP16
====

OMITTED.

CP17
====

OMITTED.

CP17OV1
=======

OMITTED.

CP17OV2
=======

OMITTED.

BOX_11
======

OMITTED.

BOX_10
======

OMITTED.

CP18
====

OMITTED.

CP19
====

OMITTED.

CP19OV1
=======

OMITTED.

CP19OV2
=======

OMITTED.

CP20
====

OMITTED.

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, 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), 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
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CP37
----------------------------------------------------

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 [this hospital stay/this visit/the last purchase of [NAME OF PRESCRIBED MEDICINE]/the services for [FLAT FEE GROUP]/the [OME ITEM GROUP NAME]/the services received at home]?

YES .................................... 1 [CP22]
NO ..................................... 2 [CP37]
REF ................................... -7 [CP37]
DK .................................... -8 [CP37]
----------------------------------------------------
this hospital stay: DISPLAY IF EVENT TYPE IS HS.

this visit: DISPLAY IF EVENT TYPE IS ER, OP, MV, OR DN.

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 services for [FLAT FEE GROUP]: DISPLAY IF EVENT-PROVIDER PAIR REPRESENTS A FLAT FEE GROUP.

FOR [FLAT FEE GROUP], DISPLAY THE NAME OF THE FLAT FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.

the [OME ITEM GROUP NAME]: DISPLAY IF EVENT TYPE IS OM.

the services received at home: DISPLAY 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.
----------------------------------------------------

CP22
====

IS ANSWER IN DOLLARS OR PERCENT?
DOLLARS ................................ 1 [CP22OV1]
PERCENT ................................ 2 [CP22OV2]
[Code One]

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]]
$
[Enter $ Amount] ....................... [CP37]
REF ................................... -7 [CP37]
DK .................................... -8 [CP37]
----------------------------------------------------
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]]
%
[Enter % Amount] ....................... [CP37]
REF ................................... -7 [CP37]
DK .................................... -8 [CP37]
----------------------------------------------------
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
======

OMITTED.

LOOP_03
=======

OMITTED.

BOX_LP03
========

OMITTED.

CP23
====

OMITTED.

CP24
====

OMITTED.

CP24OV
======

OMITTED.

END_LP03
========

OMITTED.

LOOP_04
=======

OMITTED.

BOX_LP04
========

OMITTED.

CP25
====

OMITTED.

CP26
====

OMITTED.

CP26OV
======

OMITTED.

END_LP04
========

OMITTED.

BOX_15
======

OMITTED.

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
======

OMITTED.

BOX_20
======

OMITTED.

CP31
====

OMITTED.

CP32
====

OMITTED.

CP32OV1
=======

OMITTED.

CP32OV2
=======

OMITTED.

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 [THIS EVENT/THIS FLAT FEE GROUP/ THE LAST PURCHASE OF [NAME OF PRESCRIBED MEDICINE]/THE [OME ITEM GROUP NAME]]?
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
EXPLANATION OF BENEFITS FROM PRIVATE INSURANCE CARRIER ....................... 5
CALENDAR .................................. 6
PRESCRIBED MEDICINE BOTTLE, BAG, OR CONTAINER ............................... 7
ELECTRONIC RECORDS ........................ 8
PHARMACY PATIENT PROFILE .................. 9
OTHER .................................... 91 [CP37OV]
[Code All That Apply]
----------------------------------------------------
THIS EVENT: DISPLAY IF EVENT TYPE IS HS, OP, ER, MV, DN, OR HH.

THIS 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]: 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.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH CP37OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_23
----------------------------------------------------

CP37OV
======

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.

CP39
====

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) OR '3' (USUALLY PAYS $0)
AND
CP11 IS CODED '1' (DOLLARS) AND A WHOLE DOLLAR AMOUNT GREATER THAN OR EQUAL TO (=)) $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 [you/[PERSON]]. Please tell me if any of these groups include the charge that covered [this hospital stay/this visit/the [OME ITEM GROUP NAME]/the services received at home].
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 'this hospital stay' IF EVENT TYPE IS HS.

DISPLAY 'this visit' IF EVENT TYPE IS ER, OP, MV, OR DN.

DISPLAY 'the [OME ITEM GROUP NAME]' IF EVENT TYPE IS OM.

DISPLAY 'the services received at home' IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
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 ITEMGROUP 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 [YEAR]' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATION PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN CONTEXT HEADER IS FIRST CALENDAR YEAR OF PANEL IF ROUND 3. 'YEAR' IS SECOND CALENDAR YEAR OF PANEL IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
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 [you/[PERSON]]. Please tell me which of these were included in the same charge that covered [this hospital stay/this visit/the [OME ITEM GROUP NAME]/the services received at home].
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
Provider-35]
[Display Event Code] [Display Month
Day Year-4]
[Display Month
Day Year-4]
[Display Medical
Provider-35]
[Display Event Code] [Display Month
Day Year-4]
[Display Month
Day Year-4]
[Display Medical
Provider-35]
[Display Event Code] [Display Month
Day Year-4]
[Display Month
Day Year-4]
----------------------------------------------------
DISPLAY 'this hospital stay' IF EVENT TYPE IS HS.

DISPLAY 'this visit' IF EVENT TYPE IS ER, OP, MV, OR DN.

DISPLAY 'the [OME ITEM GROUP NAME]' IF EVENT TYPE IS OM.

DISPLAY 'the services received at home' IF EVENT TYPE IS HH.
----------------------------------------------------
----------------------------------------------------
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 [YEAR]' FOR OM EVENTS THAT ARE 'ADDITIONAL' GROUP TYPE (EV02A=2).
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATION PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN CONTEXT HEADER IS FIRST CALENDAR YEAR OF PANEL IF ROUND 3. 'YEAR' IS SECOND CALENDAR YEAR OF PANEL IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
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]
----------------------------------------------------
FOR [FLAT FEE GROUP], DISPLAY THE NAME OF THE FLAT FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.
----------------------------------------------------

FF05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
How many visits did [you/[PERSON]] have before [START DATE]?
NUMBER OF VISITS:

[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.
----------------------------------------------------
FOR [FLAT FEE GROUP], DISPLAY THE NAME OF THE FLAT FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.
----------------------------------------------------

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 [you/[PERSON]] had to stay in the hospital at least one night or [were/was] [you/he/she] 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 [FLAT FEE GROUP], DISPLAY THE NAME OF THE FLAT FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR 'YEAR' IN QUESTION TEXT, 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 [you/[PERSON]] have after December 31, [YEAR]?
NUMBER OF VISITS:

[Enter Number] ......................... [FF11]
REF ................................... -7 [FF11]
DK .................................... -8 [FF11]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR 'YEAR' IN QUESTION TEXT, 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 [FLAT FEE GROUP], DISPLAY THE NAME OF THE FLAT FEE GROUP SELECTED AT FF02 OR ENTERED AT FF03.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR 'YEAR' IN QUESTION TEXT, 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 [you/[PERSON]] [have/has] to stay in the hospital at least one night or will [you/he/she] be allowed to go home the same day of the surgery?

BOX_02
======

----------------------------------------------------
RETURN TO THE EVENT DRIVER FOR THIS EVENT-PROVIDER PAIR. IF EVENT-PROVIDER PAIR BEING ASKED ABOUT WASPART 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.
----------------------------------------------------
----------------------------------------------------
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
----------------------------------------------------

PM01
====

OMITTED.

PM02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
While we were talking about [your/[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] [you/[PERSON]] obtained any medicines [we have not yet talked about]? For example, [have/has] [you/he/she] had any new prescriptions or a refill of a prescription? Please include any on-line prescriptions. [It would be very helpful if we could look at the bottles, containers, tubes, or bags for each of the medicines we will be talking about.]

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 DURINGTHE 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 [you/[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 [you/[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 ROUNDSTATUS). 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 ADDITIONTO 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) SECTIONAND 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
----------------------------------------------------
----------------------------------------------------
THERWISE, CONTINUE WITH LOOP_01
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN PERSON'S-PRESCRIBED-MEDICINES-ROSTER, ASK NAV_PM01 - 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.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_PM01 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_PM01
========

SERIES: Medicine Detail (e.g., for what condition, date first taken, number of times obtained)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
Prescribed Medicine
[1. Person's Prescribed Medicine-30] [Status-25]
[2. Person's Prescribed Medicine-30] [Status-25]
[3. Person's Prescribed Medicine-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: PRESCRIBED MEDICINE
INSTRUCTIONS: DISPLAY PERSON'S PRESCRIBED MEDICINE
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH MEDICINE EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-PRESCRIBED-MEDICINES- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY EACH MEDICINE IN PERSON'S-PRESCRIBED- MEDICINES-ROSTER THAT MEETS THE FOLLOWING CONDITIONS:
- PRESCRIBED MEDICINE IS FLAGGED AS 'CREATED' DURING THE CURRENT ROUND.
OR
- PRESCRIBED MEDICINE IS FLAGGED AS 'SELECTED' DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_01A FOR SELECTED MEDICINE.
----------------------------------------------------

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 RECORDCONDITION 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 [you/[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 [you/[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 CYCLESAGAIN. IF PM17 IS CODED '1' (YES), THE LOOP CYCLESTO 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 [you/[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 [you/[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 PRESS ENTER. TO CORRECT OR ENTER INFORMATION, 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 IS VALID.
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF THE NAME OR ADDRESS FIELDS WERE COMPLETED IN PM14 FOR THE PHARMACY BEING ASKED ABOUT (THAT IS, THE PHARMACY WAS ADDED TO THE RU-PHARMACIES- ROSTER OR A NEW ADDRESS WAS ENTERED FOR AN EXISTING PHARMACY), CONTINUE WITH PM16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO PM17
----------------------------------------------------

PM16
====

[PERSON'S FIRST MIDDLE AND LAST NAME][PHARMACY NAME] [STR-DT] [END-DT]
What type of pharmacy is that? Is it a mail-order pharmacy; a pharmacy located in another store such as a grocery or department store; a pharmacy located in an HMO, clinic, or hospital; a drug store that is not located within another facility; or is it an on-line pharmacy?

MAIL-ORDER ............................. 1 [PM17]
IN ANOTHER STORE ....................... 2 [PM17]
IN HMO/CLINIC/HOSPITAL ................. 3 [PM17]
DRUG STORE ............................. 4 [PM17]
ON-LINE ................................ 5 [PM17]
REF ................................... -7 [PM17]
DK .................................... -8 [PM17]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code One]

PM17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Did [you/[PERSON]] use another pharmacy [since [START DATE]/between [START DATE] and [END DATE]]?

FOR CHAIN ESTABLISHMENTS, PLEASE RECORD ALL PHARMACY LOCATIONS USED (I.E., THOSE WITH THE SAME NAME BUT DIFFERENT ADDRESS).
YES .................................... 1 [END_LP02]
NO ..................................... 2 [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------

END_LP02
========

----------------------------------------------------
IF PM17 IS CODED '1' (YES), CYCLE TO COLLECT INFORMATION ABOUT THE NEXT PHARMACY USED BY PERSON.
----------------------------------------------------
----------------------------------------------------
IF PM17 IS CODED '2' (NO), '-7 (REFUSED), OR '-8' (DON'T KNOW), END LOOP_02 AND CONTINUE WITH BOX_06
----------------------------------------------------

BOX_06
======

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

Disability Days (DD) Section

BOX_00
======

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

IF PRND DATES ARE MISSING USE RU DATES:
RUBEGMM, RUBEGDD, RUENDMM, RUENDDD
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF PERSON IS LESS THAN 3 YEARS OF AGE (OR AGE CATEGORIES 1 OR 2), GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH DD01
----------------------------------------------------

DD01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[The next questions ask about time/Now think about] when [you/[(PERSON]] may have missed a half day or more from work or school [since [START DATE]/between [START DATE] and [END DATE]]. [In answering these questions, please include any time when this occurred because of [your/ [PERSON]'s] physical illness or injury, or a mental or emotional problem such as stress or depression.]

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY 'The next questions ask about time' IF FIRST CYCLE THROUGH THE DISABILITY DAYS SECTION FOR THE CURRENT ROUND. OTHERWISE, DISPLAY 'Now think about'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'In answering ... or depression.' IF FIRST CYCLE THROUGH THE DISABILITY DAYS SECTION FOR THE CURRENT ROUND. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
NOTE: THERE IS NO UPPER AGE LIMIT RESTRICTION FOR PERSONS WHO ARE ASKED THE WORK-LOSS DISABILITY DAYS QUESTION.
----------------------------------------------------
----------------------------------------------------
IF PERSON IS = OR ) 3 YEARS OLD AND ( OR = 15 YEARS OLD (OR AGE CATEGORY 3), GO TO DD05
----------------------------------------------------
----------------------------------------------------
IF PERSON IS = OR ) 16 YEARS OLD (OR AGE CATEGORIES 4-9), CONTINUE WITH DD02
----------------------------------------------------

DD02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[NUMBER OF DAYS IN HOSPITAL: [NUMBER OF DAYS]]
[NUMBER OF DAYS INSTITUTIONALIZED: [NUMBER OF DAYS]]
Let's talk about work. [Including the time [you/[PERSON]] [were/was] in [the hospital] [and] [the long-term care facility], how/How] many days did [you/[PERSON]] miss a half day or more from work [since [START DATE]/between [START DATE] and [END DATE]]? Please do not include work around the house. PROBE: Include any time when a half day or more was missed because of a physical illness or injury, or a mental or emotional problem.

[Enter Number of Days] .................
NO DAYS MISSED FROM WORK ............... 995
DOES NOT WORK (OTHER THAN AROUND THE
HOUSE) ................................. 996
REF .................................... -7
DK ..................................... -8
HELP AVAILABLE FOR DEFINITION OF HALF DAY OR MORE.
----------------------------------------------------
DISPLAY 'NUMBER OF DAYS IN HOSPITAL: [ ]' IF PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
FOR 'NUMBER OF DAYS', DISPLAY TOTAL NUMBER OF DAYS PERSON WAS IN HOSPITAL FOR ALL HOSPITAL STAYS THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NUMBER OF DAYS INSTITUTIONALIZED: [ ]' IF PERSON HAS AT LEAST ONE INSTITUTIONAL STAY (IC EVENT) THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN INSTITUTION)). OTHERWISE, USE A NULL DISPLAY.
NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
FOR 'NUMBER OF DAYS', DISPLAY TOTAL NUMBER OF DAYS PERSON WAS IN AN INSTITUTION FOR ALL INSTITUTIONAL STAYS THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN INSTITUTION)).
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Including the time [you/[PERSON]] [were/ was] in [the hospital] [and] [the long-term care facility], how' IF PERSON HAS AT LEAST ONE HOSPITAL STAY (HS) OR ONE INSTITUTIONAL STAY (IC) EVENT THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL/ INSTITUTION)). OTHERWISE, DISPLAY 'How'.

DISPLAY 'the hospital' IF PERSON HAS AT LEAST ONE HOSPITAL STAY (HS) EVENT THAT ENDED IN THE CURRENT ROUND.
DISPLAY 'the long-term care facility' IF PERSON HAS AT LEAST ONE INSTITUTIONAL CARE (IC) EVENT THAT ENDED IN THE CURRENT ROUND.
DISPLAY 'and' IF PERSON HAS BOTH A HOSPITAL STAY (HS) EVENT AND A INSTITUTIONAL STAY (IC) EVENT THAT BOTH ENDED IN THE CURRENT ROUND.

DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF '0' ENTERED, DISPLAY THE FOLLOWING ERROR MESSAGE: "SELECT THE CODE 'NO DAYS MISSED FROM WORK' TO RECORD ZERO."
----------------------------------------------------
----------------------------------------------------
IF NUMBER ENTERED ) NUMBER OF DAYS IN REFERENCE PERIOD, DISPLAY THE FOLLOWING ERROR MESSAGE:
'NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER IN REFERENCE PERIOD.'
----------------------------------------------------
----------------------------------------------------
IF CODED '995' (NO DAYS MISSED FROM WORK), '996' (DOES NOT WORK), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND PERSON IS 16 THROUGH 22 YEARS OF AGE INCLUSIVE (OR AGE CATEGORY 4), GO TO DD05
----------------------------------------------------
----------------------------------------------------
IF CODED '995' (NO DAYS MISSED FROM WORK), '996' (DOES NOT WORK), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND PERSON IS 23 YEARS OF AGE OR OLDER (OR AGE CATEGORIES 5-9), GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_01A
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 1 THROUGH NUMBER OF DAYS IN REFERENCE PERIOD OR 996 FOR THIS PERSON.
----------------------------------------------------

BOX_01A
=======

----------------------------------------------------
IF ROUND 3, CONTINUE WITH DD02A
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF NOT ROUND 3), GO TO BOX_01B
----------------------------------------------------

DD02A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
NUMBER OF DAYS MISSED WORK: [NUMBER OF DAYS]
Of those days, how many were in [YEAR]?

[Enter Number of Days] ................. [BOX_01B]
REF ................................... -7 [BOX_01B]
DK .................................... -8 [BOX_01B]
----------------------------------------------------
FOR 'NUMBER OF DAYS,' DISPLAY THE NUMBER ENTERED AT DD02
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN QUESTION TEXT IS FIRST CALENDAR YEAR OF PANEL.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DAYS IN [YEAR] AT DD02A MUST BE ( OR = DAYS MISSED FROM WORK AT DD02.
----------------------------------------------------

DD03
====

OMITTED.

DD04
====

OMITTED.

BOX_01B
=======

----------------------------------------------------
IF PERSON IS 16 THROUGH 22 YEARS OF AGE INCLUSIVE (OR AGE CATEGORY 4), CONTINUE WITH DD05
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., PERSON IS 23 YEARS OF AGE OR OLDER OR IN AGE CATEGORIES 5-9), GO TO BOX_02
----------------------------------------------------

DD04A
=====

OMITTED.

DD05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[NUMBER OF DAYS IN HOSPITAL: [NUMBER OF DAYS]]
[NUMBER OF DAYS INSTITUTIONALIZED: [NUMBER OF DAYS]]
Let's talk about school (and day care). [Including the time [you/ [PERSON]] [were/was] in [the hospital] [and] [the long-term care facility], how/How] many days did [you/[PERSON]] miss a half day or more of school (or day care) [since [START DATE]/between [START DATE] and [END DATE]]? PROBE: Include any time when a half day or more of school (or day care) was missed because of a physical illness or injury, or a mental or emotional problem.

[Enter Number of Days] ................. [BOX_01C]
NO DAYS MISSED FROM SCHOOL ............. 995 [BOX_02]
DOES NOT ATTEND SCHOOL ................. 996 [BOX_02]
REF .................................... -7 [BOX_02]
DK ..................................... -8 [BOX_02]
HELP AVAILABLE FOR DEFINITION OF HALF DAY OR MORE.
[Code One]
----------------------------------------------------
DISPLAY 'NUMBER OF DAYS IN HOSPITAL: [ ]' IF PERSON HAS AT LEAST ONE HOSPITAL STAY THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
FOR 'NUMBER OF DAYS', DISPLAY TOTAL NUMBER OF DAYS PERSON WAS IN HOSPITAL FOR ALL HOSPITAL STAYS THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL)). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NUMBER OF DAYS INSTITUTIONALIZED: [ ]' IF PERSON HAS AT LEAST ONE INSTITUTIONAL STAY (IC EVENT) THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN INSTITUTION)). OTHERWISE, USE A NULL DISPLAY.
NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
FOR 'NUMBER OF DAYS', DISPLAY TOTAL NUMBER OF DAYS PERSON WAS IN AN INSTITUTION FOR ALL INSTITUTIONAL STAYS THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN INSTITUTION)).
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Including the time [you/[PERSON]] [were/ was] in [the hospital] [and] [the long-term care facility], how' IF PERSON HAS AT LEAST ONE HOSPITAL STAY (HS) OR ONE INSTITUTIONAL STAY (IC) EVENT THAT ENDED IN CURRENT ROUND (I.E., DISCHARGE DATE NOT CODED '95' (STILL IN HOSPITAL/ INSTITUTION)). OTHERWISE, DISPLAY 'How'.

DISPLAY 'the hospital' IF PERSON HAS AT LEAST ONE HOSPITAL STAY (HS) EVENT THAT ENDED IN THE CURRENT ROUND.
DISPLAY 'the long-term care facility' IF PERSON HAS AT LEAST ONE INSTITUTIONAL CARE (IC) EVENT THAT ENDED IN THE CURRENT ROUND.
DISPLAY 'and' IF PERSON HAS BOTH A HOSPITAL STAY (HS) EVENT AND A INSTITUTIONAL STAY (IC) EVENT THAT BOTH ENDED IN THE CURRENT ROUND.

DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF '0' ENTERED, DISPLAY THE FOLLOWING ERROR MESSAGE: "SELECT THE CODE 'NO DAYS MISSED FROM SCHOOL' TO RECORD ZERO."
----------------------------------------------------
----------------------------------------------------
IF NUMBER ENTERED ) NUMBER OF DAYS IN REFERENCE PERIOD, DISPLAY THE FOLLOWING ERROR MESSAGE:
'NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER OF DAYS IN REFERENCE PERIOD.'
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 1 THROUGH NUMBER OF DAYS IN REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------

BOX_01C
=======

----------------------------------------------------
IF ROUND 3, CONTINUE WITH DD05A
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF NOT ROUND 3), GO TO BOX_02
----------------------------------------------------

DD05A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
NUMBER OF DAYS MISSED SCHOOL: [NUMBER OF DAYS]
Of those days, how many were in [YEAR]?

[Enter Number of Days] ................. [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
----------------------------------------------------
FOR 'NUMBER OF DAYS,' DISPLAY THE NUMBER ENTERED AT DD05.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN QUESTION TEXT IS FIRST CALENDAR YEAR OF PANEL.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DAYS MISSED FROM SCHOOL IN [YEAR] AT DD05A MUST BE ( OR = DAYS MISSED FROM SCHOOL AT DD05.
----------------------------------------------------

DD06
====

OMITTED.

DD07
====

OMITTED.

BOX_01D
=======

OMITTED.

DD07A
=====

OMITTED.

DD08
====

OMITTED.

BOX_01E
=======

OMITTED.

DD08A
=====

OMITTED.

DD09
====

OMITTED.

BOX_02
======

----------------------------------------------------
CHECK AGE AND WORK STATUS:
IF LESS THAN 16 YEARS OF AGE (OR AGE CATEGORIES 1-3), GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
IF 16 YEARS OF AGE OR OLDER (OR AGE CATEGORIES 4-9) AND DD02 IS NOT CODED '996' (DOES NOT WORK OTHER THAN AROUND THE HOUSE), CONTINUE WITH DD10
----------------------------------------------------
----------------------------------------------------
IF 16 YEARS OF AGE OR OLDER (OR AGE CATEGORIES 4-9) AND DD02 IS CODED '996' (DOES NOT WORK OTHER THAN AROUND THE HOUSE), GO TO BOX_03
----------------------------------------------------

DD10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Besides the [NUMBER OF MISSED WORK DAYS] days [you/[PERSON]] missed a half day or more from work because of [your/his/her] own illness or injury, did/Did] [you/[PERSON]] miss more than a half day from work [between [START DATE] and [END DATE]] because of someone else's illness, injury, or health care needs, for example, to take care of a sick child or a relative?

YES .................................... 1 [DD11]
NO/DO NOT WORK ......................... 2 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
[Code One]
HELP AVAILABLE FOR DEFINITION OF HALF DAY OR MORE.
----------------------------------------------------
DISPLAY 'Besides the ..., did' IF ANY MISSED WORK DAYS RECORDED FOR THIS PERSON IN DD02. DISPLAY 'Did' IF NO MISSED WORK DAYS RECORDED FOR THIS PERSON IN DD02.

DISPLAY NUMBER RECORDED IN DD02 FOR 'NUMBER OF MISSED WORK DAYS' IF DD02 DOES NOT = '-7' (REFUSED) OR '-8' (DON'T KNOW). IF DD02 = '-7' (REFUSED) OR '-8' (DON'T KNOW), USE A NULL DISPLAY.

DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

DD11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
How many days did [you/[PERSON]] miss a half day or more from work because of someone else's illness, injury, or health care needs?

[Enter Number of Days] ................. [BOX_02A]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
IF '0' ENTERED, DISPLAY THE FOLLOWING ERROR MESSAGE: 'IF NO WORK DAYS MISSED, BACK UP AND CORRECT PREVIOUS ANSWER.'
----------------------------------------------------
----------------------------------------------------
IF NUMBER ENTERED ) NUMBER OF DAYS IN REFERENCE PERIOD, DISPLAY THE FOLLOWING ERROR MESSAGE:
'NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER IN REFERENCE PERIOD.'
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DAYS ENTERED AT DD11 MUST BE ( OR = NUMBER OF DAYS IN REFERENCE PERIOD FOR PERSON.
----------------------------------------------------

BOX_02A
=======

----------------------------------------------------
IF ROUND 3, CONTINUE WITH DD11A
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF NOT ROUND 3), GO TO BOX_03
----------------------------------------------------

DD11A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
NUMBER OF DAYS MISSED WORK DUE TO SOMEONE ELSE'S HEALTH:
[NUMBER OF DAYS]
Of those days, how many were in [YEAR]?

[Enter Number of Days] ................. [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
FOR 'NUMBER OF DAYS,' DISPLAY THE NUMBER ENTERED AT DD11.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN QUESTION TEXT IS FIRST CALENDAR YEAR OF PANEL.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DAYS IN [YEAR] AT DD11A MUST BE ( OR = DAYS MISSED WORK DUE TO SOMEONE ELSE'S HEALTH AT DD11.
----------------------------------------------------

BOX_03
======

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

Accident/Injury and Conditions (CN) Section

BOX_00
======

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

BOX_01
======

-----------------------------------------------------
IF AT LEAST ONE CONDITION ON PERSON'S-MEDICAL- CONDITIONS-ROSTER MEETS THE FOLLOWING CONDITIONS:

- CONDITION IS FLAGGED AS 'CREATED' DURING THE CURRENT ROUND
- CONDITION IS NOT A PRIORITY CONDITION, THAT IS, IT IS NOT FLAGGED AS CREATED IN THE PE SECTION
- CONDITION IS NOT FLAGGED AS 'UNLIKELY ACCIDENT/ INJURY' (THIS FLAG WILL BE DETERMINED LATER AS IT MAY BE SET FOR CERTAIN CONDITIONS THAT ARE PART OF A CONDITION LOOK-UP TABLE AND ARE DETERMINED TO BE UNLIKLY DUE TO AN ACCIDENT OR INJURY)

CONTINUE WITH CN01
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO BOX_12
-----------------------------------------------------

BOX_02
======

OMITTED.

CN01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
Now I'm going to read you a list of some of the health conditions that were reported for [you/[PERSON]] between [START DATE] and [END DATE]. READ CONDITIONS ABOVE. [Was this health condition/Were any of these health conditions] due to an accident or injury?

YES .................................... 1 [CN01A]
NO ..................................... 2 [BOX_12]
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]
HELP AVAILABLE FOR DEFINITION OF ACCIDENT/INJURY.
----------------------------------------------------
DISPLAY 'Was this health condition' IF ONLY ONE CONDITION DISPLAYED AT CN01. OTHERWISE, DISPLAY 'Were any of these health conditions'.
----------------------------------------------------
----------------------------------------------------
THE THIRD CRITERION FOR DISPLAY IN THE ROSTER WILL BE DETERMINED LATER AS THE FLAG MAY BE SET FOR CERTAIN CONDITIONS THAT ARE PART OF A CONDITION LOOK-UP TABLE AND ARE DETERMINED TO BE UNLIKLY DUE TO AN ACCIDENT/INJURY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1

COL #1 HEADER: CONDITION
INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-CONDITIONS- ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. ADD, DELETE, SELECT, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THE CONDITIONS FOR PERSON THAT ARE

- CREATED THIS ROUND
- NOT FLAGGED AS PRIORITY CONDITIONS (THAT IS, THOSE NOT FLAGGED AS CREATED IN THE PE SECTION) - NOT FLAGGED AS 'UNLIKELY ACCIDENT/INJURY'

THE CONDITIONS ARE LISTED FOR DISPLAY ONLY; THEY ARE NOT SELECTABLE.
----------------------------------------------------

CN01A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Which of [your/[PERSON]'s] health conditions were due to an accident or injury? PROBE: Any other health conditions due to an accident or injury?

[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
HELP AVAILABLE FOR DEFINITION OF ACCIDENT/INJURY.
----------------------------------------------------
FLAG ALL CONDITIONS SELECTED AT CN01A AS 'DUE TO ACCIDENT/INJURY'.
----------------------------------------------------
----------------------------------------------------
THE THIRD CRITERION FOR DISPLAY IN THE ROSTER WILL BE DETERMINED LATER AS THE FLAG MAY BE SET FOR CERTAIN CONDITIONS THAT ARE PART OF A CONDITION LOOK-UP TABLE AND ARE DETERMINED TO BE UNLIKLY DUE TO AN ACCIDENT/INJURY.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_05
----------------------------------------------------
----------------------------------------------------
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 SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY CONDITIONS THAT MEET THE FOLLOWING:

1. CONDITION IS FLAGGED AS 'CREATED' DURING THE CURRENT ROUND.
2. CONDITION IS NOT A PRIORITY CONDITION, THAT IS, THE CONDITION IS NOT FLAGGED AS CREATED IN THE PE SECTION.
3. CONDITION IS NOT FLAGGED AS 'UNLIKELY ACCIDENT/INJURY'.
----------------------------------------------------

CN02
====

OMITTED.

BOX_05
======

----------------------------------------------------
IF PERSON IS = OR ) 16 YEARS OF AGE OR IN AGE CATEGORIES 4-9, CONTINUE WITH BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF ANY CONDITIONS FLAGGED AS 'DUE TO ACCIDENT/ INJURY', CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN PERSON'S-MEDICAL-CONDITIONS- ROSTER, ASK NAV_CN01 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT MEDICAL CONDITIONS CREATED DURING THE CURRENT ROUND THAT ARE DUE TO AN ACCIDENT OR INJURY. THIS LOOP CYCLES ON MEDICAL CONDITIONS THAT MEET THE FOLLOWING CONDITIONS:

- MEDICAL CONDITION IS FLAGGED AS 'DUE TO AN ACCIDENT OR INJURY' (CONDITION SELECTED AT CN01A)
- MEDICAL CONDITION IS FLAGGED AS 'CREATED' DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_CN01 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_CN01
========

SERIES: Condition Detail [STR-DT] [END-DT]
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
Condition
[1. Person's Medical Condition-30] [Status-25]
[2. Person's Medical Condition-30] [Status-25]
[3. Person's Medical Condition-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: CONDITION
INSTRUCTIONS: DISPLAY PERSON'S MEDICAL CONDITION
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH CONDITION EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-MEDICAL-CONDITION ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY EACH CONDITION IN PERSON'S-MEDICAL- CONDITIONS-ROSTER THAT MEETS THE FOLLOWING CONDITIONS:
- MEDICAL CONDITION IS FLAGGED AS 'DUE TO AN ACCIDENT OR INJURY' (CONDITION SELECTED AT CN01A)
- MEDICAL CONDITION IS FLAGGED AS 'CREATED' DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CN07 FOR SELECTED CONDITION
----------------------------------------------------

BOX_04
======

OMITTED.

CN03
====

OMITTED.

CN04
====

OMITTED.

CN05
====

OMITTED.

CN05OV1
=======

OMITTED.

CN05OV2
=======

OMITTED.

CN06
====

OMITTED.

CN06OV1
=======

OMITTED.

CN06OV2
=======

OMITTED.

CN06A
=====

OMITTED.

CN07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [PERSON'S CN MEDICAL CONDITION.] [STR-DT] [END-DT]
Did the [CONDITION] happen while [you/[PERSON]] [were/was] at work?

YES .................................... 1 [END_LP01]
NO ..................................... 2 [END_LP01]
DOES NOT WORK .......................... 3 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
[Code One]

CN08
====

OMITTED.

CN09
====

OMITTED.

CN10
====

OMITTED.

BOX_06
======

OMITTED.

CN11
====

OMITTED.

CN12
====

OMITTED.

CN13
====

OMITTED.

CN13OV
======

OMITTED.

CN14
====

OMITTED.

CN15
====

OMITTED.

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT CONDITION IN PERSON'S-MEDICAL- CONDITIONS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER CONDITIONS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_12
----------------------------------------------------

BOX_07
======

OMITTED.

BOX_08
======

OMITTED.

LOOP_02
=======

OMITTED.

CN16
====

OMITTED.

CN17
====

OMITTED.

CN18
====

OMITTED.

CN19
====

OMITTED.

CN19OV
======

OMITTED.

END_LP02
========

OMITTED.

BOX_09
======

OMITTED.

BOX_10
======

OMITTED.

BOX_11
======

OMITTED.

CN20
====

OMITTED.

CN21
====

OMITTED.

BOX_12
======

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

Quality (Priority Conditions) Supplement (PC) Section

BOX_00A
=======

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

BOX_00
======

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

BOX_01
======

----------------------------------------------------
NOTE: CURRENTLY THE QUALITY SUPPLEMENT CONTAINS QUESTIONS FOR PERSONS FOR WHOM DIABETES OR ASTHMA WAS REPORTED IN THE PRIORITY CONDITION ENUMERATION (PE) SECTION. OTHER QUALITY QUESTIONS ARE LOCATED IN THE PREVENTIVE CARE (AP) SECTION. HOWEVER, THE QUALITY SECTION COULD INCLUDE QUESTIONS FOR THE OTHER PRIORITY CONDITIONS AS THEY ARE NEEDED IN FUTURE PANELS.
----------------------------------------------------

PC01
====

OMITTED.

BOX_02
======

----------------------------------------------------
IF PERSON IS =) 18 YEARS OF AGE OR IN AGE CATEGORIES 4-9 AND IF PERSON IS A KEY RU MEMBER AND IF 'DIABETES' ON PERSON'S- MEDICAL-CONDITIONS-ROSTER AND FLAGGED AS CREATED IN THE PE SECTION (IN ANY ROUND), CONTINUE WITH BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_04
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS FLAGGED AS 'DECEASED' FOR THE CURRENT ROUND, GO TO BOX_04
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PC02A
----------------------------------------------------

PC01A
=====

OMITTED.

PC01B
=====

OMITTED.

PC01C
=====

OMITTED.

PC01D
=====

OMITTED.

PC01E
=====

OMITTED.

PC01F
=====

OMITTED.

PC01G
=====

OMITTED.

PC01H
=====

OMITTED.

PC02
====

OMITTED.

PC02A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[During an earlier interview, it/It] was mentioned that [you/[PERSON]] [have/has] diabetes. To obtain more information on the care of adults with diabetes, we have a short questionnaire for [you/him/her].

SELECT 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS DIABETES REPORTED IN ERROR.
CONTINUE ............................... 1 [PC03]
[PERSON] DOES NOT HAVE DIABETES ........ 2 [BOX_04]
[Code One]
----------------------------------------------------
DISPLAY 'During an earlier interview, it' IF
DIABETES WAS NOT CREATED DURING THE CURRENT ROUND.
DISPLAY 'It' IF DIABETES CREATED DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NOT' IN BOLD IN THE ANSWER TEXT.

IF 'PERSON DOES NOT HAVE DIABETES' IS SELECTED, THIS DOES NOT RE-SET THE DATA FROM THE PE SECTION (PRND.PCDIABET). THE RESPONSE TO PC02A WILL DETERMINE WHETHER PC03 IS ASKED AND WHETHER THERE IS DCS FOLLOW-UP FOR THIS PERSON IN THE CL SECTION
----------------------------------------------------

PC03
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
DOB: [MM/DD/YYYY] PID: [PID] RU ID: [RUID-7]
STATUS: [CURRENT/INSTITUTIONALIZED]
DETERMINE IF SELF OR PROXY DIABETES CARE SUPPLEMENT (DCS) SHOULD BE DISTRIBUTED:
SELF DCS: FOR ANY CURRENT RU MEMBER (18 YEARS OR OLDER) WHO HAS DIABETES.
PROXY DCS: FOR ANY CURRENT RU MEMBER (18 OR OLDER) WHO IS INSTITUTIONALIZED OR OTHERWISE INCAPACITATED.
CODE TYPE OF DCS DISTRIBUTED FOR [PERSON].
SELF ................................... 1 [PC03A]
PROXY .................................. 2 [PC03OV1]
[Code One]
----------------------------------------------------
DISPLAY PID OF PERSON BEING ASKED ABOUT FOR 'PID'.

DISPLAY DATE OF BIRTH FOR PERSON BEING ASKED ABOUT FOR 'MM/DD/YYYY'.

DISPLAY THE RU ID FOR THE CURRENT CASE FOR 'RUID-7'.

DISPLAY 'CURRENT' IF PERSON BEING ASKED ABOUT IS A CURRENT RU MEMBER AND IS NOT DECEASED OR INSTITUTIONALIZED. DISPLAY 'INSTITUTIONALIZED' IF PERSON BEING ASKED ABOUT IS FLAGGED AS 'INSTITUTIONALIZED' FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS WHO ARE ASKED PC03 FOR DCS FOLLOW-UP IN THE CLOSING (CL) SECTION.
----------------------------------------------------

PC03OV1
=======

[PERSON'S FIRST MIDDLE AND LAST NAME]
DOB: [MM/DD/YYYY] PID: [PID] RU ID: [RUID-7]
STATUS: [CURRENT/INSTITUTIONALIZED]
CODE REASON FOR PROXY DCS.
INSTITUTIONALIZED ...................... 2 [PC03A]
OTHER .................................. 3 [PC03OV2]
[Code One]
----------------------------------------------------
THIS ITEM IS A SEPARATE SCREEN RATHER THAN AN OVERLAY AS IMPLIED BY THE ITEM NAME.
----------------------------------------------------

PC03OV2
=======

SPECIFY OTHER REASON FOR PROXY DCS.
[Enter Other Specify] .................. [PC03A]

PC03A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
DOB: [MM/DD/YYYY] PID: [PID] RU ID: [RUID-7]
PREPARE [SELF/PROXY] DIABETES CARE SUPPLEMENT (DCS): WRITE IN PERSON NAME, PID, DATE OF BIRTH, AND RUID.
HAND PREPARED [SELF/PROXY] DCS TO RESPONDENT AND SAY:
We hope that [you/[PERSON]]/you or someone else in the family] would be able to fill out this short questionnaire on the care [you/[PERSON]] [get/gets] for diabetes. [You/He/She] can give it to me before I leave today, or I can pick it up later.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY 'SELF' AND '[you/[PERSON]]' IF PC03 IS CODED '1' (SELF). DISPLAY 'PROXY' AND 'you or someone else in the family' IF PC03 IS CODED '2' (PROXY)
----------------------------------------------------
----------------------------------------------------
DISPLAY PID OF PERSON BEING ASKED ABOUT FOR 'PID'.

DISPLAY DATE OF BIRTH FOR PERSON BEING ASKED ABOUT FOR 'MM/DD/YYYY'.

DISPLAY THE RU ID FOR THE CURRENT CASE FOR 'RUID-7'.
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF PANEL 16 ROUND 3 OR PANEL 15 ROUND 5, CONTINUE WITH BOX_05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------
----------------------------------------------------
NOTE: THE DISTRIBUTION AND COLLECTION OF THE CANCER SAQ OCCURS ONLY DURING PANEL 16 ROUND 3 ANDPANEL 15 ROUND 5. AT THIS TIME, THERE ARE NO PLANS TO COLLECT THE CANCER SAQ IN FUTURE ROUNDS.
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF PERSON IS =) 18 YEARS OF AGE OR IN AGE CATEGORIES 4-9 AND IF PERSON IS A KEY RU MEMBER AND 'CANCER ? [ANY TYPE]' (CODED AT PE22 OR PE22OV) ON PERSON'S-MEDICAL-CONDITIONS-ROSTER AND FLAGGED AS CREATED IN THE PE SECTION (IN ANY ROUND), CONTINUE WITH BOX_06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS FLAGGED AS 'DECEASED' OR 'INSTITUTIONALIZED' FOR THE CURRENT ROUND, GO TO BOX_07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PC04
----------------------------------------------------

PC04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[During an earlier interview, it/It] was mentioned that (PERSON) [(have/has)/had] cancer. To obtain more information about experiences with cancer, we have a short questionnaire for (PERSON).

SELECT 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS CANCER REPORTED IN ERROR.
CONTINUE ............................... 1 [PC04A]
(PERSON) [DOES/DID] NOT HAVE CANCER .... 2 [BOX_07]
[Code One]
----------------------------------------------------
DISPLAY 'During an earlier interview, it' IF CANCER WAS NOT CREATED DURING THE CURRENT ROUND.
DISPLAY 'It' IF CANCER WAS CREATED DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(have/has)' AND 'DOES' IF PE25 IS CODED '2' (NO) FOR THIS PERSON FOR AT LEAST ONE CANCER TYPE. OTHERWISE, DISPLAY 'had' AND 'DID'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PERSON' IN PURPLE IN THE ANSWER TEXT.

DISPLAY 'NOT' IN BOLD IN THE ANSWER TEXT.

IF 'PERSON DOES NOT HAVE CANCER' IS SELECTED, THIS DOES NOT RE-SET THE DATA FROM THE PE SECTION (PRND.CANCERML). THE RESPONSE TO PC04 WILL DETERMINE WHETHER PC04A IS ASKED AND WHETHER THERE IS CANCER SAQ FOLLOW-UP FOR THIS PERSON IN THE CL SECTION.
----------------------------------------------------
----------------------------------------------------
NOTE: THE DISTRIBUTION AND COLLECTION OF THE CANCER SAQ OCCURS ONLY DURING PANEL 16 ROUND 3 AND PANEL 15 ROUND 5. AT THIS TIME, THERE ARE NO PLANS TO COLLECT THE CANCER SAQ IN FUTURE ROUNDS.
----------------------------------------------------

PC04A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
DOB: [MM/DD/YYYY] PID: [PID] RU ID: [RUID-7]
PREPARE 'YOUR EXPERIENCES WITH CANCER' (CANCER SAQ):
WRITE IN PERSON NAME, DATE OF BIRTH, PID, AND RUID.
HAND PREPARED CANCER SAQ TO RESPONDENT AND SAY:
We hope that (PERSON) would be able to fill out this short questionnaire on (PERSON)'s experiences with cancer. (PERSON) can give it to me before I leave today, or I can pick it up later.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY DATE OF BIRTH FOR PERSON BEING ASKED ABOUT FOR 'MM/DD/YYYY'.

DISPLAY PID OF PERSON BEING ASKED ABOUT FOR 'PID'.

DISPLAY THE RU ID FOR THE CURRENT CASE FOR 'RUID-7'.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS WHO ARE ASKED PC04A FOR CANCER SAQ FOLLOW-UP IN THE CLOSING (CL) SECTION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_07
----------------------------------------------------
----------------------------------------------------
NOTE: THE DISTRIBUTION AND COLLECTION OF THE CANCER SAQ OCCURS ONLY DURING PANEL 16 ROUND 3 AND PANEL 15 ROUND 5. AT THIS TIME, THERE ARE NO PLANS TO COLLECT THE CANCER SAQ IN FUTURE ROUNDS.
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF 'ASTHMA' ON PERSON'S-MEDICAL-CONDITIONS-ROSTER,AND FLAGGED AS CREATED IN THE PE SECTION (IN ANY ROUND), CONTINUE WITH PC04B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

PC04B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[During an earlier interview, it was mentioned that [you/[PERSON]] [have/has] asthma.] Now I would like to ask you a few questions about [your/[PERSON]'s] asthma and the course of treatment [you/he/she] received.

SELECT 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS ASTHMA REPORTED IN ERROR.
CONTINUE ............................... 1 [PC05A]
[PERSON] DOES NOT HAVE ASTHMA .......... 2 [BOX_08]
[Code One]
----------------------------------------------------
DISPLAY 'During an earlier interview....' IF ASTHMA WAS NOT CREATED DURING THE CURRENT ROUND.
IF ASTHMA WAS CREATED DURING THE CURRENT ROUND, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NOT' IN BOLD IN THE ANSWER TEXT.

IF 'PERSON DOES NOT HAVE ASTHMA' IS SELECTED, THIS DOES NOT RE-SET THE DATA AS RECORDED IN THE PE SECTION (PRND.PCASTHMA). THE RESPONSE TO PC04B WILL DETERMINE WHETHER SUBSEQUENT DETAILED ASTHMA QUESTIONS ARE ASKED IN THIS PC SECTION.
----------------------------------------------------

PC05A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
I am going to ask you about two different kinds of asthma medicine. One is for quick relief. The other does not give quick relief but protects your lungs and prevents symptoms over the long term. During the past 3 months, [have/has] [you/[PERSON]] used the kind of prescription inhaler that you breathe in through your mouth that gives quick relief from asthma symptoms?

YES .................................... 1 [PC05B]
NO ..................................... 2 [PC06A]
REF ................................... -7 [PC06A]
DK .................................... -8 [PC06A]

PC05B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
During the past 3 months, did [you/[PERSON]] use more than three canisters of this type of inhaler?

YES .................................... 1 [PC06A]
NO ..................................... 2 [PC06A]
REF ................................... -7 [PC06A]
DK .................................... -8 [PC06A]

PC06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Have/Has] [you/[PERSON]] ever taken the preventive kind of asthma medicine used every day to protect your lungs and keep you from having attacks? Include both oral medicine and inhalers. This is different from inhalers used for quick relief.

YES .................................... 1 [PC06B]
NO ..................................... 2 [PC08]
REF ................................... -7 [PC08]
DK .................................... -8 [PC08]

PC06B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Are/Is] [you/[PERSON]] now taking this medication (that protects the lungs) daily or almost daily?

YES .................................... 1 [PC08]
NO ..................................... 2 [PC08]
REF ................................... -7 [PC08]
DK .................................... -8 [PC08]

PC06
====

OMITTED.

PC07
====

OMITTED.

PC08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
A peak flow meter measures how hard you can blow air out of your lungs. [Do/Does] [you/[PERSON]] currently have a peak flow meter at home?

YES .................................... 1 [PC08A]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]

PC08A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Did [you/[PERSON]] ever use the peak flow meter?

YES .................................... 1 [PC08B]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]

PC08B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD PC-1.
When did [you/[PERSON]] last use the peak flow meter? Was it within the last seven days, more than seven days ago but within the last thirty days, or more than thirty days ago?

WITHIN LAST 7 DAYS ..................... 1 [BOX_08]
MORE THAN 7, BUT WITHIN LAST 30 DAYS ... 2 [BOX_08]
MORE THAN 30 DAYS AGO .................. 3 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
[Code One]

BOX_02
======

OMITTED.

PC09
====

OMITTED.

PC10
====

OMITTED.

PC11
====

OMITTED.

PC11OV
======

OMITTED.

PC12
====

OMITTED.

PC12_01
=======

OMITTED.

PC12_02
=======

OMITTED.

PC12_03
=======

OMITTED.

PC12_04
=======

OMITTED.

PC12_04OV
=========

OMITTED.

PC12_05
=======

OMITTED.

PC12_06
=======

OMITTED.

PC13
====

OMITTED.

PC13_01
=======

OMITTED.

PC13_02
=======

OMITTED.

PC14
====

OMITTED.

PC15
====

OMITTED.

PC16
====

OMITTED.

PC17
====

OMITTED.

PC18
====

OMITTED.

PC19
====

OMITTED.

PC20
====

OMITTED.

BOX_08
======

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

Preventive Care (AP) Section

BOX_00A
=======

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

BOX_00
======

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

AP01
====

OMITTED.

AP02
====

OMITTED.

AP03
====

OMITTED.

AP04
====

OMITTED.

AP04A
=====

OMITTED.

AP05
====

OMITTED.

AP06
====

OMITTED.

AP07
====

OMITTED.

AP08
====

OMITTED.

AP09
====

OMITTED.

AP10
====

OMITTED.

AP11
====

OMITTED.

AP11A
=====

OMITTED.

AP11B
=====

OMITTED.

AP11C
=====

OMITTED.

BOX_01
======

----------------------------------------------------
IF PERSON IS LESS THAN 1 YEAR OF AGE (OR AGE CATEGORY 1), GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH AP12
----------------------------------------------------

AP12
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
The next few questions ask about the amounts and types of preventive care [you/[PERSON]] may receive. On average, how often [do/does] [you/he/she] receive a dental check-up?

TWICE A YEAR OR MORE ................... 1
ONCE A YEAR ............................ 2
LESS THAN ONCE A YEAR .................. 3
NEVER GO TO DENTIST .................... 4
REF ................................... -7
DK .................................... -8
[Code One]
HELP AVAILABLE FOR DEFINITION OF DENTAL CHECK-UP.
----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9), CONTINUE WITH AP15
----------------------------------------------------
----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS 16 OR 17 YEARS OF AGE, GO TO AP32
----------------------------------------------------
----------------------------------------------------
OTHERWISE (THAT IS, PERSON BEING ASKED ABOUT IS LESS THAN 16 YEARS OF AGE OR IN AGE CATEGORIES 1-3), GO TO BOX_02
----------------------------------------------------

AP13
====

OMITTED.

AP14
====

OMITTED.

AP15
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since [you/[PERSON]] had [your/his/her] blood pressure checked by a doctor, nurse or other health professional?

WITHIN PAST YEAR ....................... 1 [AP16]
WITHIN PAST 2 YEARS .................... 2 [AP16]
WITHIN PAST 3 YEARS .................... 3 [AP16]
WITHIN PAST 5 YEARS .................... 4 [AP16]
MORE THAN 5 YEARS ...................... 5 [AP16]
NEVER .................................. 6 [AP16]
REF ................................... -7 [AP16]
DK .................................... -8 [AP16]
HELP AVAILABLE FOR DEFINITION OF BLOOD PRESSURE CHECK.
[Code One]

AP15OV
======

OMITTED.

AP16
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since [you/[PERSON]] had [your/his/her] blood cholesterol checked by a doctor or other health professional?

WITHIN PAST YEAR ....................... 1 [AP17]
WITHIN PAST 2 YEARS .................... 2 [AP17]
WITHIN PAST 3 YEARS .................... 3 [AP17]
WITHIN PAST 5 YEARS .................... 4 [AP17]
MORE THAN 5 YEARS ...................... 5 [AP17]
NEVER .................................. 6 [AP17]
REF ................................... -7 [AP17]
DK .................................... -8 [AP17]
HELP AVAILABLE FOR DEFINITION OF BLOOD CHOLESTEROL CHECK.
[Code One]

AP17
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since [you/[PERSON]] had a routine check-up by a doctor or other health professional?
IF NECESSARY, SAY: A routine check-up is a visit with a doctor or other health professional for assessing overall health, usually not prompted by a specific illness or complaint. It usually includes a blood pressure check, and may include taking a blood sample for analysis and questions about health behaviors such as smoking.

WITHIN PAST YEAR ....................... 1 [AP17A]
WITHIN PAST 2 YEARS .................... 2 [AP17A]
WITHIN PAST 3 YEARS .................... 3 [AP17A]
WITHIN PAST 5 YEARS .................... 4 [AP17A]
MORE THAN 5 YEARS ...................... 5 [AP17A]
NEVER .................................. 6 [AP17A]
REF ................................... -7 [AP17A]
DK .................................... -8 [AP17A]
[Code One]

AP17A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Has a doctor or other health professional ever advised [you/[PERSON]] to...

YES NO

AP17A_01
========

...Eat fewer high fat or high cholesterol foods?

1 2 ( ) AP17A_02
----------------------------------------------------
REFUSED (-7) AND DON'T KNOW (-8) ALLOWED.
----------------------------------------------------

AP17A_02
========

...Exercise more?

1 2 ( ) [AP18]
----------------------------------------------------
REFUSED (-7) AND DON'T KNOW (-8) ALLOWED.
----------------------------------------------------

AP18
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how long has it been since [you/[PERSON]] had a flu vaccination (shot or nasal spray)?

WITHIN PAST YEAR ....................... 1 [AP18A]
WITHIN PAST 2 YEARS .................... 2 [AP18A]
WITHIN PAST 3 YEARS .................... 3 [AP18A]
WITHIN PAST 5 YEARS .................... 4 [AP18A]
MORE THAN 5 YEARS ...................... 5 [AP18A]
NEVER .................................. 6 [AP18A]
REF ................................... -7 [AP18A]
DK .................................... -8 [AP18A]
[Code One]
HELP AVAILABLE FOR DEFINITION OF FLU VACCINATION.

AP18A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Do/Does] [you/[PERSON]] take aspirin every day or every other day?

YES .................................... 1 [AP18B]
NO ..................................... 2 [AP18AA]
REF ................................... -7 [AP18B]
DK .................................... -8 [AP18B]

AP18AA
======

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Do/Does] [you/[PERSON]] have a health problem or condition that makes taking aspirin unsafe for [you/him/her]?

YES .................................... 1 [AP18AAA]
NO ..................................... 2 [AP18B]
REF ................................... -7 [AP18B]
DK .................................... -8 [AP18B]

AP18AAA
=======

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is that problem stomach related or something else?

STOMACH RELATED ........................ 1 [AP18B]
SOMETHING ELSE ......................... 2 [AP18B]
REF ................................... -7 [AP18B]
DK .................................... -8 [AP18B]
[Code One]

AP18B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Have/Has] [you/[PERSON]] lost all of [your/his/her] upper and lower natural (permanent) teeth?

BOX_01A
=======

----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS MALE AND IS 40 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 6-9), CONTINUE WITH AP19
----------------------------------------------------
----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS MALE AND IS LESS THAN 40 YEARS OF AGE (OR IN AGE CATEGORIES 4-5), GO TO AP28
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., PERSON BEING ASKED ABOUT IS FEMALE), GO TO AP20A
----------------------------------------------------

AP19
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did [you/[PERSON]] have [your/his] most recent "PSA" test?
IF NECESSARY, SAY: A "P-S-A" is a blood test to detect prostate cancer. It is also called a prostate specific antigen test.

WITHIN PAST YEAR ....................... 1 [AP24]
WITHIN PAST 2 YEARS .................... 2 [AP24]
WITHIN PAST 3 YEARS .................... 3 [AP24]
WITHIN PAST 5 YEARS .................... 4 [AP24]
MORE THAN 5 YEARS ...................... 5 [AP24]
NEVER .................................. 6 [AP24]
REF ................................... -7 [AP24]
DK .................................... -8 [AP24]
[Code One]

AP20A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Have/Has] [you/[PERSON]] had a hysterectomy?

YES .................................... 1 [AP20]
NO ..................................... 2 [AP20]
REF ................................... -7 [AP20]
DK .................................... -8 [AP20]
HELP AVAILABLE FOR DEFINITION OF HYSTERECTOMY.

AP20
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did [you/[PERSON]] have [your/her] most recent Pap test?
IF NECESSARY, SAY: A Pap smear or Pap test is a routine test for women in which the doctor examines the cervix, takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.

WITHIN PAST YEAR ....................... 1 [AP21]
WITHIN PAST 2 YEARS .................... 2 [AP21]
WITHIN PAST 3 YEARS .................... 3 [AP21]
WITHIN PAST 5 YEARS .................... 4 [AP21]
MORE THAN 5 YEARS ...................... 5 [AP21]
NEVER .................................. 6 [AP21]
REF ................................... -7 [AP21]
DK .................................... -8 [AP21]
[Code One]

AP21
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did [you/[PERSON]] have [your/her] most recent breast exam?
IF NECESSARY, SAY: A breast exam is when the breasts are felt by a doctor or other health professional to check for lumps.

WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 3 YEARS .................... 3
WITHIN PAST 5 YEARS .................... 4
MORE THAN 5 YEARS ...................... 5
NEVER .................................. 6
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS 30 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 5-9), CONTINUE WITH AP22
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AP28
----------------------------------------------------

AP22
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did [you/[PERSON]] have [your/her] most recent mammogram?
IF NECESSARY SAY: A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.

WITHIN PAST YEAR ....................... 1
WITHIN PAST 2 YEARS .................... 2
WITHIN PAST 3 YEARS .................... 3
WITHIN PAST 5 YEARS .................... 4
MORE THAN 5 YEARS ...................... 5
NEVER .................................. 6
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
IF PERSON BEING ASKED ABOUT IS 40 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 6-9), CONTINUE WITH AP24
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AP28
----------------------------------------------------

AP23
====

OMITTED.

AP24
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
A blood stool test is a test that you do at home using a special kit or cards provided by a doctor or other health professional to determine whether the stool contains blood. When did [you/[PERSON]] do [your/his/her] most recent blood stool test using a home kit?

WITHIN PAST YEAR ....................... 1 [AP24A]
WITHIN PAST 2 YEARS .................... 2 [AP24A]
WITHIN PAST 3 YEARS .................... 3 [AP24A]
WITHIN PAST 5 YEARS .................... 4 [AP24A]
WITHIN PAST 10 YEARS ................... 5 [AP24A]
MORE THAN 10 YEARS ..................... 6 [AP24A]
NEVER .................................. 7 [AP26]
REF ................................... -7 [AP26]
DK .................................... -8 [AP26]
[Code One]

AP24A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What was the main reason [you/[PERSON]] had [your/his/her] most recent blood stool test using a home kit? Was it...

Part of a routine exam, ....................... 1 [AP26]
Because of a problem, or ...................... 2 [AP26]
Some other reason? ............................ 3 [AP26]
REF .......................................... -7 [AP26]
DK ........................................... -8 [AP26]
[Code One]

AP25
====

OMITTED.

AP26
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
A sigmoidoscopy and a colonoscopy are both tests that examine the bowel by inserting a tube in the rectum. The difference is that during a sigmoidoscopy, you are awake and can drive yourself home after the test; however, during a colonoscopy, you may feel sleepy and you need someone to drive you home.
When did [you/[PERSON]] have [your/his/her] most recent colonoscopy?

WITHIN PAST YEAR ....................... 1 [AP26A]
WITHIN PAST 2 YEARS .................... 2 [AP26A]
WITHIN PAST 3 YEARS .................... 3 [AP26A]
WITHIN PAST 5 YEARS .................... 4 [AP26A]
WITHIN PAST 10 YEARS ....................5 [AP26A]
MORE THAN 10 YEARS ..................... 6 [AP26A]
NEVER .................................. 7 [AP27]
REF ................................... -7 [AP27]
DK .................................... -8 [AP27]
[Code One]

AP26A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What was the main reason [you/[PERSON]] had [your/his/her] most recent colonoscopy? Was it...

Part of a routine exam, ................ 1 [AP27]
Because of a problem, or ............... 2 [AP27]
Some other reason? ..................... 3 [AP27]
REF ................................... -7 [AP27]
DK .................................... -8 [AP27]
[Code One]

AP27
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When did [you/[PERSON]] have [your/his/her] most recent sigmoidoscopy?

WITHIN PAST YEAR ....................... 1 [AP27A]
WITHIN PAST 2 YEARS .................... 2 [AP27A]
WITHIN PAST 3 YEARS .................... 3 [AP27A]
WITHIN PAST 5 YEARS .................... 4 [AP27A]
WITHIN PAST 10 YEARS ................... 5 [AP27A]
MORE THAN 10 YEARS ..................... 6 [AP27A]
NEVER .................................. 7 [AP28]
REF ................................... -7 [AP28]
DK .................................... -8 [AP28]
[Code One]

AP27A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What was the main reason [you/[PERSON]] did [your/his/her] most recent sigmoidoscopy? Was it...

Part of a routine exam, ................ 1 [AP28]
Because of a problem, or ............... 2 [AP28]
Some other reason? ..................... 3 [AP28]
REF ................................... -7 [AP28]
DK .................................... -8 [AP28]
[Code One]

AP28
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Do/Does] [you/[PERSON]] now spend half an hour or more in moderate or vigorous physical activity at least five times a week?

YES .................................... 1 [AP29]
NO ..................................... 2 [AP29]
REF ................................... -7 [AP29]
DK .................................... -8 [AP29]
HELP AVAILABLE FOR DEFINITION OF MODERATE OR VIGOROUS PHYSICAL ACTIVITY.

AP29
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how tall [are/is] [you/[PERSON]] without shoes?

PROBE FOR INCHES IF NOT REPORTED.

AP29_01
=======

FEET:
[Enter Feet] ........................... [AP29_02]
REF ................................... -7 [AP30]
DK .................................... -8 [AP30]
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 2 TO 6
----------------------------------------------------

AP29_02
=======

INCHES:
[Enter Inches] ......................... [AP30]
REF ................................... ?7 [AP30]
DK .................................... ?8 [AP30]
----------------------------------------------------
HARD CHECK:
HARD RANGE CHECK: 0 TO 11
----------------------------------------------------

AP30
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
About how much [do/does] [you/[PERSON]] weigh without shoes?

ENTER CURRENT WEIGHT TO THE NEAREST POUND.
[Enter Pounds] ......................... [AP32]
REF ................................... -7 [AP32]
DK .................................... -8 [AP31]
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 50 TO 500
----------------------------------------------------

AP31
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD AP-1.
Looking at this card, what is your best guess of [your/[PERSON]'s] weight?

99 POUNDS OR LESS ..................... 1 [AP32]
100 - 149 POUNDS ...................... 2 [AP32]
150 - 199 POUNDS ...................... 3 [AP32]
200 - 249 POUNDS ...................... 4 [AP32]
250 - 299 POUNDS ...................... 5 [AP32]
300 POUNDS OR MORE .................... 6 [AP32]
REF ................................... -7 [AP32]
DK .................................... -8 [AP32]
[Code One]

AP32
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Would [you say you wear/[PERSON] say [he/she] wears] a seat belt when driving or riding in a car...

Always, ................................ 1 [BOX_02]
Nearly Always, ......................... 2 [BOX_02]
Sometimes, ............................. 3 [BOX_02]
Seldom, or ............................. 4 [BOX_02]
Never? ................................. 5 [BOX_02]
IF VOLUNTEERED: NEVER DRIVES OR RIDES
IN A CAR/ALWAYS USES PUBLIC
TRANSPORTATION OR WALKS ........... 6 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]
----------------------------------------------------
DISPLAY 'you say you wear' IF PERSON BEING ASKED ABOUT IS THE RESPONDENT [PERSON IS SELECTED AT RE06 WHEN RE02 IS CODED '1' (RU MEMBER)].
OTHERWISE, DISPLAY '[PERSON] say [he/she] wears'.
----------------------------------------------------

BOX_02
======

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

Access to Care (AC) Section

BOX_00A
=======

----------------------------------------------------
THE AC 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, PROV.LORPNAME
----------------------------------------------------

AC01
====

OMITTED.

AC02
====

OMITTED.

AC02A
=====

OMITTED.

LOOP_01A
========

OMITTED.

NAV_AC01A
=========

OMITTED.

AC03
====

OMITTED.

AC04
====

OMITTED.

END_LP01A
=========

OMITTED.

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_AC01 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS THE NAME OF THE USUAL SOURCE OF CARE PROVIDER, IF ANY, FOR EACH CURRENT RU MEMBER. THIS LOOP CYCLES ON PERSONS WHO MEET THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_AC01 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_AC01
========

SERIES: Identifying USC Provider (e.g., provider's name,
transportation mode, provider's specialty and race)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER EXCLUDING DECEASED AND INSTITUTIONALIZED RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AC05 FOR SELECTED RU MEMBER
----------------------------------------------------

AC05
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Is there a particular doctor's office, clinic, health center, or other place that [you/[PERSON]] usually [go/goes] if [you/he/she] [are/is] sick or [need/needs] advice about [your/his/her] health?

YES ..................................... 1 [AC09]
NO ...................................... 2 [AC07]
MORE THAN ONE PLACE ..................... 3 [AC06]
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF HEALTH CARE.

AC06
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Would [you/[PERSON]] go to one of these places first or most often if [you/he/she] [are/is] sick?

YES ..................................... 1 [AC09]
NO ...................................... 2 [AC07]
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]

AC07
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What is the main reason [you/[PERSON]] [do/does] not have a usual source of health care?

SELDOM OR NEVER GETS SICK ............... 1 [AC08]
RECENTLY MOVED INTO AREA ................ 2 [AC08]
DON'T KNOW WHERE TO GO FOR CARE ......... 3 [AC08]
USUAL SOURCE OF MEDICAL CARE IN THIS AREA IS NO LONGER AVAILABLE ........... 4 [AC08]
CAN'T FIND A PROVIDER WHO SPEAKS [YOUR/HIS/HER] LANGUAGE ............... 5 [AC08]
LIKES TO GO TO DIFFERENT PLACES FOR DIFFERENT HEALTH NEEDS ................ 6 [AC08]
JUST CHANGED INSURANCE PLANS ............ 7 [AC08]
DON'T USE DOCTORS/TREAT MYSELF .......... 8 [AC08]
COST OF MEDICAL CARE .................... 9 [AC08]
NO HEALTH INSURANCE ..................... 10 [AC08]
OTHER REASON ............................ 91 [AC07OV]
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code One]
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF HEALTH CARE.

AC07OV
======

ENTER OTHER REASON:

[Enter Other Specify] .................. [AC08]
REF ................................... -7 [AC08]
DK .................................... -8 [AC08]

AC08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What are the other reasons [you/[PERSON]] [do/does] not have a usual source of health care?

CHECK ALL THAT APPLY.
NO OTHER REASONS ........................ 0 [END_LP01]
SELDOM OR NEVER GETS SICK ............... 1
RECENTLY MOVED INTO AREA ................ 2
DON'T KNOW WHERE TO GO FOR CARE ......... 3
USUAL SOURCE OF MEDICAL CARE IN THIS AREA IS NO LONGER AVAILABLE ........... 4
CAN'T FIND A PROVIDER WHO SPEAKS [YOUR/HIS/HER] LANGUAGE ............... 5
LIKES TO GO TO DIFFERENT PLACES FOR DIFFERENT HEALTH NEEDS ................ 6
JUST CHANGED INSURANCE PLANS ............ 7
DON'T USE DOCTORS/TREAT MYSELF .......... 8
COST OF MEDICAL CARE .................... 9
NO HEALTH INSURANCE ..................... 10
OTHER REASON ............................ 91 [AC08OV]
REF ..................................... -7 [END_LP01]
DK ...................................... -8 [END_LP01]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF HEALTH CARE.
----------------------------------------------------
IF 'RF' (REFUSED) OR 'DK' (DON'T KNOW) IS SELECTED, CAPI SHOULD CODE AS '0' (NO OTHER REASONS).
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATION PURPOSES ONLY: CAPI DOES NOT ALLOW CODES '0' (NO OTHER REASONS), 'RF' (REFUSED), OR 'DK' (DON'T KNOW) IN COMBINATION WITH ANY OTHER CODES.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER REASON) ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH AC08OV(NOTE THAT AC08OV IS AN OVERLAY ON AC08.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

AC08OV
======

ENTER OTHER REASON:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

AC09
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the name of the medical person, doctor's office, clinic, health center, or other place that [you/[PERSON]] usually [go/goes] if [you/he/she] [are/is] sick or [need/needs] advice about [your/his/her] health. If possible, give me the name of the particular person that [you/he/she] usually [see/sees].

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF HEALTH CARE.
----------------------------------------------------
BEGINNING IN PANEL 12, ROUND 4 AND PANEL 13, ROUND 2, AC09 AND PV01 WERE REVISED TO PROMPT RESPONDENTS TO NAME A PERSON-PROVIDER AS THE USC PROVIDER IF POSSIBLE. THE DATA AT VARIABLE PROVTY42 IS EXPECTED TO CHANGE SIGNIFICANTLY BASED ON THIS NEW WORDING AND PROBING.
----------------------------------------------------

BOX_01
======

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

BOX_02
======

----------------------------------------------------
FLAG THE PROVIDER ADDED OR SELECTED AS THE 'USC (USUAL SOURCE OF CARE) PROVIDER' FOR THIS PERSON FOR THIS PARTICULAR ROUND.
----------------------------------------------------
----------------------------------------------------
IF THIS USC PROVIDER IS FLAGGED AS 'FACILITY- TYPE-PROVIDER' OR AS 'PERSON-IN-FACILITY-PROVIDER'AND AC11 WAS NOT ALREADY ASKED FOR THIS USC PROVIDER IN AN EARLIER LOOP, GO TO AC11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, (THAT IS, IF THIS USC PROVIDER IS FLAGGED AS 'PERSON-TYPE-PROVIDER' OR IF THIS USC PROVIDER IS FLAGGED AS 'FACILITY-TYPE-PROVIDER' OR AS 'PERSON-IN-FACILITY-PROVIDER' AND AC11 HAS ALREADY BEEN ASKED FOR THIS USC PROVIDER), GO TO AC13
----------------------------------------------------

AC10
====

OMITTED.

AC11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
ASK IF NOT OBVIOUS.
[Is [PROVIDER]/Does [PROVIDER] work at] a clinic in a hospital, a hospital outpatient department, an emergency room at a hospital, or some other kind of place?

HOSPITAL CLINIC OR OUTPATIENT DEPARTMENT ............................ 1 [AC13]
HOSPITAL EMERGENCY ROOM ................. 2 [AC13]
OTHER KIND OF PLACE ..................... 3 [AC13]
REF ..................................... -7 [AC13]
DK ...................................... -8 [AC13]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'Is [PROVIDER]' IF USC PROVIDER IS FLAGGEDAS 'FACILITY-TYPE-PROVIDER'. DISPLAY 'Does [PROVIDER] work at' IF USC PROVIDER IS FLAGGED AS 'PERSON-IN-FACILITY-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
NOTE: FOR QUESTIONS AC11 ? AC20, THE CONTEXT HEADER WILL DISPLAY THE PERSON-PROVIDER NAME IF THE USC PROVIDER BEING ASKED ABOUT IS FLAGGED AS 'PERSON-TYPE-PROVIDER' OR 'PERSON-IN-FACILITY- PROVIDER'. IF THE USC PROVIDER BEING ASKED ABOUT IS FLAGGED AS 'FACILITY-TYPE-PROVIDER', THE CONTEXT HEADER WILL DISPLAY THE FACILITY-PROVIDER NAME.
----------------------------------------------------

AC12
====

OMITTED.

AC13
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.......]
How long does it usually take [you/[PERSON]] to get to [PROVIDER]?

LESS THAN 15 MINUTES ................... 1 [BOX_03]
15 TO 30 MINUTES ....................... 2 [BOX_03]
31 TO 60 MINUTES (1 HOUR) .............. 3 [BOX_03]
61 TO 90 MINUTES ....................... 4 [BOX_03]
91 TO 120 MINUTES (2 HOURS) ............ 5 [BOX_03]
MORE THAN 120 MINUTES (2 HOURS) ........ 6 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
[Code One]

AC14
====

OMITTED.

BOX_03
======

----------------------------------------------------
IF THIS USC PROVIDER IS FLAGGED AS 'PERSON- TYPE-PROVIDER' OR 'PERSON-IN-FACILITY-PROVIDER' AND AC15 WAS NOT ALREADY ASKED FOR THIS USC PROVIDER IN AN EARLIER LOOP, CONTINUE WITH AC15
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

AC15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE
PROVIDER......]
Is [PROVIDER] a medical doctor?

YES ..................................... 1 [AC17]
NO ...................................... 2 [AC16]
REF ..................................... -7 [AC18]
DK ...................................... -8 [AC18]
HELP AVAILABLE FOR DEFINITION OF MEDICAL DOCTOR.

AC16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
Is [PROVIDER] a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?

SELECT 'CHIROPRACTOR' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.
NURSE ................................... 1 [AC18]
NURSE PRACTITIONER ...................... 2 [AC18]
PHYSICIAN'S ASSISTANT ................... 3 [AC18]
MIDWIFE ................................. 4 [AC18]
CHIROPRACTOR ............................ 5 [AC18]
OTHER ................................... 91 [AC16OV]
REF ..................................... -7 [AC18]
DK ...................................... -8 [AC18]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

AC16OV
======

OTHER:

[Enter Other Specify] .................. [AC18]
REF ................................... -7 [AC18]
DK .................................... -8 [AC18]

AC17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......]
What is [PROVIDER]'s specialty?

GENERAL/FAMILY PRACTICE ................. 1 [AC18]
INTERNAL MEDICINE ....................... 2 [AC18]
PEDIATRICS .............................. 3 [AC18]
OB/GYN .................................. 4 [AC18]
SURGERY ................................. 5 [AC18]
CHIROPRACTOR ............................ 6 [AC18]
CARDIOLOGIST ............................ 7 [AC18]
DOCTOR OF OSTEOPATHY..................... 8 [AC18]
OTHER ................................... 91 [AC17OV]
REF ..................................... -7 [AC18]
DK ...................................... -8 [AC18]
[Code One]

AC17OV
======

OTHER:

[Enter Other Specify] .................. [AC18]
REF ................................... -7 [AC18]
DK .................................... -8 [AC18]

AC18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.......]
Is [PROVIDER] Hispanic or Latino?

YES .................................... 1 [AC19]
NO ..................................... 2 [AC19]
REF ................................... -7 [AC19]
DK .................................... -8 [AC19]

AC19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.......]
SHOW CARD AC-2.
What is [PROVIDER]'s race?

CHECK ALL THAT APPLY.
WHITE .................................. 1 [AC20]
BLACK/AFRICAN AMERICAN ................. 2 [AC20]
ASIAN .................................. 3 [AC20]
INDIAN/NATIVE AMERICAN/ALASKA NATIVE ... 4 [AC20]
OTHER PACIFIC ISLANDER ................. 5 [AC20]
SOME OTHER RACE ....................... 91 [AC20]
REF ................................... -7 [AC20]
DK .................................... -8 [AC20]
[Code All That Apply]

AC19OV
======

OMITTED.

AC20
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.......]
Is [PROVIDER] male or female?

MALE ................................... 1 [END_LP01]
FEMALE ................................. 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
[Code One]

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_04
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF AT LEAST ONE PROVIDER FLAGGED AS 'USC PROVIDER' ON THE RU-MEDICAL-PROVIDERS-ROSTER, CONTINUE WITH IntroUSCP
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO AC32A
----------------------------------------------------

IntroUSCP
=========

THE NEXT QUESTIONS WILL ONLY BE ASKED ONCE ABOUT EACH USUAL SOURCE OF CARE PROVIDER.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
CONTINUE WITH LOOP_02
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEDICAL-PROVIDERS- ROSTER, ASK NAV_AC02 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS DETAILED INFORMATION ON EACH UNIQUE USUAL SOURCE OF CARE PROVIDER IDENTIFIED FOR THIS RU. THIS LOOP CYCLESON PROVIDERS WHO MEET THE FOLLOWING CONDITION:

- PROVIDER FLAGGED AS 'USC PROVIDER' DURING THE CURRENT ROUND FOR A CURRENT RU MEMBER.
----------------------------------------------------
----------------------------------------------------
NOTE: IF THE USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'PERSON-TYPE-PROVIDER' OR 'PERSON-IN- FACILITY-PROVIDER' THE CONTEXT HEADER IN LOOP_02 WILL DISPLAY THE PERSON-PROVIDER NAME. IF THE USCPROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY- TYPE-PROVIDER' THE CONTEXT HEADER IN LOOP_02 WILL DISPLAY THE FACILITY-PROVIDER NAME.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_02 USES NAV_AC02 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_AC02
========

SERIES: USC Provider Detail (e.g., experience with provider, provider hours, satisfaction with provider's care)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
USC Provider
[1. Provider or Facility Name-30] [Status-25]
[2. Provider or Facility Name-30] [Status-25]
[3. Provider or Facility Name-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: USC PROVIDER
INSTRUCTIONS: DISPLAY PROVIDER FIRST INITIAL AND LAST NAME IF PERSON-PROVIDER OR PERSON-IN-FACILITY PROVIDER. DISPLAY FACILITY NAME IF FACILITY- PROVIDER.
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH PROVIDER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEDICAL-PROVIDERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PROVIDERS WHO MEET THE FOLLOWING CONDITIONS:
- PROVIDER FLAGGED AS 'USC PROVIDER' DURING THE CURRENT ROUND FOR A CURRENT RU MEMBER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AC21 FOR SELECTED PROVIDER.
----------------------------------------------------

AC21
====

[NAME OF MEDICAL CARE PROVIDER......]
The next few questions ask about the experience (READ NAME(S) BELOW) (have/has) had with [PROVIDER]. Please think about their overall experiences when answering the following questions.

IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.
[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.
----------------------------------------------------
CONTINUE WITH AC22
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND.
----------------------------------------------------

AC22
====

[NAME OF MEDICAL CARE PROVIDER......]
[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
Is [PROVIDER] the [person/place] (READ NAME(S) ABOVE) would go to for ...

YES = 1
NO = 2
RF = -7
DK = -8
AC22_01
=======
a. New health problems? ( )
AC22_02
=======
b. Preventive health care, such as general checkups, examinations, and immunizations? ( )
AC22_03
=======
c. Referrals to other health professionals when needed? ( )
AC22_04
=======
d. Ongoing health problems? ( )
HELP AVAILABLE FOR DEFINITION OF PREVENTIVE HEALTH CARE AND REFERRAL.
----------------------------------------------------
DISPLAY 'person' IF THE USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'PERSON-TYPE-PROVIDER' OR 'PERSON-IN-FACILITY-PROVIDER'. DISPLAY 'place' IFUSC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER'.
----------------------------------------------------
----------------------------------------------------
ALLOW '-7' (REFUSED) AND '-8' (DON'T KNOW) ON ALL FORM ITEMS.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND.
----------------------------------------------------

AC23
====

[NAME OF MEDICAL CARE PROVIDER......]
SHOW CARD AC-1.
How difficult is it to contact [a medical person at] [PROVIDER] during regular business hours over the telephone about a health problem? Would you say it is ...

very difficult, ......................... 1
somewhat difficult, ..................... 2
not too difficult, or ................... 3
not at all difficult? ................... 4
REF ..................................... -7
DK ...................................... -8
[Code One]
----------------------------------------------------
DISPLAY 'a medical person at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE- PROVIDER'. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF AC11 WAS CODED '2' (HOSPITAL EMERGENCY ROOM) FOR THIS USC PROVIDER, GO TO AC25
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH AC24
----------------------------------------------------

AC24
====

[NAME OF MEDICAL CARE PROVIDER......]
Does [PROVIDER] have office hours at night or on weekends?

YES ..................................... 1 [AC25]
NO ...................................... 2 [AC25]
REF ..................................... -7 [AC25]
DK ...................................... -8 [AC25]

AC25
====

[NAME OF MEDICAL CARE PROVIDER.......]
SHOW CARD AC-1.
How difficult is it to contact [a medical person at] [PROVIDER] after their regular hours in case of urgent medical needs? Would you say it is ...

very difficult, ........................ 1 [AC26]
somewhat difficult, .................... 2 [AC26]
not too difficult, or .................. 3 [AC26]
not at all difficult? .................. 4 [AC26]
REF ................................... -7 [AC26]
DK .................................... -8 [AC26]
[Code One]
----------------------------------------------------
DISPLAY 'a medical person at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE- PROVIDER'. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

AC26
====

[NAME OF MEDICAL CARE PROVIDER......]
Does [someone at] [PROVIDER] usually ask about prescription medications and treatments other doctors may give them?

YES ..................................... 1 [AC27]
NO ...................................... 2 [AC27]
REF ..................................... -7 [AC27]
DK ...................................... -8 [AC27]
----------------------------------------------------
DISPLAY 'someone at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE-PROVIDER'. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

AC27
====

[NAME OF MEDICAL CARE PROVIDER.......]
SHOW CARD AC-3.
Thinking about the types of medical, traditional and alternative treatments that (READ NAME(S) BELOW) (is/are) are happy with, how often does [a medical person at] [PROVIDER] show respect for these treatments?
Would you say...
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
never, ................................. 1 [AC28]
sometimes, ............................. 2 [AC28]
usually, or ............................ 3 [AC28]
always? ................................ 4 [AC28]
REF ................................... -7 [AC28]
DK .................................... -8 [AC28]
[Code One]
----------------------------------------------------
DISPLAY 'a medical person at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE- PROVIDER.' OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND.
----------------------------------------------------

AC28
====

[NAME OF MEDICAL CARE PROVIDER.......]
SHOW CARD AC-3.
If there were a choice between treatments, how often would [a medical person at] [PROVIDER] ask (READ NAME(S) BELOW) to help make the decision?
Would you say...
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
never, ................................. 1 [AC30]
sometimes, ............................. 2 [AC30]
usually, or ............................ 3 [AC30]
always? ................................ 4 [AC30]
REF ................................... -7 [AC30]
DK .................................... -8 [AC30]
[Code One]
----------------------------------------------------
DISPLAY 'a medical person at' IF USC PROVIDER BEING LOOPED ON IS FLAGGED AS 'FACILITY-TYPE- PROVIDER'. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
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.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO IDENTIFIED PROVIDER BEING ASKED ABOUT AS PERSON'S USC PROVIDER FOR THE CURRENT ROUND.
----------------------------------------------------

AC29
====

OMITTED.

AC30
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [a medical person at] [PROVIDER] present and explain all options to (READ NAME(S) BELOW)?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.

BOX_05
======

----------------------------------------------------
IF RE102B WAS CODED '3' (NOT WELL) OR '4' (NOT AT ALL) FOR AT LEAST ONE RU MEMBER IN ANY ROUND AND PERSON IDENTIFIED THIS USC PROVIDER AS THEIR USC PROVIDER (AC05 IS SET TO '1' OR AC06 IS SET TO '1'), CONTINUE WITH AC31
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP02
----------------------------------------------------

AC31
====

[NAME OF MEDICAL CARE PROVIDER.......]
Does [someone at] [PROVIDER] speak the language (READ NAME(S) BELOW) prefer(s) or provide translator services for them?
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN 'YOU' OR THE PARENT'S NAME.

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PROVIDER IN THE RU-MEDICAL- PROVIDERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PROVIDERS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH AC32A
----------------------------------------------------

AC32A
=====

When answering the next few questions, do not include dental care and prescription medicines. In the last 12 months, did anyone in the family or a doctor believe they needed any medical care, tests, or treatment?

YES .................................... 1 [AC32]
NO ..................................... 2 [AC40A]
REF ................................... -7 [AC40A]
DK .................................... -8 [AC40A]

AC32
====

In the last 12 months, was anyone in the family unable to obtain medical care, tests, or treatments they or a doctor believed necessary?

YES .................................... 1
NO ..................................... 2 [AC36]
REF ................................... -7 [AC36]
DK .................................... -8 [AC36]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'UNMET NEED FOR MEDICAL CARE' AT AC33 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 AC33
----------------------------------------------------

AC33
====

Who was that? PROBE: Was anyone else in the family unable to get medical care, tests, or treatments they or a doctor believed necessary?

[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED, GO TO AC36
----------------------------------------------------
----------------------------------------------------
OTHERWISE, 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:
NO FILTER; DISPLAY ALL.
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_AC03 ? END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS THE MAIN REASON AND THE PROBLEM WITH THE UNMET NEED FOR MEDICAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THEFOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR MEDICAL CARE (I.E.,PERSON WAS SELECTED AT AC33)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_03 USES NAV_AC03 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_AC03
========

SERIES: Reason for Being Unable to Obtain Medical Care
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR MEDICAL CARE (I.E.,PERSON WAS SELECTED AT AC33)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AC34 FOR SELECTED RU MEMBER
----------------------------------------------------

AC34
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD AC-4.
Which of these best describes the main reason [you/[PERSON]] [were/was] unable to get medical care, tests, or treatments [you/he/she] or a doctor believed necessary?

COULDN'T AFFORD CARE ..................... 1 [END_LP03]
INSURANCE COMPANY WOULDN'T APPROVE, COVER, OR PAY FOR CARE ................. 2 [END_LP03]
DOCTOR REFUSED TO ACCEPT FAMILY'S INSURANCE PLAN ......................... 3 [END_LP03]
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 [END_LP03]
DIFFERENT LANGUAGE ....................... 5 [END_LP03]
COULDN'T GET TIME OFF WORK ............... 6 [END_LP03]
DIDN'T KNOW WHERE TO GO TO GET CARE ...... 7 [END_LP03]
WAS REFUSED SERVICES ..................... 8 [END_LP03]
COULDN'T GET CHILD CARE .................. 9 [END_LP03]
DIDN'T HAVE TIME OR TOOK TOO LONG ....... 10 [END_LP03]
OTHER ................................... 91 [END_LP03]
REF ..................................... -7 [END_LP03]
DK ...................................... -8 [END_LP03]
[Code One]

AC35
====

OMITTED.

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 AC36
----------------------------------------------------

AC36
====

In the last 12 months, was anyone in the family delayed in getting medical care, tests, or treatments they or a doctor believed necessary?

YES .................................... 1
NO ..................................... 2 [AC40A]
REF ................................... -7 [AC40A]
DK .................................... -8 [AC40A]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'DELAY IN RECEIVING MEDICAL CARE' AT AC37 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 AC37
----------------------------------------------------

AC37
====

Who was that? PROBE: Was anyone else in the family delayed in getting medical care, tests, or treatments they or a doctor believed necessary?

[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED, GO TO AC40A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, 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:
NO FILTER; DISPLAY ALL.
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_AC04 ? END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 COLLECTS THE MAIN REASONAND THE PROBLEM WITH THE DELAY IN RECEIVING MEDICAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING MEDICAL CARE (I.E., PERSON WAS SELECTED AT AC37)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_04 USES NAV_AC04 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_AC04
========

SERIES: Reason for Delay In Obtaining Medical Care
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING MEDICAL CARE (I.E., PERSON WAS SELECTED AT AC37)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AC38 FOR SELECTED RU MEMBER
----------------------------------------------------

AC38
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD AC-4.
Which of these best describes the main reason [you/[PERSON]] [were/was] delayed in getting medical care, tests, or treatments [you/he/she] or a doctor believed necessary?

COULDN'T AFFORD CARE ..................... 1 [END_LP04]
INSURANCE COMPANY WOULDN'T APPROVE, COVER, OR PAY FOR CARE ................. 2 [END_LP04]
DOCTOR REFUSED TO ACCEPT FAMILY'S INSURANCE PLAN ......................... 3 [END_LP04]
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 [END_LP04]
DIFFERENT LANGUAGE ....................... 5 [END_LP04]
COULDN'T GET TIME OFF WORK ............... 6 [END_LP04]
DIDN'T KNOW WHERE TO GO TO GET CARE ...... 7 [END_LP04]
WAS REFUSED SERVICES ..................... 8 [END_LP04]
COULDN'T GET CHILD CARE .................. 9 [END_LP04]
DIDN'T HAVE TIME OR TOOK TOO LONG ....... 10 [END_LP04]
OTHER ................................... 91 [END_LP04]
REF ..................................... -7 [END_LP04]
DK ...................................... -8 [END_LP04]
[Code One]

AC39
====

OMITTED.

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 AC40A
----------------------------------------------------

AC40A
=====

In the last 12 months, did anyone in the family or a dentist believe they needed any dental care, tests, or treatment?

YES .................................... 1 [AC40]
NO ..................................... 2 [AC48A]
REF ................................... -7 [AC48A]
DK .................................... -8 [AC48A]

AC40
====

In the last 12 months, was anyone in the family unable to obtain dental care, tests, or treatments they or a dentist believed necessary?

YES .................................... 1
NO ..................................... 2 [AC44]
REF ................................... -7 [AC44]
DK .................................... -8 [AC44]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'UNMET NEED FOR DENTAL CARE' AT AC41 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 AC41
----------------------------------------------------

AC41
====

Who was that? PROBE: Was anyone else in the family unable to get dental care, tests, or treatments they or a dentist believed necessary?

[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED, GO TO AC44
----------------------------------------------------
----------------------------------------------------
OTHERWISE, 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:
NO FILTER; DISPLAY ALL.
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_AC05 ? END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS THE MAIN REASON AND THE PROBLEM WITH THE UNMET NEED FOR DENTAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THEFOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR DENTAL CARE (I.E., PERSON WAS SELECTED AT AC41)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_05 USES NAV_AC05 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_AC05
========

SERIES: Reason for Being Unable to Obtain Dental Care
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR DENTAL CARE (I.E., PERSON WAS SELECTED AT AC41)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AC42 FOR SELECTED RU MEMBER
----------------------------------------------------

AC42
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD AC-4.
Which of these best describes the main reason [you/[PERSON]] [were/was] unable to get dental care, tests, or treatments [you/he/she] or a dentist believed necessary?

COULDN'T AFFORD CARE ..................... 1 [END_LP05]
INSURANCE COMPANY WOULDN'T APPROVE, COVER, OR PAY FOR CARE ................. 2 [END_LP05]
DOCTOR REFUSED TO ACCEPT FAMILY'S INSURANCE PLAN ......................... 3 [END_LP05]
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 [END_LP05]
DIFFERENT LANGUAGE ....................... 5 [END_LP05]
COULDN'T GET TIME OFF WORK ............... 6 [END_LP05]
DIDN'T KNOW WHERE TO GO TO GET CARE ...... 7 [END_LP05]
WAS REFUSED SERVICES ..................... 8 [END_LP05]
COULDN'T GET CHILD CARE .................. 9 [END_LP05]
DIDN'T HAVE TIME OR TOOK TOO LONG ....... 10 [END_LP05]
OTHER ................................... 91 [END_LP05]
REF ..................................... -7 [END_LP05]
DK ...................................... -8 [END_LP05]
[Code One]

AC43
====

OMITTED.

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 AC44
----------------------------------------------------

AC44
====

In the last 12 months, was anyone in the family delayed in getting dental care, tests, or treatments they or a dentist believed necessary?

YES .................................... 1
NO ..................................... 2 [AC48A]
REF ................................... -7 [AC48A]
DK .................................... -8 [AC48A]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'DELAY IN RECEIVING DENTAL CARE' AT AC45 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 AC45
----------------------------------------------------

AC45
====

Who was that? PROBE: Was anyone else in the family delayed in getting dental care, tests, or treatments they or a dentist believed necessary?

[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED, GO TO AC48A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, 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:
NO FILTER; DISPLAY ALL.
----------------------------------------------------

LOOP_06
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_AC06 ? END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS THE MAIN REASON AND THE PROBLEM WITH THE DELAY IN RECEIVING DENTAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING DENTAL CARE (I.E., PERSON WAS SELECTED AT AC45)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_06 USES NAV_AC06 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_AC06
========

SERIES: Reason for Delay In Obtaining Dental Care
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING DENTAL CARE (I.E., PERSON WAS SELECTED AT AC45)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AC46 FOR SELECTED RU MEMBER
----------------------------------------------------

AC46
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD AC-4.
Which of these best describes the main reason [you/[PERSON]] [were/was] delayed in getting dental care, tests, or treatments [you/he/she] or a dentist believed necessary?

COULDN'T AFFORD CARE ..................... 1 [END_LP06]
INSURANCE COMPANY WOULDN'T APPROVE, COVER, OR PAY FOR CARE ................. 2 [END_LP06]
DOCTOR REFUSED TO ACCEPT FAMILY'S INSURANCE PLAN ......................... 3 [END_LP06]
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 [END_LP06]
DIFFERENT LANGUAGE ....................... 5 [END_LP06]
COULDN'T GET TIME OFF WORK ............... 6 [END_LP06]
DIDN'T KNOW WHERE TO GO TO GET CARE ...... 7 [END_LP06]
WAS REFUSED SERVICES ..................... 8 [END_LP06]
COULDN'T GET CHILD CARE .................. 9 [END_LP06]
DIDN'T HAVE TIME OR TOOK TOO LONG ....... 10 [END_LP06]
OTHER ................................... 91 [END_LP06]
REF ..................................... -7 [END_LP06]
DK ...................................... -8 [END_LP06]
[Code One]

AC47
====

OMITTED.

END_LP06
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH AC48A
----------------------------------------------------

AC48A
=====

In the last 12 months, did anyone in the family or a doctor believe they needed prescription medicines?

YES .................................... 1 [AC48]
NO ..................................... 2 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]

AC48
====

In the last 12 months, was anyone in the family unable to obtain prescription medicines they or a doctor believed necessary?

YES .................................... 1
NO ..................................... 2 [AC52]
REF ................................... -7 [AC52]
DK .................................... -8 [AC52]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'UNMET NEED FOR PRESCRIPTION MEDICINES' AT AC49 BY CAPI AND GO TO LOOP_07
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH AC49
----------------------------------------------------

AC49
====

Who was that? PROBE: Was anyone else in the family unable to get prescription medicines they or a doctor believed necessary?

[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED, GO TO AC52
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_07
----------------------------------------------------
----------------------------------------------------
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:
NO FILTER; DISPLAY ALL.
----------------------------------------------------

LOOP_07
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_AC07 ? END_LP07
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07 COLLECTS THE MAIN REASONAND THE PROBLEM WITH THE UNMET NEED FOR PRESCRIPTION MEDICINES. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR PRESCRIPTION MEDICINES (I.E., PERSON WAS SELECTED AT AC49)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_07 USES NAV_AC07 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_AC07
========

SERIES: Reason for Being Unable to Obtain Prescription Medicines
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR PRESCRIPTION MEDICINES (I.E., PERSON WAS SELECTED AT AC49)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AC50 FOR SELECTED RU MEMBER
----------------------------------------------------

AC50
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD AC-4.
Which of these best describes the main reason [you/[PERSON]] [were/was] unable to get prescription medicines [you/he/she] or a doctor believed necessary?

COULDN'T AFFORD CARE ..................... 1 [END_LP07]
INSURANCE COMPANY WOULDN'T APPROVE, COVER, OR PAY FOR CARE ................. 2 [END_LP07]
DOCTOR REFUSED TO ACCEPT FAMILY'S INSURANCE PLAN ......................... 3 [END_LP07]
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 [END_LP07]
DIFFERENT LANGUAGE ....................... 5 [END_LP07]
COULDN'T GET TIME OFF WORK ............... 6 [END_LP07]
DIDN'T KNOW WHERE TO GO TO GET CARE ...... 7 [END_LP07]
WAS REFUSED SERVICES ..................... 8 [END_LP07]
COULDN'T GET CHILD CARE .................. 9 [END_LP07]
DIDN'T HAVE TIME OR TOOK TOO LONG ....... 10 [END_LP07]
OTHER ................................... 91 [END_LP07]
REF ..................................... -7 [END_LP07]
DK ...................................... -8 [END_LP07]
[Code One]

AC51
====

OMITTED.

END_LP07
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_07 AND CONTINUE WITH AC52
----------------------------------------------------

AC52
====

In the last 12 months, was anyone in the family delayed in getting prescription medicines they or a doctor believed necessary?

YES .................................... 1
NO ..................................... 2 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE PERSON AS 'DELAY IN RECEIVING PRESCRIPTION MEDICINES' AT AC53 BY CAPI AND GO TO LOOP_08
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH AC53
----------------------------------------------------

AC53
====

Who was that? PROBE: Was anyone else in the family delayed in getting prescription medicines they or a doctor believed necessary?

[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED, GO TO BOX_06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_08
----------------------------------------------------
----------------------------------------------------
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:
NO FILTER; DISPLAY ALL.
----------------------------------------------------

LOOP_08
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_AC08 ? END_LP08
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_08 COLLECTS THE MAIN REASONAND THE PROBLEM WITH THE DELAY IN RECEIVING PRESCRIPTION MEDICINES. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING PRESCRIPTION MEDICINES (I.E., PERSON WAS SELECTED AT AC53)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_08 USES NAV_AC08 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_AC08
========

SERIES: Reason for Delay In Obtaining Prescription Medicines
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING PRESCRIPTION MEDICINES (I.E., PERSON WAS SELECTED AT AC53)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AC54 FOR SELECTED RU MEMBER
----------------------------------------------------

AC54
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD AC-4.
Which of these best describes the main reason [you/[PERSON]] [were/was] delayed in getting prescription medicines [you/he/she] or a doctor believed necessary?

COULDN'T AFFORD CARE ..................... 1 [END_LP08]
INSURANCE COMPANY WOULDN'T APPROVE, COVER, OR PAY FOR CARE ................. 2 [END_LP08]
DOCTOR REFUSED TO ACCEPT FAMILY'S INSURANCE PLAN ......................... 3 [END_LP08]
PROBLEMS GETTING TO DOCTOR'S OFFICE ...... 4 [END_LP08]
DIFFERENT LANGUAGE ....................... 5 [END_LP08]
COULDN'T GET TIME OFF WORK ............... 6 [END_LP08]
DIDN'T KNOW WHERE TO GO TO GET CARE ...... 7 [END_LP08]
WAS REFUSED SERVICES ..................... 8 [END_LP08]
COULDN'T GET CHILD CARE .................. 9 [END_LP08]
DIDN'T HAVE TIME OR TOOK TOO LONG ....... 10 [END_LP08]
OTHER ................................... 91 [END_LP08]
REF ..................................... -7 [END_LP08]
DK ...................................... -8 [END_LP08]
[Code One]

AC55
====

OMITTED.

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_06
----------------------------------------------------

BOX_06
======

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

Review of Employment Information (RJ) Section

BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME AND ESTB.ESTBNAME
[EVALUATE DATE]
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF INFORMATION ABOUT AT LEAST ONE CURRENT JOB WAS COLLECTED FOR PERSON DURING THE PREVIOUS ROUND, ASK THE REVIEW OF EMPLOYMENT INFORMATION (RJ) SECTION. THAT IS, IF:
- THIS IS NOT ROUND 1,
- PERSON NOT ADDED TO THE RU THIS ROUND,
- PERSON WAS = OR ) 16 YEARS OLD OR IN AGE CATEGORIES 4-9 DURING THE PREVIOUS ROUND, AND
- PERSON HAD A JOB WITH A JOB SUBTYPE FLAGGED AS 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' DURING THE PREVIOUS ROUND,
CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, SKIP THE RJ SECTION, THAT IS, GO TO BOX_06
----------------------------------------------------

BOX_02
======

OMITTED.

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN PERSON'S-JOBS-ROSTER, ASK NAVRJ_01 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 REVIEWS AND UPDATES INFORMATION ABOUT CURRENT JOBS COLLECTED DURING THE PREVIOUS ROUND. THIS LOOP CYCLES ON THE JOBS THAT MEET THE FOLLOWING CONDITIONS:

- JOB IS WITH AN ESTABLISHMENT FLAGGED AS 'EMPLOYER'
- JOB SUBTYPE IS FLAGGED AS EITHER 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_RJ01 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAVRJ_01
========

SERIES: Review of Jobs from a Previous Round (i.e., Still working there? Change in wage or hours? Have insurance now?)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
Employer
[1. Person's Prev. Round Employer Name-30] [Status-25]
[2. Person's Prev. Round Employer Name-30] [Status-25]
[3. Person's Prev. Round Employer Name-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY PERSON'S-JOBS-ROSTER
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH JOB EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-JOBS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY EACH JOB IN PERSON'S-JOBS-ROSTER THAT MEETS THE FOLLOWING CONDITIONS:
- JOB IS WITH AN ESTABLISHMENT FLAGGED AS 'EMPLOYER'
- JOB SUBTYPE IS FLAGGED AS EITHER 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_03 FOR SELECTED JOB
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF JOB SUBTYPE FLAGGED AS 'CURRENT MAIN', CONTINUE WITH RJ01
----------------------------------------------------
----------------------------------------------------
OTHERWISE (IF JOB SUBTYPE FLAGGED AS 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'), GO TO RJ06
----------------------------------------------------

RJ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] worked at [ESTABLISHMENT]. [[Do/Does]/Did] [you/he/she] still work at [ESTABLISHMENT] [on [END DATE OF REFERENCE PERIOD]]?

YES ................................... 1 [RJ01A]
NO .................................... 2 [RJ09]
REF ................................... -7 [RJ09]
DK .................................... -8 [RJ09]
----------------------------------------------------
FOR [PREV RD INTV DT] DISPLAY THE INTERVIEW DATE OF THE PREVIOUS ROUND.

DISPLAY 'on [END DATE OF REFERENCE PERIOD]' IF ROUND 5. OTHERWISE, USE NULL DISPLAY.

DISPLAY '[Do/Does]' IF NOT ROUND 5. DISPLAY 'Did' IF ROUND 5.

FOR [END DATE OF REFERENCE PERIOD], DISPLAY THE ROUND 5 REFERENCE PERIOD END DATE FOR THAT PERSON.
----------------------------------------------------

RJ01AA
======

OMITTED.

RJ01AAA
=======

OMITTED.

BOX_03A
=======

OMITTED.

RJ01A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
[Is/Was] [ESTABLISHMENT] still [your/[PERSON]'s] main job or business?

YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF MAIN JOB/BUSINESS.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), CHANGE JOB SUBTYPE FLAG TO 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'.
----------------------------------------------------
----------------------------------------------------
IF JOB BEING ASKED ABOUT FLAGGED AS 'SELF-EMPLOYED', GO TO RJ04
----------------------------------------------------
----------------------------------------------------
IF JOB BEING ASKED ABOUT FLAGGED AS 'NOT SELF-EMPLOYED', CONTINUE WITH RJ02
----------------------------------------------------

RJ02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
[During our last interview, we recorded that [you/[PERSON]] made [$XXXXXX.XX] per [UNIT OF TIME].] [Since [PREV RD INT DT], has/ Between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD], was] there [been] any change in the amount [you/[PERSON]] [[make/makes]/made] through [ESTABLISHMENT]?

INTERVIEWER NOTE: THIS INCLUDES CHANGES IN BOTH DIRECTIONS.
YES ................................... 1 [BOX_04]
NO .................................... 2 [RJ04]
REF ................................... -7 [RJ04]
DK .................................... -8 [RJ04]
----------------------------------------------------
[During our last interview, we recorded that [you/[PERSON]] made [$XXXXXX.XX] per [UNIT OF TIME].]: DISPLAY SENTENCE IF EW01, EW02, EW03, EW05, EW11, EW18, EW24B, AND/OR EW24C WERE NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) FOR THE JOB BEING ASKED ABOUT FOR THIS PERSON DURING THE PREVIOUS ROUND.

[$XXXXXX.XX] [UNIT OF TIME]:

IF CODED '1' (SALARIED) AT EW01 FOR THE JOB
BEING ASKED ABOUT FOR THIS PERSON DURING THE PREVIOUS ROUND, DISPLAY AMOUNT ENTERED AT EW11 FOR [$XXXXXX.XX] AND THE UNIT ENTERED AT EW11OV1 (OR AT EW11OV2 IF EW11OV1 IS CODED '91' (OTHER)) FOR [UNIT OF TIME].

IF CODED '2' (PAID BY THE HOUR) AT EW01 FOR THE
JOB BEING ASKED ABOUT FOR THIS PERSON DURING THE REVIOUS ROUND, DISPLAY AMOUNT ENTERED AT EW18 FOR [$XXXXXX.XX] AND 'HOUR' FOR [UNIT OF TIME].

IF CODED '3' (PAID SOME OTHER WAY) AT EW01 FOR THE JOB BEING ASKED ABOUT FOR THIS PERSON DURING THE PREVIOUS ROUND AND:

IF CODED '1' (BY THE DAY) AT EW02, DISPLAY THE AMOUNT ENTERED AT EW03 FOR [$XXXXXX.XX] AND 'DAY' FOR [UNIT OF TIME].
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (PIECEWORK), '5' (BY THE JOB/ MILE), OR '91' (OTHER) AT EW02, DISPLAY THE MOUNT ENTERED AT EW05 FOR [$XXXXXX.XX] AND THE UNIT ENTERED AT EW05OV1 (OR AT EW05OV2 IF EW05OV1 IS CODED '91' (OTHER)) FOR [UNIT OF TIME].

IF CODED '3' (COMMISSION) AT EW02, DISPLAY THE AMOUNT ENTERED AT EW24C FOR [$XXXXXX.XX] AND THE UNIT ENTERED AT EW24COV1 (OR AT EW24COV2 IFEW24COV1 IS CODED '91' (OTHER)) FOR [UNIT OF TIME].

IF CODED '4' (BONUS) AT EW02, DISPLAY THE AMOUNT ENTERED AT EW24B FOR [$XXXXXX.XX] AND THE UNIT ENTERED AT EW24BOV1 (OR AT EW24BOV2 IFEW24BOV1 IS CODED '91' (OTHER)) FOR [UNIT OF TIME].

[Since [PREV RD INT DT], has/Between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD], was]: DISPLAY 'Since [PREV RD INT DT], has' IF NOT ROUND 5. DISPLAY 'Between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD], was' IF ROUND 5.

[START DATE OF REFERENCE PERIOD]: DISPLAY THE ROUND 5 REFERENCE PERIOD FOR START DATE FOR THIS PERSON.

[END DATE OF REFERENCE PERIOD]: DISPLAY THE ROUND 5 REFERENCE PERIOD END DATE FOR THIS PERSON.

[been]: DISPLAY 'been' IF NOT ROUND 5. OTHERWISE, USE A NULL DISPLAY.

[[make/makes]/made]: DISPLAY '[make/makes]' IF NOT ROUND 5. DISPLAY 'made' IF ROUND 5.

FOR [PREV RD INT DT] DISPLAY THE INTERVIEW DATE OFTHE PREVIOUS ROUND.
----------------------------------------------------

RJ03
====

OMITTED.

RJ03OV
======

OMITTED.

BOX_04
======

----------------------------------------------------
ASK THE EMPLOYMENT WAGE (EW) SECTION.

AT COMPLETION OF EMPLOYMENT WAGE (EW) SECTION, CONTINUE WITH RJ04
----------------------------------------------------

RJ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] worked [full-time/part-time] at [ESTABLISHMENT]. [[Do/Does]/Did] [you/he/she] still work [35 hours or more/less than 35 hours] per week at [ESTABLISHMENT] [on [END DATE OF REFERENCE PERIOD]]?

35 HOURS OR MORE ...................... 1
LESS THAN 35 HOURS .................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
FOR [PREV RD INTV DT] DISPLAY THE INTERVIEW DATE OF THE PREVIOUS ROUND.

DISPLAY 'full-time' IF NUMERIC ENTRY AT EM104 = OR ) 35 OR IF EM104 WAS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND EM105 WAS CODED '1' (YES) DURING THE PREVIOUS ROUND FOR JOB BEING ASKED ABOUT. DISPLAY 'part-time' IF NUMERIC ENTRY AT EM104 ( 35 OR IF EM104 WAS CODED '-7' (REFUSED) OR'-8' (DON'T KNOW) AND EM105 WAS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) DURING THE PREVIOUS ROUND FOR THIS JOB BEING ASKED ABOUT.

DISPLAY '[Do/Does]' IF NOT ROUND 5. DISPLAY 'Did' IF ROUND 5.

DISPLAY '35 hours or more' IF NUMERIC ENTRY AT EM104 = OR ) 35 OR IF EM104 WAS CODED '-7'
(REFUSED) OR '-8' (DON'T KNOW) AND EM105 WAS CODED'1' (YES) DURING THE PREVIOUS ROUND FOR JOB BEING ASKED ABOUT. DISPLAY 'less than 35 hours' IF NUMERIC ENTRY AT EM104 ( 35 OR IF EM104 WAS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND EM105 WAS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) DURING THE PREVIOUS ROUND FOR THIS JOB BEING ASKED ABOUT.

DISPLAY 'on [END DATE OF REFERENCE PERIOD]' IF ROUND 5, DISPLAYING THE ROUND 5 END DATE FOR THIS PERSON FOR 'END DATE OF REFERENCE PERIOD'. OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF THE CLASSIFICATION OF NUMBER OF HOURS WORKED PER WEEK HAS CHANGED SINCE THE PREVIOUS ROUND, THAT IS, IF: - CODED '2' (LESS THAN 35 HOURS) AND THE NUMERIC ENTRY AT EM104 WAS = OR ) 35 DURING THE PREVIOUS ROUND OR EM104 WAS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND EM105 WAS CODED '1' (YES) DURING THE PREVIOUS ROUND, OR - CODED '1' (35 HOURS OR MORE) AND THE NUMERIC ENTRY AT EM104 WAS ( 35 DURING THE PREVIOUS ROUND OR EM104 WAS CODED '-7' (REFUSED)OR '-8' (DON'T KNOW) AND EM105 WAS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), CONTINUE WITH RJ05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

RJ05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
What is the main reason [you/[PERSON]] changed from [full-time/ part-time] to [part-time/full-time] at [ESTABLISHMENT]?

PROMOTION OR DEMOTION ................. 1 [BOX_05]
CHANGE IN RESPONSIBILITY .............. 2 [BOX_05]
CHANGE IN AMOUNT OF WORK BUSINESS
BRINGS IN ........................... 3 [BOX_05]
CHANGE IN SHIFT TIME .................. 4 [BOX_05]
CHANGE IN NUMBER OF EMPLOYEES
AVAILABLE TO WORK ................... 5 [BOX_05]
ILLNESS/DISABILITY (BEGINNING OR
COMPLETED) .......................... 6 [BOX_05]
TEMPORARY LEAVE (BEGINNING OR
COMPLETED) .......................... 7 [BOX_05]
MATERNITY/PATERNITY LEAVE (BEGINNING
OR COMPLETED) ....................... 8 [BOX_05]
GOING TO SCHOOL/FINISHED SCHOOL ....... 9 [BOX_05]
CHANGE IN HOME OR FAMILY SITUATION .... 10 [BOX_05]
NEEDED TIME OFF/WANTED TO WORK MORE ... 11 [BOX_05]
OTHER ................................. 91 [RJ05OV]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
[Code One]
----------------------------------------------------
[full-time/part-time]: DISPLAY 'full-time' IF NUMERIC ENTRY AT EM104 = OR ) 35 OR IF EM104 WAS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND EM105 WAS CODED '1' (YES) DURING THE PREVIOUS ROUND FOR JOB BEING ASKED ABOUT. DISPLAY 'part- time' IF NUMERIC ENTRY AT EM104 ( 35 OR IF EM104 WAS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND EM105 WAS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) DURING THE PREVIOUS ROUND FOR THIS JOB BEING ASKED ABOUT.

[part-time/full-time]: DISPLAY 'part-time' IF UMERIC ENTRY AT EM104 = OR ) 35 OR IF EM104 WAS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND EM105 WAS CODED '1' (YES) DURING THE PREVIOUS ROUND FOR JOB BEING ASKED ABOUT. DISPLAY 'full- time' IF NUMERIC ENTRY AT EM104 ( 35 OR IF EM104 WAS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND EM105 WAS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) DURING THE PREVIOUS ROUND FOR THIS JOB BEING ASKED ABOUT. THAT IS, DISPLAY THE OPPOSITE FROM WHAT WAS DISPLAYED IN THE EARLIER RJ05 [full-time/part-time] FILL.
----------------------------------------------------

RJ05OV
======

SPECIFY:
[Enter Other Specify] ................. [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]

RJ05A
=====

OMITTED.

RJ06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING
ASKED ABOUT] [JOB-ST]
[JOB-ED]
During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] worked at [ESTABLISHMENT]. [[Do/Does]/Did] [you/he/she] still work there [on [END DATE OF REFERENCE PERIOD]]?

YES ................................... 1 [BOX_05]
NO .................................... 2 [RJ09]
REF ................................... -7 [RJ09]
DK .................................... -8 [RJ09]
----------------------------------------------------
FOR [PREV RD INTV DT] DISPLAY THE INTERVIEW DATE OF THE PREVIOUS ROUND.

DISPLAY '(Do/Does)' IF NOT ROUND 5. DISPLAY 'Did' IF ROUND 5.

FOR [on [END DATE OF REFERENCE PERIOD]]: DISPLAY IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

FOR [END DATE OF REFERENCE PERIOD]: DISPLAY THE ROUND 5 REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

RJ06A
=====

OMITTED.

RJ06AA
======

OMITTED.

BOX_05AA
========

OMITTED.

BOX_05
======

----------------------------------------------------
IF JOB NOT FLAGGED AS 'PROVIDES HEALTH INSURANCE' AND INSURANCE OFFERED THROUGH ESTABLISHMENT IN PREVIOUS ROUND (EM114 CODED '1' (YES) DURING THE PREVIOUS ROUND), CONTINUE WITH RJ07
----------------------------------------------------
----------------------------------------------------
IF JOB NOT FLAGGED AS 'PROVIDES HEALTH INSURANCE' AND INSURANCE NOT OFFERED THROUGH ESTABLISHMENT INPREVIOUS ROUND (EM114 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) DURING THE PREVIOUS ROUND), GO TO RJ08
----------------------------------------------------
----------------------------------------------------
IF NOT ROUNDS 1 OR 2 AND JOB NOT FLAGGED AS 'PROVIDES HEALTH INSURANCE' (TURNED OFF IN HEALTH INSURANCE -- OE01 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) DURING THE PREVIOUS ROUND), GO TO RJ08A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

RJ07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] [were/was] offered health insurance through [ESTABLISHMENT], but chose not to take that insurance. [[Do/Does]/Did] [you/he/she] [now] have health insurance through [ESTABLISHMENT] [on [END DATE OF REFERENCE PERIOD]]?

YES ................................... 1 [BOX_05A]
NO .................................... 2 [BOX_05A]
REF ................................... -7 [BOX_05A]
DK .................................... -8 [BOX_05A]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[PREV RD INTV DT]: DISPLAY THE INTERVIEW DATE OF THE PREVIOUS ROUND.

DISPLAY '[Do/Does]' IF NOT ROUND 5. DISPLAY 'Did' IF ROUND 5.

DISPLAY 'now' IF NOT ROUND 5. IF ROUND 5, DISPLAY NULL.

FOR [on [END DATE OF REFERENCE PERIOD]]: DISPLAY IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

FOR [END DATE OF REFERENCE PERIOD]: DISPLAY THE ROUND 5 REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) FLAG THIS JOBHOLDER- ESTABLISHMENT PAIR AS 'PROVIDES HEALTH INSURANCE' AND TO BE ASKED ABOUT IN THE HEALTH INSURANCE SECTION.
----------------------------------------------------

RJ08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] [were/was] not offered health insurance through [ESTABLISHMENT]. [[Do/Does]/Did] [you/he/she] [now] have health insurance through [ESTABLISHMENT] [on [END DATE OF REFERENCE PERIOD]]?

YES ................................... 1 [BOX_05A]
NO .................................... 2 [RJ08AA]
REF ................................... -7 [BOX_05A]
DK .................................... -8 [BOX_05A]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[PREV RD INTV DT]: DISPLAY THE INTERVIEW DATE OF THE PREVIOUS ROUND.

DISPLAY '[Do/Does]' IF NOT ROUND 5. DISPLAY 'Did' IF ROUND 5.

DISPLAY 'now' IF NOT ROUND 5. IF ROUND 5, DISPLAY NULL.

FOR [on [END DATE OF REFERENCE PERIOD]]: DISPLAY IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

FOR [END DATE OF REFERENCE PERIOD]: DISPLAY THE ROUND 5 REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) FLAG THIS JOBHOLDER- ESTABLISHMENT PAIR AS 'PROVIDES HEALTH INSURANCE' AND TO BE ASKED ABOUT IN THE HEALTH INSURANCE SECTION.
----------------------------------------------------

RJ08AA
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST][JOB-ED]
[Were/Was] [you/[PERSON]] offered health insurance through [ESTABLISHMENT]?

YES ................................... 1 [BOX_05A]
NO .................................... 2 [RJ08AAA]
REF ................................... -7 [BOX_05A]
DK .................................... -8 [BOX_05A]

RJ08AAA
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
Was health insurance offered to any employees at [ESTABLISHMENT]?

RJ08AAAA
========

OMITTED.

RJ08AAOV
========

OMITTED.

RJ08A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
During our last interview on [PREV RD INTV DATE], we recorded that [you/[PERSON]] [were/was] not receiving health insurance through [ESTABLISHMENT]. [[Do/Does]/Did] [you/he/she] [now] have health insurance through [ESTABLISHMENT] [on [END DATE OF REFERENCE PERIOD]]?

YES ................................... 1 [BOX_05A]
NO .................................... 2 [BOX_05A]
REF ................................... -7 [BOX_05A]
DK .................................... -8 [BOX_05A]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[PREV RD INTV DT]: DISPLAY THE INTERVIEW DATE OF THE PREVIOUS ROUND.

DISPLAY '[Do/Does]' IF NOT ROUND 5. DISPLAY 'Did' IF ROUND 5.

DISPLAY 'now' IF NOT ROUND 5. IF ROUND 5, DISPLAY NULL.

FOR [on [END DATE OF REFERENCE PERIOD]]: DISPLAY IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

FOR [END DATE OF REFERENCE PERIOD]: DISPLAY THE ROUND 5 REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG THIS JOBHOLDER- ESTABLISHMENT PAIR AS 'PROVIDES HEALTH INSURANCE' AND TO BE ASKED ABOUT IN THE HEALTH INSURANCE SECTION.
----------------------------------------------------

BOX_05A
=======

----------------------------------------------------
IF EMPLOYER FLAGGED AS 'SELF-EMPLOYED', CONTINUE WITH RJ08B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

RJ08B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
[During our last interview we recorded that [NUMBER] employee(s), including [you/[PERSON]], worked at [ESTABLISHMENT].] What is the total number of employees who worked at the business [last week/[on [END DATE OF REFERENCE PERIOD]]]? Be sure to include the owner and all other household members that may [work/have worked] there.

[Enter Number of Employees]............ [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
----------------------------------------------------
[During our last interview we recorded that [NUMBER] employee(s), including [you/[PERSON]], worked at [ESTABLISHMENT].]: DISPLAY SENTENCE IF EM124 WAS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) DURING THE PREVIOUS ROUND FOR THE JOB BEING ASKED ABOUT. OTHERWISE, USE A NULL DISPLAY.
DISPLAY 'on [END DATE OF REFERENCE PERIOD]' IF ROUND 5. OTHERWISE, DISPLAY 'last week'.

[NUMBER]: DISPLAY THE NUMBER ENTERED AT EM124 DURING THE PREVIOUS ROUND FOR THE JOB BEING ASKED ABOUT.

DISPLAY 'work' IF NOT ROUND 5. OTHERWISE, DISPLAY 'have worked'.

FOR [END DATE OF REFERENCE PERIOD]: DISPLAY THE ROUND 5 REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
IF '1' ENTERED FOR THE NUMBER OF EMPLOYEES, FLAG EMPLOYER AS 'FIRM-SIZE-1'.
----------------------------------------------------
----------------------------------------------------
IF A NUMBER ) 1 ENTERED FOR THE NUMBER OF EMPLOYEES, FLAG EMPLOYER AS 'FIRM-SIZE-GREATER- THAN-1'.
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), RETAIN EMPLOYER SIZE FLAG USED DURING THE PREVIOUS ROUND.
----------------------------------------------------

RJ09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
When did [you/[PERSON]] last stop working at [ESTABLISHMENT] for pay?

[IF JOB ENDED AFTER 12/31/[YEAR], BACK-UP TO [RJ01/RJ06] AND SELECT
'YES'.]
[Enter Year-4, Month-2, Day-2] ........ [RJ10]
REF ................................... -7 [RJ10]
DK .................................... -8 [RJ10]
----------------------------------------------------
DISPLAY 'IF JOB ENDED ... SELECT 'YES'.' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'RJ01' IF LOOPING ON 'CURRENT-MAIN-JOB'. DISPLAY 'RJ06' IF LOOPING ON 'CURRENT- MISCELLANEOUS-JOB-WITHIN-REFERENCE-PERIOD.'
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATION PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN QUESTION TEXT IS SECONDCALENDAR YEAR OF PANEL.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
JOB END DATE MUST BE = OR ) REFERENCE PERIOD
START DATE AND ( OR = TO REFERENCE PERIOD END DATE.
----------------------------------------------------

RJ10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
What is the main reason [you/[PERSON]] no longer [have/has] this job?

JOB ENDED .............................. 1 [END_LP01]
BUSINESS DISSOLVED OR SOLD ............. 2 [END_LP01]
RETIRED ................................ 3 [END_LP01]
ILLNESS OR INJURY ...................... 4 [END_LP01]
LAID OFF ............................... 5 [END_LP01]
QUIT TO HAVE A BABY .................... 6 [END_LP01]
QUIT TO GO TO SCHOOL ................... 7 [END_LP01]
QUIT TO TAKE CARE OF HOME OR FAMILY .... 8 [END_LP01]
QUIT BECAUSE WANTED TIME OFF ........... 9 [END_LP01]
QUIT TO TAKE OTHER JOB ................ 10 [END_LP01]
UNPAID LEAVE .......................... 11 [END_LP01]
OTHER ................................. 91 [RJ10OV]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
[Code One]

RJ10OV
======

SPECIFY:
[Enter Other Specify] ................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT JOB IN THE PERSON'S-JOBS-ROSTER THATMEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER JOBS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_06
----------------------------------------------------

BOX_06
======

----------------------------------------------------
CONTINUE WITH EMPLOYMENT SUBSECTION (EM)
----------------------------------------------------

Employment Driver (EM-O) Section

BOX_01A
=======

----------------------------------------------------
NOTE: REFUSED (-7) AND DON?T KNOW (-8) ARE DISALLOWED ON ALL FIELDS IN THE EMPLOYMENT SECTIONS THAT COLLECT ESTABLISHMENT NAME.
----------------------------------------------------

LOOP_00
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK BOX_01 - END_LP00
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_00 COLLECTS INFORMATION ABOUT EMPLOYMENT FOR ALL RU MEMBERS WHO ARE 16 OR OLDER. THIS LOOP CYCLES ON RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:

- PERSON IS = OR ) 16 YEARS, OR IN AGE CATEGORIES 4-9
AND
- PERSON IS AN RU MEMBER DURING THE CURRENT ROUND
----------------------------------------------------

BOX_01
======

----------------------------------------------------
ASK REVIEW OF EMPLOYMENT (RJ) SECTION
----------------------------------------------------

END_LP00
========

----------------------------------------------------
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_00 AND CONTINUE WITH THE HEALTH INSURANCE (HX) SECTION
----------------------------------------------------

Employment (EM) Section

----------------------------------------------------
THROUGHOUT THE SPECIFICATIONS FOR THIS CAPI SECTION, FOR SCREENS THAT SPECIFY THE REFERENCE PERIOD [END DATE] AS PART OF THE CONTEXT HEADER, CAPI DISPLAYS THE [END DATE] ONLY FOR ROUND 5.
INTERVIEWS. IN ANY OTHER ROUND, CAPI DOES NOT DISPLAY THE [END DATE] IN THE CONTEXT HEADER.
FOR MOST PERSONS, THE END DATE FOR ROUND 5 WILL BE DECEMBER 31 OF THE SECOND YEAR OF THE PANEL.
----------------------------------------------------
----------------------------------------------------
NOTE THAT ESTABLISHMENT ADDRESS INFORMATION AND THE INFORMED CONSENT SCREENS WERE OMITTED STARTING IN PANEL 12 ROUND 3. THIS INFORMATION WAS IN PANEL 12 ROUNDS 1 AND 2.

STARTING IN PANEL 13 THESE ITEMS WILL BE OMITTED IN ALL ROUNDS.
----------------------------------------------------

BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, [ESTB.ESTBNAME], [(PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY)/ (JOBS.JSTRTM, JOBS.JSTRTD, JOBS.JSTRTY, JOBS.JSTOPM, JOBS.JSTOPD, JOBS.JSTOPY)].
----------------------------------------------------
----------------------------------------------------
NOTE: FOR ROUND 5, 'DEC 31 [YEAR]' WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, WILL BE DISPLAYED IN THE CONTEXT HEADER FOR 'JOB-ED' FOR ALL CURRENT MAIN AND CURRENT MISCELLANEOUS JOBS.
THAT IS, 'DEC 31 [YEAR]' WILL BE DISPLAYED INSTEAD OF THE WORD 'CURRENT' FOR THESE JOB SUBTYPES.
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF PERSON HAS ONE OF THE SAME CURRENT JOBS IN THIS ROUND AS IN THE PREVIOUS ROUND, THAT IS IF:

- CURRENT ROUND IS NOT ROUND 1, AND - PERSON WAS = OR ) 16 OR IN AGE CATEGORIES 4-9 DURING THE PREVIOUS ROUND, AND
- RJ01 IS CODED '1' (YES) OR RJ06 IS CODED '1', GO TO EM51
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH EM01
----------------------------------------------------

EM01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Now I have some questions about work experience for [you/[PERSON]].] [During our last interview on [PREV RD INTV DATE], we recorded that [you/[PERSON]] did not work at any job for pay.]
[[Do/Does]/As of December 31, [YEAR], did] [you/[PERSON]] [currently] have a job for pay or own a business [that we have not yet talked about]?
PROBE: Do not count work around the house. Include work in a family farm or business, even if unpaid.

YES ................................... 1 [EM04]
NO .................................... 2 [EM02]
REF ................................... -7 [EM02]
DK .................................... -8 [EM02]
HELP AVAILABLE FOR DEFINITIONS OF JOB FOR PAY/BUSINESS.
----------------------------------------------------
[Now I have some questions about work experience for [you/[PERSON]].]: DISPLAY THIS SENTENCE IF FIRST TIME EM SECTION BEING ASKED FOR THIS RU MEMBER (I.E., ROUND 1, PERSON WAS ADDED TO THE RU THIS ROUND, OR PERSON IS NOW = OR ) 16 YEARS OF AGE OR IN AGE CATEGORIES 4-9 BUT WAS NOT IN THE PREVIOUS ROUND.

[During our last interview on (PREV RD INTV DATE), we recorded that [you/[PERSON]] did not work at any job for pay.]: DISPLAY THIS SENTENCE IF PERSON BEING ASKED ABOUT DID NOT WORK DURING THE PREVIOUS ROUND'S REFERENCE PERIOD.

[PREV RD INTV DATE]: DISPLAY THE INTERVIEW DATE OF THE PREVIOUS ROUND.

[Do/Does/As of 12/31/[YEAR], did]: DISPLAY '[Do/Does]' IF NOT ROUND 5. DISPLAY 'As of 12/31/[YEAR], did' WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.

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

[that we have not yet talked about]: DISPLAY IF ANY JOB ASKED ABOUT DURING THE RJ SECTION DURING THIS ROUND FOR THIS PERSON.
----------------------------------------------------

EM02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
At any time [since [START DATE]/between [START DATE] and [END DATE]], did [you/[PERSON]] have [a/any other] job for pay or own a business [that we have not yet talked about]?
PROBE: Do not count work around the house. Include work in a family farm or business, even if unpaid.

YES ................................... 1 [EM26]
NO .................................... 2 [EM03]
REF ................................... -7 [EM03]
DK .................................... -8 [EM03]
HELP AVAILABLE FOR DEFINITIONS OF JOB FOR PAY/BUSINESS.
----------------------------------------------------
[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.

[a/any other]: DISPLAY 'a' IF NO JOB ASKED ABOUT DURING THE RJ SECTION DURING THIS ROUND FOR THIS PERSON. DISPLAY 'any other' IF ANY JOB ASKED ABOUT DURING THE RJ SECTION DURING THIS ROUND FOR THIS PERSON.

[that we have not yet talked about]: DISPLAY IF ANY JOB ASKED ABOUT DURING THE RJ SECTION DURING THIS ROUND FOR THIS PERSON.
----------------------------------------------------

EM03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Do/Does]/Did] [you/[PERSON]] have a job or business [you/he/she] [can/could] return to [that we have not yet talked about]?

YES .................................... 1 [EM05]
NO ..................................... 2
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITIONS OF JOB FOR PAY/BUSINESS.
----------------------------------------------------
[[Do/Does]/Did]: DISPLAY '(Do/Does)' IF NOT ROUND 5. DISPLAY 'Did' IF ROUND 5.

[can/could]: DISPLAY 'can' IF NOT ROUND 5. DISPLAY' could' IF ROUND 5.

[that we have not yet talked about]: DISPLAY IF ANY JOB ASKED ABOUT DURING THE RJ SECTION DURING THIS ROUND FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), GO TO EM05
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REF), or '-8' (DK) AND PERSON WAS ASKED EMPLOYMENT SECTION IN ANY PREVIOUS ROUND, GO TO BOX_19A
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REF), or '-8' (DK) AND PERSON WAS NOT ASKED EMPLOYMENT SECTION IN ANY PREVIOUS ROUND, GO TO EM65
----------------------------------------------------

EM04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Do/Does]/On December 31, [YEAR], did] [you/[PERSON]] [currently] work at more than one job or business?

YES ................................... 1 [EM11]
NO .................................... 2 [EM05]
REF ................................... -7 [EM05]
DK .................................... -8 [EM05]
HELP AVAILABLE FOR DEFINITIONS OF JOB FOR PAY/BUSINESS.
----------------------------------------------------
[Do/Does/On 12/31/[YEAR], did]: DISPLAY '[Do/Does]' IF NOT ROUND 5. DISPLAY 'on 12/31/[YEAR], did' WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.

[currently]: DISPLAY 'CURRENTLY' IF NOT ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

EM05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Are/Is]/[Were/Was]] [you/[PERSON]] self-employed, or [[do/does]/ did] [you/he/she] work for someone else at that job?

SELF-EMPLOYED ......................... 1 [EM06]
FOR SOMEONE ELSE ...................... 2 [EM06]
REF ................................... -7 [EM06]
DK .................................... -8 [EM06]
[Code One]
HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.
----------------------------------------------------
[[Are/Is]/[Were/Was]]: DISPLAY '[Are/Is]' IF NOT ROUND 5. DISPLAY '[Were/Was]' IF ROUND 5.

[[do/does]/did]: DISPLAY '[do/does]' IF NOT ROUND 5. DISPLAY 'did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (SELF-EMPLOYED), FLAG JOB AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (FOR SOMEONE ELSE), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG JOB AS 'NOT SELF- EMPLOYED'.
----------------------------------------------------

EM06A
=====

OMITTED.

EM06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What is the name of [the employer who [pays/paid] [you/[PERSON]]/ [your/[PERSON]'s] business]?
SELECT EMPLOYER NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF EMPLOYER IS NOT ON THE LIST, CLICK ON 'ADD EMPLOYER' TO ENTER A NEW EMPLOYER.

------------------------
ROSTER. EMPLOYER
------------------------
1. Employer Name-30
-----------------------
2. Employer Name-30
------------------------
3. Employer Name-30
------------------------
----------------------------------------------------
[the employer who [pays/paid] [you/[PERSON]]/ [your/[PERSON]'s] business]: DISPLAY 'the employer who [pays/paid] [you/[PERSON]]' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY '[your/[PERSON]'s] business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.

[pays/paid]: DISPLAY 'pays' IF NOT ROUND 5.
DISPLAY 'paid' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
'ADD EMPLOYER' IS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD EMPLOYER' IS SELECTED, CONTINUE WITH EM08 (NOTE THAT EM08 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON EM06.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (AN EMPLOYER WAS SELECTED), GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_1

COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY EMPLOYER NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE
RU-ESTABLISHMENTS-ROSTER FOR SELECTION OF PERSON'S JOB OR BUSINESS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED THROUGH 'ADD' BUTTON.

3. EDIT DISALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY ESTABLISHMENTS FLAGGED AS EMPLOYERS ON THE RU-ESTABLISHMENTS-ROSTER.
----------------------------------------------------

BOX_01A
=======

OMITTED.

EM07
====

OMITTED.

EM08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
ENTER COMPLETE NAME OF EMPLOYER AND VERIFY SPELLING.
ESTABLISHMENT: [_____________] [BOX_02]

----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER, AND FLAG ESTABLISHMENT AS 'EMPLOYER'.
----------------------------------------------------

EM09
====

OMITTED.

BOX_02
======

----------------------------------------------------
FLAG JOB SUBTYPE AS 'CURRENT MAIN'.
----------------------------------------------------
----------------------------------------------------
FLAG JOB AS 'NOT RETIRED FROM'.
----------------------------------------------------

EM10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] start working at that job?

[Enter Year-4] ........................
REF ................................... -7 [EM38]
DK .................................... -8 [EM38]
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM10OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_03
----------------------------------------------------

EM10OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
ENTRY FOR FIELD MUST CORRESPOND TO CALENDAR MONTHS. THAT IS, ALLOWABLE VALUES = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM10OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_03
----------------------------------------------------

EM10OV2
=======

[Enter Day-2] ......................... [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
HARD CHECK:
EDIT/RANGE CHECK:

ENTRY FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB START DATE MUST BE = OR ) THAN THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB START DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF JOB START DATE ( OR = (I.E., ON OR BEFORE) REFERENCE PERIOD START DATE, GO TO EM51
----------------------------------------------------
----------------------------------------------------
IF JOB START DATE ) (I.E., AFTER) REFERENCE PERIOD START DATE, GO TO EM38
----------------------------------------------------

EM11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Please think about [your/[PERSON]'s] main job or business. [[Are/Is]/[Were/Was]] [you/he/she] self-employed, or [[do/does]/ did] [you/he/she] work for someone else at that job?

SELF-EMPLOYED ......................... 1 [EM12]
FOR SOMEONE ELSE ...................... 2 [EM12]
REF ................................... -7 [EM12]
DK .................................... -8 [EM12]
[Code One]
HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.
----------------------------------------------------
[[Are/Is]/[Were/Was]]: DISPLAY '[Are/Is]' IF NOT ROUND 5. DISPLAY '[Were/Was]' IF ROUND 5.

[[do/does]/did]: DISPLAY '[do/does]' IF NOT ROUND 5. DISPLAY 'did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (SELF-EMPLOYED), FLAG JOB AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (FOR SOMEONE ELSE) '7' (REFUSED), OR '-8' (DON'T KNOW), FLAG JOB AS 'NOT SELF- EMPLOYED'.
----------------------------------------------------

BOX_04
======

OMITTED.

EM12A
=====

OMITTED.

EM12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What is the name of [your/[PERSON]'s] main [job/business]?
SELECT EMPLOYER NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF EMPLOYER IS NOT ON THE LIST, CLICK ON 'ADD EMPLOYER' TO ENTER A NEW EMPLOYER.

------------------------
ROSTER. EMPLOYER
------------------------
1. Employer Name-30
------------------------
2. Employer Name-30
------------------------
3. Employer Name-30
------------------------
----------------------------------------------------
'ADD EMPLOYER' IS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'job' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY 'business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF 'ADD EMPLOYER' IS SELECTED, CONTINUE WITH EM14 (NOTE THAT EM14 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON EM12.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (AN EMPLOYER WAS SELECTED), GO TO BOX_05.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_1

COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY EMPLOYER NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-ESTABLISHMENTS-ROSTER FOR SELECTION OF PERSON'S JOB OR BUSINESS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED BY SELECTING 'ADD EMPLOYER'.

3. EDIT DISALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY ESTABLISHMENTS FLAGGED AS EMPLOYERS ON THE RU-ESTABLISHMENTS-ROSTER.
----------------------------------------------------

BOX_04A
=======

OMITTED.

EM13
====

OMITTED.

EM14
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
ENTER COMPLETE NAME OF EMPLOYER AND VERIFY SPELLING.
ESTABLISHMENT: [_____________] [BOX_05]

----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER, AND FLAG ESTABLISHMENT AS 'EMPLOYER'.
----------------------------------------------------

EM15
====

OMITTED.

BOX_05
======

EM16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] start working at that job?

[Enter Year-4] ........................
REF ................................... -7 [EM17]
DK .................................... -8 [EM17]
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM16OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM17
----------------------------------------------------

EM16OV1
=======

[Enter Month-2]........................
REF ................................... -7 [EM17]
DK .................................... -8 [EM17]
----------------------------------------------------
ENTRIES FOR MONTH FIELD MUST CORRESPOND TO CALENDAR MONTHS. THAT IS, ALLOWABLE VALUE = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM16OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM17
----------------------------------------------------

EM16OV2
=======

[Enter Day-2]........................ [EM17]
REF ................................... -7 [EM17]
DK .................................... -8 [EM17]
----------------------------------------------------
HARD CHECK:
EDIT/RANGE CHECK:

ENTRIES FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB START DATE MUST BE = OR ) THAN THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB START DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

EM17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
You mentioned that [you/[PERSON]] [[have/has]/had] another job [now/on December 31, [YEAR]]. At any time [since [START DATE]/ between [START DATE] and [END DATE]], did [you/he/she] have health insurance through this other job?
PROBE: By this, I mean insurance which pays for hospital bills, doctor bills, or other health expenses.

YES ................................... 1 [EM18]
NO .................................... 2 [EM18]
REF ................................... -7 [EM18]
DK .................................... -8 [EM18]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[[have/has]/had]: DISPLAY '[have/has]' IF NOT ROUND 5. DISPLAY 'had' IF ROUND 5.

[now/on 12/31/[YEAR]]: DISPLAY 'now' IF NOT ROUND 5. DISPLAY 'on 12/31/[YEAR]' WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.

[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG JOB AS 'PROVIDES HEALTH INSURANCE'.
----------------------------------------------------

EM18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Are/Is]/[Were/Was]] [you/[PERSON]] self-employed, or [[do/does]/ did] [you/he/she] work for someone else at this job?

SELF-EMPLOYED ......................... 1 [EM19]
FOR SOMEONE ELSE ...................... 2 [EM19]
REF ................................... -7 [EM19]
DK .................................... -8 [EM19]
[Code One]
HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.
----------------------------------------------------
[[Are/Is]/[Were/Was]]: DISPLAY '[Are/Is]' IF NOT ROUND 5. DISPLAY '(Were/Was)' IF ROUND 5.

[[do/does]/did]: DISPLAY '[do/does]' IF NOT ROUND
5. DISPLAY 'did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (SELF-EMPLOYED), FLAG JOB AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (FOR SOMEONE ELSE), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG JOB AS 'NOT SELF- EMPLOYED'.
----------------------------------------------------

EM19A
=====

OMITTED.

EM19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What is the name of [the employer who [pays/paid] [you/[PERSON]] for that job/[your/[PERSON]'s] business]?
SELECT EMPLOYER NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF EMPLOYER IS NOT ON THE LIST, CLICK ON 'ADD EMPLOYER' TO ENTER A NEW EMPLOYER.

------------------------
ROSTER. EMPLOYER
------------------------
1. Employer Name-30
------------------------
2. Employer Name-30
------------------------
3. Employer Name-30
------------------------
----------------------------------------------------
[the employer who [pays/paid] [you/[PERSON]] for that job/[your/[PERSON]'s] business]: DISPLAY 'the employer who [pays/paid] [you/[PERSON]] for that job' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY '[your/ [PERSON]'s] business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.

[pays/paid]: DISPLAY 'pays' IF NOT ROUND 5.
DISPLAY 'paid' IF ROUND 5.

'ADD EMPLOYER' IS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD EMPLOYER' IS SELECTED, CONTINUE WITH EM22 (NOTE THAT EM22 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON EM19.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (AN EMPLOYER WAS SELECTED), GO TO BOX_06.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_1

COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY EMPLOYER NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-ESTABLISHMENTS-ROSTER FOR SELECTION OF PERSON'S JOB OR BUSINESS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED THROUGH 'ADD' BUTTON.

3. EDIT DISALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY ESTABLISHMENTS FLAGGED AS EMPLOYERS ON THE RU-ESTABLISHMENTS-ROSTER.
----------------------------------------------------

BOX_05A
=======

OMITTED.

EM20
====

OMITTED.

EM21
====

OMITTED.

EM21A
=====

OMITTED.

EM22
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
ENTER COMPLETE NAME OF EMPLOYER AND VERIFY SPELLING.
ESTABLISHMENT: [_____________] [BOX_06]

----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER, AND FLAG ESTABLISHMENT AS 'EMPLOYER'.
----------------------------------------------------

EM23
====

OMITTED.

EM24
====

OMITTED.

BOX_06
======

----------------------------------------------------
FLAG JOB SUBTYPE AS 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'.
----------------------------------------------------
----------------------------------------------------
FLAG JOB AS 'NOT RETIRED FROM'.
----------------------------------------------------

EM25
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] start working at that job?

[Enter Year-4]..........................
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM25OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

EM25OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
ENTRY FOR MONTH FIELD MUST CORRESPOND TO CALENDAR MONTHS. THAT IS, ALLOWABLE VALUES = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM25OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

EM25OV2
=======

[Enter Day-2]......................... [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
----------------------------------------------------
HARD CHECK:
EDIT/RANGE CHECK:

ENTRY FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB START DATE MUST BE = OR ) THAN THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB START DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF JOB START DATE OF CURRENT MAIN JOB (EM16) ( OR = (I.E., ON OR BEFORE) REFERENCE PERIOD START DATE, GO TO EM51
----------------------------------------------------
----------------------------------------------------
IF JOB START DATE OF CURRENT MAIN JOB (EM16) ) (I.E., AFTER) REFERENCE PERIOD START DATE, OR IF EM16 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO EM38
----------------------------------------------------

EM26
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Please think about the employer or business where [you/[PERSON]] worked [most recently/just before December 31, [YEAR]].
IF PERSON HAD MORE THAN ONE EMPLOYER, PROBE: Please think about [your/his/her] main job at the time.
At any time [since [START DATE]/between [START DATE] and [END DATE]], did [you/he/she] have health insurance through that job?
PROBE: By this, I mean insurance which pays for hospital bills, doctor bills, or other health expenses.

YES .................................... 1 [EM27]
NO ..................................... 2 [EM27]
REF ................................... -7 [EM27]
DK .................................... -8 [EM27]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[most recently/just before 12/31/[YEAR]]: DISPLAY 'most recently' IF NOT ROUND 5. DISPLAY 'just before 12/31/[YEAR]' WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.

[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG JOB AS 'PROVIDES HEALTH INSURANCE'.
----------------------------------------------------

EM27
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Were/Was] [you/[PERSON]] self-employed, or did [you/he/she] work for someone else at that job?

SELF-EMPLOYED .......................... 1 [EM28]
FOR SOMEONE ELSE ....................... 2 [EM28]
REF ................................... -7 [EM28]
DK .................................... -8 [EM28]
[Code One]
HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.
----------------------------------------------------
IF CODED '1' (SELF-EMPLOYED), FLAG JOB AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (FOR SOMEONE ELSE), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG JOB AS 'NOT SELF-EMPLOYED'.
----------------------------------------------------

EM28A
=====

OMITTED.

EM28
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What is the name of [the employer who paid [you/[PERSON]] at the job worked [most recently/just before December 31, [YEAR]]/[your/ [PERSON]'s] business]?
IF MORE THAN ONE EMPLOYER MENTIONED, PROBE: What was [your/his/her] main job at the time?
SELECT EMPLOYER NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF EMPLOYER IS NOT ON THE LIST, SELECT 'ADD EMPLOYER' TO ENTER A NEW EMPLOYER.

------------------------
ROSTER. EMPLOYER
------------------------
1. Employer Name-30
------------------------
2. Employer Name-30
------------------------
3. Employer Name-30
------------------------
----------------------------------------------------
[the employer who paid [you/[PERSON]] at the job worked [most recently/just before 12/31/[YEAR]/ [your/[PERSON]'s] business]: DISPLAY 'the employer who paid [you/[PERSON]] at the job worked [most recently/just before 12/31/[YEAR]]' WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF- EMPLOYED'. DISPLAY '[your/[PERSON]'s] business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF- EMPLOYED'.

[most recently/just before 12/31/[YEAR]]: DISPLAY 'most recently' IF NOT ROUND 5. DISPLAY 'just before 12/31/[YEAR]' WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF 'ADD EMPLOYER' IS SELECTED, CONTINUE WITH EM31 (NOTE THAT EM31 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON EM28.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (AN EMPLOYER WAS SELECTED), GO TO BOX_08.
----------------------------------------------------
----------------------------------------------------
'ADD EMPLOYER' IS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_1

COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY EMPLOYER NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-ESTABLISHMENTS-ROSTER FOR SELECTION OF PERSON'S JOB OR BUSINESS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED THROUGH 'ADD' BUTTON.

3. EDIT DISALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY ESTABLISHMENTS FLAGGED AS EMPLOYERS ON THE RU-ESTABLISHMENTS-ROSTER.
----------------------------------------------------

BOX_07A
=======

OMITTED.

EM29
====

OMITTED.

EM30
====

OMITTED.

EM30A
=====

OMITTED.

EM31
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
ENTER COMPLETE NAME OF EMPLOYER AND VERIFY SPELLING
ESTABLISHMENT: [_____________] [BOX_08]

----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER, AND FLAG ESTABLISHMENT AS 'EMPLOYER'.
----------------------------------------------------

EM32
====

OMITTED.

EM33
====

OMITTED.

BOX_08
======

----------------------------------------------------
FLAG JOB SUBTYPE AS 'FORMER MAIN WITHIN REFERENCE PERIOD'.
----------------------------------------------------

EM34
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] start working at that job?

[Enter Year-4] .........................
REF ................................... -7 [EM35]
DK .................................... -8 [EM35]
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM34OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM35
----------------------------------------------------

EM34OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [EM35]
DK .................................... -8 [EM35]
----------------------------------------------------
ENTRY FOR MONTH FIELD MUST CORRESPOND TO CALENDAR MONTHS. THAT IS, ALLOWABLE VALUES = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM34OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM35
----------------------------------------------------

EM34OV2
=======

[Enter Day-2] ......................... [EM35]
REF ................................... -7 [EM35]
DK .................................... -8 [EM35]
----------------------------------------------------
HARD CHECK:
EDIT/RANGE CHECK:

ENTRY FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB START DATE MUST BE = OR ) THAN THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB START DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

EM35
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] stop working at that job?

[Enter Year-4] .........................
REF ................................... -7 [EM36]
DK .................................... -8 [EM36]
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM35OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

EM35OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [BOX_09]
DK .................................... -8 [BOX_09]
----------------------------------------------------
ENTRY FOR MONTH FIELD MUST CORRESPOND TO CALENDAR MONTHS. THAT IS, ALLOWABLE VALUES = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM35OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_09
----------------------------------------------------

EM35OV2
=======

[Enter Day-2] ......................... [BOX_09]
REF ................................... -7 [BOX_09]
DK .................................... -8 [BOX_09]
----------------------------------------------------
HARD CHECK:
EDIT: COMPLETE DATE AT EM35 MUST BE = OR ) COMPLETE DATE AT EM34

EDIT/RANGE CHECK:

ENTRY FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB END DATE MUST BE = OR ) THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB END DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

BOX_09
======

----------------------------------------------------
IF JOB END DATE ( (I.E., PRIOR TO) THE REFERENCE PERIOD START DATE, GO TO EM37
----------------------------------------------------
----------------------------------------------------
IF JOB END DATE = OR ) (I.E., ON OR AFTER) THE REFERENCE PERIOD START DATE, GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
IF MONTH FIELD OF JOB END DATE IS MISSING (THAT IS, EM35OV1 OR EM35OV2 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW)) AND IF THE YEAR OF JOB END DATE (EM35) IS REFERENCE YEAR, CONTINUE WITH EM36
----------------------------------------------------

EM36
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
Can you just tell me if [you/[PERSON]] stopped working at that job before or after [START DATE]?

BEFORE [START DATE] .................... 1 [EM37]
ON OR AFTER [START DATE] ............... 2 [BOX_10]
REF ................................... -7 [BOX_10]
DK .................................... -8 [BOX_10]
[Code One]

EM37
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
INTERVIEWER: RESPONDENT REPORTED IN EM02 THAT [PERSON] HAD A JOB/BUSINESS SINCE [START DATE], BUT IS NOW REPORTING THAT THE JOB ENDED BEFORE [START DATE].
IF NECESSARY, VERIFY THIS INCONSISTENT INFORMATION WITH THE RESPONDENT.
IF DATE STOPPED WORKING IS BEFORE THE BEGINNING OF THE REFERENCE PERIOD, JUMPBACK TO SCREEN EM02 AND SELECT 'NO'.
IF DATE STOPPED WORKING IS AFTER THE REFERENCE PERIOD START DATE, JUMPBACK TO SCREEN EM35 AND RE-ENTER THE CORRECT JOB END DATE.

----------------------------------------------------
DISPLAY TWO RADIO BUTTONS ON THIS SCREEN LABELED 'JUMPBACK TO EM02' AND 'JUMPBACK TO EM35'.
----------------------------------------------------

BOX_10
======

----------------------------------------------------
IF JOB START DATE OF FORMER MAIN JOB ( OR = (I.E., BEFORE OR ON) REFERENCE PERIOD START DATE, GO TO EM51
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., JOB START DATE AFTER ()) REFERENCE PERIOD START DATE OR IT IS NOT KNOWN IF JOB START DATE IS BEFORE OR AFTER THE REFERENCE PERIOD START DATE), CONTINUE WITH EM38
----------------------------------------------------

EM38
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Other than [EMPLOYER FROM EM19/EM22..], did/Did] [you/[PERSON]] have a job between [START DATE] and the time the job with [EMPLOYER FROM EM06/EM08, EM12/EM14, OR EM28/EM31] started [other than what we have already discussed]?
DO NOT INCLUDE CURRENT JOBS.

YES .................................... 1 [EM39]
NO ..................................... 2 [EM51]
REF ................................... -7 [EM51]
DK .................................... -8 [EM51]
----------------------------------------------------
[Other than [EMPLOYER FROM EM19/EM22..], did/Did]: DISPLAY 'Other than [EMPLOYER FROM EM19/EM22..], did' IF A CURRENT MAIN EMPLOYER WAS COLLECTED AT EM12/EM14. DISPLAY 'Did' IF A CURRENT MAIN EMPLOYER WAS NOT COLLECTED AT EM12/EM14.

[EMPLOYER FROM EM19/EM22..]: DISPLAY THE CURRENT-MISCELLANEOUS EMPLOYER NAME COLLECTED AT THE EM19-EM22 ESTABLISHMENT ROSTER.

[EMPLOYER FROM EM06/EM08, EM12/EM14, OR EM28/EM31]:

IF COLLECTED A CURRENT-MAIN EMPLOYER AT EM06/EM08,DISPLAY THAT EMPLOYER NAME.
IF COLLECTED A CURRENT-MAIN EMPLOYER AT EM12/EM14,DISPLAY THAT EMPLOYER NAME.
IF COLLECTED A FORMER-MAIN EMPLOYER AT EM28/EM31, DISPLAY THAT EMPLOYER NAME.
----------------------------------------------------

EM39
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Please think about the employer or business where [you/[PERSON]] worked before [EMPLOYER FROM EM06/EM08, EM12/EM14, OR EM28/EM31].
IF PERSON HAD MORE THAN ONE EMPLOYER, PROBE: Please think about [your/his/her] main job at the time.
At any time [since [START DATE]/between [START DATE] and [END DATE]], did [you/he/she] have health insurance through that job?
PROBE: By this, I mean insurance which pays for hospital bills, doctor bills, or other health expenses.

YES .................................... 1 [EM40]
NO ..................................... 2 [EM40]
REF ................................... -7 [EM40]
DK .................................... -8 [EM40]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[EMPLOYER FROM EM06/EM08, EM12/EM14, OR EM28/EM31]:

IF COLLECTED A CURRENT-MAIN EMPLOYER AT EM06/EM08,DISPLAY THAT EMPLOYER NAME.
IF COLLECTED A CURRENT-MAIN EMPLOYER AT EM12/EM14,DISPLAY THAT EMPLOYER NAME.
IF COLLECTED A FORMER-MAIN EMPLOYER AT EM28/EM31, DISPLAY THAT EMPLOYER NAME.

[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG JOB AS 'PROVIDES HEALTH INSURANCE'.
----------------------------------------------------

EM40
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Were/Was] [you/[PERSON]] self-employed, or did [you/he/she] work for someone else at that job?

SELF-EMPLOYED .......................... 1 [EM41]
FOR SOMEONE ELSE ....................... 2 [EM41]
REF ................................... -7 [EM41]
DK .................................... -8 [EM41]
[Code One]
HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.
----------------------------------------------------
IF CODED '1' (SELF-EMPLOYED), FLAG JOB AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (FOR SOMEONE ELSE), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG JOB AS 'NOT SELF- EMPLOYED'.
----------------------------------------------------

EM41A
=====

OMITTED.

EM41
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What is the name of [the employer who paid [you/[PERSON]] before [EMPLOYER FROM EM06/EM08, EM12/EM14, OR EM28/EM31]/ [your/[PERSON]'s] business]?
IF MORE THAN ONE EMPLOYER MENTIONED, PROBE: What was [your/his/her] main job at the time?
SELECT EMPLOYER NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF EMPLOYER IS NOT ON THE LIST, CLICK ON 'ADD EMPLOYER' TO ENTER A NEW EMPLOYER.

------------------------
ROSTER. EMPLOYER
------------------------
1. Employer Name-30
------------------------
2. Employer Name-30
------------------------
3. Employer Name-30
------------------------
----------------------------------------------------
[the employer who paid [you/[PERSON]] before [EMPLOYER FROM EM06/EM08, EM12/EM14, OR EM28/ EM31]/[your/[PERSON]'s] business]: DISPLAY 'the employer who paid [you/[PERSON]] before [EMPLOYER FROM EM06/EM08, EM12/EM14, OR EM28/EM31]' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF- EMPLOYED'. DISPLAY '[your/[PERSON]'s] business]' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF- EMPLOYED'.

[EMPLOYER FROM EM06/EM08, EM12/EM14, OR EM28/EM31]:

IF COLLECTED A CURRENT-MAIN EMPLOYER AT EM06/EM08,DISPLAY THAT EMPLOYER NAME.
IF COLLECTED A CURRENT-MAIN EMPLOYER AT EM12/EM14,DISPLAY THAT EMPLOYER NAME.
IF COLLECTED A FORMER-MAIN EMPLOYER AT EM28/EM31, DISPLAY THAT EMPLOYER NAME.
----------------------------------------------------
----------------------------------------------------
'ADD EMPLOYER' IS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD EMPLOYER' IS SELECTED, CONTINUE WITH EM44 (NOTE THAT EM44 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON EM41.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (AN EMPLOYER WAS SELECTED), GO TO BOX_11
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_1

COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY EMPLOYER NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE
RU-ESTABLISHMENTS-ROSTER FOR SELECTION OF PERSON'S JOB OR BUSINESS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED THROUGH 'ADD' BUTTON.

3. EDIT DISALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY ESTABLISHMENTS FLAGGED AS EMPLOYERS ON THE RU-ESTABLISHMENTS-ROSTER.
----------------------------------------------------

BOX_10A
=======

OMITTED.

EM42
====

OMITTED.

EM43
====

OMITTED.

EM43A
=====

OMITTED.

EM44
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
ENTER COMPLETE NAME OF EMPLOYER AND VERIFY SPELLING
ESTABLISHMENT: [_____________] [BOX_11]

----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER, AND FLAG ESTABLISHMENT AS 'EMPLOYER'.
----------------------------------------------------

EM45
====

OMITTED.

EM46
====

OMITTED.

BOX_11
======

----------------------------------------------------
FLAG JOB SUBTYPE AS 'FORMER MAIN WITHIN REFERENCE PERIOD'.
----------------------------------------------------

EM47
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] start working at that job?

[Enter Year-4] ........................
REF ................................... -7 [EM48]
DK .................................... -8 [EM48]
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM47OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM48
----------------------------------------------------

EM47OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [EM48]
DK .................................... -8 [EM48]
----------------------------------------------------
ENTRIES FOR MONTH FIELD MUST CORRESPOND TO CALENDAR MONTH. THAT IS, ALLOWABLE VALUES = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM47OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM48
----------------------------------------------------

EM47OV2
=======

[Enter Day-2] ......................... [EM48]
REF ................................... -7 [EM48]
DK .................................... -8 [EM48]
----------------------------------------------------
HARD CHECK:
EDIT/RANGE CHECK:

ENTRIES FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB START DATE MUST BE = OR ) THAN THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB START DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

EM48
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] stop working at that job?

[Enter Year-4] ........................
REF ................................... -7 [EM49]
DK .................................... -8 [EM49]
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM48OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

EM48OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]
----------------------------------------------------
ENTRIES FOR MONTH FIELD MUST CORRESPOND TO CALENDAR MONTHS. THAT IS, ALLOWABLE VALUES = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM48OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

EM48OV2
=======

[Enter Day-2] ......................... [BOX_12]
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]
----------------------------------------------------
HARD CHECK:
EDIT: COMPLETE DATE AT EM48 MUST BE = OR ) COMPLETE DATE AT EM47.

EDIT/RANGE CHECK:

ENTRIES FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB END DATE MUST BE = OR ) THAN THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB END DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

BOX_12
======

----------------------------------------------------
IF JOB END DATE ( (I.E., PRIOR TO) THE REFERENCE PERIOD START DATE, GO TO EM50
----------------------------------------------------
----------------------------------------------------
IF JOB END DATE IS = OR ) (I.E., ON OR AFTER) REFERENCE PERIOD START DATE, GO TO EM51
----------------------------------------------------
----------------------------------------------------
IF MONTH OF JOB END DATE IS MISSING (THAT IS, EM48OV1 OR EM48OV2 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW)] AND IF THE YEAR OF JOB END DATE (EM48) IS REFERENCE YEAR, CONTINUE WITH EM49
----------------------------------------------------

EM49
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
Can you just tell me if [you/[PERSON]] stopped working at that job before or after [START DATE]?

BEFORE [START DATE] .................... 1 [EM50]
ON OR AFTER [START DATE] ............... 2 [EM51]
REF ................................... -7 [EM51]
DK .................................... -8 [EM51]
[Code One]

EM50
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
INTERVIEWER: RESPONDENT REPORTED IN EM38 THAT [PERSON] HAD A JOB/BUSINESS BETWEEN [START DATE] AND ANOTHER EMPLOYER, BUT IS NOW REPORTING THAT THIS JOB ENDED BEFORE [START DATE].
IF NECESSARY, VERIFY THIS INCONSISTENT INFORMATION WITH THE RESPONDENT.
IF DATE STOPPED WORKING IS BEFORE THE BEGINNING OF THE REFERENCE PERIOD, JUMPBACK TO SCREEN EM38 AND SELECT 'NO'.
IF DATE STOPPED WORKING IS AFTER THE REFERENCE PERIOD START DATE, JUMPBACK TO SCREEN EM48 AND RE-ENTER THE CORRECT JOB END DATE.

----------------------------------------------------
DISPLAY TWO RADIO BUTTONS ON THIS SCREEN LABELED 'JUMPBACK TO EM38' AND 'JUMPBACK TO EM48'.
----------------------------------------------------

EM51
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Since [START DATE], [have/has]/Between [START DATE] and [END DATE], did] [you/[PERSON]] [had/have] any other jobs we haven't talked about such as a job held at the same time as a job you've already mentioned?

YES .................................... 1 [LOOP_01]
NO ..................................... 2 [BOX_17]
REF ................................... -7 [BOX_17]
DK .................................... -8 [BOX_17]
----------------------------------------------------
[Since [START DATE], [have/has]/Between [START DATE] and [END DATE], did]: DISPLAY 'Since [START DATE], [have/has]' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5.

[had/have]: DISPLAY 'had' IF NOT ROUND 5. DISPLAY 'have' IF ROUND 5.
----------------------------------------------------

LOOP_01
=======

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

MISCELLANEOUS JOB

ASK EM52-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 ENUMERATES OTHER MISCELLANEOUS JOBS FOR PERSON. THE RESPONSE TO EM64 DETERMINES WHETHER THE LOOP CYCLES AGAIN.
IF EM64 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT MISCELLANEOUS JOB. IF EM64 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

EM52
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Please think about the [next most recent] employer or business where [you/[PERSON]] worked.
At any time [since [START DATE]/between [START DATE] and [END DATE]], did [you/he/she] have health insurance through that job?
PROBE: By this, I mean insurance which pays for hospital bills, doctor bills, or other health expenses.

YES .................................... 1 [EM53]
NO ..................................... 2 [EM53]
REF ................................... -7 [EM53]
DK .................................... -8 [EM53]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[next most recent]: DISPLAY NULL IF FIRST CYCLE THROUGH LOOP_01. DISPLAY 'next most recent' IF NOT FIRST CYCLE THROUGH LOOP_01.

[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG JOB AS 'PROVIDES HEALTH INSURANCE'.
----------------------------------------------------

EM53
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Were/Was] [you/[PERSON]] self-employed, or did [you/he/she] work for someone else at that job?

SELF-EMPLOYED ......................... 1 [EM54]
FOR SOMEONE ELSE ...................... 2 [EM54]
REF ................................... -7 [EM54]
DK .................................... -8 [EM54]
[Code One]
HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.
----------------------------------------------------
IF CODED '1' (SELF-EMPLOYED), FLAG JOB AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (FOR SOMEONE ELSE), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG JOB AS 'NOT SELF- EMPLOYED'.
----------------------------------------------------

EM54A
=====

OMITTED.

EM54
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What is the name of [the [next most recent] employer who paid [you/[PERSON]] at that job/[your/[PERSON]'s] [next most recent] business]?
SELECT EMPLOYER NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF EMPLOYER IS NOT ON THE LIST, CLICK ON 'ADD EMPLOYER' TO ENTER A NEW EMPLOYER.

------------------------
ROSTER. EMPLOYER
------------------------
1. Employer Name-30
------------------------
2. Employer Name-30
------------------------
3. Employer Name-30
------------------------
----------------------------------------------------
[the [next most recent] employer who paid [you/ [PERSON]] at that job/[your/[PERSON]'s] [next most recent] business]: DISPLAY 'the [next most recent] employer who paid [you/[PERSON]] at that job' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF- EMPLOYED'. DISPLAY '[your/[PERSON]'s] [next most recent] business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.

[next most recent]: DISPLAY NULL IF FIRST CYCLE THROUGH LOOP_01. DISPLAY 'next most recent' IF NOT FIRST CYCLE THROUGH LOOP_01.
----------------------------------------------------
----------------------------------------------------
'ADD EMPLOYER' IS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD EMPLOYER' IS SELECTED, CONTINUE WITH EM57 (NOTE THAT EM57 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON EM54.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (AN EMPLOYER WAS SELECTED), GO TO EM60
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_1

COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY EMPLOYER NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-ESTABLISHMENTS-ROSTER FOR SELECTION OF PERSON'S JOB OR BUSINESS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED THROUGH 'ADD' BUTTON.

3. EDIT DISALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY ESTABLISHMENTS FLAGGED AS EMPLOYERS ON THE RU-ESTABLISHMENTS-ROSTER.
----------------------------------------------------

BOX_12A
=======

OMITTED.

EM55
====

OMITTED.

EM56
====

OMITTED.

EM56A
=====

OMITTED.

EM57
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
ENTER COMPLETE NAME OF EMPLOYER AND VERIFY SPELLING.
ESTABLISHMENT: [_____________] [EM60]

----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER, AND FLAG ESTABLISHMENT AS 'EMPLOYER'.
----------------------------------------------------

EM58
====

OMITTED.

EM59
====

OMITTED.

EM60
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] start working at that job?

[Enter Year-4] .........................
REF ................................... -7 [EM61]
DK .................................... -8 [EM61]
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM60OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM61
----------------------------------------------------

EM60OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [EM61]
DK .................................... -8 [EM61]
----------------------------------------------------
ENTRIES FOR MONTH FIELD MUST CORRESPOND TO CALENDAR MONTH. THAT IS, ALLOWABLE VALUES = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM60OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM61
----------------------------------------------------

EM60OV2
=======

[Enter Day-2] ......................... [EM61]
REF ................................... -7 [EM61]
DK .................................... -8 [EM61]
----------------------------------------------------
HARD CHECK:
EDIT/RANGE CHECK:

ENTRIES FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB START DATE MUST BE = OR ) THAN THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB START DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

EM61
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] stop working at that job?
IF STILL AT JOB [ON 12/31/[YEAR]], ENTER '0' IN YEAR FIELD.

[Enter Year-4] .........................
REF ................................... -7 [EM62]
DK .................................... -8 [EM62]
----------------------------------------------------
[ON 12/31/[YEAR]]: DISPLAY 'ON 12/31/[YEAR]' WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM61OV1
----------------------------------------------------
----------------------------------------------------
IF '0' ENTERED (STILL AT JOB), GO TO BOX_14
----------------------------------------------------
----------------------------------------------------
FOR ALL OTHER YEARS, GO TO BOX_13
----------------------------------------------------

EM61OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [BOX_13]
DK .................................... -8 [BOX_13]
----------------------------------------------------
ENTRIES FOR MONTH FIELD MUST CORRESPOND TO CALENDAR MONTHS. THAT IS, ALLOWABLE VALUE = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM61OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_13
----------------------------------------------------

EM61OV2
=======

[Enter Day-2] ......................... [BOX_13]
REF ................................... -7 [BOX_13]
DK .................................... -8 [BOX_13]
----------------------------------------------------
HARD CHECK:
EDIT: COMPLETE DATE AT EM61 MUST BE = OR ) COMPLETE DATE AT EM60

EDIT/RANGE CHECK:

ENTRY FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB END DATE MUST BE = OR ) THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB END DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

BOX_13
======

----------------------------------------------------
IF JOB END DATE ( (I.E., PRIOR TO) THE REFERENCE PERIOD START DATE, GO TO EM63
----------------------------------------------------
----------------------------------------------------
IF JOB END DATE = ON ) (I.E., ON OR AFTER) THE REFERENCE PERIOD START DATE, GO TO BOX_14
----------------------------------------------------
----------------------------------------------------
IF MONTH OF JOB END DATE IS MISSING (THAT IS, EM61OV1 OR EM61OV2 IS CODED '-7' (REFUSED) OR '-8'(DON'T KNOW)) AND IF THE YEAR OF JOB END DATE (EM61) IS REFERENCE YEAR, CONTINUE WITH EM62
----------------------------------------------------

EM62
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
Can you just tell me if [you/[PERSON]] stopped working at that job before or after [START DATE]?

BEFORE [START DATE] .................... 1 [EM63]
ON OR AFTER [START DATE] ............... 2 [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX_14]
[Code One]

EM63
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
INTERVIEWER: RESPONDENT REPORTED IN EM51 THAT [PERSON] HAD SOME OTHER JOB(S)/BUSINESS(ES) SINCE [START DATE], BUT IS NOW REPORTING THAT ONE OF THESE JOBS ENDED BEFORE [START DATE].
IF NECESSARY, VERIFY THIS INCONSISTENT INFORMATION WITH THE RESPONDENT.
IF DATE STOPPED WORKING IS BEFORE THE BEGINNING OF THE REFERENCE PERIOD, CODE 'DELETE JOB' BELOW.
IF DATE STOPPED WORKING IS AFTER THE REFERENCE PERIOD START DATE, CODE 'NEED TO CORRECT DATE' BELOW.

DELETE JOB ............................. 1 [EM64]
NEED TO CORRECT DATE ................... 2
[Code One]
----------------------------------------------------
IF CODED '2' (NEED TO CORRECT DATE), THE PROGRAM WILL JUMP BACK TO EM61 AUTOMATICALLY.
----------------------------------------------------

BOX_14
======

----------------------------------------------------
IF EM61 (JOB END DATE) IS CODED '0' (STILL AT JOB), FLAG JOB SUBTYPE AS 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND FLAG JOB AS 'NOT RETIRED FROM'.
----------------------------------------------------
----------------------------------------------------
IF
A DATE IS ENTERED AT EM61 (JOB END DATE),
OR
EM62 IS CODED '2' (ON OR AFTER START DATE), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG JOB SUBTYPE AS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'.
----------------------------------------------------

EM64
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Since [START DATE], [have/has]/Between [START DATE] and [END DATE], did] [you/[PERSON]] [had/have] another job we haven't talked about [such as a job held at the same time as a job you've already mentioned]?

END_LP01
========

----------------------------------------------------
IF EM64 IS CODED '1' (YES), CYCLE TO COLLECT NEXT MISCELLANEOUS JOB.
----------------------------------------------------
----------------------------------------------------
IF EM64 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_01 AND GO TO BOX_17
----------------------------------------------------

EM65
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Have/Has] [you/[PERSON]] ever worked at a job for pay?

YES .................................... 1 [EM66]
NO ..................................... 2 [BOX_20]
REF ................................... -7 [BOX_20]
DK .................................... -8 [BOX_20]

EM66
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
I'd like to know a little bit about the last job held by [you/ [PERSON]]. When did [you/he/she] last stop working at a job for pay?

[Enter Year-4] .........................
REF ................................... -7 [EM67]
DK .................................... -8 [EM67]
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM66OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_15
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
VALUES SHOULD BE BETWEEN 1930 AND [YEAR] WHERE YEAR IS REFERENCE YEAR.
----------------------------------------------------

EM66OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [BOX_15]
DK .................................... -8 [BOX_15]
----------------------------------------------------
ENTRY FOR FIELD MUST CORRESPOND TO CALENDAR MONTHS. THAT IS, ALLOWABLE VALUES = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM66OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_15
----------------------------------------------------

EM66OV2
=======

[Enter Day-2] ......................... [BOX_15]
REF ................................... -7 [BOX_15]
DK .................................... -8 [BOX_15]
----------------------------------------------------
HARD CHECK:
EDIT/RANGE CHECK:

ENTRIES FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELD.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB END DATE MUST BE = OR ) THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( THE REFERENCE PERIOD START DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB END DATE MUST BE ( THE REFERENCE PERIOD START DATE FOR THIS PERSON.
----------------------------------------------------

BOX_15
======

----------------------------------------------------
IF JOB END DATE = OR ) (I.E., ON OR AFTER) THE REFERENCE PERIOD START DATE, GO TO EM68
----------------------------------------------------
----------------------------------------------------
IF JOB END DATE ( (I.E., PRIOR TO) THE REFERENCE PERIOD START DATE, GO TO EM69
----------------------------------------------------
----------------------------------------------------
IF MONTH OF JOB END DATE IS MISSING (THAT IS, EM66OV1 OR EM66OV2 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW)) AND IF THE YEAR OF JOB END DATE (EM66) IS REFERENCE YEAR, CONTINUE WITH EM67
----------------------------------------------------

EM67
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Can you just tell me if [you/[PERSON]] stopped working at that job before or after [START DATE]?

BEFORE [START DATE] .................... 1 [EM69]
ON OR AFTER [START DATE] ............... 2 [EM68]
REF ................................... -7 [EM69]
DK .................................... -8 [EM69]
[Code One]

EM68
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
INTERVIEWER: RESPONDENT REPORTED IN EM02 THAT [PERSON] HAS NOT HAD A JOB/BUSINESS SINCE [START DATE], BUT IS NOW REPORTING THAT THE LAST JOB HELD ENDED AFTER [START DATE].
IF NECESSARY, VERIFY THIS INCONSISTENT INFORMATION WITH THE RESPONDENT.
IF DATE STOPPED WORKING IS AFTER THE BEGINNING OF THE REFERENCE PERIOD, JUMPBACK TO SCREEN EM02 AND SELECT 'YES'.
IF DATE STOPPED WORKING IS BEFORE THE REFERENCE PERIOD START DATE, JUMPBACK TO SCREEN EM66 AND RE-ENTER THE CORRECT JOB END DATE.

----------------------------------------------------
DISPLAY TWO RADIO BUTTONS ON THIS SCREEN LABELED 'JUMPBACK TO EM02' AND 'JUMPBACK TO EM66'.
----------------------------------------------------

EM69
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
At any time [since [START DATE]/between [START DATE] and [END DATE]], did [you/[PERSON]] have health insurance through that job?
PROBE: By this, I mean insurance which pays for hospital bills, doctor bills, or other health expenses.

YES .................................... 1 [EM70]
NO ..................................... 2 [EM70]
REF ................................... -7 [EM70]
DK .................................... -8 [EM70]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG JOB AS 'PROVIDES HEALTH INSURANCE'.
----------------------------------------------------

EM70
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Were/Was] [you/[PERSON]] self-employed, or did [you/he/she] work for someone else at that job?

SELF-EMPLOYED .......................... 1 [EM71]
FOR SOMEONE ELSE ....................... 2 [EM71]
REF ................................... -7 [EM71]
DK .................................... -8 [EM71]
[Code One]
HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.
----------------------------------------------------
IF CODED '1' (SELF-EMPLOYED), FLAG JOB AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (FOR SOMEONE ELSE), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG JOB AS 'NOT SELF-EMPLOYED'.
----------------------------------------------------

EM71A
=====

OMITTED.

EM71
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What is the name of [the employer who paid [you/[PERSON]]/ [your/[PERSON]'s] business]?
SELECT EMPLOYER NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF EMPLOYER IS NOT ON THE LIST, CLICK ON 'ADD EMPLOYER' TO ENTER A NEW EMPLOYER.

------------------------
ROSTER. EMPLOYER
------------------------
1. Employer Name-30
------------------------
2. Employer Name-30
------------------------
3. Employer Name-30
------------------------
----------------------------------------------------
[the employer who paid [you/[PERSON]]/[your/ [PERSON]'s] business]: DISPLAY 'the employer who paid [you/[PERSON]]' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY '[your/ [PERSON]'s] BUSINESS' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
'ADD EMPLOYER' IS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD EMPLOYER' IS SELECTED, CONTINUE WITH EM74 (NOTE THAT EM74 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON EM71.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (AN EMPLOYER WAS SELECTED), GO TO BOX_16
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_1

COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY EMPLOYER NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-ESTABLISHMENTS-ROSTER FOR SELECTION OF PERSON'S JOB OR BUSINESS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED THROUGH 'ADD' BUTTON.

3. EDIT DISALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY ESTABLISHMENTS FLAGGED AS EMPLOYERS ON THE RU-ESTABLISHMENTS-ROSTER.
----------------------------------------------------

BOX_15A
=======

OMITTED.

EM72
====

OMITTED.

EM73
====

OMITTED.

EM73A
=====

OMITTED.

EM74
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
ENTER COMPLETE NAME OF EMPLOYER AND VERIFY SPELLING.
ESTABLISHMENT: [_____________] [BOX_16]

----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER, AND FLAG ESTABLISHMENT AS 'EMPLOYER'.
----------------------------------------------------

EM75
====

OMITTED.

EM76
====

OMITTED.

BOX_16
======

----------------------------------------------------
FLAG JOB SUBTYPE AS 'LAST JOB OUTSIDE REFERENCE PERIOD'.
----------------------------------------------------

BOX_17
======

----------------------------------------------------
IF PERSON IS ( 55 YEARS OLD OR IN AGE CATEGORIES 4-7, GO TO BOX_19A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH EM77
----------------------------------------------------

EM77
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[I have recorded that [you/[PERSON]] (have/has) retired from (READ JOB(S) BELOW):]

[ESTABLISHMENT PERSON RETIRED FROM..]
[ESTABLISHMENT PERSON RETIRED FROM..]
[ESTABLISHMENT PERSON RETIRED FROM..]

[[Have/Has]/Between [START DATE] and [END DATE], did] [you/[PERSON]] [ever retired/retire] from [a/any other] job or business?

YES .................................... 1 [EM78]
NO ..................................... 2 [BOX_19A]
REF ................................... -7 [BOX_19A]
DK .................................... -8 [BOX_19A]
HELP AVAILABLE FOR DEFINITION OF RETIRED.
----------------------------------------------------
[I have recorded that [you/[PERSON]] [have/has] retired from (READ JOB(S) BELOW):]: DISPLAY ENTIRE SENTENCE IF PERSON BEING ASKED ABOUT HAS ANY JOBS FLAGGED AS 'RETIRED FROM' DURING ANY PREVIOUS REFERENCE PERIOD.

[[Have/Has]/Between [START DATE] and [END DATE], did]: DISPLAY '[Have/Has]' IF ROUND 1. DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 2, 3, 4, OR 5.

[ever retired/retire]: DISPLAY 'ever retired' IF ROUND 1. DISPLAY 'retire' IF ROUND 2, 3, 4, OR 5.

[a/any other]: DISPLAY 'a' IF PERSON BEING ASKED ABOUT DOES NOT HAVE ANY JOBS FLAGGED AS 'RETIRED FROM' DURING ANY PREVIOUS REFERENCE PERIOD. DISPLAY 'any other' IF PERSON BEING ASKED ABOUT DOES HAVE AT LEAST ONE JOB FLAGGED AS 'RETIRED FROM' DURING ANY PREVIOUS REFERENCE PERIOD.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_JOBS_1

COL #1 HEADER: JOBS PERSON RETIRED FROM
INSTRUCTIONS: DISPLAY JOB NAME (JOBS.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-JOBS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY JOBS FLAGGED AS 'RETIRED FROM' DURING ANY ROUND.
----------------------------------------------------

EM78
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Some people retire from more than one job during their life. How many times [have/has] [you/[PERSON]] retired [since [START DATE]/ between [START DATE] and [END DATE]]?
NUMBER OF TIMES:

[Enter Number of Times] ................ [BOX_18]
REF ................................... -7 [BOX_18]
DK .................................... -8 [BOX_18]
HELP AVAILABLE FOR DEFINITION OF RETIRED.
----------------------------------------------------
[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF ROUNDS 2, 3, OR 4. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

BOX_18
======

----------------------------------------------------
IF ONLY JOB SUBTYPES FLAGGED AS 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' IN PERSON'S-JOBS-ROSTER, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH EM79
----------------------------------------------------

EM79
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Were any of the following jobs a job from which [you/[PERSON]] retired? (READ JOBS BELOW):

[EMPLOYER] [JOB START DATE] - [JOB END DATE]
[EMPLOYER] [JOB START DATE] - [JOB END DATE]
[EMPLOYER] [JOB START DATE] - [JOB END DATE]
YES .................................... 1 [EM80]
NO ..................................... 2 [LOOP_02]
REF ................................... -7 [LOOP_02]
DK .................................... -8 [LOOP_02]
----------------------------------------------------
DISPLAY ALL OF PERSON'S JOBS OTHER THAN CURRENT JOB WITH THE ASSOCIATED JOB START AND JOB END DATES (IF AND WHEN AVAILABLE).
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_JOBS_2

COL #1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY JOB NAME (JOBS.ESTBNAME)

COL #2 HEADER: JOB START
INSTRUCTIONS: DISPLAY START DATE (JOBS.JSTRTM, JOBS.JSTRTD, JOBS.JSTRTY)

COL #3 HEADER: JOB END
INSTRUCTIONS: DISPLAY END DATE (JOBS.JSTOPM, JOBS.JSTOPD, JOBS.JSTOPY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-JOBS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DO NOT DISPLAY JOBS WITH SUBTYPES FLAGGED AS 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'. CAPI WILL AUTOMATICALLY CODE AS '2' (NO).
----------------------------------------------------

EM80
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Which job did [you/[PERSON]] retire from [between [START DATE] and [END DATE]]?
PROBE: Any others?

[EMPLOYER] [JOB START DATE] - [JOB END DATE]
[EMPLOYER] [JOB START DATE] - [JOB END DATE]
[EMPLOYER] [JOB START DATE] - [JOB END DATE]
----------------------------------------------------
[between [START DATE] and [END DATE]]: DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY ALL OF PERSON'S JOBS OTHER THAN CURRENT JOB WITH THE ASSOCIATED JOB START AND JOB END DATES (IF AND WHEN AVAILABLE).
----------------------------------------------------
----------------------------------------------------
FLAG ALL SELECTED JOBS AS 'RETIRED FROM'.
----------------------------------------------------
----------------------------------------------------
FLAG ALL JOBS NOT SELECTED AS 'NOT RETIRED FROM'.
----------------------------------------------------
----------------------------------------------------
IF THE TOTAL NUMBER OF JOBS SELECTED AT EM80 EQUALS THE NUMBER OF TIMES RETIRED AT EM78, GO TO BOX_19A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: THE TOTAL NUMBER OF JOBS SELECTED AT EM80 MUST BE ( OR = NUMBER OF TIMES RETIRED AT EM78.
IF NOT, DISPLAY THE FOLLOWING MESSAGE: "NUMBER OF RETIRED JOBS EXCEEDS TIMES RETIRED. VERIFY AND RESELECT JOBS."
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_JOBS_2

COL #1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY JOB NAME (JOBS.ESTBNAME)

COL #2 HEADER: JOB START
INSTRUCTIONS: DISPLAY START DATE (JOBS.JSTRTM, JOBS.JSTRTD, JOBS.JSTRTY)

COL #3 HEADER: JOB END
INSTRUCTIONS: DISPLAY END DATE (JOBS.JSTOPM, JOBS.JSTOPD, JOBS.JSTOPY)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-JOBS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DO NOT DISPLAY JOBS WITH SUBTYPES FLAGGED AS 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'.
----------------------------------------------------

LOOP_02
=======

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

RETIREMENT JOB NOT YET ACCOUNTED FOR

ASK EM81-END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 ENUMERATES AND COLLECTS INFORMATION ABOUT JOBS PERSON RETIRED FROM THAT HAVE NOT YET BEEN ACCOUNTED FOR. THE NUMBER OF JOBS RETIRED FROM BUT NOT YET ACCOUNTED FOR (THE NUMBER ENTERED AT EM78 MINUS THE NUMBER OF JOBS SELECTED AT EM80, IF ANY) DETERMINES THE NUMBER OF LOOP CYCLES. '-7' (REFUSED) AND '-8' (DON'T KNOW) RESPONSES AT EM78 WILL BE TREATED AS A '1' (ONE JOB RETIRED FROM).
----------------------------------------------------

EM81
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Please think about the [first/next] employer or business [you/[PERSON]] retired from [between [START DATE] and [END DATE]].
At any time [since [START DATE]/between [START DATE] and [END DATE]], did [you/he/she] have health insurance through that job?
PROBE: By this, I mean insurance which pays for hospital bills, doctor bills, or other health expenses.

YES ................................... 1 [EM82]
NO .................................... 2 [EM82]
REF ................................... -7 [EM82]
DK .................................... -8 [EM82]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[first/next]: DISPLAY 'first' IF FIRST CYCLE THROUGH LOOP_02. DISPLAY 'next' IF NOT FIRST CYCLE THROUGH LOOP_02.

[between [START DATE] and [END DATE]]: DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.

[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG JOB AS 'PROVIDES HEALTH INSURANCE'.
----------------------------------------------------

EM82
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Were/Was] [you/[PERSON]] self-employed, or did [you/he/she] work for someone else at that job?

SELF-EMPLOYED .......................... 1 [EM83]
FOR SOMEONE ELSE ....................... 2 [EM83]
REF ................................... -7 [EM83]
DK .................................... -8 [EM83]
[Code One]
HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.
----------------------------------------------------
IF CODED '1' (SELF-EMPLOYED), FLAG JOB AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (FOR SOMEONE ELSE), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG JOB AS 'NOT SELF- EMPLOYED'.
----------------------------------------------------

EM83A
=====

OMITTED.

EM83
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What is the name of the [first/next] [employer/business] [you/[PERSON]] retired from [between [START DATE] and [END DATE]]?
SELECT EMPLOYER NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF EMPLOYER IS NOT ON THE LIST, CLICK ON 'ADD EMPLOYER' TO ENTER A NEW EMPLOYER.

------------------------
ROSTER. EMPLOYER
------------------------
1. Employer Name-30
------------------------
2. Employer Name-30
------------------------
3. Employer Name-30
------------------------
----------------------------------------------------
[first/next]: DISPLAY 'first' IF FIRST CYCLE THROUGH LOOP_02. DISPLAY 'next' IF NOT FIRST CYCLE THROUGH LOOP_02.

[employer/business]: DISPLAY 'employer' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY 'business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.

[between [START DATE] and [END DATE]]: DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
'ADD EMPLOYER' IS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD EMPLOYER' IS SELECTED, CONTINUE WITH EM86 (NOTE THAT EM86 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON EM83.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (AN EMPLOYER WAS SELECTED), GO TO BOX_19
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_1

COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY EMPLOYER NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE
RU-ESTABLISHMENTS-ROSTER FOR SELECTION OF PERSON'S JOB OR BUSINESS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED THROUGH 'ADD' BUTTON.

3. EDIT DISALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY ESTABLISHMENTS FLAGGED AS EMPLOYERS ON THE RU-ESTABLISHMENTS-ROSTER.
----------------------------------------------------

BOX_18A
=======

OMITTED.

EM84
====

OMITTED.

EM85
====

OMITTED.

EM85A
=====

OMITTED.

EM86
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
ENTER COMPLETE NAME OF EMPLOYER AND VERIFY SPELLING.
ESTABLISHMENT: [_____________] [BOX_19]

----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER, AND FLAG ESTABLISHMENT AS 'EMPLOYER'.
----------------------------------------------------

EM87
====

OMITTED.

EM88
====

OMITTED.

BOX_19
======

----------------------------------------------------
FLAG JOB SUBTYPE AS 'RETIREMENT JOB'.
----------------------------------------------------
----------------------------------------------------
FLAG JOB AS 'RETIRED FROM'.
----------------------------------------------------

EM89
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [STR-DT] [END-DT]
When did [you/[PERSON]] retire from that job?

[Enter Year-4] .........................
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
HELP AVAILABLE FOR DEFINITION OF RETIRED.
----------------------------------------------------
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1, CONTINUE WITH EM89OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP02
----------------------------------------------------

EM89OV1
=======

[Enter Month-2] .......................
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
ENTRY MUST CORRESPOND TO CALENDAR MONTHS. THAT IS,ALLOWABLE VALUES = 01-12

MISSING VALUES = -7 (REF) AND -8 (DK) ALLOWED FOR MONTH FIELD.
----------------------------------------------------
----------------------------------------------------
IF YEAR IS REFERENCE YEAR, CONTINUE WITH EM89OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP02
----------------------------------------------------

EM89OV2
=======

[Enter Day-2] ......................... [END_LP02]
REF ................................... -7 [END_LP02]
DK .................................... -8 [END_LP02]
----------------------------------------------------
HARD CHECK:
EDIT/RANGE CHECK:

ENTRIES FOR DAY FIELD MUST CORRESPOND TO CALENDAR 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 A LEAP YEAR;
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED '02' AND YEAR IS NOT A LEAP YEAR.

MISSING VALUES = -7 AND -8 ALLOWED FOR DAY FIELDS.
----------------------------------------------------
----------------------------------------------------
EDIT: JOB END DATE MUST BE = OR ) THE PERSON'S DATE OF BIRTH + 12 YEARS AND ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON. IF A DATE OF BIRTH IS NOT AVAILABLE, THEN JOB END DATE MUST BE ( OR = THE REFERENCE PERIOD END DATE FOR THIS PERSON.
----------------------------------------------------

END_LP02
========

----------------------------------------------------
IF ALL RETIREMENT JOBS ARE NOT YET ACCOUNTED FOR (THAT IS, IF EM78 ) 1, AND THE NUMBER OF CYCLES OF LOOP ( NUMBER OF RETIRED JOBS AT EM78 MINUS THE NUMBER OF JOBS SELECTED AT EM80), CYCLE TO COLLECT NEXT JOB RETIRED FROM.
----------------------------------------------------
----------------------------------------------------
WHEN ALL RETIREMENT JOBS ARE ACCOUNTED FOR (THAT IS, ALL 'TIMES RETIRED' CODED AT EM78 ARE ACCOUTED FOR), OR IF EM78 IS CODED '1', '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_02 AND CONTINUE WITH BOX_19A
----------------------------------------------------

BOX_19A
=======

-----------------------------------------------------
IF NO JOB WITH JOB SUBTYPE FLAGGED AS 'CURRENT MAIN' AND AT LEAST ONE JOB WITH JOB SUBTYPE FLAGGED AS 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD', CONTINUE WITH BOX_19B
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO BOX_20
-----------------------------------------------------

BOX_19B
=======

-----------------------------------------------------
IF ONLY ONE JOB WITH JOB SUBTYPE FLAGGED AS 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' CAPI AUTOMATICALLY CODES THAT JOB AT EM89A. THEN GO TO BOX_20
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, CONTINUE WITH EM89A
-----------------------------------------------------

EM89A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
We've recorded that [you/[PERSON]] [currently [work/works]/worked] at (READ EMPLOYER NAMES BELOW) [on December 31, [YEAR]]. Which [is/was] [your/his/her] main job or business [on December 31, [YEAR]]?

[EMPLOYER] [JOB START DATE] - [JOB END DATE]
[EMPLOYER] [JOB START DATE] - [JOB END DATE]
[EMPLOYER] [JOB START DATE] - [JOB END DATE]
-----------------------------------------------------
[currently [work/works]/worked]: DISPLAY 'currently [work/works]' IF NOT ROUND 5. DISPLAY 'worked' IF ROUND 5.

[is/was]: DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5.

[on 12/31/[YEAR]]: DISPLAY 'on 12/31/[YEAR]' WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
-----------------------------------------------------
-----------------------------------------------------
REPLACE JOB SUBTYPE 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' WITH THE NEW JOB SUBTYPE 'CURRENT MAIN' FOR THE JOB SELECTED IN EM89A.
-----------------------------------------------------
-----------------------------------------------------
NOTE: SINCE THIS JOB SUBTYPE IS SWITCHING TO A 'CURRENT MAIN' JOB, THIS JOB WILL BE ASKED ABOUT IN LOOP_03 DURING THE CURRENT ROUND.
-----------------------------------------------------
-----------------------------------------------------
GO TO BOX_20
-----------------------------------------------------
-----------------------------------------------------
ROSTER DETAILS:
Title: PERS_JOBS_2

COL #1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY JOB NAME (JOBS.ESTBNAME)

COL #2 HEADER: JOB START
INSTRUCTIONS: DISPLAY START DATE (JOBS.JSTRTM, JOBS.JSTRTD, JOBS.JSTRTY)

COL #3 HEADER: JOB END
INSTRUCTIONS: DISPLAY END DATE (JOBS.JSTOPM, JOBS.JSTOPD, JOBS.JSTOPY)
-----------------------------------------------------
-----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE PERSON'S-JOBS-ROSTER FOR SELECTION.
-----------------------------------------------------
-----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.

3. IF MORE THAN ONE JOB SELECTED, DISPLAY THE FOLLOWING ERROR MESSAGE: "ONLY ONE EMPLOYER MAY BE SELECTED. VERIFY AND RE-ENTER. CONTINUE."

4. IF NO JOB SELECTED, DISPLAY THE FOLLOWING ERROR MESSAGE: "MUST SELECT ONE EMPLOYER. CONTINUE."
-----------------------------------------------------
-----------------------------------------------------
ROSTER FILTER:
DISPLAY JOBS WITH SUBTYPE 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' WHERE PERSON STILL WORKS AT THE JOB.
-----------------------------------------------------

BOX_20
======

----------------------------------------------------
CONTINUE WITH EMPLOYMENT (EM) SECTION BOX_21
----------------------------------------------------
----------------------------------------------------
(USED TO BE EM_B)
----------------------------------------------------

BOX_21
======

----------------------------------------------------
IF EM65 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_36
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 1
AND
EM65 WAS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) IN A PREVIOUS ROUND
AND
THERE ARE NO JOBS ON PERSON'S-JOBS-ROSTER, GO TO BOX_36
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_22
----------------------------------------------------

BOX_22
======

----------------------------------------------------
IF:
JOB CREATED DURING THE CURRENT ROUND,
OR
JOB SUBTYPE SWITCHED FROM 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' TO
- 'CURRENT MAIN' OR
- 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND IS FLAGGED AS 'RETIRED FROM' DURING THE CURRENT ROUND,
OR
JOB SUBTYPE WAS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' DURING THE PREVIOUS ROUND AND IS FLAGGED AS 'RETIRED FROM' DURING THE CURRENT ROUND, CONTINUE WITH LOOP_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_31
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH ELEMENT IN PERSON'S-JOBS-ROSTER, ASK NAV_EM03 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS DETAILED INFORMATION ABOUT EACH JOB REPORTED FOR PERSON.
THIS LOOP CYCLES ON JOBS WHICH MEET THE FOLLOWING CONDITIONS:

- JOB CREATED DURING THE CURRENT ROUND
- JOB SUBTYPE SWITCHED FROM 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' TO
- 'CURRENT MAIN' OR
- 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND IS FLAGGED AS 'RETIRED FROM' DURING THE CURRENT ROUND,
- JOB SUBTYPE WAS 'FORMER MISCELLANEOUS JOB WITHINREFERENCE PERIOD' DURING THE PREVIOUS ROUND AND IS FLAGGED AS 'RETIRED FROM' DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_03 USES NAV_EM03 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_EM03
========

SERIES: Job Detail (e.g., size, type, job title, hours worked, wages, insurance, union)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

Employer
[1. Person's Prev. Round Employer Name-30] [Status-25]
[2. Person's Prev. Round Employer Name-30] [Status-25]
[3. Person's Prev. Round Employer Name-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: EMPLOYER
INSTRUCTIONS: DISPLAY PERSON'S-JOBS-ROSTER
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH JOB EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON'S-JOBS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY EACH JOB IN PERSON'S-JOBS-ROSTER THAT MEETS THE FOLLOWING CONDITIONS:

- JOB CREATED DURING THE CURRENT ROUND
- JOB SUBTYPE SWITCHED FROM 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' TO
- 'CURRENT MAIN' OR
- 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE
PERIOD' AND IS FLAGGED AS 'RETIRED FROM' DURING THE CURRENT ROUND,
- JOB SUBTYPE WAS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' DURING THE PREVIOUS ROUND AND IS FLAGGED AS 'RETIRED FROM' DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH EM90 FOR SELECTED JOB
----------------------------------------------------

EM90
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
I'd like to talk about [your/[PERSON]'s] [job at [EMPLOYER]/ business, that is [EMPLOYER]].
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------
DISPLAY 'job at [EMPLOYER]' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY 'business, that is [EMPLOYER]' IF JOB IS FLAGGED AS 'SELF-EMPLOYED'.
----------------------------------------------------

BOX_23
======

----------------------------------------------------
IF:
JOB SUBTYPE IS 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD',
OR
JOB SUBTYPE IS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND JOB IS FLAGGED AS 'NOT RETIRED FROM', GO TO BOX_27
----------------------------------------------------
----------------------------------------------------
IF JOB IS FLAGGED AS 'NOT SELF-EMPLOYED',
AND IF:
JOB SUBTYPE IS 'LAST JOB OUTSIDE REFERENCE PERIOD'(NOTE: JOB CAN BE FLAGGED AS 'RETIRED FROM' OR 'NOT RETIRED FROM'),
OR
JOB SUBTYPE IS 'RETIREMENT JOB',
OR
JOB SUBTYPE IS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND JOB IS FLAGGED AS 'RETIRED FROM', GO TO EM96
----------------------------------------------------
----------------------------------------------------
IF JOB IS FLAGGED AS 'SELF-EMPLOYED',
AND IF:
JOB SUBTYPE IS 'LAST JOB OUTSIDE REFERENCE PERIOD'(NOTE: JOB CAN BE FLAGGED AS 'RETIRED FROM' OR 'NOT RETIRED FROM'),
OR
JOB SUBTYPE IS 'RETIREMENT JOB',
OR
JOB SUBTYPE IS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND JOB IS FLAGGED AS 'RETIRED FROM', GO TO EM98
----------------------------------------------------
----------------------------------------------------
IF JOB IS FLAGGED AS 'SELF-EMPLOYED',
AND IF:
JOB SUBTYPE IS 'CURRENT MAIN',
OR
JOB SUBTYPE IS 'FORMER MAIN WITHIN REFERENCE PERIOD' (NOTE: JOB CAN BE FLAGGED AS 'RETIRED FROM' OR 'NOT RETIRED FROM'), GO TO EM94
----------------------------------------------------
----------------------------------------------------
IF JOB IS FLAGGED AS 'NOT SELF-EMPLOYED',
AND IF:
JOB SUBTYPE IS 'CURRENT MAIN',
OR
JOB SUBTYPE IS 'FORMER MAIN WITHIN REFERENCE PERIOD' (NOTE: JOB CAN BE FLAGGED AS 'RETIRED FROM' OR 'NOT RETIRED FROM'), CONTINUE WITH EM91
----------------------------------------------------

EM91
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
How many persons are employed by [EMPLOYER] in a usual week at the location where [you/[PERSON]] [[work/works]/worked]?
IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.

[Enter Number of Employees] ............ [EM93]
REF ................................... -7 [EM92]
DK .................................... -8 [EM92]
----------------------------------------------------
[[work/works]/worked]: DISPLAY '[work/works]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB'. DISPLAY 'worked' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB-WITHIN-REFERENCE- PERIOD'.
----------------------------------------------------
----------------------------------------------------
FLAG JOB AS 'FIRM-SIZE-GREATER-THAN-1'.
----------------------------------------------------
----------------------------------------------------
NOTE: FOR ROUND 5, 'DEC 31 [YEAR]', WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, WILL BE DISPLAYED IN THE CONTEXT HEADER FOR 'JOB-ED' FOR ALL CURRENT MAIN AND CURRENT MISCELLANEOUS JOBS.
THAT IS, 'DEC 31 [YEAR]' WILL BE DISPLED INSTEAD OF THE WORD 'CURRENT' FOR THESE JOB SUBTYPES.
----------------------------------------------------

EM92
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
About how many persons are employed there? Would you say:

Less than 10, .......................... 1 [EM93]
10 to 25, .............................. 2 [EM93]
26 to 49, .............................. 3 [EM93]
50 to 100, ............................. 4 [EM93]
101 to 500, ............................ 5 [EM93]
501 to 1,000, .......................... 6 [EM93]
1,001 to 5,000, ........................ 7 [EM93]
5,001 or more? ......................... 8 [EM93]
REF ................................... -7 [EM93]
DK .................................... -8 [EM93]
[Code One]

EM93
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Does [EMPLOYER] have facilities in more than one location?

YES .................................... 1 [EM96]
NO ..................................... 2 [EM96]
REF ................................... -7 [EM96]
DK .................................... -8 [EM96]
HELP AVAILABLE FOR DEFINITION OF MORE THAN ONE LOCATION.

EM94
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[Is/Was] [your/[PERSON]'s] business incorporated?

YES .................................... 1 [EM98]
NO ..................................... 2 [EM95]
REF ................................... -7 [EM98]
DK .................................... -8 [EM95]
HELP AVAILABLE FOR DEFINITION OF INCORPORATED.
----------------------------------------------------
[Is/Was]: DISPLAY 'Is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB'. DISPLAY 'Was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD'.
----------------------------------------------------

EM95
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[Is/Was] this business a sole proprietorship or a partnership?

SOLE PROPRIETORSHIP .................... 1 [EM98]
PARTNERSHIP ............................ 2 [EM98]
REF ................................... -7 [EM98]
DK .................................... -8 [EM98]
[Code One]
HELP AVAILABLE FOR DEFINITION OF SOLE PROPRIETORSHIP/PARTNERSHIP.
----------------------------------------------------
[Is/Was]: DISPLAY 'Is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB'. DISPLAY 'Was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD'.
----------------------------------------------------

EM96
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[[Are/Is]/[Were/Was]] [you/[PERSON]] an employee of:

A private company, individual or organization, .......................... 1 [EM98]
The Federal government, ................ 2 [EM97]
State government, ...................... 3 [EM99]
Local government, ...................... 4 [EM99]
The Armed Forces, or ................... 5 [EM99]
Foreign (non U.S.) government .......... 6 [EM98]
REF ................................... -7 [EM98]
DK .................................... -8 [EM98]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
[(Are/Is)/(Were/Was)]: DISPLAY '(Are/Is)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB'. DISPLAY '(Were/Was)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB- WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS- JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB'.
----------------------------------------------------

EM97
====

[PERSON'S FIRST MIDDLE LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[[Do/Does]/Did] [you/[PERSON]] work for the United States Postal Service?

YES .................................... 1 [EM99]
NO ..................................... 2 [EM99]
REF ................................... -7 [EM99]
DK .................................... -8 [EM99]
----------------------------------------------------
[(Do/Does)/Did]: DISPLAY '(Do/Does)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB'. DISPLAY 'Did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN-REFERENCE- PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB'.
----------------------------------------------------

EM98
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
What kind of business or industry [is/was] that?
PROBE: What do they make or do?
RECORD VERBATIM. TO CONTINUE, PRESS TAB AND THEN ENTER, OR SELECT NEXT PAGE.

[Enter Text] ........................... [EM99]
REF ................................... -7 [EM99]
DK .................................... -8 [EM99]
----------------------------------------------------
[is/was]: DISPLAY 'is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB'. DISPLAY 'was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER- MISCELLANEOUS-JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB'.
----------------------------------------------------
----------------------------------------------------
NOTE: ALLOW MULTIPLE LINES FOR ENTRY.
----------------------------------------------------

EM99
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
What [is/was] [your/[PERSON]'s] job called?
RECORD VERBATIM. TO CONTINUE, PRESS TAB AND THEN ENTER, OR SELECT NEXT PAGE.

[Enter Text] ........................... [EM100]
REF ................................... -7 [EM100]
DK .................................... -8 [EM100]
----------------------------------------------------
[is/was]: DISPLAY 'is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB'. DISPLAY 'was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER- MISCELLANEOUS-JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB'.
----------------------------------------------------
----------------------------------------------------
NOTE: ALLOW MULTIPLE LINES FOR ENTRY.
----------------------------------------------------

EM100
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED
ABOUT] [JOB-ST]
[JOB-ED]
What [[do/does]/did] [you/[PERSON]] actually do at that job? What
[are/were] some of [your/his/her] most important activities or
duties?
RECORD VERBATIM. TO CONTINUE, PRESS TAB AND THEN ENTER, OR
SELECT NEXT PAGE.

[Enter Text] ...........................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
[[do/does]/did]: DISPLAY '[do/does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB'. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN-REFERENCE- PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB'.

[are/were]: DISPLAY 'are' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB'. DISPLAY 'were' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER- MISCELLANEOUS-JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB'.
----------------------------------------------------
----------------------------------------------------
NOTE: ALLOW MULTIPLE LINES FOR ENTRY.
----------------------------------------------------
----------------------------------------------------
IF JOB SUBTYPE IS 'CURRENT MAIN', GO TO EM104
----------------------------------------------------
----------------------------------------------------
IF JOB IS FLAGGED AS 'SELF-EMPLOYED',
AND IF:
JOB SUBTYPE IS 'FORMER MAIN WITHIN REFERENCE PERIOD' AND IS FLAGGED AS 'NOT RETIRED FROM',
OR
JOB SUBTYPE IS 'LAST JOB OUTSIDE REFERENCE PERIOD'AND IS FLAGGED AS 'NOT RETIRED FROM', GO TO EM102
----------------------------------------------------
----------------------------------------------------
IF:
JOB SUBTYPE IS 'RETIREMENT JOB',
OR
JOB SUBTYPE IS 'FORMER MAIN WITHIN REFERENCE PERIOD' AND IS FLAGGED AS 'RETIRED FROM',
OR
JOB SUBTYPE IS 'LAST JOB OUTSIDE REFERENCE PERIOD' AND IS FLAGGED AS 'RETIRED FROM'
OR
JOB SUBTYPE IS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND FLAGGED AS 'RETIRED FROM', GO TO BOX_24
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH EM101
----------------------------------------------------

EM101
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
What is the main reason that [you/[PERSON]] no longer [have/has] this job?

JOB ENDED .............................. 1 [BOX_24]
RETIRED ................................ 2 [BOX_24]
ILLNESS OR INJURY ...................... 3 [BOX_24]
LAID OFF ............................... 4 [BOX_24]
QUIT TO HAVE A BABY .................... 5 [BOX_24]
QUIT TO GO TO SCHOOL ................... 6 [BOX_24]
QUIT TO TAKE CARE OF HOME OR FAMILY .... 7 [BOX_24]
QUIT BECAUSE WANTED TIME OFF ........... 8 [BOX_24]
QUIT TO TAKE OTHER JOB ................. 9 [BOX_24]
OTHER ................................. 91 [EM101OV]
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

EM101OV
=======

SPECIFY:

[Enter Other Specify] .................. [BOX_24]
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]

BOX_24
======

----------------------------------------------------
IF:
JOB SUBTYPE IS 'LAST JOB OUTSIDE REFERENCE PERIOD'(NOTE: JOB CAN BE FLAGGED AS 'RETIRED FROM' OR 'NOT RETIRED FROM'),
OR
JOB SUBTYPE IS 'RETIREMENT JOB',
OR
JOB SUBTYPE IS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND IS FLAGGED AS 'RETIRED FROM', GO TO BOX_28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM104
----------------------------------------------------

EM102
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
What is the main reason that [you/[PERSON]] no longer [have/has] this business?

BUSINESS DISSOLVED OR SOLD ............. 1 [BOX_25]
RETIRED ................................ 2 [BOX_25]
ILLNESS OR INJURY ...................... 3 [BOX_25]
STOPPED/LEFT BUSINESS TO HAVE A BABY ... 4 [BOX_25]
STOPPED/LEFT BUSINESS TO GO TO SCHOOL .. 5 [BOX_25]
STOPPED/LEFT BUSINESS TO TAKE CARE OF HOME OR FAMILY ....................... 6 [BOX_25]
STOPPED/LEFT BUSINESS BECAUSE WANTED TIME OFF ............................. 7 [BOX_25]
STOPPED/LEFT BUSINESS TO TAKE OTHER JOB ................................. 8 [BOX_25]
OTHER ................................. 91 [EM102OV]
REF ................................... -7 [BOX_25]
DK .................................... -8 [BOX_25]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

EM102OV
=======

SPECIFY:

[Enter Other Specify] .................. [BOX_25]
REF ................................... -7 [BOX_25]
DK .................................... -8 [BOX_25]

BOX_25
======

----------------------------------------------------
IF JOB SUBTYPE IS 'LAST JOB OUTSIDE REFERENCE PERIOD' (NOTE: JOB MUST BE FLAGGED AS 'NOT RETIRED FROM'), GO TO BOX_28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM104
----------------------------------------------------

EM103
=====

OMITTED.

EM104
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
For the next questions, please remember that we are talking about the period between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD].
Often the actual number of hours people work is different from the number of hours on which their salaries are based. How many hours per week [[do/does]/did] [you/[PERSON]] usually work at [EMPLOYER]? Include all the hours [you/he/she] usually [[spend/spends]/spent] working on this job, except for any unpaid travel to and from the job.

[Enter Hours Per Week] ................. [EM105C]
REF ................................... -7 [EM105]
DK .................................... -8 [EM105]
HELP AVAILABLE FOR DEFINITION OF ACTUAL HOURS WORKED PER WEEK.
----------------------------------------------------
[[do/does]/did]: DISPLAY '[do/does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN- JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.

[spends/spent]: DISPLAY 'spends' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'spent' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.

[START DATE OF REFERENCE PERIOD]: DISPLAY THE START DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[END DATE OF REFERENCE PERIOD]: DISPLAY THE END DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
NOTE: ALLOW ONLY WHOLE HOURS, NO FRACTIONS.
----------------------------------------------------
----------------------------------------------------
HARD CHECK: WHOLE NUMBERS 1-168.
----------------------------------------------------

EM105
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[[Do/Does]/Did] [you/[PERSON]] work at least 35 hours a week at this job?

YES .................................... 1 [EM105C]
NO ..................................... 2 [EM105C]
REF ................................... -7 [EM105C]
DK .................................... -8 [EM105C]
----------------------------------------------------
[[Do/Does]/Did]: DISPLAY '[Do/Does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'Did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN- JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EM105A
======

OMITTED.

EM105AOV
========

OMITTED.

EM105B
======

OMITTED.

EM105C
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Some people are in temporary jobs that last only for a limited time or until the completion of a project. [Is/Was] [your/ [PERSON]'s] job at [EMPLOYER] temporary?

YES ................................... 1 [EM105D]
NO .................................... 2 [EM105D]
REF ................................... -7 [EM105D]
DK .................................... -8 [EM105D]
----------------------------------------------------
[Is/Was]: DISPLAY 'Is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'Was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB-WITHIN- REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EM105D
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[Is/Was] [your/[PERSON]'s] job at [EMPLOYER] a year round job or [is/was] it only available during certain times of the year?
[Teachers and other school personnel who work only during the school year should consider themselves to have a year round job.]

YEAR ROUND ............................ 1 [BOX_26]
NOT YEAR ROUND ........................ 2 [BOX_26]
REF ................................... -7 [BOX_26]
DK .................................... -8 [BOX_26]
[Code One]
----------------------------------------------------
[Is/Was] and [is/was]: DISPLAY 'Is' and 'is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND ISNOT ROUND 5. DISPLAY 'Was' and 'was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

BOX_26
======

----------------------------------------------------
IF JOB IS FLAGGED AS 'SELF-EMPLOYED', GO TO BOX_28
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_26A
----------------------------------------------------

BOX_26A
=======

----------------------------------------------------
ASK THE EMPLOYMENT WAGE (EW) SECTION

AT COMPLETION OF EMPLOYMENT WAGE (EW) SECTION, CONTINUE WITH BOX_26B
----------------------------------------------------

BOX_26B
=======

----------------------------------------------------
IF EW05OV1 IS CODED '2' (PER DAY)
OR
EW24AOV1, EW24BOV1, OR EW24COV1 IS CODED '2' (PER DAY) FOR THIS JOB, CONTINUE WITH EM106
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM107
----------------------------------------------------

EM106
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Approximately how many hours per day [[do/does]/did] [you/[PERSON]] work?

[Enter Hours per Day] .................. [EM107]
REF ................................... -7 [EM107]
DK .................................... -8 [EM107]
----------------------------------------------------
[(do/does)/did]: DISPLAY '(do/does)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN- JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EM107
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
On this job, [[do/does]/did] [you/[PERSON]] have paid time off if [you/he/she] [[are/is]/[were/was]] sick?

YES .................................... 1 [EM108]
NO ..................................... 2 [EM109]
REF ................................... -7 [EM109]
DK .................................... -8 [EM109]
----------------------------------------------------
[(do/does)/did]: DISPLAY '(do/does)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN- JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.

[(are/is)/(were/was)]: DISPLAY '(are/is)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND ISNOT ROUND 5. DISPLAY '(were/was)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EM108
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[Can/Could] [you/[PERSON]] [take/have taken] paid sick leave if [you/he/she] [[have/has]/had] to visit a doctor?

YES .................................... 1 [EM109]
NO ..................................... 2 [EM109]
REF ................................... -7 [EM109]
DK .................................... -8 [EM109]
----------------------------------------------------
[Can/Could]: DISPLAY 'Can' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'Could' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB- WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.

[take/have taken]: DISPLAY 'take' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'have taken' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.

[[have/has]/had]: DISPLAY '[have/has]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'had' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EM109
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
On this job, [[do/does]/did] [you/[PERSON]] get paid vacation?

YES .................................... 1 [EM110]
NO ..................................... 2 [EM110]
REF ................................... -7 [EM110]
DK .................................... -8 [EM110]
----------------------------------------------------
[[do/does]/did]: DISPLAY '[do/does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EM110
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Not including Social Security or Railroad Retirement, [[are/is]/[were/was]] [you/[PERSON]] covered by a pension or retirement plan or [[do/does]/did] [you/he/she] have a 401K plan on this job?

YES .................................... 1 [BOX_28]
NO ..................................... 2 [BOX_28]
REF ................................... -7 [BOX_28]
DK .................................... -8 [BOX_28]
HELP AVAILABLE FOR DEFINITIONS OF PENSION/RETIREMENT PLAN.
----------------------------------------------------
[[are/is]/[were/was]]: DISPLAY '[are/is]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY '(were/was)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.

[[do/does]/did]: DISPLAY '[do/does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN- JOB-WITHIN-REFERENCE-PERIOD' OR IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

BOX_27
======

----------------------------------------------------
IF JOB SUBTYPE IS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND JOB DOES NOT PROVIDE HEALTH INSURANCE (EM52 IS CODED '2' (NO)), GO TO EM114
----------------------------------------------------
----------------------------------------------------
IF JOB SUBTYPE IS 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' AND JOB IS FLAGGED AS 'PROVIDES HEALTH INSURANCE' (EM52 IS CODED '1'(YES)), GO TO EM115
----------------------------------------------------
----------------------------------------------------
IF JOB SUBTYPE IS 'FORMER MISCELLANEOUS JOB WITHINREFERENCE PERIOD' AND EM52 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO EM116
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., JOB SUBTYPE IS 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'), CONTINUE WITH EM111
----------------------------------------------------

EM111
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[Since [START DATE OF REFERENCE PERIOD]/Between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]], how many hours [[do/does]/did] [you/[PERSON]] work at this job during a typical week?

[Enter Hours Per Week] ................. [EM111C]
REF ................................... -7 [EM111C]
DK .................................... -8 [EM111C]
HELP AVAILABLE FOR DEFINITION OF ACTUAL HOURS WORKED PER WEEK.
----------------------------------------------------
[Since [START DATE OF REFERENCE PERIOD]/Between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]]:
DISPLAY 'Since [START DATE OF REFERENCE PERIOD]' IF NOT ROUND 5. DISPLAY 'Between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]' IF ROUND 5.

[START DATE OF REFERENCE PERIOD]: DISPLAY THE START DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[END DATE OF REFERENCE PERIOD]: DISPLAY THE END DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[(do/does)/did]: DISPLAY '(do/does)' IF NOT ROUND 5. DISPLAY 'did' IF ROUND 5.
----------------------------------------------------

EM111A
======

OMITTED.

EM111AOV
========

OMITTED.

EM111B
======

OMITTED.

EM111C
======

YES ................................... 1 [EM111D]
NO .................................... 2 [EM111D]
REF ................................... -7 [EM111D]
DK .................................... -8 [EM111D]
----------------------------------------------------
[Is/Was]: DISPLAY 'Is' IF CURRENT ROUND IS NOT ROUND 5. DISPLAY 'Was' IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EM111D
======

YEAR ROUND ............................ 1 [EM112]
NOT YEAR ROUND ........................ 2 [EM112]
REF ................................... -7 [EM112]
DK .................................... -8 [EM112]
[Code One]
----------------------------------------------------
[Is/Was] AND [is/was]: DISPLAY 'Is' AND 'is' IF CURRENT ROUND IS NOT ROUND 5. DISPLAY 'Was' AND 'was' IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EM112
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[Since [START DATE OF REFERENCE PERIOD]/Between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]], what [is/was] [your/[PERSON]'s] usual weekly income before deductions for taxes or anything else from [your/his/her] job with [EMPLOYER]?

[Enter $ Per Week] ..................... [BOX_28]
REF ................................... -7 [BOX_28]
DK .................................... -8 [BOX_28]
----------------------------------------------------
[Since [START DATE OF REFERENCE PERIOD]/Between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]]:
DISPLAY 'Since [START DATE OF REFERENCE PERIOD]' IF NOT ROUND 5. DISPLAY 'Between [START DATE OF REFERENCE PERIOD] and [ENDDATE OF REFERENCE PERIOD]' IF ROUND 5.

[START DATE OF REFERENCE PERIOD]: DISPLAY THE START DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[END DATE OF REFERENCE PERIOD]: DISPLAY THE END DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[is/was]: DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5.
----------------------------------------------------

BOX_28
======

----------------------------------------------------
IF EM96 IS CODED '5' (THE ARMED FORCES), GO TO BOX_30
----------------------------------------------------
----------------------------------------------------
IF EM96 IS NOT CODED '5' AND JOB SUBTYPE IS NOT 'CURRENT MAIN' AND JOB IS FLAGGED AS 'PROVIDES HEALTH INSURANCE', GO TO EM115
----------------------------------------------------
----------------------------------------------------
IF EM96 IS NOT CODED '5' AND JOB SUBTYPE IS NOT 'CURRENT MAIN' AND JOB IS NOT FLAGGED AS 'PROVIDES HEALTH INSURANCE' (I.E., CODED '2' (NO)) GO TO EM114
----------------------------------------------------
----------------------------------------------------
IF EM96 IS NOT CODED '5' AND JOB SUBTYPE IS NOT 'CURRENT MAIN' AND 'PROVIDES HEALTH INSURANCE' STATUS FLAG IS '-7' (REFUSED) OR '-8' (DON'T KNOW) GO TO EM116
----------------------------------------------------
----------------------------------------------------
IF EM96 IS NOT CODED '5' AND JOB SUBTYPE IS 'CURRENT MAIN', CONTINUE WITH EM113
----------------------------------------------------

EM113
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
At any time [since [START DATE OF REFERENCE PERIOD]/between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]], did [you/[PERSON]] have health insurance through this [job/business]?
PROBE: By this, I mean insurance which pays for hospital bills, doctor bills, or other health expenses.

YES .................................... 1 [EM115]
NO ..................................... 2 [EM114]
REF ................................... -7 [EM116]
DK .................................... -8 [EM116]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[since [START DATE OF REFERENCE PERIOD]/between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]]: DISPLAY 'since [START DATE OF REFERENCE PERIOD]' IF NOT ROUND 5. DISPLAY 'between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]' IF ROUND 5.

[START DATE OF REFERENCE PERIOD]: DISPLAY THE
START DATE OF THE CURRENT REFERENCE PERIOD FOR
THIS PERSON.

[END DATE OF REFERENCE PERIOD]: DISPLAY THE END DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[job/business]: DISPLAY 'job' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY 'business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG JOB AS 'PROVIDES HEALTH INSURANCE'.
----------------------------------------------------

EM114
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[Earlier I recorded that [you/[PERSON]] did not have health insurance through [EMPLOYER]. [Since [START OF REFERENCE PERIOD]/Between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]]]
[Were/Was] [you/[PERSON]] offered health insurance through this [job/business]?

YES .................................... 1 [EM115]
NO ..................................... 2 [EM115A]
REF ................................... -7 [EM116]
DK .................................... -8 [EM116]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE.
----------------------------------------------------
[since [START DATE OF REFERENCE PERIOD]/between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]]: DISPLAY 'since [START DATE OF REFERENCE PERIOD]' IF NOT ROUND 5. DISPLAY 'between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD]' IF ROUND 5.

[START DATE OF REFERENCE PERIOD]: DISPLAY THE START DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[END DATE OF REFERENCE PERIOD]: DISPLAY THE END DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[job/business]: DISPLAY 'job' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY 'business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.
----------------------------------------------------

EM115
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[Even though [you/he/she] chose not to take health insurance, did/Did] [you/[PERSON]] have a choice of different health insurance plans that provided hospital and physician benefits or was only one health insurance plan offered through this [job/business]?

YES, MORE THAN ONE PLAN ................ 1 [EM116]
NO, ONLY ONE PLAN ...................... 2 [EM116]
REF ................................... -7 [EM116]
DK .................................... -8 [EM116]
[Code One]
HELP AVAILABLE FOR DEFINITION OF CHOICE OF HEALTH INSURANCE PLANS.
----------------------------------------------------
[Even though [you/he/she] chose not to take health insurance, did/Did]: DISPLAY 'Even though [you/he/she] chose not to take health insurance, did' IF JOB IS NOT FLAGGED AS PROVIDING HEALTH INSURANCE. DISPLAY 'Did' IF JOB IS FLAGGED AS PROVIDING HEALTH INSURANCE.

[job/business]: DISPLAY 'job' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY 'business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.
----------------------------------------------------

EM115A
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Was health insurance offered to any employees at this [job/business]?

YES .................................... 1 [EM116]
NO ..................................... 2 [EM116]
REF ................................... -7 [EM116]
DK .................................... -8 [EM116]
----------------------------------------------------
DISPLAY 'job' IF JOB IS FLAGGED AS 'NOT SELF- EMPLOYED'. DISPLAY 'business' IF JOB IS FLAGGED AS 'SELF-EMPLOYED'.
----------------------------------------------------

EM115B
======

OMITTED.

EM115BOV
========

OMITTED.

EM116
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[[Do/Does]/Did] [you/[PERSON]] belong to a labor union at [EMPLOYER]?

YES .................................... 1
NO ..................................... 2 [BOX_30]
REF ................................... -7 [BOX_30]
DK .................................... -8 [BOX_30]
HELP AVAILABLE FOR DEFINITION OF LABOR UNION.
----------------------------------------------------
[[Do/Does]/Did]: DISPLAY '[Do/Does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'Did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER- MISCELLANEOUS-JOB-WITHIN-REFERENCE-PERIOD', 'LAST -JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT- JOB' OR IF CURRENT ROUND IS ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND JOB IS FLAGGED AS 'PROVIDES HEALTH INSURANCE', CONTINUE WITH EM117
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_30
----------------------------------------------------

EM117
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Does the health insurance provided through this [job/business] come from [your/[PERSON]'s] [employer/business] or union?

EMPLOYER ............................... 1 [BOX_30]
UNION .................................. 2 [EM118]
BOTH EMPLOYER AND UNION ................ 3 [EM118]
REF ................................... -7 [BOX_30]
DK .................................... -8 [BOX_30]
[Code One]
HELP AVAILABLE FOR DEFINITION OF LABOR UNION.
----------------------------------------------------
[job/business]: DISPLAY 'job' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF-EMPLOYED'. DISPLAY 'business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.

[employer/business]: DISPLAY 'employer' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'NOT SELF- EMPLOYED'. DISPLAY 'business' IF JOB BEING ASKED ABOUT IS FLAGGED AS 'SELF-EMPLOYED'.
----------------------------------------------------

EM118A
======

OMITTED.

EM118
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
What is the name of the union providing the health insurance?
SELECT UNION NAME BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF UNION IS NOT ON THE LIST, CLICK ON 'ADD UNION' TO ENTER A NEW UNION.

------------------------
ROSTER. NAME OF UNION
------------------------
1. Union Name-30
-----------------------
2. Union Name-30
-----------------------
3. Union Name-30
------------------------
----------------------------------------------------
'ADD UNION' IS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW DISALLOWED.
----------------------------------------------------
----------------------------------------------------
IF 'ADD UNION' IS SELECTED, CONTINUE WITH EM120 (NOTE THAT EM120 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON EM118.)
----------------------------------------------------
----------------------------------------------------
OTHERWISE (A UNION WAS SELECTED), GO TO BOX_29
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_2

COL # 1 HEADER: UNION
INSTRUCTIONS: DISPLAY UNION NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS THE RU-ESTABLISHMENTS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. ADD ALLOWED THROUGH 'ADD' BUTTON.

3. EDIT DISALLOWED.

4. LIMITED DELETE ALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL UNIONS.
----------------------------------------------------

BOX_28A
=======

OMITTED.

EM119
=====

OMITTED.

EM120
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
ENTER COMPLETE UNION NAME AND VERIFY SPELLING.
ESTABLISHMENT: [_____________] [BOX_29]

----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER
----------------------------------------------------

EM121
=====

OMITTED.

BOX_29
======

----------------------------------------------------
FLAG ESTABLISHMENT AS 'UNION'.
----------------------------------------------------

BOX_30
======

----------------------------------------------------
IF JOB FLAGGED AS 'NOT SELF-EMPLOYED', GO TO END_LP03
----------------------------------------------------
----------------------------------------------------
IF JOB FLAGGED AS 'SELF-EMPLOYED' AND MORE THAN 1 RU MEMBER (OTHER THAN THE PERSON BEING ASKED ABOUT) IS = OR ) 16 YEARS OF AGE OR IN AGE CATEGORIES 4-9, CONTINUE WITH EM122
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM124
----------------------------------------------------

EM122
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[Does/Did] any other member of the household [now] work regularly at [your/[PERSON]'s] business?

YES .................................... 1 [EM124]
NO ..................................... 2 [EM124]
REF ................................... -7 [EM124]
DK .................................... -8 [EM124]
----------------------------------------------------
[Does/Did]: DISPLAY 'Does' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'Did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER-MAIN-JOB-WITHIN- REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB- WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR IF CURRENT ROUND IS ROUND 5.

[now]: DISPLAY 'now' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'CURRENT-MAIN- JOB' OR IS FLAGGED AS A 'CURRENT-MISCELLANEOUS- JOB' AND CURRENT ROUND IS NOT ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

EM123
=====

OMITTED.

EM124
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
What was the total number of employees who worked at the business [last week/just before [you/[PERSON]] stopped working at that business/on [END DATE OF REFERENCE PERIOD]]? Be sure to include the owner [and all other household members you just told me about].

[Enter Number of Employees] ............ [END_LP03]
REF ................................... -7 [END_LP03]
DK .................................... -8 [END_LP03]
----------------------------------------------------
[last week/just before [you/[PERSON]] stopped working at that business/on [END DATE OF REFERENCE PERIOD]]: DISPLAY 'last week' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT- MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5.

DISPLAY 'just before [you/[PERSON]] stopped working at that business' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'FORMER- MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER- MISCELLANEOUS-JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB'.

DISPLAY 'on [END DATE OF REFERENCE PERIOD]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS ROUND 5.

[END DATE OF REFERENCE PERIOD]: DISPLAY THE END DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[and all other household members you just told me about]: DISPLAY PHRASE IF EM122 IS CODED '1' (YES).
----------------------------------------------------
----------------------------------------------------
IF '1' ENTERED FOR THE NUMBER OF EMPLOYEES, FLAG JOB AS 'FIRM-SIZE-1'.
----------------------------------------------------
----------------------------------------------------
IF A NUMBER ) 1 ENTERED FOR THE NUMBER OF EMPLOYEES OR CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), FLAG JOB AS 'FIRM-SIZE-GREATER-THAN-1'.
----------------------------------------------------

END_LP03
========

----------------------------------------------------
CYCLE ON NEXT JOB IN PERSON'S-JOBS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER JOBS MEET THE STATED CONDITIONS, END LOOP_03 AND CONTINUE WITH BOX_31
----------------------------------------------------

BOX_31
======

----------------------------------------------------
IF PERSON HAS HAD NO JOBS DURING REFERENCE PERIOD, CONTINUE WITH EM126
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO EM128
----------------------------------------------------

EM125
=====

OMITTED.

EM126
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What is the main reason [you/[PERSON]] did not work [since [START DATE]/between [START DATE] and [END DATE]]?

COULD NOT FIND WORK .................... 1 [BOX_36A]
RETIRED ................................ 2 [BOX_36A]
UNABLE TO WORK BECAUSE ILL/DISABLED .... 3 [BOX_36A]
ON TEMPORARY LAYOFF .................... 4 [BOX_36A]
MATERNITY/PATERNITY LEAVE .............. 5 [BOX_36A]
GOING TO SCHOOL ........................ 6 [BOX_36A]
TAKING CARE OF HOME OR FAMILY .......... 7 [BOX_36A]
WANTED SOME TIME OFF ................... 8 [BOX_36A]
WAITING TO START NEW JOB ............... 9 [BOX_36A]
OTHER ................................. 91 [EM126OV]
REF ................................... -7 [BOX_36A]
DK .................................... -8 [BOX_36A]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
NOTE: FOR ROUND 5, DISPLAY THE PERSON'S CURRENT ROUND REFERENCE PERIOD END DATE IN THE CONTEXT HEADER FOR QUESTIONS EM126 AND EM128.
----------------------------------------------------

EM126OV
=======

SPECIFY:

[Enter Other Specify] .................. [BOX_36A]
REF ................................... -7 [BOX_36A]
DK .................................... -8 [BOX_36A]

EM127
=====

OMITTED.

EM127OV
=======

OMITTED.

EM128
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Please think about all the time [you/[PERSON]] [have/has] worked [since [START DATE]/between [START DATE] and [END DATE]], including paid vacation, sick leave, or other paid leave. How many weeks did [you/he/she] work for pay either full or part time?
NUMBER OF WEEKS IN REFERENCE PERIOD: [NUMBER OF WEEKS]
IF WORKED LESS THAN ONE WEEK, ENTER '1' FOR NUMBER OF WEEKS.

[Enter Number of Weeks] ................
WORKED THE WHOLE TIME ................. 96 [BOX_36A]
REF ................................... -7 [BOX_36A]
DK .................................... -8 [BOX_36A]
HELP AVAILABLE FOR DEFINITIONS OF WEEKS WORKED/WORK FOR PAY.
----------------------------------------------------
[since [START DATE]/between [START DATE] and [END DATE]]: DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: NUMBER OF WEEKS ENTERED CANNOT BE GREATER THAN NUMBER OF WEEKS IN REFERENCE PERIOD.
----------------------------------------------------
----------------------------------------------------
SPECIAL CHECK:
THE VALUES FOR WEKSWRKD SHOULD BE BETWEEN 0 AND 75AND SHOULD ALSO INCLUDE 96. 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.
----------------------------------------------------

EM129
=====

OMITTED.

EM130
=====

OMITTED.

EM131
=====

OMITTED.

LOOP_04
=======

OMITTED.

BOX_32
======

OMITTED.

EM132
=====

OMITTED.

EM132OV
=======

OMITTED.

EM133
=====

OMITTED.

EM133OV
=======

OMITTED.

END_LP04
========

OMITTED.

EM134
=====

OMITTED.

EM135
=====

OMITTED.

EM136
=====

OMITTED.

EM137
=====

OMITTED.

LOOP_05
=======

OMITTED.

BOX_33
======

OMITTED.

EM138
=====

OMITTED.

EM138OV
=======

OMITTED.

EM139
=====

OMITTED.

EM139OV
=======

OMITTED.

END_LP05
========

OMITTED.

BOX_34
======

OMITTED.

BOX_35
======

OMITTED.

EM140
=====

OMITTED.

EM141
=====

OMITTED.

EM141OV
=======

OMITTED.

EM142
=====

OMITTED.

BOX_36A
=======

-----------------------------------------------------
IF ROUND 3, CONTINUE WITH EM143
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE (I.E., IF NOT ROUND 3), GO TO BOX_36
-----------------------------------------------------

EM143
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT] [Were/Was] [you/[PERSON]] working as of December 31, [YEAR]?

YES .................................... 1 [BOX_36]
NO ..................................... 2 [BOX_36]
REF ................................... -7 [BOX_36]
DK .................................... -8 [BOX_36]
-----------------------------------------------------
(FOR SPECIFICATION PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): 'YEAR' IN QUESTION TEXT IS FIRST CALENDAR YEAR OF PANEL.
-----------------------------------------------------

BOX_36
======

-----------------------------------------------------
CONTINUE WITH END_LP00 (IN OVERALL STRUCTURE OF EMPLOYMENT)
-----------------------------------------------------

Employment Wage (EW) Section

BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, ESTB.ESTBNAME, JOBS.JSTARTM, JOBS.JSTARTD, JOBS.JSTARTY, JOBS.JSTOPM, JOBS.JSTOPD, JOBS.JSTOPY
----------------------------------------------------

EW01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
[For the next few questions, please think about the time between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD] and what [you/[PERSON]] [were/was] making then.] At [EMPLOYER], [[are/is]/[were/was]] [you/[PERSON]] salaried, paid by the hour, or paid some other way?
IF SALARIED AND RECEIVES TIPS, BONUS, OR COMMISSION, SELECT 'SALARIED'.
IF PAID BY THE HOUR AND RECEIVES TIPS, BONUS, OR COMMISSION, SELECT 'PAID BY THE HOUR'.

SALARIED ............................... 1 [EW11]
PAID BY THE HOUR ....................... 2 [EW18]
PAID SOME OTHER WAY .................... 3 [EW02]
REF ................................... -7 [EW08]
DK .................................... -8 [EW07]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
[For the next few questions, please think about the time between [START DATE OF REFERENCE PERIOD] and [END DATE OF REFERENCE PERIOD] and what (PERSON) was making then.]: DISPLAY THIS SENTENCE IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.

[START DATE OF REFERENCE PERIOD]: DISPLAY THE START DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[END DATE OF REFERENCE PERIOD]: DISPLAY THE END DATE OF THE CURRENT REFERENCE PERIOD FOR THIS PERSON.

[(are/is)/(were/was)]: DISPLAY '(are/is)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY '(were/was)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN-REFERENCE- PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
How [[are/is]/[were/was]] [you/[PERSON]] paid?

BY THE DAY ............................. 1 [EW03]
PIECEWORK .............................. 2 [EW05]
COMMISSION ............................. 3 [EW23]
BONUS .................................. 4 [EW23]
BY THE JOB/MILE ........................ 5 [EW05]
OTHER ................................. 91 [EW02OV]
REF ................................... -7 [EW08]
DK .................................... -8 [EW07]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
[(are/is)/(were/was)]: DISPLAY '(are/is)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY '(were/was)' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN-REFERENCE- PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW02OV
======

SPECIFY:

[Enter Other Specify] .................. [EW05]
REF ................................... -7 [EW05]
DK .................................... -8 [EW05]

EW03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
What [is/was] [your/[PERSON]'s] daily wage rate?

[Enter $ Per Day] ..................... [EW04]
REF ................................... -7 [EW08]
DK .................................... -8 [EW07]
----------------------------------------------------
[is/was]: DISPLAY 'is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE- PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN- REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE- PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
How many hours [[do/does]/did] [you/[PERSON]] usually work per day?

[Enter Hours]........................... [EW23]
REF ................................... -7 [EW23]
DK .................................... -8 [EW23]
----------------------------------------------------
[[do/does]/did]: DISPLAY '[do/does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT- MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS- JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
How much [[do/does]/did] [you/[PERSON]] usually make this way?
AMOUNT:

[Enter $ Amount] ....................... [EW05OV1]
REF ................................... -7 [EW08]
DK .................................... -8 [EW07]
----------------------------------------------------
[[do/does]/did]: DISPLAY '[do/does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT- MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS- JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW05OV1
=======

PER PERIOD:

PER HOUR ............................... 1 [EW23]
PER DAY ................................ 2 [EW23]
PER WEEK ............................... 3 [EW23]
PER TWO-WEEK PERIOD .................... 4 [EW23]
PER MONTH .............................. 5 [EW23]
PER YEAR ............................... 6 [EW23]
OTHER ................................. 91 [EW05OV2]
REF ................................... -7 [EW23]
DK .................................... -8 [EW23]
[Code One]

EW05OV2
=======

SPECIFY:

[Enter Other Specify] .................. [EW23]
REF ................................... -7 [EW23]
DK .................................... -8 [EW23]

EW06
====

OMITTED.

EW07
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
I would just like to get a rough idea of how much [you/[PERSON]] [[earn/earns]/earned] at this job. Approximately how much [[do/does]/did] [you/he/she] make per hour?

[Enter $ Per Hour] ..................... [EW23]
REF ................................... -7 [EW23]
DK .................................... -8 [EW08]
----------------------------------------------------
[[earn/earns]/earned]: DISPLAY '[earn/earns]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'earned' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN-REFERENCE- PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.

[[do/does]/did]: DISPLAY '[do/does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT- MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS- JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Could you just tell me if [you/[PERSON]] [[make/makes]/made] more or less than $10 an hour at this job?

$10 OR MORE ............................ 1 [EW09]
LESS THAN $10 .......................... 2 [EW10]
REF ................................... -7 [EW23]
DK .................................... -8 [EW23]
[Code One]
----------------------------------------------------
[[make/makes]/made]: DISPLAY '[make/makes]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'made' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN-REFERENCE- PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
More or less than $15 an hour?

$15 OR MORE ............................ 1 [EW23]
LESS THAN $15 .......................... 2 [EW23]
REF ................................... -7 [EW23]
DK .................................... -8 [EW23]
[Code One]

EW10
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
More or less than $7.25 an hour?

$7.25 OR MORE ......................... 1 [EW23]
LESS THAN $7.25 ....................... 2 [EW23]
REF ................................... -7 [EW23]
DK .................................... -8 [EW23]
[Code One]
----------------------------------------------------
THE MINIMUM WAGE AMOUNT WAS INCREASED FROM $5.15 TO $5.85 IN PANEL 12 ROUND 3 AND PANEL 13 ROUND 1.

THE MINIMUM WAGE AMOUNT WAS INCREASED FROM $5.85 TO $6.55 IN PANEL 12 ROUND 4 AND PANEL 13 ROUND 2.

THE MINIMUM WAGE AMOUNT WAS INCREASED FROM $6.55 TO $7.25 IN PANEL 13 ROUND 4 AND PANEL 14 ROUND 2.
----------------------------------------------------

EW11
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED BOUT] [JOB-ST] [JOB-ED]
How much [is/was] [your/[PERSON]'s] salary before taxes, not including tips, commissions, or bonuses?
AMOUNT:

[Enter $ Amount] ....................... [EW11OV1]
REF ................................... -7 [EW14]
DK .................................... -8 [EW13]
----------------------------------------------------
[is/was]: DISPLAY 'is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE- PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN- REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE- PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW11OV1
=======

PER PERIOD:

PER YEAR ............................... 1 [EW12]
PER MONTH .............................. 2 [EW17]
PER TWO-WEEK PERIOD .................... 3 [EW17]
PER WEEK ............................... 4 [EW17]
OTHER ................................. 91 [EW11OV2]
REF ................................... -7 [EW14]
DK .................................... -8 [EW13]
[Code One]

EW11OV2
=======

SPECIFY:

[Enter Other Specify] .................. [EW17]
REF ................................... -7 [EW17]
DK .................................... -8 [EW17]

BOX_01
======

OMITTED.

EW12
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
On how many weeks of work per year [is/was] this salary based?

[Enter Number of Weeks] ................ [EW17]
REF ................................... -7 [EW17]
DK .................................... -8 [EW17]
----------------------------------------------------
[is/was]: DISPLAY 'is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT ISFLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE- PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN- REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE- PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------
----------------------------------------------------
Hard CHECK:
ALLOWABLE RANGE IS 1-52
----------------------------------------------------

EW13
====

[Enter $ Per Hour] ..................... [EW17]
REF ................................... -7 [EW17]
DK .................................... -8 [EW14]
----------------------------------------------------
[[earn/earns]/earned]: DISPLAY '[earn/earns]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'earned' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN-REFERENCE- PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.

[[do/does]/did]: DISPLAY '[do/does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT- MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS- JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW14
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Could you just tell me if [you/[PERSON]] [[make/makes]/made] more or less than $10 an hour at this job?

$10 OR MORE ............................ 1 [EW15]
LESS THAN $10 .......................... 2 [EW16]
REF ................................... -7 [EW17]
DK .................................... -8 [EW17]
[Code One]
----------------------------------------------------
[[make/makes]/made]: DISPLAY '[make/makes]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'made' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN-REFERENCE- PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW15
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
More or less than $15 an hour?

$15 OR MORE ............................ 1 [EW17]
LESS THAN $15 .......................... 2 [EW17]
REF ................................... -7 [EW17]
DK .................................... -8 [EW17]
[Code One]

EW16
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
More or less than $7.25 an hour?

$7.25 OR MORE ......................... 1 [EW17]
LESS THAN $7.25 ....................... 2 [EW17]
REF ................................... -7 [EW17]
DK .................................... -8 [EW17]
[Code One]
----------------------------------------------------
THE MINIMUM WAGE AMOUNT WAS INCREASED FROM $5.15 TO $5.85 IN PANEL 12 ROUND 3 AND PANEL 13 ROUND 1.

THE MINIMUM WAGE AMOUNT WAS INCREASED FROM $5.85 TO $6.55 IN PANEL 12 ROUND 4 AND PANEL 13 ROUND 2.

THE MINIMUM WAGE AMOUNT WAS INCREASED FROM $6.55 TO $7.25 IN PANEL 13 ROUND 4 AND PANEL 14 ROUND 2.
----------------------------------------------------

EW17
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Often, the number of hours people work is different from the number of hours on which their salaries are based. On how many hours per week [is/was] [your/[PERSON]'s] salary based?

[Enter Hours Per Week] ................. [EW23]
REF ................................... -7 [EW23]
DK .................................... -8 [EW23]
HELP AVAILABLE FOR DEFINITION OF HOURS WORKED PER WEEK.
----------------------------------------------------
[is/was]: DISPLAY 'is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE- PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN- REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE- PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------
----------------------------------------------------
NOTE: ALLOW ONLY WHOLE HOURS, NO FRACTIONS.
----------------------------------------------------
----------------------------------------------------
Hard CHECK:
1-168 HOURS PER WEEK
----------------------------------------------------

EW18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
What [is/was] [your/[PERSON]'s] hourly wage rate for [your/his/her] regular work time, not including tips, commissions, or bonuses at [EMPLOYER]?

[Enter $ Per Hour] ..................... [EW23]
REF ................................... -7 [EW20]
DK .................................... -8 [EW20]
----------------------------------------------------
[is/was]: DISPLAY 'is' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'was' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE- PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN- REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE- PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW19
====

OMITTED.

EW19OV1
=======

OMITTED.

EW19OV2
=======

OMITTED.

EW20
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
Could you just tell me if [you/[PERSON]] [[make/makes]/made] more or less than $10 an hour at this job?

$10 OR MORE ............................ 1 [EW21]
LESS THAN $10 .......................... 2 [EW22]
REF ................................... -7 [EW23]
DK .................................... -8 [EW23]
[Code One]
----------------------------------------------------
[[make/makes]/made]: DISPLAY '[make/makes]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'made' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB-WITHIN-REFERENCE- PERIOD', 'LAST-JOB-OUTSIDE-REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW21
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
More or less than $15 an hour?

EW22
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
More or less than $7.25 an hour?

EW23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
On this job, [[do/does]/did] [you/[PERSON]] earn ...

YES NO

EW23_01
=======

tips? 1 2

----------------------------------------------------
REFUSED (-7) AND DON'T KNOW (-8) ALLOWED.
----------------------------------------------------

EW23_02
=======

bonuses? 1 2

----------------------------------------------------
REFUSED (-7) AND DON'T KNOW (-8) ALLOWED.
----------------------------------------------------

EW23_03
=======

commissions? 1 2

----------------------------------------------------
REFUSED (-7) AND DON'T KNOW (-8) ALLOWED.
----------------------------------------------------
HELP AVAILABLE FOR DEFINITION OF TIPS/BONUSES/COMMISSIONS.
----------------------------------------------------
[[do/does]/did]: DISPLAY '[do/does]' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT-MAIN-JOB' OR IS FLAGGED AS 'CURRENT- MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'did' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN-REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS- JOB-WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF EW02 IS CODED '4' (BONUS), AUTOMATICALLY CODE EW23_02 AS '1' (YES) AND DO NOT DISPLAY EW23_02
----------------------------------------------------
----------------------------------------------------
IF EW02 IS CODED '3' (COMMISSION), AUTOMATICALLY CODE EW23_03 AS '1' (YES) AND DO NOT DISPLAY EW23_03
----------------------------------------------------
----------------------------------------------------
IF EW23_01 - EW23_03 ARE ALL CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), GO TO BOX_04
----------------------------------------------------
----------------------------------------------------
IF EW23_01 IS CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH EW24A
----------------------------------------------------

EW24A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
How much [are/were] [your/[PERSON]'s] tips on average?
TIPS AMOUNT:

[Enter $ Amount] ....................... [EW24AOV1]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
----------------------------------------------------
[are/were]: DISPLAY 'are' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'were' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN- REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB- WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW24AOV1
========

PER PERIOD:

PER HOUR ............................... 1 [BOX_02]
PER DAY ................................ 2 [BOX_02]
PER WEEK ............................... 3 [BOX_02]
PER TWO-WEEK PERIOD .................... 4 [BOX_02]
PER MONTH .............................. 5 [BOX_02]
PER YEAR ............................... 6 [BOX_02]
OTHER ................................. 91 [EW24AOV2]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]

EW24AOV2
========

SPECIFY:

[Enter Other Specify] .................. [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]

BOX_02
======

----------------------------------------------------
IF EW23_02 IS CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH EW24B
----------------------------------------------------

EW24B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
How much [are/were] [your/[PERSON]'s] bonuses on average?
BONUSES AMOUNT:

[Enter $ Amount] ....................... [EW24BOV1]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
[are/were]: DISPLAY 'are' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'were' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN- REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB- WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW24BOV1
========

PER PERIOD:

PER HOUR ............................... 1 [BOX_03]
PER DAY ................................ 2 [BOX_03]
PER WEEK ............................... 3 [BOX_03]
PER TWO-WEEK PERIOD .................... 4 [BOX_03]
PER MONTH .............................. 5 [BOX_03]
PER YEAR ............................... 6 [BOX_03]
OTHER ................................. 91 [EW24BOV2]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
[Code One]

EW24BOV2
========

SPECIFY:

[Enter Other Specify] .................. [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]

BOX_03
======

----------------------------------------------------
IF EW23_03 IS CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO BOX_04
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH EW24C
----------------------------------------------------

EW24C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EMPLOYER BEING ASKED ABOUT] [JOB-ST] [JOB-ED]
How much [are/were] [your/[PERSON]'s] commissions on average?
COMMISSIONS AMOUNT:

[Enter $ Amount] ....................... [EW24COV1]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
----------------------------------------------------
[are/were]: DISPLAY 'are' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS 'CURRENT- MAIN-JOB' OR IS FLAGGED AS 'CURRENT-MISCELLANEOUS-JOB' AND CURRENT ROUND IS NOT ROUND 5. DISPLAY 'were' IF THE JOB SUBTYPE OF THE JOB BEING ASKED ABOUT IS FLAGGED AS A 'FORMER-MAIN-JOB-WITHIN- REFERENCE-PERIOD', 'FORMER-MISCELLANEOUS-JOB- WITHIN-REFERENCE-PERIOD', 'LAST-JOB-OUTSIDE- REFERENCE-PERIOD', OR 'RETIREMENT-JOB' OR CURRENT ROUND IS ROUND 5.
----------------------------------------------------

EW24COV1
========

PER PERIOD:

PER HOUR ............................... 1 [BOX_04]
PER DAY ................................ 2 [BOX_04]
PER WEEK ............................... 3 [BOX_04]
PER TWO-WEEK PERIOD .................... 4 [BOX_04]
PER MONTH .............................. 5 [BOX_04]
PER YEAR ............................... 6 [BOX_04]
OTHER ................................. 91 [EW24COV2]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
[Code One]

EW24COV2
========

SPECIFY:

[Enter Other Specify] .................. [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]

BOX_04
======

----------------------------------------------------
RETURN TO ORIGINAL QUESTIONNAIRE SECTION (EITHER RJ OR EM).
----------------------------------------------------

Health Insurance (HX) Section

BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
FOR MONTH DISPLAY 3 CHAR MONTH (EG. JAN, FEB)

ROUNDS 1-4, DISPLAY ONLY THE BEGIN DATE RATHER THAN BOTH THE BEGIN AND END DATE. IF ROUND 5 THEN DISPLAY BOTH THE BEGIN AND END DATE.

DISPLAY PERS.FULLNAME, ESTB.ESTBNAME, PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY
----------------------------------------------------

HX01
====

[STR-DT] [END-DT]
Let's talk (again) about all the health insurance coverage the family may have to help pay for the costs of medical care [since [START DATE]/between [START DATE] and [END DATE]].
[ASK RESPONDENT TO GET INSURANCE CARDS/IDENTIFYING INFORMATION IF NOT ALREADY AVAILABLE.]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------
DISPLAY 'ASK....AVAILABLE.' IF ROUND 1. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1, GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_01
----------------------------------------------------

BOX_01
======

----------------------------------------------------
ASK THE OLD EMPLOYMENT AND PRIVATE RELATED INSURANCE (OE) SECTION.
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF OE SECTION, CONTINUE WITH BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
ASK THE OLD PUBLIC RELATED INSURANCE (PR) SECTION.
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF PR SECTION, CONTINUE WITH BOX_03
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS PROVIDING HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS 'NOT SELF-EMPLOYED' OR IS FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM- SIZE-GREATER-THAN-1, CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK NAV_HX01A - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT PRIVATE HEALTH INSURANCE OBTAINED THROUGH AN EMPLOYER. THIS LOOP CYCLES ON ESTABLISHMENT- PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS PROVIDING HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS 'NOT SELF-EMPLOYED'OR IS FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM- SIZE-GREATER-THAN-1.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES BOTH NAV_HX01A AND NAV_HX01B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HX01A
=========

[STR-DT]
SERIES: Health Insurance Through Establishments
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_01 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH NAV_OE01B FOR SELECTED RU MEMBER
----------------------------------------------------

NAV_HX01B
=========

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
SERIES: Verifying Insurance during the Reference Period (including selecting a Policyholder)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member...Employer Providing Insurance
[1. Person's Name-65]...[Establishment Name-30] [Status-25]
[2. Person's Name-65]...[Establishment Name-30] [Status-25]
[3. Person's Name-65]...[Establishment Name-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER...EMPLOYER PROVIDING
INSURANCE
INSTRUCTIONS: DISPLAY RU-ESTABLISHMENT-PERSON- PAIR
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH PAIR EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL EMPLOYERS THAT MEET THE CONDITIONS STATED AT THE LOOP_01 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HX02 FOR SELECTED PAIR
----------------------------------------------------

HX02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
You mentioned that [you/[PERSON]] [were/was] covered by health insurance from [ESTABLISHMENT] [at some point after [START DATE]/between [START DATE] and [END DATE]].
SELECT 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS INSURANCE REPORTED IN ERROR.

CONTINUE ............................... 1 [BOX_04]
INSURANCE REPORTED IN ERROR ............ 2 [END_LP01]
[Code One]
----------------------------------------------------
IF ROUND 1 THROUGH ROUND 4, DISPLAY 'at some point after [START DATE]'. IF ROUND 5, DISPLAY 'between [START DATE] and [END DATE]'.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (INSURANCE REPORTED IN ERROR) FLAG THIS ESTABLISHMENT-PERSON-PAIR AS 'NOT SEPARATE SOURCE OF INSURANCE' AND GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_04
----------------------------------------------------

BOX_04
======

----------------------------------------------------
ASK THE PRIVATE HEALTH INSURANCE DETAIL (HP) SECTION FOR THIS ESTABLISHMENT-PERSON-PAIR.
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF HP SECTION, CONTINUE WITH END_LP01
----------------------------------------------------

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_05
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS PROVIDING HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS 'SELF-EMPLOYED'
AND
- FIRM SIZE OF ESTABLISHMENT = 1, CONTINUE WITH LOOP_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER, ASK LOOP_03-END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION ABOUT THE SOURCES OF DIRECTLY PURCHASED HEALTH INSURANCE ASSOCIATED WITH A SELF-EMPLOYED JOB WHERE FIRM SIZE = 1. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS FLAGGED DURING THIS ROUND AS PROVIDING HEALTH INSURANCE
AND
- ESTABLISHMENT IS AN EMPLOYER
AND
- PERSON IS A JOBHOLDER AT ESTABLISHMENT
AND
- ESTABLISHMENT IS FLAGGED AS 'SELF-EMPLOYED'
- FIRM SIZE OF ESTABLISHMENT = 1
----------------------------------------------------

LOOP_03
=======

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

INSURANCE CATEGORY 1
INSURANCE CATEGORY 2
INSURANCE CATEGORY 3
INSURANCE CATEGORY 4
INSURANCE CATEGORY 5
INSURANCE CATEGORY 6

ASK HX03 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS INFORMATION ABOUT THE WAYS PERSON PURCHASED HEALTH INSURANCE (INSURANCE CATEGORIES AT HX03) ASSOCIATED WITH A SELF-EMPLOYED JOB WITH FIRM-SIZE = 1. THE FIRST CYCLE OF THIS LOOP COLLECTS THE MAIN WAY PERSON PURCHASES INSURANCE. SUBSEQUENT CYCLES COLLECT ADDITIONAL WAYS PERSON PURCHASES INSURANCE.

THE RESPONSE AT HX04 DETERMINES WHETHER THE LOOP CYCLES AGAIN. IF HX04 IS CODED '1' (YES), THE LOOP CYCLES TO COLLECT THE NEXT INSURANCE CATEGORY. IF HX04 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

HX03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
SHOW CARD HX-1.
[You mentioned that [you/[PERSON]] [[are/is]/[were/was]] self-employed and had health insurance through that business.] Which category on this card comes closest to [the main/another] way [you/[PERSON]] [purchase/purchases] this insurance?

FROM A PROFESSIONAL ASSOCIATION ........ 1 [BOX_06]
FROM A SMALL BUSINESS GROUP ............ 2 [BOX_06]
FROM A UNION ........................... 3 [BOX_06]
DIRECTLY FROM AN INSURANCE AGENT ....... 5 [BOX_06]
DIRECTLY FROM INSURANCE COMPANY ........ 6 [BOX_06]
DIRECTLY FROM AN HMO ................... 7 [BOX_06]
FROM A PREVIOUS EMPLOYER ............... 8 [BOX_06]
FROM A PREVIOUS EMPLOYER (COBRA) ....... 9 [BOX_06]
DIRECTLY FROM A HIGH RISK POOL [/[STATE
NAME FOR HIGH RISK POOL]] ........... 10 [BOX_06]
DIRECTLY FROM [STATE EXCHANGE NAME-A] . 11 [BOX_06]
OTHER ................................. 91 [HX03OV]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
STARTING IN PANEL 12 ROUND 2, CATEGORY '4' (FROM A HEALTH INSURANCE PURCHASING ALLIANCE) WAS OMITTED AND WILL BE OMITTED IN ALL FUTURE ROUNDS.
----------------------------------------------------
----------------------------------------------------
STARTING IN PANEL 14 ROUND 5, PANEL 15 ROUND 3 AND PANEL 16 ROUND 1, CATEGORY '10' (DIRECTLY FROM A HIGH RISK POOL[/[STATE NAME FOR HIGH RISK POOL]])
WAS ADDED AND WILL BE ADDED IN ALL FUTURE ROUNDS.
----------------------------------------------------
----------------------------------------------------
STARTING IN PANEL 17 ROUND 5, PANEL 18 ROUND 3 AND PANEL 19 ROUND 1, CATEGORY '11' (DIRECTLY FROM [STATE EXCHANGE NAME]) WAS ADDED AND WILL BE ADDED IN ALL FUTURE ROUNDS.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'you mentioned that [you/[PERSON]] [[are/ is]/ [were/was]] self-employed and had health insurance through that business.' IF FIRST CYCLE THROUGH LOOP_03. OTHERWISE USE A NULL DISPLAY.

DISPLAY '[are/is]' IF ESTABLISHMENT IS FLAGGED AS A CURRENT EMPLOYER. DISPLAY '[were/was]' IF ESTABLISHMENT IS NOT FLAGGED AS A CURRENT EMPLOYER, OR IF CURRENT ROUND IS ROUND 5.

DISPLAY 'the main' IF FIRST CYCLE THROUGH LOOP_03.OTHERWISE (I.E., NOT FIRST CYCLE), DISPLAY 'another'.

DISPLAY '/[STATE NAME FOR HIGH RISK POOL]' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED OFFERS A HIGH RISK POOL HEALTH INSURANCE PLAN. THIS INCLUDES ALL STATES EXCEPT: AZ, DE, DC, GA, HI, ME, MA, MI, NV, NJ, NY, OH, PA, RI, VT, VA. IF INTERVIEW STATE IS ONE OF THESE STATES, USE A NULLDISPLAY.

FOR 'STATE NAME FOR HIGH RISK POOL' DISPLAY THE HIGH RISK POOL PLAN NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.

FOR 'STATE EXCHANGE NAME' DISPLAY THE EXCHANGE NAME 'A' ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------

HX03OV
======

OTHER:

[Enter Other Specify] .................. [BOX_06]
DK .................................... -8 [BOX_06]

BOX_06
======

----------------------------------------------------
ASK PRIVATE HEALTH INSURANCE DETAIL (HP) SECTION FOR THE RESPONSE CATEGORY SELECTED AT HX03.
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF HP SECTION, CONTINUE WITH HX04
----------------------------------------------------

HX04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
SHOW CARD HX-1.
Aside from what you already told me about, is there another category on this card which describes the way [you/[PERSON]] [purchase/purchases] health insurance for [ESTABLISHMENT]?

YES .................................... 1 [END_LP03]
NO ..................................... 2 [END_LP03]
REF ................................... -7 [END_LP03]
DK .................................... -8 [END_LP03]
HELP AVAILABLE FOR DEFINITIONS OF ITEMS ON SHOW CARD.

END_LP03
========

----------------------------------------------------
IF HX04 IS CODED '1' (YES), CYCLE TO COLLECT THE NEXT WAY OF PURCHASING INSURANCE.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, END LOOP_03 AND CONTINUE WITH END_LP02
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH BOX_07
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF ROUND 1, GO TO HX06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_08
----------------------------------------------------

BOX_08
======

----------------------------------------------------
IF:

ANY NEW RU MEMBERS ADDED TO RU THIS ROUND,
OR
ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE TURNED 65 SINCE START DATE (USE REAL DATE OF BIRTH ONLY),
OR
ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE WERE = OR ) 65 (OR IN AGE CATEGORY 9) IN PREVIOUS ROUND, CONTINUE WITH HX05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_12
----------------------------------------------------

HX05
====

[STR-DT] [END-DT]
We show that (READ NAMES BELOW) [(are/is)] [either] [65 years old or older] [or] [joined the household since our last interview].

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65

]

(Has (READ NAME ABOVE)/Have any of these people) been covered by Medicare [since [START DATE]/between [START DATE] and [END DATE]]?

YES .................................... 1
NO ..................................... 2 [LOOP_04]
REF ................................... -7 [LOOP_04]
DK .................................... -8 [LOOP_04]
HELP AVAILABLE FOR DEFINITION OF MEDICARE.
----------------------------------------------------
DISPLAY '(are/is)' AND '65 years old' IF ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE TURNED 65 SINCE START DATE OR IF ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE WERE = OR ) 65 PREVIOUS ROUND.

DISPLAY 'joined the household since our last interview' IF ANY NEW RU MEMBERS ADDED TO THE RU THIS ROUND.

DISPLAY 'either' AND 'or' IF ANY NEW RU MEMBERS ADDED TO THE RU THIS ROUND AND IF ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE TURNED 65 SINCE START DATE OR ANY RU MEMBERS NOT ALREADY FLAGGED AS RECEIVING MEDICARE WERE = OR ) 65 PREVIOUS ROUND.

DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND ONLY ONE RU MEMBER ELIGIBLE FOR HX05, SELECT THAT PERSON AUTOMATICALLY BY CAPI AT HX07 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '1' (YES) AND MORE THAN ONE RU MEMBER ELIGIBLE FOR HX05, GO TO HX07
----------------------------------------------------
----------------------------------------------------
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:
OTHERWISE, DISPLAY RU-MEMBERS WHO MEET ONE OF THE FOLLOWING CONDITIONS:
1. PERSON IS A NEW RU MEMBER THIS ROUND,

2. PERSON TURNED 65 YEARS OLD THIS ROUND AND IS NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND,

3. OR PERSON )= 65 (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------

HX06
====

[STR-DT]
SHOW CARD HX-2.
Medicare is a health insurance program for persons 65 years or over and for some disabled persons. People covered by Medicare usually have a card that looks like this.
At any time since [START DATE], has anyone in the family been covered by Medicare?

HX07
====

[STR-DT] [END-DT]
Who is covered by Medicare?
PROBE: Who else is covered by Medicare?

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65] [LOOP_04]
----------------------------------------------------
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. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT ONE OR MORE FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
IN ROUND 1, NONE. DISPLAY ALL.
IN ROUNDS 2-5, DISPLAY RU MEMBERS WHO MEET ONE OF THE FOLLOWING CONDITIONS:
1. PERSON IS A NEW RU MEMBER THIS ROUND,

2. PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND,

3. OR PERSON )= 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK BOX_09 - END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 DETERMINES IF REASON FOR MEDICARE IS CONDITION/DISABILITY FOR PERSONS ( 65 WHO RECEIVE MEDICARE AND COLLECTS SOCIAL SECURITY STATUS FOR PERSONS = ) 65 WHO ARE NOT COVERED BY MEDICARE. THIS LOOP CYCLES ON PERSONS WHO MEET ANY OF THE FOLLOWING CONDITIONS:
- IF ROUND 1: ALL CURRENT RU MEMBERS
- IF NOT ROUND 1: ALL CURRENT RU MEMBERS WHO MEET ONE OF THE FOLLOWING CONDITIONS:
- PERSON IS A NEW RU MEMBER THIS ROUND,
OR
- PERSON TURNED 65 YEARS OLD THIS ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND
OR
- PERSON =) 65 YEARS OLD (OR IN AGE CATEGORY 9) LAST ROUND AND NOT FLAGGED AS COVERED BY MEDICARE DURING ANY ROUND.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_04 USES EITHER NAV_HX04A OR NAV_HX04B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

BOX_09
======

----------------------------------------------------
IF ROUND 1, GO TO BOX_11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_10
----------------------------------------------------

BOX_10
======

----------------------------------------------------
IF PERSON ADDED THIS ROUND, CONTINUE WITH BOX_11
----------------------------------------------------
----------------------------------------------------
IF HX05 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND RU MEMBER TURNED 65 THIS ROUND, GO TO NAV_HX04B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP04
----------------------------------------------------
----------------------------------------------------
NOTE: HX09 IS NOT RE-ASKED OF PERSONS WHO WERE OVER 65 DURING THE PREVIOUS ROUND AND DID NOT RECEIVE MEDICARE AND WHO CONTINUE NOT RECEIVING MEDICARE DURING THE CURRENT ROUND.
----------------------------------------------------

BOX_11
======

----------------------------------------------------
IF PERSON IS SELECTED AT HX07 AND IS ( 65 YEARS OLD (OR IN AGE CATEGORIES 1-8), CONTINUE WITH NAV_HX04A
----------------------------------------------------
----------------------------------------------------
IF PERSON IS SELECTED AT HX07 AND IS = ) 65 YEARS
OLD (OR IN AGE CATEGORY 9), GO TO END_LP04
----------------------------------------------------
----------------------------------------------------
IF PERSON IS NOT SELECTED AT HX07 AND IS ( 65 YEARS OLD (OR IN AGE CATEGORIES 1-8), GO TO END_LP04
----------------------------------------------------
----------------------------------------------------
IF PERSON IS NOT SELECTED AT HX07 AND IS = ) 65 YEARS OLD (OR IN AGE CATEGORY 9), GO TO NAV_HX04B
----------------------------------------------------
----------------------------------------------------
IF HX07 IS NOT ASKED (I.E., HX05 OR HX06 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)) AND PERSON IS ( 65 YEARS OLD (OR IN AGE CATEGORIES 1-8), GO TO END_LP04
----------------------------------------------------
----------------------------------------------------
IF HX07 IS NOT ASKED (I.E., HX05 OR HX06 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)) AND PERSON IS = ) 65 YEARS OLD (OR IN AGE CATEGORY 9), GO TO NAV_HX04B
----------------------------------------------------

NAV_HX04A
=========

[STR-DT]
SERIES: Medicare for RU Members Under 65
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. Reason for Medicare [Person's Name-65]] [Status-25]
[2. Reason for Medicare [Person's Name-65]] [Status-25]
[3. Reason for Medicare [Person's Name-65]] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX07 AND WHO ARE ( 65 YEARS OLD (OR IN AGE CATEGORIES 1-8).
----------------------------------------------------
----------------------------------------------------
GO TO HX08 FOR SELECTED RU MEMBER.
----------------------------------------------------

NAV_HX04B
=========

SERIES: Receive Social Security for Someone 65+ Without Medicare
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

Question Series
[1. Receive Social Security...[Person's Name-65]] [Status-25]
[2. Receive Social Security...[Person's Name-65]] [Status-25]
[3. Receive Social Security...[Person's Name-65]] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: QUESTION SERIES
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED WHO MEET THE FOLLOWING CONDITIONS (SEE BOX_10 AND BOX_11):

- HX05 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND RU MEMBER TURNED 65 THIS ROUND
OR
- PERSON IS NOT SELECTED AT HX07 AND IS = ) 65 YEARS OLD (OR IN AGE CATEGORY 9)
OR
- HX07 IS NOT ASKED (I.E., HX05 OR HX06 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)) AND PERSON IS = ) 65 YEARS OLD (OR IN AGE CATEGORY 9)
----------------------------------------------------
----------------------------------------------------
GO TO HX09 FOR SELECTED RU MEMBER.
----------------------------------------------------

HX08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Do/Does] [you/[PERSON]] receive Medicare because of a medical condition or a disability?

.

HX09
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
People with Social Security usually get Medicare. [Do/Does] [you/[PERSON]] receive Social Security?

END_LP04
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON 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_12
----------------------------------------------------

BOX_12
======

----------------------------------------------------
IF MEDICAID/SCHIP PROVIDED TO ANY RU MEMBER DURING THE PREVIOUS ROUND, GO TO BOX_14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_12A
----------------------------------------------------

BOX_12A
=======

----------------------------------------------------
IF GOVT-HOSPITAL/PHYSICIAN IS A SOURCE OF INSURANCE FOR ANY RU MEMBER DURING THE CURRENT ROUND, GO TO BOX_14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HX10
----------------------------------------------------

HX10
====

[STR-DT] [END-DT]
SHOW CARD HX-3.
[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] are state programs that pay for health care for persons in need. People covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] may have a (piece of paper/card) that looks something like this.
At any time [since [START DATE]/between [START DATE] and [END DATE]], has anyone in the family been covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]?

YES .................................... 1
NO ..................................... 2 [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX_14]
HELP AVAILABLE FOR DEFINITION OF MEDICAID/SCHIP.
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'MEDICAID'. DISPLAY 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'MEDICAID.' FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS SUBSTITUTING THE REAL NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AUTOMATICALLY BY CAPI AT HX11 AND GO TO LOOP_05
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX11
----------------------------------------------------

HX11
====

[STR-DT] [END-DT]
Who is covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]?
PROBE: Who else is covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]?

[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 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'MEDICAID'. DISPLAY'STATE NAME FOR MEDICAID' (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'MEDICAID.' FOR THE SPECIFIC NAME TO USE BY STATE, SEE BOX ON HX06.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS SUBSTITUTING THE REAL NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
GO TO 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 OF RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOLWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_HX05 - END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS TIME PERIOD OVERAGE DETAIL FOR RU MEMBERS COVERED BY MEDICAID/SCHIP. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWINGCONDITIONS:
- ESTABLISHMENT IS MEDICAID/SCHIP
AND
- PERSON IS FLAGGED AS COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND (I.E., SELECTED IN HX11)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_05 USES NAV_HX05 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HX05
========

MEDICAID/SCHIP [STR-DT]
SERIES: Time Covered by MEDICAID/SCHIP during Reference Period.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. Coverage duration for [Person's Name-65] through
MEDICAID/SCHIP] [Status-25]
[2. Coverage duration for [Person's Name-65] through
MEDICAID/SCHIP] [Status-25]
[3. Coverage duration for [Person's Name-65] through
MEDICAID/SCHIP] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX11.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_13 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_13
======

-----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PERSON.
-----------------------------------------------------
-----------------------------------------------------
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP05
-----------------------------------------------------

END_LP05
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT- PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_05 AND CONTINUE WITH HX11A
----------------------------------------------------

HX11A
=====

[STR-DT] [END-DT]
Is the coverage with [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] through [STATE EXCHANGE NAME-A][, [which may also be known as [ALIAS B] [or [ALIAS C]]]]?

YES .................................... 1 [BOX_14]
NO ..................................... 2 [BOX_14]
REF ................................... -7 [BOX_14]
DK .................................... -8 [BOX_14]
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'MEDICAID'. DISPLAY'STATE NAME FOR MEDICAID' (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'MEDICAID.' FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS SUBSTITUTING THE REAL NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY ', [which may also be known as [ALIAS B] [or [ALIAS C]]]' IF THERE IS MORE THAN ONE EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or [ALIAS C]' IF THERE ARE THREE EXCHANGE NAMES ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------
----------------------------------------------------
FOR 'STATE EXCHANGE NAME-A', 'ALIAS B', AND 'ALIAS C', DISPLAY THE EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------

BOX_14
======

----------------------------------------------------
IF TRICARE/CHAMPVA PROVIDED TO ANY RU MEMBER DURING THE PREVIOUS ROUND, GO TO BOX_16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HX12
----------------------------------------------------

HX12
====

[STR-DT] [END-DT]
At any time [since [START DATE]/between [START DATE] and [END DATE]], has anyone in the family been covered by TRICARE or CHAMPVA?

YES .................................... 1 [HX12A]
NO ..................................... 2 [BOX_16]
REF ................................... -7 [BOX_16]
DK .................................... -8 [BOX_16]
HELP AVAILABLE FOR DEFINITION OF TRICARE/CHAMPVA.
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------

HX12A
=====

[STR-DT] [END-DT]
Which plan is it? Is it?
INTERVIEWER: CODE MORE THAN ONE PLAN ONLY IF DIFFERENT RU MEMBERS HAVE DIFFERENT PLANS.

CHECK ALL THAT APPLY.
TRICARE Standard; ...................... 1
TRICARE Prime; ......................... 2
TRICARE Extra; ......................... 3
TRICARE for Life; or ................... 4
CHAMPVA? ............................... 5
[Code All That Apply]
----------------------------------------------------
IF HX12 IS CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AT HX13 AUTOMATICALLY BY CAPI AND GO TO LOOP_06
----------------------------------------------------
----------------------------------------------------
IF HX12 IS CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX13
----------------------------------------------------

HX13
====

[STR-DT] [END-DT]
Who is covered by TRICARE or CHAMPVA?
PROBE: Who else is covered by TRICARE or CHAMPVA?

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
GO TO 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 OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT FROM THE LISTED MEMBERS.

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

LOOP_06
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_HX06 - END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU MEMBERS COVERED BY TRICARE OR CHAMPVA. THIS LOOP CYCLES ON ESTABLISHMENT- PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS TRICARE/CHAMPVA
AND
- PERSON IS FLAGGED AS COVERED BY TRICARE/CHAMPVADURING THE CURRENT ROUND (I.E., SELECTED AT HX13)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_06 USES NAV_HX06 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HX06
========

TRICARE OR CHAMPVA [STR-DT]
SERIES: Time Covered by TRICARE OR CHAMPVA during Reference Period.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. Coverage duration for [Person's Name-65] through
TRICARE OR CHAMPVA] [Status-25]
[2. Coverage duration for [Person's Name-65] through
TRICARE OR CHAMPVA] [Status-25]
[3. Coverage duration for [Person's Name-65] through
TRICARE OR CHAMPVA] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX13.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_15 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_15
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP06
----------------------------------------------------

END_LP06
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH BOX_16
----------------------------------------------------

BOX_16
======

----------------------------------------------------
IF MEDICAID/SCHIP IS A SOURCE OF INSURANCE FOR ANY RU MEMBER DURING CURRENT ROUND, GO TO BOX_19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_17
----------------------------------------------------

BOX_17
======

----------------------------------------------------
IF GOVT-HOSPITAL/PHYSICIAN PROVIDED TO ANY RU MEMBER DURING THE PREVIOUS ROUND, GO TO BOX_19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HX14
----------------------------------------------------

HX14
====

[STR-DT] [END-DT]
At any time [since [START DATE]/between [START DATE] and [END DATE]], has anyone in the family had any other type of health insurance from any state or local government agency which provided hospital and physician benefits?

YES .................................... 1 [HX14A]
NO ..................................... 2 [BOX_19]
REF ................................... -7 [BOX_19]
DK .................................... -8 [BOX_19]
HELP AVAILABLE FOR DESCRIPTION OF INSURANCE TYPES TO INCLUDE.
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------

HX14A
=====

[STR-DT]What is the name of the plan?

[Enter text] ...........................
----------------------------------------------------
NOTE: 'GOVT-HOSPITAL/PHYSICIAN' SHOULD BE USED FOR THE ESTABLISHMENT NAME IN THE CONTEXT HEADER (WHERE APPROPRIATE).
----------------------------------------------------
----------------------------------------------------
IF HX14 IS CODED '1' (YES) AND SINGLE-PERSON RU, SELECT PERSON AT HX15 AUTOMATICALLY BY CAPI AND GO TO LOOP_07
----------------------------------------------------
----------------------------------------------------
IF HX14 IS CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HX15
----------------------------------------------------

HX15
====

[STR-DT] [END-DT]
Who is covered by a program sponsored by a state or local government agency which provided hospital and physician benefits?
PROBE: Who else is covered by a program sponsored by a state or local government agency which provided hospital and physician benefits?

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
GO TO LOOP_07
----------------------------------------------------
----------------------------------------------------
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 RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOLWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------

LOOP_07
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_HX07 - END_LP07
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU MEMBERS COVERED BY GOVT- HOSPITAL/PHYSICIAN. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
AND
- PERSON IS FLAGGED AS BEING COVERED BY GOVT- HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND (I.E., SELECTED AT HX15)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_07 USES NAV_HX07 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HX07
========

[PLAN NAME FROM HX14A.....] [STR-DT]
SERIES: Time Covered by [PLAN NAME FROM HX14A.....] during Reference Period.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. Coverage duration for [Person's Name-65] through
[PLAN NAME FROM HX14A.....]] [Status-25]
[2. Coverage duration for [Person's Name-65] through
[PLAN NAME FROM HX14A.....]] [Status-25]
[3. Coverage duration for [Person's Name-65] through
[PLAN NAME FROM HX14A.....]] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX15.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_18 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_18
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP07
----------------------------------------------------

END_LP07
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT- PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_07 AND CONTINUE WITH HX15A
----------------------------------------------------

HX15A
=====

[STR-DT] [END-DT]
Is the coverage with a program sponsored by a state or local government agency which provided hospital and physician benefits through [STATE EXCHANGE NAME-A][, [which may also be known as [ALIAS B] [or [ALIAS C]]]]?

YES .................................... 1 [BOX_19]
NO ..................................... 2 [BOX_19]
REF ................................... -7 [BOX_19]
DK .................................... -8 [BOX_19]
----------------------------------------------------
DISPLAY ', [which may also be known as [ALIAS B] [or [ALIAS C]]]' IF THERE IS MORE THAN ONE EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or [ALIAS C]' IF THERE ARE THREE EXCHANGE NAMES ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------
----------------------------------------------------
FOR 'STATE EXCHANGE NAME-A', 'ALIAS B', AND 'ALIAS C',' DISPLAY THE EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------

BOX_19
======

----------------------------------------------------
IF ANY TYPE OF OTHER PUBLIC INSURANCE PROVIDED TO ANY RU MEMBER AT ANY TIME DURING THE PREVIOUS ROUND, GO TO HX21
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HX16
----------------------------------------------------

HX16
====

[STR-DT] [END-DT]
Some people receive health benefits from other state programs such as (READ PROGRAM NAMES BELOW) or other public programs that provide coverage for health care services.
[STATE NAME FOR PROGRAM #1..................]
[STATE NAME FOR PROGRAM #2..................]
[STATE NAME FOR PROGRAM #3..................]
[STATE NAME FOR PROGRAM #4..................]
At any time [since [START DATE]/between [START DATE] and [END DATE]], has anyone in the family been covered by any program like this?

YES .................................... 1 [LOOP_08]
NO ..................................... 2 [HX21]
REF ................................... -7 [HX21]
DK .................................... -8 [HX21]
HELP AVAILABLE FOR A LIST OF OTHER STATE PROGRAMS.
----------------------------------------------------
DISPLAY THE LIST OF UP TO FOUR ACTUAL NAMES OF STATE PROGRAMS (AS LISTED IN ATTACHMENT 36) FOR 'STATE NAME FOR PROGRAM #N' IF STATE HAS OTHER STATE PROGRAMS. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------

LOOP_08
=======

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

GROUP 1
GROUP 2

ASK BOX_20-END_LP08
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_08 COLLECTS INFORMATION ON OTHER STATE OR PUBLIC PROGRAMS. THE FIRST CYCLE OF THIS LOOP COLLECTS GROUP 1 OTHER PUBLIC INSURANCE PROGRAMS OR, IF NO GROUP 1, GROUP 2 OTHER PUBLIC INSURANCE PROGRAMS.

THIS LOOP CAN CYCLE A MAXIMUM OF TWICE. THE SUBSEQUENT CYCLE OF THE LOOP IS DETERMINED BY THE RESPONSE AT HX20. IF HX20 IS CODED '1' (YES), THE LOOP CYCLES AGAIN TO COLLECT GROUP 2 PUBLIC INSURANCE INFORMATION. IF HX20 IS CODED '2' (NO), '-7' (REFUSED), '-8' (DON'T KNOW), OR IS NOT ASKED, THE LOOP ENDS.
----------------------------------------------------

BOX_20
======

----------------------------------------------------
IF FIRST CYCLE OF LOOP_08, CONTINUE WITH HX17
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF SECOND CYCLE OF LOOP_08), GO TO HX18
----------------------------------------------------

HX17
====

[STR-DT] [END-DT]
What is the name of the program?
PROBE: Any other state program?
NOTE: IF ONLY TANF, SSI, WIC, IHS, PUBLIC HEALTH CLINIC, OR VA IS MENTIONED, SELECT 'NONE OF THESE'.

[STATE SPECIFIC PLAN 1] ................ 1
[STATE SPECIFIC PLAN 2] ................ 2
[STATE SPECIFIC PLAN 3] ................ 3
[STATE SPECIFIC PLAN 4] ................ 4
OTHER ................................. 91 [HX17OV]
NONE OF THESE ......................... 95 [HX18]
REF ................................... -7 [BOX_21]
DK .................................... -8 [BOX_21]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
FOR 'STATE SPECIFIC PLAN N', DISPLAY AN ACTUAL NAME OF A STATE PLAN WHEN INTERVIEW IS BEING CONDUCTED IN A STATE THAT HAS OTHER STATE PROGRAMS. FOR THE SPECIFIC NAMES OF PROGRAMS BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
ANY PROGRAM SELECTED IN HX17 IS CONSIDERED A GROUP 1 PROGRAM AND WILL BE GROUPED TOGETHER WHEN ASKED ABOUT IN HX19.
----------------------------------------------------
----------------------------------------------------
CODES '1', '2', '3', '4', '5', AND '6' ARE RESERVED FOR STATE SPECIFIC PLANS. IF THE STATE HAS LESS THAN 6 PLANS, DO NOT ADJUST THE OTHER CODES. (I.E., FOR A STATE WITH NO STATE-SPECIFIC PLANS, CODES WOULD START WITH '91' AT HX17 OR '7' AT HX18.)
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW '-7' (REFUSED) OR '-8' (DON'T KNOW) IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX17OV
----------------------------------------------------
----------------------------------------------------
IF CODED '95' (NONE OF THESE), GO TO HX18
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_21
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: CODE '95' (NONE OF THESE) CANNOT BE ENTERED WITH ANY OTHER CODES. IF CODED '95' (NONE OF THESE) WITH ANY OTHER CODES, DISPLAY THE FOLLOWING MESSAGE: "95 CANNOT BE CODED WITH ANY OTHER RESPONSES. VERIFY AND RE-ENTER. CONTINUE."
----------------------------------------------------

HX17OV
======

SPECIFY:

[Enter Other Specify] .................. [BOX_21]
REF ................................... -7 [BOX_21]
DK .................................... -8 [BOX_21]

HX18
====

[STR-DT] [END-DT]
What is the name of the program?
PROBE: Any other state program?

TANF (TEMPORARY ASSISTANCE FOR NEEDY FAMILIES) .............................. 7
SSI (SUPPLEMENTAL SECURITY INCOME) ..... 8
WIC (WOMEN, INFANTS AND CHILDREN) ...... 9
IHS (INDIAN HEALTH SERVICE) ........... 10
PUBLIC HEALTH CLINIC .................. 11
VA (VETERANS ADMINISTRATION) .......... 12
REF ................................... -7 [END_LP08]
DK .................................... -8 [END_LP08]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
ANY PROGRAM SELECTED IN HX18 IS CONSIDERED A GROUP 2 PROGRAM AND WILL BE GROUPED TOGETHER WHEN ASKED ABOUT IN HX19
----------------------------------------------------
----------------------------------------------------
IF:
NO CURRENT RU MEMBER COVERED BY MEDICAID OR GOVT- HOSPITAL/PHYSICIAN DURING CURRENT ROUND
AND
HX18 IS CODED '7' (TANF), '8' (SSI), OR '9' (WIC), ALONE OR WITH ANY OTHER COMBINATION OF CODES, CONTINUE WITH BOX_21
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP08
----------------------------------------------------

BOX_21
======

----------------------------------------------------
IF SINGLE-PERSON RU, SELECT PERSON AT HX19 AUTOMATICALLY BY CAPI AND GO TO LOOP_09
----------------------------------------------------
----------------------------------------------------
IF MULTI-PERSON RU, CONTINUE WITH HX19
----------------------------------------------------

HX19
====

[STR-DT] [END-DT]
PROGRAM:
[STATE PROGRAM PROVIDING COVERAGE]
[STATE PROGRAM PROVIDING COVERAGE]
[STATE PROGRAM PROVIDING COVERAGE]
[STATE PROGRAM PROVIDING COVERAGE]
Who is covered by (READ PROGRAMS ABOVE)?
PROBE: Who else is covered by (READ PROGRAMS ABOVE)?

[1. First Name,[Middle Name],Last Name-65]
[2. First Name,[Middle Name],Last Name-65]
[3. First Name,[Middle Name],Last Name-65]
----------------------------------------------------
IF COMING FROM HX17, DISPLAY ALL PROGRAMS SELECTED AT HX17. IF COMING FROM HX18, DISPLAY ALL PROGRAMS SELECTED AT HX18.
----------------------------------------------------
----------------------------------------------------
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 RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOLWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE, DISPLAY ALL.
----------------------------------------------------

LOOP_09
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS ROSTER, ASK BOX_21A - END_LP09
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_09 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU MEMBERS COVERED BY OTHER PUBLIC PROGRAMS. THIS LOOP CYCLES ON ESTABLISHMENT
-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GROUP 1 OR GROUP 2 OTHER PUBLIC PROGRAM
AND
- PERSON IS FLAGGED AS BEING COVERED BY GROUP 1 OR GROUP 2 OTHER PUBLIC PROGRAM DURING THE CURRENT ROUND (I.E., SELECTED IN HX19)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_09 USES EITHER NAV_HX09A OR NAV_HX09B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

BOX_21A
=======

----------------------------------------------------
IF FIRST TIME THROUGH LOOP_08 AND HX17 IS NOT CODED '95' (NONE OF THESE), THIS LOOP CYCLES ON A ESTABLISHMENT-PERSON-PAIR WHERE ESTABLISHMENT IS AGROUP 1 OTHER PUBLIC PROGRAM. CONTINUE WITH NAV_HX09A
----------------------------------------------------
----------------------------------------------------
IF HX17 IS CODED '95' (NONE OF THESE) OR IF SECOND CYCLE OF LOOP_08, THEN THE ESTABLISHMENT IS A GROUP 2 OTHER PUBLIC PROGRAM. GO TO NAV_HX09B
----------------------------------------------------

NAV_HX09A
=========

STATE SPECIFIC PROGRAM [STR-DT]
SERIES: Time Covered by STATE SPECIFIC PROGRAM during Reference Period.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. Coverage duration for [Person's Name-65] through
STATE SPECIFIC PROGRAM] [Status-25]
[2. Coverage duration for [Person's Name-65] through
STATE SPECIFIC PROGRAM] [Status-25]
[3. Coverage duration for [Person's Name-65] through
STATE SPECIFIC PROGRAM] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX19 AND FLAGGED AS BEING COVERED BY A GROUP 1 OTHER PUBLIC PROGRAM DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_22 FOR SELECTED RU MEMBER.
----------------------------------------------------

NAV_HX09B
=========

STATE: TANF/SSI/WIC/IHS/PHC/VA [STR-DT]
SERIES: Time Covered by STATE: TANF/SSI/WIC/IHS/PHC/VA during Reference Period.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. Coverage duration for [Person's Name-65] through
STATE: TANF/SSI/WIC/IHS/PHC/VA] [Status-25]
[2. Coverage duration for [Person's Name-65] through
STATE: TANF/SSI/WIC/IHS/PHC/VA] [Status-25]
[3. Coverage duration for [Person's Name-65] through
STATE: TANF/SSI/WIC/IHS/PHC/VA] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HX19 AND FLAGGED AS BEING COVERED BY A GROUP 2 OTHER PUBLIC PROGRAM DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_22 FOR SELECTED RU MEMBER
----------------------------------------------------

BOX_22
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PERSON.
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP09
----------------------------------------------------

END_LP09
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT- PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_09 AND CONTINUE WITH BOX_23
----------------------------------------------------

BOX_23
======

----------------------------------------------------
IF HX17 IS CODED '95' (NONE OF THESE) OR IF ON SECOND CYCLE OF LOOP_08, GO TO END_LP08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HX20
----------------------------------------------------

HX20
====

[STR-DT] [END-DT]
Are there any other state programs that provide coverage for health care services to anyone else in the family?

END_LP08
========

----------------------------------------------------
IF HX20 IS CODED '1' (YES), CYCLE TO COLLECT GROUP 2 PUBLIC INSURANCE INFORMATION.
----------------------------------------------------
----------------------------------------------------
IF HX20 IS CODED '2' (NO), '-7' (REFUSED), '-8' (DON'T KNOW), OR IS NOT ASKED, END LOOP_08 AND CONTINUE WITH HX21
----------------------------------------------------

HX21
====

[STR-DT] [END-DT]
Next, I have some questions about other sources of health insurance anyone in the family may have had [since [START DATE]/between [START DATE] and [END DATE]] to help pay hospital and doctor bills and other health expenses such as nursing home care or prescribed medicines. [This includes Medigap or Medicare Supplements, plans through a private insurance carrier, which some people who are eligible for Medicare have as additional coverage.]
[Since [START DATE]/Between [START DATE] and [END DATE]] we show the family has had the following health insurance:

HX21_01. ESTABLISHMENT NAME (INSURER) HX21_02. COVERED RU MEMBERS
[Display Establishment Name (Display Insurer Name)]
[Display First and Last Names of All Covered RU Members]
[Display Establishment Name (Display Insurer Name)]
[Display First and Last Names of All Covered RU Members]
[Display Establishment Name (Display Insurer Name)]
[Display First and Last Names of All Covered RU Members]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY 'This includes...coverage.' IF ANYONE IN RU HAS MEDICARE AS A SOURCE OF INSURANCE DURING THE CURRENT ROUND.

DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.

DISPLAY 'So far, ... and [END DATE]]:' AND THE REPORT OF CURRENT ROUND HEALTH INSURANCE IF ANY SOURCES OF INSURANCE ARE RECORDED FOR THIS RU.
----------------------------------------------------

HX22
====

[STR-DT] [END-DT]
SHOW CARD HX-4.
Please look at this card. It lists various ways people can obtain health insurance.
[Not counting insurance you already told me about, at/At] any time [since [START DATE]/between [START DATE] and [END DATE]], was anyone in the family covered by health insurance from any [other] source, such as those listed on the card?

YES .................................... 1 [LOOP_10]
NO ..................................... 2 [BOX_25]
REF ................................... -7 [BOX_25]
DK .................................... -8 [BOX_25]
HELP AVAILABLE FOR DEFINITIONS OF ITEMS ON SHOW CARD.
----------------------------------------------------
DISPLAY 'Not counting insurance you already told me about, at' AND 'other' IF ANY SOURCES OF INSURANCE ARE RECORDED FOR THIS RU.

IF NO SOURCES OF INSURANCE ARE RECORDED FOR THIS RU, DISPLAY 'At'.

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:

PRIVATELY PURCHASED INSURANCE CATEGORY 1
PRIVATELY PURCHASED INSURANCE CATEGORY 2
PRIVATELY PURCHASED INSURANCE CATEGORY 3
PRIVATELY PURCHASED INSURANCE CATEGORY 4
PRIVATELY PURCHASED INSURANCE CATEGORY 5
PRIVATELY PURCHASED INSURANCE CATEGORY 6

ASK HX23 - END_LP10
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_10 COLLECTS INFORMATION ABOUT PRIVATELY PURCHASED HEALTH INSURANCE OBTAINED FROM SOURCES OTHER THAN EMPLOYERS MENTIONED IN THE EMPLOYMENT SECTION OF THE INTERVIEW. THIS LOOP CYCLES ON SOURCES OF PRIVATELY PURCHASED INSURANCE LISTED AT HX23. THE FIRST CYCLE OF THIS LOOP COLLECTS THE FIRST SOURCEOF PRIVATELY PURCHASED INSURANCE. SUBSEQUENT CYCLES OF THE LOOP ARE DETERMINED BY THE RESPONSE AT HX24. IF HX24 IS CODED '1' (YES), THE LOOP CYCLES AGAIN TO COLLECT THE NEXT SOURCE OF PRIVATELY PURCHASED INSURANCE. IF HX24 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

HX23
====

[STR-DT] [END-DT]
SHOW CARD HX-4.
From which of the sources on this card did anyone in the family purchase health insurance?

FROM A GROUP OR ASSOCIATION .............. 1 [BOX_24]
DIRECTLY THROUGH A SCHOOL ................ 3 [BOX_24]
DIRECTLY FROM AN INSURANCE AGENT ......... 4 [BOX_24]
DIRECTLY FROM INSURANCE COMPANY .......... 5 [BOX_24]
DIRECTLY FROM AN HMO ..................... 6 [BOX_24]
FROM A UNION ............................. 7 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (COBRA) .. 8 [BOX_24]
FROM ANYONE'S PREVIOUS EMPLOYER (NOT COBRA) ............................ 9 [BOX_24]
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER .............................. 10 [BOX_24]
FROM SOME OTHER EMPLOYER ................ 11 [BOX_24]
UNDER PLAN OF SOMEONE NOT LIVING HERE ... 12 [BOX_24]
DIRECTLY FROM A HIGH RISK POOL [/[STATE NAME FOR HIGH RISK POOL]] ............. 13 [BOX_24]
DIRECTLY FROM [STATE EXCHANGE NAME-A] ... 14 [BOX_24]
OTHER SOURCE ............................ 91 [HX23OV]
REF ..................................... -7 [BOX_24]
DK ...................................... -8 [BOX_24]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
STARTING IN PANEL 12 ROUND 2, CATEGORY '2' (FROM A HEALTH INSURANCE PURCHASING ALLIANCE) WAS OMITTED AND WILL BE OMITTED IN ALL FUTURE ROUNDS.
----------------------------------------------------
----------------------------------------------------
STARTING IN PANEL 14 ROUND 5, PANEL 15 ROUND 3 AND PANEL 16 ROUND 1, CATEGORY '13' (DIRECTLY FROM A HIGH RISK POOL [/[STATE NAME FOR HIGH RISK POOL]]) WAS ADDED AS A CATEGORY AND WILL BE ADDED IN ALL FUTURE ROUNDS.
----------------------------------------------------
----------------------------------------------------
STARTING IN PANEL 17 ROUND 5, PANEL 18 ROUND 3 AND PANEL 19 ROUND 1, CATEGORY '14' (DIRECTLY FROM [STATE EXCHANGE NAME] WAS ADDED AND WILL BE ADDED IN ALL FUTURE ROUNDS.
----------------------------------------------------
----------------------------------------------------
DISPLAY '/[STATE NAME FOR HIGH RISK POOL]' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED OFFERS A HIGH RISK POOL HEALTH INSURANCE PLAN. THIS INCLUDES ALL STATES EXCEPT: AZ, DE, DC, GA, HI, ME, MA, MI, NV, NJ, NY, OH, PA, RI, VT, VA. IF INTERVIEW STATE IS ONE OF THESE STATES, USE A NULL DISPLAY.

FOR 'STATE NAME FOR HIGH RISK POOL' DISPLAY THE HIGH RISK POOL PLAN NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.

FOR 'STATE EXCHANGE NAME' DISPLAY THE EXCHANGE NAME 'A' ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------
----------------------------------------------------
DISPLAY AN 'ADD OTHER SOURCE' BUTTON ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD OTHER SOURCE' IS SELECTED, PRESENT 'ADD OTHER SOURCE' POP-UP (HX23OV) AND THEN GO TO BOX_24.
----------------------------------------------------

HX23OV
======

ENTER OTHER:

[Enter Other Specify] ..................
REF .................................... -7
DK ..................................... -8

BOX_24
======

----------------------------------------------------
ASK PRIVATE HEALTH INSURANCE DETAIL (HP) SECTION FOR THE RESPONSE CATEGORY SELECTED AT HX23 AND FLAGGED THIS ROUND AS PROVIDING HEALTH INSURANCE.
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE HP SECTION, CONTINUE WITH HX24
----------------------------------------------------

HX24
====

[STR-DT] [END-DT]
SHOW CARD HX-4.
Aside from what you already told me about, at any time [since [START DATE]/between [START DATE] and [END DATE]], was anyone in the family covered by health insurance from any other source listed on this card?
PROBE: Please include any type of health insurance anyone in the family is covered by which has not been discussed yet. This includes health insurance that was obtained from a source not listed on this card.

YES .................................... 1 [END_LP10]
NO ..................................... 2 [END_LP10]
REF ................................... -7 [END_LP10]
DK .................................... -8 [END_LP10]
HELP AVAILABLE FOR DEFINITIONS 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 HX24 IS CODED '1' (YES), CYCLE TO COLLECT THE NEXT INSURANCE CATEGORY.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, END LOOP_10, AND CONTINUE WITH BOX_25
----------------------------------------------------

BOX_25
======

----------------------------------------------------
IF NO PUBLIC OR PRIVATE INSURANCE RECORDED FOR ANY CURRENT RU MEMBER, GO TO BOX_45
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_26
----------------------------------------------------

BOX_26
======

----------------------------------------------------
IF ANY RU MEMBER HAS MEDICARE AS A SOURCE OF INSURANCE DURING THE CURRENT ROUND, CONTINUE WITH BOX_27
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_29
----------------------------------------------------

BOX_27
======

----------------------------------------------------
IF ROUND 1, GO TO LOOP_11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_28
----------------------------------------------------

BOX_28
======

----------------------------------------------------
IF NOT ROUND 1, CONTINUE WITH LOOP_11 ONLY FOR RU MEMBERS WHERE MEDICARE WAS RECORDED AS BEING RECEIVED THIS ROUND. THAT IS, CONTINUE WITH LOOP_11 ONLY IF THERE IS AT LEAST ONE ESTABLISHMENT-PERSON-PAIR WHERE THE ESTABLISHMENT IS MEDICARE AND THE PAIR WAS CREATED THIS ROUND.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_29
----------------------------------------------------

LOOP_11
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK HX25-END_LP11
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_11 COLLECTS MEDICARE CARD AND MANAGED CARE INFORMATION FOR RU MEMBERS COVERED BY MEDICARE. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWINGCONDITIONS:
IF ROUND 1:
- ESTABLISHMENT IS MEDICARE
AND
- PERSON IS AN RU MEMBER FLAGGED AS COVERED BY MEDICARE DURING THE ROUND IF NOT ROUND 1:
- ESTABLISHMENT IS MEDICARE
AND
- PERSON IS AN RU MEMBER
AND
- ESTABLISHMENT-PERSON-PAIR WAS CREATED THIS ROUND
----------------------------------------------------

HX25
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
CODE WITHOUT ASKING IF ANSWER IS KNOWN.
Can you please take out [your/[PERSON]'s] Medicare card?
We do not need [your/his/her] Medicare number, but would like to record the exact date [your/his/her] Medicare coverage became effective and what type of coverage [you/he/she] [have/has] through Medicare.

CARD AVAILABLE ......................... 1 [HX26]
CARD NOT AVAILABLE ..................... 2 [HX28A]
REF ................................... -7 [HX28A]
DK .................................... -8 [HX28A]
[Code One]
----------------------------------------------------
STARTING IN PANEL 13 ROUND 1/PANEL 12 ROUND 3, CAPI NO LONGER COLLECTS MEDICARE NUMBERS (SSN).
----------------------------------------------------

HX26
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Is that card a regular Medicare card, a Railroad Retirement Board card, or some other Medicare card?

MEDICARE CARD (RED, WHITE AND BLUE) .... 1
RAILROAD RETIREMENT BOARD CARD (RED, WHITE AND BLUE) ........................ 2
SOME OTHER CARD ........................ 3
[Code All That Apply]
----------------------------------------------------
NOTE: INTERVIEWERS WILL BE TRAINED TO CODE ANY TYPE OF MANAGED CARE CARD COLLECTED HERE AS SOME OTHER CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (MEDICARE CARD) OR '2' (RAILROAD RETIREMENT BOARD CARD), CONTINUE WITH HX27
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (SOME OTHER CARD) ONLY, GO TO HX28A
----------------------------------------------------

HX27
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HX-2.
Please tell me the effective date listed on the card.
[Are/Is] [you/[PERSON]] entitled to hospital (Part A), medical (Part B), or both?
EFFECTIVE DATE:

[Enter Month,Day,Year-4]
TYPE OF COVERAGE (IS ENTITLED TO):
HOSPITAL ONLY .......................... 1
MEDICAL AND HOSPITAL ................... 2
MEDICAL ONLY ........................... 3
[Code One]
----------------------------------------------------
STARTING IN PANEL 13, ROUND 1/PANEL 12, ROUND 3, CAPI NO LONGER COLLECTS MEDICARE NUMBERS (SSN).
----------------------------------------------------
----------------------------------------------------
GO TO HX32
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
CHECK EFFECTIVE DATE. DATE MUST BE ON OR BEFORE (I.E., ( OR =) THE INTERVIEW DATE. IF EFFECTIVE DATE IS ON OR BEFORE JANUARY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, [YEAR]'.
----------------------------------------------------
----------------------------------------------------
SOFT RANGE CHECK: MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------

HX28
=====

OMITTED.

HX28A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Part A of Medicare covers most hospital expenses. Part B covers many doctors' expenses, including doctor visits, and the premium is usually deducted from [your/[PERSON]'s] Social Security.
[Are/Is] [you/he/she] covered under Part B of Medicare?

YES ................................... 1 [HX29]
NO .................................... 2 [HX29]
REF ................................... -7 [HX29]
DK .................................... -8 [HX29]

HX29
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
When did [your/[PERSON]'s] Medicare coverage start?

[Enter Month,Year-4] .................. [HX30]
REF ................................... -7 [HX29OV]
DK .................................... -8 [HX29OV]
----------------------------------------------------
IF EFFECTIVE DATE IS:
- A VALID DATE (I.E., NOT 'RF' (REFUSED) OR 'DK' (DON'T KNOW) IN THE MONTH OR YEAR FIELDS
AND
- ON OR BEFORE JANUARY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, THEN FLAG RU MEMBER AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, [YEAR].
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DATE MUST BE ON OR BEFORE (I.E., ( OR =) INTERVIEW DATE OR 12/31/[YEAR], WHERE YEAR IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 5. '-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.

MEDICARE EFFECTIVE DATE MUST BE = OR ) BIRTH DATE OF PERSON.
----------------------------------------------------

HX29OV
======

Did [you/he/she] have Medicare coverage on January 1, [YEAR]?

YES ................................... 1 [HX30]
NO .................................... 2 [HX30]
REF ................................... -7 [HX30]
DK .................................... -8 [HX30]
----------------------------------------------------
IF HX29OV CODED '1' (YES), FLAG PERSON AS 'WITH HEALTH INSURANCE COVERAGE ON JAN 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL.
----------------------------------------------------

HX29OV2
=======

OMITTED.

HX30
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HX-2.
[Do/Does] [you/[PERSON]] have a Medicare card that looks like this?

YES .................................... 1 [HX32]
NO ..................................... 2 [HX32]
REF ................................... -7 [HX32]
DK .................................... -8 [HX32]

HX30A
=====

OMITTED.

BOX_28A
=======

OMITTED.

HX31
====

OMITTED.

HX31OV
======

OMITTED.

HX32
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Are/Is] [you/[PERSON]] currently/As of [END DATE], [were/was] [you/[PERSON]] enrolled in a Medicare Advantage or managed care plan, such as an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) to receive [your/his/her] Medicare-funded health care? When answering, please include only insurance from Medicare, not any privately purchased or job-related insurance.

YES .................................... 1 [HX33]
NO ..................................... 2 [HX35A]
REF ................................... -7 [HX35A]
DK .................................... -8 [HX35A]
HELP AVAILABLE FOR DEFINITION OF MEDICARE MANAGED CARE.
----------------------------------------------------
DISPLAY '[Are/Is] [you/[PERSON] currently' IF NOT ROUND 5. DISPLAY 'as of [END DATE], [were/was] [you/[PERSON]' IF ROUND 5.
----------------------------------------------------

HX32A
=====

OMITTED.

HX33
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What [is/was] the name of [your/[PERSON]'s] Medicare managed care plan [as of [END DATE]]?

[Enter Plan Name] ..................... [HX33A]
REF ................................... -7 [HX33A]
DK .................................... -8 [HX33A]
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5.

DISPLAY 'as of [END DATE]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
FLAG INSURER CODED ABOVE AS 'CURRENT ROUND'S MEDICARE INSURER' FOR THIS ESTABLISHMENT-PERSON- PAIR.
----------------------------------------------------

HX33A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Do/Does]/Did] [you/[PERSON]] have prescribed medicine coverage through [[NAME OF PLAN FROM HX33]/[your/his/her] Medicare managed care plan] [as of [END DATE]]?

YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY '[Do/Does]' IF NOT ROUND 5. DISPLAY 'Did' IF ROUND 5.

DISPLAY '[NAME OF PLAN FROM HX33]' IF A PLAN NAME WAS CODED AT HX33. DISPLAY '[your/his/her] Medicare managed care plan' IF HX33 IS CODED '-7' (REF) OR '-8' (DK).

DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR 'NAME OF PLAN FROM HX33' IF A PLAN NAME WAS ENTERED.

DISPLAY 'as of [END DATE]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 OR ROUND 3, CONTINUE WITH HX34
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP11
----------------------------------------------------

HX34
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, [do/does] [you/[PERSON]] (or anyone in the family) pay anything else for [the coverage with [[NAME OF PLAN FROM HX33]/this Medicare Managed Care plan]?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]

YES .................................... 1 [HX34A]
NO ..................................... 2 [END_LP11]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
DISPLAY 'the coverage with [NAME OF PLAN FROM HX33]' IF A MEDICARE PLAN NAME WAS ENTERED AT HX33. DISPLAY 'this Medicare managed care plan' IF HX33 WAS CODED '-7' (REF) OR '-8' (DK).

DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR 'NAME OF PLAN FROM HX33' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

HX34A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
How [do/does] [you/[PERSON]] pay for [your/his/her] [[NAME OF PLAN FROM HX33]/Medicare managed care] premium?
IF NECESSARY, SAY: Is the Medicare Advantage premium paid through [your/his/her] Social Security check, paid directly to the provider, or paid both ways?

DEDUCTED FROM SOCIAL SECURITY .......... 1 [HX35]
PAY DIRECTLY ........................... 2 [HX35]
BOTH ................................... 3 [HX35]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]
----------------------------------------------------
DISPLAY '[NAME OF PLAN FROM HX33]' IF A MEDICARE PLAN NAME WAS ENTERED AT HX33. DISPLAY 'Medicare managed care' IF HX33 WAS CODED '-7' (REF) OR '-8' (DK).

DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR 'NAME OF PLAN FROM HX33' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

HX35
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
How much [is [your/[PERSON]'s Social Security deduction/[do/does] [you/[PERSON]] pay in premiums] for [your/his/her] [NAME OF PLAN FROM HX33] plan?
IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.

[Enter Amount in Dollars] .............. [HX35OV1]
REF ................................... -7 [HX35AA]
DK .................................... -8 [HX35AA]
----------------------------------------------------
DISPLAY 'is [your/[PERSON]'s] Social Security deduction' IF HX34A IS CODED '1' (DEDUCTED FROM SOCIAL SECURITY'. DISPLAY '[do/does] [you/ [PERSON]] pay in premiums' IF HX34A IS CODED '2' (PAY DIRECTLY) OR '3' (BOTH).
----------------------------------------------------
----------------------------------------------------
DISPLAY '[NAME OF PLAN FROM HX33]' IF A MEDICARE PLAN NAME WAS ENTERED AT HX33. OTHERWISE (I.E., IF HX33 WAS CODED '-7' (REF) OR '-8' (DK)), USE A NULL DISPLAY.

DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR 'NAME OF PLAN FROM HX33' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

HX35OV1
=======

Is that per year, per month, per week, or what?
UNIT OF COVERAGE:

PER YEAR ............................... 1 [END_LP11]
QUARTERLY/EVERY 3 MONTHS ............... 2 [END_LP11]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [END_LP11]
PER MONTH .............................. 4 [END_LP11]
PER WEEK ............................... 5 [END_LP11]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [END_LP11]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [END_LP11]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [END_LP11]
OTHER ................................. 91 [HX35OV2]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]
[Code One]

HX35OV2
=======

SPECIFY:

[Enter Other Specify] .................. [END_LP11]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]

HX35AA
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[PLAN NAME: [NAME OF PLAN FROM HX33]]
SHOW CARD HX-6.
Which category on the card best indicates the cost of this plan per month?

1 - 50 ................................. 1 [END_LP11]
51 - 100 ............................... 2 [END_LP11]
101 - 200 .............................. 3 [END_LP11]
201 - 300 .............................. 4 [END_LP11]
301 OR MORE ............................ 5 [END_LP11]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]
----------------------------------------------------
DISPLAY 'PLAN NAME: [NAME OF PLAN FROM HX33]' IF A MEDICARE PLAN NAME WAS ENTERED AT HX33. OTHERWISE (I.E., IF HX33 WAS CODED '-7' (REF) OR '-8' (DK)), USE A NULL DISPLAY.

DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX33 FOR 'NAME OF PLAN FROM HX33' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

HX35A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Are/Is]/[Were/Was]] [you/[PERSON]] enrolled in Medicare Part D, also known as the Medicare Prescription Drug Plan [as of [END DATE]]?

HX35B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, [do/does] [you/[PERSON]] (or anyone in the family) pay anything else for [your/his/her] Medicare Prescription Drug Plan (also known as Part D)?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]

YES .................................... 1 [HX35C]
NO ..................................... 2 [END_LP11]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.

HX35C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
How [do/does] [your/[PERSON]] pay for [your/his/her] Part D premium?
IF NECESSARY, SAY: Is the Medicare drug coverage premium paid through [your/his/her] Social Security check, paid directly to the provider, or paid both ways?

DEDUCTED FROM SOCIAL SECURITY .......... 1 [HX35D]
PAY DIRECTLY ........................... 2 [HX35D]
BOTH ................................... 3 [HX35D]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]

HX35D
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
How much [is [your/[PERSON]'s] Social Security deduction/[do/does] [you/[PERSON]] pay in premiums] for [your/his/her] Part D plan?
IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.

[Enter Amount in Dollars] .............. [HX35DOV1]
REF ................................... -7 [HX35E]
DK .................................... -8 [HX35E]
----------------------------------------------------
DISPLAY 'is [your/[PERSON]'s] Social Security deduction' IF HX35C IS CODED '1' (DEDUCTED FROM SOCIAL SECURITY'. DISPLAY '[do/does] [you/ [PERSON]] pay in premiums' IF HX35C IS CODED '2' (PAY DIRECTLY) OR '3' (BOTH).
----------------------------------------------------

HX35DOV1
========

Is that per year, per month, per week, or what?
UNIT OF COVERAGE:

PER YEAR ............................... 1 [END_LP11]
QUARTERLY/EVERY 3 MONTHS ............... 2 [END_LP11]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [END_LP11]
PER MONTH .............................. 4 [END_LP11]
PER WEEK ............................... 5 [END_LP11]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [END_LP11]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [END_LP11]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [END_LP11]
OTHER ................................. 91 [HX35DOV2]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]
[Code One]

HX35DOV2
========

SPECIFY:

[Enter Other Specify] .................. [END_LP11]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]

HX35E
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HX-7.
Which category on the card best indicates the cost of this plan per month?

1 - 30 ................................. 1 [END_LP11]
31 - 60 ................................ 2 [END_LP11]
61 - 90 ................................ 3 [END_LP11]
91 - 120 ............................... 4 [END_LP11]
121 OR MORE ............................ 5 [END_LP11]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]

END_LP11
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_11 AND CONTINUE WITH BOX_29
----------------------------------------------------

BOX_29
======

----------------------------------------------------
IF ANY RU MEMBER HAS MEDICAID/SCHIP OR GOVT- HOSPITAL/PHYSICIAN AS A SOURCE OF INSURANCE DURING THE CURRENT ROUND, CONTINUE WITH BOX_30
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_32
----------------------------------------------------

BOX_30
======

----------------------------------------------------
IF NO ONE IN THE RU WAS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE PREVIOUS ROUND AND AT LEAST ONE RU MEMBER IS COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND
OR
IF NO ONE IN THE RU WAS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE PREVIOUS ROUND AND AT LEAST ONE RU MEMBER IS COVERED BY GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND, CONTINUE WITH HX42
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_32
----------------------------------------------------
----------------------------------------------------
NOTE: SINCE AN RU CANNOT HAVE BOTH MEDICAID/SCHIP AND GOVT-HOSPITAL/PHYSICIAN, HX42-HX46B WILL BE ASKED ONLY ONCE; EITHER FOR A 'YES' TO HX10 (MEDICAID/SCHIP) OR A 'YES' TO HX14 (GOVT- HOSPITAL/PHYSICIAN).
----------------------------------------------------

HX36
====

OMITTED.

HX37
====

OMITTED.

HX38
====

OMITTED.

HX38OV1
=======

OMITTED.

HX38OV2
=======

OMITTED.

HX39
====

OMITTED.

HX40
====

OMITTED.

BOX_31AA
========

OMITTED.

HX41
====

OMITTED.

HX41OV
======

OMITTED.

HX42
====

[STR-DT] END-DT]
Under [[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]/ the program sponsored by a state or local government agency which provides hospital and physician benefits] [(are/is)/(were/was)] (READ NAME(S) BELOW) enrolled in an HMO, that is a Health Maintenance Organization [between [START DATE] and [END DATE]]?
[With an HMO, you must generally receive care from HMO physicians. If another doctor is seen, the expense is not covered unless you were referred by the HMO, or there was a medical emergency.]

[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, ALL ARE ........................... 1 [HX44]
YES, SOME ARE .......................... 2 [HX44]
NO, NONE ARE ........................... 3 [HX43]
REF ................................... -7 [HX43]
DK .................................... -8 [HX43]
[Code One]
HELP AVAILABLE FOR DEFINITION OF HMO.
----------------------------------------------------
DISPLAY '[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]' IF ASKING ABOUT MEDICAID/ SCHIP. DISPLAY 'the program....benefits' IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(are/is)' IF NOT ROUND 5. DISPLAY '(were/was)' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'MEDICAID'. DISPLAY 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE REAL STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'MEDICAID.' FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. ESTABLISHMENT IS MEDICAID/SCHIP OR GOVT- HOSPITAL/PHYSICIAN,
AND
2. PERSON IS AN RU MBMBER FLAGGED AS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND.
----------------------------------------------------

HX43
====

[STR-DT] [END-DT]
[Does/Between [START DATE] and [END DATE], did] [[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]/the program sponsored by a state or local government agency which provides hospital and physician benefits] require (READ NAME(S) BELOW) to sign up with a certain primary care doctor, group of doctors, or with a certain clinic which they must go to for all of their routine care?
PROBE: Do not include emergency care or care from a specialist they were referred to.

[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, ALL REQUIRED ...................... 1 [HX44]
YES, SOME REQUIRED ..................... 2 [HX44]
NO, NONE REQUIRED ...................... 3
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITIONS OF PRIMARY CARE DOCTOR AND ROUTINE CARE.
----------------------------------------------------
DISPLAY 'Does' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISPLAY '[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]' IF ASKING ABOUT MEDICAID/SCHIP.DISPLAY 'the program....benefits' IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'MEDICAID'. DISPLAY 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE REAL STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'MEDICAID.' FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE REQUIRED), '-7' (REFUSED), OR '-8' (DON'T KNOW), THERE IS NO INSURER ASSOCIATED WITH THE CURRENT ROUND FOR MEDICAID/ SCHIP OR GOVT-HOSPITAL/PHYSICIAN.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE REQUIRED), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND IF ASKING ABOUT MEDICAID/SCHIP, GO TO HX45
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE REQUIRED), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND ASKING ABOUT GOVT- HOSPITAL/PHYSICIAN, GO TO HX45
----------------------------------------------------
----------------------------------------------------
OTHERWISE, (I.E., IF CODED '1' (YES, ALL REQUIRED) OR '2' (YES, SOME REQUIRED)), CONTINUE WITH HX44
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. ESTABLISHMENT IS MEDICAID/SCHIP OR GOVT- HOSPITAL/PHYSICIAN,
AND
2. PERSON IS AN RU MBMBER FLAGGED AS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND.
----------------------------------------------------

HX44
====

[STR-DT] [END-DT]
What is the name of the [[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]] [HMO/health insurance] [from the program sponsored by a state or local government agency which provides hospital and physician benefits]?

[Enter Plan Name] .....................
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY '[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]' IF ASKING ABOUT MEDICAID/ SCHIP. IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN, USE A NULL DISPLAY.

DISPLAY 'from the....benefits' IF ASKING ABOUT GOVT-HOSPITAL/PHYSICIAN. IF ASKING ABOUT MEDICAID/SCHIP, USE A NULL DISPLAY.

DISPLAY 'HMO' IF HX42 IS CODED '1' (YES, ALL ARE) OR '2' (YES, SOME ARE).

DISPLAY 'health insurance' IF HX43 IS CODED '1' (YES, ALL REQUIRED) OR '2' (YES, SOME REQUIRED).
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'MEDICAID'. DISPLAY 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE REAL STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'MEDICAID.' FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
FLAG INSURER CODED ABOVE AS CURRENT ROUND'S INSURER FOR MEDICAID/SCHIP OR GOVT-HOSPITAL/ PHYSICIAN.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH HX45
----------------------------------------------------

BOX_31B
=======

OMITTED.

HX45
====

[STR-DT] [END-DT]
Is there a monthly premium [for anyone in the family] for the coverage through [[NAME OF PLAN FROM HX44]/[[Medicaid/[STATE NAME FOR MEDICAID]]] or [STATE CHIP NAME]/the program sponsored by a state or local government agency which provides hospital and physician benefits]?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]
READ IF NECESSARY: A monthly premium is a fixed amount of money people pay each month to have health coverage. It does not include copays or other expenses such as prescription costs.

YES, EVERYONE COVERED PAYS ............. 1 [BOX_31]
YES, SOME COVERED PAY .................. 2 [HX45A]
NO, NO ONE COVERED PAYS ................ 3 [BOX_32]
REF ................................... -7 [BOX_32]
DK .................................... -8 [BOX_32]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
DISPLAY '[NAME OF PLAN FROM HX44]' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, DISPLAY, [[Medicaid/... and physician benefits]'. DISPLAY '[Medicaid/ [STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]' IF ASKING ABOUT MEDICAID/SCHIP. DISPLAY 'the program ... benefits' IF ASKING ABOUT GOVT- HOSPITAL/PHYSICIAN.

DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR 'NAME OF PLAN FROM HX44' IF A PLAN NAME WAS ENTERED.

DISPLAY 'for anyone in the family' IF MORE THAN ONE RU MEMBER SELECTED AS COVERED BY MEDICAID/ SCHIP OR GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHCH INTERVIEW IS BEING CONDUCTED USES THE NAME 'MEDICAID'. DISPLAY 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE REAL STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'MEDICAID.' FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS (SUBSTITUTING THE REAL STATE NAME FOR PROGRAM). FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES, EVERYONE COVERED PAYS), FLAG ALL PERSONS AT HX45A AS 'PAYS FOR COVERAGE DURING CURRENT ROUND.' IF CODED '3' (NO, NO ONE COVERED PAYS), FLAG ALL PERSONS AT HX45A AS 'DOES NOT PAY FOR COVERAGE DURING CURRENT ROUND.'

(AHRQ WILL DECIDE ON FLAGS FOR '-7', '-8' AND '-9' VALUES AFTER DETERMINING FREQUENCY IN FY2012.)
----------------------------------------------------

HX45A
=====

[STR-DT] [END-DT]
Which family members have a monthly premium for that coverage?
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]
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'PAYS FOR COVERAGE DURING CURRENT ROUND.' FLAG ALL PERSONS NOT SELECTED AS 'DOES NOT PAY FOR COVERAGE DURING CURRENT ROUND.'
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_31
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. ESTABLISHMENT IS MEDICAID/SCHIP OR GOVT- HOSPITAL/PHYSICIAN,
AND
2. PERSON IS AN RU MEMBER FLAGGED AS COVERED BY MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND.
----------------------------------------------------

BOX_31
======

----------------------------------------------------
IF ROUND 1 OR ROUND 3, CONTINUE WITH HX46
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HX46B
----------------------------------------------------

HX46
====

[STR-DT] [END-DT]
How much is the premium for [the [NAME OF PLAN FROM HX44]/that] coverage?

[Enter Amount in Dollars] .............. [HX46OV1]
REF ................................... -7 [HX46B]
DK .................................... -8 [HX46B]
----------------------------------------------------
DISPLAY 'the [NAME OF PLAN FROM HX44]' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, DISPLAY, 'that'.

DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR 'NAME OF PLAN FROM HX44' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

HX46OV1
=======

Is that per year, per month, per week, or what?
UNIT OF COVERAGE:

PER YEAR ............................... 1 [HX46B]
QUARTERLY/EVERY 3 MONTHS ............... 2 [HX46B]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [HX46B]
PER MONTH .............................. 4 [HX46B]
PER WEEK ............................... 5 [HX46B]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [HX46B]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [HX46B]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [HX46B]
OTHER ................................. 91 [HX46OV2]
REF ................................... -7 [HX46B]
DK ....................................

-8 [HX46B]
[Code One]

HX46OV2
=======

SPECIFY:

[Enter Other Specify] .................. [HX46B]
REF ................................... -7 [HX46B]
DK .................................... -8 [HX46B]

HX46B
=====

[STR-DT] [END-DT]
[PLAN NAME: [NAME OF PLAN FROM HX44]]
Is the cost of the premium subsidized based on family income?

YES .................................... 1 [BOX_31C]
NO ..................................... 2 [BOX_31C]
REF ................................... -7 [BOX_31C]
DK .................................... -8 [BOX_31C]
----------------------------------------------------
DISPLAY 'PLAN NAME: ...' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE MEDICAID/SCHIP OR GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, USE A NULL DISPLAY.

DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR 'NAME OF PLAN FROM HX44' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

BOX_31C
======

----------------------------------------------------
IF GOVERNMENT-HOSPITAL PHYSICIAN, CONTINUE WITH BOX_31D
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_32
----------------------------------------------------

BOX_31D
=======

----------------------------------------------------
IF HX15A IS CODED '1' (YES, PLAN IS EXCHANGE) AND HX45 IS CODED '1' (YES, EVERYONE COVERED PAYS) OR '2' (YES, SOME COVERED PAY), CONTINUE WITH HX47
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_32
----------------------------------------------------

HX47
====

[STR-DT] [END-DT]
Is [the [NAME OF PLAN FROM HX44] plan/this plan] a platinum, gold, silver, bronze or catastrophic plan?

PLATINUM PLAN .......................... 1 [BOX_32]
GOLD PLAN .............................. 2 [BOX_32]
SILVER PLAN ............................ 3 [BOX_32]
BRONZE PLAN ............................ 4 [BOX_32]
CATASTROPHIC PLAN ...................... 5 [BOX_32]
IF VOLUNTEERED: SOMETHING ELSE ......... 6 [BOX_32]
REF ................................... -7 [BOX_32]
DK .................................... -8 [BOX_32]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'the [NAME OF PLAN FROM HX44] plan' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, DISPLAY 'this plan.'

DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX44 FOR '[NAME OF PLAN FROM HX44]' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

HX47OV
=====

OMITTED.

BOX_31E
=======

OMITTED.

HX47A
=====

OMITTED.

HX47B
=====

OMITTED.

HX47BOV1
========

OMITTED.

HX47BOV2
========

OMITTED.

BOX_32
======

-----------------------------------------------------
IF ANY ESTABLISHMENT RECORDED AS PROVIDING PRIVATE INSURANCE (THAT WAS CREATED DURING THE CURRENT ROUND) TO A CURRENT RU MEMBER, CONTINUE WITH LOOP_12
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO BOX_44C
-----------------------------------------------------

LOOP_12
=======

-----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK HX48-END_LP12
-----------------------------------------------------
-----------------------------------------------------
LOOP DEFINITION: LOOP_12 COLLECTS PRIVATE HEALTH INSURANCE INFORMATION. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS PROVIDER OF PRIVATE HEALTH INSURANCE TO A CURRENT RU MEMBER
AND
- THE INSURANCE COVERAGE PROVIDED BY THE ESTABLISHMENT IS CREATED DURING THE CURRENT ROUND
-----------------------------------------------------

HX48
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
SHOW CARD HX-9.
Now think again about [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT]. Looking at this card, what health insurance coverage [[do/does]/did] [you/he/she] have [as of [END DATE]]?
PROBE: Any other health coverage through this plan?

CHECK ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ...... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91 [HX48OV]
REF ................................... -7 [BOX_33]
DK .................................... -8 [BOX_33]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
[NOTE: 'DISABILITY,' 'WORKER'S COMPENSATION,' AND 'ACCIDENT' WILL NOT APPEAR ON THE SHOW CARD.]
----------------------------------------------------
DISPLAY '[do/does]' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER, AND THE CURRENT ROUND IS NOT ROUND 5. OTHERWISE, DISPLAY 'did'.

DISPLAY 'as of [END DATE]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
NOTE: CODES 9, 10 AND 11 WILL NOT APPEAR ON THE SHOW CARD.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW '-7' (REFUSED) OR '-8' (DON'T KNOW) IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODE, CONTINUE WITH HX48OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------

HX48OV
======

SPECIFY:

[Enter Other Specify] ................. [BOX_33]
REF ................................... -7 [BOX_33]
DK .................................... -8 [BOX_33]

BOX_33
======

----------------------------------------------------
IF ESTABLISHMENT TYPE IS NOT INSURANCE CO. OR HMO AND HX48 IS CODED '5' (MEDICARE SUPPLEMENT OR MEDIGAP) ONLY OR '5' AND ANY OTHER CODES, CONTINUE WITH HX49
----------------------------------------------------
----------------------------------------------------
IF ESTABLISHMENT TYPE IS INSURANCE CO. OR HMO AND HX48 IS CODED '5' (MEDICARE SUPPLEMENT OR MEDIGAP) ONLY OR '5' AND ANY OTHER CODES, AUTOMATICALLY CODE HX49 WITH APPROPRIATE RESPONSES BY CAPI AND THEN GO TO BOX_35
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., HX48 IS NOT CODED '5' (MEDICARE SUPPLEMENT OR MEDIGAP)), GO TO BOX_35
----------------------------------------------------

HX49
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
What is the name of the insurance company or HMO from which [you/[POLICYHOLDER]] [receive/receives] the Medicare Supplement or Medigap benefits?
IF MORE THAN ONE NAME, PROBE: What is the main insurance company or HMO from which [you/he/she] [receive/receives] the Medicare Supplement or Medigap benefits?
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, SELECT 'HMO'.

NAME OF INSURER: [Enter Insurer] ..........
REF ...................... -7
DK ........... ........... -8
TYPE: 1 = INSURANCE COMPANY ...............
2 = HMO .............................
REF ................................. -7
DK .................................. -8
HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO.
----------------------------------------------------
FLAG INSURANCE CO./HMO AS 'SUPPLYING MEDICARE SUPPLEMENT/MEDIGAP BENEFITS'. ALSO FLAG AS CURRENT ROUND'S INSURER(S) FOR THIS ESTABLISHMENT-PERSON-PAIR.
----------------------------------------------------
----------------------------------------------------
BOTH INSURER NAME AND INSURER TYPE MUST BE ENTERED.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_35
----------------------------------------------------

BOX_34
======

OMITTED.

LOOP_13
=======

OMITTED.

HX50
====

OMITTED.

HX50OV
======

OMITTED.

END_LP13
========

OMITTED.

BOX_35
======

----------------------------------------------------
IF ESTABLISHMENT TYPE IS INSURANCE COMPANY, INSURANCE COMPANY - FROM AGENT, OR HMO, AND HX48 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) (BUT NOT '5' (MEDIGAP)), FLAG INSURANCE COMPANY/HMO AS 'SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS' AND AUTOMATICALLY CODE HX51 WITH APPROPRIATE RESPONSES BY CAPI AND GO TO BOX_38
----------------------------------------------------
----------------------------------------------------
IF ESTABLISHMENT TYPE IS NOT INSURANCE COMPANY, INSURANCE COMPANY - FROM AGENT, OR HMO, AND HX48 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) AND NOT ALSO CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP), CONTINUE WITH HX51
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND HX48 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) AND '5' (MEDICARE SUPPLEMENT/MEDIGAP) (IN COMBINATION WITH ANY OTHER CODES), GO TO BOX_38
----------------------------------------------------
----------------------------------------------------
IF HX48 IS NOT CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT IS CODED '2' (DENTAL), '3' (PRESCRIPTION DRUGS), '4' (VISION), '5' (MEDICARE SUPPLEMENT/MEDIGAP), '6' (LONG TERM CARE IN A NURSING HOME), '7' (EXTRA CASH FOR HOSPITAL STAYS), '8' (SERIOUS DISEASE OR DREAD DISEASE), OR '91' (OTHER), GO TO BOX_38
----------------------------------------------------
----------------------------------------------------
IF HX48 IS CODED ANY COMBINATION OF ONLY CODES '9'(DISABILITY), '10' (WORKER'S COMPENSATION) OR '11' (ACCIDENT), GO TO END_LP12
----------------------------------------------------
----------------------------------------------------
IF ROUND 1 AND HX48 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO BOX_39
----------------------------------------------------
----------------------------------------------------
IF ROUND 2, 3, 4, OR 5 AND HX48 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), GO TO BOX_38
----------------------------------------------------

HX51
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
What is the name of the insurance company or HMO from which [you/[POLICYHOLDER]] [receive/receives] hospital and physician benefits?
IF MORE THAN ONE NAME, PROBE: What is the main insurance company or HMO from which [you/he/she] [receive/receives] hospital and physician benefits?
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, SELECT 'HMO'.

NAME OF INSURER: [Enter Insurer] ..........
REF ...................... -7
DK ..... ................. -8
TYPE: 1 = INSURANCE COMPANY ...............
2 = HMO .............................
REF ................................. -7
DK .................................. -8
HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO.
----------------------------------------------------
FLAG INSURANCE CO./HMO AS 'SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS'. ALSO FLAG AS CURRENT ROUND'S INSURER(S) FOR THIS ESTABLISHMENT-PERSON-PAIR.
----------------------------------------------------
----------------------------------------------------
BOTH INSURER NAME AND INSURER TYPE MUST BE ENTERED.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_38
----------------------------------------------------

BOX_36
======

OMITTED.

LOOP_14
=======

OMITTED.

HX52
====

OMITTED.

HX52OV
======

OMITTED.

END_LP14
========

OMITTED.

BOX_37
======

OMITTED.

HX53
====

OMITTED.

HX54
====

OMITTED.

LOOP_15
=======

OMITTED.

HX55
====

OMITTED.

HX55OV
======

OMITTED.

END_LP15
========

OMITTED.

BOX_38
======

----------------------------------------------------
GO TO BOX_40
----------------------------------------------------

HX56
====

OMITTED.

LOOP_16
=======

OMITTED.

HX57
====

OMITTED.

HX57OV
======

OMITTED.

HX58
====

OMITTED.

END_LP16
========

OMITTED.

BOX_39
======

OMITTED.

HX59
====

OMITTED.

HX59OV
======

OMITTED.

BOX_40
======

----------------------------------------------------
IF THIS ESTABLISHMENT-PERSON-PAIR HAS AT LEAST ONE INSURER THAT PROVIDES HOSPITAL AND PHYSICIAN BENEFITS OR THAT PROVIDES MEDICARE SUPPLEMENT/ MEDIGAP COVERAGE AND THE POLICYHOLDER IS NOT LISTED AS A COVERED PERSON WITH MEDICAID OR GOVT- HOSPITAL/PHYSICIAN FOR THE CURRENT ROUND, CONTINUE WITH LOOP_17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_41A
----------------------------------------------------

LOOP_17
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-ESTABLISHMENT-PERSON- INSURER-TRIPLES-ROSTER, ASK BOX_40A - END_LP17
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_17 COLLECTS INFORMATION ON PLANS THAT PROVIDE HOSPITAL/PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/MEDIGAP COVERAGE TO EACH POLICYHOLDER NOT ALSO COVERED BY MEDICAID OR GOVT-HOSPITAL/PHYSICIAN TO DETERMINE IF THAT PLAN IS ANHMO/MANAGED CARE PLAN. THIS LOOP CYCLES ON TRIPLES THAT MEET THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS PROVIDER OF HOSPITAL/PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/MEDIGAP COVERAGE
AND
- PERSON IS NOT LISTED AS A COVERED PERSON WITH EDICAID OR GOVT-HOSPITAL/PHYSICIAN
AND
- INSURER IS THE SOURCE OF THE HOSPITAL AND PHYSICIAN BENEFITS PROVIDED TO PERSON THROUGH THE ESTABLISHMENT (I.E., THE INSURANCE COMPANY OR SELF-INSURED COMPANY)
----------------------------------------------------

BOX_40A
=======

----------------------------------------------------
IF INSURER IS AN HMO (EPIN.INSTYPE = 2), GO TO END_LP17
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF INSURER IS NOT AN HMO), CONTINUE WITH BOX_41
----------------------------------------------------

BOX_41
======

----------------------------------------------------
PRESENT MANAGED CARE (MC) SECTION FOR THIS INSURER
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE MC SECTION, CONTINUE WITH END_LP17
----------------------------------------------------

END_LP17
========

----------------------------------------------------
CYCLE ON NEXT TRIPLE ON RU-ESTABLISHMENT-PERSON- INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE TRIPLES MEET THE STATED CONDITIONS, END LOOP_17 AND CONTINUE WITH BOX_41A
----------------------------------------------------

BOX_41A
=======

----------------------------------------------------
IF HP04A IS CODED '1' (YES, PLAN IS EXCHANGE) OR IF THIS ESTABLISHMENT-PERSON-PAIR IS FLAGGED AS 'EXCHANGE COVERAGE' (HX03=11 OR HX23=14)
AND
IS FLAGGED AS 'SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS' (HX48 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT NOT '5' (MEDIGAP))
AND
POLICYHOLDER OF THIS PAIR IS 64 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-8 CONTINUE WITH HX60A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_42
----------------------------------------------------

HX60A
=====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OFESTABLISHMENT] [STR-DT][END-DT]
Is [your/[PERSON]'s] [INSURER RECORDED AT HX51] plan a platinum, gold, silver, bronze or catastrophic plan?

PLATINUM PLAN .......................... 1 [BOX_42]
GOLD PLAN .............................. 2 [BOX_42]
SILVER PLAN ............................ 3 [BOX_42]
BRONZE PLAN ............................ 4 [BOX_42]
CATASTROPHIC PLAN ...................... 5 [BOX_42]
IF VOLUNTEERED: SOMETHING ELSE ......... 6 [BOX_42]
REF ................................... -7 [BOX_42]
DK .................................... -8 [BOX_42]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY THE ACTUAL PLAN NAME ENTERED AT HX51 FOR '[INSURER RECORDED AT HX51]' IF A PLAN NAME WAS ENTERED. OTHERWISE, USE A NULL DISPLAY
----------------------------------------------------

BOX_42
======

----------------------------------------------------
IF ROUND 1 OR ROUND 3 AND IF HX48 IS CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP), CONTINUE WITH HX60
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_43
----------------------------------------------------

HX60
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
CODE WITHOUT ASKING IF ANSWER IS KNOWN.
Many Medicare Supplemental or Medigap Plans are referred to by a Plan Letter. Do you know the Plan Letter for [your/[PERSON]'s] plan?
PROBE: What is it?

[Enter Plan Letter] .................... [BOX_43]
REF ................................... -7 [BOX_43]
DK .................................... -8 [BOX_43]
HELP AVAILABLE FOR DEFINITION OF PLAN LETTER.
----------------------------------------------------
HARD CHECK: MEDICARE SUPPLEMENTAL OR MEDIGAP PLANS: MEDICARE SUPPLEMENTAL OR MEDIGAP PLAN LETTER MUST BE 1 CHARACTER LONG, A-L, UPPER OR LOWER CASE. IF CODED OTHER THAN A-L DISPLAY THE FOLLOWING MESSAGE: "Medicare Supplemental or Medigap Plan letter must be A through L. Verify and re-enter plan letter."
----------------------------------------------------

BOX_43
======

----------------------------------------------------
IF ROUND 1 OR ROUND 3, GO TO HX61
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ROUNDS 2, 4, OR 5), CONTINUE WITH BOX_43A
----------------------------------------------------

BOX_43A
=======

----------------------------------------------------
IF THIS ESTABLISHMENT-PERSON-PAIR:

- IS FLAGGED AS 'GROUP' (HX03=1 OR 2 OR HX23=1) OR'INSURANCE COMPANY-FROM AN AGENT' (HX03=5 OR HX23=4) OR 'INSURANCE COMPANY' (HX03=6 OR HX23=5) OR 'HMO' (HX03=7 OR HX23=6) OR 'EXCHANGE COVERAGE' (HX03=11 OR HX23=14) OR 'UNKNOWN TYPE
-COLLECTED AT OTHER' (HX03=91 OR HX23=91)
AND
- IS FLAGGED AS 'SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS' (HX48 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT NOT '5' (MEDIGAP))
AND
- POLICYHOLDER OF THIS PAIR IS 64 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-8 CONTINUE WITH HX61
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP12
----------------------------------------------------

HX61
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
For the coverage through [ESTABLISHMENT], does anyone in the family pay all of the premium or cost, some of the premium or cost, or none of the premium or cost?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]
[Do include any contribution made to the plan as part of a paycheck.]

YES, PAY ALL OF PREMIUM/COST ........... 1 [BOX_43B]
YES, PAY SOME OF PREMIUM/COST .......... 2 [BOX_43B]
YES, BUT DON'T KNOW IF PAY ALL OR SOME
OF PREMIUM/COST ........................ 3 [BOX_43B]
NO, DO NOT PAY ......................... 4 [BOX_44A]
REF ................................... -7 [BOX_44A]
DK .................................... -8 [BOX_44A]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY.
----------------------------------------------------

BOX_43B
=======

----------------------------------------------------
IF ROUND 1 OR ROUND 3, CONTINUE WITH HX62
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HX62A
----------------------------------------------------

HX62
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
How much [[do/does]/did] [you/[POLICYHOLDER]] pay for the [ESTABLISHMENT] coverage?

[Enter Amount in Dollars] .............. [HX62OV1]
REF ................................... -7 [BOX_44]
DK .................................... -8 [BOX_44]
----------------------------------------------------
DISPLAY '[do/does]' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW)) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'did'.
----------------------------------------------------
----------------------------------------------------
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY.
----------------------------------------------------

HX62OV1
=======

[Is/Was] that per year, per month, per week, or what?
UNIT OF COVERAGE:

PER YEAR ............................... 1 [BOX_44]
QUARTERLY/EVERY 3 MONTHS ............... 2 [BOX_44]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [BOX_44]
PER MONTH .............................. 4 [BOX_44]
PER WEEK ............................... 5 [BOX_44]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [BOX_44]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [BOX_44]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [BOX_44]
OTHER ................................. 91 [HX62OV2]
REF ................................... -7 [BOX_44]
DK .................................... -8 [BOX_44]
[Code One]
----------------------------------------------------
DISPLAY 'Is' IF INSURANCE BEING ASKED ABOUT IS CURRENT (I.E., HQ02 IS CODED '1' (YES, COVERED NOW)) FOR THE POLICYHOLDER. OTHERWISE, DISPLAY 'Was'.
----------------------------------------------------

HX62OV2
=======

SPECIFY:

[Enter Other Specify] .................. [BOX_44]
REF ................................... -7 [BOX_44]
DK .................................... -8 [BOX_44]

BOX_44
======

----------------------------------------------------
IF THIS ESTABLISHMENT-PERSON-PAIR:

- IS FLAGGED AS 'GROUP' (HX03=1 OR 2 OR HX23=1) OR 'INSURANCE COMPANY-FROM AN AGENT' (HX03=5 OR HX23=4) OR 'INSURANCE COMPANY' (HX03=6 OR HX23=5) OR 'HMO' (HX03=7 OR HX23=6) OR 'EXCHANGE COVERAGE' (HX03=11 OR HX23=14) OR 'UNKNOWN TYPE -COLLECTED AT OTHER' (HX03=91 OR HX23=91)
AND
- IS FLAGGED AS 'SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS' (HX48 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT NOT '5' (MEDIGAP))
AND
- POLICYHOLDER OF THIS PAIR IS 64 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-8 CONTINUE WITH HX62A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_44A
----------------------------------------------------

HX62A
=====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Is the cost of the premium subsidized based on family income?

YES .................................... 1 [BOX_44A]
NO ..................................... 2 [BOX_44A]
REF ................................... -7 [BOX_44A]
DK .................................... -8 [BOX_44A]

BOX_44A
=======

----------------------------------------------------
IF ROUND 1 OR ROUND 3, CONTINUE WITH BOX_44B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP12
----------------------------------------------------

HX63
====

OMITTED.

HX63OV
======

OMITTED.

BOX_44B
=======

----------------------------------------------------
IF INSURANCE BEING ASKED ABOUT PROVIDES MEDICARE SUPPLEMENT/MEDIGAP COVERAGE (I.E., HX48 IS CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP) EITHER ALONE OR WITH ANY COMBINATION OF CODES), GO TO END_LP12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HX63A
----------------------------------------------------

HX63A
=====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Is the [family] annual deductible for medical care for this plan less than [$1,300 or $1,300/$2,600 or $2,600] or more? If there is a separate deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.

LESS THAN [$1,300/$2,600] .............. 1 [END_LP12]
[$1,300/$2,600] OR MORE ................ 2 [HX63B]
NO ANNUAL DEDUCTIBLE ................... 3 [END_LP12]
REF ................................... -7 [END_LP12]
DK .................................... -8 [END_LP12]
[Code One]
HELP AVAILABLE FOR DEFINITION OF ANNUAL DEDUCTIBLE.
----------------------------------------------------
DISPLAY '$1,300 or $1,300' IN THE QUESTION TEXT AND '$1,300' IN THE RESPONSE CATEGORY OPTIONS IF THE POLICYHOLDER IS THE ONLY COVERED RU MEMBER ANDTHERE ARE NO DEPENDENTS OUTSIDE THE RU (HP17 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)) FOR THE PAIR BEING ASKED ABOUT. OTHERWISE (E.G., AT LEAST ONE RU MEMBER, OTHER THAN THE POLICYHOLDER IS LISTED AS A COVERED PERSON FOR THIS PAIR OR HP17 IS CODED '1' (YES) FOR THIS PAIR OR THE POLICYHOLDER IS NOT IN THE RU), DISPLAY 'family' and '$2,600 or $2,600' IN THE QUESTION TEXT AND '$2,600' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER (= 2 AND HP17 IS CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW), THEN DISPLAY '1,300 or 1,300' IN THE QUESTION TEXT AND '1,300' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER (= 2 AND HP17 IS CODED '1' (YES), THEN DISPLAY 'family' AND '2,600 or 2,600' IN THE QUESTION TEXT AND '2,600' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER ) 2, THEN DISPLAY 'family' AND '2,600 or 2,600' IN THE QUESTION TEXT AND '2,600' IN THE RESPONSE CATEGORY OPTIONS.
----------------------------------------------------

HX63B
=====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
With this plan, is there a special account or fund that can be used to pay for medical expenses? The accounts are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Personal Care accounts, Personal Medical funds, or Choice funds, and are different from Flexible Spending Accounts.

END_LP12
========

------------------------------------------------------
CYCLE ON NEXT PAIR IN RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
------------------------------------------------------
------------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_12 AND CONTINUE WITH BOX_44C
------------------------------------------------------

BOX_44C
=======

----------------------------------------------------
IF ROUND 1 OR ROUND 3, CONTINUE WITH HX63C
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_45
----------------------------------------------------

HX63C
=====

[STR-DT] [END-DT]
Does anyone in the family have a Flexible Spending Account for health expenses?
IF NECESSARY, SAY: These accounts are offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the year to reimburse themselves for their own or their family members' out-of-pocket expenses for health care. With this type of account, any money remaining in the account at the end of the year, following a short grace period, is lost to the employee.

YES .................................... 1 [HX63D]
NO ..................................... 2 [BOX_45]
REF ................................... -7 [BOX_45]
DK .................................... -8 [BOX_45]

HX63D
=====

[STR-DT] [END-DT]
Who has a Flexible Spending Account (FSA) for health expenses?
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] [HX63E]
----------------------------------------------------
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 OF RU MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT ONE OR MORE FROM THE LISTED MEMBERS.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS AGE 16 OR OLDER.
----------------------------------------------------

HX63E
=====

[STR-DT] [END-DT]
How much [[do/does] [you/[PERSON]]/does your family] contribute per year to [this FSA/these FSAs all together]?

[Amount] .............................. [BOX_45]
REF .................................... -7 [BOX_45]
DK ..................................... -8 [BOX_45]
----------------------------------------------------
DISPLAY '[do/does] [you/[PERSON]]' AND 'this FSA' IF ONLY ONE RU MEMBER SELECTED AT HX63D. OTHERWISE, DISPLAY 'does your family' AND 'these FSAs all together'.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
RANGE CHECK: $1-$5000
----------------------------------------------------

BOX_45
======

------------------------------------------------------
IF ROUND 1, CONTINUE WITH BOX_46
------------------------------------------------------
------------------------------------------------------
OTHERWISE, GO TO BOX_50
------------------------------------------------------

BOX_46
======

------------------------------------------------------
IF ALL PERSONS IN RU HAVE HEALTH INSURANCE (I.E., FLAGGED AS HAVING MEDICARE, MEDICAID/SCHIP, GOVT-HOSPITAL/PHYSICIAN, TRICARE/CHAMPVA, OTHER PUBLIC OR PRIVATE INSURANCE) COVERAGE ON JANUARY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, GO TO BOX_48
------------------------------------------------------
------------------------------------------------------
OTHERWISE, (AT LEAST ONE RU MEMBER BORN BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, IS WITHOUT HEALTH INSURANCE ON JANUARY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL), CONTINUE WITH LOOP_18
------------------------------------------------------

LOOP_18
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK
HX64-END_LP18
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_18 COLLECTS INFORMATION ABOUT RU MEMBERS WITH NO HEALTH INSURANCE ON JANUARY 1, [YEAR], WHERE YEAR IS THE FIRST CALENDAR YEAR OF THE PANEL. THIS LOOP CYCLES ON RU MEMBERS WHO ARE NOT A COVERED PERSON IN ANY ESTABLISHMENT-POLICYHOLDER-COVERED-PERSON-TRIPLE THAT MEETS THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICARE, MEDICAID/SCHIP, GOVT-HOSPITAL/PHYSICIAN, OTHER PUBLIC, TRICARE/CHAMPVA, OR PRIVATE INSURANCE
AND
- PERSON IS A CURRENT RU MEMBER WITH A BIRTH DATE PRIOR TO DECEMBER 31, [YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL (OR AGE CATEGORY ) 1)
AND
- PERIOD OF COVERAGE INCLUDES JANUARY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL.
----------------------------------------------------

HX64
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
I have recorded that [you/[PERSON]] [were/was] without insurance on January 1, [YEAR]. [Were/Was] [you/he/she] covered by a health insurance plan or program at any time in the years [YEAR] or [YEAR]?

YES .................................... 1 [HX65]
NO ..................................... 2 [END_LP18]
REF ................................... -7 [END_LP18]
DK .................................... -8 [END_LP18]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): IN THE QUESTION TEXT, "... on JANUARY 1, [YEAR]," 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL. IN THE QUESTION TEXT, "... at any time in the years [YEAR] or [YEAR]?" CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. (FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005 or 2006?').
----------------------------------------------------

HX65
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
When [were/was] [you/[PERSON]] most recently covered by health insurance? That is, in what month and year did that health insurance end for the last time in [YEAR] or [YEAR]?

[Enter Month,Year-4] ................... [HX66]
REF ................................... -7 [HX66]
DK .................................... -8 [HX66]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL FOR "'YEAR' OR 'YEAR'?". (FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005 or 2006?').
----------------------------------------------------
----------------------------------------------------
'-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------

HX66
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Was [your/[PERSON]'s] health insurance that ended in [MONTH AND YEAR FROM HX65/[YEAR] or [YEAR]] obtained through an employer or a union, was it a government program such as Medicaid, or what?

CHECK ALL THAT APPLY.
OBTAINED THROUGH UNION, PRIVATE EMPLOYER OR PUBLIC EMPLOYER (FEDERAL, STATE, OR LOCAL GOVT.) ................. 1
MEDICARE ............................... 2
MEDICAID ............................... 3
TRICARE/CHAMPVA ........................ 4
VA OR MILITARY HEALTH CARE ............. 5
PURCHASED DIRECTLY FROM GROUP, ASSOC., OR INS. AGENT, INS. CO. OR HMO ......... 6
OTHER TYPE OF GOVERNMENT SPONSORED PROGRAM................................ 7
OTHER PUBLIC PROGRAM:
TANF ................................ 8
SSI ................................. 9
[STATE PROGRAM 1] .................. 10
[STATE PROGRAM 2] .................. 11
[STATE PROGRAM 3] .................. 12
[STATE PROGRAM 4] .................. 13
OTHER ................................. 91 [HX66OV]
REF ................................... -7 [END_LP18]
DK .................................... -8 [END_LP18]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
IF HX65 IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY THE DATE ENTERED AT HX65 FOR 'MONTH AND YEAR FROM HX65'. DISPLAY '[YEAR] or [YEAR]' IF HX65 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), WHERE 'YEAR' AND 'YEAR' DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005' or '2006'.
----------------------------------------------------
----------------------------------------------------
FOR 'STATE PROGRAM N', DISPLAY AN ACTUAL NAME OF A STATE PLAN. FOR THE SPECIFIC NAMES OF PLANS BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW '-7' (REFUSED) OR '-8' (DON'T KNOW) IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH HX66OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP18
----------------------------------------------------

HX66OV
======

SPECIFY:

[Enter Other Specify] .................. [END_LP18]
REF ................................... -7 [END_LP18]
DK .................................... -8 [END_LP18]

HX67
====

OMITTED.

HX68
====

OMITTED.

HX68OV
======

OMITTED.

BOX_47
======

OMITTED.

HX69
====

OMITTED.

END_LP18
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_18 AND CONTINUE WITH BOX_48
----------------------------------------------------

BOX_48
======

----------------------------------------------------
IF NO CURRENT RU MEMBERS WHO WERE BORN BEFORE DECEMBER 31, [YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, HAVE ANY TYPE OF COMPREHENSIVE PUBLIC INSURANCE (I.E., MEDICARE, MEDICAID/SCHIP, GOVT- HOSPITAL/PHYSICIAN, OR TRICARE/CHAMPVA)
AND
NO CURRENT RU MEMBERS WHO WERE BORN BEFORE DECEMBER 31, [YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, HAVE ANY PRIVATE INSURANCE THAT INCLUDED HOSPITAL AND PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/ MEDIGAP BENEFITS ON 1/1/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, GO TO BOX_49
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_19
----------------------------------------------------

LOOP_19
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK HX70-END_LP19
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_19 COLLECTS INFORMATION ON ALL RU MEMBERS WITH PUBLIC AND PRIVATE HEALTH INSURANCE PROVIDING HOSPITAL/PHYSICIAN BENEFITS ORMEDICARE SUPPLEMENT/MEDIGAP BENEFITS ON JANUARY 1,[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OFTHE PANEL, TO DETERMINE PERIODS OF COVERAGE IN [YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. THIS LOOP CYCLESON PERSONS THAT MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER
AND
- PERSON'S DATE OF BIRTH IS BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, OR PERSON'S AGE IS AGE CATEGORIES 2-9
AND
- PERSON HAD COMPREHENSIVE HEALTH INSURANCE COVERAGE ON 1/1/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL. COMPREHENSIVE HEALTH INSURANCE REFERS TO THE PERSON BEING A COVERED PERSON ON AT LEAST ONE OF THE FOLLOWING ESTABLISHMENT-POLICYHOLDER-COVERED-PERSON- TRIPLES ON 1/1/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL:
- ESTABLISHMENT IS MEDICARE
- ESTABLISHMENT IS MEDICAID/SCHIP
- ESTABLISHMENT IS TRICARE
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
- ESTABLISHMENT IS PRIVATE WITH HOSPITAL AND PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP (I.E., HX48 = 1 OR 5)
----------------------------------------------------

HX70
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [STR-DT] [END-DT]
I have recorded that [you/[PERSON]] had health insurance coverage on January 1, [YEAR]. [Were/Was] [you/he/she] ever without health insurance coverage at any time in [YEAR]?

YES .................................... 1 [HX71]
NO ..................................... 2 [END_LP19]
REF ................................... -7 [END_LP19]
DK .................................... -8 [END_LP19]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR 'YEAR' IN, "... on JANUARY 1, [YEAR]," DISPLAY THE FIRST CALENDAR YEAR OF THE PANEL. FOR 'YEAR' IN "... at any time in [YEAR]," DISPLAY THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL.
----------------------------------------------------

HX71
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [STR-DT] [END-DT]
Altogether, how many weeks or months [were/was] [you/[PERSON]] without health insurance coverage in the year [YEAR]?

[Enter Small Number] ................... [HX71OV]
REF ................................... -7 [END_LP19]
DK .................................... -8 [END_LP19]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): FOR 'YEAR' IN THE QUESTION TEXT, DISPLAY THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL.
----------------------------------------------------

HX71OV
======

ENTER UNIT:

WEEKS .................................. 1 [END_LP19]
MONTHS ................................. 2 [END_LP19]
REF ................................... -7 [END_LP19]
DK .................................... -8 [END_LP19]
[Code One]

HX72
====

OMITTED.

HX73
====

OMITTED.

HX73OV
======

OMITTED.

HX74
====

OMITTED.

HX75
====

OMITTED.

HX75OV
======

OMITTED.

END_LP19
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_19 AND CONTINUE WITH BOX_49
----------------------------------------------------

BOX_49
======

----------------------------------------------------
IF ALL CURRENT RU MEMBERS WHO WERE BORN BEFORE DECEMBER 31, [YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, HAVE ONLY PRIVATE INSURANCE THAT INCLUDES HOSPITALAND PHYSICIAN BENEFITS AND/OR ALL CURRENT RU MEMBERS HAVE ONLY COMPREHENSIVE PUBLIC INSURANCE ON JANUARY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, GO TO BOX_50
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_20
----------------------------------------------------

LOOP_20
=======

----------------------------------------------------
FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK HX76-END_LP20
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_20 COLLECTS INFORMATION FOREACH RU MEMBER WHOSE DATE OF BIRTH IS PRIOR TO 12/31/[YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, (OR AGE CATEGORY ) 1), AND WHO IS COVERED BY PRIVATE INSURANCE THAT DOES NOT INCLUDE EITHER HOSPITAL/ PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT/MEDIGAP BENEFITS ON JANUARY 1, [YEAR], WHERE 'YEAR' IS THEFIRST CALENDAR YEAR OF THE PANEL. THE LOOP CYCLES ON PERSONS WERE EVER COVERED BY A MORE COMPREHENSIVE PLAN THAT PROVIDED HOSPITAL/ PHYSICIAN COVERAGE DURING [YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, OR [YEAR], WHERE 'YEAR' IS TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. THE LOOP CYCLES ON PERSONS THAT MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER
AND
- PERSON'S DATE OF BIRTH IS BEFORE 12/31/[YEAR], WHERE 'YEAR' IS THE YEAR PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL, OR IN AGE CATEGORIES2-9
AND
- PERSON DID NOT HAVE COMPREHENSIVE HEALTH INSURANCE COVERAGE ON 1/1/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL.
COMPREHENSIVE HEALTH INSURANCE REFERS TO THE PERSON BEING A COVERED PERSON ON AT LEAST ONE OFTHE FOLLOWING ESTABLISHMENT-POLICYHOLDER- COVERED-PERSON-TRIPLES ON 1/1/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL:
- ESTABLISHMENT IS MEDICARE
- ESTABLISHMENT IS MEDICAID
- ESTABLISHMENT IS TRICARE
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
- ESTABLISHMENT IS PRIVATE WITH HOSPITAL AND PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP (I.E., HX48 = 1 OR 5)
AND
- PERSON IS COVERED PERSON ON AT LEAST ONE OF THE FOLLOWING ESTABLISHMENT-POLICYHOLDER-COVERED- PERSON-TRIPLES ON 1/1/[YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL:
----------------------------------------------------
----------------------------------------------------
- ESTABLISHMENT IS GROUP 1 OR GROUP 2 OTHER PUBLIC
- ESTABLISHMENT IS PRIVATE WITHOUT HOSPITAL AND PHYSICIAN BENEFITS OR MEDICARE SUPPLEMENT OR MEDIGAP (I.E., HX48 IS NOT CODED 1 OR 5)
----------------------------------------------------

HX76
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
I have recorded that [you/[PERSON]] [had health insurance coverage for (READ TYPES OF INSURANCE BELOW) coverage] [and] [was covered by a public program] on January 1, [YEAR]. [Were/Was] [you/he/she] ever covered by a more comprehensive health insurance plan or program that paid for medical and doctor's bills at any time in the years [YEAR] or [YEAR]?

[TYPE OF INSURANCE IN HX48] [TYPE OF INSURANCE IN HX48]
[TYPE OF INSURANCE IN HX48] [TYPE OF INSURANCE IN HX48]
[TYPE OF INSURANCE IN HX48] [TYPE OF INSURANCE IN HX48]
YES .................................... 1 [HX77]
NO ..................................... 2 [END_LP20]
REF ................................... -7 [END_LP20]
DK .................................... -8 [END_LP20]
----------------------------------------------------
DISPLAY 'had health...(BELOW)' IF PERSON CONFIRMED AS POLICYHOLDER (HP09 IS CODED '1' (YES)) OR SELECTED AS POLICYHOLDER (SELECTED AT HP11) OR SELECTED AS A DEPENDENT (SELECTED AT HP16) FOR ANY PRIVATE ESTABLISHMENT-POLICYHOLDER PAIR WHERE HX48 IS NOT CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS) AND NOT CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP) EITHER ALONE OR WITH ANY COMBINATION OF CODES FOR ALL OF THOSE PRIVATE ESTABLISHMENT-POLICYHOLDER PARIS. OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'was....program' IF PERSON SELECTED AT HX19 (FOR EITHER GROUP 1 OR GROUP 2 PROGRAM). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'and' IF PERSON CONFIRMED AS POLICYHOLDER (HP09 IS CODED '1' (YES)) OR SELECTED AS POLICYHOLDER (SELECTED AT HP11) OR SELECTED AS A DEPENDENT (SELECTED AT HP16) FOR ANY PRIVATE ESTABLISHMENT-POLICYHOLDER PAIR WHERE HX48 IS NOT CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS) AND NOT CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP) EITHER ALONE OR WITH ANY COMBINATION OF CODES FOR ALL OF THOSE PRIVATE ESTABLISHMENT-POLICYHOLDER PAIRS AND PERSON SELECTED AT HX19 (FOR EITHER GROUP 1 OR GROUP 2 PROGRAM).
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): IN THE QUESTION TEXT, "... on JANUARY 1, [YEAR]," 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL. IN THE QUESTION TEXT, "... at any time in the years [YEAR] or [YEAR]?" CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. (FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005 or 2006?').
----------------------------------------------------

HX77
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
When [were/was] [you/[PERSON]] most recently covered by this kind of health insurance? That is, in what month and year did the health insurance that paid for medical and doctor's bills end for the last time in [YEAR] or [YEAR]?

[Enter Month,Year-4] ................... [HX78]
REF ................................... -7 [HX78]
DK .................................... -8 [HX78]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY): CAPI DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL FOR "'YEAR' OR 'YEAR'?". (FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005 or 2006?').
----------------------------------------------------
----------------------------------------------------
'-7' (REFUSED) AND '-8' (DON'T KNOW) ARE ALLOWED ON THE MONTH AND YEAR FIELDS.
----------------------------------------------------

HX78
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Was [your/[PERSON]'s] health insurance that ended in [DATE FROM HX77/[YEAR] or [YEAR]] obtained through an employer or union, was it a government program such as Medicare or Medicaid, or what?

CHECK ALL THAT APPLY.
OBTAINED THROUGH UNION, PRIVATE EMPLOYER OR PUBLIC EMPLOYER (FEDERAL, STATE, OR LOCAL GOVERNMENT) ............ 1
MEDICARE ............................... 2
MEDICAID ............................... 3
TRICARE/CHAMPVA ........................ 4
VA OR MILITARY HEALTH CARE ............. 5
PURCHASED DIRECTLY FROM GROUP, ASSOCIATION, OR INSURANCE AGENT, INSURANCE COMPANY OR HMO ............... 6
OTHER TYPE OF GOVERNMENT SPONSORED PROGRAM................................ 7
OTHER PUBLIC PROGRAM:
TANF ................................ 8
SSI ................................. 9
[STATE PROGRAM 1]................... 10
[STATE PROGRAM 2] .................. 11
[STATE PROGRAM 3] .................. 12
[STATE PROGRAM 4] .................. 13
OTHER ................................. 91 [HX78OV]
REF ................................... -7 [END_LP20]
DK .................................... -8 [END_LP20]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
IF HX77 IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY THE DATE ENTERED AT HX77 FOR 'MONTH AND YEAR FROM HX77'. DISPLAY 'in [YEAR] or [YEAR]' IF HX77 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), WHERE "'YEAR' or 'YEAR'" DISPLAYS THE TWO YEARS PRIOR TO THE FIRST CALENDAR YEAR OF THE PANEL. FOR PANEL 12 FOR EXAMPLE, THIS WOULD BE '2005' or '2006'.
----------------------------------------------------
----------------------------------------------------
FOR 'STATE PROGRAM N', DISPLAY AN ACTUAL NAME OF STATE PLAN WHEN INTERVIEW IS BEING CONDUCTED IN A STATE THAT HAS OTHER STATE PROGRAMS. FOR THE SPECIFIC NAMES OF PROGRAMS BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW '-7' (REFUSED) OR '-8' (DON'T KNOW) IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH OTHER CODES, CONTINUE WITH HX78OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP20
----------------------------------------------------

HX78OV
======

SPECIFY:

[Enter Other Specify] .................. [END_LP20]
REF ................................... -7 [END_LP20]
DK .................................... -8 [END_LP20]

HX79
====

OMITTED.

HX80
====

OMITTED.

HX80OV
======

OMITTED.

END_LP20
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO MORE PERSONS MEET THE STATED CONDITIONS, END LOOP_20 AND CONTINUE WITH BOX_50
----------------------------------------------------

BOX_50
======

----------------------------------------------------
IF ROUND 2 OR ROUND 4, CONTINUE WITH HX81
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_51
----------------------------------------------------

LOOP_21
=======

OMITTED.

HX81
====

When answering the next questions, think about money that your family has spent on out of pocket expenses for medical care. We do not want you to count health insurance premiums, over the counter drugs, or costs that you will be reimbursed for.
In the past 12 months did anyone in the family have problems paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home or home care.

YES .................................... 1 [HX82]
NO ..................................... 2 [HX82]
REF ................................... -7 [HX82]
DK .................................... -8 [HX82]

HX82
====

Does anyone in your family currently have any medical bills that are being paid off over time? This could include medical bills being paid off with a credit card, through personal loans, or bill paying arrangements with hospitals or other providers. The bills can be from earlier years as well as this year.

YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF HX81 IS CODED '2' (NO), GO TO BOX_51
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HX83
----------------------------------------------------

HX83
====

Does anyone in your family currently have any medical bills that you are unable to pay at all?

YES .................................... 1 [BOX_51]
NO ..................................... 2 [BOX_51]
REF ................................... -7 [BOX_51]
DK .................................... -8 [BOX_51]

END_LP21
========

OMITTED.

BOX_51
======

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

Old Employment and Private Related Insurance (OE) Section

BOX_00
======

BOX_01
======

----------------------------------------------------
IF ONE OR MORE RU MEMBERS STILL HOLDS A 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS' JOB THIS ROUND THAT WAS REPORTED DURING THE PREVIOUS ROUND AS PROVIDING HEALTH INSURANCE ON THE DATE OF THE PREVIOUS ROUND'S INTERVIEW, THAT IS:

IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE RU MEET THE FOLLOWING CONDITIONS:
- RJ01 OR RJ06 WAS CODED '1' (YES) DURING THIS ROUND FOR THIS PAIR, AND
- PERSON IS A JOBHOLDER AT ESTABLISHMENT, AND
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING THE PREVIOUS ROUND AS 'PROVIDES HEALTH INSURANCE' AND,
- THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT COVERED PERSON ON THE DATE OF THE PREVIOUS ROUND'S INTERVIEW (HQ01 WAS CODED '1' (WHOLE TIME) OR HQ02 WAS CODED '1' (YES) IN THE PREVIOUS ROUND), AND
- JOB AT ESTABLISHMENT IS NOT FLAGGED AS 'SELF- EMPLOYED' WITH A FIRM-SIZE-1,

CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT IN THE RU ON THE PREVIOUS ROUND'S INTERVIEW DATE, THE FIFTH CONDITION ABOVE CAN BE MET IF AT LEAST ONE DEPENDENT WAS COVERED BY POLICYHOLDER'S INSURANCE ON THE PREVIOUS ROUND'S INTERVIEW DATE. THE LOOP WILL CYCLE ON THE POLICYHOLDER'S NAME.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_10
----------------------------------------------------
----------------------------------------------------
NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT ROUND'S INTERVIEW DATE, BUT WHERE THE ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO ARE STILL RU MEMBERS MAY STILL QUALIFY FOR LOOP_01.
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_OE01A - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION:

LOOP_01 COLLECTS INFORMATION ABOUT THE CONTINUATION OF INSURANCE COVERAGE THROUGH A 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS' JOB THATWAS COLLECTED IN THE PREVIOUS ROUND. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THEFOLLOWING CONDITIONS:

- RJ01 OR RJ06 WAS CODED '1' (YES) DURING THIS ROUND FOR THIS PAIR, AND
- PERSON IS A JOBHOLDER AT ESTABLISHMENT, AND
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING THE PREVIOUS ROUND AS 'PROVIDES HEALTH INSURANCE' AND,
- THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT COVERED PERSON ON THE DATE OF THE PREVIOUS ROUND'S INTERVIEW (HQ01 WAS CODED '1' (WHOLE TIME) OR HQ02 WAS CODED '1' (YES) IN THE PREVIOUS ROUND), AND
- JOB AT ESTABLISHMENT IS NOT FLAGGED AS 'SELF- EMPLOYED' WITH A FIRM-SIZE-1
-----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES BOTH NAV_OE01A AND OE01B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE01A
=========

SERIES: Confirming Insurance from a Previous Round through a Current Employer (i.e., probing for who is still covered, any change in plan name, etc.)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_01 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH NAV_OE01B FOR SELECTED RU MEMBER.
----------------------------------------------------

NAV_OE01B
=========

Policyholder...Employer Providing Insurance
[1. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
[2. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
[3. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: POLICYHOLDER...EMPLOYER PROVIDING INSURANCE
INSTRUCTIONS: DISPLAY RU-ESTABLISHMENT-PERSON- PAIR
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH PAIR EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL EMPLOYERS THAT MEET THE CONDITIONS STATED AT THE LOOP_01 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE01 FOR SELECTED PAIR.
----------------------------------------------------

OE01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Now think about [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT]. [[Are/Is]/[Were/Was]] [you/he/she] or anyone in the family covered by this insurance as of [today,] [END DATE]?

YES ................................... 1 [BOX_02]
NO .................................... 2 [OE02]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
----------------------------------------------------
DISPLAY '[Are/Is]' IF NOT ROUND 5. DISPLAY '[Were/Was]' IF ROUND 5.

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

OE02
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] end?
[IF INSURANCE ENDED AFTER 12/31/[YEAR], BACK-UP TO OE01 AND SELECT 'YES'.]

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
----------------------------------------------------
DISPLAY 'IF INSURANCE ENDED... SELECT 'YES'.' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE02OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_02
----------------------------------------------------

OE02OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_02]
PART OF THE MONTH ..................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
[Code One]

BOX_02
======

----------------------------------------------------
IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, AUTOMATICALLY CODE OE03 AS '1' (YES) AND GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OE03
----------------------------------------------------

OE03
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Are/Were] (READ NAMES BELOW) all covered by [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] [until [[OE02 DATE]/it ended]/on [END DATE]]?
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]

YES ................................... 1 [BOX_03]
NO .................................... 2 [BOX_03]
REF ................................... -7 [BOX_03]
DK .................................... -8 [BOX_03]
----------------------------------------------------
DISPLAY 'Are' IF OE01 IS CODED '1' (YES).
DISPLAY 'Were' IF OE01 IS CODED '2' (NO) OR IF CURRENT ROUND IS ROUND 5.

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on [END DATE]' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH OR YEAR FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY COVERED PERSONS' NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. PERSON WAS COVERED AT PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
2. PERSON IS AN RU MEMBER
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND TO THE END DATE OF THE CURRENT ROUND, THAT IS:

IF OE01 IS CODED '1' (YES) AND OE03 IS CODED '1' (YES),

FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH THE REFERENCE PERIOD END DATE AND

GO TO BOX_05
----------------------------------------------------
----------------------------------------------------
IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND TO PART OF THE CURRENT ROUND, THAT IS:

IF OE01 IS CODED '2' (NO) AND OE03 IS CODED '1' (YES),

FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH THE DATE RECORDED AT OE02 AND

GO TO BOX_05
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., OE03 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)), CONTINUE WITH OE04
----------------------------------------------------

OE04
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Who [is/was] no longer covered by [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] [until [[OE02 DATE]/it ended]/on [END DATE]]?

[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 OE01 IS CODED '1' (YES).
DISPLAY 'was' IF OE01 IS CODED '2' (NO) OR IF CURRENT ROUND IS ROUND 5.

DISPLAY 'until [OE02 DATE]' IF OE01 IS CODED '2' (NO).
DISPLAY 'on [END DATE]' IF OE01 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE02 FOR 'OE02 DATE'.
IF THE MONTH OR YEAR FIELD AT OE02 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE02 DATE'.
----------------------------------------------------
----------------------------------------------------
IF FAMILY STILL HAS INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED '1' (YES)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED AT OE04 AS 'CONTINUOUS COVERAGE' FROM THE REFERENCE PERIOD START DATE UNTIL THE REFERENCE PERIOD END DATE.
----------------------------------------------------
----------------------------------------------------
IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED '2' (NO), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED AT OE04 AS 'CONTINUOUS COVERAGE' FROM THE REFERENCE PERIOD START DATE UNTIL DATE RECORDED AT OE02.
----------------------------------------------------
----------------------------------------------------
GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY COVERED PERSONS' NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. PERSON WAS COVERED AT PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
2. PERSON IS AN RU MEMBER
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER, ASK NAV_OE02 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS THE DATE ON WHICH THE INSURANCE COVERAGE THROUGH THIS ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE PERIOD END DATE OR THE DATE REPORTED IN OE02.
THIS LOOP CYCLES ON PERSONS SELECTED AT OE04.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_02 USES NAV_OE02 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE02
========

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
SERIES: End Date of Insurance from [POLICYHOLDER]'s [ESTABLISHMENT] plan.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTB-PLCYHLDR-COVRD-PERS- TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT OE04.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE05 FOR SELECTED RU MEMBER.
----------------------------------------------------

OE05
====

[POLICYHOLDER'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did the health insurance through [ESTABLISHMENT] end for [you/[PERSON]]?

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE05OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_04
----------------------------------------------------

OE05OV
======

Can you just tell me if [you/he/she] [were/was] was covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_04]
PART OF THE MONTH ..................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
[Code One]

BOX_04
======

----------------------------------------------------
FLAG INSURANCE FOR PERSON AS 'CONTINUOUS COVERAGE'THROUGH THE COMPLETE DATE RECORDED AT OE05 AND OE05OV.
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-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_05
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,(THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU MEMBERS NOT COVERED BY THIS INSURANCE ON THE PREVIOUS ROUND'S INTERVIEW DATE, BUT EXCLUDES RU MEMBERS JUST MARKED AS NO LONGER COVERED IN OE04),CONTINUE WITH OE06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE08A
----------------------------------------------------

OE06
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Since [START DATE]/Between [START DATE] and [END DATE]], have any persons living here, we have not yet mentioned, been covered by [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT]?

YES ................................... 1 [OE07]
NO .................................... 2 [OE08A]
REF ................................... -7 [OE08A]
DK .................................... -8 [OE08A]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'Since [START DATE]' IF NOT ROUND 5.
DISPLAY 'Between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------

OE07
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Who [has been/was] covered by [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] [since [START DATE]/between [START DATE] and [END DATE]] that we have not yet mentioned?
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]
----------------------------------------------------
DISPLAY 'has been' AND 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'was' AND 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'PERSON NOT LISTED IN RU' IS SELECTED, FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU'.
----------------------------------------------------
----------------------------------------------------
GO TO 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 OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT ONE OR MORE FROM THE LISTED MEMBERS.
2. ADD, DELETE, AND EDIT DISALLOWED.
3. DISPLAY 'PERSON NOT LISTED IN RU' AS LAST ENTRYON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO WERE NOT COVERED BY THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE.
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER, ASK NAV_OE03 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS THE COVERAGE START DATE FOR ALL PERSONS NEWLY COVERED DURING THE CURRENT ROUND BY THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON PERSONS SELECTED AT OE07.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_03 USES NAV_OE03 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE03
========

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
SERIES: Begin Date of Insurance from [POLICYHOLDER]'s [ESTABLISHMENT] plan.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTB-PLCYHLDR-COVRD-PERS- TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT OE07.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE08 FOR SELECTED RU MEMBER.
----------------------------------------------------

OE08
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did the health insurance through [ESTABLISHMENT] begin for [you/[PERSON]]?

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE08OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_06
----------------------------------------------------

OE08OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_06]
PART OF THE MONTH ..................... 2 [BOX_06]
REF ................................... -7 [BOX_06]
DK .................................... -8 [BOX_06]
[Code One]
----------------------------------------------------
HARD CHECK:
COMPLETE DATE AT OE08 MUST BE ( THAN COMPLETE DATE AT OE02 IF A DATE IS RECORDED AT OE02 OR ( THAN REFERENCE PERIOD END DATE IF NO DATE IS RECORDED AT OE02.
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF FAMILY STILL HAS INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED '1' (YES)), FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE08 UNTIL THE REFERENCE PERIOD END DATE.
----------------------------------------------------
----------------------------------------------------
IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH ESTABLISHMENT-PERSON-PAIR (OE01 IS CODED '2' (NO)) FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE08 UNTIL DATE RECORDED AT OE02.
----------------------------------------------------

END_LP03
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_03 AND GO TO BOX_07
----------------------------------------------------

OE08A
=====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Does/Between [START DATE] and [END DATE], did] [your/[POLICYHOLDER]'s] health coverage through [ESTABLISHMENT] cover as dependents any persons who do not live here?

YES .................................... 1 [BOX_07]
NO ..................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'Does' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU' IN OE07
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THEINSURANCE THROUGH THE ESTABLISHMENT-PERSON-PAIR ON THE CURRENT ROUND'S INTERVIEW DATE, THAT IS, OE01 IS CODED '1' (YES), CONTINUE WITH BOX_07A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

BOX_07A
=======

----------------------------------------------------
IF ROUND 3, CONTINUE WITH OE09A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE09
----------------------------------------------------

OE09A
=====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
For the coverage through [ESTABLISHMENT], does anyone in the family pay all of the premium or cost, some of the premium or cost, or none of the premium or cost?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]
[Do include any contribution made to the plan as part of a paycheck.]

YES, PAY ALL OF PREMIUM/COST ........... 1 [OE09AA]
YES, PAY SOME OF PREMIUM/COST .......... 2 [OE09AA]
YES, BUT DON'T KNOW IF PAY ALL OR SOME OF PREMIUM/COST ........................ 3 [OE09AA]
NO, DO NOT PAY ......................... 4 [BOX_08AA]
REF ................................... -7 [BOX_08AA]
DK .................................... -8 [BOX_08AA]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY.
----------------------------------------------------

OE09AA
======

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
How much [do/does] [you/[POLICYHOLDER]] pay for the [ESTABLISHMENT] coverage?

[Enter Amount in Dollars] ..............
REF ................................... -7 [BOX_08AA]
DK .................................... -8 [BOX_08AA]
----------------------------------------------------
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE09AAOV1
----------------------------------------------------

OE09AAOV1
=========

UNIT OF COVERAGE:
Is that per year, per month, per week, or what?

PER YEAR ............................... 1 [BOX_08AA]
QUARTERLY/EVERY 3 MONTHS ............... 2 [BOX_08AA]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [BOX_08AA]
PER MONTH .............................. 4 [BOX_08AA]
PER WEEK ............................... 5 [BOX_08AA]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [BOX_08AA]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [BOX_08AA]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [BOX_08AA]
OTHER ................................. 91 [OE09AAOV2]
REF ................................... -7 [BOX_08AA]
DK .................................... -8 [BOX_08AA]
[Code One]

OE09AAOV2
=========

SPECIFY:

[Enter Other Specify] .................. [BOX_08AA]
REF ................................... -7 [BOX_08AA]
DK .................................... -8 [BOX_08AA]

BOX_08A
=======

OMITTED.

OE09AAA
=======

OMITTED.

OE09AAAOV
=========

OMITTED.

BOX_08AA
========

----------------------------------------------------
IF INSURANCE BEING ASKED ABOUT PROVIDES MEDICARE SUPPLEMENT/MEDIGAP COVERAGE (I.E., HX48 OR OE10 OR OE24 OR OE37 WAS CODED '5' (MEDICARE SUPPLEMENT /MEDIGAP) EITHER ALONE OR WITH ANY COMBINATION OF CODES IN THE PREVIOUS ROUND FOR THIS ESTABLISHMENT -PERSON-PAIR), GO TO OE09
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OE09B
----------------------------------------------------

OE09B
=====

LESS THAN [$1,300/$2,600] .............. 1 [OE09]
[$1,300/$2,600] OR MORE ................ 2 [OE09C]
NO ANNUAL DEDUCTIBLE ................... 3 [OE09]
REF ................................... -7 [OE09]
DK .................................... -8 [OE09]
[Code One]
HELP AVAILABLE FOR DEFINITION OF ANNUAL DEDUCTIBLE.
----------------------------------------------------
DISPLAY '$1,300 or $1,300' IN THE QUESTION TEXT AND '$1,300' IN THE RESPONSE CATEGORY OPTIONS IF THE POLICYHOLDER IS THE ONLY COVERED RU MEMBER ANDTHERE ARE NO DEPENDENTS OUTSIDE THE RU (OE08A IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)) FOR THE PAIR BEING ASKED ABOUT. OTHERWISE (E.G., AT LEAST ONE RU MEMBER, OTHER THAN THE POLICYHOLDER IS LISTED AS A COVERED PERSON FOR THIS PAIR OR OE08A IS CODED '1' (YES) FOR THIS PAIR OR THE POLICYHOLDER IS NOT IN THE RU), DISPLAY 'family' and '$2,600 or $2,600' IN THE QUESTION TEXT AND '$2,600' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER (= 2 AND OE08A IS CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW), THEN DISPLAY '1,300 or 1,300' IN THE QUESTION TEXT AND '1,300' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER (= 2 AND OE08A IS CODED '1' (YES), THEN DISPLAY 'family' AND '2,600 or 2,600' IN THE QUESTION TEXT AND '2,600' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER ) 2, THEN DISPLAY 'family' AND '2,600 or 2,600' IN THE QUESTION TEXT AND '2,600' IN THE RESPONSE CATEGORY OPTIONS.
----------------------------------------------------

OE09C
=====

YES .................................... 1 [OE09]
NO ..................................... 2 [OE09]
REF ................................... -7 [OE09]
DK .................................... -8 [OE09]
[Code One]
HELP AVAILABLE FOR DEFINITION OF HEALTH SAVINGS ACCOUNTS (HSAs).

OE09
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Last time we recorded that [you/[POLICYHOLDER]] [were/was] covered by [INSURER OF ESTAB-PERS-INSURER TRIPLE ON PREV RD INT DT].]
[Since [START DATE], has there been/Between [START DATE] and [END DATE], was there] any change in the plan name of the health insurance [you/[POLICYHOLDER]] [have/has] through [ESTABLISHMENT]?

YES ................................... 1 [OE10]
NO .................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
-----------------------------------------------------
DISPLAY FIRST PARAGRAPH IF THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- PAIR HAD ANY INSURERS FLAGGED AS PROVIDING MEDIGAP OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME DURING THE PREVIOUS ROUND.
-----------------------------------------------------
-----------------------------------------------------
FOR 'NAME OF INSURER BEING LOOPED ON', DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS, DISPLAY THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP BENEFITS OR HOSPITAL/ PHYSICIAN BENEFITS) ENTERED AT HX49, HX51, OE11, OE25, OE36, OR OE38.
-----------------------------------------------------
-----------------------------------------------------
DISPLAY 'Since [START DATE], has there been' AND '[have/has]' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], was there' AND 'had' IF ROUND 5.
-----------------------------------------------------
-----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG PREVIOUS ROUND'S INSURER AS CURRENT ROUND'S INSURER FOR THIS ESTABLISHMENT-PERSON- PAIR.
-----------------------------------------------------

OE10
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
SHOW CARD HX-9.
Looking at this card, what type of health insurance coverage [[do/does]/did] [you/[POLICYHOLDER]] [now] have through [ESTABLISHMENT]'s new plan [as of [END DATE]]?
PROBE: Any other health coverage through this plan?

CHECK ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91 [OE10OV]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: 'DISABILITY,' 'WORKER'S COMPENSATION,' AND 'ACCIDENT' WILL NOT APPEAR ON THE SHOW CARD.]
----------------------------------------------------
DISPLAY '[do/does]' IF NOT ROUND 5. DISPLAY 'did'IF ROUND 5.

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

DISPLAY 'as of [END DATE]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW '-7' (REFUSED) OR '-8' (DON'T KNOW) IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODES, CONTINUE WITH OE10OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

OE10OV
======

SPECIFY:

[Enter Other Specify] .................. [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

BOX_08
======

----------------------------------------------------
NOTE: ALL ESTABLISHMENTS WHICH ARE BEING LOOPED ON HERE ARE EMPLOYERS. THEREFORE, IT IS NOT NECESSARY TO AUTOMATICALLY CODE OE11 IF THE ESTABLISHMENT IS AN INSURANCE COMPANY OR HMO.
----------------------------------------------------
----------------------------------------------------
IF OE10 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS) OR '5' (MEDICARE SUPPLEMENT/MEDIGAP), ALONE OR WITH ANY OTHER COMBINATION OF CODES, CONTINUE WITH OE11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07AA
----------------------------------------------------

OE11
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
What is the new plan name for [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] which provides the [hospital and physician benefits/Medicare Supplement or Medigap benefits]?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name?
RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE [HOSPITAL AND PHYSICIAN/MEDIGAP] BENEFITS FOR THIS PAIR.
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, SELECT HMO.
NAME OF INSURER: [Enter Insurer] ..........
REF ...................... -7
DK ..... ................. -8

TYPE:
INSURANCE COMPANY ...................... 1
HMO .................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO.
-----------------------------------------------------
DISPLAY 'hospital and physician benefits' AND 'HOSPITAL AND PHYSICIAN' IF OE10 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS), BUT NOT CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP). DISPLAY 'Medicare supplement or Medigap benefits' AND 'MEDIGAP' IF OE10 IS CODED '5' (MEDICARE SUPPLEMENT/ MEDIGAP).
-----------------------------------------------------
-----------------------------------------------------
WRITE INSURER(S) TO THE RU-ESTAB-PERSON-INSURER- TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR.
-----------------------------------------------------
----------------------------------------------------
FLAG INSURER(S) COLLECTED AT OE11 AS CURRENT ROUND'S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- PAIR.
----------------------------------------------------
----------------------------------------------------
IF OE10 IS CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP) FLAG INSURANCE CO./HMO AS 'SUPPLYING MEDICARE SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES HOSPITAL/PHYSICIAN BENEFITS)' FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF OE10 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS), BUT NOT '5' (MEDICARE SUPPLEMENT/ MEDIGAP), FLAG INSURANCE CO./HMO AS 'SUPPLYING HOSPITAL/PHYSICIAN BENEFITS' FOR THE CURRENT ROUND.
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- TRIPLES-ROSTER, ASK BOX_09A - END_LP04.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 COLLECTS MANAGED CARE INFORMATION FOR INSURERS COLLECTED AT OE11. THIS LOOP CYCLES ON TRIPLES THAT MEET THE FOLLOWING CONDITIONS:

- ESTABLISHMENT-PERSON-PAIR PROVIDES THE INSURANCEBEING ASKED ABOUT
- INSURER IS ENTERED AT OE11
----------------------------------------------------

BOX_08B
=======

OMITTED.

OE11A
=====

OMITTED.

OE11AOV
=======

OMITTED.

BOX_09A
=======

----------------------------------------------------
IF INSURER BEING LOOPED ON IS CODED '2' (HMO) IN OE11, GO TO END_LP04
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_09
----------------------------------------------------

OE11B
=====

OMITTED.

BOX_09
======

----------------------------------------------------
ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER

AT COMPLETION OF MANAGED CARE (MC) SECTION, CONTINUE WITH END_LP04
----------------------------------------------------

END_LP04
========

----------------------------------------------------
CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER INSURERS MEET THE STATED CONDITIONS, END LOOP_04 AND CONTINUE WITH BOX_07AA
----------------------------------------------------

BOX_07AA
========

-----------------------------------------------------
SMALL BUSINESS DETERMINATION

IF ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT MEETS THE FOLLOWING CONDITIONS:
- PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED AS 'PROVIDES HEALTH INSURANCE', AND
- ESTABLISHMENT FLAGGED AS A CURRENT-MAIN-JOB, AND
- JOB IS FLAGGED AS 'SELF-EMPLOYED', AND
- EM124 IS GREATER THAN 1 BUT LESS THAN 200, CONTINUE WITH OE08B
-----------------------------------------------------
-----------------------------------------------------
SMALL BUSINESS DETERMINATION

IF ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT MEETS THE FOLLOWING CONDITIONS:
- PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED AS 'PROVIDES HEALTH INSURANCE', AND
- ESTABLISHMENT FLAGGED AS A CURRENT-MAIN-JOB, AND
- JOB IS FLAGGED AS 'NOT SELF-EMPLOYED', AND
- FIRM SIZE IS SMALL (SEE DETERMINATION BELOW)
- EM91 IS LESS THAN 200
OR
- EM92 IS CODED '1' (LESS THAN 10), '2' (10 TO 25), '3' (26 TO 49) OR '4' (50 TO 100), AND
- EM93 IS CODED '2' (NO), CONTINUE WITH OE08B
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO END_LP01
-----------------------------------------------------

OE08B
=====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
In [RU STATE], [STATE SHOP NAME-A][, [which may also be known as [ALIAS B] [or [ALIAS C]]],] is a [new] program where small businesses will be able to shop for health insurance plans for their employees. Is [your/[POLICYHOLDER]'s] health insurance coverage through [ESTABLISHMENT] related at all to a program like that?

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_10
----------------------------------------------------

BOX_10
======

----------------------------------------------------
IF ONE OR MORE RU MEMBERS DOES NOT STILL HOLD A 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS' JOB THIS ROUND THAT WAS REPORTED DURING THE PREVIOUS ROUND AS PROVIDING HEALTH INSURANCE ON THE DATE OF THE PREVIOUS ROUND'S INTERVIEW, THAT IS:

IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE RU MEET THE FOLLOWING CONDITIONS:
- RJ01 OR RJ06 WAS CODED '2' (NO), '-7' (REFUSED),
'-8' (DON'T KNOW) DURING THIS ROUND FOR THIS PAIR, AND
- PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING THE PREVIOUS ROUND AS 'PROVIDES HEALTH INSURANCE' AND,
- THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT COVERED PERSON ON THE DATE OF THE PREVIOUS ROUND'S INTERVIEW (HQ01 WAS CODED '1' (WHOLE TIME) OR HQ02 WAS CODED '1' (YES) IN THE PREVIOUS ROUND), AND
- JOB AT ESTABLISHMENT IS NOT FLAGGED AS 'SELF- EMPLOYED' WITH A FIRM-SIZE-1,

CONTINUE WITH LOOP_05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_19
----------------------------------------------------
----------------------------------------------------
NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT IN THE RU ON THE PREVIOUS ROUND'S INTERVIEW DATE, THE FIFTH CONDITION IN THE ABOVE BOX CAN BE MET IF AT LEAST ONE DEPENDENT WAS COVERED BY POLICYHOLDER'S INSURANCE ON THE PREVIOUS ROUND'S INTERVIEW DATE. COVERAGE FOR THE POLICYHOLDER IS ASSUMED IN THAT CASE AND THE LOOP WILL CYCLE ON THE POLICYHOLDER'S NAME.
----------------------------------------------------
----------------------------------------------------
NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT ROUND'S INTERVIEW DATE, BUT WHERE THE ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO ARE STILL RU MEMBERS MAY STILL QUALIFY FOR LOOP_05.
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_OE05A - END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION:

LOOP_05 COLLECTS INFORMATION ABOUT THE CONTINUATION OF INSURANCE COVERAGE THROUGH A NO LONGER HELD 'CURRENT MAIN' OR 'CURRENT MISCELLANEOUS' JOB THAT WAS COLLECTED IN THE PREVIOUS ROUND. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:

- RJ01 OR RJ06 WAS CODED '2' (NO), '-7' (REFUSED),'-8' (DON'T KNOW) DURING THIS ROUND FOR THIS PAIR, AND
- PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED DURING THE PREVIOUS ROUND AS 'PROVIDES HEALTH INSURANCE' AND,
- THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT COVERED PERSON ON THE DATE OF THE PREVIOUS ROUND'S INTERVIEW (HQ01 WAS CODED '1' (WHOLE TIME) OR HQ02 WAS CODED '1' (YES) IN THE PREVIOUS ROUND), AND
- JOB AT ESTABLISHMENT IS NOT FLAGGED AS 'SELF- EMPLOYED' WITH A FIRM-SIZE-1.
-----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_05 USES BOTH NAV_OE05A AND OE05B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE05A
=========

SERIES: Confirming Insurance from a Previous Round through a Former Employer (i.e., probing for who is still covered, any change in plan name, etc.)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_05 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH NAV_OE05B FOR SELECTED RU MEMBER.
----------------------------------------------------

NAV_OE05B
=========

Policyholder...Former Employer Providing Insurance
[1. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
[2. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
[3. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: POLICYHOLDER...FORMER EMPLOYER PROVIDING INSURANCE
INSTRUCTIONS: DISPLAY RU-ESTABLISHMENT-PERSON- PAIR
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH PAIR EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL EMPLOYERS THAT MEET THE CONDITIONS STATED AT THE LOOP_05 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE12 FOR SELECTED PAIR.
----------------------------------------------------

OE12
====

YES ................................... 1 [OE16]
NO .................................... 2 [OE13]
REF ................................... -7 [END_LP05]
DK .................................... -8 [END_LP05]
----------------------------------------------------
DISPLAY '[Are/Is]' IF NOT ROUND 5. DISPLAY '[Were/Was]' IF ROUND 5.

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

OE13
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Did the health insurance [you/[POLICYHOLDER]] had through [ESTABLISHMENT] continue for any period of time after [you/he/she] stopped working at [ESTABLISHMENT]?

YES ................................... 1 [OE14]
NO .................................... 2 [OE15]
REF ................................... -7 [OE15]
DK .................................... -8 [OE15]

OE14
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Did that health insurance continue through COBRA?

YES ................................... 1 [OE15]
NO .................................... 2 [OE15]
REF ................................... -7 [OE15]
DK .................................... -8 [OE15]
HELP AVAILABLE FOR DEFINITION OF COBRA.

OE15
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] end?
[IF INSURANCE ENDED ATER 12/31/[YEAR], BACK-UP TO OE12 AND SELECT 'YES'.]

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'IF INSURANCE ENDED... SELECT 'YES'.'
IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE15OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_11
----------------------------------------------------

OE15OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_11]
PART OF THE MONTH ..................... 2 [BOX_11]
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
[Code One]

OE16
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Is [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] now extended through COBRA?

YES ................................... 1 [BOX_11]
NO .................................... 2 [BOX_11]
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
HELP AVAILABLE FOR DEFINITION OF COBRA.

BOX_11
======

----------------------------------------------------
IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, AUTOMATICALLY CODE OE17 AS '1' (YES) AND GO TO BOX_12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OE17
----------------------------------------------------

OE17
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Are/Were] (READ NAMES BELOW) all covered by [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] [until [[OE15 DATE]/it ended]/on [END DATE]]?
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]

YES ................................... 1 [BOX_12]
NO .................................... 2 [BOX_12]
REF ................................... -7 [BOX_12]
DK .................................... -8 [BOX_12]
----------------------------------------------------
DISPLAY 'Are' IF OE12 IS CODED '1' (YES).
DISPLAY 'Were' IF OE12 IS CODED '2' (NO) OR IF CURRENT ROUND IS ROUND 5.

DISPLAY 'until [OE15 DATE]' IF OE12 IS CODED '2' (NO).
DISPLAY 'on [END DATE]' IF OE12 IS CODED '1'(YES).

DISPLAY THE DATE RECORDED AT OE15 FOR 'OE15 DATE'.
IF THE MONTH OR YEAR FIELD AT OE15 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE15 DATE'.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY COVERED PERSONS' NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSONS ON THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. PERSON WAS COVERED AT PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER AND
2. PERSON IS AN RU MBMBER
----------------------------------------------------

BOX_12
======

----------------------------------------------------
IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND TO THE END DATE OF THE CURRENT ROUND, THAT IS:

IF OE12 IS CODED '1' (YES) AND OE17 IS CODED '1' (YES),

FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH THE REFERENCE PERIOD END DATE AND

GO TO BOX_14
----------------------------------------------------
----------------------------------------------------
IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND TO PART OF THE CURRENT ROUND, THAT IS:

IF OE12 IS CODED '2' (NO) AND OE17 IS CODED '1' (YES),

FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH THE DATE RECORDED AT OE15 AND

GO TO BOX_14
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., OE17 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)), CONTINUE WITH OE18
----------------------------------------------------

OE18
====

[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 OE12 IS CODED '1' (YES).
DISPLAY 'was' IF OE12 IS CODED '2' (NO) OR IF CURRENT ROUND IS ROUND 5.

DISPLAY 'until [OE15 DATE]' IF OE12 IS CODED '2' (NO).
DISPLAY 'on [END DATE]' IF OE12 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE15 FOR 'OE15 DATE'.IF THE MONTH OR YEAR FIELD AT OE15 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended' FOR 'OE15 DATE'.
----------------------------------------------------
----------------------------------------------------
IF FAMILY STILL HAS INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED '1' (YES)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED AT OE18 AS 'CONTINUOUS COVERAGE' FROM THE REFERENCE PERIOD START DATE UNTIL THE REFERENCE PERIOD END DATE.
----------------------------------------------------
----------------------------------------------------
IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED '2',(NO)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED AT OE18 AS 'CONTINUOUS COVERAGE' FROM THE REFERENCE PERIOD START DATE UNTIL DATE RECORDED AT OE15.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY COVERED PERSONS' NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
2. PERSON IS AN RU MBMBER
----------------------------------------------------

LOOP_06
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER, ASK NAV_OE06 - END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS THE DATE ON WHICH THE INSURANCE COVERAGE THROUGH THIS ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER WHOSE COVERAGE ENDED PRIOR TO THE REFERENCE PERIOD END DATE OR THE DATE REPORTED IN OE15. THIS LOOP CYCLES ON PERSONS SELECTED AT OE18.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_06 USES NAV_OE06 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE06
========

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTB-PLCYHLDR-COVRD-PERS- TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT OE18.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE19 FOR SELECTED RU MEMBER.
----------------------------------------------------

OE19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did the health insurance through [ESTABLISHMENT] end for [you/[PERSON]]?

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7 [BOX_13]
DK .................................... -8 [BOX_13]
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE19OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_13
----------------------------------------------------

OE19OV
======

Can you just tell me if [you/he/was] [were/was] was covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_13]
PART OF THE MONTH ..................... 2 [BOX_13]
REF ................................... -7 [BOX_13]
DK .................................... -8 [BOX_13]
[Code One]

BOX_13
======

----------------------------------------------------
FLAG INSURANCE FOR PERSON AS 'CONTINUOUS COVERAGE' THROUGH THE COMPLETE DATE RECORDED AT OE19 AND OE19OV.
----------------------------------------------------

END_LP06
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH BOX_14
----------------------------------------------------

BOX_14
======

----------------------------------------------------
IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,(THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU MEMBERS NOT COVERED BY THIS INSURANCE ON THE PREVIOUS ROUND'S INTERVIEW DATE, BUT EXCLUDES RU MEMBERS JUST MARKED AS NO LONGER COVERED IN OE18),CONTINUE WITH OE20
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE22A
----------------------------------------------------

OE20
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Since [START DATE]/Between [START DATE] and [END DATE]], have any persons living here, that we have not yet mentioned, been covered by [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT]?

YES ................................... 1 [OE21]
NO .................................... 2 [OE22A]
REF ................................... -7 [OE22A]
DK .................................... -8 [OE22A]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'Since [START DATE]' IF NOT ROUND 5.
DISPLAY 'Between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------

OE21
====

[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 'has been' AND 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'was' AND 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'PERSON NOT LISTED IN RU' IS SELECTED, FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU'.
----------------------------------------------------
----------------------------------------------------
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 RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT ONE OR MORE FROM THE LISTED MEMBERS.
2. ADD, DELETE, AND EDIT DISALLOWED.
3. DISPLAY 'PERSON NOT LISTED IN RU' AS LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO WERE NOT COVERED BY THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE.
----------------------------------------------------

LOOP_07
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER, ASK NAV_OE07 - END_LP07
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07 COLLECTS THE COVERAGE START DATE FOR ALL PERSONS NEWLY COVERED DURING THE CURRENT ROUND BY THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON PERSONS SELECTED AT OE21.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_07 USES NAV_OE07 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE07
========

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTB-PLCYHLDR-COVRD-PERS- TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT OE21.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE22 FOR SELECTED RU MEMBER.
----------------------------------------------------

OE22
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did the health insurance through [ESTABLISHMENT] begin for [you/[PERSON]]?

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE22OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_15
----------------------------------------------------

OE22OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_15]
PART OF THE MONTH ..................... 2 [BOX_15]
REF ................................... -7 [BOX_15]
DK .................................... -8 [BOX_15]
[Code One]
----------------------------------------------------
HARD CHECK:
COMPLETE DATE AT OE22 MUST BE ( THAN COMPLETE DATEAT OE15 IF A DATE IS RECORDED AT OE15 OR ( THAN REFERENCE PERIOD END DATE IF NO DATE IS RECORDED AT OE15.
----------------------------------------------------

BOX_15
======

----------------------------------------------------
IF FAMILY STILL HAS INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED '1' (YES)), FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE22 UNTIL THE REFERENCE PERIOD END DATE.
----------------------------------------------------
----------------------------------------------------
IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE12 IS CODED '2' (NO)), FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE22 UNTIL DATE RECORDED AT OE15.
----------------------------------------------------

END_LP07
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_07 AND GO TO BOX_16
----------------------------------------------------

OE22A
=====

YES .................................... 1 [BOX_16]
NO ..................................... 2 [BOX_16]
REF ................................... -7 [BOX_16]
DK .................................... -8 [BOX_16]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'Does' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU' IN OE21
----------------------------------------------------

BOX_16
======

----------------------------------------------------
IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR ON THE CURRENT ROUND'S INTERVIEW DATE, THAT IS, OE12 IS CODED '1'(YES), CONTINUE WITH BOX_16A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP05
----------------------------------------------------

BOX_16A
=======

----------------------------------------------------
IF ROUND 3, CONTINUE WITH OE23A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE23
----------------------------------------------------

OE23A
=====

YES, PAY ALL OF PREMIUM/COST ........... 1
YES, PAY SOME OF PREMIUM/COST .......... 2
YES, BUT DON'T KNOW IF PAY ALL OR SOME OF PREMIUM/COST ........................ 3
NO, DO NOT PAY ......................... 4 [BOX_17AA]
REF ................................... -7 [BOX_17AA]
DK .................................... -8 [BOX_17AA]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY.
----------------------------------------------------

OE23AA
======

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
How much [do/does] [you/[POLICYHOLDER]] pay for the [ESTABLISHMENT] coverage?

[Enter Amount in Dollars] .............. [OE23AAOV1]
REF ................................... -7 [BOX_17AA]
DK .................................... -8 [BOX_17AA]
----------------------------------------------------
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY.
----------------------------------------------------

OE23AAOV1
=========

Is that per year, per month, per week, or what?
UNIT OF COVERAGE:

PER YEAR ............................... 1 [BOX_17AA]
QUARTERLY/EVERY 3 MONTHS ............... 2 [BOX_17AA]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [BOX_17AA]
PER MONTH .............................. 4 [BOX_17AA]
PER WEEK ............................... 5 [BOX_17AA]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [BOX_17AA]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [BOX_17AA]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [BOX_17AA]
OTHER ................................. 91 [OE23AAOV2]
REF ................................... -7 [BOX_17AA]
DK .................................... -8 [BOX_17AA]
[Code One]

OE23AAOV2
=========

SPECIFY:

[Enter Other Specify] .................. [BOX_17AA]
REF ................................... -7 [BOX_17AA]
DK .................................... -8 [BOX_17AA]

BOX_17A
=======

OMITTED.

OE23AAA
=======

OMITTED.

OE23AAAOV
=========

OMITTED.

BOX_17AA
========

----------------------------------------------------
IF INSURANCE BEING ASKED ABOUT PROVIDES MEDICARE SUPPLEMENT/MEDIGAP COVERAGE (I.E., HX48 OR OE10 OR OE24 OR OE37 WAS CODED '5' (MEDICARE SUPPLEMENT /MEDIGAP) EITHER ALONE OR WITH ANY COMBINATION OF CODES IN THE PREVIOUS ROUND FOR THIS ESTABLISHMENT-PERSON-PAIR), GO TO OE23
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OE23B
----------------------------------------------------

OE23B
=====

LESS THAN [$1,300/$2,600] .............. 1 [OE23]
[$1,300/$2,600] OR MORE ................ 2 [OE23C]
NO ANNUAL DEDUCTIBLE ................... 3 [OE23]
REF ................................... -7 [OE23]
DK .................................... -8 [OE23]
[Code One]
HELP AVAILABLE FOR DEFINITION OF ANNUAL DEDUCTIBLE.
----------------------------------------------------
DISPLAY '$1,300 or $1,300' IN THE QUESTION TEXT AND '$1,300' IN THE RESPONSE CATEGORY OPTIONS IF THE POLICYHOLDER IS THE ONLY COVERED RU MEMBER ANDTHERE ARE NO DEPENDENTS OUTSIDE THE RU (OE22A IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)) FOR THE PAIR BEING ASKED ABOUT. OTHERWISE (E.G., AT LEAST ONE RU MEMBER, OTHER THAN THE POLICYHOLDER IS LISTED AS A COVERED PERSON FOR THIS PAIR OR OE22A IS CODED '1' (YES) FOR THIS PAIR OR THE POLICYHOLDER IS NOT IN THE RU), DISPLAY 'family' and '$2,600 or $2,600' IN THE QUESTION TEXT AND '$2,600' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER (= 2 AND OE22A IS CODED '2'(NO), '-7' (REFUSED) OR '-8' (DON'T KNOW), THEN DISPLAY '1,300 or 1,300' IN THE QUESTION TEXT AND '1,300' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER (= 2 AND OE22A IS CODED '1'(YES), THEN DISPLAY 'family' AND '2,600 or 2,600' IN THE QUESTION TEXT AND '2,600' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER ) 2, THEN DISPLAY 'family' AND '2,600 or 2,600' IN THE QUESTION TEXT AND '2,600' IN THE RESPONSE CATEGORY OPTIONS.
----------------------------------------------------

OE23C
=====

YES .................................... 1 [OE23]
NO ..................................... 2 [OE23]
REF ................................... -7 [OE23]
DK .................................... -8 [OE23]
[Code One]
HELP AVAILABLE FOR DEFINITION OF HEALTH SAVINGS ACCOUNTS (HSAs).

OE23
====

YES ................................... 1 [OE24]
NO .................................... 2 [END_LP05]
REF ................................... -7 [END_LP05]
DK .................................... -8 [END_LP05]
----------------------------------------------------
DISPLAY FIRST PARAGRAPH IF THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON- PAIR HAD ANY INSURERS FLAGGED AS PROVIDING MEDIGAP OR HOSPITAL/PHYSICIAN BENEFITS AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF INSURER BEING LOOPED ON', DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS,DISPLAY THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP BENEFITS OR HOSPITAL/ PHYSICIAN BENEFITS) ENTERED AT HX49, HX51, OE11, OE25, OE36, OR OE38.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Since [START DATE], has there been' AND '[have/has]' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], 'was there' AND 'had' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG PREVIOUS ROUND'S INSURER AS CURRENT ROUND'S INSURER FOR THIS ESTABLISHMENT-PERSON- PAIR.
----------------------------------------------------

OE24
====

CHECK ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91
REF ................................... -7 [BOX_17]
DK .................................... -8 [BOX_17]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: 'DISABILITY,' 'WORKER'S COMPENSATION,' AND 'ACCIDENT' WILL NOT APPEAR ON THE SHOW CARD.]
----------------------------------------------------
DISPLAY '[do/does]' IF NOT ROUND 5. DISPLAY 'did' IF ROUND 5.

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

DISPLAY 'as of [END DATE]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW '-7' (REFUSED) OR '-8' (DON'T KNOW) IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODES, CONTINUE WITH OE24OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_17
----------------------------------------------------

OE24OV
======

SPECIFY:

[Enter Other Specify] .................. [BOX_17]
REF ................................... -7 [BOX_17]
DK .................................... -8 [BOX_17]
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: 'DISABILITY', 'WORKER'S COMPENSATION', AND 'ACCIDENT' WILL NOT APPEAR ON THE SHOW CARD.]

BOX_17
======

----------------------------------------------------
IF OE24 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS) OR '5' (MEDICARE SUPPLEMENT/MEDIGAP), ALONE OR WITH ANY OTHER COMBINATION OF CODES, CONTINUE WITH OE25
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP05
----------------------------------------------------
----------------------------------------------------
NOTE: ALL ESTABLISHMENTS WHICH ARE BEING LOOPED ON HERE ARE EMPLOYERS. THEREFORE, IT IS NOT NECESSARY TO AUTOMATICALLY CODE OE25 IF THE ESTABLISHMENT IS AN INSURANCE CO. OR HMO.
----------------------------------------------------

OE25
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
What is the new plan name for [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] which provides the [hospital and physician benefits/Medicare supplement or Medigap benefits]?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name?
RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE [HOSPITAL AND PHYSICIAN/MEDIGAP] BENEFITS FOR THIS PAIR.
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, SELECT 'HMO'.

NAME OF INSURER: [Enter Insurer] ..........
REF ...................... -7
DK ..... ................. -8
TYPE:
INSURANCE COMPANY ...................... 1 [LOOP_08]
HMO .................................... 2 [LOOP_08]
[Code One]
HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO.
-----------------------------------------------------
DISPLAY 'hospital and physician benefits' AND 'HOSPITAL AND PHYSICIAN' IF OE24 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS), BUT NOT CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP). DISPLAY 'Medicare supplement or Medigap benefits' AND 'MEDIGAP' IF OE24 IS CODED '5' (MEDICARE SUPPLEMENT /MEDIGAP).
-----------------------------------------------------
----------------------------------------------------
WRITE INSURER(S) TO THE RU-ESTB-PERSON-INSURER- TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR.
----------------------------------------------------
----------------------------------------------------
FLAG INSURER(S) COLLECTED AT OE25 AS CURRENT ROUND'S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- PAIR.
----------------------------------------------------
----------------------------------------------------
IF OE24 IS CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP) FLAG INSURANCE CO./HMO AS 'SUPPLYING MEDICARE SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES HOSPITAL/PHYSICIAN BENEFITS)' FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF OE24 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS), BUT NOT '5' (MEDICARE SUPPLEMENT/ MEDIGAP), FLAG INSURANCE CO./HMO AS 'SUPPLYING HOSPITAL/PHYSICIAN BENEFITS' FOR THE CURRENT ROUND.
----------------------------------------------------

LOOP_08
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- TRIPLES-ROSTER, ASK BOX_18A - END_LP08.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_08 COLLECTS MANAGED CARE INFORMATION FOR INSURERS COLLECTED AT OE25. THIS LOOP CYCLES ON TRIPLES THAT MEET THE FOLLOWING CONDITIONS:

- ESTABLISH-PERSON-PAIR PROVIDES THE INSURANCE BEING ASKED ABOUT
- INSURER IS ENTERED AT OE25
----------------------------------------------------

BOX_17B
=======

OMITTED.

OE25AA
======

OMITTED.

OE25AAOV
========

OMITTED.

BOX_18A
=======

----------------------------------------------------
IF INSURER BEING LOOPED ON IS CODED '2' (HMO) IN OE25, GO TO END_LP08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_18
----------------------------------------------------

OE25B
=====

OMITTED.

BOX_18
======

----------------------------------------------------
ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER

AT COMPLETION OF MANAGED CARE (MC) SECTION, CONTINUE WITH END_LP08
----------------------------------------------------

END_LP08
========

----------------------------------------------------
CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER INSURERS MEET THE STATED CONDITIONS, END LOOP_08 AND CONTINUE WITH END_LP05
----------------------------------------------------

END_LP05
========

----------------------------------------------------
CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_05 AND CONTINUE WITH BOX_19
----------------------------------------------------

BOX_19
======

----------------------------------------------------
IF ONE OR MORE OF RU MEMBERS WAS COVERED BY INSURANCE THROUGH A NON-CURRENT EMPLOYER FROM THE PREVIOUS ROUND, AN EMPLOYER FLAGGED AS 'SELF- EMPLOYED' WITH A FIRM-SIZE-1, OR A DIRECT PURCHASE SOURCE ON THE PREVIOUS ROUND'S INTERVIEW DATE, THAT IS:

IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS IN THE RU MEETS THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS ONE OF THE FOLLOWING TYPES:
- FLAGGED AS A DIRECT PURCHASE SOURCE
- FLAGGED AS AN 'EMPLOYER' WITH FIRM-SIZE-1, FLAGGED DURING THE PREVIOUS ROUND AS 'PROVIDES HEALTH INSURANCE', OR
- FLAGGED AS AN 'EMPLOYER' WITH FIRM-SIZE- GREATER-THAN-1, FLAGGED DURING THE PREVIOUS ROUND AS 'PROVIDES HEALTH INSURANCE', AND HAD ONE OF THE FOLLOWING JOB SUBTYPES DURING THE PREVIOUS ROUND:
- 'FORMER MAIN WITHIN REFERENCE PERIOD'
- 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'
- 'LAST JOB OUTSIDE REFERENCE PERIOD'
- 'RETIREMENT JOB'
- PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT,IF THE ESTABLISHMENT IS ONE OF THE SECOND 2 TYPES NOTED ABOVE;
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE;
- THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT COVERED PERSON ON THE DATE OF THE PREVIOUS ROUND'S INTERVIEW (HQ WAS CODED '1' (WHOLE TIME) OR HQ02 WAS CODED '1' (YES) IN THE PREVIOUS ROUND);

CONTINUE WITH LOOP_09
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_29
----------------------------------------------------
----------------------------------------------------
NOTE: IF POLICYHOLDER WAS NOT PHYSICALLY PRESENT IN THE RU ON THE PREVIOUS ROUND'S INTERVIEW DATE, THE LAST CONDITION IN THE ABOVE BOX CAN BE MET IF AT LEAST ONE DEPENDENT WAS COVERED BY POLICYHOLDER'S INSURANCE ON THE PREVIOUS ROUND'S INTERVIEW DATE. THE LOOP WILL CYCLE ON THE POLICYHOLDER'S NAME.
----------------------------------------------------
----------------------------------------------------
NOTE: ESTABLISHMENT-PERSON-PAIRS WHERE THE POLICYHOLDER IS OUT-OF-SCOPE (E.G., DECEASED, INSTITUTIONALIZED, OUT OF COUNTRY) ON THE CURRENT ROUND'S INTERVIEW DATE, BUT WHERE THE ESTABLISHMENT-PERSON-PAIR COVERED DEPENDENTS WHO ARE STILL RU MEMBERS MAY STILL QUALIFY FOR LOOP_09.
----------------------------------------------------
----------------------------------------------------
NOTE: FOR DIRECT PURCHASE AND SELF-EMPLOYED-FIRM-SIZE-1, THE CONTEXT HEADER SHOULD DISPLAY THE NAMEOF THE SOURCE PROVIDING THE INSURANCE RATHER THAN THE NAME OF THE DIRECT PURCHASE CATEGORY OR THE SELF-EMPLOYED-FIRM-SIZE-1 EMPLOYER NAME OR TYPE OFPURCHASE CATEGORY. FOR EMPLOYERS WHICH ARE NOT SELF-EMPLOYED WITH FIRM-SIZE-1, USE THE JOBHOLDER NAME AND EMPLOYER NAME IN THE CONTEXT HEADER.
----------------------------------------------------

LOOP_09
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_OE09A - END_LP09
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_09 COLLECTS INFORMATION ABOUT THE CONTINUATION OF INSURANCE COVERAGE THROUGH A NON-CURRENT EMPLOYER FROM THE PREVIOUS ROUND, AN EMPLOYER FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE-1, OR A DIRECT PURCHASE SOURCE THAT WAS COLLECTED IN THE PREVIOUS ROUND. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:

- ESTABLISHMENT IS ONE OF THE FOLLOWING TYPES:
- FLAGGED AS A DIRECT PURCHASE SOURCE
- FLAGGED AS AN 'EMPLOYER' WITH FIRM-SIZE-1, FLAGGED DURING THE PREVIOUS ROUND AS 'PROVIDES HEALTH INSURANCE', OR
- FLAGGED AS AN 'EMPLOYER' WITH FIRM-SIZE- GREATER-THAN-1, FLAGGED DURING THE PREVIOUS ROUND AS 'PROVIDES HEALTH INSURANCE', AND HAD ONE OF THE FOLLOWING JOB SUBTYPES DURING THE PREVIOUS ROUND:
- 'FORMER MAIN WITHIN REFERENCE PERIOD'
- 'FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD'
- 'LAST JOB OUTSIDE REFERENCE PERIOD'
- 'RETIREMENT JOB'
- PERSON IS OR WAS A JOBHOLDER AT ESTABLISHMENT, IF THE ESTABLISHMENT IS ONE OF THE SECOND 2 TYPES NOTED ABOVE;
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE;
- THE HEALTH INSURANCE PROVIDED BY ESTABLISHMENT COVERED PERSON ON THE DATE OF THE PREVIOUS ROUND'S INTERVIEW (HQ WAS CODED '1' (WHOLE TIME) OR HQ02 WAS CODED '1' (YES) IN THE PREVIOUS ROUND)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_09 USES BOTH NAV_OE09A AND OE09B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE09A
=========

SERIES: Confirming Insurance Obtained by Someone in the Family in a Previous Round (i.e., probing for who is still covered, any change in plan name, etc.)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_09 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH NAV_OE09B FOR SELECTED RU MEMBER.
----------------------------------------------------

NAV_OE09B
=========

Policyholder...Establishment Providing Insurance
[1. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
[2. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
[3. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: POLICYHOLDER...ESTABLISHMENT PROVIDING INSURANCE
INSTRUCTIONS: DISPLAY RU-ESTABLISHMENT-PERSON- PAIR
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH PAIR EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL ESTABLISHMENTS THAT MEET THE CONDITIONS STATED AT THE LOOP_09 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_19A FOR SELECTED PAIR.
----------------------------------------------------

BOX_19A
=======

----------------------------------------------------
IF THE POLICYHOLDER OF THIS ESTABLISHMENT-PERSON- PAIR IS FLAGGED AS 'POLICYHOLDER NOT LISTED IN RU (DU)' OR 'POLICYHOLDER DECEASED', CONTINUE WITH OE25A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE26
----------------------------------------------------

OE25A
=====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
INTERVIEWER: IF [POLICYHOLDER]'S NAME IS LISTED ON THE ROSTER BELOW, SELECT IT. IF NOT, SELECT 'NAME NOT ON ROSTER' AND CONTINUE.

[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]
----------------------------------------------------
IF A DU MEMBER'S NAME IS SELECTED FROM THE ROSTER, REPLACE THIS NAME AS THE CURRENT POLICYHOLDER OF THIS ESTABLISHMENT-PERSON-PAIR.
IF 'NAME NOT ON ROSTER' SELECTED LEAVE THE POLICYHOLDER NAME OF THIS ESTABLISHMENT-PERSON- PAIR AS IS.
----------------------------------------------------
----------------------------------------------------
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 ON THE DU-MEMBERS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
3. DISPLAY 'NAME NOT ON ROSTER' AS LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL.
----------------------------------------------------

OE26
====

YES .................................... 1
NO ..................................... 2 [OE28]
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]
----------------------------------------------------
DISPLAY '[Are/Is]' IF NOT ROUND 5. DISPLAY '[Were/Was]' IF ROUND 5.

DISPLAY 'today,' IF NOT ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND THIS ESTABLISHMENT-PERSON- PAIR IS AN ESTABLISHMENT FLAGGED AS 'SELF- EMPLOYED' WITH FIRM-SIZE-1, CONTINUE WITH OE27
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF CODED '1' (YES) AND ESTABLISHMENT-PERSON-PAIR IS NOT AN ESTABLISHMENT WITH FIRM-SIZE-1), GO TO BOX_20
----------------------------------------------------

OE27
====

POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Is this insurance still through [your/[POLICYHOLDER]'s] self-employed business?

YES .................................... 1 [BOX_20]
NO ..................................... 2 [BOX_20]
REF ................................... -7 [BOX_20]
DK .................................... -8 [BOX_20]
HELP AVAILABLE FOR DEFINITION OF SELF-EMPLOYED.

OE28
====

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7 [BOX_20]
DK .................................... -8 [BOX_20]
----------------------------------------------------
DISPLAY 'IF INSURANCE ENDED... SELECT 'YES'.' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY
----------------------------------------------------
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE28OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_20
----------------------------------------------------

OE28OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_20]
PART OF THE MONTH ..................... 2 [BOX_20]
REF ................................... -7 [BOX_20]
DK .................................... -8 [BOX_20]
[Code One]

BOX_20
======

----------------------------------------------------
IF THE POLICYHOLDER IS THE ONLY PERSON COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, AUTOMATICALLY CODE OE29 AS '1' (YES) AND GO TO BOX_21
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OE29
----------------------------------------------------

OE29
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Are/Were] (READ NAMES BELOW) all covered by [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] [until [[OE28 DATE]/it ended]/on [END DATE]]?
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]

YES ................................... 1 [BOX_21]
NO .................................... 2 [BOX_21]
REF ................................... -7 [BOX_21]
DK .................................... -8 [BOX_21]
----------------------------------------------------
DISPLAY 'Are' IF OE26 IS CODED '1' (YES).
DISPLAY 'Were' IF OE26 IS CODED '2' (NO) OR IF CURRENT ROUND IS ROUND 5.

DISPLAY 'until [OE28 DATE]' IF OE26 IS CODED '2' (NO).
DISPLAY 'on [END DATE]' IF OE26 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE28 FOR 'OE28 DATE'.
IF THE MONTH OR YEAR FIELD AT OE28 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended'FOR 'OE28 DATE'.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY COVERED PERSONS' NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. PERSON WAS COVERED AT PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
2. PERSON IS AN RU MBMBER
----------------------------------------------------

BOX_21
======

----------------------------------------------------
IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND TO THE END DATE OF THE CURRENT ROUND, THAT IS:

IF OE26 IS CODED '1' (YES) AND OE29 IS CODED '1' (YES),

FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH THE REFERENCE PERIOD END DATE AND

GO TO BOX_23
----------------------------------------------------
----------------------------------------------------
IF COVERAGE IS CONTINUOUS FROM THE PREVIOUS ROUND TO PART OF THE CURRENT ROUND, THAT IS:

IF OE26 IS CODED '2' (NO) AND OE29 IS CODED '1' (YES).

FLAG INSURANCE FOR ALL COVERED PERSONS (INCLUDING THE POLICYHOLDER) AS 'CONTINUOUS COVERAGE' THROUGH THE DATE RECORDED AT OE28 AND

GO TO BOX_23
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., OE29 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)), CONTINUE WITH OE30
----------------------------------------------------

OE30
====

[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 OE26 IS CODED '1' (YES).
DISPLAY 'was' IF OE26 IS CODED '2' (NO) OR IF CURRENT ROUND IS ROUND 5.

DISPLAY 'until [OE28 DATE]' IF OE26 IS CODED '2' (NO).
DISPLAY 'on [END DATE]' IF OE26 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE28 FOR 'OE28 DATE'.
IF THE MONTH OR YEAR FIELD AT OE28 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended 'FOR 'OE28 DATE'.
----------------------------------------------------
----------------------------------------------------
IF FAMILY STILL HAS INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED '1' (YES)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED AT OE30 AS 'CONTINUOUS COVERAGE' FROM THEREFERENCE PERIOD START DATE UNTIL THE REFERENCE PERIOD END DATE.
----------------------------------------------------
----------------------------------------------------
IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED '2' (NO)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED AT OE30 AS 'CONTINUOUS COVERAGE' FROM THE REFERENCE PERIOD START DATE UNTIL DATE RECORDED AT OE28
----------------------------------------------------
----------------------------------------------------
GO TO LOOP_10
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY COVERED PERSONS' NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. PERSON WAS COVERED AT PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, INCLUDING THE POLICYHOLDER
2. PERSON IS AN RU MBMBER
----------------------------------------------------

LOOP_10
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER, ASK NAV_OE10 - END_LP10
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_10 COLLECTS THE DATE ON WHICH THE INSURANCE COVERAGE THROUGH THIS ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBERWHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCEPERIOD END DATE OR THE DATE REPORTED IN OE28.
THIS LOOP CYCLES ON PERSONS SELECTED AT OE30.
-----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_10 USES NAV_OE10 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE10
========

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTB-PLCYHLDR-COVRD-PERS- TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT OE30.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE31 FOR SELECTED RU MEMBER.
----------------------------------------------------

OE31
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did the health insurance through [ESTABLISHMENT] end for [you/[PERSON]]?

[Enter Month-2, Day-2, Year-4] ......... [OE31OV]
REF ................................... -7 [BOX_22]
DK .................................... -8 [BOX_22]
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE31OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_22
----------------------------------------------------

OE31OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_22]
PART OF THE MONTH ..................... 2 [BOX_22]
REF ................................... -7 [BOX_22]
DK .................................... -8 [BOX_22]
[Code One]

BOX_22
======

----------------------------------------------------
FLAG INSURANCE FOR PERSON AS 'CONTINUOUS COVERAGE' THROUGH THE COMPLETE DATE RECORDED AT OE31 AND OE31OV.
----------------------------------------------------

END_LP10
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_10 AND CONTINUE WITH BOX_23
----------------------------------------------------

BOX_23
======

----------------------------------------------------
IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR,(THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU MEMBERS NOT COVERED BY THIS INSURANCE ON THE PREVIOUS ROUND'S INTERVIEW DATE, BUT EXCLUDES RU MEMBERS JUST MARKED AS NO LONGER COVERED IN OE30),CONTINUE WITH OE32
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE34A
----------------------------------------------------

OE32
====

YES ................................... 1 [OE33]
NO .................................... 2 [OE34A]
REF ................................... -7 [OE34A]
DK .................................... -8 [OE34A]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'Since [START DATE]' IF NOT ROUND 5.
DISPLAY 'Between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------

OE33
====

[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 'has been' AND 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'was' AND 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'PERSON NOT LISTED IN RU' IS SELECTED, FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU'.
----------------------------------------------------
----------------------------------------------------
GO TO LOOP_11
----------------------------------------------------
----------------------------------------------------
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 RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT ONE OR MORE FROM THE LISTED MEMBERS.
2. ADD, DELETE, AND EDIT DISALLOWED.
3. DISPLAY 'PERSON NOT LISTED IN RU' AS LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO WERE NOT COVERED BY THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE.
----------------------------------------------------

LOOP_11
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER, ASK NAV_OE11 - END_LP11
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_11 COLLECTS THE COVERAGE START DATE FOR ALL PERSONS NEWLY COVERED DURING THE CURRENT ROUND BY THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON PERSONS SELECTED AT OE33.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_11 USES NAV_OE11 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE11
========

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTB-PLCYHLDR-COVRD-PERS- TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT OE33.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE34 FOR SELECTED RU MEMBER.
----------------------------------------------------

OE34
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did the health insurance through [ESTABLISHMENT] begin for [you/[PERSON]]?

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
-----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE34OV
-----------------------------------------------------
-----------------------------------------------------
OTHERWISE, GO TO BOX_24
-----------------------------------------------------

OE34OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_24]
PART OF THE MONTH ..................... 2 [BOX_24]
REF ................................... -7 [BOX_24]
DK .................................... -8 [BOX_24]
[Code One]
----------------------------------------------------
HARD CHECK:
COMPLETE DATE AT OE34 MUST BE ( THAN COMPLETE DATE AT OE28 IF A DATE IS RECORDED AT OE28 OR ( THAN REFERENCE PERIOD END DATE IF NO DATE IS RECORDED AT OE28.
----------------------------------------------------

BOX_24
======

----------------------------------------------------
IF FAMILY STILL HAS INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED '1' (YES)), FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE34 UNTIL THE REFERENCE PERIOD END DATE.
----------------------------------------------------
----------------------------------------------------
IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE26 IS CODED '2' (NO)), FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE34 UNTIL DATE RECORDED AT OE28.
----------------------------------------------------

END_LP11
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_11 AND CONTINUE WITH BOX_25
----------------------------------------------------

OE34A
=====

YES .................................... 1 [BOX_25]
NO ..................................... 2 [BOX_25]
REF ................................... -7 [BOX_25]
DK .................................... -8 [BOX_25]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'Does' IF NOT ROUND 5. DISPLAY 'Between
[START DATE] and [END DATE], did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU' IN OE33
----------------------------------------------------

BOX_25
======

----------------------------------------------------
IF ONE OR MORE RU MEMBERS ARE STILL COVERED BY THE INSURANCE THROUGH THE ESTABLISHMENT-PERSON-PAIR ON THE CURRENT ROUND'S INTERVIEW DATE, THAT IS, OE26 IS CODED '1'(YES), CONTINUE WITH BOX_25A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP09
----------------------------------------------------

BOX_25A
=======

----------------------------------------------------
IF ROUND 2 OR ROUND 4, CONTINUE WITH BOX_25AA
----------------------------------------------------
----------------------------------------------------
IF ROUND 3, GO TO OE35A
----------------------------------------------------
----------------------------------------------------
IF ROUND 5, GO TO OE35
----------------------------------------------------

BOX_25AA
========

----------------------------------------------------
IF THIS ESTABLISHMENT-PERSON-PAIR:

- WAS FLAGGED AS 'GROUP' (HX03=1 OR 2 OR HX23=1) OR 'INSURANCE COMPANY-FROM AN AGENT' (HX03=5 OR HX23=4) OR 'INSURANCE COMPANY' (HX03=6 OR HX23=5) OR 'HMO' (HX03=7 OR HX23=6) OR 'EXCHANGE COVERAGE' (HX03=11 OR HX23=14) OR 'UNKNOWN TYPE- COLLECTED AT OTHER' (HX03=91 OR HX23=91) IN THE ROUND THE PAIR WAS FIRST CREATED
AND
- WAS FLAGGED AS 'SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS' IN THE PREVIOUS ROUND
AND
- POLICYHOLDER OF THIS PAIR IS 64 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-8 CONTINUE WITH OE35A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE35
----------------------------------------------------

OE35A
=====

YES, PAY ALL OF PREMIUM/COST ........... 1 [BOX_25AAA]
YES, PAY SOME OF PREMIUM/COST .......... 2 [BOX_25AAA]
YES, BUT DON'T KNOW IF PAY ALL OR SOME OF PREMIUM/COST ........................ 3 [BOX_25AAA]
NO, DO NOT PAY ......................... 4 [BOX_26A]
REF ................................... -7 [BOX_26A]
DK .................................... -8 [BOX_26A]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY.
----------------------------------------------------

BOX_25AAA
=========

----------------------------------------------------
IF ROUND 3, CONTINUE WITH OE35AA
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE35AA2
----------------------------------------------------

OE35AA
======

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
How much [do/does] [you/[POLICYHOLDER]] pay for the [ESTABLISHMENT] coverage?

[Enter Amount in Dollars] .............. [OE35AAOV1]
REF ................................... -7 [BOX_25B]
DK .................................... -8 [BOX_25B]
----------------------------------------------------
NOTE: THE ESTABLISHMENT NAME WHICH SHOULD BE DISPLAYED HERE FOR THE INSURANCE FROM A SELF-EMPLOYED-FIRM-SIZE-1 AND INSURANCE FROM DIRECTLY PURCHASED SOURCES, SHOULD BE THE NAME OF THE SOURCE, NOT THE NAME OF THE EMPLOYER OR DIRECTLY PURCHASED CATEGORY.
----------------------------------------------------

OE35AAOV1
=========

Is that per year, per month, per week, or what?
UNIT OF COVERAGE:

PER YEAR ............................... 1 [BOX_25B]
QUARTERLY/EVERY 3 MONTHS ............... 2 [BOX_25B]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [BOX_25B]
PER MONTH .............................. 4 [BOX_25B]
PER WEEK ............................... 5 [BOX_25B]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [BOX_25B]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [BOX_25B]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [BOX_25B]
OTHER ................................. 91 [OE35AAOV2]
REF ................................... -7 [BOX_25B]
DK .................................... -8 [BOX_25B]
[Code One]

OE35AAOV2
=========

SPECIFY:

[Enter Other Specify] .................. [BOX_25B]
REF ................................... -7 [BOX_25B]
DK .................................... -8 [BOX_25B]

BOX_25B
=======

----------------------------------------------------
IF THIS ESTABLISHMENT-PERSON-PAIR:

- WAS FLAGGED AS 'GROUP' (HX03=1 OR 2 OR HX23=1) OR 'INSURANCE COMPANY-FROM AN AGENT' (HX03=5 OR HX23=4) OR 'INSURANCE COMPANY' (HX03=6 OR HX23=5) OR 'HMO' (HX03=7 OR HX23=6) OR 'EXCHANGE COVERAGE' (HX03=11 OR HX23=14) OR 'UNKNOWN TYPE- COLLECTED AT OTHER' (HX03=91 OR HX23=91) IN THE ROUND THE PAIR WAS FIRST CREATED
AND
- WAS FLAGGED AS 'SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS' IN THE PREVIOUS ROUND
AND
- POLICYHOLDER OF THIS PAIR IS 64 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-8 CONTINUE WITH OE35AA2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_26A
----------------------------------------------------

OE35AA2
=======

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Is the cost of the premium subsidized based on family income?

YES .................................... 1 [BOX_26A]
NO ..................................... 2 [BOX_26A]
REF ................................... -7 [BOX_26A]
DK .................................... -8 [BOX_26A]

BOX_26A
=======

----------------------------------------------------
IF ROUND 3, CONTINUE WITH BOX_26AA
---------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE35
----------------------------------------------------

OE35AAA
=======

OMITTED.

OE35AAAOV
=========

OMITTED.

BOX_26AA
========

----------------------------------------------------
IF INSURANCE BEING ASKED ABOUT PROVIDES MEDICARE SUPPLEMENT/MEDIGAP COVERAGE (I.E., HX48 OR OE10 OR OE24 OR OE37 WAS CODED '5' (MEDICARE SUPPLEMENT /MEDIGAP) EITHER ALONE OR WITH ANY COMBINATION OF CODES IN THE PREVIOUS ROUND FOR THIS ESTABLISHMENT -PERSON-PAIR), GO TO OE35
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OE35B
----------------------------------------------------

OE35B
=====

LESS THAN [$1,300/$2,600] .............. 1 [OE35]
[$1,300/$2,600] OR MORE ................ 2 [OE35C]
NO ANNUAL DEDUCTIBLE ................... 3 [OE35]
REF ................................... -7 [OE35]
DK .................................... -8 [OE35]
[Code One]
HELP AVAILABLE FOR DEFINITION OF ANNUAL DEDUCTIBLE.
----------------------------------------------------
DISPLAY '$1,300 or $1,300' IN THE QUESTION TEXT AND '$1,300' IN THE RESPONSE CATEGORY OPTIONS IF THE POLICYHOLDER IS THE ONLY COVERED RU MEMBER AND THERE ARE NO DEPENDENTS OUTSIDE THE RU (OE34A IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)) FOR THE PAIR BEING ASKED ABOUT. OTHERWISE (E.G., AT LEAST ONE RU MEMBER, OTHER THAN THE POLICYHOLDER IS LISTED AS A COVERED PERSON FOR THIS PAIR OR OE34A IS CODED '1' (YES) FOR THIS PAIR OR THE POLICYHOLDER IS NOT IN THE RU), DISPLAY 'family' and '$2,600 or $2,600' IN THE QUESTION TEXT AND '$2,600' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER (= 2 AND OE34A IS CODED '2'(NO), '-7' (REFUSED) OR '-8' (DON'T KNOW), THEN DISPLAY '1,300 or 1,300' IN THE QUESTION TEXT AND '1,300' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER (= 2 AND OE34A IS CODED '1'(YES), THEN DISPLAY 'family' AND '2,600 or 2,600' IN THE QUESTION TEXT AND '2,600' IN THE RESPONSE CATEGORY OPTIONS.

IF POLICYHOLDER IS FLAGGED AS 'DECEASED' AND THE NUMBER OF COVERED PERSONS ON RU-ESTB-PLCYHLDR- CVRD-PERS-TRPLS-ROSTER ) 2, THEN DISPLAY 'family' AND '2,600 or 2,600' IN THE QUESTION TEXT AND '2,600' IN THE RESPONSE CATEGORY OPTIONS.
----------------------------------------------------

OE35C
=====

YES .................................... 1 [OE35]
NO ..................................... 2 [OE35]
REF ................................... -7 [OE35]
DK .................................... -8 [OE35]
[Code One]
HELP AVAILABLE FOR DEFINITION OF HEALTH SAVINGS ACCOUNTS (HSAs).

OE35
====

YES ................................... 1
NO .................................... 2 [END_LP09]
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]
----------------------------------------------------
DISPLAY FIRST PARAGRAPH IF THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR HAD ANY INSURERS FLAGGED AS PROVIDING MEDIGAP OR HOSPITAL/ PHYSICIAN BENEFITS AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF INSURER BEING LOOPED ON', DISPLAY THE NAME OF THIS POLICYHOLDER'S CURRENT ROUND'S PRIVATE OR MEDIGAP INSURER FOR PLAN NAME. THAT IS,DISPLAY THE NAME OF THE PLAN (PROVIDING MEDICARE SUPPLEMENT / MEDIGAP BENEFITS OR HOSPITAL/ PHYSICIAN BENEFITS) ENTERED AT HX49, HX51, OE11, OE25, OE36, OR OE38.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Since [START DATE], has there been' AND '[have/has]' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], was there' AND 'had' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG PREVIOUS ROUND'S INSURER AS CURRENT ROUND'S INSURER FOR THIS ESTABLISHMENT-PERSON- PAIR.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND ESTABLISHMENT IS FLAGGED AS AN 'INSURANCE CO.', 'INSURANCE CO.-FROM AGENT', OR 'HMO', CONTINUE WITH OE36
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND ESTABLISHMENT IS NOT FLAGGED AS AN 'INSURANCE CO.', 'INSURANCE CO.-FROM AGENT', OR 'HMO', GO TO OE37
----------------------------------------------------

OE36
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
What is the new plan name of [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT]?

[Enter Plan Name/Establishment Name] .............. [OE37]
----------------------------------------------------
WRITE ESTABLISHMENT NAME CORRECTION TO THE RU- ESTABLISHMENT-PERSONS-PAIRS-ROSTER. THIS IS THE CORRECTED ESTABLISHMENT NAME.
----------------------------------------------------
----------------------------------------------------
FLAG INSURER ENTERED ABOVE AS CURRENT ROUND'S INSURER FOR THIS POLICYHOLDER-ESTABLISHMENT PAIR.
----------------------------------------------------
----------------------------------------------------
NOTE: IF A SOURCE OF INSURANCE WAS DIRECTLY PURCHASED FROM AN HMO, INSURANCE COMPANY, OR FROM AN INSURANCE AGENT, THE ESTABLISHMENT NAME IS THE SAME AS THE INSURER NAME. THEREFORE, ANY CHANGE IN PLAN NAME AUTOMATICALLY DICTATES A CHANGE IN THE ESTABLISHMENT NAME.
----------------------------------------------------

OE37
====

CHECK ALL THAT APPLY.
HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO ... 1
DENTAL ................................. 2
PRESCRIPTION DRUGS ..................... 3
VISION ................................. 4
MEDICARE SUPPLEMENT/MEDIGAP ............ 5
LONG TERM CARE IN A NURSING HOME ....... 6
EXTRA CASH FOR HOSPITAL STAYS .......... 7
SERIOUS DISEASE OR DREAD DISEASE ....... 8
DISABILITY ............................. 9
WORKER'S COMPENSATION ................. 10
ACCIDENT .............................. 11
OTHER ................................. 91 [OE37OV]
REF ................................... -7 [BOX_26]
DK .................................... -8 [BOX_26]
[Code All That Apply]
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
[NOTE: 'DISABILITY,' 'WORKER'S COMPENSATION,' AND 'ACCIDENT' WILL NOT APPEAR ON THE SHOW CARD.]
----------------------------------------------------
DISPLAY '[do/does]' IF NOT ROUND 5. DISPLAY 'did'IF ROUND 5.

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

DISPLAY 'as of [END DATE]' IF ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW '-7' (REFUSED) OR '-8' (DON'T KNOW) IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (OTHER), ALONE OR IN COMBINATION WITH ANY OTHER CODES, CONTINUE WITH OE37OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_26
----------------------------------------------------

OE37OV
======

SPECIFY:

[Enter Other Specify] .................. [BOX_26]
REF ................................... -7 [BOX_26]
DK .................................... -8 [BOX_26]
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.

BOX_26
======

----------------------------------------------------
IF OE37 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS) OR '5' (MEDICARE SUPPLEMENT/MEDIGAP), ALONE OR WITH ANY OTHER COMBINATION OF CODES, CONTINUE WITH BOX_27
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP09
----------------------------------------------------

BOX_27
======

----------------------------------------------------
IF ESTABLISHMENT ALREADY FLAGGED AS 'INSURANCE CO', 'INSURANCE CO.-FROM AGENT', OR 'HMO', AUTOMATICALLY CODE OE38 WITH APPROPRIATE RESPONSES AND GO TO LOOP_12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OE38
----------------------------------------------------

OE38
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
What is the new plan name for [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] which provides the [hospital and physician benefits/Medicare supplement or Medigap benefits]?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name?
RECORD THE NAME OF THE MAIN INSURER THAT PROVIDES THE [HOSPITAL AND PHYSICIAN/MEDIGAP] BENEFITS FOR THIS PAIR.
IF RESPONDENT SAYS BOTH INSURANCE COMPANY AND HMO, SELECT 'HMO'.

NAME OF INSURER: [Enter Insurer] ..........
REF ...................... -7
DK ..... ................. -8
TYPE:
INSURANCE COMPANY ...................... 1 [LOOP_12]
HMO .................................... 2 [LOOP_12]
[Code One]
HELP AVAILABLE FOR DEFINITION OF INSURANCE CO/HMO.
-----------------------------------------------------
DISPLAY 'hospital and physician benefits' AND 'HOSPITAL AND PHYSICIAN' IF OE37 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS), BUT NOT CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP).
DISPLAY 'Medicare supplement or Medigap benefits' AND 'MEDIGAP' IF OE37 IS CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP).
-----------------------------------------------------
-----------------------------------------------------
WRITE INSURER(S) TO THE RU-ESTAB-PERSON-INSURER- TRIPLES-ROSTER FOR THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR
-----------------------------------------------------
----------------------------------------------------
FLAG INSURER(S) COLLECTED AT OE38 AS CURRENT ROUND'S INSURER(S) FOR THIS ESTABLISHMENT-PERSON- PAIR.
----------------------------------------------------
----------------------------------------------------
IF OE37 IS CODED '5' (MEDICARE SUPPLEMENT/MEDIGAP) FLAG INSURANCE CO./HMO AS 'SUPPLYING MEDICARE SUPPLEMENT/MEDIGAP BENEFITS (WHICH INCLUDES HOSPITAL/PHYSICIAN BENEFITS)' FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF OE37 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS), BUT NOT '5' (MEDICARE SUPPLEMENT/ MEDIGAP), FLAG INSURANCE CO./HMO AS 'SUPPLYING HOSPITAL/PHYSICIAN BENEFITS' FOR THE CURRENT ROUND.
----------------------------------------------------

LOOP_12
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTAB-PERSON-INSURER- TRIPLES-ROSTER, ASK BOX_28A - END_LP12.
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_12 COLLECTS MANAGED CARE INFORMATION FOR INSURERS COLLECTED AT OE38. THIS LOOP CYCLES ON TRIPLES THAT MEET THE FOLLOWING CONDITIONS:

- ESTABLISHMENT-PERSON-PAIR PROVIDES THE INSURANCEBEING ASKED ABOUT
- INSURER IS ENTERED AT OE38
----------------------------------------------------

BOX_27A
=======

OMITTED.

OE38A
=====

OMITTED.

OE38AOV
=======

OMITTED.

BOX_28A
=======

----------------------------------------------------
IF INSURER BEING LOOPED ON IS CODED '2' (HMO) IN OE38, GO TO END_LP12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_28
----------------------------------------------------

BOX_28
======

----------------------------------------------------
ASK THE MANAGED CARE (MC) SECTION FOR THIS INSURER

AT COMPLETION OF MANAGED CARE (MC) SECTION, CONTINUE WITH END_LP12
----------------------------------------------------

END_LP12
========

----------------------------------------------------
CYCLE ON NEXT INSURER IN THE RU-ESTAB-PERSON- INSURER-TRIPLES-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER INSURERS MEET THE STATED CONDITIONS, END LOOP_12 AND CONTINUE WITH BOX_28B
----------------------------------------------------

BOX_28B
=======

----------------------------------------------------
IF HP04A WAS CODED '1' (YES, PLAN IS EXCHANGE) OR IF THIS ESTABLISHMENT-PERSON-PAIR WAS FLAGGED AS 'EXCHANGE COVERAGE' (HX03=11 OR HX23=14) THE ROUNDTHE INSURANCE WAS CREATED
AND
IS FLAGGED AS 'SUPPLYING HOSPITAL AND PHYSICIAN BENEFITS' (OE37 IS CODED '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) BUT NOT '5' (MEDIGAP))
AND
POLICYHOLDER OF THIS PAIR IS 64 YEARS OF AGE OR YOUNGER OR IN AGE CATEGORIES 1-8 CONTINUE WITH OE38B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP09
----------------------------------------------------

OE38B
=====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Is [your/[PERSON]'s] [INSURER RECORDED AT OE38] plan a platinum, gold, silver, bronze or catastrophic plan?

PLATINUM PLAN .......................... 1 [END_LP09]
GOLD PLAN .............................. 2 [END_LP09]
SILVER PLAN ............................ 3 [END_LP09]
BRONZE PLAN ............................ 4 [END_LP09]
CATASTROPHIC PLAN ...................... 5 [END_LP09]
IF VOLUNTEERED: SOMETHING ELSE ......... 6 [END_LP09]
REF ................................... -7 [END_LP09]
DK .................................... -8 [END_LP09]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY THE ACTUAL PLAN NAME ENTERED AT OE38 FOR '[INSURER RECORDED AT OE38]' IF A PLAN NAME WAS ENTERED. OTHERWISE, USE A NULL DISPLAY
----------------------------------------------------

END_LP09
========

----------------------------------------------------
CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_09 AND CONTINUE WITH BOX_29
----------------------------------------------------

BOX_29
======

----------------------------------------------------
IF ONE OR MORE RU MEMBERS WAS A COVERED PERSON BY AN ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE WHERE THE ESTABLISHMENT IS A PRIVATE SOURCE OF INSURANCE AND THE POLICYHOLDER IS FLAGGED AS 'POLICYHOLDER/DEPENDENT IN DIFFERENT RUS' AT THE CURRENT ROUND'S INTERVIEW DATE, CONTINUE WITH LOOP_13
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_33
----------------------------------------------------
----------------------------------------------------
NOTE: WHEN A POLICYHOLDER LEAVES AN RU, WE WILL NEVER ASK RJ AND THAT POLICYHOLDER WILL NEVER QUALIFY FOR LOOPS 01, 05, OR 09. WE CREATED A NEW LOOP, LOOP_13 THAT WILL HANDLE THE SITUATIONS WHERE THE POLICYHOLDER HAS LEFT THE RU AND LEFT DEPENDENTS BEHIND, OR THE SITUATION WHERE THE DEPENDENTS HAVE LEFT THE RU (WITHOUT THE POLICYHOLDER). THIS SITUATION WILL BE FLAGGED AS 'POLICYHOLDER/DEPENDENT IN DIFFERENT RUs'. THIS FLAG CAN BE ASSOCIATED WITH ANY ESTABLISHMENT- PERSON-PAIR IN A PARTICULAR RU WHERE THEY ARE COVERED PERSONS, BUT THE POLICYHOLDER IS IN ANOTHER RU. THIS FLAG SHOULD NEVER EXIST ON A PAIR IN AN RU WHERE THE POLICYHOLDER OF THE PAIR IS IN THE SAME RU AS ALL OF THE DEPENDENTS OR WHERE THE POLICYHOLDER OF THE PAIR WAS ORIGINALLY CREATED AS 'POLICYHOLDER NOT IN RU/DU' OR 'POLICYHOLDER DECEASED'.
----------------------------------------------------

LOOP_13
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_OE13A - END_LP13
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION:

LOOP_13 COLLECTS INFORMATION ABOUT THE CONTINUATION OF INSURANCE COVERAGE THROUGH AN ESTABLISHMENT-PERSON-PAIR WHERE THE POLICYHOLDER OR THE ELIGIBLE DEPENDENT(S) HAVE MOVED FROM THE RU. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET THE FOLLOWING CONDITIONS:

- THE ESTABLISHMENT IS A PRIVATE SOURCE OF INSURANCE
- THE ESTABLISHMENT-PERSON-PAIR IS FLAGGED AS 'POLICYHOLDER/DEPENDENT MOVED' AT THE CURRENT ROUND'S INTERVIEW DATE FOR THIS RU
- AT LEAST ONE RU MEMBER WAS A COVERED PERSON FOR THIS ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE
- POLICYHOLDER IS NOT A CURRENT RU MEMBER
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_13 USES BOTH NAV_OE13A AND OE13B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE13A
=========

SERIES: Confirming all of the RU Member's Insurance from a Previous Round and Policyholder is not in the RU (i.e., probing for who is still covered)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

Policyholder
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: POLICYHOLDER
INSTRUCTIONS: DISPLAY POLICYHOLDER'S FIRST, MIDDLE, AND LAST NAMES
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH POLICYHOLDER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL POLICYHOLDERS WHO MEET THE CONDITIONS STATED AT THE LOOP_13 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH NAV_OE13B FOR SELECTED POLICYHOLDER.
----------------------------------------------------

NAV_OE13B
=========

[POLICYHOLDER'S FIRST MIDDLE LAST NAME]
SERIES: Confirming all of the RU Member's Insurance from a Previous Round and Policyholder is not in the RU (i.e., probing for who is still covered)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

PolicyHolder...Establishment
[1. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
[2. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
[3. Policyholder's Name-30]...[Establishment Name-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: POLICYHOLDER...ESTABLISHMENT
INSTRUCTIONS: DISPLAY RU-ESTABLISHMENT-PERSON- PAIR
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH PAIR EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL ESTABLISHMENTS THAT MEET THE CONDITIONS STATED AT THE LOOP_13 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE39 FOR SELECTED PAIR.
----------------------------------------------------

OE39
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Now think about [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT]. [Is/Was] anyone in the family, living here [now], covered by this insurance as of [today,] [END DATE]?
IF RESPONDENT VOLUNTEERS THAT THIS INSURANCE HAS ALREADY BEEN DISCUSSED, SELECT 'INSURANCE ALREADY DISCUSSED'.

YES ................................... 1
NO .................................... 2 [OE40]
INSURANCE ALREADY DISCUSSED ........... 3 [END_LP13]
REF ................................... -7 [END_LP13]
DK .................................... -8 [END_LP13]
[Code One]
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5.

DISPLAY 'today,' AND ' now' IF NOT ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (INSURANCE ALREADY DISCUSSED), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------
----------------------------------------------------
IF YES AND ONLY ONE PERSON IS FLAGGED AS COVERED AT THE END OF THE PREVIOUS ROUND, AUTOMATICALLY CODE OE41 AS '1' (YES) AND GO TO BOX_31.

IF YES AND MORE THAN ONE PERSON FLAGGED AS COVERED AT THE END OF THE PREVIOUS ROUND, GO TO OE41.
----------------------------------------------------

OE40
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did this health insurance through [ESTABLISHMENT] end?
[IF INSURANCE ENDED AFTER 12/31/[YEAR], BACK-UP TO OE39 AND SELECT 'YES'.]

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'IF INSURANCE ENDED... SELECT 'YES'.' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY
----------------------------------------------------
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE40OV
----------------------------------------------------
----------------------------------------------------
IF ONLY ONE PERSON COVERED AT THE END OF THE PREVIOUS ROUND, GO TO LOOP_14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OE41
----------------------------------------------------

OE40OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1
PART OF THE MONTH ..................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
IF ONLY ONE PERSON COVERED AT END OF PREVIOUS ROUND, GO TO LOOP_14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH OE41
----------------------------------------------------

OE41
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Are/Were] (READ NAMES BELOW) all covered by [your/[POLICYHOLDER]'s] health insurance through [ESTABLISHMENT] [until [[OE40 DATE]/it ended]/on [END DATE]]?
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]
[PERSON WITH ESTAB-PERSON-PAIR INSURANCE ON PREV RD INTV DT]

YES ................................... 1
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'Are' IF OE39 IS CODED '1' (YES).
DISPLAY 'Were' IF OE39 IS CODED '2' (NO) OR IF CURRENT ROUND IS ROUND 5.

DISPLAY 'until [OE40 DATE]' IF OE39 IS CODED '2' (NO).
DISPLAY 'on [END DATE]' IF OE39 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE40 FOR 'OE40 DATE'.
IF THE MONTH AND DAY FIELD AT OE40 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended'FOR 'OE40 DATE'.
----------------------------------------------------
----------------------------------------------------
IF OE39 IS CODED '1' (YES) AND OE41 IS CODED '1' (YES),

FLAG INSURANCE FOR ALL COVERED PERSONS AS 'CONTINUOUS COVERAGE' THROUGH THE REFERENCE PERIOD END DATE.
----------------------------------------------------
----------------------------------------------------
IF OE39 IS CODED '2' (NO) AND OE41 IS CODED '1' (YES),

FLAG INSURANCE FOR ALL COVERED PERSONS AS 'CONTINUOUS COVERAGE' THROUGH THE DATE RECORDED AT OE40.
----------------------------------------------------
----------------------------------------------------
IF OE41 IS CODED '1' (YES) AND OE39 IS CODED '1' (YES) OR '2' (NO), GO TO BOX_31
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., OE41 CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)), CONTINUE WITH OE42
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY COVERED PERSONS' NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSONS ON THE RU-ESTB- PLCYHLDR-COVRD-PERS-TRPLS-ROSTER FOR DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. PERSON WAS COVERED AT THE PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR
AND
2. PERSON IS AN RU MBMBER
----------------------------------------------------

OE42
====

[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 OE39 IS CODED '1' (YES).
DISPLAY 'was' IF OE39 IS CODED '2' (NO) OR IF CURRENT ROUND IS ROUND 5.

DISPLAY 'until [OE40 DATE]' IF OE39 IS CODED '2' (NO).
DISPLAY 'on [END DATE]' IF OE39 IS CODED '1' (YES).

DISPLAY THE DATE RECORDED AT OE40 FOR 'OE40 DATE'.
IF THE MONTH AND DAY FIELD AT OE40 IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), DISPLAY 'it ended'FOR 'OE40 DATE'.
----------------------------------------------------
----------------------------------------------------
IF FAMILY STILL HAS INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED '1' (YES)), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED AT OE42 AS 'CONTINUOUS COVERAGE' FROM THE REFERENCE PERIOD START DATE UNTIL THE REFERENCE PERIOD END DATE.
----------------------------------------------------
----------------------------------------------------
IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED '2' (NO), FLAG INSURANCE FOR ALL PERSONS NOT SELECTED AT OE42 AS 'CONTINUOUS COVERAGE' FROM THE REFERENCE PERIOD START DATE UNTIL DATE RECORDED AT OE40.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PLCYHLDR_COVRD_PERS_TRPLS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY COVERED PERSONS' NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. PERSON WAS COVERED AT PREVIOUS ROUND'S INTERVIEW DATE BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR
AND
2. PERSON IS AN RU MBMBER
----------------------------------------------------

LOOP_14
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER, ASK NAV_OE14 - END_LP14
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_14 COLLECTS THE DATE ON WHICH THE INSURANCE COVERAGE THROUGH THIS ESTABLISHMENT-PERSON-PAIR ENDED FOR EACH RU MEMBER WHOSE COVERAGE ENDED EITHER PRIOR TO THE REFERENCE PERIOD END DATE OR THE DATE REPORTED IN OE40.
THIS LOOP CYCLES ON PERSONS SELECTED AT OE42.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_14 USES NAV_OE14 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE14
========

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTB-PLCYHLDR-COVRD-PERS- TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT OE42.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE43 FOR SELECTED RU MEMBER.
----------------------------------------------------

OE43
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did the health insurance through [ESTABLISHMENT] end for [you/[PERSON]]?

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE43OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_30
----------------------------------------------------

OE43OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_30]
PART OF THE MONTH ..................... 2 [BOX_30]
REF ................................... -7 [BOX_30]
DK .................................... -8 [BOX_30]
[Code One]

BOX_30
======

----------------------------------------------------
FLAG INSURANCE FOR PERSON AS 'CONTINUOUS COVERAGE' THROUGH THE COMPLETE DATE RECORDED AT OE43 AND OE43OV.
----------------------------------------------------

END_LP14
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_14 AND CONTINUE WITH BOX_31
----------------------------------------------------

BOX_31
======

----------------------------------------------------
IF AT LEAST ONE CURRENT RU MEMBER NOT COVERED BY THE INSURANCE FROM THIS ESTABLISHMENT-PERSON-PAIR, (THIS INCLUDES ALL NEW RU MEMBERS AND PREVIOUS RU MEMBERS NOT COVERED BY THIS INSURANCE ON THE PREVIOUS ROUND'S INTERVIEW DATE, BUT EXCLUDES RU MEMBERS JUST MARKED AS NO LONGER COVERED IN OE42), CONTINUE WITH OE44
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO OE47
----------------------------------------------------

OE44
====

YES ................................... 1 [OE45]
NO .................................... 2 [OE47]
REF ................................... -7 [OE47]
DK .................................... -8 [OE47]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'Since [START DATE]' IF NOT ROUND 5.
DISPLAY 'Between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------

OE45
====

[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 'has been' AND 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'was' AND 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
WRITE PERSONS SELECTED TO THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER.
----------------------------------------------------
----------------------------------------------------
IF 'PERSON NOT LISTED IN RU' IS SELECTED, FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU'.
----------------------------------------------------
----------------------------------------------------
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 RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. INTERVIEWER MAY SELECT ONE OR MORE FROM THE LISTED MEMBERS.
2. ADD, DELETE, AND EDIT DISALLOWED.
3. DISPLAY 'PERSON NOT LISTED IN RU' AS LAST ENTRY ON THIS ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY PERSONS WHO WERE NOT COVERED BY THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR ON THE PREVIOUS ROUND'S INTERVIEW DATE.
----------------------------------------------------

LOOP_15
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER, ASK NAV_OE15 - END_LP15
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_15 COLLECTS THE COVERAGE START DATE FOR ALL PERSONS NEWLY COVERED DURING THE CURRENT ROUND BY THE INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR. THIS LOOP CYCLES ON PERSONS SELECTED AT OE45.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_15 USES NAV_OE15 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_OE15
========

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTB-PLCYHLDR-COVRD-PERS- TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT OE45.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH OE46 FOR SELECTED RU MEMBER
----------------------------------------------------

OE46
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
On what date did the health insurance through [ESTABLISHMENT] begin for [you/[PERSON]]?

[Enter Month-2, Day-2, Year-4] .........
REF ................................... -7
DK .................................... -8
----------------------------------------------------
IF DAY FIELD IS CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MONTH FIELD IS NOT CODED '-7' (REFUSED) OR '-8' (DON'T KNOW), CONTINUE WITH OE46OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_32
----------------------------------------------------

OE46OV
======

Can you just tell me if [you/he/she] [were/was] covered under that insurance the whole month or part of the month?

WHOLE MONTH ........................... 1 [BOX_32]
PART OF THE MONTH ..................... 2 [BOX_32]
REF ................................... -7 [BOX_32]
DK .................................... -8 [BOX_32]
[Code One]
----------------------------------------------------
HARD CHECK:
EDIT: COMPLETE DATE AT OE46 MUST BE ( THAN COMPLETE DATE AT OE40 IF A DATE IS RECORDED AT OE40 OR ( THAN REFERENCE PERIOD END DATE IF NO DATE IS RECORDED AT OE40.
----------------------------------------------------

BOX_32
======

----------------------------------------------------
IF FAMILY STILL HAS INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED '1' (YES)), FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE46 UNTIL THE REFERENCE PERIOD END DATE.
----------------------------------------------------
----------------------------------------------------
IF FAMILY DOES NOT STILL HAVE INSURANCE THROUGH ESTABLISHMENT-PERSON-PAIR (OE39 IS CODED '2' (NO)) FLAG INSURANCE FOR THIS PERSON AS 'CONTINUOUS COVERAGE' FROM DATE RECORDED AT OE46 UNTIL DATE RECORDED AT OE40.
----------------------------------------------------

END_LP15
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_15 AND GO TO END_LP13
----------------------------------------------------

OE47
====

YES .................................... 1 [END_LP13]
NO ..................................... 2 [END_LP13]
REF ................................... -7 [END_LP13]
DK .................................... -8 [END_LP13]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'Does' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU' IN OE45
----------------------------------------------------

END_LP13
========

----------------------------------------------------
CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_13 AND CONTINUE WITH BOX_33
----------------------------------------------------

BOX_33
======

----------------------------------------------------
RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX.
----------------------------------------------------

Old Public Related Insurance (PR) Section

BOX_00
======

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

BOX_01
======

----------------------------------------------------
IF ONE OR MORE ESTABLISHMENT-PERSON-PAIRS MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICARE
AND
- PERSON WAS COVERED BY MEDICARE DURING THE PREVIOUS ROUND, CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_02
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_PR01 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT THE COVERAGE PROVIDED THROUGH MEDICARE.
THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICARE
AND
- PERSON WAS COVERED BY MEDICARE AT ANY TIME DURING THE PREVIOUS ROUND
-----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_PR01 TO TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_PR01
========

[STR-DT]
SERIES: Review of Medicare Managed Care Plan Coverage from a Previous Round
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICARE
AND
- PERSON WAS COVERED BY MEDICARE AT ANY TIME DURING THE PREVIOUS ROUND
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH PR03 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_01A
=======

OMITTED.

PR01
====

OMITTED.

PR01A
=====

OMITTED.

BOX_01B
=======

OMITTED.

PR02
====

OMITTED.

PR02OV
======

OMITTED.

PR03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Are/Is] [you/[PERSON]] currently/As of [END DATE], [were/was] [you/[PERSON]]] enrolled in a Medicare Advantage or managed care plan, such as an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) to receive [your/his/her] Medicare-funded health care? When answering, please include only insurance from Medicare, not any privately purchased or job-related insurance.

YES .................................... 1 [PR04]
NO ..................................... 2 [PR06B]
REF ................................... -7 [PR06B]
DK .................................... -8 [PR06B]
HELP AVAILABLE FOR DEFINITION OF MEDICARE MANAGED CARE.
----------------------------------------------------
DISPLAY '[Are/Is] [you/[PERSON]] currently' IF NOT ROUND 5. DISPLAY 'As of [END DATE], [were/was] [you/[PERSON]]' IF ROUND 5.
----------------------------------------------------

PR03A
=====

OMITTED.

PR04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What [is/was] the name of [your/[PERSON]'s] Medicare managed care plan [as of [END DATE]]?

[Enter Plan Name] ..................... [PR05]
REF ................................... -7 [PR05]
DK .................................... -8 [PR05]
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5.

DISPLAY 'as of [END DATE]' IF ROUND 5. OTHERWISE,USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
FLAG INSURER CODED ABOVE AS 'CURRENT RD'S MEDICARE INSURER' FOR THIS ESTABLISHMENT-PERSON- PAIR.
----------------------------------------------------

PR05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Do/Does]/Did] [you/[PERSON]] have prescribed medicine coverage through [[NAME OF PLAN FROM PR04]/[your/his/her] Medicare managed care plan] [as of [END DATE]]?

YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY '[Do/Does]' IF NOT ROUND 5. DISPLAY 'Did'IF ROUND 5.

DISPLAY '[NAME OF PLAN FROM PR04]' IF A PLAN NAME WAS ENTERED AT PR04. DISPLAY [your/his/her] Medicare managed care plan' IF PR04 IS CODED '-7' (REF) OR '-8' (DK).

DISPLAY THE ACTUAL PLAN NAME ENTERED AT PR04 FOR 'NAME OF PLAN FROM PR04' IF A PLAN NAME WAS ENTERED.

DISPLAY 'as of [END DATE]' IF ROUND 5. OTHERWISE,USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF ROUND 3, CONTINUE WITH PR06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

PR06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, [do/does] [you/[PERSON]] (or anyone in the family) pay anything else for [the coverage with [[NAME OF PLAN FROM PR04]/this Medicare managed care plan]?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]

YES .................................... 1 [PR06A]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
DISPLAY 'the coverage with [NAME OF PLAN FROM PR04]' IF A MEDICARE PLAN NAME WAS ENTERED AT PR04. DISPLAY 'this Medicare managed care plan' IF PR04 WAS CODED '-7' (REF) OR '-8' (DK).

DISPLAY THE ACTUAL PLAN NAME ENTERED AT PR04 FOR 'NAME OF PLAN FROM PR04' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

PR06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
How [do/does] [you/[PERSON]] pay for [your/his/her] [[NAME OF PLAN FROM PR04]/Medicare managed care] premium?
IF NECESSARY, SAY: Is the Medicare Advantage premium paid through [you/his/her] Social Security check, paid directly to the provider, or paid both ways?

DEDUCTED FROM SOCIAL SECURITY .......... 1 [PR06AA]
PAY DIRECTLY ........................... 2 [PR06AA]
BOTH ................................... 3 [PR06AA]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
----------------------------------------------------
DISPLAY '[NAME OF PLAN FROM PR04]' IF A MEDICARE PLAN NAME WAS ENTERED AT PR04. DISPLAY 'Medicare managed care' IF PR04 WAS CODED '-7' (REF) OR '-8' (DK).

DISPLAY THE ACTUAL PLAN NAME ENTERED AT PR04 FOR 'NAME OF PLAN FROM PR04' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

PR06AA
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
How much [is [your/[PERSON]'s] Social Security deduction/[do/does] [you/[PERSON]] pay in premiums] for [your/his/her] [NAME OF PLAN FROM PR04] plan?
IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.

[Enter Amount in Dollars] .............. [PR06AAOV1]
REF ................................... -7 [PR06AAA]
DK .................................... -8 [PR06AAA]
----------------------------------------------------
DISPLAY 'is [your/[PERSON]'s] Social Security deduction' IF PR06AA IS CODED '1' (DEDUCTED FROM SOCIAL SECURITY'. DISPLAY '[do/does] [you/ [PERSON]] pay in premiums' IF PR06AA IS CODED '2' (PAY DIRECTLY) OR '3' (BOTH).
----------------------------------------------------
----------------------------------------------------
DISPLAY '[NAME OF PLAN FROM PR04]' IF A MEDICARE PLAN NAME WAS ENTERED AT PR04. OTHERWISE (I.E., IF PR04 WAS CODED '-7' (REF) OR '-8' (DK)), USE A NULL DISPLAY.

DISPLAY THE ACTUAL PLAN NAME ENTERED AT PR04 FOR 'NAME OF PLAN FROM PR04' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

PR06AAOV1
=========

Is that per year, per month, per week, or what?
UNIT OF COVERAGE:

PER YEAR ............................... 1 [END_LP01]
QUARTERLY/EVERY 3 MONTHS ............... 2 [END_LP01]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [END_LP01]
PER MONTH .............................. 4 [END_LP01]
PER WEEK ............................... 5 [END_LP01]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [END_LP01]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [END_LP01]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [END_LP01]
OTHER ................................. 91 [PR06AAOV2]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
[Code One]

PR06AAOV2
=========

SPECIFY:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

PR06AAA
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[PLAN NAME: [NAME OF PLAN FROM PR04]]
SHOW CARD HX-6.
Which category on the card best indicates the cost of this plan per month?

1 - 50 ................................. 1 [END_LP01]
51 - 100 ............................... 2 [END_LP01]
101 - 200 .............................. 3 [END_LP01]
201 - 300 .............................. 4 [END_LP01]
301 OR MORE ............................ 5 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
----------------------------------------------------
DISPLAY 'PLAN NAME: [NAME OF PLAN FROM PR04]' IF A MEDICARE PLAN NAME WAS ENTERED AT PR04. OTHERWISE (I.E., IF PR04 WAS CODED '-7' (REF) OR '-8' (DK)), USE A NULL DISPLAY.

DISPLAY THE ACTUAL PLAN NAME ENTERED AT PR04 FOR 'NAME OF PLAN FROM PR04' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

PR06B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[[Are/Is]/[Were/Was]] [you/[PERSON]] enrolled in Medicare Part D, also known as the Medicare Prescription Drug Plan [as of [END DATE]]?

PR06C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, [do/does] [you/[PERSON]] (or anyone in the family) pay anything else for [your/his/her] Medicare Prescription Drug Plan (also known as Part D)?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]

YES .................................... 1 [PR06D]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.

PR06D
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
How [do/does] [you/[PERSON]] pay for [your/his/her] Part D premium?
IF NECESSARY, SAY: Is the Medicare drug coverage premium paid through [your/his/her] Social Security check, paid directly to the provider, or paid both ways?

DEDUCTED FROM SOCIAL SECURITY .......... 1 [PR06E]
PAY DIRECTLY ........................... 2 [PR06E]
BOTH ................................... 3 [PR06E]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

PR06E
=====

[Enter Amount in Dollars] .............. [PR06EOV1]
REF ................................... -7 [PR06F]
DK .................................... -8 [PR06F]
----------------------------------------------------
DISPLAY 'is [your/[PERSON]'s] Social Security deduction' IF PR06D IS CODED '1' (DEDUCTED FROM SOCIAL SECURITY'. DISPLAY '[do/does] [you/ [PERSON]] pay in premiums' IF PR06D IS CODED '2' (PAY DIRECTLY) OR '3' (BOTH).
----------------------------------------------------

PR06EOV1
========

Is that per year, per month, per week, or what?
UNIT OF COVERAGE:

PER YEAR ............................... 1 [END_LP01]
QUARTERLY/EVERY 3 MONTHS ............... 2 [END_LP01]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [END_LP01]
PER MONTH .............................. 4 [END_LP01]
PER WEEK ............................... 5 [END_LP01]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [END_LP01]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [END_LP01]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [END_LP01]
OTHER ................................. 91 [PR06EOV2]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
[Code One]

PR06EOV2
========

SPECIFY:

[Enter Other Specify] .................. [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

PR06F
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
SHOW CARD HX-7.
Which category on the card best indicates the cost of this plan per month?

1 - 30 ................................. 1 [END_LP01]
31 - 60 ................................ 2 [END_LP01]
61 - 90 ................................ 3 [END_LP01]
91 - 120 ............................... 4 [END_LP01]
121 OR MORE ............................ 5 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF ANY RU MEMBER HAD MEDICAID/SCHIP AS A SOURCE OF INSURANCE AT ANY TIME DURING THE PREVIOUS ROUND, CONTINUE WITH PR07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_05
----------------------------------------------------

PR07
====

[STR-DT] [END-DT]
During the last interview, we recorded that (READ NAME(S) BELOW) (was/were) covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME].
Have all of these people been covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] at any time [since [START DATE]/between [START DATE] and [END DATE]]?

[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, ALL .............................. 1 [BOX_03]
NO, ONLY SOME ......................... 2 [PR08]
NO, NONE .............................. 3
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
-----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'Medicaid' DISPLAY 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'Medicaid'. FOR THE SPECIFIC MEDICAID PROGRAM NAME BY STATE TO DISPLAY, SEE ATTACHMENT 36.
-----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS,SUBSTITUTING THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES, ALL), FLAG ALL RU MEMBERS LISTED HERE AS 'COVERED BY MEDICAID/SCHIP DURING CURRENT ROUND.'
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE), FLAG ALL RU MEMBERS LISTED HERE AS 'NOT COVERED BY MEDICAID/SCHIP DURING CURRENT ROUND.'
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE)
AND
IF ANY CURRENT RU MEMBERS NOT LISTED AT PR07, GO TO PR09
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE)
AND
IF ALL CURRENT RU MEMBERS ARE LISTED AT PR07, GO TO BOX_05
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. DISPLAY ONLY THOSE RU MEMBERS WHO WERE COVERED BY MEDICAID/SCHIP AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

PR08
====

[STR-DT] [END-DT]
Who has been covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] [since [START DATE]/between [START DATE] and [END DATE]]?
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]
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'Medicaid'. DISPLAY'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'Medicaid'. FOR THE SPECIFIC MEDICAID PROGRAM NAME BY STATE TO DISPLAY, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS,SUBSTITUTING THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY MEDICAID/SCHIP DURING CURRENT ROUND.' FLAG ALL PERSONS NOTSELECTED AS 'NOT COVERED BY MEDICAID/SCHIP DURING CURRENT ROUND.'
----------------------------------------------------
----------------------------------------------------
GO TO BOX_03
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. DISPLAY ONLY THOSE RU MEMBERS WHO WERE COVERED BY MEDICAID/SCHIP AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF ALL CURRENT RU MEMBERS ARE ALREADY FLAGGED AS COVERED OR NOT COVERED BY MEDICAID/SCHIP DURING CURRENT ROUND (I.E., ALL CURRENT RU MEMBERS WERE LISTED AT PR07), GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PR09
----------------------------------------------------

PR09
====

[STR-DT] [END-DT]
Besides the family members we've just talked about, have any additional family members been covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] [since [START DATE]/between [START DATE] and [END DATE]]?

YES ................................... 1 [PR10]
NO .................................... 2
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF MEDICAID/SCHIP.
-----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'Medicaid'. DISPLAY 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'Medicaid'.
FOR THE SPECIFIC MEDICAID PROGRAM NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
-----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS,SUBSTITUTING THE REAL STATE NAME FOR PROGRAM. FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '8' (DON'T KNOW) AND AT LEAST ONE RU MEMBER IS FLAGGED AS 'COVERED BY MEDICAID/SCHIP DURING CURRENT ROUND,' GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW) AND NO RU MEMBERS ARE FLAGGED AS 'COVERED BY MEDICAID/SCHIP DURING CURRENT ROUND,' GO TO BOX_05
----------------------------------------------------

PR10
====

[STR-DT] [END-DT]
Who has been covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] [since [START DATE]/between [START DATE] and [END DATE]]?
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]
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'Medicaid'. DISPLAY'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'Medicaid'.
FOR THE SPECIFIC MEDICAID PROGRAM NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS, SUBSTITUTING THE REAL STATE NAME FOR PROGRAM.
FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY MEDICAID/SCHIP' DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS 'NOT COVERED BY MEDICAID/SCHIP' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO 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 OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
1. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. RU MEMBERS NOT FLAGGED AS COVERED BY MEDICAID/ SCHIP AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_PR02 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU MEMBERS COVERED BY MEDICAID/SCHIP. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICAID/SCHIP
AND
- PERSON IS COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_02 USES NAV_PR02 TO TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_PR02
========

RU Member
[1. Coverage duration for [Person's Name-65] through
MEDICAID/SCHIP] [Status-25]
[2. Coverage duration for [Person's Name-65] through
MEDICAID/SCHIP] [Status-25]
[3. Coverage duration for [Person's Name-65] through
MEDICAID/SCHIP] [Status-25]
---------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS MEDICAID
AND
- PERSON IS COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_04 FOR SELECTED RU MEMBER
----------------------------------------------------

BOX_04
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.

AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP02
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT- PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH PR11
----------------------------------------------------

PR11
====

[STR-DT] [END-DT]
[Last time we recorded that (READ NAME(S) BELOW) may be covered by [NAME OF PREV RD'S MEDICAID/SCHIP INSURER FOR RU].]
[Since [START DATE]/Between [START DATE] and [END DATE]], has there been any change in the plan name of the health insurance the family has through [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]?

[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 [PR13]
NO ..................................... 2 [BOX_04A]
REF ................................... -7 [BOX_04A]
DK .................................... -8 [BOX_04A]
HELP AVAILABLE FOR A DEFINITION OF MEDICAID/SCHIP.
----------------------------------------------------
DISPLAY 'Last time... [NAME OF PREV RD'S MEDICAID/SCHIP INSURER FOR RU].' IF THERE IS AN INSURER ASSOCIATED WITH MEDICAID/SCHIP IN THE PREVIOUS ROUND.

FOR 'NAME OF PREV RD'S MEDICAID/SCHIP INSURER FOR RU', DISPLAY THE INSURER RECORDED FOR MEDICAID/ SCHIP DURING THE PREVIOUS ROUND.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Since [START DATE]' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'Medicaid'. DISPLAY'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'Medicaid'.
FOR THE SPECIFIC MEDICAID PROGRAM NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS, SUBSTITUTING THE REAL STATE NAME FOR PROGRAM.
FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG PREVIOUS ROUND'S INSURER AS 'CURRENT RD'S MEDICAID/SCHIP INSURER'
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. DISPLAY ONLY THOSE RU MEMBERS WHO ARE COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND.
----------------------------------------------------

PR12
====

OMITTED.

PR12OV
======

OMITTED.

PR13
====

[STR-DT] [END-DT]
Under [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] [(are/is)/(were/was)] (READ NAME(S) BELOW) enrolled in an HMO, that is a Health Maintenance Organization [between [START DATE] and [END DATE]]?
[With an HMO, you must generally receive care from HMO physicians. If another doctor is seen, the expense is not covered unless you were referred by the HMO, or there was a medical emergency.]

[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, ALL ARE ........................... 1 [PR15]
YES, SOME ARE .......................... 2 [PR15]
NO, NONE ARE ........................... 3 [PR14]
REF ................................... -7 [PR14]
DK .................................... -8 [PR14]
[Code One]
HELP AVAILABLE FOR DEFINITION OF HMO.
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'Medicaid'. DISPLAY'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'Medicaid'. FOR THE SPECIFIC MEDICAID PROGRAM NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS, SUBSTITUTING THE REAL STATE NAME FOR PROGRAM.
FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(are/is)' IF NOT ROUND 5. DISPLAY '(were/was)' IF ROUND 5.

DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. DISPLAY ONLY THOSE RU MEMBERS WHO ARE COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND.
----------------------------------------------------

PR14
====

[STR-DT] [END-DT]
[Does/Between [START DATE] and [END DATE, did] [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] require (READ NAME(S) BELOW) to sign up with a certain primary care doctor, group of doctors, or with a certain clinic which they must go to for all of their routine care?
PROBE: Do not include emergency care or care from a specialist they were referred to.

[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, ALL REQUIRED ...................... 1 [PR15]
YES, SOME REQUIRED ..................... 2 [PR15]
NO, NONE REQUIRED ...................... 3 [BOX_04A]
REF ................................... -7 [BOX_04A]
DK .................................... -8 [BOX_04A]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PRIMARY CARE DOCTOR AND ROUTINE CARE.
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'Medicaid'. DISPLAY'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'Medicaid'.
FOR THE SPECIFIC MEDICAID PROGRAM NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS, SUBSTITUTING THE REAL STATE NAME FOR PROGRAM.
FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Does' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE REQUIRED), '-7' (REFUSED), OR '-8' (DON'T KNOW), THERE IS NO INSURER ASSOCIATED WITH THE CURRENT ROUND FOR MEDICAID/ SCHIP.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. DISPLAY ONLY THOSE RU MEMBERS WHO ARE COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND.
----------------------------------------------------

PR15
====

[STR-DT] [END-DT]
What is the name of the [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] [HMO/health insurance]?

[Enter Plan Name] ..................... [BOX_04A]
REF ................................... -7 [BOX_04A]
DK .................................... -8 [BOX_04A]
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'Medicaid'. DISPLAY'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'Medicaid'.
FOR THE SPECIFIC MEDICAID PROGRAM NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS, SUBSTITUTING THE REAL STATE NAME FOR PROGRAM.
FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'HMO' IF PR13 IS CODED '1' (YES, ALL ARE) OR '2' (YES, SOME ARE). DISPLAY 'health insurance' IF PR14 IS CODED '1' (YES, ALL REQUIRED) OR '2' (YES, SOME REQUIRED).
----------------------------------------------------
----------------------------------------------------
FLAG INSURER CODED ABOVE AS 'CURRENT ROUND'S MEDICAID/SCHIP INSURER'.
----------------------------------------------------

BOX_04A
=======

----------------------------------------------------
IF ROUND 2, ROUND 3 OR ROUND 4, CONTINUE WITH PR16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, (I.E., IF ROUND 5), GO TO BOX_05
----------------------------------------------------

PR16
====

[STR-DT] [END-DT]
Is there a monthly premium [for anyone in the family] for the coverage through [[NAME OF PLAN FROM PR15]/[Medicaid/[STATE NAME FOR MEDICAID]]] or [STATE CHIP NAME]]?
[Do not include the cost of any copayments, coinsurance, or deductibles anyone in the family may have had to pay.]
READ IF NECESSARY: A monthly premium is a fixed amount of money people pay each month to have health coverage. It does not include copays or other expenses such as prescription costs.

YES, EVERYONE COVERED PAYS ............. 1 [BOX_04B]
YES, SOME COVERED PAY .................. 2 [PR16A]
NO, NO ONE COVERED PAYS ................ 3 [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
DISPLAY '[NAME OF PLAN FROM PR15]' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE MEDICAID/SCHIP INSURANCE. OTHERWISE, DISPLAY '[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]'

DISPLAY '[NAME OF PLAN FROM PR15]' IF A PLAN NAME WAS ENTERED AT PR15. DISPLAY THE ACTUAL PLAN NAME THAT WAS ENTERED.

DISPLAY 'for anyone in the family' IF MORE THAN ONE RU MEMBER SELECTED AS COVERED BY MEDICAID/ SCHIP INSURANCE. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Medicaid' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED USES THE NAME 'Medicaid'. DISPLAY'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'Medicaid'.
FOR THE SPECIFIC MEDICAID PROGRAM NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or STATE CHIP NAME' UNDER ALL CONDITIONS, SUBSTITUTING THE REAL STATE NAME FOR PROGRAM.
FOR THE SPECIFIC NAME TO DISPLAY BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES, EVERYONE COVERED PAYS), FLAG ALL PERSONS AT PR16A AS 'PAYS FOR COVERAGE DURING CURRENT ROUND.' IF CODED '3' (NO, NO ONE COVERED PAYS), FLAG ALL PERSONS AT PR16A AS 'DOES NOT PAY FOR COVERAGE DURING CURRENT ROUND.'

(AHRQ WILL DECIDE ON FLAGS FOR '-7', '-8' AND '-9'VALUES AFTER DETERMINING FREQUENCY IN FY2012.)
----------------------------------------------------

PR16A
=====

[STR-DT] [END-DT]
Which family members have a monthly premium for that coverage?
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]
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'PAYS FOR COVERAGE DURING CURRENT ROUND.' FLAG ALL PERSONS NOT SELECTED AS 'DOES NOT PAY FOR COVERAGE DURING CURRENT ROUND.'
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_04B
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
1. DISPLAY ONLY THOSE RU MEMBERS WHO ARE COVERED BY MEDICAID/SCHIP DURING THE CURRENT ROUND.
----------------------------------------------------

BOX_04B
=======

----------------------------------------------------
IF ROUND 3, CONTINUE WITH PR17
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO PR17A
----------------------------------------------------

PR17
====

[STR-DT] [END-DT]
How much is the premium for [the [NAME OF PLAN FROM PR15]/that] coverage?

[Enter Amount in Dollars] .............. [PR17OV1]
REF ................................... -7 [PR17A]
DK .................................... -8 [PR17A]
----------------------------------------------------
DISPLAY 'the [NAME OF PLAN FROM PR15]' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE MEDICAID/SCHIP INSURANCE. OTHERWISE, DISPLAY 'that'.

DISPLAY '(NAME OF PLAN FROM PR15)' IF A PLAN NAME WAS ENTERED AT PR15. DISPLAY THE ACTUAL PLAN NAME THAT WAS ENTERED.
----------------------------------------------------

PR17OV1
=======

Is that per year, per month, per week, or what?
ENTER UNIT OF COVERAGE:

PER YEAR ............................... 1 [PR17A]
QUARTERLY/EVERY 3 MONTHS ............... 2 [PR17A]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [PR17A]
PER MONTH .............................. 4 [PR17A]
PER WEEK ............................... 5 [PR17A]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [PR17A]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [PR17A]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [PR17A]
OTHER ................................. 91 [PR17OV2]
REF ................................... -7 [PR17A]
DK .................................... -8 [PR17A]
[Code One]

PR17OV2
=======

SPECIFY:

[Enter Other Specify] .................. [PR17A]
REF ................................... -7 [PR17A]
DK .................................... -8 [PR17A]

PR17A
=====

[STR-DT] [END-DT]
[PLAN NAME: [NAME OF PLAN FROM PR15]]
Is the cost of the premium subsidized based on family income?

YES .................................... 1 [BOX_05]
NO ..................................... 2 [BOX_05]
REF ................................... -7 [BOX_05]
DK .................................... -8 [BOX_05]
----------------------------------------------------
DISPLAY 'PLAN NAME: ...' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE MEDICAID/SCHIP INSURANCE. OTHERWISE, USE A NULL DISPLAY.

DISPLAY '[NAME OF PLAN FROM PR15]' IF A PLAN NAME WAS ENTERED AT PR15. DISPLAY THE ACTUAL PLAN NAME THAT WAS ENTERED.
----------------------------------------------------

PR18
====

OMITTED.

PR18OV
======

OMITTED.

BOX_05
======

----------------------------------------------------
IF ANY RU MEMBER HAD TRICARE/CHAMPVA AS A SOURCE OF INSURANCE DURING PREVIOUS ROUND, CONTINUE WITH PR19
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_08
----------------------------------------------------

PR19
====

[STR-DT] [END-DT]
During the last interview, we recorded that (READ NAME(S) BELOW) (was/were) covered by TRICARE or CHAMPVA.
Have all of these people been covered by TRICARE or CHAMPVA at any time [since [START DATE]/between [START DATE] and [END DATE]]?

[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, ALL .............................. 1 [PR19A]
NO, ONLY SOME ......................... 2 [PR19A]
NO, NONE .............................. 3
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
HELP AVAILABLE FOR DEFINITION OF TRICARE/CHAMPVA.
----------------------------------------------------
DISPLAY 'since [START DATE]' IF ROUND IS NOT 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND IS 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE), FLAG ALL RU MEMBERS LISTED HERE AS 'NOT COVERED BY TRICARE/CHAMPVA DURING CURRENT ROUND.'
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE)
AND
IF ANY CURRENT RU MEMBERS NOT LISTED IN PR19, GO TO PR21
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE),
AND
IF ALL CURRENT RU MEMBERS ARE LISTED IN PR19, GO TO BOX_08
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE COVERED BY TRICARE/CHAMPVA AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

PR19A
=====

[STR-DT] [END-DT]
Which plan is it? Is it...
INTERVIEWER: CODE MORE THAN ONE PLAN ONLY IF DIFFERENT RU MEMBERS HAVE DIFFERENT PLANS.

CHECK ALL THAT APPLY.
TRICARE Standard; ...................... 1
TRICARE Prime; ......................... 2
TRICARE Extra; ......................... 3
TRICARE for Life; or ................... 4
CHAMPVA? ............................... 5
REF ................................... -7
DK .................................... -8
[Code All That Apply]
----------------------------------------------------
IF PR19 IS CODED '1' (YES, ALL), FLAG ALL RU
MEMBERS LISTED HERE AS 'COVERED BY TRICARE/CHAMPVA DURING CURRENT ROUND.' THEN GO TO BOX_06
----------------------------------------------------
----------------------------------------------------
IF PR19 IS CODED '2' (NO, ONLY SOME), CONTINUE WITH PR20
----------------------------------------------------

PR20
====

[STR-DT] [END-DT]
Who has been covered by TRICARE or CHAMPVA [since [START DATE]/ between [START DATE] and [END DATE]]?
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]
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY TRICARE/ CHAMPVA' DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS 'NOT COVERED BY TRICARE/CHAMPVA ' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_06
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE COVERED BY TRICARE/CHAMPVA AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF ALL CURRENT RU MEMBERS ALREADY FLAGGED AS COVERED OR NOT COVERED BY TRICARE/CHAMPVA DURING CURRENT ROUND (I.E., ALL CURRENT RU MEMBERS WERE LISTED IN PR19), GO TO LOOP_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PR21
----------------------------------------------------

PR21
====

[STR-DT] [END-DT]
Besides the family members we've just talked about, have any additional family members been covered by TRICARE or CHAMPVA [since [START DATE]/between [START DATE] and [END DATE]]?

YES ................................... 1 [PR21A]
NO .................................... 2
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF TRICARE/CHAMPVA.
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED) OR '8' (DON'T KNOW) AND AT LEAST ONE RU MEMBER FLAGGED AS COVERED BY TRICARE/CHAMPVA DURING CURRENT ROUND, GO TO LOOP_03
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED) OR '8' (DON'T KNOW) AND NO RU MEMBERS FLAGGED AS COVERED BY TRICARE/CHAMPVA DURING CURRENT ROUND, GO TO BOX_08
----------------------------------------------------

PR21A
=====

[STR-DT] [END-DT]
Which plan is it? Is it...
INTERVIEWER: CODE MORE THAN ONE PLAN ONLY IF DIFFERENT RU MEMBERS HAVE DIFFERENT PLANS.

CHECK ALL THAT APPLY.
TRICARE Standard; ...................... 1 [PR22]
TRICARE Prime; ......................... 2 [PR22]
TRICARE Extra; ......................... 3 [PR22]
TRICARE for Life; or ................... 4 [PR22]
CHAMPVA? ............................... 5 [PR22]
REF ................................... -7 [PR22]
DK .................................... -8 [PR22]
[Code All That Apply]

PR22
====

[STR-DT] [END-DT]
Who has been covered by TRICARE or CHAMPVA [since [START DATE]/ between [START DATE] and [END DATE]]?
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]
----------------------------------------------------
DISPLAY 'since [START DATE]' IF ROUND IS NOT 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND IS 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY TRICARE/ CHAMPVA' DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS 'NOT COVERED BY TRICARE/CHAMPVA' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO 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 OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
1. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE NOT FLAGGEDAS COVERED BY TRICARE/CHAMPVA AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_PR03 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU MEMBERS COVERED BY TRICARE/CHAMPVA. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS TRICARE/CHAMPVA
AND
- PERSON IS COVERED BY TRICARE/CHAMPVA DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_03 USES NAV_PR03 TO
TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_PR03
========

RU Member
[1. Coverage duration for [Person's Name-65] through
TRICARE OR CHAMPVA] [Status-25]
[2. Coverage duration for [Person's Name-65] through
TRICARE OR CHAMPVA] [Status-25]
[3. Coverage duration for [Person's Name-65] through
TRICARE OR CHAMPVA] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS TRICARE/CHAMPVA
AND
- PERSON IS COVERED BY TRICARE/CHAMPVA DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_07 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_07
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.

AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP03
----------------------------------------------------

END_LP03
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT- PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_03 AND CONTINUE WITH BOX_08
----------------------------------------------------

BOX_07A
=======

OMITTED.

PR22A
=====

OMITTED.

PR22B
=====

OMITTED.

PR22BOV1
========

OMITTED.

PR22BOV2
========

OMITTED.

BOX_08
======

----------------------------------------------------
IF ANY RU MEMBER HAD GOVT-HOSPITAL/PHYSICIAN AS A SOURCE OF INSURANCE AT ANY TIME DURING PREVIOUS ROUND, CONTINUE WITH PR23
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_11
----------------------------------------------------

PR23
====

[STR-DT] [END-DT]
During the last interview, we recorded that (READ NAME(S) BELOW) (was/were) covered by a program sponsored by a state or local government agency which provided hospital and physician benefits.
Have all of these people been covered by a program sponsored by a state or local government agency at any time [since [START DATE]/ between [START DATE] and [END DATE]]?

[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, ALL .............................. 1 [BOX_09]
NO, ONLY SOME ......................... 2 [PR24]
NO, NONE .............................. 3
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
HELP AVAILABLE FOR DEFINITION OF THIS TYPE OF PROGRAM.
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE), FLAG ALL RU MEMBERS LISTED HERE AS 'NOT COVERED BY GOVT-HOSPITAL/ PHYSICIAN' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES, ALL), FLAG ALL RU MEMBERS LISTED HERE AS 'COVERED BY GOVT-HOSPITAL/ PHYSICIAN' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE)
AND
IF ANY CURRENT RU MEMBERS NOT LISTED AT PR23, GO TO PR25
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE)
AND
IF ALL CURRENT RU MEMBERS ARE LISTED AT PR23, GO TO BOX_11
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE FLAGGED AS COVERED BY GOVT-HOSPITAL/PHYSICIAN AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

PR24
====

[STR-DT] [END-DT]
Who has been covered by this program [since [START DATE]/between [START DATE] and [END DATE]]?
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]
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY GOVT-HOSPITAL/PHYSICIAN' DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS 'NOT COVERED BY GOVT-HOSPITAL/PHYSICIAN' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_09
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE COVERED BY GOVT-HOSPITAL/PHYSICIAN AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

BOX_09
======

----------------------------------------------------
IF ALL CURRENT RU MEMBERS ALREADY FLAGGED AS COVERED OR NOT COVERED BY THE GOVT-HOSPITAL/ PHYSICIAN DURING CURRENT ROUND (I.E., ALL CURRENT RU MEMBERS WERE LISTED IN PR23), GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PR25
----------------------------------------------------

PR25
====

[STR-DT] [END-DT]
Besides the family members we've just talked about, have any additional family members been covered by this program [since [START DATE]/between [START DATE] and [END DATE]]?

YES ................................... 1 [PR26]
NO .................................... 2
REF ................................... -7
DK .................................... -8
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW) AND AT LEAST ONE RU MEMBER FLAGGED AS 'COVERED BY GOVT-HOSPITAL/PHYSICIAN' DURING CURRENT ROUND, GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW) AND NO RU MEMBERS FLAGGED AS 'COVERED BY GOVT-HOSPITAL/PHYSICIAN' DURING CURRENT ROUND, GO TO BOX_11
----------------------------------------------------

PR26
====

[STR-DT] [END-DT]
Who has been covered by this program?
PROBE: Who else has been covered by a program sponsored by a state or local government agency which provides hospital and physician benefits [since [START DATE]/between [START DATE] and [END DATE]]?

[1. First Name, [Middle Name], Last Name-65]
[2. First Name, [Middle Name], Last Name-65]
[3. First Name, [Middle Name], Last Name-65]
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY GOVT- HOSPITAL/PHYSICIAN' DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS 'NOT COVERED BY GOVT-HOSPITAL/PHYSICIAN' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO 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 OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
1. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE NOT FLAGGEDAS COVERED BY GOVT-HOSPITAL/PHYSICIAN AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_PR04 - END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU MEMBERS COVERED BY GOVT- HOSPITAL/PHYSICIAN. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
AND
- PERSON IS FLAGGED AS COVERED BY GOVT-HOSPITAL/ PHYSICIAN DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_04 USES NAV_PR04 TO TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_PR04
========

[NAME OF PREV RD'S GOVT-HOSPITAL/PHYSICIAN INSURER FOR RU]
[STR-DT]
SERIES: Time Covered by [NAME OF PREV RD'S GOVT-HOSPITAL/ PHYSICIAN INSURER FOR RU] during Reference Period.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

RU Member
[1. Coverage duration for [Person's Name-65] through
[NAME OF PREV RD'S GOVT-HOSPITAL/PHYSICIAN INSURER
FOR RU]] [Status-25]
[2. Coverage duration for [Person's Name-65] through
[NAME OF PREV RD'S GOVT-HOSPITAL/PHYSICIAN INSURER
FOR RU]] [Status-25]
[3. Coverage duration for [Person's Name-65] through
[NAME OF PREV RD'S GOVT-HOSPITAL/PHYSICIAN INSURER
FOR RU]] [Status-25]
----------------------------------------------------
FOR 'NAME OF PREV RD'S GOVT-HOSPITAL/PHYSICIAN INSURER FOR RU', DISPLAY THE INSURER RECORDED FOR GOVT-HOSPITAL/PHYSICIAN AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GOVT-HOSPITAL/PHYSICIAN
AND
- PERSON IS FLAGGED AS COVERED BY GOVT-HOSPITAL/ PHYSICIAN DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_10 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_10
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.

AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP04
----------------------------------------------------

END_LP04
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_04 AND CONTINUE WITH PR27
----------------------------------------------------

PR27
====

[STR-DT] [END-DT]
[Last time we recorded that (READ NAME(S) BELOW) may be covered by [NAME OF PREV RD'S GOVT-HOSPITAL/PHYSICIAN INSURER FOR RU].]
[Since [START DATE]/Between [START DATE] and [END DATE]], has there been any change in the plan name of the health insurance the family has through the program sponsored by a state or local government agency which provides hospital and physician benefits?

[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 [PR29]
NO ..................................... 2 [BOX_10A]
REF ................................... -7 [BOX_10A]
DK .................................... -8 [BOX_10A]
HELP AVAILABLE FOR A DEFINITION OF THIS TYPE OF PROGRAM.
----------------------------------------------------
DISPLAY 'Last time .... [NAME OF PREV RD'S GOVT- HOSPITAL/PHYSICIAN INSURER FOR RU].' IF THERE IS AN INSURER ASSOCIATED WITH GOVT-HOSPITAL/ PHYSICIAN IN THE PREVIOUS ROUND.

FOR 'NAME OF PREV RD'S GOVT-HOSPITAL/PHYSICIAN INSURER FOR RU', DISPLAY THE INSURER RECORDED FOR GOVT-HOSPITAL/PHYSICIAN AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Since [START DATE]' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), FLAG PREVIOUS ROUND'S INSURER AS CURRENT ROUND'S INSURER FOR GOVT-HOSPITAL/PHYSICIAN.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO ARE FLAGGED AS COVERED BY GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND.
----------------------------------------------------

PR28
====

OMITTED.

PR28OV
======

OMITTED.

PR29
====

[STR-DT] [END-DT]
Under the program sponsored by a state or local government agency which provides hospital and physician benefits [(are/is)/(were/was)] (READ NAME(S) BELOW) enrolled in an HMO, that is a Health Maintenance Organization [between [START DATE] and [END DATE]]?
[With an HMO, you must generally receive care from HMO physicians. If another doctor is seen, the expense is not covered unless you were referred by the HMO, or there was a medical emergency.]

PR30
====

[STR-DT] [END-DT]
[Does/Between [START DATE] and [END DATE], did] the program sponsored by a state or local government agency which provides hospital and physician benefits require (READ NAME(S) BELOW) to sign up with a certain primary care doctor, group of doctors, or with a certain clinic which they must go to for all of their routine care?
PROBE: Do not include emergency care or care from a specialist they were referred to.

PR31
====

[STR-DT] [END-DT]
What is the name of the [HMO/health insurance] from the program sponsored by a state or local government agency which provides hospital and physician benefits?

[Enter Plan Name] ..................... [BOX_10A]
REF ................................... -7 [BOX_10A]
DK .................................... -8 [BOX_10A]
----------------------------------------------------
DISPLAY 'HMO' IF PR29 IS CODED '1' (YES, ALL ARE) OR '2' (YES, SOME ARE). DISPLAY 'health insurance' IF PR30 CODED '1' (YES, ALL REQUIRED) OR '2' (YES, SOME REQUIRED).
----------------------------------------------------
----------------------------------------------------
FLAG INSURER CODED ABOVE AS 'CURRENT ROUND'S INSURER FOR GOVT-HOSPITAL/PHYSICIAN.'
----------------------------------------------------

BOX_10A
=======

----------------------------------------------------
IF ROUND 2, ROUND 3 OR ROUND 4, CONTINUE WITH PR32
----------------------------------------------------
----------------------------------------------------
OTHERWISE, (I.E., IF ROUND 5), GO TO BOX_11
----------------------------------------------------

PR32
====

[STR-DT] [END-DT]
Is there a monthly premium [for anyone in the family] for the coverage through [[NAME OF PLAN FROM PR31]/the program sponsored by a state or local government agency which provides hospital and physician benefits]?
[Do not include the cost of any copayments, coinsurance, or deductibles anyone in the family may have had to pay.]
READ IF NECESSARY: A monthly premium is a fixed amount of money people pay each month to have health coverage. It does not include copays or other expenses such as prescription costs.

YES, EVERYONE COVERED PAYS ............. 1 [BOX_10B]
YES, SOME COVERED PAY .................. 2 [PR32A]
NO, NO ONE COVERED PAYS ................ 3 [BOX_11]
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
[Code One]
HELP AVAILABLE FOR DEFINITION OF PREMIUM/COPAYMENT/COINSURANCE/DEDUCTIBLE.
----------------------------------------------------
DISPLAY '[NAME OF PLAN FROM PR31]' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, DISPLAY 'the program sponsored ...'.

DISPLAY '[NAME OF PLAN FROM PR31]' IF A PLAN NAME WAS ENTERED AT PR31. DISPLAY THE ACTUAL PLAN NAME THAT WAS ENTERED.

DISPLAY 'for anyone in the family' IF MORE THAN ONE RU MEMBER SELECTED AS COVERED BY GOVT- HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES, EVERYONE COVERED PAYS), FLAG ALL PERSONS AT PR32A AS 'PAYS FOR COVERAGE DURING CURRENT ROUND.' IF CODED '3' (NO, NO ONE COVERED PAYS), FLAG ALL PERSONS AT PR32A AS 'DOES NOT PAY FOR COVERAGE DURING CURRENT ROUND.'

(AHRQ WILL DECIDE ON FLAGS FOR '-7', '-8' AND '-9'VALUES AFTER DETERMINING FREQUENCY IN FY2012.)
----------------------------------------------------

PR32A
=====

[STR-DT] [END-DT]
Which family members have a monthly premium for that coverage?
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]
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'PAYS FOR COVERAGE DURING CURRENT ROUND.' FLAG ALL PERSONS NOT SELECTED AS 'DOES NOT PAY FOR COVERAGE DURING CURRENT ROUND.'
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_10B
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO ARE COVERED BY GOVT-HOSPITAL/PHYSICIAN DURING THE CURRENT ROUND.
----------------------------------------------------

BOX_10B
=======

----------------------------------------------------
IF ROUND 3, CONTINUE WITH PR33
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO PR33A
----------------------------------------------------

PR33
====

[STR-DT] [END-DT]
How much is the premium for [the [NAME OF PLAN FROM PR31]/that] coverage?

[Enter Amount in Dollars] .............. [PR33OV1]
REF ................................... -7 [PR33A]
DK .................................... -8 [PR33A]
-----------------------------------------------------
DISPLAY 'the [NAME OF PLAN FROM PR31]' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, DISPLAY 'that'.

DISPLAY '[NAME OF PLAN FROM PR31]' IF A PLAN NAME WAS ENTERED AT PR31. DISPLAY THE ACTUAL PLAN NAME THAT WAS ENTERED.
-----------------------------------------------------

PR33OV1
=======

Is that per year, per month, per week, or what?
ENTER UNIT OF COVERAGE:

PER YEAR ............................... 1 [PR33A]
QUARTERLY/EVERY 3 MONTHS ............... 2 [PR33A]
BIMONTHLY/EVERY 2 MONTHS ............... 3 [PR33A]
PER MONTH .............................. 4 [PR33A]
PER WEEK ............................... 5 [PR33A]
BIWEEKLY/EVERY 2 WEEKS ................. 6 [PR33A]
SEMI-ANNUALLY/2 TIMES PER YEAR ......... 7 [PR33A]
SEMI-MONTHLY/2 TIMES PER MONTH ......... 8 [PR33A]
OTHER ................................. 91 [PR33OV2]
REF ................................... -7 [PR33A]
DK .................................... -8 [PR33A]
[Code One]

PR33OV2
=======

SPECIFY:

[Enter Other Specify] .................. [PR33A]
REF ................................... -7 [PR33A]
DK .................................... -8 [PR33A]

PR33A
=====

[STR-DT] [END-DT]
[PLAN NAME: [NAME OF PLAN FROM PR31]]
Is the cost of the premium subsidized based on family income?

YES .................................... 1 [BOX_10C]
NO ..................................... 2 [BOX_10C]
REF ................................... -7 [BOX_10C]
DK .................................... -8 [BOX_10C]
-----------------------------------------------------
DISPLAY 'PLAN NAME: ...' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE GOVT-HOSPITAL/ PHYSICIAN INSURANCE. OTHERWISE, USE A NULL DISPLAY.
DISPLAY THE ACTUAL PLAN NAME ENTERED AT PR31 FOR [NAME OF PLAN FROM PR31]' IF A PLAN NAME WAS ENTERED.
-----------------------------------------------------

BOX_10C
======

----------------------------------------------------
IF ROUND 3
AND
IF HX15A WAS CODED '1' (YES, PLAN IS EXCHANGE) THE ROUND THE GOV'T-HOSPITAL/PHYSICIAN INSURANCE WAS CREATED
AND
PR32 IS CODED '1' (YES, EVERYONE COVERED PAYS) OR '2' (YES, SOME COVERED PAY), CONTINUE WITH PR34
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_11
----------------------------------------------------

PR34
====

[STR-DT] [END-DT]
Is [the [NAME OF PLAN FROM PR31] plan/this plan] a platinum, gold, silver, bronze or catastrophic plan?

PLATINUM PLAN .......................... 1 [BOX_11]
GOLD PLAN .............................. 2 [BOX_11]
SILVER PLAN ............................ 3 [BOX_11]
BRONZE PLAN ............................ 4 [BOX_11]
CATASTROPHIC PLAN ...................... 5 [BOX_11]
IF VOLUNTEERED: SOMETHING ELSE ......... 6 [BOX_11]
REF ................................... -7 [BOX_11]
DK .................................... -8 [BOX_11]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
----------------------------------------------------
DISPLAY 'the [NAME OF PLAN FROM PR31] plan' IF THERE IS A CURRENT ROUND INSURER ASSOCIATED WITH THE GOVT-HOSPITAL/PHYSICIAN INSURANCE. OTHERWISE, DISPLAY 'this plan'.

DISPLAY THE ACTUAL PLAN NAME ENTERED AT PR31 FOR '[NAME OF PLAN FROM PR31]' IF A PLAN NAME WAS ENTERED.
----------------------------------------------------

PR34OV
======

OMITTED.

BOX_11
======

----------------------------------------------------
IF ANY RU MEMBER HAD OTHER PUBLIC (GROUP 1 OR 2) AS A SOURCE OF INSURANCE AT ANY TIME DURING PREVIOUS ROUND, CONTINUE WITH BOX_12
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_18
----------------------------------------------------

BOX_12
======

----------------------------------------------------
IF ANY CURRENT RU MEMBER HAD ANY GROUP 1 OTHER PUBLIC INSURANCE AT ANY TIME DURING PREVIOUS ROUND, CONTINUE WITH PR35
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_15
----------------------------------------------------
----------------------------------------------------
NOTE: FOR BOTH GROUP 1 AND GROUP 2 PUBLIC PROGRAMS, WE ASSUME THE PROGRAM IS THE SAME FROM THE PREVIOUS ROUND. ALTHOUGH WE SHOW THE SHOW CARD AND ASK IF THE FAMILY STILL HAD COVERAGE FROM ANY OF THOSE PROGRAMS, WE DO NOT ASK WHICH ONES. IF WE WERE TO ASK WHICH ONES, WE WOULD NEEDTO ADD SEVERAL QUESTIONS, LIKE THE OTHER PUBLIC SERIES IN HX.
----------------------------------------------------

PR35
====

[STR-DT] [END-DT]
During the last interview, we recorded that (READ NAMES BELOW) were covered by one or more of the following programs:
[STATE NAME FOR PROGRAM #1....]
[STATE NAME FOR PROGRAM #2....]
[STATE NAME FOR PROGRAM #3....]
[STATE NAME FOR PROGRAM #4....]
Have all of these people been covered by any of these programs at any time [since [START DATE]/between [START DATE] and [END DATE]]?

[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, ALL .............................. 1 [BOX_13]
NO, ONLY SOME ......................... 2 [PR36]
NO, NONE .............................. 3
REF ................................... -7 [BOX_15]
DK .................................... -8 [BOX_15]
HELP AVAILABLE FOR DEFINITION OF STATE SPECIFIC PROGRAMS LISTED.
----------------------------------------------------
DISPLAY THE LIST OF UP TO FOUR ACTUAL NAMES OF STATE PROGRAMS (AS LISTED IN ATTACHMENT 36) FOR 'STATE NAME FOR PROGRAM #N'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF PR35 IS CODED '1' (YES, ALL), MARK ALL RU MEMBERS LISTED HERE AS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF PR35 IS CODED '3' (NO, NONE), FLAG ALL RU MEMBERS LISTED HERE AS 'NOT COVERED BY GROUP 1 OTHER PUBLIC INSURANCE' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE)
AND
IF ANY CURRENT RU MEMBERS NOT LISTED AT PR35, GO TO PR37
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE),
AND
IF ALL CURRENT RU MEMBERS ARE LISTED AT PR35, GO TO BOX_15
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE COVERED BY GROUP 1 OTHER PUBLIC INSURANCE AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

PR36
====

[STR-DT] [END-DT]
Who has been covered by any of these programs [since [START DATE]/between [START DATE] and [END DATE]]?
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]
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY GROUP 1 OTHER PUBLIC INSURANCE' DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS 'NOT COVERED BY GROUP 1 OTHER PUBLIC INSURANCE' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_13
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE COVERED BY GROUP 1 OTHER PUBLIC INSURANCE AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

BOX_13
======

----------------------------------------------------
IF ALL CURRENT RU MEMBERS ALREADY FLAGGED AS COVERED OR NOT COVERED BY GROUP 1 OTHER PUBLIC INSURANCE DURING CURRENT ROUND (I.E., ALL CURRENT RU MEMBERS WERE LISTED IN PR35), GO TO LOOP_05
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PR37
----------------------------------------------------

PR37
====

[STR-DT] [END-DT]
Besides the family members we've just talked about, have any additional family members been covered by any of the following programs [since [START DATE]/between [START DATE] and [END DATE]]?(READ PROGRAM NAMES BELOW.)
[STATE NAME FOR PROGRAM #1....]
[STATE NAME FOR PROGRAM #2....]
[STATE NAME FOR PROGRAM #3....]
[STATE NAME FOR PROGRAM #4....]

YES ................................... 1 [PR38]
NO .................................... 2
REF ................................... -7
DK .................................... -8
HELP AVAILABLE FOR DEFINITION OF STATE SPECIFIC PROGRAMS LISTED.
----------------------------------------------------
DISPLAY THE LIST OF UP TO FOUR ACTUAL NAMES OF STATE PROGRAMS (AS LISTED IN HX16) FOR 'STATE NAMEFOR PROGRAM #N'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW) AND AT LEAST ONE RU MEMBER FLAGGED AS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE DURING CURRENT ROUND, GO TO LOOP_05
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW) AND NO RU MEMBERS FLAGGED AS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE DURING CURRENT ROUND, GO TO BOX_15
----------------------------------------------------

PR38
====

[STR-DT] [END-DT]
Who has been covered by any of these programs [since [START DATE]/between [START DATE] and [END DATE]]?
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]
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY GROUP 1 OTHER PUBLIC INSURANCE' DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS 'NOT COVERED BY GROUP 1 OTHER PUBLIC INSURANCE DURING CURRENT ROUND.'
----------------------------------------------------
----------------------------------------------------
GO TO 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 SELECTIONOF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
1. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE NOT FLAGGED AS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_PR05 - END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU MEMBERS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE. THIS LOOP CYCLES ON ESTABLISHMENT-PERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GROUP 1 OTHER PUBLIC INSURANCE
AND
- PERSON IS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_05 USES NAV_PR05 TO TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_PR05
========

RU Member
[1. Coverage duration for [Person's Name-65] through
STATE SPECIFIC PROGRAM] [Status-25]
[2. Coverage duration for [Person's Name-65] through
STATE SPECIFIC PROGRAM] [Status-25]
[3. Coverage duration for [Person's Name-65] through
STATE SPECIFIC PROGRAM] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GROUP 1 OTHER PUBLIC INSURANCE
AND
- PERSON IS COVERED BY GROUP 1 OTHER PUBLIC INSURANCE DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_14 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_14
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.

AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP05
----------------------------------------------------

END_LP05
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT- PERSON-PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_05 AND CONTINUE WITH BOX_15
----------------------------------------------------

BOX_15
======

----------------------------------------------------
IF ANY CURRENT RU MEMBER HAD ANY ELIGIBLE GROUP 2 OTHER PUBLIC INSURANCE AT ANY TIME DURING THE PREVIOUS ROUND, CONTINUE WITH PR39
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_18
----------------------------------------------------

PR39
====

[STR-DT] [END-DT]
SHOW CARD HX-11.
During the last interview, we recorded that (READ NAMES BELOW) were covered by one or more of the public programs listed on this card.
Have all of these people been covered by any of these programs at any time [since [START DATE]/between [START DATE] and [END DATE]]?

[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, ALL .............................. 1 [BOX_16]
NO, ONLY SOME ......................... 2 [PR40]
NO, NONE .............................. 3
REF ................................... -7 [BOX_18]
DK .................................... -8 [BOX_18]
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.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES, ALL), FLAG ALL RU MEMBERS LISTED HERE AS 'COVERED BY GROUP 2 OTHER PUBLIC INSURANCE' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE), FLAG ALL RU MEMBERS LISTED HERE AS 'NOT COVERED BY GROUP 2 OTHER PUBLIC INSURANCE' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE)
AND
IF ANY CURRENT RU MEMBERS NOT LISTED AT PR39, GO TO PR41
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NONE),
AND
IF ALL CURRENT RU MEMBERS ARE LISTED AT PR39, GO TO BOX_18
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE COVERED BY GROUP 2 OTHER PUBLIC INSURANCE AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

PR40
====

[STR-DT] [END-DT]
SHOW CARD HX-11.
Who has been covered by any of these programs [since [START DATE]/between [START DATE] and [END DATE]]?
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 ITEMS ON SHOW CARD.
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY GROUP 2 OTHER PUBLIC INSURANCE' DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS 'NOT COVERED BY GROUP 2 OTHER PUBLIC INSURANCE' DURING CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_16
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE COVERED BY GROUP 2 OTHER PUBLIC INSURANCE AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

BOX_16
======

----------------------------------------------------
IF ALL CURRENT RU MEMBERS ALREADY FLAGGED AS COVERED OR NOT COVERED BY GROUP 2 OTHER PUBLIC INSURANCE DURING CURRENT ROUND (I.E., ALL CURRENT RU MEMBERS WERE LISTED AT PR39), GO TO LOOP_06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH PR41
----------------------------------------------------

PR41
====

[STR-DT] [END-DT]
SHOW CARD HX-11.
Besides the family members we've just talked about, have any additional family members been covered by any of these programs [since [START DATE]/between [START DATE] and [END DATE]]?

YES ................................... 1 [PR42]
NO .................................... 2
REF ................................... -7
DK .................................... -8
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.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW) AND AT LEAST ONE RU MEMBER FLAGGED AS COVERED BY GROUP 2 OTHER PUBLIC INSURANCE DURING CURRENT ROUND, GO TO LOOP_06
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW) AND NO RU MEMBERS FLAGGED AS COVERED BY GROUP 2 OTHER PUBLIC INSURANCE DURING CURRENT ROUND, GO TO BOX_18
----------------------------------------------------

PR42
====

[STR-DT] [END-DT]
SHOW CARD HX-11.
Who has been covered by any of these programs [since [START DATE]/between [START DATE] and [END DATE]]?
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 ITEMS ON SHOW CARD.
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5. DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FLAG ALL PERSONS SELECTED AS 'COVERED BY GROUP 2 OTHER PUBLIC INSURANCE' DURING CURRENT ROUND. FLAG ALL PERSONS NOT SELECTED AS 'NOT COVERED BY GROUP 2 OTHER PUBLIC INSURANCE DURING CURRENT ROUND.'
----------------------------------------------------
----------------------------------------------------
GO TO 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 OF RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
1. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE RU MEMBERS WHO WERE NOT FLAGGEDAS COVERED BY GROUP 2 OTHER PUBLIC INSURANCE AT ANY TIME DURING THE PREVIOUS ROUND.
----------------------------------------------------

LOOP_06
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK NAV_PR06 - END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 COLLECTS TIME PERIOD COVERAGE DETAIL FOR RU MEMBERS COVERED BY GROUP 2 OTHER PUBLIC INSURANCE. THIS LOOP CYCLES ON STABLISHMENT-PERSON-PAIRS THAT MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GROUP 2 OTHER PUBLIC INSURANCE
AND
- PERSON IS COVERED BY GROUP 2 OTHER PUBLIC INSURANCE DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_06 USES NAV_PR06 TO TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_PR06
========

RU Member
[1. Coverage duration for [Person's Name-65] through
STATE: TANF/SSI/WIC/IHS/PHC/VA] [Status-25]
[2. Coverage duration for [Person's Name-65] through
STATE: TANF/SSI/WIC/IHS/PHC/VA] [Status-25]
[3. Coverage duration for [Person's Name-65] through
STATE: TANF/SSI/WIC/IHS/PHC/VA] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET BOTH OF THE FOLLOWING CONDITIONS:
- ESTABLISHMENT IS GROUP 2 OTHER PUBLIC INSURANCE
AND
- PERSON IS COVERED BY GROUP 2 OTHER PUBLIC INSURANCE DURING THE CURRENT ROUND
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_17 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_17
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION FOR THIS PAIR.

AT COMPLETION OF THE HQ SECTION, CONTINUE WITH END_LP06
----------------------------------------------------

END_LP06
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-ESTABLISHMENT-PERSON-PAIRS ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO MORE PAIRS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH BOX_18
----------------------------------------------------

BOX_18
======

----------------------------------------------------
RETURN TO THE HEALTH INSURANCE (HX) SECTION.
----------------------------------------------------

Managed Care (MC) Section

BOX_00
======

MC01
====

[POLICYHOLDER'S FIRST MIDDLE LAST NAME] [NAME OF
ESTABLISHMENT] [STR-DT]
[END-DT]
[Is/Was] [your/[POLICYHOLDER]'s] [NAME OF INSURER BEING LOOPED ON] an HMO [as of [END DATE]]? [When answering this question, do not consider [your/his/her] insurance through Medicare.] [With an HMO, you must generally receive care from HMO physicians. For other doctors, the expense is not covered unless you were referred by the HMO or there was a medical emergency.]

YES .................................... 1 [BOX_01]
NO ..................................... 2 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
HELP AVAILABLE FOR DEFINITION OF HMO.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5.

DISPLAY 'as of [END DATE]' IF ROUND 5. OTHERWISE,USE A NULL DISPLAY.

DISPLAY 'When answering this question, do not consider [your/his/her] insurance through Medicare.' IF POLICYHOLDER BEING ASKED ABOUT IS ALSO COVERED BY MEDICARE. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

MC02
====

OMITTED.

MC03
====

OMITTED.

MC04
====

OMITTED.

MC05
====

OMITTED.

BOX_01
======

----------------------------------------------------
RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN HX OR OE.
----------------------------------------------------

Private Health Insurance Detail (HP) Section

----------------------------------------------------
THROUGHOUT THE SPECIFICATIONS FOR THIS CAPI SECTION, FOR SCREENS THAT SPECIFY THE REFERENCE PERIOD [END DATE] AS PART OF THE CONTEXT HEADER, CAPI DISPLAYS THE [END DATE] ONLY FOR ROUND 5. IN ANY OTHER ROUND, CAPI DOES NOT DISPLAY THE [END DATE] IN THE CONTEXT HEADER. FOR MOST PERSONS, THE END DATE FOR ROUND 5 WILL BE DECEMBER 31 OF THE SECOND YEAR OF THE PANEL.
----------------------------------------------------
----------------------------------------------------
NOTE THAT 'HEALTH INSURANCE PURCHASING ALLIANCE' (CODE '4' AT HX03 AND CODE '2' AT HX23) WAS OMITTED IN PANEL 12 ROUND 2 AND WILL BE OMITTED IN ALL FUTURE ROUNDS.
----------------------------------------------------
----------------------------------------------------
NOTE THAT ESTABLISHMENT ADDRESS INFORMATION AND THE INFORMED CONSENT SCREENS WERE OMITTED STARTING IN PANEL 12 ROUND 3. THIS INFORMATION WAS IN PANEL 12 ROUNDS 1 AND 2.

STARTING IN PANEL 13 THESE ITEMS WILL BE OMITTED IN ALL ROUNDS.
----------------------------------------------------

BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PERS.FULLNAME, ESTB.ESTBNAME, PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY, 'INSURANCE SOURCE'.

FOR 'INSURANCE SOURCE', DISPLAY THE CATEGORY TEXT FROM HX23. IF HX23=91, DISPLAY THE OTHER SPECIFY TEXT.
----------------------------------------------------

BOX_01
======

----------------------------------------------------
IF LOOPING ON ANY ESTABLISHMENT FLAGGED IN THE EMPLOYMENT (EM) SECTION AS 'PROVIDES HEALTH INSURANCE' AND NOT FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE-1, GO TO LOOP_01
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON AN HX03 CATEGORY OR IF LOOPING ON AN HX23 CATEGORY (EXCEPT CODE '3' (DIRECTLY FROM A SCHOOL)), GO TO HP03
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '3' (DIRECTLY FROM A SCHOOL) AT HX23, CONTINUE WITH HP01
----------------------------------------------------

HP01
====

Does the insurance from the school cover only injuries caused by accidents, or does it have general health coverage?

GENERAL HEALTH COVERAGE ................ 1 [HP02]
ONLY INJURIES CAUSED BY ACCIDENTS ...... 2 [BOX_11]
REF ................................... -7 [HP02]
DK .................................... -8 [HP02]
HELP AVAILABLE FOR DEFINITION OF GENERAL HEALTH COVERAGE.
[Code One]

HP02
====

Would the insurance from the school cover health services outside of a school clinic?

YES .................................... 1 [HP03]
NO ..................................... 2 [BOX_11]
REF ................................... -7 [HP03]
DK .................................... -8 [HP03]

HP03
====

I'd like to talk about the insurance which is from [CATEGORY NAME FROM HX03 OR HX23], that is, the health insurance [through a self-employed business/someone in the family purchased or obtained directly from that source.]
SELECT 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS INSURANCE REPORTED IN ERROR.

CONTINUE ............................... 1 [LOOP_01]
INSURANCE REPORTED IN ERROR ............ 2 [BOX_11]
[Code One]
----------------------------------------------------
DISPLAY 'through a self-employed business' IF LOOPING ON AN HX03 CATEGORY. DISPLAY 'someone in the family purchased or obtained directly from that source.' IF LOOPING ON AN HX23 CATEGORY.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE FOLLOWING FOR 'CATEGORY NAME FROM HX03 OR HX23':

- 'a professional association' IF CODED '1' AT HX03
- 'a small business group' IF CODED '2' AT HX03
- 'a union' IF CODED '3' AT HX03
- 'an insurance agent' IF CODED '5' AT HX03
- 'an insurance company' IF CODED '6' AT HX03
- 'an HMO' IF CODED '7' AT HX03
- 'a previous employer' IF CODED '8' AT HX03
- 'a previous employer (COBRA)' IF CODED '9' AT HX03
- 'a high risk pool [(e.g., [STATE NAME FOR HIGH RISK POOL])]' IF CODED '10' AT HX03
- 'the [HX03OV OTHER SPECIFY TEXT]' IF CODED '91' AT HX03
- '[STATE EXCHANGE NAME]' IF CODED '11' AT HX03
- 'source purchased for that business' IF CODED
'-7' OR '-8' AT HX03

- 'a group or association' IF CODED '1' AT HX23
- 'a school' IF CODED '3' AT HX23
- 'an insurance agent' IF CODED '4' AT HX23
- 'an insurance company' IF CODED '5' AT HX23
- 'an HMO' IF CODED '6' AT HX23
- 'a union' IF CODED '7' AT HX23
- 'a previous employer (COBRA)' IF CODED '8' AT HX23
- 'a previous employer (not COBRA)' IF CODED '9' AT HX23
- 'a spouse's (or deceased spouse's) previous employer' IF CODED '10' AT HX23
- 'some other employer' IF CODED '11' AT HX23
- 'the plan of someone not living here' IF CODED '12' AT HX23
- 'a high risk pool [(e.g., [STATE NAME FOR HIGH RISK POOL])]' IF CODED '13' AT HX23
- '[STATE EXCHANGE NAME-A]' IF CODED '14' AT HX23
- 'the [HX23OV OTHER SPECIFY TEXT] IF CODED '91' AT HX23
- 'a source that provided directly purchased insurance' IF CODED '-7' OR '-8'
----------------------------------------------------
----------------------------------------------------
DISPLAY '(e.g., [STATE NAME FOR HIGH RISK POOL])' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED OFFERS A HIGH RISK POOL HEALTH INSURANCE PLAN.
THIS INCLUDES ALL STATES EXCEPT: AZ, DE, DC, GA, HI, ME, MA, MI, NV, NJ, NY, OH, PA, RI, VT, VA. IF INTERVIEW STATE IS ONE OF THESE STATES, USE A NULL DISPLAY.

FOR 'STATE NAME FOR HIGH RISK POOL' DISPLAY THE HIGH RISK POOL PLAN NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.

FOR 'STATE EXCHANGE NAME', DISPLAY THE EXCHANGE NAME 'A' ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (INSURANCE REPORTED IN ERROR), FLAG ITEM FOR SOURCE CLEAN-UP.
----------------------------------------------------

LOOP_01
=======

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

ESTABLISHMENT 1
ESTABLISHMENT 2
ESTABLISHMENT 3
ESTABLISHMENT 4

ASK BOX_01AA-END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP-01 COLLECTS DETAILED INFORMATION ABOUT INSURANCE PROVIDED THROUGH AN EMPLOYER OR THE ESTABLISHMENT NAMES OF THE INSURANCE SOURCE COLLECTED IN EITHER HX03 OR HX23.IF LOOPING ON INSURANCE PROVIDED FROM AN EMPLOYER ONLY ONE LOOP CYCLE IS COMPLETED.

IF LOOPING ON INSURANCE PROVIDED THROUGH AN INSURANCE SOURCE COLLECTED IN HX03 OR HX23, THE FIRST LOOP CYCLE COLLECTS THE MAIN ESTABLISHMENT NAME OF THE INSURANCE SOURCE. SUBSEQUENT CYCLES, IF ANY, ARE DETERMINED BY THE RESPONSE TO HP18.
IF HP18 IS CODED '1' (YES), THE LOOP CYCLES AGAIN TO COLLECT THE NEXT ESTABLISHMENT NAME. IF HP18 IS NOT ASKED OR IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------

BOX_01AA
========

----------------------------------------------------
IF LOOPING ON CODE '11' (STATE EXCHANGE NAME) AT HX03 OR CODE '14' (STATE EXCHANGE NAME) AT HX23, AUTOMATICALLY CODE HP04A AS 'YES'
AND
AUTOMATICALLY ADD THE ESTABLISHMENT NAME '[STATE EXCHANGE NAME]' TO THE HP04/HP06 ESTABLISHMENT ROSTER. THEN GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
IF LOOPING ON CODE '1' (PROFESSIONAL ASSOCIATION),'2' (SMALL BUSINESS GROUP), '5' (INSURANCE AGENT),'6' (INSURANCE COMPANY), '7' (HMO), OR '91' (OTHER) AT HX03 OR CODE '1' (GROUP/ASSOCIATION), '4' (INSURANCE AGENT), '5' (INSURANCE COMPANY), '6' (HMO), OR '91' (OTHER) AT HX23, CONTINUE WITH HP04A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_01A
----------------------------------------------------
----------------------------------------------------
NOTE: THE HP04/HP06 ESTABLISHMENT ROSTER HAS A CHARACTER LIMIT OF 30 CHARACTERS. IF AN ESTABLISHMENT IS AUTOMATICALLY ADDED TO THE ROSTER AT HP04/HP06 THAT IS OVER 30 CHARACTERS, THE ESTABLISHMENT NAME WILL BE TRUNCATED. AS OF P19R2/P18R4, THE FOLLOWING STATE EXCHANGE NAMES WERE TRUNCATED:
ORIGINAL
'the Health Insurance Marketplace'
'the Massachusetts Health Connector'
'the Washington Health Plan Finder'

TRUNCATED
'Health Insurance Marketplace'
'Massachusetts Health Connector'
'Washington Health Plan Finder'
----------------------------------------------------

HP04A
=====

Is this coverage through [STATE EXCHANGE NAME-A][, [which may also be known as [ALIAS B] [or [ALIAS C]]]]?

YES .................................... 1 [BOX_01A]
NO ..................................... 2 [BOX_01A]
REF ................................... -7 [BOX_01A]
DK .................................... -8 [BOX_01A]
----------------------------------------------------
DISPLAY ', [which may also be known as [ALIAS B] [or [ALIAS C]]]' IF THERE IS MORE THAN ONE EXCHANGE NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'or [ALIAS C]' IF THERE ARE THREE EXCHANGE NAMES ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------
----------------------------------------------------
FOR 'STATE EXCHANGE NAME-A', 'ALIAS B', AND 'ALIAS C', DISPLAY THE EXCHANGE NAME(S) ASSOCIATEDWITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------

BOX_01A
=======

----------------------------------------------------
IF LOOPING ON ANY ESTABLISHMENT FLAGGED IN EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE' AND NOT FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE-1, GO TO HP09
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP04
----------------------------------------------------

HP04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Please give me the name of the [professional association/small business group/union/insurance company/HMO/previous employer/ previous employer (using COBRA)/group or association/school/ spouse's (or deceased spouse's) previous employer/employer/ high risk pool [(e.g., [STATE NAME FOR HIGH RISK POOL])]/ [HX03OV/HX23OV OTHER SPECIFY]/source] [from which someone in the family [purchased/obtained] this insurance/for the insurance purchased from an agent]. / You mentioned that someone in the family receives health insurance from the plan of someone not living here. How does that policyholder get this insurance?]
VERIFY WITH RESPONDENT AND SELECT (ESTABLISHMENT) BELOW:

--------------------------
ROSTER. ESTABLISHMENT
--------------------------
1. Establishment Name-30
--------------------------
2. Establishment Name-30
--------------------------
3. Establishment Name-30
--------------------------
----------------------------------------------------
DISPLAY 'Please give ? an agent.' IF NOT LOOPING ON HX23 CODE '12' (UNDER PLAN OF SOMEONE NOT
LIVING HERE). DISPLAY 'You mentioned...this insurance?' IF LOOPING ON HX23 CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE).

DISPLAY 'professional association' IF LOOPING ON HX03 CODE '1' (FROM A PROFESSIONAL ASSOCIATION).

DISPLAY 'small business group' IF LOOPING ON HX03 CODE '2' (FROM A SMALL BUSINESS GROUP).

DISPLAY 'union' IF LOOPING ON HX03 CODE '3' (FROM A UNION) OR LOOPING ON HX23 CODE '7' (FROM A UNION).

DISPLAY 'insurance company' IF LOOPING ON HX03 CODE '5' (DIRECTLY FROM AN INSURANCE AGENT) OR '6'(DIRECTLY FROM INSURANCE COMPANY) OR LOOPING ON HX23 CODE '4' (DIRECTLY FROM AN INSURANCE AGENT) OR '5' (DIRECTLY FROM INSURANCE COMPANY).

DISPLAY 'HMO' IF LOOPING ON HX03 CODE '7' (DIRECTLY FROM AN HMO) OR LOOPING ON HX23 CODE '6' (DIRECTLY FROM AN HMO).

DISPLAY 'previous employer' IF LOOPING ON HX03 CODE '8' (FROM A PREVIOUS EMPLOYER) OR LOOPING ON HX23 CODE '9' (FROM ANYONE'S PREVIOUS EMPLOYER).

DISPLAY 'previous employer (using COBRA)' IF LOOPING ON HX03 CODE '9' (FROM A PREVIOUS EMPLOYER (COBRA)) OR LOOPING ON HX23 CODE '8' (FROM ANYONE'S PREVIOUS EMPLOYER (COBRA)).

DISPLAY 'group or association' IF LOOPING ON HX23 CODE '1' (FROM A GROUP OR ASSOCIATION).

DISPLAY 'school' IF LOOPING ON HX23 CODE '3' (DIRECTLY THROUGH A SCHOOL).

DISPLAY 'spouse's (or deceased spouse's) previous employer' IF LOOPING ON HX23 CODE '10' (FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER).

DISPLAY 'employer' IF LOOPING ON HX23 CODE '11' (FROM SOME OTHER EMPLOYER).

DISPLAY 'high risk pool [(e.g., [STATE NAME FOR HIGH RISK POOL])]' IF LOOPING ON HX03 CODE '10' (DIRECTLY FROM A HIGH RISK POOL) OR LOOPING ON HX23 CODE '13' (DIRECTLY FROM A HIGH RISK POOL).

DISPLAY '[HX03OV/HX23OV OTHER SPECIFY]' IF LOOPING ON HX03 CODE '91' (OTHER) OR LOOPING ON HX23 CODE '91' (OTHER SOURCE).

FOR 'HX03OV/HX23OV OTHER SPECIFY' DISPLAY THE TEXT ENTERED AT EITHER HX03OV OR HX23OV.

DISPLAY 'source' IF LOOPING ON HX03 OR HX23 CODES '-7' (REF) OR '-8' (DK).

DISPLAY 'from which someone in the family [purchased/obtained] this insurance' IF NOT LOOPING ON HX03 CODE '5' (DIRECTLY FROM AN INSURANCE AGENT) OR HX23 CODE '4' (DIRECTLY FROM AN INSURANCE AGENT) IF LOOPING ON HX03 CODE '5' OR HX23 CODE '4', DISPLAY, 'for the insurance purchased from an agent'.

DISPLAY 'purchased' IF LOOPING ON HX03 CODES '1', '2', '3', '6', '7', '10', '-7,' OR '-8' OR IF LOOPING ON HX23 CODES '1', '3', '5', '6', '7', '13', '-7,' OR '-8'.

DISPLAY 'obtained' IF LOOPING ON HX03 CODES '8', '9', OR '91' OR IF LOOPING ON HX23 CODES '8', '9', '10', '11', OR '91'.
----------------------------------------------------
----------------------------------------------------
DISPLAY '(e.g., [STATE NAME FOR HIGH RISK POOL])' IF STATE IN WHICH INTERVIEW IS BEING CONDUCTED OFFERS A HIGH RISK POOL HEALTH INSURANCE PLAN.
THIS INCLUDES ALL STATES EXCEPT: AZ, DE, DC, GA, HI, ME, MA, MI, NV, NJ, NY, OH, PA, RI, VT, VA. IF INTERVIEW STATE IS ONE OF THESE STATES, USE A NULL DISPLAY.

FOR 'STATE NAME FOR HIGH RISK POOL' DISPLAY THE HIGH RISK POOL PLAN NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.
----------------------------------------------------
----------------------------------------------------
THE CONTEXT HEADER DISPLAYED ON SCREENS HP04 - HP08 DEPENDS ON THE PATH THAT LEADS TO THE SCREEN. IF ASKING ABOUT A SPECIFIC PERSON (I.E., OBHOLDER WHEN COMING FROM AN HX03 CATEGORY), CAPI DISPLAYS THE PERSON AND START DATE. IF ASKING ABOUT A SPECIFIC ESTABLISHMENT, CAPI DISPLAYS THE ESTABLISHMENT AND START DATE.
OTHERWISE, CAPI DISPLAYS THE START DATE. FOR ROUND 5, CAPI ALSO DISPLAYS THE END DATE OF THE REFERENCE PERIOD.
----------------------------------------------------
----------------------------------------------------
DISPLAY AN "ADD ESTABLISHMENT" OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF 'ADD ESTABLISHMENT' OPTION IS SELECTED, CONTINUE WITH BOX_01B
----------------------------------------------------
----------------------------------------------------
OTHERWISE (ESTABLISHMENT WAS SELECTED FROM THE LIST), GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_3

COL # 1 HEADER: ESTABLISHMENT
INSTRUCTIONS: DISPLAY ESTABLISHMENT NAME (ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENTS-ROSTERS FOR DISPLAY OF PRIVATE INSURANCE ESTABLISHMENTS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ESTABLISHMENTS THAT ARE SOURCES OF PRIVATE INSURANCE. THIS DOES NOT INCLUDE ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 THAT ARE COMING FROM THE HX03 SERIES.
----------------------------------------------------

BOX_01B
=======

----------------------------------------------------
IF LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23 AND IF 'ADD ESTABLISHMENT' IS SELECTED, GO TO HP07. (NOTE THAT HP07 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON HP04.)
----------------------------------------------------
----------------------------------------------------
IF 'ADD ESTABLISHMENT' IS SELECTED AND IF NOT LOOPING ON CODE '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) AT HX23, CONTINUE WITH HP06 (NOTE THAT HP06 IS NOT A SEPARATE SCREEN; IT REPRESENTS A POPUP ON HP04.)
----------------------------------------------------

HP05
====

OMITTED.

HP06
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
INSURANCE SOURCE: [CATEGORY NAME FROM HX03 OR HX23]
ENTER NAME OF ESTABLISHMENT WHERE PERSON PURCHASED INSURANCE.
[ESTABLISHMENT: [_____________] [BOX_02]

----------------------------------------------------
DISPLAY THE FOLLOWING FOR 'CATEGORY NAME FROM HX03 OR HX23':

- 'PROFESSIONAL ASSOCIATION' IF CODED '1' AT HX03
- 'SMALL BUSINESS GROUP' IF CODED '2' AT HX03
- 'UNION' IF CODED '3' AT HX03
- 'INSURANCE AGENT' IF CODED '5' AT HX03
- 'INSURANCE COMPANY' IF CODED '6' AT HX03
- 'HMO' IF CODED '7' AT HX03
- 'PREVIOUS EMPLOYER' IF CODED '8' AT HX03
- 'PREVIOUS EMPLOYER [COBRA]' IF CODED '9' AT HX03
- 'HIGH RISK POOL' IF CODED '10' AT HX03
- THE TEXT ENTERED AT HX03OV IF CODED '91' AT HX03
- 'SOURCE PURCHASED FROM FOR THAT BUSINESS' IF CODED '-7' OR '-8' AT HX03

- 'GROUP OR ASSOCIATION' IF CODED '1' AT HX23
- 'SCHOOL' IF CODED '3' AT HX23
- 'INSURANCE AGENT' IF CODED '4' AT HX23
- 'INSURANCE COMPANY' IF CODED '5' AT HX23
- 'HMO' IF CODED '6' AT HX23
- 'UNION' IF CODED '7' AT HX23
- 'PREVIOUS EMPLOYER [COBRA]' IF CODED '8' AT HX23
- 'PREVIOUS EMPLOYER [NOT COBRA]' IF CODED '9' AT HX23
- 'SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER' IF CODED '10' AT HX23
- 'SOME OTHER EMPLOYER' IF CODED '11' AT HX23
- 'PLAN OF SOMEONE NOT LIVING HERE' IF CODED '12' AT HX23
- 'HIGH RISK POOL' IF CODED '13' AT HX23
- THE TEXT ENTERED AT HX23OV IF CODED '91' AT HX23
- 'SOURCE THAT PROVIDED DIRECTLY PURCHASED INSURANCE' IF CODED '-7' OR '-8'
----------------------------------------------------
----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER.
----------------------------------------------------

HP07
====

[STR-DT] [END-DT]
You mentioned that someone in the family receives health insurance from the plan of someone not living here. How does that policyholder get this insurance?
INTERVIEWER: RECORD ESTABLISHMENT NAME BELOW.

[Establishment Name] .................. [BOX_02]
----------------------------------------------------
ONLY CATEGORY '12' (UNDER PLAN OF SOMEONE NOT LIVING HERE) OF HX23 IS ASKED HP07.
----------------------------------------------------
----------------------------------------------------
WRITE ESTABLISHMENT TO THE RU-ESTABLISHMENTS- ROSTER.
----------------------------------------------------

HP08
====

OMITTED.

BOX_02
======

----------------------------------------------------
IF HX03 IS CODED '1' OR '2' FLAG ESTABLISHMENT AS 'GROUP'.
IF HX03 IS CODED '3', FLAG ESTABLISHMENT AS 'UNION'.
IF HX03 IS CODED '5', FLAG ESTABLISHMENT AS 'INSURANCE COMPANY-FROM AN AGENT'.
IF HX03 IS CODED '6', FLAG ESTABLISHMENT AS 'INSURANCE COMPANY'.
IF HX03 IS CODED '7', FLAG ESTABLISHMENT AS 'HMO'.
IF HX03 IS CODED '8', FLAG ESTABLISHMENT AS 'PREVIOUS EMPLOYER, NOT COBRA'.
IF HX03 IS CODED '9', FLAG ESTABLISHMENT AS 'COBRA'.
IF HX03 IS CODED '10', FLAG ESTABLISHMENT AS 'HIGH RISK POOL'.
IF HX03 IS CODED '11', FLAG ESTABLISHMENT AS 'EXCHANGE COVERAGE'.
IF HX03 IS CODED '91', FLAG ESTABLISHMENT AS 'UNKNOWN TYPE-COLLECTED AT OTHER'.

IF HX23 IS CODED '1', FLAG ESTABLISHMENT AS 'GROUP'.
IF HX23 IS CODED '3', FLAG ESTABLISHMENT AS 'SCHOOL'.
IF HX23 IS CODED '4', FLAG ESTABLISHMENT AS 'INSURANCE COMPANY-FROM AN AGENT'.
IF HX23 IS CODED '5', FLAG ESTABLISHMENT AS 'INSURANCE COMPANY'.
IF HX23 IS CODED '6', FLAG ESTABLISHMENT AS 'HMO'.
IF HX23 IS CODED '7', FLAG ESTABLISHMENT AS 'UNION'.
IF HX23 IS CODED '8', FLAG ESTABLISHMENT AS 'COBRA'.
IF HX23 IS CODED '9', FLAG ESTABLISHMENT AS 'PREVIOUS EMPLOYER, NOT COBRA'.
IF HX23 IS CODED '10', FLAG ESTABLISHMENT AS 'SPOUSE PREVIOUS EMPLOYER'.
IF HX23 IS CODED '11', FLAG ESTABLISHMENT AS 'EMPLOYER'.
IF HX23 IS CODED '12', FLAG ESTABLISHMENT AS 'UNKNOWN TYPE-OUTSIDE RU'.
IF HX23 IS CODED '13', FLAG ESTABLISHMENT AS 'HIGH RISK POOL'.
IF HX23 IS CODED '14', FLAG ESTABLISHMENT AS 'EXCHANGE COVERAGE'.
IF HX23 IS CODED '91', FLAG ESTABLISHMENT AS 'UNKNOWN TYPE - COLLECTED AT OTHER'.
----------------------------------------------------
----------------------------------------------------
NOTE THAT 'HEALTH INSURANCE PURCHASING ALLIANCE' (CODE '4' AT HX03 AND CODE '2' AT HX23) WAS OMITTED IN PANEL 12 ROUND 2 AND WILL BE OMITTED IN ALL FUTURE ROUNDS.
----------------------------------------------------

BOX_03
======

----------------------------------------------------
IF LOOPING ON AN HX23 CATEGORY, GO TO HP11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP09
----------------------------------------------------

HP09
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[[Are/Is]/As of [END DATE], [were/was]] [you/[PERSON]] the primary insured person or policyholder of this health coverage through [ESTABLISHMENT]?

YES .................................... 1 [LOOP_02]
NO ..................................... 2 [HP10]
REF ................................... -7 [HP10]
DK .................................... -8 [HP10]
HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.
----------------------------------------------------
DISPLAY '[Are/Is]' IF NOT ROUND 5. DISPLAY 'As of [END DATE], [were/was]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
PERSON REFERS TO JOBHOLDER.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG JOBHOLDER AS 'POLICYHOLDER'.
----------------------------------------------------

HP10
====

[NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Who [is/was] the primary insured person or policyholder of this health coverage through [ESTABLISHMENT] [on [END DATE)]]?
[JOBHOLDER/EMPLOYER-PAIR 1]
[JOBHOLDER/EMPLOYER-PAIR 2]
[JOBHOLDER/EMPLOYER-PAIR 3]

JOBHOLDER/EMPLOYER IS LISTED ........... 1 [END_LP01]
JOBHOLDER/EMPLOYER IS NOT LISTED ....... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.
[Code One]
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on [END DATE]' IF ROUND 5. OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
IF CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW), FLAG FOR EVENT CLEANUP.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_2

COL # 1 HEADER: JOBHOLDER/EMPLOYER PAIR
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAME/ESTABLISHMENT NAME (PERS.FULLNAME/ ESTB.ESTBNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-ESTABLISHMENT-PERSON-PAIRS- ROSTER FOR DISPLAY OF EMPLOYER/JOBHOLDER PAIRS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.

2. SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PAIRS ON THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER THAT MEET BOTH OF THE FOLLOWING CONDITIONS:

1. ESTABLISHMENT IS FLAGGED AS AN 'EMPLOYER' THAT IS ALSO FLAGGED AS 'PROVIDES HEALTH INSURANCE'
AND

2. PERSON IS A JOBHOLDER AT THE JOB PROVIDED BY ESTABLISHMENT
----------------------------------------------------

HP11
====

[NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Please tell me the names of everyone who is a primary insured person or policyholder of the/Who [is/was] the primary insured person or policyholder of this] health coverage through [ESTABLISHMENT] [on [END DATE]]?

[CODE ALL THAT APPLY.]
[1. First Name,[Middle Name],Last Name-35] ..
[2. First Name,[Middle Name],Last Name-35] ..
[3. First Name,[Middle Name],Last Name-35] ..
HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.
[Code All that Apply]
----------------------------------------------------
DISPLAY 'Please tell me the names of everyone who is a primary insured person or policyholder of the' IF HX23 IS CODED '14' (DIRECTLY FROM [STATE EXCHANGE NAME]). OTHERWISE, DISPLAY 'Who [is/was] the primary insured person or policyholder of the'. DISPLAY 'CODE ALL THAT APPLY' IF HX23 IS CODED '14' (DIRECTLY FROM [STATE EXCHANGE NAME]). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'is' IF NOT ROUND 5. DISPLAY 'was' IF ROUND 5. DISPLAY 'on [END DATE]' IF ROUND 5. OTHERWISE, USE NULL DISPLAY. DISPLAY A "POLICYHOLDER NOT LISTED IN DU" AND "POLICYHOLDER DECEASED" OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
IF BOTH 'POLICYHOLDER NOT LISTED IN DU' AND 'POLICYHOLDER DECEASED' ARE NOT SELECTED, GO TO LOOP_02
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES EXCEPT 'POLICYHOLDER NOT LISTED IN DU', GO TO HP11B
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER NOT LISTED IN DU' SELECTED, ALONE OR IN COMBINATION WITH OTHER NAMES AND/OR POLICYHOLDER DECEASED', CONTINUE WITH HP11A
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_1

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

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL DU MEMBERS.
----------------------------------------------------

HP11A
=====

[NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
INTERVIEWER: ENTER NAME OR DESCRIPTION OF POLICYHOLDER WHO IS NOT IN THE DU:

[Enter Specify-15] .................... [LOOP_02]
HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.
----------------------------------------------------
WHENEVER THIS POLICYHOLDER IS BEING ASKED ABOUT IN THE REMAINDER OF HP, HQ, HX, AND OE, THE POLICYHOLDER NAME IN THE CONTEXT HEADER WILL BE DISPLAYED AS 'PLCYHLDR NOT IN DU-' FOLLOWED BY THE 15 CHARACTER ENTRY AT HP11A.
----------------------------------------------------
----------------------------------------------------
IF 'POLICYHOLDER DECEASED' SELECTED AT HP11, CONTINUE WITH HP11B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO LOOP_02
----------------------------------------------------

HP11B
=====

[NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
INTERVIEWER: ENTER NAME OF DECEASED POLICYHOLDER:

[Enter Specify-40] .................... [LOOP_02]
HELP AVAILABLE FOR DEFINITION OF POLICYHOLDER.
----------------------------------------------------
FLAG POLICYHOLDER AS 'DECEASED'.
----------------------------------------------------
----------------------------------------------------
WHENEVER THE POLICYHOLDER IS BEING ASKED ABOUT IN THE REMAINDER OF HP, HQ, HX, AND OE, THE POLICYHOLDER NAME IN THE CONTEXT HEADER WILL BE DISPLAYED AS 'PLCYHLDR DECEASED-' FOLLOWED BY THE FIRST 15 CHARACTERS OF THE ENTRY AT HP11B.
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-ESTABLISHMENT-PERSON- PAIRS-ROSTER, ASK BOX_04 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION ABOUT THE POLICYHOLDER AND DEPENDENTS FOR EACH ESTABLISHMENT-PERSON. THIS LOOP CYCLES ON EACH ESTABLISHMENT-PERSON-PAIR CREATED AT HP09 AND HP11 DURING THE CURRENT ROUND FOR THE ESTABLISHMENT BEING CYCLED ON IN LOOP_01.
----------------------------------------------------

BOX_04
======

----------------------------------------------------
IF LOOPING ON AN ESTABLISHMENT FLAGGED IN EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE', GO TO BOX_07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_05
----------------------------------------------------

BOX_05
======

----------------------------------------------------
IF HX23 IS CODED '8' (PREVIOUS EMPLOYER-COBRA), '9' (PREVIOUS EMPLOYER-NOT COBRA), '10' (SPOUSE PREVIOUS EMPLOYER), OR '11' (OTHER EMPLOYER) CONTINUE WITH BOX_06
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07
----------------------------------------------------

BOX_06
======

----------------------------------------------------
IF POLICYHOLDER WAS FLAGGED AT HP11 AS 'DECEASED', CODE HP12 AS '4' (DECEASED) AUTOMATICALLY BY CAPI AND GO TO HP13
----------------------------------------------------
----------------------------------------------------
IF POLICYHOLDER IS NOT A CURRENT RU MEMBER, GO TO BOX_07
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP12
----------------------------------------------------

HP12
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Are/Is] [you/[POLICYHOLDER]] currently employed at this job, retired from this job, previously employed at this job, or is it some other situation?

CURRENTLY EMPLOYED ..................... 1 [HP13]
RETIRED ................................ 2 [HP13]
PREVIOUSLY EMPLOYED .................... 3 [HP13]
DECEASED ............................... 4 [HP13]
OTHER ................................. 91 [HP12OV]
REF ................................... -7 [HP13]
DK .................................... -8 [HP13]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
[Code One]
----------------------------------------------------
IF CODED '4' (DECEASED), FLAG POLICYHOLDER AS 'DECEASED'.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
CODE '4' (DECEASED) CANNOT BE SELECTED FOR A POLICYHOLDER WHO IS A CURRENT RU MEMBER.
----------------------------------------------------

HP12OV
======

SPECIFY:

[Enter Other Specify] .................. [HP13]
REF ................................... -7 [HP13]
DK .................................... -8 [HP13]

HP13
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[[Are/Is]/[Were/Was]] [you/[POLICYHOLDER]] a federal government employee at this job?

YES ................................... 1 [BOX_07]
NO .................................... 2 [BOX_07]
REF ................................... -7 [BOX_07]
DK .................................... -8 [BOX_07]
HELP AVAILABLE FOR DEFINITION OF FEDERAL GOVERNMENT.
----------------------------------------------------
DISPLAY '[Are/Is]' IF HP12 IS CODED '1' (CURRENTLY EMPLOYED). OTHERWISE, DISPLAY '[Were/Was]'.
----------------------------------------------------

BOX_07
======

----------------------------------------------------
IF ESTABLISHMENT THAT PROVIDES INSURANCE IS FLAGGED AS:
'EMPLOYER' AND JOB SUBTYPE IS NOT 'CURRENT AIN', 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD', OR 'RETIREMENT JOB'
OR
'EMPLOYER' AND [JOB SUBTYPE IS 'FORMER MAIN', 'FORMER MISCELLANEOUS' OR 'LAST JOB OUTSIDE REFERENCE PERIOD'] AND JOB IS ALSO FLAGGED AS 'NOT RETIRED FROM'
OR
'PREVIOUS EMPLOYER, NOT COBRA' (I.E., HX03-CODE '8'; HX23-CODE '9')
OR
'EMPLOYER' (I.E., HX23-CODE '11') AND HP12 IS NOT CODED '1' (CURRENTLY EMPLOYED)
OR
'SPOUSE PREVIOUS EMPLOYER' (I.E., HX23-CODE '10')
OR
'UNKNOWN TYPE-OUTSIDE RU' (I.E., HX23-CODE '12')
OR
'UNKNOWN TYPE-COLLECTED AT OTHER' (I.E., HX23- CODE '91'),

CONTINUE WITH HP14
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_07A
----------------------------------------------------

HP14
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Some employer insurance can be continued after leaving the company by continuing to pay the premium. This is sometimes referred to as a COBRA plan.
[Is/Was] [your/[POLICYHOLDER]'s] [ESTABLISHMENT] insurance like that [on [END DATE]]?

YES .................................... 1 [BOX_07A]
NO ..................................... 2 [BOX_07A]
REF ................................... -7 [BOX_07A]
DK .................................... -8 [BOX_07A]
HELP AVAILABLE FOR DEFINITION OF COBRA.
----------------------------------------------------
DISPLAY 'Is' IF NOT ROUND 5. DISPLAY 'Was' IF ROUND 5. DISPLAY 'on [END DATE]' IF ROUND 5. OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------

BOX_07A
=======

----------------------------------------------------
SMALL BUSINESS DETERMINATION

IF ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT MEETS THE FOLLOWING CONDITIONS:
- PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND
- PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED AS 'PROVIDES HEALTH INSURANCE', AND
- ESTABLISHMENT FLAGGED AS A CURRENT-MAIN-JOB, AND
- JOB IS FLAGGED AS 'SELF-EMPLOYED', AND
- EM124 IS GREATER THAN 1 BUT LESS THAN 200, CONTINUE WITH HP14A
----------------------------------------------------
----------------------------------------------------
SMALL BUSINESS DETERMINATION

IF ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT MEETS THE FOLLOWING CONDITIONS:
- PERSON WAS A JOBHOLDER AT ESTABLISHMENT, AND - PERSON IS FLAGGED AS THE POLICYHOLDER OF THIS INSURANCE, AND
- ESTABLISHMENT IS AN EMPLOYER FLAGGED AS 'PROVIDES HEALTH INSURANCE', AND
- ESTABLISHMENT FLAGGED AS A CURRENT-MAIN-JOB, AND
- JOB IS FLAGGED AS 'NOT SELF-EMPLOYED', AND
- FIRM SIZE IS SMALL (SEE DETERMINATION BELOW)
- EM91 IS LESS THAN 200
OR
- EM92 IS CODED '1' (LESS THAN 10), '2' (10 TO 25), '3' (26 TO 49) OR '4' (50 TO 100), AND - EM93 IS CODED '2' (NO), CONTINUE WITH HP14A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HP15
----------------------------------------------------

HP14A
=====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
In [RU STATE], [STATE SHOP NAME-A][, [which may also be known as [ALIAS B] [or [ALIAS C]]],] is a [new] program where small businesses will be able to shop for health insurance plans for their employees. Is our/[POLICYHOLDER]'s] health insurance coverage through [ESTABLISHMENT] related at all to a program like that?

YES .................................... 1 [HP15]
NO ..................................... 2 [HP15]
REF ................................... -7 [HP15]
DK .................................... -8 [HP15]
----------------------------------------------------
FOR 'RU STATE', DISPLAY THE FULL STATE NAME ASSOCIATED WITH THIS RU'S ADDRESS.

DISPLAY ', [which may also be known as [ALIAS B] [or [ALIAS C]]],' IF THERE IS MORE THAN ONE SHOP NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.

DISPLAY 'or [ALIAS C]' IF THERE ARE THREE SHOP NAMES ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.

FOR 'STATE SHOP NAME-A' 'ALIAS B', AND 'ALIAS C', DISPLAY THE SMALL BUSINESS HEALTH OPTIONS PROGRAM NAME ASSOCIATED WITH THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED.

DISPLAY 'new' IF PANEL 17 ROUND 5, PANEL 18 ROUNDS 3-5, PANEL 19 ROUNDS 1-5 OR PANEL 20 ROUNDS 1-3 (YEARS 2014 AND 2015). OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------

HP15
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Was anyone [living here] covered as a dependent under [your/ [POLICYHOLDER]'s] health coverage through [ESTABLISHMENT] at any time [since [START DATE]/between [START DATE] and [END DATE]]?

YES .................................... 1 [HP16]
NO ..................................... 2 [HP17]
REF ................................... -7 [HP17]
DK .................................... -8 [HP17]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'living here' IF LOOPING ON CODE '12' (OUTSIDE RU) AT HX23.

DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------

HP16
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DATE]
Who is that?
PROBE: Was anyone else covered as a dependent [since [START DATE]/between [START DATE] and [END DATE]]?

[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 All That Apply]
----------------------------------------------------
DISPLAY 'since [START DATE]' IF NOT ROUND 5.
DISPLAY 'between [START DATE] and [END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF 'PERSON NOT LISTED IN RU' IS SELECTED, FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU'.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_08
----------------------------------------------------
----------------------------------------------------
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 RU-MEMBERS.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.

2. ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER EXCLUDING THE PERSON WHO IS THE POLICYHOLDER FOR THIS INSURANCE; THAT IS, DO NOT DISPLAY THE NAME OF PERSON IN THE ESTABLISHMENT-PERSON-PAIR BEING ASKED ABOUT.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PERSON NOT LISTED IN RU' AS LAST ITEM ON ROSTER.
----------------------------------------------------

HP17
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Does/Between [START DATE] and [END DATE], did] [your/ [POLICYHOLDER]'s] health coverage through [ESTABLISHMENT] cover as dependents any persons who do not live here?

YES .................................... 1 [BOX_08]
NO ..................................... 2 [BOX_08]
REF ................................... -7 [BOX_08]
DK .................................... -8 [BOX_08]
HELP AVAILABLE FOR DEFINITION OF DEPENDENT.
----------------------------------------------------
DISPLAY 'Does' IF NOT ROUND 5. DISPLAY 'Between [START DATE] and [END DATE], did' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES), FLAG INSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR AS 'COVERING PERSON NOT LISTED IN RU' IN HP16.
----------------------------------------------------

BOX_08
======

----------------------------------------------------
IF THERE ARE NO POLICYHOLDERS OR DEPENDENTS WHO ARE CURRENT RU MEMBERS, THAT IS, POLICYHOLDER IS ADU MEMBER BUT NOT A CURRENT RU MEMBER, OR IS FLAGGED AS 'NOT LISTED IN DU' OR 'POLICYHOLDER DECEASED' AND INSURANCE ALSO FLAGGED ONLY AS 'COVERING PERSON NOT IN RU', GO TO END_LP02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH LOOP_03
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER, ASK NAV_HP03 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 COLLECTS TIME PERIOD COVERAGE FOR ALL CURRENT RU MEMBERS COVERED BY THEINSURANCE THROUGH THIS ESTABLISHMENT-PERSON-PAIR.
THIS LOOP CYCLES ON CURRENT RU MEMBERS WHO ARE SELECTED AS DEPENDENTS AT HP16 AND THE RU MEMBER WHO IS FLAGGED AS THE POLICYHOLDER FOR THIS INSURANCE.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_03 USES NAV_HP03 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_HP03
========

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT]
SERIES: [Insurance Coverage Duration during Reference Period / Self-Employed RU Member's Insurance Coverage]
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

Question Series
[1. Coverage duration for [Person's Name-65] through
[Establishment Name-30]] [Status-25]
[2. Coverage duration for [Person's Name-65] through
[Establishment Name-30]] [Status-25]
[3. Coverage duration for [Person's Name-65] through
[Establishment Name-30]] [Status-25]
----------------------------------------------------
DISPLAY 'Self-Employed RU Member's Insurance Coverage' IF LOOPING ON AN HX03 CATEGORY. OTHERWISE, DISPLAY 'Insurance Coverage Duration during Reference Period.'
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: QUESTION SERIES
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-ESTB-PLCYHLDR-COVRD- PERS-TRPLS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS SELECTED AT HP16.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_09 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_09
======

----------------------------------------------------
ASK THE TIME PERIOD COVERED DETAIL (HQ) SECTION.

AT COMPLETION OF TIME PERIOD COVERED DETAIL (HQ) SECTION, CONTINUE WITH END_LP03
----------------------------------------------------

END_LP03
========

----------------------------------------------------
CYCLE ON NEXT PERSON IN THE RU-ESTB-PLCYHLDR- COVRD-PERS-TRPLS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_03 AND CONTINUE WITH END_LP02
----------------------------------------------------

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PAIR IN THE RU-ESTABLISHMENT-PERSON-PAIRS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH BOX_10
----------------------------------------------------

BOX_10
======

----------------------------------------------------
IF LOOPING ON AN ESTABLISHMENT FLAGGED IN EMPLOYMENT AS 'PROVIDES HEALTH INSURANCE' AND NOT FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE-1,
OR
IF LOOPING ON AN ESTABLISHMENT FLAGGED AS 'EXCHANGE COVERAGE' (I.E., LOOPING ON HX03 CATEGORY '11' OR HX23 CATEGORY '14'), GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH HP18
----------------------------------------------------

HP18
====

[POLICYHOLDER FIRST MIDDLE LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
Aside from [your/[POLICYHOLDER]'s] [ESTABLISHMENT] insurance, is there another health insurance plan that anyone in the family obtains from [CATEGORY NAME FROM HX03 OR HX23]?

YES .................................... 1 [END_LP01]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
----------------------------------------------------
DISPLAY THE FOLLOWING FOR 'CATEGORY NAME FROM HX03 OR HX23':

- 'a professional association' IF CODED '1' AT HX03
- 'a small business group' IF CODED '2' AT HX03
- 'a union' IF CODED '3' AT HX03
- 'an insurance agent' IF CODED '5' AT HX03
- 'an insurance company' IF CODED '6' AT HX03
- 'an HMO' IF CODED '7' AT HX03
- 'a previous employer' IF CODED '8' AT HX03
- 'a previous employer (COBRA)' IF CODED '9' AT HX03
- 'a high risk pool' IF CODED '10' AT HX03
- 'the [HX03OV OTHER SPECIFY TEXT]' IF CODED '91' AT HX03
- 'source purchased for that business' IF CODED
'-7' OR '-8' AT HX03
- 'a group or association' IF CODED '1' AT HX23
- 'a school' IF CODED '3' AT HX23
- 'an insurance agent' IF CODED '4' AT HX23
- 'an insurance company' IF CODED '5' AT HX23
- 'an HMO' IF CODED '6' AT HX23
- 'a union' IF CODED '7' AT HX23
- 'a previous employer (COBRA)' IF CODED '8' AT HX23
- 'a previous employer (not COBRA)' IF CODED '9' AT HX23
- 'a spouse's (or deceased spouse's) previous employer' IF CODED '10' AT HX23
- 'some other employer' IF CODED '11' AT HX23
- 'the plan of someone not living here' IF CODED '12' AT HX23
- 'a high risk pool' IF CODED '13' AT HX23
- 'the [HX23OV OTHER SPECIFY TEXT] IF CODED '91' AT HX23
- 'a source that provided directly purchased insurance' IF CODED '-7' OR '-8'
----------------------------------------------------

END_LP01
========

----------------------------------------------------
IF HP18 IS CODED '1' (YES), CYCLE TO COLLECT NEXT ESTABLISHMENT NAME.
----------------------------------------------------
----------------------------------------------------
IF HP18 IS NOT ASKED OR IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), END LOOP_01 AND CONTINUE WITH BOX_11
----------------------------------------------------

BOX_11
======

----------------------------------------------------
RETURN TO THE HEALTH INSURANCE (HX) SECTION.
----------------------------------------------------

Time Period Covered Detail (HQ) Section

BOX_00
======

HQ01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Were/Was] [you/[PERSON]] covered the whole time from [START DATE] until [today/[END DATE]], or only part of the time?

WHOLE TIME ............................. 1 [BOX_01]
PART OF THE TIME ....................... 2
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]
----------------------------------------------------
DISPLAY 'today' IF NOT ROUND 5. DISPLAY '[END DATE]' IF ROUND 5.
----------------------------------------------------
----------------------------------------------------
FOR ROUND 5, DISPLAY END DATE IN THE CONTEXT HEADER FOR QUESTIONS HQ01 AND HQ05.
-----------------------------------------------------
----------------------------------------------------
IF ROUND 5 AND CODED '2' (PART OF THE TIME), GO TO HQ05
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 5 AND CODED '2' (PART OF THE TIME), CONTINUE WITH HQ02
----------------------------------------------------

HQ02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Are/Is] [you/[PERSON]] covered now?

YES .................................... 1 [HQ03]
NO ..................................... 2 [HQ04]
REF ................................... -7 [HQ04]
DK .................................... -8 [HQ04]

HQ03
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Have/Has] [you/[PERSON]] been covered continuously, since the first of [INTERVIEW MONTH] through today?

YES .................................... 1 [HQ05]
NO ..................................... 2 [HQ05]
REF ................................... -7 [HQ05]
DK .................................... -8 [HQ05]
----------------------------------------------------
DISPLAY NAME OF MONTH IN WHICH INTERVIEW IS BEING CONDUCTED (I.E., MONTH IN WHICH INTERVIEW FIRST STARTED) FOR 'INTERVIEW MONTH'.
----------------------------------------------------

HQ04
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
[Were/Was] [you/[PERSON]] covered at all during [INTERVIEW MONTH]?

HQ05
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF ESTABLISHMENT] [STR-DT] [END-DT]
For each of the following months, [were/was] [you/[PERSON]] covered the whole month, part of the month, or not at all during the month? (READ MONTH NAMES BELOW.)
1 = WHOLE MONTH
2 = PART OF MONTH (INCLUDING FIRST OF MONTH)
3 = PART OF MONTH (NOT INCLUDING FIRST OF MONTH)
4 = NOT COVERED

HQ05_01. MONTH AND YEAR HQ05_02. COVERAGE
1. MONTH AND YEAR [Enter Selection]
2. MONTH AND YEAR [Enter Selection]
3. MONTH AND YEAR [Enter Selection]
----------------------------------------------------
NOTE: THE NUMBER AND NAMES OF THE MONTHS LISTED ARE DETERMINED BY THE NUMBER OF MONTHS BETWEEN THE MONTH PRIOR TO THE MONTH OF THE INTERVIEW AND THE MONTH OF THE REFERENCE DATE.
FOR EXAMPLE, IF THE REFERENCE DATE IS JANUARY 1 AND THE INTERVIEW DATEIS APRIL 10, 'JANUARY', 'FEBRUARY', AND 'MARCH' ARE DISPLAYED. 'APRIL' WOULD NOT BE ASKED ABOUT INHQ05 BECAUSE QUESTIONS HQ03 AND HQ04 DETERMINED THE COVERAGE DURING THE INTERVIEW MONTH.

FOR ROUND 5, THE END DATE IS NOT THE INTERVIEW DATE. IT IS EITHER 12/31/[YEAR] OR THE DATE THE PERSON LEFT THE RU, DIED, WAS INSTITUTIONALIZED, MOVED, ETC.
----------------------------------------------------
----------------------------------------------------
THE SCREEN LAYOUT SHOULD ACCOMMODATE AS MANY MONTHS AS POSSIBLE.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDIT: ALL MONTHS DISPLAYED AT HQ05 CANNOT BE CODED '4' (NOT COVERED) WHEN THE PERSON IS NOT COVERED DURING THE INTERVIEW MONTH (HQ04=2). IF ALL ARE, DISPLAY THE FOLLOWING MESSAGE: "MUST BE COVERED AT LEAST PART OF ONE MONTH. IF NOT, BACK UP AND DELETE PERSON FROM COVERED PERSON ROSTER."
----------------------------------------------------
----------------------------------------------------
GO TO BOX_01
----------------------------------------------------

BOX_01
======

----------------------------------------------------
RETURN TO THE HX, HP, OR PR SECTION.
----------------------------------------------------

Income (IN) Section

BOX_00A
=======

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

BOX_00A
=======

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

IN01
====

For the next questions, it might be useful to have out some of the family's financial records, such as a copy of the family's tax forms or materials used to complete the tax form, such as year end bank statements, financial summaries, pay stubs, W-2 forms, and the like.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
NOTE: FOR ALL DOLLAR AMOUNT RANGE CHECKS, ALLOW THE ENTRY OF WHOLE DOLLAR AMOUNTS ONLY; DO NOT COLLECT CENTS.
----------------------------------------------------

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_IN01 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 DETERMINES WHICH RU MEMBERS HAVE FILED OR WILL FILE A FEDERAL INCOME TAX FORM FOR THE CALENDAR YEAR. IF A JOINT RETURNWAS OR WILL BE FILED, THE LOOP DETERMINES WHO IS THE SECONDARY FILER. THIS LOOP CYCLES ON PERSONS WHO MEET THE FOLLOWING CONDITION:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_IN01 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_IN01
========

SERIES: Filing Federal Income Tax Return? (e.g., filed yet, filing status, who filing with, which 1040 form, type of deductions?)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS INCLUDING DECEASED AND INSTITUTIONALIZED RU MEMBERS
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_00 FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_00
======

----------------------------------------------------
IF PERSON BEING LOOPED ON IS FLAGGED AS 'SECONDARY FILER ON JOINT FEDERAL TAX RETURN', GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH IN02
----------------------------------------------------

IN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Have/Has] [you/[PERSON]] filed a [YEAR] Federal income tax return?

YES .................................... 1 [IN04]
NO ..................................... 2 [IN03]
REF ................................... -7 [IN03]
DK .................................... -8 [IN03]
HELP AVAILABLE FOR DEFINITION OF TAX RETURN.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN03
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Will [you/[PERSON]] file a [YEAR] Federal income tax return?

YES .................................... 1 [IN04]
NO ..................................... 2 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
HELP AVAILABLE FOR DEFINITION OF TAX RETURN.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN04
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
What [was/will be] [your/[PERSON]'s] filing status ...

single; ................................ 1 [IN06]
married filing joint return; ........... 2 [IN05]
married filing separately; ............. 3 [IN06]
head of household with qualifying person; or ........................... 4 [IN06]
qualifying widow(er) with dependent children? ............................ 5 [IN06]
REF ................................... -7 [IN06]
DK .................................... -8 [IN06]
[Code One]
HELP AVAILABLE FOR DEFINITION OF RESPONSE CATEGORIES.
----------------------------------------------------
DISPLAY 'was' IF IN02 IS CODED '1' (YES). DISPLAY 'will be' IF IN03 IS CODED '1' (YES).
----------------------------------------------------
----------------------------------------------------
FLAG PERSON BEING LOOPED ON AS 'PRIMARY FILER ON FEDERAL TAX RETURN'.
----------------------------------------------------

IN05
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Who is the other taxpayer that [you/[PERSON]] [are/is] filing jointly with?

[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 'FILING JOINTLY'.
----------------------------------------------------
FLAG PERSON SELECTED AT IN05 AS 'SECONDARY FILER ON JOINT FEDERAL TAX RETURN'.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH IN06
----------------------------------------------------
----------------------------------------------------
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. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.

3. DISPLAY 'PERSON NOT IN RU' AS THE LAST ENTRY ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON IS NOT ALREADY FLAGGED AS A 'PRIMARY FILER ON FEDERAL TAX RETURN'
- PERSON IS NOT ALREADY FLAGGED AS A 'SECONDARY FILER ON FEDERAL TAX RETURN'
----------------------------------------------------

IN06
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Did/Will] [you/[PERSON]] claim any dependents on [your/his/her] Federal tax return?

YES .................................... 1 [IN07]
NO ..................................... 2 [IN09]
REF ................................... -7 [IN09]
DK .................................... -8 [IN09]
HELP AVAILABLE FOR DEFINITION OF DEPENDENTS.
----------------------------------------------------
DISPLAY 'Did' IF IN02 IS CODED '1' (YES). DISPLAY 'Will' IF IN03 IS CODED '1' (YES).
----------------------------------------------------

IN07
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Who [is/will be] listed as [your/[PERSON]'s] dependents?

[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]
----------------------------------------------------
DISPLAY 'is' IF IN02 IS CODED '1' (YES). DISPLAY 'will be' IF IN03 IS CODED '1' (YES).
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_IN07
----------------------------------------------------
----------------------------------------------------
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.

3. DISPLAY 'PERSON(S) NOT IN RU' AS THE LAST ENTRY ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON IS NOT A JOINT FILER (I.E., PERSON WAS NOT SELECTED AT IN05)
- PERSON IS NOT CURRENTLY BEING LOOPED ON.
----------------------------------------------------

BOX_IN07
========

----------------------------------------------------
IF 'PERSON(S) NOT IN RU' SELECTED AT IN07, CONTINUE WITH IN08
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO IN09
----------------------------------------------------

IN08
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How many of the dependents that are being claimed on [your/[PERSON]'s] Federal income tax return live outside of this household?

[Enter Number of Dependents] ........... [IN09]
REF .................................... -7 [IN09]
DK ..................................... -8 [IN09]
HELP AVAILABLE FOR DEFINITION OF HOUSEHOLD.
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 1-10
----------------------------------------------------

IN09
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Did/Will] [you/[PERSON]] file on the long form 1040, the short form 1040A, or the short form 1040EZ?

LONG FORM 1040 ......................... 1 [IN15]
SHORT FORM 1040A ....................... 2 [IN17]
SHORT FORM 1040EZ ...................... 3 [END_LP01]
OTHER .................................. 91 [IN15]
REF .................................... -7 [END_LP01]
DK ..................................... -8 [END_LP01]
[Code One]
----------------------------------------------------
DISPLAY 'Did' IF IN02 IS CODED '1' (YES). DISPLAY 'Will' IF IN03 IS CODED '1' (YES).
----------------------------------------------------

IN10
====

OMITTED.

IN11
====

OMITTED.

IN12
====

OMITTED.

IN13
====

OMITTED.

IN14
====

OMITTED.

IN15
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Did/Will] [you/[PERSON]] claim a deduction for health insurance premiums?

YES .................................... 1 [IN17]
NO ..................................... 2 [IN17]
NOT APPLICABLE ......................... 3 [IN17]
REF ................................... -7 [IN17]
DK .................................... -8 [IN17]
[Code One]
HELP AVAILABLE FOR DEFINITION OF HEALTH INSURANCE DEDUCTION.
----------------------------------------------------
DISPLAY 'Did' IF IN02 IS CODED '1' (YES). DISPLAY 'Will' IF IN03 IS CODED '1' (YES).
----------------------------------------------------

IN16
====

OMITTED.

IN17
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
[Did/Will] [you/[PERSON]] receive earned income credits?

YES .................................... 1 [END_LP01]
NO ..................................... 2 [END_LP01]
NOT APPLICABLE ......................... 3 [END_LP01]
REF ................................... -7 [END_LP01]
DK .................................... -8 [END_LP01]
[Code One]
HELP AVAILABLE FOR DEFINITION OF EARNED INCOME CREDITS.
----------------------------------------------------
DISPLAY 'Did' IF IN02 IS CODED '1' (YES). DISPLAY 'Will' IF IN03 IS CODED '1' (YES).
----------------------------------------------------

END_LP01
========

BOX_01
======

OMITTED.

IN17A
=====

TAXABLE INCOME QUESTIONS ARE NEXT.
SELECT NEXT PAGE OR PRESS ENTER TO CONTINUE.
----------------------------------------------------
CONTINUE WITH LOOP_02
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_IN02 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS INFORMATION ON TAXABLE INCOME FOR EACH RU MEMBER WHO IS 16 YEARS OF AGE OR OLDER OR HAS FILED OR WILL FILE A FEDERAL TAX RETURN FOR THIS CALENDAR YEAR. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS- ROSTER WHO MEETS THE FOLLOWING CONDITION:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED
AND INSTITUTIONALIZED RU MEMBERS)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_02 USES NAV_IN02 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_IN02
========

SERIES: Taxable Income Information for Those Filing or Over 16 (e.g., wages, interest, dividends, business or property income or loss, IRAs, pensions, unemployment?)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS INCLUDING DECEASED AND INSTITUTIONALIZED RU MEMBERS
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_01A FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_01A
=======

----------------------------------------------------
IF PERSON BEING LOOPED ON IS FLAGGED AS A 'PRIMARY FILER ON FEDERAL TAX RETURN', GO TO IN18
----------------------------------------------------
----------------------------------------------------
IF PERSON BEING LOOPED ON IS FLAGGED AS A 'SECONDARY FILER ON A JOINT FEDERAL TAX RETURN', GO TO END_LP02
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., PERSON IS NOT FLAGGED AS EITHER 'PRIMARY FILER ON FEDERAL TAX RETURN' OR A 'SECONDARY FILER ON A JOINT FEDERAL TAX RETURN', THAT IS, IN03 IS CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW)), CONTINUE WITH BOX_01B
----------------------------------------------------

BOX_01B
=======

----------------------------------------------------
IF PERSON BEING LOOPED ON IS 16 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9), CONTINUE WITH IN18
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., PERSON IS LESS THAN 16 YEARS OF AGE (OR IN AGE CATEGORIES 1-3) AND IN03 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW)), GO TO END_LP02
----------------------------------------------------
----------------------------------------------------
NOTE: THE PURPOSE OF BOX_01A AND BOX_01B IS TO SKIP OUT PERSONS ALREADY FLAGGED AS SECONDARY FILERS AND PERSONS YOUNGER THAN 16 YEARS OF AGE WHO HAVE NOT ALREADY REPORTED THAT THEY HAVE FILED OR WILL FILE A FEDERAL INCOME TAX RETURN.
----------------------------------------------------
----------------------------------------------------
NOTE: PERSONS REPORTING THAT THEY HAVE FILED OR WILL FILE A 1040A SHORT FORM (IN09=2) OR A 1040EZ FORM (IN09=3) RECEIVE THE WAGES, INTEREST, DIVIDENDS, IRA, PENSIONS, UNEMPLOYMENT, AND SOCIALSECURITY TAXABLE INCOME ITEMS.

PERSONS REPORTING THAT THEY HAVE FILED OR WILL FILE A 1040 LONG FORM, OTHER TYPE OF FORM, OR REFUSED OR DON'T KNOW THE TYPE OF FORM (IN09=1, 91, -7, -8) RECEIVE ALL THE TAXABLE INCOME QUESTIONS.

PERSONS REPORTING THAT THEY HAVE NOT AND WILL NOT FILE ANY FEDERAL TAX RETURN (IN03=2, -7, -8) AND ARE 16 YEARS OF AGE OR OLDER ALSO RECEIVE ALL THE TAXABLE INCOME QUESTIONS.
----------------------------------------------------

IN18
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
[People get money from many different sources, such as wages and salaries, social security, and interest on savings. The next few questions ask about different sources of income that [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] received in [YEAR]. It would be useful to have out any tax materials that you may have.] [Now let's talk about [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]].] During [YEAR], how much money did [they/[you/he/she]] receive from wages or salary, tips, commissions, or bonuses?

[Enter $ Amount] ....................... [BOX_IN18]
REF .................................... -7 [IN19]
DK ..................................... -8 [IN18A]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.
----------------------------------------------------
DISPLAY 'People get money from many different sources, such as wages and salaries, social security, and interest on savings. The next few questions ask about different sources of income that (READ NAME(S) ABOVE) received in [YEAR]. It would be useful to have out any tax materials that you may have.' IF FIRST CYCLE THROUGH LOOP_02.
OTHERWISE, USE NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'Now let's talk about (READ NAME(S) ABOVE):' IF NOT FIRST CYCLE THROUGH LOOP_02. IF FIRST CYCLE THROUGH LOOP_02, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.

DISPLAY 'they' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, DISPLAY '[you/he/she]' USING THE PERSON BEING LOOPED ON TO DETERMINE PRONOUN SUBSTITUTION.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-300,000
----------------------------------------------------

BOX_IN18
========

----------------------------------------------------
IF AMOUNT OTHER THAN ZERO ENTERED AT IN18 AND IN04 IS CODED '2' (MARRIED FILING JOINT RETURN), CONTINUE WITH IN18OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO IN19
----------------------------------------------------

IN18OV
======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
What percentage of this amount was received by [you/[PERSON]]?

[Enter Percent] ........................ [IN19]
REF .................................... -7 [IN19]
DK ..................................... -8 [IN19]
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0-100
----------------------------------------------------

IN18A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-1.
Which of the ranges on this card is the best estimate of how much money was received [from wages or salary, tips, commissions, or bonuses in [YEAR]]?

1 - 5,000 ............................... 1 [IN19]
5,001 - 10,000 .......................... 2 [IN19]
10,001 - 15,000 ......................... 3 [IN19]
15,001 - 25,000 ......................... 4 [IN19]
25,001 - 50,000 ......................... 5 [IN19]
50,001 - 100,000 ........................ 6 [IN19]
100,001 OR MORE ......................... 7 [IN19]
REF .................................... -7 [IN19]
DK ..................................... -8 [IN19]
[Code One]
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN19
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive in taxable interest from savings accounts, bonds, NOW accounts, money market accounts, or similar types of investments? [IF NECESSARY, SAY: If any interest from a joint account, include only the amount that would be [your/his/her] portion.]

[Enter $ Amount] ....................... [IN20]
REF .................................... -7 [IN20]
DK ..................................... -8 [IN19A]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.
----------------------------------------------------
DISPLAY 'IF NECESSARY, SAY ... portion.' IF IN04 IS NOT CODED '2' (MARRIED, FILING JOINT RETURN) OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED '2' (MARRIED, FILING JOINT RETURN), USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-100,000
----------------------------------------------------

BOX_IN19
========

OMITTED.

IN19OV
======

OMITTED.

IN19A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was received [in interest from savings accounts, bonds, NOW accounts, money market accounts, or similar types of investments in [YEAR]]?

1 - 100 ................................. 1 [IN20]
101 - 500 ............................... 2 [IN20]
501 - 1,000 ............................. 3 [IN20]
1,001 - 5,000 ........................... 4 [IN20]
5,001 - 15,000 .......................... 5 [IN20]
15,001 OR MORE .......................... 6 [IN20]
REF .................................... -7 [IN20]
DK ..................................... -8 [IN20]
[Code One]
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN19B
=====

OMITTED.

BOX_02
======

OMITTED.

IN20
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from dividends? [IF NECESSARY, SAY: If any dividends from a joint source, include only the amount that would be [your/his/her] portion.]

[Enter $ Amount] ....................... [BOX_02A]
REF .................................... -7 [BOX_02A]
DK ..................................... -8 [IN20A]
HELP AVAILABLE FOR DEFINITION OF DIVIDENDS.
----------------------------------------------------
DISPLAY 'IF NECESSARY, SAY ... portion.' IF IN04 IS NOT CODED '2' (MARRIED, FILING JOINT RETURN) OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED '2' (MARRIED, FILING JOINT RETURN), USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: $0-$100,000
----------------------------------------------------

IN20A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was received [from dividends in [YEAR]]?

1 - 100 ................................. 1 [BOX_02A]
101 - 500 ............................... 2 [BOX_02A]
501 - 1,000 ............................. 3 [BOX_02A]
1,001 - 5,000 ........................... 4 [BOX_02A]
5,001 - 15,000 .......................... 5 [BOX_02A]
15,001 OR MORE .......................... 6 [BOX_02A]
REF .................................... -7 [BOX_02A]
DK ..................................... -8 [BOX_02A]
[Code One]
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

BOX_02A
=======

----------------------------------------------------
IF IN09 IS CODED '2' (SHORT FORM 1040A), OR '3' (SHORT FORM 1040EZ) GO TO IN25
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH IN22
----------------------------------------------------

IN21
====

OMITTED.

IN21A
=====

OMITTED.

IN22
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from alimony?

[Enter $ Amount] ....................... [IN23]
REF .................................... -7 [IN23]
DK ..................................... -8 [IN22A]
HELP AVAILABLE FOR DEFINITION OF ALIMONY.
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-100,000
----------------------------------------------------

IN22A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was received [from alimony in [YEAR]]?

1 - 100 ................................. 1 [IN23]
101 - 500 ............................... 2 [IN23]
501 - 1,000 ............................. 3 [IN23]
1,001 - 5,000 ........................... 4 [IN23]
5,001 - 15,000 .......................... 5 [IN23]
15,001 OR MORE .......................... 6 [IN23]
REF .................................... -7 [IN23]
DK ..................................... -8 [IN23]
[Code One]
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN23
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] earn or lose from [their/[your/his/her]] own farm or non-farm business or practice? [IF NECESSARY, SAY: If any money from a shared business, include only the amount that would be [your/his/her] portion.]

[Enter $ Amount] ....................... [BOX_IN23]
REF .................................... -7 [IN24]
DK ..................................... -8 [IN23A]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.
----------------------------------------------------
DISPLAY 'IF NECESSARY, SAY ... portion.' IF IN04 IS NOT CODED '2' (MARRIED, FILING JOINT RETURN) OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED '2' (MARRIED, FILING JOINT RETURN), USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.

DISPLAY 'their' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, DISPLAY '[your/his/her]' USING THE PERSON BEING LOOPED ON TO DETERMINE PRONOUN SUBSTITUTION.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-300,000
----------------------------------------------------

BOX_IN23
========

----------------------------------------------------
IF AMOUNT OTHER THAN ZERO ENTERED AT IN23, CONTINUE WITH IN23OV1
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO IN24
----------------------------------------------------

IN23OV1
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
INTERVIEWER: WAS THE AMOUNT ENTERED EARNINGS OR LOSS?
EARNINGS ............................... 1 [BOX_IN23OV1]
LOSS ................................... 2 [BOX_IN23OV1]
[Code One]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

BOX_IN23OV1
===========

----------------------------------------------------
IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN), CONTINUE WITH IN23OV2
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO IN24
----------------------------------------------------

IN23OV2
=======

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
What percentage of this amount was [received/lost] by [you/[PRIMARY FILER]]?

[Enter Percent] ........................ [IN24]
REF .................................... -7 [IN24]
DK ..................................... -8 [IN24]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.
----------------------------------------------------
IF IN23OV1 IS CODED '1' (EARNINGS), DISPLAY 'received'. IF IN23OV1 IS CODED '2' (LOSS), DISPLAY 'lost'.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 0-100
----------------------------------------------------

IN23A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was earned or lost [from [their/[your/his/her]] own farm or non-farm business or practice in [YEAR]]?

1 - 100 ................................. 1 [IN23AOV]
101 - 500 ............................... 2 [IN23AOV]
501 - 1,000 ............................. 3 [IN23AOV]
1,001 - 5,000 ........................... 4 [IN23AOV]
5,001 - 15,000 .......................... 5 [IN23AOV]
15,001 OR MORE .......................... 6 [IN23AOV]
REF .................................... -7 [IN24]
DK ..................................... -8 [IN24]
[Code One]
----------------------------------------------------
DISPLAY 'their' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, DISPLAY '[your/his/her]' USING THE PERSON BEING LOOPED ON TO DETERMINE PRONOUN SUBSTITUTION.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN23AOV
=======

INTERVIEWER: DOES THE RANGE SELECTED REPRESENT EARNINGS OR LOSS?
EARNINGS ............................... 1 [IN24]
LOSS ................................... 2 [IN24]
[Code One]

IN24
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much money was [your/[PERSON]'s] [and [your/[NAME OF SECONDARY FILER]'s]] net gain or net loss from the sale of property or other assets, including the sale of [their/[your/his/her]] home, if it was taxable? [IF NECESSARY, SAY: If any money from a shared property or other asset, include only the amount that would be [your/his/her] portion.]

[Enter $ Amount] ....................... [BOX_IN24]
REF .................................... -7 [IN25]
DK ..................................... -8 [IN24A]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.
----------------------------------------------------
DISPLAY 'IF NECESSARY, SAY ... portion.' IF IN04 IS NOT CODED '2' (MARRIED, FILING JOINT RETURN) OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED '2' (MARRIED, FILING JOINT RETURN), USE A NULL DISPLAY.
----------------------------------------------------
-----------------------------------------------------
DISPLAY '[and [your/[NAME OF SECONDARY FILER]'s]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN) OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'your' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]'s]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.

DISPLAY 'their' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, DISPLAY '[your/his/her]' USING THE PERSON BEING LOOPED ON TO DETERMINE PRONOUN SUBSTITUTION.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-300,000
----------------------------------------------------

BOX_IN24
========

----------------------------------------------------
IF AMOUNT OTHER THAN ZERO ENTERED AT IN24, CONTINUE WITH IN24OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO IN25
----------------------------------------------------

IN24OV
======

INTERVIEWER: WAS THE AMOUNT ENTERED A NET GAIN OR A NET LOSS?
NET GAIN ............................... 1 [IN25]
NET LOSS ............................... 2 [IN25]
[Code One]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

IN24A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was earned or lost [from the sale of property or other assets, including the sale of [their/[your/his/her]] home, if it was taxable, in [YEAR]]?

1 - 100 ................................. 1 [IN24AOV]
101 - 500 ............................... 2 [IN24AOV]
501 - 1,000 ............................. 3 [IN24AOV]
1,001 - 5,000 ........................... 4 [IN24AOV]
5,001 - 15,000 .......................... 5 [IN24AOV]
15,001 OR MORE .......................... 6 [IN24AOV]
REF .................................... -7 [IN25]
DK ..................................... -8 [IN25]
[Code One]
----------------------------------------------------
DISPLAY 'their' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, DISPLAY '[your/his/her]' USING THE PERSON BEING LOOPED ON TO DETERMINE PRONOUN SUBSTITUTION.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN24AOV
=======

INTERVIEWER: DOES THE RANGE SELECTED REPRESENT NET GAIN OR NET LOSS?
NET GAIN ............................... 1 [IN25]
NET LOSS ............................... 2 [IN25]
[Code One]

IN25
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from payments from Individual Retirement Accounts, that is, IRA, Keogh, or 401K accounts?

[Enter $ Amount] ....................... [IN26]
REF .................................... -7 [IN26]
DK ..................................... -8 [IN25A]
HELP AVAILABLE FOR DEFINITION OF IRA.
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-100,000
----------------------------------------------------

BOX_IN25
========

OMITTED.

IN25OV
======

OMITTED.

IN25A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was received [from payments from IRA, Keogh, and 401K accounts in [YEAR]]?

1 - 100 ................................. 1 [IN26]
101 - 500 ............................... 2 [IN26]
501 - 1,000 ............................. 3 [IN26]
1,001 - 5,000 ........................... 4 [IN26]
5,001 - 15,000 .......................... 5 [IN26]
15,001 OR MORE .......................... 6 [IN26]
REF .................................... -7 [IN26]
DK ..................................... -8 [IN26]
[Code One]
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN26
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from private pensions, military retirement, other Federal government employee pensions, state or local government employee pensions, or annuities?

[Enter $ Amount] ....................... [BOX_02B]
REF .................................... -7 [BOX_02B]
DK ..................................... -8 [IN27]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-300,000
----------------------------------------------------

IN27
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-1.
Which of the ranges on this card is the best estimate of how much money was received [from private pensions, military retirement, Other Federal government employee pensions, state or local government employee pensions, or annuities in [YEAR]]?

1 - 5,000 ............................... 1 [BOX_02B]
5,001 - 10,000 .......................... 2 [BOX_02B]
10,001 - 15,000 ......................... 3 [BOX_02B]
15,001 - 25,000 ......................... 4 [BOX_02B]
25,001 - 50,000 ......................... 5 [BOX_02B]
50,001 - 100,000 ........................ 6 [BOX_02B]
100,001 OR MORE ......................... 7 [BOX_02B]
REF .................................... -7 [BOX_02B]
DK ..................................... -8 [BOX_02B]
[Code One]
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

BOX_02B
=======

----------------------------------------------------
IF IN09 IS CODED '2' (SHORT FORM 1040A) OR '3' (SHORT FORM 1040EZ), GO TO IN30
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH IN28
----------------------------------------------------

IN28
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive as a net gain or loss from estates or trusts, partnerships, S corporations, royalties, or from rental income? [IF NECESSARY, SAY: If any money from a joint venture, include only the amount that would be [your/his/her] portion.]

[Enter $ Amount] ....................... [BOX_IN28]
REF .................................... -7 [IN30]
DK ..................................... -8 [IN28A]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.
----------------------------------------------------
DISPLAY 'IF NECESSARY, SAY ... portion.' IF IN04 IS NOT CODED '2' (MARRIED, FILING JOINT RETURN) OR IF IN04 WAS NOT ASKED. IF IN04 IS CODED '2' (MARRIED, FILING JOINT RETURN), USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-300,000
----------------------------------------------------

BOX_IN28
========

----------------------------------------------------
IF AMOUNT OTHER THAN ZERO ENTERED AT IN28, CONTINUE WITH IN28OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO IN30
----------------------------------------------------

IN28OV
======

INTERVIEWER: WAS THE AMOUNT ENTERED A NET GAIN OR A NET LOSS?
NET GAIN ............................... 1 [IN30]
NET LOSS ............................... 2 [IN30]
[Code One]
HELP AVAILABLE FOR DESCRIPTION OF AMOUNTS TO INCLUDE.

IN28A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was earned or lost [from estates or trusts, partnerships, S corporations, royalties, or from rental income in [YEAR]]?

1 - 100 ................................. 1 [IN28AOV1]
101 - 500 ............................... 2 [IN28AOV1]
501 - 1,000 ............................. 3 [IN28AOV1]
1,001 - 5,000 ........................... 4 [IN28AOV1]
5,001 - 15,000 .......................... 5 [IN28AOV1]
15,001 OR MORE .......................... 6 [IN28AOV1]
REF .................................... -7 [IN30]
DK ..................................... -8 [IN30]
[Code One]
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN28AOV1
========

INTERVIEWER: DOES THE RANGE SELECTED REPRESENT
NET GAIN OR NET LOSS?
NET GAIN ............................... 1 [IN30]
NET LOSS ............................... 2 [IN30]
[Code One]

IN29
====

OMITTED.

BOX_IN29
========

OMITTED.

IN29OV1
=======

OMITTED.

BOX_IN29OV1
===========

OMITTED.

IN29OV2
=======

OMITTED.

IN29A
=====

OMITTED.

IN29AOV
=======

OMITTED.

IN30
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from unemployment compensation?

[Enter $ Amount] ....................... [IN31]
REF .................................... -7 [IN31]
DK ..................................... -8 [IN30A]
HELP AVAILABLE FOR DEFINITION OF UNEMPLOYMENT COMPENSATION.
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-100,000
----------------------------------------------------

BOX_IN30
========

OMITTED.

IN30OV
======

OMITTED.

IN30A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was received [from unemployment compensation in [YEAR]]?

1 - 100 ................................. 1 [IN31]
101 - 500 ............................... 2 [IN31]
501 - 1,000 ............................. 3 [IN31]
1,001 - 5,000 ........................... 4 [IN31]
5,001 - 15,000 .......................... 5 [IN31]
15,001 OR MORE .......................... 6 [IN31]
REF .................................... -7 [IN31]
DK ..................................... -8 [IN31]
[Code One]
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

BOX_03
======

OMITTED.

IN31
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from Social Security and equivalent tier 1 Railroad Retirement benefits?

[Enter $ Amount] ....................... [END_LP02]
REF .................................... -7 [END_LP02]
DK ..................................... -8 [IN32]
HELP AVAILABLE FOR DEFINITION OF SOCIAL SECURITY.
----------------------------------------------------
DISPLAY '[and [you/[NAME OF SECONDARY FILER]]]' IF IN04 IS CODED '2' (MARRIED FILING JOINT RETURN). OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'you' IF THE SECONDARY FILER SELECTED AT IN05 IS SELECTED AS THE RESPONDENT. OTHERWISE, DISPLAY '[NAME OF SECONDARY FILER]' SUBSTITUTING THE PERSON'S NAME SELECTED AT IN05.
----------------------------------------------------
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-100,000
----------------------------------------------------

BOX_IN31
========

OMITTED.

IN31OV
======

OMITTED.

IN32
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
SHOW CARD IN-1.
Which of the ranges on this card is the best estimate of how much money was received [from Social Security and equivalent tier 1 Railroad Retirement benefits in [YEAR]]?

1 - 5,000 ............................... 1 [END_LP02]
5,001 - 10,000 .......................... 2 [END_LP02]
10,001 - 15,000 ......................... 3 [END_LP02]
15,001 - 25,000 ......................... 4 [END_LP02]
25,001 - 50,000 ......................... 5 [END_LP02]
50,001 - 100,000 ........................ 6 [END_LP02]
100,001 OR MORE ......................... 7 [END_LP02]
REF .................................... -7 [END_LP02]
DK ..................................... -8 [END_LP02]
[Code One]
----------------------------------------------------
FOR 'NAME OF SECONDARY FILER', DISPLAY THE PERSON'S NAME SELECTED AT IN05 DURING LOOP_01 FOR THE PRIMARY FILER CURRENTLY BEING ASKED ABOUT. IF IN05 WAS NOT ASKED IN LOOP_01 FOR THIS PERSON, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN33
====

OMITTED.

BOX_IN33
========

OMITTED.

IN33OV
======

OMITTED.

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH IN34
----------------------------------------------------

IN34
====

During [YEAR], did anyone in the family receive Worker's Compensation?

YES .................................... 1
NO ..................................... 2 [IN37]
REF ................................... -7 [IN37]
DK .................................... -8 [IN37]
HELP AVAILABLE FOR DEFINITION OF WORKER'S COMPENSATION.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVED WORKER'S COMPENSATION' AT IN35 AND GO TO LOOP_03
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH IN35
----------------------------------------------------

IN35
====

Who received Worker's Compensation in [YEAR]? PROBE: Anyone else receive Worker's Compensation in [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]
[Code All That Apply]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
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 WHO MEET THE FOLLOWING CONDITION:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED MEMBERS)
----------------------------------------------------

LOOP_03
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_IN03 - END_LP03
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_03 DETERMINES HOW MUCH MONEY WAS RECEIVED FROM WORKER'S COMPENSATION FOR RU MEMBERS WHO RECEIVED WORKER'S COMPENSATION IN THE CALENDAR YEAR. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED WORKER'S COMPENSATION IN THE CALENDAR YEAR (SELECTED AT IN35)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_03 USES NAV_IN03 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_IN03
========

SERIES: Amount Received from Worker's Compensation
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED WORKER'S COMPENSATION IN THE CALENDAR YEAR (SELECTED AT IN35)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH IN36 FOR SELECTED RU MEMBER.
----------------------------------------------------

IN36
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How much money did [you/[PERSON]] receive from Worker's Compensation [in [YEAR]]?

[Enter $ Amount] ....................... [END_LP03]
REF .................................... -7 [END_LP03]
DK ..................................... -8 [IN36A]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-50,000
----------------------------------------------------

IN36A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was received [from Worker's Compensation in [YEAR]]?

1 - 100 ................................. 1 [END_LP03]
101 - 500 ............................... 2 [END_LP03]
501 - 1,000 ............................. 3 [END_LP03]
1,001 - 5,000 ........................... 4 [END_LP03]
5,001 - 15,000 .......................... 5 [END_LP03]
15,001 OR MORE .......................... 6 [END_LP03]
REF .................................... -7 [END_LP03]
DK ..................................... -8 [END_LP03]
[Code One]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

END_LP03
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_03 AND CONTINUE WITH IN37
----------------------------------------------------

IN37
====

During [YEAR], did anyone in the family receive Supplemental Security Income, also known as S.S.I.?

YES .................................... 1
NO ..................................... 2 [IN41]
REF ................................... -7 [IN41]
DK .................................... -8 [IN41]
HELP AVAILABLE FOR DEFINITION OF S.S.I.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVED S.S.I.' AT IN38 AND GO TO LOOP_04
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH IN38
----------------------------------------------------

IN38
====

Who received Supplemental Security Income in [YEAR]? PROBE: Anyone else receive S.S.I. in [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]
[Code All That Apply]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
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 WHO MEET THE FOLLOWING CONDITION:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
----------------------------------------------------

LOOP_04
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_IN04 - END_LP04
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_04 DETERMINES HOW MUCH MONEY WAS RECEIVED FROM SUPPLEMENTAL SECURITY INCOME (S.S.I) FOR RU MEMBERS WHO RECEIVED S.S.I. IN THE CALENDAR YEAR. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED SUPPLEMENTAL SECURITY INCOME IN THE CALENDAR YEAR (SELECTED AT IN38)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_04 USES NAV_IN04 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_IN04
========

SERIES: Supplemental Security Income ? Number of Months Received and Amount Received Monthly
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED SUPPLEMENTAL SECURITY INCOME IN THE CALENDAR YEAR (SELECTED AT IN38)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH IN40A FOR SELECTED RU MEMBER.
----------------------------------------------------

BOX_03A
=======

OMITTED.

IN39
====

OMITTED.

IN40A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
For how many months in [YEAR] did [you/[PERSON]] receive money from Supplemental Security Income?

[Enter Number of Months] ................ [IN40B]
REF .................................... -7 [IN40B]
DK ..................................... -8 [IN40B]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 1-12
----------------------------------------------------

IN40B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On average, how much money did [you/[PERSON]] get per month [from Supplemental Security Income in [YEAR]]?

[Enter $ Amount] ........................ [END_LP04]
REF .................................... -7 [END_LP04]
DK ..................................... -8 [IN40C]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-50,000
----------------------------------------------------

IN40C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD IN-3.
Which of the ranges on this card is the best estimate of how much money was received per month [from Supplemental Security Income in [YEAR]]?

1 - 250 ................................. 1 [END_LP04]
251 - 500 ............................... 2 [END_LP04]
501 - 750 ............................... 3 [END_LP04]
751 - 1,000 ............................. 4 [END_LP04]
1,001 OR MORE ........................... 5 [END_LP04]
REF .................................... -7 [END_LP04]
DK ..................................... -8 [END_LP04]
[Code One]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

END_LP04
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_04 AND CONTINUE WITH IN41
----------------------------------------------------

IN41
====

During [YEAR], did anyone in the family receive any money from public assistance, such as Temporary Assistance for Needy Families, also known as TANF[, [STATE TANF NAME 1]][, [STATE TANF NAME 2]][, [STATE TANF NAME 3]], or general assistance?

YES .................................... 1
NO ..................................... 2 [IN46]
REF ................................... -7 [IN46]
DK .................................... -8 [IN46]
HELP AVAILABLE FOR DEFINITION OF PUBLIC ASSISTANCE.
----------------------------------------------------
DISPLAY ', [STATE TANF NAME 1]' (SUBSTITUTING THE REAL STATE NAME FOR THE TANF PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS ONE OR MORE TANF NAME(S). OTHERWISE, USE A NULL DISPLAY.

DISPLAY ', [STATE TANF NAME 2]' (SUBSTITUTING THE REAL STATE NAME FOR THE TANF PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS A SECOND OTHER TANF NAME. OTHERWISE, USE A NULL DISPLAY.

DISPLAY ', [STATE TANF NAME 3]' (SUBSTITUTING THE REAL STATE NAME FOR THE TANF PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS A THIRD OTHER TANF NAME. OTHERWISE, USE A NULL DISPLAY.

FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVED PUBLIC ASSISTANCE' AT IN42 AND GO TO LOOP_05
----------------------------------------------------
---------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH IN42
----------------------------------------------------

IN42
====

Whose name was on the checks? PROBE: Does anyone else receive a check from public assistance in their name?

[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]
----------------------------------------------------
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 WHO MEET THE FOLLOWING CONDITION:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
----------------------------------------------------

LOOP_05
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_IN05 - END_LP05
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_05 DETERMINES WHO WAS COVERED BY PUBLIC ASSISTANCE, WHETHER ANY OF THE CHECKS INCLUDED MONEY FROM TANF AND HOW MUCH WAS RECEIVED PER MONTH. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON'S NAME WAS ON THE PUBLIC ASSISTANCE CHECKS (SELECTED AT IN42)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_05 USES NAV_IN05 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_IN05
========

SERIES: Public Assistance (who covered, TANF included, number of months received, amount received monthly)
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON'S NAME WAS ON THE PUBLIC ASSISTANCE CHECKS (SELECTED AT IN42)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH IN43 FOR SELECTED RU MEMBER.
----------------------------------------------------

IN43
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Sometimes checks from public assistance cover more than one person in the family, even though only one person's name is on the check. Who is covered by [your/[PERSON]'s] checks from public assistance? PROBE: Did [your/his/her] checks cover 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]
[Code All That Apply]
----------------------------------------------------
CONTINUE WITH IN44
----------------------------------------------------
----------------------------------------------------
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.

3. DISPLAY 'PERSON NOT IN RU' AS THE 2ND TO LAST ENTRY ON THE ROSTER.

4. DISPLAY 'CHECK ONLY COVERS (PERSON) IN HEADER' AS THE LAST ENTRY ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON IS NOT SELECTED AS RECEIVING HIS OWN PUBLIC ASSISTANCE CHECKS; THAT IS PERSON WAS NOT SELECTED AT IN42
----------------------------------------------------

IN44
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Did any of [your/[PERSON]'s] checks include money from Temporary Assistance for Needy Families, also known as TANF[,/ or] [STATE TANF NAME 1][,/, or] [STATE TANF NAME 2][, or STATE TANF NAME 3]?

YES .................................... 1 [IN45A]
NO ..................................... 2 [IN45A]
REF ................................... -7 [IN45A]
DK .................................... -8 [IN45A]
HELP AVAILABLE FOR DEFINITION OF TANF.
----------------------------------------------------
DISPLAY ',' IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS AT TWO OR MORE OTHER STATE SPECIFIC TANF NAMES. DISPLAY 'or' IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS ONLY ONE STATE SPECIFIC TANF NAME. USE A NULL DISPLAY IF STATE HAS NO STATE SPECIFIC TANF NAMES.

DISPLAY '[STATE TANF NAME 1]' (SUBSTITUTING THE REAL STATE NAME FOR THE TANF PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS ONE OR MORE TANF NAME(S). OTHERWISE, USE A NULL DISPLAY.

DISPLAY ',' IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS THREE OTHER STATE SPECIFIC TANF NAMES. DISPLAY ', or' IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS TWO STATE TANF NAMES. USE A NULL DISPLAY IF STATE HAS ZERO OR ONLY ONE STATE SPECIFIC TANF NAME.

DISPLAY '[STATE TANF NAME 2]' (SUBSTITUTING THE REAL STATE NAME FOR THE TANF PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS A SECOND OTHER TANF NAME. OTHERWISE, USE A NULL DISPLAY.

DISPLAY ', or [STATE TANF NAME 3]' (SUBSTITUTING THE REAL STATE NAME FOR THE TANF PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED HAS A THIRD OTHER TANF NAME. OTHERWISE, USE A NULL DISPLAY.

FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------

IN45A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
For how many months in [YEAR] did [you/[PERSON]] receive checks from public assistance?

[Enter Number of Months] ................ [IN45B]
REF .................................... -7 [IN45B]
DK ..................................... -8 [IN45B]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 1-12
----------------------------------------------------

IN45B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On average, how much money did [you/[PERSON]] get per month [from public assistance in [YEAR]]?

[Enter $ Amount] ........................ [END_LP05]
REF .................................... -7 [END_LP05]
DK ..................................... -8 [IN45C]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-50,000
----------------------------------------------------

IN45C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD IN-3.
Which of the ranges on this card is the best estimate of how much money was received per month [from public assistance in [YEAR]]?

1 - 250 ................................. 1 [END_LP05]
251 - 500 ............................... 2 [END_LP05]
501 - 750 ............................... 3 [END_LP05]
751 - 1,000 ............................. 4 [END_LP05]
1,001 OR MORE ........................... 5 [END_LP05]
REF .................................... -7 [END_LP05]
DK ..................................... -8 [END_LP05]
[Code One]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

END_LP05
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_05 AND CONTINUE WITH IN46
----------------------------------------------------

IN46
====

During [YEAR], did anyone in the family receive any money from child support?

YES .................................... 1
NO ..................................... 2 [IN49]
REF ................................... -7 [IN49]
DK .................................... -8 [IN49]
HELP AVAILABLE FOR DEFINITION OF CHILD SUPPORT.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVED CHILD SUPPORT' AT IN47 AND GO TO LOOP_06
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH IN47
----------------------------------------------------

IN47
====

Who received child support in [YEAR]? PROBE: Anyone else receive child support in [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]
[Code All That Apply]
HELP AVAILABLE FOR DESCRIPTION OF WHO TO INCLUDE.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
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 WHO MEET THE FOLLOWING CONDITION:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
----------------------------------------------------

LOOP_06
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_IN06 - END_LP06
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_06 DETERMINES HOW MUCH MONEY WAS RECEIVED FROM CHILD SUPPORT FOR RU MEMBERS WHO RECEIVED CHILD SUPPORT IN CALENDAR YEAR. THIS LOOP CYCLES ON EACH PERSON ON THE RU- MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED CHILD SUPPORT IN CALENDAR YEAR (SELECTED AT IN47)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_06 USES NAV_IN06 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_IN06
========

SERIES: Child Support ? Number of Months Received and Amount Received Monthly
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED CHILD SUPPORT IN CALENDAR YEAR (SELECTED AT IN47)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH IN48A FOR SELECTED RU MEMBER.
----------------------------------------------------

IN48A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
For how many months in [YEAR] did [you/[PERSON]] receive money from child support?

[Enter Number of Months] ................ [IN48B]
REF .................................... -7 [IN48B]
DK ..................................... -8 [IN48B]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 1-12
----------------------------------------------------

IN48B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On average, how much money did [you/[PERSON]] get per month [from child support in [YEAR]]?

[Enter $ Amount] ........................ [END_LP06]
REF .................................... -7 [END_LP06]
DK ..................................... -8 [IN48C]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-100,000
----------------------------------------------------

IN48C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD IN-3.
Which of the ranges on this card is the best estimate of how much money was received per month [from child support in [YEAR]]?

1 - 250 ................................. 1 [END_LP06]
251 - 500 ............................... 2 [END_LP06]
501 - 750 ............................... 3 [END_LP06]
751 - 1,000 ............................. 4 [END_LP06]
1,001 OR MORE ........................... 5 [END_LP06]
REF .................................... -7 [END_LP06]
DK ..................................... -8 [END_LP06]
[Code One]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

END_LP06
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_06 AND CONTINUE WITH IN49
----------------------------------------------------

IN49
====

Not counting military retirement, during [YEAR], did anyone in the family receive any veteran's payments such as education or disability benefits?

YES .................................... 1
NO ..................................... 2 [IN52]
REF ................................... -7 [IN52]
DK .................................... -8 [IN52]
HELP AVAILABLE FOR DEFINITION OF VETERAN'S PAYMENTS.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVED VETERAN'S PAYMENTS' AT IN50 AND GO TO LOOP_07
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH IN50
----------------------------------------------------

IN50
====

Who received veteran's payments such as education or disability benefits [in [YEAR]]? PROBE: Anyone else receive veteran's payments in [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]
[Code All That Apply]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_07
----------------------------------------------------
----------------------------------------------------
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 WHO MEET THE FOLLOWING CONDITION:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
----------------------------------------------------

LOOP_07
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_IN07 - END_LP07
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07 DETERMINES HOW MUCH MONEY WAS RECEIVED FROM VETERAN'S PAYMENTS FOR RU MEMBERS WHO RECEIVED VETERAN'S PAYMENTS IN THE CALENDAR YEAR. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASEDAND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED VETERAN'S PAYMENTS IN THE CALENDAR YEAR (SELECTED AT IN50)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_07 USES NAV_IN07 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_IN07
========

SERIES: Amount Received from Veteran's Payments
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED VETERAN'S PAYMENTS IN THE CALENDAR YEAR (SELECTED AT IN50)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH IN51 FOR SELECTED RU MEMBER.
----------------------------------------------------

IN51
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
How much money did [you/[PERSON]] receive from veteran's payments such as education or disability benefits in [YEAR]? [Do not include military retirement.]

[Enter $ Amount] ....................... [END_LP07]
REF .................................... -7 [END_LP07]
DK ..................................... -8 [IN51A]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-100,000
----------------------------------------------------

IN51A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was received [from veteran's payments such as education or disability benefits in [YEAR]]?

1 - 100 ................................. 1 [END_LP07]
101 - 500 ............................... 2 [END_LP07]
501 - 1,000 ............................. 3 [END_LP07]
1,001 - 5,000 ........................... 4 [END_LP07]
5,001 - 15,000 .......................... 5 [END_LP07]
15,001 OR MORE .......................... 6 [END_LP07]
REF .................................... -7 [END_LP07]
DK ..................................... -8 [END_LP07]
[Code One]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

END_LP07
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_07 AND CONTINUE WITH IN52
----------------------------------------------------

IN52
====

Besides what we have already talked about, during [YEAR], did anyone in the family receive any money from regular cash contributions from people who do not live in this household?

YES .................................... 1
NO ..................................... 2 [IN55]
REF ................................... -7 [IN55]
DK .................................... -8 [IN55]
HELP AVAILABLE FOR DESCRIPTION OF REGULAR CASH CONTRIBUTIONS AND HOUSEHOLD.
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVED REGULAR CASH CONTRIBUTIONS FROM OUTSIDE HOUSEHOLD' AT IN53 AND GO TO LOOP_08
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH IN53
----------------------------------------------------

IN53
====

Who received regular cash contributions from people who do not live in this household [in [YEAR]]? PROBE: Anyone else receive regular cash contributions, in [YEAR], from people who do not live here?

[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]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_08
----------------------------------------------------
----------------------------------------------------
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, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CURRENT RU MEMBERS (INCLUDING PERSONS WHO ARE DECEASED AND INSTITUTIONALIZED THIS ROUND WHO ARE CURRENT ROUND 3 MEMBERS.
----------------------------------------------------

LOOP_08
=======

----------------------------------------------------
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK NAV_IN08 - END_LP08
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_08 DETERMINES HOW MUCH MONEY WAS RECEIVED FROM REGULAR CASH CONTRIBUTIONS FROM OUTSIDE THE HOUSEHOLD FOR RU MEMBERS WHO RECEIVED THESE TYPES OF CONTRIBUTIONS IN THE CALENDAR YEAR. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASEDAND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED REGULAR CASH CONTRIBUTIONS FROM SOMEONE OUTSIDE OF THE HOUSEHOLD IN THE CALENDAR YEAR (SELECTED AT IN53)
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_08 USES NAV_IN08 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_IN08
========

SERIES: Regular Cash Contributions ? Number of Months Received and Amount Received Monthly
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASEDAND INSTITUTIONALIZED RU MEMBERS)
- PERSON RECEIVED REGULAR CASH CONTRIBUTIONS FROM SOMEONE OUTSIDE OF THE HOUSEHOLD IN THE CALENDAR YEAR (SELECTED AT IN53)
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH IN54A FOR SELECTED RU MEMBER.
----------------------------------------------------

IN54A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
For how many months in [YEAR] did [you/[PERSON]] receive money from regular cash contributions from people who do not live in this household?

[Enter Number of Months] ................ [IN54B]
REF .................................... -7 [IN54B]
DK ..................................... -8 [IN54B]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 1-12
----------------------------------------------------

IN54B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
On average, how much money did [you/[PERSON]] get per month [from regular cash contributions from people who do not live in this household, in [YEAR]]?

[Enter $ Amount] ........................ [END_LP08]
REF .................................... -7 [END_LP08]
DK ..................................... -8 [IN54C]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-100,000
----------------------------------------------------

IN54C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SHOW CARD IN-3.
Which of the ranges on this card is the best estimate of how much money was received per month [from regular cash contributions from people who do not live in this household, in [YEAR]]?

1 - 250 ................................. 1 [END_LP08]
251 - 500 ............................... 2 [END_LP08]
501 - 750 ............................... 3 [END_LP08]
751 - 1,000 ............................. 4 [END_LP08]
1,001 OR MORE ........................... 5 [END_LP08]
REF .................................... -7 [END_LP08]
DK ..................................... -8 [END_LP08]
[Code One]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

END_LP08
========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_08 AND CONTINUE WITH IN55
----------------------------------------------------

IN55
====

During [YEAR], did anyone in the family get benefits from the Supplemental Nutrition Assistance Program, also known as SNAP [or [STATE SNAP NAME]], or food stamps?

YES .................................... 1 [IN56]
NO ..................................... 2 [IN59]
REF ................................... -7 [IN59]
DK .................................... -8 [IN59]
HELP AVAILABLE FOR DEFINITION OF SNAP.
----------------------------------------------------
DISPLAY 'or [STATE SNAP NAME]' (SUBSTITUTING THE REAL STATE NAME FOR THE SNAP PROGRAM) IF THE STATE IN WHICH INTERVIEW IS BEING CONDUCTED DOES NOT USE THE NAME 'SNAP.' FOR THE SPECIFIC NAME TO USE BY STATE, SEE ATTACHMENT 36.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

IN56
====

For how many months in [YEAR] were SNAP or other food stamp benefits received?

[Enter Months] ......................... [IN58]
REF ................................... -7 [IN58]
DK .................................... -8 [IN58]
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
RANGE CHECK: 1-12
----------------------------------------------------

IN57
====

OMITTED.

IN58
====

What was the approximate monthly value of the SNAP or other food stamp benefits?

[Enter $ Amount] ....................... [IN59]
REF ................................... -7 [IN59]
DK .................................... -8 [IN59]
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-1,000
----------------------------------------------------

IN59
====

SHOW CARD IN-4.
This card lists some sources of income. Has anyone in the family received any income, other than income we have already talked about, such as income from sources listed on this card?

YES .................................... 1 [LOOP_09]
NO ..................................... 2 [BOX_04]
REF ................................... -7 [BOX_04]
DK .................................... -8 [BOX_04]
HELP AVAILABLE FOR DEFINITIONS OF SHOW CARD CATEGORIES.

LOOP_09
=======

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

OTHER INCOME SOURCE CATEGORY 1
OTHER INCOME SOURCE CATEGORY 2
OTHER INCOME SOURCE CATEGORY 3
OTHER INCOME SOURCE CATEGORY 4
OTHER INCOME SOURCE CATEGORY 5

ASK IN60 - END_LP09
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_09 COLLECTS INFORMATION ABOUT OTHER SOURCES OF TAXABLE INCOME. THIS LOOP CYCLES ON SOURCES OF TAXABLE INCOME LISTED AT IN60. THE FIRST CYCLE OF THIS LOOP COLLECTS THE THE FIRST SOURCE OF TAXABLE INCOME. SUBSEQUENT CYCLES OF THE LOOP ARE DETERMINED BY THE RESPONSE AT IN63. IF IN63 IS CODED '1' (YES), THE LOOP CYCLES AGAIN TO COLLECT THE NEXT SOURCE OF TAXABLE INCOME. IF IN63 IS CODED '2' (NO), '-7' (REFUSED), OR '-8' (DON'T KNOW), THE LOOP ENDS.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_09 USES NAV_IN09 TO CONTROL THE FLOW OF THE LOOP AND THE SOURCES SELECTED AT IN60.
----------------------------------------------------

IN60
====

SHOW CARD IN-4.
From which of the sources on this card did anyone in the family receive income [that we have not yet talked about]?

WAGES AND SALARY ...................... 1 [NAV_IN09]
FARM INCOME (OR LOSS) ................. 2 [NAV_IN09]
BUSINESS INCOME (OR LOSS) ............. 3 [NAV_IN09]
SOCIAL SECURITY/RAILROAD RETIREMENT ... 4 [NAV_IN09]
PRIVATE, MILITARY, OR GOVERNMENT
PENSIONS ............................ 5 [NAV_IN09]
INTEREST .............................. 6 [NAV_IN09]
DIVIDENDS ............................. 7 [NAV_IN09]
RENTAL INCOME (OR LOSS) ............... 8 [NAV_IN09]
OTHER SOURCE .......................... 91 [IN60OV]
REF ................................... -7 [NAV_IN09]
DK .................................... -8 [NAV_IN09]
[Code One]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES

.

IN60OV
======

ENTER OTHER INCOME SOURCE:
[Other Specify] ......................... [NAV_IN09]
REF .................................... ?7 [NAV_IN09]
DK ..................................... ?8 [NAV_IN09]
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.

NAV_IN09
========

[STR-DT]
SERIES: Additional Sources of Income and Amount
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
Income Source
[1. Income Source Selected at IN60] [Status-25]
[2. Income Source Selected at IN60] [Status-25]
[3. Income Source Selected at IN60] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: INCOME SOURCE
INSTRUCTIONS: DISPLAY THE INCOME SOURCE CATEGORY SELECTED AT IN60 FOR THIS CYCLE OF THE LOOP.
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY ALL INCOME SOURCES SELECTED AT IN60.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.
2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL INCOME SOURCES SELECTED AT IN60.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_03B FOR SELECTED INCOME SOURCE.
----------------------------------------------------

BOX_03B
=======

-----------------------------------------------------
IF SINGLE PERSON RU, AUTOMATICALLY CODE PERSON AS 'RECEIVED INCOME FROM IN60 SOURCE' AT IN61 AND GO TO IN62. OTHERWISE, CONTINUE WITH IN61
-----------------------------------------------------

IN61
====

Who received income from [CATEGORY SELECTED AT IN60] in [YEAR]? PROBE: Anyone else receive income from (INCOME SOURCE) in [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]
[Code All That Apply]
----------------------------------------------------
FOR 'CATEGORY SELECTED AT IN60', DISPLAY THE RESPONSE CATEGORY NAME SELECTED AT IN60 DURING THE CURRENT LOOP.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH IN62
----------------------------------------------------
----------------------------------------------------
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 WHO MEET THE FOLLOWING CONDITION:

- PERSON IS A CURRENT RU MEMBER (INCLUDES DECEASED AND INSTITUTIONALIZED RU MEMBERS)
----------------------------------------------------

IN62
====

What is the total amount received from [CATEGORY SELECTED AT IN60], in [YEAR], for [all of the people just mentioned/[you/[PERSON]]]?

[Enter $ Amount] ....................... [BOX_IN62]
REF ................................... -7 [IN63]
DK .................................... -8 [IN62A]
----------------------------------------------------
FOR 'CATEGORY SELECTED AT IN60', DISPLAY THE RESPONSE CATEGORY NAME SELECTED AT IN60 DURING THE CURRENT LOOP.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'all of the people just mentioned' IF A MULTI-PERSON RU. OTHERWISE (I.E., SINGLE-PERSON RU), DISPLAY '[you/[PERSON]]'.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------
----------------------------------------------------
BEGINNING IN PANEL 12, PRE-FILL CENTS DIGITS WITH '00' SO THAT FIELD ACCEPTS WHOLE DOLLAR AMOUNT ONLY.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
SOFT RANGE CHECK: 0-100,000
----------------------------------------------------

BOX_IN62
========

----------------------------------------------------
IF AMOUNT OTHER THAN ZERO ENTERED AT IN62 AND IN60 IS CODED '2' (FARM INCOME OR LOSS), '3' (BUSINESS INCOME OR LOSS), '8' (RENTAL INCOME OR LOSS), OR '91' (OTHER SOURCE), CONTINUE WITH IN62OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO IN63
----------------------------------------------------

IN62OV
======

INCOME SOURCE: [DISPLAY CATEGORY SELECTED AT IN60.........]
INTERVIEWER: WAS THE AMOUNT ENTERED A NET GAIN OR A NET LOSS?
NET GAIN ............................... 1 [IN63]
NET LOSS ............................... 2 [IN63]
[Code One]

IN62A
=====

SHOW CARD IN-2.
Which of the ranges on this card is the best estimate of how much money was received [from [CATEGORY SELECTED AT IN60] in [YEAR]]?

1 - 100 ................................. 1 [BOX_IN62A]
101 - 500 ............................... 2 [BOX_IN62A]
501 - 1,000 ............................. 3 [BOX_IN62A]
1,001 - 5,000 ........................... 4 [BOX_IN62A]
5,001 - 15,000 .......................... 5 [BOX_IN62A]
15,001 OR MORE .......................... 6 [BOX_IN62A]
REF .................................... -7 [BOX_IN62A]
DK ..................................... -8 [BOX_IN62A]
[Code One]
----------------------------------------------------
FOR 'CATEGORY SELECTED AT IN60', DISPLAY THE RESPONSE CATEGORY NAME SELECTED AT IN60 DURING THE CURRENT LOOP.
----------------------------------------------------
----------------------------------------------------
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES AUTOMATICALLY:) IF ROUND 3, DISPLAY FIRST CALENDAR YEAR OF PANEL FOR [YEAR]. IF ROUND 5, DISPLAY SECOND CALENDAR YEAR OF PANEL FOR [YEAR].
----------------------------------------------------

BOX_IN62A
=========

----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) IS NOT CODED AT IN62A AND IN60 IS CODED '2' (FARM INCOME OR LOSS), '3' (BUSINESS INCOME OR LOSS), '8' (RENTAL INCOME OR LOSS), OR '91' (OTHER SOURCE), CONTINUE WITH IN62AOV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO IN63
----------------------------------------------------

IN62AOV
=======

INCOME SOURCE: [DISPLAY CATEGORY SELECTED AT IN60.........]
INTERVIEWER: DOES THE RANGE SELECTED REPRESENT NET GAIN OR NET LOSS?
NET GAIN ............................... 1 [IN63]
NET LOSS ............................... 2 [IN63]
[Code One]

IN63
====

SHOW CARD IN-4.
Aside from what you already told me about, has anyone in the family received any other income, such as income from another source listed on this card?

END_LP09
========

----------------------------------------------------
IF IN63 IS CODED '1' (YES), CYCLE TO COLLECT THE NEXT OTHER INCOME CATEGORY.
----------------------------------------------------
----------------------------------------------------
OTHERWISE END LOOP_09, AND CONTINUE WITH BOX_04
----------------------------------------------------

BOX_04
======

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

IN64
====

OMITTED.

Assets (AS) Section

BOX_00
======

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

AS01
====

Savings and investments are an important part of family finances. In these next questions, we are going to be asking about a number of different kinds of savings or investments the members of this family may have. The information you provide us is confidential, and will be analyzed in combination with information from other households.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

AS02
====

Does anyone in the family own this home? IF NECESSARY READ: By 'own' we mean that someone in the family living here now has their name on the title, even if mortgage or loan payments are still being made.

YES .................................... 1 [AS03]
NO ..................................... 2 [AS09]
REF ................................... -7 [AS09]
DK .................................... -8 [AS09]

AS03
====

Who in the family owns this home? PROBE: Does anyone else in the family own this home?

[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]
----------------------------------------------------
DISPLAY 'PERSON DECEASED' AND 'PERSON NOT IN RU' AS THE LAST TWO OPTIONS ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AS04
----------------------------------------------------
----------------------------------------------------
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, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL.
----------------------------------------------------

AS04
====

About how much is the current value of this home if sold today?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
IF VALUE IS NOTHING, CODE '0'.
AMOUNT:
[Enter Whole $ Value] ................. [AS06]
REF ................................... -7 [AS06]
DK .................................... -8 [AS05]
HELP AVAILABLE FOR DEFINITION OF VALUE.
----------------------------------------------------
HARD CHECK:
AMOUNT SHOULD BE 0 OR A WHOLE DOLLAR AMOUNT $1 - $9,999,999
----------------------------------------------------

AS05
====

SHOW CARD AS-1.
Which category on the card best indicates the current value of this home if sold today?

0 ? 10,000 ............................. 1 [AS06]
10,001 ? 25,000 ........................ 2 [AS06]
25,001 ? 50,000 ........................ 3 [AS06]
50,001 - 100,000 ....................... 4 [AS06]
100,001 - 250,000 ...................... 5 [AS06]
250,001 - 500,000 ...................... 6 [AS06]
500,001 - 1,000,000 .................... 7 [AS06]
1,000,001 OR MORE ...................... 8 [AS06]
REF ................................... -7 [AS06]
DK .................................... -8 [AS06]
[Code One]

AS06
====

Are there any mortgages or other loans outstanding on this home?

YES .................................... 1 [AS07]
NO ..................................... 2 [AS09]
REF ................................... -7 [AS09]
DK .................................... -8 [AS09]
HELP AVAILABLE FOR DEFINITION OF MORTGAGES AND OUTSTANDING LOANS.

AS07
====

How much is currently owed on these mortgages or loans?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
AMOUNT:
[Enter Whole $ Amount Owed] ........... [AS09]
REF ................................... -7 [AS09]
DK .................................... -8 [AS08]
HELP AVAILABLE FOR DEFINITION OF 'CURRENTLY OWED'.
----------------------------------------------------
HARD RANGE CHECK:
AMOUNT SHOULD BE A WHOLE DOLLAR AMOUNT $1 ? $9,999,999
----------------------------------------------------

AS08
====

SHOW CARD AS-1.
Which category on the card best indicates the total current amount owed?

0 ? 10,000 ............................. 1 [AS09]
10,001 ? 25,000 ........................ 2 [AS09]
25,001 ? 50,000 ........................ 3 [AS09]
50,001 - 100,000 ....................... 4 [AS09]
100,001 - 250,000 ...................... 5 [AS09]
250,001 - 500,000 ...................... 6 [AS09]
500,001 - 1,000,000 .................... 7 [AS09]
1,000,001 OR MORE ...................... 8 [AS09]
REF ................................... -7 [AS09]
DK .................................... -8 [AS09]
[Code One]

AS09
====

Does anyone in the family own any transportation vehicles, such as cars, trucks, vans, or motorcycles? Please do not include leased vehicles or recreational vehicles, such as trailers, motor homes, boats, or airplanes. IF NECESSARY READ: By 'own' we mean that someone in the family living here now has their name on the title(s), even if loan payments are still being made.

YES .................................... 1 [AS10]
NO ..................................... 2 [AS16]
REF ................................... -7 [AS16]
DK .................................... -8 [AS16]

AS10
====

Who in the family owns the transportation vehicles (such as cars, trucks, vans, or motorcycles)? PROBE: Does anyone else in the family own the transportation vehicles (such as cars, trucks, vans, or motorcycles)?

[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]
----------------------------------------------------
DISPLAY 'PERSON DECEASED' AND 'PERSON NOT IN RU' AS THE LAST TWO OPTIONS ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AS11
----------------------------------------------------
----------------------------------------------------
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, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL.
----------------------------------------------------

AS11
====

Altogether, what is the current value of the transportation vehicles (such as cars, trucks, vans, or motorcycles) if they were sold today?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
IF VALUE IS NOTHING, CODE '0'.
AMOUNT:
[Enter Whole $ Value] ................. [AS13]
REF ................................... -7 [AS13]
DK .................................... -8 [AS12]
HELP AVAILABLE FOR DEFINITION OF VALUE.
----------------------------------------------------
HARD CHECK:
AMOUNT SHOULD BE 0 OR A WHOLE DOLLAR AMOUNT $1 - $9,999,999
----------------------------------------------------

AS12
====

SHOW CARD AS-2.
Which category on the card best indicates the total current value of these transportation vehicles (such as cars, trucks, vans, or motorcycles) if they were sold today?

0 - 100 ................................ 1 [AS13]
101 - 500 .............................. 2 [AS13]
501 - 1,000 ............................ 3 [AS13]
1,001 - 5,000 .......................... 4 [AS13]
5,001 - 10,000 ......................... 5 [AS13]
10,001 - 25,000 ........................ 6 [AS13]
25,001 - 50,000 ........................ 7 [AS13]
50,001 ? 100,000 ....................... 8 [AS13]
100,001 OR MORE ....................... 9 [AS13]
REF ................................... -7 [AS13]
DK .................................... -8 [AS13]
[Code One]

AS13
====

Is any money owed or are there any loans outstanding on these transportation vehicles (such as cars, trucks, vans, or motorcycles)?

YES .................................... 1 [AS14]
NO ..................................... 2 [AS16]
REF ................................... -7 [AS16]
DK .................................... -8 [AS16]
HELP AVAILABLE FOR DEFINITION OF MONEY OWED AND OUTSTANDING LOANS.

AS14
====

How much is currently owed on these transportation vehicles (such as cars, trucks, vans, or motorcycles)?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
AMOUNT:
[Enter Whole $ Amount Owed] ........... [AS16]
REF ................................... -7 [AS16]
DK .................................... -8 [AS15]
HELP AVAILABLE FOR DEFINITION OF 'CURRENTLY OWED'.
----------------------------------------------------
HARD RANGE CHECK:
AMOUNT SHOULD BE A WHOLE DOLLAR AMOUNT $1 ? $9,999,999
----------------------------------------------------

AS15
====

SHOW CARD AS-2.
Which category on the card best indicates the total current amount owed?

0 - 100 ................................ 1 [AS16]
101 - 500 .............................. 2 [AS16]
501 - 1,000 ............................ 3 [AS16]
1,001 - 5,000 .......................... 4 [AS16]
5,001 - 10,000 ......................... 5 [AS16]
10,001 - 25,000 ........................ 6 [AS16]
25,001 - 50,000 ........................ 7 [AS16]
50,001 ? 100,000 ....................... 8 [AS16]
100,001 OR MORE ....................... 9 [AS16]
REF ................................... -7 [AS16]
DK .................................... -8 [AS16]
[Code One]

AS16
====

Does anyone in the family have any Individual Retirement Accounts often referred to as IRAs, or other retirement accounts(such as 401K, 403(b) or Keogh accounts)?

YES .................................... 1 [AS17]
NO ..................................... 2 [AS20]
REF ................................... -7 [AS20]
DK .................................... -8 [AS20]
HELP AVAILABLE FOR DEFINITION OF RETIREMENT ACCOUNTS.

AS17
====

Who in the family has Individual Retirement Accounts (IRAs) or other retirement accounts (such as 401K, 403(b) or Keogh accounts)? 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] ...
[Code All That Apply]
----------------------------------------------------
DISPLAY 'PERSON DECEASED' AND 'PERSON NOT IN RU' AS THE LAST TWO OPTIONS ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AS18
----------------------------------------------------
----------------------------------------------------
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, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL.
----------------------------------------------------

AS18
====

Altogether, what is the current value of these retirement accounts?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
AMOUNT:
[Enter Whole $ Value] ................. [AS20]
REF ................................... -7 [AS20]
DK .................................... -8 [AS19]
HELP AVAILABLE FOR DEFINITION OF VALUE.
----------------------------------------------------
HARD CHECK:
AMOUNT SHOULD BE A WHOLE DOLLAR AMOUNT $1 - $9,999,999
----------------------------------------------------

AS19
====

SHOW CARD AS-3.
Which category on the card best indicates the total current value of these retirement accounts?

0 - 1,000 .............................. 1 [AS20]
1,001 - 5,000 .......................... 2 [AS20]
5,001 - 10,000 ......................... 3 [AS20]
10,001 - 25,000 ........................ 4 [AS20]
25,001 - 50,000 ........................ 5 [AS20]
50,001 - 100,000 ....................... 6 [AS20]
100,001 - 250,000 ...................... 7 [AS20]
250,001 - 500,000 ...................... 8 [AS20]
500,001 OR MORE ........................ 9 [AS20]
REF ................................... -7 [AS20]
DK .................................... -8 [AS20]
[Code One]

AS20
====

Does anyone in the family have any bank accounts, including checking accounts, savings accounts, or money market accounts? Please do not include any bank accounts that we have already talked about.

YES .................................... 1 [AS21]
NO ..................................... 2 [AS24]
REF ................................... -7 [AS24]
DK .................................... -8 [AS24]
HELP AVAILABLE FOR DEFINITION OF BANK ACCOUNTS.

AS21
====

Who in the family has bank accounts, including checking accounts, savings accounts, or money market accounts? 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] ...
[Code All That Apply]
----------------------------------------------------
DISPLAY 'PERSON DECEASED' AND 'PERSON NOT IN RU' AS THE LAST TWO OPTIONS ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AS22
----------------------------------------------------
----------------------------------------------------
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, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL.
----------------------------------------------------

AS22
====

Altogether, what is the current value of these bank accounts?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
IF VALUE IS NOTHING, CODE '0'.
AMOUNT:
[Enter Whole $ Value] ................. [AS24]
REF ................................... -7 [AS24]
DK .................................... -8 [AS23]
HELP AVAILABLE FOR DEFINITION OF VALUE.
----------------------------------------------------
HARD CHECK:
AMOUNT SHOULD BE 0 OR A WHOLE DOLLAR AMOUNT $1 - $9,999,999
----------------------------------------------------

AS23
====

SHOW CARD AS-2.
Which category on the card best indicates the total current value of these bank accounts?

0 ? 100 ................................ 1 [AS24]
101 - 500 .............................. 2 [AS24]
501 - 1,000 ............................ 3 [AS24]
1,001 - 5,000 .......................... 4 [AS24]
5,001 - 10,000 ......................... 5 [AS24]
10,001 - 25,000 ........................ 6 [AS24]
25,001 - 50,000 ........................ 7 [AS24]
50,001 ? 100,000 ....................... 8 [AS24]
100,001 OR MORE ....................... 9 [AS24]
REF ................................... -7 [AS24]
DK .................................... -8 [AS24]
[Code One]

AS24
====

SHOW CARD AS-4.
Now think about the approximate value of some other financial assets your family may own. Please look at this card. Does anyone in the family have any of these assets? Please do not include any accounts or assets that we have already talked about.

YES .................................... 1 [AS25]
NO ..................................... 2 [AS28]
REF ................................... -7 [AS28]
DK .................................... -8 [AS28]
HELP AVAILABLE FOR DEFINITION OF OTHER ACCOUNTS OR FINANCIAL ASSETS.

AS25
====

Who in the family owns these other financial assets [such as certificates of deposit (CDs), government savings bonds, individual development accounts, treasury bills, bonds, bond mutual funds, shares of stock, stock mutual funds, education savings accounts, annuities, trusts to which they are beneficiaries, or other financial assets]? PROBE: Does anyone else in the family own these other financial assets?

[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]
----------------------------------------------------
DISPLAY 'PERSON DECEASED' AND 'PERSON NOT IN RU' AS THE LAST TWO OPTIONS ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AS26
----------------------------------------------------
----------------------------------------------------
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, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL.
----------------------------------------------------

AS26
====

Altogether, what is the current value of these accounts or other financial assets?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
IF VALUE IS NOTHING, CODE '0'.
AMOUNT:
[Enter Whole $ Value] ................. [AS28]
REF ................................... -7 [AS28]
DK .................................... -8 [AS27]
HELP AVAILABLE FOR DEFINITION OF VALUE.
----------------------------------------------------
HARD CHECK:
AMOUNT SHOULD BE 0 OR A WHOLE DOLLAR AMOUNT $1 - $9,999,999
----------------------------------------------------

AS27
====

SHOW CARD AS-3.
Which category on the card best indicates the total current value of these accounts or other financial assets?

0 - 1,000 .............................. 1 [AS28]
1,001 - 5,000 .......................... 2 [AS28]
5,001 - 10,000 ......................... 3 [AS28]
10,001 - 25,000 ........................ 4 [AS28]
25,001 - 50,000 ........................ 5 [AS28]
50,001 - 100,000 ....................... 6 [AS28]
100,001 - 250,000 ...................... 7 [AS28]
250,001 - 500,000 ...................... 8 [AS28]
500,001 OR MORE ........................ 9 [AS28]
REF ................................... -7 [AS28]
DK .................................... -8 [AS28]
[Code One]

AS28
====

SHOW CARD AS-5.
Now please think about the approximate value of all other property and assets your family may own. Please look at this card. Does anyone in the family have any of these assets? Please do not include any property or assets we have already talked about.

YES .................................... 1 [AS29]
NO ..................................... 2 [AS35]
REF ................................... -7 [AS35]
DK .................................... -8 [AS35]
HELP AVAILABLE FOR DEFINITION OF ALL OTHER PROPERTY AND ASSETS.

AS29
====

Who in the family owns these other properties and assets [such as second homes, rental real estate, a business or farm, money owed to you by persons outside of the family, boats or other recreational vehicles, or other significant assets such as jewelry, art work or antiques]? PROBE: Does anyone else in the family own other properties or assets?

[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]
----------------------------------------------------
DISPLAY 'PERSON DECEASED' AND 'PERSON NOT IN RU' AS THE LAST TWO OPTIONS ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AS30
----------------------------------------------------
----------------------------------------------------
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, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL.
----------------------------------------------------

AS30
====

Altogether, what is the current value of these other properties and assets if sold today?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
IF VALUE IS NOTHING, CODE '0'.
AMOUNT:
[Enter Whole $ Value] ................. [AS32]
REF ................................... -7 [AS32]
DK .................................... -8 [AS31]
HELP AVAILABLE FOR DEFINITION OF VALUE.
----------------------------------------------------
HARD CHECK:
AMOUNT SHOULD BE 0 OR A WHOLE DOLLAR AMOUNT $1 - $9,999,999
----------------------------------------------------

AS31
====

SHOW CARD AS-3.
Which category on the card best indicates the total current value of these other properties and assets if sold today?

0 - 1,000 .............................. 1 [AS32]
1,001 - 5,000 .......................... 2 [AS32]
5,001 - 10,000 ......................... 3 [AS32]
10,001 - 25,000 ........................ 4 [AS32]
25,001 - 50,000 ........................ 5 [AS32]
50,001 - 100,000 ....................... 6 [AS32]
100,001 - 250,000 ...................... 7 [AS32]
250,001 - 500,000 ...................... 8 [AS32]
500,001 OR MORE ........................ 9 [AS32]
REF ................................... -7 [AS32]
DK .................................... -8 [AS32]
[Code One]

AS32
====

Is any money owed or are there any loans outstanding on these other properties and assets [such as second homes, rental real estate, a business or farm, boats or other recreational vehicles, or other significant assets]?

YES .................................... 1 [AS33]
NO ..................................... 2 [AS35]
REF ................................... -7 [AS35]
DK .................................... -8 [AS35]
HELP AVAILABLE FOR DEFINITION OF MONEY OWED AND OUTSTANDING LOANS.

AS33
====

How much is currently owed for these other properties and assets [such as second homes, rental real estate, a business or farm, boats or other recreational vehicles, or other significant assets]?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
AMOUNT:
[Enter Whole $ Amount Owed] ........... [AS35]
REF ................................... -7 [AS35]
DK .................................... -8 [AS34]
HELP AVAILABLE FOR DEFINITION OF 'CURRENTLY OWED'.
----------------------------------------------------
HARD RANGE CHECK:
AMOUNT SHOULD BE A WHOLE DOLLAR AMOUNT $1 ? $9,999,999
----------------------------------------------------

AS34
====

SHOW CARD AS-3.
Which category on the card best indicates the total current amount owed?

0 - 1,000 .............................. 1 [AS35]
1,001 - 5,000 .......................... 2 [AS35]
5,001 - 10,000 ......................... 3 [AS35]
10,001 - 25,000 ........................ 4 [AS35]
25,001 - 50,000 ........................ 5 [AS35]
50,001 - 100,000 ....................... 6 [AS35]
100,001 - 250,000 ...................... 7 [AS35]
250,001 - 500,000 ...................... 8 [AS35]
500,001 OR MORE ........................ 9 [AS35]
REF ................................... -7 [AS35]
DK .................................... -8 [AS35]
[Code One]

AS35
====

Does anyone in the family have any debts that we haven't asked about, such as credit card balances, debts owed to medical providers, life insurance policy loans, loans from relatives, and so forth? Please exclude any debts we have already discussed, such as debts related to your home, vehicles, second homes, rental real estate, a business or farm, boats or other recreational vehicles, and other significant assets.

YES .................................... 1 [AS36]
NO ..................................... 2 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
HELP AVAILABLE FOR DEFINITION OF DEBTS.

AS36
====

Who in the family has these debts [such as credit card balances, debts owed to medical providers, life insurance policy loans, loans from relatives and so forth]? PROBE: Does anyone else in the family have these debts?

[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]
----------------------------------------------------
DISPLAY 'PERSON DECEASED' AND 'PERSON NOT IN RU' AS THE LAST TWO OPTIONS ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH AS37
----------------------------------------------------
----------------------------------------------------
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, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NONE. DISPLAY ALL.
----------------------------------------------------

AS37
====

How much do these debts amount to?

IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT 'DON'T KNOW'.
AMOUNT:
[Enter Whole $ Amount Owed] ........... [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [AS38]
HELP AVAILABLE FOR DEFINITION OF 'DEBTS AMOUNT TO'.
----------------------------------------------------
HARD RANGE CHECK:
AMOUNT SHOULD BE A WHOLE DOLLAR AMOUNT $1 ? $9,999,999
----------------------------------------------------

AS38
====

SHOW CARD AS-3.
Which category on the card best indicates the total current amount owed?

0 - 1,000 .............................. 1 [BOX_01]
1,001 - 5,000 .......................... 2 [BOX_01]
5,001 - 10,000 ......................... 3 [BOX_01]
10,001 - 25,000 ........................ 4 [BOX_01]
25,001 - 50,000 ........................ 5 [BOX_01]
50,001 - 100,000 ....................... 6 [BOX_01]
100,001 - 250,000 ...................... 7 [BOX_01]
250,001 - 500,000 ...................... 8 [BOX_01]
500,001 OR MORE ........................ 9 [BOX_01]
REF ................................... -7 [BOX_01]
DK .................................... -8 [BOX_01]
[Code One]

BOX_01
======

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

Provider Directory (PD) Section

----------------------------------------------------
NOTE: THERE ARE THREE BASIC TYPES OF PROVIDERS:
1. PERSON-TYPE-PROVIDERS
2. PERSON-IN-FACILITY-PROVIDERS
3. FACILITY PROVIDERS
THE PROVIDER DIRECTORY (PD) SECTION DEALS ONLY WITH THE FIRST AND THIRD TYPES. THE SECOND TYPE (PERSON-IN-FACILITY-PROVIDERS) SHOULD BE TREATED AS A FACILITY FOR THE PURPOSES OF THE PD SECTION. THAT IS, THE PERSON'S NAME IS NOT DISPLAYED OR SEARCHED ON, BUT RATHER THE FACILITY WITH WHICH S/HE IS ASSOCIATED WILL BE DISPLAYED AND SEARCHED ON. THEREFORE, IF THERE IS MORE THAN ONE PERSON-IN-FACILITY-PROVIDER ASSOCIATED WITH THE SAME FACILITY, THE PROVIDER LOOP WILL BE CYCLED ON ONCE FOR THAT FACILITY.
----------------------------------------------------

BOX_00
======

----------------------------------------------------
CONTEXT HEADER DISPLAY INSTRUCTIONS:
DISPLAY PROV.LORPNAME, PROV.PVSTRT1
----------------------------------------------------

PD01AA
======

OMITTED.

LOOP_01
=======

-----------------------------------------------------
FOR EACH ELEMENT IN RU-MEDICAL-PROVIDERS-ROSTER, ASK NAV_PD01 - END_LP01
-----------------------------------------------------
-----------------------------------------------------
LOOP DEFINITION: LOOP_01 COLLECTS VA AFFILIATION AND ADDRESS INFORMATION FOR PROVIDERS. THIS LOOP CYCLES ON PROVIDERS THAT MEET THE FOLLOWING CONDITIONS:

- CREATED THIS ROUND AND LINKED TO A KEY RU MEMBER
OR
- CREATED IN A PREVIOUS ROUND AND NOW LINKED TO A KEY RU MEMBER (AND HAS NOT BEEN THROUGH THE PD SECTION PREVIOUSLY)
AND
- ASSOCIATED WITH AN HS, ER, OP, OR IC EVENT
OR
- ASSOCIATED WITH AN MV EVENT
OR
- ASSOCIATED WITH AN HH EVENT AND FLAGGED AS 'AGENCY'
-----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_01 USES NAV_PD01 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_PD01
========

SERIES: Provider Look-Up and VA Affiliation
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.

Provider
[1. Provider Last Name or Facility Name-30] [Status-25]
[2. Provider Last Name or Facility Name-30] [Status-25]
[3. Provider Last Name or Facility Name-30] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: PROVIDER
INSTRUCTIONS: DISPLAY RU-MEDICAL-PROVIDERS-ROSTER
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH PROVIDER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS THE RU-MEDICAL-PROVIDERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY EACH PROVIDER IN THE RU-MEDICAL-PROVIDERS-ROSTER THAT MEETS THE CONDITIONS STATED IN LOOP_01
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH PD01A FOR SELECTED PROVIDER
----------------------------------------------------

PD01A
=====

PROVIDER: [NAME OF MEDICAL CARE PROVIDER......]
[Is the clinic or place where [PROVIDER] was seen a facility of the Veteran's Administration?/ Is [PROVIDER] a facility of the Veteran's Administration?]

YES .................................... 1 [BOX_01A]
NO ..................................... 2 [BOX_01A]
REF ................................... -7 [BOX_01A]
DK .................................... -8 [BOX_01A]
-----------------------------------------------------
DISPLAY NAME OF PROVIDER BEING LOOPED ON FOR 'NAME OF MEDICAL CARE PROVIDER.'
-----------------------------------------------------
-----------------------------------------------------
IF PERSON PROVIDER DISPLAY 'Is the clinic or place where (PROVIDER) was seen a facility of the Veteran's Administration?'

IF FACILITY PROVIDER DISPLAY 'Is (PROVIDER) a facility of the Veteran's Administration?'
-----------------------------------------------------

BOX_01A
=======

----------------------------------------------------
IF PROVIDER IS:
- ASSOCIATED WITH AN HS, ER, OP, OR IC EVENT
OR
- ASSOCIATED WITH AN MV EVENT AND MV03 IS CODED '1' (YES-TALKED TO A MEDICAL DOCTOR) OR MV03 IS CODED '2' (NO), '-7' (REFUSED) OR '-8' (DON'T KNOW) AND MV06 IS CODED '1' (YES-MEDICAL DOCTORS WORK AT LOCATION)
OR
- ASSOCIATED WITH A HH EVENT AND FLAGGED AS 'AGENCY', CONTINUE WITH BOX_03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO END_LP01
----------------------------------------------------

BOX_01
======

OMITTED.

BOX_02
======

OMITTED.

PD01
====

OMITTED.

PD02
====

OMITTED.

BOX_03
======

----------------------------------------------------
IF LOOPING ON PROVIDER ASSOCIATED ONLY WITH AN MV EVENT AND RU IS NOT SELECTED FOR THE MEDICAL PROVIDER COMPONENT (MPC), GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_04
----------------------------------------------------

BOX_04
======

-----------------------------------------------------
IF FIRST TIME THROUGH LOOP_01, CONTINUE WITH PD03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO PD05A IF PERSON-PROVIDER OR PD05B IF FACILITY-PROVIDER
----------------------------------------------------

PD03
====

To make sure my information is complete, I am going to use a directory to look up the medical providers you mentioned.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------
IF PROVIDER TYPE IS PERSON GO TO PD05A
----------------------------------------------------
----------------------------------------------------
OTHERWISE GO TO PD05B
----------------------------------------------------

PD04
====

OMITTED.

PD05A
=====

PROVIDER NAME: [NAME OF MEDICAL CARE PROVIDER FROM PV]
STREET ADDRESS: [STREET ADDRESS FOR MEDICAL CARE PROVIDER FROM PV]
CURRENT STATE CODE: [STATE ABBREVIATION FOR RESPONDENT]

STATE: [_____] [CHANGE STATE FOR SEARCH]
SELECT A SEARCH STRATEGY:
_ SEARCH ON PROVIDER NAME AND ADDRESS
_ SEARCH ON PROVIDER NAME
_ SEARCH ON ADDRESS
_ SEARCH ON TELEPHONE NUMBER
----------------------------------------------------
ITEM DETAILS
FIRST NAME: .. [Display Provider First Name]
AST NAME: ... [Display Provider Last Name (Legal)]
ADDRESSS: .... [Display Provider First Line Business Location Street Address]
.... [Display Second Line Business Location Address]
.... [Display Provider Business LocationAddress City, State, Zip]
PHONE: ....... [Display Provider Business LocationAddress Telephone Number]
SPECIALTY: ... [Display Healthcare Provider Taxonomy Code (Primary)]
----------------------------------------------------
[SEARCH CRITERIA 1]
[SEARCH CRITERIA 2]
[SEARCH]
THE NUMBER OF POTENTIAL MATCHES FOUND: [NUMBER OF MATCHES]
PROVIDER ADDRESS CITY PHONE
[Display
Provider Name-40]
[Display
Street Address-35]
[Display
City -15]
[Display Phone
Number-12]
[Display
Provider Name-40]
[Display
Street Address-35]
[Display
City -15]
[Display Phone
Number-12]
[DON'T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES]
----------------------------------------------------
DISPLAY THE FOLLOWING MESSAGE: 'The number of potential matches exceeds the number that can be displayed. Add more detail and search again.' IF THE NUMBER OF POTENTIAL MATCHES EXCEEDS THE MAXIMUM NUMBER OF MATCHES THAT CAN BE DISPLAYED.
----------------------------------------------------
----------------------------------------------------
NOTE: AS OF PANEL 20 ROUND 1, THE MAXIMUM NUMBER OF MATCHES THAT CAN BE DISPLAYED IS 750.
----------------------------------------------------
----------------------------------------------------
DISPLAY NAME OF PROVIDER AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'NAME OF MEDICAL PROVIDER FROM PV'.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'STREET ADDRESS FROM PV'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'FIRST NAME' FOR SEARCH CRITERIA 1 AND 'LAST NAME' FOR SEARCH CRITERIA 2 IF 'SEARCH ON PROVIDER NAME SHOWN ABOVE' SELECTED.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'STREET LIKE' FOR SEARCH CRITERIA 1 IF 'SEARCH ON CORE STREET NAME' SELECTED. DISPLAY NO SEARCH CRITERIA 2.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PHONE NUMBER' FOR SEARCH CRITERIA 1 IF 'SEARCH ON TELEPHONE NUMBER' SELECTED. DISPLAY NO SEARCH CRITERIA 2.
----------------------------------------------------
----------------------------------------------------
DISPLAY TWO-CHARACTER STATE ABBREVIATION ASSOCIATED WITH THIS RU'S ADDRESS FOR 'STATE ABBREVIATION FOR RESPONDENT'.
----------------------------------------------------
----------------------------------------------------
A LIST OF PROVIDERS IS DISPLAYED ON THE BOTTOM HALF OF THE SCREEN AFTER SEARCH CRITERIA ENTERED AND 'SEARCH' BUTTON SELECTED.
----------------------------------------------------
----------------------------------------------------
AN 'ITEM DETAILS' BOX WILL APPEAR AFTER A PROVIDER HAS BEEN SELECTED FROM THE LIST OF PROVIDERS.
----------------------------------------------------
----------------------------------------------------
SEARCHES CAN BE CONDUCTED MULTIPLE TIMES FROM THIS SCREEN WITHOUT MOVING FORWARD IN THE INSTRUMENT.
----------------------------------------------------
----------------------------------------------------
YOU CAN ONLY PROCEED AFTER A PROVIDER OR 'DON'T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES' HAS BEEN SELECTED.
----------------------------------------------------
----------------------------------------------------
IF A PROVIDER IS SELECTED, PROCEED TO PD14
----------------------------------------------------
----------------------------------------------------
IF 'DON'T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES' HAS BEEN SELECTED, PROCEED TO PD18
----------------------------------------------------

PD05B
=====

PROVIDER NAME: [NAME OF MEDICAL CARE PROVIDER FROM PV]
STREET ADDRESS: [STREET ADDRESS FOR MEDICAL CARE PROVIDER FROM PV]
STATE: [STATE ABBREVIATION FOR RESPONDENT]
STATE: [_____] [CHANGE STATE FOR SEARCH]
SELECT A SEARCH STRATEGY:

_ SEARCH ON PROVIDER NAME AND ADDRESS
_ SEARCH ON PROVIDER NAME
_ SEARCH ON ADDRESS
_ SEARCH ON TELEPHONE NUMBER
----------------------------------------------------
ITEM DETAILS
PROVIDER: .... [Display Provider Organization Name]
OTHER NAME: .. [Display Provider Other Organization Name]
ADDRESSS: .... [Display Provider First Line Business Location Address]
.... [Display Second Line Business
Location Address
.... [Display Provider Business Location Address, City, State, Zip]
PHONE: ....... [Display Provider Business LocationAddress Telephone Number]
SPECIALTY: ... [Display Healthcare Provider Taxonomy Code (Primary)]
----------------------------------------------------
[SEARCH CRITERIA 1]
[SEARCH CRITERIA 2]
[SEARCH]
THE NUMBER OF POTENTIAL MATCHES FOUND: [NUMBER OF MATCHES]
PROVIDER OTHER NAME ADDRESS PHONE
[Display
Provider Name-35]
[Display
Other Provider
Name-20]
[Display
Street
Address-35]
[Display Phone
Number-12]
[Display
Provider Name-35]
[Display
Other Provider
Name-20]
[Display
Street
Address-35]
[Display Phone
Number-12]
[DON'T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES]
----------------------------------------------------
DISPLAY THE FOLLOWING MESSAGE: 'The number of potential matches exceeds the number that can be displayed. Add more detail and search again.' IF THE NUMBER OF POTENTIAL MATCHES EXCEEDS THE MAXIMUM NUMBER OF MATCHES THAT CAN BE DISPLAYED.
----------------------------------------------------
----------------------------------------------------
NOTE: AS OF PANEL 20 ROUND 1, THE MAXIMUM NUMBER OF MATCHES THAT CAN BE DISPLAYED IS 750.
----------------------------------------------------
----------------------------------------------------
DISPLAY NAME OF PROVIDER AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'NAME OF MEDICAL PROVIDER FROM PV'.
----------------------------------------------------
----------------------------------------------------
DISPLAY TWO-CHARACTER STATE ABBREVIATION ASSOCIATED WITH THIS RU'S ADDRESS FOR 'STATE ABBREVIATION FOR RESPONDENT'.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'STREET ADDRESS FROM PV'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PROVIDER LIKE' FOR SEARCH CRITERIA 1 IF 'SEARCH ON PROVIDER NAME SHOWN ABOVE' SELECTED. DISPLAY NO SEARCH CRITERIA 2.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'STREET LIKE' FOR SEARCH CRITERIA 1 IF 'SEARCH ON CORE STREET NAME' SELECTED. DISPLAY NO SEARCH CRITERIA 2.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PHONE NUMBER' FOR SEARCH CRITERIA 1 IF 'SEARCH ON TELEPHONE NUMBER' SELECTED. DISPLAY NO SEARCH CRITERIA 2.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'PROVIDER LIKE' FOR SEARCH CRITERIA 1 AND 'STREET LIKE' FOR SEARCH CRITERIA 2 IF 'SEARCH ON PROVIDER NAME AND STREET SHOWN ABOVE' SELECTED.
----------------------------------------------------
----------------------------------------------------
A LIST OF PROVIDERS IS DISPLAYED ON THE BOTTOM HALF OF THE SCREEN AFTER SEARCH CRITERIA ENTERED AND 'SEARCH' BUTTON SELECTED.
----------------------------------------------------
----------------------------------------------------
AN 'ITEM DETAILS' BOX WILL APPEAR AFTER A PROVIDER HAS BEEN SELECTED FROM THE LIST OF PROVIDERS.
----------------------------------------------------
----------------------------------------------------
SEARCHES CAN BE CONDUCTED MULTIPLE TIMES FROM THISSCREEN WITHOUT MOVING FORWARD IN THE INSTRUMENT.
----------------------------------------------------
----------------------------------------------------
YOU CAN ONLY PROCEED AFTER A PROVIDER OR 'DON'T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES' HAS BEENSELECTED.
----------------------------------------------------
----------------------------------------------------
IF A PROVIDER IS SELECTED, PROCEED TO PD14
----------------------------------------------------
----------------------------------------------------
IF 'DON'T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES' HAS BEEN SELECTED, PROCEED TO PD18
----------------------------------------------------

LOOP_02
=======

OMITTED.

PD05
====

OMITTED.

PD06
====

OMITTED.

PD07
====

OMITTED.

PD08
====

OMITTED.

PD09
====

OMITTED.

PD10
====

OMITTED.

PD11
====

OMITTED.

BOX_05
======

OMITTED.

PD12
====

OMITTED.

PD13
====

OMITTED.

PD14
====

YOU HAVE CHOSEN THE FOLLOWING PROVIDER:
[NAME OF PROVIDER SELECTED AT PD05A/B]
[ADDRESS OF PROVIDER SELECTED AT PD05A/B]
YOUR ORIGINAL INPUT PROVIDER:
[NAME OF MEDICAL CARE PROVIDER FROM PV]
[STREET ADDRESS FROM PV]
YOUR OPTIONS:

ACCEPT PROVIDER AS SHOWN ............... 1 [END_LP01]
ACCEPT PROVIDER BUT MAKE CHANGES ....... 2 [PD15]
WRONG PROVIDER, GO BACK TO PREVIOUS
SCREEN ............................... 3
DON'T SEARCH ANYMORE ................... 4 [PD18]
----------------------------------------------------
DISPLAY NAME OF PROVIDER AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'NAME OF MEDICAL PROVIDER FROM PV'. IF PERSON-TYPE-PROVIDER, DISPLAY PERSON NAME. IF FACILITY-PROVIDER, DISPLAY FACILITY NAME.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'STREET ADDRESS FROM PV'.
----------------------------------------------------
----------------------------------------------------
DISPLAY FULL INFORMATION (I.E., NAME, ADDRESS, CITY, STATE, ZIP, TELEPHONE, AND SPECIALTY) FOR PROVIDER SELECTED IN PD05A OR PD05B FOR 'NAME OF PROVIDER SELECTED AT PD05A/PD05B'.
----------------------------------------------------
----------------------------------------------------
IF CODED '1' (ACCEPT PROVIDER AS SHOWN) OR '2' (ACCEPT PROVIDER BUT MAKE CHANGES), STORE THIS PROVIDER DIRECTORY ID.
----------------------------------------------------
----------------------------------------------------
NOTE: INFORMATION OBTAINED FROM THE PROVIDER DIRECTORY SEARCH IS NOT USED TO REPLACE DATA REPORTED BY THE RESPONDENT DURING THE INTERVIEW OR INCORPORATED INTO PROVIDER ROSTER DISPLAYS.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (WRONG PROVIDER, GO BACK TO PREVIOUS SCREEN), CAPI AUTOMATICALLY RETURNS TO PD05A OR PD05B.
----------------------------------------------------

PD15
====

PROVIDER NAME: [NAME OF PROVIDER SELECTED AT PD05A/B]
PROVIDER ADDRESS: [ADDRESS OF PROVIDER SELECTED AT PD05A/B]
PROVIDER NAME: [NAME OF MEDICAL CARE PROVIDER FROM PV]
STREET ADDRESS: [STREET ADDRESS FROM PV]
MAKE CORRECTIONS TO ADDRESS BELOW.
USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH NEED CORRECTION.

[Display Prov Name from ProvDir]
NAME: [______________________________]
[Display Prov Street Address from ProvDir]
1ST_STR_ ADDRESS: [______________________________]
[Display Prov City from ProvDir]
CITY: [______________________________]
[Display Prov State from ProvDir]
STATE: [______________________________]
[Display Prov Zip Code from ProvDir]
ZIP CODE: [______________________________]
[Display Prov Telephone from ProvDir]
TELEPHONE: [______________________________]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY NAME OF PROVIDER AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'NAME OF MEDICAL PROVIDER FROM PV'. IF PERSON-TYPE-PROVIDER, DISPLAY PERSON NAME. IF FACILITY-PROVIDER, DISPLAY FACILITY NAME.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'STREET ADDRESS FROM PV'.
----------------------------------------------------
----------------------------------------------------
DISPLAY NAME, ADDRESS, CITY, STATE, ZIP, AND TELEPHONE FOR PROVIDER SELECTED IN PD05A OR PD05B 'NAME OF PROVIDER SELECTED AT PD05A/B'.
----------------------------------------------------
----------------------------------------------------
ENTRY FIELD SPECIFICATIONS:

- FOR NAME, IF PERSON-TYPE-PROVIDER, DISPLAY TITLE, FIRST NAME, AND LAST NAME FIELDS.

- ELSE, DISPLAY FACILITY NAME FIELD.
----------------------------------------------------
----------------------------------------------------
FLAG THIS RECORD AS 'UPDATED. NEEDS HOME OFFICE REVIEW.'
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH PD19
----------------------------------------------------

PD16
====

OMITTED.

PD16OV
======

OMITTED.

PD17
====

OMITTED.

PD18
====

ENTER COMPLETE PROVIDER NAME, ADDRESS, AND TELEPHONE.
USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH NEED CORRECTION.
IF NEEDED, TYPE THREE Xs (XXX) TO DELETE 2ND STREET ADDRESS.

[Provider Name from PV]
NAME: [______________________________]
[1ST_STR_Provider Address from PV]
1ST_STR_ADDRESS: [______________________________]
[2ND_STR_Provider Address from PV]
2ND_STR_ADDRESS: [______________________________]
CITY: [______________________________]
STATE: [______________________________]
ZIP CODE: [______________________________]
PHONE: [______________________________]
SPECIALTY: [______________________________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
IF STREET ADDRESS LINES ARE CODED REFUSED OR DON'TKNOW (-7 OR -8) IN PROVIDER ROSTER (PV) SECTION, DISPLAY BLANK LINES FOR THESE FIELDS.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE NAME AND ADDRESS AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'PROVIDER NAME FROM PV'. IF PERSON-TYPE-PROVIDER, DISPLAY PERSON NAME. IF FACILITY-PROVIDER, DISPLAY FACILITY NAME.
----------------------------------------------------
----------------------------------------------------
ENTRY FIELD SPECIFICATIONS:

- FOR NAME, IF PERSON-TYPE-PROVIDER, DISPLAY TITLE, FIRST NAME, AND LAST NAME FIELDS.

- ELSE, DISPLAY FACILITY NAME FIELD.

- DISPLAY THE NAME (IN APPROPRIATE FIRST AND LAST NAME OR FACILITY FIELDS) AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON IN THE ENTRY FIELD FOR THE INTERVIEWER TO EITHER ACCEPT OR EDIT.

- DISPLAY THE ADDRESS (IN APPROPRIATE FIRST AND SECOND STREET FIELDS) AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON IN THE ENTRY FIELD FOR THE INTERVIEWER TO EITHER ACCEPT OR EDIT.
----------------------------------------------------
----------------------------------------------------
FLAG THIS RECORD AS 'NEW NAME/ADDRESS INFORMATION.NEEDS HOME OFFICE REVIEW.'
----------------------------------------------------
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED IN ALL FIELDS, EXCEPT THE 'NAME' AND 'STATE' FIELDS.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH PD19
----------------------------------------------------

PD19
====

YES .................................... 1 [PD19OV]
NO ..................................... 2 [END_LP01]
----------------------------------------------------
DISPLAY NAME OF PROVIDER AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'NAME OF MEDICAL CARE PROVIDER'. IF PERSON-TYPE PROVIDER, DISPLAY PERSON NAME. IF FACILITY-PROVIDER, DISPLAY FACILITY NAME.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON THE PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER BEING LOOPED ON FOR 'STREET ADDRESS'.
----------------------------------------------------
----------------------------------------------------
IF PROVIDER SELECTED AT PD05A/B, DISPLAY NAME, ADDRESS, CITY, STATE, ZIP, AND TELEPHONE FOR PROVIDER SELECTED IN PD05A OR PD05B FOR 'NAME OF PROVIDER SELECTED AT PD05A/B'.
----------------------------------------------------

PD19OV
======

PROVIDER NAME: [NAME OF PROVIDER SELECTED AT PD05A/B]
PROVIDER ADDRESS: [ADDRESS OF PROVIDER SELECTED AT PD05A/B]
PROVIDER NAME: [NAME OF MEDICAL CARE PROVIDER FROM PV]
STREET ADDRESS: [STREET ADDRESS FROM PV]
RECORD NOTE. TO CONTINUE, PRESS TAB AND THEN ENTER, OR SELECT NEXT PAGE.

[ENTER TEXT].................... [END_LP01]
----------------------------------------------------
ALLOW MULTIPLE LINES FOR ENTRY.
----------------------------------------------------

END_LP02
========

OMITTED.

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PROVIDER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PROVIDER MEETS THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH BOX_06
----------------------------------------------------

BOX_06
======

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

Closing (CL) Section

----------------------------------------------------
Subsection 1: MPC Authorization Forms (Round 1 through Round 5)
----------------------------------------------------

BOX_00
======

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

BOX_01
======

----------------------------------------------------
IF:
AT LEAST ONE PERSON-PROVIDER-PAIR ELIGIBLE (SEE SAMPLING BOXES BELOW) FOR AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND,
OR
AT LEAST ONE PERSON-PROVIDER-PAIR ELIGIBLE FOR AUTHORIZATION FORM COLLECTION DURING THE PREVIOUS ROUND AND CL04 WAS CODED '3' (LEFT WITH R), '4' (MAILED TO R), '5' (REFUSED), '91' (OTHER) OR '-1'(ADDED BY COMMENT REVIEW) FOR THIS PERSON- PROVIDER-PAIR IN PREVIOUS ROUND, CONTINUE WITH CL01
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
NOTE: RECEIPT CONTROL WILL UPDATE CAPI INTER- ROUND, USING THE CODE STRUCTURE AT CL04. UPDATES CAN BE EITHER POSITIVE OR NEGATIVE. THIS MEANS THAT INTER-ROUND AN AUTHORIZATION FORM'S STATUS CAN EITHER GET UPDATED TO A HIGHER STATUS CODE (FROM UNSIGNED TO SIGNED) OR TO A LOWER STATUS CODE (FROM SIGNED TO UNSIGNED -- I.E., IT WAS NOT SIGNED BY THE RIGHT PERSON). SEE MAPPING SPECIFICATIONS FOR EXACT UPDATES TO STATUS CODES.
----------------------------------------------------
----------------------------------------------------
NOTE: DUE TO LEGISLATION THAT WENT INTO EFFECT IN APRIL 2003, MEPS CHANGED TO NEW HIPAA- COMPLIANT AUTHORIZATION FORMS.
----------------------------------------------------
----------------------------------------------------
NOTEBOX THERE ARE 6 PERSON TYPES (AND TWO SUB-TYPES) IN THE MEPS RU

TYPE PRSLT DECEASED/ELIGIBLE FOR PART OF REF PERIOD 41 INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD 51 IN A HEALTHCARE FACILITY (INSTTTYPE 1 OR 2) IN A NON-HEALTHCARE FACILITY (INSTTYPE 3) MEPS STUDENT/ELIGIBLE ALL OF REF PERIOD 71 LIVING OUTSIDE US/ELIGIBLE PT OF REF PERIOD 75 LIVING-MILITARY BASE/ELIGIBLE PT REF PERIOD 76 ELIGIBLE FOR ALL OF REFERENCE PERIOD 99

THE FOLLOWING PERSON TYPES (AND SUB-TYPES) ARE ELIGIBLE FOR AUTHORIZATION FORM COLLECTION:
- PRSLT 41 - DECEASED/ELIGIBLE FOR PART OF REF PERIOD
- PRSLT 51 ? SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A HEALTHCARE FACILITY (INSTTYPE 1 OR 2)
- PRSLT 71 - MEPS STUDENT/ELIGIBLE ALL OF REF PERIOD
- PRSLT 99 - ELIGIBLE FOR ALL OF REFERENCE PERIOD

THERE ARE TWO TYPES OF OUT OF SCOPE RU MEMBERS THAT ARE ELIGIBLE FOR AUTHORIZATION FORM COLLECTION (NOTE: OUT OF SCOPE REFERS TO RU MEMBERS WHO HAD PARTIAL ELIGIBILITY IN THE PREVIOUS ROUND AND NO ELIGIBILITY IN THE CURRENT ROUND):
- PRSLT 41 - DECEASED/ELIGIBLE FOR PART OF REF PERIOD
- PRSLT 51 ? SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A HEALTHCARE FACILITY (INSTTYPE 1 OR 2)

2 PERSON TYPES AND 1 SUB-TYPE ARE NOT ELIGIBLE FOR
AUTHORIZATION FORM COLLECTION:
- PRSLT 51 ? SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A NON-HEALTHCARE FACILITY (INSTTYPE 3)
- PRSLT 75 - LIVING OUTSIDE US/ELIGIBLE PT OF REF PERIOD
- PRSLT 76 - LIVING-MILITARY BASE/ELIGIBLE PT REF PERIOD

PERSON-PROVIDER-PAIRS WHERE THE PROVIDER LOCATION IS IN A FOREIGN COUNTRY I.E., 'FC' IS ENTERED IN THE STATE FIELD OF PROVIDER'S ADDRESS ARE NOT ELIGIBLE FOR MPC AUTHORIZATION FORM COLLECTION)
----------------------------------------------------
----------------------------------------------------
SAMPLING BOX PERSON-PROVIDER-PAIRS ELIGIBLE FOR MPC AUTHORIZATION FORM COLLECTION:
NOTE: PERSON IS A KEY, ELIGIBLE RU MEMBER (AT TIME OF EVENT).

ROUND 1: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE:

- PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL EVENTS (HS) BOTH OPEN AND CLOSED.
- PERSON-PROVIDER PAIRS ASSOCIATED WITH EMERGENCY ROOM EVENTS (ER).
- PERSON-PROVIDER PAIRS ASSOCIATED WITH OUTPATIENT EVENTS (OP).

ROUND 2: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE:

- PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL TYPE EVENTS (HS, ER AND OP) AS IN ROUND 1.
- PERSON-PROVIDER PAIRS ASSOCIATED WITH MEDICAL EVENTS (MV) WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY (MV03=1) OR WORKS AT A MEDICAL FACILITY (MV06=1).
- PERSON-PROVIDER PAIRS ASSOCIATED WITH HOME HEALTH EVENTS (HH) WHERE THE HHTYPE IS AN AGENCY, BOTH OPEN AND CLOSED.
- PERSON-PROVIDER PAIRS ASSOCIATED WITH INSTITUTIONAL CARE EVENTS (IC), BOTH OPEN AND CLOSED.
- ANY OUTSTANDING PERSON-PROVIDER PAIRS FROM ROUND 1 ARE ALSO REQUESTED FOR THE HOSPITAL RELATED PROVIDERS (EVENT TYPES HS, ER, OP), IC, HH (WHERE THE HHTYPE IS AN AGENCY) OR MV EVENTS WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY OR WORKS AT A MEDICAL FACILITY).

ROUND 3: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE:

- PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL TYPE EVENTS (HS, ER AND OP) AS IN OTHER ROUNDS.
- PERSON-PROVIDER PAIRS ASSOCIATED WITH MEDICAL EVENTS (MV) WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY (MV03=1) OR WORKS AT A MEDICAL FACILITY (MV06=1).
- PERSON-PROVIDER PAIRS ASSOCIATED WITH HOME HEALTH EVENTS (HH) WHERE THE HHTYPE IS AN AGENCY, BOTH OPEN AND CLOSED.
- PERSON-PROVIDER PAIRS ASSOCIATED WITH INSTITUTIONAL CARE EVENTS (IC), BOTH OPEN AND CLOSED.
- ANY OUTSTANDING PERSON-PROVIDER PAIRS FROM ROUND 1 AND ROUND 2 ARE REQUESTED.

----------------------------------------------------
----------------------------------------------------
ROUND 4: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE:
- PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL TYPE EVENTS (HS, ER AND OP) AS IN OTHER ROUNDS.
- PERSON-PROVIDER PAIRS ASSOCIATED WITH MEDICAL EVENTS (MV) WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY (MV03=1) OR WORKS AT A MEDICAL FACILITY (MV06=1).
- PERSON-PROVIDER PAIRS ASSOCIATED WITH HOME
HEALTH EVENTS (HH) WHERE THE HHTYPE IS AN AGENCY, BOTH OPEN AND CLOSED.
- PERSON-PROVIDER PAIRS ASSOCIATED WITH INSTITUTIONAL CARE EVENTS (IC), BOTH OPEN AND CLOSED.
- ANY OUTSTANDING PERSON-PROVIDER PAIRS ASSOCIATED WITH EVENTS OCCURRING (OR ENDING) IN REFERENCE YEAR 2 ARE ALSO REQUESTED.

NOTE: FOR HS AND IC EVENTS THIS MEANS THE PERSON LEFT THE INSTITUTION/HOSPITAL DURING REFERENCE YEAR 2 (I.E., THE EVENT'S END DATE IS REFERENCE YEAR 2).

FOR OTHER EVENT TYPES, ANY WITH DATE OF SERVICE WITH A REFERENCE YEAR 1 ARE NO LONGER REQUESTED
----------------------------------------------------
----------------------------------------------------
ROUND 5: PERSON-PROVIDER-PAIRS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION ARE:

- PERSON-PROVIDER PAIRS ASSOCIATED WITH HOSPITAL TYPE EVENTS (HS, ER AND OP) AS IN OTHER ROUNDS.
- PERSON-PROVIDER PAIRS ASSOCIATED WITH MEDICAL EVENTS (MV) WHERE THE PROVIDER EITHER IS A MEDICAL FACILITY (MV03=1) OR WORKS AT A MEDICAL FACILITY (MV06=1).
- PERSON-PROVIDER PAIRS ASSOCIATED WITH HOME HEALTH EVENTS (HH) WHERE THE HHTYPE IS AN AGENCY, BOTH OPEN AND CLOSED.
- PERSON-PROVIDER PAIRS ASSOCIATED WITH INSTITUTIONAL CARE EVENTS (IC), BOTH OPEN AND CLOSED.
- ANY OUTSTANDING PERSON-PROVIDER PAIRS ASSOCIATED WITH EVENTS OCCURRING (OR ENDING) IN REFERENCE YEAR 2 ARE ALSO REQUESTED.

NOTE: FOR HS AND IC EVENTS THIS MEANS THE PERSON LEFT THE INSTITUTION/HOSPITAL DURING REFERENCE YEAR 2 (I.E., THE EVENT'S END DATE IS REFERENCE YEAR 2).
----------------------------------------------------
----------------------------------------------------
SAMPLING BOX (FOR ROUNDS 2-5) CONT'D:

WHEN DETERMINING IF THE MV EVENTS FOR AN RU REQUIRE AUTHORIZATION FORMS, AN RU IS SELECTED FOR THE MPC SAMPLE AT THE TIME OF THE ROUND 1 INTERVIEW USING THE FOLLOWING RATES:
- 100% OF RUs WITH AT LEAST ONE RU MEMBER COVERED BY MEDICAID OR GOV'T HOSPITAL (PHYSICIAN) INSURANCE AT ANY TIME DURING THE REFERENCE PERIOD
- 100% OF THE REMAINING RUs (THAT IS, RUs WITH NO RU MEMBER COVERED BY MEDICAID OR GOV'T- HOSPITAL/PHYSICIAN INSURANCE AT ANY TIME DURING THE REFERENCE PERIOD) WITH AT LEAST ONE RU MEMBER WITH HMO COVERAGE AT ANY TIME DURING THE REFERENCE PERIOD. HMO COVERAGE IS DEFINED AS:
IF AT LEAST ONE PRIVATE INSURANCE PLAN IN RU MEETS THE FOLLOWING CONDITIONS:
- FLAGGED AS 'PROVIDING HOSPITAL/PHYSICIAN BENEFITS' (EXCLUDE INSURERS WHERE
HOSPITAL/PHYSICIAN BENEFITS ARE PROVIDED SOLELY THROUGH MEDIGAP)
- ESTABLISHMENT OR INSURER IS FLAGGED AS 'HMO'
OR
INSURER IS AN HMO (MC01 IS CODED '1' (YES))
OR
INSURER REQUIRES PERSONS TO SIGN UP WITH PRIMARY PHYSICIAN (MC02 IS CODED '1' (YES)
- 100% OF THE REMAINING RUs (THAT IS, RUs WITH NO RU MEMBER COVERED BY MEDICAID OR GOV'T- HOSPITAL/PHYSICIAN INSURANCE AND HMO COVERAGE AT ANY TIME DURING THE REFERENCE PERIOD).
----------------------------------------------------
----------------------------------------------------
NOTE: IF THE SAME PROVIDER IS ASSOCIATED MORE THAN ONCE WITH A PARTICULAR PERSON, ONLY ONE AUTHORIZATION FORM IS CREATED FOR THAT PAIR. IF THE SAME PROVIDER IS ASSOCIATED WITH MORE THAN ONE PERSON, AN AUTHORIZATION FORM IS CREATED FOR EACH UNIQUE PERSON-PROVIDER-PAIR.
----------------------------------------------------
----------------------------------------------------
NOTE: IF THE PERSON-PROVIDER-PAIR IS OUTSTANDING FROM A PREVIOUS ROUND AND THERE IS A NEW ELIGIBLE EVENT FOR THIS PAIR IN THE CURRENT ROUND, THE PAIR WILL NOT BE TREATED AS IF IT IS OUTSTANDING. THAT IS, THE DISPLAYS FOR PREVIOUS ROUND STATUS WILL NOT BE SHOWN, ETC.
----------------------------------------------------

CL01
====

[[As I mentioned during the last interview], we/We] request written authorization to contact medical providers for more information about the services they provide. I would like to get authorization from the following people: [HAND RESPONDENT THE AUTHORIZATION FORM BOOKLET.] [These materials explain more about why we contact medical providers and answer questions people sometimes ask about this part of the study. Please take a minute to review this information while I prepare the forms.]

[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
----------------------------------------------------
DISPLAY '[As I mentioned during the last interview], we' IF NOT ROUND 1 AND AT LEAST ONE PERSON-PROVIDER-PAIR WAS ELIGIBLE FOR MPC AUTHORIZATION FORM COLLECTION DURING THE PREVIOUS ROUND. OTHERWISE, DISPLAY 'We'.
----------------------------------------------------
----------------------------------------------------
DISPLAY EACH UNIQUE ELIGIBLE PERSON NAME ONLY ONCE.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH LOOP_01
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_ESTB_PERS_PAIRS_1

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

2. SELECT, ADD, DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE PERSONS WHO MEET THE FOLLOWING CONDITION(S):
- PERSON IS ELIGIBLE FOR MPC AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_01 SAMPLING SPECIFICATIONS)
OR
- PERSON WAS ASSOCIATED WITH A PERSON-PROVIDER- PAIR ELIGIBLE FOR AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND, AND
- CL04 WAS CODED '3' (LEFT WITH R), '4' (MAILED TO R), '5' (REFUSED), '91' (OTHER) OR '-1' (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PROVIDER-PAIR IN PREVIOUS ROUND
----------------------------------------------------

CL02
====

OMITTED.

LOOP_01
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-PERSON-PROVIDER-PAIRS- ROSTER, ASK CL03 - END_LP01
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_01 PRESENTS EACH UNIQUE PERSON-PROVIDER-PAIR ELIGIBLE FOR AUTHORIZATION FORM COLLECTION (THIS INCLUDES NEW AND OUTSTANDING FORMS) FOR THE INTERVIEWER TO COMPLETE THE AUTHORIZATION FORM. THIS LOOP CYCLES ON RU- PERSON-PROVIDER-PAIRS WITH AN EVENT-PROVIDER- PAIR THAT MEET THE FOLLOWING CONDITION(S):
- PAIR IS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_01 SAMPLING SPECIFICATIONS)
OR
- PAIR WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND, AND
- CL04 WAS CODED '3' (LEFT WITH R), '4' (MAILED TO R), '5' (REFUSED), '91' (OTHER) OR '-1' (ADDED BY COMMENT REVIEW) FOR THIS PAIR IN THE PREVIOUS ROUND
----------------------------------------------------
----------------------------------------------------
NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON- PROVIDER-PAIR.
----------------------------------------------------

CL03
====

INTERVIEWER: [COMPLETE A NEW MPC AF FOR THIS PAIR./CHECK FIRST FOR PREPRINTED MPC AF FOR THIS PAIR. IF THERE IS NO PREPRINTED AF, FILL OUT A BLANK MPC AF.]
PID: [PID-3] PERSON: [First,[Middle],Last Name-35]
DOB: [MM/DD/YYYY] AGE: [XXX] STATUS: [Status Code Description]
RU ID: [RUID-7] REGION: [Reg ID-1] PROVIDER ID: [ProvID-4]
PROVIDER NAME: [Provider Full Name-65]
PROVIDER ADDRESS: [Street Address from Provider Directory]
[City Name], [ST] [Zip Code] [Telephone]
[AF STATUS FROM PREVIOUS ROUND: [DISPLAY PREVIOUS ROUND STATUS - 40]]
SIGNATURE DATE ON MPC AF MUST BE ON OR AFTER: [MM/DD/YYYY]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
HELP AVAILABLE FOR MORE INFORMATION ON MPC AUTHORIZATION FORMS.
----------------------------------------------------
DISPLAY 'COMPLETE A NEW MPC AF FOR THIS PAIR.' IF ROUND 1. OTHERWISE, (I.E., ROUND 2-5) DISPLAY 'CHECK...MPC AF.'

DISPLAY 'AF STATUS ... -40]' IF CURRENT PERSON- PROVIDER-PAIR IS OUTSTANDING FROM THE PREVIOUS ROUND AND NO ELIGIBLE EVENT WAS CREATED FOR THIS PAIR IN THE CURRENT ROUND.

FOR 'DISPLAY PREVIOUS...-40', DISPLAY THE CATEGORY ENTRY ASSOCIATED WITH THE PREVIOUS ROUND (OR RECEIPT CONTROL UPDATED) CL04 OUTSTANDING STATUS.
THAT IS, IF CL04 WAS CODED '3', DISPLAY 'LEFT WITH R'; IF CL04 WAS CODED '4', DISPLAY 'MAILED TO R'; IF CL04 WAS CODED '5', DISPLAY 'REFUSED'; AND IF CL04 WAS CODED '91' OR '-1', DISPLAY THE FIRST 40 CHARACTERS FROM THE OTHER SPECIFY ENTRY FIELD (OR THE RECEIPT CONTROL UPDATE TEXT GENERATED FOR THE '91' AND '-1' CODES).

DISPLAY THE INTERVIEW DATE OF THE MOST RECENT ROUND'S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR 'MM/DD/YYYY'.
----------------------------------------------------

END_LP01
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-PERSON-PROVIDER- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_01 AND CONTINUE WITH LOOP_02
----------------------------------------------------

LOOP_02
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-PERSON-PROVIDER-PAIRS- ROSTER, ASK CL04 - END_LP02
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02 COLLECTS THE STATUS OF PERSON-PROVIDER AUTHORIZATION FORMS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION (THIS INCLUDES NEW AND OUTSTANDING FORMS). THIS LOOP CYCLES ON RU-PERSON-PROVIDER-PAIRS WITH AN EVENT-PROVIDER- PAIR THAT MEET THE FOLLOWING CONDITION(S):
- PAIR IS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_01 SAMPLING SPECIFICATIONS)
OR
- PAIR WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND, AND
- CL04 WAS CODED '3' (LEFT WITH R), '4' (MAILED TOR), '5' (REFUSED), '91' (OTHER) OR '-1' (ADDED BY COMMENT REVIEW) FOR THIS PAIR IN THE PREVIOUS ROUND
----------------------------------------------------
----------------------------------------------------
NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON- PROVIDER-PAIR.
----------------------------------------------------

CL04
====

INTERVIEWER: ASK APPROPRIATE PERSON(S) TO SIGN AUTHORIZATION FORM.
IF NOT AVAILABLE TO SIGN, LEAVE AF AND BOOKLET WITH RESPONDENT.
PID: [PID-3] PERSON: [First, [Middle], Last Name-35]
DOB: [MM/DD/YYYY] AGE: [XXX] STATUS: [Status Code Description]
RU ID: [RUID-7] REGION: [Reg ID-1] PROVIDER ID: [ProvID-4]
PROVIDER NAME: [Provider Full Name-65]
PROVIDER ADDRESS: [Street Address from Provider Directory]
[City Name], [ST] [Zip Code] [Telephone]
SIGNATURE DATE ON MPC AF MUST BE ON OR AFTER: [MM/DD/YYYY]
SELECT THE AUTHORIZATION FORM STATUS:
SIGNED, NO PROBLEM ..................... 1 [CL05]
SIGNED WITH PROBLEM .................... 2 [CL04OV1]
LEFT WITH RESPONDENT ................... 3 [END_LP02]
MAILED TO RESPONDENT ................... 4 [END_LP02]
REFUSED ................................ 5 [CL06]
OTHER ................................. 91 [CL04OV2]
HELP AVAILABLE FOR MORE INFORMATION ON MPC AUTHORIZATION FORMS.
[Code One]
----------------------------------------------------
FOR 'MM/DD/YYYY', DISPLAY THE RU END REFERENCE DATE OF THE MOST RECENT ROUND'S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
CODE '4' (MAILED TO R) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE '4' SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: 'UNLIKELY RESPONSE. VERIFY AND RE-ENTER.'
----------------------------------------------------

CL04OV1
=======

PROBLEM:
[Enter Problem-45] ..................... [CL05]
HELP AVAILABLE FOR MORE INFORMATION ON MPC AUTHORIZATION FORMS.

CL04OV2
=======

SPECIFY:
[Enter Other Specify-45] ............... [END_LP02]
HELP AVAILABLE FOR MORE INFORMATION ON MPC AUTHORIZATION FORMS.

CL05
====

PID: [PID-3] PERSON: [First, [Middle], Last Name-35]
DOB: [MM/DD/YYYY] AGE: [XXX] STATUS: [Status Code Description]
RU ID: [RUID-7] REGION: [Reg ID-1] PROVIDER ID: [ProvID-4]
PROVIDER NAME: [Provider Full Name-65]
PROVIDER ADDRESS: [Street Address from Provider Directory]
[City Name], [ST] [Zip Code] [Telephone]
SIGNATURE DATE ON MPC AF MUST BE ON OR AFTER: [MM/DD/YYYY]
ENTER MPC AUTHORIZATION FORM NUMBER:
[Enter Number-8] ....................... [CL05OV]
----------------------------------------------------
FOR 'MM/DD/YYYY', DISPLAY THE RU END REFERENCE DATE OF THE MOST RECENT ROUND'S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION.
----------------------------------------------------
----------------------------------------------------
NOTE: EACH AUTHORIZATION FORM HAS A PRE-ASSIGNED AUTHORIZATION FORM NUMBER.
----------------------------------------------------
----------------------------------------------------
HARD CHECK ? PANEL 18 MPC AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN AND END WITH AN ALPHA CHARACTER.
PANEL 18 MPC AUTHORIZATION FORMS ARE PRINTED ON GREEN PAPER.
----------------------------------------------------
ORIGIN LETTER
5-NUMBER
SEQUENCE
CHECK
DIGIT
ROUND
IDENTIFIER
PREGENERATED
A-M 00001-
29499
RANDOM
(0-9)
G,H,J,K,L
FIELD
GENERATED
A-M 29500-
44999
RANDOM
(0-9)
G,H,J,K,L
HOME
OFFICE
T 45000-
49999
RANDOM
(0-9)
G,H,J,K,L
TRAINING/
QC
Y 96000-
96399
RANDOM
(0-9)
G,H,J,K,L
----------------------------------------------------
HARD CHECK ? PANEL 19 MPC AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN WITH AN ALPHA CHARACTER AND END WITH AN ALPHA CHARACTER. PANEL 19 MPC AUTHORIZATION FORMS ARE PRINTED ON WHITE PAPER.
----------------------------------------------------
ORIGIN LETTER
5-NUMBER
SEQUENCE
CHECK
DIGIT
ROUND
IDENTIFIER
PREGENERATED
A-M 00001-
29499
RANDOM
(0-9)
M,N,P,Q,R
FIELD
GENERATED
A-M 29500-
44999
RANDOM
(0-9)
M,N,P,Q,R
HOME
OFFICE
T 45000-
49999
RANDOM
(0-9)
M,N,P,Q,R
TRAINING/
QC
Y 96000-
96399
RANDOM
(0-9)
M,N,P,Q,R
----------------------------------------------------
HARD CHECK ? PANEL 20 MPC AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN AND END WITH AN ALPHA CHARACTER.
PANEL 20 MPC AUTHORIZATION FORMS ARE PRINTED ON BLUE PAPER.
----------------------------------------------------
ORIGIN LETTER
5-NUMBER
SEQUENCE
CHECK
DIGIT
ROUND
IDENTIFIER
PREGENERATED
A-M 00001-
29499
RANDOM
(0-9)
S,T,U,V,W
FIELD
GENERATED
A-M 29500-
44999
RANDOM
(0-9)
S,T,U,V,W
HOME
OFFICE
T 45000-
49999
RANDOM
(0-9)
S,T,U,V,W
TRAINING/
QC
Y 96000-
96399
RANDOM
(0-9)
S,T,U,V,W
----------------------------------------------------
SOME IMPORTANT POINTS TO REMEMBER ABOUT MPC AUTHORIZATION FORMS:
- THE PREFIX LETTER CHANGES BASED ON THE TYPE OF AUTHORIZATION FORM AND THE ORIGIN OF THE FORM.
THIS MEANS THAT A PRE-PRINTED OR FIELD GENERATED MPC AUTHORIZATION FORM WILL DRAW FROM THE SAME LETTER OR RANGE OF LETTERS IN EACH PANEL.
- THE 5-NUMBER SEQUENCE REPEATS ITSELF FOR EACH PANEL.
- THE CHECK-DIGIT ALWAYS REMAINS CONSTANT.
- THE ROUND IDENTIFIER IS DIFFERENT FOR EACH PANEL. THE ROUND IDENTIFIER WILL REMAIN THE SAME FOR ALL AUTHORIZATION FORMS COLLECTED WITHIN A PANEL, BUT CHANGES BASED ON THE ROUND.
FOR EXAMPLE: AUTHORIZATION FORMS GENERATED FOR PANEL 19, ROUND 1 WILL USE THE ROUND IDENTIFIER "M"; "M" OR "N" FOR ROUND 2; "M", "N", OR "P" FOR ROUND 3; "M", "N", "P" OR "Q" FOR ROUND 4; AND "M", "N", "P", "Q" OR "R" FOR ROUND 5.
----------------------------------------------------

CL05OV
======

MPC AUTHORIZATION FORM SIGNATURE DATE:
[Enter Month, Day, Year-4] .................. [END_LP02]
----------------------------------------------------
NOTE: INTERVIEWERS WILL BE INSTRUCTED TO COLLECT SIGNED MPC AUTHORIZATION FORMS WITH DATES EARLIER THAN THE ONE DISPLAYED, BUT WILL NOT ENTER THE NUMBER IN CAPI SINCE THE CURRENT STATUS FOR THE AUTHORIZATION FORM WITH THE CORRECT DATE MAY BE SOMETHING ELSE. THE CAPI STATUS OF THE MPC AUTHORIZATION FORM SHOULD REFLECT THE FORM WITH THE MOST RECENT DATE.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DATE ENTERED MUST BE ON OR AFTER THE INTERVIEW DATE OF THE MOST RECENT ROUND'S INTERVIEW FOR WHICH THE PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION, BUT CANNOT BE AFTER 'TODAY'S' DATE (THE CURRENT DATE SET ON THE LAPTOP. IF DATE IS BEFORE CORRECT DATE, DISPLAY THE FOLLOWING MESSAGE: 'MPC AF MUST BE SIGNED ON OR AFTER ABOVE DATE. VERIFY AND RE-ENTER DATE OR COMPLETE NEW AF.'
----------------------------------------------------

CL06
====

CL06OV
======

OTHER REASON FOR REFUSAL:
[Enter Other Specify-45] ............... [END_LP02]

END_LP02
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-PERSON-PROVIDER- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE WITH BOX_02
----------------------------------------------------

BOX_02
======

----------------------------------------------------
IF NOT ROUND 1 AND ANY KEY RU MEMBER HAD A STATUS OF INSTITUTIONALIZED (IN A HEALTH CARE INSTITUTION) AT THE PREVIOUS ROUND'S INTERVIEW DATE, BUT HAS A DIFFERENT STATUS AS OF THE CURRENT ROUND'S INTERVIEW DATE, CONTINUE WITH LOOP_02A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_03
----------------------------------------------------

LOOP_02A
========

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV_CL02A - END_LP02A
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_02A INSTRUCTS THE INTERVIEWER TO COLLECT THE HEALTH CARE INSTITUTION HISTORY AND THE APPROPRIATE NUMBER OF MEDICAL PROVIDER AUTHORIZATION FORMS FOR ALL RU MEMBERS WHO HAD A STATUS OF INSTITUTIONALIZED (IN A HEALTH CARE INSTITUTION) IN ANY PREVIOUS ROUND BUT WHO REJOINED THE COMMUNITY (OR CHANGED STATUS) DURING THE CURRENT ROUND. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS AN RU MEMBER
- PERSON IS KEY
- PERSON DOES NOT HAVE A STATUS OF INSTITUTIONALIZED AS OF THE CURRENT ROUND'S INTERVIEW DATE (RE19A = 1, 3, -7, -8 IN THE CURRENT ROUND)
- PERSON HAD A STATUS OF INSTITUTIONALIZED IN ANY PREVIOUS ROUND
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_02A USES NAV_CL02A TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_CL02A
=========

SERIES: Complete the Institutionalized Health History Worksheet
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_02A DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CL06A FOR SELECTED RU MEMBER.
----------------------------------------------------

CL06A
=====

PID: [PID-3] PERSON: [First,[Middle],Last Name-35]
DOB: [MM/DD/YYYY] AGE: [XXX] STATUS: [Status Code Description]
DATE ORIGINALLY INSTITUTIONALIZED: [MM/DD/YYYY]
DATE REJOINED COMMUNITY/CHANGED STATUS: [MM/DD/YYYY]
RU ID: [RUID-7] REGION: [Reg ID-1]
SIGNATURE DATE ON MPC AF MUST BE ON OR AFTER: [MM/DD/YYYY]
[We request written authorization to contact medical facilities for more information about the services they provide. [HAND RESPONDENT THE AUTHORIZATION FORM BOOKLET.] [These materials explain more about why we contact medical facilities and answer questions people sometimes ask about this part of the study. Please take a minute to review this information while I prepare the forms.]]

INTERVIEWER: THE PERSON NAMED ABOVE WAS INSTITUTIONALIZED IN A PREVIOUS ROUND AND HAS NOW REJOINED THE COMMUNITY OR CHANGED STATUS. COMPLETE THE FOLLOWING STEPS:
1. FILL OUT HEALTH CARE INSTITUTION HISTORY.
2. COMPLETE A MPC AF FOR EACH DIFFERENT HEALTH CARE INSTITUTION LISTED ON HEALTH CARE INSTITUTION HISTORY. WRITE 'IC' IN UPPER LEFT CORNER OF MPC AF. REFER TO SECTION 3 OF HISTORY FOR INSTRUCTIONS ON COMPLETING THESE AF(S).
3. REQUEST SIGNATURE(S) ON AF(S).
4. LEAVE UNSIGNED AF(S) AND THE AF BOOKLET WITH RESPONDENT.
5. PLACE EACH SIGNED MPC AF IN THE CASE FOLDER. MAKE FOLLOW-UP ARRANGEMENTS FOR EACH UNSIGNED MPC AF. CAPI WILL NOT COLLECT INFORMATION ON STATUS.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY THE INTERVIEW DATE OF THE MOST RECENT ROUND'S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR 'MM/DD/YYYY'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'We request ... prepare the forms.]' IF CL01 WAS NOT ASKED FOR THE CURRENT ROUND.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH END_LP02A
----------------------------------------------------

END_LP02A
=========

BOX_03
======

----------------------------------------------------
Subsection 2: HIPS AUTHORIZATION FORMS (BEGINNING WITH THE SECOND YEAR OF PANEL 2 AND THE FIRST YEAR OF PANEL 3 (1998), SAMPLING CONTINUES BUT AUTHORIZATION FORMS ARE NOT COLLECTED).

SAMPLING BOX FOR ROUNDS 2 AND 3: (TO BASE ON ROUND 1 CRITERIA FOR COLLECTION OF AFs IN ROUND 2 AND ROUND 3):
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE PERSON IS THE POLICYHOLDER OF THIS INSURANCE ON THE DATE OF THE ROUND 1 INTERVIEW AND THE ESTABLISHMENT IS A PRIVATE SOURCE OF INSURANCE (DEFINED LATER) HELD ON THE DATE OF THE ROUND 1 INTERVIEW (DEFINED LATER) WITH FOUR EXCEPTIONS:
1. ESTABLISHMENT IS FLAGGED AS 'EMPLOYER' AND EMPLOYER IS THE FEDERAL GOVERNMENT (EM96=2 OR HP13=1)
2. ESTABLISHMENT IS FLAGGED AS 'NOT SELF- EMPLOYED' WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2)
3. PERSON IS THE POLICYHOLDER OF THIS INSURANCE AND IS FLAGGED AS 'POLICYHOLDER NOT LISTED IN RU'
4. ESTABLISHMENT ONLY PROVIDES LONG TERM CARE IN A NURSING HOME, EXTRA CASH FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD DISEASE, DISABILITY, WORKER'S COMPENSATION, OR ACCIDENT INSURANCE (HX48 IS CODED ONLY COMBINATIONS OF CODES '6', '7', '8', '9', '10', AND '11').
----------------------------------------------------
----------------------------------------------------
SAMPLING BOX FOR ROUNDS 2 AND 3: (TO BASE ON ROUND 1 CRITERIA FOR COLLECTION OF AFs IN ROUND 2 AND ROUND 3):
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE ESTABLISHMENT IS FLAGGED AS 'EMPLOYER' AND THE JOB SUBTYPE OF THAT EMPLOYER IS FLAGGED AS 'CURRENT MAIN' AND THE JOB IS NOT FLAGGED AS 'PROVIDES HEALTH INSURANCE' (PERSON IS THE JOBHOLDER OF THIS CURRENT MAIN JOB ON THE DATE OF THE ROUND 1 INTERVIEW) AS OF THE ROUND 1 INTERVIEW DATE WITH THREE EXCEPTIONS:
1. ESTABLISHMENT IS THE FEDERAL GOVERNMENT (EM96 = 2)
2. ESTABLISHMENT IS FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE=1
3. ESTABLISHMENT IS FLAGGED AS 'NOT SELF- EMPLOYED' WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2)
----------------------------------------------------
----------------------------------------------------
SAMPLING BOX FOR ROUNDS 4 AND 5:
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE ESTABLISHMENT IS FLAGGED AS 'EMPLOYER' AND THE JOB SUBTYPE OF THAT EMPLOYER IS FLAGGED AS 'CURRENT MAIN' AND THE JOB IS NOT FLAGGED AS 'PROVIDES HEALTH INSURANCE' (PERSON IS THE JOBHOLDER OF THIS CURRENT MAIN JOB ON THE DATE OF THE ROUND 1 INTERVIEW) AS OF THE ROUND 1 INTERVIEW DATE WITH THREE EXCEPTIONS:
1. ESTABLISHMENT IS THE FEDERAL GOVERNMENT (EM96 = 2)
2. ESTABLISHMENT IS FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE=1
3. ESTABLISHMENT IS FLAGGED AS 'NOT SELF- EMPLOYED' WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2)
----------------------------------------------------
----------------------------------------------------
NOTE: PRIVATE INSURANCE IS DEFINED AS:
- ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND FLAGGED AS 'PROVIDES HEALTH INSURANCE' (ESTABLISHMENTS FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 ARE TREATED AS DIRECT PURCHASED, SEE NOTE BELOW)
- DIRECT PURCHASED INSURANCE, THAT IS, ESTABLISHMENTS CREATED FROM THE HX23 SERIES
----------------------------------------------------
----------------------------------------------------
NOTE: HELD ON THE DATE OF THE ROUND 1 INTERVIEW:
- FOR PRIVATE SOURCES -- POLICYHOLDER HELD INSURANCE AT THE TIME OF THE ROUND 1 INTERVIEW DATE (HQ01 IS CODED '1' (WHOLE TIME) OR HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER)
- FOR PRIVATE SOURCES WHERE POLICYHOLDER IS DECEASED -- AT LEAST ONE DEPENDENT (SELECTED AT HP16) IS COVERED BY THE INSURANCE AT THE TIME OF THE ROUND 1 INTERVIEW DATE (HQ01 IS CODED '1' (WHOLE TIME) OR HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE COVERED PERSON)
----------------------------------------------------
----------------------------------------------------
NOTE: ESTABLISHMENTS WHICH ARE EMPLOYERS AND PROVIDE HEALTH INSURANCE AND ARE FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE=1 ARE TREATED AS DIRECT PURCHASED INSURANCE, THAT IS, HIPS WILL CONTACT THE ESTABLISHMENT PROVIDING THE INSURANCE, (I.E., CREATED FROM THE HX03 SERIES) NOT THE EMPLOYER.
----------------------------------------------------
----------------------------------------------------
NOTE: FOR ESTABLISHMENTS WHICH ARE CURRENT MAIN EMPLOYERS (ON THE ROUND 1 INTERVIEW DATE) AND PROVIDE HEALTH INSURANCE, WHERE THE HEALTH INSURANCE IS ONLY FROM A UNION (EM117=2), A HIPS AUTHORIZATION FORM IS REQUIRED FOR BOTH THE EMPLOYER AND THE UNION. IN THESE CASES, BOTH ESTABLISHMENT-PERSON-PAIRS ARE ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION.
----------------------------------------------------
----------------------------------------------------
NOTE: IF A CURRENT MAIN JOB IS FLAGGED AS 'PREVIOUS HEALTH INSURANCE' BUT THAT INSURANCE IS ONLY LONG TERM CARE IN A NURSING HOME, EXTRA CASH FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD DISEASE, DISABILITY, WORKER'S COMPENSATION, AND/OR ACCIDENT INSURANCE, THE JOB IS PROCESSED AS IF IT DOES NOT PROVIDE HEALTH INSURANCE BUT IS ELIGIBLE FOR HEALTH INSURANCE PROVIDER AUTHORIZATION FORM COLLECTION (AS LONG AS OTHER REQUIREMENTS ARE MET).
----------------------------------------------------
----------------------------------------------------
NOTE: A '-7' (REFUSED) AND '-8' (DON'T KNOW) RESPONSE AT ANY QUESTION LISTED ABOVE DOES NOT MEET THE CRITERIA.
----------------------------------------------------
----------------------------------------------------
NOTE: IN ROUND 4, A NEW HIPS FLAG WILL BE SET AND NEW HIPS AUTHORIZATION FORMS WILL BE COLLECTED FOR ALL ESTABLISHMENT-PERSON-PAIRS BASED ON THE ABOVE SAMPLING CRITERIA, BUT USING ROUND 3 DATA.
----------------------------------------------------
----------------------------------------------------
SAMPLING BOX (TO BASE ON ROUND 3 CRITERIA, FOR COLLECTION OF AFs IN ROUNDS 4 AND 5):
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE PERSON IS THE POLICYHOLDER OF THIS INSURANCE ON THE DATE OF THE ROUND 3 INTERVIEW AND THE ESTABLISHMENT IS A PRIVATE SOURCE OF INSURANCE (DEFINED LATER) HELD ON THE DATE OF THE ROUND 3 INTERVIEW (DEFINED LATER) WITH FOUR EXCEPTIONS:
1. ESTABLISHMENT IS FLAGGED AS 'EMPLOYER' AND EMPLOYER IS THE FEDERAL GOVERNMENT (EM96=2 OR HP13=1)
2. ESTABLISHMENT IS FLAGGED AS 'NOT SELF- EMPLOYED' WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2)
3. PERSON IS THE POLICYHOLDER OF THIS INSURANCE AND IS FLAGGED AS 'POLICYHOLDER NOT LISTED IN DU'
4. ESTABLISHMENT PROVIDES ONLY LONG TERM CARE IN A NURSING HOME, EXTRA CASH FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD DISEASE, DISABILITY, WORKER'S COMPENSATION, OR ACCIDENT INSURANCE (HX48, OE10, OE24, OR OE37 IS CODED ONLY COMBINATIONS OF CODES '6', '7', '8', '9', '10', AND '11').
----------------------------------------------------
----------------------------------------------------
SAMPLING BOX FOR ROUNDS 4 AND 5: (TO BASE ON ROUND 3 CRITERIA, FOR COLLECTION OF AFs IN ROUNDS 4 AND 5):
RU-ESTABLISHMENT-PERSON-PAIRS ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION:

- ALL PAIRS WHERE THE ESTABLISHMENT IS FLAGGED AS 'EMPLOYER' AND THE JOB SUBTYPE OF THAT EMPLOYER IS FLAGGED AS 'CURRENT MAIN' AND THE JOB IS NOT FLAGGED AS 'PROVIDES HEALTH INSURANCE' (PERSON IS THE JOBHOLDER OF THIS CURRENT MAIN JOB ON THE DATE OF THE ROUND 3 INTERVIEW) AS OF THE ROUND 3 INTERVIEW DATE WITH THREE EXCEPTIONS:
1. ESTABLISHMENT IS THE FEDERAL GOVERNMENT (EM96 = 2)
2. ESTABLISHMENT IS FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE=1
3. ESTABLISHMENT IS FLAGGED AS 'NOT SELF- EMPLOYED' WITH ONE EMPLOYEE (EM91=1) AND ONE LOCATION (EM93=2)
----------------------------------------------------
----------------------------------------------------
NOTE: PRIVATE INSURANCE IS DEFINED AS:
- ESTABLISHMENTS FLAGGED AS 'EMPLOYER' AND FLAGGED AS 'PROVIDES HEALTH INSURANCE' (ESTABLISHMENTS FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE-1 ARE TREATED AS DIRECT PURCHASED, SEE NOTE BELOW)
- DIRECT PURCHASED INSURANCE, THAT IS, ESTABLISHMENTS CREATED FROM THE HX23 SERIES
----------------------------------------------------
----------------------------------------------------
NOTE: HELD ON THE DATE OF THE ROUND 3 INTERVIEW:
- FOR PRIVATE SOURCES -- POLICYHOLDER HELD INSURANCE AT THE TIME OF THE ROUND 3 INTERVIEW DATE [(HQ01 IS CODED '1' (WHOLE TIME) OR HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE POLICYHOLDER) OR (OE01, OE12, OE26 IS CODED '1' (YES) FOR THE POLICYHOLDER)
- FOR PRIVATE SOURCES WHERE POLICYHOLDER IS DECEASED -- AT LEAST ONE DEPENDENT [(SELECTED AT HP16 OR OE45) OR (CONFIRMED AS STILL COVERED AT OE29 OR OE30)] IS COVERED BY THE INSURANCE AT THE TIME OF THE ROUND 3 INTERVIEW DATE [(HQ01 IS CODED '1' (WHOLE TIME) OR HQ02 IS CODED '1' (YES, COVERED NOW) FOR THE COVERED PERSON) OR (OE26 IS CODED '1' (YES) FOR THE COVERED PERSON)]
----------------------------------------------------
----------------------------------------------------
NOTE: ESTABLISHMENTS WHICH ARE EMPLOYERS AND PROVIDE HEALTH INSURANCE AND ARE FLAGGED AS 'SELF-EMPLOYED' WITH A FIRM-SIZE=1 ARE TREATED AS DIRECT PURCHASED INSURANCE, THAT IS, HIPS WILL CONTACT THE ESTABLISHMENT PROVIDING THE INSURANCE, (I.E., CREATED FROM THE HX03 SERIES) NOT THE EMPLOYER.
----------------------------------------------------
----------------------------------------------------
NOTE: FOR ESTABLISHMENTS WHICH ARE CURRENT MAIN EMPLOYERS (ON THE ROUND 3 INTERVIEW DATE) AND PROVIDE HEALTH INSURANCE, WHERE THE HEALTH INSURANCE IS ONLY FROM A UNION (EM117=2), A HIPS AUTHORIZATION FORM IS REQUIRED FOR BOTH THE EMPLOYER AND THE UNION. IN THESE CASES, BOTH ESTABLISHMENT-PERSON-PAIRS ARE ELIGIBLE FOR HIPS AUTHORIZATION FORM COLLECTION.
----------------------------------------------------
----------------------------------------------------
NOTE: IF A CURRENT MAIN JOB IS FLAGGED AS 'PREVIOUS HEALTH INSURANCE' BUT THAT INSURANCE IS ONLY LONG TERM CARE IN A NURSING HOME, EXTRA CASH FOR HOSPITAL STAYS, SERIOUS DISEASE OR DREAD DISEASE, DISABILITY, WORKER'S COMPENSATION, AND/OR ACCIDENT INSURANCE, THE JOB IS PROCESSED AS IF IT DOES NOT PROVIDE HEALTH INSURANCE BUT IS ELIGIBLE FOR HEALTH INSURANCE PROVIDER AUTHORIZATION FORM COLLECTION (AS LONG AS OTHER REQUIREMENTS ARE MET).
----------------------------------------------------
----------------------------------------------------
NOTE: A '-7' (REFUSED) AND '-8' (DON'T KNOW) RESPONSE AT ANY QUESTION LISTED ABOVE DOES NOT MEET THE CRITERIA.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_10
----------------------------------------------------

BOX_04A
=======

OMITTED.

BOX_04
======

OMITTED.

CL07
====

OMITTED.

LOOP_03
=======

OMITTED.

CL08
====

OMITTED.

CL09
====

OMITTED.

CL09OV1
=======

OMITTED.

CL09OV2
=======

OMITTED.

CL10
====

OMITTED.

CL11
====

OMITTED.

CL11OV
======

OMITTED.

END_LP03
========

OMITTED.

BOX_05
======

OMITTED.

BOX_06
======

OMITTED.

CL12
====

OMITTED.

CL13
====

OMITTED.

CL14
====

OMITTED.

LOOP_04
=======

OMITTED.

CL15
====

OMITTED.

CL15OV
======

OMITTED.

CL16
====

OMITTED.

CL17
====

OMITTED.

CL17OV
======

OMITTED.

END_LP04
========

OMITTED.

BOX_07
======

OMITTED.

CL18
====

OMITTED.

CL18OV
======

OMITTED.

CL19
====

OMITTED.

CL20
====

OMITTED.

CL20OV
======

OMITTED.

BOX_08
======

OMITTED.

LOOP_04A
========

OMITTED.

CL21
====

OMITTED.

END_LP04A
=========

OMITTED.

BOX_09
======

OMITTED.

CL22
====

OMITTED.

BOX_10
======

----------------------------------------------------
Subsection 4: Pharmacy Requests and Authorization Forms (Rounds 2-5)

AS A PHARMACY WAS ENTERED OR SELECTED DURING THE PRESCRIBED MEDICINES SECTION, THE PERSON-PHARMACY- PAIR WAS FLAGGED 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 AUTHORIZATION FORM COLLECTION FOR THIS RU MEMBER.
----------------------------------------------------
----------------------------------------------------
IF ROUND 1, GO TO BOX_14
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ROUNDS 2-5), CONTINUE WITH BOX_11
----------------------------------------------------
----------------------------------------------------
NOTE: PANELS 1 THROUGH 12 INCLUDED PHARMACY AF COLLECTION ONLY IN ROUNDS 3 AND 5. PANEL 13 INCLUDES PHARMACY AF COLLECTION IN ROUNDS 3, 4, AND 5. BEGINNING IN PANEL 14, AND ALL SUBSEQUENT PANELS, PHARMACY AF COLLECTION OCCURS IN ROUNDS 2-5.
----------------------------------------------------

BOX_11
======

----------------------------------------------------
IF AT LEAST ONE PERSON-PHARMACY-PAIR ELIGIBLE (SEE SAMPLING BOX BELOW) FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND,
OR
AT LEAST ONE PERSON-PHARMACY-PAIR ELIGIBLE FOR AUTHORIZATION FORM COLLECTION DURING THE PREVIOUS ROUND AND CL32 WAS CODED '3' (LEFT WITH R), '4' (MAILED TO R), '5' (REFUSED), '91' (OTHER), OR '-1' (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PHARMACY-PAIR IN PREVIOUS ROUND, CONTINUE WITH CL30
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_14
----------------------------------------------------
----------------------------------------------------
NOTE: RECEIPT CONTROL WILL UPDATE CAPI INTER- ROUND, USING THE CODE STRUCTURE AT CL32. UPDATES CAN BE EITHER POSITIVE OR NEGATIVE. THIS MEANS THAT INTER-ROUND AN AUTHORIZATION FORM'S STATUS CAN EITHER GET UPDATED TO A HIGHER STATUS CODE (FROM UNSIGNED TO SIGNED) OR TO A LOWER STATUS CODE (FROM SIGNED TO UNSIGNED -- I.E., IT WAS NOT SIGNED BY THE RIGHT PERSON). SEE MPC MAPPING SPECIFICATIONS FOR EXACT UPDATES TO STATUS CODES.
----------------------------------------------------
----------------------------------------------------
NOTE BOX THERE ARE 6 PERSON TYPES (AND TWO SUB-TYPES) IN THE MEPS RU

TYPE PRSLT DECEASED/ELIGIBLE FOR PART OF REF PERIOD 41 INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD 51 IN A HEALTHCARE FACILITY (INSTTTYPE 1 OR 2) IN A NON-HEALTHCARE FACILITY (INSTTYPE 3) MEPS STUDENT/ELIGIBLE ALL OF REF PERIOD 71 LIVING OUTSIDE US/ELIGIBLE PT OF REF PERIOD 75 LIVING-MILITARY BASE/ELIGIBLE PT REF PERIOD 76 ELIGIBLE FOR ALL OF REFERENCE PERIOD 99

THE FOLLOWING PERSON TYPES (AND SUB-TYPES) ARE ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION:
- PRSLT 41 - DECEASED/ELIGIBLE FOR PART OF REF PERIOD
- PRSLT 51 ? SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A HEALTHCARE FACILITY (INSTTYPE 1 OR 2)
- PRSLT 71 - MEPS STUDENT/ELIGIBLE ALL OF REF PERIOD
- PRSLT 99 - ELIGIBLE FOR ALL OF REFERENCE PERIOD

THERE ARE TWO TYPES OF OUT OF SCOPE RU MEMBERS THAT ARE ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION (NOTE: OUT OF SCOPE REFERS TO RU MEMBERS WHO HAD PARTIAL ELIGIBILITY IN THE PREVIOUS ROUND AND NO ELIGIBILITY IN THE CURRENT ROUND):
- PRSLT 41 - DECEASED/ELIGIBLE FOR PART OF REF PERIOD
- PRSLT 51 ? SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A HEALTHCARE FACILITY (INSTTYPE 1 OR 2)

2 PERSON TYPES AND 1 SUB-TYPE ARE NOT ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION:
- PRSLT 51 ? SUB-TYPE INSTITUTIONALIZED/ELIGIBLE PT OF REF PERIOD IN A NON-HEALTHCARE FACILITY (INSTTYPE 3)
- PRSLT 75 - LIVING OUTSIDE US/ELIGIBLE PT OF REF PERIOD
- PRSLT 76 - LIVING-MILITARY BASE/ELIGIBLE PT REF PERIOD

PERSON-PHARMACY-PAIRS WHERE THE PHARMACY LOCATION IS IN A FOREIGN COUNTRY (I.E., 'FC' IS ENTERED IN THE STATE FIELD OF PHARMACY'S ADDRESS ARE NOT ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION)
----------------------------------------------------
----------------------------------------------------
NOTE: PHARMACY AUTHORIZATION FORMS ARE NOT EVENT DEPENDENT, ARE NOT LINKED TO ANY SPECIFIC YEAR IN ROUND 3 AND ARE ASKED AS TWO SEPARATE SAMPLES.
FOR THE FIRST SAMPLE, CAPI REQUESTS AUTHORIZATION FORMS FROM ROUNDS 1, 2 AND 3. FOR THE SECOND SAMPLE, CAPI REQUESTS AUTHORIZATION FORMS FROM ROUNDS 3, 4 AND 5. REQUESTS FOR OUTSTANDING AUTHORIZATION FORMS FROM ROUNDS 1 AND 2 SHOULD NOT BE CONTINUED IN ROUND 4, INCLUDING AUTHORIZATION FORMS FOR DECEASED AND INSTITUTIONALIZED PERSONS.
----------------------------------------------------
----------------------------------------------------
SAMPLING BOX

PERSON-PHARMACY-PAIRS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION:
NOTE: PERSON IS A KEY, ELIGIBLE RU MEMBER (AT TIME OF EVENT).

ROUND 1:
- AUTHORIZATION FORMS (AFS) ARE NOT REQUESTED IN ROUND 1 BUT PHARMACY RECORDS ARE CREATED.

ROUND 2:
- PERSON-PHARMACY PAIRS CREATED IN THE CURRENT ROUND.
- PERSON-PHARMACY PAIRS CREATED IN THE PREVIOUS ROUND.

ROUND 3:
- PERSON-PHARMACY PAIRS CREATED IN THE CURRENT ROUND.
- PERSON-PHARMACY PAIRS OUTSTANDING FROM THE PREVIOUS ROUND.
- PERSON-PHARMACY PAIRS CREATED IN PREVIOUS ROUNDS BUT SELECTED IN THE CURRENT ROUND.
ROUND.

ROUND 4:
- PERSON-PHARMACY PAIRS CREATED IN THE CURRENT ROUND.
- PERSON-PHARMACY PAIRS OUTSTANDING FROM THE PREVIOUS ROUND IF THEY WERE CREATED IN ROUND 3.
- PERSON-PHARMACY PAIRS CREATED IN PREVIOUS ROUNDS BUT SELECTED IN THE CURRENT ROUND.

ROUND 5:
- PERSON-PHARMACY PAIRS CREATED IN THE CURRENT ROUND.
- PERSON-PHARMACY PAIRS OUTSTANDING FROM THE PREVIOUS ROUND IF THEY WERE CREATED IN ROUND 3 OR 4.
- PERSON-PHARMACY PAIRS CREATED IN PREVIOUS ROUNDS BUT SELECTED IN THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
NOTE: IF THE SAME PHARMACY IS ASSOCIATED MORE THAN ONCE WITH A PARTICULAR PERSON, ONLY ONE AUTHORIZATION FORM IS ASKED ABOUT FOR THAT PAIR. IF THE SAME PHARMACY IS ASSOCIATED WITH MORE THAN ONE PERSON, AN AUTHORIZATION FORM IS ASKED FOR EACH UNIQUE PERSON-PHARMACY-PAIR.
----------------------------------------------------
----------------------------------------------------
NOTE: IF THE PERSON-PHARMACY-PAIR IS OUTSTANDING FROM A PREVIOUS ROUND AND THE SAME PHARMACY IS SELECTED FOR THAT PERSON IN THE CURRENT ROUND, HE PAIR WILL NOT BE TREATED AS IF IT IS OUTSTANDING. THAT IS, THE DISPLAYS FOR PREVIOUS ROUND STATUS WILL NOT BE SHOWN, ETC.
----------------------------------------------------

CL23
====

OMITTED.

CL24
====

OMITTED.

LOOP_05
=======

OMITTED.

CL25
====

OMITTED.

END_LP05
========

OMITTED.

CL26
====

OMITTED.

BOX_12
======

OMITTED.

CL27
====

OMITTED.

LOOP_06
=======

OMITTED.

CL28
====

OMITTED.

END_LP06
========

OMITTED.

BOX_13
======

OMITTED.

CL29
====

OMITTED.

CL30
====

To obtain complete and accurate information about health care use and expenditures, we would like authorization to contact pharmacies to obtain a printed summary for: (READ PERSON BELOW)'s prescriptions filled at (READ PHARMACY BELOW). [HAND RESPONDENT THE AUTHORIZATION FORM BOOKLET.] [These materials explain more about why we contact pharmacies and answer questions people sometimes ask about this part of the study. Please take a minute to review this information while I gather the forms.]

ROSTER. PERSON CL30_01. PHARMACY
[First, [Middle], Last Name-35] [Name of Pharmacy.............-30]
[First, [Middle], Last Name-35] [Name of Pharmacy.............-30]
[First, [Middle], Last Name-35] [Name of Pharmacy.............-30]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_PERS_PHAR_PAIR_1

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

COL # 2 HEADER: PHARMACY
INSTRUCTIONS: DISPLAY PHARMACY NAME (PHAR.PHARNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY EACH UNIQUE PAIR ON THE RU-PERSON- PHARMACY-PAIRS-ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.

2. SELECT, EDIT, ADD, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ONLY THOSE PAIRS THAT MEET THE FOLLOWING CONDITION(S):
- PAIR IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_11 SAMPLING SPECIFICATIONS)
OR
- PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND,
AND
- CL32 WAS CODED '3' (LEFT WITH R), '4' (MAILED TO R), '5' (REFUSED), '91' (OTHER) OR '-1' (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PHARMACY-PAIR IN PREVIOUS ROUND
----------------------------------------------------
----------------------------------------------------
NOTE: DISPLAY EACH UNIQUE ELIGIBLE PERSON- PHARMACY-PAIR ONLY ONCE.
----------------------------------------------------

LOOP_07
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-PERSON-PHARMACY-PAIRS- ROSTER, ASK CL31 - END_LP07
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_07 PRESENTS EACH UNIQUE PERSON-PHARMACY-PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE INTERVIEWER TO COMPLETE THE AUTHORIZATION FORM. THIS LOOP CYCLES ON THE RU-PERSON-PHARMACY-PAIRS THAT MEET THE FOLLOWING CONDITIONS:

- PAIR IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_11 SAMPLING SPECIFICATIONS)
OR
- PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND,
AND
- CL32 WAS CODED '3' (LEFT WITH R), '4' (MAILED TO R), '5' (REFUSED), '91' (OTHER) OR '-1' (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PHARMACY-PAIR IN PREVIOUS ROUND
----------------------------------------------------
----------------------------------------------------
NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON- PHARMACY-PAIR.
----------------------------------------------------

CL31
====

INTERVIEWER: CHECK FIRST FOR PREPRINTED PHARMACY AF FOR THIS PAIR.
IF THERE IS NO PREPRINTED AF, FILL OUT A BLANK PHARMACY AF.
PID: [PID] PERSON: [First,[Middle],Last Name-35]
DOB: [MM/DD/YYYY] AGE: [XXX] STATUS: [Status Code Description]
RU ID: [RUID-7] REGION: [Reg ID-1] PHARMID: [PharmID-4]
PHARMACY NAME: [Pharmacy Name-35]
PHARMACY ADDRESS: [Street Address for Pharmacy]
[City Name], [ST] [Zip Code] [Telephone]
[PHARMACY AF STATUS FROM PREVIOUS ROUND: [DISPLAY PREVIOUS ROUND STATUS ? 40]]
SIGNATURE DATE ON PHARMACY AF MUST BE ON OR AFTER: [MM/DD/YYYY]
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
HELP AVAILABLE FOR MORE INFORMATION ON PHARMACY AUTHORIZATION FORMS.
----------------------------------------------------
ISPLAY 'PHARMACY AF STATUS ... -40]' IF CURRENT PERSON-PHARMACY-PAIR IS OUTSTANDING FROM THE PREVIOUS ROUND.

FOR 'DISPLAY PREVIOUS ROUND STATUS-40', DISPLAY THE CATEGORY ENTRY ASSOCIATED WITH THE PREVIOUS ROUND (OR RECEIPT CONTROL UPDATED) CL32 OUTSTANDING STATUS. THAT IS, IF CL32 WAS CODED '3', DISPLAY 'LEFT WITH R'; IF CL32 WAS CODED '4', DISPLAY 'MAILED TO R'; IF CL32 WAS CODED '5', DISPLAY 'REFUSED'; AND IF CL32 WAS CODED '91' OR '-1', DISPLAY THE FIRST 40 CHARACTERS FROM THE OTHER SPECIFY ENTRY FIELD (OR THE RECEIPT CONTROL UPDATE TEXT GENERATED FOR THE '91' OR '-1' CODES)

DISPLAY THE INTERVIEW DATE OF THE MOST RECENT ROUND'S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION FOR
'MM/DD/YYYY'.
----------------------------------------------------

END_LP07
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-PERSON-PHARMACY- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_07 AND CONTINUE WITH LOOP_08
----------------------------------------------------

LOOP_08
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-PERSON-PHARMACY-PAIRS- ROSTER, ASK CL32 - END_LP08
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_08 PRESENTS EACH UNIQUE PERSON-PHARMACY-PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE INTERVIEWER TO RECORD THE STATUS OF THE AUTHORIZATION FORM.
THIS LOOP CYCLES ON THE RU-PERSON-PHARMACY-PAIRS THAT MEET THE FOLLOWING CONDITIONS:

- PAIR IS ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION FOR THE CURRENT ROUND (SEE BOX_11 SAMPLING SPECIFICATIONS)
OR
- PAIR ELIGIBLE FOR PHARMACY AUTHORIZATION FORM COLLECTION IN PREVIOUS ROUND,
AND
- CL32 WAS CODED '3' (LEFT WITH R), '4' (MAILED TO R), '5' (REFUSED), '91' (OTHER) OR '-1' (ADDED BY COMMENT REVIEW) FOR THIS PERSON- PHARMACY-PAIR IN PREVIOUS ROUND
----------------------------------------------------
----------------------------------------------------
NOTE: LOOP ONLY ONE TIME FOR EACH UNIQUE PERSON- PHARMACY-PAIR.
----------------------------------------------------

CL32
====

INTERVIEWER: ASK APPROPRIATE PERSON(S) TO SIGN AUTHORIZATION FORM.
IF NOT AVAILABLE TO SIGN, LEAVE AUTHORIZATION FORM AND BOOKLET WITH RESPONDENT.
PID: [PID] PERSON: [First,[Middle],Last Name-35]
DOB: [MM/DD/YYYY] AGE: [XXX] STATUS: [Status Code Description]
RU ID: [RUID-7] REGION: [Reg ID-1] PHARMID: [PharmID-4]
PHARMACY NAME: [Pharmacy Name-35]
PHARMACY ADDRESS: [Street Address for Pharmacy]
[City Name], [ST] [Zip Code] [Telephone]
SIGNATURE DATE ON PHARMACY AF MUST BE ON OR AFTER: [MM/DD/YYYY]
SELECT THE PHARMACY AUTHORIZATION FORM STATUS:
SIGNED, NO PROBLEM ..................... 1 [CL33]
SIGNED WITH PROBLEM .................... 2 [CL32OV1]
LEFT WITH R ............................ 3 [END_LP08]
MAILED TO R ............................ 4 [END_LP08]
REFUSED ................................ 5 [CL34]
OTHER ................................. 91 [CL32OV2]
[Code One]
HELP AVAILABLE FOR MORE INFORMATION ON PHARMACY AUTHORIZATION FORMS.
----------------------------------------------------
FOR 'MM/DD/YYY', DISPLAY THE RU END REFERENCE DATE OF THE MOST RECENT ROUND'S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
CODE '4' (MAILED TO R) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE '4' SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: 'UNLIKELY RESPONSE. VERIFY AND RE-ENTER.'
----------------------------------------------------

CL32OV1
=======

PROBLEM:
[Enter Problem-45] ..................... [CL33]
HELP AVAILABLE FOR MORE INFORMATION ON PHARMACY AUTHORIZATION FORMS.

CL32OV2
=======

SPECIFY:
[Enter Other Specify-45] ............... [END_LP08]
HELP AVAILABLE FOR MORE INFORMATION ON PHARMACY AUTHORIZATION FORMS.

CL33
====

PID: [PID] PERSON: [First,[Middle],Last Name-35]
DOB: [MM/DD/YYYY] AGE: [XXX] STATUS: [Status Code Description]
RU ID: [RUID-7] REGION: [Reg ID-1] PHARMID: [PharmID-4]
PHARMACY NAME: [Pharmacy Name-35]
PHARMACY ADDRESS: [Street Address for Pharmacy]
[City Name], [ST] [Zip Code] [Telephone]
SIGNATURE DATE ON PHARMACY AF MUST BE ON OR AFTER: [MM/DD/YYYY]
ENTER PHARMACY AUTHORIZATION FORM NUMBER:
[Enter Number-8] ....................... [CL33OV]
----------------------------------------------------
FOR 'MM/DD/YYYY', DISPLAY THE RU END REFERENCE DATE OF THE MOST RECENT ROUND'S INTERVIEW FOR WHICH PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION.
----------------------------------------------------
----------------------------------------------------
NOTE: EACH PHARMACY AUTHORIZATION FORM HAS A PRE-ASSIGNED PHARMACY AUTHORIZATION FORM NUMBER.
----------------------------------------------------
----------------------------------------------------
HARD CHECK?PANEL 18 PHARMACY AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN AND END WITH AN ALPHA CHARACTER.
PANEL 18 PHARMACY AUTHORIZATION FORMS ARE PRINTED
ON GRAY PAPER.
----------------------------------------------------
ORIGIN LETTER
5-NUMBER
SEQUENCE
CHECK
DIGIT
ROUND
IDENTIFIER
PREGENERATED
Q,R,S 70000-
79999
RANDOM
(0-9)
G,H,J,K,L
FIELD
GENERATED
Q,R,S 80000-
89999
RANDOM
(0-9)
G,H,J,K,L
HOME
OFFICE
Z 90000-
95999
RANDOM
(0-9)
G,H,J,K,L
TRAINING/
QC
Y 96600-
96799
RANDOM
(0-9)
G,H,J,K,L
----------------------------------------------------
HARD CHECK?PANEL 19 PHARMACY AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN WITH AN ALPHA CHARACTER AND END WITH AN ALPHA CHARACTER. PANEL 19 PHARMACY AUTHORIZATION FORMS ARE PRINTED ON ORCHID PAPER.
----------------------------------------------------
ORIGIN LETTER
5-NUMBER
SEQUENCE
CHECK
DIGIT
ROUND
IDENTIFIER
PREGENERATED
Q,R,S 70000-
79999
RANDOM
(0-9)
M,N,P,Q,R
FIELD
GENERATED
Q,R,S 80000-
89999
RANDOM
(0-9)
M,N,P,Q,R
HOME
OFFICE
Z 90000-
95999
RANDOM
(0-9)
M,N,P,Q,R
TRAINING/
QC
Y 96600-
96799
RANDOM
(0-9)
M,N,P,Q,R
----------------------------------------------------
HARD CHECK?PANEL 20 PHARMACY AUTHORIZATION FORMS:
AUTHORIZATION FORM NUMBERS ARE PANEL AND ROUND SPECIFIC. NUMBER ENTERED MUST BE 8 CHARACTERS LONG AND MUST BEGIN AND END WITH AN ALPHA CHARACTER.
PANEL 20 PHARMACY AUTHORIZATION FORMS ARE PRINTED ON PINK PAPER.
----------------------------------------------------
ORIGIN LETTER
5-NUMBER
SEQUENCE
CHECK
DIGIT
ROUND
IDENTIFIER
PREGENERATED
Q,R,S 70000-
79999
RANDOM
(0-9)
S,T,U,V,W
FIELD
GENERATED
Q,R,S 80000-
89999
RANDOM
(0-9)
S,T,U,V,W
HOME
OFFICE
Z 90000-
95999
RANDOM
(0-9)
S,T,U,V,W
TRAINING/
QC
Y 96600-
96799
RANDOM
(0-9)
S,T,U,V,W
----------------------------------------------------
SOME IMPORTANT POINTS TO REMEMBER ABOUT PHARMACY AUTHORIZATION FORMS:
- THE PREFIX LETTER CHANGES BASED ON THE TYPE OF AUTHORIZATION FORM AND THE ORIGIN OF THE FORM.
THIS MEANS THAT A PRE-PRINTED OR FIELD GENERATED AUTHORIZATION FORM WILL DRAW FROM THE SAME LETTER OR RANGE OF LETTERS IN EACH PANEL. THE EXCEPTION IS PANEL 14 PHARMACY AUTHORIZATION FORMS WHICH WILL DRAW FROM AN EXPANDED LIST OF PREFIX LETTERS TO ACCOMMODATE A CHANGE IN COLLECTION PROCEDURES.
- THE 5-NUMBER SEQUENCE REPEATS ITSELF FOR EACH PANEL.
- THE CHECK-DIGIT ALWAYS REMAINS CONSTANT.
- THE ROUND IDENTIFIER IS DIFFERENT FOR EACH PANEL. THE ROUND IDENTIFIER WILL REMAIN THE SAME FOR ALL AUTHORIZATION FORMS COLLECTED WITHIN A PANEL, BUT CHANGES BASED ON THE ROUND.
FOR EXAMPLE: AUTHORIZATION FORMS GENERATED FOR PANEL 19, ROUND 1 WILL USE THE ROUND IDENTIFIER "M"; "M" OR "N" FOR ROUND 2; "M", "N", OR "P" FOR ROUND 3; "M", "N", "P" OR "Q" FOR ROUND 4; AND "M", "N", "P", "Q" OR "R" FOR ROUND 5.
----------------------------------------------------

CL33OV
======

PHARMACY AUTHORIZATION FORM SIGNATURE DATE:
[Enter Month, Day, Year-4] .................. [END_LP08]
----------------------------------------------------
NOTE: INTERVIEWERS WILL BE INSTRUCTED TO COLLECT SIGNED PHARMACY AUTHORIZATION FORMS WITH DATES EARLIER THAN THE ONE DISPLAYED, BUT WILL NOT ENTER THE NUMBER IN CAPI SINCE THE CURRENT STATUS FOR THE AUTHORIZATION FORM WITH THE CORRECT DATE MAY BE SOMETHING ELSE. THE CAPI STATUS OF THE PHARMACY AUTHORIZATION FORM SHOULD REFLECT THE FORM WITH THE MOST RECENT DATE.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DATE ENTERED MUST BE ON OR AFTER THE INTERVIEW DATE OF THE MOST RECENT ROUND'S INTERVIEW FOR WHICH THE PAIR IS/WAS ELIGIBLE FOR AUTHORIZATION FORM COLLECTION BUT CANNOT BE AFTER 'TODAY'S DATE' (THE CURRENT DATE SET ON THE LAPTOP). IF DATE IS BEFORE CORRECT DATE, DISPLAY THE FOLLOWING MESSAGE: 'PHARMACY AF MUST BE SIGNED ON OR AFTER ABOVE DATE. VERIFY AND RE-ENTER DATE OR COMPLETE NEW AF.'
----------------------------------------------------

CL34
====

CL34OV
======

OTHER REASON FOR REFUSAL:
[Enter Other Specify-45] ................. [END_LP08]

END_LP08
========

----------------------------------------------------
CYCLE ON NEXT PAIR ON THE RU-PERSON-PHARMACY- PAIRS-ROSTER THAT MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION.
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PAIRS MEET THE STATED CONDITIONS, END LOOP_08 AND CONTINUE WITH BOX_14
----------------------------------------------------

LOOP_08A
========

OMITTED.

NAV_CL08B
=========

OMITTED.

CL34A
=====

OMITTED.

Cl34AOV1
========

OMITTED.

Cl34AOV2
========

OMITTED.

Cl34B
=====

OMITTED.

END_LP08A
=========

OMITTED.

BOX_14
======

----------------------------------------------------
SUBSECTION 5: SELF-ADMINISTERED QUESTIONNAIRE (ROUNDS 2 THROUGH 5)
----------------------------------------------------
----------------------------------------------------
IF ROUND 2 OR 4, CONTINUE WITH BOX_15
----------------------------------------------------
----------------------------------------------------
IF ROUND 3 OR 5, GO TO BOX_16
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_16A
----------------------------------------------------

BOX_15
======

----------------------------------------------------
IF ROUND 2 OR 4 AND AT LEAST ONE KEY RU MEMBER ELIGIBLE FOR SAQ (I.E., AT LEAST ONE CURRENT RU MEMBER WHO IS KEY AND WHO IS NOT DECEASED OR INSTITUTIONALIZED AND IS IN THE RU AT THE ROUND 2 OR 4 INTERVIEW DATE AND IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2 OR ON JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2, OR JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 4, CONTINUE WITH CL35
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_16E
----------------------------------------------------
----------------------------------------------------
NOTE: DETERMINING WHICH ADULTS IN THE RU RECEIVE AN SAQ AND WHICH ADULTS ARE FOLLOWED-UP IN ROUND 3 OR 5 WILL BE BASED ONLY ON ROUND 2 OR 4 INFORMATION. THAT IS, NO RU MEMBERS ADDED IN ROUND 3 OR 5 WILL BE ASKED TO COMPLETE AN SAQ.
----------------------------------------------------

CL35
====

Now I would like to ask (READ PERSON NAMES BELOW) to complete a brief survey about health and health opinions.

ROSTER. PERSON CL35_01. PID
[First Name, [Middle Name], Last Name-65] [PID]
[First Name, [Middle Name], Last Name-65] [PID]
[First Name, [Middle Name], Last Name-65] [PID]
AS APPROPRIATE, PREPARE AN SAQ FOR EACH PERSON LISTED ABOVE.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
HELP AVAILABLE FOR MORE INFORMATION ON SAQ COLLECTION.
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU-MEMBERS_7

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

COL # 2 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS' 3-DIGIT ID (PERS.PID)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, EDIT, ADD, DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS KEY
- PERSON DOES NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON CURRENTLY IN RU ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2, OR ON JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2 OR JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL AND THE DATE OF THE INTERVIEW IF ROUND 4.
----------------------------------------------------

LOOP_09
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV_CL09 ? END_LP09
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_09 COLLECTS THE SAQ STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THE SAQ.
THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:
- PERSON IS KEY
- PERSON DOES NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON CURRENTLY IN RU ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2, OR ON JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2 OR JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL AND THE DATE OF THE INTERVIEW IF ROUND 4.
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_09 USES NAV_CL09 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_CL09
========

SERIES: Collect and Record the Status of Each SAQ.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
RU Member
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: RU MEMBER
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_09 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CL36 FOR SELECTED RU MEMBER.
----------------------------------------------------

CL36
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
PID: [PID]
COLLECT [PERSON]'S COMPLETED SAQ [AND EXPLAIN THAT THEY WILL RECEIVE $5.00 FOR EACH COMPLETED SAQ].
IF [PERSON] NOT AVAILABLE OR NOT ABLE TO COMPLETE SAQ AT THIS TIME, LEAVE SAQ WITH [HIM/HER] OR RESPONDENT AND EXPLAIN INSTRUCTIONS.
SELECT THE STATUS OF THE SAQ:
COMPLETED AND GIVEN TO INTERVIEWER ..... 1 [END_LP09]
NOT COMPLETED, WILL PICK UP AT LATER DATE ........................... 2 [END_LP09]
NOT COMPLETED, WILL MAIL TO HOME OFFICE. 3 [END_LP09]
MAILED TO SAQ RESPONDENT ............... 4 [END_LP09]
REFUSED TO COMPLETE .................... 5 [CL37]
OTHER ................................. 91 [CL36OV]
[Code One]
----------------------------------------------------
DISPLAY THE PERSON'S 3-DIGIT PID FOR 'PID'.

DISPLAY 'AND EXPLAIN...SAQ' IF PANEL 17, ROUND 4.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
NOTE: STARTING IN PANEL 18, PAYMENT WILL NO LONGER BE MADE FOR COMPLETED SAQ. FORMS.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
CODE '4' (MAILED TO SAQ RESPONDENT) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE '4' SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: 'UNLIKELY RESPONSE. VERIFY AND RE-ENTER.'
----------------------------------------------------

CL36OV
======

SPECIFY:
[Enter Other Specify-45] ............... [END_LP09]

CL37
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SELECT MAIN REASON FOR REFUSAL:
TOO BUSY/NOT INTERESTED ................ 1 [END_LP09]
TOO PERSONAL/SENSITIVE INFORMATION ..... 2 [END_LP09]
TOO MUCH OF A PHYSICAL/MENTAL HARDSHIP . 3 [END_LP09]
HAS ALREADY GIVEN ENOUGH INFORMATION ... 4 [END_LP09]
WANTS MORE INFORMATION ................. 5 [END_LP09]
NOT INTERESTED ......................... 6 [END_LP09]
NO REASON GIVEN ........................ 7 [END_LP09]
OTHER ................................. 91 [CL37OV]
[Code One]

CL37OV
======

OTHER REASON FOR REFUSAL:
[Enter Other Specify-45] ................. [END_LP09]

END_LP09
========

BOX_16
======

----------------------------------------------------
IF AT LEAST ONE PERSON WITH AN SAQ DISPOSITION IN THE PREVIOUS ROUND (SAQSTAT) OF '5' (REFUSED TO COMPLETE SAQ) OR ['91' (OTHER) AND UPDATED BY RECEPIT CONTROL (RCFLG) to 0, 1, or 3] DURING ROUND 2 OR 4 AND NOT UPDATED BY RECEIPT, CONTINUE WITH CL38
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_16A
----------------------------------------------------

CL38
====

During the last interview a short booklet about health and health opinions was left with (READ PERSON NAMES BELOW) to complete. I would like to check to see if I could pick these booklets up or if they were already mailed back to the home office.]

ROSTER. PERSONAL CL38_01. PID
[First Name, [Middle Name], Last Name-65] [PID]
[First Name, [Middle Name], Last Name-65] [PID]
[First Name, [Middle Name], Last Name-65] [PID]
1. COLLECT SAQs, IF AVAILABLE.
2. IF ANY REPORTED AS LOST, RE-DISTRIBUTE APPROPRIATE NUMBER AND TYPE OF SAQs TO THE RESPONDENT.
HELP AVAILABLE FOR MORE INFORMATION ON SAQ COLLECTION.
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU-MEMBERS_7

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

COL # 2 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS' 3-DIGIT ID (PERS.PID)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, EDIT, ADD, DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS KEY
- PERSON DID NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON WAS CURRENTLY IN RU ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2, OR ON JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2 OR JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL AND THE DATE OF THE INTERVIEW IF ROUND 4.
- CL36 WAS CODED '1' (COMPLETED AND GIVEN TO INTERVIEWER), '2' (NOT COMPLETED, WILL PICK UP AT LATER DATE), '3' (NOT COMPLETED, WILL MAIL TO OFFICE),'4' (MAILED TO SAQ RESPONDENT), '5' (REFUSED TO COMPLETE SAQ), OR '91' (OTHER) DURING ROUND 2 OR 4 FOR PERSON AND NOT UPDATED BY RECEIPT CONTROL TO '1' (COMPLETE), '2' (PARTIAL COMPLETE), '4' (PROBLEM), OR '6' (WRONG SAQ TYPE) ((I.E., RECEIPT CONTROL IS EQUAL TO '3' (REFUSED) OR '5' (NOT HERE/BLANK))
----------------------------------------------------

LOOP_10
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV_CL10 - END_LP10
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_10 COLLECTS THE SAQ STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THE SAQ.
THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:
- PERSON IS KEY
- PERSON DID NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 2 OR 4 INTERVIEW DATE
- PERSON WAS CURRENTLY IN RU ON ROUND 2 OR 4 NTERVIEW DATE
- PERSON IS 18 YEARS OF AGE OR OLDER (OR IN AGE CATEGORIES 4-9) ON JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, IF ROUND 2, OR ON JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL, IF ROUND 4, OR HAS TURNED 18 BETWEEN JULY 1, [YEAR], WHERE 'YEAR' IS THE FIRST CALENDAR YEAR OF THE PANEL, AND THE DATE OF THE INTERVIEW IF ROUND 2 OR JULY 1, [YEAR], WHERE 'YEAR' IS THE SECOND CALENDAR YEAR OF THE PANEL AND THE DATE OF THE INTERVIEW IF ROUND 4.
- CL36 WAS CODED '1' (COMPLETED AND GIVEN TO INTERVIEWER), '2' (NOT COMPLETED, WILL PICK UP AT LATER DATE), '3' (NOT COMPLETED, WILL MAIL TO OFFICE),'4' (MAILED TO SAQ RESPONDENT), '5' (REFUSED TO COMPLETE SAQ), OR '91' (OTHER) DURING ROUND 2 OR 4 FOR PERSON AND NOT UPDATED BY RECEIPT CONTROL TO '1' (COMPLETE), '2' (PARTIAL COMPLETE), '4' (PROBLEM), OR '6' (WRONG SAQ TYPE) ((I.E., RECEIPT CONTROL IS EQUAL TO '3' (REFUSED) OR '5' (NOT HERE/BLANK))
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_10 USES NAV_CL10 TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_CL10
========

SERIES: SAQ Forms.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
SAQ Forms
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: SAQ FORMS
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_10 DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CL39 FOR SELECTED RU MEMBER.
----------------------------------------------------

CL39
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
PID: [PID]
[SAQ STATUS FROM PREVIOUS ROUND: [PREVIOUS ROUND STATUS -40]]
COLLECT [PERSON]'s COMPLETED SAQ [AND EXPLAIN THAT THEY WILL RECEIVE $5.00 FOR EACH COMPLETED SAQ].
SELECT THE STATUS OF THE SAQ:
COMPLETED AND GIVEN TO INTERVIEWER ..... 1 [END_LP10]
NOT COMPLETED, WILL PICK UP AT LATER DATE ........................... 2 [END_LP10]
NOT COMPLETED, WILL MAIL TO HOME OFFICE. 3 [END_LP10]
MAILED TO SAQ RESPONDENT ............... 4 [END_LP10]
REFUSED TO COMPLETE .................... 5 [CL40]
OTHER ................................. 91 [CL39OV]
[Code One]
----------------------------------------------------
DISPLAY THE PERSON'S 3-DIGIT PID FOR 'PID'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'SAQ STATUS FROM PREVIOUS ROUND' [PREVIOUS ROUND STATUS -40]'. OTHERWISE, USE A NULL DISPLAY.

FOR 'PREVIOUS ROUND STATUS-40', DISPLAY THE TEXT ASSOCIATED WITH THE ROUND 2 OR 4 (OR RECEIPT CONTROL UPDATED STATUS) STATUS ENTERED AT CL36.
OTHERWISE, USE A NULL DISPLAY.

DISPLAY 'AND EXPLAIN...SAQ' IF PANEL 17, ROUND 5.
OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
NOTE: STARTING IN PANEL 18, PAYMENT WILL NO LONGER BE MADE FOR COMPLETED SAQ FORMS.
----------------------------------------------------

CL39OV
======

SPECIFY:
[Enter Other Specify-45] ............... [END_LP10]

CL40
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SELECT MAIN REASON FOR REFUSAL:
TOO BUSY/NOT INTERESTED ................ 1 [END_LP10]
TOO PERSONAL/SENSITIVE INFORMATION ..... 2 [END_LP10]
TOO MUCH OF A PHYSICAL/MENTAL HARDSHIP . 3 [END_LP10]
HAS ALREADY GIVEN ENOUGH INFORMATION ... 4 [END_LP10]
WANTS MORE INFORMATION ................. 5 [END_LP10]
NOT INTERESTED ......................... 6 [END_LP10]
NO REASON GIVEN ........................ 7 [END_LP10]
OTHER ................................. 91 [CL40OV]
[Code One]

CL40OV
======

OTHER REASON FOR REFUSAL:
[Enter Other Specify-45] ................. [END_LP10]

END_LP10
========

BOX_16A
=======

----------------------------------------------------
SUBSECTION 5A: DIABETES CARE SUPPLEMENT (DCS) QUESTIONNAIRE (ROUNDS 3 AND 5 ONLY)
----------------------------------------------------
----------------------------------------------------
IF ROUND 3 OR 5, CONTINUE WITH BOX_16B
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CL41
----------------------------------------------------

BOX_16B
=======

----------------------------------------------------
IF ROUND 3 OR 5 AND AT LEAST ONE RU MEMBER ELIGIBLE FOR DIABETES CARE SUPPLEMENT (I.E., AT LEAST ONE RU MEMBER WHO IS CONFIRMED AS HAVING DIABETES AT PC02A), CONTINUE WITH CL40A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_16C
----------------------------------------------------

CL40A
=====

SELF DIABETES CARE SUPPLEMENT (DCS):
Earlier we asked (READ SELF NAMES BELOW) to complete a few questions about the care received for diabetes. PROXY DCS: Earlier we asked that someone knowledgeable about (READ PROXY NAMES BELOW) diabetes complete a few questions about the care received.

ROSTER. PERSON CL40A_01. PID CL40A_02. TYPE OF DCS
[First Name, [Middle Name], Last Name-65] [PID] [SELF/PROXY]
[First Name, [Middle Name], Last Name-65] [PID] [SELF/PROXY]
[First Name, [Middle Name], Last Name-65] [PID] [SELF/PROXY]
AS APPROPRIATE, COLLECT A DCS FOR EACH PERSON LISTED ABOVE.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY THE ROW PERSON'S PID FOR 'PID'.
----------------------------------------------------
----------------------------------------------------
DISPLAY THE TYPE OF DCS FOR THE PERSON FOR 'SELF/PROXY'. IF PC03 FOR THE ROW PERSON IS CODED '1' (SELF), DISPLAY 'SELF.' IF PC03 FOR THE ROW PERSON IS CODED '2' (PROXY), DISPLAY 'PROXY.'
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU-MEMBERS_9

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

COL # 2 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS' 3-DIGIT ID (PERS.PID)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, EDIT, DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO MEET THE FOLLOWING CONDITION:

- PC02A IS CODED '1' (CONTINUE) FOR THE PERSON
----------------------------------------------------

LOOP_10A
========

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV-CL10A ? END_LP10A
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_10A COLLECTS THE DCS STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THE DCS.
THIS LOOP CYCLES ON EACH PERSON ON THE RU- MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITION:

- PC02A IS CODED '1' (CONTINUE) FOR THE PERSON
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_10A USES NAV_CL10A TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_CL10A
=========

SERIES: DCS Forms.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
DCS Forms
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: DCS FORMS
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_10A DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CL40B FOR SELECTED RU MEMBER.
----------------------------------------------------

CL40B
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
PID: [PID] TYPE OF DCS: [SELF/PROXY]
COLLECT [PERSON]'S COMPLETED DIABETES CARE SUPPLEMENT IF [PERSON] NOT AVAILABLE OR NOT ABLE TO COMPLETE DCS AT THIS TIME, LEAVE DCS WITH [HIM/HER] OR RESPONDENT AND EXPLAIN INSTRUCTIONS.
SELECT THE STATUS OF THE DCS:
COMPLETED AND GIVEN TO INTERVIEWER ..... 1 [END_LP10A]
NOT COMPLETED, WILL PICK UP AT
LATER DATE ........................... 2 [END_LP10A]
NOT COMPLETED, WILL MAIL TO OFFICE ..... 3 [END_LP10A]
MAILED TO DCS RESPONDENT ............... 4 [END_LP10A]
REFUSED TO COMPLETE .................... 5 [CL40C]
OTHER ................................. 91 [CL40BOV]
[Code One]
----------------------------------------------------
DISPLAY THE PERSON'S 3-DIGIT PID FOR 'PID'.
----------------------------------------------------
---------------------------------------------------
FOR 'SELF/PROXY', DISPLAY 'SELF' IF THE PERSON BEING LOOPED ON IS CODED '1' (SELF) AT PC03.
DISPLAY 'PROXY' IF THE PERSON BEING LOOPED ON IS CODED '2' (PROXY) AT PC03.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
CODE '4' (MAILED TO DCS RESPONDENT) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE '4' SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: 'UNLIKELY RESPONSE. VERIFY AND RE-ENTER.'
----------------------------------------------------

CL40BOV
=======

SPECIFY:
[Enter Other Specify-45] ............... [END_LP10A]

CL40C
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SELECT MAIN REASON FOR REFUSAL:
TOO BUSY/NOT INTERESTED ................ 1 [END_LP10A]
TOO PERSONAL/SENSITIVE INFORMATION ..... 2 [END_LP10A]
TOO MUCH OF A PHYSICAL/MENTAL HARDSHIP . 3 [END_LP10A]
HAS ALREADY GIVEN ENOUGH INFORMATION ... 4 [END_LP10A]
WANTS MORE INFORMATION ................. 5 [END_LP10A]
NOT INTERESTED ......................... 6 [END_LP10A]
NO REASON GIVEN ........................ 7 [END_LP10A]
OTHER ................................. 91 [CL40COV]
[Code One]

CL40COV
=======

OTHER REASON FOR REFUSAL:
[Enter Other Specify-45] ................. [END_LP10A]

END_LP10A
=========

BOX_16C
=======

----------------------------------------------------
SUBSECTION 5B: CANCER SAQ QUESTIONNAIRE (ROUNDS 3 AND 5 ONLY)
----------------------------------------------------
----------------------------------------------------
IF PANEL 16 ROUND 3 OR PANEL 15 ROUND 5, CONTINUE WITH BOX_16D
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_16E
----------------------------------------------------
----------------------------------------------------
NOTE: THE DISTRIBUTION AND COLLECTION OF THE CANCER SAQ OCCURS ONLY DURING PANEL 16 ROUND 3 AND PANEL 15 ROUND 5. AT THIS TIME, THERE ARE NO PLANS TO COLLECT THE CANCER SAQ IN FUTURE ROUNDS.
----------------------------------------------------

BOX_16D
=======

----------------------------------------------------
IF PANEL 16 ROUND 3 OR PANEL 15 ROUND 5 AND AT LEAST ONE RU MEMBER ELIGIBLE FOR CANCER SAQ (I.E., AT LEAST ONE RU MEMBER WHO IS CONFIRMED AS HAVING CANCER AT PC04), CONTINUE WITH CL40D
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_16E
----------------------------------------------------

CL40D
=====

CANCER SAQ FOLLOW-UP:
Earlier we asked (READ NAMES BELOW) to complete a short survey about their experience with cancer.

ROSTER. PERSON CL40D_01. PID
[First Name, [Middle Name], Last Name-65] [PID]
[First Name, [Middle Name], Last Name-65] [PID]
[First Name, [Middle Name], Last Name-65] [PID]
AS APPROPRIATE, COLLECT A CANCER SAQ FOR EACH PERSON LISTED ABOVE.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU-MEMBERS_9

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

COL # 2 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS' 3-DIGIT ID (PERS.PID)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, ADD, EDIT, DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO MEET THE FOLLOWING CONDITION:

- PC04 IS CODED '1' (CONTINUE) FOR THE PERSON
----------------------------------------------------

LOOP_10B
========

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV-CL10B ? END_LP10B
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_10B COLLECTS THE CANCER SAQ STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THE CANCER SAQ. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITION:

- PC04 IS CODED '1' (CONTINUE) FOR THE PERSON
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_10B USES NAV_CL10B TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_CL10B
=========

SERIES: Cancer SAQ Forms.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
Cancer SAQ Forms
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: CANCER SAQ FORMS
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_10B DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CL40E FOR SELECTED RU MEMBER.
----------------------------------------------------

CL40E
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
PID: [PID]
COLLECT [PERSON]'S COMPLETED CANCER SAQ.
IF [PERSON] NOT AVAILABLE OR NOT ABLE TO COMPLETE CANCER SAQ AT THIS TIME, LEAVE CANCER SAQ WITH [HIM/HER] OR RESPONDENT AND EXPLAIN INSTRUCTIONS.
SELECT THE STATUS OF THE CANCER SAQ:
COMPLETED AND GIVEN TO INTERVIEWER ..... 1 [END_LP10B]
NOT COMPLETED, WILL PICK UP AT LATER DATE ........................... 2 [END_LP10B]
NOT COMPLETED, WILL MAIL TO HOME OFFICE ............................... 3 [END_LP10B]
MAILED TO CANCER SAQ RESPONDENT ........ 4 [END_LP10B]
REFUSED TO COMPLETE .................... 5 [CL40F]
OTHER ................................. 91 [CL40EOV]
[Code One]
----------------------------------------------------
DISPLAY THE PERSON'S 3-DIGIT PID FOR 'PID'.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
CODE '4' (MAILED TO CANCER SAQ RESPONDENT) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE '4' SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: 'UNLIKELY RESPONSE. VERIFY AND RE-ENTER.'
----------------------------------------------------

CL40EOV
=======

SPECIFY:
[Enter Other Specify-45] ............... [END_LP10B]

CL40F
=====

[PERSON'S FIRST MIDDLE AND LAST NAME]
SELECT MAIN REASON FOR REFUSAL:
TOO BUSY/NOT INTERESTED ................ 1 [END_LP10B]
TOO PERSONAL/SENSITIVE INFORMATION ..... 2 [END_LP10B]
TOO MUCH OF A PHYSICAL/MENTAL HARDSHIP . 3 [END_LP10B]
HAS ALREADY GIVEN ENOUGH INFORMATION ... 4 [END_LP10B]
WANTS MORE INFORMATION ................. 5 [END_LP10B]
NOT INTERESTED ......................... 6 [END_LP10B]
NO REASON GIVEN ........................ 7 [END_LP10B]
OTHER ................................. 91 [CL40FOV]
[Code One]

CL40FOV
=======

OTHER REASON FOR REFUSAL:
[Enter Other Specify-45] ................. [END_LP10B]

END_LP10B
=========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITION STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITION, END LOOP_10B AND GO TO BOX_16E
----------------------------------------------------
----------------------------------------------------
BOX_16E BEGINS SUBSECTION 5B: COLLECTING/UPDATING PREVENTIVE CARE SAQ STATUS (ROUND 5)
----------------------------------------------------

BOX_16E
======

----------------------------------------------------
SUBSECTION 5B: PREVENTIVE CARE SELF- ADMINISTERED QUESTIONNAIRE (ROUND 5)
----------------------------------------------------
----------------------------------------------------
IF ROUND 5 AND AT LEAST ONE RU MEMBER ELIGIBLE FOR PREVENTIVE CARE SAQ (I.E., AT LEAST ONE CURRENT RU MEMBER WHO DOES NOT HAVE ROUND 5 STATUS OF DECEASED OR INSTITUTIONALIZED WAS SAMPLED), CONTINUE WITH CL40AA
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CL41
----------------------------------------------------
----------------------------------------------------
NOTE: THERE WILL BE NO FOLLOW-UP ON THE PREVENTIVE CARE SAQS. COLLECTION INFORMATION IN ROUND 5 WILL BE BASED ONLY ON PRELOADED SAMPLE INFORMATION. THAT IS, NO RU MEMBERS ADDED IN ROUND 5 WILL BE ASKED TO COMPLETE A PREVENTIVE CARE SAQ.
----------------------------------------------------

CL40AA
=======

(Not long ago), we mailed a short [blue/purple] questionnaire about health choices to (READ PERSON NAMES BELOW). I want to check if (READ NAMES BELOW) completed that questionnaire already or needs a replacement.

ROSTER. PERSON CL40AA_01. PID CL40AA_02. SEX
[First Name, [Middle Name], Last Name-65] [PID] [MALE/FEMALE]
[First Name, [Middle Name], Last Name-65] [PID] [MALE/FEMALE]
[First Name, [Middle Name], Last Name-65] [PID] [MALE/FEMALE]
1. COLLECT BLUE PREVENTIVE CARE SAQ FROM MALES.
COLLECT PURPLE PREVENTIVE CARE SAQ FROM FEMALES.
2. IF INCORRECT COLOR PREVENTIVE CARE SAQ COMPLETED, GIVE CORRECT COLOR.
3. IF ANY REPORTED AS LOST, RE-DISTRIBUTE APPROPRIATE NUMBER AND TYPE OF SAQs TO THE RESPONDENT.
HELP AVAILABLE FOR MORE INFORMATION ON PREVENTIVE CARE SAQ COLLECTION.
----------------------------------------------------
DISPLAY 'blue' IF PERSON BEING ASKED ABOUT IS MALE. DISPLAY 'purple' IF PERSON BEING ASKED ABOUT IS FEMALE. IF MULTIPLE PERSONS OF DIFFERENT SEXES ARE BEING ASKED ABOUT, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU-MEMBERS_7

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

COL # 2 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS' 3-DIGIT ID (PERS.PID)

COL # 3 HEADER: SEX
INSTRUCTIONS: DISPLAY RU MEMBERS' SEX (PERS.SMPSEXR)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. DISPLAY ONLY.
2. SELECT, EDIT, ADD, DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON MARKED WITH THE IN-SAMPLE INDICATOR - PERSON CURRENTLY IN RU ON ROUND 5 INTERVIEW DATE
- PERSON DOES NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 5 INTERVIEW DATE
----------------------------------------------------

LOOP_10C
========

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK NAV_CL10C - END_LP10C
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_10C COLLECTS THE YOUR CHOICES ABOUT YOUR HEALTH SAQ STATUS FOR EACH PERSON ELIGIBLE TO COMPLETE THIS SAQ. THIS LOOP CYCLES ON EACH PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE FOLLOWING CONDITIONS:
- RU MEMBER MARKED WITH THE IN-SAMPLE INDICATOR
- PERSON CURRENTLY IN RU ON ROUND 5 INTERVIEW DATE
- PERSON DOES NOT HAVE A STATUS OF DECEASED OR INSTITUTIONALIZED ON ROUND 5 INTERVIEW DATE
----------------------------------------------------
----------------------------------------------------
NAVIGATOR DETAILS: LOOP_10C USES NAV_CL10C TO CONTROL THE FLOW OF THE LOOP.
----------------------------------------------------

NAV_CL10C
========

SERIES: Your Choices About Your Health SAQ.
USE THE LINKS BELOW TO COMPLETE ALL QUESTIONS WITHIN THIS SERIES.
WHEN ALL LINKS ARE MARKED "DONE," USE [Continue Interview] TO GO PAST THIS SERIES.
IF NEEDED, [Previous Page] WILL TAKE YOU TO QUESTIONS BEFORE THIS SERIES.
"Your Choices About Your Health" SAQ
[1. First Name,[Middle Name],Last Name-65] [Status-25]
[2. First Name,[Middle Name],Last Name-65] [Status-25]
[3. First Name,[Middle Name],Last Name-65] [Status-25]
----------------------------------------------------
ROSTER DETAILS:
COL # 1 HEADER: YOUR CHOICES ABOUT YOUR HEALTH
SAQ FORMS
INSTRUCTIONS: DISPLAY RU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
COL # 2 HEADER: EMPTY
INSTRUCTIONS: DISPLAY THE MOST CURRENT NAVIGATOR STATUS FOR EACH RU MEMBER EACH TIME THE NAVIGATOR IS PRESENTED
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ALLOWED.

2. MULTIPLE SELECT, ADD, DELETE, AND EDIT DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL RU MEMBERS WHO MEET THE CONDITIONS STATED AT THE LOOP_10C DEFINITION.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CL40AAA FOR SELECTED RU MEMBER.
----------------------------------------------------

CL40AAA
=======

[PERSON'S FIRST MIDDLE AND LAST NAME]
DOB: [MM/DD/YYYY] PID: [PID-3] RU ID: [RUID-7]
COLLECT [PERSON]'S COMPLETED "YOUR CHOICES ABOUT YOUR HEALTH" SAQ.
IF [PERSON] NOT AVAILABLE OR NOT ABLE TO COMPLETE THIS SAQ AT THIS TIME, LEAVE [MALE=BLUE/FEMALE=PURPLE] "YOUR CHOICES ABOUT YOUR HEALTH" SAQ WITH [HIM/HER] OR RESPONDENT AND EXPLAIN SAQ INSTRUCTIONS.
SELECT THE STATUS OF THE SAQ:
COMPLETED AND GIVEN TO INTERVIEWER ..... 1 [END_LP10C]
NOT COMPLETED, WILL PICK UP AT
LATER DATE ........................... 2 [END_LP10C]
NOT COMPLETED, WILL MAIL TO HOME OFFICE. 3 [END_LP10C]
MAILED TO SAQ RESPONDENT ............... 4 [END_LP10C]
REFUSED TO COMPLETE .................... 5 [CL40AAAA]
OTHER ................................. 91 [CL40AAAOV]
[Code One]
----------------------------------------------------
DISPLAY THE PERSON'S 3-DIGIT PID FOR 'PID'.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'MALE=BLUE' AND 'HIM' IF PERSON BEING ASKED ABOUT IS MALE. DISPLAY 'FEMALE=PURPLE' AND 'HER' IF PERSON BEING ASKED ABOUT IS FEMALE.
----------------------------------------------------
----------------------------------------------------
SOFT CHECK:
CODE '4' (MAILED TO SAQ RESPONDENT) MUST BE VERIFIED (ENTERED TWICE) IF RU IS NOT A STUDENT RU. IF CODE '4' SELECTED AND RU IS NOT A STUDENT RU, DISPLAY THE FOLLOWING MESSAGE: 'UNLIKELY RESPONSE. VERIFY AND RE-ENTER.'
----------------------------------------------------

CL40AAAOV
=========

SPECIFY:
[Enter Other Specify-45] ............... [END_LP10C]

CL40AAAA
========

[PERSON'S FIRST MIDDLE AND LAST NAME]
SELECT MAIN REASON FOR REFUSAL:
TOO BUSY/NOT INTERESTED ................ 1 [END_LP10C]
TOO PERSONAL/SENSITIVE INFORMATION ..... 2 [END_LP10C]
TOO MUCH OF A PHYSICAL/MENTAL HARDSHIP . 3 [END_LP10C]
HAS ALREADY GIVEN ENOUGH INFORMATION ... 4 [END_LP10C]
WANTS MORE INFORMATION ................. 5 [END_LP10C]
NOT INTERESTED ......................... 6 [END_LP10C]
NO REASON GIVEN ........................ 7 [END_LP10C]
OTHER ................................. 91 [CL40_4OV]
[Code One]

CL40_4OV
========

OTHER REASON FOR REFUSAL:
[Enter Other Specify-45] ................. [END_LP10C]

END_LP10C
=========

----------------------------------------------------
CYCLE ON NEXT PERSON ON THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS STATED IN THE LOOP DEFINITION
----------------------------------------------------
----------------------------------------------------
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_10C AND GO TO CL41
----------------------------------------------------
----------------------------------------------------
CL41 BEGINS SUBSECTION 6: COLLECTING/UPDATING LOCATING INFORMATION (ROUND 1 THROUGH ROUND 5)
----------------------------------------------------

CL41
====

[In the coming months, we will be contacting you again to collect information on health care use and expenses./We are nearing the end of this study. I'd like to verify a few pieces of information in case my supervisor needs to reach you to confirm that I was here and collected this information correctly.] [Just to make sure I can reach you for the next interview, I'd like to ask a few questions to help locate you in case you move./ Let me quickly review and update the information we have for locating you that was collected during the last interview.]

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
----------------------------------------------------
DISPLAY 'In the coming months, ... use and expenses.' IF ROUNDS 1, 2, 3, OR 4. OTHERWISE, DISPLAY 'We are nearing ... correctly.'

DISPLAY 'Just ... move.' IF ROUND 1. OTHERWISE, DISPLAY 'Let ... interview.'
----------------------------------------------------
----------------------------------------------------
IF NOT ROUND 5, CONTINUE WITH CL42
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ROUND 5), GO TO BOX_17
----------------------------------------------------

CL42
====

What is the best time of day and day of the week to get in touch with you?

ENTER BEST TIME TO CONTACT RESPONDENT/PROXY.
RECORD VERBATIM. TO LEAVE BOX, PRESS TAB.
[Enter Text] ............................. [CL42OV1]

CL42OV1
=======

SELECT WHO BEST TIME RECORDED FOR:
CURRENT RESPONDENT ..................... 1 [BOX_17]
CURRENT PROXY .......................... 2 [BOX_17]
ENTIRE RU .............................. 3 [BOX_17]
OTHER ................................. 91 [CL42OV2]
[Code One]
----------------------------------------------------
NOTE: CL42OV1 IS ALWAYS DISPLAYED ON THE SCREEN WITH CL42. IT IS NOT A TRUE 'OVERLAY'.
----------------------------------------------------

CL42OV2
=======

SPECIFY:
[Enter Other Specify] .................... [BOX_17]

BOX_17
======

----------------------------------------------------
IF NO CURRENT RU MEMBER PART OF THE RU ON THE CURRENT INTERVIEW DATE (I.E., ALL RU MEMBERS DECEASED, INSTITUTIONALIZED, OR OUT OF THE COUNTRY ON CURRENT INTERVIEW DATE), GO TO BOX_18
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_17AA
----------------------------------------------------

BOX_17AA
========

----------------------------------------------------
IF ROUND 1, GO TO CL42B
----------------------------------------------------
----------------------------------------------------
IF ROUNDS 2-5, AND THERE IS AN EMAIL ADDRESS LINKED TO THE PID OF THE CURRENT RESPONDENT OR THE CURRENT PROXY, CONTINUE WITH CL42A
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ROUNDS 2-5 AND THE CURRENT RESPONDENT OR THE CURRENT PROXY DOES NOT HAVE AN EMAIL LINKED TO THEIR PID), GO TO CL42B
----------------------------------------------------

CL42A
=====

Is this still the best email address to contact you to schedule appointments and send MEPS interview reminders?

Current Info: [EMAIL_ADDRESS]
YES .................................... 1 [CL42E]
NO, UPDATE EMAIL ADDRESS ............... 2 [CL42C]
NO, NO EMAIL ADDRESS ................... 3 [CL43]
REF ................................... -7 [CL43]
DK .................................... -8 [CL43]
[Code One]
----------------------------------------------------
FOR 'EMAIL_ADDRESS' DISPLAY THE EMAIL ADDRESS ASSOCIATED WITH THE PID OF THE CURRENT RESPONDENT.
----------------------------------------------------
----------------------------------------------------
IF CODED '3' (NO, NO EMAIL ADDRESS), '-7' (REF) OR '-8' (DK), DELETE THE EMAIL ADDRESS ASSOCIATED WITH THE PID OF THE CURRENT RESPONDENT.
----------------------------------------------------

CL42B
=====

Do you send or receive emails?

YES .................................... 1 [CL42C]
NO ..................................... 2 [CL43]
REF ................................... -7 [CL43]
DK .................................... -8 [CL43]

CL42C
=====

[What is your new email address?/We'd like to contact you by email to help schedule the next interview and send an interview reminder. May I have your email address?]

ENTER COMPLETE EMAIL ADDRESS. CONFIRM SPELLING.
EMAIL ADDRESS: [_____________] [CL42D]
REF ................................... -7 [CL43]
DK .................................... -8 [CL43]
----------------------------------------------------
DISPLAY 'What is your new email address?' IF CL42A IS CODED '2' (NO, UPDATE EMAIL ADDRESS). DISPLAY 'We'd like to ... your email address?' IF CL42B IS CODED '1' (YES).
----------------------------------------------------
----------------------------------------------------
ALLOW A 50 CHARACTER ENTRY INCLUDING ALPHA AND NUMERIC CHARACTERS AS WELL AS SYMBOLS.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
EDITS: EMAIL ADDRESS MUST CONTAIN AN '@' SYMBOL.
IF ENTRY DOES NOT INCLUDE THIS SYMBOL, DISPLAY THE FOLLOWING MESSAGE: "EMAIL ADDRESS MUST CONTAIN AN '@' SYMBOL. VERIFY AND RE-ENTER."

EMAIL ADDRESS MUST NOT CONTAIN ANY SPACES.
IF ENTRY INCLUDES A SPACE, DISPLAY THE FOLLOWING MESSAGE: "EMAIL ADDRESS CANNOT CONTAIN BLANK SPACES. VERIFY AND RE-ENTER."
----------------------------------------------------
----------------------------------------------------
LINK EMAIL ADDRESS COLLECTED TO PID OF RESPONDENT SELECTED AT RE06/RE08 OR PROXY SELECTED AT RE07/RE08 FOR THE CURRENT ROUND.
----------------------------------------------------

CL42D
=====

Is that your personal e-mail, work e-mail, a family or shared e-mail address, or some other type of email account?

PERSONAL ............................... 1 [CL42E]
WORK ................................... 2 [CL42E]
FAMILY/SHARED .......................... 3 [CL42E]
OTHER TYPE ............................ 91 [CL42DOV]
REF ................................... -7 [CL42E]
DK .................................... -8 [CL42E]
[Code One]

CL42DOV
=======

SPECIFY TYPE OF EMAIL ACCOUNT:
[Enter Other Specify] .................. [CL42E]
REF ................................... -7 [CL42E]
DK .................................... -8 [CL42E]

CL42E
=====

How often do you check this email account? PROBE: How many times per day, per week, per month, per year do you check this email account?

NUMBER:
[Enter Number of Times-3] .............. [CL42EOV1]
REF ................................... -7 [CL43]
DK .................................... -8 [CL43]

CL42EOV1
========

PER PERIOD:
PER DAY ................................ 1 [CL43]
PER WEEK ............................... 2 [CL43]
PER MONTH .............................. 3 [CL43]
PER YEAR ............................... 4 [CL43]
REF ................................... -7 [CL43]
DK .................................... -8 [CL43]
[Code One]

CL43
====

Do you have a second phone number where you can be reached such as a cell phone, a work number, or the number of a friend or relative?

IF AVAILABLE, VERIFY CURRENT SECOND PHONE SHOWN BELOW.
Current Info: [2ND_TELEPHONE]
YES, ENTER NEW SECOND PHONE ............ 1 [CL44]
YES, SECOND PHONE ABOVE CORRECT ........ 2 [CL46]
YES, SECOND PHONE ABOVE NEEDS
CORRECTION ........................... 3 [CL44_2]
NO ..................................... 4 [CL46]
REF ................................... -7 [CL46]
DK .................................... -8 [CL46]
----------------------------------------------------
ASSUMPTION: THE QUESTIONS IN CLOSING IN WHICH CONTACT AND LOCATING INFORMATION IS PRE-RECORDED IN CAPI (CL43-CL64) ARE SPECIFIED WITH THE FOLLOWING BASIC ASSUMPTIONS:
1. LOCATING AND CONTACTING INFORMATION WILL NOT BEWRITTEN OVER FROM ROUND TO ROUND.
2. ONLY THE MOST CURRENT INFORMATION WILL APPEAR IN THE TEXT OF THESE QUESTIONS AND NO HISTORY OF CONTACT AND LOCATING INFORMATION WILL APPEAR ON THE CAPI SCREEN FOR THE INTERVIEWER.
3. IF INFORMATION STAYS THE SAME, IT WILL BE CARRIED FORWARD.
4. WHETHER OR NOT PREVIOUS ROUND'S INFORMATION OR ANY CONTACT HISTORY WILL BE PRINTED ON THE FACE SHEET FOR ANY OF THE CONTACTING AND LOCATING QUESTIONS IS STILL NOT KNOWN.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
CODES '2' (YES, SECOND PHONE ABOVE CORRECT) AND '3' (YES, SECOND PHONE ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT SECOND PHONE INFORMATION AVAILABLE. IF CODES '2' OR '3' SELECTED WHEN NO CURRENT SECOND PHONE, DISPLAY THE FOLLOWING MESSAGE: 'CODE NOT AVAILABLE. NO CURRENT SECOND PHONE. VERIFY AND RE-ENTER.'
----------------------------------------------------

CL44
====

[What is that telephone number?]

ENTER COMPLETE SECOND TELEPHONE NUMBER.
Current Info: [2ND_TELEPHONE]
[Enter Area Code,Exchange,Local] ...... [CL45]
REF ................................... -7 [CL45]
DK .................................... -8 [CL45]
----------------------------------------------------
FLAG SECOND PHONE INFORMATION FOR THE RU WITH THE NUMBER ENTERED OR CORRECTED AT CL44 FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DISALLOW LEADING ZEROES AS AN ENTRY.

AN ENTRY MUST BE MADE FOR EVERY FIELD (REF AND DK ARE ALLOWED).
----------------------------------------------------

CL44_2
======

[What is that telephone number?]

UPDATE CURRENT SECOND PHONE.
TO CORRECT OR ENTER NEW INFORMATION, TYPE ENTIRE FIELD.
Current Info: [2ND_TELEPHONE]
[Enter Area Code,Exchange,Local] ...... [CL45]
REF ................................... -7 [CL45]
DK .................................... -8 [CL45]
----------------------------------------------------
FLAG SECOND PHONE INFORMATION FOR THE RU WITH THE NUMBER ENTERED OR CORRECTED AT CL44 FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
DISALLOW LEADING ZEROS AS AN ENTRY.
----------------------------------------------------

CL45
====

Where is that telephone located?

OFFICE/PLACE OF BUSINESS ............... 1 [CL45OV2]
RELATIVE ............................... 2 [CL45OV2]
NEIGHBOR ............................... 3 [CL45OV2]
FRIEND ................................. 4 [CL45OV2]
CELL PHONE ............................. 5 [CL45OV2]
OTHER ..................................91 [CL45OV1]
REF ................................... -7 [CL45OV2]
DK .................................... -8 [CL45OV2]
[Code One]

CL45OV1
=======

SPECIFY:
[Enter Other Specify-45] .............. [CL45OV2]
REF ................................... -7 [CL45OV2]
DK .................................... -8 [CL45OV2]

CL45OV2
=======

ENTER NAME AND/OR DESCRIPTION OF SECOND PHONE. ALSO, INCLUDE ANY SPECIAL INSTRUCTIONS FOR CALLING AT THE ALTERNATE TELEPHONE NUMBER (FOR EXAMPLE, CALL ONLY IN EMERGENCY).
[Enter Description] ................... [CL46]
REF ................................... -7 [CL46]
DK .................................... -8 [CL46]
----------------------------------------------------
ALLOW 2 LINES OF 45 CHARACTERS FOR DESCRIPTION.
----------------------------------------------------

CL46
====

Do you receive your mail at an address different from your home address, such as a P.O. Box?

IF AVAILABLE, VERIFY CURRENT MAILING ADDRESS SHOWN BELOW.
Current Info: [1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY]
[STATE]
[ZIP CODE]
YES, ENTER NEW MAILING ADDRESS (DIFFERENT FROM HOME ADDRESS) ........ 1 [CL47]
YES, MAILING ADDRESS ABOVE CORRECT ..... 2 [BOX_17A]
YES, MAILING ADDRESS ABOVE NEEDS CORRECTION ........................... 3 [CL47_2]
NO (RECEIVE MAIL AT HOME ADDRESS) ...... 4 [BOX_17A]
REF ................................... -7 [BOX_17A]
DK .................................... -8 [BOX_17A]
----------------------------------------------------
HARD CHECK:
CODES '2' (YES, MAILING ADDRESS ABOVE CORRECT) AND '3' (YES, MAILING ADDRESS ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT MAILING ADDRESS INFORMATION AVAILABLE. IF CODES '2' OR '3' SELECTED WHEN NO CURRENT MAILING ADDRESS, DISPLAY THE FOLLOWING MESSAGE: 'CODE NOT AVAILABLE. NO CURRENT MAILING ADDRESS.
VERIFY AND RE-ENTER.'
----------------------------------------------------

CL47
====

[What is that address?]

ENTER COMPLETE MAILING ADDRESS.
Current Info: [1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY],[STATE] [ZIP CODE]
1ST_STR_ADDRESS: [_____________]
2ND_STR_ADDRESS: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________] [BOX_17A]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
CONTINUE WITH BOX_17A
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).
----------------------------------------------------

CL47_2
======

[What is that address?]

BOX_17A
=======

----------------------------------------------------
IF NOT ROUND 5, CONTINUE WITH CL48
----------------------------------------------------
----------------------------------------------------
OTHERWISE (I.E., IF ROUND 5), GO TO BOX_18
----------------------------------------------------

CL48
====

Do you have a second home, such as a vacation home, where we could contact you if you're not available at your usual address?

IF AVAILABLE, VERIFY CURRENT SECOND HOME INFORMATION SHOWN BELOW.
Current Info: [1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
YES, ENTER NEW SECOND HOME ADDRESS AND TELEPHONE ............................ 1 [CL49]
YES, SECOND HOME ADDRESS AND TELEPHONE ABOVE CORRECT ........................ 2 [CL50]
YES, SECOND HOME ADDRESS OR TELEPHONE ABOVE NEEDS CORRECTION ............... 3 [CL49_2]
NO ..................................... 4 [CL50]
REF ................................... -7 [CL50]
DK .................................... -8 [CL50]
----------------------------------------------------
HARD CHECK:
CODES '2' (YES, SECOND HOME ADDRESS AND TELEPHONE ABOVE CORRECT) AND '3' (YES, SECOND HOME ADDRESS OR TELEPHONE ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT SECOND HOME ADDRESS INFORMATION AVAILABLE. IF CODES '2' OR '3' SELECTED WHEN NO CURRENT SECOND HOME ADDRESS, DISPLAY THE FOLLOWING MESSAGE: 'CODE NOT AVAILABLE. NO CURRENT SECOND HOME ADDRESS.
VERIFY AND RE-ENTER.'
----------------------------------------------------

CL49
====

[What is the address and phone number of that home?]

ENTER COMPLETE SECOND HOME ADDRESS.
Current Info: [1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
1ST_STR_ADDRESS: [_____________]
2ND_STR_ADDRESS: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
TELEPHONE: [_____________][CL50]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).
----------------------------------------------------

CL49_2
======

[What is the address and phone number of that home?]

CL50
====

Do you have a friend or relative who does not live here who will always know how to get in touch with the family?

IF AVAILABLE, VERIFY CURRENT CONTACT INFORMATION SHOWN BELOW.
Current Info: [CONTACT_NAME]
[1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
[RELATIONSHIP]
YES, ENTER NEW CONTACT PERSON/INFORMATION .. 1 [CL51]
YES, CONTACT PERSON/ADDRESS ABOVE CORRECT .. 2 [CL52]
YES, CONTACT PERSON/ADDRESS ABOVE NEEDS
CORRECTION ............................... 3 [CL51_2]
NO CONTACT PERSON AVAILABLE ................ 4 [CL53]
REF ....................................... -7 [CL53]
DK ........................................ -8 [CL53]
----------------------------------------------------
HARD CHECK:
CODES '2' (YES, CONTACT PERSON/ADDRESS ABOVE CORRECT) AND '3' (YES, CONTACT PERSON/ADDRESS ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT CONTACT PERSON INFORMATION AVAILABLE. IF CODES '2' OR '3' SELECTED WHEN NO CURRENT CONTACT INFORMATION, DISPLAY THE FOLLOWING MESSAGE: 'CODE NOT AVAILABLE. NO CURRENT CONTACT INFORMATION.
VERIFY AND RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: BEGINNING IN PANEL 17 ROUND 1, PANEL 16 ROUND 3, AND PANEL 14 ROUND 5 AND FOR ALL FUTURE ROUNDS MEPS NO LONGER COLLECTS OR DISPLAYS THE CONTACT PERSON'S MIDDLE NAME (HOME.CONTMNAM) IN CAPI OR IN THE IMS.
----------------------------------------------------

CL51
====

[What is the name, address, and phone number of that person?] [PROBE: What is (his/her) relationship to [NAME OF REFERENCE PERSON]?]

ENTER COMPLETE CONTACT INFORMATION.
Current Info: [NAME]
[1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
[RELATIONSHIP]
NAME [FIRST, LAST] [_____________]
1ST_STR_ADDRESS [_____________]
2ND_STR_ADDRESS [_____________]
CITY [_____________]
STATE [_____________]
ZIP CODE [_____________]
TELEPHONE [_____________]
RELATIONSHIP [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE RU FOR 'NAME OF REFERENCE PERSON'.
----------------------------------------------------
----------------------------------------------------
GO TO CL53
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).
----------------------------------------------------

CL51_2
======

[What is the name, address, and phone number of that person?] [PROBE: What is (his/her) relationship to [NAME OF REFERENCE PERSON]?]

USE TAB TO MOVE THROUGH FIELDS REQUIRING NO CORRECTION.
TO CORRECT OR ENTER NEW INFORMATION, TYPE ENTIRE FIELD.
TYPE THREE Xs (XXX) TO DELETE 2ND STREET ADDRESS.
Current Info: [CONTACT_NAME]
[1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
[RELATIONSHIP]
CONTACT_NAME: [_____________]
1ST_STR_ADDRESS: [_____________]
2ND_STR_ADDRESS: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
TELEPHONE: [_____________]
RELATIONSHIP: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE RU FOR 'NAME OF REFERENCE PERSON'.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH CL53
----------------------------------------------------

CL52
====

OMITTED.

CL52_2
======

OMITTED.

CL53
====

If you are not available for the next interview, who would be the best person to provide information about the family for the next interview?

IF AVAILABLE, VERIFY CURRENT ALTERNATE RESPONDENT INFORMATION SHOWN ELOW.
Current Info: [ALTERNATE_NAME]
[1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
ENTER NEW ALTERNATE RESPONDENT INFORMATION .......................... 1 [CL54]
ALTERNATE RESPONDENT INFORMATION ABOVE CORRECT .............................. 2 [CL56]
ALTERNATE RESPONDENT INFORMATION ABOVE NEEDS CORRECTION ..................... 3 [CL54]
NO ALTERNATE RESPONDENT AVAILABLE ...... 4 [CL57]
REF ................................... -7 [CL57]
DK .................................... -8 [CL57]
----------------------------------------------------
IF CURRENT ALTERNATE RESPONDENT IS A DU MEMBER, DO NOT DISPLAY CURRENT ADDRESS AND PHONE INFORMATION. ONLY DISPLAY CURRENT ADDRESS AND PHONE INFORMATION IF CURRENT ALTERNATE RESPONDENT IS OUTSIDE OF THE DU.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
CODES '2' (ALTERNATE RESPONDENT INFORMATION CORRECT) AND '3' (ALTERNATE RESPONDENT INFORMATION NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT ALTERNATE RESPONDENT INFORMATION AVAILABLE. IF CODES '2' OR '3' SELECTED WHEN NO CURRENT ALTERNATE RESPONDENT INFORMATION, DISPLAY THE FOLLOWING MESSAGE: 'RESPONSE NOT AVAILABLE. NO NO CURRENT ALTERNATE INFORMATION. VERIFY AND RE-ENTER.'
----------------------------------------------------

CL54
====

INTERVIEWER: SELECT PERSON NAMED FROM ROSTER.
[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
----------------------------------------------------
IF 'SOMEONE OUTSIDE DU' SELECTED AND CL53 IS 'ENTER NEW ALTERNATE RESPONDENT INFORMATION, CONTINUE WITH CL55.
ELSE IF 'SOMEONE OUTSIDE DU' SELECTED AND CL53 IS 'ALTERNATE RESPONDENT INFORMATION NEEDS CORRECTION', CONTINUE WITH CL55_2.
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CL57
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: DU_MEMBERS_1

COL # 1 HEADER: NAME
INSTRUCTIONS: DISPLAY DU MEMBER'S FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY PERSONS ON THE DU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. SELECT ONE ALLOWED.
2. MULTIPLE SELECT, EDIT, ADD, DELETE DISALLOWED.
3. DISPLAY 'SOMEONE OUTSIDE DU' AS LAST ENTRY ON ROSTER.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY THOSE DU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT CURRENT RESPONDENT
- PERSON IS NOT DECEASED
----------------------------------------------------

CL55
====

[What is the name, address, and phone number of that person?]

ENTER COMPLETE ALTERNATE RESPONDENT INFORMATION.
ENTER 'NMN' IF NO MIDDLE NAME.
Current Info: [ALTERNATE_NAME]
[1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
ALTERNATE_NAME: [_____________]
1ST_STR_ADDRESS: [_____________]
2ND_STR_ADDRESS: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
TELEPHONE: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
IF THERE IS NO CURRENT ALTERNATE RELATIONSHIP, PROCEED TO CL56.
OTHERWISE, PROCEED TO CL56_2.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).
----------------------------------------------------

CL55_2
======

[What is the name, address, and phone number of that person?]

USE TAB TO MOVE THROUGH FIELDS REQUIRING NO CORRECFTION.
TO CORRECT OR ENTER NEW INFORMATION, TYPE ENTIRE FIELD.
ENTER 'NMN' IF NO MIDDLE NAME.
TYPE THREE Xs (XXX) TO DELETE 2ND STREET ADDRESS.
Current Info: [ALTERNATE_NAME]
[1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
ALTERNATE_NAME: [_____________]
1ST_STR_ADDRESS: [_____________]
2ND_STR_ADDRESS: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
TELEPHONE: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
IF THERE IS NO CURRENT ALTERNATE RELATIONSHIP, PROCEED TO CL56.
OTHERWISE, PROCEED TO CL56_2.
----------------------------------------------------

CL56
====

What is [NAME OF ALTERNATE RESPONDENT CL55]'s relationship to [NAME OF REFERENCE PERSON]?

ENTER COMPLETE ALTERNATE RESPONDENT RELATIONSHIP.
Current Info: [ALTERNATE_RELATIONSHIP]
ALTERNATE_RELATIONSHIP: [_____________] [CL57]
----------------------------------------------------
DISPLAY THE NAME ENTERED AT CL55 FOR 'NAME OF ALTERNATE RESPONDENT CL55'.

DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE RU FOR 'NAME OF REFERENCE PERSON'.
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
AN ENTRY MUST BE MADE (REF AND DK ARE ALLOWED).
----------------------------------------------------

CL56_2
======

[What is [NAME OF ALTERNATE RESPONDENT CL55]'s relationship to [NAME OF REFERENCE PERSON]?]

UPDATE CURRENT ALTERNATE RESPONDENT.
TO CORRECT OR ENTER NEW INFORMATION, TYPE ENTIRE FIELD.
Current Info: [ALTERNATE_RELATIONSHIP]
ALTERNATE_RELATIONSHIP: [_____________] [CL57]
----------------------------------------------------
DISPLAY THE NAME ENTERED AT CL55 FOR 'NAME OF ALTERNATE RESPONDENT CL55'.

DISPLAY THE NAME OF THE REFERENCE PERSON FOR THE RU FOR 'NAME OF REFERENCE PERSON'.
----------------------------------------------------

CL57
====

Is anyone in the family planning to move within the next 3 months?

YES .................................... 1 [CL58]
NO ..................................... 2 [BOX_18]
REF ................................... -7 [BOX_18]
DK .................................... -8 [BOX_18]

CL58
====

Who is that? PROBE: Anyone else?

[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
----------------------------------------------------
CONTINUE WITH LOOP_11
----------------------------------------------------
----------------------------------------------------
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, EDIT, DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS WHO ARE CURRENT RU MEMBERS (I.E., A MEMBER OF THE RU ON THE INTERVIEW DATE)
----------------------------------------------------

LOOP_11
=======

----------------------------------------------------
FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK CL59 - END_LP11
----------------------------------------------------
----------------------------------------------------
LOOP DEFINITION: LOOP_11 COLLECTS ADDRESS INFORMATION FOR POTENTIAL FUTURE MOVERS. THIS LOOP CYCLES ON PERSONS ON THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (I.E., PERSON PART OF THE RU ON INTERVIEW DATE)
- PERSON SELECTED AS A FUTURE MOVER (I.E., SELECTED AT CL58)
- PERSON NOT FLAGGED AS 'PROCESSED FUTURE MOVER' (I.E., PERSON HAS NOT YET BEEN PROCESSED THROUGH THIS LOOP OR SELECTED AT CL61)
----------------------------------------------------

CL59
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
Please give me the address and telephone number of the place where [you/[PERSON]] [are/is] planning to move.

1ST_STR_ADDRESS: [_____________]
2ND_STR_ADDRESS: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
TELEPHONE: [_____________] [CL60]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
REFUSED AND DON'T KNOW ALLOWED FOR EACH FIELD.
----------------------------------------------------
----------------------------------------------------
FLAG PERSON AS 'PROCESSED FUTURE MOVER'.
----------------------------------------------------
----------------------------------------------------
IF ALL PERSONS SELECTED AS FUTURE MOVERS (I.E., SELECTED AT CL58) ARE FLAGGED AS 'PROCESSED FUTURE MOVER', GO TO END_LP11
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH CL60
----------------------------------------------------
----------------------------------------------------
HARD CHECK: CAPI REQUIRES AN ENTRY IN ALL FIELDS EXCEPT SECOND STREET ADDRESS.
----------------------------------------------------

CL60
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
IF KNOWN, CODE WITHOUT ASKING.
[Are/Is] [you/[PERSON]] planning to move with anyone in the family?

YES .................................... 1 [CL61]
NO ..................................... 2 [END_LP11]
REF ................................... -7 [END_LP11]
DK .................................... -8 [END_LP11]

CL61
====

[PERSON'S FIRST MIDDLE AND LAST NAME]
IF KNOWN, CODE WITHOUT ASKING.
Who [are/is] [you/[PERSON]] `planning to move with?

[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
[First Name, [Middle Name], Last Name-65]
----------------------------------------------------
FLAG ALL SELECTED PERSONS AS 'PROCESSED FUTURE MOVER'.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH END_LP11
----------------------------------------------------
----------------------------------------------------
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 PERSONS ON THE RU-MEMBERS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, EDIT, DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS IN THE RU-MEMBERS-ROSTER WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER (I.E., PERSON PART OF THE RU ON INTERVIEW DATE)
- PERSON SELECTED AS A FUTURE MOVER (I.E., SELECTED AT CL58)
- PERSON NOT FLAGGED AS 'PROCESSED FUTURE MOVER'
----------------------------------------------------

END_LP11
========

BOX_18
======

----------------------------------------------------
IF CURRENT RESPONDENT IS A PROXY, CONTINUE WITH CL61A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO BOX_18A
----------------------------------------------------

CL61A
=====

FOR PROXY RESPONDENT:
May I please have your address and telephone number?

IF AVAILABLE, VERIFY CURRENT PROXY ADDRESS SHOWN BELOW.
Current Info: [PROXY_NAME]
[1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
YES, ENTER NEW PROXY ADDRESS AND TELEPHONE ............................ 1 [CL61B]
YES, PROXY ADDRESS AND TELEPHONE ABOVE CORRECT .............................. 2 [BOX_18A]
YES, PROXY ADDRESS OR TELEPHONE ABOVE NEEDS CORRECTION ..................... 3 [CL61B_2]
NO ..................................... 4 [BOX_18A]
REF ................................... -7 [BOX_18A]
DK .................................... -8 [BOX_18A]
----------------------------------------------------
HARD CHECK:
CODES '2' (YES, PROXY ADDRESS AND TELEPHONE ABOVE CORRECT) AND '3' (YES, PROXY ADDRESS OR TELEPHONE ABOVE NEEDS CORRECTION) CANNOT BE SELECTED IF NO CURRENT PROXY ADDRESS INFORMATION AVAILABLE. IF CODES '2' OR '3' SELECTED WHEN NO CURRENT PROXY ADDRESS, DISPLAY THE FOLLOWING MESSAGE: 'CODE NOT AVAILABLE. NO CURRENT PROXY ADDRESS. VERIFY AND RE-ENTER.'
----------------------------------------------------

CL61B
=====

What is your address and phone number?

ENTER COMPLETE PROXY ADDRESS.
Current Info: [1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
1ST_STR_ADDRESS: [_____________]
2ND_STR_ADDRESS: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
TELEPHONE: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
FLAG PROXY ADDRESS INFORMATION FOR THE RU WITH THE ADDRESS AND PHONE ENTERED OR CORRECTED AT CL61B FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_18A
----------------------------------------------------
----------------------------------------------------
HARD CHECK:
AN ENTRY MUST BE MADE FOR EVERY FIELD EXCEPT SECOND STREET ADDRESS (REF AND DK ARE ALLOWED).
----------------------------------------------------

CL61B_2
=======

[What is your address and phone number?]

USE TAB TO MOVE THROUGH FIELDS REQUIRING NO CORRECTION.
TO CORRECT OR ENTER NEW INFORMATION, TYPE ENTIRE FIELD.
TYPE THREE Xs (XXX) TO DELETE 2ND STREET ADDRESS.
Current Info: [1ST_STR_ADDRESS]
[2ND_STR_ADDRESS]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]
1ST_STR_ADDRESS: [_____________]
2ND_STR_ADDRESS: [_____________]
CITY: [_____________]
STATE: [_____________]
ZIP CODE: [_____________]
TELEPHONE: [_____________]
USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.
----------------------------------------------------
FLAG PROXY ADDRESS INFORMATION FOR THE RU WITH THE ADDRESS AND PHONE ENTERED OR CORRECTED AT CL61B FOR THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_18A
----------------------------------------------------

CL62
====

OMITTED.

CL62A
=====

OMITTED.

CL62AOV
=======

OMITTED.

CL63
====

OMITTED.

CL64
====

OMITTED.

BOX_18A
=======

----------------------------------------------------
IF ROUND 1, GO TO CL67
----------------------------------------------------
----------------------------------------------------
OTHERWISE, CONTINUE WITH BOX_18B
----------------------------------------------------

BOX_18B
=======

----------------------------------------------------
IF AT LEAST ONE RU MEMBER COMPLETED THE SAQ [CL36 IS CODED '1' (COMPLETED AND GIVEN TO INTERVIEWER) FOR AT LEAST ONE RU MEMBER AND IF PANEL 17, ROUND 4 OR CL39 IS CODED '1' (COMPLETED AND GIVEN TO INTERVIEWER) FOR AT LEAST ONE RU MEMBER AND IF PANEL 17, ROUND 5], CONTINUE WITH CL64A
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CL67
----------------------------------------------------
----------------------------------------------------
NOTE: STARTING IN PANEL 18, PAYMENT WILL NO LONGER BE MADE FOR COMPLETED SAQ FORMS.
----------------------------------------------------

CL64A
=====

INTERVIEWER: FILL OUT SAQ CHECK(S) WITH SAQ RESPONDENT NAME(S). THEN RECORD PAYMENT TYPE AND CHECK NUMBER(S) (IF APPLICABLE).
CL64A_01.PID CL64A_02. ROSTER.
RU MEMBER
CL64A_03.
PAYMENT TYPE
CL64A_04.
CHECK NUMBER
[Display PID]
[First Name, [Middle Name], Last Name-65]
[Select Payment Type]
[Enter Check Number]
[Display PID]
[First Name, [Middle Name], Last Name-65]
[Select Payment Type]
[Enter Check Number]
[Display PID]
[First Name, [Middle Name], Last Name-65]
[Select Payment Type]
[Enter Check Number]
----------------------------------------------------
ROSTER DETAILS:
TITLE: RU_MEMBERS

COL # 1 HEADER: PID
INSTRUCTIONS: DISPLAY RU MEMBERS' 3-DIGIT ID (PERS.PID)

COL # 2 HEADER: RU MEMBER
NSTRUCTIONS: DISPLAY RU MEMBERS' FIRST, MIDDLE, AND LAST NAMES (PERS.FULLNAME)

COL # 3 HEADER: PAYMENT TYPE
INSTRUCTIONS: SELECT PAYMENT TYPE

COL # 4 HEADER: CHECK NUMBER
INSTRUCTIONS: ENTER CHECK NUMBER
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY PERSONS ON THE RU-MEMBERS-ROSTER FOR DISPLAY ONLY.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. THE PID COLUMN IS PROTECTED; NO CHANGES ARE ALLOWED.

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

3. THE PAYMENT TYPE COLUMN IS A DROP DOWN SELECTION BOX WITH TWO CHOICES: CHECK AND CASH.

4. THE CHECK NUMBER COLUMN IS A 7 DIGIT NUMERIC ENTRY FIELD.

5. THE CHECK NUMBER COLUMN SHOULD BE INACTIVE OR "GRAYED OUT" UNTIL A SELECTION IS MADE IN THE PAYMENT TYPE COLUMN. IF 'CHECK' IS SELECTED, THE CURSOR MOVES TO THE CHECK NUMBER COLUMN FOR COMPLETION. IF 'CASH' IS SELECTED THE CHECK NUMBER COLUMN REMAINS INACTIVE AND THE CURSOR MOVES TO THE PAYMENT TYPE COLUMN FOR THE NEXT RU MEMBER ON THE ROSTER.

6. SELECT, ADD, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL PERSONS ON THE RU-MEMBERS-ROSTER THAT HAVE COMPLETED AN SAQ FOR THIS ROUND. THAT IS, DISPLAY ALL RU MEMBERS THAT MEET THE FOLLOWING CONDITION:

- IF ROUNDS 2 OR 4: CL36 IS CODED '1' (COMPLETED AND GIVEN TO INTERVIEWER) FOR THIS PERSON
OR
- IF ROUNDS 3 OR 5: CL39 IS CODED '1' (COMPLETED AND GIVEN TO INTERVIEWER) FOR THIS PERSON
----------------------------------------------------

CL67
====

READ IF RESPONDENT REFERRED TO RECORDS DURING THE INTERVIEW:
Thank you for your cooperation in this important research. And I especially wanted to thank you for referring to records during the interview to help answer the questions. We've learned over the years that using records can help the interview move along a little more easily.

REVIEW WITH THE RESPONDENT WHICH OF THE FOLLOWING MEMORY AIDS WERE USED DURING THE INTERVIEW AND CODE ANY APPLICABLE. ENCOURAGE RECORD USE FOR NEXT ROUND. REFER TO RECORDS JOB AID AS APPROPRIATE.

CL67_01
=======

CALENDAR YES NO
(PAPER OR ELECTRONIC; COMPLETED PRIOR TO INTERVIEW)

CL67_03
=======

ELECTRONIC RECORDS YES NO
(E.G., ONLINE PATIENT PORTALS, MOBILE HEALTH APPS, ETC.)

CL67_04
=======

INSURANCE PAYMENT STATEMENT/EOB YES NO

CL67_05
=======

BILL/STATEMENT FROM PROVIDER YES NO

CL67_06
=======

PHARMACY PATIENT PROFILE YES NO

CL67_07
=======

MEDICINE BOTTLE/RECEIPT YES NO

CL67_08
=======

CHECK BOOK YES NO

CL67_09
=======

DOCTOR'S CARD OR APPOINTMENT SLIP YES NO

CL67_10
=======

TELEPHONE BOOK YES NO

CL67_11
=======

TAX RETURN/TAX FORM YES NO

CL67_12
=======

INSURANCE CARDS YES NO

CL67_13
=======

OTHER YES NO
HELP AVAILABLE FOR DEFINITIONS OF MEMORY AIDS.
----------------------------------------------------
IF CL67_13 IS CODED '1' (YES), CONTINUE WITH CL67OV
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO CL65
----------------------------------------------------

CL67OV
======

OTHER:
[Enter Other Specify] .................. [CL65]

CL65
====

INTERVIEWER: FILL OUT INTERVIEW CHECK WITH RESPONDENT'S NAME. THEN RECORD PAYMENT TYPE AND CHECK NUMBER BELOW (IF APPLICABLE).
GIVE CHECK TO RESPONDENT. THANK RESPONDENT FOR THIS INTERVIEW.
(READ STATEMENT BELOW)
Thank you again for your cooperation in this important research. This check is a gift to show our appreciation. [The next interview will take place in about six months.] [GIVE RESPONDENT GIFT./GIVE RESPONDENT CERTIFICATE: I would also like to thank you on behalf of the two Department of Health and Human Services agencies that sponsor this study ? the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention. As a token of their appreciation, they would like you to have this certificate recognizing your time and effort participating in the Medical Expenditure Panel Survey.]

CHECK .................................. 1 [CL65OV]
CASH ................................... 2 [BOX_20]

CL65OV
======

CHECK NUMBER:
[Enter Check Number ? 7] ................. [BOX_20]
----------------------------------------------------
DISPLAY 'The next interview will take place in about six months.' IF ROUNDS 1 OR 2 OR 3 OR 4. IF ROUND 5, USE A NULL DISPLAY.

DISPLAY 'GIVE RESPONDENT GIFT.' IF ROUND 1. DISPLAY 'GIVE RESPONDENT ... Panel Survey.' IF ROUND 5. IF ROUNDS 2 OR 3 OR 4, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
CL65OV SHOULD ALWAYS BE DISPLAYED AT CL65 (NOT AN OVERLAY), BUT IT SHOULD BE INACTIVE OR "GRAYED OUT". IF CL65 IS CODED '1' (CHECK), CL65OV SHOULD BECOME ACTIVE. IF CL65 IS CODED '2' (CASH), CL65OV REMAINS INACTIVE.
----------------------------------------------------

CL66
====

OMITTED. (COMBINED WITH CL65)

CL68
====

OMITTED. (COMBINED WITH CL67)

BOX_20
======

----------------------------------------------------
END INTERVIEW.
----------------------------------------------------

Your Choices About Your Health

There are a lot of clinical preventive care services available, such as screening tests for different types of cancer or heart disease. Not everyone makes the same choices about which tests to have, when to have a particular test or how often. By answering this questionnaire, you will help MEPS learn about the different choices different people make about preventive care.
Please mark an X to answer each question.

1.

Are you male or female?

() Male Please call Alex Scott, toll free at 1-800-945-6377 before completing.
() Female

What is your age?

_____ Age in years

When was the last time you visited a doctor or nurse for a check-up, follow-up care for an ongoing problem, or a concern that you have about your health? Do not include times you were hospitalized overnight or visits to the hospital emergency room.

() Within the past 12 months
() Within the past one to two years
() Within the past one to five years
() More than five years ago
() Never

During the past 12 months, have you had either a flu shot (directly in the arm or into the skin) or a flu vaccine that was sprayed in your nose?

() Yes
() No

In the past 12 months, has a doctor, nurse, or other health care professional weighed you?

() Yes
() No

About how much do you weigh without shoes?

_____ Weight (pounds)

About how tall are you without shoes?

_____ Feet _____ Inches

In the past 12 months, has a doctor, nurse, or other health care professional given you advice about how to manage your weight, discussed weight loss goals with you, or referred you to a weight loss program to help with your diet and exercise?

() Yes
() No

In the last 12 months, has a doctor, nurse, or other health professional asked you how much and how often you drink alcohol? You may have answered in person, on paper, or on a computer.

() Yes
() No

10.

In the last 12 months, have you had 4 or more drinks in one day? (A drink refers to one 12 oz. beer, 5 oz. glass of wine, or 1.5 oz. shot of hard liquor.)

() Yes
() No

11.

In the last 12 months, has a doctor, nurse, or other health care professional advised you to cut back or stop drinking alcohol?

() Yes
() No

12.

Has a doctor, nurse, or other health care professional ever asked you if you smoke or use tobacco? You may have answered in person, on paper, or on a computer.

() Yes
() No

13.

In the last 12 months, on average, would you say you smoked cigarettes or used tobacco every day, some days, or not at all?

() Every day
() Some days
() Not at all Skip to Question 17

14.

In the past 12 months, were you advised by a doctor, nurse, or other health care professional to quit smoking or quit using tobacco?

() Yes
() No

15.

In the past 12 months, were you advised by a doctor, nurse, or other health care professional to take a medication to assist you with quitting smoking or using tobacco? Some medications that can be used are: nicotine gum, patch, nasal spray, inhaler, or prescription medicine.

() Yes
() No

16.

In the past 12 months, has a doctor, nurse, or other health care professional discussed or provided methods and strategies other than medication to assist you with quitting smoking or using tobacco? Examples of methods and strategies are: telephone helpline, individual or group counseling, or program to help stop smoking.

() Yes
() No

17.

In the past 12 months, has your doctor, nurse, or other health care professional asked you about your mood, such as whether you are anxious or depressed? You may have answered in person, on paper, or on a computer.

() Yes
() No

18.

During the past 24 months, have you had your blood pressure checked by a doctor, nurse, or other health care professional?

() Yes
() No

19.

Within the past 5 years, have you had your blood cholesterol checked by a doctor, nurse, or other health care professional?

() Yes
() No

20.

Have you had a hysterectomy or have you ever had cervical cancer?

Yes Skip to Question 23
No

21.

Within the past 5 years, have you had a Pap test? A Pap smear or Pap test is a routine test in which the doctor takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.

() Yes
() No

22.

About how old were you the last time you had a Pap test?

() Younger than 35
() 35 to 44 years old
() 45 to 54 years old
() 55 to 64 years old
() 65 to 74 years old
() 75 or older

23.

Within the past 5 years, have you been tested for HIV, the virus that causes AIDS? Include blood testing and/or testing fluid from your mouth.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

If you are 50 or older, please continue to the next questions.
If you are under 50 years old, please go to the back cover section.

24.

Have you ever had a pneumonia shot? A pneumonia shot or pneumococcal vaccine is usually only given once or twice in a person's lifetime.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

25.

Have you had the shingles vaccine? The vaccine is called Zostavax the zoster vaccine, or the shingles vaccine. The chicken pox virus causes shingles. The vaccine has been available since May 2006.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

26.

Is there any medical reason why you cannot take aspirin, such as an allergy, another medication you take, or other side effect?

() Yes Skip to Question 28
() No

27.

Has a doctor, nurse, or other health care professional ever discussed with you the use of aspirin to prevent heart attack or stroke?

() Yes
() No

28.

Have you had both breasts removed or have you ever had breast cancer?

() Yes Skip to Question 30
() No

29.

Within the past 2 years, have you had a mammogram? A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.

() Yes
() No

30.

Have you had colon cancer or your entire colon removed?

() Yes Skip to Question 34
() No

31.

Within the past 10 years, have you had a colonoscopy? A colonoscopy test examines the bowel by inserting a tube into the rectum. After a colonoscopy, you feel tired and usually need someone to drive you home.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

32.

Within the past 5 years, have you had a sigmoidoscopy? A sigmoidoscopy test also examines the bowel by inserting a tube into the rectum. You are awake during this test and can drive yourself home.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

33.

Within the past 12 months, have you had a blood stool test using a home kit? A doctor, nurse, or other health professional provides you a special kit or cards to use at home to determine whether the stool contains blood.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

If you are 65 or older, please answer questions 34 and 35.
If you are under 65 years old, please go to the back cover section.

34.

Have you ever been told by a doctor, nurse, or other health care professional that you have osteoporosis? Osteoporosis is when the bones become fragile and break easily.

() Yes Please go to the back cover section.
() No

35.

There are several tests to measure bone density and detect osteoporosis at an early stage, including a DEXA scan. Have you ever had your bone density measured?

() Yes
() No

Date completed:

MONTH __ / DAY __ / YEAR _______

Your Choices About Your Health

Are you male or female?

() Male
() Female Please call Alex Scott, toll free at 1-800-945-6377 before completing.

What is your age?

_____ Age in years

() Within the past 12 months
() Within the past one to two years
() Within the past one to five years
() More than five years ago
() Never

During the past 12 months, have you had either a flu shot (directly in the arm or into the skin) or a flu vaccine that was sprayed in your nose?

() Yes
() No

In the past 12 months, has a doctor, nurse, or other health care professional weighed you?

() Yes
() No

About how much do you weigh without shoes?

_____ Weight (pounds)

About how tall are you without shoes?

_____ Feet _____ Inches

() Yes
()No

In the last 12 months, has a doctor, nurse, or other health professional asked you how much and how often you drink alcohol? You may have answered in person, on paper, or on a computer.

() Yes
() No

10.

In the last 12 months, have you had 5 or more drinks in one day? (A drink refers to one 12 oz. beer, 5 oz. glass of wine, or 1.5 oz. shot of hard liquor.)

() Yes
() No

11.

In the last 12 months, has a doctor, nurse, or other health care professional advised you to cut back or stop drinking alcohol?

() Yes
() No

12.

Has a doctor, nurse, or other health care professional ever asked you if you smoke or use tobacco? You may have answered in person, on paper, or on a computer.

() Yes
() No

13.

In the last 12 months, on average, would you say you smoked cigarettes or used tobacco every day, some days, or not at all?

() Every day
() Some days
() Not at all Skip to Question 17

14.

In the past 12 months, were you advised by a doctor, nurse, or other health care professional to quit smoking or quit using tobacco?

() Yes
() No

15.

() Yes
() No

16.

() Yes
() No

17.

() Yes
() No

18.

During the past 24 months, have you had your blood pressure checked by a doctor, nurse, or other health care professional?

() Yes
() No

19.

Within the past 5 years, have you had your blood cholesterol checked by a doctor, nurse, or other health care professional?

() Yes
() No

20.

Within the past 5 years, have you been tested for HIV, the virus that causes AIDS? Include blood testing and/or testing fluid from your mouth.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

If you are 50 or older, please continue to the next questions.
If you are under 50 years old, please go to the back cover section.

21.

Have you ever had a pneumonia shot? A pneumonia shot or pneumococcal vaccine is usually only given once or twice in a person's lifetime.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

22.

Have you had the shingles vaccine? The vaccine is called Zostavax, the zoster vaccine, or the shingles vaccine. The chicken pox virus causes shingles. The vaccine has been available since May 2006.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

23.

Is there any medical reason why you cannot take aspirin, such as an allergy, another medication you take, or other side effect?

() Yes Skip to Question 25
() No

24.

Has a doctor, nurse, or other health care professional ever discussed with you the use of aspirin to prevent heart attack or stroke?

() Yes
() No

25.

Have you had colon cancer or your entire colon removed?

() Yes Skip to Question 29
() No

26.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

27.

Within the past 5 years, have you had a sigmoidoscopy? A sigmoidoscopy test also examines the bowel by inserting a tube into the rectum. You are awake during this test and can drive yourself home.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

28.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

If you are 65 or older, please answer questions 34 and 35.
If you are under 65 years old, please go to the back cover section.

29.

Have you had prostate cancer?

() Yes Please go to the back cover section.
() No

30.

About how old were you the last time you had a PSA test? A "P-S-A" is a blood test to detect prostate cancer. It is also called a prostate specific antigen test.

() Never had a PSA test
() Under age 50
() Between 51 and 64
() Between 65 and 74
() 75 or older

Date completed:

MONTH __ / DAY __ / YEAR _______

Your Health and Health Opinions

Your Opinion Matters!
Medical Expenditure Panel Survey (MEPS)
Understanding how people feel about their health and health care is an important goal of MEPS. Please take a few minutes to answer the questions in this booklet.

Survey Instructions
Please answer every question by checking one box ?.? If you are unsure about how to answer a question, please give the best answer you can.
You are sometimes told to skip over some questions in this survey. When this happens you will be told what questions to answer next, otherwise, go to the next question.
This Booklet Should Be Completed By
Region:
RUID:
PID:
Name:
Version:
DOB:
Your participation is voluntary and all of your answers will be kept confidential to the extent permitted by law. If you have any questions about this booklet, please call Alex Scott at 1-800-945-MEPS (6377).
Store your completed booklet in the envelope provided. Have it ready to give to your interviewer at his or her next visit.
This survey is authorized under 42 U.S.C. 299a. The confidentiality of your responses to this survey is protected by Sections 944(c) and 308(d) of the Public Health Service Act [42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)]. Information that could identify you will not be disclosed unless you have consented to that disclosure. Public reporting burden for this collection of information is estimated to average 7 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-0118)AHRQ, 5600 Fishers Lane, Rockville, MD 20857.
The Agency for Healthcare Research and Quality and
The Centers for Disease Control and Prevention of the
U.S. Department of Health and Human Services

Start Here
Your Health Care in the Last 12 Months

1. In the last 12 months, did you have an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office?

1 Yes
2 No Skip to Question 3

2. In the last 12 months, when you needed care right away, how often did you get care as soon as you thought you needed?

1 Never
2 Sometimes
3 Usually
4 Always

3. In the last 12 months, not counting the times you needed care right away, did you make any appointments for your health care at a doctor?s office or clinic?

1 Yes
2 No Skip to Question 5

4. In the last 12 months, not counting the times you needed care right away, how often did you get an appointment for your health care at a doctor?s office or clinic as soon as you thought you needed?

1 Never
2 Sometimes
3 Usually
4 Always

5. In the last 12 months, not counting the times you went to an emergency room, how many times did you go to a doctor?s office or clinic to get health care for yourself?

0 None Skip to Question 18
1 1
2 2
3 3
4 4
5 5 to 9
6 10 or more

6. In the last 12 months, did you or a doctor believe you needed any care, tests, or treatment?

1 Yes
2 No Skip to Question 8

7. In the last 12 months, how often was it easy to get the care, tests, or treatment you or a doctor believed necessary?

1 Never
2 Sometimes
3 Usually
4 Always

8. In the last 12 months, how often did doctors or other health providers listen carefully to you?

1 Never
2 Sometimes
3 Usually
4 Always

9.In the last 12 months, how often did doctors or other health providers explain things in a way that was easy to understand?

1 Never
2 Sometimes
3 Usually
4 Always

10. In the last 12 months, how often did doctors or other health providers show respect for what you had to say?

1 Never
2 Sometimes
3 Usually
4 Always

11. In the last 12 months, how often did doctors or other health providers spend enough time with you?

1 Never
2 Sometimes
3 Usually
4 Always

12. In the last 12 months, did a doctor or other health provider give you instructions about what to do about a specific illness or health condition?

1 Yes
2 No Skip to Question 15

13. In the last 12 months, how often were these instructions easy to understand?

1 Never
2 Sometimes
3 Usually
4 Always

14. In the last 12 months, how often did doctors or other health providers ask you to describe how you were going to follow these instructions?

1 Never
2 Sometimes
3 Usually
4 Always

15. In the last 12 months, did you have to fill out or sign any forms at a doctor?s or other health provider?s office?

1 Yes
2 No Skip to Question 17

16. In the last 12 months, how often were you offered help in filling out a form at the doctor?s or other health provider?s office?

1 Never
2 Sometimes
3 Usually
4 Always

17. 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 your health care in the last 12 months?

0 0 Worst health care possible
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
9 9
10 10 Best health care possible

18. Do you currently smoke?

1 Yes
2 No Skip to Question 20

19. In the last 12 months, did a doctor advise you to quit smoking?

1 Yes
2 No
3 Had no visits in the last 12 months

20. In the last 2 years, has your blood pressure been checked by a doctor, nurse, or other health professional?

1 Yes
2 No

Getting Health Care from a Specialist
When you answer the next questions, do not include dental visits.

21. 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 you needed to see a specialist?

1 Yes
2 No Skip to Question 23

22. In the last 12 months, how often was it easy to see a specialist that you needed to see?

1 Never
2 Sometimes
3 Usually
4 Always

General Health

23. In general, would you say your health is:

1 Excellent
2 Very good
3 Good
4 Fair
5 Poor

The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?

24. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf

1 Yes, limited a lot
2 Yes, limited a little
3 No, not limited at all

25. Climbing several flights of stairs

1 Yes, limited a lot
2 Yes, limited a little
3 No, not limited at all

During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

26. Accomplished less than you would like