01 Box = BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100, BOX_110
02 Loop = LOOP_10, LOOP_20, LOOP_30
03 End Loop = END_LP10, END_LP20, ENDLP_30
04 Single Select = AC10, AC20, AC30, AC40, AC50, AC60, AC70, AC80, AC90, AC100, AC120, AC140, AC150, AC160, AC170, AC180, AC190, AC200, AC210, AC230, AC240, AC250
08 Multiple Select = AC110
10 Multiple Select with Fill in Answer Text = AC220
20 OS Text Field = AC80OS, AC90OS

Route Details: The AC section is asked in rounds 2 and 4 only. If it is round 1, 3, or 5, continue to the next section.

Route Details: Context header display instructions: display Person.FullName, Prov.LorpName, LPERSON.FULLNAME

For each element in the RU-members-roster, ask AC10 - END_LP10.
Loop definition: LOOP_10 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 (included in person array)
-Person is not deceased (PersRndStatus ?Deceased)
-Person is not institutionalized (PersRndStatus ? Institutionalized)

BLAISE NAME: HaveUSC
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:

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?
HELP: F1

YES 1 AC30 (AC1030)
NO 2 AC40 (AC1035)
MORE THAN ONE PLACE 3 AC20 (AC1025)
REFUSED RF END_LP10 (AC1120)
DON'T KNOW DK END_LP10 (AC1120)

BLAISE NAME: GoFirst
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:

Would [you/[PERSON]] go to one of these places first or most often if [you/he/she] [are/is] sick?

YES 1 AC30 (AC1030)
NO 2 AC40 (AC1035)
REFUSED RF END_LP10 (AC1120)
DON'T KNOW DK END_LP10 (AC1120)

BLAISE NAME: USCLoctn
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:

Does the medical provider [you/[PERSON]] usually [see/sees] have his or her own practice that is not part of a group practice, health center, clinic, or other facility?

OWN PRACTICE, NOT PART OF GROUP/FACILITY 1 BOX_30 (AC1036)
PRACTICE IS ASSOCIATED WITH GROUP/FACILITY 2 BOX_30 (AC1036)
REFUSED RF BOX_30 (AC1036)
DON'T KNOW DK BOX_30 (AC1036)

Display 'see' if asking about the respondent. Otherwise, display 'sees'
For response 1 "OWN PRACTICE, NOT PART OF GROUP/FACILITY", display the word "NOT" with an underline.

BLAISE NAME: WhyNoUSC
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:

What is the main reason [you/[PERSON]] [do/does] not have a usual source of health care?
HELP: F1

SELDOM OR NEVER GETS SICK 1 END_LP10 (AC1120)
RECENTLY MOVED INTO AREA 2 END_LP10 (AC1120)
JUST CHANGED INSURANCE PLANS 3 END_LP10 (AC1120)
NO HEALTH INSURANCE, OTHER INSURANCE RELATED REASON 4 END_LP10 (AC1120)
DON'T KNOW WHERE TO GO FOR CARE 5 END_LP10 (AC1120)
USUAL SOURCE OF MEDICAL CARE IN THIS AREA IS NO LONGER AVAILABLE 6 END_LP10 (AC1120)
LIKES TO GO TO DIFFERENT PLACES FOR DIFFERENT HEALTH NEEDS 7 END_LP10 (AC1120)
DON'T USE DOCTORS/TREAT MYSELF 8 END_LP10 (AC1120)
COST OF MEDICAL CARE 9 END_LP10 (AC1120)
OTHER REASON 91 END_LP10 (AC1120)
REFUSED RF END_LP10 (AC1120)
DON'T KNOW DK END_LP10 (AC1120)

Ask the provider roster (PV) section.
At the completion of the provider roster (PV) section, continue with BOX_40.

If provider added or selected at PV30LU is a person provider, that person provider will be considered the ?USC (USUAL SOURCE OF CARE PROVIDER) PROVIDER? for this person for this round.
If provider added or selected at PV30LU is a facility provider and PV70=0, that facility provider will be considered the ?USC (USUAL SOURCE OF CARE PROVIDER) PROVIDER? for this person for this round.
If provider added or selected at PV30LU is a facility provider and PV70 ? 0 or empty, the entry at PV70, in conjunction with the facility provider at PV30LU, will be the ?(USUAL SOURCE OF CARE PROVIDER) PROVIDER? for this person for this round.
If the USC provider is a person provider, then the USC type is PERSON-TYPE PROVIDER.
If the USC provider is a facility provider and PV70=0, then the USC type is a FACILITY-TYPE PROVIDER.
If the USC provider is a facility provider and PV70?0 or empty, then the USC type is a PERSON-IN-FACILITY-TYPE PROVIDER and the entry entered at PV70 will be considered the USC in conjunction with the facility provider selected or added at PV30LU.
If USC provider selected at PV30LU is a FACILITY-TYPE PROVIDER or a PERSON-IN-FACILITY-TYPE PROVIDER and AC50 was not already asked for this USC provider in an earlier loop, or in round 2 if round 4 or if it?s round 4 and in round 2, this item was coded as missing (RF, DK), go to AC50.
Otherwise, if USC provider selected at PV30LU is (a PERSON-TYPE PROVIDER) or (a FACILITY-TYPE PROVIDER or a PERSON IN FACILITY TYPE PROVIDER and AC50 has already been asked for this USC provider in an earlier loop, or in round 2 if round 4 (Preload.PlaceType)), go to AC60.

BLAISE NAME: PlaceType
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

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?
HELP: F1

Responses: 

HOSPITAL CLINIC OR OUTPATIENT DEPARTMENT 1 AC60 (AC1065)
HOSPITAL EMERGENCY ROOM 2 AC60 (AC1065)
OTHER KIND OF PLACE 3 AC60 (AC1065)
REFUSED RF AC60 (AC1065)
DON'T KNOW DK AC60 (AC1065)

Programmer Instructions: Note: for questions AC50-AC120, the context header will always display the name of the USC provider entered at PV30LU for ?NAME OF FACILITY?. Display the entry entered at PV70 for ?NAME OF MEDICAL CARE PROVIDER?? otherwise, use a null display.
Display Instructions: Display ?Is [PROVIDER]? if USC provider is a ?FACILITY-TYPE- PROVIDER?.
Display ?Does [PROVIDER] work at? if USC provider is a ?PERSON IN FACILITY-TYPE-PROVIDER? and display the entry selected or added at PV70 for ?PROVIDER?

BLAISE NAME: TimeProv
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

How long does it usually take [you/[PERSON]] to get to [PROVIDER]?

LESS THAN 15 MINUTES 1 BOX_50 (AC1070)
16 TO 30 MINUTES 2 BOX_50 (AC1070)
31 TO 60 MINUTES (1 HOUR) 3 BOX_50 (AC1070)
61 TO 90 MINUTES 4 BOX_50 (AC1070)
91 TO 120 MINUTES (2 HOURS) 5 BOX_50 (AC1070)
MORE THAN 120 MINUTES (2 HOURS) 6 BOX_50 (AC1070)
REFUSED RF BOX_50 (AC1070)
DON'T KNOW DK BOX_50 (AC1070)

BLAISE NAME: ProvDoc
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

Is [PROVIDER] a medical doctor?
HELP: F1

Responses: 
YES 1 AC90 (AC1090)
NO 2 AC80 (AC1080)
REFUSED RF AC100 (AC1100)
DON'T KNOW DK AC100 (AC1100)
Display Instructions:

BLAISE NAME: ProvOthType
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

Responses: 
NURSE 1 BOX_60 (AC1096)
NURSE PRACTITIONER 2 BOX_60 (AC1096)
PHYSICIAN'S ASSISTANT 3 BOX_60 (AC1096)
MIDWIFE 4 BOX_60 (AC1096)
CHIROPRACTOR 5 BOX_60 (AC1096)
OTHER 91 AC80OS (AC1085)
REFUSED RF BOX_60 (AC1096)
DON'T KNOW DK BOX_60 (AC1096)
Display Instructions: 
Display AC80 and AC80OS on the same form pane.

BLAISE NAME: ProvOthTypeOS
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

Responses: 

Display Instructions: 

BLAISE NAME: ProvSpeclt
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

What is [PROVIDER]'s specialty?

GENERAL/FAMILY PRACTICE 1 BOX_60 (AC1096)
INTERNAL MEDICINE 2 BOX_60 (AC1096)
PEDIATRICS 3 BOX_60 (AC1096)
OB/GYN 4 BOX_60 (AC1096)
SURGERY 5 BOX_60 (AC1096)
CHIROPRACTOR 6 BOX_60 (AC1096)
CARDIOLOGIST 7 BOX_60 (AC1096)
DOCTOR OF OSTEOPATHY 8 BOX_60 (AC1096)
OTHER 91 AC90OS (AC1095)
REFUSED RF BOX_60 (AC1096)
DON'T KNOW DK BOX_60 (AC1096)

Display AC90 and AC90OS on the same form pane.

BLAISE NAME: ProvSpecltOS
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

SPECIFY: OTHER SPECIALTY.

BLAISE NAME: ProvHispLat
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

Is [PROVIDER] Hispanic or Latino?

BLAISE NAME: ProvRace
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

AC-1.
What is [PROVIDER]'s race?
ENTER ALL THAT APPLY.

WHITE 1 BOX_80 (AC1111)
BLACK/AFRICAN AMERICAN 2 BOX_80 (AC1111)
ASIAN 3 BOX_80 (AC1111)
INDIAN/NATIVE AMERICAN/ALASKA NATIVE 4 BOX_80 (AC1111)
OTHER PACIFIC ISLANDER 5 BOX_80 (AC1111)
SOME OTHER RACE 91 BOX_80 (AC1111)
REFUSED RF BOX_80 (AC1111)
DON'T KNOW DK BOX_80 (AC1111)

If this USC provider is a 'PERSON-TYPE-PROVIDER' or 'PERSON IN FACILITY TYPE-PROVIDER' and (AC120 not already answered this round for this same USC provider in an earlier cycle) or (if round 4 and Preload.ProvGender=DK, RF, or EMPTY (i.e., AC120 never asked in round2) for this same USC provider)], go to AC120.
Otherwise, go to END_LP10.

BLAISE NAME:  ProvGender
Context Header:  [PERSON?S FIRST MIDDLE AND LAST NAME][[NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

Is [PROVIDER] male or female?

MALE 1 END_LP10 (AC1120)
FEMALE 2 END_LP10 (AC1120)
REFUSED RF END_LP10 (AC1120)
DON'T KNOW DK END_LP10 (AC1120)

Cycle on next person in the RU-members-roster who meets the conditions stated in the loop definition.
If no other persons meet the stated conditions, end LOOP_10 and continue with BOX_90.

If at least one provider was selected or added as a ?USC provider? on the RU- medical-providers-roster, continue with LOOP_20.
Otherwise, go to AC210.

For each element in the RU-medical-providers-roster, ask AC140 - END_LP20.
Loop definition: LOOP_20 collects detailed information on each unique usual source of care provider identified for this RU. This loop cycles on providers who meet the following condition:
-Provider was selected or added as ?USC provider? during the current round for a current RU member.
Note: if the USC provider being looped on is a 'PERSON IN FACILITY-TYPE-PROVIDER' the context header in LOOP_20 will display the name of facility selected or added at PV30LU. if the USC provider being looped on is a ?FACILITY- TYPE- PROVIDER', the context header in LOOP_20 will display the facility-provider name. If the USC provider being looped on is ?PERSON-TYPE PROVIDER? the context header in LOOP_20 will display the person-provider name.
For ?PROVIDER? in the question text, display the name of the facility if the USC type is a FACILITY TYPE PROVIDER, display the name of the person provider, if the USC type is a PERSON TYPE PROVIDER, and display the name entered at PV70, if the USC type is PERSON IN FACILITY TYPE PROVIDER.

BLAISE NAME: PhoneDfclt
Context Header: [NAME OF MEDICAL CARE PROVIDER......]
[NAME OF FACILITY]
Question Text:

AC-2.
The next few questions ask about the experience [[PERSON 1],] [PERSON 2],] [PERSON 3],] [PERSON 4],] [PERSON N],] [or their parents] [have had/has had] with [PROVIDER] . Please think about their overall experiences when answering the following questions.
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, somewhat difficult, not too difficult, or not at all difficult?

VERY DIFFICULT 1
SOMEWHAT DIFFICULT 2
NOT TOO DIFFICULT 3
NOT AT ALL DIFFICULT 4
REFUSED RF
DON'T KNOW DK

Programmer Instructions: 

If AC50 was coded ?2? (HOSPITAL EMERGENCY ROOM) for this USC provider, go to AC160.
Otherwise, continue with AC150.

Display ?a medical person at? if USC provider being looped on is a ?FACILITY-TYPE- PROVIDER?.
Otherwise, use a null display.
Display 'have had' if roster list displayed at the question text includes the respondent or includes more than 1 person. Otherwise, display 'has had'.
Roster definition: Roster 1 - Report
This item displays RU-members-roster for display. Display RU member?s first, middle, and last names (Person.FullName). Display ?you? rather than the respondent?s name, when respondent?s name is included in the list. Separate each name with a comma and before the last RU member?s name display an ?and?.
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.
Display ?or their parents? if all the RU members displayed in the roster are less than or equal to 17 years old (or age category 1-3), otherwise, use a null display.

BLAISE NAME: OffHours
Context Header: [NAME OF MEDICAL CARE PROVIDER......][NAME OF FACILITY]
Question Text:

Does [PROVIDER] have office hours at night or on weekends?

YES 1 AC160 (AC1150)
NO 2 AC160 (AC1150)
REFUSED RF AC160 (AC1150)
DON'T KNOW DK AC160 (AC1150)

BLAISE NAME: AfterHours
Context Header: [NAME OF MEDICAL CARE PROVIDER.......][NAME OF FACILITY]
Question Text:

AC-2.
How difficult is it to contact [a medical person at] [PROVIDER] after their regular hours in case of urgent medical needs?

VERY DIFFICULT 1 AC170 (AC1155)
SOMEWHAT DIFFICULT 2 AC170 (AC1155)
NOT TOO DIFFICULT 3 AC170 (AC1155)
NOT AT ALL DIFFICULT 4 AC170 (AC1155)
REFUSED RF AC170 (AC1155)
DON'T KNOW DK AC170 (AC1155)

Display ?a medical person at? if USC provider being looped on is a 'FACILITY- TYPE- PROVIDER?. Otherwise, use a null display.

BLAISE NAME: OthTrtmt
Context Header: [NAME OF MEDICAL CARE PROVIDER......] [NAME OF FACILITY]
Question Text:

Does [someone at] [PROVIDER] usually ask about prescription medications and treatments other doctors may give

YES 1 AC180 (AC1160)
NO 2 AC180 (AC1160)
REFUSED RF AC180 (AC1160)
DON'T KNOW DK AC180 (AC1160)

Display ?someone at? if USC provider being looped on is a ?FACILITY-TYPE- PROVIDER?. Otherwise, use a null display.

BLAISE NAME: AskChoose
Context Header: [NAME OF MEDICAL CARE PROVIDER.......] [NAME OF FACILITY]
Question Text:

AC-3.
If there were a choice between treatments, how often would [a medical person at] [PROVIDER] ask [[PERSON 1],] [PERSON 2],] [PERSON 3],] [PERSON 4],][PERSON N],] [or their parents] to help make the decision?
Would you say never, sometimes, usually, or always?

NEVER 1 AC190 (AC1165)
SOMETIMES 2 AC190 (AC1165)
USUALLY 3 AC190 (AC1165)
ALWAYS 4 AC190 (AC1165)
REFUSED RF AC190 (AC1165)
DON'T KNOW DK AC190 (AC1165)

Display Instructions: 

Roster definition: Roster 1 - Report
This item displays RU-members-roster for display. Display RU member?s first, middle, and last names (Person.FullName).
Display ?you? rather than the respondent?s name, when respondent?s name is included in the list.
Display reference person?s name, when the respondent is a proxy. Separate each name with a comma and before the last RU member?s name display an ?and?.
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.
Display ?or their parents? if all the RU members displayed in the roster are less than or equal to 17 years old (or age category 1-3), otherwise, use a null display.
Display ?a medical person at? if USC provider being looped on is a ?FACILITY- TYPE- PROVIDER?. Otherwise, use a null display.

BLAISE NAME: ExplOpt
Context Header: [NAME OF MEDICAL CARE PROVIDER.......] [NAME OF FACILITY]
Question Text:

Does [a medical person at] [PROVIDER] present and explain all options to [[PERSON 1],] [[PERSON 2],] [[PERSON 3],] [[PERSON 4],] [[and] PERSON N] [or their parents]?

YES 1 BOX_100 (AC1166)
NO 2 BOX_100 (AC1166)
REFUSED RF BOX_100 (AC1166)
DON'T KNOW DK BOX_100 (AC1166)

Roster definition: Roster 1 - Report
This item displays RU-members-roster for display. Display RU member?s first, middle, and last names (Person.FullName).
Display ?you? rather than the respondent?s name, when respondent?s name is included in the list.
Display reference person?s name, when the respondent is a proxy. Separate each name with a comma and before the last RU member?s name display an ?and?.
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.
Display ?or their parents? if all the RU members displayed in the roster are less than or equal to 17 years old (or age category 1-3), otherwise, use a null display.
Display ?a medical person at? if USC provider being looped on is a ?FACILITY- TYPE-PROVIDER?.

If at least one person who identified the USC provider currently being looped on as their USC provider AND RE1170_09 was coded ?3? (NOT WELL) or ?4? (NOT AT ALL) in any round for that person (preload.EngCompLevel), continue with AC200.
Otherwise, go to END_LP20.

BLAISE NAME: LangPref
Context Header: [NAME OF MEDICAL CARE PROVIDER.......] [NAME OF FACILITY]
Question Text:

Does [someone at] [PROVIDER] speak the language [[PERSON 1],] [[PERSON 2],] [[PERSON 3],] [[PERSON 4],] [[and] PERSON N] [or their parents] prefer(s) or provide translator services for them?

YES 1 END_LP20 (AC1180)
NO 2 END_LP20 (AC1180)
REFUSED RF END_LP20 (AC1180)
DON'T KNOW DK END_LP20 (AC1180)

Display 'someone at' if USC provider being looped on is a 'FACILITY-TYPE-PROVIDER.' Otherwise, use a null display.
Roster definition: Roster 1 - Report
This item displays RU-members-roster for display. Display RU member?s first, middle, and last names (Person.FullName ). Display "you" rather than the respondent?s name, when respondent?s name is included in the list.
Display reference person?s name, when the respondent is a proxy. Separate each name with a comma and before the last RU member?s name display an "and".
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 and
-Coded RE1170_09 as ?3? (NOT WELL) or ?4? (NOT AT ALL) in any round.
Display "or their parents" if all the RU members displayed in the roster are less than or equal to 17 years old (or age category 1-3), otherwise, use a null display.

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_20 and continue with AC210.

BLAISE NAME: DelayCare
Question Text:

The following questions are about the use of health care. Do not include dental care or prescription medicines.
Please think about the last 12 months, that is, between [MONTH YEAR-1] and today. [[Have you/Has [PERSON]] delayed seeking medical care/Has medical care been delayed for anyone in the household] because of worry about the cost?

 YES 1 AC220 (AC1186)
NO 2 AC230 (AC1187)
REFUSED RF AC230 (AC1187)
DON'T KNOW DK AC230 (AC1187)

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

For ?MONTH YEAR-1? display the month of the current interview and the current interview year minus 1.
Display ?[Have you/Has [PERSON]] delayed seeking medical care? if SINGLE-PERSON RU. Otherwise, display ?Has medical care been delayed for anyone in the household?.

BLAISE NAME: DelayWho
Question Text:

Who was that?
PROBE: Did anyone else delay seeking medical care because of worry about the cost?
ENTER ALL THAT APPLY.

 [FIRST NAME [MIDDLE NAME] LAST NAME]1 1
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5

Go to AC230.

Roster 2 - no add/edit/delete
Roster definition:
This item displays RU members roster for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster filter:
No filter; display all.

BLAISE NAME: AffrdCare
Question Text:

In the last 12 months, was there any time when [[you/[PERSON]]/anyone in the household] needed medical care, but did not get it because [[you/he/she]/they] couldn?t afford it?

YES 1 AC240 (AC1188)
NO 2 AC250 (AC1189)
REFUSED RF AC250 (AC1189)
DON'T KNOW DK AC250 (AC1189)

If coded ?1? (YES) and a MULTI-PERSON RU, continue with AC240. If coded ?1? (YES) and a SINGLE-PERSON RU, automatically code person at AC240, and go to AC250.

Display ?[you/[PERSON]]? if SINGLE-PERSON RU. Otherwise, display ?anyone in the household?.

BLAISE NAME: AffrdWho
Question Text:

Who was that?
PROBE: Did anyone else need medical care but did not get it because they couldn?t afford it?
ENTER ALL THAT APPLY.

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5

Go to AC250.

Roster 2 - no add/edit/delete
Roster definition:
This item displays RU members roster for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster filter:
No filter; display all.

BLAISE NAME: DelayCareDN
Question Text:

Now please think only about dental care. In the last 12 months [that is, between [MONTH YEAR-1] and today], [have you/has [PERSON]] delayed seeking dental care (including check-ups)/has dental care (including check-ups) been delayed for anyone in the household] because of worry about the cost?

YES 1
NO 2 AC270 (AC1191)
REFUSED RF AC270 (AC1191)
DON'T KNOW DK AC270 (AC1191)

If coded ?1? (YES) and a MULTI-PERSON RU, continue with AC260.
If coded ?1? (YES) and a SINGLE-PERSON RU, automatically code person at AC260, and go to AC270.

For ?MONTH YEAR-1? display the month of the current interview and the current interview year minus 1.
Display ?[have you/Has [PERSON]] delayed seeking dental care (including check-ups)? if SINGLE-PERSON RU. Otherwise, display ?has dental care been delayed (including check-ups) for anyone in the household?.

BLAISE NAME: DelayWhoDN
Question Text:

Who was that?
PROBE: Did anyone else delay seeking dental care (including check-ups) because of worry about the cost?
ENTER ALL THAT APPLY.

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5

Go to AC270.

Roster 2 - no add/edit/delete
Roster definition:
This item displays RU members roster for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster filter:
No filter; display all.

BLAISE NAME: AffrdCareDN
Question Text:

In the last 12 months, was there any time when [[you/[PERSON]]/anyone in the household] needed dental care, but did not get it because [[you/he/she]/they] couldn?t afford it?

YES 1
NO 2 AC290 (AC1193)
REFUSED RF AC290 (AC1193)
DON'T KNOW DK AC290 (AC1193)

If coded ?1? (YES) and a MULTI-PERSON RU, continue with AC280.
If coded ?1? (YES) and a SINGLE-PERSON RU, automatically code person at AC280, and go to AC290.

Display ?[you/[PERSON]]? if SINGLE-PERSON RU. Otherwise, display ?anyone in the household?.

BLAISE NAME: AffrdWhoDN
Question Text:

Who was that?
PROBE: Did anyone else need dental care but did not get it because they couldn?t afford it?
ENTER ALL THAT APPLY.

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5
Programmer Instructions: Go to AC290.
Display Instructions: Roster 2 - no add/edit/delete
Roster definition:
This item displays RU members roster for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster filter:
No filter; display all.

Please think about the last 12 months, that is, between [MONTH YEAR-1] and today. [[Have you/Has [PERSON]] delayed getting prescription medicines/Have prescription medicines been delayed for anyone in the household] because of worry about the cost?

YES 1
NO 2 AC310 (AC1195)
REFUSED RF AC310 (AC1195)
DON'T KNOW DK AC310 (AC1195)

If coded ?1? (YES) and a MULTI-PERSON RU, continue with AC300.
If coded ?1? (YES) and a SINGLE-PERSON RU, automatically code person at AC300, and go to AC310.

For ?MONTH YEAR-1? display the month of the current interview and the current interview year minus 1.
Display ?Have you/Has [PERSON]] delayed getting prescription medicines? if SINGLE-PERSON RU. Otherwise, display ?Have prescription medicines been delayed for anyone in the household?.

BLAISE NAME: DelayWhoPM
Question Text:

Who was that?
PROBE: Did anyone else delay getting prescription medicines because of worry about the cost?
ENTER ALL THAT APPLY.

 [FIRST NAME [MIDDLE NAME] LAST NAME]1 1
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5

Go to AC310.

Roster 2 - no add/edit/delete
Roster definition:
This item displays RU members roster for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster filter:
No filter; display all.

BLAISE NAME: AffrdCarePM
Question Text:

In the last 12 months, was there any time when [[you/[PERSON]]/anyone in the household] needed prescription medicines, but did not get it because [[you/he/she]/they] couldn?t afford it?

YES 1
NO 2 BOX_110 (AC1215)
REFUSED RF BOX_110 (AC1215)
DON'T KNOW DK BOX_110 (AC1215)

If coded ?1? (YES) and a MULTI-PERSON RU, continue with AC320.
If coded ?1? (YES) and a SINGLE-PERSON RU, automatically code person at AC320 and go to BOX_110.

Display ?[you/[PERSON]]? if SINGLE-PERSON RU. Otherwise, display ?anyone in the household?.

BLAISE NAME: AffrdWhoPM
Question Text:

Who was that?
PROBE: Did anyone else need prescription medicines but did not get it because they couldn?t afford it?
ENTER ALL THAT APPLY.

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5

Go to BOX_110.

Roster 2 - no add/edit/delete
Roster definition:
This item displays RU members roster for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster filter:
No filter; display all.

Route Details: Go to next questionnaire section.

01 Box = BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100, BOX_110, BOX_120
02 Loop = LOOP_10
03 End Loop = END_LP10
04 Single Select = AH10, AH40, AH90, AH100, AH110, AH120
05 Single Select with Display Roster = AH70
10 Multiple Select with Fill in Answer Text = AH80
19 Numeric Field = AH20, AH30, AH50, AH60

Context header display instructions: Display Person.FullName, BegRefM, BegRefD, BegRefY, EndRefM, EndRefD, EndRefY.
General Display Instructions for Question Text: For '[PERSON'S START DATE]', display the person level reference period PERSON?S START DATE. Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variables BegRefM, BegRefD, BegRefY.
For '[PERSON?S END DATE]', display the person level reference period PERSON?S END DATE. Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variables EndRefM,EndRefD, EndRefY.

Note: The following section is for:
-all persons and
- for all rounds
This section is part of the larger person level looping that includes the PM, OM, AH, CS, and QS sections.
Continue to BOX_30.

If person is less than or equal to 15 years old (or age category 3), go to BOX_70.
Otherwise, continue with AH10.

BLAISE NAME: MissWork
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

[NUMBER OF DAYS IN HOSPITAL: [NUMBER OF DAYS]]
[NUMBER OF DAYS INSTITUTIONALIZED: [NUMBER OF DAYS]]
[The next questions ask about time/Now think about] when [you/[PERSON]] may have missed a half day or more from work [since [PERSON?S START DATE]/between [PERSON?S START DATE] and [PERSON?S 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.]
[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 [PERSON?S START DATE]/ between [PERSON?S START DATE] and [PERSON?S 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.
HELP: F1

RECORD NUMBER OF DAYS 1 AH20 (AH1030)
NO DAYS MISSED FROM WORK 2 BOX_50 (AH1045)
DOES NOT WORK (OTHER THAN AROUND THE HOUSE) 3 BOX_50 (AH1045)
REFUSED RF BOX_50 (AH1045)
DON'T KNOW DK BOX_50 (AH1045)

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.
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 'The next questions ask about time' if first time through the Additional Healthcare Questions (AH) Section in the current round. Otherwise, display 'Now think about'.
Display 'since [PERSON?S START DATE]' if not round 5. Display 'between [PERSON?S START DATE] and [PERSON?S END DATE]' if round 5.
Display 'In answering . . . or depression.' if first time through the AH section in the current round. 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. Otherwise, use a null display.
Display 'the long-term care facility' if person has at least one institutional care (IC) event that ended in the current round. Otherwise, use a null display.
Display 'and' if person has both a hospital stay (HS) event and an institutional care (IC) event that both ended in the current round. Otherwise, use a null display.

BLAISE NAME: NoWork
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

[NUMBER OF DAYS IN HOSPITAL: [NUMBER OF DAYS]]
[NUMBER OF DAYS INSTITUTIONALIZED: [NUMBER OF DAYS]]
[[The next questions ask about time/Now think about] when [you/[PERSON]] may have missed a half day or more from work [since [PERSON?S START DATE]/between [PERSON?S START DATE] and [PERSON?S 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.]
[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 [PERSON?S START DATE]/ between [PERSON?S START DATE] and [PERSON?S 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
HELP: F1

Responses: 1 BOX_40 (AH1035)
Programmer Instructions: Hard Checks:

RF/DK not allowed. If RF/DK coded here display the following message: ?REFUSED AND DON?T KNOW DISALLOWED. IF NUMBER OF DAYS MISSED FROM WORK IS UNKNOWN, SELECT REFUSED OR DON?T KNOW AT PREVIOUS QUESTION (AH10-MissWork).?
?0? not allowed. If ?0? entered, display the following message: "IF NO DAYS MISSED FROM WORK, SELECT CODE 2 'NO DAYS MISSED FROM WORK' AT PREVIOUS QUESTION (AH10-MissWork).?
1 through number of days in person?s reference period allowed. If number entered number of days in person?s reference period, display the following message: ?NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER IN [PERSON]?S REFERENCE PERIOD.?

Display ?[The next questions ? around the house? and the PROBE in lighter grayed out text and in brackets.
Display AH10 and AH20 on the same form pane.
See AH10 for other display instructions.

If round 3, continue with AH30.
Otherwise (i.e., if not round 3), go to BOX_50.

BLAISE NAME: MissWorkYr
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

NUMBER OF DAYS MISSED WORK: [NUMBER OF DAYS]
Of those days, how many were in [YEAR]?
ENTER NUMBER OF DAYS
Responses: 1 BOX_50 (AH1045)
REFUSED RF BOX_50 (AH1045)
DON'T KNOW DK BOX_50 (AH1045)

Programmer Instructions: Hard Check:

Days missed from work in [YEAR] entered at AH30 must be less than or equal to total days missed from work entered at AH20. If AH30 greater than AH20, display the following message: ?DAYS MISSED IN [YEAR] MUST BE LESS THAN OR EQUAL TO TOTAL NUMBER OF DAYS MISSED FROM WORK.?
Instructions: For 'NUMBER OF DAYS,' display the number entered at AH20.
(For specifications purposes only; CAPI handles automatically): 'YEAR' in question text is first calendar year of panel (FirstPanYear).

 If AH10 is coded '3' (DOES NOT WORK (OTHER THAN AROUND THE HOUSE)), go to BOX_70.
Otherwise, continue with AH40.

BLAISE NAME: MissWorkOth
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

[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 [PERSON?S START DATE] and [PERSON?S 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?
HELP:F1

YES 1 AH50 (AH1055)
NO/DO NOT WORK 2 BOX_70 (AH1070)
REFUSED RF BOX_70 (AH1070)
DON'T KNOW DK BOX_70 (AH1070)
Display Instructions: Display ?Besides the ..., did? if AH10 is coded ?1? (RECORD NUMBER OF DAYS). Otherwise, display ?Did?.
For ?NUMBER OF MISSED WORK DAYS?, display number recorded at AH20.
Display 'between [PERSON?S START DATE] and [PERSON?S END DATE]' if round 5. Otherwise, use a null display.

BLAISE NAME: DaysOth
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

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
HELP: F1

1 BOX_60 (AH1060)
REFUSED RF BOX_70 (AH1070)
DON'T KNOW DK BOX_70 (AH1070)

Programmer Instructions: Hard Checks:

?0? not allowed. If ?0? entered, display the following message: ?IF NO WORK DAYS MISSED, BACK UP AND CORRECT PREVIOUS ANSWER (AH40-MissWorkOth).?
1 through number of days in person?s reference period allowed. If number entered at AH50 number of days in person?s reference period, display the following message: ?NUMBER OF DAYS MUST BE EQUAL TO OR LESS THAN NUMBER IN [PERSON]?S REFERENCE PERIOD.?

Route Details: 

If round 3, continue with AH60.
Otherwise (i.e., if not round 3), go to BOX_70.

BLAISE NAME: DaysOthYr
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:

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

1 BOX_70 (AH1070)
REFUSED RF BOX_70 (AH1070)
DON'T KNOW DK BOX_70 (AH1070)

Programmer Instructions: Hard Check:

Days in missed from work in [YEAR] entered at AH60 must be less than or equal to days missed work due to someone else's health at AH50. If AH60 is greater than AH50, display the following message: ?DAYS MISSED IN [YEAR] MUST BE LESS THAN OR EQUAL TO TOTAL NUMBER OF DAYS MISSED FROM WORK DUE TO SOMEONE ELSE?S HEALTH.?

Display Instructions: 

For ?NUMBER OF DAYS?, display the number entered at AH50.
(For specifications purposes only; CAPI handles automatically): 'YEAR' in question text is first calendar year of panel (FirstPanYear).

If at least one condition on person?s-medical-conditions-roster meets the following conditions:
Condition was ?created? during the current round (RndCreated=current round).
Condition is not a priority condition, that is, condition was not created in the PE section.
If Condition[I].DeleteFlg?Yes and
If the Condition[I]SelectRnd_UT=current round or Condition[I]SelectRnd_PM=current round, or both, then
Continue with AH70.
Otherwise, go to BOX_100.

BLAISE NAME: CondInj
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

Now I'm going to read you a list of some of the health conditions that were reported for [you/[PERSON]] between [PERSON?S START DATE] and [PERSON?S END DATE].
READ CONDITIONS BELOW.
[Medical Condition]1
[Medical Condition]2
[Medical Condition]3
[Medical Condition]4
[Medical Condition]N
[Was this health condition/Were any of these health conditions] due to an accident or injury?
HELP: F1

YES 1
NO 2 BOX_100 (AH1110)
REFUSED RF BOX_100 (AH1110)
DON'T KNOW DK BOX_100 (AH1110)

Programmer Instructions: Roster behavior:

1. Select, add, delete, and edit disallowed.
If coded ?1? (YES) and only 1 condition eligible for display at AH70, auto-code that condition at AH80 and go to BOX_80. If coded ?1? (YES) and more than 1 condition eligible for display at AH70, continue with AH80.

Roster 1- Report
Roster Definition:
This item displays the person's-conditions-roster.
Roster filter:
Display only the conditions for person that meet the following conditions:
Condition was ?created? during the current round (RndCreated=current round).
Condition is not a priority condition, that is, condition was not created in the PE section.
Display 'was this health condition' if only one condition eligible for display at AH70. Otherwise, display 'were any of these health conditions'.

BLAISE NAME: Injury
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

Which of [your/[PERSON]'s] health conditions were due to an accident or injury?

Any other health conditions due to an accident or injury?
ENTER ALL THAT APPLY
HELP: F1

[MEDICAL CONDITION] 1 1 BOX_80 (AH1085)
[MEDICAL CONDITION] 2 2 BOX_80 (AH1085)
[MEDICAL CONDITION] 3 3 BOX_80 (AH1085)
[MEDICAL CONDITION] 4 4 BOX_80 (AH1085)
[MEDICAL CONDITION]N 5 BOX_80 (AH1085)

Programmer Instructions: Roster Behavior:

Multiple select allowed.
Select, add, delete, and edit disallowed.
Display Instructions: Roster 2- no add/edit/delete

Display the person-medical-conditions-roster for selection.

Display conditions that meet the following:
Condition was ?created? during the current round (RndCreated=current round).
Condition is not a priority condition, that is, condition was not created in the PE section.

If person is = or 16 years of age or in age categories 4-9, continue with BOX_90.
Otherwise, go to BOX_100.

If at least one condition selected (or auto-coded) at AH80, continue with LOOP_10.
Otherwise, go to BOX_100.

Route Details: For each element in person?s-medical-conditions-roster, ask AH90 - END_LP10.
Loop definition:

LOOP_10 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:
Condition was selected (or auto-coded) at AH80 in the current round (condition is due to an accident or injury)
Condition was ?created? during the current round (RndCreated=current round).

BLAISE NAME: InjWork
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [CONDITION] [PERS STR-DT] [PERS END-DT]
Question Text:

[You indicated that [you/[PERSON]] [are/is] not working now. Did the [CONDITION] happen while [you/[PERSON]] [were/was] at work on any previous job?/Did the [CONDITION] happen while [you/[PERSON]] [were/was] at work?]

 YES 1 END_LP10 (AH1105)
NO 2 END_LP10 (AH1105)
DOES NOT WORK 3 END_LP10 (AH1105)
REFUSED RF END_LP10 (AH1105)
DON'T KNOW DK END_LP10 (AH1105)

Display Instructions: Display "You indicated that [you/[PERSON]]...previous job?" if AH10 is coded '3' (DOES NOT WORK (OTHER THAN AROUND THE HOUSE)). Otherwise, display ?Did the [CONDITION] happen while [you/[PERSON]] [were/was] at work??
For ?[CONDITION]?, display the name of the medical condition being looped on.

 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_10 and continue with BOX_100.

If rounds 3 or 5, continue with BOX_110.
Otherwise (i.e., if rounds 1, 2, or 4), go to BOX_120.

If person is = or 18 years of age or in age categories 4-9, continue with AH100.
Otherwise, go to BOX_120.

BLAISE NAME: AllTeeth
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

The next few questions ask you to consider [your/[PERSON?s]] health.
[Have/Has] [you/[PERSON]] lost all of [your/his/her] upper and lower natural (permanent) teeth?

YES 1 AH110 (AH1125)
NO 2 AH110 (AH1125)
REFUSED RF AH110 (AH1125)
DON'T KNOW DK AH110 (AH1125)

BLAISE NAME: Exer5Days
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

[Do/Does] [you/[PERSON]] now spend half an hour or more in moderate or vigorous physical activity at least five times a week?
HELP: F1

 YES 1 AH120 (AH1130)
NO 2 AH120 (AH1130)
REFUSED RF AH120 (AH1130)
DON'T KNOW DK AH120 (AH1130)

BLAISE NAME: OFtSmoke
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

[Do/Does] [you/[PERSON]] now smoke cigarettes every day, some days or not at all?

EVERY DAY 1 BOX_120 (AH1135)
SOME DAYS 2 BOX_120 (AH1135)
NOT AT ALL 3 BOX_120 (AH1135)
REFUSED RF BOX_120 (AH1135)
DON'T KNOW DK BOX_120 (AH1135)

End of section. Continue to the next section of the questionnaire.

01 Box equals BOX_00, BOX_10, BOX_20
04 Single Select equals AS20, AS50, AS60, AS80, AS90, AS120
10 Multiple Select with Fill in Answer Text equals AS30, AS100
18 Dollar Items Not Allowing Cents equals AS40, AS70, AS110
Roster 2: AS30, AS100
24 Information Screen equals AS10

The AS section is asked in Round 5 only. If it is Round 1, 2, 3, or 4, continue to the next section.

BLAISE NAME: AssetIntro
Question Text:

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 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 AS20 (AS1010)
Display Instructions:

BLAISE NAME: OwnHome
Question Text:

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 AS30 (AS1015)
NO 2 AS90 (AS1085)
REFUSED RF AS90 (AS1085)
DON'T KNOW DK AS90 (AS1085)

BLAISE NAME: HomeOwner
Question Text:

Who in the family owns this home?
PROBE: Does anyone else in the family own this home?
ENTER ALL THAT APPLY.

(FIRST NAME, [MIDDLE NAME], LAST NAME)1 1 AS40 (AS1020)
(FIRST NAME, [MIDDLE NAME], LAST NAME)2 2 AS40 (AS1020)
(FIRST NAME, [MIDDLE NAME], LAST NAME)3 3 AS40 (AS1020)
(FIRST NAME, [MIDDLE NAME], LAST NAME)4 4 AS40 (AS1020)
(FIRST NAME, [MIDDLE NAME], LAST NAME)N 5 AS40 (AS1020)
PERSON DECEASED 98 AS40 (AS1020)
PERSON NOT IN RU 99 AS40 (AS1020)

Programmer Instructions: Roster Behavior:

1. Multiple select allowed.

Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster Filter:
None. Display all.
Display ?PERSON DECEASED? and ?PERSON NOT IN RU? as the last two entries on the roster.

BLAISE NAME: HomeValue
Question Text:

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?.
ENTER AMOUNT
HELP: F1

1 AS60 (AS1030)
REFUSED RF AS60 (AS1030)
DON'T KNOW DK AS50 (AS1025)

Display a mask of ?$ .00? in Gray to denote that only the number of dollars will be accepted in this field as described in the UI document.

BLAISE NAME: HomeValueRng
Question Text:

AS-1.
Which category on card AS-1 best indicates the current value of this home if sold today?

0 - 10,000 1 AS60 (AS1030)
10,001 - 25,000 2 AS60 (AS1030)
25,001 - 50,000 3 AS60 (AS1030)
50,001 - 100,000 4 AS60 (AS1030)
100,001 - 250,000 5 AS60 (AS1030)
250,001 - 500,000 6 AS60 (AS1030)
500,001 - 1,000,000 7 AS60 (AS1030)
1,000,001 OR MORE 8 AS60 (AS1030)
REFUSED RF AS60 (AS1030)
DON'T KNOW DK AS60 (AS1030)

BLAISE NAME: HomeOwe
Question Text:

Are there any mortgages or other loans outstanding on this home?
HELP: F1

YES 1 AS70 (AS1035)
NO 2 AS90 (AS1085)
REFUSED RF AS90 (AS1085)
DON'T KNOW DK AS90 (AS1085)

BLAISE NAME: AmtHomeOwe
Question Text:

How much is still currently owed on these mortgages or loans?
IF RESPONDENT IS NOT SURE, DO NOT PROBE. SELECT ?DON?T KNOW?.
ENTER AMOUNT
HELP: F1

1 AS90 (AS1085)
REFUSED RF AS90 (AS1085)
DON'T KNOW DK AS80 (AS1040)

Display a mask of ?$ .00? in Gray to denote that only the number of dollars will be accepted in this field as described in the UI document.

BLAISE NAME: AmtHomeOweRng
Question Text:

AS-1.
Which category on card AS-1 best indicates the total current amount owed?

0 - 10,000 1 AS90 (AS1085)
10,001 - 25,000 2 AS90 (AS1085)
25,001 - 50,000 3 AS90 (AS1085)
50,001 - 100,000 4 AS90 (AS1085)
100,001 - 250,000 5 AS90 (AS1085)
250,001 - 500,000 6 AS90 (AS1085)
500,001 - 1,000,000 7 AS90 (AS1085)
1,000,001 OR MORE 8 AS90 (AS1085)
REFUSED RF AS90 (AS1085)
DON'T KNOW DK AS90 (AS1085)

BLAISE NAME: RetirAcct
Question Text:

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)?
HELP: F1

YES 1 AS100 (AS1095)
NO 2 BOX__20 (AS1275)
REFUSED RF BOX__20 (AS1275)
DON'T KNOW DK BOX__20 (AS1275)

BLAISE NAME: WhoRetirAcct
Question Text:

Who in the family has Individual Retirement Accounts (IRAs) or other retirement accounts (such as 401K, 403 (b) or Keogh accounts)?
PROBE: Anyone else?
ENTER ALL THAT APPLY.
HELP: F1

(FIRST NAME, [MIDDLE NAME], LAST NAME)1 1 AS110 (AS1105)
(FIRST NAME, [MIDDLE NAME], LAST NAME)2 2 AS110 (AS1105)
(FIRST NAME, [MIDDLE NAME], LAST NAME)3 3 AS110 (AS1105)
(FIRST NAME, [MIDDLE NAME], LAST NAME)4 4 AS110 (AS1105)
(FIRST NAME, [MIDDLE NAME], LAST NAME)N 5 AS110 (AS1105)
PERSON DECEASED 98 AS110 (AS1105)
PERSON NOT IN RU 99 AS110 (AS1105)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

Display Instructions: Roster 2-no add/edit/delete

Roster definition:
This item displays RU-MEMBERS-ROSTER for selection. Display RU member?s first, middle, and last name (Person.FullName).
Roster filter:
None. Display all.
Display ?PERSON DECEASED? and ?PERSON NOT IN RU? as the last two options on the roster.

BLAISE NAME: RetirAcctValue
Question Text:

Altogether, what is the current value of these retirement accounts?
IF RESPONDENT IS NOT SURE, DO NOT PROBEL. SELECT 'DON'T KNOW'.
ENTER AMOUNT
HELP: F1

1 BOX__20 (AS1275)
REFUSED RF BOX__20 (AS1275)
DON'T KNOW DK AS120 (AS1115)

Display a mask of "$.00" in Gray to denote that only the number of dollars will be accepted in this field as described in the UI document.

BLAISE NAME: RetirAcctValueRng
Question Text:

AS-2.
Which category on card AS-2 best indicates the total current value of these retirement accounts?

0 - 1,000 1
1,001 - 5,000 2
5,001 - 10,000 3
10,001 - 25,000 4
25,001 - 50,000 5
50,001 - 100,000 6
100,001 - 250,000 7
250,001 - 500,000 8
500,001 OR MORE 9
REFUSED RF
DON'T KNOW DK

Go to next questionnaire section.

01 Box equals BOX_10, BOX_20, BOX_30, BOX_40, BOX_50
02 Loop equals LOOP_10, LOOP_20, LOOP_30
03 End Loop equals END_LP10, END_LP20, END_LP30
04 Single Select equals CA10, CA20, CA60, CA90, CA100
05 Single Select with Roster Display equals CA30_01, CA30_02, CA30_03, CA30_04, CA30_05, CA30_06, CA30_07, CA80_01
16 Date Picker equals CA70
20 OS Text Field equals CA30_08
24 Information Screen equals CA40, CA50
Grid 2 equals CA30_01, CA30_02, CA30_03, CA30_04, CA30_05, CA30_06, CA30_07, CA30_08, CA80_01

BLAISE NAME: AnyRec
Question Text:

To answer the next set of questions, you will find it helpful to refer to records about the health care (you/(REFERENCE PERSON)/(your/(REFERENCE PERSON)?s) household) received since (START OF REFERENCE PERIOD). Records that identify the place or person that provided the health care, the dates of health care visits, and any charges for the care will help answer the questions.
Any records you refer to should cover health care (since (START DATE OF REFERENCE PERIOD)/between (START DATE OF REFERENCE PERIOD) and (END DATE OF REFERENCE PERIOD)).
Do you have any records you can use to help answer this next set of questions?

HAS RECORD KEEPING MATERIALS FOR AT LEAST 1 PERSON 1 CA30_01 (CA1015)
DOES NOT HAVE ANY RECORDS 2
WILL NOT USE RECORDS 3

Programmer Instructions: RF/DK disallowed

If Round 2-5 and CA10 is coded ?2? (DOES NOT HAVE ANY RECORDS) or ?3? (WILL NOT USE RECORDS) and CA30 was not asked in the prior round, go to CA40 (Preload.UseRecLRnd equals Empty).
If Round 2-5 and CA10 is coded ?2? (DOES NOT HAVE ANY RECORDS) or ?3? (WILL NOT USE RECORDS) and CA30 was asked in the prior round, go to CA20 (Preload.UseRecLRnd equals Yes).
Otherwise, go to CA40.

If a 1 person RU display ?you/(REFERENCE PERSON)?. Otherwise, display ?(your/(REFERENCE PERSON)?s) household?.
Display ?you? if RU member respondent. Otherwise display ?(REFERENCE PERSON)? substituting the name of the reference person.
Display ?your? if RU member respondent. Otherwise, display ?(REFERENCE PERSON)?s? substituting the name of the reference person.
Display ?since (START DATE OF REFERENCE PERIOD)? if Rounds 1-4, substituting the reference period start date. Otherwise, display ?between (START DATE OF REFERENCE PERIOD) and (END DATE OF REFERENCE PERIOD)? substituting the reference period start and end dates.
For ?START DATE OF REFERENCE PERIOD?, display the RU level reference period start date (typically-but not always Jan 1 if Round 1 or the previous round interview date if Rds 2-5).
For ?END DATE OF REFERENCE PERIOD?, display the RU level reference period end date (typically but not always current round interview date if Rds 1-4 or Dec 31 if Round 5).

BLAISE NAME: LRndRec
Question Text:

During the last interview, we used ((a calendar),) ((provider or insurance statements),) ((patient portal information),) ((payment records),) ((medicine bottles, tubes, containers, or other prescription records),) (CA30_08 text string/OM90 text string) to help answer the next set of questions. Do you have any of these same records or any other records available that cover the health care each person in (your/this) household received (since (START DATE OF REFERENCE PERIOD)/between (START DATE OF REFERENCE PERIOD) and (END DATE OF REFERENCE PERIOD))?

HAS RECORD KEEPING MATERIALS FOR AT LEAST 1 PERSON 1 CA30_01 (CA1015)
DOES NOT HAVE ANY RECORDS 2 CA40 (CA1055)
WILL NOT USE RECORDS 3 CA40 (CA1055)

If proxy respondent, display ?this?, otherwise, ?your".
Display the following text when there was at least 1 YES response for this record type or it was selected at OM80 for at least one RU member in the previous round. If CA30_ 01 was coded ?1? (Calendar with Health Care Entries) or OM80 was coded ?1? for at least one RU member in the previous round, display ?a calendar? (Preload.UseCalndrFlag equals Yes). Otherwise, use a null display.
If CA30_02 was coded ?1? (Provider or Insurance Statements) or OM80 was coded ?2? for at least one RU member in the previous round, display ?provider or insurance statements? (Preload.ProvHinsstmtFlag equals Yes). Otherwise, use a null display.
If CA30_03 was coded ?1? (Patient Portal) or OM80 was coded ?3? for at least one RU member in the nrevious round, display ?patient portal information? (Preload.PtntPortalFlag equals Yes). Otherwise, use a null display.
If CA30_04 was coded ?1? (Payment Records) or OM80 was coded ?4?for at least one RU member in the previous round, display ?payment records? (Preload.PymtRecFlag equals Yes). Otherwise, use a null display.
If CA30_05 was coded ?1? (RX Records/Bottles) or OM80 was coded ?5? for at least one RU member in the previous round, display ?medicine bottles, tubes, containers, or other prescription records' (Preload.RxRecBottleFlag equals Yes). Otherwise, use a null display.
If CA30_07 was coded ?1? (Other record) or OM80 was coded ?7? for at least one RU member in the nrevious round, display ?(CA30_08 text string/OM90 text string)? (Preload.OthRecFlag equals Yes). Display only one, if both had values set in the prior round, CA30_07 supersedes what was entered at OM90 (Use Preload.OthRecOSPrev). Otherwise, use a null display.
Display ?and? before the last record in the question text. Display the ?,? in between multiple records, otherwise, if only one record displayed, do not display the comma.
Display 'and' if only two records are displayed. Do not display the comma.
For ?START DATE OF REFERENCE PERIOD?, display the RU level reference period start date (typically-but not always Jan 1 if Round 1 or the previous round interview date if Rds 2-5).
For ?END DATE OF REFERENCE PERIOD?, display the RU level reference period end date (typically but not always current round interview date if Rds 1-4 or Dec 31 if Round 5).

BLAISE NAME: UseCalndr
Question Text:

(Thanks for keeping these records. Let me review the records with you first.)
Please tell me who the record is for, and the type of record you?re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, or something else.
(Do/Does) (you/(PERSON)) have a calendar with health entries?
NAVIGATION: Complete the grid in order of respondent's answers.

YES, HAS CALENDAR WITH HEALTH CARE ENTRIES FOR (PERSON) 1
NO, DOES NOT HAVE CALENDAR WITH HEALTH CARE ENTRIES FOR (PERSON) 2

Preloaded Grid Type 2: flexible navigation, including CA30_01, CA30_02, CA30_03, CA30_04, CA30_05, CA30_06, CA30_07, and CA30_08
Allow empty.
RF/DK not allowed.
Enable movement on screen so interviewer can enter record types for all persons by row.

Display Instructions: Roster Report 1

Display RU-Members-Roster
Col #1 Header: Records for RU member
Instructions: Display RU members' first, middle, and last names (FULLNAME)
Format response pane in columns with headers: Col#2 Header: CA30_01 Calendar with health care entries, Col# 3 Header: CA30_02 Provider or Insurance Statements, Col# 4 Header: CA30_03 Patient Portal, Col# 5 Header: CA30_04 Payment Records, Col# 6 Header: CA30_05 RX Records/Bottles, Col# 7 Header: CA30_06 PR/MB Follow-Up, Col# 8 Header: CA30_07 Other, Col# 9 Header: CA30_08 Other Specify, Col#10 Header : CA30DONE
Roster filter:
Display all RU members.
Display ?Thanks for keeping these records. Let me review the record with you first.? Only for the first person in the grid. Otherwise, use null display.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.

BLAISE NAME: ProvHinsStmt
Question Text:

[Please tell me who the record is for, and the type of record you?re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]
(Do/Does) (you/(PERSON)) have provider or insurance statements?
NAVIGATION: Complete the grid in order of respondent's answers.

YES, HAS PROVIDER OR INSURANCE STATEMENT(S) FOR (PERSON) 1
NO, DOES NOT HAVE PROVIDER OR INSURANCE STATEMENTS FOR (PERSON) 2

Display ?Please tell me who the record is for...? text in grayed out in lighter text and in brackets.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.

BLAISE NAME: PtntPortal
Question Text:

[Please tell me who the record is for, and the type of record you?re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]
(Do/Does) (you/(PERSON)) have a patient portal?
NAVIGATION: Complete the grid in order of respondent's answers.

YES, HAS PATIENT PORTAL FOR (PERSON) 1
NO, DOES NOT HAVE PATIENT PORTAL FOR (PERSON) 2

Display ?Please tell me who the record is for ...?
text in grayed out in lighter text and in brackets.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.

BLAISE NAME: PymtRec
Question Text:

[Please tell me who the record is for, and the type of record you?re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]
(Do/Does) (you/(PERSON)) have payment records?
NAVIGATION: Complete the grid in order of respondent's answers.

YES, HAS PAYMENT RECORDS FOR (PERSON) 1
NO, DOES NOT HAVE PAYMENT RECORDS FOR (PERSON) 2

Display ?Please tell me who the record is for...? text in grayed out in lighter text and in brackets.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.

BLAISE NAME: RxRecBottle
Question Text:

[Please tell me who the record is for, and the type of record you?re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]
(Do/Does) (you/(PERSON)) have prescription records such as medicine bottles, tubes, or containers?
NAVIGATION: Complete the grid in order of respondent's answers.

YES, HAS PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR (PERSON) 1
NO, DOES NOT HAVE PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR (PERSON) 2

If coded ?1? (YES) for anyone in the RU, go to CA30_06, otherwise, go to CA30_07.

Display ?Please tell me who the record is for...? text in grayed out in lighter text and in brackets.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.

BLAISE NAME: RxRecBottleInfo
Question Text:

Does this prescription record/medicine bottle for (PERSON) contain information for a health care visit that occurred between (START DATE) and (END DATE)?
NAVIGATION: Complete the grid in order of respondent's answers.

YES, PRESCRIPTION RECORD/MEDICINE BOTTLE CONTAINS HEALTH CARE VISIT INFORMATION FOR (PERSON) 1
NO, PRESCRIPTION RECORD/MEDICINE BOTTLE DOES NOT CONTAIN HEALTH CARE VISIT INFORMATION FOR (PERSON) 2

Allow Empty. Display this cell as active only if RU member coded CA30_05 '1' (YES,HAS PRESCRIPTION RECORD/MEDICINE BOTTLES FOR (PERSON) ). Otherwise, display cell as inactive.

For ?START DATE?, display the person level reference period start date.
For ?END DATE?, display the person level reference period end date.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.

BLAISE NAME: OthRec
Question Text:

[Please tell me who the record is for, and the type of record you?re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]
(Do/Does) (you/(PERSON)) have another type of record?
NAVIGATION: Complete the grid in order of respondent's answers.

YES, HAS OTHER RECORD FOR (PERSON) 1
NO, DOES NOT HAVE OTHER RECORD FOR (PERSON) 2

If coded ?1? (YES), go to CA30_08, for each person in the grid, otherwise, go to BOX_10. .
Hard check: at least one cell in grid (CA30_01 through CA30_07) should be coded ?1? (YES, HAS RECORDS).
If not, display error message: AT (CA10 (AnyRec)/CA20 (LRndRec)) YOU INDICATED SOMEONE IN THIS HOUSEHOLD HAD RECORDS, GO BACK TO REVIEW GRID. IF NO ONE IN THIS HOUSEHOLD HAS RECORDS, BACK UP TO (CA10 (AnyRec)/CA20 (LRndRec)) AND CHANGE YOUR ANSWER TO CONTINUE.
Error message should display two options: to return to CA10 (AnyRec)/CA20 (LRndRec) or return to the last question in the grid answered NO. If ?AnyRec? selected, CAPI should go back to CA10 or CA20, whichever was answered.
Display the question that was answered either (CA10/CA20) in display error message and the response options. Go to BOX_10.

Display ?Please tell me who the record is for...? text in grayed out in lighter text and in brackets.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.

BLAISE NAME: OthRecOS
Question Text:

[Please tell me who the record is for, and the type of record you?re looking at, such as a calendar, or a provider or insurance statement, patient portal information, payment records, prescription records such as medicine bottles, tubes, or containers or something else.]
ENTER OTHER RECORD.
NOTE: BE AS SPECIFIC AS POSSIBLE BECAUSE YOU WILL BE REFERRING TO THIS TEXT IN THE NEXT ROUND.
NAVIGATION: Complete the grid in order of respondent's answers.

Responses: 1
Programmer Instructions: RF/DK disallowed.

Display this cell as active only if RU member coded CA30_07 '1' (YES, HAS OTHER RECORD FOR (PERSON)). Otherwise, display cell as inactive.
Hard check: at least one cell in grid (CA30_01 through CA30_07) should be coded ?1? (YES, HAS RECORDS).
If not, display error message: AT (CA10 (AnyRec)/CA20 (LRndRec)) YOU INDICATED SOMEONE IN THIS HOUSEHOLD HAD RECORDS, GO BACK TO REVIEW GRID. IF NO ONE IN THIS HOUSEHOLD HAS RECORDS, BACK UP TO (CA10 (AnyRec)/CA20 (LRndRec)) AND CHANGE YOUR ANSWER TO CONTINUE.
Error message should display two options: to return to CA10 (AnyRec)/CA20 (LRndRec) or return to the last question in the grid answered NO. If ?AnyRec? or ?LRndRec? selected, CAPI should go back to CA10 or CA20, whichever was answered.
Display the question that was answered either (CA10 (AnyRec)/CA20 (LRndRec)) in display error message and the response options.

Display ?Please tell me who the record is for...? text in grayed out in lighter text and in brackets.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' in red text.

BLAISE NAME: GiveCalndr
Question Text:

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 ((PREV RD INTV DT))).
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_10 (CA1060)
Display Instructions: 

Display ?today's date? is 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.
For ?(PREV RD INTV DT)?, display the date of the previous round interview. Typically, but not always, the current round RU reference period start date.

(If rounds 2-5) and (if at least one open HS, IC, or HH event continue with LOOP_10.
Otherwise, go to BOX_30

For each element in the RU-Members-Roster, ask LOOP_20-END_LP10
Loop definition: LOOP_10 cycles on persons who had an open HS, IC, or HH event in the nrevious round. This loop cycles on RU members who meet any of the following conditions (Preload.CaseID, Preload.EvntID, Preload.PersID, Preload.ProvID, Preload.EvntType, Preload.EvntEndDt, Preload.EvntEndM, Preload.EvntEndD, Preload.EvntEndY):
-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).
-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).
-Person had an HH event coded ?1? (YES) during the previous round interview month.
Note: If the respondent is eligible for this loop, CAPI should cycle on the respondent first, followed by eligible RU members in PID order.

For each element in person?s-medical-events-roster, ask BOX_15-END_LP20
Loop definition: Loop_10 closes out HS, IC, or HH event that were ?OPEN? in the previous round. This loop cycles on this person?s events that meet any of the following conditions:
-Event type is HS and event had a discharge date reported in the previous round as code ?95? (STILL IN HOSPITAL).
-Event type is IC and event had a discharge date reported in the previous round as ?95? (STILL IN INSTITUTION).
-Event type is HH and EV70 for the previous round interview month was coded ?1? (YES).

 (If rounds 2-5) and if at least one open HS, or IC event and preload.providerID equals empty for any RU member from the previous round, go to the Provider Roster (PV) section. At the completion of the PV section, continue with CA50.
(If rounds 2-5) and if at least one open HH event and preload.providerID=empty for any RU member from the previous round, go to CA43. Otherwise, continue with CA50.

BLAISE NAME: CA43
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME)
Question Text:

((Before we discuss the health care events for each household member since (PREV RD INTV DT )/Next) I need to update the information for (you/(PERSON)) (who was receiving care at home/when you were receiving care at home) at the time of the last interview on (PREV RD INTV 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.
HELP: F1

 FRIEND/NEIGHBOR 1 CA80_01 (CA1095)
RELATIVE 2 CA80_01 (CA1095)
VOLUNTEER 3 CA80_01 (CA1095)
OTHER - PAID 4 CA46 (CA1073)
VOLUNTEER: MEAL DELIVERY SERVICE 5 END_LP20 (CA1115)

If coded ?1? (FRIEND/NEIGHBOR):
-Add ?FRIEND(S) OR NEIGHBOR(S)? to the RU-medical-providers-roster, person- type- nrovider name column. No address information is necessary.
If coded ?2? (RELATIVE):
-Add ?RELATIVE(S)? to the RU-medical-providers-roster, person-type-provider name column. No address information is necessary.
If coded ?3? (VOLUNTEER):
-Add ?VOLUNTEER(S)? to the RU-medical-providers-roster, person-type-provider name column. No address information is necessary.
If coded ?5? (VOLUNTEERED: MEAL DELIVERY SERVICE), create an event record with HH as the event type and the only attribute for this record is VOLUNTEERED: MEAL DELIVERY SERVICE. No other information is necessary.
If CA43 is coded '1' (FRIEND/NEIGHBOR), '2' (RELATIVE), or '3' (VOLUNTEER), flag nrovider as ?INFORMAL? for PROV.HHTYPE (this will have to be replaced when we know what variable it is being stored as).

Display 'Before we discuss the health care events...? if it?s the first open HH event with preload.providerID equals empty being cycled on.
Otherwise, if it's not the first open HH event with preload.providerID=empty being cycled on, display 'Next'.
Display ?who was receiving care at home? if the person being looped on is not the respondent.
Otherwise, display ?when you were receiving care at home?.

BLAISE NAME: CA46
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME)
Question Text:

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_18 (CA1074)
WORKED FOR SELF 2 BOX_18 (CA1074)
REFUSED RF BOX_18 (CA1074)
DON'T KNOW DK BOX_18 (CA1074)

Ask Provider Roster (PV) section for this event.
If CA46 is coded '1' (WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME), flag nrovider just collected in PV section as ?AGENCY? for PROV.HHTYPE.
If CA46 is coded '2' (WORKED FOR SELF), 'RF' (REFUSED), or 'DK' (DON'T KNOW), flag provider just collected in PV section as ?PAID INDEPENDENT? for PROV.HHTYPE.
(After flagging, continue with BOX_20.)

BLAISE NAME: ContinEvnt
Question Text:

(Before we discuss the health care events for each household member since (PREV RD INTV DT)/Next), I need to update the information for (PERSON) who (was in the hospital/was staying at a residential care facility/was receiving care at home) at the time of the last interview on (PREV RD INTV DT). (Please refer to any of the records that you might have for (you/(PERSON)).)
(I have a few more questions to ask about the (hospital stay/stay at a residential care facility/home health care) recorded for (PERSON) at the time of the last interview on (PREV RD INTV DT) (Please refer to any of the records you have for (you/(PERSON)).)
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_20 (CA1080)
Display Instructions: 

Display instructions for the first paragraph:
First cycle of LOOP_10 and not coming from the PV section display: ?Before we discuss the health care events for each household member since (START DATE)? Otherwise, if it's not the first cycle and not coming from the PV section, display ?Next". Do not display the second paragraph if not coming from the PV section, ?I have a few more questions to ask about the...?
If cycling on open HS event: ?was in the hospital?
If cycling on open IC event: ?was staying at a residential care facility? If cycling on open HH event: ?receiving care at home? If at least one code ?1? (YES, HAS RECORD TYPE) at CA30_01 through CA30_06 for this person, display: ?Please refer to any records that you might have for (you/(PERSON)).
Otherwise, use a null display.
For ?PREV RD INTV DT?, display the date of the previous round interview. Typically, but not always, the current round RU reference period start date if rounds 2-5, and Jan 1 if round 1.
Display instructions for the second paragraph:
Display ?I have a few more questions to ask for...? if coming from the PV section, and do not display the first paragraph ?(Before we discuss the health care events for each household member since...?
If at least one code ?1? (YES, HAS RECORD TYPE) at CA30_01 through CA30_06 for this person, display: ?Please refer to any records that you might have for (you/(PERSON)).? Otherwise, use a null display.
If cycling on open HS event: ?was in the hospital?
If cycling on open IC event: ?was staying at a residential care facility? If cycling on open HH event: ?receiving care at home?

If cycling on an open HS or IC event and the respondent is not the person this event is for, continue with CA60. Otherwise, go to CA70.
If cycling on an open HH event, go to CA80_01.

BLAISE NAME: StillHSIC
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER?.)
Question Text:

Last time, we recorded that (PERSON) entered (PROVIDER) on (DAY OF WEEK, MONTH, DAY, YEAR OF ADMIT DATE). Was (he/she) discharged from (PROVIDER)?

YES 1 CA70 (CA1090)
NO 2 END_LP20 (CA1115)

If coded ?2? (NO), set this event to ?95? (STILL IN HOSPITAL/IC FACILITY).

 Display the admit date for this event for (DAY OF WEEK, MONTH, DAY, YEAR OF ADMIT DATE).

BLAISE NAME: DischDate
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER?.)
Question Text:

On what date (were/was) (you/he/she) discharged from (PROVIDER)?
PRESS ALT AND DOWN ARROW KEY TO SELECT THE DATE FROM THE CALENDAR. PRESS ENTER TO CONTINUE.

1 END_LP20 (CA1115)
REFUSED RF END_LP20 (CA1115)
DON'T KNOW DK END_LP20 (CA1115)

Pressing the ALT- down arrow key will bring up the pop-up calendar, or it can be entered manually.
CAPI should record this date to the event array as the hospital end date for this now closed event.
Hard check:
If open event occurred in round 1, admit date allowed to be 1 year prior to the start of the nerson?s reference period. The discharge date must be after the admit date. If a date outside of this range is entered, display the following message: ?UNLIKELY RESPONSE. DATE MUST BE ON OR AFTER ADMITTANCE DATE AND BEFORE THE PERSON'S REFERENCE PERIOD END DATE. CONFIRM DATES WITH RESPONDENT.?
If open event occurred in rounds 2-4, date entered must be between the person?s reference period begin date (BegRefM, BegRefD, BegRefY) and the person?s reference period end date (EndRefM, EndRefD, EndRefY). If a date outside of this range is entered, display the following message: ?DATE CANNOT BE AFTER PERSON?S REFERENCE PERIOD END DATE OR BEFORE PERSON?S REFERENCE PERIOD BEGIN DATE. VERIFY WITH RESPONDENT AND REENTER.?
NOTE: If the open event was created in round 1, admit date allowed to be 1 year prior to the start of the person?s reference period. The discharge date must be after the admit date. If a date outside of this range is entered, display the following message: ?UNLIKELY RESPONSE. DATE MUST BE ON OR AFTER ADMITTANCE DATE. CONFIRM DATES WITH RESPONDENT.?

Display the empty date field for entry.
Default to display the previous round interview month.

BLAISE NAME: EvpvBegMM
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER?.)
Question Text:

On (PREV ROUND INTV DATE), we recorded that (you/(PERSON)) received care at home from (someone from) (PROVIDER) during some part of (PREV ROUND INTERVIEW MONTH).
Did you continue to receive care at home from (someone from) (PROVIDER) into (MONTH AFTER PREV ROUND INTV MONTH)?
PROBE: How about in (MONTH)?

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Preloaded grid type 1: forced navigation including CA80_01, CA80_02, CA80_03, CA80_04, CA80_N.
The CA80 grid has to accommodate at least 10 months.

Roster 1- Report
Col #1 Header: Month
Instructions: Display months in person?s reference period in the form pane
Roster Filter:
Grid displays all the months of the person?s reference period excluding the previous round interview month.
Display ?someone from? if provider is a facility. Otherwise, use a null display.
Display the months of the person?s reference period excluding the current month, as that was asked about in the last round. For example, for a round 2 interview the person?s reference period is March 5-August 15, CAPI would display months ?APRIL?, ?MAY?, ?JUNE?, ?JULY?, and ?AUGUST?.
RF (REFUSED) and DK (DON?T KNOW) are allowed for CA80_01, CA80_02, CA80_03, CA80_04, CA80_N but will be treated as a ?NO? when creating events.
If current interview month is coded ?1? (YES), display the following message: ?HOME HEALTH UTILIZATION SEC FOR (INT MONTH) WLL NOT BE ASKED UNTIL NEXT ROUND.?
Variable question text display for each of the question in the grid: CA80_02: ??during the month of (MONTH_2)? ? CA80_03: ?How about during the month of (MONTH_3)?? CA80_04: ??during the month of (MONTH_4)?? CA80_N: ? ?during the month of (MONTH_N)?? Repeat question text from CA80_02-CA80_N for months displayed beyond. Display ?on (PREV ROUND INTV DATE)?? in bold black text every fourth month displayed, otherwise, display in lighter grayed out text.
?PREV ROUND INTV DATE?, display the date of the previous round interview. Typically, but not always, the current round RU reference period start date.
For ?PREV ROUND INTERVIEW MONTH?, display the full month name of previous round interview month for this HH event that is being carried forward for this person-provider pair (Preload.EvntEndDt, Preload.EvntEndM).
For ?MONTH AFTER PREV ROUND INTV MONTH?, display the first full month of the person's current reference period to be asked about for this round.

Cycle on next event for this person being looped on that meets the conditions stated in the loop definition.
If no more events meet the stated conditions, end LOOP_20 and continue with END_LP10.

Cycle on next person in RU-Members-Roster that meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_10 and continue with BOX_30.

If coded 1 ?YES, HAS RECORD? for at least one RU member at either CA30_01, CA30_02, CA30_03, CA30_04, or CA30_07 continue with LOOP_30. Otherwise, go to BOX_50.
If CA30_05 is the only item in the CA30 grid that is coded and it is coded ?1? (YES), check to see if CA30_06 is coded ?1? (YES) and continue with LOOP_30, otherwise (if CA30_05 is coded ?1? (YES) and CA30_06 is coded ?2? (NO), go to BOX_50.

For each of the following:
Record 1
Record 2
Record 3
Record 4
Ask BOX_40-END_LP30.
Loop definition: LOOP_30 enumerates events from records. The response to CA90 or CA100 determines if the loop cycles again. If CA90 or CA100 is coded ?1? (YES), the loop cycles to collect the next even from records. When both CA90 and CA100 are coded ?2? (NO), ?RF? (REFUSED), or ?DK? (DON?T KNOW), the loop ends.

Ask the Event Roster (EV) Section for record collection.
At completion of the EV section, continue with CA90.

BLAISE NAME: AnotherEvnt
Question Text:

CODE ?YES? IF THE RECORD YOU ARE LOOKING AT HAS ANOTHER HEALTH CARE EVENT NOT YET ENTERED INTO CAPI. THE HEALTH CARE EVENT CAN BE FOR ANY PERSON.
IF UNSURE, ASK: Is there another health care visit covered in that record?

YES 1 END_LP30 (CA1150)
NO 2 CA100 (CA1145)

Programmer Instructions: RF and DK disallowed.
Display Instructions:

BLAISE NAME: AnotherRec
Question Text:

CODE ?YES? IF YOU HAVE ANOTHER RECORD NOT YET REVIEWED WHICH CONTAINS HEALTH CARE EVENT INFORMATION. THE RECORD CAN BE FOR ANY PERSON.
IF UNSURE, ASK: Do you have another record for any person in the household?

YES 1 END_LP30 (CA1150)
NO 2 END_LP30 (CA1150)

Programmer Instructions: RF and DK disallowed.

Soft Check: If coded ?2? (NO), check that every person who has a record reported at CA30 grid has at least one health care event recorded through the EV section. If at least one person who reported a record at CA30 grid, does not have a health care event recorded through the EV section, display the following message: ?You mentioned earlier that (you/(PERSON 1, )) (PERSON 2, ) (PERSON 3, ) (PERSON 4, ) (PERSON N) had a record to help them report their health care, but you didn?t report any health care events for them yet. TO ADD A HEALTH CARE EVENT, SELECT YES AT THIS QUESTION.?
Display the names of the RU members that have records reported in the CA30 grid, but do not have at least one event recorded for them.

If CA90 or CA100 is coded ?1? (YES), cycle to collect next event from records.
If both CA90 and CA100 are coded ?2? (NO), end LOOP_30 and continue with BOX_50.

Route Details: Go to next questionnaire section, Provider Probes (PP) section.

01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100, BOX_110, BOX_120, BOX_130, BOX_140
02 Loop = LOOP_10
03 End Loop = END_LP10
04 Single Select = CL30, CL60, CL80_01, CL80_06, CL90, CL100, CL120, CL140, CL150, CL160, CL180, CL210, CL220, CL240, CL250, CL270, CL300, CL320
06 Single Select with fill in answer text = CL80_03, CL190
10 Multiple select with fill in answer text = CL280, CL310
11 Multiple Select with Add/Edit/Delete = CL50
12 Address - Newly Collected = CL40_01, CL40_02, CL40_03, CL40_04, CL40_05, CL40_06, CL290_01, CL290_02, CL290_03, CL290_04, CL290_05, CL290_06
13 Address-Preloaded = CL170_03, CL170_04, CL170_05, CL170_06, CL170_07, CL170_08, CL170_09, CL200_03, CL200_04, CL200_05, CL200_06, CL200_07, CL200_08, CL200_09, CL230_01, CL230_02, CL230_03, CL230_04, CL230_05, CL260_01, CL260_02, CL260_03, CL260_04, CL260_05, CL260_06
19 Numeric Field = CL70, CL130, CL330
20 OS Text Field = CL80_02, CL120OS
23 Text Field = CL20, CL80_04, CL80_05, CL80_07, CL110, CL170_01, CL170_02, CL200_01, CL200_02
24 Information Screen = CL10

Place holder for any section description/Context header description? Not sure we really have anything.

BLAISE NAME: ContactIntro
Question Text: 

[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 1 AND ENTER TO CONTINUE.

CONTINUE 1

If Rounds 1-4, continue with CL20.
Otherwise (i.e., if round 5), go to BOX_20.

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.'

BLAISE NAME: BestTimeDay
Question Text: 

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.

 1 BOX_20 (CL1525)

Display the entry field as 45 characters across and 4 lines high. For the 45 characters across, be sure that the custom width allows you to see all 45 characters.
Link the best time recorded with the current respondent PID or proxy ID (selected/added at ST50 or ST60 or confirmed at ST20) for this interviewing session.

 For '[RESPONDENT/PROXY]', display the name of the current round RU member respondent PID or proxy ID (selected/added at ST50 or ST60 or confirmed at ST20) for this interviewing session.

 If there is a preloaded address linked to the proxy ID for this interviewing session, continue with CL30. (Use Preload.ProxyStrt1, Preload. ProxyStrt2, Preload.ProxyCity, Preload.ProxyState, Preload.ProxyZip)
Otherwise, go to CL40_01.

BLAISE NAME: SameProxyAddr
Context Header: PROXY: [PROXY FIRST MIDDLE LAST NAME]
Question Text:

 Is [LINKED PROXY ADDRESS], with telephone number [LINKED PROXY PHONE] still your address and telephone number?

YES 1 BOX_40 (CL1567)
NO, EDIT PROXY ADDRESS 2 CL40_01 (CL1541)
REFUSED RF BOX_40 (CL1567)
DON'T KNOW DK BOX_40 (CL1567)

If coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set the current round proxy address and phone for the proxy ID for this interviewing session to the preloaded proxy address and phone.

For "PROXY FIRST MIDDLE LAST NAME", display the first, middle, and last name of the proxy for this interviewing session.
For "LINKED PROXY ADDRESS", display the preloaded address linked to the proxy ID for this interviewing session. Display as "Street 1 Street 2, City, State Zip". (Use Preload.ProxyStrt1, Preload.ProxyStrt2, Preload.ProxyCity, Preload.ProxyState, Preload.ProxyZip)
For "LINKED PROXY PHONE", display the preloaded phone linked to the proxy ID for this interviewing session. Display as "(xxx)xxx-xxxx". (Use Preload.ProxyPhone)

BLAISE NAME: ProxyStrt1
Context Header: PROXY: [PROXY FIRST MIDDLE LAST NAME]
Question Text:

 [EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED./May I please have your address and telephone number?]
[Is your street address:/What is your street address?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL40_02 (CL1546)
REFUSED RF CL40_02 (CL1546)
DON'T KNOW DK CL40_02 (CL1546)

General programming instructions for CL40_01 to CL40_06: If CL30 is coded '2' (NO, EDIT PROXY ADDRESS), prefill each address field in the response pane entry fields with the proxy address information linked to the proxy ID for this interviewing session and displayed at CL30. Use Preload.ProxyStrt1, Preload.ProxyStrt2, Preload.ProxyCity, Preload.ProxyState, Preload.ProxyZip, and Preload.ProxyPhone.
General programming instructions for CL40_01 to CL40_06: If CL30 was not asked (no address information is linked to the current round proxy ID), leave the response pane entry fields empty for completion.

Display CL40_01 through CL40_06 vertically on the same form pane.
For "PROXY FIRST MIDDLE LAST NAME", display the first, middle, and last name of the proxy for this interviewing session.
Display "EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED." if CL30 is coded '2' (NO, EDIT PROXY ADDRESS). Otherwise, display "May I please have your address and telephone number?"
Display "Is your street address:" if CL30 is coded is coded '2' (NO, EDIT PROXY ADDRESS) and Preload.ProxyStrt1 () empty, RF or DK. Otherwise, display, "What is your street address?"
Display address fields in the info pane with most recent proxy address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS1] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: ProxyStrt2
Context Header: PROXY: [PROXY FIRST MIDDLE LAST NAME]
Question Text: 

[EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED./May I please have your address and telephone number?]
[EDIT/ENTER] APARTMENT OR UNIT NUMBER, IF AVAILABLE. IF NONE, PRESS ENTER TO CONTINUE.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL40_03 (CL1551)
EMPTY Empty CL40_03 (CL1551)
REFUSED RF CL40_03 (CL1551)
DON'T KNOW DK CL40_03 (CL1551)

See general programming instructions at CL40_01.

Display CL40_01 through CL40_06 vertically on the same form pane.
For "PROXY FIRST MIDDLE LAST NAME", display the first, middle, and last name of the proxy for this interviewing session.
Display "EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED." if CL30 is coded '2' (NO, EDIT PROXY ADDRESS). Otherwise, display "May I please have your address and telephone number?"
Display "EDIT PROXY ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL40_02 through CL40_06.
Display "EDIT" if CL30 is coded is coded '2' (NO, EDIT PROXY ADDRESS) and Preload.ProxyStrt2 () emtpy, RF or DK. Otherwise, display, "ENTER".
Display address fields in the info pane with most recent proxy address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS2] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: ProxyCity
Context Header: PROXY: [PROXY FIRST MIDDLE LAST NAME]
Question Text:

 [EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED./May I please have your address and telephone number?]
[Is your city:/What is your city?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL40_04 (CL1556)
REFUSED RF CL40_04 (CL1556)
DON'T KNOW DK CL40_04 (CL1556)

See general programming instructions at CL40_01.

Display CL40_01 through CL40_06 vertically on the same form pane.
For "PROXY FIRST MIDDLE LAST NAME", display the first, middle, and last name of the proxy for this interviewing session.
Display "EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED." if CL30 is coded '2' (NO, EDIT PROXY ADDRESS). Otherwise, display "May I please have your address and telephone number?"
Display "EDIT PROXY ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL40_02 through CL40_06.
Display "Is your city:" if CL30 is coded is coded '2' (NO, EDIT PROXY ADDRESS) and Preload.ProxyCity () emtpy, RF or DK. Otherwise, display, "What is your city?"
Display address fields in the info pane with most recent proxy address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [CITY] in the info pane in bold, black, but all other address display fields in lighter "grayed- out" text.

BLAISE NAME: ProxyState
Context Header: PROXY: [PROXY FIRST MIDDLE LAST NAME]
Question Text:

 [EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED./May I please have your address and telephone number?]
[Is your state:/What is your state?]
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND
PRESS ENTER TO SELECT.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

 1 CL40_05 (CL1561)
REFUSED RF CL40_05 (CL1561)
DON'T KNOW DK CL40_05 (CL1561)

See general programming instructions at CL40_01.
Use the state lookup file.
Note: The entry Foreign Country (FC) is allowed.

Display CL40_01 through CL40_06 vertically on the same form pane.
For "PROXY FIRST MIDDLE LAST NAME", display the first, middle, and last name of the proxy for this interviewing session.
Display "EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED." if CL30 is coded '2' (NO, EDIT PROXY ADDRESS). Otherwise, display "May I please have your address and telephone number?"
Display "EDIT PROXY ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL40_02 through CL40_06.
Display "Is your state:" if CL30 is coded is coded '2' (NO, EDIT PROXY ADDRESS) and Preload.ProxyState () emtpy, RF or DK. Otherwise, display, "What is your state?"
Display address fields in the info pane with most recent proxy address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STATE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: ProxyZip
Context Header: PROXY: [PROXY FIRST MIDDLE LAST NAME]
Question Text:

[EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED./May I please have your address and telephone number?]
[Is your zip code:/What is your zip code?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL40_06 (CL1566)
REFUSED RF CL40_06 (CL1566)
DON'T KNOW DK CL40_06 (CL1566)

See general programming instructions at CL40_01.
Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered or any characters entered that are not numeric, display the following message: "ZIP CODE ENTRY REQUIRES EXACTLY 5 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL ZIP CODE IS NOT KNOWN."

Display CL40_01 through CL40_06 vertically on the same form pane.
For "PROXY FIRST MIDDLE LAST NAME", display the first, middle, and last name of the proxy for this interviewing session.
Display "EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED." if CL30 is coded '2' (NO, EDIT PROXY ADDRESS). Otherwise, display "May I please have your address and telephone number?"
Display "EDIT PROXY ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL40_02 through CL40_06.
Display "Is your zip code:" if CL30 is coded is coded '2' (NO, EDIT PROXY ADDRESS) and Preload.ProxyZip () emtpy, RF or DK. Otherwise, display, "What is your zip code?"
Display address fields in the info pane with most recent proxy address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [ZIP CODE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: ProxyPhone
Context Header: PROXY: [PROXY FIRST MIDDLE LAST NAME]
Question Text: 

[EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED./May I please have your address and telephone number?]
[Is your telephone number:/What is your telephone number?]
IF NO TELEPHONE, ENTER DON'T KNOW.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 BOX_40 (CL1567)
REFUSED RF BOX_40 (CL1567)
DON'T KNOW DK BOX_40 (CL1567)

See general programming instructions at CL40_01.
10-digit entry required; use number input mask (xxx-xxx-xxxx) in response field.
Hard check: Exactly 10 digit numeric entry required. If less than 10 numeric digits entered or any characters entered that are not numeric, display the following message:
"PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."

Display CL40_01 through CL40_06 vertically on the same form pane.
For "PROXY FIRST MIDDLE LAST NAME", display the first, middle, and last name of the proxy for this interviewing session.
Display "EDIT PROXY ADDRESS AND TELEPHONE, AS NEEDED." if CL30 is coded '2' (NO, EDIT PROXY ADDRESS). Otherwise, display "May I please have your address and telephone number?"
Display "EDIT PROXY ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL40_02 through CL40_06.
Display "Is your telephone number:" if CL30 is coded is coded '2' (NO, EDIT PROXY ADDRESS) and Preload.ProxyPhone () emtpy, RF or DK. Otherwise, display, "What is your telephone number?"
Display address fields in the info pane with most recent proxy address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [TELEPHONE NUMBER] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

If no RU member is part of the RU on the current interview date (i.e., all eligible RU members have a PersRndStatus = Deceased, Institutionalized, Living Outside U.S., or Living Military Base), go to CL320.
Otherwise, continue with BOX_50.

If there is at least one preloaded alternate phone linked to this RU in the previous round, continue with CL50.
(Use Preload.AltPhoneNum)
Otherwise, go to CL60.

BLAISE NAME: AltPhoneVerif
[Other than [RE40_07 PHONE] (this household's number), let's/Let's] verify the alternate number[s] I have where [[you/your household]/[REFERENCE PERSON]'s household] can be reached.
PROBE: Is there another alternate phone number where [[you/your household]/[REFERENCE PERSON]'s household] can be reached?
REVIEW THE ALTERNATE PHONES LISTED BELOW. USE CTRL-A TO ADD ANY NEW ALTERNATE PHONE NUMBERS. USE CTRL-E TO EDIT INFORMATION ABOUT AN EXISTING PHONE NUMBER.
ENTER '99-ALTERNATE NUMBERS VERIFIED' WHEN FINISHED WITH VERIFICATION.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

[TYPE-[SPECIFY TEXT] [WHO-SPECIFY TEXT] [NUMBER] [TEXTING OK ] [RULES]1 1
[TYPE-[SPECIFY TEXT] [WHO-SPECIFY TEXT] [NUMBER] [TEXTING OK ] [RULES]2 2
[TYPE-[SPECIFY TEXT] [WHO-SPECIFY TEXT] [NUMBER] [TEXTING OK ] [RULES]3 3
[TYPE-[SPECIFY TEXT] [WHO-SPECIFY TEXT] [NUMBER] [TEXTING OK ] [RULES]4 4
[TYPE-[SPECIFY TEXT] [WHO-SPECIFY TEXT] [NUMBER] [TEXTING OK ] [RULES]N 5
ALTERNATE NUMBERS VERIFIED 99 BOX_60 (CL1615)

Refused and Don't Know not allowed.
Hard check:
Only coded '99' (ALTERNATE NUMBERS VERIFIED) is allowed as a final entry. If a phone number is selected, display the following message: "ENTER '99' (ALTERNATE NUMBERS VERIFIED) WHEN VERIFICATION IS COMPLETE. USE CTRL-A, CTRL-E, AND CTRL-D TO UPDATE ALTERNATE PHONE INFORMATION."
No more than 10 active alternate phone numbers allowed. If CTRL-A is pressed when there are already 10 active alternate phone numbers, display the following message:
"ONLY 10 ALTERNATE PHONE NUMBERS ALLOWED. A NEW NUMBER CANNOT BE ADDED UNLESS ANOTHER NUMBER IS FIRST DELETED."
If CTRL-A is selected, CAPI should go to CL80_01 for the FI to enter 1 new alternate phone number. CAPI will return to CL50 for the FI to finish the verification after the CL80 grid is completed. CTRL-A can be activated to add new numbers until there are 10 active alternate phone numbers.
If CTRL-E is selected, CAPI presents a Manipula pop-up to select the phone number to be edited. Every alternate phone is available for editing. After the phone number is selected for editing, CAPI displays a second Manipula pop-up where all 5 fields of alternate phone information can be edited for the row where CTRL-E was called (Type, Specify Type, Number, Texting, and Rules). See the fields listed at the CL80 grid for the rules of number of characters and entry values for the various fields that can be edited.
If CTRL-D is selected, CAPI presents the standard Manipula pop-ups to delete a phone number. All alternate phone numbers are available for deletion.

Display the roster in non-proportional text.
Roster 1 - Report Roster Definition:
This item displays all alternate phone numbers linked to this RU. Use preloaded data or current round data as available or as updated.
Roster Filter:
None. Display all.
Display underlined column headers as part of the info pane.
Display 's' if more than one alternate number linked to this RU. If exactly one alternate number linked to this household, use a null display.
Display "[you/your household]" if respondent for this interviewing session is an RU member.
Otherwise (respondent is a proxy), display "[REFERENCE PERSON]'s household" (substituting the full name (Person.FullName) of the current round reference person).
Display "you" if single-person RU. Otherwise, display "your household".
Display "Other than [RE40_07 PHONE] (this household's number), let's" if CurrPhone ( ) Empty, RF or DK. Otherwise, display, "Let's".
For "RE40_07 PHONE" display the entry at RE40_07 (CurrPhone) as (xxx)xxx-xxxx.
Upon return to CL50, after CTRL-A has been launched at least once, display the question text "[Other than [RE40_07 PHONE] (this household's number), let's/Let's] verify the alternate number[s] I have where [[you/your household]/[REFERENCE PERSON]'s household] can be reached." in brackets and "grayed out" text. The instruction "PROBE: Is there another alternate phone number where [[you/your household]/[REFERENCE PERSON]'s household] can be reached?" and the two lines of interviewer instructions remain in bold black text.
Display eligible alternate phone numbers formatted into the following roster columns: Column Header
#1: Type (Allow up to 15 characters)
Display "Cell" if 80_01=1. Display "Work/Office" if CL80_01=2. Display "Relative" if CL80_01=3.
Display "Friend" if CL80_01=4. Display "Oth-[SPECIFY]" if CL80_01=91. For "SPECIFY", display the first 11 characters of the entry at CL80_02. Display "Refused" if CL80_01=RF. Display "Don't Know" if CL80_01=DK.
Column Header #2: Who (Allow up to 25 characters)
Display the full name (Person.FullName) from CL80_03 if an RU member was selected. If CL80_03 was coded '98' (SOMEONE OUTSIDE THE RU), display "Out RU-[SPECIFY WHO]".
For "SPECIFY WHO", display the first 18 characters of the entry at CL80_04.
Column Header #3: Number (Allow up to 12 characters)
Display the number entered at CL80_05 as "xxx-xxx-xxxx". Display "Refused" if CL80_05=RF.
Display "Don't Know" if CL80_05=DK.
Column Header #4: Texting (Allow up to 10 characters)
Display "Texting OK" if CL80_06=1. Display "No Texting" if CL80_06=2, RF, DK. Leave empty if CL80_06=empty.
Column Header #5: Rules (Allow up to 40 characters)
Display the first 40 characters of CL80_07 if CL80_07( )empty, RF, or DK. Display "Rules Refused" if CL80_07=RF. Display "Don't Know Rules" if CL80_07=DK. Display "No Rules Entered" if CL80_07=empty.

BLAISE NAME: HaveAltPhone
Question Text: 

[I have recorded [RE40_07 PHONE] as the phone number for the household.] [Do you have/Is there] an alternate phone number where [you [or someone in your household]/[REFERENCE PERSON]'s household] can be reached such as a cell phone, a work number, or the number of a relative or friend [other than yourself]?

YES 1 CL70 (CL1575)
NO 2 BOX_60 (CL1615)
REFUSED RF BOX_60 (CL1615)
DON'T KNOW DK BOX_60 (CL1615)

Display CL60 and CL70 on the same form pane.
Display "I have recorded [RE40_07 PHONE] as the phone number for the household." if CurrPhone( )Empty, RF or DK. Otherwise, use a null display.
For "RE40_07 PHONE" display the entry at RE40_07 (CurrPhone) as (xxx)xxx-xxxx.
Display "Do you have" if respondent for this interviewing session is an RU member. Otherwise (respondent is a proxy), display "Is there".
Display "you [or someone in your household]" if respondent for this interviewing session is an RU member. Otherwise (respondent is a proxy), display "[REFERENCE PERSON]'s household" (substituting the full name (Person.FullName) of the current round reference person).
Display "or someone in your household" if a multi-person RU. Otherwise, use a null display.
Display "other than yourself" if respondent for this interviewing session is a proxy. Otherwise, use a null display.

BLAISE NAME: NumAltPhone
Question Text: 

SPECIFY HOW MANY ALTERNATE PHONE NUMBER(S) DO YOU WISH TO ENTER FOR THIS HOUSEHOLD (LIMIT 10).

1 CL80_01 (CL1580)

Refused and Don't Know disallowed.

Display CL60 and CL70 on the same form pane.

BLAISE NAME: AltPhoneType
Question Text:

Is this a cell or work number or the number of a friend or relative?
NAVIGATION: Complete the grid in order of respondent's answers.

CELL PHONE 1
WORK/OFFICE/PLACE OF BUSINESS 2
RELATIVE 3
FRIEND 4
OTHER 91
REFUSED RF
DON'T KNOW DK

Preloaded Grid Type 2 (Flexible Navigation) including questions CL80_01, CL80_02, CL80_03, CL80_04, CL80_ 05, CL80_06, and CL80_07.

Roster 1 - Report
Roster Definition:
This grid displays one row for each alternate phone number linked to this RU.
Roster Filter:
Display rows on the grid based on one of the following conditions:
If CL60 was coded '1' (YES), the grid will be preloaded with the number of rows based on the entry at CL70. There can be no more than 10 rows. All cells within those rows will be empty and ready for completion.
If CL50 was coded CTRL-A, the grid will be preloaded with all active alternate phone numbers and one blank row for the new number to be added. All cells within the new row will be empty and ready for completion. The rows with the active alternate phone numbers will be prefilled with the most current information available for those active numbers. These rows will all be grayed out and uneditable. Use the current/updated value of AltPhoneType, AltPhoneTypeOS, AltPhoneWho, AltPhoneName, AltPhoneNum, AltPhoneText, AltPhoneInstr for the prefilled display.
Format the form pane in columns with headers:
CL80_01: Type
CL80_02: Specify Type
CL80_03: Who
CL80_04: Specify Who
CL80_05: Number
CL80_06: Texting
CL80_07: Rules
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' In red text.

BLAISE NAME: AltPhoneTypeOS
Question Text:

SPECIFY OTHER LOCATION OF ALTERNATE PHONE NUMBER:
NAVIGATION: Complete the grid in order of respondent's answers.

Display CL80_02 as an active cell if CL80_01 is coded '91' (OTHER). Otherwise, CL80_02 is an inactive cell.
Refused and Don't Know disallowed.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' In red text.

BLAISE NAME: AltPhoneWho
Question Text:

Whose phone is this?
NAVIGATION: Complete the grid in order of respondent's answers.

[FIRST NAME,[MIDDLE NAME], LAST NAME]1 1
[FIRST NAME,[MIDDLE NAME], LAST NAME]2 2
[FIRST NAME,[MIDDLE NAME], LAST NAME]3 3
[FIRST NAME,[MIDDLE NAME], LAST NAME]4 4
[FIRST NAME,[MIDDLE NAME], LAST NAME]N 5
SOMEONE OUTSIDE THE RU 98

Roster Behavior:
1. Single select allowed.
Roster 2- No Add/Edit/Delete
Roster Definition:
This item displays RU-members-roster for selection. Display person's first, middle and last name (Person.FullName).
Roster Filter:
No filter. Display all RU members. Display "SOMEONE OUTSIDE THE RU" as the last entry on the roster.
Refused and Don't Know disallowed.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' In red text.

BLAISE NAME: AltPhoneName
Question Text: 

[Whose phone is this?]
ENTER NAME AND VERIFY SPELLING.
NAVIGATION: Complete the grid in order of respondent's answers.

Display CL80_04 as an active cell if CL80_03 is coded '98' (SOMEONE OUTSIDE THE RU). Otherwise, CL80_04 is an inactive cell.
Refused and Don't Know disallowed.

Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' In red text.

BLAISE NAME: AltPhoneNum
Question Text: 

What is [[NAME FROM CL80_03 OR CL80_04]'s/that] [cell/work] phone number?
NAVIGATION: Complete the grid in order of respondent's answers.

REFUSED RF
DON'T KNOW DK

10-digit entry required; use number input mask (xxx-xxx-xxxx) in response field.
Hard check: Exactly 10 digit numeric entry required. If less than 10 numeric digits entered or any characters entered that are not numeric, display the following message:
"PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."

Display "[NAME FROM CL80_03 OR CL80_04]'s" if [the selection at CL80_03 is an RU member] or [(if the selection at CL80_03 is '98' (SOMEONE OUTSIDE THE RU)) and (CL80_04 ( ) empty)]. Otherwise, display "that".
For "NAME FROM CL80_03 OR CL80_04" display the full name (Person.FullName) from CL80_03 if an RU member was selected. If CL80_03 is coded '98' (SOMEONE OUTSIDE THE RU), display the text entry at CL80_04.
Display "cell" if CL80_01 is coded '1' (CELL PHONE). Display "work" if CL80_01 is coded '2' (WORK/OFFICE/PLACE OF BUSINESS). Otherwise, use a null display.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' In red text.

BLAISE NAME: AltPhoneText
Question Text:

Is it okay to send text messages to [[NAME FROM CL80_03 OR CL80_04]'s/that] cell phone?
NAVIGATION: Complete the grid in order of respondent's answers.

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Display CL80_06 as an active cell if CL80_01 is coded '1' (CELL PHONE). Otherwise, CL80_06 is an inactive cell.

Display "[NAME FROM CL80_03 OR CL80_04]'s" if [the selection at CL80_03 is an RU member] or [(if the selection at CL80_03 is '98' (SOMEONE OUTSIDE THE RU)) and (CL80_04 ( ) empty)]. Otherwise, display "that".
For "NAME FROM CL80_03 OR CL80_04" display the full name (Person.FullName) from CL80_03 if an RU member was selected. If CL80_03 is coded '98' (SOMEONE OUTSIDE THE RU), display the text entry at CL80_04.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' In red text.

BLAISE NAME: AltPhoneInstr
Question Text: 

Are there any [other] special rules for using this number, such as best times to call?"
RECORD ANY SPECIAL INSTRUCTIONS OR RESTRICTIONS FOR CALLING AT THE ALTERNATE TELEPHONE NUMBER.
FOR EXAMPLE, CALL ONLY IN EMERGENCY; DO NOT CALL DURING BUSINESS HOURS; CALL BEFORE 9 PM;
ALWAYS LEAVE MESSAGE/VOICE MAIL, ETC.
NAVIGATION: Complete the grid in order of respondent's answers.

1
REFUSED RF
DON'T KNOW DK

When grid is complete, return to CL50 if CL50 was asked. Otherwise, continue with BOX_60 when grid is complete.
Before leaving the grid, CAPI should verify that all eligible fields per row of the grid have a valid answer entered. If not, display error message "ONE OR MORE QUESTIONS HAVE NOT BEEN ANSWERED. PRESS (OK) TO GO TO THE FIRST UNANSWERED QUESTION: [Question Tag] FOR [ROWn]". CAPI will move to the first unanswered item/field, starting from the top left of the grid and moving to the next unanswered item, left to right by row, until all are complete.

Display "other" if CL80_06( ) empty. If CL80_06=empty, use a null display.
Display the interviewer instruction 'NAVIGATION: Complete the grid in order of respondent's answers.' In red text.

If there is an email address linked to this respondent PID or proxy ID for this interviewing session, continue with CL90. (Use Preload.EmailAddr)
Otherwise, go to CL100.

BLAISE NAME: StillEmail
Question Text:

Is [LINKED EMAIL] still the best email address to contact you to schedule appointments and send MEPS interview reminders?

YES 1 BOX_70 (CL1655)
NO, EDIT EMAIL ADDRESS 2 CL110 (CL1630)
NO, DELETE EMAIL ADDRESS 3 BOX_70 (CL1655)
REFUSED RF BOX_70 (CL1655)
DON'T KNOW DK BOX_70 (CL1655)

If coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set the current round email address for the PID of the current RU member or proxy respondent for this interviewing session to the preloaded email address for the same PID.
If coded '2' (NO, EDIT EMAIL ADDRESS), the email address for the current RU member or proxy respondent for this interviewing session will be updated/set at CL110.
If coded '3' (NO, DELETE EMAIL ADDRESS), delete the email address linked to the current RU member or proxy respondent for this interviewing session. There will be no email address linked to this RU member or proxy for the next round.

For "LINKED EMAIL", display the email address linked to this respondent PID or proxy ID for this interviewing session. (Use Preload.EmailAddr)

BLAISE NAME: UseEmail
Question Text: 

Do you send or receive emails?

YES 1 CL110 (CL1630)
NO 2 BOX_70 (CL1655)
REFUSED RF BOX_70 (CL1655)
DON'T KNOW DK BOX_70 (CL1655)

BLAISE NAME: EmailAddr
Question Text: 

[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.

1 CL120 (CL1635)
REFUSED RF BOX_70 (CL1655)
DON'T KNOW DK BOX_70 (CL1655)

Link the email address recorded with the current respondent PID or proxy ID (selected/added at ST50 or ST60 or confirmed at ST20) for this interviewing session.
Hard Checks:
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 spaces. If entry includes a space, display the following message: "EMAIL ADDRESS CANNOT CONTAIN BLANK SPACES. VERIFY AND RE- ENTER."

Display 'What is your new email address?' if CL90 is coded '2' (NO, EDIT EMAIL ADDRESS).
Otherwise, display 'We'd like to ... your email address?'

BLAISE NAME: EmailType
Question Text:

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 CL130 (CL1645)
WORK 2 CL130 (CL1645)
FAMILY/SHARED 3 CL130 (CL1645)
OTHER TYPE 91 CL120OS (CL1640)
REFUSED RF CL130 (CL1645)
DON'T KNOW DK CL130 (CL1645)

Display CL120 and CL120OS on the same form pane.

BLAISE NAME: EmailTypeOS
Question Text: 

SPECIFY TYPE OF EMAIL ACCOUNT:

1 CL130 (CL1645)

Refused and Don't Know disallowed.

Display CL120 and CL120OS on the same form pane.

BLAISE NAME: OftChkEmail
Question Text: 

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:
Responses: 1 CL140 (CL1650)
REFUSED RF BOX_70 (CL1655)
DON'T KNOW DK BOX_70 (CL1655)

Display CL130 and CL140 on the same form pane.

BLAISE NAME: ChkEmailPeriod
Question Text:

[How often do you check this email account?]
Is that per day, per week, per month, or per year?
PER PERIOD:

PER DAY 1 BOX_70 (CL1655)
PER WEEK 2 BOX_70 (CL1655)
PER MONTH 3 BOX_70 (CL1655)
PER YEAR 4 BOX_70 (CL1655)
REFUSED RF BOX_70 (CL1655)
DON'T KNOW DK BOX_70 (CL1655)

Display CL130 and CL140 on the same form pane.
Display "[How often do you check this email account?]" in grayed-out text.

If rounds 1 through 4, continue with BOX_80.
If round 5, go to BOX_110.

If there is a preloaded contact person linked to this RU in the previous round, continue with CL150. (Use Preload.ContPersPID, Preload.ContPersFName and Preload.ContPersLName).
Otherwise, go to CL160.

BLAISE NAME: StillContact
Question Text: 

Is [CONTACT PERSON] still the person, who does not live here, who will always know how to get in touch with [your household/[REFERENCE PERSON]'s household]?

YES 1 CL170_03 (CL1685)
NO 2 CL160 (CL1670)
REFUSED RF BOX_90 (CL1720)
DON'T KNOW DK BOX_90 (CL1720)

If coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set the current round contact person first and last name to the preloaded contact person first and last name.
If coded 'RF' (REFUSED), or 'DK' (DON'T KNOW), set the current round contact person address, telephone, and relationship to the preloaded contact person address, telephone, and relationship.

For "CONTACT PERSON", display the preloaded first and last name of the contact person for this RU from the previous round. Use Preload.ContPersFName and Preload.ContPersLName.
Display "your household" if respondent for this interviewing session is an RU member. Otherwise (respondent is a proxy), display "[REFERENCE PERSON]'s household" substituting the full name (Person.FullName) of the current round reference person.

BLAISE NAME: HaveContact
Question Text: 

[Do you have/Other than you, is there] a friend or relative who does not live here who will always know how to get in touch with [your household/[REFERENCE PERSON]'s household]?

YES 1 CL170_01 (CL1675)
NO 2 BOX_90 (CL1720)
REFUSED RF BOX_90 (CL1720)
DON'T KNOW DK BOX_90 (CL1720)

Display "Do you have" if respondent for this interviewing session is an RU member. Otherwise (respondent is a proxy), display "Other than you, is there".
Display "your household" if respondent for this interviewing session is an RU member. Otherwise (respondent is a proxy), display "[REFERENCE PERSON]'s household" substituting the full name (Person.FullName) of the current round reference person.

BLAISE NAME: ContPersFName
Question Text: 

What is that person's first name?

1 CL170_02 (CL1680)

Refused and Don't Know disallowed.
If CL150 was coded '1' (YES), CL170_01 is not on path, but the response entry field for CL170_01 should be prefilled with ContPersFName. CL170_01 will be display only and the field should be uneditable.
If CL150 was coded '2' (NO) and CL160 was coded '1' (YES), CL170_01 will be on path, but should display as empty, ready for completion.

Display CL170_01 through CL170_09 vertically on the same form pane.

BLAISE NAME: ContPersLName
Question Text:

What is that person's last name?

1 CL170_03 (CL1685)

Refused and Don't Know disallowed.
If CL150 was coded '1' (YES), CL170_02 is not on path, but the response entry field for CL170_02 should be prefilled with ContPersLName. CL170_02 will be display only and the field should be uneditable.
If CL150 was coded '2' (NO) and CL160 was coded '1' (YES), CL170_02 will be on path, but should display as empty, ready for completion.
When CL160 is coded '1' (YES), set a three-byte contact person identifier (C01, C02, etc.) for the contact person entered at CL170_01 and CL170_02. There can be a maximum of 5 contact persons per RU. (ContPersPID)

Display CL170_01 through CL170_09 vertically on the same form pane.

BLAISE NAME: ContPersStrt1
Question Text: 

[VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE./What is [CONTACT PERSON]'s address and telephone number?]
[Is the street address:/What is the street address?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL170_04 (CL1690)
REFUSED RF CL170_04 (CL1690)
DON'T KNOW DK CL170_04 (CL1690)

General programming instructions for CL170_03 to CL170_08: If CL150 is coded '1' (YES), prefill each available address field in the response pane entry fields with information from the previous round linked to the contact person verified at CL150. Use Preload.ContPersStrt1, Preload.ContPersStrt2, Preload.ContPersCity, Preload.ContPersState, Preload.ContPersZip, and Preload.ContPersPhone.
General programming instructions for CL170_03 to CL170_08: If CL160 is coded '1' (YES), leave the response pane entry fields empty for completion. NOTE: The response pane entry fields should also display empty in instances when CL150 is coded '2' (NO) and CL160 is coded '1' (YES).

Display CL170_01 through CL170_09 vertically on the same form pane.
Display "VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE." if CL150 is coded '1' (YES). Otherwise, display "What is [CONTACT PERSON]'s address and telephone number?"
For "CONTACT PERSON", display the first and last name of the current round contact person (ContPersFName, ContPersLName).
Display "Is the street address:" if CL150 is coded '1' (YES) and Preload.ContPersStrt1 () emtpy, RF or DK. Otherwise, display, "What is the street address?"
Display address fields in the info pane with most recent contact person address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS1] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: ContPersStrt2
Question Text: 

[VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE./What is [CONTACT PERSON]'s address and telephone number?]
[VERIFY/ENTER] APARTMENT OR UNIT NUMBER, IF AVAILABLE. IF NONE, PRESS ENTER TO CONTINUE.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL170_05 (CL1695)
EMPTY Empty CL170_05 (CL1695)
REFUSED RF CL170_05 (CL1695)
DON'T KNOW DK CL170_05 (CL1695)

See general programming instructions at CL170_03.

Display CL170_01 through CL170_09 vertically on the same form pane.
Display "VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE." if CL150 is coded '1' (YES). Otherwise, display "What is [CONTACT PERSON]'s address and telephone number?".
For "CONTACT PERSON", display the first and last name of the current round contact person (ContPersFName, ContPersLName).
Display "VERIFY [CONTACT PERSON]'s?" or "What is [CONTACT PERSON]'s?" in brackets and lighter "grayed-out" text when on CL170_04 through CL170_08.
Display "VERIFY" if CL150 is coded '1' (YES) and Preload.ContPersStrt2 () emtpy, RF or DK.
Otherwise, display, "ENTER"
Display address fields in the info pane with most recent contact person address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS2] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: ContPersCity
Question Text: 

[VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE./What is [CONTACT PERSON]'s address and telephone number?]
[Is the city:/What is the city?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL170_06 (CL1700)
REFUSED RF CL170_06 (CL1700)
DON'T KNOW DK CL170_06 (CL1700)

See general programming instructions at CL170_03.

Display CL170_01 through CL170_09 vertically on the same form pane.
Display "VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE." if CL150 is coded '1' (YES). Otherwise, display "What is [CONTACT PERSON]'s address and telephone number?"
For "CONTACT PERSON", display the first and last name of the current round contact person (ContPersFName, ContPersLName).
Display "VERIFY [CONTACT PERSON]'s?" or "What is [CONTACT PERSON]'s?" in brackets and lighter "grayed-out" text when on CL170_04 through CL170_08.
Display "Is the city:" if CL150 is coded '1' (YES) and Preload.ContPersCity () emtpy, RF or DK.
Otherwise, display, "What is the city?"
Display address fields in the info pane with most recent contact person address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [CITY] in the info pane in bold, black, but all other address display fields in lighter "grayed- out" text.

BLAISE NAME: ContPersState
Question Text: 

[VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE./What is [CONTACT PERSON]'s address and telephone number?]
[Is the state:/What is the state?]
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND
PRESS ENTER TO SELECT.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL170_07 (CL1705)
REFUSED RF CL170_07 (CL1705)
DON'T KNOW DK CL170_07 (CL1705)

See general programming instructions at CL170_03.
Use the state lookup file.
Note: The entry Foreign Country (FC) is allowed.

Display CL170_01 through CL170_09 vertically on the same form pane.
Display "VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE." state:" if CL150 is coded '1' (YES). Otherwise, display "What is [CONTACT PERSON]'s address and telephone number?"
For "CONTACT PERSON", display the first and last name of the current round contact person (ContPersFName, ContPersLName).
Display "VERIFY [CONTACT PERSON]'s?" or "What is [CONTACT PERSON]'s?" in brackets and lighter "grayed-out" text when on CL170_04 through CL170_08.
Display "Is the state:" if CL150 is coded '1' (YES) and Preload.ContPersState () emtpy, RF or DK.
Otherwise, display, "What is the state?"
Display address fields in the info pane with most recent contact person address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STATE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: ContPersZip
Question Text: 

[VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE./What is [CONTACT PERSON]'s address and telephone number?]
[Is the zip code:/What is the zip code?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL170_08 (CL1710)
REFUSED RF CL170_08 (CL1710)
DON'T KNOW DK CL170_08 (CL1710)

See general programming instructions at CL170_03.
Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered or any characters entered that are not numeric, display the following message: "ZIP CODE ENTRY REQUIRES EXACTLY 5 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL ZIP CODE IS NOT KNOWN."

Display CL170_01 through CL170_09 vertically on the same form pane.
Display "VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE." if CL150 is coded '1' (YES). Otherwise, display "What is [CONTACT PERSON]'s address and telephone number?"
For "CONTACT PERSON", display the first and last name of the current round contact person (ContPersFName, ContPersLName).
Display "VERIFY [CONTACT PERSON]'s?" or "What is [CONTACT PERSON]'s?" in brackets and lighter "grayed-out" text when on CL170_04 through CL170_08.
Display "Is the zip code:" if CL150 is coded '1' (YES) and Preload.ContPersZip () emtpy, RF or DK. Otherwise, display, "What is the zip code?"
Display address fields in the info pane with most recent contact person address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [ZIP CODE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: ContPersPhone
Question Text: 

[VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE./What is [CONTACT PERSON]'s address and telephone number?]
[Is the telephone number:/What is the telephone number?]
IF NO TELEPHONE, ENTER DON'T KNOW.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL170_09 (CL1715)
REFUSED RF CL170_09 (CL1715)
DON'T KNOW DK CL170_09 (CL1715)

See general programming instructions at CL170_03.
10-digit entry required; use number input mask (xxx-xxx-xxxx) in response field.
Hard check: Exactly 10 digit numeric entry required. If less than 10 numeric digits entered or any characters entered that are not numeric, display the following message:
"PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."

Display CL170_01 through CL170_09 vertically on the same form pane.
Display "VERIFY [CONTACT PERSON]'s ADDRESS AND TELEPHONE." if CL150 is coded '1' (YES). Otherwise, display "What is [CONTACT PERSON]'s address and telephone number?"
For "CONTACT PERSON", display the first and last name of the current round contact person (ContPersFName, ContPersLName).
Display "VERIFY [CONTACT PERSON]'s?" or "What is [CONTACT PERSON]'s?" in brackets and lighter "grayed-out" text when on CL170_04 through CL170_08.
Display "Is the telephone number:" if CL150 is coded '1' (YES) and Preload.ContPersPhone () emtpy, RF or DK. Otherwise, display, "What is the telephone number?"
Display address fields in the info pane with most recent contact person address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [TELEPHONE NUMBER] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: ContPersRel
Question Text: 

[I have that [CONTACT PERSON] is [your/[REFERENCE PERSON]'s] [RELATIONSHIP]. Is that correct?/What is
[CONTACT PERSON]'s relationship to [you/[REFERENCE PERSON]]?]
[EDIT RELATIONSHIP AS NEEDED. IF RELATIONSHIP IS CORRECT, PRESS ENTER TO CONTINUE WITHOUT MAKING EDITS.]

1 BOX_90 (CL1720)

Refused and Don't Know disallowed.
If CL150 is coded '1' (YES), prefill relationship field in the response pane entry fields with information from the previous round linked to the contact person verified at CL150.
Use Preload.ContPersRel.
If CL160 is coded '1' (YES), leave the response pane entry fields empty for completion.

Display CL170_01 through CL170_09 vertically on the same form pane.
Display "I have that [CONTACT PERSON] is [your/[REFERENCE PERSON]'s] [RELATIONSHIP]. Is that correct?" if CL150 is coded '1' (YES) and Preload. ContPersRel () emtpy, RF or DK. Otherwise, display "What is [CONTACT PERSON]'s relationship to [you/[REFERENCE PERSON]]?"
For "CONTACT PERSON", display the first and last name of the current round contact person (ContPersFName, ContPersLName).
Display "your" or "you" if RU member respondent for current interviewing session is the same as the current round reference person. Otherwise, display "[REFERENCE PERSON]" substituting the full name (Person.FullName) of the current round reference person.
For "RELATIONSHIP", display the preloaded relationship linked to the contact person verified at CL150. Use Preload.ContPersRel.
Display "EDIT RELATIONSHIP AS NEEDED. IF RELATIONSHIP IS CORRECT, PRESS ENTER TO CONTINUE WITHOUT MAKING EDITS." If CL150 is coded '1' (YES). Otherwise, use a null display.

If respondent for this interviewing session is a proxy, go to BOX_110.
If there is no prior round preloaded alternate respondent linked to this RU (Preload.AltRespPID=Empty) or if the prior round preloaded alternate respondent is the same as the current round respondent (Preload.AltRespPID=RespondentPersPID) or if the prior round preloaded alternate respondent was the same as the contact person (Preload.AltRespPID=903), go to CL190.
Otherwise (there is a prior round alternate respondent linked to this RU, but that person is not the same as the current round respondent, Preload.AltRespPID()RespondentPersPID), continue with CL180.

BLAISE NAME: StillAltResp
Question Text:

Is [ALTERNATE RESPONDENT] still the best person to provide information about your household for the next interview if you are not available?

YES 1 BOX_100 (CL1730)
NO 2 CL190 (CL1735)
REFUSED RF BOX_110 (CL1785)
DON'T KNOW DK BOX_110 (CL1785)

If coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set the current round alternate respondent to the preloaded alternate respondent (AltRespPID=Preload.AltRespPID). If the previous round alternate respondent was not a DU member, set the current round alternate respondent first and last name to the preloaded alternate respondent first and last name.
If coded 'RF' (REFUSED), or 'DK' (DON'T KNOW) and if the preloaded alternate respondent was not a DU member, set the current round alternate respondent address, telephone, and relationship to the preloaded alternate respondent address, telephone, and relationship.

For "ALTERNATE RESPONDENT", display the preloaded first, (middle) and last name of the alternate respondent (Preload.AltRespPID) for this RU from the previous round. (This is the first and last name linked to the Preload.AltRespPID, which may be Person.FullName or Preload.AltRespFName and Peload.AltRespLName.)

If the prior round preloaded alternate respondent was an RU or DU member, go to BOX_110 (no address information collected or verified for RU or DU member alternate respondents).
Otherwise, go to CL200_03.

BLAISE NAME: AltResp
Question Text: 

[If you are not available for the next interview, who/Who] would be the best person to provide information about your household for the next interview [(if you are not available)]?
[ENTER '97-ALTERNATE RESPONDENT SAME AS CONTACT PERSON.' IF RESPONDENT NAMES [CONTACT PERSON].]
ENTER '98-SOMEONE NOT LISTED' TO ADD AN ALTERNATE RESPONDENT OUTSIDE OF THE RU.

[FIRST NAME,[MIDDLE NAME], LAST NAME]1 1 BOX_110 (CL1785)
[FIRST NAME,[MIDDLE NAME], LAST NAME]2 2 BOX_110 (CL1785)
[FIRST NAME,[MIDDLE NAME], LAST NAME]3 3 BOX_110 (CL1785)
[FIRST NAME,[MIDDLE NAME], LAST NAME]4 4 BOX_110 (CL1785)
[FIRST NAME,[MIDDLE NAME], LAST NAME]N 5 BOX_110 (CL1785)
[ALTERNATE RESPONDENT SAME AS CONTACT PERSON] 97 BOX_110 (CL1785)
SOMEONE NOT LISTED 98 CL200_01 (CL1740)
NO ALTERNATE RESPONDENT 99 BOX_110 (CL1785)

Roster Behavior:
1. Single select allowed. Roster 2- No Add/Edit/Delete
Roster Definition:
This item displays DU-members-roster for selection.
Roster Filter:
No filter; display all DU members. This can include DU members where PriorRndInelig=YES or EMPTY, but should exclude RU members where RemovedAtRE330=YES. This setting will exclude RU members who were deceased in a prior round as well as any RU members marked as non-key living away, unrelated 1 person RU and incorrectly listed but continues to show persons who could eventually rejoin the RU such as those who are in jail or outside the country.
Refused and Don't Know disallowed.
If a DU member is selected, set the DU member PID to the current round AltRespPID.
If 'ALTERNATE RESPONDENT SAME AS CONTACT PERSON' selected, set the
AltRespPID=903 (ALTERNATE RESPONDENT SAME AS CONTACT PERSON). This will be the display in the Face Sheet so FI knows to look at contact person information for the alternate respondent name.
If 'NO ALTERNATE RESPONDENT' selected, there is no current round alternate respondent.

Display "If you are not available for the next interview, who" if no prior round alternate respondent linked to this RU (Preload.AltRespPID=Empty) or if prior round alternate respondent is the same as the current round respondent (Preload.AltRespPID=RespondentPersPID) or if the prior round alternate respondent was the same as the contact person (Preload.AltRespPID=903). Otherwise, display "Who".
Display "(if you are not available)" if there is a prior round alternate respondent linked to this RU, but that person is not the same as the current round respondent (Preload.AltRespPID() RespondentPersPID). Otherwise, use a null display.
Display "ENTER '97-ALTERNATE RESPONDENT SAME AS CONTACT PERSON.' IF RESPONDENT NAMES [CONTACT PERSON]." if there is a current round contact person for this RU (ContPersPID( ) empty). Otherwise, use a null display.
For "CONTACT PERSON", display the first and last name of the current round contact person for this RU. Use ContPersFName and ContPersRespLName.
Display response option '97' (ALTERNATE RESPONDENT SAME AS CONTACT PERSON) if there is a current round contact person for this RU. Otherwise, use a null display.

BLAISE NAME: AltRespFName
Question Text: 

What is that person's first name?

1 CL200_02 (CL1745)

Refused and Don't Know disallowed.
If CL180 was coded '1' (YES), CL200_01 is not on path, but the response entry field for CL200_01 should be prefilled with AltRespFName. CL200_01 will be display only and the field should be uneditable.
If CL180 was coded '2' (NO) and CL190 was coded '98' (SOMEONE NOT LISTED), CL200_01 will be on path, but should display as empty, ready for completion.

Display CL200_01 through CL200_09 vertically on the same form pane.

BLAISE NAME: AltRespLName
Question Text: 

What is that person's last name?

1 CL200_03 (CL1750)

Refused and Don't Know disallowed.
If CL180 was coded '1' (YES), CL200_02 is not on path, but the response entry field for CL200_02 should be prefilled with AltRespLName. CL200_02 will be display only and the field should be uneditable.
If CL180 was coded '2' (NO) and CL190 was coded '98' (SOMEONE NOT LISTED), CL200_02 will be on path, but should display as empty, ready for completion.
When CL190 is coded '98' (SOMEONE NOT LISTED), set a three-byte alternate respondent identifier (beginning with 904 etc.) for the alternate respondent entered at CL200_01 and CL200_02. There can be a maximum of 5 alternate respondents per RU. (AltRespPID)

Display CL200_01 through CL200_09 vertically on the same form pane.

BLAISE NAME: AltRespStrt1
Question Text: 

[VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE./What is [ALTERNATE RESPONDENT]'s address and telephone number?]
[Is the street address:/What is the street address?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL200_04 (CL1755)
REFUSED RF CL200_04 (CL1755)
DON'T KNOW DK CL200_04 (CL1755)

General programming instructions for CL200_03 to CL200_08: If CL180 is coded '1' (YES), prefill each available address field in the response pane entry fields with information from the previous round linked to the alternate respondent verified at CL180.
Use Preload.AltRespStrt1, Preload.AltRespStrt2, Preload.AltRespCity, Preload.AltRespState, Preload.AltRespZip, and Preload.AltRespPhone.
General programming instructions for CL200_03 to CL200_08: If CL190 is coded '98' (SOMEONE NOT LISTED), leave the response pane entry fields empty for completion.
NOTE: The response pane entry fields should also display empty in instances when CL180 was coded '2' (NO) and CL190 is coded '98' (SOMEONE NOT LISTED).

Display CL200_01 through CL200_09 vertically on the same form pane.
Display "VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE." if CL180 is coded '1' (YES). Otherwise, display "What is [ALTERNATE RESPONDENT]'s address and telephone number?"
For "ALTERNATE RESPONDENT", display the first and last name of the current round alternate respondent (AltRespFName, AltRespLName).
Display "Is the street address:" if CL180 is coded '1' (YES) and Preload.AltRespStrt1 () emtpy, RF or DK. Otherwise, display, "What is the street address?"
Display address fields in the info pane with most recent alternate respondent address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS1] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: AltRespStrt2
Question Text: 

[VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE./What is [ALTERNATE RESPONDENT]'s address and telephone number?]
[VERIFY/ENTER] APARTMENT OR UNIT NUMBER, IF AVAILABLE. IF NONE, PRESS ENTER TO CONTINUE.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL200_05 (CL1760)
EMPTY Empty CL200_05 (CL1760)
REFUSED RF CL200_05 (CL1760)
DON'T KNOW DK CL200_05 (CL1760)

See general programming instructions at CL200_03.

Display CL200_01 through CL200_09 vertically on the same form pane.
Display "VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE." if CL180 is coded '1' (YES). Otherwise, display "What is [ALTERNATE RESPONDENT]'s address and telephone number?"
For "ALTERNATE RESPONDENT", display the first and last name of the current round alternate respondent (AltRespFName, AltRespLName).
Display "VERIFY [ALTERNATE RESPONDENT]'s?" or "What is [ALTERNATE RESPONDENT]'s?" in brackets and lighter "grayed-out" text when on CL200_04 through CL200_08.
Display "VERIFY" if CL180 is coded '1' (YES) and Preload.AltRespStrt2 () emtpy, RF or DK.
Otherwise, display, "ENTER"
Display address fields in the info pane with most recent alternate respondent address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS2] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: AltRespCity
Question Text: 

[VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE./What is [ALTERNATE RESPONDENT]'s address and telephone number?]
[Is the city:/What is the city?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL200_06 (CL1765)
REFUSED RF CL200_06 (CL1765)
DON'T KNOW DK CL200_06 (CL1765)

See general programming instructions at CL200_03.

Display CL200_01 through CL200_09 vertically on the same form pane.
Display "VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE." if CL180 is coded '1' (YES). Otherwise, display "What is [ALTERNATE RESPONDENT]'s address and telephone number?"
For "ALTERNATE RESPONDENT", display the first and last name of the current round alternate respondent (AltRespFName, AltRespLName).
Display "VERIFY [ALTERNATE RESPONDENT]'s?" or "What is [ALTERNATE RESPONDENT]'s?" in brackets and lighter "grayed-out" text when on CL200_04 through CL200_08.
Display "Is the city:" if CL180 is coded '1' (YES) and Preload.AltRespCity () emtpy, RF or DK.
Otherwise, display, "What is the city?"
Display address fields in the info pane with most recent alternate respondent address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [CITY] in the info pane in bold, black, but all other address display fields in lighter "grayed- out" text.

BLAISE NAME: AltRespState
Question Text: 

[VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE./What is [ALTERNATE RESPONDENT]'s address and telephone number?]
[Is the state:/What is the state?]
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND PRESS ENTER TO SELECT.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL200_07 (CL1770)
REFUSED RF CL200_07 (CL1770)
DON'T KNOW DK CL200_07 (CL1770)

See general programming instructions at CL200_03.
Use the state lookup file.
Note: The entry Foreign Country (FC) is allowed.

Display CL200_01 through CL200_09 vertically on the same form pane.
Display "VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE." if CL180 is coded '1' (YES). Otherwise, display "What is [ALTERNATE RESPONDENT]'s address and telephone number?"
For "ALTERNATE RESPONDENT", display the first and last name of the current round alternate respondent (AltRespFName, AltRespLName).
Display "VERIFY [ALTERNATE RESPONDENT]'s?" or "What is [ALTERNATE RESPONDENT]'s?" in brackets and lighter "grayed-out" text when on CL200_04 through CL200_08.
Display "Is the state:" if CL180 is coded '1' (YES) and Preload.AltRespState () emtpy, RF or DK.
Otherwise, display, "What is the state?"
Display address fields in the info pane with most recent alternate respondent address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STATE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: AltRespZip
Question Text: 

[VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE./What is [ALTERNATE RESPONDENT]'s address and telephone number?]
[Is the zip code:/What is the zip code?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL200_08 (CL1775)
REFUSED RF CL200_08 (CL1775)
DON'T KNOW DK CL200_08 (CL1775)

See general programming instructions at CL200_03.
Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered or any characters entered that are not numeric, display the following message: "ZIP CODE ENTRY REQUIRES EXACTLY 5 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL ZIP CODE IS NOT KNOWN."

Display CL200_01 through CL200_09 vertically on the same form pane.
Display "VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE." if CL180 is coded '1' (YES). Otherwise, display "What is [ALTERNATE RESPONDENT]'s address and telephone number?"
For "ALTERNATE RESPONDENT", display the first and last name of the current round alternate respondent (AltRespFName, AltRespLName).
Display "VERIFY [ALTERNATE RESPONDENT]'s?" or "What is [ALTERNATE RESPONDENT]'s?" in brackets and lighter "grayed-out" text when on CL200_04 through CL200_08.
Display "Is the zip code:" if CL180 is coded '1' (YES) and Preload.AltRespZip () emtpy, RF or DK.
Otherwise, display, "What is the zip code?"
Display address fields in the info pane with most recent alternate respondent address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [ZIP CODE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: AltRespPhone
Question Text:

[VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE./What is [ALTERNATE RESPONDENT]'s address and telephone number?]
[Is the telephone number:/What is the telephone number?]
IF NO TELEPHONE, ENTER DON'T KNOW.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL200_09 (CL1780)
REFUSED RF CL200_09 (CL1780)
DON'T KNOW DK CL200_09 (CL1780)

See general programming instructions at CL200_03.
10-digit entry required; use number input mask (xxx-xxx-xxxx) in response field.
Hard check: Exactly 10 digit numeric entry required. If less than 10 numeric digits entered or any characters entered that are not numeric, display the following message:
"PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."

Display CL200_01 through CL200_09 vertically on the same form pane.
Display "VERIFY [ALTERNATE RESPONDENT]'s ADDRESS AND TELEPHONE." if CL180 is coded '1' (YES). Otherwise, display "What is [ALTERNATE RESPONDENT]'s address and telephone number?"
For "ALTERNATE RESPONDENT", display the first and last name of the current round alternate respondent (AltRespFName, AltRespLName).
Display "VERIFY [ALTERNATE RESPONDENT]'s?" or "What is [ALTERNATE RESPONDENT]'s?" in brackets and lighter "grayed-out" text when on CL200_04 through CL200_08.
Display "Is the telephone number:" if CL180 is coded '1' (YES) and Preload.AltRespPhone () emtpy, RF or DK. Otherwise, display, "What is the telephone number?"
Display address fields in the info pane with most recent alternate respondent address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [TELEPHONE NUMBER] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: AltRespRel
Question Text: 

[I have that [ALTERNATE RESPONDENT] is [your/[REFERENCE PERSON]'s] [RELATIONSHIP]. Is that correct?/What is [ALTERNATE RESPONDENT]'s relationship to [you/[REFERENCE PERSON]]?]
[EDIT RELATIONSHIP AS NEEDED. IF RELATIONSHIP IS CORRECT, PRESS ENTER TO CONTINUE WITHOUT MAKING EDITS.]

1 BOX_110 (CL1785)

Refused and Don't Know disallowed.
If CL180 is coded '1' (YES), prefill relationship field in the response pane entry fields with information from the previous round linked to the alternate respondent verified at CL180. Use Preload.AltRespRel.
If CL190 is coded '98' (SOMEONE NOT LISTED), leave the relationship field in the response pane entry fields empty for completion.

Display CL200_01 through CL200_09 vertically on the same form pane.
Display "I have that [ALTERNATE RESPONDENT] is [your/[REFERENCE PERSON]'s]
[RELATIONSHIP]. Is that correct?" if CL180 is coded '1' (YES) and Preload.AltRespRel () empty, RF or DK. Otherwise, display "What is [ALTERNATE RESPONDENT]'s relationship to [you/[REFERENCE PERSON]]?"
For "ALTERNATE RESPONDENT", display the first and last name of the current round alternate respondent (AltRespFName, AltRespLName).
Display "your" or "you" if RU member respondent for current interviewing session is the same as the current round reference person. Otherwise, display "[REFERENCE PERSON]" substituting the full name (Person.FullName) of the current round reference person.
For "RELATIONSHIP", display the preloaded relationship linked to the alternate respondent verified at CL180. Use Preload.AltRespRel.
Display "EDIT RELATIONSHIP AS NEEDED. IF RELATIONSHIP IS CORRECT, PRESS ENTER TO CONTINUE WITHOUT MAKING EDITS." if CL180 is coded '1' (YES). Otherwise, use a null display.

If there is a preloaded mailing address linked to this RU in the previous round, continue with CL210. (Use Preload.MailStrt1, Preload.MailStrt2, Preload.MailCity, Preload.MailState, Preload.MailZip)
Otherwise, go to CL220.

BLAISE NAME: StillMailAddr
Question Text: 

Is [MAILING ADDRESS] still the address where [you receive your/[REFERENCE PERSON]'s household receives] mail that is different from [your/their] home address?

YES 1 BOX_120 (CL1825)
NO, EDIT MAILING ADDRESS 2 CL230_01 (CL1800)
NO, DELETE MAILING ADDRESS 3 BOX_120 (CL1825)
REFUSED RF BOX_120 (CL1825)
DON'T KNOW DK BOX_120 (CL1825)

If coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set the current round mailing address to the preloaded mailing address.
If coded '2' (NO, EDIT MAILING ADDRESS), the mailing address for the current round will be updated/set at CL230.
If coded '3' (NO, DELETE MAILING ADDRESS), leave the fields for mailing address for the current round empty. There will be no mailing address linked to this RU for the current round.

For "MAILING ADDRESS", display the preloaded mailing address linked to this RU in the previous round. Display as "Street 1 Street 2, City, State Zip". (Use Preload.MailStrt1, Preload.MailStrt2, Preload.MailCity, Preload.MailState, Preload.MailZip)
Display "you receive your" and "your" if respondent for this interviewing session is an RU member.
Otherwise (respondent is a proxy), display "[REFERENCE PERSON]'s household receives" (substituting the full name (Person.FullName) of the current round reference person) and "their".

BLAISE NAME: HaveMailAddr
Question Text: 

[Do you/Does [REFERENCE PERSON]'s household] receive [your] mail at an address different from [your/their] home address, such as a P.O. Box?

YES 1 CL230_01 (CL1800)
NO 2 BOX_120 (CL1825)
REFUSED RF BOX_120 (CL1825)
DON'T KNOW DK BOX_120 (CL1825)

Display "Do you" and "your" if respondent for this interviewing session is an RU member. Otherwise (respondent is a proxy), display "Does [REFERENCE PERSON]'s household" (substituting the full name (Person.FullName) of the current round reference person) and "their".
Display "your" if respondent for this interviewing session is an RU member. Otherwise (respondent is a proxy), use a null display.

BLAISE NAME: MailStrt1
Question Text: 

1 CL230_02 (CL1805)
REFUSED RF CL230_02 (CL1805)
DON'T KNOW DK CL230_02 (CL1805)

General programming instructions for CL230_01 to CL230_05: If CL210 is coded '2' (NO, EDIT MAILING ADDRESS), prefill each address field in the response pane entry fields with the mailing address information from the previous round displayed at CL210. Use Preload.MailStrt1, Preload.MailStrt2, Preload.MailCity, Preload.MailState, and Preload.MailZip.
General programming instructions for CL230 to CL230_05: If CL220 is coded '1' (YES), leave the response pane entry fields empty for completion.

Display CL230_01 through CL230_05 vertically on the same form pane.
Display "EDIT MAILING ADDRESS, AS NEEDED." if CL210 is coded '2' (NO, EDIT MAILING ADDRESS). Otherwise, display "May I please have that mailing address?"
Display "Is the street address:" if CL210 is coded '2' (NO, EDIT MAILING ADDRESS) and Preload.MailStrt1 () emtpy, RF or DK. Otherwise, display, "What is the street address?"
Display address fields in the info pane with most recent mailing address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS1] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: MailStrt2
Question Text: 

[EDIT MAILING ADDRESS, AS NEEDED./May I please have that mailing address?]
[EDIT/ENTER] APARTMENT OR UNIT NUMBER, IF AVAILABLE. IF NONE, PRESS ENTER TO CONTINUE.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]

1 CL230_03 (CL1810)
EMPTY Empty CL230_03 (CL1810)
REFUSED RF CL230_03 (CL1810)
DON'T KNOW DK CL230_03 (CL1810)

See general programming instructions at CL230_01.

Display CL230_01 through CL230_05 vertically on the same form pane.
Display "EDIT MAILING ADDRESS, AS NEEDED." if CL210 is coded '2' (NO, EDIT MAILING ADDRESS). Otherwise, display "May I please have that mailing address?"
Display "EDIT MAILING ADDRESS?" or "May I please?" in brackets and lighter "grayed-out" text when on CL230_02 through CL230_05.
Display "EDIT" if CL210 is coded '2' (NO, EDIT MAILING ADDRESS) and Preload.MailStrt2 () emtpy, RF or DK. Otherwise, display, "ENTER".
Display address fields in the info pane with most recent mailing address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS2] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: MailCity
Question Text: 

[EDIT MAILING ADDRESS, AS NEEDED./May I please have that mailing address?]
[Is the city:/What is the city?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]

1 CL230_04 (CL1815)
REFUSED RF CL230_04 (CL1815)
DON'T KNOW DK CL230_04 (CL1815)

See general programming instructions at CL230_01.

Display CL230_01 through CL230_05 vertically on the same form pane.
Display "EDIT MAILING ADDRESS, AS NEEDED." if CL210 is coded '2' (NO, EDIT MAILING ADDRESS). Otherwise, display "May I please have that mailing address?"
Display "EDIT MAILING ADDRESS?" or "May I please?" in brackets and lighter "grayed-out" text when on CL230_02 through CL230_05.
Display "Is the city:" if CL210 is coded '2' (NO, EDIT MAILING ADDRESS) and Preload.MailCity () emtpy, RF or DK. Otherwise, display, "What is the city?"
Display address fields in the info pane with most recent mailing address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [CITY] in the info pane in bold, black, but all other address display fields in lighter "grayed- out" text.

BLAISE NAME: MailState
Question Text: 

[EDIT MAILING ADDRESS, AS NEEDED./May I please have that mailing address?]
[Is the state:/What is the state?]
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND PRESS ENTER TO SELECT.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]

1 CL230_05 (CL1820)
REFUSED RF CL230_05 (CL1820)
DON'T KNOW DK CL230_05 (CL1820)

See general programming instructions at CL230_01.
Use the state lookup file.
Note: The entry Foreign Country (FC) is allowed.

Display CL230_01 through CL230_05 vertically on the same form pane.
Display "EDIT MAILING ADDRESS, AS NEEDED." if CL210 is coded '2' (NO, EDIT MAILING ADDRESS). Otherwise, display "May I please have that mailing address?"
Display "EDIT MAILING ADDRESS?" or "May I please?" in brackets and lighter "grayed-out" text when on CL230_02 through CL230_05.
Display "Is the state:" if CL210 is coded '2' (NO, EDIT MAILING ADDRESS) and Preload.MailState () emtpy, RF or DK. Otherwise, display, "What is the state?"
Display address fields in the info pane with most recent mailing address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STATE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: MailZip
Question Text: 

[EDIT MAILING ADDRESS, AS NEEDED./May I please have that mailing address?]
[Is the zip code:/What is the zip code?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]

1 BOX_120 (CL1825)
REFUSED RF BOX_120 (CL1825)
DON'T KNOW DK BOX_120 (CL1825)

See general programming instructions at CL230_01.
Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered or any characters entered that are not numeric, display the following message: "ZIP CODE ENTRY REQUIRES EXACTLY 5 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL ZIP CODE IS NOT KNOWN."

Display CL230_01 through CL230_05 vertically on the same form pane.
Display "EDIT MAILING ADDRESS, AS NEEDED." if CL210 is coded '2' (NO, EDIT MAILING ADDRESS). Otherwise, display "May I please have that mailing address?"
Display "EDIT MAILING ADDRESS?" or "May I please?" in brackets and lighter "grayed-out" text when on CL230_02 through CL230_05.
Display "Is the zip code:" if CL210 is coded '2' (NO, EDIT MAILING ADDRESS) and Preload.MailZip () emtpy, RF or DK. Otherwise, display, "What is the zip code?"
Display address fields in the info pane with most recent mailing address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [ZIP CODE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

If rounds 1 through 4, continue with BOX_130.
If round 5, go to CL320.

If respondent for this interviewing session is a proxy, go to CL270.
If there is a preloaded second home address linked to this RU in the previous round, continue with CL240. (Use Preload.SecnHomeStrt1, Preload.SecnHomeStrt2, Preload.SecnHomeCity, Preload.SecnHomeState, Preload.SecnHomeZip) Otherwise, go to CL250.

BLAISE NAME: StillSecnHome
Question Text: 

Is [SECOND HOME ADDRESS][, with telephone number [SECOND HOME PHONE]] still a second home where we could contact you if you are not available at your usual address?

YES 1 CL270 (CL1875)
NO, EDIT SECOND HOME ADDRESS 2 CL260_01 (CL1845)
NO, DELETE SECOND HOME ADDRESS 3 CL270 (CL1875)
REFUSED RF CL270 (CL1875)
DON'T KNOW DK CL270 (CL1875)

If coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set the current round second home address and phone to the preloaded second home address and phone.
If coded '2' (NO, EDIT SECOND HOME ADDRESS), the second home address and phone for the current round will be updated/set at CL260.
If coded '3' (NO, DELETE SECOND HOME ADDRESS), leave the fields for second home address and phone for the current round empty. There will be no second home address linked to this RU for the current round.

For "SECOND HOME ADDRESS", display the preloaded second home address linked to this RU in the previous round. Display as "Street 1 Street 2, City, State Zip". (Use Preload.SecnHomeStrt1, Preload.SecnHomeStrt2, Preload.SecnHomeCity, Preload.SecnHomeState, Preload.SecnHomeZip)
Display ", with telephone number [SECOND HOME PHONE]" if there is a valid second hone phone number linked to this RU in the previous round (Preload.SecnHomePhone ( ) empty, RF, or DK).
Otherwise, use a null display.
For "SECOND HOME PHONE", display the preloaded second home address linked to this RU in the previous round. Display as "(xxx)xxx-xxxx". (Use Preload.SecnHomePhone)

BLAISE NAME: HaveSecnHome
Question Text: 

Do you have a second home, such as a vacation home, where we could contact you if you are not available at your usual address?

YES 1 CL260_01 (CL1845)
NO 2 CL270 (CL1875)
REFUSED RF CL270 (CL1875)
DON'T KNOW DK CL270 (CL1875)

BLAISE NAME: SecnHomeStrt1
Question Text: 

[EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED./May I please have the address of that (second) home?]
[Is the street address:/What is the street address?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL260_02 (CL1850)
REFUSED RF CL260_02 (CL1850)
DON'T KNOW DK CL260_02 (CL1850)

General programming instructions for CL260_01 to CL260_06: If CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS), prefill each address field in the response pane entry fields with the second home address information from the previous round displayed at CL240. Use Preload.SecnHomeStrt1, Preload.SecnHomeStrt2, Preload.SecnHomeCity, Preload.SecnHomeState, Preload.SecnHomeZip, and Preload.SecnHomePhone.
General programming instructions for CL260_01 to CL260_06: If CL250 is coded '1' (YES), leave the response pane entry fields empty for completion.

Display CL260_01 through CL260_06 vertically on the same form pane.
Display "EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED." if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS). Otherwise, display "May I please have the address of that (second) home?"
Display "Is the street address:" if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS) and Preload.SecnHomeStrt1 () emtpy, RF or DK. Otherwise, display, "What is the street address?"
Display address fields in the info pane with most recent second home address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS1] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: SecnHomeStrt2
Question Text: 

[EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED./May I please have the address of that (second) home?]
[EDIT/ENTER] APARTMENT OR UNIT NUMBER, IF AVAILABLE. IF NONE, PRESS ENTER TO CONTINUE.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL260_03 (CL1855)
EMPTY Empty CL260_03 (CL1855)
REFUSED RF CL260_03 (CL1855)
DON'T KNOW DK CL260_03 (CL1855)

See general programming instructions at CL260_01.

Display CL260_01 through CL260_06 vertically on the same form pane.
Display "EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED." if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS). Otherwise, display "May I please have the address of that (second) home?"
Display "EDIT SECOND HOME ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL260_02 through CL260_06.
Display "EDIT" if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS) and Preload.SecnHomeStrt2 () emtpy, RF or DK. Otherwise, display, "ENTER".
Display address fields in the info pane with most recent second home address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS2] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: SecnHomeCity
Question Text: 

[EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED./May I please have the address of that (second) home?]
[Is the city:/What is the city?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL260_04 (CL1860)
REFUSED RF CL260_04 (CL1860)
DON'T KNOW DK CL260_04 (CL1860)

See general programming instructions at CL260_01.

Display CL260_01 through CL260_06 vertically on the same form pane.
Display "EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED." if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS). Otherwise, display "May I please have the address of that (second) home?"
Display "EDIT SECOND HOME ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL260_02 through CL260_06.
Display "Is the city:" if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS) and Preload.SecnHomeCity () emtpy, RF or DK. Otherwise, display, "What is the city?"
Display address fields in the info pane with most recent second home address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [CITY] in the info pane in bold, black, but all other address display fields in lighter "grayed- out" text.

BLAISE NAME: SecnHomeState
Question Text: 

[EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED./May I please have the address of that (second) home?]
[Is the state:/What is the state?]
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND PRESS ENTER TO SELECT.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL260_05 (CL1865)
REFUSED RF CL260_05 (CL1865)
DON'T KNOW DK CL260_05 (CL1865)

See general programming instructions at CL260_01.
Use the state lookup file.
Note: The entry Foreign Country (FC) is allowed.

Display CL260_01 through CL260_06 vertically on the same form pane.
Display "EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED." if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS). Otherwise, display "May I please have the address of that (second) home?"
Display "EDIT SECOND HOME ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL260_02 through CL260_06.
Display "Is the state:" if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS) and Preload.SecnHomeState () emtpy, RF or DK. Otherwise, display, "What is the state?"
Display address fields in the info pane with most recent second home address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STATE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: SecnHomeZip
Question Text: 

[EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED./May I please have the address of that (second) home?]
[Is the zip code:/What is the zip code?]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL260_06 (CL1870)
REFUSED RF CL260_06 (CL1870)
DON'T KNOW DK CL260_06 (CL1870)

See general programming instructions at CL260_01.
Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered or any characters entered that are not numeric, display the following message: "ZIP CODE ENTRY REQUIRES EXACTLY 5 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL ZIP CODE IS NOT KNOWN."

Display CL260_01 through CL260_06 vertically on the same form pane.
Display "EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED." if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS). Otherwise, display "May I please have the address of that (second) home?"
Display "EDIT SECOND HOME ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL260_02 through CL260_06.
Display "Is the zip code:" if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS) and Preload.SecnHomeZip () emtpy, RF or DK. Otherwise, display, "What is the zip code?"
Display address fields in the info pane with most recent second home address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [ZIP CODE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: SecnHomePhone
Question Text: 

[EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED./May I please have the address of that (second) home?]
[Is the telephone number:/What is that telephone number?]
IF NO TELEPHONE, ENTER DON'T KNOW.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1 CL270 (CL1875)
REFUSED RF CL270 (CL1875)
DON'T KNOW DK CL270 (CL1875)

See general programming instructions at CL260_01.
10-digit entry required; use number input mask (xxx-xxx-xxxx) in response field.
Hard check: Exactly 10 digit numeric entry required. If less than 10 numeric digits entered or any characters entered that are not numeric, display the following message:
"PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."

Display CL260_01 through CL260_06 vertically on the same form pane.
Display "EDIT SECOND HOME ADDRESS AND TELEPHONE, AS NEEDED." if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS). Otherwise, display "May I please have the address of that (second) home?"
Display "EDIT SECOND HOME ADDRESS?" or "May I please?" in brackets and lighter "grayed- out" text when on CL260_02 through CL260_06.
Display "Is the telephone number:" if CL240 is coded '2' (NO, EDIT SECOND HOME ADDRESS) and Preload.SecnHomePhone () emtpy, RF or DK. Otherwise, display, "What is the telephone number?"
Display address fields in the info pane with most recent second home address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [TELEPHONE NUMBER] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: FutuMvr3Mon
Question Text:

Is anyone in this household planning to move within the next 3 months?

YES 1
NO 2 CL320 (CL1935)
REFUSED RF CL320 (CL1935)
DON'T KNOW DK CL320 (CL1935)

If coded '1' (YES) and a single person RU, automatically code person at CL280 by CAPI and then go to LOOP_10.
If coded '1' (YES) and a multi-person RU, continue with CL280.

BLAISE NAME: WhoFutuMvrRoster
Question Text: 

Who is that?
PROBE: Anyone else?

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 LOOP_10 (CL1885)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 LOOP_10 (CL1885)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 LOOP_10 (CL1885)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 LOOP_10 (CL1885)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 LOOP_10 (CL1885)

Roster Behavior:
1. Multiple Select Allowed.

Roster 2 - no add/edit/delete
Roster definition:
Display the RU-MEMBERS-ROSTER for selection. Display RU member's first, middle, and last names (Person.FullName)
Roster filter:
Display only persons present in the household on the interview date. This excludes all persons with a PersRndStatus = Deceased, Institutionalized, Living Outside U.S., or Living Military Base.

For each element on the RU-MEMBERS-ROSTER, ask CL290_01 - END_LP10.
Loop definition: LOOP_10 collects address information for potential future movers.
This loop cycles on persons on the RU-MEMBERS-ROSTER who meet the following conditions:
Person selected as a future mover (i.e., selected at CL280)
ProcessedFutureMover=Empty for person (i.e., person has not yet been processed through this loop or selected at CL310)

BLAISE NAME: FutuMvrStrt1
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text: 

Please give me the address and telephone number of the place where [you/[PERSON]] [are/is] planning to move.
What is the street address?
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL290_02 (CL1895)
REFUSED RF CL290_02 (CL1895)
DON'T KNOW DK CL290_02 (CL1895)

Display CL290_01 through CL290_06 vertically on the same form pane.
Display address fields in the info pane with most recent future mover address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS1] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: FutuMvrStrt2
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text: 

Please give me the address and telephone number of the place where [you/[PERSON]] [are/is] planning to move.
ENTER APARTMENT OR UNIT NUMBER, IF AVAILABLE. IF NONE, PRESS ENTER TO CONTINUE.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL290_03 (CL1900)
EMPTY Empty CL290_03 (CL1900)
REFUSED RF CL290_03 (CL1900)
DON'T KNOW DK CL290_03 (CL1900)

Display CL290_01 through CL290_06 vertically on the same form pane.
Display "Please give me the address?" in brackets and lighter "grayed-out" text when on CL290_02 through CL290_06.
Display address fields in the info pane with most recent future mover address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STREET ADDRESS2] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: FutuMvrCity
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text: 

Please give me the address and telephone number of the place where [you/[PERSON]] [are/is] planning to move.
What is the city?
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL290_04 (CL1905)
REFUSED RF CL290_04 (CL1905)
DON'T KNOW DK CL290_04 (CL1905)

Display CL290_01 through CL290_06 vertically on the same form pane.
Display "Please give me the address?" in brackets and lighter "grayed-out" text when on CL290_02 through CL290_06.
Display address fields in the info pane with most recent future mover address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [CITY] in the info pane in bold, black, but all other address display fields in lighter "grayed- out" text.

BLAISE NAME: FutuMvrState
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text: 

Please give me the address and telephone number of the place where [you/[PERSON]] [are/is] planning to move.
What is the state?
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND
PRESS ENTER TO SELECT.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL290_05 (CL1910)
REFUSED RF CL290_05 (CL1910)
DON'T KNOW DK CL290_05 (CL1910)

Use the state lookup file.
Note: The entry Foreign Country (FC) is allowed.

Display CL290_01 through CL290_06 vertically on the same form pane.
Display "Please give me the address?" in brackets and lighter "grayed-out" text when on CL290_02 through CL290_06.
Display address fields in the info pane with most recent future mover address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [STATE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: FutuMvrZip
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

Please give me the address and telephone number of the place where [you/[PERSON]] [are/is] planning to move.
What is the zip code?
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE]

1 CL290_06 (CL1915)
REFUSED RF CL290_06 (CL1915)
DON'T KNOW DK CL290_06 (CL1915)

Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered or any characters entered that are not numeric, display the following message: "ZIP CODE ENTRY REQUIRES EXACTLY 5 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL ZIP CODE IS NOT KNOWN."

Display CL290_01 through CL290_06 vertically on the same form pane.
Display "Please give me the address?" in brackets and lighter "grayed-out" text when on CL290_02 through CL290_06.
Display address fields in the info pane with most recent future mover address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [ZIP CODE] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: FutuMvrPhone
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text: 

Please give me the address and telephone number of the place where [you/[PERSON]] [are/is] planning to move.
What is that telephone number?
IF NO TELEPHONE, ENTER DON'T KNOW.
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

1
REFUSED RF
DON'T KNOW DK

Set ProcessedFutureMover=YES for person being looped on.
If all persons eligible to be looped on in LOOP_10 are set to ProcessedFutureMover=YES, go to END_LP10.
Otherwise, (at least one mover not processed), continue with CL300.
10-digit entry required; use number input mask (xxx-xxx-xxxx) in response field.
Hard check: Exactly 10 digit numeric entry required. If less than 10 numeric digits entered or any characters entered that are not numeric, display the following message: "PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."

Display CL290_01 through CL290_06 vertically on the same form pane.
Display "Please give me the address?" in brackets and lighter "grayed-out" text when on CL290_02 through CL290_06.
Display address fields in the info pane with most recent future mover address information. Use a null display if response entry fields are empty. As entries are updated in the current round, the display in the info pane should also be updated.
Display [TELEPHONE NUMBER] in the info pane in bold, black, but all other address display fields in lighter "grayed-out" text.

BLAISE NAME: WithMvr
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text: 

IF KNOWN, CODE WITHOUT ASKING.
[Are/Is] [you/[PERSON]] planning to move with anyone in the family?

YES 1 CL310 (CL1925)
NO 2 END_LP10 (CL1930)
REFUSED RF END_LP10 (CL1930)
DON'T KNOW DK END_LP10 (CL1930)

BLAISE NAME: WhoWithMvr
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text: 

IF KNOWN, CODE WITHOUT ASKING.
Who [are/is] [you/[PERSON]] planning to move with?
ENTER ALL THAT APPLY.

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 END_LP10 (CL1930)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 END_LP10 (CL1930)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 END_LP10 (CL1930)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 END_LP10 (CL1930)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 END_LP10 (CL1930)

Set ProcessedFutureMover=YES for all persons selected at CL310.
Roster behavior:
1. Multiple select allowed.

Roster 2 - No add/edit/delete
Roster definition:
Display persons on the RU-MEMBERS-ROSTER for selection. Display RU member's first, middle, and last names (Person.FullName)
Roster filter:
Display all persons in the RU-MEMBERS-ROSTER who meet the following conditions:
Person selected as a future mover (i.e., selected at CL280) ProcessedFutureMover=Empty for person

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_10 and continue with CL320.

BLAISE NAME: CheckCash
Question Text: 

FILL OUT INTERVIEW CHECK WITH [RESPONDENT'S/PROXY'S] NAME.
[RESPONDENT/PROXY]: [NAME OF CURRENT RESPONDENT/PROXY]
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 CL330 (CL1940)
CASH 2 BOX_140 (CL1945)

Display 'RESPONDENT'S' if current respondent is an RU member. Otherwise, display 'PROXY'S'.
For 'NAME OF CURRENT RESPONDENT/PROXY', display the first middle and last name of the current round RU member respondent PID or proxy ID (selected/added at ST50 or ST60 or confirmed at ST20) for this interviewing session. (Use FName, MName, LName).
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 CERTIFICATE? Panel Survey.' if round 5. If rounds 2 or 3 or 4, use a null display. Display CL320 and CL330 on the same form pane.

BLAISE NAME: CheckNum
Question Text: 

CHECK NUMBER:

1 BOX_140 (CL1945)

Hard check: Exactly 7 digit numeric entry required. If less than 7 numeric digits entered or any characters entered that are not numeric, display the following message: "CHECK NUMBER REQUIRES EXACTLY 7 NUMBERS. VERIFY CHECK NUMBER AND RE-ENTER."

Display CL320 and CL330 on the same form pane.

End interview.

01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100,BOX_110, BOX_120, BOX_130, BOX_140, BOX_150
04 Single Select = CP20, CP40, CP60, CP70, CP100, CP110, CP160, CP170, CP180, CP190, CP210, CP240
06 Single Select with Fill in Answer Text = CP10, CP80, CP120, CP130, CP140
11 Multiple Select with Add/Edit/Delete = CP220
18 Dollar Items Not Allowing Cents = CP30, CP150, CP200, CP230
23 Text Field = CP90
24 Information Screen = CP50
Grid 2 = CP230

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
Display [NAME OF MEDICAL CARE PROVIDER] in the context header if the event type is not 'OM' (Other Medical Expenses). Otherwise, use null value.
Display [EVN-DT] in the context header if event type is not 'OM' (Other Medical Expenses).
Display [REF-DT] in the context header if event type is 'OM' (Other Medical Expenses).
Display 'repeat visit: [NAME OF REPEAT VISIT GROUP]' in the context header if this event is a repeat visit stem.
For '[REF- DT]', displayed in the context header, display the start date of the current round.
Display [OME ITEM GROUP NAME] in the context header if the event type is OM.
For [OME ITEM GROUP NAME] display the name of the other medical expenses item group being asked about for this event.
Display 'Glasses or Contact Lenses' if this is an OM event for 'GLASSES OR CONTACT LENSES' (EE40='1' YES, EE50='1' YES, or OM10 = '1' YES).
Display 'Ambulance Services' if this is an OM event for 'AMBULANCE SERVICES' (OM30='1' YES).
Display 'Disposable Supplies' if this is an OM event for 'DISPOSABLE SUPPLIES' (OM40='1' YES).
Display 'Long-term Medical Equipment' if this is an OM event for 'LONG-TERM MEDICAL EQUIPMENT' (OM50='1' YES).

Throughout the Charge/Payment (CP) section, entry of all dollar amounts will include only whole dollars. Entry of cents will be disallowed.
Some items (CP220) in this section allow the addition of a source of payment for the RU. When the interviewer presses CTRL-A, CAPI displays a pop-up with a blank entry field and a selectable pick list of some common sources as follows:
What is the source of payment?
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'
- Other Source not listed
- When 'Other Source not listed' is selected, CAPI should display a text box for entry
Display '/STATE NAME FOR MEDICAID' (substituting the real state name for program) if the state in which interview being conducted does not use the name 'Medicaid'. Otherwise, use a null display. For the specific name to use by state, see the plan fill file.
Display 'STATE NAME FOR CHIP' under all conditions (substituting the real state name for program). For the specific name to use by state, see the plan fill file.
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. If a source already listed in the roster is added at the pick list pop-up for a second time, CAPI should display the following error message: "SOURCE ALREADY ADDED. VERIFY. IF SAME SOURCE, CANCEL POP-UP AND SELECT SOURCE AT MAIN QUESTION."
If event type is HH and HH provider associated with the event being asked about is coded 'AGENCY' (EV60 = 1'WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME), 'INFORMAL' (EV50=1 'FRIEND/NEIGHBOR', 2 'RELATIVE', 3 'VOLUNTEER') or 'VOLUNTEERED: MEAL DELIVERY SERVICE' (EV50=5 VOLUNTEERED MEAL DELIVERY SERVICE) go to BOX_150.

If event type is ER, OP, MV, or DN, and is first time through charge payment for this person-provider pair and pair was flagged as 'COPAYMENT SITUATION' during the previous round (Provdier.PersonProvider (CoPaySituation)) (OM events can't be flagged as a copayment situation), continue with BOX_40.
Otherwise, go to CP50.
NOTE: Copayment data at a person-provider level needs to come forward from the previous round (Provdier.PersonProvider (CoPaySituation)).

If copay amount from previous round is greater than $0, go to CP10 (Provider.Person[I].CPayAmt).
If copay amount from previous round is equal to $0, go to CP40 (Provider.Person[I].CPayAmt).

BLAISE NAME: CPaySameLRnd
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

My records indicate that at the last interview, [you/[PERSON]] (or someone in the family) usually pay[s] a [$ AMT COPAY] copayment to [PROVIDER]. Is this still correct?
HELP: F1

YES, STILL PAY [$ AMT COPAY] 1 CP50 (CP1065)
NO 2 CP20 (CP1056)
REFUSED RF CP50 (CP1065)
DON'T KNOW DK CP50 (CP1065)

If coded '1' (YES, STILL PAY [$ AMT COPAY]), 'RF' (REFUSED), OR 'DK' (DON'T KNOW), flag this person-provider as 'copayment situation' for the current round and set copayment amount from the previous round (Provider.PersonProvider[I].CpayAmt) as this person-provider pair's copayment amount for the current round.

For '$ AMT COPAY' in the question text and response option '1' (YES, STILL PAY [$ AMT COPAY]), display the CP200 amount flagged as 'copayment situation' during the previous round (Provider.PersonProvider[I].CpayAmt) for this person-provider pair.

BLAISE NAME: CPayChng
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

Has your copayment amount changed, or do you no longer have a copayment?
HELP: F1

PAY A DIFFERENT COPAYMENT AMOUNT 1 CP30 (CP1060)
NOT A COPAYMENT SITUATION ANYMORE 2 CP50 (CP1065)
REFUSED RF CP50 (CP1065)
DON'T KNOW DK CP50 (CP1065)

If coded 2 'NOT A COPAYMENT SITUATION ANYMORE', DK 'DON'T KNOW', or RF 'REFUSED', do not flag this person-provider as 'copayment situation' for the current round.

BLAISE NAME: CPayAmt
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

What is the correct copayment amount?
ENTER AMOUNT
HELP: F1

1 CP50 (CP1065)
REFUSED RF CP50 (CP1065)
DON'T KNOW DK CP50 (CP1065)

Programmer Instructions: 

If amount entered, flag this person-provider as 'copayment situation' for the current round. Set dollar amount entered at CP30 as the new copayment amount for this person- provider pair for the current round.
If coded 'RF' (REFUSED), or 'DK' (DON'T KNOW), flag this person-provider pair as 'copayment situation' for the current round and set copayment amount from previous round (Provider.PersonProvider[I].CPayAmt) as copayment amount for the current round.
Soft check:
If amount entered is greater than or = $75, display the following message: "ENTER A DOLLAR AMOUNT LESS THAN OR = $75, RF, OR DK."

BLAISE NAME: ProvNoPay
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

My records indicate that at the last interview, [you/[PERSON]] (or someone in the family) do not usually have to make any payments for visits to [PROVIDER]. Is this still correct?
HELP: F1

YES 1 CP50 (CP1065)
NO 2 CP50 (CP1065)
REFUSED RF CP50 (CP1065)
DON'T KNOW DK CP50 (CP1065)

If coded '1' (YES), DK 'DON'T KNOW', or RF 'REFUSED', flag this person-provider pair as 'copayment situation' for the current round and set copayment amount from the previous round (Provider.PersonProvider[I].CPayAmt) as the person's copayment amount for the current round ($0).
If coded '2' (NO), do not flag this person-provider as 'copayment situation' for the current round.

BLAISE NAME: CPayIntro
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

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 [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 1 AND ENTER TO CONTINUE.
HELP: F1

Responses: CONTINUE 1

If event type is ER, OP, MV, or DN and person-provider pair is flagged as 'COPAYMENT SITUATION' for the current round, go to CP60.
Otherwise, go to CP70.

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 '[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 this is an event for 'GLASSES OR CONTACT LENSES' (EE40='1' YES, EE50='1' YES, or OM10='1' YES).
Display 'ambulance services' if This is an OM event for 'AMBULANCE SERVICES' (OM30='1' YES)
Display 'disposable supplies' if this is an OM event for 'DISPOSABLE SUPPLIES' (OM40='1' YES)
Display 'long-term medical equipment' if this is an OM event for 'LONG-TERM MEDICAL EQUIPMENT' (OM50='1' YES).

BLAISE NAME: CPayOnlyAmt
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVNDT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

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?
HELP: F1

YES 1 BOX_130 (CP1485)
NO 2 CP70 (CP1080)
REFUSED RF CP70 (CP1080)
DON'T KNOW DK CP70 (CP1080)

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), 'RF' (REFUSED), or 'DK' (DON'T KNOW), do NOT copy the copayment charge payment data for this person-provider pair to this event-provider pair.
Full charge payment data for this event-provider pair will be collected. The copayment flag remains unchanged for this person-provider pair, however, it is not applied to this particular event.
Display Instructions: Display 'only paid the [$ AMT COPAY] copayment' if this person-provider pair's copayment amount for the current round does not equal zero ($0).
For '$ AMT COPAY': Display the current copayment amount for this person-provider pair for this round (confirmed at CP10, updated at CP30, or amount entered at CP200 and set as current copayment amount per BOX_140).
Display 'paid nothing' if this person-provider pair's copayment amount for the current round equals zero ($0).

BLAISE NAME: EvpvRcvBill
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REFDT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

[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 [OME ITEM GROUP NAME]/the services received at home]?

YES, AND DOCUMENTATION AVAILABLE 1 BOX_50 (CP1096)
YES, BUT DOCUMENTATION NOT AVAILABLE 2 BOX_50 (CP1096)
NO 3 CP80 (CP1085)
REFUSED RF CP80 (CP1085)
DON'T KNOW DK CP80 (CP1085)

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 this is an OM event for 'GLASSES OR CONTACT LENSES'(EE40='1' YES, EE50='1' YES, or OM10= '1' YES) .
Display 'ambulance services' if this is an OM event for 'AMBULANCE SERVICES' (OM30= '1' YES) .
Display 'disposable supplies' if this is an OM event for 'DISPOSABLE SUPPLIES' (OM40= '1' YES).
Display 'long-term medical equipment' if this is an OM event for 'LONG-TERM MEDICAL EQUIPMENT' (OM50= '1' YES).

BLAISE NAME: EvpvYNoBill
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [OME ITEM GROUP NAME] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

AND CP-1.
Please look at 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.]
HELP: F1

PAID AT TIME OF VISIT 1 BOX_50 (CP1096)
MADE A COPAYMENT 2 BOX_50 (CP1096)
BILL SENT DIRECTLY TO OTHER SOURCE 3 CP90 (CP1090)
BILL HAS NOT ARRIVED 4 BOX_50 (CP1096)
NO BILL SENT: HMO PLAN 5 BOX_50 (CP1096)
NO BILL SENT: VA (VETERANS ADMINISTRATION)/CHAMPVA 6 BOX_50 (CP1096)
NO BILL SENT: MILITARY FACILITY 7 BOX_50 (CP1096)
NO BILL SENT: PUBLIC ASSISTANCE/MEDICAID/SCHIP 8 BOX_50 (CP1096)
NO BILL SENT: INDIAN HEALTH SERVICE (IHS) 9 BOX_50 (CP1096)
NO BILL SENT: WORKER'S COMPENSATION 10 BOX_50 (CP1096)
NO BILL SENT: PRIVATE HEALTH CENTER/CLINIC 11 BOX_50 (CP1096)
NO BILL SENT: PUBLIC CLINIC/HEALTH CENTER OR PRIVATE CHARITY 12 BOX_50 (CP1096)
NO CHARGE: TELEPHONE CALL 13 BOX_130 (CP1485)
FREE FROM PROVIDER 14 BOX_130 (CP1485)
GOVERNMENT-FINANCED RESEARCH AND CLINICAL TRIALS 15 BOX_130 (CP1485)
[INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)] 95
REFUSED RF BOX_50 (CP1096)
DON'T KNOW DK BOX_50 (CP1096)

If 'INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)' is selected, and event- provider pair does not represent a repeat visit group or this is not an OM event, ask the Flat Fee (FF) section immediately. Charge Payment information in the context of the single event is no longer needed.

Display the interviewer instruction "SELECT 'INCLUDED WITH OTHER CHARGES' IF THIS IS A FLAT FEE SITUATION." if event-provider pair does not represent repeat visit stem or this is not an OM event. Otherwise, use a null display.
Display response option 95 ''INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)' if event provider pair does not represent a repeat visit stem or this is not an OM event. Otherwise, use a null display.

BLAISE NAME: EvpvWhereBill
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV][OME ITEM GROUP NAME] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

To whom was the bill sent?
RECORD VERBATIM.

1 CP100 (CP1095)
REFUSED RF CP100 (CP1095)
DON'T KNOW DK CP100 (CP1095)

BLAISE NAME: EvpvWhereBillTp
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [OME ITEM GROUP NAME] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

INTERVIEWER: SELECT TYPE OF ORGANIZATION TO WHOM BILL WAS SENT:
HELP: F1

HMO 1 BOX_50 (CP1096)
VA (VETERANS ADMINISTRATION)/CHAMPVA 2 BOX_50 (CP1096)
TRICARE 3 BOX_50 (CP1096)
OTHER MILITARY 4 BOX_50 (CP1096)
PUBLIC ASSISTANCE/MEDICAID/SCHIP 5 BOX_50 (CP1096)
WORKER'S COMPENSATION 6 BOX_50 (CP1096)
PRIVATE INSURANCE COMPANY 7 BOX_50 (CP1096)
INDIAN HEALTH SERVICE (IHS) 8 BOX_50 (CP1096)
OTHER 91 BOX_50 (CP1096)
REFUSED RF BOX_50 (CP1096)
DON'T KNOW DK BOX_50 (CP1096)

 If event is for orthodontics (DN20=12 'ORTHODONTIA, BRACES, OR RETAINERS') or dental restorative services (DN20=6 'FILLINGS, INLAYS, CROWNS OR CAPS' or 7 'Root Canal'), go to CP110.
Otherwise, go to BOX_60.

BLAISE NAME: FFeeSituation
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

Sometimes a person can be charged a 'lump sum' for orthodontia or dental restorative treatments that require a series of visits like braces, retainers, fillings, inlays, crowns, or caps. We call this "a flat fee situation." Is [your/[PERSON]'s] visit to [PROVIDER] on [VISIT DATE] part of a flat fee?

YES 1
NO 2 BOX_60 (CP1098)
REFUSED RF BOX_60 (CP1098)
DON'T KNOW DK BOX_60 (CP1098)

If coded '1' YES, and event-provider pair does not represent a repeat visit group, ask the Flat Fee (FF) section immediately. Charge Payment information in the context of the single event is no longer needed.

If CP70 is coded '1' (YES, AND DOCUMENTATION AVAILABLE) or '2' (YES, BUT DOCUMENTATION NOT AVAILABLE);
or
If CP80 is coded '1' (PAID AT TIME OF VISIT), '2' (MADE A COPAYMENT), '4' (BILL HAS NOT ARRIVED), 'DK' (DON'T KNOW), or 'RF' (REFUSED);
or
If CP100 is coded '3' (TRICARE), '91' (OTHER), 'DK' (DON'T KNOW), or 'RF' (REFUSED);
Go to CP120.
Otherwise, continue with BOX_70.

Route Details: If:

- Event type is OM OR HH
or
- event type is HS, go to CP200.
Otherwise, go to CP170.

BLAISE NAME: EvpvKnowTotal
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

Do you know the total charge for [this hospital stay/this visit/the [OME ITEM GROUP NAME]/the services received at home]?
[ENTER 'INCLUDED WITH OTHER CHARGES' IF THIS IS A FLAT FEE SITUATION.]
HELP: F1

YES 1 BOX_80 (CP1106)
NO 2
[INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)] 95
REFUSED RF
DON'T KNOW DK

Programmer Instructions: If:

Coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW)
And
(event type is OM or HH or HS, go to CP200.
If: coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW)
And
event type is ER, OP, MV, or DN, go to CP170.
If coded 95 'INCLUDED WITH OTHER CHARGES' (E.G. FLAT FEE)' and the event- provider pair does not represent a repeat visit group or this is not an OM event, ask the Flat Fee (FF) section immediately. Charge Payment information in the context of the single event is no longer needed.

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.
Display the interviewer instruction "ENTER 'INCLUDED WITH OTHER CHARGES' IF THIS IS A FLAT FEE SITUATION" if event-provider pair does not represent a repeat visit stem or this is not an OM event. 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 this is an OM event for 'GLASSES OR CONTACT LENSES'(EE40='1' YES, EE50='1' YES, or OM10= '1' YES) .
Display 'ambulance services' if this is an OM event for 'AMBULANCE SERVICES' (OM30= '1' YES) .
Display 'disposable supplies' if this is an OM event for 'DISPOSABLE SUPPLIES' (OM40= '1' YES).
Display 'long-term medical equipment' if this is an OM event for 'LONG-TERM MEDICAL EQUIPMENT' (OM50= '1' YES).
Display response option 95 ''INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)' if event provider pair does not represent a repeat visit stem or this is not an OM event.
Otherwise, use a null display.

If the current event type is OM = '3' (DISPOSABLE SUPPLIES) then go to CP130. Else go to CP140.

BLAISE NAME: EvpvTotChrgRng
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [REF-DT]
Question Text:

AND CP-2
Please look at card CP-2, and tell me how much the total charge was for all of the disposable supplies purchased [since [START DATE]/between [START DATE] and [END DATE]]? Include any amounts that may be paid by health insurance or other sources. Was it $0, $1 to $10, $11 to $30, $31 to $100, $101 or more?
HELP: F1

$0 1 BOX_130 (CP1485)
$1 TO $10 2 CP180 (CP1126)
$11 TO $30 3 CP180 (CP1126)
$31 TO $100 4 CP180 (CP1126)
$101 OR MORE 5 CP180 (CP1126)
REFUSED RF CP190 (CP1127)
DON'T KNOW DK CP190 (CP1127)

 Display 'Since [START DATE]' if not round 5. Display 'Between [START DATE] and [END DATE]', if round 5.

BLAISE NAME: EvpvChrgTp
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [OME ITEM GROUP NAME] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]

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 CP150 (CP1115)
[INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)] 95

If coded '95' 'INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)' and the event- provider-pair does not represent a repeat visit group or this is not an OM event, ask the Flat Fee (FF) section immediately. Charge Payment information in the context of the single event is no longer needed.
Display Instructions: Display 'Do not include any services billed for separately such as physician charges or other services if event type is HS, ER, or OP. Otherwise, use a null display.
Display 'Include charges for procedures such as x-rays, lab tests, or diagnostic procedures that are listed separately on the [hospital] bill [or statement]." if CP70 is coded '1' (YES, AND DOCUMENTATION AVAILABLE). 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, or HH. 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 repeat visit stem or this is not a OM event. Otherwise, use a null display.
Display response option 95 ''INCLUDED W/OTHER CHARGES (E.G. FLAT FEE)' if event provider pair does not represent a repeat visit stem or this is not an OM event.
Otherwise, use a null display.

BLAISE NAME: EvpvTotChrg
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

[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.]
ENTER AMOUNT.

1
REFUSED RF
DON'T KNOW DK

If the amount is $0, go to BOX_130.
If: event type is ER, OP, MV, or DN and total charge is a non-zero whole number less than or = $50.00 or CP150 is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW), go to CP170.
If the amount is not $0, DK, or RF and the event type is HH, continue with CP160.
Otherwise, go to CP200.
Soft check: If amount entered is greater than or = $100,000, display the following message: display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Hard check:
Amount cannot be less than 0.

Display the question text "How much?other sources?" and "IF WORKING...DENIED CHARGES" in brackets and grayed-out text.
Display 'Do not include any services billed for separately such as physician charges or other services.' in brackets and grayed-out text, 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]." In brackets and grayed-out text, if CP70 is coded '1' (YES, AND DOCUMENTATION AVAILABLE). 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, or HH. Otherwise, use a null display.

BLAISE NAME: EvpvMonthly
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

You said that the total charge for the services received at home was [$ AMOUNT]. Is that dollar amount a monthly amount or not?

YES, MONTHLY AMOUNT 1 CP200 (CP1130)
NO, NOT A MONTHLY AMOUNT 2
REFUSED RF CP200 (CP1130)
DON'T KNOW DK CP200 (CP1130)

[$ AMOUNT]: Display amount entered at CP150.
Hard Check:
If coded '2' (NO), display the following message: "IF [$ AMOUNT] IS NOT THE MONTHLY AMOUNT CHARGED, CORRECT TOTAL CHARGE AT CP150 (EvpvTotChrg)." CAPI displays a selection CP150 as an option to return to. Code '2' (NO) is never allowed as a final response at CP160.

BLAISE NAME: EvpvSetAmt
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

Is this the type of situation in which [you/he/she] always [make/makes] the same set dollar amount copayment regardless of what happens during the visit?
HELP: F1

YES 1 CP200 (CP1130)
NO 2 CP200 (CP1130)
USUALLY PAYS $0 (REGARDLESS OF SERVICE) 3 CP200 (CP1130)
REFUSED RF CP200 (CP1130)
DON'T KNOW DK CP200 (CP1130)

BLAISE NAME: EvpvFamPaid
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [OME ITEM GROUP NAME]
[REF-DT]
Question Text:

How much of the total charge for the disposable supplies did anyone in the family pay 'out-of-pocket,' that is, before any reimbursements? Was it all or almost all of the total charge, none of the total charge, or some of the total charge?
HELP: F1

ALL OR ALMOST ALL OF THE TOTAL CHARGE 1 BOX_90 (CP1145)
NONE OF THE TOTAL CHARGE 2 BOX_90 (CP1145)
OR SOME OF THE TOTAL CHARGE 3 CP190 (CP1127)
REFUSED RF CP190 (CP1127)
DON'T KNOW DK CP190 (CP1127)

BLAISE NAME: EvpvAmtUPayRng
Question Text:

AND CP-2
Please look at card CP-2, and tell me how much of the total charges for the disposable supplies did anyone in the family pay 'out-of-pocket,' that is, before any reimbursements? Was it $0, $1 to $10, $11 to $30, $31 to $100, $101 or more?
HELP: F1

$0 1 BOX_90 (CP1145)
$1 TO $10 2 BOX_90 (CP1145)
$11 TO $30 3 BOX_90 (CP1145)
$31 TO $100 4 BOX_90 (CP1145)
$101 OR MORE 5 BOX_90 (CP1145)
REFUSED RF BOX_90 (CP1145)
DON'T KNOW DK BOX_90 (CP1145)

BLAISE NAME: EvpvAmtUPay
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [OME ITEM GROUP NAME] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

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, ENTER 0.
ENTER AMOUNT.
HELP:F1

1 BOX_90 (CP1145)
REFUSED RF BOX_90 (CP1145)
DON'T KNOW DK BOX_90 (CP1145)

Soft check: If amount entered is greater than or = $10,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."

Display '[AMT TOT CH]' if an amount is given for the total charge at CP150. Display 'total charge' if CP120 is coded '2' (NO), 'RF' (REFUSED), 'DK' (DON'T KNOW), if CP120 =1 but CP150 = RF or DK, or is not asked.
For [AMT TOT CH] display the dollar amount entered at CP150.

Route Details: If:

CP200 is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW) and CP120 is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW) and CP170 is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), go to BOX_130.
Otherwise, continue with CP210.

BLAISE NAME: EvpvAnySrcPay
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

Has any private insurance company, HMO, Medicare, Medicaid, or any other source made any payments [to [PROVIDER]] for [this hospital stay/this visit/the [OME ITEM GROUP NAME]/the services received at home]?
HELP: F1

YES 1 CP220 (CP1165)
NO 2 BOX_100 (CP1295)
REFUSED RF BOX_100 (CP1295)
DON'T KNOW DK BOX_100 (CP1295)

Display "to [PROVIDER]' if event type is not OM. 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 [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 this is an OM event for 'GLASSES OR CONTACT LENSES'(EE40='1' YES, EE50='1' YES, or OM10= '1' YES) .
Display 'ambulance services' if this is an OM event for 'AMBULANCE SERVICES' (OM30= '1' YES) .
Display 'disposable supplies' if this is an OM event for 'DISPOSABLE SUPPLIES' (OM40= '1' YES).
Display 'long-term medical equipment' if this is an OM event for 'LONG-TERM MEDICAL EQUIPMENT' (OM50= '1' YES).

BLAISE NAME: EvpvSOPRoster
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [OME ITEM GROUP NAME] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

Who else paid?
PROBE: Anyone else?
TO ADD A NEW SOURCE OF PAYMENT, PRESS CTRL-A.
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

[Name of Source of Payment] 1 1 CP230 (CP1170)
[Name of Source of Payment] 2 2 CP230 (CP1170)
[Name of Source of Payment] 3 3 CP230 (CP1170)
[Name of Source of Payment] 4 4 CP230 (CP1170)
[Name of Source of Payment] N 5 CP230 (CP1170)

Roster behavior:
Multiple select allowed.
Multiple add allowed.
Pressing CTRL-A displays a pop-up with a text entry field and a selectable list of 15 common sources of payment. (See BOX_20 for a detailed list). The interviewer can type a new source or select one from the list. Upon return to CP220, the added source will appear on the roster as selected.
Limited delete allowed. If interviewer adds a source of payment, delete is possible for that source only, as long as the charge payment section for this person-provider pair has not been completed.
Write sources selected to the Event's-Sources-of- Payment-roster.
If at least one source is added or selected during the current round, the flag SOPFlag should be set to YES.

Roster 3- add/edit/delete allowed.
Roster definition:
Display the RU-Sources-Of-Payment-roster for selection.
Display payment source name (SRCS.SRCNAME)
Roster filter:
Display all sources of payment except PERSON/FAMILY

BLAISE NAME: PayMAmtPaid
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

How much did [SOURCE] pay?
ENTER AMOUNT.
TOTAL CHARGE: $[TOTAL CHARGE]

1
REFUSED RF
DON'T KNOW DK

Preloaded Grid Type 2
Soft check: If amount entered is greater than $10,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Flag all sources and associated amounts as 'payment'.
Interviewer enters a dollar amount for each source displayed. Amounts can be changed as many times as necessary before the interviewer leaves the screen.
2. The PERSON/FAMILY amount paid cell is protected and prefilled with the family out- of- pocket payment amount entered at CP200; no changes are allowed to this amount.
Soft Check:
If any source coded '$0', display the following message: "IF [SOURCE] DID NOT PAY ANY PART OF THE TOTAL CHARGE, CORRECT THE SOURCES THAT MADE DIRECT PAYMENTS TO THIS PROVIDER AT CP210 (AnySrcPay) OR CP220 (SOPRoster). IF [SOURCE] IS THE ONLY SOURCE OF DIRECT PAYMENT, GO TO CP210 (AnySrcPay) AND CODE '2' (NO). IF THERE ARE OTHER SOURCES OF PAYMENT, GO TO CP220 (SOPRoster) AND DELETE [SOURCE] FROM THE LIST OF SOURCES OF DIRECT PAYMENT. IF RESPONDENT DOES NOT KNOW HOW MUCH [SOURCE] PAID, CODE "DK" AT CP230 (AmtPaid)."

Roster 1- Report
Roster definition:
Display the Event's-Sources-of-Payment-roster for entry of payment amount in the form pane.
Display payment source name.
Roster Filter:
Display all sources selected at CP220 for this event-provider pair and the 'PERSON/FAMILY' record.
For TOTAL CHARGE, display amount entered at CP130, if event is OM event type '3' (DISPOSABLE SUPPLIES). Otherwise display amount entered at CP150.

 If the event type is OM event type '3' (DISPOSABLE SUPPLIES), go to BOX_130
Otherwise, continue with BOX_110.

If CP150 (TOTAL CHARGE) or 'AMOUNT PAID' by any source of payment (all payments sources, including PERSON/FAMILY entered or displayed at CP230) is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW), go to BOX_130.
Otherwise, continue with BOX_120.

Determine if there is an underpayment. Subtract the total payment (PERSON/FAMILY entered at CP200 plus all payments sources entered at CP230) from the total charge entered at CP150. If the value of the remainder is greater than 3% OR $5 (whichever is higher) of the total charge, continue with CP240.
Otherwise, go to BOX_130.
NOTE: Negative values (overpayments) are not eligible for CP240.

BLAISE NAME: EvpvElsePay
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EV] [EVN-DT/REF-DT] [REPEAT VISIT: [NAME OF REPEAT VISIT GROUP]]
Question Text:

Does anyone in the family or any other source expect to make additional payments for [this hospital stay/this visit/the [OME ITEM GROUP NAME]/the services received at home]?

YES 1 BOX_130 (CP1485)
NO 2 BOX_130 (CP1485)
REFUSED RF BOX_130 (CP1485)
DON'T KNOW DK BOX_130 (CP1485)

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.
[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 this is an OM event for 'GLASSES OR CONTACT LENSES'(EE40='1' YES, EE50='1' YES, or OM10= '1' YES) .
Display 'ambulance services' if this is an OM event for 'AMBULANCE SERVICES' (OM30= '1' YES) .
Display 'long-term medical equipment' if this is an OM event for 'LONG-TERM MEDICAL EQUIPMENT' (OM50= '1' YES).
Display 'the services received at home' if event type is HH.

If: event type is HS, OM, or HH, or event type is ER, OP, MV, or DN and PERSON-PROVIDER pair already flagged as 'COPAYMENT SITUATION', go to BOX_150.
Otherwise, continue with BOX_140.

If CP120 is coded '2' (NO), 'RF (REFUSED), or 'DK' (DON'T KNOW) and
CP170 is coded '1' (YES) or '3' (USUALLY PAYS $0 REGARDLESS OF SERVICE) and
CP200 is a whole dollar amount greater than or equal to (?) $0 and less than or equal (?) to $50
Flag this person-provider pair as a 'COPAYMENT SITUATION' and continue with BOX_150.
If
The amount entered in CP150 is equal to the amount entered in CP200 and
CP170 is coded '1' (YES) or '3'' (USUALLY PAYS $0 REGARDLESS OF SERVICE) and
CP200 is a whole dollar amount greater than or equal to (?) $0 and less than or equal(?) to $50,
Flag this person-provider pair as a 'COPAYMENT SITUATION' and continue with BOX_150.
If
CP80 is coded '5' (NO BILL SENT: HMO PLAN), '6' (NO BILL SENT: VA (VETERANS ADMINISTRATION)/CHAMPVA), '8' (NO BILL SENT: PUBLIC ASSISTANCE/MEDICAID/SCHIP) or '9' (NO BILL SENT: INDIAN HEALTH SERVICE (HIS)) and
CP170 is coded '1' (YES) or '3' (USUALLY PAYS $0 REGARDLESS OF SERVICE) and
CP200 is a whole dollar amount greater than or equal to (?) $0 and less than or equal (?) to $50, flag this person-provider pair as a 'COPAYMENT SITUATION' and continue with BOX_150.
If one of the three situations above is met, set amount entered at CP200 as this person- provider pair's copayment amount for the current round.
Otherwise, do not set any flags and then continue with BOX_150.

If event type is HS and HS50 is coded '4' (GIVE BIRTH TO A BABY) or '5' (TO BE BORN), go to the EF section.
If event type is MV and MV100 is coded '2' (SOMEWHERE ELSE) go to the EF section. Otherwise (event type = OP, ER, DN, HH, HS where HS50 ? 4, 5, MV where MV100 ? 2) flag CP status of event-provider pair as 'PROCESSED'.
If event is a "STEM" event from the OP, MV, or HH utilization sections, flag CP status of all "LEAF" events (events selected at either OP120, MV140 or HH130) as 'PROCESSED' and not editable or accessible during interview.
NOTE: All utilization and charge/payment data will be copied during MHOP to those "LEAF" events, including condition data.

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100, BOX_110, BOX_120, BOX_130, BOX_140, BOX_150
04 Single Select equal to CS10, CS20, CS30, CS40, CS50, CS60, CS70, CS80, CS90, CS100, CS110, CS120, CS130, CS140, CS190, CS200, CS210, CS220, CS230, CS240, CS250, CS260, CS270, CS290, CS300, CS310, CS320, CS340, CS350, CS370, CS380, CS390, CS400, CS410, CS420, CS430, CS440, CS450, CS460, CS470, CS480, CS490, CS500, CS510, CS520
19 Numeric Field equal to CS280, CS330_01, CS330_02, CS360
22 Stem and Leaf equal to CS150A, CS150B, CS150C, CS150D, CS160A, CS160B, CS160C, CS170A, CS170B, CS170C, CS180A, CS180B, CS180C

This CS section is asked in rounds 2 and 4 only. If it is round 1, 3, or 5, continue to the next section in the questionnaire.
AHRQ will determine what subsections will be asked during each round. CAPI will need to be programmed to be configurable to this administration.
The CS section includes four subsections:
LWIM (CS10 - CS140)
CIS (CS150A - CS180C)
CAHPS (CS190-CS300)
Prevention (CS310 - CS520)
CAPI will administer the LWIM series every R2/R4 administration
CAPI will administer the CAHPS and CIS series in R2 for Panels whose R1 collection occurred in an odd year (FirstPanYearequal toodd), and R4 for Panels whose R1 collection occurred in an even year (FirstPanYearequal toeven).
CAPI will administer the Prevention series in R2 for Panels whose R1 collection occurred in an even year (FirstPanYearequal toeven), and R4 for Panels whose R1 collection occurred in an odd year (FirstPanYearequal toodd).
Context header display instruction: Display RU member's first, middle, and last name (Person.FullName).

 If RU member being asked about is deceased, go to BOX_140. Otherwise (RU member is a current RU member or institutionalized), continue with BOX_30.

 If RU member being asked about is less than or equal to 17 years of age or in age categories 1 through 4, continue with BOX_40.
Otherwise, go to BOX_140.

 Subsection 1: The first subsection is Living with Illness measures (CS10-CS140). This subsection is asked every R2/R4 administration.
Continue with CS10.

BLAISE NAME: NeedRxMed
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

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.
(Do/Does) (you/(PERSON)) currently need or use medicine prescribed by a doctor, other than vitamins?
HELP: F1

YES 1 CS20 (CS1070)
NO 2 CS40 (CS1080)
REFUSED RF CS40 (CS1080)
DON'T KNOW DK CS40 (CS1080)

Display Instructions: Display CS10, CS20, and CS30 on the same form pane.

BLAISE NAME: RxMedCond
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is this because of any medical, behavioral or other health condition?

YES 1 CS30 (CS1075)
NO 2 CS40 (CS1080)
REFUSED RF CS40 (CS1080)
DON'T KNOW DK CS40 (CS1080)

Display Instructions: Display CS10, CS20, and CS30 on the same form pane.

BLAISE NAME: RxCond12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is this a condition that has lasted or is expected to last for at least 12 months?

 YES 1 CS40 (CS1080)
NO 2 CS40 (CS1080)
REFUSED RF CS40 (CS1080)
DON'T KNOW DK CS40 (CS1080)

Display Instructions: Display CS10, CS20, and CS30 on the same form pane.

BLAISE NAME: MoreMedical
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

(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 CS50 (CS1085)
NO 2 CS70 (CS1095)
REFUSED RF CS70 (CS1095)
DON'T KNOW DK CS70 (CS1095)

Display Instructions: Display CS40, CS50, and CS60 on the same form pane.

BLAISE NAME: MoreMedCond
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is this because of any medical, behavioral or other health condition?

YES 1 CS60 (CS1090)
NO 2 CS70 (CS1095)
REFUSED RF CS70 (CS1095)
DON'T KNOW DK CS70 (CS1095)

Display Instructions: Display CS40, CS50, and CS60 on the same form pane.

BLAISE NAME: MoreMedCond12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is this a condition that has lasted or is expected to last for at least 12 months?

Responses: 

YES 1 CS70 (CS1095)
NO 2 CS70 (CS1095)
REFUSED RF CS70 (CS1095)
DON'T KNOW DK CS70 (CS1095)

Display Instructions: Display CS40, CS50, and CS60 on the same form pane.

BLAISE NAME: LmtAbility
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

(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?

Responses: 

YES 1 CS80 (CS1100)
NO 2 CS100 (CS1110)
REFUSED RF CS100 (CS1110)
DON'T KNOW DK CS100 (CS1110)

Display Instructions: Display CS70, CS80, and CS90 on the same form pane.

BLAISE NAME: LmtAbilityCond
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is this because of any medical, behavioral or other health condition?

YES 1 CS90 (CS1105)
NO 2 CS100 (CS1110)
REFUSED RF CS100 (CS1110)
DON'T KNOW DK CS100 (CS1110)

Display Instructions: Display CS70, CS80, and CS90 on the same form pane.

BLAISE NAME: LmtAbilityCond12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is this a condition that has lasted or is expected to last for at least 12 months?

YES 1 CS100 (CS1110)
NO 2 CS100 (CS1110)
REFUSED RF CS100 (CS1110)
DON'T KNOW DK CS100 (CS1110)

Display Instructions: Display CS70, CS80, and CS90 on the same form pane.

BLAISE NAME: SpeclThrpy
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

(Do/Does) (you/(PERSON)) need or get special therapy such as physical, occupational or speech therapy?

Responses: 

YES 1 CS110 (CS1115)
NO 2 CS130 (CS1125)
REFUSED RF CS130 (CS1125)
DON'T KNOW DK CS130 (CS1125)

Display Instructions: Display CS100, CS110, and CS120 on the same form pane.

BLAISE NAME: SpeclThrpyCond
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is this because of any medical, behavioral or other health condition?

YES 1 CS120 (CS1120)
NO 2 CS130 (CS1125)
REFUSED RF CS130 (CS1125)
DON'T KNOW DK CS130 (CS1125)

Display Instructions: Display CS100, CS110, and CS120 on the same form pane.

BLAISE NAME: SpeclThrpyCond12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is this a condition that has lasted or is expected to last for at least 12 months?

YES 1 CS130 (CS1125)
NO 2 CS130 (CS1125)
REFUSED RF CS130 (CS1125)
DON'T KNOW DK CS130 (CS1125)

Display Instructions: Display CS100, CS110, and CS120 on the same form pane.

BLAISE NAME: ProbTrtmt
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

(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 CS140 (CS1130)
NO 2 BOX_50 (CS1135)
REFUSED RF BOX_50 (CS1135)
DON'T KNOW DK BOX_50 (CS1135)

Display Instructions: Display CS130 and CS140 on the same form pane.

BLAISE NAME: ProbTrtmt12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is this a condition that has lasted or is expected to last for at least 12 months?

Responses: 

YES 1 BOX_50 (CS1135)
NO 2 BOX_50 (CS1135)
REFUSED RF BOX_50 (CS1135)
DON'T KNOW DK BOX_50 (CS1135)

Display Instructions: Display CS130 and CS140 on the same form pane.

Subsection 2: The second subsection is the Columbia Impairment Scale (CS150A-CS180C) will be administered in round 2 if calendar year of CAPI administration is an odd year (FirstPanYearequal toodd) and this subsection will be administered in round 4 if the calendar year of CAPI administration is an even year (FirstPanYearequal toeven): round 4(panel 23 (2018) round 4 or panel 24 (2019) round 2)

If RU member being asked about is aged 5-17 years, inclusive, or in age categories 3 or 4 and subsection is on route for inclusion in this round, continue with CS150A.
Otherwise, go to BOX_60.

BLAISE NAME: ProbTrouble
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
(The following questions are about some aspects of (your/(PERSON)'s) health.)
(In this series of questions, please/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) with:
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
a. Getting into trouble?

1 CS150B (CS1150)
REFUSED RF CS150B (CS1150)
DON'T KNOW DK CS150B (CS1150)

Programmer Instructions: Range check:

The values for TROUBLE should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

The CS150 question series represent a stem and leaf question format. Each leaf in this stem and leaf series (CS150A - CS150D) should display on the same form pane. Use the same question stem display.
Display "(The following questions are about some aspects of (your/(PERSON)'s) health.)" only when presenting the first (stem) question for this person. Otherwise, use a null display.
Display "(In this series of questions, please?)" only when presenting the first (stem) question for this person in bold, black standard text. Otherwise, display "Please rate (yourself/him/her) on a scale of 0 to 4?" in grayed-out text for each subsequent (leaf) question in this series.
Display "In general, how much of a problem do you think (you/(PERSON)) (have/has) with: " in bold black standard text for the first question (stem) for this person. Otherwise, display it in brackets and "grayed-out" text for each subsequent (leaf) question in this series.
Display each leaf in bold black standard text when its entry field is active. Otherwise, always display in "grayed-out" text.

BLAISE NAME: ProbMother
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
[Please rate 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) with:]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
b. Getting along with (your/his/her) mother?

Responses: 

1 CS150C (CS1155)
REFUSED RF CS150C (CS1155)
DON'T KNOW DK CS150C (CS1155)

Programmer Instructions: Range check:

The values for MOTHPROB should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

Display Instructions: See CS150A for display instructions.

BLAISE NAME: ProbFather
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
[Please rate 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) with:]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
c. Getting along with (your/his/her) father?
Responses: 1 CS150D (CS1160)
REFUSED RF CS150D (CS1160)
DON'T KNOW DK CS150D (CS1160)

Programmer Instructions: Range check:

The values for FATHPROB should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

Display Instructions: See CS150A for display instructions.

BLAISE NAME: ProbSad
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
[Please rate 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) with:]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
d. Feeling unhappy or sad?

1 CS160A (CS1165)
REFUSED RF CS160A (CS1165)
DON'T KNOW DK CS160A (CS1165)

Programmer Instructions: Range check:

The values for UNHAPSAD should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

Display Instructions: See CS150A for display instructions.

BLAISE NAME: ProbSchBehav
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
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 would you say (you/(PERSON)) (have/has):
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
e. With (your/his/her) behavior at school?

1 CS160B (CS1170)
REFUSED RF CS160B (CS1170)
DON'T KNOW DK CS160B (CS1170)

Programmer Instructions: Range check:

The values for should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

The CS160 question series represent a stem and leaf question format. Each leaf in this stem and leaf series (CS160A - CS160C) should display on the same form pane. Use the same question stem display.
Display "Please rate on a scale of 0 to 4 where 0 indicates no problem and 4 indicates a very big problem" in bold black text for the first question (stem) in this series, otherwise, display this text in brackets and grayed-out text for each subsequent (leaf) question in this series.
Display "How much of a problem would you say (you/(PERSON)) (have/has):" in bold black standard text for the first (stem) question. Otherwise, display it in brackets and grayed out text for each subsequent (leaf) question in this series.
Display each leaf in bold black standard text when its entry field is active. Otherwise, always display in "grayed-out" text.

BLAISE NAME: ProbHaveFun
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
[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 would you say (you/(PERSON)) (have/has):]
f. With having fun?
Responses: 1 CS160C (CS1175)
REFUSED RF CS160C (CS1175)
DON'T KNOW DK CS160C (CS1175)

Programmer Instructions: Range check:

The values for HAVFUNPR should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

Display Instructions: See CS160A for display instructions.

BLAISE NAME: ProbAdults
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
[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 would you say (you/(PERSON)) (have/has):]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
g. Getting along with adults other than (your/his/her) mother/father?

Responses: 

1 CS170A (CS1180)
REFUSED RF CS170A (CS1180)
DON'T KNOW DK CS170A (CS1180)

Programmer Instructions: Range check:

The values for ADULPROB should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

Display Instructions: See CS160A for display instructions.

BLAISE NAME: ProbFearful
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
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 (do/does) (you/(PERSON)) have:
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
h. With feeling nervous or afraid?

1 CS170B (CS1185)
REFUSED RF CS170B (CS1185)
DON'T KNOW DK CS170B (CS1185)

Programmer Instructions: Range check:

The values for NERVAFRD should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

The CS170 question series represent a stem and leaf question format. Each leaf in this stem and leaf series (CS170A - CS170C) should display on the same form pane. Use the same question stem display.
Display "Please rate on a scale of 0 to 4 where 0 indicates no problem and 4 indicates a very big problem." In bold black text for the first question (stem) in this series, otherwise, display in brackets and grayed-out text for each subsequent (leaf) question in the series.
Display "How much of a problem (do/does) (you/(PERSON)) have:" in bold black standard text for the first (stem) question. Otherwise, display it in brackets and grayed out text for each subsequent (leaf) question in the series.
Display each leaf in bold black standard text when its entry field is active. Otherwise, always display in "grayed-out" text.

BLAISE NAME: ProbSiblings
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
[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 (do/does) (you/(PERSON)) have:]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
i. Getting along with (your/his/her) brothers and sisters?

1 CS170C (CS1190)
REFUSED RF CS170C (CS1190)
DON'T KNOW DK CS170C (CS1190)

Programmer Instructions: Range check:

The values for SIBSPROB should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

Display Instructions: See CS170A for display instructions.

BLAISE NAME: ProbOthCh
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
[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 (do/does) (you/(PERSON)) have:]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
j. Getting along with other kids (your/his/her) age?

Responses: 

1 CS180A (CS1195)
REFUSED RF CS180A (CS1195)
DON'T KNOW DK CS180A (CS1195)

Programmer Instructions: Range check:

The values for KIDSPROB should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

Display Instructions: See CS170A for display instructions.

BLAISE NAME: ProbSportHobby
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
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 would you say (you/(PERSON) (have/has):
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
k. Getting involved in activities like sports or hobbies?

Responses: 

1 CS180B (CS1200)
REFUSED RF CS180B (CS1200)
DON'T KNOW DK CS180B (CS1200)

Programmer Instructions: Range check:

The values for SPORTHOB should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

The CS180 question series represent a stem and leaf question format. Each leaf in this stem and leaf series (CS180A - CS180C) should display on the same form pane. Use the same question stem display.
Display "Please rate on a scale of 0 to 4 where 0 indicates no problem and 4 indicates a very big problem." In bold black standard text for the first question (stem) in this series, otherwise, display in brackets and grayed-out text for each subsequent (leaf) question in this series.
Display "How much of a problem would you say (you/(PERSON)) (have/has):" in bold black standard text for the first (stem) question. Otherwise, display it in brackets and grayed out text for each subsequent (leaf) question in this series.
Display each leaf in bold black standard when its entry field is active. Otherwise, always display in "grayed-out" text.

BLAISE NAME: ProbSchWork
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
[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 would you say (you/(PERSON)) (have/has):]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
l. With (your/his/her) school work (or doing (your/his/her) job))?

Responses: 

1 CS180C (CS1205)
REFUSED RF CS180C (CS1205)
DON'T KNOW DK CS180C (CS1205)

Programmer Instructions: Range check:

The values for SCHLWORK should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

See CS180A for display instructions.
Display 'or doing (your/his/her)job))' if RU member is equal to or greater than 16 years old (or in age category 4).
Otherwise, use a null display.

BLAISE NAME: ProbHomeBehav
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-1.
[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 would you say (you/(PERSON)) (have/has):]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
m. With (your/his/her) behavior at home?

Responses: 

1 BOX_60 (CS1206)
REFUSED RF BOX_60 (CS1206)
DON'T KNOW DK BOX_60 (CS1206)

Programmer Instructions: Range check:

The values for BEHVHOME should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."

Display Instructions: See CS180A for display instructions.

Subsection 3: The third subsection is CAHPS unmet need, provider satisfaction measures (CS190-CS300) will be administered in round 2 if calendar year of CAPI administration is an odd year (FirstPanYearequal toodd) and this subsection will be administered in round 4 if calendar year of CAPI administration is an even year (FirstPanYearequal toeven): round 4(panel 23 (2018) round 4 or panel 24 (2019) round 2).
If subsection is on route for inclusion in this round, continue with CS190.
Otherwise, go to BOX_70.

BLAISE NAME: AcuteIll12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

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?

Responses: 

YES 1 CS200 (CS1215)
NO 2 CS210 (CS1220)
REFUSED RF CS210 (CS1220)
DON'T KNOW DK CS210 (CS1220)

Display Instructions: Display CS190 and CS200 on the same form pane.

BLAISE NAME: AcuteCare12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-2.
Looking at card CS-2, in the last 12 months, when (you/(PERSON)) needed care right away, how often did (you/he/she) get care as soon as (you/he/she) needed?

NEVER 1 CS210 (CS1220)
SOMETIMES 2 CS210 (CS1220)
USUALLY 3 CS210 (CS1220)
ALWAYS 4 CS210 (CS1220)
REFUSED RF CS210 (CS1220)
DON'T KNOW DK CS210 (CS1220)

Display Instructions: Display CS190 and CS200 on the same form pane.

BLAISE NAME: RoutnAppt12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

In the last 12 months, did you make any appointments for a check-up or routine care for (yourself/(PERSON)) at a doctor's office or clinic?

Responses: 

YES 1 CS220 (CS1225)
NO 2 CS230 (CS1230)
REFUSED RF CS230 (CS1230)
DON'T KNOW DK CS230 (CS1230)

Display Instructions: Display CS210 and CS220 on the same form pane.

BLAISE NAME: OftRoutnAppt12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-2.
Looking at card CS-2, in the last 12 months, how often did you get an appointment for a check-up or routine care for (yourself/(PERSON)) at a doctor's office or clinic as soon as (you/he/she) needed?

NEVER 1 CS230 (CS1230)
SOMETIMES 2 CS230 (CS1230)
USUALLY 3 CS230 (CS1230)
ALWAYS 4 CS230 (CS1230)
REFUSED RF CS230 (CS1230)
DON'T KNOW DK CS230 (CS1230)

Display Instructions: Display CS210 and CS220 on the same form pane.

BLAISE NAME: SeeProv12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-3.
Looking at card CS-3, 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 CS290 (CS1270)
1 TIME 1 CS240 (CS1245)
2 TIMES 2 CS240 (CS1245)
3 TIMES 3 CS240 (CS1245)
4 TIMES 4 CS240 (CS1245)
5 TO 9 TIMES 5 CS240 (CS1245)
10 OR MORE TIMES 6 CS240 (CS1245)
REFUSED RF CS290 (CS1270)
DON'T KNOW DK CS290 (CS1270)

BLAISE NAME: ProvExplain12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-2.
Looking at card CS-2, in the last 12 months, how often did (your/(PERSON)'s) doctors or other health professionals explain things about (your/his/her) health in a way that was easy to understand?

NEVER 1 CS250 (CS1250)
SOMETIMES 2 CS250 (CS1250)
USUALLY 3 CS250 (CS1250)
ALWAYS 4 CS250 (CS1250)
REFUSED RF CS250 (CS1250)
DON'T KNOW DK CS250 (CS1250)

BLAISE NAME: ProvListen12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-2.
Looking at card CS-2, in the last 12 months, how often did (your/(PERSON)'s) doctors or other health professionals listen carefully to you?

Responses: 

NEVER 1 CS260 (CS1255)
SOMETIMES 2 CS260 (CS1255)
USUALLY 3 CS260 (CS1255)
ALWAYS 4 CS260 (CS1255)
REFUSED RF CS260 (CS1255)
DON'T KNOW DK CS260 (CS1255)

BLAISE NAME: ProvRespect12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-2.
Looking at card CS-2, in the last 12 months, how often did (your/(PERSON)'s) doctors or other health professionals show respect for what you had to say?

Responses: 

NEVER 1 CS270 (CS1260)
SOMETIMES 2 CS270 (CS1260)
USUALLY 3 CS270 (CS1260)
ALWAYS 4 CS270 (CS1260)
REFUSED RF CS270 (CS1260)
DON'T KNOW DK CS270 (CS1260)

BLAISE NAME: ProvTime12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-2.
Looking at card CS-2, in the last 12 months, how often did (your/(PERSON)'s) doctors or other health professionals spend enough time with (you/him/her)?

Responses: 

NEVER 1 CS280 (CS1265)
SOMETIMES 2 CS280 (CS1265)
USUALLY 3 CS280 (CS1265)
ALWAYS 4 CS280 (CS1265)
REFUSED RF CS280 (CS1265)
DON'T KNOW DK CS280 (CS1265)

BLAISE NAME: RateHCare12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-4.
Please look at card CS-4. 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?
ENTER RATING:

Responses: 

1 CS290 (CS1270)
REFUSED RF CS290 (CS1270)
DON'T KNOW DK CS290 (CS1270)

BLAISE NAME: SpeclAppt12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When you answer the next questions, do not include dental visits or care (you/(PERSON)) got when (you/he/she) stayed overnight in a hospital.
Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and other doctors who specialize in one area of health care.
In the last 12 months, did you make any appointments for (yourself/(PERSON)) to see a specialist?

YES 1 CS300 (CS1275)
NO 2 BOX_70 (CS1276)
REFUSED RF BOX_70 (CS1276)
DON'T KNOW DK BOX_70 (CS1276)

BLAISE NAME: OftSpeclAppt12Mon
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

CS-2.
Looking at card CS-2, in the last 12 months, how often did you get appointments for (yourself/(PERSON)) to see a specialist as soon as (you/he/she) needed?

NEVER 1 BOX_70 (CS1276)
SOMETIMES 2 BOX_70 (CS1276)
USUALLY 3 BOX_70 (CS1276)
ALWAYS 4 BOX_70 (CS1276)
REFUSED RF BOX_70 (CS1276)
DON'T KNOW DK BOX_70 (CS1276)

Subsection 4: The fourth subsection is the MEPS historical series on preventive care (CS310- CS520).
If the calendar year of CAPI administration is an even year, this subsection will be administered in round 2 (FirstPanYearequal toeven),. If the calendar year of CAPI administration is an odd year (FirstPanYearequal toodd), this subsection will be administered in round 4 (panel 22 (2017) round 4 or panel 23 (2018) round 2).
If subsection is on route for inclusion in this round, continue with CS310. Otherwise, go to BOX_140.

BLAISE NAME: ProvMeasrHeight
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Has a doctor or other health provider ever measured (your/(PERSON)'s) height?

Responses: 

YES 1 CS320 (CS1285)
NO 2
REFUSED RF
DON'T KNOW DK

If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW) and RU member is less than or equal to5 years old (or in age categories 1 or 2), go to CS340. Otherwise, if coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW) and RU member is greater than or equal to 6 years old (or in age categories 3 or 4), go to CS330_01.

Display Instructions: Display CS310 and CS320 on the same form pane.

BLAISE NAME: WhenMeasrHeight
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When was that?

Responses: 

WITHIN PAST YEAR 1
WITHIN PAST 2 YEARS 2
MORE THAN 2 YEARS 3
REFUSED RF
DON'T KNOW DK

If RU member is less than or equal to 5 years old (or in age categories 1 or 2), go to CS340. Otherwise, continue with CS330_01.

Display Instructions: Display CS310 and CS320 on the same form pane.

BLAISE NAME: HeightFeet
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

About how tall (are/is) (you/(PERSON)) without shoes?
ENTER FEET
PROBE FOR INCHES IF NOT REPORTED.

Responses: 

1 CS330_02 (CS1300)
REFUSED RF CS340 (CS1305)
DON'T KNOW DK CS340 (CS1305)

Soft check: If amount is above 7, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."

Display Instructions: Display CS330_01 and CS330_02 on the same form pane.

BLAISE NAME: HeightInch
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

[About how tall (are/is) (you/(PERSON)) without shoes?]
ENTER INCHES
[PROBE FOR INCHES IF NOT REPORTED.]

Responses: 

1 CS340 (CS1305)
REFUSED RF CS340 (CS1305)
DON'T KNOW DK CS340 (CS1305)

Programmer Instructions: Soft check:

If amount is above 11 when feet (CS330_01) greater than 0, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
If feet (CS330_01) equal to 0, inches (CS330_02) must be 1-30. If feet (CS330_01) greater than 0, inches (CS330_02) must be 0-11.

Display CS330_01 and CS330_02 on the same form pane.
Display question text: "About how tall (are/is) (you/(PERSON)) without shoes?" in brackets and grayed out text.

BLAISE NAME: ProvMeasrWeight
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Has a doctor or other health provider ever measured (your/(PERSON)'s) weight?

Responses: 

YES 1 CS350 (CS1310)
NO 2
REFUSED RF
DON'T KNOW DK

If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW) and RU member is less than or equal to 5 years old (or in age categories 1 or 2), go to BOX_80. Otherwise, if coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW) and RU member is greater than or equal to 6 years old (or in age categories 3 or 4), go to CS360.

Display Instructions: Display CS340 and CS350 on the same form pane.

BLAISE NAME: WhenMeasrWeight
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When was that?

Responses: 

WITHIN PAST YEAR 1
WITHIN PAST 2 YEARS 2
MORE THAN 2 YEARS 3
REFUSED RF
DON'T KNOW DK

Programmer Instructions: If RU member is less than or equal to 5 years old (or in age categories 1 or 2), go to BOX_80. Otherwise, go to CS360.

Display Instructions: Display CS340 and CS350 on the same form pane.

BLAISE NAME: WeightPound
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

About how much (do/does) (you/(PERSON)) weigh without shoes?
ENTER POUNDS

Responses: 

1 BOX_80 (CS1330)
REFUSED RF BOX_80 (CS1330)
DON'T KNOW DK BOX_80 (CS1330)

Programmer Instructions: Soft check:

If amount is above 300, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."

If RU member being asked about is aged 3-6 years, inclusive, or in age categories 2 or 3, continue with CS370.
Otherwise, go to BOX_90.

BLAISE NAME: ProvCheckVision
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Has a doctor or other health provider ever checked (your/(PERSON)'s) vision?

Responses: 

YES 1 BOX_90 (CS1340)
NO 2 BOX_90 (CS1340)
TRIED, BUT (YOU/HE/SHE) (WERE/WAS) UNCOOPERATIVE 3 BOX_90 (CS1340)
REFUSED RF BOX_90 (CS1340)
DON'T KNOW DK BOX_90 (CS1340)

If RU member being asked about is greater than or equal to 2 years of age or in age categories 2 through 4, continue with CS380.
Otherwise, go to BOX_100.

BLAISE NAME: AdvHlthFood
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Has a doctor or other health provider ever given you (or (PERSON)) advice about (him/her) eating healthy?
HELP: F1

YES 1 CS390 (CS1370)
NO 2 CS400 (CS1375)
REFUSED RF CS400 (CS1375)
DON'T KNOW DK CS400 (CS1375)

Display 'or (PERSON)' and '(him/her)' if RU member being asked about is not selected as the respondent. Otherwise, (RU member being asked about is selected as the respondent), use a null display.
Display CS380 and CS390 on the same form pane.

BLAISE NAME: WhenAdvHlthFood
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When was that?

WITHIN PAST YEAR 1 CS400 (CS1375)
WITHIN PAST 2 YEARS 2 CS400 (CS1375)
MORE THAN 2 YEARS 3 CS400 (CS1375)
REFUSED RF CS400 (CS1375)
DON'T KNOW DK CS400 (CS1375)

Display Instructions: Display CS380 and CS390 on the same form pane.

BLAISE NAME: AdvExer
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

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?
HELP: F1

YES 1 CS410 (CS1380)
NO 2 BOX_100 (CS1385)
REFUSED RF BOX_100 (CS1385)
DON'T KNOW DK BOX_100 (CS1385)

Display Instructions: Display CS400 and CS410 on the same form pane.

Display 'or (PERSON)' if RU member being asked about is NOT selected as the respondent.
Otherwise, (RU member being asked about is selected as the respondent), use a null display.

BLAISE NAME: WhenAdvExer
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When was that?

WITHIN PAST YEAR 1 BOX_100 (CS1385)
WITHIN PAST 2 YEARS 2 BOX_100 (CS1385)
MORE THAN 2 YEARS 3 BOX_100 (CS1385)
REFUSED RF BOX_100 (CS1385)
DON'T KNOW DK BOX_100 (CS1385)

Display Instructions: Display CS400 and CS410 on the same form pane.

Route Details: If RU member being asked about:

[- (Has a weight at CS360 less than or equal to 40) or
-[(If CS360 is empty) and (person less than or equal to 4 years of age (or in age categories 1 or 2))], continue with CS420.]
If RU member being asked about:
[-(Has a weight at CS360 greater than 40 and less than or equal to 80 pounds) or
-[(If CS360 is coded 'RF' or 'DK' or empty) and (person greater than 4 and less than or equal to 9 years of age
(or in age category 3))], go to CS440.]
If RU member being asked about:
[-(Has a weight at CS360greater than 80 pounds,) or
-[(If CS360 is coded 'RF' or 'DK') and (Person greater than 9 years of age (or in age category 4))], go to CS460.]

BLAISE NAME: AdvSafetySeat
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Has a doctor or other health provider ever given you advice about (him/her) using a child safety seat while riding in the car?
HELP: F1

YES 1 CS430 (CS1395)
NO 2 BOX_120 (CS1425)
REFUSED RF BOX_120 (CS1425)
DON'T KNOW DK BOX_120 (CS1425)

Display Instructions: Display CS420 and CS430 on the same form pane.

BLAISE NAME: WhenAdvSafetySeat
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When was that?

WITHIN PAST YEAR 1 BOX_120 (CS1425)
WITHIN PAST 2 YEARS 2 BOX_120 (CS1425)
MORE THAN 2 YEARS 3 BOX_120 (CS1425)
REFUSED RF BOX_120 (CS1425)
DON'T KNOW DK BOX_120 (CS1425)

Display Instructions: Display CS420 and CS430 on the same form pane.

BLAISE NAME: AdvBooster
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Has a doctor or other health provider ever given you advice about (him/her) using a booster seat when riding in the car?
HELP: F1

YES 1 CS450 (CS1405)
NO 2 BOX_110 (CS1410)
REFUSED RF BOX_110 (CS1410)
DON'T KNOW DK BOX_110 (CS1410)

Display Instructions: Display CS440 and CS450 on the same form pane.

BLAISE NAME: WhenAdvBooster
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When was that?

Responses: 

WITHIN PAST YEAR 1 BOX_110 (CS1410)
WITHIN PAST 2 YEARS 2 BOX_110 (CS1410)
MORE THAN 2 YEARS 3 BOX_110 (CS1410)
REFUSED RF BOX_110 (CS1410)
DON'T KNOW DK BOX_110 (CS1410)

Display Instructions: Display CS440 and CS450 on the same form pane.

Route Details: 

If CS360 is coded 'RF' or 'DK' for RU member being asked about and person is in age category 3 (age is unknown), continue with CS460.
Otherwise, go to BOX_120.

BLAISE NAME: AdvBelts
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

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?
HELP: F1

Responses: 

YES 1 CS470 (CS1420)
NO 2 BOX_120 (CS1425)
REFUSED RF BOX_120 (CS1425)
DON'T KNOW DK BOX_120 (CS1425)

Display 'or (PERSON)' and '(him/her)' if RU member being asked about is not selected as the respondent. Otherwise, (RU member being asked about is selected as the respondent), use a null display.
Display CS460 and CS470 on the same form pane.

BLAISE NAME: WhenAdvBelts
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When was that?

WITHIN PAST YEAR 1 BOX_120 (CS1425)
WITHIN PAST 2 YEARS 2 BOX_120 (CS1425)
MORE THAN 2 YEARS 3 BOX_120 (CS1425)
REFUSED RF BOX_120 (CS1425)
DON'T KNOW DK BOX_120 (CS1425)

Display Instructions: Display CS460 and CS470 on the same form pane.

If RU member being asked about is greater than or equal to 2 years of age or in age categories 2 through 4, continue with CS480.
Otherwise, go to CS500.

BLAISE NAME: AdvHelmet
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

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?
HELP: F1

YES 1 CS490 (CS1435)
NO 2 CS500 (CS1440)
REFUSED RF CS500 (CS1440)
DON'T KNOW DK CS500 (CS1440)

Display Instructions: 

Display 'or (PERSON)' and '(him/her)' if RU member being asked about is not selected as the respondent. Otherwise, (RU member being asked about is selected as the respondent), use a null display.
Display CS480 and CS490 on the same form pane.

BLAISE NAME: WhenAdvHelmet
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When was that?

WITHIN PAST YEAR 1 CS500 (CS1440)
WITHIN PAST 2 YEARS 2 CS500 (CS1440)
MORE THAN 2 YEARS 3 CS500 (CS1440)
REFUSED RF CS500 (CS1440)
DON'T KNOW DK CS500 (CS1440)

Display Instructions: Display CS480 and CS490 on the same form pane.

BLAISE NAME: AdvSmoking
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

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?
HELP: F1

YES 1 CS510 (CS1445)
NO 2 BOX_130 (CS1450)
REFUSED RF BOX_130 (CS1450)
DON'T KNOW DK BOX_130 (CS1450)

Display Instructions: Display CS500 and CS510 on the same form pane.

BLAISE NAME: WhenAdvSmoking
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

When was that?

WITHIN PAST YEAR 1 BOX_130 (CS1450)
WITHIN PAST 2 YEARS 2 BOX_130 (CS1450)
MORE THAN 2 YEARS 3 BOX_130 (CS1450)
REFUSED RF BOX_130 (CS1450)
DON'T KNOW DK BOX_130 (CS1450)

Display Instructions: Display CS500 and CS510 on the same form pane.

If RU member being asked about is greater than or equal to 12 years of age or in age category 4, continue with CS520.
Otherwise, go to BOX_140.

BLAISE NAME: ProvAlone

Context Header: (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?

YES 1 BOX_140 (CS1465)
NO 2 BOX_140 (CS1465)
REFUSED RF BOX_140 (CS1465)
DON'T KNOW DK BOX_140 (CS1465)

Route Details: Go to next questionnaire section.

01 Box equal to BOX_00, BOX_10
08 Multiple Select equal to DN10, DN20
20 OS Text Field equal to DN20OS

BLAISE NAME: CodeAllDNProvTp
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

DN-1.
Looking at card DN-1, what type of dental care provider did (you/(PERSON)) see during this visit?
PROBE: Any other type of dental care person?
ENTER ALL THAT APPLY
HELP: F1

GENERAL DENTIST 1 DN20 (DN1005)
PEDIATRIC DENTIST 2 DN20 (DN1005)
DENTAL SPECIALIST (E.G, ORTHODONTIST, ENDODONTIST,PERIODONTIST) 3 DN20 (DN1005)
DENTAL HYGIENIST 4 DN20 (DN1005)
OTHER 91 DN20 (DN1005)
REFUSED RF DN20 (DN1005)
DON'T KNOW DK DN20 (DN1005)

Programmer Instructions: For specifications purposes only (CAPI handles automatically) : CAPI does not allow RF or DK in combination with any other code.

BLAISE NAME: CodeAllDNSvc

Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

DN-2.
Looking at card DN-2, what did (you/(PERSON)) have done during this visit?
PROBE: What else was done?
ENTER ALL THAT APPLY.
HELP: F1

GENERAL EXAM, CHECKUP, OR CONSULTATION 1
CLEANING, PROPHYLAXIS, OR POLISHING, PERIODONTAL RECALL VISIT (PERIODIC OR REGULAR) 2
X-RAYS, RADIOGRAPHS, OR BITEWINGS 3
FLUORIDE TREATMENT 4
SEALANT (PLASTIC COATINGS ON BACK TEETH) 5
FILLINGS, INLAYS, CROWNS OR CAPS 6
ROOT CANAL 7
PERIODONTAL SCALING, ROOT PLANING, OR GUM SURGERY 8
EXTRACTION, TOOTH PULLED OR OTHER ORAL SURGERY 9
IMPLANTS 10
FIXED BRIDGES, DENTURES OR REMOVABLE PARTIAL DENTURES, RELINING OR REPAIR OF BRIDGES OR DENTURES 11
ORTHODONTIA, BRACES, OR RETAINERS 12
OTHER 91
REFUSED RF
DON'T KNOW DK

If code ?91? (OTHER) entered alone or in combination with any other code, continue with DN20OS.
Otherwise, go to BOX_10.
Headings and code categories will appear in the response pane (except for DIAGNOSTIC OR PREVENTIVE and ORAL SURGERY which are programmatically included in the info pane, but will look like they are part of the response list pane), on the help screen and show card DN-2. Headings should be associated with codes as follows:
*DIAGNOSTIC OR PREVENTIVE equal to CODES 1-5
*RESTORATIVE OR ENDODONTIC equal to CODES 6-7
*PERIODONTIC (GUM TREATMENT) equal to CODE 8
*ORAL SURGERY equal to CODES 9-10
*PROSTHETICS equal to CODES 11
*ORTHODONTICS equal to CODE 12
*ADDITIONAL PROCEDURES equal to CODE 91
The response pane should contain two even columns (as possible) with headers directly above response categories.
The headers should be underlined.
For specifications purposes only (CAPI handles automatically): CAPI does not allow RF or DK in combination with any other code.

BLAISE NAME: DNSvcOS
Question Text:

SPECIFY: OTHER TYPE OF DENTAL CARE:

 1 BOX_10 (DN1025)
REFUSED RF BOX_10 (DN1025)
DON'T KNOW DK BOX_10 (DN1025)

 Go to the Charge/Payment (CP) section if it needs to be asked for this event, i.e. its status wasn?t set to ?Completed? because it was part of a Flat Fee situation where the charges were collected in the CP section for another event in that Flat Fee group.
Otherwise, go to the event driver (ED) section.

Route Details: 

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50
02 Loop equal to LOOP_10, LOOP_20
03 End Loop equal to END_LP10, END_LP20
06 Single Select with Fill in Answer Text equal to ED30_03
31 Date Item Single Field equal to ED20, ED30_01, ED30_02
99 Uncategorized equal to ED10
Grid 2 equal to ED10

Context header display instructions: display PERS.FULLNAME, PROV.LORPNAME, EVPV.EVNTTYPE, EVPV.EVNTBEGM, EVPV.EVNTBEGD, and EVPV.EVNTBEGY.

Context header display instructions: display PERS.FULLNAME, PROV.LORPNAME, EVPV.EVNTTYPE, EVPV.EVNTBEGM, EVPV.EVNTBEGD, and EVPV.EVNTBEGY.

Programmer Instructions: If this instance of ED was launched through the F2, Add/Review Overview button, continue with LOOP_10

For each element in person?s-medical-events- roster, ask LOOP_20 ? END_LP10.
Loop definition: LOOP_10 cycles on all persons with at least one medical event to be
reviewed. This loop cycles on persons that meet the following conditions:
-RU member with reported events in the current round or with open events in the prior
round, that now need to be followed up on (Preload.xxx).
The loop should start with the respondent, and then move to the RU member with the lowest PersID that hasn?t been looped on yet with reported events.

Loop Definition: LOOP_20 corrects event information, if necessary, and calls the appropriate utilization section for each event. LOOP_20 cycles on RU members' events within each provider in reverse chronological order (i.e. starting with the most recent event within the provider displayed first).
The loop cycles on events that meet the following conditions:
-event type is not OM
-event type is not HH Volunteered: Meal delivery service
-event is not yet flagged as processed in utilization
-event is not yet flagged as processed in charge payment
-event is not yet flagged as processed in the Event Follow-up (EF) section
Ask ED10 to END_LP20.

BLAISE NAME: EvntGrid

Context Header: 

(PERSON'S FIRST MIDDLE AND LAST NAME) (EVN-DT) (EV)
(NAME OF MEDICAL CARE PROVIDER......)-(DOC or DEPT)

((The next few questions ask detail about each of the times (you/(PERSON)) received medical or dental care.)
(Before continuing with the interview, let's/Let's) (first) 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/(DOC OR DEPT)) at (PROVIDER) on (VISIT DATE)/ when(you/(PERSON)) received medical care from ((DOC OR DEPT) at) (PROVIDER) on (VISIT DATE)/ when (you/(PERSON)) received dental care from (PROVIDER) on (VISIT DATE)/the services (you/(PERSON)) received at home from (PROVIDER) during (MONTH)/(your/(PERSON)'S) stay at (PROVIDER) that began on (ADMIT DATE)) (that we just added for (you/him/her)). (We will not be asking questions about (your/(PERSON)'s)( hospital stay/care received at home) (that began on (ADMIT DATE)/ for the month of (VISIT MONTH)) until the next interview. )
PRESS 1 AND ENTER TO CONTINUE WITH EVENT.
(CTRL-A: ADD NEW EVENT FOR ANYONE)
CTRL-E: EDIT DATE FOR SELECTED EVENT CTRL-D: DELETE SELECTED EVENT
(CTRL-S: SWITCH TO EVENTS FOR A DIFFERENT RU MEMBER)
THERE ARE (NUMBER) REMAINING EVENTS TO PROCESS FOR (PERSON).
((number of events displayed) out of (total number of events) events shown for (PERSON) - scroll for more).

Responses: CONTINUE 1

Preloaded Grid type 2- Flexible navigation, allow empty.
Once all the events show a status of complete in both the utilization and charge payment columns, go to END_LP20.
Hard check: All cells in the column for ED10 are allowed to display empty, however, if FI tries to move off of this page and go to the next person and there is still at least one event that does not have a status of ?DONE?, display the following message: ?YOU MUST COMPLETE ALL EVENTS FOR THIS PERSON BEFORE CONTINUING. (IF YOU WOULD LIKE TO TALK ABOUT A DIFFERENT PERSON, SELECT CTRL-S.)? Display the sentence ?IF YOU WOULD LIKE TO TALK ABOUT A DIFFERENT PERSON?,? if there is more than one RU member with events that haven?t been completed.
If coded 1, immediately go to appropriate utilization section: If event is coded HS, go to HS utilization section. If event is coded ER, go to ER utilization section. If event is coded OP, go to OP utilization section. If event is coded MV, go to MV utilization section. If event is coded DN, go to DN utilization section. If event is coded HH, go to HH utilization section. If event is coded IC, go to IC utilization section.
If event type is HS, and discharge date is ?95? (STILL IN HOSPITAL) [or round 5, coded ?95? indicates ?STILL IN HOSPITAL? and ?RELEASED IN (YEAR)?], 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 the MPC follow-up.)
If event type is IC, and discharge date is ?95? STILL IN INSTITUTION? [or if round 5, code ?95? indicates ?STILL IN INSTITUTION? and ?RELEASED IN (YEAR)?], do not ask the Institutional Care Stay (IC) section for this event (We will follow up with these events next round. If round 5, we will obtain necessary information during the MPC follow-up.)
If event type is HH, and the HH event was coded as occurring in the current interview month, CAPI will not ask the HH utilization section for this event, except for round 5 (We will follow up with these events next round. If round 5, all home health care events should go through the utilization section because the reference period ends in December and the interview month is always the next calendar year.)
If CTRL-A is selected, go to Event Roster (EV) section. Once the EV section is complete, return to ED10. Display added event in chronological order within provider, but the cursor should go back to where it was before adding the event.
If CTRL-D is selected, display the message: ?ARE YOU SURE YOU WANT TO DELETE THIS EVENT FOR THIS PERSON?? And CAPI provides the options: YES, DELETE or NO. On the pop-up manipula, CAPI should display the context header information for the event selected. Once ?YES, DELETE? is selected CAPI shows a pop-up dialogue box where a selection must be made before this deletion is taking place:
WHY ARE YOU DELETING THIS EVENT?
-Need to change event type
-Event is for a different RU member
-Event did not occur
-Need to change the provider
FI?s must select a reason for deleting the event before continuing with the interview. If FI tries to continue without selecting a reason, display the following error message: ?MUST SELECT REASON FOR DELETING EVENT?
If one of the following reasons is selected ?Need to change event type, Event type is for a different RU member, or Need to change the provider, display the following pop-up manipula box with the message: ?To (change event type/link event to different RU member/change provider) you must enter the event as new with this correction. Press 1 to Add event with this update, 2 if new event already added with update or press 3 to cancel.?
Add new event with the update
New event already added with update
Keep original event as is, nothing deleted
Display ?change event? if selected ?Need to change event type? at the Reason for deletion pop-up manipula. Display ?link event to different RU member? if selected ?Event type is for a different RU member? at Reason for deletion pop-up manipula. Display ?change provider? if selected ?Need to change the provider? at the Reason for Deletion pop-up manipula. If coded ?1? ?Add new event with the update? option is selected, go to BOX_30. If coded 2 ?New event already added with update? is selected, return to ED10.
If code 3 ?Keep original event as is, nothing deleted? is selected here, return to ED10.
If CTRL-E is selected, go to BOX_40. If event type is HH, display the following error message: ?THIS CODE IS NOT AVAILABLE FOR HH EVENTS. IF CORRECTION NECESSARY, DELETE AND RE-ADD THIS HH EVENT? And return to ED10.
If CTRL-S is selected, display a pop-up: "INTERVIEWER: SELECT THE RU MEMBER RESPONDENT WANTS TO DISCUSS NEXT." With an option to cancel to return to the screen they came from. CTRL-S allows the FI to select another RU member to talk about. Display the RU members for selection. Next to their name, display the number of events completed/total number of events for person. For example:
RU MEMBER 1 (5/5 events completed) RU MEMBER 2 (0/5 events completed)
If all events for an RU member have a DONE status, the RU member cannot be selected at the CTRL-S pop-up. CAPI can display that person, but they should displayed as inactive. They should have all events completed/total events for that person next to their name and they should not be selectable. The only way this person can be selected again is if an event is added for them at ED10. If cycling on the last RU member, and all other RU members? events are completed and have a status of DONE, pressing CTRL-S would display all RU members and they should display as inactive and FI cannot select them.
The completion status of the Event Follow-Up (EF) and Flat Fee (FF) sections, if applicable, supersedes the ?Done? status of C/P. That is, if the EF or FF sections are required and not completed, set the status of C/P to ?Started? or ?Not Completed,? whichever is applicable. CAPI will not allow FI to proceed with interview until these required sections (EF and/or FF) are completed.
The cursor should display on the first event listed, as described in the loop definition, but FI can select any event in any order. Once the utilization and charge payment greater than columns have been completed and display as ?Done? in the column, the row should automatically be grayed out, and the cursor should move to the next event on the grid that needs to be completed.
For open HS, IC, and HH events, and repeat visit group "leaves" that do not require a utilization or charge/payment section, once ?1? is selected for that event, the event row is grayed out and the cursor moves to the next event.
Whenever a change is made, Add, delete, edit, the cursor should go back to where it previously was. When adding an event for a different RU member, CAPI should go back to the ED screen it was prior to adding the event.

Display "The next few questions...care" if first event to be asked about for this person.
Display ?Before continuing with the interview, let?s? if this instance of ED was launched through the F2, Add/Review Overview button (i.e., launched from OF Section). Otherwise, display ?Let?s?.
Display ?first? if this instance of ED was launched through the F2, Add/Review Overview button (i.e., launched from OF Section). Otherwise, use a null display.
Display ?the hospital stay for?? if event type is HS.
Display ?when (you/(PERSON)) visited the emergency room?? if event type is ER.
Display ?when (you/(PERSON)) received medical care?? if event type is MV.
Display ?(DOC OR DEPT) at? if PV70 has a value of 1-N for this person-provider pair and display the doctor or department selected or added at PV70. Otherwise, use null display.
Display ?when (you/(PERSON)) received medical care from (an outpatient department/(DOC OR DEPT))?? if event type is OP. Display ?(DOC OR DEPT)? if PV70 has a value of 1-N for this person-provider pair and display the doctor or department selected or added at PV70. Otherwise, display ?an outpatient department?.
Display ?when (you/(PERSON)) received dental care?? if event type is DN. Display ?the services (you/(PERSON)) received at home?? if event type is HH. Display ?your/(PERSON)?S stay at (PROVIDER) that began? if event type is IC.
If event type is HS or IC and the discharge date is coded ?95? STILL IN HOSPITAL/FACILITY, OR if event type is HH and the care received was coded during the current interview month display ?We will not ask questions about?? Display ?hospital stay? if event type is HS or IC. Display ?care received at home? if event type is HH. Display ?that began on (VISIT DATE)? if event type is HS or IC. Display ?for the month of (VISIT MONTH)? if event type is HH.
Display ?that we just added for (you/him/her)? if this instance of ED was launched through the F2, Add/Review Overview button (i.e., launched from OF Section). Otherwise, use a null display.
Display ?CTRL-A: ADD NEW EVENT FOR ANYONE? and ?CTRL-S: SWITCH TO EVENTS FOR A DIFFERENT RU MEMBER? if this instance of ED was NOT launched through the F2, Add/Review Overview button (i.e., not launched through OF Section). Otherwise, use a null display (if this instance of ED was launched through the F2, Add/Review Overview button).
Format form pane with the following headers: ED10, RU Member, Event Type, Provider, Date, Repeat Visits, Util, C/P. ED10 is the selection cell; all other columns are protected and uneditable.
Display RU member?s full name in RU Member column.
Display the abbreviation for the corresponding event type for Event Type column.
For the Provider column, display the provider added or selected at PV20LU. Display ?(- DOC OR DEPT)? if PV70 has a value of 1-N for this person-provider pair and display the doctor or department selected or added at PV70. If PV70 does not have a value, use a null display.
For the date column, display the event date for MV, DN, OP, and ER events. For HH events, display the event month. For HS stays, display the start date and end date.
For the Repeat Visit column, display a letter starting with the letter ?A? for each repeat visit group. Allow empty. Set these display rules across the entire RU. These labels will not be retained across rounds. Note: This field could display one letter, or in a few instance, it could display several variable pulled from different sources. The column width needs to account for this and should be concatenated.
For repeat visits created in EV (for events where person-provider pairs exceed TBD number of events) display the range of dates starting with the first date selected to the most recent date selected. Display the three-letter month abbreviation, the two digit day, and the four digit year with a comma after the day. For example: Jan 01, 2016 ? Dec 12, 2016 with the total number of events shown in parenthesis after the most recent date displayed, for example Jan 01, 2016 ? Dec 12, 2016 (40).
Display status of appropriate utilization section: Not started, Started, Done, and N/A.
Display status of charge payment section: Not started, Started, Done, N/A where, Not startedequal to the section has not been started Startedequal to the section has been started but not completed. Display this status if a break-off occurs before the completion of a section. Doneequal tothe section has been completed, flagged as processed and no edits can be made to the data.
N/A: this section does not apply for this event; such is the case for OM?s, open HS, IC, and HH greater than events, as well as HH events where the HH provider's (HHType equal to 1 or 2) are agency or informal (friends, relatives, or volunteers)
Display an N/A in the utilization and charge payment columns on the grid for open HS, IC, and HH events.
Display N/A in the charge payment columns on the grid for HH events where HHTypeequal to1 (agency) or HHtypeequal to2 (informal). Only HHtypeequal to3 (paid independent) will go to charge payment as specified in the CP section.
Display row grayed out and uneditable after C/P column shows as ?Done? or as ?N/A? as applicable.
For the interviewer instruction ?THERE ARE (NUMBER) REMAINING?? display the number of events that have yet to be completed. By completed, we mean that the utilization and charge payment sections have been processed and completed and display ?Done? in the corresponding columns.
Display "((number of events displayed) OUT OF (total number of events) EVENTS SHOWN FOR (PERSON) - SCROLL TO SEE MORE)" in red text only when there are more than 8 events for person being looped on.

Ask the Event Roster (EV) section.
At completion of EV section, return to ED10.

The EV section, as well as all sections called within EV should present the traditional Blaise items with the green (instead of beige) background. Any Manipula or other special items within these sections can remain the original color scheme.

Route Details: 

If event type is MV, OP, DN, ER go to ED20.
If event type is HS or IC, go to ED30_01

BLAISE NAME: EvntDate

(PERSON?S FIRST MIDDLE AND LAST NAME) (EVN-DT) (EV) (NAME OF MEDICAL CARE PROVIDER......) (DOC or DEPT)

DATE ENTERED: (VISIT DATE)
Please tell me the correct date.
SELECT VISIT DATE.
PRESS THE ALT AND DOWN ARROW KEY TO SELECT THE DATE FROM THE CALENDAR. PRESS ENTER TO CONTINUE.
IF RESPONDENT DOESN?T KNOW THE DATES, PRESS F1 FOR A LIST OF PROBES.
HELP: F1

Responses: 1

Programmer Instructions:

REFUSED (RF) and DON?T KNOW (DK) are not allowed.
Return to ED10 with the date updated for this event.
Hard check: Date entered must be between the person?s reference period begin date (BegRefM, BegRefD, BegRefY) and the person?s reference period end date (EndRefM, EndRefD, EndRefY). If a date outside of this range is entered, display the following message: DATE CANNOT BE AFTER PERSON?S REFERENCE PERIOD END DATE OR BEFORE PERSON?S REFERENCE PERIOD BEGIN DATE. VERIFY WITH RESPONDENT AND RE-ENTER.?

Display the date field for visit date. Pressing the ALT and down arrow key, will bring up the pop- up calendar defaulted to display the month the interview is taking place. The interviewer may also manually enter the date.
Pressing enter to continue will take the FI to the next screen.

BLAISE NAME: EvntBegDate

(PERSON?S FIRST MIDDLE AND LAST NAME) (EV)

DATE ENTERED: (ADMIT DATE)-(DISCHARGE DATE)
Please tell me the correct date, starting with the date (you/(PERSON)) (were/was) admitted to the (hospital/facility).
SELECT ADMIT DATE.
PRESS THE ALT + DOWN ARROW KEY TO SELECT THE DATE FROM THE CALENDAR. PRESS ENTER TO CONTINUE.

Responses: 1

Hard check: If round 1 only, allow an admit date of one year prior to the start of the person?s reference period begin date (BegRefM, BegRefD, BegRefY). If a date outside of this range is entered, display the following message: ?UNLIKELY RESPONSE. DATE CANNOT BE MORE THAN A YEAR PRIOR TO THE PERSON?S REFERENCE PERIOD START DATE. VERIFY WITH RESPONSENT AND RE-ENTER.?
Admit date cannot be after the person?s reference period end date (EndRefM, EndRefD, EndRefY). If a date outside of this range is entered, display the following message: ?DATE CANNOT BE AFTER PERSON?S REFERENCE PERIOD END DATE. VERIFY WITH RESPONDENT AND RE-ENTER.?
Hard check: If rounds 2-5, date entered must be between person?s reference period begin date (BegRefM, BegRefD, BegRefY) and the person?s reference period end date (EndRefM, EndRefD, EndRefY). If a date outside of this range is entered, display the following message: ?DATE CANNOT BE AFTER PERSON?S REFERENCE PERIOD END DATE OR BEFORE PERSON?S REFERENCE PERIOD BEGIN DATE. VERIFY WITH REPONDENT AND RE-ENTER.?

Display ED30_01, ED30_02 and ED30_03 on the same form pane.
Display the date field for admittance date. Pressing the ALT + down arrow key, will bring up the pop- up calendar defaulted to display the month the interview is taking place. The interviewer may also manually enter the date.
Pressing enter to continue will take the FI to the next screen.
Display ?hospital? if event type is HS.
For (ADMIT DATE)-(DISCHARGE DATE) display the event date that was entered at EV30 associated with this event.

BLAISE NAME: EvntEndDate

(PERSON?S FIRST MIDDLE AND LAST NAME) (EV)

DATE ENTERED: (ADMIT DATE)(DISCHARGE DATE)
Please tell me the date (you/(PERSON)) (were/was) discharged from the (hospital/facility).
SELECT DISCHARGE DATE.IF RU MEMBER IS STILL IN THE HOSPITAL OR FACILITY, PRESS ENTER TO CONTINUE TO NEXT QUESTION.
PRESS THE ALT + DOWN ARROW KEY TO SELECT THE DATE FROM THE CALENDAR. PRESS ENTER TO CONTINUE.

Responses: 1

EMPTY Empty ED30_03 (ED1050)

Hard check: If round 1, admit date allowed to be 1 year prior to the start of the person?s reference greater than period. The discharge date must be after the admit date. If a date outside of this range is entered, display the following message: ?UNLIKELY RESPONSE. DATE MUST BE ON OR AFTER ADMITTANCE DATE. CONFIRM DATES WIITH RESPONDENT.?
The discharge date cannot be after the person?s reference period end date. If a date outside of this range is entered, display the following message: ?DATE CANNOT BE AFTER PERSON?S REFERENCE PERIOD END DATE. VERIFY WITH RESPONDENT AND RE-ENTER.?
Hard check: If rounds 2-5, date entered must be between person?s reference period begin date (BegRefM, BegRefD, BegRefY) and the person?s reference period end date (EndRefM, EndRefD, EndRefY). If a date outside of this range is entered, display the following message: ?DATE CANNOT BE AFTER PERSON?S REFERENCE PERIOD END DATE OR BEFORE PERSON?S REFERENCE PERIOD BEGIN DATE. VERIFY WITH REPONDENT AND RE-ENTER.?

Display ED30_01, ED30_02, and ED30_03 on the same form pane.
Display the empty date field for entry. Pressing the ALT +down arrow key, will bring up the pop- up calendar defaulted to display the month the interview is taking place. The interviewer may also manually enter the date.
Pressing enter to continue will take the FI to the next screen.
Display the current admit and discharge date for the HS/IC event for ?DATE ENTERED??
Display ?hospital? if event type is HS.
Display ?facility? if event type is IC.

BLAISE NAME: StillInHSIC

(PERSON?S FIRST MIDDLE AND LAST NAME) (EV)

DATE ENTERED: (ADMIT DATE)(DISCHARGE DATE)
Please tell me the date (you/(PERSON)) (were/was) discharged from the (hospital/facility).
ENTER DISCHARGE DATE.

STILL IN (HOSPITAL/FACILITY) 1
EMPTY Empty

REFUSED (RF) and DON?T KNOW (DK) are not allowed. If FI tries to code RF or DK, display the following message: ?THAT CODE IS NOT ALLOWED AT THIS SCREEN. BACK UP TO ENTER DISCHARGE DATE.?
Allow empty. ED30_02 is optional, but either ED30_02 or ED30_03 must be coded to move on. If both are empty, display the following message: ?YOU MUST MAKE A SELECTION. TO ENTER A DISCHARGE DATE BACK UP TO ED30_02 (EvntEndDate). TO SELECT STILL IN (HOSPITAL/FACILITY) PRESS 1 AND ENTER TO CONTINUE.?
Go back to ED10.
If coded ?1? (STILL IN HOSPITAL/FACILITY), event is not closed in the current round. Flag event as processed and flag charge payment as processed. Write correction to the person?s-medical-events-roster.

Display ED30_01, ED30_02, and ED30_03 on the same form pane.
Display the date field for discharge date. Pressing the ALT + down arrow key, will bring up the pop-up calendar defaulted to display the month the interview is taking place. The interviewer may also manually enter the date. Pressing enter to continue will take the FI to the next screen.
Display the current admit and discharge date for the HS/IC event for ?DATE ENTERED?? Display ?hospital? if event type is HS. Display ?facility? if event type is IC.
Display HOSPITAL in response pane if event type is HS. Display FACILITY in response pane if event type is IC. For (ADMIT DATE)-(DISCHARGE DATE) display the event date that was entered at EV30 associated with this event.

Go to the next event for this person that meets the criteria as stated in LOOP_20.
Once the statuses of the utilization and charge payment section for each event has been completed, end loop and go to END_LP10.

Go to the next RU member that meet the criteria as stated in LOOP_10.
Once all the RU members that meet the criteria in the loop definition, end loop and go to BOX_50.

End of Event Driver (ED) section. If ED launched from Off Path section, return to OF greater than section. Otherwise, go to Prescribed Medicines (PM) section.

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50
02 Loop equal to LOOP_10, LOOP_20
03 End Loop equal to END_LP10, END_LP20
04 Single Select equal to EE30, EE40
05 Single Selectwith Display Roster equal to EE50_01
10 Multiple Select with Fill in Answer Text equal to EE10
24 Information Screen equal to EE20
Grid 1 equal to EE50_01
Roster 2 equal to EE10

If 'OTHER RU MEMBER' selected for the provider probe that launched this instance of the EE section, continue with EE10.
Otherwise, go LOOP_10.

BLAISE NAME: RosterProbe
Question Text:

Who else (PROVIDER PROBE QUESTION TEXT)?
ENTER ALL THAT APPLY.

(FIRST NAME [MIDDLE NAME] LAST NAME)1 1 LOOP_10 (EE1015)
(FIRST NAME [MIDDLE NAME] LAST NAME)2 2 LOOP_10 (EE1015)
(FIRST NAME [MIDDLE NAME] LAST NAME)3 3 LOOP_10 (EE1015)
(FIRST NAME [MIDDLE NAME] LAST NAME)4 4 LOOP_10 (EE1015)
(FIRST NAME [MIDDLE NAME] LAST NAME)N 5 LOOP_10 (EE1015)

Create event record for this person.
Roster Behavior:
Multiple select allowed.
RF/DK disallowed.

Roster 2- no add/edit/delete
Roster Definition: Display RU-Members-Roster in the form pane.
Col #1 Header: RU Members Display RU members First, Middle and Last Names
Roster Filter: Display only RU members who are part of the Family Subunit.
Display the following text under specified conditions for (PROVIDER PROBE QUESTION TEXT):
If coming from PP170 display "had a stay at the hospital"
If coming from PP180 display "had a visit to the hospital emergency room"
If coming from PP190 display "had a visit to the outpatient department"
If coming from PP200 display "had a visit to the medical doctor"
If coming from PP210 display "had a visit to the specialist"
If coming from PP220 display "had a visit to any other type of medical professional"
If coming from PP230 display "received care at a health clinic"
If coming from PP240 display "had a visit to a medical lab or testing facility"
If coming from PP250 display "had a visit to a mental health professional"
If coming from PP260 display "had a visit to a therapist"
If coming from PP270 display "had a visit to a dental care provider"
If coming from PP280 display "had a visit to a vision or eye care provider"
If coming from PP290 display "had a visit to someone who practices alternative care"
If coming from PP300 display "received care at home"
If coming from PP310 display "had a visit to any type of residential rehabilitation facility or treatment facility"

For each element in the RU-Members-Roster, Ask LOOP_20-END_LP10.
Loop definition: LOOP_10 cycles on persons who were selected as having an event for the provider probe that launched this instance of the EE section. This loop cycles on RU members who meet the following conditions:
If EE section launched from first cycle through provider probes (PP10-PP160_01-PP160_N) then
-Person marked as '1' (YES) for the probe that launched this instance of the EE section.
OR
-Person selected at PP160_01-PP160_N grid as '1' (YES).
If EE section launched from second cycle through Provider Probes (PP170-PP320_01-320_N, PP325_01-PP325_N), then
-Person selected at the probe that launched this instance of the EE section
OR
-Person selected at EE10.
NOTE: If the respondent is eligible for this loop, CAPI should cycle on the respondent first, followed by eligible RU members in PID order.

For each of the following:
EVENT 1
EVENT 2
EVENT 3
EVENT 4
EVENT N
Ask BOX_20-END_LP20.
Loop definition: LOOP_20 enumerates each event of this Provider Probes type for this person. The response to EE30 determines if the loop cycles again. If EE30 is coded '1' (YES), the loop cycles to collect the next event. When EE30 is coded '2' (NO), 'RF' (REFUSED), 'DK' (DON?T KNOW), the loop ends.

Route Details: If this is the first cycle of LOOP_20 for this person, go to EE20, otherwise go to BOX_30.

BLAISE NAME: EvntIntro
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)
Question Text:

(I?m going to first ask a few more questions about/Now, let?s talk about) (your/(PERSON)?s) (PROVIDER PROBE QUESTION TEXT).
PRESS 1 AND ENTER TO CONTINUE.

Display "I?m going to first ask a few more questions about" if first cycle through LOOP_10 (first person to be asked about for this probe.) Otherwise, display "Now, let?s talk about"
Display the following text under specified conditions for (PROVIDER PROBE QUESTION TEXT):
If coming from PP10 or PP170 display "stay at the hospital"
If coming from PP20 or PP180 display "visit to the hospital emergency room"
If coming from PP30 or PP190 display "visit to the outpatient department"
If coming from PP40 or PP200 display "visit to the medical doctor"
If coming from PP50 or PP210 display "visit to the specialist"
If coming from PP60 or PP220 display "visit to any other type of medical professional"
If coming from PP70 or PP230 display "care received at a health clinic"
If coming from PP80 or PP240 display "visit to a medical lab or testing facility"
If coming from PP90 or PP250 display "visit to a mental health professional"
If coming from PP100 or PP260 display "visit to a therapist"
If coming from PP110 or PP270 display "visit to a dental care provider"
If coming from PP120 or PP280 display "visit to a vision or eye care provider"
If coming from PP130 or PP290 display "visit to someone who practices alternative care"
If coming from PP140 or PP300 display "care received at home"
If coming from PP150 or PP310 display "visit to any type of residential rehabilitation facility or treatment facility"
If coming from PP160_01-PP160_N or PP320_01-PP320_N, display "other health care received"

Route Details: Ask the Event Roster (EV) section for record collection.
At completion of the EV section, continue with EE30.

BLAISE NAME: AnyOthCare
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)
Question Text:

Other than what we just talked about, (have/has)(you/(PERSON) (PROVIDER PROBE QUESTION TEXT) (between (START DATE) and (END DATE)/since (START DATE)?

YES 1 END_LP20 (EE1060)
NO 2
REFUSED RF
DON?T KNOW DK

If coming from PP120 or PP280 and EE30 is coded '2' (NO), 'RF' (REFUSED), 'DK' (DON?T KNOW), go to EE40.
Otherwise, if coming from all other probes, and EE30 is coded '2' (NO), 'RF' (REFUSED) or 'DK' (DON?T KNOW), go to END_LP20.
If EE30 is coded '1' (YES), create event q from the probe that launched this instance of EE and go to END_LP20.

Display "since (START DATE) if not round 5, otherwise display "between (START DATE) and (END DATE)"
Display the following text for (PROVIDER PROBE QUESTION TEXT):
If coming from PP10 or PP170 display "been admitted to the hospital at any other time, looking at card PP-1"
If coming from PP20 or PP180 display "received any other care in a hospital emergency room, looking at card PP-2"
If coming from PP30 or PP190 display "had any other visits to a hospital outpatient department, looking at card PP-3"
If coming from PP40 or PP200 display "seen any other medical doctor such as a primary care provider, general practitioner, family medicine provider, pediatrician or internist, as shown on card PP-4"
If coming from PP50 or PP210 display "had any other visits to any kind of health care specialist shown on card PP-5"
If coming from PP60 or PP220 display "had any other visits to any kind of medical professional shown on card PP-6"
If coming from PP70 or PP230 display "received care at any other kind of health clinic, family planning center, walk-in urgent care or retail clinic shown on card PP-7"
If coming from PP80 or PP240 display "had any other visits to a medical lab or testing facility shown on card PP-8"
If coming from PP90 or PP250 display "had any other visits to a psychiatrist, psychologist, a licensed clinical social worker, a mental health therapist or counselor or any type of mental health professional shown on card PP-9"
If coming from PP100 or PP260 display "had any other visits to a physical therapist, occupational therapist, speech therapist, chiropractor or any other type of health care therapist shown on card PP-10"
If coming from PP110 or PP270 display "had any other visits to a dentist, oral surgeon, orthodontist, or any type of dental care provider shown on card PP-11"
If coming from PP120 or PP280 and display "had any other visits to a vision or eye care provider shown on card PP-12"
If coming from PP130 or PP290 display "had any other visits to someone who practices alternative care shown on card PP-13"
If coming from PP140-PP300 display "had any other type of home care services as shown on card PP-14"
If coming from PP150 or PP310 display "received any other care at a residential rehabilitation facility or treatment facility as shown on card PP-15"
If coming from PP160_01-PP160_N or PP320_01-PP320_N display "received any other kind of care, as shown on the records job aid"

BLAISE NAME: GlassesPers
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)
Question Text:

Did (you/(PERSON)) purchase eye glasses or contact lenses as part of (that visit/any of those visits), or at any other time between (START DATE) and (END DATE)?

Responses: 

YES 1 END_LP20 (EE1060)
NO 2 END_LP20 (EE1060)
REFUSED RF END_LP20 (EE1060)
DON?T KNOW DK END_LP20 (EE1060)

Programmer Instructions: If coded yes, create OM event for this person, for GLASSES/CONTACTS.

Display "that visit" if cycled through LOOP_20 only once for this person (only one event was added for this PERSON so far). Otherwise, display "any of those visits."

If EE30 is coded '1' (YES), cycle to collect next event for person at LOOP_20.
If EE30 is coded '2' (NO), 'RF' (REFUSED), 'DK' (DON?T KNOW), end LOOP_20 and continue with END_LP10.

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_10 and continue with BOX_40.

Check to make sure that the RU members in the subunit they are in that coded '1' (YES) to PP120 or PP280 have been cycled on. If all members who coded '1' (YES) have cycled to collect event (glasses or contact lenses) information, check to see if there are remaining members of the specific subfamily currently looping that coded '2' (NO) to PP120 or persons not selected at PP280. If so, go to EE50_01; otherwise, go to BOX_50.

BLAISE NAME: Glasses1
Question Text:

Did (DISPLAY NAME) purchase eye glasses or contact lenses between (START DATE) and (END DATE)?

YES 1
NO 2
REFUSED RF
DON?T KNOW DK

Preloaded grid type 1: forced navigation including EE50_01, EE, 50_02, EE50_03, EE50_04?, EE50_N.
If coded '1' (YES) create OM event for GLASSES/CONTACTS for each person coded '1' (YES) and go to BOX_50.
Otherwise, go to BOX_50.

Roster 1-Report Col #1: RU Members' Names Instructions: Display First, Middle, Last name of RU member
Roster Filter: Display names of all persons within the subunit who did not report any vision care (PP120 coded '2' (NO) or person not selected at PP280).
Variable question text display for each person in the roster, display the following: EE50_02: 2nd person on the roster: How about (DISPLAY NAME 2)? EE50_03: 3rd person on the roster: How about (DISPLAY NAME 3)? EE50_04: 4th person on the roster: Did (DISPLAY NAME 4) purchase glasses or contact lenses between (START DATE) and (END DATE)? EE50_N: N person on the roster: repeat question text in order from EE50_01-EE50_04.
Display question stem 'Did (DISPLAY NAME) purchase eye glasses?" in brackets and grayed-out text when displaying the variable question text display for the 2nd person to the Nth person.

Route Details: Return to next probe in the Provider Probes (PP) section.

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30
04 Single Select equal to EF10,EF20, EF30

If MV event and MV100 coded ?2? (SOMEWHERE ELSE), go to EF10.
If HS event and HS50 is coded ?4? (GIVE BIRTH TO A BABY) go to EF20.
If HS event and HS50 is coded ?5? (TO BE BORN), go to EF30.
Otherwise, go to BOX_30.

BLAISE NAME: ConfLabVst
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME)
Question Text:

You mentioned earlier that (you/(PERSON)) received lab tests somewhere other than (your/his/her) doctor's office. Has that lab visit already been recorded?
PRESS F2 TO REVIEW THE EVENTS RECORDED FOR THIS PERSON.

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

If coded ?1? (YES),?RF? (REFUSED), or ?DK? (DON?T KNOW) go to BOX_30.
If coded ?2? go to BOX_20.

BLAISE NAME: ConfPregVst
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME)
Question Text:

Earlier, you mentioned that (you/(PERSON)) (were/was) admitted to the hospital on (ADMIT DATE)to give birth to a baby. Let me check to make sure I have a hospital stay recorded for the baby.
PRESS F2 TO REVIEW THE EVENTS RECORDED FOR THE RU.

ENTER EVENT FOR BABY 1
EVENT ALREADY RECORDED FOR BABY/NO BABY IN RU 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions: 

If coded ?1? (ENTER EVENT FOR BABY), go to BOX_20.
If coded ?2?(EVENT ALREADY RECORDED FOR BABY/NO BABY IN RU), ?RF? (REFUSED) or ?DK? (DON?T KNOW) continue with BOX_30.

For "PERSON" display the person for whom the event was cycled on during this instance of HS in this person-level loop.
Display the (ADMIT DATE) for the event cycled on at HS during this person-level loop.

BLAISE NAME: ConfBirthVst
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME)
Question Text:

Earlier you mentioned that (PERSON) was admitted to the hospital on (ADMIT DATE) to be born. Let me check to make sure I have a hospital stay recorded for the mother.
PRESS F2 TO REVIEW EVENTS RECORDED FOR THE RU.

ENTER EVENT FOR MOTHER 1
EVENT ALREADY RECORDED FOR MOTHER/NO MOTHER IN RU 2
REFUSED RF
DON'T KNOW DK

If coded ?1? (ENTER EVENT FOR MOTHER), go to BOX_20.
If coded ?2?(EVENT ALREADY RECORDED FOR MOTHER/NO MOTHER IN RU), ?RF? (REFUSED), or ?DK? (DON?T KNOW), go to BOX_30.

For "PERSON" display the person for whom the event was cycled on during this instance of HS in this person-level loop.
Display the (ADMIT DATE) for the event cycled on at HS during this person-level loop.

Go to the EV section and create an event record for this person.
At the completion of the EV section, go to BOX_30.

At the completion of the EV section, flag CP status of event-provider pair as 'PROCESSED' and go to the ED section.

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100, BOX_110, BOX_120, BOX_130, BOX_140, BOX_150, BOX_160, BOX_170, BOX_180, BOX_190, BOX_200, BOX_210, BOX_220, BOX_230, BOX_240, BOX_250, BOX_260, BOX_270, BOX_290, BOX_300, BOX_310, BOX_320, BOX_340, BOX_350, BOX_360, BOX_370.

02 Loop equal to LOOP_10, LOOP_20, LOOP_30
03 End Loop equal to END_LP10, END_LP20, END_LP30
04 Single Select equal to EM10, EM20, EM30, EM40, EM170, EM230, EM290, EM300, EM420, EM440, EM450, EM460, EM470, EM480, EM520, EM530, EM550, EM560, EM570, EM580, EM590, EM600, EM610, EM630, EM640, EM660, EM670, EM680, EM690,EM700, EM710, EM730, EM750, EM770
05 Single Select with Display Roster equal to EM350, EM370
06 Single Select with Fill in Answer Text equal to EM150, EM210, EM270, EM320, EM410
07 Single Select with Add/Edit/Delete equal to EM50, EM80, EM100, EM120, EM180, EM240, EM340, EM390, EM720
10 Multiple Select with Fill in Answer Text equal to EM380
15 Regular Date Entry with Skips equal to EM60_01, EM60_02, EM60_03, EM90_01,EM90_02, EM90_03, EM110_01, EM110_02, EM110_03, EM130_01, EM130_02, EM130_03, EM140_01, EM140_02, EM140_03, EM190_01, EM190_02, EM190_03, EM200_01, EM200_02, EM200_03, EM250_01, EM250_02, EM250_03, EM260_01, EM260_02, EM260_03, EM310_01, EM310_02, EM310_03, EM400_01, EM400_02, EM400_03
17 Dollar Items Allowing Cents equal to EM650
19 Numeric Field equal to EM360, EM430, EM540, EM620, EM740, EM760
20 OS Text Field equal to EM520OS, EM750OS
23 Text Field equal to EM490, EM500, EM510

Throughout the specifications for this CAPI section, REFERENCE YEAR refers to BegRefY.

Context header display instructions:
Display PERSON.FULLNAME, (JobsEstbName), ((BegRefM, BegRefD, BegRefY, EndRefM, EndRefD, EndRefY)/(JobStartMM/DD/YYYY, JobStopMM/DD/YYYY)).
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 JobStopMM/DD/YYYY for all current main and current miscellaneous jobs. That is, 'Dec 31 (YEAR)' will display instead of the word 'current' for these job subtypes.

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 equal to or greater than 16 or in age categories 4-9 during the previous round, and RJ10 is coded '1' (YES) or RJ60 is coded '1' (YES), go to EM230. Else go to EM10.

BLAISE NAME: JobPay
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

(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)?

Do not count work around the house. Include work in a family farm or business, even if unpaid.

YES 1 EM40 (EMA1025)
NO 2 EM20 (EMA1015)
REFUSED RF EM20 (EMA1015)
DON'T KNOW DK EM20 (EMA1015)

Display (Now I have some questions about work experience for (you/(person)).): 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 equal to or greater than 16 years age or in age categories 4-9 but was not in previous round.)
Display (During our last interview on (PREV RD INTV DATE), we recorded that (you/(person)) did not work at any job for pay.): if person being asked about did not work during the previous round's reference period.
Display the previous round interview date (Preload.RUEndM, RUEndD, RUEndY) for (PREV RD INTV DATE)
Display '(Do/Does)' if not round 5.
Display 'as of December 31, /(YEAR), did' where 'year' is the second calendar year of the panel, if round 5.
Display (currently): if not round 5. Otherwise, use a null display.
Display (that we have not yet talked about) if any job asked about during the RJ section during this round for this person (RJ10not equal to EMPTY or RJ60not equal to EMPTY)

BLAISE NAME:AnyWork
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

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.
HELP: F1

YES 1 EM120 (EMA1520)
NO 2 EM30 (EMA1020)
REFUSED RF EM30 (EMA1020)
DON'T KNOW DK EM30 (EMA1020)

Display (since (START DATE) if not round 5. Display ?between (START DATE) and (END DATE)? if round 5.
Display (a/any other): ?a? if no job asked about during the RJ section during this round for this person.(RJ10 equal to EMPTY OR RJ60 equal to EMPTY
Display ?any other? if any job asked about during the RJ section during this round for this person.(RJ10not equal to EMPTY OR RJ60not equal to EMPTY
Display (that we have not yet talked about): if any job asked about during the RJ section during this round for this person (RJ10not equal to EMPTY OR RJ60not equal to EMPTY.

BLAISE NAME: ReturnJob
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

((Do/Does)/Did) (you/(PERSON)) have a job or business (you/he/she) (can/could) return to (that we have not yet talked about)?
HELP: F1

YES 1 EM50 (EMA1040)
NO 2
REFUSED RF
DON'T KNOW DK

If coded '1' (YES), go to EM50.
If coded ?2? (NO), ?RF' or ?DK? and person was asked employment section in any previous round, (job exists where Job.PersID equal to Person.PersID or (no job exists where Job.PersID equal to Person.PersID and SimplePerson.Pre_EM300 not equal to Empty)), go to BOX_210.
Otherwise [If coded ?2? (NO), ?RF? or ?DK? and person was not asked employment section in any previous round (no job exists where Job.PersID equal to Person.PersID of person being looped on and SimplePerson.Pre_EM300 equal to empty) ], go to EM300.

Display ?(Do/Does)? if not round 5. Display ?Did? if round 5.
Display ?can? if not round 5. Display ?could? if round 5.
Display (that we have not yet talked about): if any job asked about during the RJ section during this round for this person. (RJ10not equal to EMPTY OR RJ60not equal to EMPTY)

BLAISE NAME: WorkMore1Job
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

(Do/Does)/On December 31, (YEAR), did) (you/(PERSON)) (currently) work at more than one job or business?
HELP: F1

YES 1 EM80 (EMA1185)
NO 2 EM50 (EMA1040)
REFUSED RF EM50 (EMA1040)
DON'T KNOW DK EM50 (EMA1040)

Display '(Do/Does)' if not round 5.
Display 'on December 31, /(YEAR), did' where 'year' is the second calendar year of the panel, if round 5.
Display (currently) if not round 5. Otherwise, use a null display.

BLAISE NAME: JobARoster
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

What is the name of (your/(PERSON)'s) employer or business (that (you/he/she) could return to)?
SELECT EMPLOYER/BUSINESS NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF NOT ON THE LIST, PRESS CTRL-A TO ENTER A NEW EMPLOYER/BUSINESS.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

(JobsEstbName) 1 1 BOX_40 (EMA1145)
(JobsEstbName) 2 2 BOX_40 (EMA1145)
(JobsEstbName) 3 3 BOX_40 (EMA1145)
(JobsEstbName) 4 4 BOX_40 (EMA1145)
(JobsEstbName) N 5 BOX_40 (EMA1145)

Roster behavior: Roster 3 ? add/edit/delete allowed
Only single select or single add allowed.
Limited edit allowed.
Limited delete allowed.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ and DeDupOrgTp].
Regardless of whether organization is selected or added, set Job.DeDupOrgID equal to DedupOrg.DedupOrgID and Job.JobsEstbName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Employer.
Allow 40 characters for DeDupOrgName roster entries.

Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
When CTRL-A selected, display the following customized question wording in the pop-up:ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.
Display (that (you/he/she) could return to) if EM30 coded ?1? (YES).

Set JobTp equal to CURRENT MAIN.
Set RetireJob equal to NO
Continue with EM60_01

BLAISE NAME: JobAStartYYYY
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

When did (you/(PERSON)) start working at that job?
ENTER 4-DIGIT YEAR

Responses:1

REFUSED RF EM170 (EMA1730)
DON'T KNOW DK EM170 (EMA1730)

Set JobStartYYYY
If year is on or after reference year minus 1, continue with EM60_02.
Otherwise, go to BOX_50.

Display EM60_01, EM60_02, and EM60_03 on the same form pane.

BLAISE NAME: JobAStartMM
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER MONTH

Responses: 1

REFUSED RF BOX_50 (EMA1165)
DON'T KNOW DK BOX_50 (EMA1165)

Programmer Instructions: Set JobStartMM

If year is on or after reference year, continue with EM60_03. Otherwise, go to BOX_50.

Display Instructions:

Display EM60_01, EM60_02, and EM60_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

BLAISE NAME: JobAStartDD
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER DAY

1 BOX_50 (EMA1165)
REFUSED RF BOX_50 (EMA1165)
DON'T KNOW DK BOX_50 (EMA1165)

Programmer Instructions: Set JobStartDD

Range check:
Edit: job start date must be equal to greater than Person.DOBM, Person.DOBD, Person.DOBY + 12 years and less than or equal to the reference period end date for this person. If a date of birth is not available, then job start date must be less than or equal to the reference period end date for this person.
If date is outside the range display the following message: "DATE INCONSISTENT WITH AGE. PLEASE VERIFY AND RE-ENTER."
Hard Check: If date entered is after person's reference period end date (EndRefM, EndRefD, EndRefY) display the following message: ?JOB START DATE MUST BE ON OR BEFORE (PERSON?S REFERENCE PERIOD END DATE). PLEASE VERIFY AND RE-ENTER.?

Display Instructions: 

Display EM60_01, EM60_02, and EM60_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

If job start date (EM60_01, EM60_02, and EM60_03) less than or equal to (on or before) reference period start date, go to EM230.
If month field of job start date is missing (that is, EM60_02 or EM60_03 is coded 'RF' or 'DK') and if the year of job start date (EM60_01) is reference year, continue with EM170.
Else go to EM170.

BLAISE NAME: JobBRoster
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Please think about (your/(PERSON)?s) main job or business. What is the name of (your/(PERSON)'s) main job or business?
SELECT EMPLOYER/BUSINESS NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF NOT ON THE LIST, PRESS CTRL-A TO ENTER A NEW EMPLOYER/BUSINESS.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

(JobsEstbName) 1 1 BOX_60 (EMA1290)
(JobsEstbName) 2 2 BOX_60 (EMA1290)
(JobsEstbName) 3 3 BOX_60 (EMA1290)
(JobsEstbName) 4 4 BOX_60 (EMA1290)
(JobsEstbName) N 5 BOX_60 (EMA1290)

Roster behavior: Roster 3 ? add/edit/delete allowed
1. Only single select or single add allowed.
2. Limited edit allowed.
3. Limited delete allowed.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ and DeDupOrgTp].
Regardless of whether organization is selected or added, set Job.DeDupOrgID equal to DedupOrg.DedupOrgID and Job.JobsEstbName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Employer.
Allow 40 characters for DeDupOrgName roster entries.

Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
When CTRL-A selected, display the following customized question wording in the pop-up:ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.

Set JobTp equal to CURRENT MAIN
Set RetireJob equal to NO.
Continue with EM90_01

BLAISE NAME: JobBStartYYYY
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

When did (you/(PERSON)) start working at that job?
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF EM100 (EMA1325)
DON'T KNOW DK EM100 (EMA1325)

Programmer Instructions: Set JobStartYYYY

If year is on or after reference year minus 1, continue with EM90_02.
Otherwise, go to EM100.

Display EM90_01, EM90_02, and EM90_03 on the same form pane.

BLAISE NAME: JobBStartMM
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER MONTH

Responses: 1

REFUSED RF EM100 (EMA1325)
DON'T KNOW DK EM100 (EMA1325)

Programmer Instructions: Set JobStartMM

If year is on or after reference year, continue with EM90_03. Otherwise, go to EM100.

Display EM90_01, EM90_02, and EM90_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

BLAISE NAME: JobBStartDD
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER DAY

1 EM100 (EMA1325)
REFUSED RF EM100 (EMA1325)
DON'T KNOW DK EM100 (EMA1325)

Programmer Instructions: Set JobStartDD

Range check:
Edit: job start date must be equal to greater than Person.DOBM, Person.DOBD, Person.DOBY + 12 years and less than or equal to the reference period end date for this person. If a date of birth is not available, then job start date must be less than or equal to the reference period end date for this person.
If date is outside the range display the following message: "DATE INCONSISTENT WITH AGE. PLEASE VERIFY AND RE-ENTER."
Hard Check: If date entered is after person's reference period end date (EndRefM, EndRefD, EndRefY) display the following message: ?JOB START DATE MUST BE ON OR BEFORE (PERSON?S REFERENCE PERIOD END DATE). PLEASE VERIFY AND RE-ENTER.?

Display EM90_01, EM90_02, and EM90_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

BLAISE NAME: JobCRoster
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

You mentioned that (you/(PERSON)) ((have/has)/had) another job (now/on December 31,(YEAR)). What is the name of (your/(PERSON)'s) employer or business?
SELECT EMPLOYER/BUSINESS NAMED BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF IS NOT ON THE LIST, PRESS CTRL-A TO ENTER A NEW EMPLOYER/BUSINESS.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

(JobsEstbName) 1 1 BOX_70 (EMA1480)
(JobsEstbName) 2 2 BOX_70 (EMA1480)
(JobsEstbName) 3 3 BOX_70 (EMA1480)
(JobsEstbName) 4 4 BOX_70 (EMA1480)
(JobsEstbName) N 5 BOX_70 (EMA1480)

Roster behavior: Roster 3 ? add/edit/delete allowed
Only single select or single add allowed.
Limited edit allowed.
Limited delete allowed.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ and DeDupOrgTp].
Regardless of whether organization is selected or added, set Job.DeDupOrgID equal to DedupOrg.DedupOrgID and Job.JobsEstbName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Employer.
Allow 40 characters for DeDupOrgName roster entries.

Display Instructions: Roster 3 ? add/edit/delete allowed

Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
When CTRL-A selected, display the following customized question wording in the pop-up:ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.
Display ?now? if not round 5.
Display ?on December 31, (YEAR)? if round 5.
Display ?(have/has)? if not round 5.
Display ?had? if round 5.

Set JobTp equal to CURRENT MISC
Set RetireJob equal to NO.
Continue with EM110_01.

BLAISE NAME: JobCStartYYYY
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

When did (you/(PERSON)) start working at that job?
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF BOX_80 (EMA1500)
DON'T KNOW DK BOX_80 (EMA1500)

Programmer Instructions: Set JobStartYYYY

If year is on or after reference year minus 1, continue with EM110_02.
Otherwise, go to BOX_80.

Display EM110_01, EM110_02, and EM110_03 on the same form pane.

BLAISE NAME: JobCStartMM
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER MONTH

Responses: 1

REFUSED RF BOX_80 (EMA1500)
DON'T KNOW DK BOX_80 (EMA1500)

Programmer Instructions: Set JobStartMM

If year is on or after reference year, continue with EM110_03. Otherwise, go to BOX_80.

Display EM110_01, EM110_02, and EM110_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

BLAISE NAME: JobCStartDD
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER DAY

1 BOX_80 (EMA1500)
REFUSED RF BOX_80 (EMA1500)
DON'T KNOW DK BOX_80 (EMA1500)

Programmer Instructions: Set JobStartDD

Range check:
Edit: job start date must be equal to greater than Person.DOBM, Person.DOBD, Person.DOBY + 12 years and less than or equal to the reference period end date for this person. If a date of birth is not available, then job start date must be less than or equal to the reference period end date for this person.
If date is outside of the range display the following message: "DATE INCONSISTENT WITH AGE. PLEASE VERIFY AND RE-ENTER."
Hard Check: If date entered is after person's reference period end date (EndRefM, EndRefD, EndRefY) display the following message: ?JOB START DATE MUST BE ON OR BEFORE (PERSON?S REFERENCE PERIOD END DATE). PLEASE VERIFY AND RE-ENTER.?

Display EM110_01, EM110_02, and EM110_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

If job start date of current main job (EM90_01. EM90_02, EM90_03) less than or equal to (on or before) reference period start date, go to EM230.
If job start date of current main job (EM90) greater than (after) reference period start date, or if EM90_01 is coded 'RF' or 'DK', go to EM170.
If month field of job start date is missing (that is, EM90_02 or EM90_03 is coded 'RF' or 'DK') and if the year of job start date (EM90_01) is reference year, continue with EM170.

BLAISE NAME: JobDRoster
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)