Access to Care (AC) Section

BOX_00 (AC1000)

Route Details:

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

BOX_10 (AC1005)

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.

BOX_20 (AC1010)

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

LOOP_10 (AC1015)

Route Details:

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)

AC10 (AC1020)

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

Responses:

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)

Display Instructions:

AC20 (AC1025)

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?

Responses:

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

Display Instructions:

AC30 (AC1030)

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?

Responses:

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 Instructions:

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.

AC40 (AC1035)

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

Responses:

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)

Display Instructions:

BOX_30 (AC1036)

Route Details:

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

BOX_40 (AC1055)

Route Details:

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.

AC50 (AC1060)

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?

AC60 (AC1065)

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]?

Responses:

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)

Display Instructions:

BOX_50 (AC1070)

Route Details:

If this USC provider is a ?PERSON-TYPE-PROVIDER? OR 'PERSON IN FACILITY-TYPE-PROVIDER' and
If (Round 2) and (AC70 was not asked for this USC provider in an earlier loop)
or
If (Round 4) and (AC70 was not asked in Round 2 for this USC provider [Preload.ProvDoc = empty]) and (AC70 was not asked for this USC provider in an earlier loop in Round 4)
or
If (Round 4) and (AC70 was coded as refused or don?t know for this USC provider in Round 2 [Preload.ProvDoc = RF, DK]) and (AC70 was not asked for this USC provider in an earlier loop in Round 4)
or
If (Round 4) and (AC70 was coded ?1? (YES) and AC90 was coded as refused or don?t know for this USC provider in Round 2 [Preload.ProvDoc = Yes and Preload.ProvSpecIt=DK, RF]) and (AC70 was not asked for this USC provider in an earlier loop in Round 4)
or
If (Round 4) and (AC70 was coded ?2? (NO) and AC80 was coded as refused or don?t know for this USC provider in Round 2 [Preload.ProvDoc = No and Preload.ProvOthType=DK, RF]) and (AC70 was not asked for this USC provider in an earlier loop in Round 4), continue with AC70.
Otherwise, go to BOX_60.

AC70 (AC1075)

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:

AC80 (AC1080)

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

Is [PROVIDER] a nurse, nurse practitioner, physician's assistant, midwife, or some other kind of person?
SELECT 'CHIROPRACTOR' IF CHIROPRACTOR VOLUNTEERED AS TYPE OF MEDICAL PERSON.
HELP: F1

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.

AC80OS (AC1085)

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

SPECIFY: OTHER TYPE

Responses:

1 BOX_60 (AC1096)
REFUSED RF BOX_60 (AC1096)
DON'T KNOW DK BOX_60 (AC1096)

Display Instructions:

Display AC80 and AC80OS on the same form pane.

AC90 (AC1090)

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?

Responses:

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 Instructions:

Display AC90 and AC90OS on the same form pane.

AC90OS (AC1095)

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.

Responses:

1 BOX_60 (AC1096)
REFUSED RF BOX_60 (AC1096)
DON'T KNOW DK BOX_60 (AC1096)

Display Instructions:

Display AC90 and AC90OS on the same form pane.

BOX_60 (AC1096)

Route Details:

If this USC provider is a 'PERSON-TYPE-PROVIDER' or 'PERSON IN FACILITY TYPE-PROVIDER' and [(AC100 not already answered this round for this same USC provider in an earlier cycle) or (if round 4 and Preload.ProvHispLat=DK, RF, or EMPTY (i.e., AC100 never asked in round 2, DK, or RF) for this same USC provider)], go to AC100.
Otherwise, go to BOX_70.

AC100 (AC1100)

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?

Responses:

YES 1 BOX_70 (AC1101)
NO 2 BOX_70 (AC1101)
REFUSED RF BOX_70 (AC1101)
DON'T KNOW DK BOX_70 (AC1101)

Display Instructions:

BOX_70 (AC1101)

Route Details:

If this USC provider is a 'PERSON-TYPE-PROVIDER' or 'PERSON IN FACILITY TYPE-PROVIDER' and (AC110 not already answered this round for this same USC provider in an earlier cycle) or (if round 4 and Preload.AskProvRace=1 (YES) (i.e., AC110 never asked, or RF, DK in round 2) for this same USC provider)], go to AC110.
Otherwise, go to BOX_80.

AC110 (AC1110)

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.

Responses:

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)

Display Instructions:

BOX_80 (AC1111)

Route Details:

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.

AC120 (AC1115)

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?

Responses:

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

Display Instructions:

END_LP10 (AC1120)

Route Details:

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.

BOX_90 (AC1121)

Route Details:

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.

LOOP_20 (AC1130)

Route Details:

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.

AC140 (AC1140)

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?

Responses:

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 Instructions:

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.

AC150 (AC1145)

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?

Responses:

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

Display Instructions:

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?

Responses:

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 Instructions:

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

AC170 (AC1155)

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

Responses:

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

Display Instructions:

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

AC180 (AC1160)

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?

Responses:

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.

AC190 (AC1165)

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]?

Responses:

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

Display Instructions:

BOX_100 (AC1166)

Route Details:

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.

AC200 (AC1175)

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?

Responses:

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

Display Instructions:

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.

END_LP20 (AC1180)

Route Details:

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.

AC210 (AC1185)

BLAISE NAME: DelayCare
Question Text:

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

Responses:

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

Programmer Instructions:

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

Display Instructions:

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

AC220 (AC1186)

BLAISE NAME: DelayWho
Question Text:

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

Responses:

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

Programmer Instructions:

Go to AC230.

Display Instructions:

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

AC230 (AC1187)

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?

Responses:

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

Programmer Instructions:

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 Instructions:

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

AC240 (AC1188)

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.

Responses:

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

Programmer Instructions:

Go to AC250.

Display Instructions:

AC250 (AC1189)

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?

Responses:

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

Programmer Instructions:

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.

Display Instructions:

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

AC260 (AC1190)

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.

Responses:

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

Programmer Instructions:

Go to AC270.

Display Instructions:

AC270 (AC1191)

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?

Responses:

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

Programmer Instructions:

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 Instructions:

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

AC280 (AC1192)

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.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5
Programmer Instructions: Go to 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.

AC290 (AC1193)
BLAISE NAME: DelayCarePM
Question Text:

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?

Responses:

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

Programmer Instructions:

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.

Display Instructions:

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

AC300 (AC1194)

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.

Responses:

Programmer Instructions:

Go to AC310.

Display Instructions:

AC310 (AC1195)

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?

Responses:

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

Programmer Instructions:

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 Instructions:

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

AC320 (AC1196)

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.

Responses:

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

Programmer Instructions:

Go to BOX_110.

Display Instructions:

BOX_110 (AC1215)

Route Details: Go to next questionnaire section.

Additional Healthcare Questions (AH) Section

BOX_00 (AH1000)

Route Details:

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

BOX_10 (AH1005)

Route Details:

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.

BOX_20 (AH1010)

Route Details:

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.

BOX_30 (AH1015)

Route Details:

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

AH10 (AH1025)

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

Responses:

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 Instructions:

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.

AH20 (AH1030)

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 Instructions:

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.

BOX_40 (AH1035)

Route Details:

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

AH30 (AH1040)

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).

BOX_50 (AH1045)

Route Details:

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

AH40 (AH1050)

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

Responses:

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.

AH50 (AH1055)

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

Responses:

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.?

Display Instructions:

BOX_60 (AH1060)

Route Details:

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

AH60 (AH1065)

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

Responses:

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).

BOX_70 (AH1070)

Route Details:

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.

AH70 (AH1075)

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

Responses:

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.

Display Instructions:

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'.

AH80 (AH1080)

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?

PROBE:

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

Responses:

[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

Roster Definition:

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

Roster Filter:

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.

BOX_80 (AH1085)

Route Details:

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

BOX_90 (AH1090)

Route Details:

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

LOOP_10 (AH1095)

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).

AH90 (AH1100)

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?]

Responses:

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.

END_LP10 (AH1105)

Route Details:

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.

BOX_100 (AH1110)

Route Details:

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

BOX_110 (AH1115)

Route Details:

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

AH100 (AH1120)

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?

Responses:

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

Display Instructions:

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

Responses:

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

Display Instructions:

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?

Responses:

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)

Display Instructions:

BOX_120 (AH1135)

Route Details:

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

Assets (AS) Section

BOX_00 (AS1000)
Route Details:

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

BOX_10 (AS1001)

Route Details:

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

AS10 (AS1005)

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:

AS20 (AS1010)

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.

Responses:

YES 1 AS30 (AS1015)
NO 2 AS90 (AS1085)
REFUSED RF AS90 (AS1085)
DON'T KNOW DK AS90 (AS1085)

Display Instructions:

AS30 (AS1015)

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.

Responses:

(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.

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 entries on the roster.

AS40 (AS1020)

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

Responses:

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

Display Instructions:

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.

AS50 (AS1025)

BLAISE NAME: HomeValueRng
Question Text:

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

Responses:

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)

Display Instructions:

AS60 (AS1030)

BLAISE NAME: HomeOwe
Question Text:

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

Responses:

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

Display Instructions:

AS70 (AS1035)

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

Responses:

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

Display Instructions:

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.

AS80 (AS1040)

BLAISE NAME: AmtHomeOweRng
Question Text:

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

Responses:

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)

Display Instructions:

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

Responses:

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

Display Instructions:

AS100 (AS1095)

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

Responses:

(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.

AS110 (AS1105)

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

Responses:

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

Display Instructions:

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.

AS120 (AS1115)

BLAISE NAME: RetirAcctValueRng
Question Text:

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

Responses:

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

Display Instructions:

BOX__20 (AS1275)

Route Details:

Go to next questionnaire section.

Calendar (CA) Section

BOX_00 (CA1000)

Route Details:

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

CA10 (CA1005)

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?

Responses:

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.

Display Instructions:

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).

CA20 (CA1010)

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))?

Responses:

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)

Display Instructions:

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).

CA30_01 (CA1015)

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.

Responses:

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

Programmer Instructions:

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.

CA30_02 (CA1020)

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.

Responses:

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

Display Instructions:

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.

CA30_03 (CA1025)

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.

Responses:

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

Display Instructions:

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.

CA30_04 (CA1030)

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.

Responses:

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

Display Instructions:

CA30_05 (CA1035)

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.

Responses:

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

Programmer Instructions:

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

Display Instructions:

CA30_06 (CA1037)

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.

Responses:

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

Programmer Instructions:

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.

Display Instructions:

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.

CA30_07 (CA1040)

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.

Responses:

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

Programmer Instructions:

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 Instructions:

CA30_08 (CA1045)

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 Instructions:

CA40 (CA1055)

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.

BOX_10 (CA1060)

Route Details:

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

LOOP_10 (CA1065)

Route Details:

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.

LOOP_20 (CA1070)

Route Details:

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).

BOX_15 (CA1071)

Programmer Instructions:

(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.

CA43 (CA1072)

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

Responses:

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)

Programmer Instructions:

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 Instructions:

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?.

CA46 (CA1073)

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?

Responses:

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)

Display Instructions:

BOX_18 (CA1074)

Route Details:

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.)

CA50 (CA1075)

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?

BOX_20 (CA1080)

Route Details:

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.

CA60 (CA1085)

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)?

Responses:

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

Programmer Instructions:

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

Display Instructions:

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

CA70 (CA1090)

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.

Responses:

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

Programmer Instructions:

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 Instructions:

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

CA80_01 (CA1095)

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)?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

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.

Display Instructions:

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.

END_LP20 (CA1115)

Route Details:

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.

END_LP10 (CA1120)

Route Details:

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.

BOX_30 (CA1125)

Route Details:

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.

LOOP_30 (CA1130)

Route Details:

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.

BOX_40 (CA1135)

Route Details:

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

CA90 (CA1140)

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?

Responses:

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

Programmer Instructions: RF and DK disallowed.
Display Instructions:

CA100 (CA1145)

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?

Responses:

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.

Display Instructions:

END_LP30 (CA1150)

Route Details:

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.

BOX_50 (CA1155)

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

Closing (CL) Section

BOX_00 (CL1001)

Route Details:

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

BOX_10 (CL1005)

Route Details:

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

CL10 (CL1505)

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.

Responses:

CONTINUE 1

Programmer Instructions:

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

Display Instructions:

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.'

CL20 (CL1510)

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.

Responses:

> 1 BOX_20 (CL1525)

Programmer Instructions:

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.

Display Instructions:

> 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.

BOX_20 (CL1525)
Route Details: If respondent for this interviewing session is a proxy, continue with BOX_30.
Otherwise, go to BOX_40.

BOX_30 (CL1531)

Route Details:

> 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.

CL30 (CL1536)

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?

Responses:

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)

Programmer Instructions:

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.

Display Instructions:

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)

CL40_01 (CL1541)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL40_02 (CL1546)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL40_01.

Display Instructions:

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.

CL40_03 (CL1551)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL40_01.

Display Instructions:

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.

CL40_04 (CL1556)

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]

Responses:

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

Programmer Instructions:

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

Display Instructions:

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.

CL40_05 (CL1561)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL40_06 (CL1566)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

BOX_40 (CL1567)

Route Details:

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.

BOX_50 (CL1568)

Route Details:

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.

CL50 (CL1569)

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

Responses:

>[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)

Programmer Instructions:

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 Instructions:

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.

CL60 (CL1570)

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]?

Responses:

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

Display Instructions:

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.

CL70 (CL1575)

BLAISE NAME: NumAltPhone
Question Text:

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

Responses:

1 CL80_01 (CL1580)

Programmer Instructions:

Refused and Don't Know disallowed.

Display Instructions:

Display CL60 and CL70 on the same form pane.

CL80_01 (CL1580)

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.

Responses:

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

Programmer Instructions:

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

Display Instructions:

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.

CL80_02 (CL1585)

BLAISE NAME: AltPhoneTypeOS
Question Text:

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

Responses: 1

Programmer Instructions:

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 Instructions:

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

CL80_03 (CL1590)

BLAISE NAME: AltPhoneWho
Question Text:

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

Responses:

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

Programmer Instructions:

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 Instructions:

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

CL80_04 (CL1595)

BLAISE NAME: AltPhoneName
Question Text:

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

Responses: 1

Programmer Instructions:

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 Instructions:

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

CL80_05 (CL1600)

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.

Responses: 1

REFUSED RF
DON'T KNOW DK

Programmer Instructions:

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 Instructions:

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.

CL80_06 (CL1605)

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.

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

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

Display Instructions:

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.

CL80_07 (CL1610)

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.

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

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 Instructions:

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.

BOX_60 (CL1615)

Route Details:

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.

CL90 (CL1620)

BLAISE NAME: StillEmail
Question Text:

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

Responses:

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)

Programmer Instructions:

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.

Display Instructions:

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

CL100 (CL1625)

BLAISE NAME: UseEmail
Question Text:

Do you send or receive emails?

Responses:

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

Display Instructions:

CL110 (CL1630)

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.

Responses:

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

Programmer Instructions:

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 Instructions:

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?'

CL120 (CL1635)

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?

Responses:

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 Instructions:

Display CL120 and CL120OS on the same form pane.

CL120OS (CL1640)

BLAISE NAME: EmailTypeOS
Question Text:

SPECIFY TYPE OF EMAIL ACCOUNT:

Responses:

1 CL130 (CL1645)

Programmer Instructions:

Refused and Don't Know disallowed.

Display Instructions:

Display CL120 and CL120OS on the same form pane.

CL130 (CL1645)

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 Instructions:

Display CL130 and CL140 on the same form pane.

CL140 (CL1650)

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:

Responses:

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 Instructions:

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

BOX_70 (CL1655)

Route Details:

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

BOX_80 (CL1660)

Route Details:

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.

CL150 (CL1665)

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]?

Responses:

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

Programmer Instructions:

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.

Display Instructions:

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.

CL160 (CL1670)

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]?

Responses:

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

Display Instructions:

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.

CL170_01 (CL1675)

BLAISE NAME: ContPersFName
Question Text:

What is that person's first name?

Responses:

1 CL170_02 (CL1680)

Programmer Instructions:

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 Instructions:

Display CL170_01 through CL170_09 vertically on the same form pane.

CL170_02 (CL1680)

BLAISE NAME: ContPersLName
Question Text:

What is that person's last name?

Responses:

1 CL170_03 (CL1685)

Programmer Instructions:

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 Instructions:

Display CL170_01 through CL170_09 vertically on the same form pane.

CL170_03 (CL1685)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL170_04 (CL1690)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL170_03.

Display Instructions:

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.

CL170_05 (CL1695)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL170_03.

Display Instructions:

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.

CL170_06 (CL1700)

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]

Responses:

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

Programmer Instructions:

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

Display Instructions:

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.

CL170_07 (CL1705)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL170_08 (CL1710)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL170_09 (CL1715)

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.]

Responses:

1 BOX_90 (CL1720)

Programmer Instructions:

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 Instructions:

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.

BOX_90 (CL1720)

Route Details:

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.

CL180 (CL1725)

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?

Responses:

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

Programmer Instructions:

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.

Display Instructions:

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.)

BOX_100 (CL1730)

Route Details:

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.

CL190 (CL1735)

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.

Responses:

[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)

Programmer Instructions:

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 Instructions:

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.

CL200_01 (CL1740)

BLAISE NAME: AltRespFName
Question Text:

What is that person's first name?

Responses:

1 CL200_02 (CL1745)

Programmer Instructions:

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 Instructions:

Display CL200_01 through CL200_09 vertically on the same form pane.

CL200_02 (CL1745)

BLAISE NAME: AltRespLName
Question Text:

What is that person's last name?

Responses:

1 CL200_03 (CL1750)

Programmer Instructions:

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 Instructions:

Display CL200_01 through CL200_09 vertically on the same form pane.

CL200_03 (CL1750)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL200_04 (CL1755)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL200_03.

Display Instructions:

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.

CL200_05 (CL1760)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL200_03.

Display Instructions:

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.

CL200_06 (CL1765)

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]

Responses:

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

Programmer Instructions:

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

Display Instructions:

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.

CL200_07 (CL1770)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL200_08 (CL1775)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL200_09 (CL1780)

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.]

Responses:

1 BOX_110 (CL1785)

Programmer Instructions:

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 Instructions:

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.

BOX_110 (CL1785)

Route Details:

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.

CL210 (CL1790)

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?

Responses:

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)

Programmer Instructions:

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.

Display Instructions:

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".

CL220 (CL1795)

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?

Responses:

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

Display Instructions:

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.

CL230_01 (CL1800)

BLAISE NAME: MailStrt1
Question Text:

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

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL230_02 (CL1805)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL230_01.

Display Instructions:

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.

CL230_03 (CL1810)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL230_01.

Display Instructions:

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.

CL230_04 (CL1815)

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]

Responses:

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

Programmer Instructions:

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

Display Instructions:

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.

CL230_05 (CL1820)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

BOX_120 (CL1825)

Route Details:

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

BOX_130 (CL1830)

Route Details:

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.

CL240 (CL1835)

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?

Responses:

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)

Programmer Instructions:

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.

Display Instructions:

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)

CL250 (CL1840)

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?

Responses:

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

Display Instructions:

CL260_01 (CL1845)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL260_02 (CL1850)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL260_01.

Display Instructions:

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.

CL260_03 (CL1855)

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]

Responses:

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

Programmer Instructions:

See general programming instructions at CL260_01.

Display Instructions:

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.

CL260_04 (CL1860)

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]

Responses:

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

Programmer Instructions:

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

Display Instructions:

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.

CL260_05 (CL1865)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL260_06 (CL1870)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL270 (CL1875)

BLAISE NAME: FutuMvr3Mon
Question Text:

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

Responses:

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

Programmer Instructions:

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.

Display Instructions:

CL280 (CL1880)

BLAISE NAME: WhoFutuMvrRoster
Question Text:

Who is that?
PROBE: Anyone else?

Responses:

[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)

Programmer Instructions:

Roster Behavior:
1. Multiple Select Allowed.

Display Instructions:

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.

LOOP_10 (CL1885)

Route Details:

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)

CL290_01 (CL1890)

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]

Responses:

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

Display Instructions:

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.

CL290_02 (CL1895)

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]

Responses:

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

Display Instructions:

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.

CL290_03 (CL1900)

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]

Responses:

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

Display Instructions:

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.

CL290_04 (CL1905)

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]

Responses:

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

Programmer Instructions:

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

Display Instructions:

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.

CL290_05 (CL1910)

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]

Responses:

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

Programmer Instructions:

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 Instructions:

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.

CL290_06 (CL1915)

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]

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

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 Instructions:

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.

CL300 (CL1920)

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?

Responses:

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

Display Instructions:

CL310 (CL1925)

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.

Responses:

[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)

Programmer Instructions:

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

Display Instructions:

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

END_LP10 (CL1930)

Route Details:

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.

CL320 (CL1935)

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.]

Responses:

CHECK 1 CL330 (CL1940)
CASH 2 BOX_140 (CL1945)

Display Instructions:

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.

CL330 (CL1940)

BLAISE NAME: CheckNum
Question Text:

CHECK NUMBER:

Responses:

1 BOX_140 (CL1945)

Programmer Instructions:

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 Instructions:

Display CL320 and CL330 on the same form pane.

BOX_140 (CL1945)

Route Details:

End interview.

Charge/Payment (CP) Section

BOX_00 (CP1000)

Route Details:

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

BOX_10 (CP1001)

Route Details:

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).

BOX_20 (CP1005)

Route Details:

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.

BOX_30 (CP1050)

Route Details:

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)).

BOX_40 (CP1051)

Route Details:

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).

CP10 (CP1055)

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

Responses:

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

Programmer Instructions:

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.

Display Instructions:

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.

CP20 (CP1056)

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

Responses:

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)

Programmer Instructions:

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.

Display Instructions:

CP30 (CP1060)

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

Responses:

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."

Display Instructions:

CP40 (CP1061)

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

Responses:

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

Programmer Instructions:

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.

Display Instructions:

CP50 (CP1065)

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

Programmer Instructions:

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 Instructions:

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).

CP60 (CP1075)

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

Responses:

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

Programmer Instructions:

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).

CP70 (CP1080)

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]?

Responses:

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 Instructions:

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).

CP80 (CP1085)

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

Responses:

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)

Programmer Instructions:

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 Instructions:

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.

CP90 (CP1090)

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.

Responses:

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

Display Instructions:

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

Responses:

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)

Display Instructions:

BOX_50 (CP1096)

Route Details:

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.

CP110 (CP1097)

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?

Responses:

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

Programmer Instructions:

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.

Display Instructions:

BOX_60 (CP1098)

Route Details:

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.

BOX_70 (CP1100)

Route Details: If:

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

CP120 (CP1105)

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

Responses:

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 Instructions:

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.

BOX_80 (CP1106)

Route Details:

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

CP130 (CP1107)

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

Responses:

$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 Instructions:

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

CP140 (CP1110)

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]]

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.
[SELECT 'INCLUDED WITH OTHER CHARGES' IF THIS IS A FLAT FEE SITUATION.]

Responses:

AMOUNT 1 CP150 (CP1115)
[INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)] 95

Programmer Instructions:

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.

CP150 (CP1115)

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.

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

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 Instructions:

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.

CP160 (CP1120)

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?

Responses:

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

Programmer Instructions:

[$ 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.

Display Instructions:

CP170 (CP1125)

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

Responses:

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)

Display Instructions:

CP180 (CP1126)

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

Responses:

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)

Display Instructions:

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

Responses:

$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)

Display Instructions:

CP200 (CP1130)

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

Responses:

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

Programmer Instructions:

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 Instructions:

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.

BOX_90 (CP1145)

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.

CP210 (CP1160)

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

Responses:

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

Display Instructions:

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).

CP220 (CP1165)

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

Responses:

[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)

Programmer Instructions:

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.

Display Instructions:

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

CP230 (CP1170)

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]

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

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)."

Display Instructions:

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.

BOX_100 (CP1295)

Route Details:

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

BOX_110 (CP1300)

Route Details:

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.

BOX_120 (CP1305)

Route Details:

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.

CP240 (CP1310)

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]?

Responses:

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

Display Instructions:

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.

BOX_130 (CP1485)

Route Details:

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.

BOX_140 (CP1490)

Route Details:

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.

BOX_150 (CP1495)

Route Details:

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.

Child Preventive Health (CS) Section

BOX_00 (CS1000)

Route Details:

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

BOX_10 (CS1001)

Route Details:

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).

BOX_20 (CS1005)

Route Details:

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.

BOX_30 (CS1010)

Route Details:

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.

BOX_40 (CS1030)

Route Details:

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

CS10 (CS1065)

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

Responses:

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.

CS20 (CS1070)

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?

Responses:

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.

CS30 (CS1075)

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?

Responses:

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.

CS40 (CS1080)

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?

Responses:

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.

CS50 (CS1085)

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?

Responses:

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.

CS60 (CS1090)

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.

CS70 (CS1095)

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.

CS80 (CS1100)

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?

Responses:

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.

CS90 (CS1105)

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?

Responses:

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.

CS100 (CS1110)

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.

CS110 (CS1115)

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?

Responses:

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.

CS120 (CS1120)

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?

Responses:

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.

CS130 (CS1125)

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?

Responses:

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.

CS140 (CS1130)

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.

BOX_50 (CS1135)

Route Details:

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.

CS150A (CS1145)

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?

Responses:

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."

Display Instructions:

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.

CS150B (CS1150)

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.

CS150C (CS1155)

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

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.

CS150D (CS1160)

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

Responses:

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.

CS160A (CS1165)

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?

Responses:

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."

Display Instructions:

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.

CS160B (CS1170)

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.

CS160C (CS1175)

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.

CS170A (CS1180)

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?

Responses:

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."

Display Instructions:

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.

CS170B (CS1185)

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?

Responses:

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.

CS170C (CS1190)

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.

CS180A (CS1195)

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."

Display Instructions:

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.

CS180B (CS1200)

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."

Display Instructions:

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.

CS180C (CS1205)

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.

BOX_60 (CS1206)

Route Details:

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.

CS190 (CS1210)

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.

CS200 (CS1215)

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?

Responses:

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.

CS210 (CS1220)

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.

CS220 (CS1225)

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?

Responses:

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.

CS230 (CS1230)

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?

Responses:

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)

Display Instructions:

CS240 (CS1245)

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?

Responses:

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)

Display Instructions:

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)

Display Instructions:

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)

Display Instructions:

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)

Display Instructions:

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)

Display Instructions:

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?

Responses:

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

Display Instructions:

CS300 (CS1275)

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?

Responses:

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)

Display Instructions:

BOX_70 (CS1276)

Programmer Instructions:

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.

CS310 (CS1280)

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

Programmer Instructions:

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.

CS320 (CS1285)

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

Programmer Instructions:

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.

CS330_01 (CS1295)

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)

Programmer Instructions:

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.

CS330_02 (CS1300)

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 Instructions:

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.

CS340 (CS1305)

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

Programmer Instructions:

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.

CS350 (CS1310)

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.

CS360 (CS1320)

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."

Display Instructions:

BOX_80 (CS1330)

Route Details:

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.

CS370 (CS1335)

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)

Display Instructions:

BOX_90 (CS1340)

Route Details:

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.

CS380 (CS1365)

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

Responses:

YES 1 CS390 (CS1370)
NO 2 CS400 (CS1375)
REFUSED RF CS400 (CS1375)
DON'T KNOW DK CS400 (CS1375)

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 CS380 and CS390 on the same form pane.

CS390 (CS1370)

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

When was that?

Responses:

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.

CS400 (CS1375)

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

Responses:

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.

CS410 (CS1380)

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

When was that?

Responses:

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.

BOX_100 (CS1385)

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.]

CS420 (CS1390)

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

Responses:

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.

CS430 (CS1395)

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

When was that?

Responses:

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.

CS440 (CS1400)

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

Responses:

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.

CS450 (CS1405)

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.

BOX_110 (CS1410)

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.

CS460 (CS1415)

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 Instructions:

CS470 (CS1420)

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

When was that?

Responses:

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.

BOX_120 (CS1425)

Route Details:

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.

CS480 (CS1430)

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

Responses:

YES 1 CS490 (CS1435)
NO 2 CS500 (CS1440)
REFUSED RF CS500 (CS1440)
DON'T KNOW DK CS500 (CS1440)

Display Instructions:

CS490 (CS1435)

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

When was that?

Responses:

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.

CS500 (CS1440)

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

Responses:

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.

CS510 (CS1445)

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

When was that?

Responses:

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.

BOX_130 (CS1450)

Route Details:

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.

CS520 (CS1455)

BLAISE NAME: ProvAlone

Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)

Question Text:

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?

Responses:

YES 1 BOX_140 (CS1465)
NO 2 BOX_140 (CS1465)
REFUSED RF BOX_140 (CS1465)
DON'T KNOW DK BOX_140 (CS1465)

Display Instructions:

BOX_140 (CS1465)

Route Details: Go to next questionnaire section.

Dental Visit (DN) Section

BOX_00 (DN1000)

Route Details:

01 Box equal to BOX_00, BOX_10
08 Multiple Select equal to DN10, DN20
20 OS Text Field equal to DN20OS

DN10 (DN1001)

BLAISE NAME: CodeAllDNProvTp
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

Question Text:

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

Responses:

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.

Display Instructions:

DN20 (DN1005)

BLAISE NAME: CodeAllDNSvc

Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

Question Text:

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

Responses:

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

Programmer Instructions:

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.

Display Instructions:

DN20OS (DN1010)

BLAISE NAME: DNSvcOS
Question Text:

SPECIFY: OTHER TYPE OF DENTAL CARE:

Responses:

1 BOX_10 (DN1025)
REFUSED RF BOX_10 (DN1025)
DON'T KNOW DK BOX_10 (DN1025)

Display Instructions:

BOX_10 (DN1025)

Route Details:

Event Driver (ED) Section

BOX_00 (ED1000)

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

BOX_10 (ED1005)

Route Details:

Context header display instructions: display PERS.FULLNAME, PROV.LORPNAME, EVPV.EVNTTYPE, EVPV.EVNTBEGM, EVPV.EVNTBEGD, and EVPV.EVNTBEGY.

Programmer Instructions:

Context header display instructions: display PERS.FULLNAME, PROV.LORPNAME, EVPV.EVNTTYPE, EVPV.EVNTBEGM, EVPV.EVNTBEGD, and EVPV.EVNTBEGY.

BOX_20 (ED1010)

Programmer Instructions: If this instance of ED was launched through the F2, Add/Review Overview button, continue with LOOP_10

.
LOOP_10 (ED1015)

Route Details:

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_20 (ED1020)

Route Details:

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.

ED10 (ED1025)

BLAISE NAME: EvntGrid

Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (EVN-DT) (EV)
(NAME OF MEDICAL CARE PROVIDER......)-(DOC or DEPT)

Question Text:

((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

Programmer Instructions:

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 Instructions:

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.

BOX_30 (ED1026)

Route Details:

Ask the Event Roster (EV) section.
At completion of EV section, return to ED10.

Programmer Instructions:

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.

BOX_40 (ED1030)

Route Details:

If event type is MV, OP, DN, ER go to ED20.
If event type is HS or IC, go to ED30_01

ED20 (ED1035)

BLAISE NAME: EvntDate

Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (EVN-DT) (EV) (NAME OF MEDICAL CARE PROVIDER......) (DOC or DEPT)

Question Text:

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 Instructions:

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.

ED30_01 (ED1040)

BLAISE NAME: EvntBegDate

Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (EV)

Question Text:

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

Programmer Instructions:

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 Instructions:

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.

ED30_02 (ED1045)

BLAISE NAME: EvntEndDate

Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (EV)

Question Text:

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)

Programmer Instructions:

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 Instructions:

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.

ED30_03 (ED1050)

BLAISE NAME: StillInHSIC

Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (EV)

Question Text:

DATE ENTERED: (ADMIT DATE)(DISCHARGE DATE)
Please tell me the date (you/(PERSON)) (were/was) discharged from the (hospital/facility).
ENTER DISCHARGE DATE.

Responses:

STILL IN (HOSPITAL/FACILITY) 1
EMPTY Empty

Programmer Instructions:

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 Instructions:

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.

END_LP20 (ED1055)

Route Details:

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.

END_LP10 (ED1060)

Route Details:

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.

BOX_50 (ED1065)

Route Details:

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.

Event Enumeration (EE) Section

BOX_00 (EE1000)

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
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

BOX_10 (EE1005)

Route Details:

If 'OTHER RU MEMBER' selected for the provider probe that launched this instance of the EE section, continue with EE10.
Otherwise, go LOOP_10.

EE10 (EE1010)

BLAISE NAME: RosterProbe
Question Text:

Who else (PROVIDER PROBE QUESTION TEXT)?
ENTER ALL THAT APPLY.

Responses:

(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)

Programmer Instructions:

Create event record for this person.
Roster Behavior:
Multiple select allowed.
RF/DK disallowed.

Display Instructions:

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"

LOOP_10 (EE1015)

Route Details:

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.

LOOP_20 (EE1020)

Route Details:

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.

BOX_20 (EE1025)

Route Details: If this is the first cycle of LOOP_20 for this person, go to EE20, otherwise go to BOX_30.

EE20 (EE1030)

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.

Responses:

CONTINUE 1 BOX_30 (EE1035)
Programmer Instructions: Create event record for this person.

Display Instructions:

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"

BOX_30 (EE1035)

Route Details: Ask the Event Roster (EV) section for record collection.
At completion of the EV section, continue with EE30.

EE30 (EE1040)

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)?

Responses:

YES 1 END_LP20 (EE1060)
NO 2
REFUSED RF
DON?T KNOW DK

Programmer Instructions:

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 Instructions:

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"

EE40 (EE1045)

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 Instructions:

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."

END_LP20 (EE1060)

Route Details:

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.

END_LP10 (EE1065)

Route Details:

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.

BOX_40 (EE1066)

Route Details:

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.

EE50_01 (EE1067)

BLAISE NAME: Glasses1
Question Text:

Did (DISPLAY NAME) purchase eye glasses or contact lenses between (START DATE) and (END DATE)?

Responses:

YES 1
NO 2
REFUSED RF
DON?T KNOW DK

Programmer Instructions:

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.

Display Instructions:

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.

BOX_50 (EE1070)

Route Details: Return to next probe in the Provider Probes (PP) section.

Event Follow-Up (EF) Section
Fall 2018

BOX_00 (EF1000)

Route Details:

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30
04 Single Select equal to EF10,EF20, EF30

BOX_10 (EF1005)

Route Details:

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.

EF10 (EF1010)

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.

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded ?1? (YES),?RF? (REFUSED), or ?DK? (DON?T KNOW) go to BOX_30.
If coded ?2? go to BOX_20.

EF20 (EF1015)

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.

Responses:

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.

Display Instructions:

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.

EF30 (EF1016)

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.

Responses:

ENTER EVENT FOR MOTHER 1
EVENT ALREADY RECORDED FOR MOTHER/NO MOTHER IN RU 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

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.

Display Instructions:

BOX_20 (EF1020)

Route Details:

Go to the EV section and create an event record for this person.
At the completion of the EV section, go to BOX_30.

BOX_30 (EF1025)

Route Details:

At the completion of the EV section, flag CP status of event-provider pair as 'PROCESSED' and go to the ED section.

Employment (EMA) Section
Fall 2018

BOX_00 (EMA1000)
Route Details:

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

BOX_10 (EMA1002)

Route Details:

Throughout the specifications for this CAPI section, REFERENCE YEAR refers to BegRefY.

BOX_20 (EMA1003)

Route Details:

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.

BOX_30 (EMA1005)

Route Details:

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.

EM10 (EMA1010)

BLAISE NAME: JobPay
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

(Now I have some questions about work experience for (you/(PERSON)).)(During our last interview on (PREV RD INTV DATE), we recorded that (you/(PERSON)) did not work at any job for pay.
((Do/Does)/As of December 31, (YEAR), did) (you/(PERSON)) (currently) have a job for pay or own a business (that we have not yet talked about)?

PROBE:

Do not count work around the house. Include work in a family farm or business, even if unpaid.

Responses:

YES 1 EM40 (EMA1025)
NO 2 EM20 (EMA1015)
REFUSED RF EM20 (EMA1015)
DON'T KNOW DK EM20 (EMA1015)

Display Instructions:

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)

EM20 (EMA1015)

BLAISE NAME:AnyWork
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

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

Responses:

YES 1 EM120 (EMA1520)
NO 2 EM30 (EMA1020)
REFUSED RF EM30 (EMA1020)
DON'T KNOW DK EM30 (EMA1020)

Display Instructions:

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.

EM30 (EMA1020)

BLAISE NAME: ReturnJob
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

((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

Responses:

YES 1 EM50 (EMA1040)
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

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 Instructions:

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)

EM40 (EMA1025)

BLAISE NAME: WorkMore1Job
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

(Do/Does)/On December 31, (YEAR), did) (you/(PERSON)) (currently) work at more than one job or business?
HELP: F1

Responses:

YES 1 EM80 (EMA1185)
NO 2 EM50 (EMA1040)
REFUSED RF EM50 (EMA1040)
DON'T KNOW DK EM50 (EMA1040)

Display Instructions:

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.

EM50 (EMA1040)

BLAISE NAME: JobARoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

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

Responses:

(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)

Programmer Instructions:

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:

BOX_40 (EMA1145)

Route Details:

Set JobTp equal to CURRENT MAIN.
Set RetireJob equal to NO
Continue with EM60_01

EM60_01 (EMA1150)

BLAISE NAME: JobAStartYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

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)

Programmer Instructions:

Set JobStartYYYY
If year is on or after reference year minus 1, continue with EM60_02.
Otherwise, go to BOX_50.

Display Instructions:

Display EM60_01, EM60_02, and EM60_03 on the same form pane.

EM60_02 (EMA1155)

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.

EM60_03 (EMA1160)

BLAISE NAME: JobAStartDD
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER DAY

Responses:

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.

BOX_50 (EMA1165)

Route Details:

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.

EM80 (EMA1185)

BLAISE NAME: JobBRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

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

Responses:

(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)

Programmer Instructions:

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.

Display Instructions:

BOX_60 (EMA1290)
Route Details:

Set JobTp equal to CURRENT MAIN
Set RetireJob equal to NO.
Continue with EM90_01

EM90_01 (EMA1295)

BLAISE NAME: JobBStartYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

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 Instructions:

Display EM90_01, EM90_02, and EM90_03 on the same form pane.

EM90_02 (EMA1300)

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 Instructions:

Display EM90_01, EM90_02, and EM90_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM90_03 (EMA1305)

BLAISE NAME: JobBStartDD
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER DAY

Responses:

1 EM100 (EMA1325)
REFUSED RF EM100 (EMA1325)
DON'T KNOW DK EM100 (EMA1325)

Programmer Instructions: Set JobStartDD

Display Instructions:

Display EM90_01, EM90_02, and EM90_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM100 (EMA1325)

BLAISE NAME: JobCRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

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

Responses:

(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)

Programmer Instructions:

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.

BOX_70 (EMA1480)

Route Details:

Set JobTp equal to CURRENT MISC
Set RetireJob equal to NO.
Continue with EM110_01.

EM110_01 (EMA1485)

BLAISE NAME: JobCStartYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

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 Instructions:

Display EM110_01, EM110_02, and EM110_03 on the same form pane.

EM110_02 (EMA1490)

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 Instructions:

Display EM110_01, EM110_02, and EM110_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM110_03 (EMA1495)

BLAISE NAME: JobCStartDD
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER DAY

Responses:

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 Instructions:

Display EM110_01, EM110_02, and EM110_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

BOX_80 (EMA1500)

Route Details:

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.

EM120 (EMA1520)

BLAISE NAME: JobDRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

Please think about the employer or business where (you/(PERSON)) worked (most recently/just before December 31(YEAR)). What is the name of (your/his/her) employer or business?
IF PERSON HAD MORE THAN ONE EMPLOYER/BUSINESS, PROBE: Please think about (your/his/her) main job at the time.
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
IF PERSON HAD MORE THAN ONE EMPLOYER/BUSINESS, PROBE: Please think about (your/his/her) main job at the time.

Responses:

(JobsEstbName) 1 1 BOX_90 (EMA1675)
(JobsEstbName) 2 2 BOX_90 (EMA1675)
(JobsEstbName) 3 3 BOX_90 (EMA1675)
(JobsEstbName) 4 4 BOX_90 (EMA1675)
(JobsEstbName) N 5 BOX_90 (EMA1675)

Programmer Instructions:

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 ?most recently? if not round 5.
'Display ?just before December 31, (YEAR)' where 'year' is the second calendar year of the panel, if round 5.'

BOX_90 (EMA1675)

Route Details:

Set JobTp equal to FORMER MAIN
Go to EM130_01.

EM130_01 (EMA1680)

BLAISE NAME: JobDStartYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

When did (you/(PERSON)) start working at that job?
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF EM140_01 (EMA1695)
DON'T KNOW DK EM140_01 (EMA1695)

Programmer Instructions: Set JobStartYYYY

If year is on or after reference year minus 1, continue with EM130_02.
Otherwise, go to EM140_01.

Display Instructions:

Display EM130_01, EM130_02, and EM130_03 on the same form pane.

EM130_02 (EMA1685)

BLAISE NAME: JobDStartMM
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER MONTH

Responses: 1

REFUSED RF EM140_01 (EMA1695)
DON'T KNOW DK EM140_01 (EMA1695)

Programmer Instructions: Set JobStartMM

If year is on or after reference year, continue with EM130_03.
Otherwise, go to EM140_01.

Display Instructions:

Display EM130_01, EM130_02, and EM130_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM130_03 (EMA1690)

BLAISE NAME: JobDStartDD
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER DAY

Responses:

1 EM140_01 (EMA1695)
REFUSED RF EM140_01 (EMA1695)
DON'T KNOW DK EM140_01 (EMA1695)

Programmer Instructions: Set JobStart DD

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 Instructions:

Display EM130_01, EM130_02, and EM130_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM140_01 (EMA1695)

BLAISE NAME: JobDStopYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

When did (you/(PERSON)) stop working at that job?
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF EM150 (EMA1715)
DON'T KNOW DK EM150 (EMA1715)

Programmer Instructions: Set JobStopYYYY

If year is on or after reference year minus 1, continue with EM140_02.
Otherwise, go to BOX_100.
Display EM140_01, EM140_02, and EM140_03 on the same form pane.

EM140_02 (EMA1700)

BLAISE NAME: JobDStopMM
Question Text:

[When did (you/(PERSON)) stop working at that job?]
ENTER MONTH

Responses: 1

REFUSED RF BOX_100 (EMA1710)
DON'T KNOW DK BOX_100 (EMA1710)

Programmer Instructions: Set JobStopMM

If year is on or after reference year, continue with EM140_03. Otherwise, go to BOX_100.

Display Instructions:

Display EM140_01, EM140_02, and EM140_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM140_03 (EMA1705)

BLAISE NAME: JobDStopDD
Question Text:

[When did (you/(PERSON)) stop working at that job?]
ENTER DAY

Responses:

1 BOX_100 (EMA1710)
REFUSED RF BOX_100 (EMA1710)
DON'T KNOW DK BOX_100 (EMA1710)

Programmer Instructions: Set JobStopDD

Range check:
Hard Check: the date entered at EM140_01, 02,03 must be greater than or equal to the date at EM130_01,_02, 03.
Display the following message: THE DATE ENTERED MUST BE ON OR AFTER THE JOB START DATE.
Edit: job end 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 end 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 END DATE MUST BE ON OR BEFORE (PERSON?S REFERENCE PERIOD END DATE). PLEASE VERIFY AND RE-ENTER.?

Display Instructions:

Display EM140_01, EM140_02, and EM140_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

BOX_100 (EMA1710)

Route Details:

If job end date (EM140_01, EM140_02, and EM140_03 ) less than (prior to) the reference period start date, go to EM150.
If job end date (EM140_01, EM140_02, and EM140_03) equal to or greater than (on or after) the reference period start date, go to BOX_110.
If month field of job end date is missing (that is, EM140_02 or EM140_03 is coded 'RF' or 'DK') and if the year of job end date (EM140_01) is reference year, continue with EM150.

EM150 (EMA1715)

BLAISE NAME: JobDStopBefAft
Context Header:

(PERSON?S FIRST, MIDDLE, AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

Can you tell me if (you/(PERSON)) stopped working at that job before or after (START DATE)?

Responses:

BEFORE (START DATE) 1
ON OR AFTER (START DATE) 2 BOX_110 (EMA1725)
REFUSED RF BOX_110 (EMA1725)
DON'T KNOW DK BOX_110 (EMA1725)

Programmer Instructions: Hard Check:

If EM150 is coded 1 display the following message:
?INTERVIEWER: RESPONDENT REPORTED IN EM20 (AnyWork) THAT (PERSON) HAD A JOB/BUSINESS SINCE (START DATE), BUT IS NOW REPORTING THAT THE JOB ENDED BEFORE (START DATE).
VERIFY THIS INCONSISTENT INFORMATION WITH THE RESPONDENT.?
IF DATE STOPPED WORKING IS BEFORE THE BEGINNING OF THE REFERENCE PERIOD, GO TO SCREEN EM20 (AnyWork) AND SELECT 'NO'.
IF DATE STOPPED WORKING IS AFTER THE REFERENCE PERIOD START DATE, GO TO SCREEN EM140_01 (JobDStopYYYY) AND RE-ENTER THE CORRECT JOB END DATE.
Questions Involved: EM20, EM140_01

Display Instructions:

BOX_110 (EMA1725)

Route Details:

If job start date of former main job (EM130_01, EM130_02, EM130_03) less than or equal to (before or on) reference period start date, go to EM230.
Otherwise (job start date (EM130_01, EM130_02, EM130_03) is after ( greater than ) reference period start date or it is not known if job start date is before or after the reference period start date), continue with EM170.

EM170 (EMA1730)

BLAISE NAME: PrevJob
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

(Other than (JobsEstbName FROM EM100), did/Did) (you/(PERSON)) have a job between (START DATE) and the time the job with (JobsEstbName FROM EM50, EM80, OR EM120) started [other than what we have already discussed]?
DO NOT INCLUDE CURRENT JOBS.

Responses:

YES 1 EM180 (EMA1750)
NO 2 EM230 (EMA1950)
REFUSED RF EM230 (EMA1950)
DON'T KNOW DK EM230 (EMA1950)

Display Instructions:

Display ?other than (JobsEstbName FROM EM100), did? if a current main employer was collected at EM80.
Display ?Did? if a current main employer was not collected at EM80.
(JobsEstbName FROM EM100): display the current-miscellaneous JobsEstbName collected at the EM100 JOBS roster.
(JobsEstbName FROM EM50, EM80, or EM120):
If collected a current main employer at EM50(JobTp equal to CURRENT MAIN), display that JobsEstbName.
If collected a current-main employer at EM80 (JobTp equal to CURRENT MAIN), display that JobsEstbName. If collected a former-main employer at EM120 (JobTp equal to FORMER MAIN), display that JobsEstbName.

EM180 (EMA1750)

BLAISE NAME: JobERoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

Please think about the employer or business where (you/(PERSON)) worked before (JobsEstbName FROM EM50, EM80, OR EM120). What is the name of that job or business?
IF PERSON HAD MORE THAN ONE EMPLOYER/BUSINESS, PROBE: Please think about (your/his/her) main job at the time. What is the name of that 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

Responses:

(JobsEstbName) 1 1 BOX_120 (EMA1900)
(JobsEstbName) 2 2 BOX_120 (EMA1900)
(JobsEstbName) 3 3 BOX_120 (EMA1900)
(JobsEstbName) 4 4 BOX_120 (EMA1900)
(JobsEstbName) N 5 BOX_120 (EMA1900)

Programmer Instructions:

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.
(JobsEstbName FROM EM50, EM80, or EM120):
If collected a current main employer at EM50 (JobTp equal to CURRENT MAIN), display that JobsEstbName. If collected a current-main employer at EM80 (JobTp equal to CURRENT MAIN), display that JobsEstbName. If collected a former-main employer at EM120 (JobTp equal to FORMER MAIN), display that JobsEstbName.

BOX_120 (EMA1900)

Route Details:

Set JobTp equal to FORMER MAIN
Go to EM190_01.

EM190_01 (EMA1905)

BLAISE NAME: JobEStartYYYY
Context Header:

(PERSON?S FIRST, MIDDLE, AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

When did (you/(PERSON)) start working at that job?
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF EM200_01 (EMA1920)
DON'T KNOW DK EM200_01 (EMA1920)

Programmer Instructions: Set JobStartYYYY

If year is on or after reference year minus 1, continue with EM190_02.
Otherwise, go to EM200_01.

Display Instructions:

Display EM190_01, EM190_02, and EM190_03 on the same form pane.

EM190_02 (EMA1910)

BLAISE NAME: JobEStartMM
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER MONTH

Responses: 1

REFUSED RF EM200_01 (EMA1920)
DON'T KNOW DK EM200_01 (EMA1920)

Programmer Instructions: Set JobStartMM

If year is on or after reference year, continue with EM190_03. Otherwise, go to EM200_01.

Display Instructions:

Display EM190_01, EM190_02, and EM190_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM190_03 (EMA1915)

BLAISE NAME: JobEStartDD
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER DAY

Responses:

1 EM200_01 (EMA1920)
REFUSED RF EM200_01 (EMA1920)
DON'T KNOW DK EM200_01 (EMA1920)

Programmer Instructions: Set JobStartDD

Display Instructions:

Display EM190_01, EM190_02, and EM190_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM200_01 (EMA1920)

BLAISE NAME: JobEStopYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

When did (you/(PERSON)) stop working at that job?
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF EM210 (EMA1940)
DON'T KNOW DK EM210 (EMA1940)

Programmer Instructions: Set JobStopYYYY

If year is on or after reference year minus 1, continue with EM200_02.
Otherwise, go to BOX_130.

Display Instructions:

Display EM200_01, EM200_02, and EM200_03 on the same form pane.

EM200_02 (EMA1925)

BLAISE NAME: JobEStopMM
Question Text:

[When did (you/(PERSON)) stop working at that job?]
ENTER MONTH

Responses: 1

REFUSED RF BOX_130 (EMA1935)
DON'T KNOW DK BOX_130 (EMA1935)

Programmer Instructions: Set JobStopMM

If year is on or after reference year, continue with EM200_03. Otherwise, go to BOX_130.

Display Instructions:

Display EM200_01, EM200_02, and EM200_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM200_03 (EMA1930)

BLAISE NAME: JobEStopDD
Question Text:

[When did (you/(PERSON)) stop working at that job?]
ENTER DAY

Responses:

1 BOX_130 (EMA1935)
REFUSED RF BOX_130 (EMA1935)
DON'T KNOW DK BOX_130 (EMA1935)

Programmer Instructions: Set JobStopDD

Range check:
Edit: complete date at EM200_01, EM200_02, EM200_03 must be equal to or greater than start date at EM190_01, EM190_02, EM190_ 03.
Display the following message: THE DATE ENTERED MUST BE ON OR AFTER THE JOB START DATE.
Edit: job end 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 end 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 END DATE MUST BE ON OR BEFORE (PERSON?S REFERENCE PERIOD END DATE). PLEASE VERIFY AND RE-ENTER.?

Display Instructions:

Display EM200_01, EM200_02, and EM200_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

BOX_130 (EMA1935)

Route Details:

If job end date (EM200_01, EM200_2, EM200_3) less than (prior to) the reference period start date, go to EM210.
If job end date (EM200_01, EM200_2, EM200_3) is equal to or greater than (on or after) reference period start date, go to EM230.
If month of job end date is missing (that is, EM200_02 or EM200_03 is coded 'RF' or 'DK') and if the year of job end date (EM200_01) is reference year, continue with EM210

EM210 (EMA1940)

BLAISE NAME: JobEStopBefAft
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

Can you tell me if (you/(PERSON)) stopped working at that job before or after (START DATE)?

Responses:

BEFORE (START DATE) 1
ON OR AFTER (START DATE) 2 EM230 (EMA1950)
REFUSED RF EM230 (EMA1950)
DON'T KNOW DK EM230 (EMA1950)

Programmer Instructions:

Hard Check: If EM210 coded ?1? display the following message
?INTERVIEWER: RESPONDENT REPORTED IN EM170 (PrevJob) THAT (PERSON) HAD A JOB/BUSINESS BETWEEN (START DATE) AND ANOTHER EMPLOYER, BUT IS NOW REPORTING THAT THIS JOB ENDED BEFORE(START DATE).
VERIFY THIS INCONSISTENT INFORMATION WITH THE RESPONDENT.?
IF DATE STOPPED WORKING IS BEFORE THE BEGINNING OF THE REFERENCE PERIOD, GO TO SCREEN EM170 (PrevJob) AND SELECT 'NO'.
IF DATE STOPPED WORKING IS AFTER THE REFERENCE PERIOD START DATE, GOTO SCREEN EM200_01 (JobEStopYYYY) AND RE-ENTER THE CORRECT JOB END DATE.
Questions involved: EM170, EM200_01

Display Instructions:

EM230 (EMA1950)

BLAISE NAME: OtherJob
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

(Since (START DATE), (have/has)/Between (START DATE) and (END DATE), did) (you/(PERSON)) (had/have) any other jobs we haven't talked about such as a job held at the same time as a job you've already mentioned?

Responses:

YES 1 LOOP_10 (EMA1955)
NO 2 BOX_180 (EMA2400)
REFUSED RF BOX_180 (EMA2400)
DON'T KNOW DK BOX_180 (EMA2400)

Display Instructions:

Display ?Since (start date), (have/has)? if not round 5.
Display ?Between (start date) and (end date), did? if round 5.
Display ?had? if not round 5.
Display ?have? if round 5.

LOOP_10 (EMA1955)

Route Details:

For each of the following JobTp equal to CURRENT MISC
Ask EM240-END_LP10.
Loop definition: LOOP_10 enumerates other miscellaneous jobs for person. The response to EM290 determines whether the loop cycles again. If EM290 is coded ?1?(YES), the loop cycles to collect the next miscellaneous job. If EM290 is coded ?2? (NO), ?RF?, or ?DK? , the loop ends.

EM240 (EMA1975)

BLAISE NAME: JobFRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

Please think about the (next most recent) employer or business where (you/(PERSON)) worked. What is the name of that job or business?
ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.
IF NOT ON THE LIST, PRESS CTRL-A TO ENTER A NEW EMPLOYER/BUSINESS.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(JobsEstbName) 1 1 EM250_01 (EMA2130)
(JobsEstbName) 2 2 EM250_01 (EMA2130)
(JobsEstbName) 3 3 EM250_01 (EMA2130)
(JobsEstbName) 4 4 EM250_01 (EMA2130)
(JobsEstbName) N 5 EM250_01 (EMA2130)

Programmer Instructions:

Display Instructions:

EM250_01 (EMA2130)

BLAISE NAME: JobFStartYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

When did (you/(PERSON)) start working at that job?
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF EM260_01 (EMA2145)
DON'T KNOW DK EM260_01 (EMA2145)

Programmer Instructions: Set JobStartYYYY

If year is on or after reference year minus 1, continue with EM250_02.
Otherwise, go to EM260_01.

Display Instructions:

Display EM250_01, EM250_02, and EM250_03 on the same form pane.

EM250_02 (EMA2135)

BLAISE NAME: JobFStartMM
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER MONTH

Responses: 1

REFUSED RF EM260_01 (EMA2145)
DON'T KNOW DK EM260_01 (EMA2145)

Programmer Instructions: Set JobStartMM

If year is on or after reference year, continue with EM250_03.Otherwise, go to EM260_01

Display Instructions:

Display EM250_01, EM250_02, and EM250_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM250_03 (EMA2135)

BLAISE NAME: JobFStartDD
Question Text:

[When did (you/(PERSON)) start working at that job?]
ENTER DAY

Responses:

1 EM260_01 (EMA2145)
REFUSED RF EM260_01 (EMA2145)
DON'T KNOW DK EM260_01 (EMA2145)

Programmer Instructions: Set JobStartDD

Display Instructions:

Display EM250_01, EM250_02, and EM250_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM260_01 (EMA2145)

BLAISE NAME: JobFStopYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

When did (you/(PERSON)) stop working at that job?
IF STILL AT JOB (ON December 31, (YEAR)), ENTER '0' IN YEAR FIELD.
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF EM270 (EMA2165)
DON'T KNOW DK EM270 (EMA2165)

Programmer Instructions: Set JobStopYYYY

If year is on or after reference year minus 1, continue with EM260_02.
If '0' entered (STILL AT JOB), go to BOX_150. For all other years, go to BOX_140.

Display Instructions:

Display ?ON December 31, (YEAR))? where 'year' is the second calendar year of the panel, if round 5. Otherwise, use a null display.
Display EM260_01, EM260_02, and EM260_03 on the same form pane.

EM260_02 (EMA2150)

BLAISE NAME: JobFStopMM
Question Text:

[When did (you/(PERSON)) stop working at that job?]
ENTER MONTH

Responses: 1

REFUSED RF BOX_140 (EMA2160)
DON'T KNOW DK BOX_140 (EMA2160)

Programmer Instructions: Set JobStopMM

If year is on or after reference year, continue with EM260_03. Otherwise, go to BOX_140.

Display Instructions:

Display EM260_01, EM260_02, and EM260_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM260_03 (EMA2155)

BLAISE NAME: JobFStopDD
Question Text:

[When did (you/(PERSON)) stop working at that job?]
ENTER DAY

Responses:

1 BOX_140 (EMA2160)
REFUSED RF BOX_140 (EMA2160)
DON'T KNOW DK BOX_140 (EMA2160)

Programmer Instructions: Set JobStopDD

Range check:
Edit: complete date at EM260_01,02,03 must be equal to or greater than complete date at EM250_01,02,03.
Display the following message: THE DATE ENTERED MUST BE ON OR AFTER THE JOB START DATE.
Edit: job end 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 end 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 END DATE MUST BE ON OR BEFORE (PERSON?S REFERENCE PERIOD END DATE). PLEASE VERIFY AND RE-ENTER.?

Display Instructions:

Display EM260_01, EM260_02, and EM260_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

BOX_140 (EMA2160)

Route Details:

If job end date (EM260_01, EM260_02, EM260_03) less than (prior to) the reference period start date, go to EM270.
If job end date (EM260_01, EM260_02, EM260_03) equal to on greater than (on or after) the reference period start date, go to BOX_150.
If month of job end date is missing (that is, EM260_02 or EM260_03 is coded 'RF' or 'DK') and if the year of job end date (EM260_01) is reference year, continue with EM270.

EM270 (EMA2165)

BLAISE NAME: JobFStopBefAft
Context Header: (

PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

Can you tell me if (you/(PERSON)) stopped working at that job before or after (START DATE)?

Responses:

BEFORE (START DATE) 1
ON OR AFTER (START DATE) 2 BOX_150 (EMA2175)
REFUSED RF BOX_150 (EMA2175)
DON'T KNOW DK BOX_150 (EMA2175)

Programmer Instructions: Hard Check:

If is EM270 coded ?1? display the following message:
?INTERVIEWER: RESPONDENT REPORTED IN EM230 (OtherJob) THAT (PERSON) HAD SOME OTHER JOB(S)/BUSINESS(ES) SINCE (START DATE), BUT IS NOW REPORTING THAT ONE OF THESE JOBS ENDED BEFORE (START DATE).
VERIFY THIS INCONSISTENT INFORMATION WITH THE RESPONDENT.
IF DATE STOPPED WORKING IS BEFORE THE BEGINNING OF THE REFERENCE PERIOD, GO TO EM230 (OtherJob) AND CODE ?2? NO.
IF DATE STOPPED WORKING IS AFTER THE REFERENCE PERIOD START DATE, GO TO EM260_01 (JobFStopYYYY) TO CORRECT DATE.
Questions involved: EM230, EM260_01

Display Instructions:

BOX_150 (EMA2175)

Route Details:

If EM260_01 (JobStopMM/DD/YYYY) is coded '0' (STILL AT JOB), Set JobTp equal to CURRENT MISC and .Set RetireJob equal to NO
If EM260_01 ? 0 (JobStopMM/DD/YYYY), or EM270 is coded '2' (ON OR AFTER START DATE), 'RF' , or 'DK' , SET JobTp equal to 'FORMER MISC.
Go to EM290

EM290 (EMA2180)

BLAISE NAME: MoreJobsb
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

(Since (START DATE), (have/has)/Between (START DATE) and (END DATE), did) (you/(PERSON)) (have/had) any other jobs we haven't talked about such as a job held at the same time as a job you've already mentioned?

Responses:

YES 1 END_LP_10 (EMA2185)
NO 2 END_LP10 (EMA2185)
REFUSED RF END_LP10 (EMA2185)
DON'T KNOW DK END_LP10 (EMA2185)

Display Instructions:

Display ?Since (START DATE), (have/has)? if not round 5.
Display ?Between (START DATE) and (END DATE), did? if round 5.
Display ?had? if not round 5.
Display ?have? if round 5.
Display 'such as a job held at the same time as a job you've already mentioned' if any jobs recorded for person during the current reference period.

END_LP10 (EMA2185)

Route Details:

If EM290 is coded ?1? (YES), go to EM240.
If EM290 is coded ?2? (NO), ?RF?, or ?DK? , go to BOX_ 180.

EM300 (EMA2190)

BLAISE NAME:EverWorked
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

(Have/Has) (you/(PERSON)) ever worked at a job for pay?
HELP: F1

Responses:

YES 1 EM310_01 (EMA2195)
NO 2 BOX_230 (EMA2645)
REFUSED RF BOX_230 (EMA2645)
DON'T KNOW DK BOX_230 (EMA2645)

Display Instructions:

EM310_01 (EMA2195)

BLAISE NAME: JobGStopYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

I'd like to know a little bit about the last job held by (you/(PERSON)). When did (you/he/she) last stop working at a job for pay?
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF EM320 (EMA2215)
DON'T KNOW DK EM320 (EMA2215)

Programmer Instructions: Set JobStopYYYY

If year is on or after reference year minus 1, continue with EM310_02.
Otherwise, go to BOX_160.
Range Check:
Values should be between 1930 and (YEAR) where year is end reference year. If the value is outside of the range display the following message:
"YEAR MUST BE BETWEEN 1930 AND (YEAR). VERIFY AND RE-ENTER DATE."

Display Instructions:

Display EM310_01, EM310_02, and EM310_03 on the same form pane.

EM310_02 (EMA2200)

BLAISE NAME: JobGStopMM
Question Text:

[I'd like to know a little bit about the last job held by (you/(PERSON)). When did (you/he/she) last stop working at a job for pay?]
ENTER MONTH

Responses: 1

REFUSED RF BOX_160 (EMA2210)
DON'T KNOW DK BOX_160 (EMA2210)

Programmer Instructions: Set JobStopMM

If year is on or after reference year, continue with EM310_03. Otherwise, go to BOX_160

Display Instructions:

Display EM310_01, EM310_02, and EM310_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM310_03 (EMA2205)

BLAISE NAME: JobGStopDD
Question Text:

[I'd like to know a little bit about the last job held by (you/(PERSON)). When did (you/he/she) last stop working at a job for pay?]
ENTER DAY

Responses:

1 BOX_160 (EMA2210)
REFUSED RF BOX_160 (EMA2210)
DON'T KNOW DK BOX_160 (EMA2210)

Programmer Instructions: Set JobStopDD

Range check:
Edit: job end 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 end 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 END DATE MUST BE ON OR BEFORE (PERSON?S REFERENCE PERIOD END DATE). PLEASE VERIFY AND RE-ENTER.?

Display Instructions:

Display EM310_01, EM310_02, and EM310_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

BOX_160 (EMA2210)

Route Details:

If job end date (EM310_1, EM310_2, EM310_3) equal to or greater than (on or after) the reference period start date, go to EM320.
If job end date (EM310_1, EM310_2, EM310_3) less than (prior to) the reference period start date, go to EM340.
If month of job end date is missing (that is, EM310_02 or EM310_03 is coded 'RF' or 'DK') and if the year of job end date (EM310_01) is reference year, continue with EM320.

EM320 (EMA2215)

BLAISE NAME: JobGStopBefAft
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

Can you tell me if (you/(PERSON)) stopped working at that job before or after (START DATE)?

Responses:

BEFORE (START DATE) 1 EM340 (EMA2240)
ON OR AFTER (START DATE) 2
REFUSED RF EM340 (EMA2240)
DON'T KNOW DK EM340 (EMA2240)

Programmer Instructions: Hard Check:

If EM320 coded ?2? display the following message
?INTERVIEWER: RESPONDENT REPORTED IN EM20 (AnyWork) THAT (PERSON) HAS NOT HAD A JOB/BUSINESS SINCE (START DATE), BUT IS NOW REPORTING THAT THE LAST JOB HELD ENDED AFTER (START DATE).
VERIFY THIS INCONSISTENT INFORMATION WITH THE RESPONDENT.?
IF DATE STOPPED WORKING IS AFTER THE BEGINNING OF THE REFERENCE PERIOD, GO TO SCREEN EM20 (AnyWork) AND SELECT 'YES'.
IF DATE STOPPED WORKING IS BEFORE THE REFERENCE PERIOD START DATE, GO TO SCREEN EM310_01 (JobGStopYYYY) AND RE-ENTER THE CORRECT JOB END DATE?
Questions involved: EM20, EM310_01

Display Instructions:

EM340 (EMA2240)

BLAISE NAME: JobGRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

What is the name of (your/(PERSON)'s) employer or business that (you/he/she) stopped working at on (DATE)?
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(JobsEstbName) 1 1 BOX_170 (EMA2395)
(JobsEstbName) 2 2 BOX_170 (EMA2395)
(JobsEstbName) 3 3 BOX_170 (EMA2395)
(JobsEstbName) 4 4 BOX_170 (EMA2395)
(JobsEstbName) N 5 BOX_170 (EMA2395)

Programmer Instructions:

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
Display JobStopMM/DD/YYYY set at EM310_01,_02,_03 for "DATE".
When CTRL-A selected, display the following customized question wording in the pop-up:
ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.

BOX_170 (EMA2395)

Route Details:

Set JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD
Go to Box_180.

BOX_180 (EMA2400)

Route Details:

If person is less than 55 years old or in age categories 4-7, go to BOX_210. Otherwise, continue with EM350.

EM350 (EMA2405)

BLAISE NAME: EverRetire
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

(I have recorded that (you/(PERSON)) (have/has) retired from (READ JOB(S) BELOW).)
(JobsEstbName) 1
(JobsEstbName) 2
(JobsEstbName) 3
(JobsEstbName) 4
(JobsEstbName) N
((Have/Has)/Between (START DATE) and (END DATE), did) (you/(PERSON)) (ever retired/retire) from (a/any other) job or business?
HELP: F1

Responses:

YES 1 EM360 (EMA2410)
NO 2 BOX_210 (EMA2630)
REFUSED RF BOX_210 (EMA2630)
DON'T KNOW DK BOX_210 (EMA2630)

Display Instructions:

Roster 1- Report
Roster Definition:
This item displays the PERSON'S JOBS ROSTER for display.
Roster Filter:
Display only RetireJob equal to YES during any round.
Display (I have recorded that (you/(PERSON)) (have/has) retired from (READ JOB(S) BELOW).) if person being asked about has any jobs set as RETIRED FROM(RetireJob equal to YES) during any previous reference period.
Display '(Have/Has)' if round 1.
Display 'Between (START DATE) and (END DATE), did' if round 2, 3, 4, or 5.
Display 'ever retired' if round 1.
Display 'retire' if round 2, 3, 4, or 5.
Display 'a' if person being asked about does not have any jobs set as 'RETIRED FROM' (RetireJob equal to NO) during any previous reference period.
Display 'any other' if person being asked about does have at least one job set as RETIRED FROM (RetireJob equal to YES) during any previous reference period.

EM360 (EMA2410)

BLAISE NAME: NumRetired
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

Some people retire from more than one job during their life. How many times (have/has) (you/(PERSON)) retired (since (START DATE)/between (START DATE) and (END DATE))?
ENTER NUMBER OF TIMES
HELP: F1

Responses:

1 BOX_190 (EMA2415)
REFUSED RF BOX_190 (EMA2415)
DON'T KNOW DK BOX_190 (EMA2415)

Display Instructions:

Display ?since (START DATE)? if rounds 2, 3, or 4.
Display ?between (START DATE) and (END DATE)? if round 5.
Otherwise, use a null display.

BOX_190 (EMA2415)

Route Details:

If only jobs in Person?s Jobs roster are JobTp equal to CURRENT MAIN or JobTp equal to CURRENT MISC go to LOOP_20.
Otherwise, continue with EM370.

EM370 (EMA2420)

BLAISE NAME: AnyJobsRetired
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

Were any of the following jobs a job from which (you/(PERSON)) retired? (READ JOBS BELOW):
(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY)1
(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY)2
(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY)3
(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY)4
(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY)N

Responses:

YES 1 EM380 (EMA2425)
NO 2 LOOP_20 (EMA2430)
REFUSED RF LOOP_20 (EMA2430)
DON'T KNOW DK LOOP_20 (EMA2430)

Programmer Instructions: Roster 1- Report
Display Instructions: Roster Definition:

This item displays the PERSON'S JOBS ROSTER for display.
Roster Filter:
Do not display jobs JobTp equal to 'CURRENT MAIN OR JobTp equal to CURRENT MISC
Display all of person's jobs other than current job with the associated job start and job end dates (if and when available).

EM380 (EMA2425)

BLAISE NAME: JobHRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

Which job did (you/(PERSON)) retire from (between (START DATE) and (END DATE))?
PROBE: Any others?
ENTER ALL THAT APPLY

Responses:

(JobsEstbName) (JobStartMM/DD/YYYY) 1 - (JobStopMM/DD/YYYY) 1
(JobsEstbName) (JobStartMM/DD/YYYY) 2 - (JobStopMM/DD/YYYY) 2
(JobsEstbName) (JobStartMM/DD/YYYY) 3 - (JobStopMM/DD/YYYY) 3
(JobsEstbName) (JobStartMM/DD/YYYY) 4 - (JobStopMM/DD/YYYY) 4
(JobsEstbName) (JobStartMM/DD/YYYY) 5 - (JobStopMM/DD/YYYY) N

Programmer Instructions:

Set all selected jobs to RetireJob equal to YES
Set all jobs not selected to RetireJob equal to NO
If the total number of jobs selected at EM380 equals the number of times retired at EM360, go to BOX_210.
If total number of jobs selected at EM380 is less than the number of times retired at EM360 go to LOOP_20.
Hard check:
Edit: The total number of jobs selected at EM380 must be less than or equal to number of times retired at EM360. If not, display the following message: "NUMBER OF RETIRED JOBS EXCEEDS TIMES RETIRED. VERIFY AND RESELECT JOBS."
Roster behavior: Multiple select allowed.

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

Roster definition:
This item displays the person's jobs roster for selection.
Roster filter:
Do not display jobs JobTp equal to CURRENT MAIN OR JobTp equal to CURRENT MISC
Display 'between (START DATE) and (END DATE)' if round 5.
Otherwise, use a null display.
Display all of person's jobs other than current job with the associated job start and job end dates (if and when available).

LOOP_20 (EMA2430)

Route Details:

For each of the following:
Retirement job not yet accounted for
Ask EM390-END_LP20.
Loop definition: LOOP_20 enumerates and collects information about jobs person retired from that have not yet been accounted for. The number of jobs retired from but not yet accounted for (the number entered at EM360 minus the number of jobs selected at EM380, if any) determines the number of loop cycles. ?RF? and ?DK? responses at EM360 will be treated as a ?1? (ONE JOB RETIRED FROM).

EM390 (EMA2450)

BLAISE NAME: JobIRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

Please think about the (first/next) employer or business (you/(PERSON)) retired from (between (START DATE) and(END DATE)). What is the name of that employer or business (you/(PERSON)) retired from?
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

Responses:

(JobsEstbName) 1 1 BOX_200 (EMA2605)
(JobsEstbName) 2 2 BOX_200 (EMA2605)
(JobsEstbName) 3 3 BOX_200 (EMA2605)
(JobsEstbName) 4 4 BOX_200 (EMA2605)
(JobsEstbName) N 5 BOX_200 (EMA2605)

Programmer Instructions:

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 ?first? if first cycle through LOOP_20.
Display ?next? if not first cycle through LOOP_20.
Display ?between (START DATE) and (END DATE)? if round 5.
Otherwise, use a null display.

BOX_200 (EMA2605)

Route Details:

Set JobTp equal to RETIREMENT.
Set RetireJob equal to YES.

EM400_01 (EMA2610)

BLAISE NAME: JobIStopYYYY
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName) (START DATE) (END DATE)

Question Text:

When did (you/(PERSON)) retire from that job?
ENTER 4-DIGIT YEAR

Responses: 1

REFUSED RF END_LP20 (EMA2625)
DON'T KNOW DK END_LP20 (EMA2625)

Programmer Instructions:

Set JobStopYYYY
If year is on or after reference year minus 1, continue with EM400_02.
Otherwise, go to END_LP20.

Display Instructions:

Display EM400_01, EM400_02, and EM400_03 on the same form pane.

EM400_02 (EMA2615)

BLAISE NAME: JobIStopMM
Question Text:

[When did (you/(PERSON)) retire from that job?]
ENTER MONTH
HELP: F1

Responses: 1

REFUSED RF END_LP20 (EMA2625)
DON'T KNOW DK END_LP20 (EMA2625)

Programmer Instructions:

Set JobStopMM
If year is on or after reference year, continue with EM400_03.
Otherwise, go to END_LP20.

Display Instructions:

Display EM400_01, EM400_02, and EM400_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

EM400_03 (EMA2620)

BLAISE NAME: JobIStopDD
Question Text:

[When did (you/(PERSON)) retire from that job?]
ENTER DAY
HELP: F1

Responses:

1 END_LP20 (EMA2625)
REFUSED RF END_LP20 (EMA2625)
DON'T KNOW DK END_LP20 (EMA2625)

Programmer Instructions: Set JobStopDD

Range check:
Edit: job end 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 end 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 END DATE MUST BE ON OR BEFORE (PERSON?S REFERENCE PERIOD END DATE). PLEASE VERIFY AND RE-ENTER.?

Display Instructions:

Display EM400_01, EM400_02, and EM400_03 on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

END_LP20 (EMA2625)

Route Details:

If all retirement jobs are not yet accounted for (that is, if EM360 greater than 1, and the number of cycles of loop less than number of retired jobs at EM360 minus the number of jobs selected at EM380), cycle to collect next job retired from.
When all retirement jobs are accounted for (that is, all ?TIMES RETIRED? coded at EM360 are accounted for), or if EM360 is coded ?1?, ?RF?, or ?DK? , end LOOP_20 and continue with BOX_210.

BOX_210 (EMA2630)

Route Details:

If no JobTp equal to CURRENT MAIN and at least one JobTp equal to CURRENT MISC continue with BOX_220.
Otherwise, go to BOX_230.

BOX_220 (EMA2635)

Route Details:

If only one job with JobTp equal to CURRENT MISC Set JobTp equal to CURRENT MAIN then go to BOX_ 230.
Otherwise, continue with EM410.

EM410 (EMA2640)

BLAISE NAME: JobJRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

We've recorded that (you/(PERSON)) (currently (work/works)/worked) at (READ JobsEstbNameS BELOW) (on December 31, (YEAR)). Which (is/was) (your/his/her)
main job or business (on December 31,(YEAR))?

Responses:

(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY) 1 1 BOX_230 (EMA2645)
(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY) 2 2 BOX_230 (EMA2645)
(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY) 3 3 BOX_230 (EMA2645)
(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY) 4 4 BOX_230 (EMA2645)
(JobsEstbName) (JobStartMM/DD/YYYY) - (JobStopMM/DD/YYYY) N 5 BOX_230 (EMA2645)

Programmer Instructions:

Change JobTp equal to CURRENT MISC to JobTp equal to CURRENT MAIN for the job selected in EM410.
Note: Since this job type is switching to a ?CURRENT MAIN? job, this job will be asked about in LOOP_30 during the current round.
Roster behavior:
Select allowed.
If more than one job selected, display the following error message: "ONLY ONE EMPLOYER MAY BE SELECTED. VERIFY AND RE-ENTER. CONTINUE."
If no job selected, display the following error message: "MUST SELECT ONE EMPLOYER. CONTINUE."

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

Roster definition:
This item displays the person's jobs roster for selection.
Roster filter:
Display jobs JobTp equal to CURRENT MISC where person still works at the job (JobStopMM/DD/YYYY equal to EMPTY and RetireJob equal to No)
If (JobStopMM/DD/YYYY) equal to EMPTY (person is still at job) display "CURRENT"
Display ?currently (work/works)? if not round 5.
Display ?worked? if round 5.
Display 'is' if not round 5.
Display 'was' if round 5.
Display ?on December 31, (YEAR)? where 'year' is the second calendar year of the panel, if round 5.
Otherwise, use a null display.

BOX_230 (EMA2645)

Route Details:

Continue with Employment (EM) section BOX_240. (Used to be EM_B)

BOX_240 (EMA2650)

Route Details:

If Round 1 and
EM300 is coded '2' (NO), 'RF , or 'DK , GO TO BOX_ 350.
If rounds 2-5 AND
PL_Person.Pre_EM300 equal to NO, DK OR RF (EM300 was coded ?2? (NO), ?RF , or ?DK? in a previous round)
AND
There are no jobs on person?s jobs roster, go to BOX_350.
Otherwise, continue with BOX_250.

BOX_250 (EMA2655)

Route Details:

If:
job created during the current round,(OrigRnd equal to CURRENT ROUND)
OR
JobTp switched from PR_JobTp equal to CURRENT MISC) to JobTp equal to CURRENT MAIN
OR
JobTp equal to FORMER MISC' and RetireJob equal to YES is set during the current round,
OR
PR_JobTp equal to FORMER MISC and RetireJob equal to YES during the current round, continue with LOOP_30.
Otherwise, go to BOX_350.

LOOP_30 (EMA2660)

Route Details:

For each element in person?s jobs roster, ask BOX_255-END_LP30.
Loop definition: LOOP_30 collects detailed information about each job reported for person. This loop cycles on jobs which meet the following conditions:
Job created during the current round (OrigRnd equal to CURRENT ROUND)
OR
JobTp switched from PR_JobTp equal to CURRENT MISC to JobTp equal to CURRENT MAIN
OR
JobTp equal to FORMER MISC and RetireJob equal to YES during the current round,
OR
PR_JobTp equal to FORMER MISC and RetireJob equal to YES during the current round

BOX_255 (EMA2661)

Route Details:

If job created during the current round (OrigRnd equal to CURRENT ROUND), continue with EM420. Otherwise, go to BOX_260.

EM420 (EMA2670)

BLAISE NAME: SelfEmp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

I'd like to talk about (your/(PERSON)'s) job or business at (JobsEstbName).
(Are/Is)/(Were/Was)) (you/(PERSON)) self-employed, or ((do/does)/did) (you/he/she) work for someone else at that job?

Responses:

SELF-EMPLOYED 1 BOX_260 (EMA2675)
FOR SOMEONE ELSE 2 BOX_260 (EMA2675)
REFUSED RF BOX_260 (EMA2675)
DON'T KNOW DK BOX_260 (EMA2675)

Programmer Instructions:

If coded ?1? (SELF-EMPLOYED), set SelfEmp equal to SelfEmpl.

Display Instructions:

Display ?(Are/Is)? if not round 5.
Display ?(Were/Was)? if round 5 or JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT.
Display ?(do/does)? if not round 5.
Display ?did? if round 5 or JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT.

BOX_260 (EMA2675)

Route Details:

If:
JobTp equal to CURRENT MISC
OR
(JobTp equal to FORMER MISC and RetireJob equal to NO)
Go to BOX_310.

If job is set as SelfEmpnot equal to SelfEmpl,
AND
JobTp equal to LAST JOB OUTSIDE OF REFERENCE PERIOD
OR
JobTp equal to RETIREMENT
OR
(JobTp equal to FORMER MISC and RetireJob equal to YES),
Go to EM480.

If SelfEmp equal to SelfEmpl
AND
JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD
AND
RETIREJOB equal to NO
AND
JobStopMM/DD/YYYY greater than 2 years from current interview date then go to EM530

If SelfEmp equal to SelfEmpl
AND
JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD
AND
RETIREJOB equal to YES
AND
JobStopMM/DD/YYYY greater than 2 years from current interview date then go to EM660

If SelfEmp equal to SelfEmpl
AND
JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD
AND
JobStopMM/DD/YYYY less than or equal to 2 years from current interview date then go to EM490

If SelfEmp equal to SelfEmpl
AND
JobTp equal to RETIREMENT JOB
AND
and JobStopMM/DD/YYYY greater than 2 years from current interview date then go to EM660

If SelfEmp equal to SelfEmpl
AND
JobTp equal to RETIREMENT JOB
AND
and JobStopMM/DD/YYYY less than or equal to 2 years from current interview date then go to EM490

If SelfEmp equal to SelfEmpl
AND
(JobTp equal to FORMER MISC and RetireJob equal to YES), Go to EM490.

If SelfEmp equal to SelfEmpl
AND
JobTp equal to CURRENT MAIN,
OR
JobTp equal to FORMER MAIN,
Go to EM460.
Otherwise Go to EM430.

EM430 (EMA2680)

BLAISE NAME: NumEmp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

How many persons are employed by (JobsEstbName) in a usual week at the location where (you/(PERSON)) ((work/works)/worked)?
IF RESPONDENT IS NOT SURE, DO NOT PROBE, CODE ?DON?T KNOW?. ENTER NUMBER

Responses:

1 EM450 (EMA2690)
REFUSED RF EM440 (EMA2685)
DON'T KNOW DK EM440 (EMA2685)

Programmer Instructions:

SET TotNumEmp equal to VALUE ENTERED AT EM430
If the value entered for the number of employees equal to 0 set EmpEstm equal to ?0?
If the value entered for the number of employees equal to 1 set EmpEstm equal to ?1?
If the value entered for the number of employees equal to 2-9, inclusive, set EmpEstm equal to ?2-9?
If the value entered for the number of employees equal to 10-25, inclusive, set EmpEstm equal to ?10-25?
If the value entered for the number of employees equal to 26-50, inclusive, set EmpEstm equal to ?26-50?
If the value entered for the number of employees equal to 51-100, inclusive, set EmpEstm equal to ?51-100?
If the value entered for the number of employees equal to 101-200, inclusive, set EmpEstm equal to ?101-200?
If the value entered for the number of employees equal to 201-500, inclusive, set EmpEstm equal to ?201-500?
If the value entered for the number of employees is greater than 500 set EmpEstm equal to ?501+?
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 be displayed instead of the word ?CURRENT? for these job types.

Display Instructions:

Display ?(work/works)? if JobTp equal to CURRENT MAIN.
Display ?worked? if JobTp equal to FORMER MAIN.

EM440 (EMA2685)

BLAISE NAME: EmpEstm

Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)(JobStopMM/DD/YYYY)

Question Text:

About how many persons are employed there? Would you say 2 to 9, 10 to 25, 26 to 50, 51 to 100, 101 to 200, 201 to 500 or more than 500?

Responses:

2-9 2 EM450 (EMA2690)
10-25 3 EM450 (EMA2690)
26-50 4 EM450 (EMA2690)
51-100 5 EM450 (EMA2690)
101-200 6 EM450 (EMA2690)
201-500 7 EM450 (EMA2690)
501+ 8 EM450 (EMA2690)
REFUSED RF EM450 (EMA2690)
DON'T KNOW DK EM450 (EMA2690)

Programmer Instructions:

If coded ?2? set EmpEstm equal to ?2-9?
If coded ?3?, set EmpEstm equal to ?10-25?
If coded ?4? set EmpEstm equal to ?26-50?
If coded ?5? set EmpEstm equal to ?51-100?
If coded ?6? set EmpEstm equal to ?101-200?
If coded ?7? set EmpEstm equal to '201-500'
If coded '8' set EmpEstm equal to '501+'
If coded DK set EmpEstm equal to DK
If coded RF set EmpEstm equal to RF

Display Instructions:

EM450 (EMA2690)

BLAISE NAME: MoreLoctn
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

Does (JobsEstbName) have facilities in more than one location?
HELP: F1

Responses:

YES 1 EM480 (EMA2705)
NO 2 EM480 (EMA2705)
REFUSED RF EM480 (EMA2705)
DON'T KNOW DK EM480 (EMA2705)

Programmer Instructions:

If coded ?1? (YES) set MoreLoctn equal to YES
If coded ?2? (NO) set MoreLoctn equal to NO
If coded ?RF? set MoreLoctn equal to RF
If coded ?DK? set MoreLoctn equal to DK

Display Instructions:

EM460 (EMA2695)

BLAISE NAME: BusnIncorp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

(Is/Was) (your/(PERSON)'s) business incorporated?
HELP: F1

Responses:

YES 1 EM490 (EMA2715)
NO 2 EM470 (EMA2700)
REFUSED RF EM490 (EMA2715)
DON'T KNOW DK EM470 (EMA2700)

Display Instructions:

Display ?Is? if JobTp equal to CURRENT MAIN.
Display ?Was? if JobTp equal to FORMER MAIN.

EM470 (EMA2700)

BLAISE NAME: ProprietPartner
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

(Is/Was) this business a sole proprietorship or a partnership?
HELP: F1

Responses:

SOLE PROPRIETORSHIP 1 EM490 (EMA2715)
PARTNERSHIP 2 EM490 (EMA2715)
REFUSED RF EM490 (EMA2715)
DON'T KNOW DK EM490 (EMA2715)

Display Instructions:

Display ?Is? if JobTp equal to CURRENT MAIN.
Display ?Was? if JobTp equal to FORMER MAIN.

EM480 (EMA2705)

BLAISE NAME: JobsEmpTp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

((Are/Is)/(Were/Was)) (you/(PERSON)) an employee of private company, individual or organization, the Federal government, state government, local government, the Armed Forces, or foreign (non U.S.) government?
HELP: F1

Responses:

A PRIVATE COMPANY, INDIVIDUAL OR ORGANIZATION 1
THE FEDERAL GOVERNMENT 2
STATE GOVERNMENT 3
LOCAL GOVERNMENT 4
THE ARMED FORCES 5
FOREIGN (NON U.S.) GOVERNMENT 6
REFUSED RF
DON'T KNOW DK

Programmer Instructions: Soft Check:

If EM480 Coded 5 ?Armed Forces? display the message ?CIVILIAN EMPLOYEES OF THE ARMED FORCES SHOULD SELECT ?THE FEDERAL GOVERNMENT? AS EMPLOYER TYPE. VERIFY WITH RESPONDENT IF NECESSARY.?
If EM480 coded ?1? set JobsEmpTp equal to ?A PRIVATE COMPANY, INDIVIDUAL OR ORGANIZATION?
If EM480 coded ?2? set JobsEmpTp equal to ?THE FEDERAL GOVERNMENT?
If EM480 coded ?3? set JobsEmpTp equal to ?STATE GOVERNMENT?
If EM480 coded ?4? set JobsEmpTp equal to ?LOCAL GOVERNMENT?
If EM480 coded ?5? set JobsEmpTp equal to ?THE ARMED FORCES?
If EM480 coded ?6? set JobsEmpTp equal to ?FOREIGN (NON U.S.) GOVERNMENT?
If EM480 coded ?RF? set JobsEmpTp equal to ?RF?
If EM480 coded ?DK? set JobsEmpTp equal to ?DK?
IF (JobTp equal to LAST JOB OUTSIDE THE REFERENCE PERIOD And RetireJob equal to NO AND JobStopMM/DD/YYYY greater than 2 years from current interview date then go to EM520
IF (JobTp equal to LAST JOB OUTSIDE THE REFERENCE PERIOD And RetireJob equal to YES AND JobStopMM/DD/YYYY greater than 2 years from current interview date then go to EM660
If JobTp equal to RETIREMENT and JobStopMM/DD/YYYY greater than 2 years from current interview date then go to EM660
Else
If EM480 coded ?1?, ?6?, ?RF? or ?DK? go to EM490.
Otherwise go to EM500.

Display Instructions:

Display ?(Are/Is)? if JobTp equal to CURRENT MAIN.
Display ?(Were/Was)? if JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT.

EM490 (EMA2715)

BLAISE NAME: BusnTp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

What kind of business or industry (is/was) that?
PROBE: What do they make or do?
RECORD VERBATIM.

Responses:

1 EM500 (EMA2720)
REFUSED RF EM500 (EMA2720)
DON'T KNOW DK EM500 (EMA2720)

Programmer Instructions:

Note: allow multiple lines for entry.
Display text entry box as two (2) rows high, by 50 characters long.

Display Instructions:

Display ?Is? if JobTp equal to CURRENT MAIN.
Display ?Was? if JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT.

EM500 (EMA2720)

BLAISE NAME: JobTitle
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

What (is/was) (your/(PERSON)'s) job called?
RECORD VERBATIM.

Responses:

1 EM510 (EMA2725)
REFUSED RF EM510 (EMA2725)
DON'T KNOW DK EM510 (EMA2725)

Programmer Instructions:

Note: allow multiple lines for entry.
Display text entry box as two (2) rows high, by 50 characters long.

Display Instructions:

Display ?Is? if JobTp equal to CURRENT MAIN.
Display ?Was? if JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT.

EM510 (EMA2725)

BLAISE NAME: JobDuties
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

What ((do/does)/did) (you/(PERSON)) actually do at that job? What (are/were) some of (your/his/her) most important activities or duties?
RECORD VERBATIM.

Responses: 1

REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If JobTp equal to CURRENT MAIN, go to EM540.
If SelfEmp equal to SelfEmpl
And
(JobTp equal to FORMER MAIN and RetireJob equal to NO) OR
(JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD and RetireJob equal to NO), Go to EM530.
If:
JobTp equal to RETIREMENT, OR
(JobTp equal to FORMER MAIN and RetireJob equal to YES), OR
(JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD and RetireJob equal to YES) OR
(JobTp equal to FORMER MISC and RetireJob equal to YES) Go to BOX_270.
Otherwise, continue with EM520. Note: allow multiple lines for entry.
Display text entry box as two (2) rows high, by 50 characters long.

Display Instructions:

Display ?(do/does)? if JobTp equal to CURRENT MAIN.
Display ?did? if JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT.
Display ?are? if JobTp equal to CURRENT MAIN
Display ?were? if JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT.

EM520 (EMA2730)

BLAISE NAME: LeftJobResn
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

What is the main reason that (you/(PERSON)) no longer (have/has) this job?
HELP: F1

Responses:

JOB ENDED, TEMPORARY, SEASONAL, CONTRACT, ETC. 1 BOX_270 (EMA2740)
BUSINESS CLOSED OR SOLD 2 BOX_270 (EMA2740)
ILLNESS, INJURY, HEALTH PROBLEM 3 BOX_270 (EMA2740)
TERMINATED, FIRED, DISMISSED 4 BOX_270 (EMA2740)
LAID OFF, LET GO 5 BOX_270 (EMA2740)
QUIT - FAMILY REASON, MATERNITY LEAVE 6 BOX_270 (EMA2740)
QUIT -- SCHOOL 7 BOX_270 (EMA2740)
QUIT - JOB RELATED REASON 8 BOX_270 (EMA2740)
QUIT - ANY OTHER REASON 9 BOX_270 (EMA2740)
OTHER - SPECIFY 91 EM520OS (EMA2735)
REFUSED RF BOX_270 (EMA2740)
DON'T KNOW DK BOX_270 (EMA2740)

Display Instructions:

Display EM520 and EM520OS on the same form pane.

EM520OS (EMA2735)

BLAISE NAME: LeftJobResnOS
Question Text:

SPECIFY:

Responses:

1 BOX_270 (EMA2740)
REFUSED RF BOX_270 (EMA2740)
DON'T KNOW DK BOX_270 (EMA2740))

Display Instructions: Display EM520 and EM520OS on the same form pane.

BOX_270 (EMA2740)

Route Details:

If:
JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD
RetireJob equal to YES OR NO),
OR
JobTp equal to RETIREMENT OR
(JobTp equal to FORMER MISC AND RetireJob equal to YES) go to EM660.
OTHERWISE, GO TO EM540.

EM530 (EMA2745)

BLAISE NAME: NoBusnResn
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

What is the main reason that (you/(PERSON)) no longer (have/has) this business?
HELP: F1

Responses:

BUSINESS CLOSED OR SOLD 1
RETIRED 2
ILLNESS OR INJURY 3
OTHER 91
REFUSED RF
DON'T KNOW DK EM540 (EMA2765))

Programmer Instructions:

If JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD AND RETIREJOB equal to NO go to Box_320.
Otherwise go to EM540

Display Instructions:

EM540 (EMA2765)

BLAISE NAME: HoursWeekA
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

For the next questions, please remember that we are talking about the period between (START DATE) and (END DATE).

Often the actual number of hours people work is different from the number of hours on which their salaries are based. How many hours per week ((do/does)/did) (you/(PERSON)) usually work at (JobsEstbName)? Include all the hours (you/he/she) usually ((spend/spends)/spent) working on this job, except for any unpaid travel to and from the job.
ENTER HOURS
HELP: F1

Responses:

1 EM560 (EMA2775)
REFUSED RF EM550 (EMA2770)
DON'T KNOW DK EM550 (EMA2770)

Programmer Instructions:

Set FTPTStatus equal to PT IF EM540 less than 35
Set FTPTStatus equal to FT IF EM540 greater than equal to 35
Note: allow only whole hours, no fractions. Hard check: whole numbers 1-168.

Display Instructions:

Display ?(do/does)? if JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?did? if JobTp equal to FORMER-MAIN, or if current round is round 5.

Display ?(spend/spends)? if ?JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?spent? if JobTp equal to FORMER MAIN, or if current round is round 5.

EM550 (EMA2770)

BLAISE NAME: AtLeast35Hr
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

(Do/Does)/Did) (you/(PERSON)) work at least 35 hours a week at this job?

Responses:

YES 1 EM560 (EMA2775)
NO 2 EM560 (EMA2775)
REFUSED RF EM560 (EMA2775)
DON'T KNOW DK EM560 (EMA2775)

Programmer Instructions:

If coded ?1? (YES) Set FTPTStatus equal to FT
If coded ?2? (NO), ?RF? or ?DK? set FTPTStatus equal to PT

Display Instructions:

Display ?(Do/Does)? if JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?Did? if JobTp equal to FORMER MAIN, or if current round is round 5.

EM560 (EMA2775)

BLAISE NAME: JobTemporaryA

Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

Some people are in temporary jobs that last only for a limited time or until the completion of a project. (Is/Was) (your/(PERSON)'s) job at (JobsEstbName) temporary?

Responses:

YES 1 EM570 (EMA2780)
NO 2 EM570 (EMA2780)
REFUSED RF EM570 (EMA2780)
DON'T KNOW DK EM570 (EMA2780)

Display Instructions:

>(Is/Was): Display 'Is' if 'JobTp equal to CURRENT MAIN and current round is not round 5.
Display 'Was' if JobTp equal to FORMER MAIN, or if current round is round 5.

EM570 (EMA2780)

BLAISE NAME: JobSeasonalA
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

(Is/Was) (your/(PERSON)'s) job at (JobsEstbName) a year round job or (is/was) it only available during certain times of the year?
[Teachers and other school personnel who work only during the school year should consider themselves to have a year round job.]

Responses:

YEAR ROUND 1 BOX_290 (EMA2785)
NOT YEAR ROUND 2 BOX_290 (EMA2785)
REFUSED RF BOX_290 (EMA2785)
DON'T KNOW DK BOX_290 (EMA2785)

Display Instructions:

(Is/Was) and (is/was): Display 'Is' and 'is' if the job subtype of the job being asked about is set as JobTp equal to CURRENT MAIN and current round is not round 5.
Display 'Was' and 'was' if JobTp equal to FORMER MAIN or if current round is round 5.

BOX_290 (EMA2785)

Route Details:

If SelfEmp equal to SelfEmpl go to BOX_320.
Otherwise, continue with BOX_300.

BOX_300 (EMA2790)

Route Details:

Ask the Employment Wage (EW) section.
At completion of Employment Wage (EW) section, continue with EM580.

EM580 (EMA2805)

BLAISE NAME: SickPay
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

On this job, ((do/does)/did) (you/(PERSON)) have paid time off if (you/he/she) ((are/is)/(were/was)) sick?

Responses:

YES 1 EM590 (EMA2815)
NO 2 EM600 (EMA2815)
REFUSED RF EM600 (EMA2815)
DON'T KNOW DK EM600 (EMA2815)

Display Instructions:

Display ?(do/does)? if the job subtype of the job being asked about is set as JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?did? if the job subtype of the job being asked about is set as JobTp equal to FORMER MAIN, or if current round is round 5.

Display ?(are/is)? if JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?(were/was)? if JobTp equal to FORMER MAIN or if current round is round 5.

EM590 (EMA2810)

BLAISE NAME: SickPayDocVst
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

(Can/Could) (you/(PERSON)) (take/have taken) paid sick leave if (you/he/she) ((have/has)/had) to visit a doctor?

Responses:

YES 1 EM600 (EMA2815)
NO 2 EM600 (EMA2815)
REFUSED RF EM600 (EMA2815)
DON'T KNOW DK EM600 (EMA2815)

Display Instructions:

(Can/Could): Display ?Can? if the job subtype of the job being asked about is set as JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?Could? if the job subtype of the job being asked about is set as JobTp equal to FORMER MAIN, or if current round is round 5.
Display ?take? if JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?have taken? JobTp equal to FORMER MAIN, or if current round is round 5.
Display ?(have/has)? if JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?had? if t JobTp equal to FORMER MAIN, or if current round is round 5.

EM600 (EMA2815)

BLAISE NAME: PaidVacation
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

On this job, ((do/does)/did) (you/(PERSON)) get paid vacation?

Responses:

YES 1 EM610 (EMA2820)
NO 2 EM610 (EMA2820)
REFUSED RF EM610 (EMA2820)
DON'T KNOW DK EM610 (EMA2820)

Display Instructions:

Display ?(do/does)? if JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?did? if JobTp equal to FORMER MAIN, or if current round is round 5.

EM610 (EMA2820)

BLAISE NAME: RetirePlan
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

Not including Social Security or Railroad Retirement, ((are/is)/(were/was)) (you/(PERSON)) covered by a pension or retirement plan or ((do/does)/did) (you/he/she) have a 401K plan on this job?
HELP: F1

Responses:

YES 1 BOX_320 (EMA2850)
NO 2 BOX_320 (EMA2850)
REFUSED RF BOX_320 (EMA2850)
DON'T KNOW DK BOX_320 (EMA2850)

Display Instructions:

Display ?are/is? if JobTp equal to CURRENT MAIN, and current round is not round 5.
Display ?were/was? if JobTp equal to FORMER MAIN, or if current round is round 5.
(Display ?do/does? if JobTp equal to CURRENT MAIN and current round is not round 5.
Display ?did? if JobTp equal to FORMER MAIN, or if current round is round 5.

BOX_310 (EMA2825)

Route Details:

If JobTp equal to CURRENT MISC continue with EM620.
If JobTp switched from PR_JobTp equal to CURRENT MISC to JobTp equal to CURRENT MAIN, go to END_LP30.
Otherwise, go to EM660.

EM620 (EMA2830)

BLAISE NAME: HoursWeekB
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

((Since (START DATE)/Between (START DATE ) and (END DATE)), how many hours ((do/does)/did) (you/(PERSON)) work at this job during a typical week?
ENTER HOURS
HELP: F1

Responses:

1 EM630 (EMA2835)
REFUSED RF EM630 (EMA2835)
DON'T KNOW DK EM630 (EMA2835)

Display Instructions:

Display ?Since (START DATE)? if not round 5.
Display ?Between (START DATE) and (END DATE) if round 5.
Display '(do/does)' if not round 5.
Display 'did' if round 5.

EM630 (EMA2835)

BLAISE NAME: JobTemporaryB

Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

Some people are in temporary jobs that last only for a limited time or until the completion of a project. (Is/Was) (your/(PERSON)'s) job at (JobsEstbName) temporary?

Responses:

YES 1 EM640 (EMA2840)
NO 2 EM640 (EMA2840)
REFUSED RF EM640 (EMA2840)
DON'T KNOW DK EM640 (EMA2840)

Display Instructions:

Display 'Is' if current round is not round 5.
Display 'Was' if current round is 5.

EM640 (EMA2840)

BLAISE NAME: JobSeasonalB
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

Responses:

YEAR ROUND 1 EM650 (EMA2845)
NOT YEAR ROUND 2 EM650 (EMA2845)
REFUSED RF EM650 (EMA2845)
DON'T KNOW DK EM650 (EMA2845)

Display Instructions:

(Display ?Is? and ?is?; if current round is not round 5.
Display ?Was? and ?was? if current round is round 5.

EM650 (EMA2845)

BLAISE NAME: WeeklyGrossInco
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

(Since (START DATE)/Between (START DATE) and (END DATE)), what (is/was) (your/(PERSON)'s) usual weekly income before deductions for taxes or anything else from (your/his/her) job with (JobsEstbName)?

Responses:

1 BOX_320 (EMA2850)
REFUSED RF BOX_320 (EMA2850)
DON'T KNOW DK BOX_320 (EMA2850)

Programmer Instructions:

Set SalaryAmt equal to Value entered at EM650
Set SalaryUnit equal to ?PER WEEK?
Use dollar sign input mask [$.] in response field.

Display Instructions:

Display ?Since (START DATE)? if not round 5.
Display ?Between (START DATE) and (END DATE)? if round 5.
Display ?is? if not round 5. Display ?was? if round 5.

BOX_320 (EMA2850)

Route Details:

If JobTp switched from PR_JobTp equal to CURRENT MISC to JobTp equal to CURRENT MAIN, go to END_LP30.
Else if EM480 coded ?5? (The Armed Forces) and JobTp equal to CURRENT MAIN, go to Box_340.
Else, go to EM660.

EM660 (EMA2855)

BLAISE NAME: EmpHI
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

At any time (since (START DATE)/between (START DATE) and (END DATE)), did (you/(PERSON)) have health insurance through this (job/business)?
PROBE: By this, I mean insurance which pays for hospital bills, doctor bills, or other health expenses.
HELP F1:

Responses:

YES 1 EM680 (EMA2865)
NO 2 EM670 (EMA2860)
REFUSED RF EM700 (EMA2885)
DON'T KNOW DK EM700 (EMA2885)

Programmer Instructions:

If coded ?1? (YES), SET EmpHI equal to YES.

Display Instructions:

Display (since (START DATE)/between (START DATE) and (END DATE)):
Display ?since (START DATE)? if not round 5.
Display ?between (START DATE) and (END DATE)? if round 5.
Display ?job? if SelfEmpnot equal to SelfEmpl
Display ?business? if SelfEmp equal to SelfEmpl

EM670 (EMA2860)

BLAISE NAME: OffrdHIChoseNot
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

(Since (START DATE)/Between (START DATE) and (END DATE)), (were/was) (you/(PERSON)) offered health insurance through this (job/business)?
HELP:F1

Responses:

YES 1
NO 2
REFUSED RF EM700 (EMA2885)
DON'T KNOW DK EM700 (EMA2885)

Programmer Instructions:

IF coded ?1? (YES) set OffrdHIChoseNot equal to YES
If coded ?2? (NO), ?RF? or ?DK? set OffrdHIChoseNot equal to NO
If EM670 is coded ?1? go to EM680
Otherwise, go to EM690.

Display Instructions:

Display ?since (START DATE)? if not round 5.
Display ?between (START DATE) and (END DATE)? if round 5.
Display ?job? if SelfEmpnot equal to SelfEmpl
Display ?business? if SelfEmp equal to SelfEmpl

EM680 (EMA2865)

BLAISE NAME: ChoicePlans
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

(Even though (you/he/she) chose not to take health insurance, did/Did) (you/(PERSON)) have a choice of different health insurance plans that provided hospital and physician benefits or was only one health insurance plan offered through this (job/business)?
HELP:F1

Responses:

YES, MORE THAN ONE PLAN 1 EM700 (EMA2885)
NO, ONLY ONE PLAN 2 EM700 (EMA2885)
REFUSED RF EM700 (EMA2885)
DON'T KNOW DK EM700 (EMA2885)

Display Instructions:

Display ?Even though (you/he/she) chose not to take health insurance, did? if EmpHI equal to EMPTY.
DISPLAY ?Did? if EmpHI equal to YES
Display ?job? if SelfEmpnot equal to SelfEmpl
Display ?business? if SelfEmp equal to SelfEmpl

EM690 (EMA2870)

BLAISE NAME: AnyOffrdHI
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

Was health insurance offered to any employees at this (job/business)?

Responses:

YES 1 EM700 (EMA2885)
NO 2 EM700 (EMA2885)
REFUSED RF EM700 (EMA2885)
DON'T KNOW DK EM700 (EMA2885)

Display Instructions:

Display ?job? if SelfEmpnot equal to SelfEmpl
Display ?business? if SelfEmp equal to SelfEmpl

EM700 (EMA2885)

BLAISE NAME: BelongUnion
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

((Do/Does)/Did) (you/(PERSON)) belong to a labor union at (JobsEstbName)?
HELP:F1

Responses:

YES 1
NO 2 BOX_340 (EMA3010)
REFUSED RF BOX_340 (EMA3010)
DON'T KNOW DK BOX_340 (EMA3010)

Programmer Instructions:

If coded ?1? (YES) and EmpHI equal to YES continue with EM710.
Otherwise, go to BOX_340.

Display Instructions:

Display ?(Do/Does)? if the job subtype of the job being asked about is set as JobTp equal to CURRENT MAIN or JobTp equal to CURRENT MISC and current round is not round 5.
Display ?Did? if JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT or if current round is round 5.

EM710 (EMA2890)

BLAISE NAME: WhoPrvdHI
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

Does the health insurance provided through this (job/business) come from [your/(PERSON)'s) (employer/business) or union?
HELP:F1

Responses:

EMPLOYER 1 BOX_340 (EMA3010)
UNION 2 EM720 (EMA2900)
BOTH EMPLOYER AND UNION 3 EM720 (EMA2900)
REFUSED RF BOX_340 (EMA3010)
DON'T KNOW DK BOX_340 (EMA3010)

Display Instructions:

Display ?job? if SelfEmpnot equal to SelfEmpl
Display ?business? if SelfEmp equal to SelfEmpl
Display ?employer? if SelfEmpnot equal to SelfEmpl
Display ?business? if SelfEmp equal to SelfEmpl

EM720 (EMA2900)

BLAISE NAME: UnionRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE)

Question Text:

What is the name of the union providing the health insurance?
SELECT UNION NAME BELOW AND VERIFY WITH RESPONDENT BEFORE LEAVING SCREEN.
IF UNION IS NOT ON THE LIST, PRESS CTRL-A TO ENTER A NEW UNION.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(UnionName)1 1 BOX_340 (EMA3010)
(UnionName)2 2 BOX_340 (EMA3010)
(UnionName)3 3 BOX_340 (EMA3010)
(UnionName)4 4 BOX_340 (EMA3010)
(UnionName)N 5 BOX_340 (EMA3010)

Programmer Instructions:

Roster behavior:
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.UnionDedupOrgID equal to DedupOrg.DedupOrgID and Job.UnionName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Union
Allow 40 characters for DeDupOrgName roster entries.

Display Instructions: Roster 3- add/delete allowed

Roster definition:
This item displays the RU UNION roster for selection.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Union, DirectPurchase_Union
When CTRL-A selected, display the following customized question wording in the pop-up: ENTER COMPLETE UNION NAME AND VERIFY SPELLING.

BOX_340 (EMA3010)

Route Details:

If SelfEmp not equal to SelfEmpl,
OR
If SelfEmp equal to SelfEmpl AND JobTp equal to LAST JOB OUTSIDE THE REFERENCE PERIOD and JobStopMM/DD/YYYY greater than 2 years from current interview date,
OR
If SelfEmp equal to SelfEmpl AND JobTp equal to RETIREMENT and JobStopMM/DD/YYYY greater than 2 years from current interview date, go to END_LP30.
If SelfEmp equal to SelfEmpl and more than 1 RU member (other than the person being asked about) is equal to or greater than 16 years of age or in age categories 4-9, continue with EM730.
Otherwise, go to EM740.

EM730 (EMA3015)

BLAISE NAME: OthHHMembAtEmp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

(Does/Did) any other member of the household (now) work regularly at (your/(PERSON)'s) business?

Responses:

YES 1 EM740 (EMA3025)
NO 2 EM740 (EMA3025)
REFUSED RF EM740 (EMA3025)
DON'T KNOW DK EM740 (EMA3025)

Display Instructions:

(Does/Did): Display ?Does? if the job subtype of the job being asked about is set as JobTp equal to CURRENT MAIN or JobTp equal to CURRENT MISC and current round is not round 5.
Display ?DID? if JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT or if current round is round 5.
Display ?now? if JobTP equal to CURRENT MAIN OR JobTp equal to CURRENT MISC and current round is not round 5.
Otherwise, use a null display.

EM740 (EMA3025)

BLAISE NAME: TotNumEmp

Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (JobsEstbName)
(JobStartMM/DD/YYYY)
(JobStopMM/DD/YYYY)

Question Text:

What was the total number of employees who worked at the business (last week/just before (you/(PERSON)) stopped working at that business/on (END DATE))? Be sure to include the owner (and all other household members you just told me about).
ENTER AT LEAST 1 TO COUNT THE OWNER. ENTER NUMBER

Responses:

1 END_LP30 (EMA3030)
REFUSED RF END_LP30 (EMA3030)
DON'T KNOW DK END_LP30 (EMA3030)

Programmer Instructions: Hard check:

Numeric value entered must be equal to or greater than 1. If '0' is entered, display the following message: "SINCE (you/(PERSON'S FIRST MIDDLE AND LAST NAME)) (is/are) the owner, I am going to enter 1 to count (you/him/her). ENTER 1 AT EM740 (TotNumEmp) FOR NUMBER OF EMPLOYEES TO CONTINUE."
Set TotNumEmp equal to The value entered at EM740
If the value entered for the number of employees equal to 1 set EmpEstm equal to ?1?
If the value entered for the number of employees equal to 2-9, inclusive, set EmpEstm equal to ?2-9?
If the value entered for the number of employees equal to 10-25, inclusive, set EmpEstm equal to ?10-25?
If the value entered for the number of employees equal to 26-50, inclusive, set EmpEstm equal to ?26-50?
If the value entered for the number of employees equal to 51-100, inclusive, set EmpEstm equal to ?51-100?
If the value entered for the number of employees equal to 101-200, inclusive, set EmpEstm equal to ?101-200?
If the value entered for the number of employees equal to 201-500, inclusive, set EmpEstm equal to ?201-500?
If the value entered for the number of employees is greater than 500 set EmpEstm equal to ?500+?
If coded DK set EmpEstm equal to DK
If coded RF set EmpEstm equal to RF

Display Instructions:

Display ?last week? if the job subtype of the job being asked about is set as JobTp equal to CURRENT MAIN or JobTp equal to CURRENT MISC and current round is not round 5.
Display ?just before (you/(PERSON)) stopped working at that business? JobTp equal to FORMER MAIN, JobTp equal to FORMER MISC, JobTp equal to LAST JOB OUTSIDE REFERENCE PERIOD, or JobTp equal to RETIREMENT
Display ?on (END DATE)? if s JobTp equal to CURRENT MAIN or JobTp equal to CURRENT MISCELLANEOUS JOB and current round is round 5.
Display (and all other household members you just told me about): if EM730 is coded ?1? (YES)

END_LP30 (EMA3030)

Route Details:

Cycle on next job in person?s-jobs-roster that meets the conditions stated in the loop definition.
If no other jobs meet the stated conditions, end LOOP_30 and continue with BOX_350.

BOX_350 (EMA3035)

Route Details:

If current round EM300 equal to NO, DK or RF
OR if round greater than 1 and Pre_EM300 equal to NO, DK or RF and person?s total job count is zero, go to Box_370.
If person has a CURRENT MAIN job, a CURRENT MISC job, a FORMER MAIN job that was created this round, a FORMER MISC job that was created this round, a FORMER MAIN job that was a CURRENT MAIN job in the previous round (JobTp equal to FmrMainJob AND PR_JobTp equal to CurrMainJob), or a FORMER MISC job that was a CURRENT MISC job in the previous round (JobTp equal to FmrMiscJob AND PR_JobTp equal to CurrMiscJob) go to EM760.
Otherwise, go to EM750.

EM750 (EMA3045)

BLAISE NAME: ResnNotWork
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

What is the main reason (you/(PERSON)) did not work (since (START DATE)/between (START DATE) and (END DATE))?
HELP: F1

Responses:

COULD NOT FIND WORK 1 BOX_360 (EMA3195)
RETIRED 2 BOX_360 (EMA3195)
UNABLE TO WORK BECAUSE ILL/DISABLED 3 BOX_360 (EMA3195)
GOING TO SCHOOL 4 BOX_360 (EMA3195)
TAKING CARE OF HOME OR FAMILY 5 BOX_360 (EMA3195)
DON'T WANT TO WORK 6 BOX_360 (EMA3195)
OTHER-SPECIFY 91 EM750OS (EMA3050)
REFUSED RF BOX_360 (EMA3195)
DON'T KNOW DK BOX_360 (EMA3195)

Programmer Instructions:

Note: For round 5, Display the person's current round reference period end date in the context header for questions EM750 and EM760.

Display Instructions:

Display EM750 and EM750OS on the same form pane.
Display 'since? (START DATE)' if not round 5.
Display 'between (START DATE) and (END DATE)' if round 5.

EM750OS (EMA3050)

BLAISE NAME: ResnNotWorkOS

Question Text:

SPECIFY:

Responses:

1 BOX_360 (EMA3195)
REFUSED RF BOX_360 (EMA3195)
DON'T KNOW DK BOX_360 (EMA3195)

Display Instructions:

Display EM750 and EM750OS on the same form pane.

EM760 (EMA3065)

BLAISE NAME: WksWorked
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

Please think about all the time (you/(PERSON)) (have/has) worked (since (START DATE)/between (START DATE) and (END DATE)), including paid vacation, sick leave, or other paid leave. How many weeks did (you/he/she) work for pay either full or part time?
NUMBER OF WEEKS IN REFERENCE PERIOD: (NUMBER OF WEEKS)
IF WORKED THE WHOLE TIME, ENTER ?96? FOR NUMBER OF WEEKS.
IF WORKED LESS THAN ONE WEEK, ENTER ?1? FOR NUMBER OF WEEKS.
ENTER NUMBER
HELP: F1

Responses: 1

REFUSED RF BOX_360 (EMA3195)
DON'T KNOW DK BOX_360 (EMA3195)

Programmer Instructions:

If ?96? is entered for number of weeks worked, go to BOX_360.
Hard check:
Edit: Number of weeks entered cannot be greater than number of weeks in reference period.
If the value is outside of the range display the following message: "THE NUMBER OF WEEKS ENTERED CANNOT BE GREATER THAN THE NUMBER OF WEEKS IN THE REFERENCE PERIOD. PLEASE VERIFY AND RE-ENTER."
Special check:
The values for WEKSWRKD should be between 0 and 75 and should also include 96. A check should be conducted to ensure that any values outside of those defined produce an error and prohibit the interviewer from continuing until corrected.

Display Instructions:

Display ?since? (START DATE)' if not round 5.
Display ?between? (START DATE) and (END DATE)' if round 5.

BOX_360 (EMA3195)

Route Details:

If round 3, continue with EM770.
Otherwise go to BOX_370.

EM770 (EMA3200)

BLAISE NAME: Job1231
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (START DATE) (END DATE)

Question Text:

(Were/Was) (you/(PERSON)) working as of December 31, (YEAR)?

Responses:

YES 1 BOX_370 (EMA3205)
NO 2 BOX_370 (EMA3205)
REFUSED RF BOX_370 (EMA3205)
DON'T KNOW DK BOX_370 (EMA3205)

Programmer Instructions:

(For specification purposes only; CAPI handles automatically): ?YEAR? in question text is first calendar year of panel.

Display Instructions:

BOX_370 (EMA3205)

Route Details: Continue with END_LP10(in EM-O)

Employment Driver (EMO) Section

BOX_10 (EMO1001)

Route Details:

Note: REFUSED (RF) and DON?T KNOW (DK) Are disallowed on all fields in the Employment sections that collect JobsEstbName or UnionName name.

LOOP_10 (EMO1005)

Route Details:

For each element in the RU-Members-Roster, ask BOX_20 - END_LP10.
Loop Definition: LOOP_10 collects information about employment for all RU members who are 16 or older. This loop cycles on RU members who meet both of the following conditions:
Person is = or greater than 16 years, or in age categories 4-9 And
Person is an RU member during the current round
Note:
All rounds begin with RJ section
If Round 1 (or no employment information was collected in the previous round) no questions are asked in the RJ section; ask the EM section
Ask the EW section to collect wage information.
If information was collected for at least one job in the previous round, ask the RJ section.
If there is a change in wages since the previous round ask the EW section.

BOX_20 (EMO1006)

Programmer Instructions:
In EM, CAPI will allow the interviewer to press CTRL-S to select a different RU member and complete the sections (including not starting with the respondent/reference person) at any point during the section. CAPI should return to the first unanswered question when returning to an RU member?s section that has already been started but not completed.

EMIntroduction (EMO1007)

BLAISE NAME: EMIntroduction
Question Text:
EMPLOYMENT (EM) SECTION ? ASKED FOR EACH RU MEMBER.
CTRL-S: SWITCH TO EM QUESTIONS FOR A DIFFERENT RU MEMBER.
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 BOX_30 (EMO1010)
Programmer Instructions:
This item is presented only for the first person that goes through the EM section. Skip EMIntroduction for all other RU members.
Display Instructions:

BOX_30 (EMO1010)

Route Details:

Ask Review of Employment (RJ) section.

END_LP10 (EMO1015)

Route Details:

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 the Health Insurance (HX) section.

Emergency Room (ER) Section

BOX_00 (ER1000)

Route Details:

01 Box = BOX_00, BOX_10, BOX_20
04 Single Select = ER20, ER40, ER60
06 Single Select with Fill in Answer Text = ER10
08 Multiple Select = ER50
11 Multiple Select with Add/Edit/Delete = ER30, ER70
Roster 3 = ER30, ER70

BOX_10 (ER1001)

Route Details:

Context header display instructions:
Display PERS.FULLNAME, PROV.LORPNAME, EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY.

ER10 (ER1010)

BLAISE NAME: ERVstCat
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Question Text:
And ER-1:
Please look at card ER-1 and tell me which category best describes the care [you/[PERSON]] received during the visit to [PROVIDER] emergency room on [VISIT DATE].
HELP: F1

Responses:
DIAGNOSIS OR TREATMENT 1 ER20 (ER1015)
EMERGENCY (E.G., ACCIDENT OR INJURY) 2 ER20 (ER1015)
PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING 3 ER20 (ER1015)
FOLLOW-UP OR POST-OPERATIVE VISIT 4 ER20 (ER1015)
IMMUNIZATIONS OR SHOTS 5 ER20 (ER1015)
[PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)] 6 ER20 (ER1015)
OTHER 91 ER20 (ER1015)
REFUSED RF ER20 (ER1015)
DON'T KNOW DK ER20 (ER1015)
Display Instructions: Display response option ?6? (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY) ), if person is female and age 15 to 55 inclusive (or age categories 3 to 8).
Otherwise, use a null display.

ER20 (ER1015)

BLAISE NAME: ERSpecCond
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Question Text:
Was this visit related to any specific health condition or were any conditions discovered during this visit?

Responses:
YES 1 ER30 (ER1020)
NO 2 ER40 (ER1023)
REFUSED RF ER40 (ER1023)
DON'T KNOW DK ER40 (ER1023)
Display Instructions:

ER30 (ER1020)

BLAISE NAME: ERCondRoster
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Question Text:
What conditions were discovered or led [you/[PERSON]] to make this visit?
PROBE: Any other condition?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

Responses:
[MEDICAL CONDITION] 1 1 ER50 (ER1025)
[MEDICAL CONDITION] 2 2 ER50 (ER1025)
[MEDICAL CONDITION] 3 3 ER50 (ER1025)
[MEDICAL CONDITION] 4 4 ER50 (ER1025)
[MEDICAL CONDITION]N 5 ER50 (ER1025)
Programmer Instructions:
Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Display Instructions:
Roster 3 - add/edit/delete allowed
Roster definition:
Display the person-medical-conditions-roster for the selection and addition of one or many medical condition(s) associated with this event. Display name of medical condition (COND.CONDNAM)
Roster filter:
Display all conditions on person's roster; no filter.

ER40 (ER1023)

BLAISE NAME: ERSurgProc
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Question Text:
Was a surgical procedure performed on [you/[PERSON]] during this visit?
HELP: F1

Responses:
YES 1 ER50 (ER1025)
NO 2 ER50 (ER1025)
REFUSED RF ER50 (ER1025)
DON'T KNOW DK ER50 (ER1025)
Display Instructions:

ER50 (ER1025)

BLAISE NAME: CodeAllERSvc
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Question Text:
And ER-2.
Looking at this card, which of these services, if any, did [you/[PERSON]] have during this visit?
ENTER ALL THAT APPLY.
HELP: F1

Responses:
LABORATORY TESTS 1 ER60 (ER1035)
SONOGRAM OR ULTRASOUND 2 ER60 (ER1035)
X-RAYS 3 ER60 (ER1035)
MAMMOGRAM 4 ER60 (ER1035)
MRI OR CATSCAN 5 ER60 (ER1035)
EKG, ECG, OR EEG 6 ER60 (ER1035)
VACCINATION 7 ER60 (ER1035)
NONE OF THESE SERVICES RECEIVED 95 ER60 (ER1035)
REFUSED RF ER60 (ER1035)
DON'T KNOW DK ER60 (ER1035)
Programmer Instructions:
Soft Check:
If coded ?4? (MAMMOGRAM) and person being asked about is male or is female and less than or = 17 years of age (or age categories 1-3), display the following message: ?UNLIKELY RESPONSE FOR [MALES/CHILDREN 17 AND YOUNGER]. VERIFY AND RE-ENTER.?
Display ?MALE? in error message if person being asked about is a male greater than 17 years of age (or age categories 4 through 9). Display ?CHILDREN 17 AND YOUNGER? in the error message if person being asked about is male or female and less than or = 17 years of age (or age categories 1-3).
Allow code '95' (NONE OF THESE SERVICES RECEIVED) , 'RF' (REFUSED), and 'DK' (DON'T KNOW) alone only; these responses may not be selected with any other response.
Note: 'NONE OF THESE SERVICES RECEIVED' is not displayed on show card.
Hard check:
Edit: if coded ?95? (NONE OF THESE SERVICES RECEIVED), no other service categories can be coded.
If interviewer selects another code with NONE OF THESE SERVICES RECEIVED, display the following message: "NONE OF THESE SERVICES RECEIVED CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE- ENTER."
Display Instructions:

ER60 (ER1035)

BLAISE NAME: ERPmed
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Question Text:
During this visit, were any medicines prescribed for [you/[PERSON]]? Please include only prescriptions which were filled.

Responses:
YES 1 ER70 (ER1040)
NO 2 BOX_20 (ER1045)
REFUSED RF BOX_20 (ER1045)
DON'T KNOW DK BOX_20 (ER1045)
Display Instructions:

ER70 (ER1040)

BLAISE NAME: ERPmedRoster
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Question Text:
Please tell me the names of the prescriptions from this visit that were filled.
PROBE: Any other prescribed medicines from this visit that were filled?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:
[PRESCRIBED MEDICINE]1 1 BOX_20 (ER1045)
[PRESCRIBED MEDICINE]2 2 BOX_20 (ER1045)
[PRESCRIBED MEDICINE]3 3 BOX_20 (ER1045)
[PRESCRIBED MEDICINE]4 4 BOX_20 (ER1045)
[PRESCRIBED MEDICINE]N 5 BOX_20 (ER1045)
Programmer Instructions: Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a medicine added at this item until CAPI creates the link between this medicine and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit medicines added at this item until CAPI creates the link between this medicine and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.
When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.
When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name.
General flag rules for medicines:
- Round medicine first created (by definition a medicine is selected the same time it is created)
- Question number medicine first created
- Round medicine selected
- Event medicine is linked to (however, this is known by virtue that the medicine was selected at ER70 for this event)
Display Instructions:
Roster 3 - add/edit/delete allowed
Roster definition:
This item displays the person's-prescription medicines-roster for selection. Display name of prescribed medicine (DRUG.DRUGNAME).
Roster filter:
Display all medicines on person's roster; no filter.

BOX_20 (ER1045)

Route Details:

Go to the Charge/Payment (CP) section if it needs to be asked for this emergency room 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.

Event Roster (EV) Section

BOX_00 (EV1000)

Route Details:

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, BOX_160
02 Loop - LOOP_10, LOOP_20, LOOP_30
03 End Loop - END_LP10, END_LP20, END_LP30
04 Single Select - EV50, EV60, EV80, EV110, EV130, EV150, EV180, EV200, EV230, EV250
05 Single Select with Display Roster - EV70_01
06 Single Select with Fill in Answer Text - EV10, EV20, EV100, EV170, EV220
10 Multiple Select with Fill in Answer Text - EV90, EV160, EV210
16 Date Picker - EV30, EV40
31 Date Item Single Field = EV120, EV140, EV190, EV240, EV260
24 Information Screen - EV15, EV25
Grid 1 - EV70_01
Roster 2 - EV10, EV90, EV100, EV160, EV170, EV210, EV220
23 Text Field = EV45

BOX_10 (EV1001)

Route Details:

Context header display instructions:
Display PERS.FULLNAME, PROV.DRFNAM, PROV.LORPNAME (if EVNT.PROVNUM ^= -1), EVNT.EVNTTYPE (if set), EVNT.EVNTBEGM, D (EVNTBEGM only for HH), (PRND.BEGREFMM, DD for OM), EVNT.EVNTENDM, D (if EVNT = HS), (PRND.ENDREFMM, DD for OM).
When creating an event, set the following:
Round the event was created in
The question number the event was created at

BOX_20 (EV1005)

Route Details:

If coming from Calendar (CA) Section, Event Follow-Up (EF) Section, or from Off Path route, continue with EV10.
Otherwise (coming from EE section, where Person is already known), go to EV20.

EV10 (EV1010)

BLAISE NAME: EvntPersRoster

Question Text:

[INTERVIEWER: SELECT CORRECT PERSON FOR THIS EVENT.]
[[Next I need to enter some basic information about the health care visits from the records you have for the people in this household.] Let?s [start/continue] with this [next] record. Please tell me who [(else)] this record is for.]

Responses:

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

Programmer Instructions:

Roster behavior: 1. Single select only.
If person selected at EV10 has NOT reported at least one ?1? (YES, HAS RECORD TYPE) at CA30_01 through CA30_08, go to EV15. Otherwise, go to EV20.
NOTE TO PROGRAMMER: For each person selected at EV10 without at least one value of 1 (YES, HAS RECORD TYPE) at CA30_01 through CA30_08, CAPI will display this person?s name at either PP10 or PP170 in a fill.

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition: Display the RU members-Roster for selection.
Roster filter: No filter; display all RU members.
-Display ?INTERVIEWER: SELECT CORRECT PERSON FOR THIS EVENT? if coming from the Off path route or the Event Follow-Up (EF) Section. Otherwise, use a null display.
Display paragraph ?[Next I need ? this record is for?]? if coming from Calendar (CA) Section. Otherwise, use a null display.
-Display ?Next I need to enter some basic information about the health care visits from the records you have for the people in this household.? if first time going through LOOP_30 in CA section, otherwise, use null display.
-Display ?start? if first time EV10 is being asked. Otherwise, display ?continue.?
Display ?next? if CA100 was coded ?1? (YES) to loop again. Otherwise, use a null display.
Display ?(else)? if CA90 was coded ?1? (YES) to loop again for this record. Otherwise, use a null display.

EV15 (EV1015)

BLAISE NAME: ProbeReminder
Question Text:

At the moment, we're going to focus on [[you]/[and] [NAMES OF PEOPLE WITH RECORDS]] since you have records to help you report [your/their] health care. We'll talk about health care for [you/[PERSON ]] a little later in the interview. I will remind you when we get to that section.
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1

Programmer Instructions:

Go to BOX_160.
NOTE TO PROGRAMMERS: A person level variable needs to store the response to EV15. If EV15 has a value, the Provider Probes section (PP10 or PP170) will use the information to determine a fill display for a person in the family or non-family subunit Display the RU members? names that have at least 1 record reported at CA30_01-CA30_08.
Display RU member?s name (or you for respondent) selected at EV10 who didn?t report at least one record ?1? (YES HAS RECORD) at CA30_01-CA30_08.
Display ?you? if the respondent has reported at least 1 record at CA30_01-CA30_08.
Display ?and? if both the respondent and another RU member has at least 1 record reported at CA30_01 -CA30_08.

EV20 (EV1020)

BLAISE NAME: EvntTp
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME]
Question Text:

AND EV-1[A/B]
[Looking at show card EV-1[A/B], at what type of place did [you/[PERSON]] receive the care?/
Looking at show card EV-1[A/B], tell me if [you/[PERSON]] received the care at [a hospital/a hospital emergency room/home/a residential or long term care facility] or at some other type of place listed on the card?]
REFER TO QUICK REFERENCE GUIDE FOR EVENT TYPE FOLLOW-UP PROBES.
HELP: F1

Responses:

HOSPITAL (HS) 1 BOX_30 (EV1030)
HOSPITAL EMERGENCY ROOM (ER) 2 BOX_30 (EV1030)
HOSPITAL OUTPATIENT DEPARTMENT (OP) 3 BOX_30 (EV1030)
DENTAL OFFICE (DN) 4 BOX_30 (EV1030)
MEDICAL PROVIDER OFFICE OR CLINIC (MV) 5 BOX_30 (EV1030)
CARE RECEIVED AT HOME (HH) 6 EV50 (EV1050)
RESIDENTIAL OR LONG TERM CARE FACILITY (IC) 7 BOX_30 (EV1030)
[GLASSES/CONTACT LENSES] 8
[OTHER MEDICAL EXPENSES] 9

Programmer Instructions:

If coming from Calendar (CA) or Event Follow-Up (EF) and coded ?8? (GLASSES/CONTACTS), create an OM(E) record ?GLASSES/CONTACTS? and go to BOX_160.
If coming from Off Path Section (OF) and coded ?8? (GLASSES/CONTACTS), display the following message ?RECORD THE PURCHASE OF GLASSES IN THE OM SECTION IF AT (OR BEFORE) THE OM SECTION FOR THIS PERSON. OTHERWISE, MAKE A COMMENT.? and then go to BOX_160.
If coming from Calendar (CA) or Event Follow-Up (EF) and coded ?9? (OTHER MEDICAL EXPENSES), go to EV25.
If coming from Off Path Section (OF) and coded ?9? (OTHER MEDICAL EXPENSES), display the following message ?RECORD THE PURCHASE OF OTHER MEDICAL EXPENSES IN THE OM SECTION IF AT (OR BEFORE) THE OM SECTION FOR THIS PERSON. OTHERWISE, MAKE A COMMENT.? and then go to BOX_160.

Display Instructions:

If coming from Off Path Route, Calendar (CA) or Event Follow-Up (EF) sections, display ?B?. Otherwise, display ?A?. If coming from Off Path Route, Calendar (CA) or Event Follow-Up (EF) sections, display response options for ?GLASSES/CONTACT LENSES ?and? OTHER MEDICAL EXPENSES? Otherwise, use a null display.
Display ?Looking at show card EV-1[A/B], tell me if [you/[PERSON]] received the care at?? If the event is coming from PP10, PP170, PP20, PP180, PP140, PP300, PP150, PP310, or if coming from the EE section and EE30=1 and the instance of EE is launched from any of those questions (PP10, PP170, PP20, PP180, PP140, PP300, PP150, PP310) AND
Display ?a hospital? if coming from PP10 or PP170, or if coming from EE30, and EE30=1 and instance of EE was launched from PP10 or PP170.
Display ?a hospital emergency room? if coming from PP20 or PP180 or if coming from EE30 and EE30=1 and instance of EE was launched from PP20 or PP180.
Display ?at home? if coming from PP140 or PP300 or if coming from EE30 and EE30=1 and instance of EE was launched from PP140 or PP300.
Display ?a residential or long term care facility? if coming from PP150 or PP310 or if coming from EE30 and EE30=1 and instance of EE was launched from PP150 or PP310.
Otherwise, display ?Looking at show card EV-1[A/B], at what type of place did [you/[PERSON]] receive the care?]

EV25 (EV1025)

BLAISE NAME: OMReminder
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME]
Question Text:

At this time we are just recording visits to health care providers. I have recorded this information and will remind you to tell me about [your/[PERSON]?s] medical purchases at a later point in the interview.
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1

Programmer Instructions:

Go to BOX_160.
NOTE TO PROGRAMMERS: A person level variable needs to store the response to EV25. If EV25 has a value, the Other Medical Expenses (OM) Section will use the information to determine a question display for the person being cycled on through the OM section.

Display Instructions:

BOX_30 (EV1030)

Route Details:

Ask Provider Roster (PV) section for this event.
At completion of the PV section, go to BOX_40.

BOX_40 (EV1035)

Route Details:

If event type is HS or IC, continue with EV30.
Otherwise, go to EV40.

EV30 (EV1040)

BLAISE NAME: HSICDatePicker
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME][STR-DT][END-DT][EV] [NAME OF MEDICAL CARE PROVIDER......]
Question Text:

When [were/was] [you/[PERSON]] admitted to and discharged from [PROVIDER]? If [you/he/she] went more than once, please tell me all stays between [START DATE] and [END DATE].
PRESS 1 AND ENTER TO LAUNCH DATE PICKER.

Responses:

CONTINUE 1 BOX_60 (EV1070)
EMPTY Empty BOX_60 (EV1070)

Programmer Instructions:

Launch range date picker when ?1? (CONTINUE) is selected. CAPI will copy the dates selected at this instance of EV and move it into the Event Array. Control Variables must be set so that the dates selected at this instance are saved, to be used later in the EV section. Set a variable (e.g. CurrEventsIDs) to a dash delimited string with all EventIDs created at this EV30 instance.
Ideally, although these dates will be saved to the event array once FI moves past this screen, if FI was to back up, we would like for the dates that were selected during this instance to display as active and editable, with the option of ?cancel ?to move away and keep backing up or going forward without making any changes. If an FI backs-up over EV30, the ?1? (CONTINUE) should be emptied out so that the FI must select ?1? again to launch the datepicker. The datepicker should not automatically display during back-up and moving forward.
Hard Check: Before an interviewer moves off EV30 for the first time during this instance, there should be a check to determine that at least 1 event date was added at the datepicker. If at least one date was not added, display the datepicker and the message ?At least one stay must be added.?
Edit 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).
At completion of date picker, go to BOX_60.

Display Instructions:
EV40 (EV1045)

BLAISE NAME: OthEvntDatePicker
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME][STR-DT][END-DT] [EV] [NAME OF MEDICAL CARE PROVIDER......]-[DOC or DEPT]
Question Text:

When did [you/[PERSON]] visit [PROVIDER] - [DOC or DEPT]? Please tell me all the dates between [START DATE] and [END DATE].
PRESS 1 AND ENTER TO LAUNCH DATE PICKER.

Responses:

CONTINUE 1 BOX_60 (EV1070)
EMPTY Empty BOX_60 (EV1070)

Programmer Instructions:

Launch standard date picker when ?1? (CONTINUE) is selected. CAPI will copy the dates selected at this instance of EV and move it into the Event Array. Control Variables must be set so that the dates selected at this instance are saved, to be used later in the EV section. Set a variable (e.g. CurrEventsIDs) to a dash delimited string with all EventIDs created at this EV40 instance.
Ideally, although these dates will be saved to the event array once FI moves past this screen, if FI was to back up, we would like for the dates that were selected during this instance to display as active and editable, with the option of ?cancel? to move away and keep backing up or going forward without making any changes. If an FI backs-up over EV40, the ?1? (CONTINUE) should be emptied out so that the FI must select ?1? again to launch the datepicker. The datepicker should not automatically display during back-up and moving forward.
Hard Check: Before an interviewer moves off EV40 for the first time during this instance, there should be a check to determine that at least 1 event date was added at the datepicker. If at least one date was not added, display the datepicker and the message ?At least one visit must be added.?
Note: The datepicker will only display the dates within the person?s reference period.
At completion of date picker go to BOX_60.

Display Instructions:

EV50 (EV1050)

BLAISE NAME: HHEvntTp
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME][STR-DT][END-DT]
Question Text:

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

Responses:

FRIEND/NEIGHBOR 1 EV70_01 (EV1065)
RELATIVE 2 EV70_01 (EV1065)
VOLUNTEER 3 EV70_01 (EV1065)
OTHER - PAID 4 EV60 (EV1055)
VOLUNTEER: MEAL DELIVERY SERVICE 5 BOX_160 (EV1235)

Programmer Instructions:

If coded ?1? (FRIEND/NEIGHBOR):
-Add ?FRIEND(S) OR NEIGHBOR(S)? to the RU-medical-providers-roster, person-type-provider 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 EV50 is coded ?1? (FRIEND/NEIGHBOR), ?2? (RELATIVE), or ?3? (VOLUNTEER), flag provider as ?INFORMAL? for PROV.HHTYPE (this will have to be replaced when we know what variable it is being stored as).

Display Instructions:

EV60 (EV1055)

BLAISE NAME: EvntAgencySelf
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [STR-DT][END-DT]
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?

Responses:

WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME 1 BOX_50 (EV1060)
WORKED FOR SELF 2 BOX_50 (EV1060)
REFUSED RF BOX_50 (EV1060)
DON?T KNOW DK BOX_50 (EV1060)

Display Instructions:

BOX_50 (EV1060)

Route Details:

Ask Provider Roster (PV) section for this event.
If EV60 is coded ?1? (WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME), flag provider just collected in PV section as ?AGENCY? for PROV.HHTYPE.
If EV60 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 EV70_01.)

EV70_01 (EV1065)

BLAISE NAME: HHMth1
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME][STR-DT][END-DT] [EV][NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Did [someone from] [PROVIDER] provide home care services for [you/[PERSON]]?
?during the month of [MONTH_1]?

Responses:

YES 1
NO 2
REFUSED RF
DON?T KNOW DK

Programmer Instructions:

Preloaded Grid Type 1- forced navigation including EV70_01, EV70_02, EV70_03, EV70_04?, EV70_N.
If the current round interview month is coded ?1? (YES), the HH utilization section will not be asked this round and set the status of this event to ?95? (OPEN HH EVENT) to be followed up on in the next round.
Grid must accommodate at least 10 months.
?RF? (REFUSED) and ?DK? (DON?T KNOW) are allowed for EV70_01, EV70_02, EV70_03, EV70_04?, EV70_N. However, they will be treated as a ?NO? when creating events.
For each month that is coded ?1? (YES), CAPI will create one event for that person-provider pair.
Go to BOX_160.

Display Instructions:

Roster 1 Report.
Display Months Col#1 Header: Months Instructions: Display months according to specifications in roster filter.
Roster Filter: Display all months in person?s reference period including the previous round interview month. If, however, the previous round interview month was already coded ?YES? during the previous interview do not display here. Display the subsequent month. Display the following variable question text wording in person?s reference period for the months following the first:
EV70_02. How about in [MONTH_2]?
EV70_03. How about in [MONTH_3]?
EV70_04. ?during the month of [MONTH_4]?
EV70_N. How about in [MONTH_N]?
Repeat variable question text for EV70_01-EV70_N for months beyond.
Display ?Did [someone from] [PROVIDER] provide home care services for?? in black bold text for every fourth question in this grid, otherwise, display in lighter grayed-out text.
Display ?someone from? if provider is a facility. Otherwise, use a null display.

BOX_60 (EV1070)

Route Details:

If event was created at EV20 and was coded ?2? (HOSPITAL EMERGENCY ROOM), continue with EV80.
If event was created at EV20 and was coded ?1? (HOSPITAL STAY), go to EV150.
If event was created at EV20 and was coded ?7? (RESIDENTIAL/LONG TERM CARE
FACILITY), go to EV200.
Otherwise, go to BOX_160.

EV80 (EV1075)

BLAISE NAME: HSFollowER
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [EV] [NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Did [any of] [your/PERSON]?s] [visit/visits] to the emergency room lead to an admission to the hospital on the same day or the next day?

Responses:

YES 1
NO 2 BOX_160 (EV1235)
REFUSED RF BOX_160 (EV1235)
DON?T KNOW DK BOX_160 (EV1235)

Programmer Instructions:

Use the variable CurrEventIDs created at EV40. If CurrEventIDs consists of exactly one EventID then use a null display for the first fill and display ?visit? for the second fill. If CurrEventIDs consists of more than one EventID, then display ?any of? for the first fill and display ?visits? for the second fill.
If EV80 is ?1? (YES) and more than one emergency room (ER) event record at EV40 in this pass through the EV section, continue with EV90.
If EV80 is coded ?1? (YES) and exactly one emergency room (ER) event record at EV40 in this pass through the EV section, auto-code that ER event at EV90 and then go to LOOP_10.
If EV80 is coded ?1? (YES), create another event record for the person currently looping on this instance of the EV section and the type is an HS event. The provider and date will be collected in LOOP_10 for this newly created linked HS event.

Display Instructions:

Display ?any of? if more than 1 ER event record at EV40 in this pass through the EV section. Otherwise, use a null display.
Display ?visit? if exactly 1 ER event record at EV40 in this pass through the EV section. Otherwise, display ?visits?.

EV90 (EV1080)

BLAISE NAME: ERLinkRoster1
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [EV] [NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Which emergency room visit or visits were followed by a hospital stay?
ENTER ALL THAT APPLY.
Date Provider

Responses:

[MONTH, DAY, YEAR] [PROVIDER]1 1
[MONTH, DAY, YEAR] [PROVIDER]2 2
[MONTH, DAY, YEAR] [PROVIDER]3 3
[MONTH, DAY, YEAR] [PROVIDER]4 4
[MONTH, DAY, YEAR] [PROVIDER]N 5

Programmer Instructions:

Use the variable CurrEventIDs created at EV40 to be able to list the correct response options for event dates and provider names.
For each ER visits selected at EV90, create another event record. The event type is HS, and the person is the RU member in the context header. The two events are linked in BOX_90.
Go to LOOP_10.
Roster Behavior:
Multiple select allowed.

Display Instructions:

Roster type 2- no add/edit/delete allowed
Roster definition: Display only ER events that were just recorded at EV40 in this current pass through the EV section.
The headings Date and Provider should appear in the response pane located directly above the [MONTH, DAY, YEAR] and [PROVIDER] displayed in two columns.
Roster Filter:
Display only those events with the following characteristics:
Event was created this round.
Event is for this person.
Event has event type of ?ER?
Event recorded at EV40 in this current pass through the EV section.

LOOP_10 (EV1085)

Route Details:

For each ER event selected at EV90 as being followed by a hospital stay event on this person medical-events roster, ask BOX_70-END_LP10.
Loop definition: LOOP_10 cycles on each ER event selected at EV90 as being followed by a hospital stay event. Cycle (ask BOX_70-END_LP10) on all events that meet the following conditions:
-Event type is ER and was selected at EV90.

BOX_70 (EV1090)

Route Details:

Check to see if any HS events have been recorded with has an admit date after the ER visit date selected at EV90 that is currently being looped on, for person being looped on. If person has reported at least one HS event that meets this criteria, go to EV100, otherwise, go to EV110.

EV100 (EV1093)

BLAISE NAME: HSLinkRoster1
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [STR-DT][END-DT] [EV] [NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Which hospital stay followed [your/[PERSON]?s] emergency room visit to [PROVIDER] on [VISIT DATE]?
Admit date Discharge date Provider

Responses:

HOSPITAL STAY NOT YET RECORDED 0
[MONTH, DAY, YEAR] [MONTH,DAY,YEAR] [PROVIDER] 1 1
[MONTH, DAY, YEAR] [MONTH,DAY,YEAR] [PROVIDER] 2 2
[MONTH, DAY, YEAR] [MONTH,DAY,YEAR] [PROVIDER] 3 3
[MONTH, DAY, YEAR] [MONTH,DAY,YEAR] [PROVIDER] 4 4
[MONTH, DAY, YEAR] [MONTH,DAY,YEAR] [PROVIDER] N 5

Programmer Instructions:

Roster behavior:
Single select allowed.
If HS event selected, go to BOX_90. If EV100 is coded ?0? (HOSPITAL STAY NOT LISTED) go to EV110.

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition: This item displays all HS events reported for this person during this round.
The headings Admit Date, Discharge date, and Provider should appear in the response pane located directly above the [MONTH, DAY, YEAR] [MONTH, DAY, YEAR] and [PROVIDER] displayed in three columns.
Roster Filter:
Display only those events with the following characteristics:
Event was created this round or was created in the immediate previous round and had a discharge date of ?95? (STILL IN HOSPITAL).
Event is for this person.
Event has event type of ?HS'.
Event has an admit date after the ER visit date selected at EV90 that is currently being looped on.

EV110 (EV1095)

BLAISE NAME: ERHSSameProv1
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [STR-DT][END-DT] [EV][NAME OF MEDICAL CARE PROVIDER?]

Question Text:

Was the hospital stay that followed [your/[PERSON]?s] emergency room visit on [VISIT DATE] also to [PROVIDER]?

Responses:

YES 1 EV120 (EV1110)
NO 2 BOX_80 (EV1105)
REFUSED RF EV120 (EV1110)
DON?T KNOW DK EV120 (EV1110)

Programmer Instructions:

If coded ?1? (YES), ?RF? (REFUSED), or ?DK? (DON?T KNOW), link the HS event record in process of being created to the same provider as the ER event being looped on.

Display Instructions: Display the ?VISIT DATE ?selected at EV90

BOX_80 (EV1105)

Route Details:

Ask Provider Roster (PV) section for this event. Link the HS event record being created to the provider added or selected in the PV section.
At completion of the PV section, continue with EV120.

EV120 (EV1110)

BLAISE NAME: HSBegDate
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME]
Question Text:

What date [were/was] [you/[PERSON]] admitted to and discharged from [HS EVENT PROVIDER] after [your/[PERSON]?s] emergency room visit on [VISIT DATE] [also] to [ER EVENT PROVIDER]?
ENTER ADMIT DATE:

Responses: 1 EV130 (EV1115)

Programmer Instructions:

Hard check: The HS admittance date entered at EV120 should be on or within 5 days after the ER visit date selected at EV90 and currently being cycled on. If the admittance date for the hospital stay is greater than 6 days after the ER visit, display the following message: ?HOSPITAL STAY FOLLOWING THIS ER VISIT ON [VISIT DATE] MUST HAVE BEEN ON OR WITHIN 5 DAYS AFTER THE [VISIT DATE]. CORRECT DATE ON BACK-UP TO EV80 (HSFollowER) AND DO NOT LINK THIS HOSPITAL STAY TO THIS ER VISIT. THE HOSPITAL STAY SHOULD BE ENTERED AS A STAND-ALONE EVENT.?
Hard check: The admittance date entered at EV120 should be after the ER visit selected at EV90, and is currently being cycled on. If the admittance date entered is before the ER visit, display the following message: HOSPITAL STAY THAT FOLLOWED THE EMERGENCY ROOM VISIT ON [VISIT DATE] CANNOT BEGIN AFTER [VISIT DATE]. HOSPITAL STAY THAT FOLLOWED THE ER VISIT MUST HAVE BEEN ON OR WITHIN 5 DAYS AFTER [VISIT DATE]. CORRECT DATE OR BACK-UP TO EV90 (ERLinkRoster1) AND DO NOT LINK THIS HOSPITAL STAY TO THE ER VISIT. THE HOSPITAL STAY SHOULD BE ENTERED AS A STAND-ALONE EVENT.?
Hard check: If date entered is before the RU member?s reference period, display the following message: ?YOU MUST SELECT AN ADMITTANCE DATE WITHIN THE REFERENCE PERIOD?.

Display Instructions:

Display EV120, EV130, and EV140 on the same form pane.
Display ?also? if EV110 is coded ?1? (YES), otherwise use null display. Display ?VISIT DATE? if looping on more than one date in LOOP_10.
For [HS EVENT PROVIDER] display the provider name of the HS event currently looping on selected or added at EV100. For [ER EVENT PROVIDER] display the provider name of the ER event selected at EV90.
Display the date field for the Admit date here.

EV130 (EV1115)

BLAISE NAME: StillInHS
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [EV] [NAME OF MEDICAL CARE PROVIDER?.]
Question Text:

[What date [were/was] [you/[PERSON]] admitted to and discharged from [HS EVENT PROVIDER] after [your/[PERSON]?s]emergency room visit on [VISIT DATE] [also] to [ER EVENT PROVIDER]?]
PRESS 1 AND ENTER TO SELECT A DISCHARGE DATE. PRESS 95 TO INDICATE PERSON IS STILL IN THE HOSPITAL.

Responses:

DISCHARGE DATE 1 EV140 (EV1117)
STILL IN THE HOSPITAL 95 BOX_90 (EV1120)

Display Instructions:

Display EV120, EV130, and EV140 on the same form pane.
For [HS EVENT PROVIDER] display the provider name of the HS event currently looping on selected or added at EV100.
For [ER EVENT PROVIDER] display the provider name of the ER event selected at EV90.
Display ?What date were?? in brackets and lighter grayed out text.

EV140 (EV1117)

BLAISE NAME: HSEndDate
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [EV] [NAME OF MEDICAL CARE
Question Text:

[What date [were/was] [you/[PERSON]] admitted to and discharged from [HS EVENT PROVIDER] after [your/[PERSON]?s]emergency room visit on [VISIT DATE] [also] to [ER EVENT PROVIDER]?]
DISCHARGE DATE:

Responses: 1 BOX_90 (EV1120)

Programmer Instructions:

Hard check: Discharge date must be on or after Admit date. If the FI selects a date before the Admit date display: DISCHARGE DATE MUST ON OR AFTER ADMITTANCE DATE. CONFIRM DATES WITH RESPONDENT.
Hard check: If date entered is after the RU member?s reference period, display the following message: ?YOU MUST SELECT A DISCHARGE DATE WITHIN THE REFERENCE PERIOD'.

Display Instructions:

Display EV120, EV130, and EV140 on the same form pane.
For [HS EVENT PROVIDER] display the provider name of the HS event currently looping on selected or added at EV100.
For [ER EVENT PROVIDER] display the provider name of the ER event selected at EV90.
Display the date field for the discharge date here. Display ?What date were?? in brackets and lighter grayed out text.

BOX_90 (EV1120)

Route Details:

Create ER-HS link between ER event being looped on and HS event selected/created at EV100-EV140. Set the LinkedTo variable for the ER event to the EventID of the HS event and vice versa.
Continue with END_LP10.

END_LP10 (EV1125)

Route Details:

Cycle on next ER event in Person?s-Medical-Events-Roster that meets the conditions stated in the loop definition.
If no more ER events meet the stated conditions, end LOOP_10 and go to BOX_160.

EV150 (EV1130)

BLAISE NAME: ERLeadHS
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT] [EV] [NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Did a visit to the emergency room lead to [any of] [your/[PERSON]?s] admission[s] to the hospital that began on [ADMIT DATE]?

Responses:

YES 1
NO 2 BOX_160 (EV1235)
REFUSED RF BOX_160 (EV1235)
DON?T KNOW DK BOX_160 (EV1235)

Programmer Instructions:

If EV150 is coded ?1? (YES) and more than 1 HS event recorded at EV30 in this pass through of the EV section, continue with EV160.
If EV150 is coded ?1? (YES) and exactly 1 HS event recorded at EV30 in this pass through the EV section, auto-code that HS event at EV160 and go to LOOP_20.
If EV150 is coded ?1? (YES), create another event record for the person currently looping on this instance of the EV section and the type is an ER event. The provider and date will be collected in LOOP_20 for this newly created linked ER event.

Display Instructions:

Use the variable CurrEventIDs created at EV30. If CurrEventIDs consists of exactly one EventID then use a null display for the first fill and display ?admission? for the second fill. If CurrEventIDs consists of more than one EventID, then use ?any of? for the first fill and display ?admissions? for the second fill.

EV160 (EV1135)

BLAISE NAME: HSLinkRoster2
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT] [EV] [NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Which hospital stay(s) were preceded by a visit to the emergency room?
ENTER ALL THAT APPLY.
Admit Date Discharge Date Provider

Responses:

[MONTH, DAY, YEAR] [PROVIDER]1 1
[MONTH, DAY, YEAR] [PROVIDER]2 2
[MONTH, DAY, YEAR] [PROVIDER]3 3
[MONTH, DAY, YEAR] [PROVIDER]4 4
[MONTH, DAY, YEAR] [PROVIDER]N 5

Programmer Instructions:

Use the variable CurrEventIDs created at EV30 to be able to list the correct response options for event dates and provider names. For each HS stay selected at EV160, create another event record. The event type is ER, and the person is the RU member in the context header. The two events are linked in BOX_120.
Go to LOOP_20.
Roster behavior:
1. Multi-select allowed.

Display Instructions:

Roster type 2- no add/edit/delete allowed
Roster definition: This item displays all HS events reported for this person during this round.
The headings Admit Date, Discharge Date, and Provider should appear in the response pane located directly above the [MONTH, DAY, YEAR] [MONTH, DAY, YEAR] and [PROVIDER] displayed in three columns.
Roster filter:
Display only those events with the following characteristics:
Event was created this round.
Event is for this person.
Event has event type ?HS?.
Event recorded at EV30 in this current pass through the EV section.

LOOP_20 (EV1140)

Route Details:

For each HS event selected at EV160 as being preceded by an emergency room event on this person?s medical-events-roster, ask BOX_100-END_LP20.
Loop definition: LOOP_20 cycles on each HS event selected at EV160 as being preceded by an emergency room event. Cycle (BOX_100-END_LP20) on all events that meet the following conditions:
-Event type is HS and was selected at EV160.

BOX_100 (EV1145)

Route Details:

Check to see if any ER events with a visit date that are not after the HS admit date selected at EV160, have been recorded for person being looped on. If person has reported at least one ER event that meet this criteria, go to EV170, otherwise, go to EV180.

EV170 (EV1150)

BLAISE NAME: ERLinkRoster2
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME]
Question Text:

Which emergency room visit led to [your/[PERSON]?s] admission on [ADMIT DATE]?
Date Provider

Responses:

ER VISIT NOT YET RECORDED 0
[MONTH, DAY, YEAR] [PROVIDER] 1 1
[MONTH, DAY, YEAR] [PROVIDER] 2 2
[MONTH, DAY, YEAR] [PROVIDER] 3 3
[MONTH, DAY, YEAR] [PROVIDER] 4 4
[MONTH, DAY, YEAR] [PROVIDER] N 5

Programmer Instructions:

Roster behavior: Single select only.
If ER event is selected, go to BOX_120. If EV170 is coded ?0? (EMERGENCY ROOM VISIT NOT LISTED), go to EV180.

Display Instructions:

Roster 2 - No add/edit/delete allowed
Roster definition: Display all ER events reported for this person in this round.
The headings Date and Provider should appear in the response pane located directly above the [MONTH, DAY, YEAR] and [PROVIDER] displayed in two columns.
Roster filter:
Display only those events with the following characteristics.
Event was created this round.
Event is for this person.
Event has event type of ?ER?.
Event visit date is not after the HS admit date selected at EV160.

EV180 (EV1155)

BLAISE NAME: ERHSSameProv2
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT] [EV] [NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Was the emergency room visit that led to [your/[PERSON]?s] hospital stay that started on [ADMIT DATE] also to [PROVIDER]?

Responses:

YES 1 EV190 (EV1165)
NO 2 BOX_110 (EV1160)
REFUSED RF EV190 (EV1165)
DON?T KNOW DK EV190 (EV1165)

Programmer Instructions:

If coded ?1? (YES), ?RF? (REFUSED), or ?DK? (DON?T KNOW), link event in process of being created to the same provider as the HS event being looped on.

Display Instructions:

Display the [ADMIT DATE] of the HS event selected at EV160.

BOX_110 (EV1160)

Route Details:

Ask Provider Roster (PV) section for this event. Link the ER event being created to the provider added or selected in the PV section.
At completion of the PV section, continue with EV190.

EV190 (EV1165)

BLAISE NAME: ERDate
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME]

Question Text:

What date did [you/[PERSON]] visit the emergency room at [ER EVENT PROVIDER] that led to [your/his/her] hospital stay on [ADMIT DATE] [also] to [HS EVENT PROVIDER]?

Responses: 1 BOX_120 (EV1170)

Programmer Instructions:

Hard check: The emergency room visit date entered at EV190 should be less than or equal to 5 days prior to the admit date of the hospital stay selected at EV160 and is currently being cycled on. If the visit date entered is greater than 6 days prior to the admit date of this HS stay, display the following message: ?EMERGENCY ROOM VISIT LEADING TO THIS HOSPITAL STAY ON [ADMIT DATE] MUST HAVE BEEN ON OR WITHIN 5 DAYS BEFORE [ADMIT DATE]. CORRECT DATE OR BACK-UP TO EV150 (ERLeadHS) AND DO NOT LINK THIS ER VISIT TO THE HOSPITAL STAY. THE ER VISIT SHOULD BE ENTERED AS A STAND-ALONE EVENT.?
Hard check: The emergency room visit date entered at EV190 should be before the admit date of the hospital stay selected at EV160 and is currently being looped on. If the visit date entered is after the admit date of the HS stay, display the following message: ?EMERGENCY ROOM VISIT LEADING TO HOSPITAL STAY ON [ADMIT DATE] CANNOT BEGIN AFTER [ADMIT DATE]. ER VISIT LEADING TO HS STAY MUST HAVE BEEN ON OR WITHIN 5 DAYS BEFORE [ADMIT DATE]. CORRECT DATE OR BACK-UP TO EV150 (ERLeadHS) AND DO NOT LINK THIS ER VISIT TO THE HOSPITAL STAY. THE ER VISIT SHOULD BE ENTERED AS A STAND-ALONE EVENT.?
Hard check: If date entered is before the RU member?s reference period, display the following message: ?YOU MUST SELECT A VISIT DATE WITHIN THE REFERENCE PERIOD?.

Display Instructions:

Display ?also? if EV180 is coded ?1? (YES), otherwise use null display.
Display the date field for the visit date here.
For [ER EVENT PROVIDER] display the provider name of the ER event currently looping on selected or added at EV170. For [HS EVENT PROVIDER] display the provider name for the HS event selected at EV160.

BOX_120 (EV1170)

Route Details:

Create HS-ER link between HS event being looped on and ER event selected/created at EV170-EV190. Set the LinkedTo variable for the HS event to the EventID of the ER event and vice versa.
Continue with END_LP20.

END_LP20 (EV1175)

Route Details:

Cycle on next HS event in Person?s Medical-Events-Roster that meets the conditions stated in the loop definition.
If no more HS events meet the stated conditions, end LOOP_20 and go to BOX_160.

EV200 (EV1180)

BLAISE NAME: ICFollowHS
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME][EV][NAME OF MEDICAL CARE PROVIDER?]

Question Text:

Did an admission to the hospital lead to [any of] [your/[PERSON]?s]] stay[s] at [PROVIDER]?

Responses:

YES 1
NO 2 BOX_160 (EV1235)
REFUSED RF BOX_160 (EV1235)
DON?T KNOW DK BOX_160 (EV1235)

Programmer Instructions:

Use the variable CurrEventIDs created at EV30. If CurrEventIDs consists of exactly one EventID then use a null display for the first fill and display ?stay? for the second fill. If CurrEventIDs consists of more than one EventID, then display ?any of? for the first fill and display ?visits? for the second fill.
If EV200 is coded ?1? (YES) and more than 1 IC event recorded at EV30 in this pass through the EV section, continue with EV210.
If EV200 is coded ?1? (YES) and exactly 1 IC event recorded at EV30 in this pass through the EV section, auto-code that IC event at EV210 and go to LOOP_30.
If EV200 is coded ?1? (YES), create event record for person currently looping on where the event type is HS. Provider and date will be collected in LOOP_30 for this newly created linked HS event.

Display Instructions:

Display ?any of? and ?s? on stays if more than 1 IC event record at EV30 in this pass through the EV section. Otherwise, use a null display.
For [PROVIDER] display the name of the IC provider currently being looped on.

EV210 (EV1185)

BLAISE NAME: ICLinkRoster
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [EV] [NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Which stay(s) at [PROVIDER] was preceded by a hospital stay?
ENTER ALL THAT APPLY.
Admit Date Discharge Date Provider

Responses:

[MONTH, DAY, YEAR] [MONTH, DAY,YEAR] [PROVIDER]1 1
[MONTH, DAY, YEAR] [MONTH, DAY, YEAR] [PROVIDER]2 2
[MONTH, DAY, YEAR] [MONTH, DAY,YEAR] [PROVIDER]3 3
[MONTH, DAY, YEAR] [MONTH, DAY,YEAR] [PROVIDER]4 4
[MONTH, DAY, YEAR] [MONTH, DAY,YEAR] [PROVIDER]N 5

Programmer Instructions:

Use the variable CurrEventIDs created at EV30 to be able to list the correct response options for event dates and provider names. For each IC stay selected at EV210, create another event record. The event type is HS, and the person is the RU member in the context header. The two events are linked in BOX_150.
Go to LOOP_30.
Roster Behavior:
1. Multiple select allowed.

Display Instructions:

Roster 2-no add/edit/delete. Roster definition: This item displays the IC events that were just recorded at EV30 in this current pass through of the EV section.
The headings Admit Date, Discharge date, and Provider should appear in the response pane located directly above the [MONTH, DAY, YEAR] [MONTH, DAY, YEAR] and [PROVIDER] displayed in three columns.
Roster filter: Display only those events with the following characteristics.
Event was created this round.
Event was created for this person.
Event has event type ?IC?.
Event recorded at EV30 in this current pass through the EV section.
For [PROVIDER] display the name of the IC provider currently being looped on.

LOOP_30 (EV1190)

Route Details:

For each IC event selected at EV210 as being preceded by a hospital stay event on this person?s medical-events roster, ask BOX_130-END_LP30.
Loop definition: LOOP_30 cycles on each IC event selected at EV210 as being preceded by a hospital stay event. Cycle (ask BOX_130-END_LP30) on all events that meet the following conditions:
-Event type is IC and was selected at EV210.

BOX_130 (EV1195)

Route Details:

Check to see if any HS events that have an admit date that does not take place after the admit date of the IC event selected at EV210 currently looping on, have been recorded for person being looped on. If person has reported at least one HS event, that meet this criteria, go to EV220. Otherwise, go to EV230

EV220 (EV1200)

BLAISE NAME: HSLinkRoster3
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT][EV] [NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Which hospital stay led to [your/[PERSON]?s] admission to [PROVIDER] on [ADMIT DATE]?
Admit Date Discharge Date Provider

Responses:

Programmer Instructions:

Roster behavior: Single select only.
If HS event is selected, go to BOX_150. If EV220 is coded ?0? (HOSPITAL STAY NOT LISTED), go to EV230.

Display Instructions:

Roster 2-no add/edit/delete.
The headings Admit Date, Discharge date, and Provider should appear in the response pane located directly above the [MONTH, DAY, YEAR] [MONTH, DAY, YEAR] and [PROVIDER] displayed in three columns.
Roster definition: Display all HS events linked to this person.
Roster filter:
Display only those events with the following characteristics.
Event was created this round or was created in the immediate previous round and had a discharge date of ?95? (STILL IN HOSPITAL).
Event is for this person.
Event has event type of ?HS?.
Event has an admit date that does not take place after the admit date of the IC event selected at EV210 currently looping on.
For [PROVIDER] display the name of the IC provider currently being looped on.

EV230 (EV1205)

BLAISE NAME: HSICSameProv
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT][EV] [NAME OF MEDICAL CARE PROVIDER?]
Question Text:

Was the hospital stay that led to [your/[PERSON]?s] admission to [PROVIDER] on [ADMIT DATE] also to [PROVIDER]?

Responses:

YES 1 EV240 (EV1215)
NO 2 BOX_140 (EV1210)
REFUSED RF EV240 (EV1215)
DON?T KNOW DK EV240 (EV1215)

Programmer Instructions:

If coded ?1? (YES), ?RF? (REFUSED) or ?DK? (DON?T KNOW), link event in process of being created as to the same provider as the IC event being looped on.

Display Instructions:

Display the ?ADMIT DATE? for the IC event currently being looped on.
For [PROVIDER] display the name of the IC provider currently being looped on in both the question text fill and also the context header.

BOX_140 (EV1210)

Route Details:

Ask Provider Roster (PV) section for this event. Link the HS event record being created to the provider added or selected in the PV section.
At completion of the PV section, continue with EV240.

EV240 (EV1215)

BLAISE NAME: HSBegDate2
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME]
Question Text:

What date [were/was] [you/[PERSON]] admitted to and discharged from [HS EVENT PROVIDER] that led to [your/his/her] stay on [ADMIT DATE] [also] to [IC EVENT PROVIDER]?
ENTER ADMIT DATE:

Responses: 1 EV250 (EV1220)
Programmer Instructions:

Hard check: The admittance date entered at EV240 should be before the IC visit selected at EV210, and is currently being cycled on. If the HS admittance date entered is after the IC visit, display the following message: IT IS UNLIKELY THAT THE HOSPITAL ADMISSION DATE IS AFTER THE STAY AT [PROVIDER] ON [ADMIT DATE]. RESPONDENT SAID THEY HAD A HOSPITAL ADMISSION BEFORE THEIR STAY AT [PROVIDER] VISIT. CHECK TO MAKE SURE THE DATE IS CORRECT AND MAKE THE NECESSARY CORRECTIONS. Display the IC provider currently being looped on for [PROVIDER] for the hard check message.
Hard check: If date entered is before the RU member?s reference period, display the following message: ?YOU MUST SELECT AN ADMITTANCE DATE WITHIN THE REFERENCE PERIOD?.

Display Instructions:

Display ?also? if EV230 is coded ?1? (YES), otherwise use null display.
For [HS EVENT PROVIDER] display the provider name of the HS event selected at EV220.
For [IC EVENT PROVIDER] display the provider name of the IC event selected or added at EV220.
Display EV240, EV250, and EV260 on the same form pane.

EV250 (EV1220)

BLAISE NAME: StillInHS2
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME]
Question Text:

[What date [were/was] [you/[PERSON]] admitted to and discharged from [HS EVENT PROVIDER] that led to [your/his/her] stay on [ADMIT DATE] [also] to [IC EVENT PROVIDER]?]
PRESS 1 AND ENTER TO SELECT THE DISCHARGE DATE. PRESS 95 TO INDICATE PERSON IS STILL IN THE HOSPITAL.

Responses:

DISCHARGE DATE 1 EV260 (EV1222)
STILL IN THE HOSPITAL 95 BOX_150 (EV1225)

Display Instructions:

Display EV240, EV250, and EV260 on the same form pane.
Display ?also? if EV230 is coded ?1? (YES), otherwise use null display.
For [HS EVENT PROVIDER] display the provider name of the HS event selected at EV220.
For [IC EVENT PROVIDER] display the provider name of the IC event selected or added at EV210.
Display ?What date were?? in brackets and lighter grayed out text.

EV260 (EV1222)

BLAISE NAME: HSEndDate2
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME]
Question Text:

[What date [were/was] [you/[PERSON]] admitted to and discharged from [HS EVENT PROVIDER] that led to [your/his/her] stay on [ ADMIT DATE] [also] to [IC EVENT PROVIDER]?]
ENTER DISCHARGE DATE:

Responses: 1 BOX_150 (EV1225)

Programmer Instructions:

Hard check: Discharge date must be on or after Admit date. If the FI selects a date before the Admit date display: DISCHARGE DATE MUST BE ON OR AFTER ADMITTANCE DATE. CONFIRM DATES WITH RESPONDENT.
Hard check: If date entered is after the RU member?s reference period, display the following message: ?YOU MUST SELECT A DISCHARGE DATE WITHIN THE REFERENCE PERIOD'.

Display Instructions:

Display EV240, EV250, and EV260 on the same form pane.
For [HS EVENT PROVIDER] display the provider name of the HS event selected at EV220.
For [IC EVENT PROVIDER] display the provider name of the IC event selected or added at EV220.

BOX_150 (EV1225)

Route Details:

Create IC-HS link between IC event being looped on and HS event selected/created at EV220-EV260. Set the LinkedTo variable for the HS event to the EventID of the IC event and vice versa.
Continue with END_LP30.

END_LP30 (EV1230)

Route Details:

Cycle on next IC event in Person?s Medical-Events-Roster that meets the conditions stated in the loop definition.
If no more IC events meet the stated conditions, end LOOP_30 and go to BOX_160.

BOX_160 (EV1235)

Route Details: Return to original questionnaire section in CA, EE, ED, EF, or OF

Employment Wages (EW) Section

BOX_00 (EW1000)

Route Details:

01 Box = BOX_00, BOX_10, BOX_20, BOX_25, BOX_30, BOX_40, BOX_50.
04 Single Select= EW10, EW20, EW60, EW80, EW90, EW100, EW120, EW150, EW160, EW170, EW200, EW210, EW220, EW250, EW270, EW290.
17 Dollar Items Allowing Cents= EW30, EW50, EW70, EW110, EW140, EW190, EW240, EW260, EW280.
19 Numeric Field= EW40, EW130, EW180.
20 OS Text Field= EW20OS, EW60OS, EW120OS, EW250OS, EW270OS, EW290OS.
22 Stem and Leaf= EW230A, EW230B, EW230C.

BOX_10 (EW1001)

Route Details:

Context Header Display Instructions:
DISPLAY PERSON.FULLNAME, JobsEstbName, JobStartMM/DD/YYYY, JobStopMM/DD/YYYY.

EW10 (EW1005)

BLAISE NAME: Salaried
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
[For the next few questions, please think about the time between [START DATE] and [END DATE] and what [you/[PERSON]] [were/was] making then.]
At [EMPLOYER], [[are/is] / [were/was]] [you/[PERSON]] salaried, paid by the hour, or paid some other way?
IF SALARIED AND RECEIVES TIPS, BONUS, OR COMMISSION, SELECT 'SALARIED'.
IF PAID BY THE HOUR AND RECEIVES TIPS, BONUS, OR COMMISSION, SELECT 'PAID BY THE HOUR'.
HELP: F1

Responses:
SALARIED 1 EW110 (EW1070)
PAID BY THE HOUR 2 EW190 (EW1115)
PAID SOME OTHER WAY 3 EW20 (EW1010)
REFUSED RF EW80 (EW1055)
DON'T KNOW DK EW70 (EW1050)
Display Instructions:
[For the next few questions, please think about the time between [START DATE] and [END DATE]] and what (PERSON) was making then.]: display this sentence if round 5.
Otherwise, use a null display.
[START DATE] Display the start date of the current reference period for this person.
[END DATE] display the end date of the current reference period for this person.
Display ?are/is? if the job type of the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?were/was? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD? (JobTP=FORMER MAIN), ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD? (JobTP=FORMER MISC), ?LAST JOB OUTSIDE REFERENCE PERIOD?, (JobTP= Last Job Outside Reference Period) or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW20 (EW1010)

BLAISE NAME: HowPaid
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
How [[are/is]/[were/was]] [you[PERSON]] paid?
HELP: F1

Responses:
BY THE DAY 1 EW30 (EW1020)
PIECEWORK 2 EW50 (EW1030)
COMMISSION 3 BOX_20 (EW1150)
BONUS 4 BOX_20 (EW1150)
BY THE JOB/MILE 5 EW50 (EW1030)
OTHER 91 EW20OS (EW1015)
REFUSED RF EW80 (EW1055)
DON'T KNOW DK EW70 (EW1050)
Display Instructions:
Display EW20 and EW20OS on the same form pane.
Display ?are/is? if the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?were/was? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN), ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC), ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP= Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW20OS (EW1015)

BLAISE NAME: HowPaidOS
Question Text:
SPECIFY:

Responses:
1 EW50 (EW1030)
REFUSED RF EW50 (EW1030)
DON'T KNOW DK EW50 (EW1030)
Display Instructions: Display EW20 and EW20OS on the same form pane.

EW30 (EW1020)

BLAISE NAME: DayWage
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
What [is/was] [your/[PERSON]'s] daily wage rate?

Responses:
1 EW40 (EW1025)
REFUSED RF EW80 (EW1055)
DON'T KNOW DK EW70 (EW1050)
Programmer Instructions:
Soft:
Soft check range: $10.00 - $750.00
If the amount at EW40 is outside of the soft check range display the message ?UNLIKELY RESPONSE. VERIFY THE AMOUNT OR BACK-UP AND RE-CODE EW20 (HowPaid)."
Display Instructions:
Display ?is? if the job being asked about is set as ?CURRENT MAIN JOB?(JobTP=CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?was? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) , ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW40 (EW1025)

BLAISE NAME: HoursDay
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
How many hours [[do/does]/did] [you/[PERSON]] usually work per day?
ENTER HOURS

Responses:
1 BOX_20 (EW1150)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Programmer Instructions:
Hard range: Range check:1-24
If amount is outside of the range check, display the following message: "THE NUMBERS OF HOURS MUST BE BETWEEN 1 AND 24. VERIFY WITH RESPONDENT AND RE-ENTER."
Display Instructions:
Display ?do/does? if the job being asked about is set as ?CURRENT MAIN JOB?(JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?did? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period)JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.set.

EW50 (EW1030)

BLAISE NAME: MakeAmt
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
How much [[do/does]/did] [you/[PERSON]] usually make this way?
ENTER AMOUNT:

Responses:
1 EW60 (EW1035)
REFUSED RF EW80 (EW1055)
DON'T KNOW DK EW70 (EW1050)
Display Instructions:
Display EW50, EW60, and EW60OS on the same form pane.
Display ?do/does? if the job being asked about is set as ? CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ? CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?did? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN), ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC), ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW60 (EW1035)

BLAISE NAME: PayPeriodUnit
Question Text:
PER PERIOD:

Responses:
PER DAY 1 BOX_20 (EW1150)
PER WEEK 2 BOX_20 (EW1150)
PER MONTH 3 BOX_20 (EW1150)
PER YEAR 4 BOX_20 (EW1150)
OTHER 91 EW60OS (EW1040)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Display Instructions:
Display EW50, EW60, and EW60OS on the same form pane.

EW60OS (EW1040)

BLAISE NAME: PayPeriodUnitOS
Question Text:
SPECIFY:

Responses:
1 BOX_20 (EW1150)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Programmer Instructions:
Soft check:
Soft range check:
Per day: $10.00 - $750.00
Per week: $75.00 - $5,000.00
Per month: $375.00 - $20,000.00
Per year: $5,000.00 - $200,000.00
If the amount at EW60OS is outside of the soft range check, display the message ?UNLIKELY RESPONSE. VERIFY THE AMOUNT OR BACK-UP AND RECODE EW60 (PayPeriodUnit)."
Display Instructions:
Display EW50, EW60, and EW60OS on the same form pane.

EW70 (EW1050)

BLAISE NAME: HourlyWageA
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
I would just like to get a rough idea of how much [you/[PERSON] [[earn/earns]/earned] at this job. Approximately how much [[do/does]/did] [you/he/she] make per hour?

Responses:
1 BOX_20 (EW1150)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK EW80 (EW1055)
Programmer Instructions:
Soft check:
Soft check range: $1.00 - $125.00
If the amount at EW70 is outside of the soft range check, display the message ?UNLIKELY RESPONSE. VERIFY WITH RESPONDENT?
Display Instructions:
Display ?earn/earns? if the job being asked about is set as ? CURRENT MAIN JOB?(JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?earned? if the job being asked about is set as a ?FORMER MAIN- JOB WITHIN
REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER- MISCELLANEOUS JOB WITHIN
REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.
Display ?do/does? if the job being asked about is set as ? CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ? CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?did? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN), ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC), ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW80 (EW1055)

BLAISE NAME: More10HourA
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
Could you just tell me if [you/[PERSON]] [[make/makes]/made] more or less than $10 an hour at this job?

Responses:
$10 OR MORE 1 EW90 (EW1060)
LESS THAN $10 2 EW100 (EW1065)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Display Instructions:
Display ?make/makes? if the job being asked about is set as ?CURRENT MAIN JOB?(JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?made? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW90 (EW1060)

BLAISE NAME: More15HourA
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
More or less than $15 an hour?

Responses:
$15 OR MORE 1 BOX_20 (EW1150)
LESS THAN $15 2 BOX_20 (EW1150)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Display Instructions:

EW100 (EW1065)

BLAISE NAME: MoreMinWageA
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
More or less than $7.25 an hour?

Responses:
$7.25 OR MORE 1 BOX_20 (EW1150)
LESS THAN $7.25 2 BOX_20 (EW1150)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Display Instructions:

EW110 (EW1070)

BLAISE NAME: GrossPay
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
How much [is/was] [your/[PERSON]'s] salary before taxes, not including tips, commissions, or bonuses?
ENTER AMOUNT:

Responses:
1 EW120 (EW1075)
REFUSED RF EW150 (EW1095)
DON'T KNOW DK EW140 (EW1090)
Display Instructions:
Display EW110, EW120, and EW120OS on the same form pane screen.
Display ?is? if the job being asked about is set as ?CURRENT-MAIN JOB? (JobTP= CURRENT MAIN) or is set as ? CURRENT MISCELLANEOUS JOB ?(JobTP=CURRENT MISC) and current round is not round 5.
Display ?was? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN), ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC), ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW120 (EW1075)

BLAISE NAME: GrossPayPeriod
Question Text:
PER PERIOD:

Responses:
PER YEAR 1 EW130 (EW1085)
PER MONTH 2 EW180 (EW1110)
PER TWO-WEEK PERIOD 3 EW180 (EW1110)
PER WEEK 4 EW180 (EW1110)
OTHER 91 EW120OS (EW1080)
REFUSED RF EW150 (EW1095)
DON'T KNOW DK EW140 (EW1090)
Display Instructions:
Display EW110, EW120, and EW120OS on the same form pane screen.

EW120OS (EW1080)

BLAISE NAME: GrossPayPeriodOS
Question Text:
SPECIFY:

Responses:
1 EW180 (EW1110)
REFUSED RF EW180 (EW1110)
DON'T KNOW DK EW180 (EW1110)
Programmer Instructions:
Soft check:
Soft range check:
Per year: $5,000.00 - $200,000.00
Per month: $375.00 - $20,000.00
Per two week period: $150.00 - $10,000.00 Per week: $75.00 - $5,000.00
If the amount at EW120OS is outside of the soft range check then display the message ?UNLIKELY RESPONSE. VERIFY WITH RESPONDENT OR RE-CODE EW120 (GrossPayPeriod)?
Display Instructions:
Display EW110, EW120, and EW120OS on the same form pane screen.

EW130 (EW1085)

BLAISE NAME: SalaryWeeks
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
On how many weeks of work per year [is/was] this salary based?
ENTER WEEKS

Responses:
1 EW180 (EW1110)
REFUSED RF EW180 (EW1110)
DON'T KNOW DK EW180 (EW1110)
Programmer Instructions:
Hard range: 1-52 Range check:
If the amount is outside of the range check, display the following message: ?THE NUMBER OF WEEKS MUST BE BETWEEN 1 AND 52. VERIFY WITH RESPONDENT AND RE-ENTER.?
Display Instructions:
Display ?is? if the job being asked about is set as ?CURRENT-MAIN- JOB? (JobTP= CURRENT MAIN) or is set as ? CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?was? if the job being asked about is set as a ?FORMER-MAIN-JOB- WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN), ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW140 (EW1090)

BLAISE NAME: HourlyWageB
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
I would just like to get a rough idea of how much [you/[PERSON]] [[earn/earns]/earned] at this job. Approximately how much [do/does]/did] [you/he/she] make per hour?

Responses: 1 EW180 (EW1110)
REFUSED RF EW180 (EW1110)
DON'T KNOW DK EW150 (EW1095)
Programmer Instructions: Soft check:
Soft check range: $1.00 - $125.00
If the amount at EW140 is outside of the soft check range, display the message: UNLIKELY RESPONSE. VERIFY WITH RESPONDENT.
Display Instructions: Display ?earn/earns? if the job being asked about is set as ? CURRENT MAIN JOB? (JobTP=CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?earned? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.
Display ?do/does if the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ? CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?did? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) , ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC), ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW150 (EW1095)

BLAISE NAME: More10HourB
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
Could you just tell me if [you/[PERSON]] [[make/makes]/made] more or less than $10 an hour at this job?

Responses: $10 OR MORE 1 EW160 (EW1100)
LESS THAN $10 2 EW170 (EW1105)
REFUSED RF EW180 (EW1110)
DON'T KNOW DK EW180 (EW1110)
Display Instructions: Display ?make/makes? if the job being asked about is set as ? CURRENT MAIN JOB? (JobTP=CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?made? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW160 (EW1100)

BLAISE NAME: More15HourB
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
More or less than $15 an hour?

Responses: $15 OR MORE 1 EW180 (EW1110)
LESS THAN $15 2 EW180 (EW1110)
REFUSED RF EW180 (EW1110)
DON'T KNOW DK EW180 (EW1110)
Display Instructions:

EW170 (EW1105)

BLAISE NAME: MoreMinWageB
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
More or less than $7.25 an hour?

Responses: $7.25 OR MORE 1 EW180 (EW1110)
LESS THAN $7.25 2 EW180 (EW1110)
REFUSED RF EW180 (EW1110)
DON'T KNOW DK EW180 (EW1110)
Display Instructions:

EW180 (EW1110)

BLAISE NAME: HrsSalaryBased
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
Often, the number of hours people work is different from the number of hours on which their salaries are based. On how many hours per week [is/was] [your/[PERSON]'s] salary based?
ENTER HOURS
HELP: F1

Responses: 1 BOX_20 (EW1150)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Programmer Instructions: NOTE: Note: allow only whole hours, no fractions. Hard range: 1-168 Range check:
If amount is outside of the range check, display the following message: ?THE NUMBER OF HOURS MUST BE BETWEEN 1 AND 168. VERIFY WITH RESPONDENT AND RE-ENTER.?
Display Instructions: Display ?is? if the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB?(JobTP=CURRENT MISC) and current round is not round 5.
Display ?was? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW190 (EW1115)

BLAISE NAME: HourlyWageC
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
What [is/was] [your/[PERSON]'s] hourly wage rate for [your/his/her] regular work time, not including tips, commissions, or bonuses at [EMPLOYER]?

Responses: 1 BOX_20 (EW1150)
REFUSED RF EW200 (EW1135)
DON'T KNOW DK EW200 (EW1135)
Programmer Instructions: Soft check:
Soft check range: $1.00- $125.00
If the amount at EW190 is outside of the soft range check, display the message ?UNLIKELY RESPONSE. VERIFY WITH RESPONDENT OR BACK UP AND RE CODE EW10 (Salaried).
Display Instructions: Display ?is? if the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ? CURRENT MISCELLANEOUS JOB?(JobTP=CURRENT MISC) and current round is not round 5.
Display ?was? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW200 (EW1135)

BLAISE NAME: More10HourC
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
Could you just tell me if [you/[PERSON]] [[make/makes]/made] more or less than $10 an hour at this job?

Responses: $10 OR MORE 1 EW210 (EW1140)
LESS THAN $10 2 EW220 (EW1145)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Display Instructions: Display ?make/makes? if the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?made? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW210 (EW1140)

BLAISE NAME: More15HourC
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
More or less than $15 an hour?

Responses: $15 OR MORE 1 BOX_20 (EW1150)
LESS THAN $15 2 BOX_20 (EW1150)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Display Instructions:

EW220 (EW1145)

BLAISE NAME: MoreMinWageC
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
More or less than $7.25 an hour?

Responses: $7.25 OR MORE 1 BOX_20 (EW1150)
LESS THAN $7.25 2 BOX_20 (EW1150)
REFUSED RF BOX_20 (EW1150)
DON'T KNOW DK BOX_20 (EW1150)
Display Instructions:

BOX_20 (EW1150)

Route Details: EW230A through EW230C represent a stem and leaf series.
Cycle through the leaf text in the A C sequence until all rows are displayed.
Each leaf in this stem and leaf series, should display on the same form pane. Use the same question stem display.
Display the question stem ?[On this job, [[do/does]/did] [you/[PERSON]] earn...]? only when presenting the first question for this person. Otherwise always display question stem in brackets and ?grayed out? text.
Display each leaf in bold black when its entry field is active. Otherwise always display in ?grayed-out? text.
Go to EW230A.

EW230A (EW1155)

BLAISE NAME: EarnTips
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
[[]On this job, [[do/does]/did] [you/[PERSON]] earn - []]
a. tips?
HELP: F1

Responses: YES 1 EW230B (EW1160)
NO 2 EW230B (EW1160)
REFUSED RF EW230B (EW1160)
DON'T KNOW DK EW230B (EW1160)
Programmer Instructions: If EW20 is coded '4' (BONUS), automatically code EW230B as '1' (YES)
IF EW20 is coded '3' (COMMISSION), automatically Programmer code EW230C as '1' (YES)
Display Instructions: Use ?same question stem? display.
If at EW230A, do not display question text in brackets. Otherwise, display question text in brackets.
Array responses and variable text columns in the panel. Display ?variable text? in the a-c sequence until all rows have been displayed.
Display ?do/does? if the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?did? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW230B (EW1160)

BLAISE NAME: EarnBonus
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
[[]On this job, [[do/does]/did] [you/[PERSON]] earn []]
b. bonuses?
HELP: F1

Responses: YES 1 EW230C (EW1165)
NO 2 EW230C (EW1165)
REFUSED RF EW230C (EW1165)
DON'T KNOW DK EW230C (EW1165)
Display Instructions:

EW230C (EW1165)

BLAISE NAME: EarnComm
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
[[]On this job, [[do/does]/did] [you/[PERSON]] earn []]
c. commissions?
HELP: F1

Responses: YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions: If EW230A, EW230B and EW230C are all coded '2' (NO), 'RF'or 'DK' go to BOX_50.
Otherwise go to Box_25
Display Instructions:

BOX_25 (EW1168)

Route Details: If EW230A is coded '2' (NO), 'RF' or 'DK' go to BOX_30.
Otherwise, continue with EW240.

EW240 (EW1170)

BLAISE NAME: TipsAmt
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
How much [are/were] [your/[PERSON]'s] tips on average?

ENTER TIPS AMOUNT
Responses: 1 EW250 (EW1175)
REFUSED RF BOX_30 (EW1185)
DON'T KNOW DK BOX_30 (EW1185)
Display Instructions: Display EW240, EW250, and EW250OS on the same form pane screen.
Display ?are? if the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?were? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW250 (EW1175)

BLAISE NAME: TipsUnit
Question Text:
PER PERIOD:

Responses: PER DAY 1 BOX_30 (EW1185)
PER WEEK 2 BOX_30 (EW1185)
PER MONTH 3 BOX_30 (EW1185)
PER YEAR 4 BOX_30 (EW1185)
OTHER 91 EW250OS (EW1180)
REFUSED RF BOX_30 (EW1185)
DON'T KNOW DK BOX_30 (EW1185)
Display Instructions: Display EW240, EW250, and EW250OS on the same form pane screen.

EW250OS (EW1180)

BLAISE NAME: TipsUnitOS
Question Text:
SPECIFY:

Responses: 1 BOX_30 (EW1185)
REFUSED RF BOX_30 (EW1185)
DON'T KNOW DK BOX_30 (EW1185)
Display Instructions: Display EW240, EW250, and EW250OS on the same form pane screen.

BOX_30 (EW1185)

Route Details: IF EW230B is coded '2' (NO), 'RF' or 'DK' go to BOX_40.
Otherwise, continue with EW260.

EW260 (EW1190)

BLAISE NAME: BonusAmt
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
How much [are/were] [your/[PERSON]'s] bonuses on average?
ENTER BONUSES AMOUNT

Responses: 1 EW270 (EW1195)
REFUSED RF BOX_40 (EW1205)
DON'T KNOW DK BOX_40 (EW1205)
Display Instructions: Display EW260, EW270, and EW270OS on the same form pane screen.
Display ?are? if the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ? CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?were? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW270 (EW1195)

BLAISE NAME: BonusUnit
Question Text:
PER PERIOD:

Responses: PER HOUR 1 BOX_40 (EW1205)
PER DAY 2 BOX_40 (EW1205)
PER WEEK 3 BOX_40 (EW1205)
PER TWO WEEK PERIOD 4 BOX_40 (EW1205)
PER MONTH 5 BOX_40 (EW1205)
PER YEAR 6 BOX_40 (EW1205)
OTHER 91 EW270OS (EW1200)
REFUSED RF BOX_40 (EW1205)
DON'T KNOW DK BOX_40 (EW1205)
Display Instructions: Display EW260, EW270, and EW270OS on the same form pane screen.

EW270OS (EW1200)

BLAISE NAME: BonusUnitOS
Question Text:
SPECIFY:

Responses: 1 BOX_40 (EW1205)
REFUSED RF BOX_40 (EW1205)
DON'T KNOW DK BOX_40 (EW1205)
Display Instructions: Display EW260, EW270, and EW270OS on the same form pane screen.

BOX_40 (EW1205)

Route Details: If EW230C is coded '2' (NO), 'RF' or 'DK' go to BOX_50.
Otherwise, continue with EW280

EW280 (EW1210)

BLAISE NAME: CommAmt
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]
Question Text:
How much [are/were] [your/[PERSON]'s] commissions on average?
ENTER COMMISSIONS AMOUNT

Responses: 1 EW290 (EW1215)
REFUSED RF BOX_50 (EW1221)
DON'T KNOW DK BOX_50 (EW1221)
Display Instructions: Display EW280, EW290, and EW290OS on the same form pane screen.
Display ?are? if the job being asked about is set as ?CURRENT MAIN JOB? (JobTP= CURRENT MAIN) or is set as ?CURRENT MISCELLANEOUS JOB? (JobTP=CURRENT MISC) and current round is not round 5.
Display ?were? if the job being asked about is set as a ?FORMER MAIN JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MAIN) ?FORMER MISCELLANEOUS JOB WITHIN REFERENCE PERIOD?, (JobTP=FORMER MISC) ?LAST JOB OUTSIDE REFERENCE PERIOD? (JobTP=Last Job Outside Reference Period), or ?RETIREMENT JOB? (JobTP=Retirement) or current round is round 5.

EW290 (EW1215)

BLAISE NAME: CommUnit
Question Text:
PER PERIOD:

Responses: PER HOUR 1 BOX_50 (EW1221)
PER DAY 2 BOX_50 (EW1221)
PER WEEK 3 BOX_50 (EW1221)
PER TWO WEEK PERIOD 4 BOX_50 (EW1221)
PER MONTH 5 BOX_50 (EW1221)
PER YEAR 6 BOX_50 (EW1221)
OTHER 91 EW290OS (EW1220)
REFUSED RF BOX_50 (EW1221)
DON'T KNOW DK BOX_50 (EW1221)
Display Instructions: Display EW280, EW290, and EW290OS on the same form pane screen.

EW290OS (EW1220)

BLAISE NAME: CommUnitOS
Question Text:
SPECIFY:

Responses: 1 BOX_50 (EW1221)
REFUSED RF BOX_50 (EW1221)
DON'T KNOW DK BOX_50 (EW1221)
Display Instructions: Display EW280, EW290, and EW290OS on the same form pane screen.

BOX_50 (EW1221)

Route Details: Return to original questionnaire section (eitheRJ or EM-A).

Flat Fee (FF) Section

BOX_00 (FF1000)

Route Details:

01 BOX = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40. BOX_50. BOX_60
04 Single Select = FF40, FF60, FF90, FF100, FF120, FF130, FF160, FF190
06 Single Select with Fill in Answer Text = FF10
11 Multiple Select with Add/Edit/Delete = FF170
18 Dollar Items Not Allowing Cents = FF140, FF150, FF180
19 Numeric Field = FF50, FF70
23 Text Field = FF30, FF110
24 Information Screen = FF80
30 Multiple Select with Fill in Answer Text and Display Roster = FF20
Roster 2 = FF10, FF20
Roster 3 = FF170
Grid 2 = FF180

BOX_10 (FF1001)

Route Details:

Throughout the Flat Fee (FF) section, entry of all dollar amounts will include only whole dollars. Entry of cents will be disallowed.
Context Header Display Instructions: Display PERS.FULLNAME, PROV.PROVNAME, EVPV.EVNTTYPE, EVPV.EVNTBEGM, EVPV.EVNTBEGD, EVPV.EVNTBEGY, EVPV.EVNTENDM, EVPV.EVNTENDD, EVPV.EVNTENDY, FFEE.FFEENAME. Display EVPV.EVNTENDM, EVPV.EVNTENDD, and EVPV.EVNTENDY for IC or HS events, only.
For ?[STR-DT]? display the person?s reference period start date.

BOX_20 (FF1005)

Route Details:

If no flat fee groups already on PERSONS-FLAT-FEE-GROUPS-ROSTER, go to FF20. Otherwise, continue with FF10.

FF10 (FF1015)

BLAISE NAME: FFeeGrp
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
Question Text:
Let me review the groups of health care events I have recorded for [you/[PERSON]]. Please tell me if any of these groups include the charge that covered [this hospital stay/this visit]/the services received at home].
REVIEW FLAT FEE GROUPS WITH RESPONDENT. SELECT FLAT FEE GROUP COVERED BY SAME CHARGE AS EVENT BEING ASKED ABOUT.

Responses:
ADD GROUP 0 FF20 (FF1020)
[FLAT FEE GROUP] 1 1 BOX_60 (FF1160)
[FLAT FEE GROUP] 2 2 BOX_60 (FF1160)
[FLAT FEE GROUP] 3 3 BOX_60 (FF1160)
[FLAT FEE GROUP] 4 4 BOX_60 (FF1160)
[FLAT FEE GROUP] N 5 BOX_60 (FF1160)
Programmer Instructions: Since this roster will include all flat fee groups, current round single events can be added to any flat fee group created during the current round or a previous round (FlatFeeGroup[I].FFeeName).
Roster Behavior: 1.Only single select allowed.
Display Instructions: Roster 2- No Add/Edit/Delete
Roster Definition: Display the person's-flat-fee-groups-roster (FFEE, FFEENAME) for selection.
Roster Filter: No filter; display all.
Display 'this hospital stay' if event type is HS.
Display 'this visit' if event type is ER, OP, MV, or DN.
Display 'the services received at home' if event type is HH.

FF20 (FF1020)

BLAISE NAME: FFeeRoster
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
Question Text:
Let me review the list of health care events I have recorded for [you/[PERSON]]. Please tell me which of these were included in the same charge that covered [this hospital stay/this visit/the services received at home].
REVIEW EVENTS WITH RESPONDENT.
SELECT EVENTS COVERED BY SAME CHARGE AS EVENT BEING ASKED ABOUT.
ENTER ALL THAT APPLY.
MEDICAL PROVIDER DOCTOR OR EVENT TYPE ADMIT DATE DISCHARGE DATE DEPARTMENT NAME
EVENT OUTSIDE REFERENCE PERIOD 0
[MEDICAL PROVIDER] [DOC OR DEPT] [EVENT TYPE][ADMIT DATE] [DISCHARGE DATE]1
[MEDICAL PROVIDER] [DOC OR DEPT] [EVENT TYPE][ADMIT DATE] [DISCHARGE DATE]2
[MEDICAL PROVIDER] [DOC OR DEPT] [EVENT TYPE][ADMIT DATE] [DISCHARGE DATE]3
[MEDICAL PROVIDER] [DOC OR DEPT] [EVENT TYPE][ADMIT DATE] [DISCHARGE DATE]4
[MEDICAL PROVIDER] [DOC OR DEPT] [EVENT TYPE][ADMIT DATE] [DISCHARGE DATE]N

Responses:
Programmer Instructions: RF/DK not allowed.
Display Instructions: Display the roster in nonproportional text.
Roster 1 - Report
Roster Definition:
This item displays all medical events on person's-medical-events- roster for selection in the info pane. The 5 columns to be displayed are: MEDICAL PROVIDER, DOCTOR OR DEPARTMENT NAME, EVENT TYPE, ADMIT DATE, DISCHARGE DATE. For MEDICAL PROVIDER, display the name of provider associated with this event (EVNT.LORPNAME), if PV70 has a value, display the doctor or department associated with this event, display the two- letter event abbreviation (EVNT.EVNTTPYE) for EVENT TYPE, for Admit date display the month, day, and year of medical events (EVNT.EVNTBEGM,EVNT,EVNTBEGD,EVNT,EVNTBEGY), and the discharge date for HS events (EVNT.EVNTENDM,EVNT.EVNTENDD,EVNT.EVNTENDY). For MV, ER, OP, or DN, events display the visit date for [ADMIT DATE] and use a null display for [DISCHARGE DATE].
For HS events display the hospital stay admit date for [ADMIT DATE] and the hospital stay discharge date for the [DISCHARGE DATE].
Roster Filter:
Display events that meet the following conditions:
Event is not the event currently looping on.
Event has CP status of 'PROCESSED' or 'UNPROCESSED' (display event regardless of CP status).
Event is not already included in a flat fee group or a repeat visit group.
Event is not already coded (VERIFIED) as a copayment.
Event type is not IC.
Event is not an HS event with a discharge date coded '95' (STILL IN HOSPITAL).
Event is not an HH event with event date = interview month.
Event is not an HH event type 'INFORMAL' or 'VOLUNTEERED: MEAL DELIVERY SERVICE.'
Event is not an OM event.

FF30 (FF1035)

BLAISE NAME: FFeeName
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
INTERVIEWER: RECORD 'NAME OF FLAT FEE GROUP' FOR EVENTS SELECTED IN PREVIOUS QUESTION:

Responses:
1
Programmer Instructions: If Round 1, continue with FF40.
If Round 5, go to FF60.
Otherwise, go toFF80.
Write flat fee group to person?s-flat-fee-groups-roster.
Display Instructions:

FF40 (FF1045)

BLAISE NAME: FFeeVstBefStart
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
Question Text:
Did the charge which included the services for [FLAT FEE GROUP] cover any visits before [START DATE]?

Responses:
YES 1 FF50 (FF1050)
NO 2 FF80 (FF1080)
REFUSED RF FF80 (FF1080)
DON'T KNOW DK FF80 (FF1080)
Display Instructions: For [FLAT FEE GROUP], display the name of the flat fee group selected at FF10 or entered at FF30.

FF50 (FF1050)

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

Responses:
1 FF80 (FF1080)
REFUSED RF FF80 (FF1080)
DON'T KNOW DK FF80 (FF1080)
Display Instructions:

FF60 (FF1070)

BLAISE NAME: FFeeVisAft
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP]
Question Text:
Will the charge which includes the services for [FLAT FEE GROUP] cover any visits after December 31, [YEAR]?

Responses:
YES 1 FF70 (FF1075)
NO 2 FF80 (FF1080)
REFUSED RF FF80 (FF1080)
DON'T KNOW DK FF80 (FF1080)
Display Instructions:
For [FLAT FEE GROUP], display the name of the flat fee group selected at FF10 or entered at FF30.
(For specifications purposes only; CAPI handles automatically): for 'YEAR' in question text, display the second year of the panel.

FF70 (FF1075)

BLAISE NAME: FFeeNumVisAft
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
FLAT FEE GROUP: [NAME OF FLAT FEE EVENT GROUP..]
Question Text:
Approximately, how many visits will [you/ [PERSON]] have after December 31, [YEAR]?
NUMBER OF VISITS:

Responses:
1 FF80 (FF1080)
REFUSED RF FF80 (FF1080)
DON'T KNOW DK FF80 (FF1080)
Programmer Instructions:
Hard Range: TBD
Display Instructions:
(For specifications purposes only; CAPI handles automatically): for 'YEAR' in question text, display the second year of the panel.

FF80 (FF1080)

BLAISE NAME: FFeeIntro
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
Now I'd like to ask you about the charges for the services for [FLAT FEE GROUP] for [you/[PERSON]].
PRESS 1 AND ENTER TO CONTINUE.
HELP:F1

Responses:
CONTINUE 1 FF90 (FF1085)
Display Instructions:
For '[FLAT FEE GROUP]' display the name of the flat fee group selected at FF10 or entered at FF30.

FF90 (FF1085)

BLAISE NAME: FFeeRcvBill
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
[Have/Has] [you/[PERSON]] (or anyone in the family) received anything in writing, such as a bill, receipt, or statement, for the services for [FLAT FEE GROUP]?
ELP:F1

Responses:
YES, AND DOCUMENTATION AVAILABLE 1 BOX_30 (FF1105)
YES, BUT DOCUMENTATION NOT AVAILABLE 2 BOX_30 (FF1105)
NO 3 FF100 (FF1090)
REFUSED RF FF100 (FF1090)
DON'T KNOW DK FF100 (FF1090)
Display Instructions:
For '[FLAT FEE GROUP]' display the name of the flat fee group selected at FF10 or entered at FF30.

FF100 (FF1090)

BLAISE NAME: FFeeYNoBill
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT 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?
HELP:F1

Responses:
PAID AT TIME OF VISIT 1 BOX_30 (FF1105)
MADE A COPAYMENT 2 BOX_30 (FF1105)
BILL SENT DIRECTLY TO OTHER SOURCE 3 FF110 (FF1095)
BILL HAS NOT ARRIVED 4 BOX_30 (FF1105)
NO BILL SENT: HMO PLAN 5 BOX_30 (FF1105)
NO BILL SENT: VA (VETERANS ADMINISTRATION)/CHAMPVA 6 BOX_30 (FF1105)
NO BILL SENT: MILITARY FACILITY 7 BOX_30 (FF1105)
NO BILL SENT: PUBLIC ASSISTANCE/MEDICAID/SCHIP 8 BOX_30 (FF1105)
NO BILL SENT: INDIAN HEALTH SERVICE (IHS) 9 BOX_30 (FF1105)
NO BILL SENT: WORKER'S COMPENSATION 10 BOX_30 (FF1105)
NO BILL SENT: PRIVATE HEALTH CENTER/CLINIC 11 BOX_30 (FF1105)
NO BILL SENT: PUBLIC CLINIC/HEALTH CENTER OR PRIVATE CHARITY 12 BOX_30 (FF1105)
NO CHARGE: TELEPHONE CALL 13 BOX_60 (FF1160)
FREE FROM PROVIDER 14 BOX_60 (FF1160)
GOVERNMENT-FINANCED RESEARCH AND CLINICAL TRIALS 15 BOX_60 (FF1160)
REFUSED RF BOX_30 (FF1105)
DON'T KNOW DK BOX_30 (FF1105)
Display Instructions:

FF110 (FF1095)

BLAISE NAME: FFeeWhereBill
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
To whom was the bill sent?
RECORD VERBATIM.

Responses:
1 FF120 (FF1100)
REFUSED RF FF120 (FF1100)
DON'T KNOW DK FF120 (FF1100)
Display Instructions:

FF120 (FF1100)

BLAISE NAME: FfeeWhereBillTp
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
INTERVIEWER: SELECT TYPE OF ORGANIZATION TO WHOM BILL WAS SENT:
HELP: F1

Responses:

HMO 1 BOX_30 (FF1105)
VA (VETERANS ADMINISTRATION)/CHAMPVA 2 BOX_30 (FF1105)
TRICARE 3 BOX_30 (FF1105)
OTHER MILITARY 4 BOX_30 (FF1105)
PUBLIC ASSISTANCE/MEDICAID/SCHIP 5 BOX_30 (FF1105)
WORKER'S COMPENSATION 6 BOX_30 (FF1105)
PRIVATE INSURANCE COMPANY 7 BOX_30 (FF1105)
INDIAN HEALTH SERVICE (IHS) 8 BOX_30 (FF1105)
OTHER 91 BOX_30 (FF1105)
REFUSED RF BOX_30 (FF1105)
DON'T KNOW DK BOX_30 (FF1105)
Display Instructions:

BOX_30 (FF1105)

Route Details:
If FF90 is coded ?1? (YES, AND DOCUMENTATION AVAILABLE) or ?2? (YES, BUT DOCUMENTATION NOT AVAILABLE);
or
If FF100 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 FF120 is coded ?3? (TRICARE), ?91? (OTHER), ?DK? (DON?T KNOW), or ?RF? (REFUSED);
Go to FF130.
Otherwise, go to FF150

FF130 (FF1110)

BLAISE NAME: FFeeKnowTotal
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
Do you know the total charge for the services for [FLAT FEE GROUP]?
HELP: F1

Responses:
YES 1 FF140 (FF1115)
NO 2 FF150 (FF1120)
REFUSED RF FF150 (FF1120)
DON'T KNOW DK FF150 (FF1120)
Display Instructions:
For '[FLAT FEE GROUP]' display the name of the flat fee group selected at FF10 or entered at FF30.

FF140 (FF1115)

BLAISE NAME: FFeeTotChrg
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
How much was the total charge, including any amounts that may be paid by health insurance or other sources?
[Include charges for procedures such as x-rays, lab tests, or diagnostic procedures that are listed separately on the bill or statement.]
IF WORKING FROM DOCUMENTATION, ENTER TOTAL CHARGES. DO NOT DEDUCT DISCOUNTS OR DISALLOWED OR DENIED CHARGES.
HELP: F1

Responses:
1
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
If the amount is $0, go to BOX_60. Otherwise, go to FF150.
Soft check: If amount is greater than $100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Hard check: Amount cannot be less than 0.
Display Instructions:
Display 'Include charges for procedures such as x-rays, lab tests, or diagnostic procedures that are listed separately on the bill or statement.? if FF90 is coded '1' (YES, AND DOCUMENTATION AVAILABLE). Otherwise, use a null display.

FF150 (FF1120)

BLAISE NAME: FFeeAmtUPay
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT 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

Responses:
1 FF160 (FF1125)
REFUSED RF FF160 (FF1125)
DON'T KNOW DK FF160 (FF1125)
Programmer Instructions:
Soft check: if amount is greater than $10,000, display the following message: ?VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED.?
Display Instructions:
Display ?[AMT TOT CH]? if an amount is given for the total charge at FF140. Display ?total charge? if FF130 is coded ?2? (NO), ?RF? (REFUSED), ?DK? (DON?T KNOW), or is not asked.
For [AMT TOT CH] display the dollar amount entered at FF140.

FF160 (FF1125)

BLAISE NAME: FFeeAnySrcPay
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
Has any private insurance company, HMO, Medicare, Medicaid, or any other source made any payments for the services for [FLAT FEE GROUP]?
HELP: F1

Responses:
YES 1 FF170 (FF1130)
NO 2 BOX_40 (FF1145)
REFUSED RF BOX_40 (FF1145)
DON'T KNOW DK BOX_40 (FF1145)
Display Instructions:
For '[FLAT FEE GROUP]' display the name of the flat fee group selected at FF10 or entered at FF30.

FF170 (FF1130)

BLAISE NAME: FFeeSOPRoster
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
Who else paid?
PROBE: Anyone else?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:
[Name of Source of Payment]1 1 FF180 (FF1135)
[Name of Source of Payment] 2 2 FF180 (FF1135)
[Name of Source of Payment] 3 3 FF180 (FF1135)
[Name of Source of Payment] 4 4 FF180 (FF1135)
[Name of Source of Payment] N 5 FF180 (FF1135)
EMPTY Empty
Programmer Instructions:
Roster behavior:
Multiple select allowed.
Multiple add allowed.
Pressing CTRL-A displays a pop-up with a blank text entry field and a selectable pick list of 15 common sources of payment. (See below for a detailed list). The interviewer can type a new source or select one from the list. Upon return to FF170, the added source will appear on the roster as selected.
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
Limited delete allowed. If interviewer adds a source of payment, delete is possible for that source only, as long as the interviewer has not left the screen. If delete is attempted when it is not allowed, CAPI displays the following error message: 'DELETE ALLOWED ONLY WHEN SOURCE IS FIRST ENTERED.'
If 'Other Source not listed' is selected, CAPI should display a text box for entry.
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.
Display Instructions:
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
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.

FF180 (FF1135)

BLAISE NAME: PayFAmtPaid
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
How much did [SOURCE] pay?
ENTER AMOUNT.
TOTAL CHARGE: $[TOTAL CHARGE]

Responses:
1
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Preloaded Grid Type 2- including FF180
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 FF150; 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 FF160 (FFeeAnySrcPay) OR FF170 (FFeeSOPRoster). IF [SOURCE] IS THE ONLY SOURCE OF DIRECT PAYMENT, GO TO FF160 (FFeeAnySrcPay) AND CODE ?2? (NO). IF THERE ARE OTHER SOURCES OF PAYMENT, GO TO FF170 (FFeeSOPRoster) AND DELETE [SOURCE] FROM THE LIST OF SOURCES OF DIRECT PAYMENT. IF RESPONDENT DOES NOT KNOW HOW MUCH[SOURCE] PAID, CODE ?DK? AT FF180 (PayFAmtPaid).? CAPI displays F160 (FFeeAnySrcPay), FF170 (FFeeSOPRoster), and FF180 (PayFAmtPaid) as options to return to.
Display Instructions:
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 FF170 for this event-provider pair and the ?PERSON/FAMILY? record.
For TOTAL CHARGE, display amount entered at FF140, otherwise, display "N/A" if FF140=empty, DK, RF.

BOX_40 (FF1145)

Route Details:

If FF140 (TOTAL CHARGE) or 'AMOUNT PAID' by any source of direct payment (all payments sources, including PERSON/FAMILY entered or displayed at FF180) is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW), go to BOX_60.
Otherwise, continue with BOX_50.

BOX_50 (FF1150)

Route Details:

Determine if there is an underpayment. Subtract the total payment (PERSON/FAMILY entered at FF150 plus all payments sources entered at FF180) from the total charge entered at FF140.
Determine what 3% of the total charge is. Compare that value with $5 and determine which of these two values is greater. CAPI will use the greater value to compare against the remainder.
If the value of the remainder is greater than 3% OR $5 (whichever is higher) of the total charge, continue with FF190.
Otherwise, go to BOX_60.
NOTE: Negative values (overpayments) are not eligible for FF190.

FF190 (FF1155)

BLAISE NAME: FFeeElsePay
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] FLAT FEE GROUP:
[NAME OF FLAT FEE EVENT GROUP]
Question Text:
Does anyone in the family or any other source expect to make additional payments for the services for [FLAT FEE iGROUP]?

Responses:
YES 1 BOX_60 (FF1160)
NO 2 BOX_60 (FF1160)
REFUSED RF BOX_60 (FF1160)
DON'T KNOW DK BOX_60 (FF1160)
Display Instructions: For '[FLAT FEE GROUP]' display the name of the flat fee group selected at FF10 or entered at FF30.

BOX_60 (FF1160)

Route Details:

If the event provider pair that launched the flat fee section represents a HS event and HS50 is coded ?4? (GIVE BIRTH TO A BABY) or ?5? (TO BE BORN) OR a MV event and MV100 is coded ?2? (SOMEWHERE ELSE), go to the EF section.
Otherwise, return to the Event Driver for this Event-Provider Pair. Flag the status of CP as ?Processed? for all event-provider pairs in the flat fee group.

Health Status (HE) Section

BOX_00 (HE1000)

Route Details:

01 Box = BOX_10, BOX_20, BOX_30, BOX_40
02 Loop = LOOP_10, LOOP_20, LOOP_30, LOOP_40
03 End Loop = END_LP10, END_LP20, END_LP30, END_LP40
04 Single Select = HE10, HE30, HE40, HE60, HE70, HE90, HE110, HE120, HE130, HE140,HE150, HE160, HE170, HE180, HE190,HE220, HE230, HE270, HE290, HE310, HE330,HE350, HE370
08 Multiple Select = HE210
10 Multiple Select with Fill in Answer Text = HE20, HE50, HE80, HE100, HE200, HE240, HE260, HE280, HE300, HE320, HE340, HE360, HE380
22 Stem and Leaf = HE250A, HE250B, HE250C
Roster 2 = HE20, HE50, HE80, HE100, HE200, HE240, HE260, HE280, HE300, HE320, HE340, HE360, HE380

BOX_10 (HE1005)

Route Details:

Context Header Display Instructions: Display [HOME.RUBEGMM, HOME.RUBEGDD, HOME.RUBEGYY, HOME.RUENDMM, HOME.RUENDDD, HOME.RUENDYY/PERS.FULLNAME, PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY]

BOX_20 (HE1010)

Route Details:

If Round 1 or Round 3 and there is at least one RU member who is not deceased, continue with HE10. If Round 2 or Round 4 and there is at least one RU member who is not deceased, go to HE270. If Round 5, go to BOX_4O.
NOTE: This section is asked for all current RU members and institutionalized persons. This section includes deceased persons only when there is at least one other current or institutionalized person listed as part of the RU.
Otherwise (e.g., Rounds 1-4 and all RU members are deceased), go to BOX_40.
NOTE: Questions HE10 through HE260 are asked in Rounds 1 and 3. Questions HE270 through HE380 are asked in Rounds 2 and 4.
NOTE: Throughout the Health Status (HE) section, age categories are referenced when a true age was not obtained. The ages for these age categories are as follows:
1 = LESS THAN 1 YEAR OLD
2 = 1-4
3 = 5-15
4 = 16-23
5 = 24-34
6 = 35-44
7 = 45-54
8 = 55-64
9 = 65 YEARS OLD OR OLDER

HE10 (HE1015)

BLAISE NAME: HelpPhone
Context Header: [STR-DT]
[END-DT]
Question Text:

Does anyone in this household receive help or supervision using the telephone, paying bills, taking medications, preparing light meals, doing laundry, or going shopping (because of an impairment or a physical or mental health problem)?

Responses:

YES 1
NO 2 HE40 (HE1055)
REFUSED RF HE40 (HE1055)
DON'T KNOW DK HE40 (HE1055)

Programmer Instructions:

If coded '1' (YES) and a single person RU, automatically code person as 'RECEIVES HELP' at HE20 by CAPI then
- If person is less than 13 or in age categories 1-3 go to LOOP_10.
- Otherwise, go to HE40.
If coded '1' (YES) and a multi-person RU, continue with HE20.

Display Instructions:

HE20 (HE1020)

BLAISE NAME: HelpPhoneRoster
Context Header: [STR-DT]
[END-DT]
Question Text:

Who is that?
PROBE: Does anyone else receive help or supervision doing these types of activities [such as using the telephone, paying bills, taking medications, preparing light meals, doing laundry, or going shopping]?
ENTER ALL THAT APPLY.

Responses:

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

Programmer Instructions:

If any of the persons selected are less than 13 or in age categories 1-3, continue with LOOP_10.
Otherwise, go to HE40.
Roster behavior:
1. Multiple select allowed.

Display Instructions:

Roster 2 ? no add/edit/delete
Roster Definition: This item displays RU-members-roster (FULLNAME) for selection.
Roster Filter: None. Display all RU members.
Note: Placeholder for MHOP specifications. Throughout the HE section, deceased RU members in multi-person RUs where there is at least one RU member who is not deceased will display on rosters for selection. This was done for administration ease so FIs do not have to back up to re-code a gate question if a deceased person was mentioned. This is a change from the administration method in WVS. During post-processing, HE data for deceased persons will need to be cleared out (set to -1) at some point along the process so that the data patterns are consistent.

LOOP_10 (HE1025)

Route Details:

For each element in the RU-Members-Roster, ask HE30 - END_LP10.
LOOP DEFINITION: LOOP_10 determines if persons receive help or supervision
with
instrumental activities of daily living because of an impairment or physical or mental health
problem. This loop cycles on RU members who meet the following conditions:
- Person is not deceased
- Person receives help with instrumental activities of daily living (i.e., person selected at HE20)
- Person is less than 13 years of age or in age categories 1-3

HE30 (HE1040)
BLAISE NAME: HelpPhoneBillsHlth
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Question Text:

[Do/Does] [you/[PERSON]] receive help or supervision using the telephone, paying bills, taking medications, preparing light meals, doing laundry or going shopping because of an impairment or a physical or mental health problem?
HELP: F1

Responses:

YES 1 END_LP10 (HE1050)
NO 2 END_LP10 (HE1050)
REFUSED RF END_LP10 (HE1050)
DON'T KNOW DK END_LP10 (HE1050)

Display Instructions:

END_LP10 (HE1050)
Route Details:

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 HE40.

HE40 (HE1055)

BLAISE NAME: HelpPersnlCare
Context Header: [STR-DT]
[END-DT]
Question Text:

Does anyone in this household receive help or supervision with personal care such as bathing, dressing, or getting around the house (because of an impairment or a physical or mental health problem)?
HELP: F1

Responses:

YES 1
NO 2 HE70 (HE1100)
REFUSED RF HE70 (HE1100)
DON'T KNOW DK HE70 (HE1100)

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person as 'RECEIVES HELP' at HE50 by CAPI then
- If person is less than 13 or in age categories 1-3 go to LOOP_20.
- Otherwise, go to HE70.
If coded '1' (YES) and multi-person RU, continue with HE50.

Display Instructions:

HE50 (HE1060)

BLAISE NAME: HelpPersnlCareRoster
Context Header: [STR-DT]
[END-DT]
Question Text:

Who is that?
PROBE: Does anyone else receive help or supervision with personal care [such as bathing, dressing, or getting around the house]?
ENTER ALL THAT APPLY.

Responses:

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

Programmer Instructions:

If any of the person(s) selected are less than 13 or in age categories 1-3, continue with LOOP_20.
Otherwise, go to HE70.
Roster Behavior:
1. Multiple select allowed.

Display Instructions:

Roster 2 ? no add/edit/delete
Roster Definition:
This item displays RU-members-roster for selection.
Roster Filter:
None. Display all RU members.

LOOP_20 (HE1065)

Route Details:

For each element in the RU-Members-Roster, ask HE60 - END_LP20.
LOOP DEFINITION: LOOP_20 determines if persons receive help or supervision with personal care (i.e., activities of daily living) because of an impairment or physical or mental health problem. This loop cycles on RU members who meet the following conditions:
- Person is not deceased
- Person receives help or supervision with personal care (i.e., activities of daily living, that is, the person is selected at HE50)
- Person is less than 13 years of age or in age categories 1-3

HE60 (HE1080)

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

[Do/Does] [you/[PERSON]] receive help or supervision with personal care such as bathing, dressing or getting around the house because of an impairment or a physical or mental health problem?
HELP: F1

Responses:

YES 1 END_LP20 (HE1090)
NO 2 END_LP20 (HE1090)
REFUSED RF END_LP20 (HE1090)
DON'T KNOW DK END_LP20 (HE1090)

Display Instructions:

END_LP20 (HE1090)

Route Details:

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_20 and continue with HE70.

HE70 (HE1100)

BLAISE NAME: HelpAids
Context Header: [STR-DT]
[END-DT]
Question Text:

Does anyone in this household use any aids such as a walker, grab bars in the bathtub or any other special equipment for personal care or everyday activities (because of an impairment or a physical or mental health problem)?
HELP: F1

Responses:

YES 1
NO 2 HE90 (HE1110)
REFUSED RF HE90 (HE1110)
DON'T KNOW DK HE90 (HE1110)

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person as 'USES AIDS' at HE80 by CAPI and go to HE90.
If coded '1' (YES) and a multi-person RU, continue with HE80.

Display Instructions:

HE80 (HE1105)

BLAISE NAME: HelpAidsRoster
Context Header: [STR-DT]
[END-DT]
Question Text:

Who is that?
PROBE: Does anyone else use any aids [such as a walker, grab bars in the bathtub or any other special equipment] for personal care or everyday activities?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 HE90 (HE1110)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 HE90 (HE1110)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 HE90 (HE1110)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 HE90 (HE1110)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 HE90 (HE1110)

Programmer Instructions: Roster behavior:

1. Multiple select allowed.

Display Instructions:

Roster 2 ? no add/edit/delete
Roster Definition:
This item displays RU-members-roster (FULLNAME) for selection.
Roster Filter:
None. Display all RU members.

HE90 (HE1110)

BLAISE NAME: HelpWalkClimb
Context Header: [STR-DT] [END-DT]
Question Text:

Does anyone in this household have difficulties walking, climbing stairs, grasping objects, reaching overhead, lifting, bending or stooping, or standing for long periods of time (because of an impairment or a physical or mental health problem)?

Responses:

YES 1
NO 2 HE190 (HE1180)
REFUSED RF HE190 (HE1180)
DON'T KNOW DK HE190 (HE1180)

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person as 'HAVING DIFFICULTY' at HE100 by CAPI then
- If person is greater than or equal to 13 or in age categories 4-9 go to LOOP_30.
- Otherwise, go to HE190
If coded '1' (YES) and a multi-person RU, continue with HE100.

Display Instructions:

HE100 (HE1115)

BLAISE NAME: HelpWalkClimbRoster
Context Header:

[STR-DT]
[END-DT]

Question Text:

Who is that?
PROBE: Does anyone else have difficulties [walking, climbing stairs, grasping objects, reaching overhead, lifting, bending or stooping, or standing for long periods of time]?
ENTER ALL THAT APPLY.

Responses:

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

Programmer Instructions:

If any of the person(s) selected are greater than or equal to 13 or in age categories 4-9, continue with LOOP_30.
Otherwise, go to HE190.
Roster Behavior:
Multiple select allowed.

Display Instructions:

Roster 2 ? no add/edit/delete Roster Definition:
This item displays RU-members-roster for selection.
Roster Filter:
None. Display all RU members.

LOOP_30 (HE1120)

Route Details:

For each element in the RU-Members-Roster, ask HE110 - END_LP30.
LOOP DEFINITION: LOOP_30 collects information on the level of functional limitation with various physical activities for persons greater than or equal to 13 years of age. This loop cycles on RU members who meet the following conditions:
- Person is not deceased
- Person has functional limitations (i.e., person selected at HE100)
- Person greater than or equal to 13 years of age or in age categories 4-9

HE110 (HE1130)

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

ANDHE-1.
[For these next questions, I would like you to think about the time when [you/[PERSON]] entered the institution and what [you/he/she] was able to do at that time.]
Please look at show card HE-1 and tell me how much difficulty [do/does] [you/[PERSON]] have lifting something as heavy as 10 pounds, such as a full bag of groceries? Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses:

NO DIFFICULTY 1 HE120 (HE1135)
SOME DIFFICULTY 2 HE120 (HE1135)
A LOT OF DIFFICULTY 3 HE120 (HE1135)
COMPLETELY UNABLE TO DO IT 4 HE120 (HE1135)
REFUSED RF HE120 (HE1135)
DON'T KNOW DK HE120 (HE1135)

Display Instructions:

Display ?For these next questions, I would like you to think about the time when [you/[PERSON]] entered the institution and what [you/he/she] was able to do at that time.? if person being asked about coded as being institutionalized at end date. If person being asked about is a current RU member living in the RU, use a null display.

HE120 (HE1135)

BLAISE NAME: DfcltStair
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]

Question Text:

AND HE-1.
Looking at show card HE-1, how much difficulty [do/does] [you/[PERSON]] have walking up 10 steps without resting?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?
IF RESPONDENT VOLUNTEERS THAT PERSON IS COMPLETELY UNABLE TO WALK, SELECT 'COMPLETELY UNABLE TO WALK.'

Responses:

NO DIFFICULTY 1 HE130 (HE1140)
SOME DIFFICULTY 2 HE130 (HE1140)
A LOT OF DIFFICULTY 3 HE130 (HE1140)
COMPLETELY UNABLE TO DO IT 4 HE130 (HE1140)
COMPLETELY UNABLE TO WALK 5 HE170 (HE1160)
REFUSED RF HE130 (HE1140)
DON'T KNOW DK HE130 (HE1140)

Programmer Instructions:

If coded '5' (COMPLETELY UNABLE TO WALK), automatically code HE130, HE140, HE150, and HE160 as '4' (COMPLETELY UNABLE TO DO IT) by CAPI.

Display Instructions:

HE130 (HE1140)

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

AND HE-1.
Looking at show card HE-1, how much difficulty [do/does] [you/[PERSON]] have walking about 3 city blocks or about a quarter of a mile?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses:

NO DIFFICULTY 1 HE140 (HE1145)
SOME DIFFICULTY 2 HE140 (HE1145)
A LOT OF DIFFICULTY 3 HE140 (HE1145)
COMPLETELY UNABLE TO DO IT 4 HE150 (HE1150)
REFUSED RF HE140 (HE1145)
DON'T KNOW DK HE140 (HE1145)

Programmer Instructions:

If coded '4' (COMPLETELY UNABLE TO DO IT), automatically code HE140 as '4' (COMPLETELY UNABLE TO DO IT) by CAPI.

Display Instructions:

HE140 (HE1145)

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

AND HE-1.
Looking at show card HE-1, how much difficulty [do/does] [you/[PERSON]] have walking a mile?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses:

NO DIFFICULTY 1 HE150 (HE1150)
SOME DIFFICULTY 2 HE150 (HE1150)
A LOT OF DIFFICULTY 3 HE150 (HE1150)
COMPLETELY UNABLE TO DO IT 4 HE150 (HE1150)
REFUSED RF HE150 (HE1150)
DON'T KNOW DK HE150 (HE1150)

Display Instructions:

HE150 (HE1150)

BLAISE NAME: DfcltStand20Min
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT]
[END-DT]
Question Text:

AND HE-1.
Looking at show card HE-1, how much difficulty [do/does] [you/[PERSON]] have standing for about 20 minutes?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses:

NO DIFFICULTY 1 HE160 (HE1155)
SOME DIFFICULTY 2 HE160 (HE1155)
A LOT OF DIFFICULTY 3 HE160 (HE1155)
COMPLETELY UNABLE TO DO IT 4 HE160 (HE1155)
REFUSED RF HE160 (HE1155)
DON'T KNOW DK HE160 (HE1155)

Display Instructions:

HE160 (HE1155)

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

AND HE-1.
Looking at show card HE-1, how much difficulty [do/does] [you/[PERSON]] have bending down or stooping from a standing position to pick up an object from the floor or tie a shoe?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses:

NO DIFFICULTY 1 HE170 (HE1160)
SOME DIFFICULTY 2 HE170 (HE1160)
A LOT OF DIFFICULTY 3 HE170 (HE1160)
COMPLETELY UNABLE TO DO IT 4 HE170 (HE1160)
REFUSED RF HE170 (HE1160)
DON'T KNOW DK HE170 (HE1160)

Display Instructions:

HE170 (HE1160)

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

AND HE-1.
Looking at show card HE-1, how much difficulty [do/does] [you/[PERSON]] have reaching up overhead, for example to remove something from a shelf?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses:

NO DIFFICULTY 1 HE180 (HE1165)
SOME DIFFICULTY 2 HE180 (HE1165)
A LOT OF DIFFICULTY 3 HE180 (HE1165)
COMPLETELY UNABLE TO DO IT 4 HE180 (HE1165)
REFUSED RF HE180 (HE1165)
DON'T KNOW DK HE180 (HE1165)

Display Instructions:

HE180 (HE1165)

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

ANDHE-1.
Looking at show card HE-1, how much difficulty [do/does] [you/[PERSON]] have using fingers to grasp or handle something such as picking up a glass from a table or using a pencil to write?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or completely unable to do it?

Responses:

NO DIFFICULTY 1 END_LP30 (HE1175)
SOME DIFFICULTY 2 END_LP30 (HE1175)
A LOT OF DIFFICULTY 3 END_LP30 (HE1175)
COMPLETELY UNABLE TO DO IT 4 END_LP30 (HE1175)
REFUSED RF END_LP30 (HE1175)
DON'T KNOW DK END_LP30 (HE1175)

Display Instructions:

END_LP30 (HE1175)

Route Details:

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_30 and continue with HE190.

HE190 (HE1180)

BLAISE NAME: LmtWork
Context Header: [STR-DT]
[END-DT]
Question Text:

Is anyone in this household limited in any way in the ability to work at a job, do housework, or go to school because of an impairment or a physical or mental health problem?
HELP: F1

Responses:

YES 1
NO 2 HE230 (HE1215)
REFUSED RF HE230 (HE1215)
DON'T KNOW DK HE230 (HE1215)

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person as 'LIMITED ABILITY' at HE200 by CAPI then
- If person is greater than or equal to 5 or in age categories 3-9 go to LOOP_40.
- Otherwise, go to HE230
If coded '1' (YES) and a multi-person RU, continue with HE200.

Display Instructions:

HE200 (HE1185)

BLAISE NAME: LmtWorkRoster
Context Header: [STR-DT]
[END-DT]
Question Text:

Who is that?
PROBE: Is anyone else limited in the ability to work at a job, do housework, or go to school because of an impairment or a physical or mental health problem?
ENTER ALL THAT APPLY.

Responses:

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

Programmer Instructions:

If any of the persons selected are greater than or equal to 5 or in age categories 3-9, continue with LOOP_40.
Otherwise, go to HE230.
Roster behavior:
1. Multiple select allowed.

Display Instructions:

Roster 2 ? no add/edit/delete.
Roster definition:
This item displays RU-members-roster for selection.
Roster filter:
None. Display all RU members.

LOOP_40 (HE1190)

Route Details:

For each element in the RU-Members-Roster, ask HE210 - END_LP40.
LOOP DEFINITION: LOOP_40 collects information on work/housework/school limitations because of an impairment or physical or mental health problem for persons greater than or equal to 5 years of age. This loop cycles on RU members who meet the following conditions:
- Person is not deceased
- Person is limited in ability to work at a job, do housework, or go to school (i.e., person selected at HE200)
- Person greater than or equal to 5 years of age or in age categories 3-9

HE210 (HE1200)

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

Which activities [are/is] [you/[PERSON]] limited in doing because of an impairment or a physical or mental health problem - working at a job, doing housework, or going to school?
ENTER ALL THAT APPLY.

Responses:

WORKING AT A JOB 1 HE220 (HE1205)
DOING HOUSEWORK 2 HE220 (HE1205)
GOING TO SCHOOL 3 HE220 (HE1205)
REFUSED RF HE220 (HE1205)
DON'T KNOW DK HE220 (HE1205)

Display Instructions:

HE220 (HE1205)

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

[At the time [you/[PERSON]] entered the institution, was / [Are/Is]] [you/[PERSON]] completely unable to [work at a job], [,/ and] [do housework] [ and] [ go to school]?

Responses:

YES 1 END_LP40 (HE1210)
NO 2 END_LP40 (HE1210)
REFUSED RF END_LP40 (HE1210)
DON'T KNOW DK END_LP40 (HE1210)

Display Instructions:

Display ?At the time [you/[PERSON]] entered the institution, was? if person being asked about coded as being institutionalized at end date. Display ?[Are/Is]? if person being asked about is a current RU member living in the RU.
Display ?work at a job? if HE210 is coded ?1? (WORKING AT A JOB), either alone or in combination with other codes or if HE210 is coded ?RF? (REFUSED) or ?DK? (DON'T KNOW). If HE210 is not coded ?1? (WORKING AT A JOB), ?RF? (REFUSED), or ?DK? (DON'T KNOW), use a null display.
Display ?,? if HE210 is coded ?1? (WORKING AT A JOB), ?2? (DOING HOUSEWORK), and ?3? (GOING TO SCHOOL) or if HE210 is coded either ?RF? (REFUSED) or ?DK? (DON'T KNOW). Display ? and? if HE210 is coded ?1? (WORKING AT A JOB) and either ?2? (DOING HOUSEWORK) or ?3? (GOING TO SCHOOL) . Otherwise, use a null display.
Display ?do housework? if HE210 is coded ?2? (DOING HOUSEWORK), either alone or in combination with other codes or if HE210 is coded ?RF? (REFUSED) or ?DK? (DON'T KNOW). If HE210 is not coded ?2? (DOING HOUSEWORK), ?RF? (REFUSED), or ?DK? (DON'T KNOW), use a null display.
Display ?and? if only codes ?2? (DOING HOUSEWORK) and ?3? (GOING TO SCHOOL) are selected at HE210 or if codes ?1? (WORKING AT A JOB), ?2? (DOING HOUSEWORK), and ?3? (GOING TO SCHOOL) are all selected at HE210 or if coded either ?RF? (REFUSED) or ?DK? (DON'T KNOW) at HE210. Otherwise, use a null display.
Display ?go to school? if HE210 is coded ?3? (GOING TO SCHOOL), either alone or in combination with other codes or if HE210 is coded ?RF? (REFUSED) or ?DK? (DON'T KNOW). If HE210 is not coded ?3? (GOING TO SCHOOL), ?RF? (REFUSED), or ?DK? (DON'T KNOW), use a null display.

END_LP40 (HE1210)

Route Details:

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_40 and continue with HE230.

HE230 (HE1215)

BLAISE NAME: LmtSocial
Context Header: [STR-DT]
[END-DT]
Question Text:

(Besides the limitations we just talked about,) is anyone in this household limited in participating in social, recreational or family activities because of an impairment or a physical or mental health problem?
HELP: F1

Responses:

YES 1
NO 2 BOX_30 (HE1225)
REFUSED RF BOX_30 (HE1225)
DON'T KNOW DK BOX_30 (HE1225)

Programmer Instructions:

If coded '1' (YES) and a single person RU, automatically code person as 'LIMITED IN PARTICIPATION' at HE240 by CAPI and go to BOX_30.
If coded '1' (YES) and a multi-person RU, continue with HE240.

Display Instructions:

HE240 (HE1220)

BLAISE NAME: LmtSocialRoster
Context Header: [STR-DT]
[END-DT]
Question Text:

Who is that?
PROBE: Is anyone else limited in participating in social, recreational, or family activities because of an impairment or a physical or mental health problem?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 BOX_30 (HE1225)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 BOX_30 (HE1225)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 BOX_30 (HE1225)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 BOX_30 (HE1225)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 BOX_30 (HE1225)

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 names (FULLNAME).
Roster filter:
None. Display all RU members.

BOX_30 (HE1225)

Route Details:

HE250A through HE250C represent a stem and leaf series.
Cycle through the leaf text in the A-# sequence until all rows are displayed.
Each leaf in this stem and leaf series, should display on the same form pane. Use the same question stem display.
Display the question stem ?[Do any of the adults in this household...]? only when presenting the first question for this household. Otherwise always display question stem in brackets and "grayed-out" text.
Display each leaf in bold black when its entry field is active. Otherwise always display in ?grayed-out? text.
Go to HE250A.

HE250A (HE1230)

BLAISE NAME: DfcltMmry
Context Header: [STR-DT]
[END-DT]
Question Text:

Do any of the adults in this household...
a. Experience confusion or memory loss such that it interferes with daily activities?

Responses:

YES 1 HE250B (HE1235)
NO 2 HE250B (HE1235)
REFUSED RF HE250B (HE1235)
DON'T KNOW DK HE250B (HE1235)

Display Instructions:

HE250B (HE1235)

BLAISE NAME: DfcltDecision
Question Text:

[Do any of the adults in this household...]
b. Have problems making decisions to the point that it interferes with daily activities?

Responses:

YES 1 HE250C (HE1240)
NO 2 HE250C (HE1240)
REFUSED RF HE250C (HE1240)
DON'T KNOW DK HE250C (HE1240)

Display Instructions:

HE250C (HE1240)

BLAISE NAME: DfcltSup
Question Text:

[Do any of the adults in this household...]
c. Require supervision for their own safety?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If HE250A, HE250B, or HE250C is coded '1' (YES) and a single-person RU, automatically code as 'EXPERIENCES CONFUSION' at HE260 by CAPI and go to BOX_40.
If HE250A, HE250B, and HE250C are all coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), go to BOX_40.
Otherwise, continue with HE260.

Display Instructions:

HE260 (HE1245)

BLAISE NAME: DfcltMDSRoster
Context Header: [STR-DT]
[END-DT]
Question Text:

Who is that?
PROBE: Does anyone else [experience confusion or memory loss such that it interferes with daily activities] [[or ] have problems making decisions to the point that it interferes with daily activities] [[or ] require supervision for their own safety]?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 BOX_40 (HE1495)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 BOX_40 (HE1495)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 BOX_40 (HE1495)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 BOX_40 (HE1495)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 BOX_40 (HE1495)

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.
Roster filter:
None. Display all RU members..
Display 'experience confusion or memory loss such that it interferes with daily activities' if HE250A coded '1' (YES).
Display '[or] have problems making decisions to the point that it interferes with daily activities' if HE250B coded '1' (YES). Display the 'or' only if HE250A is also coded ?1? (YES).
Display '[or] require supervision for their own safety' if HE250C is coded '1' (YES). Display 'or' only if HE250A and/or HE250B are also coded ?1? (YES).

HE270 (HE1250)

BLAISE NAME: DfcltHear
Question Text:

With this next set of questions we want to learn about people who have physical, mental, or emotional conditions that cause serious difficulties with their daily

activities.
[Please answer the next few questions for family members age 1 or older.]
Is anyone in this household deaf or does anyone have serious difficulty hearing?

Responses:

YES 1
NO 2 HE290 (HE1280)
REFUSED RF HE290 (HE1280)
DON'T KNOW DK HE290 (HE1280)

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person at HE280 by CAPI and go to HE290.
If coded '1' (YES) and a multi-person RU, continue with HE280.

Display Instructions:

Display the sentence ?Please answer...age 1 or older.? if any RU members are less than 1 year of age or in age category 1. Otherwise, use a null display.

HE280 (HE1255)

BLAISE NAME: DfcltHearRoster
Question Text:

Who is that?
PROBE: Anyone else?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 HE290 (HE1280)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 HE290 (HE1280)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 HE290 (HE1280)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 HE290 (HE1280)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 HE290 (HE1280)

Programmer Instructions:

Roster behavior:
1. Multiple select allowed.

Display Instructions:

Roster 2 ? no add/edit/delete
Roster definition:
This item displays RU-members-roster (RU_MEMBERS_1/FULLNAME) for selection
Roster filter:
Display only RU members who meet the following conditions:
person is greater than or equal to 1 year of age or in age categories 2-9

HE290 (HE1280)

BLAISE NAME: DfcltSee
Question Text:

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

Responses:

YES 1
NO 2 HE310 (HE1310)
REFUSED RF HE310 (HE1310)
DON'T KNOW DK HE310 (HE1310)

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person at HE300 by CAPI and go to HE310.
If coded '1' (YES) and a multi-person RU, continue with HE300.

Display Instructions:

HE300 (HE1285)

BLAISE NAME: DfcltSeeRoster
Question Text:

Who is that?
PROBE : Anyone else?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 HE310 (HE1310)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 HE310 (HE1310)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 HE310 HE1310)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 HE310 (HE1310)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 HE310 (HE1310)

Programmer Instructions:

Roster behavior:
1. Multiple select allowed.

Display Instructions:

Roster 2 ? no add/edit/delete
Roster definition:
This item displays RU-members-roster (RU_MEMBERS_1/FULLNAME) for selection.
Roster filter:
Display only RU members who meet the following conditions:
person is greater than or equal to 1 year of age or in age categories 2-9

HE310 (HE1310)

BLAISE NAME: DfcltMind
Question Text:

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

Responses:

YES 1
NO 2 HE330 (HE1320)
REFUSED RF HE330 (HE1320)
DON'T KNOW DK HE330 (HE1320)

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person at HE320 by CAPI and go to HE330.
If coded '1' (YES) and a multi-person RU, continue with HE320.

Display Instructions:

Display the sentence ?Please answer ? age 5 or older.? if any RU members are less than 5 years of age or in age categories 1 or 2. Otherwise, use a null display.

HE320 (HE1315)

BLAISE NAME: DfcltMindRoster
Question Text:

Who is that?
PROBE : Anyone else?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 HE330 (HE1320)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 HE330 (HE1320)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 HE330 (HE1320)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 HE330 (HE1320)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 HE330 (HE1320)

Programmer Instructions:

Roster behavior:
1. Multiple select allowed.

Display Instructions:

HE330 (HE1320)

BLAISE NAME: DfcltWalk
Question Text:

Does anyone in this household have serious difficulty walking or climbing stairs?

Responses:

YES 1
NO 2 HE350 (HE1330)
REFUSED RF HE350 (HE1330)
DON'T KNOW DK HE350 (HE1330)

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person at HE340 by CAPI and go to HE350.
If coded '1' (YES) and a multi-person RU, continue with HE340.

Display Instructions:

HE340 (HE1325)

BLAISE NAME: DfcltWalkRoster
Question Text:

Who is that?
PROBE: Anyone else?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 HE350 (HE1330)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 HE350 (HE1330)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 HE350 (HE1330)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 (HE350 HE1330)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 HE350 (HE1330)

Programmer Instructions:

Roster behavior:
1. Multiple select allowed.

Display Instructions:

HE350 (HE1330)

BLAISE NAME: DfcltDress
Question Text:

Does anyone in this household have difficulty dressing or bathing?

Responses:

YES 1
NO 2 HE370 (HE1345)
REFUSED RF HE370 (HE1345)
DON'T KNOW DK HE370 (HE1345)

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person at HE360 by CAPI and go to HE370.
If coded '1' (YES) and a multi-person RU, continue with HE360.

Display Instructions:

HE360 (HE1335)

BLAISE NAME: DfcltDressRoster
Question Text:

Who is that?
PROBE : Anyone else?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 HE370 (HE1345)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 HE370 (HE1345)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 HE370 (HE1345)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 HE370 (HE1345)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 HE370 (HE1345)

Programmer Instructions:

Roster behavior:
1. Multiple select allowed.

Display Instructions:

HE370 (HE1345)

BLAISE NAME: DfcltErrand
Question Text:

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

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded '1' (YES) and a single-person RU, automatically code person at HE380 by CAPI and go to BOX_40.
If coded '1' (YES) and a multi-person RU, continue with HE380.

Display Instructions:

Display the sentence ?Please answer...age 15 or older.? if any RU members are less than 15 years of age or in age categories 1 - 3. Otherwise, use a null display.

HE380 (HE1350)

BLAISE NAME: DfcltErrandRoster
Question Text:

Who is that?
PROBE : Anyone else?
ENTER ALL THAT APPLY

Responses:

Programmer Instructions:

Roster behavior:
1. Multiple select allowed.

Display Instructions:

BOX_40 (HE1495)

Route Details:

Go to next questionnaire section.

Home Health (HH) Section

BOX_00 (HH1000)

Route Details:

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70
04 Single Select equal to HH40, HH50, HH60, HH70, HH90, HH120
08 Multiple Select equal to HH10, HH20
09 Multiple Select with Display Roster equal to HH130
11 Multiple Select with Add/Edit/Delete equal to HH80
19 Numeric Field equal to HH30, HH100, HH110
23 Text Field equal to HH140
Roster 2 equal to HH130
Roster 3 equal to HH80

BOX_10 (HH1001)

Route Details:

Context header display instructions: display EVNT.EVNTBEGM as three letters.

BOX_20 (HH1010)

Route Details:

If provider is flagged as ?AGENCY?, in the current round or prior round (preload.HHType equal to 1), continue with HH10.
If provider is flagged as ?INFORMAL? in the current round or prior round (preload.HHType equal to 2) and it is Round 1, go to BOX_40.
If provider is flagged as ?PAID INDEPENDENT?, in the current round or prior round (preload.HHType equal to 3), go to BOX_30.
Otherwise, go to HH70.

HH10 (HH1015)

BLAISE NAME: CodeAllHcarWrkrProf
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

HH-1
Please look at card HH-1. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (you/(PERSON))?
ENTER ALL THAT APPLY.
HELP: F1

Responses:

CERTIFIED NURSING ASSISTANT (CNA) 1 HH20 (HH1020)
DIETITIAN/NUTRITIONIST 2 HH20 (HH1020)
I.V. OR INFUSION THERAPIST 3 HH20 (HH1020)
MEDICAL DOCTOR 4 HH20 (HH1020)
NURSE/NURSE PRACTITIONER 5 HH20 (HH1020)
OCCUPATIONAL THERAPIST 6 HH20 (HH1020)
PHYSICAL THERAPIST 7 HH20 (HH1020)
RESPIRATORY THERAPIST 8 HH20 (HH1020)
SOCIAL WORKER 9 HH20 (HH1020)
SPEECH THERAPIST 10 HH20 (HH1020)
NONE OF THESE 95 HH20 (HH1020)
REFUSED RF HH20 (HH1020)
DON'T KNOW DK HH20 (HH1020)

Programmer Instructions:

For specifications purposes only (this check is automatic): CAPI does not allow ?95? (NONE OF THESE), 'RF' (REFUSED) or 'DK' (DON'T KNOW) in combination with any other code.
Display the following message if these codes are selected in combination with any other code ?THIS CODE CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE-ENTER.?
MHOP NOTE: Codes 1-10 represented providers who are skilled.

Display Instructions:

HH20 (HH1020)

BLAISE NAME: CodeAllHcarWrkrOth
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

HH-2
Please look at card HH-2. (Which/Other than what we have discussed, which) of these types of health care workers from (PROVIDER) provided home care services for (you/(PERSON)) during (VISIT MONTH)?
ENTER ALL THAT APPLY.
HELP: F1

Responses:

COMPANION 1 HH30 (HH1025)
HOMEMAKER/HOUSE CLEANER 2 HH30 (HH1025)
HOME HEALTH AIDE/HOME CARE AIDE 3 HH30 (HH1025)
HOSPICE WORKER 4 HH30 (HH1025)
NURSE'S AIDE 5 HH30 (HH1025)
PERSONAL CARE ATTENDANT 6 HH30 (HH1025)
NONE OF THESE 95 HH30 (HH1025)
REFUSED RF HH30 (HH1025)
DON'T KNOW DK HH30 (HH1025)

Programmer Instructions:

Display Instructions:

Display ?Which? if HH10 is coded ?95? (NONE OF THESE), ?RF? (REFUSED) or ?DK? (DON'T KNOW). Otherwise, display ?Other than what we have discussed, which?.

HH30 (HH1025)

BLAISE NAME: HHMPNum
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

How many people from (PROVIDER) provided home care services for (you/(PERSON))?

Responses: 1

REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If Round 1, go to BOX_40.
Otherwise, go to HH70.

Display Instructions:

BOX_30 (HH1026)

Route Details:

If provider is HHType equal to 3 and HH40 is coded 1-10, or RF or HH50 is coded 1-6, or RF in this round for this provider, or preload.HHProvTypenot equal to empty for this provider, go to BOX_40.

HH40 (HH1027)

BLAISE NAME: HHProfTp
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

HH-1
Please look at card HH-1. What type of health care worker is (PROVIDER) who provided home care services for (you/(PERSON)) during (VISIT MONTH) ?
HELP: F1

Responses:

CERTIFIED NURSING ASSISTANT (CNA) 1
DIETITIAN/NUTRITIONIST 2
I.V. OR INFUSION THERAPIST 3
MEDICAL DOCTOR 4
NURSE/NURSE PRACTITIONER 5
OCCUPATIONAL THERAPIST 6
PHYSICAL THERAPIST 7
RESPIRATORY THERAPIST 8
SOCIAL WORKER 9
SPEECH THERAPIST 10
NONE OF THESE 95
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded 95, ?NONE OF THESE? or ?DK? (DON?T KNOW), go to HH50.
If round 1, and coded 1-10, RF go to BOX_40.
Otherwise, go to HH70

Display Instructions:

HH50 (HH1030)

BLAISE NAME: HHProfTpOth
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

HH-2
Please look at card HH-2. Which of these types of health care workers, if any, is (PROVIDER) who provided home care services for (you/(PERSON)) during (VISIT MONTH)?
HELP:F1

Responses:

COMPANION 1
HOMEMAKER/HOUSE CLEANER 2
HOME HEALTH AIDE/HOME CARE AIDE 3
HOSPICE WORKER 4
NURSE'S AIDE 5
PERSONAL CARE ATTENDANT 6
NONE OF THESE 95
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If round 1, go to BOX_40.
Otherwise, go to HH70.

Display Instructions:

BOX_40 (HH1032)

Route Details:

If HH60 was already asked for this same RU member-provider pair, go to HH70.
Otherwise, continue with HH60.

HH60 (HH1033)

BLAISE NAME: HHCareBefYr

Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

Did (someone from) (PROVIDER) ever provide home care services for (you/(PERSON)) before January 1, (YEAR)?

Responses:

YES 1 HH70 (HH1040)
NO 2 HH70 (HH1040)
REFUSED RF HH70 (HH1040)
DON'T KNOW DK HH70 (HH1040)

Display Instructions:

Display ?someone from? if provider is flagged as 'AGENCY'. Otherwise, use a null display.
For specifications purposes only; CAPI handles automatically: ?YEAR? in question text is first calendar year of panel.

HH70 (HH1040)

BLAISE NAME: HHSpecCond
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

Thinking about all of the home care services (you/ (PERSON)) (have/has) received from (someone from) (PROVIDER) during (VISIT MONTH), were any of these home care services related to any specific health problem?
IF OLD AGE MENTIONED, SELECT 'YES' AND ENTER ?OLD AGE? AS CONDITION
HELP: F1

Responses:

YES 1 HH80 (HH1045)
NO 2 HH90 (HH1085)
REFUSED RF HH90 (HH1085)
DON'T KNOW DK HH90 (HH1085)

Display Instructions:

Display ?someone from? if provider is flagged as ?AGENCY?.

HH80 (HH1045)

BLAISE NAME: HHCondRoster
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

What health condition led (you/(PERSON)) to receive home health care services from (someone from) (PROVIDER) during (VISIT MONTH)?
PROBE: Any other health condition?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

Responses:

(MEDICAL CONDITION) 1 1 HH90 (HH1085)
(MEDICAL CONDITION) 2 2 HH90 (HH1085)
(MEDICAL CONDITION) 3 3 HH90 (HH1085)
(MEDICAL CONDITION) 4 4 HH90 (HH1085)
(MEDICAL CONDITION)N 5 HH90 (HH1085)

Programmer Instructions:

Roster Behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event.
The link is created when the collection of utilization and/or charge/payment data is complete.

Display Instructions:

Roster 3 - Add/Edit/Delete Allowed
Roster Definition:
Display the Person's-Medical-Conditions Roster for the selection and/or addition of one or more medical condition (s) associated with this event. Display name of medical condition (COND.CONDNAM).
Roster Filter:
Display all conditions on person's roster; no filter.
Display ?someone from? if provider is flagged as ?AGENCY?.

HH90 (HH1085)

BLAISE NAME: HHFreq
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

During (VISIT MONTH), did (someone from) (PROVIDER) usually come to the home to help (you/ (PERSON)) every week, only some weeks, or did they come only once during (VISIT MONTH)?

Responses:

EVERY WEEK 1 HH100 (HH1090)
SOME WEEKS 2 HH110 (HH1095)
ONLY CAME ONCE 3 BOX_50 (HH1125)
REFUSED RF BOX_50 (HH1125)
DON'T KNOW DK BOX_50 (HH1125)

Display Instructions:

Display ?someone from? if provider is flagged as ?AGENCY?.

HH100 (HH1090)

BLAISE NAME: HHDaysWeek
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

During (VISIT MONTH), about how many days per week did (someone from) (PROVIDER) come?
PROBE: We just need to know in general.
ENTER DAYS PER WEEK

Responses:

1 BOX_50 (HH1125)
REFUSED RF BOX_50 (HH1125)
DON'T KNOW DK BOX_50 (HH1125)

Programmer Instructions:

Hard range: 1-7.
Display the following message if an out of range response is entered: ?THE VALUE MUST BE BETWEEN 1 AND 7. VERIFY WITH RESPONDENT AND RE-ENTER.?

Display Instructions:

Display ?someone from? if provider is flagged as ?AGENCY?.

HH110 (HH1095)

BLAISE NAME: HHDaysMth
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

About how many days during (VISIT MONTH) did (someone from) (PROVIDER) come?
PROBE: We just need to know in general.
ENTER 1-(28/29/30/31) DAYS PER MONTH

Responses:

1 BOX_50 (HH1125)
REFUSED RF BOX_50 (HH1125)
DON'T KNOW DK BOX_50 (HH1125)

Programmer Instructions:

Hard range: 1-31.
Range Check:
CAPI will display an error message and force the interviewer to rectify the data if any of the following situations occur:
If (VISIT MONTH) is: January, March, May, July, August, October or December: 1-31 for number of days.
If (VISIT MONTH) is: April, June, September or November: 1-30 for number of days.
If (VISIT MONTH) is: February: 1-29 for leap years.
Otherwise, 1-28 for number of days.

Display Instructions:

Display ?someone from? if provider is flagged as ?AGENCY?.
Display ?28? if HH visit month is February and event year is not a leap year.
Display ?29? if HH visit month is February and event year is a leap year.
Display ?30? if HH visit month is April, June, September or November.
Display ?31? if HH visit month is January, March, May, July, August, October or December.

BOX_50 (HH1125)

Route Details:

If 2 or more months, excluding interview month, for this provider for this person have not completed the Home Health (HH) utilization section and if this event is not part of a flat fee group, continue with HH120.
Otherwise, go to BOX_60.

HH120 (HH1130)

BLAISE NAME: HHFreqOthMth
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

I have recorded that (you/(PERSON)) received services from (PROVIDER) during other months. In the other months, did (PROVIDER) visit (only once/the same number of times/(FREQUENCY OF SERVICES?))?

Responses:

YES 1 HH130 (HH1135)
NO 2 BOX_60 (HH1145)
REFUSED RF BOX_60 (HH1145)
DON'T KNOW DK BOX_60 (HH1145)

Display Instructions:

Display ?only once? if HH90 was coded ?3? (ONLY CAME ONCE). Display ?the same number of times? if HH90, HH100 or HH110 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW). Otherwise, display ?(FREQUENCY OF SERVICES)?.
For 'FREQUENCY OF SERVICES':
Display number entered at HH100 and the phrase ?days per week? if a response was recorded at HH100.
Display number entered at HH110 and the phrase ?days per month? if a response was recorded at HH110.

HH130 (HH1135)

BLAISE NAME: HHMthRoster
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

During which of the following months did (PROVIDER) visit (only once/the same number of times/(FREQUENCY OF SERVICES))?
PROBE: Any other months with the same number of visits?
ENTER ALL THAT APPLY.

Responses:

(SELECT ALL EVENTS) 0 HH140 (HH1140)
(MONTH,YEAR)1 1 HH140 (HH1140)
(MONTH,YEAR)2 2 HH140 (HH1140)
(MONTH,YEAR)3 3 HH140 (HH1140)
(MONTH,YEAR)4 4 HH140 (HH1140)
(MONTH,YEAR)N 5 HH140 (HH1140)

Programmer Instructions:

If coded '0' SELECT ALL EVENTS, CAPI should automatically select all of the events displayed on the roster and flag as being part of the repeat visit group.
Flag each month selected at HH130 as a repeat visit related to the event being asked about. (NOTE: The event being cycled on through this HH section administration is the ?stem? repeat visit. The events selected at HH130 are each a ?leaf?. The event driver (ED) section will not serve these repeat visits for the HH section.)
Assign next repeat visit number at the household level. (NOTE: Each repeat visit grouping, whether OP, MV, or HH is assigned this number at a household level. The number will start over every round.)
Roster Behavior:
Multiple select allowed.
Add, delete, and edit disallowed.

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition:
Display the person's Medical-Events-Roster for selection.
Roster filter:
Display only those events that meet the following criteria:
- Have event type 'HH'.
- Created this round, excluding the interview month. (If round 5, do not exclude Dec.)
- Are associated with the same provider as the event asked about during this round.
- Have not been processed through utilization.
Display ?only once? if HH90 was coded ?3? (ONLY CAME ONCE). Display ?the same number of times? if HH90, HH100 or HH110 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).
Otherwise, display ?(FREQUENCY OF SERVICES)?.
For 'FREQUENCY OF SERVICES':
Display number entered at HH100 and the phrase ?days per week? if a response was recorded at HH100.
Display number entered at HH110 and the phrase ?days per month? if a response was recorded at HH110.
For "MONTH,YEAR" in the response option area, display visit dates as "MON, YYYY". Abbreviate the month name as three letters.
Display the response option '0' SELECT ALL EVENTS when there is more than one event to display on the roster, otherwise use a null display.

HH140 (HH1140)

BLAISE NAME: HHVstGrp
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

Question Text:

INTERVIEWER: RECORD ?NAME OF REPEAT VISIT GROUP? FOR MONTHS SELECTED IN PREVIOUS QUESTION.

Responses: 1 BOX_60 (HH1145)
Display Instructions:

BOX_60 (HH1145)

Route Details:

Go to the Charge/Payment (CP) section if it needs to be asked for this home health 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.

BOX_70 (HH1150)

Route Details:

Go to the Event Driver (ED) section.

Health Insurance Detail (HP) Section

BOX_00 (HP1000)

Route Details:

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
02 Loop = LOOP_10
03 End Loop = END_LP10
04 Single Select = HP10, HP20, HP30, HP50, HP70, HP120, HP130, HP140, HP150, HP160, HP180, HP190
05 Single Select with Display Roster = HP80
06 Single Select with Fill in Answer Text = HP40
07 Single Select with Add/Edit/Delete = HP60
10 Multiple Select with Fill in Answer Text = HP90, HP170
20 OS Text Field = HP40OS, HP120OS
23 Text Field = HP100, HP110

BOX_10 (HP1005)

Route Details:
Context Header Display Instructions:

Display Person.FullName, Insurance.Plcyhldr, Insurance.HISrcName
General Display Instructions for Question Text:
For ?[START DATE]?, 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable BegRefDt. For ?[END DATE]?, 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable EndRefDt.

BOX_20 (HP1015)

Route Details:

If looping on any insurance associated with an employer or union from the Employment (EM) section that provides health insurance (Insurance.HISrc=Employer or Union), go to LOOP_10.
If looping on code '2' (DIRECTLY THROUGH A SCHOOL) at HX200 or HX300 (Insurance.DirectPurchTp= School), continue with HP10.
Otherwise, go to HP30.

HP10 (HP1020)

BLAISE NAME: SchHICovKind
Question Text:
Does the insurance from the school cover only injuries caused by accidents, or does it have general health coverage?

HELP:F1
Responses:
GENERAL HEALTH COVERAGE 1 HP20 (HP1025)
ONLY INJURIES CAUSED BY ACCIDENTS 2 BOX_150 (HP1220)
REFUSED RF HP20 (HP1025)
DON'T KNOW DK HP20 (HP1025)
Programmer Instructions:
Note: If coded '2' (ONLY INJURIES CAUSED BY ACCIDENTS), school insurance is not added to the insurance array.
Display Instructions:

HP20 (HP1025)

BLAISE NAME: SchHICovNotClinic
Question Text:
Would the insurance from the school cover health services outside of a school clinic?

Responses:
YES 1 HP30 (HP1030)
NO 2 BOX_150 (HP1220)
REFUSED RF HP30 (HP1030)
DON'T KNOW DK HP30 (HP1030)
Programmer Instructions:
Note: If coded '2' (NO), school insurance is not added to the insurance array.
Display Instructions:

HP30 (HP1030)

BLAISE NAME: DirectPurchDisavow
Question Text:
I'd like to talk about the insurance which is from [DIRECT PURCHASE TYPE], that is, the health insurance someone in the household purchased or obtained directly from that source.
ENTER 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS INSURANCE REPORTED IN ERROR.

Responses:
CONTINUE 1 LOOP_10 (HP1035)
INSURANCE REPORTED IN ERROR 2 BOX_150 (HP1220)
Programmer Instructions:
If coded '2' (INSURANCE REPORTED IN ERROR), flag item for source clean-up.
A permanent variable should be created at this item to track the use of this option.
Display Instructions:
Display the following for 'DIRECT PURCHASE TYPE':
'a group or association' if coded '1' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Group).
'a school' if coded '2' at HX200 or HX300 (looping on Insurance.DirectPurchTp=School).
'an insurance agent' if coded '3' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Agent).
'an insurance company' if coded '4' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Insurance Co).
'an HMO' if coded '5' at HX200 or HX300 (looping on Insurance.DirectPurchTp=HMO).
'a union' if coded '6' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Union).
'a previous employer' if coded '7' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Previous Employer).
'a spouse's (or deceased spouse's) previous employer' if coded '8' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Deceased Spouse?s Previous Employer).
'some other employer' if coded '9' at HX200 or HX300 or if looping because HX225 is coded ?2? (NO), ?DK? (DON?T KNOW), or ?RF? (REFUSED) (looping on Insurance.DirectPurchTp=Other Employer).
'the plan of someone not living here' if coded '10' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Plan of Someone Not Living Here).
'[STATE EXCHANGE NAME-A]' if coded '11' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Exchange).
'the [OTHER SPECIFY TEXT]' if coded '91' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Other).
'a source that provided directly purchased insurance' if coded 'RF' or 'DK' at HX200 or HX300 (looping on Insurance.DirectPurchTp=RF or DK).
For 'STATE EXCHANGE NAME-A', display exchange name 'A' associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.
For 'OTHER SPECIFY TEXT' display the text entered at HX200OS or HX300OS.

LOOP_10 (HP1035)

Route Details:

Ask BOX_30-END_LP10.
Loop definition: LOOP_10 collects detailed information about insurance provided through an employer or union or the insurance source names of the direct purchase insurance source created in the HX section during the current round.
If looping on insurance provided through an insurance source created in the HX section during the current round (i.e., source selected at HX200 or HX300 or HX225 is coded ?2? (NO), ?DK? (DON?T KNOW), or ?RF? (REFUSED)) (Insurance.HISrc=Direct Purchase), the first loop cycle collects the main insurance source name of the insurance. Subsequent cycles, if any, are determined by the response to HP190. If HP190 is coded '1' (YES), the loop cycles again to collect the next insurance source name with the same direct purchase type. If HP190 is not asked or is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), the loop ends for that direct purchase type.
When looping through the HP section on any insurance associated with an employer or union from the Employment (EM) section that provides health insurance (Insurance.HISrc=Employer or Union), LOOP_10 will cycle only one time.

BOX_30 (HP1036)

Route Details:

If looping on any insurance associated with an employer from the Employment (EM) section that provides health insurance and is self-employed, firm size = 1 (Insurance.HISrc=Employer and Job.SELFEMP=SelfEmpl and Job.EmpEstm= 1), continue with HP40.
If looping insurance associated with an employer or union from the Employment (EM) section that provides health insurance and is not self-employed, firm size=1 [(Insurance.HISrc= Union) or Insurance.HISrc=Employer and not (Job.SELFEMP=SelfEmpl and Job.EmpEstm=1))], go to HP70.
Otherwise, go to BOX_40.

HP40 (HP1037)

BLAISE NAME: HIPurchCat
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
and HX-8.
You mentioned that [you/[PERSON]] [[are/is]/[were/was]] self-employed and had health insurance through that business. Which category on card HX-8 comes closest to the main way [you/[PERSON]] [purchase/purchases] this insurance?
HELP: F1

Responses:
FROM A PROFESSIONAL ASSOCIATION 1 HP50 (HP1062)
FROM A SMALL BUSINESS GROUP 2 HP50 (HP1062)
FROM A UNION 3 HP70 (HP1080)
DIRECTLY FROM AN INSURANCE AGENT 4 HP50 (HP1062)
DIRECTLY FROM AN INSURANCE COMPANY 5 HP50 (HP1062)
DIRECTLY FROM AN HMO 6 HP50 (HP1062)
FROM A PREVIOUS EMPLOYER 7 HP70 (HP1080)
DIRECTLY FROM [STATE EXCHANGE NAME-A] 8 HP70 (HP1080)
OTHER 91 HP40OS (HP1038)
REFUSED RF HP70 (HP1080)
DON'T KNOW DK HP70 (HP1080)
Display Instructions:
Display ?[are/is]? if Rounds 1-4 and employer is a current job (Job.JobTp=CURRENT MAIN or CURRENT MISC). Otherwise, display ?[were/was]?.
For 'STATE EXCHANGE NAME' display the exchange name 'A' associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.
Display HP40 and HP40OS on the same form pane. For ?[PERSON]?, display the full name (Person.FullName) of the jobholder that came into HP from HX LOOP_10.

HP40OS (HP1038)

BLAISE NAME: HIPurchCatOS
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
SPECIFY: OTHER

Responses:
1 HP50 (HP1062)
REFUSED RF HP50 (HP1062)
DON'T KNOW DK HP50 (HP1062)
Display Instructions: Display HP40 and HP40OS on the same form pane.

BOX_40 (HP1040)

Route Details:

If looping on code '11' (STATE EXCHANGE NAME) at HX200 or HX300 (Insurance.DirectPurchTp=Exchange), automatically code HP50 as 'YES' and Automatically add the insurance source name '[STATE EXCHANGE NAME-A]' to the HP60 roster. [Set Insurance.HISrcName='[STATE EXCHANGE NAME-A]']. Then go to BOX_50.
If looping on code '1' (FROM A GROUP OR ASSOCIATION), '3' (DIRECTLY FROM AN INSURANCE AGENT), '4' (DIRECTLY FROM INSURANCE COMPANY), '5' (DIRECTLY FROM AN HMO), or '91' (OTHER SOURCE) at HX200 or HX300(Insurance.DirectPurchTp=Group, Agent, Insurance Co, HMO, or Other), continue with HP50.
Otherwise, go to HP60.

HP50 (HP1062)

BLAISE NAME: StExCovg
Question Text:
Is this coverage through [STATE EXCHANGE NAME-A] [, [which may also be known as [ALIAS B] [or [ALIAS C]]]]?

Responses:
YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
If looping on any insurance associated with an employer from the Employment (EM) section that provides health insurance and is self-employed, firm size = 1 (Insurance.HISrc=Employer and Job.SELFEMP=SelfEmpl and Job.EmpEstm= 1), go to HP70.
Otherwise, continue with HP60.
Display Instructions:
Display ?, [which may also be known as [ALIAS B] [or [ALIAS C]]]? if there is more than one exchange name associated with the state in which interview is being conducted.
Display ?or [ALIAS C]? if there are three exchange names associated with the state in which interview is being conducted.
For 'STATE EXCHANGE NAME-A', 'ALIAS B', and 'ALIAS C', display the exchange name(s) associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

HP60 (HP1065)
BLAISE NAME: PrivHIRoster
Question Text:
[Please give me the name of the [union/insurance company/HMO/previous employer/group or association/school/spouse's (or deceased spouse's) previous employer/employer/[OTHER SPECIFY TEXT]/source] [from which someone in the family [purchased/obtained] this insurance/for the insurance purchased from an agent]. / You mentioned that someone in the family receives health insurance from the plan of someone not living here. How does that policyholder get this insurance?]
VERIFY WITH RESPONDENT AND SELECT (INSURANCE SOURCE) BELOW:
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:
[Organization Name]1 1 BOX_50 (HP1075)
[Organization Name]2 2 BOX_50 (HP1075)
[Organization Name]3 3 BOX_50 (HP1075)
[Organization Name]4 4 BOX_50 (HP1075)
[Organization Name]N 5 BOX_50 (HP1075)
Programmer Instructions:
Roster Behavior:
Single select or single add allowed.
Limited delete allowed. Interviewer may delete only newly added insurance source names at this item until HP LOOP_10 is completed. Once LOOP_10 is completed, the insurance source name cannot be deleted.
Limited edit allowed. Interviewer may edit only newly added insurance source names at this item until HP LOOP_10 is completed. Once LOOP_10 is completed, the insurance source name cannot be edited.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ, MostRecentRU, and DeDupOrgTp].
Regardless of whether organization is selected or added, set Insurance.DeDupOrgID = DedupOrg.DedupOrgID and Insurance.HISrcName = DedupOrg.DeDupOrgName
If a new organization is created at HP60, set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ, MostRecentRU, and DeDupOrgTp. If Insurance.DirectPurchTp= 7, 8, 9 then DeDupOrgTp = DirectPurchase_Employer. If Insurance.DirectPurchaseTp = 6 then DeDupOrgTp = DirectPurchase_Union. If Insurance.DirectPurchaseTp = 1, 2, 3, 4, 5, 10, 11, 91, DK, RF then DeDupOrgTp = DirectPurchase_Other.
Allow 40 characters for DeDupOrgName roster entries.
Display Instructions:
Roster 3-Add/Edit/Delete Allowed.
Roster Definition:
This item displays jobs, unions, or sources of direct purchase insurance that are linked to this RU (DeDupOrgName).
Roster Filter:
Display jobs, unions, or sources of direct purchase insurance that are linked to this RU (DeDupOrgName where MostRecentRU=this RU), but excludes organization names that were added in error or flagged for clean-up.
When CTRL-A is selected, display the following customized question wording in the pop-up:
If looping on code '10' (UNDER PLAN OF SOMEONE NOT LIVING HERE) at HX200 or HX300 (Insurance.DirectPurchTp=Plan of Someone Not Living Here), display:
You mentioned that someone in the family receives health insurance from the plan of someone not living here. How does that policyholder get this insurance?
INTERVIEWER: RECORD INSURANCE SOURCE NAME BELOW, SUCH AS EMPLOYER OR UNION NAME OR NAME OF DIRECT PURCHASE ORGANIZATION.
Otherwise, display:
INSURANCE SOURCE: [DIRECT PURCHASE TYPE]
RECORD SOURCE NAME WHERE PERSON PURCHASED/OBTAINED INSURANCE.
Display the following for ?DIRECT PURCHASE TYPE' on pop-up:
'GROUP OR ASSOCIATION' if coded '1' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Group)
'SCHOOL' if coded '2' at HX200 or HX300 (looping on Insurance.DirectPurchTp=School)
'INSURANCE AGENT' if coded '3' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Agent)
'INSURANCE COMPANY' if coded '4' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Insurance Co)
'HMO' if coded '5' at HX200 or HX300 (looping on Insurance.DirectPurchTp=HMO)
'UNION' if coded '6' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Union)
'PREVIOUS EMPLOYER' if coded '7' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Previous Employer)
'SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER' if coded '8' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Deceased Spouse?s Previous Employer)
'SOME OTHER EMPLOYER' if coded '9' at HX200 or HX300 or if looping because HX225 was coded ?2? (NO), ?RF? (REFUSED), or ?DK? (DON?T KNOW) (looping on Insurance.DirectPurchTp=Other Employer)
'PLAN OF SOMEONE NOT LIVING HERE' if coded '10 at HX200 or HX300 (looping on Insurance.DirectPurchTp=Plan of Someone Not Living Here)
'[OTHER SPECIFY TEXT]'if coded '91' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Other)
'SOURCE THAT PROVIDED DIRECTLY PURCHASED INSURANCE' if coded 'RF' or 'DK at HX200 or HX300 (looping on Insurance.DirectPurchTp=RF or DK)
Display ?Please give? an agent.? if Insurance.DirectPurchTp () Plan of Someone Not Living Here.
Otherwise, display 'You mentioned? this insurance?'
Display 'group or association' if Insurance.DirectPurchTp=Group.
Display 'school' if Insurance.DirectPurchTp=School.
Display 'insurance company' if Insurance.DirectPurchTp=Agent or Insurance Co.
Display 'HMO' if Insurance.DirectPurchTp=HMO.
Display 'union' if Insurance.DirectPurchTp=Union.
Display 'previous employer' if Insurance.DirectPurchTp=Previous Employer.
Display 'spouse's (or deceased spouse's) previous employer' if Insurance.DirectPurchTp=Deceased Spouse?s Previous Employer.
Display 'employer' if Insurance.DirectPurchTp=Other Employer.
Display '[OTHER SPECIFY TEXT]' if Insurance.DirectPurchTp=Other. For 'OTHER SPECIFY TEXT' display the text entered at HX200OS or HX300OS.
Display 'source' if Insurance.DirectPurchTp=RF or DK.
Display 'from which someone in the family [purchased/obtained] this insurance' if Insurance.DirectPurchTp () Agent. Otherwise, display 'for the insurance purchased from an agent'.
Display 'purchased' if Insurance.DirectPurchTp=Group, School, Insurance Co, HMO, Union, RF, DK.
Otherwise, display ?obtained?.

BOX_50 (HP1075)

Route Details:

If looping on a direct purchase type (i.e., category selected at HX200 or HX300 or code ?2?, ?DK?, or ?RF? at HX225) (Insurance.HISrc=Direct Purchase), go to HP90.
Otherwise, continue with HP70.

HP70 (HP1080)

BLAISE NAME: Plcyhldr
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
[[Are/Is]/As of [END DATE], [were/was]] [you/[PERSON]] the primary insured person or policyholder of this health coverage through [INSURANCE SOURCE NAME]?
HELP: F1

Responses:
YES 1 BOX_60 (HP1110)
NO 2 HP80 (HP1085)
REFUSED RF HP80 (HP1085)
DON'T KNOW DK HP80 (HP1085)
Programmer Instructions:
Person refers to jobholder.
If coded '1' (YES), set jobholder as 'POLICYHOLDER'. [Set Insurance.Plcyhldr=Jobs.PersID]
Display Instructions:
Display '[Are/Is]' if not round 5. Display 'As of [END DATE], [were/was]' if round 5.
For ?[PERSON]?, display the full name (Person.FullName) of the jobholder that came into HP from HX LOOP_10.

HP80 (HP1085)

BLAISE NAME: JobEmpList
Context Header:
[NAME OF INSURANCE SOURCE]
Question Text:
Who [is/was] the primary insured person or policyholder of this health coverage through [INSURANCE SOURCE NAME] [on [END DATE]]?
[JOBHOLDER/EMPLOYER-PAIR 1]
[JOBHOLDER/EMPLOYER-PAIR 2]
[JOBHOLDER/EMPLOYER-PAIR 3]
[JOBHOLDER/EMPLOYER-PAIR 4]
[JOBHOLDER/EMPLOYER-PAIR N]
HELP: F1

Responses:
JOBHOLDER/EMPLOYER IS LISTED 1 END_LP10 (HP1215)
JOBHOLDER/EMPLOYER IS NOT LISTED 2 END_LP10 (HP1215)
REFUSED RF END_LP10 (HP1215)
DON'T KNOW DK END_LP10 (HP1215)
Programmer Instructions:
Roster Behavior:
1. Display only.
Flag insurance being looped on where jobholder is not policyholder (HP70=2, RF, DK) for cleanup.
Display Instructions:
Roster 2: No Add/Edit/Delete
Roster Definition:
This item displays employer/jobholder pairs. [Display Person.FullName and Job.JobsEstbName where PersID=Job.PersID]
Roster Filter:
Display all pairs that meet the following condition:
1. Job 'PROVIDES HEALTH INSURANCE' [Job.EmpHi=Yes]
Display 'is' if not round 5. Display 'was' if round 5. Display 'on [END DATE]' if round 5. Otherwise, use null display.

HP90 (HP1090)

BLAISE NAME: PlcyhldrRoster
Context Header:
[NAME OF INSURANCE SOURCE]
Question Text:
Who [is/was] the primary insured person or policyholder of this health coverage through [INSURANCE SOURCE NAME] [on [END DATE]]?
CAPI WILL PROMPT SEPARATELY FOR ANOTHER POLICYHOLDER WITH A PLAN FROM [DIRECT PURCHASE TYPE].
HELP:F1

Responses:
[FIRST NAME,[MIDDLE NAME], LAST 1 NAME]1
[FIRST NAME,[MIDDLE NAME], LAST 2 NAME]2
[FIRST NAME,[MIDDLE NAME], LAST 3 NAME]3
[FIRST NAME,[MIDDLE NAME], LAST 4 NAME]4
[FIRST NAME,[MIDDLE NAME], LAST 5 NAME]N
POLICYHOLDER NOT LISTED IN DU 98
POLICYHOLDER DECEASED 99
Programmer Instructions:
Roster Behavior:
1. Single select allowed.
If 'POLICYHOLDER DECEASED' selected, go to HP110.
If 'POLICYHOLDER NOT LISTED IN DU' selected, continue with HP100.
Otherwise, go to BOX_60.
Set Insurance.Plcyhldr=PersID if DU member selected or set to 901 if ?Policyholder Deceased? selected or set to 902 if ?Policyholder Not in DU? selected.
Set Insurance.HIPubPriv=Private and Insurance.HISrc=Direct Purchase and Insurance.DirectPurchTp=DirPType being looped on. Set Create Q and OrigRnd.
Hard Check:
If looping on code '11' (DIRECTLY FROM [STATE EXCHANGE NAME-A]) at HX200 or HX300, an RU member cannot be selected if he/she is already listed as a current policyholder for insurance coverage ?DIRECTLY FROM [STATE EXCHANGE NAME-A]? [looping on Insurance.DirectPurchTp=Exchange and array has a person where [PersID=Insurance.Plcyhldr where Insurance.DirectPurchTp=Exchange]. If so, display the following message: ?[PERSON] ALREADY HAS COVERAGE THROUGH [STATE EXCHANGE NAME]. SELECT ANOTHER PERSON AS THE POLICYHOLDER OR BACK-UP TO REVIEW RESPONSES.?
Display Instructions:
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.
If looping on code '11' (DIRECTLY FROM [STATE EXCHANGE NAME-A]) at HX200 or HX300, display any RU member who is already listed as a current policyholder for insurance coverage that is ?DIRECTLY FROM [STATE EXCHANGE NAME-A]? as grayed-out text [looping on Insurance.DirectPurchTp=Exchange and array has a person where [PersID=Insurance. Plcyhldr where Insurance.DirectPurchTp=Exchange].
Display 'is' if not round 5. Display 'was' if round 5.
Display 'on' [END DATE]' if round 5. Otherwise, use null display.
Display the following for 'DIRECT PURCHASE TYPE':
'A GROUP OR ASSOCIATION' if coded '1' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Group).
'A SCHOOL' if coded '2' at HX200 or HX300 (looping on Insurance.DirectPurchTp=School).
'AN INSURANCE AGENT' if coded '3' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Agent).
'AN INSURANCE COMPANY' if coded '4' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Insurance Co).
'AN HMO' if coded '5' at HX200 or HX300 (looping on Insurance.DirectPurchTp=HMO).
'A UNION' if coded '6' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Union).
'A PREVIOUS EMPLOYER' if coded '7' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Previous Employer).
'A SPOUSE'S (OR DECEASED SPOUSE'S) PREVIOUS EMPLOYER' if coded '8' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Deceased Spouse?s Previous Employer).
'SOME OTHER EMPLOYER' if coded '9' at HX200 or HX300 or if looping because HX225 is coded ?2? (NO), ?DK? (DON?T KNOW), or ?RF? (REFUSED) (looping on Insurance.DirectPurchTp=Other Employer).
?SOMEONE NOT LIVING HERE' if coded '10' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Plan of Someone Not Living Here).
'[STATE EXCHANGE NAME-A]' if coded '11' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Exchange).
'[OTHER SPECIFY TEXT]? if coded '91' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Other).
'A SOURCE THAT PROVIDED DIRECTLY PURCHASED INSURANCE' if coded 'RF' or 'DK' at HX200 or HX300 (looping on Insurance.DirectPurchTp=RF or DK).
For 'STATE EXCHANGE NAME-A', display exchange name 'A' associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.
For 'OTHER SPECIFY TEXT' display the text entered at HX200OS or HX300OS.

HP100 (HP1095)

BLAISE NAME: PlcyhldrNotDUName
Context Header:
[NAME OF INSURANCE SOURCE]
Question Text:
INTERVIEWER: ENTER NAME OR DESCRIPTION OF POLICYHOLDER WHO IS NOT IN THE DU:
HELP:F1

Responses:
1 BOX_60 (HP1110)
Programmer Instructions:
If Insurance.Plcyhldr = 902, set the display for Insurance.Plcyhldr = PLCYHLDR NOT IN DU-followed by the first 15 characters entered at HP100
Display Instructions:

HP110 (HP1100)

BLAISE NAME: PlcyhldrDecdName
Context Header:
[NAME OF INSURANCE SOURCE]
Question Text:
INTERVIEWER: ENTER NAME OF DECEASED POLICYHOLDER:
HELP: F1

Responses:
1 BOX_60 (HP1110)
Programmer Instructions:
If Insurance.Plcyhldr = 901, set the display for Insurance.Plcyhldr = PLCYHLDR DECEASED-followed by the first 15 characters entered at HP110
Display Instructions:

BOX_60 (HP1110)

Route Details:

If looping on any insurance associated with an employer or union from the Employment (EM) section that provides health insurance (Insurance.HISrc=Employer or Union), go to BOX_90.
Otherwise, continue with BOX_70.

BOX_70 (HP1115)

Route Details:

If looping on code '7' (FROM ANYONE?S PREVIOUS EMPLOYER), code '8' (FROM SPOUSE?S/DECEASED SPOUSE?S PREVIOUS EMPLOYER), or code '9' (FROM SOME OTHER EMPLOYER) at HX200 or HX300 or if looping because HX225 is coded ?2? (NO), ?DK? (DON?T KNOW), or ?RF? (REFUSED) (Insurance.DirectPurchTp=Previous Employer, Deceased Spouse?s Previous Employer, or Other Employer), continue with BOX_80.
Otherwise, go to BOX_90.

BOX_80 (HP1120)

Route Details:

If policyholder currently being cycled on is deceased [(Insurance.Plcyhldr = 901) or (Insurance.Plcyhldr=PersID where Person.PersRndStatus=DeadEligPt)], auto-code HP120 as '4' (DECEASED) and go to BOX_90.
If policyholder is not a current RU member [(Insurance.Plcyhldr=902) or (Insurance.Plcyhldr=PersID where Person.MostRecentRU()RUUnit)], go to BOX_90.
Otherwise, continue with HP120.

HP120 (HP1125)

BLAISE NAME: PlcyhldrEmpStat
Context Header:
[POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
[Are/Is] [you/ [POLICYHOLDER]] currently employed at this job, retired from this job, previously employed at this job, or is it some other situation?
HELP: F1

Responses:
CURRENTLY EMPLOYED 1 BOX_90 (HP1135)
RETIRED 2 BOX_90 (HP1135)
PREVIOUSLY EMPLOYED 3 BOX_90 (HP1135)
DECEASED 4 BOX_90 (HP1135)
OTHER 91 HP120OS (HP1130)
REFUSED RF BOX_90 (HP1135)
DON'T KNOW DK BOX_90 (HP1135)
Programmer Instructions:
Do not display response code ?4? (DECEASED) as a response option when HP120 is presented on path. It remains only as an option for when it is auto-coded via BOX_80.
Display Instructions:
Display HP120 and HP120OS on the same form pane.

HP120OS (HP1130)

BLAISE NAME: PlcyhldrEmpStatOS
Context Header:
[POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF NSURANCE SOURCE]
Question Text:
SPECIFY:

Responses:
1 BOX_90 (HP1135)
REFUSED RF BOX_90 (HP1135)
DON'T KNOW DK BOX_90 (HP1135)
Display Instructions:
Display HP120 and HP120OS on the same form pane.

BOX_90 (HP1135)

Route Details:

If looping on code ?10? (UNDER PLAN OF SOMEONE NOT LIVING HERE) at HX200 or HX300 (Insurance.DirectPurchTp=Plan of Someone Not Living Here), continue with HP130.
If looping on code ?7? (FROM ANYONE?S PREVIOUS EMPLOYER) or code ?8? (FROM SPOUSE?S/DECEASED SPOUSE?S PREVIOUS EMPLOYER) or code ?91? (OTHER SOURCE) at HX200 or HX300 (Insurance.DirectPurchTp=Previous Employer, Deceased Spouse?s Previous Employer, or Other), go to HP140.
If looping on [code ?9? (FROM SOME OTHER EMPLOYER) at HX200 or HX300 or if looping because HX225 is coded ?2? (NO), ?DK? (DON?T KNOW), or ?RF? (REFUSED)(Insurance.DirectPurchTp=Other Employer)] and [HP120 is not coded '1' (CURRENTLY EMPLOYED)], go to HP140.
If looping on insurance associated with an employer from the Employment (EM) section that provides health insurance and job type is 'FORMER MAIN', 'FORMER
MISCELLANEOUS' or 'LAST JOB OUTSIDE REFERENCE PERIOD' and job is 'NOT RETIRED FROM' [Insurance.HISrc=Employer and (JobTp=FORMER MAIN or FORMER MISC or LAST JOB OUTSIDE REFERENCE PERIOD) and (Job.RetireJob()Yes)], go to HP140.
Otherwise, go to BOX_100.

HP130 (HP1140)

BLAISE NAME: HIThroughEmp
Context Header:
[POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
Is the [INSURANCE SOURCE NAME] health coverage [POLICYHOLDER] has through an employer or previous employer?

Responses:
YES 1 HP140 (HP1145)
NO 2 BOX_110 (HP1160)
REFUSED RF HP140 (HP1145)
DON'T KNOW DK HP140 (HP1145)
Display Instructions:

HP140 (HP1145)

BLAISE NAME: COBRAPlan
Context Header:
[POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
Some employer insurance can be continued after leaving the company by continuing to pay the premium. This is sometimes referred to as a COBRA plan.
[Is/Was] [your/[POLICYHOLDER]'s] [INSURANCE SOURCE NAME] insurance like that [on [END DATE]]?
HELP: F1

Responses:
YES 1 BOX_100 (HP1150)
NO 2 BOX_100 (HP1150)
REFUSED RF BOX_100 (HP1150)
DON'T KNOW DK BOX_100 (HP1150)
Display Instructions:
Display 'Is' if not round 5. Display 'Was' if round 5. Display 'on (END DATE)' if round 5.
Otherwise, use null display.

BOX_100 (HP1150)

Route Details:

Small Business Determination
If insurance being asked about meets the following conditions:
Insurance is associated with an employer from the Employment (EM) section that provides health insurance (Insurance.HISrc=Employer), and
Job is a 'CURRENT-MAIN-JOB? (Job.JobTp=CURRENT MAIN), and Job is 'SELF-EMPLOYED' (Job.SELFEMP=SelfEmpl), and EM740 (total employees) or RJ110 (total employees) is greater than 1 but less than=200 (Job.EmpEstm = 2-9 or 10-25 or 26-50 or 51-100 or 101-200), continue with HP150
Small Business Determination
If insurance being asked about meets the following conditions:
Insurance is associated with an employer from the Employment (EM) section that provides health insurance (Insurance.HISrc=Employer), and Job is a 'CURRENT-MAIN-JOB? (Job.JobTp=CURRENT MAIN), and Job is a 'NOT SELF-EMPLOYED' (Job.SELFEMPless than greater thanSelfEmpl), and
Firm size is small (see determination below), and - EM430 (firm size) is greater than 1 but less than= 200 (Job.EmpEstm = 2-9 or 10-25 or 26-50 or 51-100 or 101-200), or - EM440 (firm size category) is coded ?2? (2 TO 9), '3' (10 TO 25), '4' (26 TO 50), '5' (51 TO 100), or ?6? (101 TO 200) (Job.EmpEstm = 2-9 or 10-25 or 26-50 or 51-100 or 101-200)
EM450 (multiple locations) is coded '2' (NO) (MORELOCTN=No) continue with HP150.
Otherwise, go to BOX_110.

HP150 (HP1155)

BLAISE NAME: StSHOP
Context Header:
[POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
In [RU STATE], [STATE SHOP NAME-A] [, [which may also be known as [ALIAS B] [or [ALIAS C]]],] is a program where small businesses will be able to shop for health insurance plans for their employees. Is [your/[POLICYHOLDER]'s] health insurance coverage through [INSURANCE SOURCE NAME] related at all to a program like that?

Responses:
YES 1 BOX_110 (HP1160)
NO 2 BOX_110 (HP1160)
REFUSED RF BOX_110 (HP1160)
DON'T KNOW DK BOX_110 (HP1160)
Display Instructions:
For 'RU STATE', display the full state name associated with this RU's address.
Display Instructions:
?, [which may also be known as [ALIAS B] [or [ALIAS C]]],? if there is more than one SHOP name associated with the state in which interview is being conducted.
Display ?or [ALIAS C]? if there are three exchange names associated with the state in which interview is being conducted.
For 'STATE SHOP NAME-A' 'ALIAS B', and 'ALIAS C' display the small business health options program name associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

BOX_110 (HP1160)

Route Details:

If single-person RU and the only RU member is selected as the policyholder of the insurance being asked about, auto-code HP160 as code ?2? (NO) and then go to HP180.
If single-person RU and the policyholder selected at HP90 is not a current RU member or code ?99? (POLICYHOLDER DECEASED) or code ?98? (POLICYHOLDER NOT LISTED IN DU) selected at HP90 [(Insurance.Plcyhldr=901 or 902) or (Insurance.Plcyhldr=PersID where Person.MostRecentRUless than greater thanRUUnit)], auto-code HP160 as code ?1? (YES), auto-code HP170 with the name of the only RU member, and then go to BOX_120.
Otherwise, continue with HP160.

HP160 (HP1165)

BLAISE NAME: CovdDepend
Context Header:
[POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
Was anyone [living here] covered as a dependent under [your/[POLICYHOLDER]'s] health coverage through [INSURANCE SOURCE NAME] at any time [since [START DATE] /between [START DATE] and [END DATE]]?
HELP: F1

Responses:
YES 1 HP170 (HP1170)
NO 2 HP180 (HP1175)
REFUSED RF HP180 (HP1175)
DON'T KNOW DK HP180 (HP1175)
Programmer Instructions:
Soft Check: If coded ?2? (NO), ?RF? (REFUSED), or ?DK? (DON?T KNOW) and if the policyholder selected at HP90 is not a current RU member or code ?99? (POLICYHOLDER DECEASED) or code ?98? (POLICYHOLDER NOT LISTED IN DU) [(Insurance.Plcyhldr = 901 or 902) or (PolicyHolder=PersID where Person.MostRecentRUless than greater thanRUUnit)], display the following message: ?UNLIKELY RESPONSE. NO ONE IN THE RU IS COVERED AS A DEPENDENT AND THE POLICYHOLDER IS NOT AN RU MEMBER. REVIEW ENTRIES FOR POLICYHOLDER (HP90 (PlcyhldrRoster)) AND WHETHER ANYONE IN RU COVERED (HP160 (CovdDepend)). IF CHANGES ARE NOT MADE, INSURANCE WILL BE DELETED.? If the soft check is suppressed without corrections being made, that is no current RU members are in the covered person array, the insurance will need to be flagged for clean-up. If insurance is flagged for clean-up, remaining follow-up items in HP are not asked for this instance of LOOP_10. Exit LOOP_10 and go to BOX_150.
Display Instructions:
Display 'living here' if looping on code ?10? (UNDER PLAN OF SOMEONE NOT LIVING HERE) at HX200 or HX300 (Insurance.DirectPurchTp=Plan of Someone Not Living Here.
Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.

HP170 (HP1170)

BLAISE NAME: DependRoster
Context Header:
[POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
Who is that?
PROBE: Was anyone else covered as a dependent [since [START DATE] /between [START DATE] and [END DATE]]?
ENTER ALL THAT APPLY.

Responses:
[First Name, [Middle Name], Last Name]1 1 BOX_120 (HP1180)
[First Name, [Middle Name], Last Name]2 2 BOX_120 (HP1180)
[First Name, [Middle Name], Last Name]3 3 BOX_120 (HP1180)
[First Name, [Middle Name], Last Name]4 4 BOX_120 (HP1180)
[First Name, [Middle Name], Last Name]N 5 BOX_120 (HP1180)
PERSON NOT LISTED IN RU 99 BOX_120 (HP1180)
Programmer Instructions:
Roster Behavior:
Multiple select allowed.
Add all selected RU members to the Covered Person array.
If coded ?99? (PERSON NOT LISTED IN RU), set Insurance.CovPersOutRU=Yes.
Soft Check: If code ?99? (PERSON NOT LISTED IN RU) selected alone at HP170 and if the policyholder selected at HP90 (and currently being cycled on) is not a current RU member or code ?99? (POLICYHOLDER DECEASED) or code ?98? (POLICYHOLDER NOT LISTED IN DU) or [(Insurance.Plcyhldr = 901 or 902) or (PolicyHolder=PersID where Person.MostRecentRU()RUUnit)], display the following message: ?UNLIKELY RESPONSE. NO ONE IN THE RU IS COVERED AS A DEPENDENT AND THE POLICYHOLDER IS NOT AN RU MEMBER. REVIEW ENTRIES FOR POLICYHOLDER (HP90 (PlcyhldrRoster)) AND DEPENDENTS (HP170 (DependRoster)). IF CHANGES ARE NOT MADE, INSURANCE WILL BE DELETED.? If the soft check is suppressed without corrections being made, that is no current RU members are in the covered person array, the insurance will need to be flagged for clean- up. If insurance is flagged for clean-up, remaining follow-up items in HP are not asked for this instance of LOOP_10. Exit LOOP_10 and go to BOX_150.
Display Instructions:
Roster 2 - No Add/Edit/Delete
Roster Definition:
This item displays RU-members-roster (Person.FullName) for selection of RU-members.
Roster Filter:
Display all persons on the RU-members-roster excluding the person who is the policyholder for this insurance being looped on.
Display 'since [START DATE]' if not round 5. Display 'between [START DATE] and [END DATE]' if round 5.

HP180 (HP1175)

BLAISE NAME: CovPersOutRU
Context Header:
[POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
[Does/Between [START DATE] and [END DATE], did] [your/ [POLICYHOLDER]'s] health coverage through [INSURANCE SOURCE NAME] cover as dependents any persons who do not live here?
HELP: F1

Responses:
YES 1 BOX_120 (HP1180)
NO 2 BOX_120 (HP1180)
REFUSED RF BOX_120 (HP1180)
DON'T KNOW DK BOX_120 (HP1180)
Programmer Instructions:
If coded ?1? (YES), set Insurance.CovPersOutRU=Yes.
Display Instructions:
Display 'Does' if not round 5. Display 'Between [START DATE] and [END DATE], did ' if round 5.

BOX_120 (HP1180)

Route Details:

If at least one RU member is listed as the policyholder or as a covered person, continue with BOX_130.
Otherwise, go to BOX_140.

BOX_130 (HP1190)
Item Type: Route Type Class: If Then

Route Details:

Ask the time period covered detail (HQ) section.
This instance of the HQ section collects time period coverage detail for all current RU members that are covered as either the policyholder or a dependent through this insurance being looped on. The grid for the HQ section should be preloaded with all persons in the covered person array for this insurance.
Note: The persons in the covered persons array include the following:
Person is a current RU member and is flagged as the policyholder for this pair (HP70 is coded ?1? (YES) (Jobholder=Policyholder) or a current RU member is selected at HP90)
or
Person was selected at as dependent at HP170 for this pair (do not include selections of code ?99? (PERSON NOT LISTED IN RU) at HP170
At completion of time period covered detail (HQ) section, continue with BOX_140.

BOX_140 (HP1205)

Route Details:

If looping on insurance associated with an employer or union from the Employment (EM) section that provides health insurance (Insurance.HISrc=Employer or Union), go to END_LP10.
Otherwise, continue with HP190.

HP190 (HP1210)

BLAISE NAME: AnotherDirectPurch
Context Header:
[POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
Aside from [your/[POLICYHOLDER]'s] [INSURANCE SOURCE NAME] insurance, is there another health insurance plan that anyone in the family obtains [directly] from [DIRECT PURCHASE TYPE]?

Responses:
YES 1 END_LP10 (HP1215)
NO 2 END_LP10 (HP1215)
REFUSED RF END_LP10 (HP1215)
DON'T KNOW DK END_LP10 (HP1215)
Programmer Instructions:
Programmer Instructions: If coded ?1? (YES), create direct purchase insurance with the same type that is currently being looped on [set Insurance.HIPubPriv=Private and Insurance.HISrc=Direct Purchase and Insurance.DirectPurchTp=DirPType being looped on)] [set Create Q and OrigRnd]. NOTE: While the insurance is being created at HP190, for the purposes of the specifications, it will be treated as if was created at HX200 or HX300, wherever the original direct purchase insurance was created.
Display Instructions:
Display ?directly? if looping on code '11' (DIRECTLY FROM [STATE EXCHANGE NAME-A]) at HX200 or HX300 (Insurance.DirectPurchTp=Exchange). Otherwise, use a null display.
Display the following for 'DIRECT PURCHASE TYPE':
'a group or association' if coded '1' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Group).
'a school' if coded '2' at HX200 or HX300 (looping on Insurance.DirectPurchTp=School).
'an insurance agent' if coded '3' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Agent).
'an insurance company' if coded '4' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Insurance Co).
'an HMO' if coded '5' at HX200 or HX300 (looping on Insurance.DirectPurchTp=HMO).
'a union' if coded '6' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Union).
'a previous employer' if coded '7' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Previous Employer).
'a spouse's (or deceased spouse's) previous employer' if coded '8' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Deceased Spouse?s Previous Employer).
'some other employer' if coded '9' at HX200 or HX300 or if looping because HX225 is coded ?2? (NO), ?DK? (DON?T KNOW), or ?RF? (REFUSED) (looping on Insurance.DirectPurchTp=Other Employer).
'the plan of someone not living here' if coded '10' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Plan of Someone Not Living Here).
'[STATE EXCHANGE NAME-A]' if coded '11' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Exchange).
'the [OTHER SPECIFY TEXT]? if coded '91' at HX200 or HX300 (looping on Insurance.DirectPurchTp=Other).
'a source that provided directly purchased insurance' if coded 'RF' or 'DK' at HX200 or HX300 (looping on Insurance.DirectPurchTp=RF or DK).
For 'STATE EXCHANGE NAME-A', display exchange name 'A' associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.
For 'OTHER SPECIFY TEXT' display the text entered at HX200OS or HX300OS.

END_LP10 (HP1215)

Route Details:

If HP190 is coded '1' (YES), cycle to collect next insurance source name for this same direct purchase type.
If HP190 is not asked or is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), end LOOP_10 and continue with BOX_150.

BOX_150 (HP1220)

Route Details:

Return to the health insurance (HX) section.

Time Period Covered Detail (HQ) Section

BOX_00 (HQ1000)

Route Details:

01 Box equal to BOX_00, BOX_10, BOX_20, BOX 25, BOX_30
05 Single Select with Display Roster equal to HQ10_01, HQ10_02, HQ10_03, HQ10_04, HQ10_05

BOX_10 (HQ1002)

Route Details:

General Display Instructions for Question Text:
For ?(START DATE)?, 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable BegRefDt.
For ?(END DATE)?, 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable EndRefDt.
For ?(PERSON?S START DATE)?, display the person level reference period start date. Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variables Person.BegRefM, Person.BegRefD, Person.BegRefY.
For ?(PERSON?S END DATE)?, display the person level reference period end date.
Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variables Person.EndRefM, Person.EndRefD, Person.EndRefY.

BOX_20 (HQ1003)

Route Details:

Context header display instructions:
Display Person.FullName, Insurance.Plcyhldr , Insurance.HISrcName
Display the first part of the context header ?(POLICYHOLDER?S FIRST MIDDLE LAST NAME) INSURANCE THROUGH? only when the HQ section was launched for private insurance (Insurance.HIPubPriv equal to Private).

HQ10_01 (HQ1005)

BLAISE NAME: CovdWholeTime
Context Header:

((POLICYHOLDER?S FIRST MIDDLE LAST NAME) INSURANCE THROUGH) (NAME OF INSURANCE SOURCE)

Question Text:

(Were/Was) (you/ (PERSON)) covered the whole time from (PERSON?S START DATE) until (today/ (PERSON?S END DATE)), or only part of the time?
NAVIGATION: Complete the grid in order of respondent?s answers.

Responses:

WHOLE TIME 1
PART OF THE TIME 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded Grid Type 2 (flexible navigation) including question HQ10_01, HQ10_02, HQ10_03, HQ10_04, HQ10_05, and BOX 25.
If Round 1 and coded ?1? (WHOLE TIME), set SimplePerson.CovdJan1 equal to Yes.

Display Instructions:

Display 'today' if (not round 5) and (Person level reference period end date equal to RU level reference period end date). Otherwise, display '(PERSON?S END DATE)'.
Roster 1 - Report
Roster definition:
See the originating section for the grid roster definition and roster filter instructions. (The HQ section is called from multiple items within the HX, HP, and PR sections. The grid will be preloaded based on where the section is called from.)
Format form pane in columns with headers:
RU Member
Insurance Source Name
Covd Whole Time? (HQ10_01)
Covd Now? (HQ10_02)
Covd (INTV MONTH)? (HQ10_03)
Covd at all (INTV MONTH)? (HQ10_04)
Covd (MONTH_1)? (HQ10_05)
Covd (MONTH_2)? (HQ10_06)
Covd (MONTH_3)? (HQ10_07)
Covd (MONTH_4)? (HQ10_08)
Covd (MONTH_5)? (HQ10_09)
Covd (MONTH_N)? (HQ10_N)
For RU Member:
Display the RU member's first, middle, and last names (Person.FullName) from the covered person array that is linked to this instance of HQ. This column is protected. No changes are allowed.
For Insurance Source Name:
Display the name of the insurance linked to this instance of HQ (Insurance.HISrcName). This column is protected. No changes are allowed.
For (INTV MONTH), display the interview month using three letter abbreviation.
For (MONTH_1) ? (MONTH_N), display the months between the RU reference period start date and the RU reference period end date, excluding the interview month if not round 5. In Round 5, display all the months of the RU reference period, including December. Use the three letter abbreviation for each month. However, for each row person, the only months that are active for that person are the ones that are part of that person?s reference period, excluding the interview month.
January equal to JAN July equal to JUL
February equal to FEB August equal to AUG
March equal to MAR September equal to SEP
April equal to APR October equal to OCT
May equal to MAY November equal to NOV
June equal to JUN December equal to DEC
Display the interviewer instruction ?NAVIGATION': Complete the grid in order of respondent?s answers. ? In red text.

HQ10_02 (HQ1010)

BLAISE NAME: CovdNow
Context Header:

((POLICYHOLDER?S FIRST MIDDLE LAST NAME) INSURANCE THROUGH) (NAME OF INSURANCE SOURCE)

Question Text:

(Are/Is) (you/(PERSON)) covered now?
NAVIGATION: Complete the grid in order of respondent?s answers.

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Display HQ10_02 as an active cell for the person?s row, if it is (rounds 1 -4) and (HQ10_01 is coded ?2? (PART OF THE TIME)) and (person's reference period end date includes the interview month).
Otherwise, HQ10_02 is an inactive cell for the person?s row.

Display Instructions:

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

HQ10_03 (HQ1015)

BLAISE NAME: CovdContin
Context Header:

((POLICYHOLDER?S FIRST MIDDLE LAST NAME) INSURANCE THROUGH) (NAME OF INSURANCE SOURCE)

Question Text:

(Have/Has) (you/(PERSON)) been covered continuously, since the first of (INTERVIEW MONTH) through today?
NAVIGATION: Complete the grid in order of respondent?s answers.

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Display HQ10_03 as an active cell for the person?s row, if it is rounds 1 -4 and HQ10_02 is coded ?1? (YES) (YES, covered now).
Otherwise, HQ10_03 is an inactive cell for the person?s row.
If Round 1 and interview month equal to January and coded ?1? (YES), set SimplePerson.CovdJan1 equal to Yes.

Display Instructions:

Display name of month in which interview is being conducted (month in which interview first started) for ?INTERVIEW MONTH?. (Use month from EndRefDt)
Display the interviewer instruction ?NAVIGATION': Complete the grid in order of respondent?s answers. ? In red text.

HQ10_04 (HQ1020)

BLAISE NAME: CovdIntvMth
Context Header:

((POLICYHOLDER?S FIRST MIDDLE LAST NAME) INSURANCE THROUGH) (NAME OF INSURANCE SOURCE)

Question Text:

(Were/Was) (you/(PERSON)) covered at all during (INTERVIEW MONTH)?
NAVIGATION: Complete the grid in order of respondent?s answers.

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Display HQ10_04 as an active cell for the person?s row, if it is rounds 1- 4 and HQ10_02 is coded ?2? (NO), ?RF? (REFUSED), or ?DK? (DON?T KNOW) (NO/DK/RF if covered now).
Otherwise, HQ10_04 is an inactive cell for the person?s row.

Display Instructions:

Display name of month in which interview is being conducted (i.e., month in which interview first started) for ?INTERVIEW MONTH?. (Use month from EndRefDt)
Display the interviewer instruction ?NAVIGATION': Complete the grid in order of respondent?s answers. ? In red text.

HQ10_05 (HQ1025)

BLAISE NAME: CovdMth
Context Header:

((POLICYHOLDER?S FIRST MIDDLE LAST NAME) INSURANCE THROUGH) (NAME OF INSURANCE SOURCE)

Question Text:

(VARIABLE TEXT [a-e])
HQ10_05[1] a. In (MONTH(, YEAR)), (were/was) (you/(PERSON)) covered the whole month, part of the month, or not at all during the month?
HQ10_06[2] b. How about in (MONTH(, YEAR))? (Were/Was) (you/he/she) covered the whole month, part of the month, or not at all during the month?
HQ10_07[3] c. What about in (MONTH(, YEAR))? [(Were/Was) (you/he/she) covered the whole month, part of the month, or not at all during the month?]
HQ10_08[4] d. What about in (MONTH(, YEAR))? [(Were/Was) (you/he/she) covered the whole month, part of the month, or not at all during the month?]
HQ10_09[5] e. What about in (MONTH(, YEAR))? (Were/Was) (you/(PERSON)) covered the whole month, part of the month, or not at all during the month?
For items HQ10_07[3] c. and HQ10_08[4] d., display the text [(Were/Was) (you/he/she) covered the whole month, part of the month, or not at all during the month?] in brackets and in grayed out text.
NAVIGATION: Complete the grid in order of respondent?s answers.

Responses:

WHOLE MONTH 1 BOX_30 (HQ1040)
PART OF MONTH (INCLUDING FIRST OF MONTH) 2 BOX_30 (HQ1040)
PART OF MONTH (NOT INCLUDING FIRST OF MONTH) 3 BOX_30 (HQ1040)
NOT COVERED 4 BOX_30 (HQ1040)
REFUSED RF BOX_30 (HQ1040)
DON'T KNOW DK BOX_30 (HQ1040)

Programmer Instructions:

HQ10_05 also includes HQ10_06, HQ10_07, HQ10_08, HQ10_09, ? HQ10_N.
Display HQ10_05? HQ10_N as active cells for the person?s row if HQ10_01 is coded ?2? (PART OF THE TIME). Otherwise, HQ10_05?HQ10_N are inactive cells for the person?s row.
Note: The number and names of the months listed in the full grid are determined by the number of months between the month prior to the month of the interview and the month of the reference date. For example, if the reference date is January 1 and the interview date is April 10, 'January', 'February', and 'March' are displayed. 'April' would not be asked about in HQ10_05 because questions HQ10_03 and HQ10_04 determined the coverage during the interview month. However, not all RU members will be eligible for every month. The cells for the months that are not applicable for that RU member should not be active. The only month cells that should be active for a specific row are the ones that apply to that person's individual reference period.
For round 5, the end date is not the interview date. It is either 12/31/(YEAR) or the date the person left the RU, died, was institutionalized, moved, etc.
The screen layout should accommodate all the months in the person?s reference period. Horizontal scrolling may be necessary in the grid.
Hard Check:
Edit: If Rounds 1-4, person must be covered at least one month during the reference period. If person does not have coverage during the interview month (HQ10_02 equal to 2 or HQ10_04 equal to 2) and does not have coverage for any of the months displayed at HQ10_05 (all months displayed at HQ10_05 are coded '4' (NOT COVERED)), display the following message: "MUST BE COVERED AT LEAST PART OF ONE MONTH. IF NOT, BACK UP AND DELETE PERSON AS A COVERED PERSON (DEPENDENT) FOR THIS INSURANCE."
Edit: If Round 5, all months displayed at HQ10_05 cannot be coded '4' (NOT COVERED). If all are, display the following message: "MUST BE COVERED AT LEAST PART OF ONE MONTH. IF NOT, BACK UP AND DELETE PERSON AS A COVERED PERSON (DEPENDENT) FOR THIS INSURANCE."
For each person (row), if Round 1 and if January is coded ?1? (WHOLE MONTH) or ?2? (PART OF MONTH (INCLUDING FIRST OF MONTH), set SimplePerson.CovdJan1 equal to Yes.

Display Instructions:

Display ?, YEAR? as a 4-digit year only if Round 3. Otherwise, use a null display for ?YEAR?.
Array responses and variable text columns in the panel. Display "variable text" in the a-e sequence until all rows have been displayed. Variable question text displays for each month in the reference period. If more than 5 months to display, repeat, the question wording, beginning from ?a? for other months in the reference period eligible to be displayed. As the cursor moves from one month row to the next, display the other rows in grayed out text.
The wording for each row is as follows:
HQ10_05[1] a. In (MONTH(, YEAR)), (were/was) (you/(PERSON)) covered the whole month, part of the month, or not at all during the month?
HQ10_06[2] b. How about in (MONTH(, YEAR))? (Were/Was) (you/he/she) covered the whole month, part of the month, or not at all during the month?
HQ10_07[3] c. What about in (MONTH(, YEAR))? [(Were/Was) (you/he/she) covered the whole month, part of the month, or not at all during the month?]
HQ10_08[4] d. What about in (MONTH(, YEAR))? [(Were/Was) (you/he/she) covered the whole month, part of the month, or not at all during the month?]
HQ10_09[5] e. What about in (MONTH(, YEAR))? (Were/Was) (you/(PERSON)) covered the whole month, part of the month, or not at all during the month?
For items HQ10_07[3] c. and HQ10_08[4] d., display the text [(Were/Was) (you/he/she) covered the whole month, part of the month, or not at all during the month?] in brackets and in grayed out text.
Display the interviewer instruction ?NAVIGATION': Complete the grid in order of respondent?s answers. ? In red text.

BOX 25 (HQ1026)

Route Details:

Continue with BOX_30
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 (ENTER) TO GO TO THE FIRST UNANSWERED QUESTION.? 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. If coded ?2? (NO), CAPI should return 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.

BOX_30 (HQ1040)

Route Details: Return to the HX, HP, or PR section.
Programmer Instructions:

CovdPers.LRndCovd
MHOP will need to set a flag on the Covered Person Array to determine if an RU member is considered covered for the following round. This flag will be called CovdPers.LRndCovd and will be used in the OE and PR sections to determine whether coverage is asked about for each eligible RU member. This setting will need to be made prior to rounds 2-5. The value of the Flag will be the current round. If the RU member was considered covered in Round 1, for review in Round 2, the flag will be set to ?1?. If the RU member was considered covered in Round 2, for review in Round 3, the flag will be set to ?2?, etc.
Public Insurance (Medicare) [Insurance.HIPubPriv equal to Public, Insurance.HISrc equal to Medicare] ? once an RU member is added as having Medicare coverage, CAPI collects an effective date for coverage in the HX section. An effective end date is never collected and it is assumed that Medicare coverage never ends for that RU member. In cases of Medicare coverage, LRndCovd is not necessary.
Public Insurance (except Medicare) [Insurance.HIPubPriv equal to Public, Insurance.HISrc not equal to Medicare] ? The HQ section determines what months each RU member is covered by each source of public insurance. To be eligible for to be reviewed for public coverage, the RU member must have been covered at least one day in the previous round (not necessarily on the interview date).
Set CovdPers.LRndCovd equal to (current round) for this RU member for this insurance if:
HQ10_01 equal to ?1? (WHOLE TIME) or
HQ10_02 equal to ?1? (YES) or
HQ10_04 equal to ?1? (YES) or
HQ10_05 equal to ?1? (WHOLE MONTH), ?2? (PART OF MONTH (INCLUDING FIRST OF MONTH)), or ?3? (PART OF MONTH (NOT INCLUDING FIRST OF MONTH)) for at least one month in the grid
Private Insurance [Insurance.HIPubPriv equal to Private, Insurance.OrigRnd equal to current round] ? The HQ section determines what months each RU member is covered by each source of private insurance that was created in the current round. (The specifications for this flag for private insurance that was reviewed during the current round is included in the OE section.) To be eligible to be reviewed for private coverage, the RU member must have been covered on the interview date of the previous round
Set CovdPers.LRndCovd equal to (current round) for this RU member for this insurance if:
HQ10_01 equal to ?1? (WHOLE TIME) or
HQ10_02 equal to ?1? (YES)

Hospital Stay (HS) Section

BOX_00 (HS1000)

Route Details:

01 Box equal to BOX_00, BOX_10
04 Single Select equal to HS10, HS30, HS60, HS70, HS80, HS90
06 Single Select with Fill in Answer Text equal to HS50
11 Multiple Select with Add/Edit/Delete equal to HS40, HS100
19 Numeric Field equal to HS20
Roster 3 equal to HS40, HS100

HS10 (HS1002)

BLAISE NAME: ConfIPStay
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

Question Text:

I have recorded that (you/(PERSON)) ((were/was) admitted to and discharged from (PROVIDER) on the same day./stayed in (PROVIDER) (XX) (night/nights)). Is that correct?

Responses:

YES 1 HS30 (HS1015)
NO 2 HS20 (HS1005)
REFUSED RF HS30 (HS1015)
DON?T KNOW DK HS30 (HS1015)

Display Instructions

Display ?were admitted to and discharged from (PROVIDER) on the same day.? if the reported admit and discharge dates for this stay were the same day. Otherwise, display ?STAYED IN (PROVIDER) (XX) (NIGHT/NIGHTS).?
For ?XX? display the number of nights in the hospital using the reported admit and discharge dates for this stay.
Display ?NIGHT? if number of nights in the hospital is equal to 1. Otherwise, display ?nights?.

HS20 (HS1005)

BLAISE NAME: NumNight
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

Question Text:

How many nights did (you/(PERSON)) stay in (PROVIDER)?
ENTER NIGHTS.

Responses:

1 HS30 (HS1015)
REFUSED RF HS30 (HS1015)
DON?T KNOW DK HS30 (HS1015)

Programmer Instructions:

Soft range 1-30.
Range check:
If number entered is above 30, display the following message: ?A HOSPITAL STAY LONGER THAN 30 NIGHTS IS UNLIKELY. VERIFY AND RE-ENTER IF NEEDED.?
If number entered is less than 1, display the following message: ?EARLIER RU MEMBER SAID THEY HAD A HOSPITAL STAY OF AT LEAST ONE NIGHT. VERIFY AND RE-ENTER. OR GO BACK TO HS10 (ConflPStay)?
CAPI should give the option to return to HS10 to change their response on this message screen.

Display Instructions:

HS30 (HS1015)

BLAISE NAME: IPRelCond
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

Question Text:

Was this hospital stay related to any specific health condition or were any conditions discovered during this stay?

Responses:

YES 1 HS40 (HS1020)
NO 2 HS50 (HS1025)
REFUSED RF HS50 (HS1025)
DON?T KNOW DK HS50 (HS1025)

Display Instructions:

HS40 (HS1020)

BLAISE NAME: IPCondRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

Question Text:

What conditions were discovered or led (you/(PERSON)) to enter the hospital?
PROBE: Any other condition?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

Responses:

(MEDICAL CONDITION) 1 1 HS50 (HS1025)
(MEDICAL CONDITION) 2 2 HS50 (HS1025)
(MEDICAL CONDITION) 3 3 HS50 (HS1025)
(MEDICAL CONDITION) 4 4 HS50 (HS1025)
(MEDICAL CONDITION)N 5 HS50 (HS1025)

Programmer Instructions:

Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.

Display Instructions:

Roster 3 - add/edit/delete allowed
Roster definition:
This item displays person-medical-conditions-roster for selection and addition of one or many medical conditions associated with this event. Display name of medical condition (COND.CONDNAM)
Roster filter:
Display all conditions on person's roster; display all.

HS50 (HS1025)

BLAISE NAME: ResnHosp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

Question Text:

HS-1
Please look at card HS-1 and tell me which category best describes the reason (you/(PERSON)) entered (PROVIDER) on (ADMIT DATE).
IF NECESSARY, PROBE: What was the main reason (you/he/she) entered (PROVIDER)?
HELP: F1

Responses:

OPERATION OR SURGICAL PROCEDURE 1 HS80 (HS1035)
TREATMENT OR THERAPY, NOT INCLUDING SURGERY 2 HS70 (HS1030)
DIAGNOSTIC TESTS ONLY 3 HS70 (HS1030)
(GIVE BIRTH TO A BABY - NORMAL OR CAESAREAN SECTION (MOTHER)) 4
(TO BE BORN (BABY)) 5 HS70 (HS1030)
(PREGNANCY-RELATED COMPLICATIONS) 6 HS70 (HS1030)
OTHER 91 HS70 (HS1030)
REFUSED RF HS70 (HS1030)
DON?T KNOW DK HS70 (HS1030)

Programmer Instructions:

If HS50 is coded ?1? (OPERATION OR SURGICAL PROCEDURE), auto code HS70 as ?1? (YES) by CAPI.
NOTE: CAPI will present a follow-up question to determine whether a hospital stay event for the baby/mother is present whenever HS50 is coded ?4? (GIVE BIRTH TO A BABY) or ?5? (TO BE BORN).

Display Instructions:

Display response option ?4? (GIVE BIRTH TO A BABY) and response option ?6? (PREGNANCY-RELATED COMPLICATIONS) only if person is female and age 15 to 55 inclusive (or age categories 3 to 8). Otherwise, use a null display.
Display response option ?5? (TO BE BORN) only if person is less than or equal to 1 year old (or age category 1).
Otherwise, use a null display.

HS70 (HS1030)

BLAISE NAME: IPSurgProc
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

Question Text:

Were any operations or surgical procedures performed on (you/(PERSON)) during this stay?
HELP: F1

Responses:

YES 1 HS80 (HS1035)
NO 2 HS80 (HS1035)
REFUSED RF HS80 (HS1035)
DON?T KNOW DK HS80 (HS1035)

Display Instructions:

HS80 (HS1035)

BLAISE NAME: ICU
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

Question Text:

Did (you/(PERSON)) spend any time in an intensive or critical care unit (ICU) during this stay?
HELP: F1

Responses:

YES 1 HS90 (HS1055)
NO 2 HS90 (HS1055)
REFUSED RF HS90 (HS1055)
DON?T KNOW DK HS90 (HS1055)

Display Instructions:

HS90 (HS1055)

BLAISE NAME: IPPmed
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

Question Text:

At the time (you/(PERSON)) (were/was) discharged, were any medicines prescribed for (you/him/her)? Please do not include medications received while (you/he/she) (were/was) a patient in the hospital.
HELP: F1

Responses:

YES 1 HS100 (HS1060)
NO 2 BOX_10 (HS1065)
REFUSED RF BOX_10 (HS1065)
DON?T KNOW DK BOX_10 (HS1065)

Display Instructions:

HS100 (HS1060)

BLAISE NAME: IPPmedRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

Question Text:

Please tell me the names of the prescribed medicines from this stay that were filled.
PROBE: Any other prescribed medicines from this stay that were filled?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(PRESCRIBED MEDICINE)1 1 BOX_10 (HS1065)
(PRESCRIBED MEDICINE)2 2 BOX_10 (HS1065)
(PRESCRIBED MEDICINE)3 3 BOX_10 (HS1065)
(PRESCRIBED MEDICINE)4 4 BOX_10 (HS1065)
(PRESCRIBED MEDICINE)N 5 BOX_10 (HS1065)

Programmer Instructions:

Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a medicine added at this item until CAPI creates the link between this medicine and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit medicines added at this item until CAPI creates the link between this medicine and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.
When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.
When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name.
General flag rules for medicines:
- Round medicine first created (by definition a medicine is selected the same time it is created)
- Question number medicine first created
- Round medicine selected
- Event medicine is linked to (however, this is known by virtue that the medicine was selected at HS100 for this event)

Display Instructions:

Roster 3 - add/edit/delete allowed
Roster definition:
This item displays the Person?s-Prescribed-Medicines-Roster for selection and addition of prescribed medicines. Display name of prescribed medicine.
Roster filter:
Display all medicines on person?s roster; no filter.

BOX_10 (HS1065)

Route Details:

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.
If the Charge/Payment (CP) section is completed for this Hospital Stay (HS) event and if HS50 is coded ?4? (GIVE BIRTH TO A BABY) or ?5? (TO BE BORN) go to EF section.
Otherwise, go to the Event Driver (ED) section.

Health Insurance (HX) Section

BOX_00 (HX1000)

Route Details:

01 Box= BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_45, 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_280, BOX_290, BOX_300, BOX_310, BOX_320, BOX_330, BOX_340, BOX_350, BOX_360, BOX_ 370, BOX_380, BOX_390, BOX_400, BOX_405, BOX_410, BOX_420, BOX_430, BOX_440, BOX_450, BOX_460, BOX_470, BOX_480, BOX_490, BOX_500, BOX_510, BOX_ 520, BOX_530, BOX_540, BOX_550, BOX_560, BOX_570
02 Loop= LOOP_10, LOOP_20, LOOP_30, LOOP_40, LOOP_50, LOOP_55, LOOP_60, LOOP_70
3 End Loop= END_LP10, END_LP20, END_LP30, END_LP40, END_LP50, END_LP55, END_LP60, END_LP70
04 Single Select= HX14, HX15, HX20, HX21, HX22, HX23, HX70, HX80, HX90, HX105, HX130, HX150, HX180, HX190, HX210, HX215, HX220, HX225, HX240, HX250, HX280, HX310, HX340, HX350, HX370, HX380, HX390, HX410, HX420, HX430, HX450, HX460, HX470, HX480, HX490, HX510, HX520, HX590, HX600, HX610, HX650, HX660, HX680, HX690, HX710, HX720, HX750, HX770, HX780, HX790
05 Single Select with Display Roster= HX30, HX50_01, HX100_01, HX110, HX120_01, HX290, HX530, HX540, HX560, HX760
06 Single Select with Fill in Answer Text= HX300, HX700
08 Multiple Select= HX260, HX320, HX620
09 Multiple Select with Display Roster= HX125_01
10 Multiple Select with Fill in Answer Text= HX40, HX60, HX140, HX170, HX200, HX230, HX570, HX575, HX730
14 Regular Date Entry= HX330_1, HX330_2, HX330_3, HX360_1, HX360_2 17 Dollar Items Allowing Cents= HX440, HX500, HX580, HX670
18 Dollar Items Not Allowing Cents= HX740_01
20 OS Text Field= HX200OS, HX300OS, HX450OS, HX510OS, HX590OS, HX620OS, HX680OS,
23 Text Field= HX160, HX270, HX400, HX550, HX630, HX640
24 Information Screen= HX10, HX16

BOX_10 (HX1005)

Route Details:

Context header display instructions:
Display Person.FullName, Insurance.Plcyhldr, Insurance.HISrcName.
General Display Instructions for Question Text:
For '[START DATE]', 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable BegRefDt.
For '[END DATE]', 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable EndRefDt.
For '[PERSON'S START DATE]', display the person level reference period 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 end date. Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variables EndRefM, EndRefD, EndRefY.
Unless there is a more specific fill instruction provided at the item level, for any fill using the variable 'Insurance.Insurer', display the text entry stored or display "Refused Insurer" if Insurance.Insurer=RF or display "Don't Know Insurer" if Insurance.Insurer=DK. Items using Insurance.Insurer include HX290, HX560, HX580, HX590, HX590OS, HX600, HX610, and HX650.
General Notes:
HospHI and MedgapHI:
The values of Insurance.HospHI and Insurance.MedigapHI should be initialized as the corresponding preload values (PR_Insurance.HospHI and PR_Insurance.MedigapHI).
These values may or may not be updated at OE130. If OE130 is asked, then the values are overwritten. Otherwise, the current round values are the same as the previous round values.
Active vs. Inactive
As insurance is added or reviewed, it is determined to be active or inactive with an "inactive flag". Active insurance is insurance that covers an RU member during the current round. Inactive insurance is insurance that was reviewed and no longer covers any RU members for any period of time during the current round.
Insurance can also be "flagged for clean-up" or set with a "delete flag". This includes insurance that was indicated by the respondent as added in error or insurance added. It also includes insurance added which does not cover any current RU members (for example, insurance added with a policyholder outside the RU, and no current RU members are covered). This can also include insurance that was added, but upon backup, a person was deselected as being covered by this insurance.
Unless otherwise specified, any insurance marked as "inactive" or "deleted" does not qualify for any of the loops within any of the health insurance sections.
Logic to set preload insurance Activeflg for preload public insurance (OrigRnd()Roundnumber):
Set Activeflg= InActive if PR150=No, DK, RF, or PR260=No, DK, RF or PR290=No, DK, RF or PR310=No, DK, RF
Logic to set preload insurance Activeflg for preload private insurance (OrigRnd()Roundnumber) at the end of OE LOOP_10:
If OE20_01=YES/DK/RF or OE30_01=ENTERDATE or OE50_01=YES for anyone THEN
Insurance.ActiveFlg := Active. ELSE Insurance.ActiveFlg := InActive Covered Person Array
The use of the phrase "covered person" or "covered person array" throughout the health insurance specifications references the coverage flag list. The coverage flag list is a list of RU members and a YES/NO flag indicating whether that person is covered by a particular insurance source (InsSrcN). The insurance sources in this list are not identified by the insurance ID in the insurance array, but rather by the insurance array element. For example InsSrc1 is the first insurance on the insurance array.
Dependents Separated from Policyholder Prior to the Health Insurance Section, CAPI will determine if there is private insurance where dependents are covered but the RU member policyholder is no longer an eligible RU member to be included as part of THIS RU (policyholder may or may not be included as part of another RU). The situation is treated as "Dependent(s) Separated from Policyholder". The insurance for the policyholder continues to move with the policyholder and will be treated as regular insurance without this special flag or special processes. The requirements for this flag include:
There is private insurance to be reviewed in the current round.
There is at least one eligible (for any portion of the round) RU members listed in the covered person array for this private insurance who is not listed as the policyholder.
The policyholder of this private insurance is no longer a current RU member (this person does not have any eligibility during the current round for this RU).
This excludes policyholders set to 901 (Policyholder Deceased) or 902 (Policyholder Not in DU).
Includes any RU policyholder that now has a different RU Unit or was set to PriorRndInelig between rounds.
This situation is noted for this insurance (for the covered persons) every round the policyholder is not part of the RU and the insurance is eligible to be reviewed for eligible dependents.
There are two special MHOP procedures that may be necessary for this situation.
The variables Insurance.HospHI and Insurance.MedigapHI for the insurance array for the dependents must be updated inter-round with the values collected for the policyholder. If the values for the policyholder were not collected, then the variables Insurance.HospHI and Insurance.MedigapHI must be maintained from the latest value and moved forward every round the insurance is eligible.
This situation "Dependent(s) Separated from Policyholder" may need to be set inter- round when an RU member policyholder becomes ineligible between rounds.

HX10 (HX1010)

BLAISE NAME: HXStart
Question Text:

[Let's talk about all the health insurance coverage the household may have to help pay for the costs of medical care [since [START DATE] /between [START DATE] and [END DATE]]./I recorded some information earlier about the health insurance coverage for this household [since [START DATE]/between [START DATE] and [END DATE]], but I need to ask again to be sure I have details for all the health insurance coverage the household may have to help pay for the costs of medical care.]
[ASK RESPONDENT TO GET INSURANCE CARDS/IDENTIFYING INFORMATION IF NOT ALREADY AVAILABLE.]
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1
Programmer Instructions:

If round 1, go to BOX_40.
Otherwise, continue with BOX_20.

Display Instructions:

Display 'Let's talk ? and [END DATE]]. ' if no source of payments selected for any RU member in the charge/payment or flat fee section in the current round (SOPFlag = NO). Otherwise (SOPFlag = YES), display 'I recorded some ?. costs of medical care.'
Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.
Display 'ASK...AVAILABLE.' if round 1. Otherwise, use a null display.

BOX_20 (HX1015)

Route Details:

Ask the Old Employment and Private Related Insurance (OE) section.
At completion of OE section, continue with BOX_30.

BOX_30 (HX1020)

Route Details:

Ask the Old Public Related Insurance (PR) section.
At completion of PR section, continue with BOX_40.

BOX_40 (HX1025)

Route Details:

If one or more jobs/unions meet the following condition:
Newly created job provides health insurance or reviewed job now provides health insurance [EMPHI=Yes for the current round] continue with LOOP_10. Otherwise, go to BOX_60.

LOOP_10 (HX1030)

Route Details:

For each element in the jobs array, ask BOX_45 - END_LP10.
Loop definition: LOOP_10 collects information about private health insurance obtained through an employer or union. This loop cycles on jobs that meet the following conditions:
Newly created job provides health insurance or reviewed job now provides health insurance [EMPHI=Yes for the current round].
NOTE: Loop by RU member, then jobs/unions for that RU member. If the respondent has job that provides health insurance, loop on the respondent first. If an RU member has job linked to both an employer and union that provides health insurance (i.e., EM710 is coded '3' (BOTH EMPLOYER AND UNION)), Loop_10 will cycle a total of 2 times - once for the Employer and once for the Union. In those cases, always loop on the employer before looping on the union for that person.

BOX_45 (HX1031)

Route Details:

If job being cycled is an Employer and is linked to a union that also provides health insurance (EM710 is coded '3' (BOTH EMPLOYER AND UNION)), continue with HX14.
If job being cycled on is a Union and is linked to an employer that also provides health insurance (EM710 is coded '3' (BOTH EMPLOYER AND UNION)) and [during the loop for the employer linked to this union, HX14 was coded '2' (TWO SEPARATE PLANS) or HX15 was coded '2' (JUST FROM UNION)], go to HX16.
If job being cycled on is a Union and is linked to an employer that also provides health insurance (EM710 is coded '3' (BOTH EMPLOYER AND UNION)), and [during the loop for the employer linked to this union, HX14 was coded '3' (IF VOLUNTEERED: INSURANCE REPORTED IN ERROR) or HX15 was coded '1' (JUST FROM EMPLOYER)], go to END_LP10 (Union was flagged for clean-up and will not go into HP section to create insurance).
Otherwise, go to HX20.
Tester Notes:
The purpose of BOX_45 is to route health insurance plans where there is one plan from the employer and one from the union (both created at the same time in Employment). For these two plans you would cycle through LOOP_10 first for the plan from the employer and then a second time for the plan from the union. The references to HX14 and HX15 in BOX_45 refer to the values coded there when you cycled through LOOP_10 for the employer and now you are cycling through for the union. It's the case that HX14 is only ever asked when cycling through for the employer.
Scenario: EM710=3 both employer and union. (But you find out really insurance is just from employer)
1st cycle Loop_10 -Employer
BOX_45 - meets first condition, continue with HX14
HX14 = One plan
HX15 = Just employer
BOX_50 - HP section
End_Lp10
2nd cycle Loop_10 - Union
BOX_45 = meets 3rd condition, HX15=just from employer (Union insurance never created and never goes into HP)
End_Lp10
Scenario: EM710=3 both employer and union. (But you find out really insurance is just from union)
1st cycle Loop_10 -Employer
BOX_45 - meets first condition, continue with HX14
HX14 = One plan
HX15 = Just union (Employer insurance never created and never goes into HP)
End_Lp10 (current spec says HX16-but that was a typo from the mark-up - should say
END_LP10)
2nd cycle Loop_10 - Union
BOX_45 = meets 2nd condition, HX15=just from union
HX16=Continue
BOX_50 - HP section
End_Lp10
Scenario: EM710=3 both employer and union. (But you find out insurance is really from both)
1st cycle Loop_10 -Employer
BOX_45 - meets first condition, continue with HX14
HX14 = Two plans
BOX_50 - HP section
End_Lp10
2nd cycle Loop_10 - Union
BOX_45 = meets 2nd condition, HX14=two plans
HX16=Continue
BOX_50 - HP section
End_Lp10
Scenario: EM710=3 both employer and union. (But you find out insurance is in error)
1st cycle Loop_10 -Employer
BOX_45 - meets first condition, continue with HX14
HX14 = No insurance from job (both Employer and Union insurance never created, neither go into HP)
End_Lp10
2nd cycle Loop_10 - Union
BOX_45 = meets 3rd condition, HX14=error
End_Lp10

HX14 (HX1032)

BLAISE NAME: HIOneTwoPlan
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

You mentioned that [you/[PERSON]] [were/was] covered by health insurance from both [EMPLOYER] and [UNION]
[at some point after [START DATE]/between [START DATE] and [END DATE]]. Is that just one plan or two separate plans?

Responses:

ONE PLAN 1 HX15 (HX1033)
TWO SEPARATE PLANS 2 BOX_50 (HX1040)
IF VOLUNTEERED: INSURANCE 3 HX21 (HX1036)
REPORTED IN ERROR

Programmer Instructions:

If coded '2' (TWO SEPARATE PLANS), create two insurance records - one for this employer and one for this union. [For insurance through employer: set Insurance.HIPubPriv=Private and Insurance.HISrc=Employer and set Insurance.HISrcName to JobsEstbName] [set CreateQ and OrigRnd] [For insurance through union: set Insurance.HIPubPriv=Private and Insurance.HISrc=Union and set Insurance.HISrcName to UnionName] [set CreateQ and OrigRnd]
If coded '3' (IF VOLUNTEERED: INSURANCE REPORTED IN ERROR), flag Insurance linked to both the Employer and the Union for clean-up. Neither pair will go into HP section to create insurance. However, HX21-HX23 will be asked one time when cycling through LOOP_10 for an Employer and that employer is linked to a union that also provides health insurance (EM710 is coded '3' (BOTH EMPLOYER AND UNION)).

Display Instructions:

For 'EMPLOYER' display the name of the Employer associated with the job being cycled on during this loop.
For 'UNION' display the name of the union entered at EM720 that is associated with the job being cycled on during this loop.
If round 1 through round 4, display 'at some point after [START DATE]'. If round 5, display 'between [START DATE] and [END DATE]'.

HX15 (HX1033)

BLAISE NAME: HIEmpUnion
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

Is that health insurance plan then just from [your/[PERSON]'s] employer, [EMPLOYER], or is it just from [your/his/her] union, [UNION]?

Responses:

JUST FROM EMPLOYER 1 BOX_50 (HX1040)
JUST FROM UNION 2 END_LP10 (HX1045)

Programmer Instructions:

If coded '1' (JUST FROM EMPLOYER), create insurance for this employer [set Insurance.HIPubPriv=Private and Insurance.HISrc=Employer and set Insurance.HISrcName to JobsEstbName] [set CreateQ and OrigRnd]. Then flag insurance linked to the Union for clean-up. That insurance for the Union will not go into HP section to create insurance.
If coded '2' (JUST FROM UNION), create insurance for this union [set Insurance.HIPubPriv=Private and Insurance.HISrc=Union and set Insurance.HISrcName to UnionName] [set CreateQ and OrigRnd]. Then flag insurance linked to the Employer for clean-up. The insurance for the Employer will not go into HP section to create insurance, but the Union will go into HP during a later cycle through LOOP_10.

Display Instructions:

For 'EMPLOYER' display the name of the Employer linked to the job currently being cycled on.
For 'UNION' display the name of the union entered at EM720 that is linked to the job currently being cycled on.

HX16 (HX1034)

BLAISE NAME: HIUnionIntro
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]

Question Text:

Now we will discuss the health insurance that is from [your/[PERSON]'s] union, [UNION].
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_50 (HX1040)

Display Instructions:

For 'UNION' display the name of the union entered at EM720 that is currently being cycled on.

HX20 (HX1035)

BLAISE NAME: HIEmpUnionDisavow
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

You mentioned that [you/[PERSON]] [were/was] covered by health insurance from [JOB/UNION PROVIDING INSURANCE] [at some point after [START DATE]/between [START DATE] and [END DATE]].
SELECT 'CONTINUE' UNLESS RESPONDENT VOLUNTEERS INSURANCE REPORTED IN ERROR.

Responses:

CONTINUE 1 BOX_50 (HX1040)
INSURANCE REPORTED IN ERROR 2 HX21 (HX1036)

Programmer Instructions:

If coded '1' (CONTINUE) and looping on job providing insurance, create insurance for this job [set Insurance.HIPubPriv=Private and Insurance.HISrc=Employer and set Insurance.HISrcName to JobsEstbName] [set CreateQ and OrigRnd]
If coded '1' (CONTINUE) and looping on union providing insurance, create insurance for this union [set Insurance.HIPubPriv=Private and Insurance.HISrc=Union and set Insurance.HISrcName to UnionName] [set CreateQ and OrigRnd]
If coded '2' (INSURANCE REPORTED IN ERROR), for the current interviewing session EMPHI will remain unchanged and the insurance source being cycled on during LOOP_10 will finish out the loop (without going into HP), but the insurance will be flagged for cleanup and will not count as insurance during the current round.
Placeholder for MHOP specifications. This will be deleted once those specifications are available: If coded '2' (INSURANCE REPORTED IN ERROR), there will need to be some clean up during inter round processing between the EM/RJ and HX sections to correct responses to EMPHI and other data that is being collected at HX21-HX23 but will eventually be stored as part of the Employment data.

Display Instructions:

For 'JOB/UNION PROVIDING INSURANCE', display the name of the job or union (being cycled on) that provides health insurance or the name of the reviewed job now provides health insurance [EMPHI=Yes for the current round].
If round 1 through round 4, display 'at some point after [START DATE]'. If round 5, display 'between [START DATE] and [END DATE]'.

HX21 (HX1036)

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

[Earlier, I recorded that [you/[PERSON]] [belong/belongs] to [UNION NAME] at [EMPLOYER].] [Since [START DATE]/Between [START DATE] and [END DATE]], [were/was] [you/[PERSON]] offered health insurance through [EMPLOYER]?
HELP: F1

Responses:

YES 1
NO 2 HX23 (HX1038)
REFUSED RF END_LP10 (HX1045)
DON'T KNOW DK END_LP10 (HX1045)

Programmer Instructions:

If coded '1' (YES) and insurance source being cycled on through LOOP_10 is a reviewed job/employer (RJ10 or RJ60 was asked in the current round for this insurance source), go to END_LP10. Otherwise, continue with HX22.
Placeholder for MHOP specifications. This will be deleted once those specifications are available:
OffrdHIChoseNotHX will need to be set during inter round processing when data between the EM/RJ and HX sections are cleaned for this job that now does not have health insurance.
IF coded '1' (YES) set OffrdHIChoseNotHX =YES
If coded '2' (NO), 'RF' or 'DK' set OffrdHIChoseNotHX =NO

Display Instructions:

Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.
Display '[Earlier, I recorded that [you/[PERSON]] belong to [UNION NAME] at [EMPLOYER].]' if cycling through LOOP_10 for a newly created union that provides health insurance (EMPHI=YES) for the union only, but not the job itself (EM710=2). Otherwise, use a null display.
For "UNION NAME" display the name of the newly created union (UnionName entered at EM720) being cycled on through LOOP_10 that provides health insurance (EMPHI=YES).
If cycling through LOOP_10 for a newly created union that provides health insurance (EMPHI=YES) for the union only, but not the job itself (EM710=2), display the name of the Job linked to this union for "EMPLOYER".
If cycling through LOOP_10 for a newly created job (not a union) or a reviewed job (not a union) that now provides health insurance [EMPHI=Yes for the current round], display the name of that job/employer being cycled on through LOOP_10 for "EMPLOYER".

HX22 (HX1037)

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

Even though [you/he/she] chose not to take health insurance, did [you/[PERSON]] have a choice of different health insurance plans that provided hospital and physician benefits or was only one health insurance plan offered through [EMPLOYER]?
HELP: F1

Responses:

YES, MORE THAN ONE PLAN 1 END_LP10 (HX1045)
NO, ONLY ONE PLAN 2 END_LP10 (HX1045)
REFUSED RF END_LP10 (HX1045)
DON'T KNOW DK END_LP10 (HX1045)

Display Instructions:

If cycling through LOOP_10 for a newly created union that provides health insurance (EMPHI=YES) for the union only, but not the job itself (EM710=2), display the name of the Job linked to this union for "EMPLOYER".
If cycling through LOOP_10 for a newly created job (not a union) or a reviewed job (not a union) that now provides health insurance [EMPHI=Yes for the current round], display the name of that job/employer being cycled on through LOOP_10 for "EMPLOYER".

HX23 (HX1038)

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

Was health insurance offered to any employees at [EMPLOYER]?

Responses:

YES 1 END_LP10 (HX1045)
NO 2 END_LP10 (HX1045)
REFUSED RF END_LP10 (HX1045)
DON'T KNOW DK END_LP10 (HX1045)

Display Instructions:

BOX_50 (HX1040)

Route Details:

Ask the Private Health Insurance detail (HP) section for this insurance.
At completion of HP section, continue with END_LP10.

END_LP10 (HX1045)

Route Details:

Cycle on next job/union that meets the conditions stated in the loop definition.
If no more jobs/unions meet the stated conditions, END LOOP_10 and continue with BOX_60.

BOX_60 (HX1050)

Route Details:

If round 1, go to BOX_80.
Otherwise, continue with BOX_70.

BOX_70 (HX1055)

Route Details: If:

Any new RU members added to RU this round, excluding merges, [(Person[].PreloadOrd = EMPTY],
OR
Any RU members turned 65 since RU level reference period start date (use real date of birth only) and no insurance for this person has Insurance.HISrc=Medicare and OrigRnd () current round
OR
Any RU members = >65(or in age category 9) in previous round (Preload.xxx) and no insurance for this person has Insurance.HISrc=Medicare and OrigRnd ()current round, continue with HX30.
Otherwise, go to BOX_120.

HX30 (HX1060)

BLAISE NAME: AnyCareR25
Question Text:

We show that [PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N] [[are/is]] [either] [65 years old or older] [or] [joined the household since our last interview].
[[Have you/Has [PERSON]]/Have any of these people] been covered by Medicare [since [START DATE]/between [START DATE] and [END DATE]]?
HELP: F1

Responses:

YES 1
NO 2 LOOP_20 (HX1085)
REFUSED RF LOOP_20 (HX1085)
DON'T KNOW DK LOOP_20 (HX1085)

Programmer Instructions:

If HX30 is coded '1' (YES) and only one RU member eligible for HX30, select that person automatically by CAPI at HX40 and go to LOOP_ 20.
If HX30 is coded '1' (YES) and more than one RU member eligible for HX30, go to HX40.
Roster behavior:
1. Select, add, delete, and edit disallowed.

Display Instructions:

Roster 1 - Report
Roster definition:
This item displays RU-members-roster for display of RU-members. Display RU members' first, middle, and last names (Person.FullName).
Roster filter:
Display RU-members who meet one of the following conditions:
Person is a new RU member this round, excluding merges, [(Person[].PreloadOrd = EMPTY],
OR
Person turned 65 years old this round and no insurance for this person has Insurance.HISrc=Medicare and OrigRnd ( ) current round.
OR
Person greater than or equal to 65 (or in age category 9) in the previous round (Preload.xxx) and no insurance for this person has Insurance.HISrc=Medicare and OrigRnd ( ) current round.
For '[PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N]', use the roster definition and filter specifications above. Substitute "you" for the person's full name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display '[are/is]' and '65 years old or older' if anyone on this roster turned 65 since start date or were greater than or equal to 65 (or in age category 9) in the previous round. Display 'is' if the only eligible RU member to be displayed at HX30 is someone other than the respondent. Otherwise, display "are".
Display 'joined the household since our last interview' if any new RU members added to the RU this round.
Display 'either' and 'or' if any new RU members added to the RU this round and if anyone on this roster turned 65 since start date or were greater than or equal to 65(or in age category 9) in the previous round.
Display '[Have you/Has [PERSON]' if only one eligible RU member to be displayed at HX30.
Otherwise, display 'Have any of these people'.
Display 'since [START DATE]' if not round 5. Display 'between [START DATE] and [END DATE]' if round 5.

HX40 (HX1065)

BLAISE NAME: WhoCareR25Roster
Question Text:

Who is covered by Medicare?
PROBE: Who else is covered by Medicare?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 LOOP_20 (HX1085)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 LOOP_20 (HX1085)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 LOOP_20 (HX1085)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 LOOP_20 (HX1085)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 LOOP_20 (HX1085)

Programmer Instructions: Roster behavior:

1. Multiple select allowed. Interviewer may select one or more from the listed members.
For each person selected, create insurance through Medicare for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Medicare and Insurance.HISrcName=Medicare and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition:
Use HX30 definition.
Roster filter:
Use HX30 filter

.
BOX_80 (HX1070)

Route Details:

If at least one RU member is 65 years of age or older (= >65) or in age category 9, continue with HX50.
Otherwise, go to HX60.

HX50_01 (HX1075)

BLAISE NAME: WhoCareR1GE65
Question Text:

AND HX-1
Medicare is a health insurance program for persons 65 years or over and for some persons with disabilities. People covered by Medicare usually have a card that looks like this.
At any time since [START DATE], [have you/has [PERSON 1]] been covered by Medicare?
HELP: F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

After grid completion, if at least one current RU member who is 64 years of age or younger (less than = 64) or in age categories 1-8, continue with HX60.
Otherwise, go to LOOP_20.
Preloaded grid type 1: forced navigation including HX50_01, HX50_02, HX50_03, HX50_ 04, HX50_N.
For each person coded '1' (YES), create insurance through Medicare for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Medicare and Insurance.HISrcName=Medicare and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions:

Roster 1-Report no add/edit/delete allowed.
Format the following columns on the form pane.
Col#1: RU Member
Instructions: Display RU members' First Middle and Last name (Pers.FullName).
Roster Filter:
Display only those RU members who are 65 years of age or older (greater than or equal to 65) or in age category 9.
Display variable question text. Replace "At any time since [START DATE], [have you/has [PERSON 1]] been covered by Medicare?":
HX50_02: What about [PERSON 2]?
HX50_03: What about [PERSON 3]?
HX50_04: What about [PERSON N]? Has [he/she] been covered by Medicare at any time since [START DATE]?
HX50_N: Repeat question text HX50_02-HX50_N for as many RU members that fit the roster filter criteria.
Display first names only in the variable question text display. Substitute "you" for the person's first name if the respondent is included in this list.
Display first paragraph of question text in brackets and grayed out text when on HX50_02 - HX50_N. Display in bold black and no brackets when on HX50_01.

HX60 (HX1080)

BLAISE NAME: WhoCareR1LT65Roster
Question Text:

AND HX-1
[Medicare is a health insurance program for persons 65 years or over and for some persons with disabilities. People covered by Medicare usually have a card that looks like this.]
At any time since [START DATE], [have/has] [PERSON 1 less than or equal to64, PERSON 2 less than or equal to64, PERSON 3 less than or equal to64] been covered by Medicare?
ENTER ALL THAT APPLY.
HELP: F1

Responses:

[FIRST NAME,[MIDDLE NAME], LAST NAME] 1 1 LOOP_20 (HX1085)
[FIRST NAME,[MIDDLE NAME], LAST NAME] 2 2 LOOP_20 (HX1085)
[FIRST NAME,[MIDDLE NAME], LAST NAME] 3 3 LOOP_20 (HX1085)
[FIRST NAME,[MIDDLE NAME], LAST NAME] 4 4 LOOP_20 (HX1085)
[FIRST NAME,[MIDDLE NAME], LAST NAME] N 5 LOOP_20 (HX1085)
NO ONE 99 LOOP_20 (HX1085)

Programmer Instructions:

Roster behavior:
Multiple select allowed. Interviewer may select one or more from the listed members..
For each person selected, create insurance through Medicare for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Medicare and Insurance.HISrcName=Medicare and Insurance.Plcyhldr = PersID and CovdPers.Depend=PersID] [set Create Q and OrigRnd]
Hard check:
Code '99' (NO ONE) cannot be selected in combination with any other response option. If HX60 is coded '99' (NO ONE) is selected with any other response code: "NO ONE CANNOT BE SELECTED IF ANOTHER RESPONSE OPTION IS ALREADY SELECTED. VERIFY AND RE-ENTER."

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition:
This item displays the RU-MEMBERS-ROSTER for selection of RU members. Display RU members' first, middle, and last names (Person.FullName)
Roster filter:
Display RU members who are 64 years of age or younger (less than or equal to 64) or in age categories 1-8.
Display 'Medicare is a health insurance program for persons 65 years or over and for some persons with disabilities. People covered by Medicare usually have a card that looks like this.' if HX50 was NOT asked (i.e., no RU members are 65 years of age or older or in age category 9). Otherwise, use a null display.
For '[PERSON 1 less than or equal to64, PERSON 2 less than or equal to64, PERSON 3 less than or equal to64]', display the first names only of all RU members who are 64 years of age or younger or in age categories 1-8. Substitute "you" for the person's first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "or" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "or".
Display 'have' if list includes the respondent. Otherwise, display 'has'.

LOOP_20 (HX1085)

Route Details:

For each element in RU-MEMBERS-ROSTER, ask BOX_90-END_LP20.
Loop definition: LOOP_20 determines if reason for Medicare is condition/disability for persons less than 65 who receive Medicare and collects social security status for persons greater than or equal to 65 who are not covered by Medicare. This loop cycles on persons who meet any of the following conditions:
-If round 1: all current RU members
-If not round 1: all current RU members who meet one of the following conditions:
Person is a new RU member this round, excluding merges, [(Person[].PreloadOrd = EMPTY], or Person turned 65 years old this round and no insurance for this person has Insurance.HISrc=Medicare and not covered by Medicare during any round or Person greater than or equal to 65 years old (or in age category 9) in previous round (Preload.xxx) and and no insurance for this person has Insurance.HISrc=Medicare
NOTE: When doing the check for being covered by Medicare, you will need to exclude any Medicare coverage that was created during the current round in the verification series (HX230). We need to ensure that this loop doesn't become off path if Medicare is created later.

BOX_90 (HX1090)
Route Details:

If round 1, go to BOX_110.
Otherwise, continue with BOX_100.

BOX_100 (HX1095)

Route Details:

If person added this round, continue with BOX_110.
If person [(turned 65 years old this round and no insurance for this person has Insurance.HISrc=Medicare and OrigRnd ( ) current round) or (= >65 (or in age category 9) in the previous round and no insurance for this person has Insurance.HISrc=Medicare and OrigRnd ( ) current round)] and [person was not selected at HX40], go to HX80.
Otherwise, go to END_LP20.

BOX_110 (HX1100)

Route Details:

If person has insurance with Insurance.HISrc=Medicare and is less than 65 years old (or in age categories 1-8), continue with HX70.
If person has insurance with Insurance.HISrc=Medicare and is = > 65 years old (or in age category 9), go to END_LP20.
If no Medicare insurance for this person (no insurance in array with Insurance.HISrc=Medicare) and this person is less than 65 years old (or in age categories 1-8), go to END_LP20.
If no Medicare insurance for this person has (no insurance in array with Insurance.HISrc=Medicare) and this person is = > 65 years old (or in age category 9), go to HX80.

HX70 (HX1105)

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

[Do/Does] [you/[PERSON]] receive Medicare because of a medical condition or a disability?
HELP: F1

Responses:

YES 1 END_LP20 (HX1115)
NO 2 END_LP20 (HX1115)
REFUSED RF END_LP20 (HX1115)
DON'T KNOW DK END_LP20 (HX1115)

Display Instructions:

HX80 (HX1110)

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

People with Social Security usually get Medicare. [Do/Does] [you/[PERSON]] receive Social Security?
HELP: F1

Responses:

YES 1 END_LP20 (HX1115)
NO 2 END_LP20 (HX1115)
REFUSED RF END_LP20 (HX1115)
DON'T KNOW DK END_LP20 (HX1115)

Display Instructions:

END_LP20 (HX1115)

Route Details:

Cycle on next person who meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_20 and continue with BOX_120.

BOX_120 (HX1120)

Route Details:

If Medicaid/SCHIP provided to any RU member during the previous round (Preload.xxx) and therefore already reviewed as part of the PR section [Insurance.HISrc=Medicaid and PR150 () EMPTY], go to BOX_140.
Otherwise, continue with HX90.

HX90 (HX1130)

BLAISE NAME: AnyCaid
Question Text:

AND HX-2
[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] are state programs that pay for health care for persons in need. People covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] may have a (piece of paper/card) that looks something like this.
At any time [since [START DATE]/between [START DATE] and [END DATE]], has anyone in the household been covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] ?
HELP: F1

Responses:

YES 1
NO 2 BOX_140 (HX1160)
REFUSED RF BOX_140 (HX1160)
DON'T KNOW DK BOX_140 (HX1160)

Programmer Instructions:

If coded '1' (YES) and single-person RU, autocode HX100_01 as '1' (YES) for that person and go to BOX_130.
If coded '1' (YES) and multi-person RU, continue with HX100_01.

Display Instructions:

Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'state name for Medicaid' (substituting the real state name for program) if the state in which interview is being conducted does not use the name 'Medicaid.' For the specific name to use by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions substituting the real state name for program.
For the specific name to use by state, see the plan fill file.
Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.

HX100_01 (HX1135)

BLAISE NAME: WhoCaid
Question Text:

[Have you/Has [PERSON 1]] been covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] at any time [since [START DATE]/between [START DATE] and [END DATE]]?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: forced navigation including HX100_01, HX100_02, HX100_03, HX100_ 04, HX100_N.
After grid completion, continue with BOX_130.
For each person coded '1' (YES), create insurance through Medicaid/SCHIP for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Medicaid and Insurance.HISrcName=[Medicaid/[STATE NAME FOR MEDICAID]]/[STATE CHIP NAME] and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]
Hard check: At least one person must be coded '1' (YES). If no RU member coded '1' (YES), display the following message: "IF NO ONE COVERED BY MEDICAID/SCHIP, BACK UP TO HX90 (AnyCaid) AND REVIEW RESPONSES."

Display Instructions:

Roster 1 - Report no add/edit/delete
Format the following columns on the form pane.
Col#1: RU Member
Instructions: Display RU members' First Middle and Last name (Person.FullName)
Roster filter: none, display all.
Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for program) if the state in which interview is being conducted does not use the name 'Medicaid.' For the specific name to use by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions substituting the real name for program. For the specific name to use by state, see the plan fill file.
Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.
Display variable question text. Replace "[Have you/Has [PERSON 1]] been covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] at any time [since [START DATE]/between [START DATE] and [END DATE]]?" with:
HX100_02: What about [PERSON 2]?
HX100_03: What about [PERSON 3]?
HX100_04: What about [PERSON N]? Has [he/she] been covered by [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] at any time [since [START DATE]/between [START DATE] and [END DATE]]?
HX100_N: Repeat question text HX100_02-HX100_N for as many RU members that fit the roster filter criteria.

BOX_130 (HX1145)

Route Details:

Ask the time period covered detail (HQ) section for this person.
This instance of the HQ section collects time period coverage detail for all RU members that are covered by Medicaid/SCHIP. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
Insurance source is Medicaid/SCHIP [Insurance.HISrc=Medicaid]
And
Person is "COVERED BY MEDICAID/SCHIP" during the current round, that is, HX100_01-HX100_N is coded '1' (YES) for this person.
At completion of the HQ section, continue with HX105.

HX105 (HX1155)

BLAISE NAME: CaidStExch
Question Text:

Is the coverage with [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] through [STATE EXCHANGE NAME-A] [, [which may also be known as [ALIAS B] [or [ALIAS C]]]]?

Responses:

YES 1 BOX_140 (HX1160)
NO 2 BOX_140 (HX1160)
REFUSED RF BOX_140 (HX1160)
DON'T KNOW DK BOX_140 (HX1160)

If coded '1' (YES), set HX_Main.CaidExch=Yes. Else, set HX_Main.CaidExch=No.

Display Instructions:

Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for program) if the state in which interview is being conducted does not use the name 'Medicaid.' For the specific name to use by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions substituting the real name for program. For the specific name to use by state, see the plan fill file.
Display ', [which may also be known as [ALIAS B] [or [ALIAS C]]]' if there is more than one exchange name associated with the state in which interview is being conducted.
Display 'or [ALIAS C]' if there are three exchange names associated with the state in which interview is being conducted.
For 'STATE EXCHANGE NAME-A', 'ALIAS B', and 'ALIAS C', display the exchange name associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

BOX_140 (HX1160)

Route Details:

If MILITARY HEALTH provided to any RU member during the previous round (Preload.xxx) and therefore already reviewed as part of the PR section [Insurance.HISrc=Military and PR260 () EMPTY], go to BOX_160.
Otherwise, continue with HX110.

HX110 (HX1165)

BLAISE NAME: AnyMilitCovg
Question Text:

[Previously, we've recorded that [MILITARY PERSON 1, MILITARY PERSON 2, MILITARY PERSON N] [is/are] [full- time active duty in the Armed Forces] [or] [honorably discharged from active duty].]
At any time [since [START DATE]/between [START DATE] and [END DATE]], has anyone in the household been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage?
HELP: F1

Responses:

YES 1
NO 2 BOX_160 (HX1195)
REFUSED RF BOX_160 (HX1195)
DON'T KNOW DK BOX_160 (HX1195)

Programmer Instructions:

If coded '1' (YES) and single-person RU, autocode HX120_01 as '1' (YES) for that person and go to HX125_01.
If coded '1' (YES) and multi-person RU, continue with HX120_01.

Display Instructions:

Display 'Previously, we've recorded that [MILITARY PERSON 1, MILITARY PERSON 2, MILITARY PERSON N] [is/are] [full-time active duty in the Armed Forces] [or] [honorably discharged from active duty].' if at least one current RU member is currently FT active duty (Person.FTADuty=Yes) or honorably discharged from the Armed Forces in any round [Person.HonDisch=Yes (preloaded value or current round value)]. Otherwise, use a null display.
Display 'full-time active duty in the Armed Forces' if at least one current RU member is currently FT active duty. Otherwise, use a null display.
Display 'honorably discharged from active duty' if at least one RU member has been honorably discharged in any round. Otherwise, use a null display.
Display 'or' if there is at least one current RU member who is FT active duty and one current RU member who is honorably discharged in any round. Otherwise, use a null display.
For '[MILITARY PERSON 1, MILITARY PERSON 2, MILITARY PERSON N]', display the first names of all RU members who are either currently FT active duty or honorably discharged from the Armed Forces in any round. Separate the names using a comma and substitute 'you' if the respondent's name is part of the list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display 'is' if only one person listed and that person is not selected as respondent. Otherwise, display 'are'.
Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.

HX120_01 (HX1170)

BLAISE NAME: WhoMilitCovg
Question Text:

[Have you/Has [PERSON 1]] been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage, at any time [since [START DATE]/between [START DATE] and [END DATE]]?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: forced navigation including HX120_01, HX120_02, HX120_03, HX120_ 04, HX120_N.
After grid completion, continue with HX125_01.
For each person coded '1' (YES), create insurance through Military health care for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Military and Insurance.HISrcName=Military Health and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]
Hard check: At least one person must be coded '1' (YES). If no RU member coded '1' (YES), display the following message: "IF NO ONE COVERED BY MILITARY HEALTH CARE, BACK UP TO HX110 (AnyMilitCovg) AND REVIEW RESPONSES."

Display Instructions:

Roster 1 - Report no add/edit/delete
Format the following columns on the form pane.
Col#1: RU Member
Instructions: Display RU members' First Middle and Last name (Person.FullName)
Roster filter: none, display all.
Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.
Display variable question text. Replace "[Have you/Has [PERSON 1]] been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage, at any time [since [START DATE]/between [START DATE] and [END DATE]]?" with:
HX120_02: What about [PERSON 2]?
HX120_03: What about [PERSON 3]?
HX120_04: What about [PERSON N]? Has [he/she] been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage, at any time [since [START DATE]/between [START DATE] and [END DATE]]?
HX120_N: Repeat question text HX120_02-HX120_N for as many RU members that fit the roster filter criteria.

HX125_01 (HX1175)

BLAISE NAME: CodeAllMilitPlan
Question Text:

What types of military health coverage [do/does] [you/[PERSON 1]] have? [Do you/Does [he/she]] have TRICARE Standard, TRICARE Prime, TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?
ENTER ALL THAT APPLY.
HELP: F1

Responses:

TRICARE STANDARD 1
TRICARE PRIME 2
TRICARE EXTRA 3
TRICARE FOR LIFE 4
CHAMPVA 5
VA (VETERAN'S ADMINISTRATION) 6

Programmer Instructions:

Preloaded grid type 1: forced navigation including HX125_01, HX125_02, HX125_03, HX125_04, HX125_N After grid completion, continue with BOX_150.
DK and RF disallowed.

Display Instructions:

Roster 1-Report no add/edit/delete allowed. Format the following columns on the form pane.
Col#1: RU Member
Instructions: Display RU members' First Middle and Last name (Person.FullName)
Roster Filter:
Display only those RU members "COVERED BY MILITARY HEALTH" during the current round, that is, coded '1' (YES) at HX120.
Display variable question text. Replace "What types of military health coverage [do/does] [you/[PERSON 1]] have? [Do you/Does [he/she]] have TRICARE Standard, TRICARE Prime, TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?" with:
HX125_02: What about [PERSON 2]?
HX125_03: What about [PERSON 3]?
HX125_04: What about [PERSON N]? Does [he/she] have TRICARE Standard, TRICARE Prime,
TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?
HX125_N: Repeat question text HX125_02-HX125_N for as many RU members that fit the roster filter criteria.
Display first names only in the variable question text display. Substitute "you" for the person's first name if the respondent is included in this list.

BOX_150 (HX1185)

Ask the time period covered detail (HQ) section for this person.
This instance of the HQ section collects time period coverage detail for all RU members that are covered by military health coverage. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
Insurance source is Military Health [Insurance.HISrc=Military]
And
Person is "COVERED BY MILITARY HEALTH" during the current round, that is, HX120_01-HX120_N is coded '1' (YES) for this person.
At completion of the HQ section, continue with BOX_160.

BOX_160 (HX1195)

Route Details:

If Indian Health Service (IHS) insurance provided to any RU member at any time during the previous round (Preload.xxx) and therefore already reviewed as part of the PR section
[Insurance.HISrc=IHS and PR290 () EMPTY], go to BOX_180.
Otherwise, continue with HX130.

HX130 (HX1200)

BLAISE NAME: AnyIHS
Question Text:

The Indian Health Service (IHS) is the health care system for federally recognized American Indian and Alaska Natives.
The IHS is not a health insurance provider but rather, it provides healthcare only to eligible Alaska Natives and American Indians at its federal hospitals and clinics.
At any time [since [START DATE]/between [START DATE] and [END DATE]], has anyone in this household been enrolled in the Indian Health Service?

Responses:

YES 1
NO 2 BOX_180 (HX1225)
REFUSED RF BOX_180 (HX1225)
DON'T KNOW DK BOX_180 (HX1225)

Programmer Instructions:

If HX130 is coded '1' (YES) and single-person RU, select person at HX140 automatically by CAPI and go to BOX_170.
If HX130 is coded '1' (YES) and multi-person RU, continue with HX140.

Display Instructions:

Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5

HX140 (HX1205)

BLAISE NAME: WhoIHSRoster
Question Text:

Who is enrolled in the Indian Health Service (IHS)?
PROBE: Who else is enrolled in the Indian Health Service (IHS) [since [START DATE]/between [START DATE] and [END DATE]]?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 BOX_170 (HX1215)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 BOX_170 (HX1215)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 BOX_170 (HX1215)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 BOX_170 (HX1215)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 BOX_170 (HX1215)

Programmer Instructions:

Roster behavior:
Multiple select allowed. Interviewer may select from the listed members.
For each person selected, create insurance through Indian Health Service for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=IHS and Insurance.HISrcName=Indian Health Service and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]
Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition:
This item displays RU-MEMBERS-ROSTER for selection of RU-members. Display RU member's first, middle, and last names (Person.FullName) Roster filter: none, display all.

BOX_170 (HX1215)

Route Details:

Ask the time period covered detail (HQ) section for this person.
This instance of the HQ section collects time period coverage detail for all RU members that are covered by the Indian Health Service. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
Insurance source is Indian Health Service [Insurance.HISrc=IHS] and Person is "COVERED BY INDIAN HEALTH SERVICE" during the current round, that is, person is selected at HX140.
At completion of the HQ section, continue with BOX_180.

BOX_180 (HX1225)

Route Details:

If Govt-hospital/physician provided to any RU member during the previous round (Preload.xxx) and therefore already reviewed as part of the PR section [Insurance.HISrc=GHP and PR310 () EMPTY], go to HX190.
Otherwise, continue with HX150.

HX150 (HX1235)

[Not counting insurance you already told me about, at/At] any time [since [START DATE]/between [START DATE] and [END DATE]], has anyone in the household had any other type of health insurance from any state or local government agency which provided hospital and physician benefits?
HELP: F1

Responses:

YES 1 HX160 (HX1240)
NO 2 HX190 (HX1270)
REFUSED RF HX190 (HX1270)
DON'T KNOW DK HX190 (HX1270)

Display Instructions:

Display 'Not counting insurance you already told me about, at' if any sources of insurance are recorded for this RU for the current round.. Otherwise, display 'At'.
Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.
Display HX150 and HX160 on the same form pane.

HX160 (HX1240)

BLAISE NAME: GovProgName
Question Text:

What is the name of the program?

Responses: 1

Programmer Instructions:

If HX150 is coded '1' (YES) and single-person RU, select person at HX170 automatically by CAPI and go to BOX_190.
If HX150 is coded '1' (YES) and multi-person RU, continue with HX170.
Note: 'GOVT-HOS/PHY-[PROGRAM NAME FROM HX160]' substituting 17 characters of the entry at HX160 should be used for the Insurance.HISrcName in the context header (where appropriate).
Set HX_Main.GHPProgName=Yes.

Display Instructions: Display HX150 and HX160 on the same form pane

HX170 (HX1245)

BLAISE NAME: WhoGovProgRoster
Question Text:

Who is covered by [PROGRAM NAME FROM HX160], the program sponsored by a state or local government agency which provided hospital and physician benefits?
PROBE: Who else is covered by [PROGRAM NAME FROM HX160], the program sponsored by a state or local government agency which provided hospital and physician benefits [since [START DATE]/between [START DATE] and [END DATE]]?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 BOX_190 (HX1255)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 BOX_190 (HX1255)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 BOX_190 (HX1255)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 BOX_190 (HX1255)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 BOX_190 (HX1255)

Programmer Instructions:

Roster behavior:
Multiple select allowed. Interviewer may select from the listed members.
For each person selected, create insurance through Gov't-Hospital/Physician for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=GHP and Insurance.HISrcName= GOVT-HOS/PHY-[PROGRAM NAME FROM HX160]' and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition:
This item displays RU-members-roster for selection of RU-members. Display RU member's first, middle, and last names (Person.FullName)
Roster filter: none, display all.
For '[PROGRAM NAME FROM HX160]', display the text entry from HX160.
Display 'since [START DATE]' if not round 5.
Display 'between [START DATE] and [END DATE]' if round 5.

BOX_190 (HX1255)

Route Details:

Ask the time period covered detail (HQ) section for this person.
This instance of the HQ section collects time period coverage detail for all RU members that are covered by Government-Hospital/Physician coverage. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
Insurance source is Govt-Hospital/Physician [Insurance.HISrc=GHP] and Person is "COVERED BY GOV'T-HOSPITAL/PHYSICIAN" during the current round, that is, person is selected at HX170.
At completion of the HQ section, continue with HX180.

HX180 (HX1265)

BLAISE NAME: GovProgStExch

Question Text:

Is the coverage with [PROGRAM NAME FROM HX160], the program sponsored by a state or local government agency which provided hospital and physician benefits, through [STATE EXCHANGE NAME-A] [, [which may also be known as [ALIAS B] [or [ALIAS C]]]]?

Responses:

YES 1 HX190 (HX1270)
NO 2 HX190 (HX1270)
REFUSED RF HX190 (HX1270)
DON'T KNOW DK HX190 (HX1270)

Programmer Instructions: If coded '1' (YES), set HX_Main.GHPExchange=Yes. Else, set HX_Main.GHPExchange=No.

Display Instructions:

For '[PROGRAM NAME FROM HX160]', display the text entry from HX160.
Display ', [which may also be known as [ALIAS B] [or [ALIAS C]]]' if there is more than one exchange name associated with the state in which interview is being conducted.
Display 'or [ALIAS C]' if there are three exchange names associated with the state in which interview is being conducted.
For 'STATE EXCHANGE NAME-A', 'ALIAS B' and 'ALIAS C' display the exchange name associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

HX190 (HX1270)

BLAISE NAME: AnyOthHICovg
Question Text:

ANDHX-3
Next, I have some questions about other sources of health insurance anyone in this household may have had [since [START DATE] /between [START DATE] and [END DATE]] to help pay hospital and doctor bills and other health expenses such as nursing home care or prescribed medicines. [This includes Medigap or Medicare Supplements which some people who are eligible for Medicare have through a private carrier as additional coverage.]
Please look at card HX-3. It lists various ways people can obtain health insurance. [Not counting insurance you already told me about, at/At] any time [since [START DATE]/between [START DATE] and [END DATE]], was anyone in this household covered by health insurance from any [other] source, such as those listed on the card?

Responses:

YES 1 HX200 (HX1275)
NO 2 BOX_210 (HX1300)
REFUSED RF BOX_210 (HX1300)
DON'T KNOW DK BOX_210 (HX1300)

Display Instructions:

Display 'since [START DATE]' if not round 5. Display 'between [START DATE] and
[END DATE]' if round 5.
Display 'This includes...coverage.' if anyone in RU is "COVERED BY MEDICARE" during the current round [(Insurance.HISrc=Medicare) and ((OrigRnd () current round) or (OrigRnd=current round and person selected at HX40 or HX60 or HX50=Yes)) for at least one person].
Display 'Not counting insurance you already told me about, at' and 'other' if any sources of insurance are recorded for this RU for the current round. Otherwise, display 'At'.

HX200 (HX1275)

BLAISE NAME: CodeAllOthHI
Question Text:

ANDHX-3
From which of the sources on card HX-3 did anyone in this household purchase health insurance?
ENTER ALL THAT APPLY.
HELP: F1

Responses:

FROM A GROUP OR ASSOCIATION 1
DIRECTLY THROUGH A SCHOOL 2
DIRECTLY FROM AN INSURANCE AGENT 3
DIRECTLY FROM INSURANCE COMPANY 4
DIRECTLY FROM AN HMO 5
FROM A UNION 6
FROM ANYONE'S PREVIOUS EMPLOYER 7
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER 8
FROM SOME OTHER EMPLOYER 9
UNDER A PLAN OF SOMEONE NOT LIVING HERE 10
DIRECTLY FROM [STATE EXCHANGE NAME-A] 11
OTHER SOURCE 91
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded '91' (OTHER SOURCE), alone or in combination with any other code, continue with HX200OS.
Otherwise, go to LOOP_30.
For specifications purposes only: CAPI does not allow 'RF' or 'DK' in combination with any other code.
When source is selected, create direct purchase insurance with the type selected at HX200 [set Insurance.HIPubPriv=Private and Insurance.HISrc=DirectPurchase and Insurance.DirectPurchTp=type selected] [set Create Q and OrigRnd]

Display Instructions:

For 'STATE EXCHANGE NAME-A' display exchange name 'A' associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.
Display HX200 and HX200OS on the same form pane screen.

HX200OS (HX1280)

BLAISE NAME: OthHIOS
Question Text:

SPECIFY: OTHER SOURCE

Responses: 1 LOOP_30 (HX1285)
Programmer Instructions: Refused and Don't Know disallowed.
Display Instructions: Display HX200 and HX200OS on the same form pane screen.

LOOP_30 (HX1285)

Route Details:

For each source, ask BOX_200 - END_LP30.
Loop definition: LOOP_30 collects information about private health insurance obtained through a source selected at HX200. This loop cycles once for each source selected at HX200.

BOX_200 (HX1290)

Route Details:

Ask Private Health Insurance detail (HP) section for the response category selected at HX200 that is currently being looped on.
At completion of the HP section, continue with END_LP30.

END_LP30 (HX1295)

Route Details:

Cycle on next source that meets the conditions stated in the loop definition.
If no more sources meet the stated conditions, END LOOP_30 and continue with BOX_210.

BOX_210 (HX1300)

Route Details:

Programmer Instructions:

BOX_210 will set a person level flag - Person.HasCovFlag - YES/NO. This flag is set one time and is not reset even when backing up and coming forward again. Once Loop_40 is "on path" it needs to stay on path.
An RU member is WITH any source of public or private health insurance if he/she meets the following conditions:
Round 1:
Person is covered by public insurance, excluding IHS [Insurance.HIPublPriv=Public and Insurance.HISrc () IHS])
OR
Persons is covered by private insurance [Insurance.HIPublPriv=Private and PersID exists in covered person array]
Note: IHS does not count as covered in Round 1. Being listed as a covered person on any other insurance source during Round 1 counts as "being covered".
Rounds 2-5:
Person is covered by Medicare in the current round [Insurance.HISrc=Medicare and ((OrigRnd () current round) or (OrigRnd=current round and person selected at HX40 or HX60 or HX50=Yes))]
OR
Person is covered by Medicaid/SCHIP in the current round [Insurance.HISrc=Medicaid and (HX100_01=Yes or PR150_01=Yes or PR160_01=Yes for person)]
OR
Person is covered by Military Health in the current round [Insurance.HISrc=Military and (HX120_01=Yes or PR260_01=Yes or PR270_01=Yes for person)]
OR
Person is covered by Gov't-Hospital/Physician in the current round [Insurance.HISrc=GHP and (person selected HX170 or PR310_01=Yes or PR320_01=Yes for person)]
OR
Person is covered by private insurance created this round [Insurance.HIPublPriv=Private and PersID exists in covered person array and OrigRnd=current round]
OR
Person is covered by private insurance (created in a previous round) with hospital and physician or Medigap benefits and for which they are still covered at least one day during the current round [(Insurance.HIPublPriv=Private) and (PersID exists in covered person array) and (Insurance.HospHI=Yes or Insurance.MedigapHI= Yes) and (OrigRnd () current round) and (OE20_01=1/DK/RF or OE30_01=1 or OE50_01=Yes for person)]
Note: IHS does not count as covered in Rounds 2-5. Private insurance without hospital/physician benefits or Medigap benefits does not count as covered in Round 2-5. In the OE section, the coverage question, OE130 may or may not have been asked. If not asked, use preloaded value to check for type of coverage provided by that insurance. Being listed as a covered person on any other source counts as "being covered" during the current round.
However, if a person is covered by private insurance and the coverage type is empty, count that as "being covered" during the current round. We want to count anyone with newly added employer, union, direct purchase insurance (anything just created at HX200 in the current round) as covered.
Note: If the RU member had coverage, even if it ended on the first day of the reference period (i.e., reviewed in Rd 2 and ended that first day), the current process would consider them insured.
Otherwise, if an RU member does not meet any of the above conditions, then that RU member is WITHOUT any source of public or private health insurance (set Person.HasCovFlag=No).
Person.HasCovFlag is set only one time. The first time the RU member passes through BOX_210/LOOP_40.

LOOP_40 (HX1305)

Route Details:

For each element in RU-MEMBERS-ROSTER, ask HX210-END_LP40.
Loop definition: LOOP_40 cycles through all RU members without any source of public or private health insurance during the entire reference period to receive a verification question.
This loop cycles on RU members who are NOT a covered person on any insurance (Person.HasCovFlag()YES).
Note: See BOX_210 for programming definition of Person.HasCovFlag.

HX210 (HX1310)

BLAISE NAME: HospMDCovg

Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]

Question Text:

[I have recorded that [you are/[PERSON] is] covered by [Indian Health Service] [and] [health insurance that may not include hospital and physician benefits]./I have recorded that [you are/[PERSON] is] not currently covered by any kind of health plan or health coverage.]
[Were you/Was [PERSON]] covered at any time [since [PERSON'S START DATE]/between [PERSON'S START DATE] and [PERSON'S END DATE]], even if just for one day, by any [other] kind of health plan or health coverage that included hospital and physician benefits?

Responses:

YES, COVERED 1 HX215 (HX1315)
NO, NOT COVERED 2 END_LP40 (HX1430)
REFUSED RF END_LP40 (HX1430)
DON'T KNOW DK END_LP40 (HX1430)

Display Instructions:

Display 'I have recorded ? physician benefits.' if RU member being looped on is "COVERED BY INDIAN HEALTH SERVICE" [Insurance.HISrc=IHS and (person selected at HX140 or PR290_01=Yes or PR300_01=Yes for person)] or is listed as a covered person for insurance that does not provide hospital and physician or Medigap coverage during the current round [(Insurance.HIPubPriv=Private) and (PersID exists in covered person array) and (Insurance.HospHI ()Yes and Insurance.MedigapHI ()Yes) and (OrigRnd () current round)]. Otherwise, display 'I have recorded ? health coverage.'
Display 'Indian Health Service' is RU member being looped on is "COVERED BY INDIAN HEALTH SERVICE" during the current round. Otherwise, use a null display.
Display 'health insurance that may not include hospital and physician benefits' if RU member being looped on is listed as a covered person for private insurance that does not include hospital and physician benefits or Medigap benefits. Otherwise, use a null display.
Display 'and' if RU member being looped on has both Indian Health Service and private coverage without hospital and physician or Medigap benefits. Otherwise, use a null display.
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 'other' if RU member being looped on is "COVERED BY INDIAN HEALTH SERVICE" or is listed as a covered person for insurance that does not provide hospital and physician or Medigap coverage during the current round. Otherwise, use a null display.

HX215 (HX1315)

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

For that coverage, [do you/does [PERSON]] get it through a job, the government or state, is it privately purchased, for example through an insurance company, HMO, or [do you/does [he/she]] get it some other way?
IF NEEDED, SAY:
JOB: Former job/Retiree, Union, Spouse/parent's job, Job with the government, COBRA GOVERNMENT OR STATE:
[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME], Medicare (Parts A+B; Part C), Medicare Advantage, Military health coverage (TRICARE, CHAMPVA, VA); State-provided health coverage PRIVATELY PURCHASED: From an insurance agent, insurance company, HMO, Exchange plan/Marketplace OTHER: Parent or spouse, Group or association, Medicare Supplements

Responses:

JOB (CURRENT OR FORMER) 1 HX225 (HX1317)
GOVERNMENT OR STATE 2 HX220 (HX1316)
PRIVATELY PURCHASED 3 BOX_310 (HX1400)
SOME OTHER WAY 4 BOX_310 (HX1400)

Programmer Instructions: DK and RF disallowed.

Display Instructions:

HX220 (HX1316)

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

Is that coverage related to a job with the government or state?
IF NECESSARY, SAY: Include coverage through former employers and unions, and COBRA plans.

Responses:

YES 1 HX225 (HX1317)
NO 2 HX230 (HX1325)
REFUSED RF HX230 (HX1325)
DON'T KNOW DK HX230 (HX1325)

Display Instructions:

HX225 (HX1317)

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

Is that plan related to military service in any way?
IF NECESSARY, SAY: Examples of military plans include: VA Care, TRICARE, TRICARE for Life, CHAMPVA, or other military care.
HELP: F1

Responses:

YES 1 HX260 (HX1365)
NO 2 BOX_310 (HX1400)
REFUSED RF BOX_310 (HX1400)
DON'T KNOW DK BOX_310 (HX1400)

Programmer Instructions:

If coded '1' (YES), create insurance through Military health care for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Military and Insurance.HISrcName=Military Health and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions:

HX230 (HX1325)

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

AND HX-4
From which of the government or state sources on card HX-4 [were you/was [PERSON]] covered by?
ENTER ALL THAT APPLY.
HELP: F1>

Responses:

MEDICARE 1 BOX_220 (HX1330)
MEDICAID/[STATE NAME FOR MEDICAID] 2 BOX_220 (HX1330)
SCHIP/[STATE NAME FOR SCHIP] 3 BOX_220 (HX1330)
TRICARE 4 BOX_220 (HX1330)
CHAMPVA 5 BOX_220 (HX1330)
VA 6 BOX_220 (HX1330)
OTHER GOVERNMENT PROGRAM PROVIDING HOSPITAL/PHYSICIAN BENEFITS 7 BOX_220 (HX1330)

Programmer Instructions:

If coded '1' (MEDICARE), create public insurance through Medicare for this person [set Insurance.HIPublPriv=Public and Insurance.HISrc=Medicare and Insurance.HISrcName=Medicare and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]
If coded '2' (MEDICAID) and/or '3' (SCHIP), create public insurance through
Medicaid/SCHIP for this person [set Insurance.HIPublPriv=Public and Insurance.HISrc=Medicaid and Insurance.HISrcName=[Medicaid/[STATE NAME FOR MEDICAID]]/[STATE CHIP NAME]and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]
If coded '4' (TRICARE), '5' (CHAMPVA), and/or '6' (VA), create public insurance through Military health care for this person [set Insurance.HIPublPriv=Public and Insurance.HISrc=Military and Insurance.HISrcName=Military Health and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]
If coded '7' (OTHER GOVERNMENT PROGRAM PROVIDING HOSPITAL/PHYSICIAN BENEFITS), create public insurance through Gov't-Hospital/Physician for this person [set Insurance.PublPriv=Public and Insurance.HISrc =GHP and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd] Note: Insurance.HISrcName is set later.

Display Instructions:

BOX_220 (HX1330)

Route Details:

If HX230 is coded '1' (MEDICARE) and person is less than 65 years old (or in age categories 1- 8), continue with HX240.
Otherwise, go to BOX_230.

HX240 (HX1335)

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

[Do/Does] [you/[PERSON]] receive Medicare because of a medical condition or a disability?
HELP: F1

Responses:

YES 1 BOX_230 (HX1340)
NO 2 BOX_230 (HX1340)
REFUSED RF BOX_230 (HX1340)
DON'T KNOW DK BOX_230 (HX1340)

Display Instructions:

BOX_230 (HX1340)

Route Details:

If HX230 is coded '2' (MEDICAID) and/or '3' (SCHIP), continue with BOX_240.
Otherwise, go to BOX_260.

BOX_240 (HX1345)

Route Details:

Ask the time period covered detail (HQ) section for this person.
This instance of the HQ section collects time period coverage detail for the current RU member that just had Medicaid/SCHIP added at HX230. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
Insurance source is Medicaid/SCHIP [Insurance.HISrc=Medicaid]
AND
HX230 is coded '2' (MEDICAID) and/or '3' (SCHIP) for the person being looped on At completion of the HQ section, continue with BOX_250.

BOX_250 (HX1350)

Route Details:

If HX_Main.CaidExch () EMPTY, go to BOX_260.
Otherwise, continue with HX250.
NOTE: Preload.HX_Main.CaidExch is written to HX_Main.CaidExch if Medicaid is confirmed for the RU in the PR section (i.e., PR150_01 or PR160_01 is coded '1' (YES) for at least one RU member). This skip is trying to determine if the exchange coverage question has already been asked (collected at [HX105] or [HX250 during an earlier cycle] or collected [during a previous round at one of these items and Medicaid/SHIP insurance was confirmed in PR]). Exchange coverage is collected only once for Medicaid/SCHIP name per RU and it is collected when the coverage is first created.

HX250 (HX1355)

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

Is the coverage with [Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME] through [STATE EXCHANGE NAME-A] [, [which may also be known as [ALIAS B] [or [ALIAS C]]]]?

Responses:

YES 1 BOX_260 (HX1360)
NO 2 BOX_260 (HX1360)
REFUSED RF BOX_260 (HX1360)
DON'T KNOW DK BOX_260 (HX1360)

Programmer Instructions:

If coded '1' (YES), set HX_Main.CaidExch = Yes. Else, set HX_Main.CaidExch=No.

Display Instructions:

BOX_260 (HX1360)

Route Details:

If HX230 is coded '4' (TRICARE), '5' (CHAMPVA), and/or '6' (VA), continue with HX260.
Otherwise, go to BOX_280.

HX260 (HX1365)

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

What types of military health coverage [do/does] [you/[PERSON]] have? [Do you/Does [he/she]] have TRICARE Standard, TRICARE Prime, TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?
ENTER ALL THAT APPLY.
HELP: F1

Responses:

TRICARE STANDARD 1 BOX_270 (HX1370)
TRICARE PRIME 2 BOX_270 (HX1370)
TRICARE EXTRA 3 BOX_270 (HX1370)
TRICARE FOR LIFE 4 BOX_270 (HX1370)
CHAMPVA 5 BOX_270 (HX1370)
VA (VETERAN'S ADMINISTRATION) 6 BOX_270 (HX1370)

Programmer Instructions: DK and RF disallowed.
Display Instructions:

BOX_270 (HX1370)

Route Details:

Ask the time period covered detail (HQ) section for this person.
This instance of the HQ section collects time period coverage detail for the current RU member that just had Military Health added at HX230. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
Insurance source is MILITARY HEALTH (Insurance.HISrc=Military) and HX225 is coded '1' (YES) or HX230 is coded '4' (TRICARE), '5' (CHAMPVA), and/or '6' (VA) for the person being looped on At completion of the HQ section, continue with BOX_280.

BOX_280 (HX1375)

Route Details:

If HX230 is coded '7' (OTHER GOVERNMENT PROGRAM PROVIDING HOSPITAL/PHYSICIAN BENEFITS) and HX_Main.GHPProgName()EMPTY, set Insurance.HISrcName to Insurance.HISrcName for that person's GHP coverage and then go to BOX_290.
If HX230 is coded '7' (OTHER GOVERNMENT PROGRAM PROVIDING HOSPITAL/PHYSICIAN BENEFITS) and HX_Main.GHPProgName=Empty, go to HX270.
Otherwise, go to END_LP40.
NOTE: Preload.HX_Main.GHPProgName is written to HX_Main.GHPProgName if Government-Hospital/Physician coverage is confirmed for the RU in the PR section (i.e., PR310_01 or PR320_01 is coded '1' (YES) for at least one RU member). This skip is trying to determine if there is already a program name linked to the Gov't Hospital/Physician insurance (collected at [HX160] or [HX270 during an earlier cycle] or collected [during a previous round at one of these items and Gov't Hospital/Physician insurance was confirmed in PR]). There can only be one Gov't Hospital/Physician program name per RU and it is collected when the coverage is first created.

HX270 (HX1380)

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

What is the name of the program from any state or local government agency which provided hospital and physician

Responses: 1 BOX_290 (HX1385)
Programmer Instructions:

Set Insurance.HISrcName= 'GOVT-HOS/PHY-[PROGRAM NAME FROM HX270]'.
Set HX_Main.GHPProgName=Yes.
Note: 'GOVT-HOS/PHY-[PROGRAM NAME FROM HX270]' substituting 17 characters of the entry at HX270 should be used for the insurance source name in the context header (where appropriate).

Display Instructions:

BOX_290 (HX1385)

Route Details:

Ask the time period covered detail (HQ) section for this person.
This instance of the HQ section collects time period coverage detail for the current RU member that just had Govt-Hospital/Physician added at HX230. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
Insurance source is Govt-Hospital/Physician (Insurance.HISrc = GHP)
AND
HX230 is coded '7' (OTHER GOVERNMENT PROGRAM PROVIDING HOSPITAL/PHYSICIAN BENEFITS) for the person being looped on
At completion of the HQ section, continue with BOX_300.

BOX_300 (HX1390)

Route Details:

If HX_Main.GHPExchange() EMPTY, go to END_LP40.
Otherwise, continue with HX280.
NOTE: Preload.HX_Main.GHPExchange is written to HX_Main.GHPExchange if
Government-Hospital/Physician is confirmed for the RU in the PR section (i.e., PR310_01 or PR320_01 is coded '1' (YES) for at least one RU member). This skip is trying to determine if the exchange coverage question has already been asked (collected at [HX180] or [HX280 during an earlier cycle] or collected [during a previous round at one of these items and Gov't Hospital/Physician insurance was confirmed in PR]). Exchange coverage is collected only once for Gov't Hospital/Physician name per RU and it is collected when the coverage is first created.

HX280 (HX1395)

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

Is the coverage with [PROGRAM NAME FROM HX270], the program sponsored by a state or local government agency which provided hospital and physician benefits, through [STATE EXCHANGE NAME-A] [, [which may also be known as [ALIAS B] [or [ALIAS C]]]]?

Responses:

YES 1 END_LP40 (HX1430)
NO 2 END_LP40 (HX1430)
REFUSED RF END_LP40 (HX1430)
DON'T KNOW DK END_LP40 (HX1430)

Programmer Instructions:

If coded '1' (YES), set HX_Main.GHPExchange = Yes. Else, set HX_Main.GHPExchange=No.

Display Instructions:

For '[PROGRAM NAME FROM HX270]', display the text entry from HX270.
Display ', [which may also be known as [ALIAS B] [or [ALIAS C]]]' if there is more than one exchange name associated with the state in which interview is being conducted.
Display 'or [ALIAS C]' if there are three exchange names associated with the state in which interview is being conducted.
For 'STATE EXCHANGE NAME-A', 'ALIAS B' and 'ALIAS C' display the exchange name associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

BOX_310 (HX1400)

Route Details:

Check health insurance in RU. If any existing private health insurance coverage (including Employer, Union, Direct Purchase) for anyone in the RU, that is, at least one insurance on the insurance array meets one of the following conditions.
Private insurance created this round [Insurance.HIPubPriv=Private and OrigRnd=current round]
OR
Private insurance (created in a previous round) and for which at least one person is still covered at least one day during the current round [(Insurance.HIPubPriv=Private) and (at least one PersID exists in covered person array) and (OrigRnd () current round) and (OE20_01 or OE30_01=1 or OE50_01=Yes for that person in the covered person array)] continue with HX290.
Otherwise, go to BOX_330.

HX290 (HX1405)

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

I have recorded health insurance for other members of this household. Was the health coverage [you/[PERSON] had [since [PERSON'S START DATE]/between [PERSON'S START DATE] and [PERSON'S END DATE]] one of these?
USING LIST BELOW, REVIEW SOURCES OF HEALTH INSURANCE ALREADY CREATED FOR OTHER RU MEMBERS.
IF [PERSON] COVERED BY EXISTING INSURANCE, SELECT THAT INSURANCE.
IF [PERSON] NOT COVERED BY ANY OF THESE EXISTING INSURANCE SOURCES, SELECT 'INSURANCE NOT LISTED' TO ADD NEW INSURANCE.

Responses:

[POLICYHOLDER] [INSURANCE SOURCE] [PLAN] [COVERED RU MEMBERS]1 1 BOX_320 (HX1410)
[POLICYHOLDER] [INSURANCE SOURCE] [PLAN] [COVERED RU MEMBERS]2 2 BOX_320 (HX1410)
[POLICYHOLDER] [INSURANCE SOURCE] [PLAN] [COVERED RU MEMBERS]3 3 BOX_320 (HX1410)
[POLICYHOLDER] [INSURANCE SOURCE] [PLAN] [COVERED RU MEMBERS]4 4 BOX_320 (HX1410)
[POLICYHOLDER] [INSURANCE SOURCE] [PLAN] [COVERED RU MEMBERS]N 5 BOX_320 (HX1410)
INSURANCE NOT LISTED 99 BOX_330 (HX1411)

Programmer Instructions:

RF/DK not allowed.
If not already included in the covered person array, add the person being looped on to the covered person array for the insurance source selected.
Note: Since the persons is being added to an existing insurance source, it is not necessary to set the create Q and OrigRnd here. Those should have been set elsewhere.

Display Instructions:

Display the roster in non-proportional text.
Roster 1 - Report
Roster Definition:
This item displays sources of insurance in the insurance array.
Roster Filter:
Display only private insurance that meets one of the of the following two conditions:
Private insurance created this round [Insurance.HIPubPriv=Private and OrigRnd=current round]
OR
Private insurance (created in a previous round) and for which at least one person is still covered at least one day during the current round [(Insurance.HIPubPriv=Private) and (at least one PersID exists in covered person array) and (OrigRnd () current round) and (OE20_01=1/DK/RF or OE30_01=1 or OE50_01=Yes for that person in the covered person array)]
Display underlined column headers as part of the info pane.
Display eligible insurance formatted into the following roster columns:
Column Header #1: Policyholder
Display the first 25 characters of the full name (Person.FullName) of policyholder for this insurance source (Insurance.Plcyhldr). This includes the full name of any RU or DU member selected as the policyholder. If the policyholder is outside of the DU, display the policyholder name as 'PLCYHLDR NOT IN DU-' followed by the first 6 characters of the entry at HP100. If the policyholder is deceased, display the policyholder name as 'PLCYHLDR DECEASED-' followed by the first 7 characters of the entry at HP110.
Column Header #2: Insurance Source
Display the first 25 characters of the name of the insurance source; e.g., job, union, group name (Insurance.HISrcName)
Column Header #3: Plan
Display the first 18 characters of the plan name of the insurance source (Insurance.Insurer). Leave cell blank if plan name is empty.
Column Header #4: Covered RU Members
Display the first 11 characters of the first names (Pers.FName) of all current RU members listed in the covered person array for this insurance source, excluding any DU member policyholder. Separate each name with a comma. Do not substitute "you" for respondent. Allow up to 38 characters for this column (which would allow for the first 3 covered persons in the first row and then next 3-6 in the second row).
Display 'since [START DATE]' if not round 5. Display 'between [START DATE] and [END DATE]' if round 5.

BOX_320 (HX1410)

Route Details:

Ask the time period covered detail (HQ) section for this person if person is not already listed in the covered person array for the insurance selected.
This instance of the HQ section collects time period coverage detail for the person being looped on who was just selected as a covered person for the private insurance selected at HX290. The grid for the HQ section should be preloaded with insurance meets both of the following conditions:
Insurance source selected at HX290 and Person is being looped on.
At completion of the HQ section or if person already listed in the covered person array for the insurance selected, go to END_LP40.

BOX_330 (HX1411)

Route Details:

If HX225 is coded '2' (NO), 'DK' (DON'T KNOW), or 'RF' (REFUSED), continue with BOX_340.
Otherwise, go to HX300.

BOX_340 (HX1412)

Route Details:

If HX225 is coded '2' (NO), 'DK' (DON'T KNOW), or 'RF' (REFUSED), create direct purchase insurance with the type "some other employer" for this person [set Insurance.HIPublPriv=Private and Insurance.HISrc=Direct Purchase and Insurance.DirectPurchTp=9 (Other Employer)] [set Create Q and OrigRnd]. Then ask the Private Health Insurance detail (HP) section for the direct purchase insurance with the type 'some other employer' just created.
At completion of HP section, go to END_LP40.

HX300 (HX1415)

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

ANDHX-3
From which source on card HX-3 did [you/[PERSON]] purchase or obtain this health insurance coverage?
HELP: F1

Responses:

FROM A GROUP OR ASSOCIATION 1 BOX_350 (HX1425)
DIRECTLY THROUGH A SCHOOL 2 BOX_350 (HX1425)
DIRECTLY FROM AN INSURANCE AGENT 3 BOX_350 (HX1425)
DIRECTLY FROM INSURANCE COMPANY 4 BOX_350 (HX1425)
DIRECTLY FROM AN HMO 5 BOX_350 (HX1425)
FROM A UNION 6 BOX_350 (HX1425)
FROM ANYONE'S PREVIOUS EMPLOYER 7 BOX_350 (HX1425)
FROM SPOUSE'S/DECEASED SPOUSE'S PREVIOUS EMPLOYER 8 BOX_350 (HX1425)
FROM SOME OTHER EMPLOYER 9 BOX_350 (HX1425)
UNDER A PLAN OF SOMEONE NOT LIVING HERE 10 BOX_350 (HX1425)
DIRECTLY FROM [STATE EXCHANGE NAME-A] 11 BOX_350 (HX1425)
OTHER SOURCE 91 HX300OS (HX1420)
REFUSED RF BOX_350 (HX1425)
DON'T KNOW DK BOX_350 (HX1425)

Programmer Instructions:

When source is selected, create direct purchase insurance with the type selected at HX300 for this person [set Insurance.HIPublPriv=Private and Insurance.HISrc=DirectPurchase and Insurance.DirectPurchTp=type selected] [set Create Q and OrigRnd]

Display Instructions:

Display HX300 and HX300OS on the same form pane screen.
For 'STATE EXCHANGE NAME-A' display exchange name 'A' associated with the state in which interview is being conducted. For the specific name to use by state, see the plan fill file.

HX300OS (HX1420)

BLAISE NAME: DirectPurchTpOS
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
SPECIFY: OTHER SOURCE
Responses: 1 BOX_350 (HX1425)
Programmer Instructions: Refused and Don't Know disallowed.
Display Instructions: Display HX300 and HX300OS on the same form pane screen.

BOX_350 (HX1425)

Route Details:

Ask Private Health Insurance detail (HP) section for the response category selected at HX300.
At completion of the HP section, continue with END_LP40.

END_LP40 (HX1430)

Route Details:

Cycle on next person that meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_40 and continue with BOX_360.

BOX_360 (HX1435)

Route Details:

If any RU member has Medicare as a source of insurance during the current round (Insurance.HISrc=Medicare), continue with BOX_370.
Otherwise, go to BOX_390.

BOX_370 (HX1440)

Route Details:

If round 1, go to LOOP_50.
Otherwise, continue with BOX_380.

BOX_380 (HX1445)

Route Details:

If not round 1, continue with LOOP_50 only for RU members where Medicare was recorded as being received this round. That is, continue with LOOP_50 only if there is at least one insurance that is Medicare and was created this round (Insurance.HISrc=Medicare and OrigRnd=current round).
Otherwise, go to BOX_390.

LOOP_50 (HX1450)

Route Details:

For each insurance, ask HX310- END_LP50.
Loop definition: LOOP_50 collects Medicare card and managed care information for RU members covered by Medicare. This loop cycles on insurance that meets the following conditions:
If round 1:
Insurance source is Medicare (Insurance.HISrc=Medicare)
If not round 1:
Insurance source is Medicare (Insurance.HISrc=Medicare)
AND
Medicare was created this round (OrigRnd=current round)

HX310 (HX1455)

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

CODE WITHOUT ASKING IF ANSWER IS KNOWN.
Can you please take out [your/[PERSON]' s] Medicare card?
We do not need [your/his/her] Medicare number, but would like to record the exact date [your/his/her] Medicare coverage became effective and what type of coverage [you/he/she] [have/has] through Medicare.

Responses:

CARD AVAILABLE 1 HX320 (HX1460)
CARD NOT AVAILABLE 2 HX350 (HX1485)
REFUSED RF HX350 (HX1485)
DON'T KNOW DK HX350 (HX1485)

Display Instructions:

HX320 (HX1460)

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

Is that card a regular Medicare card, a Railroad Retirement Board card, or some other Medicare card?

Responses:

MEDICARE CARD (RED, WHITE AND BLUE) 1
RAILROAD RETIREMENT BOARD CARD (RED, WHITE AND BLUE) 2
SOME OTHER CARD 3

Programmer Instructions:

If coded '1' (MEDICARE CARD) or '2' (RAILROAD RETIREMENT BOARD CARD), alone or in combination with any other code continue with HX330_01.
If coded '3' (SOME OTHER CARD) alone, go to HX350.
Note: HX320 is a multi-select item, but the "ENTER ALL THAT APPLY." Instruction is purposely left off the screen.
DK and RF disallowed.

Display Instructions:

HX330_01 (HX1465)

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

ANDHX-1
Please tell me the effective date listed on the card.
ENTER MONTH

Responses:

1 HX330_02 (HX1470)
REFUSED RF HX330_02 (HX1470)
DON'T KNOW DK HX330_02 (HX1470)

Display Instructions:

Display HX330_01, HX330_02, and HX330_03 on the same form pane.

HX330_02 (HX1470)

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

AND HX-1
[Please tell me the effective date listed on the card.]
ENTER DAY

Responses:

1 HX330_03 (HX1475)
REFUSED RF HX330_03 (HX1475)
DON'T KNOW DK HX330_03 (HX1475)

Display Instructions:

Display show card icon and reference and question text in lighter "grayed out" text.
Display HX330_01, HX330_02, and HX330_03 on the same form pane.

HX330_03 (HX1475)

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

AND HX-1
[Please tell me the effective date listed on the card.]
ENTER YEAR

Responses:

1 HX340 (HX1480)
REFUSED RF HX340 (HX1480)
DON'T KNOW DK HX340 (HX1480)

Programmer Instructions:

Hard checks:
Check effective date entered at HX330_01-HX330_03. Date entered must be on or before (i.e., or =) the person's reference period end date for this round (EndRefM, EndRefD). In round 5, that is typically Dec. 31 for panel year 2. If not, display the following message: "EFFECTIVE DATE MUST BE BEFORE [PERSON'S REFERENCE PERIOD END DATE]. VERIFY AND RE-ENTER."
Soft range check:
Medicare effective date entered at HX330_01-HX330_03 must be on or after (= or ) birth date of person. If not, display the following message: "UNLIKELY RESPONSE. EFFECTIVE DATE IS PRIOR TO [PERSON]'S DOB [MM/DD/YYYY]. VERIFY AND CORRECT EFFECTIVE DATE. If any part of birth date is unknown, hard check is not invoked.
If Round 1 and if effective date is on or before January 1, [YEAR], where 'year' is the first calendar year of the panel (FirstPanYear), set SimplePerson.CovdJan1=Yes.

Display Instructions:

Display show card icon and reference and question text in lighter "grayed out" text.
Display HX330_01, HX330_02, and HX330_03 on the same form pane.

HX340 (HX1480)

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

AND HX-1
[Are/is] [you/[PERSON]] entitled to hospital (Part A), medical (Part B), or both?

Responses:

HOSPITAL ONLY 1 HX390 (HX1510)
MEDICAL AND HOSPITAL 2 HX390 (HX1510)
MEDICAL ONLY 3 HX390 (HX1510)

Display Instructions:

HX350 (HX1485)

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

Part A of Medicare covers most hospital expenses. Part B covers many doctor's expenses, including doctor visits, and the premium is usually deducted from [your/[PERSON]'s] Social Security.
[Are/Is] [you/he/she] covered under Part B of Medicare?

Responses:

YES 1 HX360_01 (HX1490)
NO 2 HX360_01 (HX1490)
REFUSED RF HX360_01 (HX1490)
DON'T KNOW DK HX360_01 (HX1490)

Display Instructions:

HX360_01 (HX1490)

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

When did [your/[PERSON]'s] Medicare coverage start?
ENTER MONTH

Responses:

1 HX360_02 (HX1495)
REFUSED RF HX360_02 (HX1495)
DON'T KNOW DK HX360_02 (HX1495)

Display Instructions: Display HX360_01 and HX360_02 on the same form pane.

HX360_02 (HX1495)

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

[When did [your/[PERSON]'s] Medicare coverage start?]
ENTER YEAR

Responses: 1

REFUSED RF HX370 (HX1500)
DON'T KNOW DK HX370 (HX1500)

Programmer Instructions:

If HX360_02 is equal to Panel Year 1 (FirstPanYear) and HX360_01 is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW), continue with HX370. Otherwise (when there is a value for year), go to HX380.
If Round 1 and if effective date entered at HX360_01 and HX360_02 is:
A valid date (i.e., not 'RF (REFUSED) or 'DK' (DON'T KNOW) in the month or year fields and on or before January, [YEAR], where 'YEAR' is the first calendar year of the panel (FirstPanYear), then set SimplePerson.CovdJan1=Yes
Hard check:
Check effective date entered at HX360_01 and HX360_02. Date entered must be on or before (i.e., less than or =) the person's reference period end date for this round (EndRefM, EndRefD). In round 5, that is typically Dec. 31 for panel year 2.. If not, display the following message: "EFFECTIVE DATE MUST BE BEFORE [PERSON'S REFERENCE PERIOD END DATE]. VERIFY AND RE-ENTER."
Soft range check: Medicare effective date entered at HX360_01 and HX360_02 must be on or after (= or >) birth date of person. If not, display the following message: "UNLIKELY RESPONSE. EFFECTIVE DATE IS PRIOR TO [PERSON]'S DOB [MM/DD/YYYY]. VERIFY AND CORRECT EFFECTIVE DATE. If any part of birth date is unknown, hard check is not invoked.

Display Instructions:

Display question text in lighter "grayed out" text.
Display HX360_01 and HX360_02 on the same form pane.

HX370 (HX1500)

BLAISE NAME: CareCovJan1
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

Did [you/he/she] have Medicare coverage on January 1, [YEAR]?

Responses:

YES 1 HX380 (HX1505)
NO 2 HX380 (HX1505)
REFUSED RF HX380 (HX1505)
DON'T KNOW DK HX380 (HX1505)

Programmer Instructions: If Round 1 and if HX370 coded '1' (YES), set SimplePerson.CovdJan1=Yes.
Display Instructions:

HX380 (HX1505)

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

ANDHX-1
[Do/Does] [you/[PERSON]] have a Medicare card that looks like this?

Responses:

YES 1 HX390 (HX1510)
NO 2 HX390 (HX1510)
REFUSED RF HX390 (HX1510)
DON'T KNOW DK HX390 (HX1510)

Display Instructions:

HX390 (HX1510)

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

[[Are/Is] [you/[PERSON]] currently/As of [PERSON'S END DATE], [were/was] [you/[PERSON]] enrolled in a Medicare Advantage or managed care plan, such as an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) to receive [your/his/her] Medicare-funded health care? When answering, please include only insurance from Medicare, not any privately purchased or job-related insurance.
HELP: F1

Responses:

YES 1 HX400 (HX1515)
NO 2 HX470 (HX1555)
REFUSED RF HX470 (HX1555)
DON'T KNOW DK HX470 (HX1555)

Display Instructions:

Display '[Are/Is] [you/[PERSON]] currently' if not round 5. Display 'As of [PERSON'S END DATE], [were/was] [you/[PERSON]]' if round 5.

HX400 (HX1515)

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

What [is/was] the name of [your/[PERSON]'s] Medicare managed care plan [as of [PERSON'S END DATE]]?
ENTER PLAN NAME

Responses:

1 HX410 (HX1520)
REFUSED RF HX410 (HX1520)
DON'T KNOW DK HX410 (HX1520)

Programmer Instructions: Set Insurance.Insurer to HX400.
Display Instructions:

Display 'is' if not round 5. Display 'was' if round 5.
Display 'as of [PERSON'S END DATE]' if round 5. Otherwise, use a null display.

HX410 (HX1520)

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

[Do/Does]/Did] [you/[PERSON]] have prescribed medicine coverage through [[NAME OF PLAN FROM HX400] [your/his/her] Medicare managed care plan] [as of [PERSON'S END DATE]]?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If round 1 or round 3, continue with HX420.
Otherwise, go to END_LP50.

Display Instructions:

Display '[Do/Does]' if not round 5. Display 'Did' if round 5.
Display '[NAME OF PLAN FROM HX400]' if a plan name was coded at HX400. Display '[your/his/her] Medicare managed care plan' if HX400 is coded RF (REFUSED) or DK (DON'T KNOW).
Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.
Display 'as of [PERSON'S END DATE]' if round 5. Otherwise, use a null display.

HX420 (HX1525)

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

Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, [do/does] [you/[PERSON]] (or anyone in the family) pay anything else for [the coverage with [[NAME OF PLAN FROM HX400]/this Medicare managed care plan]?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]
HELP: F1

Responses:

YES 1 HX430 (HX1530)
NO 2 END_LP50 (HX1590)
REFUSED RF END_LP50 (HX1590)
DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

Display 'the coverage with [NAME OF PLAN FROM HX400]' if a Medicare plan name was entered at HX400. Display 'this Medicare managed care plan' if HX400 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).
Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.

HX430 (HX1530)

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

How [do/does] [you/[PERSON]] pay for [your/his/her] [[NAME OF PLAN FROM HX400]/Medicare managed care] premium?
IF NECESSARY, SAY: Is the Medicare Advantage premium paid through [your/his/her] Social Security check, paid directly to the provider, or paid both ways?

Responses:

DEDUCTED FROM SOCIAL SECURITY 1 HX440 (HX1535)
PAY DIRECTLY 2 HX440 (HX1535)
BOTH 3 HX440 (HX1535)
REFUSED RF END_LP50 (HX1590)
DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

Display '[NAME OF PLAN FROM HX400]' if a Medicare plan name was entered at HX400. Display 'Medicare managed care' if HX400 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).
Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.

HX440 (HX1535)

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

How much [is [your/[PERSON]'s] Social Security deduction/[do/does] [you/[PERSON]] pay in premiums] for [your/his/her] [NAME OF PLAN FROM HX400] plan?
IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.
ENTER AMOUNT

Responses:

1 HX450 (HX1540)
REFUSED RF HX460 (HX1550)
DON'T KNOW DK HX460 (HX1550)

Programmer Instructions: Allow for entry of dollars and cents.

Display Instructions:

Display HX440, HX450 and HX450OS on the same form pane.
Display 'is [your/[PERSON]'s] Social Security deduction' if HX430 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '[do/does] [you/[PERSON]] pay in premiums' if HX430 is coded '2' (PAY DIRECTLY) or '3' (BOTH).
Display '[NAME OF PLAN FROM HX400]' if a Medicare plan name was entered at HX400.
Otherwise (i.e., if HX400 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW)), use a null display.
Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.

HX450 (HX1540)

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

Is that per year, per month, per week, or what?
UNIT OF COVERAGE:

Responses:

PER YEAR 1 END_LP50 (HX1590)
EVERY 3 MONTHS (QUARTERLY) 2 END_LP50 (HX1590)
EVERY 2 MONTHS (BIMONTHLY) 3 END_LP50 (HX1590)
PER MONTH 4 END_LP50 (HX1590)
PER WEEK 5 END_LP50 (HX1590)
EVERY 2 WEEKS (BIWEEKLY) 6 END_LP50 (HX1590)
2 TIMES PER YEAR (SEMI-ANNUALLY) 7 END_LP50 (HX1590)
2 TIMES PER MONTH (SEMI-MONTHLY) 8 END_LP50 (HX1590)
OTHER 91 HX450OS (HX1545)
REFUSED RF END_LP50 (HX1590)
DON'T KNOW DK END_LP50 (HX1590)

Display Instructions: Display HX440, HX450 and HX450OS on the same form pane.

HX450OS (HX1545)

BLAISE NAME: CareCovgUnitOS
Question Text:

SPECIFY: UNIT OF COVERAGE

Responses:

1 END_LP50 (HX1590)
REFUSED RF END_LP50 (HX1590)
DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

Display HX440, HX450 and HX450OS on the same form pane.

HX460 (HX1550)

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

[PLAN NAME: [NAME OF PLAN FROM HX400]]
AND HX-5
Which category on card HX-5 best indicates the cost of this plan per month?

Responses:

$1 - $50 1 END_LP50 (HX1590)
$51 - $100 2 END_LP50 (HX1590)
$101 - $200 3 END_LP50 (HX1590)
$201 - $300 4 END_LP50 (HX1590)
$301 OR MORE 5 END_LP50 (HX1590)
REFUSED RF END_LP50 (HX1590)
DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

Display 'PLAN NAME: [NAME OF PLAN FROM HX400]' if a Medicare plan name was entered at HX400. Otherwise (i.e., if HX400was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW)), use a null display.
Display the actual plan name entered at HX400 for 'NAME OF PLAN FROM HX400' if a plan name was entered.

HX470 (HX1555)

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

[[Are/Is]/[Were/Was]] [you/[PERSON]] enrolled in Medicare Part D, also known as the Medicare Prescription Drug Plan [as of [PERSON'S END DATE]]?
HELP: F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded '1' (YES) and round 1 or round 3, continue with HX480.
Otherwise, go to END_LP50.

Display Instructions:

Display '[Are/Is]' if not round 5.
Display '[Were/Was]' if round 5.
Display 'as of [PERSON'S END DATE]' if round 5. Otherwise, use a null display.

HX480 (HX1560)

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

Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, [do/does] [you/[PERSON]] (or anyone in the family) pay anything else for [your/his/her] Medicare Prescription Drug Plan (also known as Part D)?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]
HELP: F1

Responses:

YES 1 HX490 (HX1565)
NO 2 END_LP50 (HX1590)
REFUSED RF END_LP50 (HX1590)
DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

HX490 (HX1565)

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

How [do/does] [you/[PERSON]] pay for [your/his/her] Part D premium?
IF NECESSARY, SAY: Is the Medicare drug coverage premium paid through [your/his/her] Social Security check, paid directly to the provider, or paid both ways?

Responses:

DEDUCTED FROM SOCIAL SECURITY 1 HX500 (HX1570)
PAY DIRECTLY 2 HX500 (HX1570)
BOTH 3 HX500 (HX1570)
REFUSED RF END_LP50 (HX1590)
DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

HX500 (HX1570)

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

How much [is [your/[PERSON]'s] Social Security deduction/[do/does] [you/[PERSON]] pay in premiums] for [your/his/her] Part D plan?
IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.
ENTER AMOUNT

Responses:

1 HX510 (HX1575)
REFUSED RF HX520 (HX1585)
DON'T KNOW DK HX520 (HX1585)

Programmer Instructions: Allow for the entry of dollars and cents.
Display Instructions:

Display HX500, HX510 and HX510OS on the same form pane.
Display 'is [your/[PERSON]'s] Social Security deduction' if HX490 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '[do/does] [you/[PERSON]] pay in premiums' if HX490 is coded '2' (PAY DIRECTLY) or '3' (BOTH).

HX510 (HX1575)

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

[How much [is [your/[PERSON]'s] Social Security deduction/[do/does] [you/[PERSON]] pay in premiums] for [your/his/her] Part D plan?]
Is that per year, per month, per week, or what?
ENTER UNIT OF COVERAGE:

Responses:

PER YEAR 1 END_LP50 (HX1590)
EVERY 3 MONTHS (QUARTERLY) 2 END_LP50 (HX1590)
EVERY 2 MONTHS (BIMONTHLY) 3 END_LP50 (HX1590)
PER MONTH 4 END_LP50 (HX1590)
PER WEEK 5 END_LP50 (HX1590)
EVERY 2 WEEKS (BIWEEKLY) 6 END_LP50 (HX1590)
2 TIMES PER YEAR (SEMI-ANNUALLY) 7 END_LP50 (HX1590)
2 TIMES PER MONTH (SEMI-MONTHLY) 8 END_LP50 (HX1590)
OTHER 91 HX510OS (HX1580)
REFUSED RF END_LP50 (HX1590)
DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

Display HX500, HX510 and HX510OS on the same form pane.
Display the "How much[is [your/[PERSON]'s] Social Security?" in brackets and grayed out text.
Display 'is [your/[PERSON]'s] Social Security deduction' if HX490 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '[do/does] [you/[PERSON]] pay in premiums' if HX490 is coded '2' (PAY DIRECTLY) or '3' (BOTH).

HX510OS (HX1580)

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

[How much [is [your/[PERSON]'s] Social Security deduction/[do/does] [you/[PERSON]] pay in premiums] for [your/his/her] Part D plan?]
SPECIFY: OTHER UNIT OF COVERAGE

Responses:

1 END_LP50 (HX1590)
REFUSED RF END_LP50 (HX1590)
DON'T KNOW DK END_LP50 (HX1590)

Display Instructions:

HX520 (HX1585)

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

AND HX-6
Which category on card HX-6 best indicates the cost of this plan per month?

Responses:

$1 - $30 1
$31 - $60 2
$61 - $90 3
$91 - $120 4
$121 OR MORE 5
REFUSED RF
DON'T KNOW DK

Display Instructions:

END_LP50 (HX1590)

Route Details:

Cycle on next insurance that meets the conditions stated in the loop definition.
If no other insurance meets the stated conditions, end LOOP_50 and continue with BOX_390.

BOX_390 (HX1595)

Route Details:

If any RU member has MEDICAID/SCHIP or GOVT-HOSPITAL/PHYSICIAN as a source of insurance during the current round (Insurance.HISrc=Medicaid or GHP), continue with BOX_400.
Otherwise, go to BOX_420.

BOX_400 (HX1600)

Route Details:

If at least one RU member is "COVERED BY MEDICAID/SCHIP" during the current round and PR150_01 was not asked for this RU [Insurance.HISrc=Medicaid and (HX100=YES) or ((HX230=2 or 3) and PR150 = EMPTY for everyone)], continue with LOOP_55.
If at least one RU member is "COVERED BY GOVT- HOSPITAL/PHYSICIAN" during the current round and PR310_01 was not asked for this RU [Insurance.HISrc=GHP and (at least one person selected at HX170) or ((HX230=7) and PR310 = EMPTY for everyone)], continue with LOOP_55.
Otherwise, go to BOX_420.

LOOP_55 (HX1601)

Route Details:

Ask HX530 to END_LP55 if Medicaid/SCHIP or Government-Hospital/Physician insurance covers at least one RU member.
Loop definition: LOOP_55 collects managed care and premium information for RUs with newly created Medicaid/SCHIP and/or Gov't-Hospital/Physician coverage. This loop can cycle a maximum of two times per RU - once for Medicaid/SCHIP and once for Gov't-Hospital/Physician. This loop does not cycle for Medicaid/SCHIP or Gov't-
Hospital/Physician if that coverage was already reviewed as part of the PR Section. This loop cycles on insurance that meets the following conditions:
If Round 1:
Insurance source is Medicaid/SCHIP and/or Gov't-Hospital/Physician (Insurance.HISrc=Medicaid or GHP)
If Rounds 2-5:
Insurance source is Medicaid/SCHIP and/or Gov't-Hospital/Physician (Insurance.
HISrc=Medicaid or GHP)
At least one RU member is "COVERED BY MEDICAID/SCHIP" and/or "COVERED BY GOVT- HOSPITAL/PHYSICIAN" during the current round and either PR150_01 or PR310_01 was not asked in the current round for the insurance source being cycled on.
-[Insurance. HISrc=Medicaid and (HX100=YES) or ((HX230=2 or 3) and PR150_01=EMPTY for everyone)]
OR
-[Insurance. HISrc=GHP and (at least one person selected at HX170) or ((HX230=7) and PR310_01= EMPTY for everyone)]
"NAME OF INSURANCE SOURCE" in the context header for this loop represents either Medicaid/SCHIP or Gov't-Hospital/Physician. [Insurance.HISrcName]

HX530 (HX1605)

BLAISE NAME: GovHMO
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

Under [[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]/[PROGRAM NAME FROM HX160/HX270], the program sponsored by a state or local government agency which provides hospital and physician benefits,] [[are/is]/[were/was]] [PERSON 1], [PERSON 2], [PERSON 3], [PERSON 4], [PERSON N] enrolled in an HMO, that is a Health Maintenance Organization [between [START DATE] and [END DATE]]?
[With an HMO, you must generally receive care from HMO physicians. If another doctor is seen, the expense is not covered unless you were referred by the HMO, or there was a medical emergency.]
HELP: F1

Responses:

YES, ALL ARE 1 HX550 (HX1615)
YES, SOME ARE 2 HX550 (HX1615)
NO, NONE ARE 3 HX540 (HX1610)
REFUSED RF HX540 (HX1610)
DON'T KNOW DK HX540 (HX1610)

Display Instructions:

Roster 1 - Report
Roster definition:
This item uses the insurance array to display RU member's first, middle, and last names (Person.FullName) in the question text. Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Roster filter:
When looping on Medicaid/SCHIP:
Insurance source is MEDICAID/SCHIP (Insurance.HISrc=Medicaid), and Person is an RU member covered by MEDICAID/SCHIP during the current round (HX100=YES) or (HX230=2 or 3), and [Round 1] or [Round 2-5 and PR150 = EMPTY for everyone].
When looping on Gov't-Hospital/Physician:
Insurance source is GOVT-HOSPITAL/PHYSICIAN (Insurance.HISrc=GHP), and Person is an RU member covered by GOVT-HOSPITAL/PHYSICIAN during the current round (at least one person selected at HX170) or (HX230=7), and [Round 1] or [Round 2-5 and PR310= EMPTY for everyone ].
Display '[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]' if asking about MEDICAID/SCHIP. Display '[PROGRAM NAME FROM HX160/HX270], the program...benefits,' if asking about GOVT- HOSPITAL/PHYSICIAN.
For '[PROGRAM NAME FROM HX160/HX270]', display the text entry from HX160 or HX270.
Display '(are/is)' if not round 5. Display (were/was)' if round 5.
Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for the program) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific name to use by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions (substituting the real state name for program).
For the specific name to use by state, see the plan fill file.
Display '[are/is]' if not round 5. Display '[were/was]' if round 5.
Display 'is' or 'was' if the list includes 1 person who is not the respondent. Otherwise, display 'are' or 'were'.
Display 'between [START DATE] and [END DATE]' if round 5. Otherwise, use a null display.

HX540 (HX1610)

BLAISE NAME: GovPrimaryMD
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

[Does/Between [START DATE] and [END DATE], did] [[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]/[PROGRAM NAME FROM HX160/HX270], the program sponsored by a state or local government agency which provides hospital and physician benefits,] require [PERSON 1], [PERSON 2], [PERSON 3], [PERSON 4], [PERSON N] to sign up with a certain primary care doctor, group of doctors, or with a certain clinic which they must go to for all of their routine care?
PROBE: Do not include emergency care or care from a specialist they were referred to.
HELP: F1

Responses:

YES, ALL REQUIRED 1 HX550 (HX1615)
YES, SOME REQUIRED 2 HX550 (HX1615)
NO, NONE REQUIRED 3 HX560 (HX1620)
REFUSED RF HX560 (HX1620)
DON'T KNOW DK HX560 (HX1620)

Programmer Instructions:

Note: If coded '3' (NO, NONE REQUIRED), 'RF' (REFUSED), or 'DK' (DON'T KNOW), there is no insurer associated with the current round for MEDICAID/SCHIP or GOVT-HOSPITAL/PHYSICIAN.

Display Instructions:

Roster 1 - Report
Roster definition:
Use HX530 definition.
Display RU member's first, middle, and last names (Person.FullName) in the question text. Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Roster filter:
Use HX530 filter.
Display 'Does' if not round 5. Display 'Between [START DATE] and [END DATE], did' if round 5.
Display '[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]' if asking about MEDICAID/SCHIP. Display '[PROGRAM NAME FROM HX160/HX270], the program... benefits,' if asking about GOVT-HOSPITAL/PHYSICIAN.
For '[PROGRAM NAME FROM HX160/HX270]', display the text entry from HX160 or HX270.
Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for the program) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific name to use by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions (substituting the real state name for program).
For the specific name to use by state, see the plan fill file.

HX550 (HX1615)

BLAISE NAME: OthGovProgName
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

What is the name of the [[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]] [HMO/health insurance] [from the program sponsored by a state or local government agency which provides hospital and physician benefits]?
ENTER PLAN NAME

Responses:

1 HX560 (HX1620)
REFUSED RF HX560 (HX1620)
DON'T KNOW DK HX560 (HX1620)

Programmer Instructions: Set Insurance.Insurer= HX550.
Display Instructions:

Display '[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]' if asking about MEDICAID/SCHIP. If asking about GOVT-HOSPITAL/PHYSICIAN, use a null display.
Display 'from the....benefits' if asking about GOVT-HOSPITAL/PHYSICIAN. If asking about MEDICAID/SCHIP, use a null display.
Display 'HMO' if HX530 is coded '1' (YES, ALL ARE) or '2' (YES, SOME ARE).
Display 'health insurance' if HX540 is coded '1' (YES, ALL REQUIRED) or '2' (YES, SOME REQUIRED).
Display 'Medicaid' if state in which interview is being conducted uses the name 'MEDICAID'.
Display 'STATE NAME FOR MEDICAID' (substituting the real state name for the program) if the state in which interview is being conducted does not use the name 'MEDICAID'. For the specific name to use by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions (substituting the real state name for program).
For the specific name to use by state, see the plan fill file.

HX560 (HX1620)

BLAISE NAME: GovPayPrem
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

Is there a monthly premium for [PERSON 1, PERSON 2, PERSON 3, PERSON N] for the coverage through [[NAME OF PLAN FROM HX550]/[[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]/[PROGRAM NAME FROM HX160/HX270], the program sponsored by a state or local government agency which provides hospital and physician benefits]]?
[Do not include the cost of any copayments, coinsurance or deductibles [you/he/she/they] may have had to pay.]
READ IF NECESSARY: A monthly premium is a fixed amount of money people pay each month to have health coverage. It does not include copays or other expenses such as prescription costs.
HELP: F1

Responses:

YES, EVERYONE COVERED PAYS 1 BOX_410 (HX1630)
YES, SOME COVERED PAY 2 BOX_405 (HX1623)
NO, NO ONE COVERED PAYS 3 BOX_420 (HX1670)
REFUSED RF BOX_420 (HX1670)
DON'T KNOW DK BOX_420 (HX1670)

Programmer Instructions:

Placeholder for MHOP specifications. This will be deleted once those specifications are available:
If coded '1' (YES, EVERYONE COVERED PAYS) at HX560 (HOME.PRMEDPRE), code PRND.MEDGOVP for each person in the roster at HX570/HX575 as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND.)
If coded '3' (NO, NO ONE COVERED PAYS) at HX560 (HOME.PRMEDPRE), code PRND.MEDGOVP for each person in the roster at HX570/HX575 as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND.)
If coded RF or DK or set to -9 (whether everyone is covered is missing) at HX560 (HOME.PRMEDPRE), code PRND.MEDGOVP equal to the missing value in HOME.PRMEDPRE for each person in the HX570/HX575 roster.
Leave PRND.MEDGOVP blank (no value) for any RU member not on the roster at HX570/HX575.
The HX570/HX575 roster includes all persons with MEDICAID/SCHIP or GOVT-
HOSPITAL/PHYSICIAN program coverage (EPRS.MCAID = 1 or EPRS.GOVTPROG = 1) in the current RU for the current round (but excludes any RU members already reviewed in the PR section - HX560 is not on path if the PR section was asked for the corresponding insurance type).

Display Instructions:

Roster 1 - Report
Roster definition:
Use HX530 definition.
Display RU member's first, middle, and last names (Person.FullName) in the question text. Substitute
"you" for the person's name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Roster filter:
Use HX530 filter.
Display '[NAME OF PLAN FROM HX550]' if there is a current round insurer associated with the MEDICAID/SCHIP or GOVT- HOSPITAL/PHYSICIAN INSURANCE (Insurance.Insurer () empty).
Otherwise, display, [[Medicaid/...and physician benefits]'. Display '[Medicaid/[STATE NAME FOR MEDICAID]] or [STATE CHIP NAME]' if asking about MEDICAID/SCHIP. Display '[PROGRAM NAME FROM HX160/HX270], the program...benefits' if asking about GOVT-HOSPITAL/PHYSICIAN.
Display the actual plan name entered at HX550 for 'NAME OF PLAN FROM HX550' if a plan name was entered (Insurance.Insurer).
For '[PROGRAM NAME FROM HX160/HX270]', display the text entry from HX160 or HX270.
Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the real state name for the program) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific name to use by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions (substituting the real state name for program).
For the specific name to use by state, see the plan fill file.
Display 'you' if the respondent is the only person eligible to be displayed.. Display 'he' if only one RU member is eligible to be displayed that person is not the respondent and is male. Display 'she' if only one RU member eligible to be displayed and that person is not the respondent and is female.
Otherwise, display 'they.'

BOX_405 (HX1623)

Route Details:

If looping on Medicaid/SCHIP (Insurance.HISrc=Medicaid), continue with HX570.
Otherwise, that is if looping on Gov't-Hospital/Physician (Insurance.HISrc= GHP), go to HX575.

HX570 (HX1625)

BLAISE NAME: WhoPayPremRosterMed
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

Who has a monthly premium for that coverage?
PROBE: Anyone else?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 BOX_410 (HX1630)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 BOX_410 (HX1630)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 BOX_410 (HX1630)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 BOX_410 (HX1630)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 BOX_410 (HX1630)

Programmer Instructions:

Roster behavior:
1. Multiple select allowed.
Placeholder for MHOP specifications. This will be deleted once those specifications are available:
The HX570 roster includes all persons with MEDICAID/SCHIP program coverage (EPRS.MCAID = 1) in the current RU for the current round (but excludes any RU members already reviewed in the PR section - HX570 is not on path if the PR section was asked for the corresponding insurance type).
Code PRND.MEDGOVP as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND) for all persons from the HX570 roster who are selected.
Code PRND.MEDGOVP as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND) for all persons on the HX570 roster who are not selected.
Leave PRND.MEDGOVP blank (no value) for any RU member not on the roster at HX570.

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition:
This item uses the insurance array to display RU member's first, middle, and last names (Person.FullName).
Roster filter:
Insurance source is MEDICAID/SCHIP (Insurance.HISrc=Medicaid), and Person is an RU member covered by MEDICAID/SCHIP during the current round (HX100 =YES) or (HX230=2 or 3), and 3. [Round 1] or [Round 2-5 and PR150 = EMPTY for everyone].

HX575 (HX1627)

BLAISE NAME: WhoPayPremRosterGHP
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

Who has a monthly premium for that coverage?
PROBE: Anyone else?
ENTER ALL THAT APPLY.

Responses:

Programmer Instructions:

Roster behavior:
1. Multiple select allowed.
Placeholder for MHOP specifications. This will be deleted once those specifications are available:
The HX575 roster includes all persons with GOVT- HOSPITAL/PHYSICIAN program coverage (EPRS.GOVTPROG = 1) in the current RU for the current round (but excludes any RU members already reviewed in the PR section - HX575 is not on path if the PR section was asked for the corresponding insurance type).
Code PRND.MEDGOVP as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND) for all persons from the HX575 roster who are selected.
Code PRND.MEDGOVP as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND) for all persons on the HX575 roster who are not selected.
Leave PRND.MEDGOVP blank (no value) for any RU member not on the roster at HX575.

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition:
This item uses the insurance array to display RU member's first, middle, and last names (Person.FullName).
Roster filter:
Insurance source is GOVT-HOSPITAL/PHYSICIAN (Insurance.HISrc=GHP), and Person is an RU member covered by GOVT-HOSPITAL/PHYSICIAN during the current round (at least one person selected at HX170) or (HX230=7), and 3. [Round 1] or [Round 2-5 and PR310= EMPTY for everyone ].

BOX_410 (HX1630)

Route Details:

If round 1 or round 3, continue with HX580.
Otherwise, go to HX600.

HX580 (HX1635)

BLAISE NAME: GovPremAmt
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

How much is the premium for [the [NAME OF PLAN FROM HX550]/that] coverage?
IF MORE THAN ONE PERSON PAYS A PREMIUM FOR THIS COVERAGE, SAY: Please give me the total amount for premiums paid by all individuals with this coverage.
USE CTRL+Z TO ACCESS CALCULATOR TO ADD ALL PREMIUMS.
ENTER AMOUNT

Responses:

1 HX590 (HX1640)
REFUSED RF HX600 (HX1650)
DON'T KNOW DK HX600 (HX1650)

Programmer Instructions: Allow for the entry of dollars and cents.

Display Instructions:

Display HX580, HX590, and HX590OS on the same form pane.
Display 'the [NAME OF PLAN FROM HX550]' if HX550 has an entry other than 'RF' or 'DK' or EMPTY. Otherwise, display, 'that'.
Display the actual plan name entered at HX550 for 'NAME OF PLAN FROM HX550' if a plan name was entered.

HX590 (HX1640)

BLAISE NAME: GovPremUnit
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

[How much is the premium for [the [NAME OF PLAN FROM HX550]/that] coverage?]
IF MORE THAN ONE PERSON PAYS A PREMIUM FOR THIS COVERAGE, SAY: Please give me the total amount for premiums paid by all individuals with this coverage.
USE CTRL+Z TO ACCESS CALCULATOR TO ADD ALL PREMIUMS.
Is that per year, per month, per week, or what?
ENTER UNIT OF COVERAGE

Responses:

PER YEAR 1 HX600 (HX1650)
EVERY 3 MONTHS (QUARTERLY) 2 HX600 (HX1650)
EVERY 2 MONTHS (BIMONTHLY) 3 HX600 (HX1650)
PER MONTH 4 HX600 (HX1650)
PER WEEK 5 HX600 (HX1650)
EVERY 2 WEEKS (BIWEEKLY) 6 HX600 (HX1650)
2 TIMES PER YEAR (SEMI-ANNUALLY) 7 HX600 (HX1650)
2 TIMES PER MONTH (SEMI-MONTHLY) 8 HX600 (HX1650)
OTHER 91 HX590OS (HX1645)
REFUSED RF HX600 (HX1650)
DON'T KNOW DK HX600 (HX1650)

Display Instructions:

Display HX580, HX590, and HX590OS on the same form pane.
Display "How much ? ADD ALL PREMIUMS." in brackets and grayed out text.
Display 'the [NAME OF PLAN FROM HX550]' if HX550 has an entry other than 'RF' or 'DK' or EMPTY. Otherwise, display, 'that'.
Display the actual plan name entered at HX550 for 'NAME OF PLAN FROM HX550' if a plan name was entered.

HX590OS (HX1645)

BLAISE NAME: GovPremUnitOS
Question Text:

Responses:

1 HX600 (HX1650)
REFUSED RF HX600 (HX1650)
DON'T KNOW DK HX600 (HX1650)

Display Instructions:

HX600 (HX1650)

BLAISE NAME: GovPremSubsdz
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

[PLAN NAME: [NAME OF PLAN FROM HX550]]
Is the cost of the premium subsidized based on household income?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If [GOVERNMENT-HOSPITAL/PHYSICIAN] and if [plan is exchange coverage (HX180=1 or HX280=1)] and if [HX560 is coded '1' (YES, EVERYONE COVERED PAYS) or '2' (YES, SOME COVERED PAY)], continue with HX610.
Otherwise, go to END_LP55.

Display Instructions:

Display 'PLAN NAME: ...' if HX550 has an entry other than 'RF' or 'DK' or EMPTY.
Otherwise, use a null display.
Display the actual plan name entered at HX550 for 'NAME OF PLAN FROM HX550' if a plan name was entered.

HX610 (HX1665)

BLAISE NAME: GovMetalPlan
Context Header: [NAME OF INSURANCE SOURCE]
Question Text:

Is [the [NAME OF PLAN FROM HX550] plan/this plan] a platinum, gold, silver, bronze or catastrophic plan?
HELP: F1

Responses:

PLATINUM PLAN 1 END_LP55 (HX1666)
GOLD PLAN 2 END_LP55 (HX1666)
SILVER PLAN 3 END_LP55 (HX1666)
BRONZE PLAN 4 END_LP55 (HX1666)
CATASTROPHIC PLAN 5 END_LP55 (HX1666)
IF VOLUNTEERED: SOMETHING ELSE 6 END_LP55 (HX1666)
REFUSED RF END_LP55 (HX1666)
DON'T KNOW DK END_LP55 (HX1666)

Display Instructions:

Display 'the [NAME OF PLAN FROM HX550] plan' if HX550 has an entry other than 'RF' or 'DK' or EMPTY. Otherwise, display 'this plan'.
Display the actual plan name entered at HX550 for '[NAME OF PLAN FROM HX550]' if a plan name was entered.

END_LP55 (HX1666)

Route Details:

Cycle on next insurance that meets the conditions stated in the loop definition.
If no more insurance meet the stated conditions, end LOOP_55 and continue with BOX_420.

BOX_420 (HX1670)

Route Details:

If any insurance recorded as providing private insurance (that was created during the current round) to a current RU member (Insurance.HIPubPriv=Private and OrigRnd=current round), continue with LOOP_60.
Otherwise, go to BOX_530.

LOOP_60 (HX1675)

Route Details:

For each insurance, ask HX620- END_LP60.
Loop definition: LOOP_60 collects private health insurance information. This loop cycles on insurance that meets the following conditions:
Insurance is provider of private health insurance to a current RU member [Insurance.HIPubPriv=Private]
AND
The insurance coverage provided was created during the current round [OrigRnd=current round].

HX620 (HX1680)

BLAISE NAME: CodeAllHICovg
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

AND HX-7
Now think again about [your/[POLICYHOLDER]'s] health insurance through [INSURANCE SOURCE NAME]. Looking at card HX-7, what health insurance coverage [[do/does]/did] [you/he/she] have [as of [END DATE]]?
PROBE: Any other health coverage through this plan?
[NOTE: 'DISABILITY', 'WORKER'S COMPENSATION', AND 'ACCIDENT' WILL NOT APPEAR ON THE SHOW CARD.]
ENTER ALL THAT APPLY.
HELP: F1

Responses:

HOSPITAL AND PHYSICIAN BENEFITS, 1
INCLUDING COVERAGE THROUGH AN HMO
DENTAL 2
PRESCRIPTION DRUGS 3
VISION 4
MEDICARE SUPPLEMENT/MEDIGAP 5
LONG TERM CARE IN A NURSING HOME 6
EXTRA CASH FOR HOSPITAL STAYS 7
SERIOUS DISEASE OR DREAD DISEASE 8
DISABILITY 9
WORKER'S COMPENSATION 10
ACCIDENT 11
OTHER 91 HX620OS (HX1685)
REFUSED RF BOX_430 (HX1690)
DON'T KNOW DK BOX_430 (HX1690)

Programmer Instructions:

If coded '91' (OTHER), alone or in combination with any other code, continue with HX620OS.
Otherwise, go to BOX_430.
For specifications purposes only: CAPI does not allow 'RF' or 'DK' in combination with any other code.
If '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN HMO) is one of the selections and '5' (MEDIGAP) is not one of the selections, set Insurance.HospHI=Yes.
If '5' (MEDIGAP) is one of the selections, set Insurance.MedigapHI=Yes

Display Instructions:

Display '[do/does]' if [not round 5] and if [insurance being asked about is current (HQ10_01 is coded '1' (COVERED WHOLE TIME) or HQ10_02 is coded '1' (YES, COVERED NOW) for the policyholder (or for oldest PID in the covered person array if policyholder is not a current RU member)]. Otherwise, display 'did'.
Display 'as of [END DATE]' if round 5. Otherwise, use a null display.
Display HX620 and HX620OS on the same form pane.

HX620OS (HX1685)

BLAISE NAME: HICovgOS
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:
SPECIFY: HEALTH INSURANCE COVERAGE
Responses: 1 BOX_430 (HX1690)
Display Instructions: Display HX620 and HX620OS on the same form pane.

BOX_430 (HX1690)

Route Details:

If insurance source is (Employer or Union; Insurance.HISrc=Employer or Union) or (insurance source is direct purchase and direct purchase type is not insurance company, insurance company-from agent, or HMO [HX200 or HX300 ( ) 3, 4, or 5;
Insurance.DirectPurchTp()Agent, Insurance Co, HMO]) and insurance provides Medicare Supplement/Medigap coverage [Insurance.MedigapHI=Yes], continue with HX630.
If insurance source is direct purchase and direct purchase type is insurance company, insurance company-from agent, or HMO [HX200 or HX300 = 3, 4, or 5;
Insurance.DirectPurchTp=Agent, Insurance Co, HMO] and insurance provides Medicare Supplement/Medigap coverage [Insurance.MedigapHI=Yes], automatically code HX630 with appropriate responses by CAPI and then go to BOX_440 [Set Insurance.HISrcName=Insurance.Insurer].
Otherwise (HX620 is not coded '5' (MEDICARE SUPPLEMENT OR MEDIGAP; Insurance.MedigapHI() Yes)), go to BOX_440.

HX630 (HX1695)

BLAISE NAME: MedigapName
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

What is the name of the insurance company or HMO from which [you/[POLICYHOLDER]] [receive/receives] the Medicare Supplement or Medigap benefits?
IF MORE THAN ONE NAME, PROBE: What is the main insurance company or HMO from which [you/he/she] [receive/receives] the Medicare Supplement or Medigap benefits?
HELP:F1
NAME OF INSURER

Responses:

1 BOX_440 (HX1700)
REFUSED RF BOX_440 (HX1700)
DON'T KNOW DK BOX_440 (HX1700)

Programmer Instructions: Set Insurance.Insurer = HX630
Display Instructions:

BOX_440 (HX1700)

Route Details:

If insurance source is (Employer or Union; Insurance.HISrc=Employer or Union) or (insurance source is direct purchase and direct purchase type is not insurance company, insurance company - from agent, or HMO [HX200 or HX300 ( ) 3, 4, or 5;
Insurance.DirectPurchTp()Agent, Insurance Co, HMO]), and insurance provides Hospital/Physician coverage (but not Medigap) [Insurance.HospHI=Yes and Insurance.MedigapHI()Yes], continue with HX640.
If insurance source is direct purchase and direct purchase type is insurance company, insurance company - from agent, or HMO [HX200 or HX300 = 3, 4, or 5;
Insurance.DirectPurchTp=Agent, Insurance Co, HMO], and insurance provides Hospital/Physician coverage (but not Medigap) [Insurance.HospHI=Yes and Insurance.MedigapHI()Yes] automatically code HX640 with appropriate responses by CAPI and go to BOX_450 [Set Insurance.HISrcName=Insurance.Insurer].
If any combination of only codes '9' (DISABILITY), '10' (WORKER'S COMPENSATION) or '11' (ACCIDENT) selected at HX620, go to END_LP60.
If insurance provides Medicare Supplement/Medigap coverage [Insurance.MedigapHI=Yes], go to BOX_450.
Otherwise, go to BOX_460.

HX640 (HX1705)

BLAISE NAME: HospHIName
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

What is the name of the insurance company or HMO from which [you/[POLICYHOLDER]] [receive/receives] hospital and physician benefits?
IF MORE THAN ONE NAME, PROBE: What is the main insurance company or HMO from which [you/he/she] [receive/receives] hospital and physician benefits?
HELP:F1
NAME OF INSURER

Responses:

1 BOX_450 (HX1715)
REFUSED RF BOX_450 (HX1715)
DON'T KNOW DK BOX_450 (HX1715)

Programmer Instructions: Set Insurance.Insurer = HX640
Display Instructions:

BOX_450 (HX1715)

Route Details:

Ask the Managed Care (MC) section for this insurer (Insurance.Insurer).
At completion of the MC section, continue with BOX_460.

BOX_460 (HX1720)

Route Details:

Continue with HX650 if insurance meets the following conditions:
If (HP50 is coded '1' (YES, PLAN IS EXCHANGE)) or (direct purchase type is exchange ' (HX200=11 or HX300=11)) or (exchange for SE, FS=1 job (HP40=8))
And
Insurance provides Hospital/Physician coverage (but not Medigap) (Insurance.HospHI=Yes and Insurance.MedigapHI()Yes)
And
Policyholder is 64 years of age or younger or in age categories 1-8 or Policyholder is "Policyholder deceased" or "Policyholder outside the DU" (Insurance.Plcyhldr=901 or 902).
Otherwise, go to BOX_470.

HX650 (HX1725)

BLAISE NAME: HospMetaPlan
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

Is [your/PERSON]'s] [INSURER AT HX640] plan a platinum, gold, silver, bronze or catastrophic plan?
HELP: F1

Responses:

PLATINUM PLAN 1 BOX_470 (HX1730)
GOLD PLAN 2 BOX_470 (HX1730)
SILVER PLAN 3 BOX_470 (HX1730)
BRONZE PLAN 4 BOX_470 (HX1730)
CATASTROPHIC PLAN 5 BOX_470 (HX1730)
IF VOLUNTEERED: SOMETHING ELSE 6 BOX_470 (HX1730)
REFUSED RF BOX_470 (HX1730)
DON'T KNOW DK BOX_470 (HX1730)

Display Instructions:

Display the actual plan name entered or autocoded at HX640 for '[INSURER AT HX640]' if HX640 has an entry other than 'RF' or 'DK' or EMPTY (Insurance.Insurer). Otherwise, use a null display.

BOX_470 (HX1730)

Route Details:

If round 1 or round 3, go to HX660.
Otherwise (i.e., if round 2, 4, or 5), continue with BOX_480.

BOX_480 (HX1735)

Route Details:

Note: You only are routed to BOX_480 in Rounds 2, 4, and 5. This box specifies a "likely exchange" check. BOX_500 is a similar check made in Rounds 1 and 3.
Continue with HX660 if this insurance meets the following conditions:
Is a 'PROFESSIONAL ASSOCIATION' (HP40=1), 'GROUP' (HX200=1 or HX300=1 or HP40=2) or 'INSURANCE COMPANY-FROM AN AGENT' (HX200=3 or HX300=3 or HP40=4) or 'INSURANCE COMPANY' (HX200=4 or HX300=4 or HP40=5) or 'HMO' (HX200=5 or HX300=5 or HP40=6) or 'EXCHANGE COVERAGE' (HX200=11 or HX300=11 or HP40=8) or 'UNKNOWN TYPE-COLLECTED AT OTHER' (HX200=91 or HX300=91 or HP40=91) [(Insurance.DirectPurchTp=Group, Agent, Insurance Co, HMO, Exchange, Other) or (Insurance.HISrc=Employer and HP40=1, 2, 4, 5, 6, 8, or 91)]
And
Insurance provides Hospital/Physician coverage (but not Medigap) (Insurance.HospHI=Yes and Insurance.MedigapHI()Yes)
And
Policyholder is 64 years of age or younger or in age categories 1-8 or Policyholder is "Policyholder deceased" or "Policyholder outside the DU" (Insurance.Plcyhldr=901 or 902).
Otherwise, go to END_LP60.

HX660 (HX1740)

BLAISE NAME: FamPayPrem
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

For the coverage through [INSURANCE SOURCE NAME], does anyone in the family pay all of the premium or cost, some of the premium or cost, or none of the premium or cost?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]
[Do include any contribution made to the plan as part of a paycheck.]
HELP: F1

Responses:

YES, PAY ALL OF PREMIUM/COST 1 BOX_490 (HX1745)
YES, PAY SOME OF PREMIUM/COST 2 BOX_490 (HX1745)
YES, BUT DON'T KNOW IF PAY ALL OR 3 BOX_490 (HX1745)
SOME OF PREMIUM/COST
NO, DO NOT PAY 4 BOX_510 (HX1775)
REFUSED RF BOX_510 (HX1775)
DON'T KNOW DK BOX_510 (HX1775)

Display Instructions:

BOX_490 (HX1745)

Route Details:

If round 1 or round 3, continue with HX670.
Otherwise, go to HX690.

HX670 (HX1750)

BLAISE NAME: PlcyhlderPayAmt
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

How much [[do/does]/did] [you/[POLICYHOLDER]] pay for the [INSURANCE SOURCE NAME] coverage?
ENTER AMOUNT

Responses:

1 HX680 (HX1755)
REFUSED RF BOX_500 (HX1765)
DON'T KNOW DK BOX_500 (HX1765)

Programmer Instructions: Allow the entry of dollars and cents.
Display Instructions:

Display HX670, HX680, and HX680OS on the same form pane.
Display '[do/does]' if [not round 5] and if [insurance being asked about is current (HQ10_01 is coded '1' (COVERED WHOLE TIME) or HQ10_02 is coded '1' (YES, COVERED NOW) for the policyholder (or for oldest PID on the covered person array if policyholder is not a current RU member)]. Otherwise, display 'did'.

HX680 (HX1755)

BLAISE NAME: PlcyhlderPayUnit
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

[Is/Was] that per year, per month, per week, or what?
UNIT OF COVERAGE:

Responses:

PER YEAR 1 BOX_500 (HX1765)
EVERY 3 MONTHS (QUARTERLY) 2 BOX_500 (HX1765)
EVERY 2 MONTHS (BIMONTHLY) 3 BOX_500 (HX1765)
PER MONTH 4 BOX_500 (HX1765)
PER WEEK 5 BOX_500 (HX1765)
EVERY 2 WEEKS (BIWEEKLY) 6 BOX_500 (HX1765)
2 TIMES PER YEAR (SEMI-ANNUALLY) 7 BOX_500 (HX1765)
2 TIMES PER MONTH (SEMI-MONTHLY) 8 BOX_500 (HX1765)
OTHER 91 HX680OS (HX1760)
REFUSED RF BOX_500 (HX1765)
DON'T KNOW DK BOX_500 (HX1765)

Display Instructions:

Display HX670, HX680, and HX680OS on the same form pane.
Display 'Is' if [not round 5] and if [insurance being asked about is current (HQ10_01 is coded '1' (COVERED WHOLE TIME) or HQ10_02 is coded '1' (YES, COVERED NOW) for the policyholder (or for oldest PID on the covered person array if policyholder is not a current RU member)]. Otherwise, display 'Was'.

HX680OS (HX1760)

BLAISE NAME: PlcyhlderPayUnitOS
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

SPECIFY: UNIT OF COVERAGE

Responses:

1 BOX_500 (HX1765)
REFUSED RF BOX_500 (HX1765)
DON'T KNOW DK BOX_500 (HX1765)

Display Instructions:

Display HX670, HX680, and HX680OS on the same form pane.

BOX_500 (HX1765)

Route Details:

Note: You only are routed to BOX_500 in Rounds 1 and 3. This box specifies a "likely exchange" check. BOX_480 is a similar check made in Rounds 2, 4, and 5.
Continue with HX690 if this insurance meets the following conditions:
Is 'PROFESSIONAL ASSOCIATION' (HP40=1), 'GROUP' (HX200=1 or HX300=1 or HP40=2) or 'INSURANCE COMPANY-FROM AN AGENT' (HX200=3 or HX300=3 or HP40=4) or 'INSURANCE COMPANY' (HX200=4 or HX300=4 or HP40=5) or 'HMO' (HX200=5 or HX300=5 or HP40=6) or 'EXCHANGE COVERAGE' (HX200=11 or HX300=11 or HP40=8) or 'UNKNOWN TYPE-COLLECTED AT OTHER' (HX200=91 or HX300=91 or HP40=91) [(Insurance.DirectPurchTp=Group, Agent, Insurance Co, HMO, Exchange, Other) or (Insurance.HISrc=Employer and HP40=1, 2, 4, 5, 6, 8, or 91)]
And
Insurance provides Hospital/Physician coverage (but not Medigap) (Insurance.HospHI=Yes and Insurance.MedigapHI()Yes)
And
Policyholder is 64 years of age or younger or in age categories 1-8 or Policyholder is "Policyholder deceased" or "Policyholder outside the DU" (Insurance.Plcyhldr=901 or 902).
Otherwise, go to BOX_510.

HX690 (HX1770)

BLAISE NAME: HospPremSubsdz
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

Is the cost of the premium subsidized based on family income?

Responses:

YES 1 BOX_510 (HX1775)
NO 2 BOX_510 (HX1775)
REFUSED RF BOX_510 (HX1775)
DON'T KNOW DK BOX_510 (HX1775)

Display Instructions:

BOX_510 (HX1775)

Route Details:

If round 1 or round 3, continue with BOX_520.
Otherwise, go to END_LP60.

BOX_520 (HX1780)

Route Details:

If insurance being asked about provides Medicare supplement/Medigap coverage (Insurance.MedigapHI=Yes), go to END_LP60.
Otherwise, continue with HX700.

HX700 (HX1785)

BLAISE NAME: AnnDeductAmt
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

Is the [family] annual deductible for medical care for this plan less than [$1,350/$2,700] or is it [$1,350/$2,700] or more? If there is a separate deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.
HELP: F1

Responses:

LESS THAN [$1,350/$2,700] 1 END_LP60 (HX1795)
[$1,350/$2,700] OR MORE 2 HX710 (HX1790)
NO ANNUAL DEDUCTIBLE 3 END_LP60 (HX1795)
REFUSED RF END_LP60 (HX1795)
DON'T KNOW DK END_LP60 (HX1795)

Display Instructions:

Use a null display for 'family' and display '$1,350' in the question text and '$1,350' in the response category options if this insurance meets the following conditions:
[The policyholder is the only covered person (PersID of Insurance.Plcyhldr = only PersID in covered person array)
OR
The policyholder is deceased and there is exactly one covered person (Insurance.Plcyhldr=901 and only one PersID in covered person array)]
AND
Insurance does not cover any persons outside the RU (Insurance.CovPersOutRU()Yes).
Otherwise, display 'family' and '$2,700' in the question text and '$2,700' in the response category options.
Note: The amounts to be used will need to be verified yearly and adjusted in HX and OE.

HX710 (HX1790)

BLAISE NAME: PlanHasHSA
Context Header: [POLICYHOLDER FIRST MIDDLE LAST NAME] INSURANCE THROUGH [NAME OF INSURANCE SOURCE]
Question Text:

With this plan, is there a special account or fund that can be used to pay for medical expenses? The accounts are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Personal Care accounts, Personal Medical funds, or Choice funds, and are different from Flexible Spending Accounts.
HELP: F1

Responses:

YES 1 END_LP60 (HX1795)
NO 2 END_LP60 (HX1795)
REFUSED RF END_LP60 (HX1795)
DON'T KNOW DK END_LP60 (HX1795)

Display Instructions:

END_LP60 (HX1795)

Route Details:

Cycle on insurance that meets the conditions stated in the loop definition.
If no more insurance meet the stated conditions, end LOOP_60 and continue with BOX_530.

BOX_530 (HX1800)

Route Details:

If round 1 or round 3, continue with HX720.
Otherwise, go to BOX_540.

HX720 (HX1805)

BLAISE NAME: AnyFSA
Question Text:

Does anyone in this household have a Flexible Spending Account for health expenses?
IF NECESSARY, SAY: These accounts are offered by some employers to allow employees to set aside pre-tax dollars of their own money for their use throughout the year to reimburse themselves for their own or their family members' out-of- pocket expenses for health care. With this type of account, any money remaining in the account at the end of the year, following a short grace period, is lost to the employee.

Responses:

YES 1 HX730 (HX1810)
NO 2 BOX_540 (HX1820)
REFUSED RF BOX_540 (HX1820)
DON'T KNOW DK BOX_540 (HX1820)

Display Instructions:

HX730 (HX1810)

BLAISE NAME: WhoFSARoster
Question Text:

Who has a Flexible Spending Account (FSA) for health expenses?
PROBE: Anyone else?
ENTER ALL THAT APPLY.

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 HX740_01 (HX1815)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 HX740_01 (HX1815)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 HX740_01 (HX1815)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 HX740_01 (HX1815)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 HX740_01 (HX1815)

Programmer Instructions:

Roster behavior:
1. Multiple select allowed. Interviewer may select one or more from the listed members.

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition:
This item displays the RU-MEMBERS-ROSTER (Person.FullName) for selection of RU members.
Roster filter:
Display all persons age 16 or older or in age categories 4-9.

HX740_01 (HX1815)

BLAISE NAME: FSAAmt
Question Text:

How much [do/does] [you/[PERSON 1]] contribute per year to [your/his/her] FSA?
ENTER AMOUNT

Responses: 1

REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: forced navigation including HX740_01, HX740_02, HX740_03, HX740_ 04, HX740_N.
After grid completion, continue with BOX_540.
SOFT RANGE:
$10-$2550
If amount entered is greater than $2550, display the following message: "AMOUNT CONTRIBUTED IS HIGHER THAN EXPECTED FOR ONE PERSON. VERIFY AND CORRECT IF NEEDED."
If amount entered is less than $10, display the following message: "AMOUNT CONTRIBUTED IS LOWER THAN EXPECTED FOR ONE PERSON. VERIFY AND CORRECT IF NEEDED."
Note: The upper soft range limit needs to be verified yearly to determine if it should be adjusted.

Display Instructions:

Roster 1 - Report no add/edit/delete
Format the following columns on the form pane.
Col#1 Header: RU Member
Instructions: Display RU members' First Middle and Last name (Person.FullName). This column should be protected - no edit/add/delete
Col#2 Header: Amount
Instructions: Entry field to enter an amount. Allow whole dollars only, no cents. Display '$' and '.00' mask.
Roster Filter:
Display all persons selected at HX730
Display variable question text. Replace "How much [do/does] [you/[PERSON 1]] contribute per year to [your/his/her] FSA?" with:
HX740_02: What about [PERSON 2]?
HX740_03: What about [PERSON 3]?
HX740_04: What about [PERSON N]? How much does [he/she] contribute per year to [his/her] FSA?
HX740_N: Repeat question text HX740_02-HX740_N for as many RU members that fit the roster filter criteria.

BOX_540 (HX1820)

Route Details:

If round 1, continue with Loop_70.
Otherwise, go to BOX_560.

LOOP_70 (HX1821)

Route Details:

For each person in the RU-Members-Roster, ask BOX_550 to END_LP70.
Loop Definition: LOOP_70 cycles on all current RU members to determine insurance coverage in the previous two years if RU member not covered by eligible insurance on January 1 of panel year 1.

BOX_550 (HX1822)

Route Details:

If born after 12/31/[YEAR], where 'YEAR' is the year prior to the first calendar year of the panel (FirstPanYear) or age category =1, go to END_LP70.
If person's reference period does not include January 1,[YEAR], where 'YEAR' is the first calendar year of the panel (FirstPanYear), go to END_LP70.
If person had comprehensive insurance on January 1, [YEAR], where 'YEAR' is the first calendar year of the panel (FirstPanYear), go to END_LP70 (definition below)
[with health insurance on January 1, [YEAR], where 'YEAR' is the first calendar year of the panel (FirstPanYear)([PersID is included in at least one covered person array where SimplePerson.CovdJan1=Yes for that same PersID), and that coverage (where SimplePerson.CovdJan1=Yes) was Public insurance (excluding IHS) or Private with hospital/physician or Medigap benefits (Insurance.HIPubPriv=Public and Insurance.HISrc()IHS) or (Insurance.HIPubPriv=Private and (Insurance.HospHI=Yes or Insurance.MedigapHI=Yes))]
4. If person is without health insurance on January 1, [YEAR], where 'YEAR' is the first calendar year of the panel (FirstPanYear) [PersID not included in any covered person array where SimplePerson.CovdJan1=Yes for that same PersID], go to HX750.
5. Otherwise (person had only IHS or private insurance without hospital/physician or Medigap coverage on January 1, [YEAR], where 'YEAR' is the first calendar year of the panel), go to HX760.

HX750 (HX1835)

BLAISE NAME: CovPrev2Year
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

I have recorded that [you/[PERSON]] [were/was] without insurance on January 1, [YEAR]. [Were/Was] [you/he/she] covered by a health insurance plan or program at any time in the years [YEAR] or [YEAR]?

Responses:

YES 1 END_LP70 (HX1865)
NO 2 END_LP70 (HX1865)
REFUSED RF END_LP70 (HX1865)
DON'T KNOW DK END_LP70 (HX1865)

Display Instructions:

(For specifications purposes only; CAPI handles automatically): in the question text, "? on January 1, [YEAR]," 'YEAR' is the first calendar year of the panel (FirstPanYear). In the question text, "? at any time in the years [YEAR] or [YEAR]?" CAPI displays the two years prior to the first calendar year of the panel. (For panel 23 for example, this would be '2016 or 2017?').

HX760 (HX1860)

BLAISE NAME: CovMorePrev2Year
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:

I have recorded that [you/[PERSON]] [had health insurance coverage for (READ TYPES OF INSURANCE BELOW) coverage] [and] [[were/was] covered under the Indian Health Service] on January 1, [YEAR]. [Were/Was] [you/he/she] ever covered by [any other kind of/a more comprehensive health insurance] plan or program that paid for medical and doctor's bills at any time in the years [YEAR] or [YEAR]?
[TYPE OF COVERAGE IN HX620] [TYPE OF COVERAGE IN HX620]
[TYPE OF COVERAGE IN HX620] [TYPE OF COVERAGE IN HX620]
[TYPE OF COVERAGE IN HX620] [TYPE OF COVERAGE IN HX620]
[TYPE OF COVERAGE IN HX620] [TYPE OF COVERAGE IN HX620]
[TYPE OF COVERAGE IN HX620] [TYPE OF COVERAGE IN HX620]

Responses:

YES 1 END_LP70 (HX1865)
NO 2 END_LP70 (HX1865)
REFUSED RF END_LP70 (HX1865)
DON'T KNOW DK END_LP70 (HX1865)

Display Instructions:

Roster 1 - Report no add/edit/delete
Roster Definition: This item uses the insurance array to display the types of coverage the RU member may have had if they have private insurance without hospital and physician benefits or Medigap. If person is only covered by IHS, the roster display is null and nothing is displayed for "TYPE OF COVERAGE IN HX620".
Roster Filter:
Display the coverage listed at HX620 for every insurance where:
Person confirmed as policyholder (HP80 is coded '1' (YES)) or selected as policyholder (selected at HP90) or selected as a dependent (selected at HP170) for at least one private insurance source with coverage on January 1 (Insurance.HIPublPriv=Private and SimplePerson.CovdJan1=Yes) and
This insurance did not include hospital/physician benefits or Medigap benefits [HX620 was not coded '1' or '5' (Insurance.HospHI()Yes and Insurance.MedigapHI()Yes)].
Display 'had health...(BELOW)' if person confirmed as policyholder (HP80 is coded '1' (YES)) or selected as policyholder (selected at HP90) or selected as a dependent (selected at HP170) for at least one private insurance source with coverage on January 1 (Insurance.HIPublPriv=Private and SimplePerson.CovdJan1=Yes). Otherwise, use a null display.
Display '[were/was] covered under the Indian Health Service' if person was covered by IHS on January 1 [selected at HX140 (for IHS coverage) and SimplePerson.CovdJan1=Yes]. Otherwise, use a null display.
Display 'and' if person has both private and IHS as described in previous two paragraphs.
Display "any other kind of" if person selected at HX140 (for IHS coverage). Otherwise, display "a more comprehensive health insurance". (For specifications purposes only; CAPI handles automatically): in the question text, "? on January 1, [YEAR]," 'YEAR' is the first calendar year of the panel (FirstPanYear). In the question text, "? at any times in the years [YEAR] or [YEAR]?. " CAPI displays the two years prior to the first calendar year of the panel. (For panel 23 for example, this would be '2016 or 2017?')
For "TYPE OF COVERAGE IN HX620" display:
'Dental' if HX620 was coded '2' for this insurance.
'Prescription Drugs' if HX620 was coded '3' for this insurance.
'Vision' if HX620 was coded '4' for this insurance.
'Long Term Care in a Nursing Home' if HX620 was coded '6' for this insurance.
'Extra Cash for Hospital Stays' if HX620 was coded '7' for this insurance.
'Serious Disease or Dread Disease' if HX620 was coded '8' for this insurance.
'Disability' if HX620 was coded '9' for this insurance.
'Worker's Compensation' if HX620 was coded '10' for this insurance.
'Accident' if HX620 was coded '11' for this insurance.
'The text from HX620OS if HX620 was coded '91' for this insurance.
'Refused Coverage' if HX620 was coded 'RF' for this insurance.
'Don't Know Coverage' if HX620 was coded 'DK' for this insurance.

END_LP70 (HX1865)

Route Details:

Cycle on next person that meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_70 and continue with BOX_560.

BOX_560 (HX1870)

Route Details:

If round 2 or round 4, continue with HX770.
Otherwise, go to BOX_570.

HX770 (HX1875)

BLAISE NAME: FamProbPayBill
Question Text:

When answering the next questions, think about money that your household has spent on out of pocket expenses for medical care. We do not want you to count health insurance premiums, over the counter drugs, or costs that you will be reimbursed for.
In the past 12 months did anyone in the household have problems paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home or home care.

Responses:

YES 1 HX780 (HX1880)
NO 2 HX780 (HX1880)
REFUSED RF HX780 (HX1880)
DON'T KNOW DK HX780 (HX1880)

Display Instructions:

HX780 (HX1880)

BLAISE NAME: FamPayOverTime
Question Text:

Does anyone in your household currently have any medical bills that are being paid off over time? This could include medical bills being paid off with a credit card, through personal loans, or bill paying arrangements with hospitals or other providers. The bills can be from earlier years as well as this year.

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If HX770 is coded '2' (NO), go to BOX_570. Otherwise, continue with HX790

Display Instructions:

HX790 (HX1885)

BLAISE NAME: FamUnablePay
Question Text:

Does anyone in your household currently have any medical bills that you are unable to pay at all?

Responses:

YES 1 BOX_570 (HX1890)
NO 2 BOX_570 (HX1890)
REFUSED RF BOX_570 (HX1890)
DON'T KNOW DK BOX_570 (HX1890)

Display Instructions:

BOX_570 (HX1890)

Route Details: Go to next questionnaire section.

Institutional Care Stay (IC) Section

BOX_00 (IC1000)

Route Details:

01 Box = BOX_00, BOX_10
04 Single Select = IC10, IC20
11 Multiple Select with Add/Edit/Delete = IC30
Roster 3 = IC30

BOX_05 (IC1005)

Programmer Instructions:

If provider already has IC10 (provider type) recorded for this round (for any RU member) or in a previous round (for any RU member) (preload.ICPlaceTp=1) go to IC20, otherwise, continue with IC10.

IC10 (IC1010)

BLAISE NAME: ICPlaceTP
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Question Text:

AND IC-1.
Looking at card IC-1, what kind of place is [PROVIDER]?
HELP: F1

Responses:

INPATIENT REHABILITATION FACILITY OR CONVALESCENT HOME 1 IC20 (IC1015)
NURSING HOME 2 IC20 (IC1015)
RESIDENTIAL MENTAL HEALTH TREATMENT CENTER 3 IC20 (IC1015)
RESIDENTIAL EATING DISORDER TREATMENT CENTER 4 IC20 (IC1015)
RESIDENTIAL DRUG AND ALCOHOL OR ADDICTION TREATMENT CENTER 5 IC20 (IC1015)
RESIDENTIAL HOSPICE CARE 6 IC20 (IC1015)
RESIDENTIAL RESPITE CARE 7 IC20 (IC1015)
OTHER 91 IC20 (IC1015)
REFUSED RF IC20 (IC1015)
DON'T KNOW DK IC20 (IC1015)

Display Instructions:

IC20 (IC1015)

BLAISE NAME: ICRelCond
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]

Question Text:

Was [your/[PERSON]?s] stay at [PROVIDER] related to any specific health condition or were any conditions discovered during this stay?

Responses:

YES 1 IC30 (IC1020)
NO 2 BOX_10 (IC1025)
REFUSED RF BOX_10 (IC1025)
DON'T KNOW DK BOX_10 (IC1025)

Display Instructions:

IC30 (IC1020)

BLAISE NAME: ICCondRoster
Context Header: [PERSON?S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Question Text:

What conditions were discovered or led [you/[PERSON]] to enter [PROVIDER]?

PROBE: Any other condition?
ENTER ALL THAT APPLY
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

Responses:

[MEDICAL CONDITION] 1 1 BOX_10 (IC1025)
[MEDICAL CONDITION] 2 2 BOX_10 (IC1025)
[MEDICAL CONDITION] 3 3 BOX_10 (IC1025)
[MEDICAL CONDITION] 4 4 BOX_10 (IC1025)
[MEDICAL CONDITION]N 5 BOX_10 (IC1025)

Programmer Instructions:

Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event.
The link is created when the collection of utilization and/or charge/payment data is complete.

Display Instructions:

Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays Person-Medical-Conditions-Roster for selection and addition of one or many medical conditions associated with this event. Display name of medical condition (COND.CONDNAM)
Roster filter:
Display all conditions on person's roster; display all.

BOX_10 (IC1025)

Route Details:

The Charge/Payment (CP) section is not required for this Institutional Care Stay (IC) event.
Go to the Event Driver (ED) section.

Income (IN) Section

BOX_00 (IN1000)

Route Details:

01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_75, BOX_80, BOX_90, BOX_100, BOX_110, BOX_120, BOX_130, BOX_140, BOX_150, BOX_160, BOX_170
02 Loop = LOOP_10, LOOP_20, LOOP_30, LOOP_40, LOOP_50, LOOP_60, LOOP_70, LOOP_80, LOOP_90
03 End Loop = END_LP10, END_LP20, END_LP30, END_LP40, END_LP50, END_LP60, END_LP70, END_LP80, END_LP90
04 Single Select = IN20, IN30, IN40, IN60, IN100, IN120, IN140, IN160, IN180, IN200, IN220, IN230, IN250, IN260, IN270, IN290, IN310, IN330, IN340, IN350, IN370, IN390, IN400, IN430, IN440, IN480, IN490, IN550, IN560, IN600, IN610, IN640, IN650, IN690, IN700, IN730, IN770, IN780, IN790
06 Single Select with Fill in Answer Text = IN50
08 Multiple Select = IN740
10 Multiple Select with Fill in Answer Text = IN410, IN450, IN500, IN510, IN570, IN620, IN660, IN750
18 Dollar Items Not Allowing Cents = IN90, IN110, IN130, IN150, IN170, IN190, IN240, IN280, IN300, IN320, IN360, IN380, IN420, IN470, IN540, IN590, IN630, IN680, IN720, IN760
19 Numeric Field = IN210, IN460, IN530, IN580, IN670, IN710
20 OS Text Field = IN740OS
24 Information Screen = IN10

BOX_10 (IN1001)

Route Details:

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

BOX_20 (IN1005)

Route Details:

Context header display instructions:
Display PERSON.FULLNAME, Pers.PrimaryFilerPID.

IN10 (IN1010)

BLAISE NAME: FinanceIntro
Question Text:
For the next questions, it might be useful to have out some of the family's financial records, such as a copy of the family's tax forms or materials used to complete the tax form, such as year end bank statements, financial summaries, pay stubs, W-2 forms, and the like.
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 LOOP_10 (IN1015)
Programmer Instructions:
Note: for all dollar amount range checks, allow the entry of whole dollars amounts only; do not collect cents.
Display Instructions:

LOOP_10 (IN1015)

Route Details:

For each element in the RU-members-roster, ask BOX_30 - END_LP10.
Loop definition: LOOP_10 determines which RU members have filed or will file a federal income tax form for the calendar year. If a joint return was or will be filed, the loop determines who is the secondary filer. This loop cycles on persons who meet the following condition:
- Person is a current RU member (includes deceased and institutionalized RU members).

BOX_30 (IN1025)

Route Details:

If person being looped on is a 'SECONDARY FILER ON JOINT FEDERAL TAX RETURN' [person has Pers.PrimaryFilerPID set with a value], go to END_LP10.
Otherwise, continue with IN20.

IN20 (IN1030)

BLAISE NAME: FiledTax
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[Have/Has] [you/[PERSON]] filed a [YEAR] Federal income tax return?
HELP: F1

Responses:
YES 1 IN40 (IN1040)
NO 2 IN30 (IN1035)
REFUSED RF IN30 (IN1035)
DON'T KNOW DK IN30 (IN1035)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN30 (IN1035)

BLAISE NAME: WillFileTax
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
Will [you/[PERSON]] file a [YEAR] Federal income tax return?
HELP: F1

Responses:
YES 1 IN40 (IN1040)
NO 2 END_LP10 (IN1095)
REFUSED RF END_LP10 (IN1095)
DON'T KNOW DK END_LP10 (IN1095)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN40 (IN1040)

BLAISE NAME: FileStatus
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[Was/Will] [your/[PERSON]'s] filing status [be] single, married filing joint return, married filing separately, head of household with qualifying person, or qualifying widow(er) with dependent children?
HELP: F1

Responses:
SINGLE 1 IN60 (IN1070)
MARRIED FILING JOINT RETURN 2 IN50 (IN1045)
MARRIED FILING SEPARATELY 3 IN60 (IN1070)
HEAD OF HOUSEHOLD WITH QUALIFYING PERSON 4 IN60 (IN1070)
QUALIFYING WIDOW(ER) WITH DEPENDENT CHILDREN 5 IN60 (IN1070)
REFUSED RF IN60 (IN1070)
DON'T KNOW DK IN60 (IN1070)
Programmer Instructions:
The person being looped on will be the 'PRIMARY FILER ON FEDERAL TAX RETURN'.
NOTE TO PROGRAMMERS: Do we need a primary filer flag set for everyone here to facilitate the looping at LOOP_20?
Display Instructions:
Display 'was' if IN20 is coded '1' (YES). Display 'will ' and 'be' if IN30 is coded '1' (YES).

IN50 (IN1045)

BLAISE NAME: JointFiler
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
Who is the other taxpayer that [you/[PERSON]] [are/is] filing jointly with?
HELP: F1

Responses:
[FIRST NAME, [MIDDLE NAME], LAST NAME]1 1 IN60 (IN1070)
[FIRST NAME, [MIDDLE NAME], LAST NAME]2 2 IN60 (IN1070)
[FIRST NAME, [MIDDLE NAME], LAST NAME]3 3 IN60 (IN1070)
[FIRST NAME, [MIDDLE NAME], LAST NAME]4 4 IN60 (IN1070)
[FIRST NAME, [MIDDLE NAME], LAST NAME]N 5 IN60 (IN1070)
PERSON NOT IN RU 99 IN60 (IN1070)
Programmer Instructions:
The person selected at IN50 will be the 'SECONDARY FILER ON JOINT FEDERAL TAX RETURN' linked to the person currently being looped on. Set the Pers.PrimaryFilerPID with the PRIMARY FILER's PID (person currently being looped on) on the person selected at IN50's Pers array.
NOTE TO PROGRAMMERS: This links the secondary filer to the primary filer. Is it also necessary to link the primary filer to the secondary filer? Do we need to set a secondary filer PID variable on the primary filer's person array?
Display Instructions:
Roster definition:
Roster 2 - no add/edit/delete
This item displays RU-MEMBERS-ROSTER for selection. Display RU member's first, middle, and last name (Person.FullName)
Roster filter:
Display all RU members who meet the following conditions:
Person is a current RU member (includes deceased and institutionalized RU members).
Person is not already the 'PRIMARY FILER ON FEDERAL TAX RETURN'.
Person is not already the 'SECONDARY FILER ON FEDERAL TAX RETURN'.

IN60 (IN1070)

BLAISE NAME: TaxForm
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[Did/Will] [you/[PERSON]] file on the long form 1040, the short form 1040A, or the short form 1040EZ?

Responses:
LONG FORM 1040 1 END_LP10 (IN1095)
SHORT FORM 1040A 2 END_LP10 (IN1095)
SHORT FORM 1040EZ 3 END_LP10 (IN1095)
OTHER 91 END_LP10 (IN1095)
REFUSED RF END_LP10 (IN1095)
DON'T KNOW DK END_LP10 (IN1095)
Display Instructions:
Display 'Did' if IN20 is coded '1' (YES). Display 'Will' if IN30 is coded '1' (YES).

END_LP10 (IN1095)

Route Details:

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 LOOP_20.

LOOP_20 (IN1105)

Route Details:

For each element in the RU-MEMBERS-ROSTER, ask BOX_40 - END_LP20.
Loop definition: LOOP_20 collects information on taxable income for each RU member who is 16 years of age or older or has filed or will file a federal tax return for this calendar year.
This loop cycles on each person on the RU-MEMBERS-ROSTER who meets the following condition:
- Person is a current RU member (includes deceased and institutionalized RU members).
General Display Instructions for Loop_20:
For 'NAME OF SECONDARY FILER', display the person's name selected at IN50 during LOOP_10 for the primary filer currently being asked about. This person will have Pers.PrimaryFilerPID set with the PID of the person being looped on. If IN50 was not asked in LOOP_ 10 for this person, use a null display.

BOX_40 (IN1115)

Route Details:

If person being looped on is the 'PRIMARY FILER ON FEDERAL TAX RETURN' [IN40 ? EMPTY], go to IN90.
If person being looped on is a 'SECONDARY FILER ON A JOINT FEDERAL TAX RETURN' [person has a value set for Pers.PrimaryFilerPID], go to END_LP20.
Otherwise (i.e., person is not either the 'PRIMARY FILER ON FEDERAL TAX RETURN' or the 'SECONDARY FILER ON A JOINT FEDERAL TAX RETURN', that is, IN30 is coded '2' (NO), 'RF' (REFUSED) or 'DK' (DON'T KNOW) for this person), continue with BOX_50.

BOX_50 (IN1120)

Route Details:

If person being looped on is 16 years of age or older (or in age categories 4-9), continue with IN90.
Otherwise (i.e., person is less than 16 years of age (or in age categories 1-3) and IN30 is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW)), go to END_LP20.
Note: The purpose of BOX_40 and BOX_50 is to skip out persons already identified as secondary filers and persons younger than 16 years of age who have not already reported that they have filed or will file a federal income tax return.
Note: Persons reporting that they have filed or will file a 1040A short form (IN60=2) or a 1040EZ form (IN60=3) receive the wages, interest, dividends, IRA, pensions, unemployment, and social security taxable income items.
Persons reporting that they have filed or will file a 1040 long form, other type of form, or refused or don't know the type of form (IN60=1, 91, RF, DK) receive all the taxable income questions.
Persons reporting that they have not filed and will not file any federal tax return (IN30=2, RF, DK) and are 16 years of age or older also receive all the taxable income questions.

IN90 (IN1125)

BLAISE NAME: AmtWage
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
[People can get money from many different sources, such as wages and salaries, social security, and interest on savings.
The next few questions ask about different sources of income that [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] received in [YEAR]. It would be useful to have out any year-end paystubs, W-2 forms, or other tax forms that you may have.]
[Now let's talk about [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]].]
During [YEAR], how much money did [they/[you/he/she]] receive from wages or salary, tips, commissions, or bonuses?
ENTER AMOUNT

Responses:
1 BOX_60 (IN1130)
REFUSED RF IN130 (IN1145)
DON'T KNOW DK IN100 (IN1126)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 300,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display 'People get money from many different sources, such as wages and salaries, social security, and interest on savings. The next few questions ask about different sources of income that [you/PERSON]] [and [you/[NAME OF SECONDARY FILER]]] received in [YEAR]. It would be useful to have out any year-end paystubs, W-2 forms, or other tax forms that you may have.' If first cycle through LOOP_20.
Otherwise, use null display.
Display 'Now let's talk about [you/PERSON]] [and [you/NAME OF SECONDARY FILER]]].]' if not first cycle through LOOP_20. If first cycle through LOOP_20, use a null display.
Display '[and [you/[NAME OF SECONDARY FILER]]]' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, Display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
Display 'they' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, display '[you/he/she]' using the person being looped on to determine pronoun substitution.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN90, IN100, IN110 and IN120 on the same form pane.

IN100 (IN1126)

BLAISE NAME: AmtWageRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
IN-1.
Which of the ranges on card IN-1 is the best estimate of how much money was received [from wages or salary, tips, commissions, or bonuses in [YEAR]]?

Responses:
1 - 5,000 1 BOX_60 (IN1130)
5,001 - 10,000 2 BOX_60 (IN1130)
10,001 - 15,000 3 BOX_60 (IN1130)
15,001 - 25,000 4 BOX_60 (IN1130)
25,001 - 50,000 5 BOX_60 (IN1130)
50,001 - 100,000 6 BOX_60 (IN1130)
100,001 OR MORE 7 BOX_60 (IN1130)
REFUSED RF BOX_60 (IN1130)
DON'T KNOW DK BOX_60 (IN1130)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN90, IN100, IN110 and IN120 on the same form pane.

BOX_60 (IN1130)

Route Details:

If IN40 is coded '2' (MARRIED FILING JOINT RETURN), continue with IN110.
Otherwise, go to IN130.

IN110 (IN1135)

BLAISE NAME: AmtWageFiler
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
[Of the [AMOUNT ENTERED AT IN90], how/How] much money did [you/[PRIMARY FILER]] receive from wages or salary, tips, commissions, or bonuses?
ENTER AMOUNT

Responses:
1 IN130 (IN1145)
REFUSED RF IN130 (IN1145)
DON'T KNOW DK IN120 (IN1140)
Programmer Instructions:
Hard Check:
If a dollar amount is entered at both IN90 and IN110, then the amount entered at IN110 must be less than or equal to the amount entered at IN90 (i.e., IN110 less than= IN90). If the amount entered at IN110 is greater than the amount entered at IN90, display the following message:
"AMOUNT ENTERED AT IN110 (AmtWageFiler) MUST BE LESS THAN OR EQUAL TO TOTAL WAGE AMOUNT ENTERED AT IN90 (AmtWage). VERIFY AND RE-ENTER."
Soft Check:
If a range amount is entered at IN100 and a dollar amount is entered at IN110, the amount entered at IN110 must be less than or equal to the upper limit of the range amount selected at IN100. (For example, if IN100 is coded '5' (25,001-50,000), then the amount entered at IN110 should be less than or equal to 50,000). If the amount entered at IN110 is greater than upper limit of the range amount selected at IN110 (excluding RF and DK values), display the following message: "VALUE ENTERED IS HIGHER THAN EXPECTED. AMOUNT ENTERED AT IN110 (AmtWageFiler) IS GREATER THAN RANGE SELECTED AT IN100(AmtWageRng). Verify and correct if needed."
If the current respondent is listed as the Secondary Tax Filer of the tax filing unit being looped on, set WageSplit=Secondary Filer for this tax filing unit.
Placeholder for MHOP processing:
If WageSplit=Secondary Filer, then the amount entered at AmtWageFiler must be recalculated to represent the amount earned by the primary filer.
Display Instructions:
Display IN90, IN100, IN110 and IN120 on the same form pane.
Display "Of the [AMOUNT ENTERED AT IN90], how" if an amount is entered at IN90. Display "How" if IN90 is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).
For "AMOUNT ENTERED AT IN90", display the entry made at IN90 as "$xxxxxx.00".
Display "you" if the current respondent is listed as either the Primary or Secondary Tax filer in this tax filing unit. Otherwise (current respondent is not listed as part of this unit), display "[PRIMARY FILER]" substituting the full name of the primary filer in this tax filing unit.

IN120 (IN1140)

BLAISE NAME: AmtWageRngFiler
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
And IN-;
Which of the ranges on card IN-1 is the best estimate of how much money [you/[PRIMARY FILER]] received [from wages or salary, tips, commissions, or bonuses in [YEAR]]?

Responses:
1 - 5,000 1 IN130 (IN1145)
5,001 - 10,000 2 IN130 (IN1145)
10,001 - 15,000 3 IN130 (IN1145)
15,001 - 25,000 4 IN130 (IN1145)
25,001 - 50,000 5 IN130 (IN1145)
50,001 - 100,000 6 IN130 (IN1145)
100,001 OR MORE 7 IN130 (IN1145)
REFUSED RF IN130 (IN1145)
DON'T KNOW DK IN130 (IN1145)
Programmer Instructions:
Hard Check:
1. If a range is entered at both IN100 and IN120, then range entered at IN120 must be less than or equal to the range selected at IN100. (Do not invoke this check if either IN100 or IN120 has a RF or DK value). If the range selected at IN120 is greater than the range selected at IN100, display the following message: "RANGE SELECTED AT IN120 (AmtWageRngFiler) MUST BE LESS THAN OR EQUAL TO TOTAL WAGE RANGE SELECTED AT IN100 (AmtWageRng). VERIFY AND RE-ENTER."
Soft Check:
1. If a dollar amount was entered at IN90 and a range was selected at IN120, the lower limit of the range at IN120 should be less than or equal to the amount entered at IN90. (For example, if IN90 =30,000 the range selected at IN120 can be any category with a lower limit that is less than or equal to 30,000 - which would be categories 1-5.) If the range selected at IN120 (excluding RF and DK values) has a lower limit that is greater than amount entered at IN90, display the following message: "RANGE SELECTED IS HIGHER THAN EXPECTED.
RANGE SELECTED AT IN120 (AmtWageRngFiler) IS GREATER THAN AMOUNT ENTERED AT IN90 (AmtWage). VERIFY AND CORRECT IF NEEDED."
Placeholder for MHOP processing:
If WageSplit=Secondary Filer, then the amount entered at AmtWageRngFiler must be recalculated to represent the amount earned by the primary filer. Rules may need to be implemented when ranges are entered at IN100 and IN120 in order to properly determine what the amount received by the primary filer should be.
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display "you" if the current respondent is listed as either the Primary or Secondary Tax filer in this tax filing unit. Otherwise (current respondent is not listed as part of this unit), display "[PRIMARY FILER]" substituting the full name of the primary filer in this tax filing unit.
Display IN90, IN100, IN110 and IN120 on the same form pane.

IN130 (IN1145)

BLAISE NAME: AmtInt
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive in taxable interest from savings accounts, bonds, NOW accounts, money market accounts, or similar types of investments?
[IF NECESSARY, SAY: If any interest from a joint account, include only the amount that would be [your/his/her] portion.]
ENTER AMOUNT

Responses:
1 IN150 (IN1155)
REFUSED RF IN150 (IN1155)
DON'T KNOW DK IN140 (IN1150)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display 'IF NECESSARY, SAY ... portion.' if IN40 is not coded '2' (MARRIED, FILING JOINT RETURN) or if IN40 was not asked. If IN40 is coded '2' (MARRIED, FILING JOINT RETURN), use a null display.
Display 'and [you/[NAME OF SECONDARY FILER]]' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN140 (IN1150)

BLAISE NAME: AmtIntRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
And IN-2;
Which of the ranges on card IN-2 is the best estimate of how much money was received [in interest from savings accounts, bonds, NOW accounts, money market accounts, or similar types of investments in [YEAR]]

Responses:
1 - 100 1 IN150 (IN1155)
101 - 500 2 IN150 (IN1155)
501 - 1,000 3 IN150 (IN1155)
1,001 - 5,000 4 IN150 (IN1155)
5,001 - 15,000 5 IN150 (IN1155)
15,001 OR MORE 6 IN150 (IN1155)
REFUSED RF IN150 (IN1155)
DON'T KNOW DK IN150 (IN1155)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN150 (IN1155)

BLAISE NAME: AmtDivd
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much money did [you/[PERSON]] [and [you[NAME OF SECONDARY FILER]]] receive from dividends?
[IF NECESSARY, SAY: If any dividends from a joint source, include only the amount that would be [your/his/her] portion.]
ENTER AMOUNT
HELP: F1

Responses:
1 BOX_70 (IN1165)
REFUSED RF BOX_70 (IN1165)
DON'T KNOW DK IN160 (IN1160)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display 'IF NECESSARY, SAY ... portion).' if IN40 is not coded '2' (MARRIED, FILING JOINT RETURN) or if IN40 was not asked. If IN40 is coded '2' (MARRIED, FILING JOINT RETURN), use a null display.
Display '[and [you/[NAME OF SECONDARY FILER]]]' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, Use A Null Display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN160 (IN1160)

BLAISE NAME: AmtDivdRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
And IN-2;
Which of the ranges on card IN-2 is the best estimate of how much money was received [from dividends in [YEAR]]?

Responses:
1 - 100 1 BOX_70 (IN1165)
101 - 500 2 BOX_70 (IN1165)
501 - 1,000 3 BOX_70 (IN1165)
1,001 - 5,000 4 BOX_70 (IN1165)
5,001 - 15,000 5 BOX_70 (IN1165)
15,001 OR MORE 6 BOX_70 (IN1165)
REFUSED RF BOX_70 (IN1165)
DON'T KNOW DK BOX_70 (IN1165)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

BOX_70 (IN1165)

Route Details:

If IN60 is coded '2' (SHORT FORM 1040A), or '3' (SHORT FORM 1040EZ) go to IN280.
Otherwise, continue with BOX_75 .

BOX_75 (IN1170)

Route Details:

If the primary filer and the secondary filer are both 16 years or older (or in age categories 4-9)
AND
Both the primary filer and the secondary filer are married in the current round and in 2 prior rounds (Person.FullYrMarried=1 as set in the RE Wall), Go to IN190.
Otherwise, continue with IN170.

IN170 (IN1180)

BLAISE NAME: AmtAlim
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from alimony?
ENTER AMOUNT
HELP: F1

Responses:
1 IN190 (IN1190)
REFUSED RF IN190 (IN1190)
DON'T KNOW DK IN180 (IN1185)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display '[and [you/[NAME OF SECONDARY FILER]]]' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN180 (IN1185)

BLAISE NAME: AmtAlimRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
and IN-2.
Which of the ranges on card IN-2 is the best estimate of how much money was received [from alimony in [YEAR]]?

Responses:
1 - 100 1 IN190 (IN1190)
101 - 500 2 IN190 (IN1190)
501 - 1,000 3 IN190 (IN1190)
1,001 - 5,000 4 IN190 (IN1190)
5,001 - 15,000 5 IN190 (IN1190)
15,001 OR MORE 6 IN190 (IN1190)
REFUSED RF IN190 (IN1190)
DON'T KNOW DK IN190 (IN1190)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN190 (IN1190)

BLAISE NAME: AmtBusn
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] earn or lose from [their/[your/his/her]] own farm or non-farm business or practice?
[IF NECESSARY, SAY: If any money from a shared business, include only the amount that would be [your/his/her] portion.]
ENTER AMOUNT
HELP: F1

Responses:
1 BOX_80 (IN1195)
REFUSED RF IN240 (IN1225)
DON'T KNOW DK IN220 (IN1215)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 300,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display 'IF NECESSARY, SAY ... portion).' if IN40 is not coded '2' (MARRIED, FILING JOINT RETURN) or if IN40 was not asked. If IN40 is coded '2' (MARRIED, FILING JOINT RETURN), use a null display.
Display '[and [you/[NAME OF SECONDARY FILER]]]' if IN40 is coded `2` (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
Display 'their' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, display '[your/his/her]' using the person being looped on to determine pronoun substitution.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN190 and IN200 on the same form pane.

BOX_80 (IN1195)

Route Details:

If amount other than zero entered at IN190, continue with IN200.
Otherwise, go to IN240.

IN200 (IN1200)

BLAISE NAME: BusnEarnLoss
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
INTERVIEWER: WAS THE AMOUNT ENTERED EARNINGS OR LOSS?

Responses:
EARNINGS 1 BOX_90 (IN1205)
LOSS 2 BOX_90 (IN1205)
Display Instructions:
Display IN190 and IN200 on the same form pane.

BOX_90 (IN1205)

Route Details:

If IN40 is coded '2' (MARRIED FILING JOINT RETURN), continue with IN210.
Otherwise, go to IN240.

IN210 (IN1210)

BLAISE NAME: PctBusnFiler
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
What percentage of this amount was [received/lost] by [you/[PRIMARY FILER]]?
ENTER PERCENT

Responses:
1 IN240 (IN1225)
REFUSED RF IN240 (IN1225)
DON'T KNOW DK IN240 (IN1225)
Display Instructions:
If IN200 is coded '1' (EARNINGS), display 'received'. If IN200 is coded '2' (LOSS), display 'lost'.
Display IN210, IN220, and IN240 on the same form pane if a percentage is entered here.

IN220 (IN1215)

BLAISE NAME: AmtBusnRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
and IN-2.
Which of the ranges on card IN-2 is the best estimate of how much money was earned or lost [from [their/[your/his/her]] own farm or non-farm business or practice in [YEAR]]?

Responses:
1 - 100 1 IN230 (IN1220)
101 - 500 2 IN230 (IN1220)
501 - 1,000 3 IN230 (IN1220)
1,001 - 5,000 4 IN230 (IN1220)
5,001 - 15,000 5 IN230 (IN1220)
15,001 OR MORE 6 IN230 (IN1220)
REFUSED RF IN240 (IN1225)
DON'T KNOW DK IN240 (IN1225)
Display Instructions:
Display 'their' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, Display '[your/his/her]' using the person being looped on to determine pronoun substitution.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN210, IN220, and IN230 on the same form pane.

IN230 (IN1220)

BLAISE NAME: BusnRngEarnLoss
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
INTERVIEWER: DOES THE RANGE SELECTED REPRESENT EARNINGS OR LOSS?

Responses:
EARNINGS 1 IN240 (IN1225)
LOSS 2 IN240 (IN1225)
Display Instructions:
Display IN210, IN220, and IN230 on the same form pane.

IN240 (IN1225)

BLAISE NAME: AmtSale
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much money was [your/[PERSON]] [and [your/[NAME OF SECONDARY FILER]'s]] net gain or net loss from the sale of property or other assets, after excluding expenses, including the sale of [their/[your/his/her]] home, if it was taxable?
[IF NECESSARY, SAY: A net gain or net loss would subtract the purchase cost and other related expenses from the sale price. [If any money from a shared property or other asset, include only the amount that would be [your/his/her] portion.]
ENTER AMOUNT
HELP: F1

Responses:
1 BOX_100 (IN1230)
REFUSED RF IN280 (IN1250)
DON'T KNOW DK IN260 (IN1240)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 300,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display 'If any money from a shared property or other asset ... portion).' if IN40 is not coded '2' (MARRIED, FILING JOINT RETURN) or if IN40 was not asked. If IN40 is coded '2' (MARRIED, FILING JOINT RETURN), use a null display.
Display 'and [your/[NAME OF SECONDARY FILER]'s]' If IN40 is coded `2` (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'your' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, display '[NAME OF SECONDARY FILER]'s]' substituting the person's name selected at IN50.
Display 'their' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, display '[your/his/her]' using the person being looped on to determine pronoun substitution.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN240, IN250, IN260, and IN270 on the same form pane.

BOX_100 (IN1230)

Route Details:

If amount other than zero entered at IN240, continue with IN250.
Otherwise, go to IN280.

IN250 (IN1235)

BLAISE NAME: SaleGainLoss
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
INTERVIEWER: WAS THE AMOUNT ENTERED A NET GAIN OR A NET LOSS?

Responses:
NET GAIN 1 IN280 (IN1250)
NET LOSS 2 IN280 (IN1250)
Programmer Instructions:
RF/DK disallowed.
Display Instructions:
Display IN240, IN250, IN260, and IN270 on the same form pane.

IN260 (IN1240)

BLAISE NAME: AmtSaleRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
and IN-2.
Which of the ranges on card IN-2 is the best estimate of how much money was earned or lost [from the sale of [their/[your/his/her]] property or other assets, including the sale of home, if it was taxable, in [YEAR]]?

Responses:
1 - 100 1 IN270 (IN1245)
101 - 500 2 IN270 (IN1245)
501 - 1,000 3 IN270 (IN1245)
1,001 - 5,000 4 IN270 (IN1245)
5,001 - 15,000 5 IN270 (IN1245)
15,001 OR MORE 6 IN270 (IN1245)
REFUSED RF IN280 (IN1250)
DON'T KNOW DK IN280 (IN1250)
Display Instructions:
Display 'their' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, display '[your/his/her]' using the person being looped on to determine pronoun substitution.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN240, IN250, IN260 and IN270 on the same form pane.

IN270 (IN1245)

BLAISE NAME: SaleRngGainLoss
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
INTERVIEWER: DOES THE RANGE SELECTED REPRESENT NET GAIN OR NET LOSS?

Responses:
NET GAIN 1 IN280 (IN1250)
NET LOSS 2 IN280 (IN1250)
Programmer Instructions:
RF/DK disallowed.
Display Instructions:
Display IN240, IN250, IN260 and IN270 on the same form pane.

IN280 (IN1250)

BLAISE NAME: AmtRetir
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from payments from Individual Retirement Accounts, that is, IRA, 401k, 403(b), or Keogh accounts?
ENTER AMOUNT
HELP: F1

Responses:
1 IN300 (IN1260)
REFUSED RF IN300 (IN1260)
DON'T KNOW DK IN290 (IN1255)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display '[and [you/[NAME OF SECONDARY FILER]]]' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN280 and IN290 on the same form pane.

IN290 (IN1255)

BLAISE NAME: AmtRetirRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
and IN-2.
Which of the ranges on card IN-2 is the best estimate of how much money was received [from payments from IRA, Keogh, and 401K accounts in [YEAR]]?

Responses:
1 - 100 1 IN300 (IN1260)
101 - 500 2 IN300 (IN1260)
501 - 1,000 3 IN300 (IN1260)
1,001 - 5,000 4 IN300 (IN1260)
5,001 - 15,000 5 IN300 (IN1260)
15,001 OR MORE 6 IN300 (IN1260)
REFUSED RF IN300 (IN1260)
DON'T KNOW DK IN300 (IN1260)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN280 and IN290 on the same form pane.

IN300 (IN1260)

BLAISE NAME: AmtPension
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from private pensions, military retirement, other Federal government employee pensions, state or local government employee pensions, or annuities?
ENTER AMOUNT
HELP: F1

Responses:
1 BOX_110 (IN1270)
REFUSED RF BOX_110 (IN1270)
DON'T KNOW DK IN310 (IN1265)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 300,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display '[and [you/[NAME OF SECONDARY FILER]]]' If IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
For 'NAME OF SECONDARY FILER', display the person's name selected at IN50 during LOOP_10 for the primary filer currently being asked about. If IN50 was not asked in LOOP_10 for this person, use a null display.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN300 and IN310 on the same form pane.

IN310 (IN1265)

BLAISE NAME: AmtPensionRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
and IN-1.
Which of the ranges on card IN-1 is the best estimate of how much money was received [from private pensions, military retirement, other Federal government employee pensions, state or local government employee pensions, or annuities in [YEAR]]?

Responses:
1 - 5,000 1 BOX_110 (IN1270)
5,001 - 10,000 2 BOX_110 (IN1270)
10,001 - 15,000 3 BOX_110 (IN1270)
15,001 - 25,000 4 BOX_110 (IN1270)
25,001 - 50,000 5 BOX_110 (IN1270)
50,001 - 100,000 6 BOX_110 (IN1270)
100,001 OR MORE 7 BOX_110 (IN1270)
REFUSED RF BOX_110 (IN1270)
DON'T KNOW DK BOX_110 (IN1270)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN300 and IN310 on the same form pane.

BOX_110 (IN1270)

Route Details:

If IN60 is coded '2' (SHORT FORM 1040A) or '3' (SHORT FORM 1040EZ), go to BOX_130.
Otherwise, continue with IN320.

IN320 (IN1275)

BLAISE NAME: AmtTrust
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive as a net gain or loss, after excluding expenses, from estates or trusts, partnerships, S corporations, royalties, or from rental income?
[IF NECESSARY, SAY: A net gain or net loss would subtract the purchase cost and other related expenses from the sale price. [If any money from a joint venture, include only the amount that would be [your/his/her] portion.]

Responses:
1 BOX_120 (IN1280)
REFUSED RF BOX_130 (IN1296)
DON'T KNOW DK IN340 (IN1290)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 300,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display 'If any money from ... portion).' if IN40 is not coded '2' (MARRIED, FILING JOINT RETURN) or if IN40 was not asked. If IN40 is coded '2' (MARRIED, FILING JOINT RETURN), use a null display.
Display '[and [you/[NAME OF SECONDARY FILER]]]' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. OTHERWISE, Display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN320, IN330, IN340 and IN350 on the same form pane.

BOX_120 (IN1280)

Route Details:

If amount other than zero entered at IN320, continue with IN330.
Otherwise, go to BOX_130.

IN330 (IN1285)

BLAISE NAME: TrustGainLoss
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
INTERVIEWER: WAS THE AMOUNT ENTERED A NET GAIN OR A NET LOSS?

Responses:
NET GAIN 1 BOX_130 (IN1296)
NET LOSS 2 BOX_130 (IN1296)
Programmer Instructions:
RF/DK disallowed.
Display Instructions:
Display IN320, IN330, IN340 and IN350 on the same form pane.

IN340 (IN1290)

BLAISE NAME: AmtTrustRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
and IN-2.
Which of the ranges on card IN-2 is the best estimate of how much money was earned or lost [from estates or trusts, partnerships, S corporations, royalties, or from rental income in [YEAR]]?

Responses:
1 - 100 1 IN350 (IN1295)
101 - 500 2 IN350 (IN1295)
501 - 1,000 3 IN350 (IN1295)
1,001 - 5,000 4 IN350 (IN1295)
5,001 - 15,000 5 IN350 (IN1295)
15,001 OR MORE 6 IN350 (IN1295)
REFUSED RF BOX_130 (IN1296)
DON'T KNOW DK BOX_130 (IN1296)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN320, IN330, IN340 and IN350 on the same form pane.

IN350 (IN1295)

BLAISE NAME: TrustRngGainLoss
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
INTERVIEWER: DOES THE RANGE SELECTED REPRESENT NET GAIN OR NET LOSS?

Responses:
NET GAIN 1 BOX_130 (IN1296)
NET LOSS 2 BOX_130 (IN1296)
Programmer Instructions:
RF/DK disallowed.
Display Instructions:
Display IN320, IN330, IN340 and IN350 on the same form pane.

BOX_130 (IN1296)

Route Details:

If the primary filer and the secondary filer (tax unit) are both 16 years or older (or in age categories 4-9)
AND
Each RU member in the tax unit had the same current main job in the current round (Job.JobTp=1) and prior 2 rounds (preload.Job.PR.JobTp=1 previous round and preload.Job.PR2_JobTp=1 two rounds ago)
AND
The job started earlier than current year - 1 (preload.Job.JobStartYYYYless thancurrent year-1)
Go to IN380.
Otherwise, continue with IN360.

IN360 (IN1300)

BLAISE NAME: AmtUnemp
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from unemployment compensation?
ENTER AMOUNT
HELP: F1

Responses:
1 IN380 (IN1310)
REFUSED RF IN380 (IN1310)
DON'T KNOW DK IN370 (IN1305)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display '[and [you/[NAME OF SECONDARY FILER]]]' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN360 and IN370 on the same form pane.

IN370 (IN1305)

BLAISE NAME: AmtUnempRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
and IN-2.
Which of the ranges on card IN-2 is the best estimate of how much money was received [from unemployment compensation in [YEAR]]?

Responses:
1 - 100 1 IN380 (IN1310)
101 - 500 2 IN380 (IN1310)
501 - 1,000 3 IN380 (IN1310)
1,001 - 5,000 4 IN380 (IN1310)
5,001 - 15,000 5 IN380 (IN1310)
15,001 OR MORE 6 IN380 (IN1310)
REFUSED RF IN380 (IN1310)
DON'T KNOW DK IN380 (IN1310)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN360 and IN370 on the same form pane.

IN380 (IN1310)

BLAISE NAME: AmtSocSec
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
During [YEAR], how much money did [you/[PERSON]] [and [you/[NAME OF SECONDARY FILER]]] receive from Social Security and equivalent tier 1 Railroad Retirement benefits?
HELP: F1

Responses:
1 END_LP20 (IN1320)
REFUSED RF END_LP20 (IN1320)
DON'T KNOW DK IN390 (IN1315)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
Display '[and [you/[NAME OF SECONDARY FILER]]]' if IN40 is coded '2' (MARRIED FILING JOINT RETURN). Otherwise, use a null display.
Display 'you' if the secondary filer selected at IN50 is selected as the respondent. Otherwise, display '[NAME OF SECONDARY FILER]' substituting the person's name selected at IN50.
For 'NAME OF SECONDARY FILER', display the person's name selected at IN50 during LOOP_10 for the primary filer currently being asked about. If IN50 was not asked in LOOP_10 for this person, use a null display.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN380 and IN390 on the same form pane.

IN390 (IN1315)

BLAISE NAME: AmtSocSecRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF SECONDARY FILER]
Question Text:
and IN-1.
Which of the ranges on card IN-1 is the best estimate of how much money was received [from Social Security and equivalent tier 1 Railroad Retirement benefits in [YEAR]]?

Responses:
1 - 5,000 1 END_LP20 (IN1320)
5,001 - 10,000 2 END_LP20 (IN1320)
10,001 - 15,000 3 END_LP20 (IN1320)
15,001 - 25,000 4 END_LP20 (IN1320)
25,001 - 50,000 5 END_LP20 (IN1320)
50,001 - 100,000 6 END_LP20 (IN1320)
100,001 OR MORE 7 END_LP20 (IN1320)
REFUSED RF END_LP20 (IN1320)
DON'T KNOW DK END_LP20 (IN1320)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN380 and IN390 on the same form pane.

END_LP20 (IN1320)

Route Details:

Cycle on next person on the RU-MEMBERS-ROSTER that meets the conditions stated in the loop definition.
If no other persons meet the stated conditions, end LOOP_20 and continue with IN400.

IN400 (IN1325)

BLAISE NAME: WrkrComp
Question Text:
During [YEAR], did anyone in the household receive Worker's Compensation?
HELP: F1

Responses:
YES 1
NO 2 IN440 (IN1360)
REFUSED RF IN440 (IN1360)
DON'T KNOW DK IN440 (IN1360)
Programmer Instructions:
If coded '1' (YES) and a single person RU, automatically code person as 'RECEIVED WORKER'S COMPENSATION' at IN410 and go to LOOP_30.
If coded '1' (YES) and a multi-person RU, continue with IN410.
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN410 (IN1330)

BLAISE NAME: WhoWrkrComp
Question Text:
Who received Worker's Compensation in [YEAR]?
PROBE: Anyone else receive Worker's Compensation in [YEAR]?
ENTER ALL THAT APPLY.

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 LOOP_30 (IN1335)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 LOOP_30 (IN1335)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 LOOP_30 (IN1335)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 LOOP_30 (IN1335)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 LOOP_30 (IN1335)
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:
Display all RU members who meet the following condition:
- Person is a current RU member (includes deceased and institutionalized members).
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

LOOP_30 (IN1335)

Route Details:

For each element in the RU-MEMBERS-ROSTER, ask IN420 - END_LP30.
Loop definition: LOOP_30 determines how much money was received from worker's compensation for RU members who received worker's compensation in the calendar year.
This loop cycles on each person on the RU-MEMBERS-ROSTER who meets the following conditions:
- Person is a current RU member (includes deceased and institutionalized RU members)
- Person received worker's compensation in the calendar year (selected at IN410)

IN420 (IN1345)

BLAISE NAME: AmtWrkrComp
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
How much money did [you/[PERSON]] receive from Worker's Compensation [in [YEAR]]?
ENTER AMOUNT

Responses:
1 END_LP30 (IN1355)
REFUSED RF END_LP30 (IN1355)
DON'T KNOW DK IN430 (IN1350)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 50,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN430 (IN1350)

BLAISE NAME: AmtWrkrCompRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
and IN-2.
Which of the ranges on card IN-2 is the best estimate of how much money was received [from Worker's Compensation in [YEAR]]?

Responses:
1 - 100 1 END_LP30 (IN1355)
101 - 500 2 END_LP30 (IN1355)
501 - 1,000 3 END_LP30 (IN1355)
1,001 - 5,000 4 END_LP30 (IN1355)
5,001 - 15,000 5 END_LP30 (IN1355)
15,001 OR MORE 6 END_LP30 (IN1355)
REFUSED RF END_LP30 (IN1355)
DON'T KNOW DK END_LP30 (IN1355)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

END_LP30 (IN1355)

Route Details:

Cycle on next person on the RU-MEMBERS-ROSTER that meets the conditions stated in the loop definition.
If no other persons meet the stated conditions, end LOOP_30 and continue with IN440.

IN440 (IN1360)

BLAISE NAME: SSI
Question Text:
During [YEAR], did anyone in the household receive Supplemental Security Income, also known as S.S.I.?
HELP: F1

Responses:
YES 1
NO 2 IN490 (IN1410)
REFUSED RF IN490 (IN1410)
DON'T KNOW DK IN490 (IN1410)
Programmer Instructions:
If coded '1' (YES) and a single person RU, automatically code person as 'RECEIVED S.S.I.' at IN450 and go to LOOP_40.
If coded '1' (YES) and a multi-person RU, continue with IN450.
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN450 (IN1365)

BLAISE NAME: WhoSSI
Question Text:
Who received Supplemental Security Income in [YEAR]?
PROBE: Anyone else receive S.S.I. in [YEAR]?
ENTER ALL THAT APPLY.

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 LOOP_40 (IN1370)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 LOOP_40 (IN1370)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 LOOP_40 (IN1370)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 LOOP_40 (IN1370)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 LOOP_40 (IN1370)
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:
Display all RU members who meet the following condition:
- Person is a current RU member (includes deceased and institutionalized members).
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

LOOP_40 (IN1370)

Route Details:

For each element in the RU-MEMBERS-ROSTER, ask IN460 - END_LP40.
Loop definition: LOOP_40 determines how much money was received from Supplemental Security Income (S.S.I) for RU members who received S.S.I. in the calendar year. This loop cycles on each person on the RU-MEMBERS-ROSTER who meets the following conditions:
- Person is a current RU member (includes deceased and institutionalized RU members)
- Person received Supplemental Security Income in the calendar year (selected at IN450)

IN460 (IN1390)

BLAISE NAME: MonSSI
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
For how many months in [YEAR] did [you/[PERSON]] receive money from Supplemental Security Income?
ENTER MONTHS

Responses:
1 IN470 (IN1395)
REFUSED RF IN470 (IN1395)
DON'T KNOW DK IN470 (IN1395)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN470 (IN1395)

BLAISE NAME: AmtSSIMon
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
On average, how much money did [you/[PERSON]] get per month [from Supplemental Security Income in [YEAR]]?
ENTER AMOUNT

Responses:
1 END_LP40 (IN1405)
REFUSED RF END_LP40 (IN1405)
DON'T KNOW DK IN480 (IN1400)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 50,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN480 (IN1400)

BLAISE NAME: AmtSSIMonRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
And IN-3;
Which of the ranges on card IN-3 is the best estimate of how much money was received per month [from Supplemental Security Income in [YEAR]]?

Responses:
1 - 250 1 END_LP40 (IN1405)
251 - 500 2 END_LP40 (IN1405)
501 - 750 3 END_LP40 (IN1405)
751 - 1,000 4 END_LP40 (IN1405)
1,001 OR MORE 5 END_LP40 (IN1405)
REFUSED RF END_LP40 (IN1405)
DON'T KNOW DK END_LP40 (IN1405)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

END_LP40 (IN1405)

Route Details:

Cycle on next person on the RU-MEMBERS-ROSTER that meets the conditions stated in the loop definition.
If no other persons meet the stated conditions, end LOOP_40 and continue with IN490.

IN490 (IN1410)

BLAISE NAME: PubAssist
Question Text:
During [YEAR], did anyone in the household receive any money from public assistance or welfare, such as Temporary Assistance for Needy Families, also known as TANF [, [STATE TANF NAME 1]] [, [STATE TANF NAME 2]] [, [STATE TANF NAME 3]], or general assistance?
HELP: F1

Responses:
YES 1
NO 2 IN560 (IN1460)
REFUSED RF IN560 (IN1460)
DON'T KNOW DK IN560 (IN1460)
Programmer Instructions:
If coded '1' (YES) and a single person RU, automatically code person as 'RECEIVED PUBLIC ASSISTANCE' at IN500 and go to LOOP_50.
If coded '1' (YES) and a multi-person RU, continue with IN500.
Display Instructions:
Display ', [STATE TANF NAME 1]' (substituting the real state name for the TANF program) if the state in which interview is being conducted has one or more TANF name(s). Otherwise, use a null display.
Display ', [STATE TANF NAME 2]' (substituting the real state name for the TANF program) if the state in which interview is being conducted has a second other TANF name. Otherwise, use a null display.
Display ', [STATE TANF NAME 3]' (substituting the real state name for the TANF program) if the state in which interview is being conducted has a third other TANF name. Otherwise, use a null display.
For the specific name to use by state, see TBD.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN500 (IN1415)

BLAISE NAME: WhoPubAssist
Question Text:
In whose name were the public assistance or welfare benefits received?
PROBE: Who received a deposit, or whose name was on the electronic benefit card (EBT), debit card or check?
ENTER ALL THAT APPLY.

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 LOOP_50 (IN1420)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 LOOP_50 (IN1420)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 LOOP_50 (IN1420)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 LOOP_50 (IN1420)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 LOOP_50 (IN1420)
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:
Display all RU members who meet the following condition:
- Person is a current RU member (includes deceased and institutionalized RU members)

LOOP_50 (IN1420)

Route Details:

For each element in the RU-MEMBERS-ROSTER, ask IN510 - END_LP50.
Loop definition: LOOP_50 determines who was covered by public assistance, whether any of the checks included money from TANF and how much was received per month. this loop cycles on each person on the RU-MEMBERS-ROSTER who meets the following conditions:
Person is a current RU member (includes deceased and institutionalized RU members)
Person's name was on the public assistance checks (selected or auto-coded at IN500)

IN510 (IN1430)

BLAISE NAME: PubAssistCov
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
Sometimes checks from public assistance cover more than one person in the household, even though only one person's name is on the check.
Who is covered by [your/[PERSON]'s] checks from public assistance?
PROBE: Did [your/his/her] checks cover anyone else?
ENTER ALL THAT APPLY.

IN530 (IN1440)

BLAISE NAME: MonPubAssist
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
For how many months in [YEAR] did [you/[PERSON]] receive checks from public assistance?
ENTER MONTHS

Responses:
1 IN540 (IN1445)
REFUSED RF IN540 (IN1445)
DON'T KNOW DK IN540 (IN1445)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN540 (IN1445)

BLAISE NAME: AmtPubAssistMon
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
On average, how much money did [you/[PERSON]] get per month [from public assistance in [YEAR]]?
ENTER AMOUNT

Responses:
1 END_LP50 (IN1455)
REFUSED RF END_LP50 (IN1455)
DON'T KNOW DK IN550 (IN1450)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft range check: If amount entered is greater than or =50,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN550 (IN1450)

BLAISE NAME: AmtPubAssistMonRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
and IN-3.
Which of the ranges on card IN-3 is the best estimate of how much money was received per month [from public assistance in [YEAR]]?

Responses:
1 - 250 1 END_LP50 (IN1455)
251 - 500 2 END_LP50 (IN1455)
501 - 750 3 END_LP50 (IN1455)
751 - 1,000 4 END_LP50 (IN1455)
1,001 OR MORE 5 END_LP50 (IN1455)
REFUSED RF END_LP50 (IN1455)
DON'T KNOW DK END_LP50 (IN1455)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

END_LP50 (IN1455)

Route Details:

Cycle on next person on the RU-MEMBERS-ROSTER that meets the conditions stated in the loop definition.
If no other persons meet the stated conditions, end LOOP_50 and continue with IN560.

IN560 (IN1460)

BLAISE NAME: ChSuprt
Question Text:
During [YEAR], did anyone in the household receive any money from child support?
HELP: F1

Responses:
YES 1
NO 2 IN610 (IN1500)
REFUSED RF IN610 (IN1500)
DON'T KNOW DK IN610 (IN1500)
Programmer Instructions:
If coded '1' (YES) and a single person RU, automatically code person as 'RECEIVED CHILD SUPPORT' at IN570 and go to LOOP_60.
If coded '1' (YES) and a multi-person RU, continue with IN570.
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN570 (IN1465)

BLAISE NAME: WhoChSuprt
Question Text:
Who received child support in [YEAR]?
PROBE: Anyone else receive child support in [YEAR]?
ENTER ALL THAT APPLY.
HELP: F1

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 LOOP_60 (IN1470)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 LOOP_60 (IN1470)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 LOOP_60 (IN1470)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 LOOP_60 (IN1470)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 LOOP_60 (IN1470)
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:
Display all RU members who meet the following condition:
- Person is a current RU member (includes deceased and institutionalized members)
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

LOOP_60 (IN1470)

Route Details:

For each element in the RU-MEMBERS-ROSTER, ask IN580 - END_LP60.
Loop definition: LOOP_60 determines how much money was received from child support for RU members who received child support in calendar year. This loop cycles on each person on the RU-MEMBERS-ROSTER who meets the following conditions:
- Person is a current RU member (includes deceased and institutionalized RU members)
- Person received child support in calendar year (selected at IN570).

IN580 (IN1480)

BLAISE NAME: MonChSuprt
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
For how many months in [YEAR] did [you/[PERSON]] receive money from child support?
ENTER MONTHS

Responses:
1 IN590 (IN1485)
REFUSED RF IN590 (IN1485)
DON'T KNOW DK IN590 (IN1485)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN590 (IN1485)

BLAISE NAME: AmtChSuprtMon
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
On average, how much money did [you/[PERSON]] get per month [from child support in [YEAR]]?
ENTER AMOUNT

Responses:
1 END_LP60 (IN1495)
REFUSED RF END_LP60 (IN1495)
DON'T KNOW DK IN600 (IN1490)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft range check: If amount entered is greater than or =100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN600 (IN1490)

BLAISE NAME: AmtChSuprtMonRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
and IN-3.
Which of the ranges on card IN-3 is the best estimate of how much money was received per month [from child support in [YEAR]]?

Responses:
1 - 250 1 END_LP60 (IN1495)
251 - 500 2 END_LP60 (IN1495)
501 - 750 3 END_LP60 (IN1495)
751 - 1,000 4 END_LP60 (IN1495)
1,001 OR MORE 5 END_LP60 (IN1495)
REFUSED RF END_LP60 (IN1495)
DON'T KNOW DK END_LP60 (IN1495)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

END_LP60 (IN1495)

Route Details:

Cycle on next person on the RU-MEMBERS-ROSTER that meets the conditions stated in the loop definition.
If no other persons meet the stated conditions, end LOOP_60 and continue with IN610.

IN610 (IN1500)

BLAISE NAME: VetPymt
Question Text:
Not counting military retirement, during [YEAR], did anyone in the household receive any veteran's payments such as education or disability benefits?
HELP: F1

Responses:
YES 1
NO 2 IN650 (IN1535)
REFUSED RF IN650 (IN1535)
DON'T KNOW DK IN650 (IN1535)
Programmer Instructions:
If coded '1' (YES) and a single person RU, automatically code person as 'RECEIVED VETERAN'S PAYMENTS' at IN620 and go to LOOP_70.
If coded '1' (YES) and a multi-person RU, continue with IN620.
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN620 (IN1505)

BLAISE NAME: WhoVetPymt
Question Text:
Who received veteran's payments such as education or disability benefits [in [YEAR]]?
PROBE: Anyone else receive veteran's payments in [YEAR]?
ENTER ALL THAT APPLY.

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 LOOP_70 (IN1510)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 LOOP_70 (IN1510)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 LOOP_70 (IN1510)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 LOOP_70 (IN1510)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 LOOP_70 (IN1510)
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:
Display all RU members who meet the following condition:
- Person is a current RU member (includes deceased and institutionalized members).
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

LOOP_70 (IN1510)

Route Details:

For each element in the RU-MEMBERS-ROSTER, ask IN630 - END_LP70.
Loop definition: LOOP_70 determines how much money was received from veteran's payments for RU members who received veteran's payments in the calendar year. This loop cycles on each person on the RU-MEMBERS-ROSTER who meets the following conditions:
Person is a current RU member (includes deceased and institutionalized RU members).
Person received veteran's payments in the calendar year (selected or auto-coded at IN620).

IN630 (IN1520)

BLAISE NAME: AmtVetPymt
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
How much money did [you/[PERSON]] receive from veteran's payments such as education or disability benefits in
[YEAR]?
[Do not include military retirement.]

Responses:
1 END_LP70 (IN1530)
REFUSED RF END_LP70 (IN1530)
DON'T KNOW DK IN640 (IN1525)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft range check: If amount entered is greater than or =100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN640 (IN1525)

BLAISE NAME: AmtVetPymtRng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
and IN-2.
Which of the ranges on card IN-2 is the best estimate of how much money was received [from veteran's payments such as education or disability benefits in [YEAR]]?

Responses:
1 - 100 1 END_LP70 (IN1530)
101 - 500 2 END_LP70 (IN1530)
501 - 1,000 3 END_LP70 (IN1530)
1,001 - 5,000 4 END_LP70 (IN1530)
5,001 - 15,000 5 END_LP70 (IN1530)
15,001 OR MORE 6 END_LP70 (IN1530)
REFUSED RF END_LP70 (IN1530)
DON'T KNOW DK END_LP70 (IN1530)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

END_LP70 (IN1530)

Route Details:

Cycle on next person on the RU-MEMBERS-ROSTER that meets the conditions stated in the loop definition.
If no other persons meet the stated conditions, end LOOP_70 and continue with IN650.

IN650 (IN1535)

BLAISE NAME: Cash
Question Text:
Besides what we have already talked about, during [YEAR], did anyone in the household receive any money from regular cash contributions from people who do not live in this household?
HELP: F1

Responses:
YES 1
NO 2 IN700 (IN1575)
REFUSED RF IN700 (IN1575)
DON'T KNOW DK IN700 (IN1575)
Programmer Instructions:
If coded '1' (YES) and a single person RU, automatically code person as 'RECEIVED REGULAR CASH CONTRIBUTIONS FROM OUTSIDE HOUSEHOLD' at IN660 and go to LOOP_80.
If coded '1' (YES) and a multi-person RU, continue with IN660.
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN660 (IN1540)

BLAISE NAME: WhoCash
Question Text:
Who received regular cash contributions from people who do not live in this household [in [YEAR]]?
PROBE: Anyone else receive regular cash contributions, in [YEAR], from people who do not live here?
ENTER ALL THAT APPLY.

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 LOOP_80 (IN1545)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 LOOP_80 (IN1545)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 LOOP_80 (IN1545)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 LOOP_80 (IN1545)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 LOOP_80 (IN1545)
Programmer Instructions:
Roster behavior:
1. Multiple select allowed.
Display Instructions:
Roster definition:
This item displays RU-MEMBERS-ROSTER for selection. Display RU member's first, middle, and last name (Person.FullName)
Roster filter:
Display all current RU members (including persons who are deceased and institutionalized this round who are current round 3 members.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

LOOP_80 (IN1545)

Route Details:

For each element in the RU-MEMBERS-ROSTER, ask IN670 - END_LP80.
Loop definition: LOOP_80 determines how much money was received from regular cash contributions from outside the household for RU members who received these types of contributions in the calendar year. This loop cycles on each person on the RU-MEMBERS-
ROSTER who meets the following conditions:
Person is a current RU member (includes deceased and institutionalized ru members)
Person received regular cash contributions from someone outside of the household in the calendar year (selected or auto-coded at IN660)

IN670 (IN1555)

BLAISE NAME: MonCash
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
For how many months in [YEAR] did [you/[PERSON]] receive money from regular cash contributions from people who do not live in this household?
ENTER MONTHS

Responses:
1 IN680 (IN1560)
REFUSED RF IN680 (IN1560)
DON'T KNOW DK IN680 (IN1560)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN680 (IN1560)

BLAISE NAME: AmtCashMon
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
On average, how much money did [you/[PERSON]] get per month [from regular cash contributions from people who do not live in this household, in [YEAR]]?
ENTER AMOUNT

Responses:
1 END_LP80 (IN1570)
REFUSED RF END_LP80 (IN1570)
DON'T KNOW DK IN690 (IN1565)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN690 (IN1565)

BLAISE NAME: AmtCashMonRng
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
and IN-3.
Which of the ranges on card IN-3 is the best estimate of how much money was received per month [from regular cash contributions from people who do not live in this household, in [YEAR]]?

Responses:
1 - 250 1 END_LP80 (IN1570)
251 - 500 2 END_LP80 (IN1570)
501 - 750 3 END_LP80 (IN1570)
751 - 1,000 4 END_LP80 (IN1570)
1,001 OR MORE 5 END_LP80 (IN1570)
REFUSED RF END_LP80 (IN1570)
DON'T KNOW DK END_LP80 (IN1570)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

END_LP80 (IN1570)

Route Details:

Cycle on next person on the RU-MEMBERS-ROSTER that meets the conditions stated in the loop definition.
If no other persons meet the stated conditions, end LOOP_80 and continue with IN700.

IN700 (IN1575)

BLAISE NAME: FoodStmp
Question Text:
During [YEAR], did anyone in the household get benefits from the Supplemental Nutrition Assistance Program, also known as SNAP [or [STATE SNAP NAME]], or food stamps?
HELP: F1

Responses:
YES 1 IN710 (IN1580)
NO 2 IN730 (IN1595)
REFUSED RF IN730 (IN1595)
DON'T KNOW DK IN730 (IN1595)
Display Instructions:
Display 'or [STATE SNAP NAME]' (substituting the real state name for the SNAP program) if the state in which interview is being conducted does not use the name 'SNAP.' For the specific name to use by state, see ATTACHMENT 36.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN710 (IN1580)

BLAISE NAME: MonFoodStmp
Question Text:
For how many months in [YEAR] were SNAP or other food stamp benefits received?
ENTER MONTHS

Responses:
1 IN720 (IN1590)
REFUSED RF IN720 (IN1590)
DON'T KNOW DK IN720 (IN1590)
Display Instructions:
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN720 (IN1590)

BLAISE NAME: AmtFoodStmpMon
Question Text:
What was the approximate monthly value of the SNAP or other food stamp benefits?
ENTER AMOUNT

Responses:
1 IN730 (IN1595)
REFUSED RF IN730 (IN1595)
DON'T KNOW DK IN730 (IN1595)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than or = to 1,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:

IN730 (IN1595)

BLAISE NAME: OthInco
Question Text:
and IN-4.
Card IN-4 lists some sources of income. Has anyone in the household received any income, other than income we have already talked about, such as income from sources listed on this card?
HELP: F1

Responses:
YES 1 IN740 (IN1605)
NO 2 BOX_170 (IN1670)
REFUSED RF BOX_170 (IN1670)
DON'T KNOW DK BOX_170 (IN1670)
Display Instructions:

LOOP_90 (IN1600)

Route Details:

For each source:
Ask BOX 140 - END_LP90.
Loop definition: LOOP_90 collects information about other sources of taxable income. This loop cycles on each source of taxable income selected at IN740.

IN740 (IN1605)

BLAISE NAME: OthIncoSrc
Question Text:
and IN-4.
From which of the sources on card IN-4 did anyone in the household receive income [that we have not yet talked about]?
ENTER ALL THAT APPLY.
HELP: F1

Responses:
WAGES AND SALARY 1 BOX_140 (IN1620)
FARM INCOME (OR LOSS) 2 BOX_140 (IN1620)
BUSINESS INCOME (OR LOSS) 3 BOX_140 (IN1620)
SOCIAL SECURITY/RAILROAD RETIREMENT 4 BOX_140 (IN1620)
PRIVATE, MILITARY, OR GOVERNMENT PENSIONS 5 BOX_140 (IN1620)
INTEREST 6 BOX_140 (IN1620)
DIVIDENDS 7 BOX_140 (IN1620)
RENTAL INCOME (OR LOSS) 8 BOX_140 (IN1620)
OTHER SOURCE 91 IN740OS (IN1610)
REFUSED RF BOX_140 (IN1620)
DON'T KNOW DK BOX_140 (IN1620)
Programmer Instructions:
If coded '91' (OTHER SOURCE), alone or in combination with any other code, continue with IN740OS.
Otherwise, go to LOOP_90.
Display Instructions:
Display IN740 and IN740OS on the same form pane.

IN740OS (IN1610)

BLAISE NAME: OthIncoSrcOS
Question Text:
ENTER OTHER INCOME SOURCE:

Responses:
1 BOX_140 (IN1620)
REFUSED RF BOX_140 (IN1620)
DON'T KNOW DK BOX_140 (IN1620)
Display Instructions:
Display IN740 and IN740OS on the same form pane.

BOX_140 (IN1620)

Route Details:

If single person RU, automatically code person as 'RECEIVED INCOME FROM IN730 SOURCE' at IN750 and go to IN760. Otherwise, continue with IN750.

IN750 (IN1625)

BLAISE NAME: WhoOthInco
Question Text:
Who received income from [CATEGORY SELECTED AT IN740] in [YEAR]?
PROBE: Anyone else receive income from [CATEGORY SELECTED AT IN740] in [YEAR]?
ENTER ALL THAT APPLY.

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 IN760 (IN1630)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 IN760 (IN1630)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 IN760 (IN1630)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 IN760 (IN1630)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 IN760 (IN1630)
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:
Display all RU members who meet the following condition:
- Person is a current RU member (includes deceased and institutionalized RU members)
For 'CATEGORY SELECTED AT IN740', display the response category name selected at IN740 during the current loop.
If '91' (OTHER) was selected at IN740, display 'OTHER: [SPECIFY]' for '[CATEGORY SELECTED AT IN740]', where 'SPECIFY' is the text that was entered at IN740OS. If IN740OS is coded RF or DK, display 'OTHER: [REFUSED/DON'T KNOW].'
If 'RF' (REFUSED) was selected at IN740, display "REFUSED INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.
If 'DK' (DON'T KNOW) was selected at IN740, display "DON'T KNOW INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).

IN760 (IN1630)

BLAISE NAME: AmtOthInco
Question Text:
What is the total amount received from [CATEGORY SELECTED AT IN740], in [YEAR], for [all of the people just mentioned/ [you/[PERSON]]]?
ENTER AMOUNT

Responses:
1 BOX_150 (IN1635)
REFUSED RF END_LP90 (IN1665)
DON'T KNOW DK IN780 (IN1645)
Programmer Instructions:
Pre-fill cents digits with '00' so that field accepts whole dollar amount only.
Soft check: If amount entered is greater than to 100,000, display the following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display Instructions:
For 'CATEGORY SELECTED AT IN740', display the response category name selected at IN740 during the current loop.
If '91' (OTHER) was selected at IN740, display 'OTHER: [SPECIFY]' for '[CATEGORY SELECTED AT IN740]', where 'SPECIFY' is the text that was entered at IN740OS. If IN740OS is coded RF or DK, display 'OTHER: [REFUSED/DON'T KNOW].'
If 'RF' (REFUSED) was selected at IN740, display "REFUSED INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.
If 'DK' (DON'T KNOW) was selected at IN740, display "DON'T KNOW INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.
Display 'all of the people just mentioned' if more than one person was selected at IN750. Otherwise
(i.e.if only one person was selected), display 'you' if the respondent was selected or display 'PERSON' 's name selected at IN750.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN760 and IN770 on the same form pane.

BOX_150 (IN1635)

Route Details:

If amount other than zero entered at IN760 and IN740 is coded '2' (FARM INCOME OR LOSS), '3' (BUSINESS INCOME OR LOSS), '8' (RENTAL INCOME OR LOSS), or '91' (OTHER SOURCE), continue with IN770.
Otherwise, go to END LP90.

IN770 (IN1640)

BLAISE NAME: OthIncoGainLoss
Question Text:
INCOME SOURCE: [CATEGORY SELECTED AT IN740??????..]
INTERVIEWER: WAS THE AMOUNT ENTERED A NET GAIN OR A NET LOSS?

Responses:
NET GAIN 1 END_LP90 (IN1665)
NET LOSS 2 END_LP90 (IN1665)
Programmer Instructions:
RF/DK disallowed.
Display Instructions:
For 'CATEGORY SELECTED AT IN740', display the response category name selected at IN740 during the current loop.
If '91' (OTHER) was selected at IN740, display 'OTHER: [SPECIFY]' for '[CATEGORY SELECTED AT IN740]', where 'SPECIFY' is the text that was entered at IN740OS. If IN740OS is coded RF or DK, display 'OTHER: [REFUSED/DON'T KNOW].'
If 'RF' (REFUSED) was selected at IN740, display "REFUSED INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.
If 'DK' (DON'T KNOW) was selected at IN740, display "DON'T KNOW INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.

IN780 (IN1645)

BLAISE NAME: AmtOthIncoRng
Question Text:
and IN-2.
Which of the ranges on card IN-2 is the best estimate of how much money was received [from [CATEGORY SELECTED AT IN740] in [YEAR]]?

Responses:
1 - 100 1 BOX_160 (IN1650)
101 - 500 2 BOX_160 (IN1650)
501 - 1,000 3 BOX_160 (IN1650)
1,001 - 5,000 4 BOX_160 (IN1650)
5,001 - 15,000 5 BOX_160 (IN1650)
15,001 OR MORE 6 BOX_160 (IN1650)
REFUSED RF BOX_160 (IN1650)
DON'T KNOW DK BOX_160 (IN1650)
Display Instructions:
For 'CATEGORY SELECTED AT IN740', display the response category name selected at IN740 during the current loop.
If '91' (OTHER) was selected at IN740, display 'OTHER: [SPECIFY]' for '[CATEGORY SELECTED AT IN740]', where 'SPECIFY' is the text that was entered at IN740OS. If IN740OS is coded RF or DK, display 'OTHER: [REFUSED/DON'T KNOW].'
If 'RF' (REFUSED) was selected at IN740, display "REFUSED INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.
If 'DK' (DON'T KNOW) was selected at IN740, display "DON'T KNOW INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.
(For specifications purposes only; CAPI handles automatically:) If round 3, display first calendar year of panel for [YEAR] (FirstPanYear). If round 5, display second calendar year of panel for [YEAR] (SecondPanYear).
Display IN780 and IN790 on the same form pane.

BOX_160 (IN1650)

Route Details:

If 'RF' (REFUSED) or 'DK' (DON'T KNOW) is not coded at IN780 and IN740 is coded '2' (FARM INCOME OR LOSS), '3' (BUSINESS INCOME OR LOSS), '8' (RENTAL INCOME OR LOSS), or '91' (OTHER SOURCE), continue with IN790.
Otherwise, go to END LP90.

IN790 (IN1655)

BLAISE NAME: OthIncoRngGainLoss
Question Text:
INCOME SOURCE: [DISPLAY CATEGORY SELECTED AT IN740????????.]
INTERVIEWER: DOES THE RANGE SELECTED REPRESENT NET GAIN OR NET LOSS?

Responses:
NET GAIN 1 END_LP90 (IN1665)
NET LOSS 2 END_LP90 (IN1665)
Programmer Instructions:
RF/DK disallowed.
Display Instructions:
Display IN780 and IN790 on the same form pane.
For 'CATEGORY SELECTED AT IN740', display the response category name selected at IN740 during the current loop.
If '91' (OTHER) was selected at IN740, display 'OTHER: [SPECIFY]' for '[CATEGORY SELECTED AT IN740]', where 'SPECIFY' is the text that was entered at IN740OS. If IN740OS is coded RF or DK, display 'OTHER: [REFUSED/DON'T KNOW].'
If 'RF' (REFUSED) was selected at IN740, display "REFUSED INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.
If 'DK' (DON'T KNOW) was selected at IN740, display "DON'T KNOW INCOME SOURCE" for '[CATEGORY SELECTED AT IN740]'.

END_LP90 (IN1665)

Route Details:

Cycle on next source that meets conditions stated in the loop definition.
If no more sources meet the stated conditions, END LOOP_90 and continue with BOX_170.

BOX_170 (IN1670)

Route Details:

Go to next questionnaire section.

Managed Care (MC) Section

BOX_00 (MC1000)

Route Details:

01 Box equal to BOX_00, BOX_10, BOX_20
04 Single Select equal to MC10

BOX_10 (MC1010)

Route Details:

Context Header Display Instructions:
Display Person.FullName, Insurance.Plcyhldr, Insurance.HISrcName General Display Instructions for Question Text:
For ?(START DATE)?, 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable BegRefDt.
For ?(END DATE)?, 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable EndRefDt.

MC10 (MC1015)

BLAISE NAME: HMOPlan
Context Header:

(POLICYHOLDER?S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)

Question Text:

(Is/Was) (your/(POLICYHOLDER)'s) (NAME OF INSURED) an HMO (as of (END DATE))? (When answering this question, do not consider (your/his/her) insurance through Medicare.)
[With an HMO, you must generally receive care from HMO physicians. For other doctors, the expense is not covered unless you were referred by the HMO or there was a medical emergency.]
HELP: F1

Responses:

YES 1 BOX_20 (MC1025)
NO 2 BOX_20 (MC1025)
REFUSED RF BOX_20 (MC1025)
DON'T KNOW DK BOX_20 (MC1025)

Display Instructions:

Display 'Is' if not round 5. Display 'Was' if round 5.
For "NAME OF INSURER", display the name current round's insurer for this insurance as collected in the HX or OE section that launched MC (Insurance.Insurer). Display "Refused Insurer" if Insurance.Insurer equal to RF or display "Don't Know Insurer" if Insurance.Insurer equal to DK.
Display 'as of (END DATE)' if round 5. Otherwise, use a null display.
Display ?When answering this question, do not consider (your/his/her) insurance through Medicare.? if policyholder being asked about is also covered by Medicare (Insurance.HISrc equal toMedicare). Otherwise, use a null display.

BOX_20 (MC1025)

Route Details: Return to original questionnaire section in HX or OE.

Medical Visit (MV) Section

BOX_00 (MV1000)

Route Details:

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60
04 Single Select equal to MV10, MV20, MV30, MV40, MV60, MV80, MV100, MV110
05 Single Select with Display Roster equal to MV130
06 Single Select with Fill in Answer Text equal to MV50
08 Multiple Select equal to MV90
11 Multiple Select with Add/Edit/Delete equal to MV70, MV120
23 Text Field equal to MV150
28 Trigram Lookup equal to MV20LU
30 Multiple Select with Fill in Answer Text and Display Roster equal to MV140
Roster 2 equal to MV140
Roster 3 equal to MV70, MV120

BOX_10 (MV1001)

Route Details:

Context Header Display Instructions:
DISPLAY PERS.FULLNAME, PROV.LORPNAME, EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY.
If provider is flagged as facility provider, also display doctor or department linked to this facility provider for this event (if available).
If a provider is flagged as a person-provider and MV10 has already been asked for this person-provider in this round (for any RU member), auto-code MV10 with the response that was coded when it was first looped on and go to BOX 20.
Otherwise, continue with MV10.

MV10 (MV1015)

BLAISE NAME: MVSeeDoc
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

(Is (PROVIDER) a medical doctor?/Did (you/(PERSON)) see a medical doctor during this particular visit?)
HELP: F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer:

If MV10 is coded ?1? (YES) and provider associated with event is a facility-provider, go to MV20.
If MV10 is coded ?2? (NO), ?RF? or ?DK? and provider associated with event is a facility-provider, go to MV30.
Otherwise, continue with BOX_20.

Display Instructions:

Display ?Is (PROVIDER) a medical doctor?? if Provider linked to this event is flagged as a ?person-provider?. Otherwise, display ?Did (you/(PERSON)) see a medical doctor during this particular visit??

BOX_20 (MV1017)

Route Details:

If MV10 is coded ?1? (YES) and provider associated with event is a person-provider, and person-provider already has MV20/20OS (specialty) recorded this round (for any RU member) or in a previous round (for any RU member) (preload.MVDocSpecFlag),
OR
If MV10 is coded ?2? (NO), ?DK?, or ?RF? and provider associated with event is a person-provider, and person-provider already has MV30 (provider type) recorded this round (for any RU member) or in a previous round (for any RU member) (preload.MVMedTypeFlag), Go to BOX_30.
If MV10 is coded ?1? (YES) and provider associated with event is a person-provider, and person-provider does NOT already have MV20/20OS (specialty) recorded this round (for any RU member) or in a previous round (for any RU member), go to
MV20(preload.MVDocSpecFlag)
If MV10 is coded ?2? (NO), ?DK?, or ?RF? and provider associated with event is a person-provider, and person-provider does NOT already have MV30 (provider type) recorded this round (for any RU member) or in a previous round (for any RU member), go to MV30 (preload.MVMedTypeFlag).

MV20 (MV1020)

BLAISE NAME: MVDocSpeclty
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

What was the doctor's specialty?
IF TALKED TO MORE THAN ONE DOCTOR, PROBE FOR MAIN PROVIDER.

Responses:

ALLERGY/IMMUNOLOGY 1 BOX_30 (MV1030)
CARDIOLOGY (HEART) 3 BOX_30 (MV1030)
DERMATOLOGY (SKIN) 4 BOX_30 (MV1030)
ENDOCRINOLOGY/METABOLISM (DIABETES, THYROID) 5 BOX_30 (MV1030)
FAMILY PRACTICE 6 BOX_30 (MV1030)
GASTROENTEROLOGY 7 BOX_30 (MV1030)
GENERAL PRACTICE 8 BOX_30 (MV1030)
GENERAL SURGERY 9 BOX_30 (MV1030)
GYNECOLOGY/OBSTETRICS 11 BOX_30 (MV1030)
INTERNAL MEDICINE (INTERNIST) 14 BOX_30 (MV1030)
NEPHROLOGY (KIDNEYS) 15 BOX_30 (MV1030)
NEUROLOGY 16 BOX_30 (MV1030)
ONCOLOGY (TUMORS, CANCER) 18 BOX_30 (MV1030)
OPHTHALMOLOGY (EYES) 19 BOX_30 (MV1030)
ORTHOPEDICS 20 BOX_30 (MV1030)
OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT) 22 BOX_30 (MV1030)
PEDIATRICIAN 24 BOX_30 (MV1030)
PSYCHIATRY/PSYCHIATRIST 28 BOX_30 (MV1030)
UROLOGY 33 BOX_30 (MV1030)
OTHER DR SPECIALTY 91 MV20LU (MV1023)
REFUSED RF BOX_30 (MV1030)
DON'T KNOW DK BOX_30 (MV1030)

Display Instructions:

MV20LU (MV1023)

BLAISE NAME: MVDocSpecltyLU
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

ENTER OTHER DOCTOR SPECIALTY.
TYPE THE FIRST 3 LETTERS OF THE SPECIALTY, THEN USE ARROW KEYS IF NEEDED TO LOCATE SPECIALTY, AND PRESS ENTER TO SELECT.

Responses:

ALLERGY/IMMUNOLOGY 1
ANESTHESIOLOGY 2
CARDIOLOGY (HEART) 3
DERMATOLOGY (SKIN) 4
ENDOCRINOLOGY/METABOLISM (DIABETES, THYROID) 5
FAMILY PRACTICE 6
GASTROENTEROLOGY 7
GENERAL PRACTICE 8
GENERAL SURGERY 9
GERIATRICS (ELDERLY) 10
GYNECOLOGY/OBSTETRICS 11
HEMATOLOGY (BLOOD) 12
HOSPITAL RESIDENCE 13
INTERNAL MEDICINE (INTERNIST) 14
NEPHROLOGY (KIDNEYS) 15
NEUROLOGY 16
NUCLEAR MEDICINE 17
ONCOLOGY (TUMORS, CANCER) 18
OPHTHALMOLOGY (EYES) 19
ORTHOPEDICS 20
OSTEOPATHY (DO) 21
OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT) 22
PATHOLOGY 23
PEDIATRICIAN 24
PHYSICAL MEDICINE/REHAB 25
PLASTIC SURGERY 26
PROCTOLOGY 27
PSYCHIATRY/PSYCHIATRIST 28
PULMONARY 29
RADIOLOGY 30
RHEUMATOLOGY (ARTHRITIS) 31
THORACIC SURGERY (CHEST) 32
UROLOGY 33
OTHER DR SPECIALTY 91
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Go to BOX_30.
Responses listed are part of the provider specialty look-up file that works similar to a trigram search.
Browser window should be labeled ?SELECT SPECIALTY?.
Response code numbers should be stored behind the scenes and not visible in the look-up window.

Display Instructions:

MV30 (MV1025)

BLAISE NAME: MVMPTp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) - (DOC OR DEPT) (EVN-DT)

Question Text:

What type of medical person did (you/(PERSON)) talk to on (VISIT DATE)?
IF TALKED TO MORE THAN ONE MEDICAL PERSON, PROBE FOR MAIN PROVIDER.
HELP: F1

Responses:

ACUPUNCTURIST 1 BOX_30 (MV1030)
CHIROPRACTOR 2 BOX_30 (MV1030)
DENTIST/DENTAL CARE PERSON 3 BOX_30 (MV1030)
HOMEOPATHIC/NATUROPATHIC/HERBALIST/OTHER ALTERNATIVE/COMPLEMENTARY CARE PROVIDER 4 BOX_30 (MV1030)
MASSAGE THERAPIST 5 BOX_30 (MV1030)
MENTAL HEALTH COUNSELOR/MARITAL OR FAMILY THERAPIST 6 BOX_30 (MV1030)
MIDWIFE 7 BOX_30 (MV1030)
NURSE/NURSE PRACTITIONER 8 BOX_30 (MV1030)
OPTOMETRIST 9 BOX_30 (MV1030)
PHYSICAL/OCCUPATIONAL THERAPIST 10 BOX_30 (MV1030)
PHYSICIAN'S ASSISTANT 11 BOX_30 (MV1030)
PODIATRIST 12 BOX_30 (MV1030)
PSYCHOLOGIST 13 BOX_30 (MV1030)
SOCIAL WORKER 14 BOX_30 (MV1030)
TECHNICIAN 15 BOX_30 (MV1030)
OTHER 91 BOX_30 (MV1030)
REFUSED RF BOX_30 (MV1030)
DON'T KNOW DK BOX_30 (MV1030)

Display Instructions:

BOX_30 (MV1030)

Route Details:

IF MV10 IS CODED '1' (YES), GO TO MV50.
If MV10 is coded ?2? (NO), ?RF? or ?DK? and MV40 was coded ?1? (YES) for this person-type provider in this round for any RU member, auto code MV40 for this event as ?1? (YES) and go to MV50.
If MV10 is coded ?2? (NO), ?RF? or ?DK? and MV40 was coded ?2? (NO), ?RF? OR ?DK? for this same person-type provider in the current round, auto code MV40 for this event with the same response (NO, RF, DK) and go to MV50.
OTHERWISE, CONTINUE WITH MV40.

MV40 (MV1035)

BLAISE NAME: MVDocLoctn
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) - (DOC OR DEPT) (EVN-DT)

Question Text:

TYPE OF PERSON HAD CONTACT: (MEDICAL PERSON TYPE FROM MV30)
CODE WITHOUT ASKING IF OBVIOUS. OTHERWISE, ASK:
Do any medical doctors work at (the same location as (PROVIDER)/(PROVIDER))?
HELP: F1

Responses:

YES 1 MV50 (MV1040)
NO 2 MV50 (MV1040)
REFUSED RF MV50 (MV1040)
DON'T KNOW DK MV50 (MV1040)

Display Instructions:

Display ?the same location as (PROVIDER)? if provider is flagged as ?PERSON-TYPE-PROVIDER?. Display ?(PROVIDER)? if provider is flagged as ?FACILITY-PROVIDER?.
For ?MEDICAL PERSON TYPE FROM MV30?, display the following text for each code selected at MV30 (regardless if MV30 was collected for this RU member or in a previous round) (Provider[I]. MVMPTp):
Code ?1?equal to ACUPUNCTURIST
Code ?2? equal to CHIROPRACTOR
Code ?3? equal to DENTIST/DENTAL CARE PERSON
Code ?4?equal to HOMEOPATHIC/NATUROPATHIC/HERBALIST/ OTHER ALTERNATIVE/COMPLEMENTARY CARE PROVIDER
Code ?5?equal to MASSAGE THERAPIST
Code ?6?equal to MENTAL HEALTH COUNSELOR/MARITAL OR FAMILY THERAPIST
Code ?7? equal to MIDWIFE
Code ?8? equal to NURSE/NURSE PRACTITIONER
Code ?9? equal to OPTOMETRIST
Code ?10? equal to PHYSICAL?/ OCCUPATIONAL THERAPIST
Code ?11? equal to PHYSICIAN?S ASSISTANT
Code ?12? equal to PODIATRIST
Code ?13?equal to PSYCHOLOGIST
Code ?14?equal to SOCIAL WORKER
Code ?15?equal to TECHNICIAN
Code ?91?equal to OTHER
Code ?RF?equal to REFUSED PROVIDER TYPE
Code ?DK?equal to DON?T KNOW PROVIDER TYPE

MV50 (MV1040)

BLAISE NAME: MVVstCat
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) - (DOC OR DEPT) (EVN-DT)

Question Text:

MV-1.
Please look at card MV-1 and tell me which category best describes the care (you/(PERSON)) received during the visit to ( (DOC OR DEPT) at) (PROVIDER) on (VISIT DATE).
HELP: F1

Responses:

GENERAL CHECKUP 1 MV60 (MV1045)
DIAGNOSIS OR TREATMENT 2 MV60 (MV1045)
EMERGENCY (E.G., ACCIDENT OR INJURY) 3 MV60 (MV1045)
PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING 4 MV60 (MV1045)
FOLLOW-UP OR POST-OPERATIVE VISIT 5 MV60 (MV1045)
IMMUNIZATIONS OR SHOTS 6 MV60 (MV1045)
VISION EXAM 7 MV60 (MV1045)
(PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)) 8 MV60 (MV1045)
(WELL CHILD EXAM) 9 MV60 (MV1045)
LASER EYE SURGERY 10 MV60 (MV1045)
OTHER 91 MV60 (MV1045)
REFUSED RF MV60 (MV1045)
DON'T KNOW DK MV60 (MV1045)

Display Instructions:

Display response option ?8? (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)) if person is female and age 15 to 55 inclusive (or age categories 3 to 8). Otherwise, use a null display.
Display response option ?9? (WELL CHILD EXAM) if PERSON IS less than 7 YEARS OLD (OR AGE CATEGORIES 1 THROUGH 3). Otherwise, use a null display.
Display ?(DOC OR DEPT) at? if PROVIDER linked to this event is flagged as a facility provider and there a doctor or department linked to this specific event. Otherwise, use a null display.

MV60 (MV1045)

BLAISE NAME: MVSpecCond
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) - (DOC OR DEPT) (EVN-DT)

Question Text:

(Other than (your/his/her) (general checkup/well child exam), was/Was) this visit related to any specific health condition or were any conditions discovered during this visit?
HELP:F1

Responses:

YES 1 MV70 (MV1050)
NO 2 MV80 (MV1055)
REFUSED RF MV80 (MV1055)
DON'T KNOW DK MV80 (MV1055)

Display Instructions:

Display ?Other than (your/his/her) (general checkup/well child exam), was? if MV50 was coded ?1? (GENERAL CHECKUP) OR ?9? (WELL CHILD EXAM). Otherwise, display ?Was?.
Display ?general checkup? if MV50 was coded ?1? (GENERAL CHECKUP). Display ?well child exam? if MV50 was coded ?9? (WELL CHILD EXAM).

MV70 (MV1050)

BLAISE NAME: MVCondRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) - (DOC OR DEPT) (EVN-DT)

Question Text:

What conditions were discovered or led (you/ (PERSON)) to make this visit?
PROBE: Any other condition?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP:F1

Responses:

(MEDICAL CONDITION) 1 1 MV80 (MV1055)
(MEDICAL CONDITION) 2 2 MV80 (MV1055)
(MEDICAL CONDITION) 3 3 MV80 (MV1055)
(MEDICAL CONDITION) 4 4 MV80 (MV1055)
(MEDICAL CONDITION)N 5 MV80 (MV1055)

Programmer Instructions:

Display Instructions:

Roster 3-add/edit/delete allowed.
Roster definition:
Display the Person-Medical-Conditions-Roster for selection and addition of one or many medical condition (s) associated with this event. Display name of medical condition (COND.CONDNAM)
Roster filter:
Display all conditions on person's roster; no filter.

MV80 (MV1055)

BLAISE NAME: MVSurgProc
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) - (DOC OR DEPT) (EVN-DT)

Question Text:

Was a surgical procedure performed on (you/(PERSON)) during this visit?
HELP: F1

Responses:

YES 1 MV90 (MV1070)
NO 2 MV90 (MV1070)
REFUSED RF MV90 (MV1070)
DON'T KNOW DK MV90 (MV1070)

Display Instructions:

MV90 (MV1070)

BLAISE NAME: MVSvcTp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE
PROVIDER) - (DOC OR DEPT (EVN-DT)

Question Text:

MV-2.
Looking at card MV-2, which of these services, if any, did (you/(PERSON)) have during this visit?
ENTER ALL THAT APPLY.
HELP: F1

Responses:

LABORATORY TESTS 1 MV100 (MV1075)
SONOGRAM OR ULTRASOUND 2 MV110 (MV1080)
X-RAYS 3 MV110 (MV1080)
MAMMOGRAM 4 MV110 (MV1080)
MRI OR CATSCAN 5 MV110 (MV1080)
EKG, ECG, OR EEG 6 MV110 (MV1080)
VACCINATION 7 MV110 (MV1080)
NONE OF THESE SERVICES RECEIVED 95 MV110 (MV1080)
REFUSED RF MV110 (MV1080)
DON'T KNOW DK MV110 (MV1080)

Programmer Instructions:

Soft check:
If MV90 (MVSvcTp) is coded '4' (MAMMOGRAM) and person being asked about is male or is female and less than or equal to 17 years of age (or age categories 1-3), display the following message: "UNLIKELY RESPONSE FOR (MALES/CHILDREN 17 AND YOUNGER). VERIFY AND RE-ENTER."
Display 'MALES' in error message if person being asked about is a male greater than 17 years of age (or age categories 4 through 9). Display 'CHILDREN 17 AND YOUNGER' in the error message if person being asked about is male or female and less than or equal to 17 years of age (or age categories 1-3).
Allow code '95' (NONE OF THESE SERVICES RECEIVED), 'RF' (REFUSED) and 'DK' (DON'T KNOW) alone only. These responses may not be selected with any other response.
'NONE OF THESE SERVICES RECEIVED' is not displayed on show card.
Hard check:
Edit: If MV90 (MVSvcTp) is coded '95' (NONE OF THESE SERVICES RECEIVED), no other treatment categories can be coded. If interviewer selects another code with 'NONE OF THESE SERVICES', display the following message: "NONE OF THESE SERVICES RECEIVED CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE-ENTER."

Display Instructions:

MV100 (MV1075)

BLAISE NAME: WhereLabTest
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

Did (you/(PERSON)) receive the lab tests at ((PROVIDER/(PROVIDER)?s office)) or somewhere else?

Responses:

THIS PROVIDER 1 MV110 (MV1080)
SOMEWHERE ELSE 2 MV110 (MV1080)
REFUSED RF MV110 (MV1080)
DON'T KNOW DK MV110 (MV1080)

Programmer Instructions:

NOTE: CAPI will present a follow-up question to determine whether the separate lab event has already been recorded whenever MV100 is coded ?2? (SOMEWHERE ELSE).

Display Instructions:

Display ?(PROVIDER)? if provider associated with this event is a facility provider. Otherwise, display ?(PROVIDER)?s office.?

MV110 (MV1080)

BLAISE NAME: MVPmed
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) - (DOC OR DEPT) (EVN-DT)

Question Text:

During this visit, were any medicines prescribed for (you/(PERSON))? Please include only prescriptions which were filled.
HELP: F1

Responses:

YES 1 MV120 (MV1085)
NO 2 BOX_40 (MV1095)
REFUSED RF BOX_40 (MV1095)
DON'T KNOW DK BOX_40 (MV1095)

Display Instructions:

MV120 (MV1085)

BLAISE NAME: MVPmedRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) - (DOC OR DEPT) (EVN-DT)

Question Text:

Please tell me the names of the prescriptions from this visit that were filled.
PROBE: Any other prescribed medicines from this visit that were filled?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(PRESCRIBED MEDICINE)1 1 BOX_40 (MV1095)
(PRESCRIBED MEDICINE)2 2 BOX_40 (MV1095)
(PRESCRIBED MEDICINE)3 3 BOX_40 (MV1095)
(PRESCRIBED MEDICINE)4 4 BOX_40 (MV1095)
(PRESCRIBED MEDICINE)N 5 BOX_40 (MV1095)

Programmer Instructions:

Display Instructions:

Roster 3- Add/Edit/Delete Allowed
Roster definition:
This item displays the Person?s-Prescription-Medicines-Roster for selection. Display name of prescribed medicine (DRUG.DRUGNAME)
Roster filter:
Display all medicines in person's roster; no filter.

BOX_40 (MV1095)

Route Details:

If no condition is associated with this visit to this provider for this person, go to BOX_60. Otherwise, continue with BOX_50.

BOX_50 (MV1100)

Route Details:

If 1 or more visits to this provider for this person have not completed the medical provider visits utilization module and if this event is not part of a flat fee group, continue with MV130. Note: If provider is a facility provider, check all events to the same facility provider regardless of the doctor or department linked to the specific events)
Otherwise, go to BOX_60.

MV130 (MV1105)

BLAISE NAME: MVOthSameCond
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

Question Text:

Earlier I recorded that (you/(PERSON)) had some other visits to (PROVIDER). (Were any of these visits related to (your/his/her) (PERSON?S MV MEDICAL CONDITION)?/Were any of the other visits also for (your/his/her) (PERSON?S MV MEDICAL CONDITION) or (PERSON?S MV MEDICAL CONDITION) (or (PERSON?S MV MEDICAL CONDITION))?/ Were any of the other visits also for one of these conditions (READ CONDITIONS BELOW):)
(CONDITIONS
(PERSON'S MV MEDICAL CONDITION)1
(PERSON'S MV MEDICAL CONDITION)2
(PERSON'S MV MEDICAL CONDITION)3
(PERSON'S MV MEDICAL CONDITION)4
(PERSON'S MV MEDICAL CONDITION)N)

Responses:

YES 1 MV140 (MV1115)
NO 2 BOX_60 (MV1125)
REFUSED RF BOX_60 (MV1125)
DON'T KNOW DK BOX_60 (MV1125)

Display Instructions:

(DOC OR DEPT) should not display in context header.
Display ?Were any of these visits related to (your/his/her) (PERSON?S MV MEDICAL CONDITION)?? if only one condition selected or added to Person?s-Medical-Conditions-Roster at MV70. Display ?Were any of the other visits also for (your/his/her) (PERSON?S MV MEDICAL CONDITION) or (PERSON?S MV MEDICAL CONDITION) (or (PERSON?S MV MEDICAL CONDITION))?? if exactly 2 or 3 conditions selected or added to Person?s-Medical-Conditions-Roster at MV70. Otherwise, display ?Were any of the other visits also for one of these conditions (READ CONDITIONS BELOW):?
Display ?or (PERSON?S MV MEDICAL CONDITION? if exactly 3 conditions selected or added to Person?s-Medical-Conditions-Roster at MV70. Otherwise, use a null display.
For ?PERSON?S MV MEDICAL CONDITION? display the condition selected from or added to Person?s-Medical-Conditions-Roster at MV70.
Display the header ?CONDITIONS? and the list of conditions if more than three conditions selected or added to Person?s-Medical-Conditions-Roster at MV70. Otherwise, use a null display. For ?PERSON?S MV MEDICAL CONDITION?, display all conditions selected from or added to Person?s-Medical-Conditions-Roster at MV70.

MV140 (MV1115)

BLAISE NAME: MVRepVstRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

Question Text:

(Which of the following visits were also for (your/(PERSON)?s) (PERSON?S MV MEDICAL CONDITION) ((or (your/his/her)/,) (PERSON?S MV MEDICAL CONDITION)) (or (your/his/her) (PERSON?S MV MEDICAL CONDITION))?/ Which of the following visits were also for one of these conditions (READ CONDITIONS BELOW) ?)
PROBE: Any other visits for the same condition?
ENTER ALL THAT APPLY.
(CONDITIONS
(PERSON'S MV MEDICAL CONDITION)1
(PERSON'S MV MEDICAL CONDITION)2
(PERSON'S MV MEDICAL CONDITION)3
(PERSON'S MV MEDICAL CONDITION)4
(PERSON'S MV MEDICAL CONDITION)N)

Responses:

(SELECT ALL EVENTS) 0 MV150 (MV1120)
(MONTH,DAY,YEAR) - (DOC OR DEPT)1 1 MV150 (MV1120)
(MONTH,DAY,YEAR) - (DOC OR DEPT)2 2 MV150 (MV1120)
(MONTH,DAY,YEAR) - (DOC OR DEPT)3 3 MV150 (MV1120)
(MONTH,DAY,YEAR) - (DOC OR DEPT)4 4 MV150 (MV1120)
(MONTH,DAY,YEAR) - (DOC OR DEPT)N 5 MV150 (MV1120)

Programmer Instructions:

If coded '0' SELECT ALL EVENTS, CAPI should automatically select all of the events displayed on the roster and flag as being part of the repeat visit group.
Flag each visit selected at MV140 as a repeat visit related to the event being asked about.
(NOTE: The event being cycled on through this MV section administration is the ?stem? repeat visit. The events selected at MV140 are the ?leaves?. The event driver (ED) section will not serve these repeat visits for the MV section.)
Assign next repeat visit number at the household level. (NOTE: Each repeat visit grouping, whether OP, MV, or HH is assigned this number at a household level. The number will start over every round.)
Roster behavior:
1. Multiple select allowed.

Display Instructions:

(DOC OR DEPT) should not display in context header.
Roster 2- No Add/Edit/Delete
Roster definition:
This item displays all medical events (dates) on person's medical- events-roster for selection.
Display event begin date (EVNT.EVNTBEGM,EVNT.EVNTBEGD,EVNT.EVNTBEGY)
Roster filter:
Display only those event with the following characteristics.
Event was created this round.
Event has not been processed in utilization.
Event has event type ?MV?.
Event is associated with the same provider as the event being asked about (regardless of the doctor or department linked to the specific event if provider is a facility provider).
Event is not already flagged as part of a flat fee bundle.
Next to each event date, display the doctor or department linked to that specific visit date.
Display ?Which of the following visits were also for (your/(PERSON)?s) (PERSON?S MV MEDICAL CONDITION) ((or (your/his/her)/,) (PERSON?S MV MEDICAL CONDITION)) (or (your/his/her) (PERSON?S MV MEDICAL CONDITION))?? if three or less conditions selected or added to Person?s-Medical-Conditions-Roster at MV70. Otherwise display, ?Which of the following visits were also for one of these conditions (READ CONDITIONS BELOW)??
Display ?(or (your/his/her)/,) (PERSON?S MV MEDICAL CONDITION)? if two or three conditions selected or added to Person?s-Medical-Conditions-Roster at MV70. Otherwise, use a null display.
Display ?or (your/his/her)? if exactly two conditions selected or added to Person?s-Medical-Conditions-Roster at MV70. Otherwise, display ?,?.
Display ?or (your/his/her) (PERSON?S MV MEDICAL CONDITION)? if exactly three conditions selected or added to Person?s-Medical-Conditions-Roster at MV70. Otherwise, use a null display.
For ?PERSON?S MV MEDICAL CONDITION? display the condition selected from or added to Person?s-Medical-Conditions-Roster AT MV70.
Display the header ?CONDITIONS? and the list of conditions if more than three conditions selected or added to Person?s-Medical-Conditions-Roster at MV70. Otherwise, use a null display. For ?PERSON?S MV MEDICAL CONDITION?, display all conditions selected from or added to Person?s-Medical-Conditions-Roster at MV70.
For "MONTH,DAY,YEAR" in the response option area, display visit dates as "MON DD, YYYY".
Abbreviate the month name as three letters.
Display the response option '0' SELECT ALL EVENTS when there is more than one event to display on the roster, otherwise use a null display.

MV150 (MV1120)

BLAISE NAME: MVEvntVstGrp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

Question Text:

INTERVIEWER: RECORD ?NAME OF REPEAT VISIT GROUP? FOR EVENTS SELECTED IN PREVIOUS QUESTION:

Responses: 1 BOX_60 (MV1125)
Programmer Instructions: 'RF/DK not allowed'
Display Instructions:

(DOC OR DEPT) should not display in context header.

BOX_60 (MV1125)

Route Details:

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.
If the Charge/Payment (CP) section is completed for this Medical Provider Visit (MV) event and MV100 is coded '2' (SOMEWHERE ELSE) go to EF section.
Otherwise, go to the Event Driver (ED) section.

Old Empl\Priv Related Ins (OE) Section

BOX_00 (OE1000)

Route Details:

01 Box: BOX_00, BOX_10, BOX_20, BOX_25, 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.
02 Loop: LOOP_10.
03 End Loop: END_LP10.
04 Single Select: OE20_01, OE20_05, OE40, OE60_05, OE80, OE90, OE100, OE110, OE150, OE160, OE170, OE190, OE200, OE220.
05 Single Select with Display Roster: OE50_01, OE70.
06 Single Select with Fill in Answer Text: OE10, OE30_01, OE60_01, OE210.
08 Multiple Select: OE130.
14 Regular Date Entry: OE30_02, OE30_03, OE30_04.
15 Regular Date Entry with Skips: OE60_02, OE60_03, OE60_04.
17 Dollar Items Allowing Cents: OE180.
20 OS Text Field: OE130OS, OE190OS.
23 Text Field: OE120, OE140.

BOX_10 (OE1001)

Route Details:

Context Header Instructions:
Display Person.FullName, Insurance.Plcyhldr, Insurance.HISrcName.
Throughout the specifications for this CAPI section, for displays of '(you/(POLICYHOLDER))', display 'you' only if the current round respondent is the same PersID as the policyholder for the insurance being looped on.
Otherwise, display '(POLICYHOLDER)' substituting the name of the policyholder. If the policyholder is 'POLICYHOLDER NOT LISTED IN DU' (Insurance.Plcyhldr=902), display 'PLCYHLDR NOT IN DU-' followed by the 15 character entry at HP100. If the policyholder is 'POLICYHOLDER DECEASED' (Insurance.Plcyhldr=901), display 'PLCYHLDR DECEASED-' followed by the first 15 characters of the entry at HP110 (see HP specifications).
General Display Instructions for Question Text:
For '(START DATE)', 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable BegRefDt.
For '(END DATE)', display the RU level reference period end date (typically but not always current round interview date if Rds 2-4 or Dec 31 if Round 5). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable EndRefDt.
For '(PERSON'S START DATE)', display the person level reference period start date.
Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variables Person.BegRefM, Person.BegRefD, Person.BegRefY.
For '(PERSON'S END DATE)', display the person level reference period end date.
Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variables Person.EndRefM, Person.EndRefD, Person.EndRefY.
Unless there is a more specific fill instruction provided at the item level, for any fill using the variable 'Insurance.Insurer', display the text entry stored or display "Refused Insurer" if Insurance.Insurer=RF or display "Don't Know Insurer" if Insurance.Insurer=DK. Items using Insurance.Insurer include OE110, OE120, OE160.

BOX_20 (OE1010)

Route Details:

If one or more current RU members were listed as a policyholder or covered person on a private health insurance source (employer, union, direct purchase) as of the previous round interview date [Insurance.HIPubPriv=Private and there is at least one RU member on the covered person array where Person.MostRecentRU=RUUnit and Preload.CovdPers.LRndCovd =(previous round) and Insurance.OrigRnd()current round], continue with LOOP_10.
Otherwise, go to BOX_210.

Programmer Instructions:

NOTE: Definition for being listed as a policyholder or covered person on a private health insurance source (employer, union, direct purchase) as of the previous round interview date:
- Insurance is flagged as a current or former employer, union or direct purchase source that provides health insurance
- At least one current RU member is flagged as a policyholder or a covered person for this insurance
- At least one RU member was a covered person on the previous round's interview date for the health insurance provided by insurance source

LOOP_10 (OE1015)

Route Details:

For each private insurance, ask BOX_ 25 - END_LP10.
Loop definition: Loop_10 collection information about private insurance that was created in a previous round and at least one current RU member is covered as a policyholder or a dependent on the previous round's interview date. This loop cycles by policyholder, then by insurance. If the respondent is a policyholder on any insurance, cycle on that insurance first. [Insurance.HIPubPriv=Private and there is at least one RU member on the covered person array where Person.MostRecentRU=RUUnit and Preload.CovdPers.LRndCovd=(previous round) and Insurance.OrigRnd()current round]
NOTE: LOOP_10 collects information about the following situations:
The continuation of insurance coverage associated with an employer from the Employment (EM) section that provides health insurance and is through a 'CURRENT MAIN' or 'CURRENT MISCELLANEOUS' job that was collected in a previous round (that employer may now be either current or non-current depending on responses in RJ).
The continuation of insurance coverage associated with an employer or union from the Employment (EM) section that provides health insurance collected in a previous round but was not through a current main or miscellaneous job reviewed during the RJ section.
The continuation of insurance coverage through a direct purchase source that was collected in a previous round. This includes insurance where the policyholder was originally marked as "POLICYHOLDER NOT LISTED IN DU" and "POLICYHOLDER DECEASED".
The continuation of insurance coverage through insurance where the eligible dependent(s) are separated from the policyholder (the policyholder or the dependents have left the original RU). When a jobholder/policyholder leaves an RU, we will never ask RJ.
This last set of conditions handles the situation where the policyholder has left the RU and left dependents behind, or the situation where the dependents have left the RU (without the policyholder). This situation will be treated as 'Dependent(s) Separated from Policyholder'.
This situation can be associated with any insurance in a particular RU where they are covered persons, but the policyholder is in another RU. This situation will carryforward with the insurance every round.
This situation should never exist on insurance in an RU where the policyholder is in the same RU as all of the dependents or where the policyholder was originally created as 'POLICYHOLDER NOT LISTED IN DU' or 'POLICYHOLDER DECEASED'. See HX BOX_10 for more information on this situation.
For all situations above, there must be at least one RU member (or the policyholder) who was a covered person on the previous round's interview date for this insurance to be reviewed in the current round.

BOX_25 (OE1025)

Route Details:

If the policyholder is 'POLICYHOLDER NOT LISTED IN DU' (Insurance.Plcyhldr=902 , HP90=98), continue with OE10.
Otherwise, go to OE20_01.

OE10 (OE1030)

BLAISE NAME: OEPlcyhldrRoster
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

INTERVIEWER: IF (POLICYHOLDER)'S NAME IS LISTED ON THE ROSTER BELOW, SELECT IT. IF NOT, SELECT 'NAME NOT ON ROSTER' AND CONTINUE.

Responses:

(FIRST NAME, [MIDDLE NAME], LAST NAME)1 1 OE20_01 (OE1035)
(FIRST NAME, [MIDDLE NAME], LAST NAME)2 2 OE20_01 (OE1035)
(FIRST NAME, [MIDDLE NAME], LAST NAME)3 3 OE20_01 (OE1035)
(FIRST NAME, [MIDDLE NAME], LAST NAME)4 4 OE20_01 (OE1035)
(FIRST NAME, [MIDDLE NAME], LAST NAME)N 5 OE20_01 (OE1035)
NAME NOT ON ROSTER 99 OE20_01 (OE1035)

Programmer Instructions:

Roster 2 - no add/edit/delete Roster behavior:
Single select allowed.
If a DU member's name is selected from the roster, replace this name as the current policyholder of this insurance. [Set Insurance.Plcyhldr=PersID if DU member selected] If 'NAME NOT ON ROSTER' selected leave the policyholder name as is.

Display Instructions:

Roster Definition:
This item displays persons in the DU-members-roster for selection.
Roster filter:
No filter; display all. 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.

OE20_01 (OE1035)

BLAISE NAME: ConfCovd
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

During our last interview, we recorded that (you/(POLICYHOLDER)) had health insurance through (INSURANCE SOURCE NAME) (which covered (PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N?)).
((Are/Is)/(Were/Was))(you/(PERSON 1)) still covered through (INSURANCE SOURCE NAME) as of (today,) (END DATE)?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1- forced navigation including OE20_01, OE20_02, OE20_03, OE20_04, OE20_N.
At grid completion, if OE20 is coded '2' (NO), for at least one person, continue with OE30_01.
Otherwise, (if OE20 is coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW) for all persons listed at OE20), go to BOX_30.
If insurance is through a current employer (Insurance.HISrc=Employer and Jobs.JobTp=Current Main or Current Misc), set Jobs.ConfCovd= OE20_01 entry for the policyholder. (Check OE20_N for the policyholder. If OE20_N= '1' (YES), set Jobs.ConfCovd=Yes. If OE20_N= '2' (NO), set Jobs.ConfCovd=No. If OE20_N= 'RF' (REFUSED), set Jobs.ConfCovd=RF. If OE20_N= 'DK' (DON'T KNOW), set Jobs.ConfCovd=DK.)
Note: Persons coded '1' (YES), 'DK' (DON'T KNOW), or 'RF' (REFUSED) are considered covered RU members for the current round.

Display Instructions:

Roster 1 - Report
Col #1 Header: PlcyHldr
Instructions: Display an "X" for the row of the person who is the policyholder. If no current RU member covered person is the policyholder, this column is empty. This is a protected, uneditable field.
Col #2 Header: RU member
Instructions: Display the covered person's name (Person.FullName) from the covered person array.
This is a protected, uneditable field.
Roster Filter:
Policyholder or person was covered on the previous round's interview date by the insurance (the policyholder or person is an RU member on the covered person array where Person.MostRecentRU=RUUnit and Preload.CovdPers.LRndCovd =(previous round))
Col #3 Header: Still Covered?
Instructions: Entry field for OE20_01 - OE20_N
For the display of person names in the first paragraph: (PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N?), display the list of RU members according to the above roster filter specifications.
Display first names only. Substitute "you" for the person's first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
NOTE: Ideally, if the policyholder is a current RU member covered person, that person will be listed first in the form pane grid, followed by RU members in descending PID order.
However, that might not be possible without first creating a separate person array for this item. If not possible (grid order is predetermined by single person array), policyholder may not be listed first in the form pane grid.
Variable question text display. Replace "((Are/Is)/(Were/Was))(you/(PERSON 1)) still covered through?" with:
OE20_02: What about (you/(PERSON 2))? ((Are/Is)/(Were/Was)) (you/he/she) still covered through (INSURANCE SOURCE NAME) as of (today,) (END DATE)?
OE20_03: What about (PERSON 3)?
OE20_04: What about (PERSON 4)?
OE20_N: Repeat question text for OE20_02-OE20_N for as many RU members that fit the roster filter criteria.
Display 'During our last interview?which covered (PERSON 1)?' in bold black text every fourth question displayed, otherwise, display the question text in brackets and lighter grayed out text.
Display '(Are/Is)' if not round 5. Display '(Were/Was)' if round 5.
Display 'today,' if the current round RU reference period end date is equal to the computer date.
Otherwise, use a null display.

OE30_01 (OE1046)

BLAISE NAME: EnterHIEndDate
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

On what date after (START DATE) did (your/(PERSON)'s) health insurance through (INSURANCE SOURCE NAME) end?
(IF INSURANCE ENDED AFTER 12/31/(YEAR), BACK-UP AND CHANGE OE20 TO 'YES'.)

Responses:

ENTER DATE 1 OE30_02 (OE1047)
VOLUNTEERED, ENDED BEFORE (START 2
DATE)

Programmer Instructions:

Preloaded grid type 2 - forced navigation, including items OE30_01, OE30_02, OE_30_03, OE30_04, OE30_05.
Only display OE30_01 and applicable follow-up items for row entries where OE20_01 is coded '2' (NO) for this person.
If coded '2' (VOLUNTEERED, ENDED BEFORE (START DATE)), go to the next person in the grid. If no next person in grid, go to BOX_30.
Note: Persons coded '1' (ENTER DATE) are considered covered RU members for the current round.

Display Instructions:

Roster Report 1
Col #1 Header: PlcyHldr
Instructions: Display an "X" for the row of the person who is the policyholder. If no current RU member covered person is the policyholder, this column is empty. This is a protected, uneditable field.
Col #2 Header: RU member
Instructions: Display the covered person's name (Person.FullName) from the covered person array.
This is a protected, uneditable field.
Roster Filter:
Use OE20_01 filter.
NOTE: Ideally, if the policyholder is a current RU member covered person, that person will be listed first in the form pane grid, followed by RU members in descending PID order. However, that might not be possible without first creating a separate person array for this item. If not possible (grid order is predetermined by single person array), policyholder may not be listed first in the form pane grid.
Col #3 Header: Still Covered?
Instructions: Display the entered responses from OE20_01 for each person in a protected, uneditable field.
Col#4 Header: When Ended
Instructions: Item OE30_01. Only display as an active cell if OE20_01 is coded '2' (NO) for this person.
Col #5 Header: Month
Instructions: Item OE30_02. Only display as an active cell if OE30_01 is answered '1'.
Col #6 Header: Day
Instructions: Item OE30_03. Only display as an active cell if OE30_01 is answered '1' and OE30_02 () 'RF' (REFUSED) or 'DK' (DON'T KNOW).
Col#7 Header: Year
Instructions: Item OE30_04. Only display as an active cell if OE30_01 is answered '1'.
Col #8 Header: Whole Month?
Instructions: Item OE30_05. Only display as an active cell if OE30_02 ( ) RF, DK and OE30_ 03=RF, DK.
Display 'IF INSURANCE ENDED .. YES'.' if Round 5, where 'YEAR' is the second calendar year of the panel (SecondPanYear). Otherwise, use a null display.

OE30_02 (OE1047)

BLAISE NAME: HIEndMM
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

[On what date after (START DATE) did (your/(PERSON)'s) health insurance through (INSURANCE SOURCE NAME) end?]
ENTER MONTH

Responses:

1 OE30_03 (OE1048)
REFUSED RF OE30_04 (OE1049)
DON'T KNOW DK OE30_04 (OE1049)

Display Instructions:

Display question text in brackets and in lighter grayed out text.

OE30_03 (OE1048)

BLAISE NAME: HIEndDD
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

[On what date after (START DATE) did (your/(PERSON)'s) health insurance through (INSURANCE SOURCE NAME) end?]
ENTER DAY

Responses:

1 OE30_04 (OE1049)
REFUSED RF OE30_04 (OE1049)
DON'T KNOW DK OE30_04 (OE1049)

Display Instructions:

Display question text in brackets and in lighter grayed out text.

OE30_04 (OE1049)

BLAISE NAME: HIEndYYYY
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

[On what date after (START DATE) did (your/(PERSON)'s) health insurance through (INSURANCE SOURCE NAME) end?]
ENTER YEAR

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If OE30_03 (day) is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW) and OE30_02 (month) is NOT coded 'RF' (REFUSED) or 'DK' (DON'T KNOW), continue with OE30_5.
Otherwise, return to OE30_01 for next person on grid.
Hard check:
Complete date entered at OE30_02 - OE30_04 must not be prior to the current round's RU level reference period start date. If full date is prior to start date, display the following message: "IF COVERAGE ENDED PRIOR TO (REF PERIOD START DATE), BACK-UP TO OE30_01 (EnterHIEndDate) AND CORRECT RESPONSE."
Complete date entered at OE30_02 - OE30_04 must be on or before (i.e., less than or equal to) the person's reference period end date for this round (EndRefM, EndRefD). In round 5, that is typically Dec. 31 for panel year 2. If not, display the following message: "COVERAGE END DATE MUST BE ON OR BEFORE (PERSON'S REFERENCE PERIOD END DATE) (DATE PERSON NO LONGER IS PART OF RU). VERIFY AND CORRECT ENTRIES. IF COVERAGE ENDED AFTER PERSON LEFT RU, ENTER (PERSON'S REFERENCE PERIOD END DATE)."

Display Instructions:

Display question text in brackets and in lighter grayed out text.

OE30_05 (OE1050)

BLAISE NAME: HIEndWholeMth
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

[On what date after (START DATE) did (your/(PERSON)'s) health insurance through (INSURANCE SOURCE NAME) end?]
(Were/Was) (you/he/she) covered under that insurance the whole month or part of the month?

Responses:

WHOLE MONTH 1
PART OF THE MONTH 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Return to OE30_01 for next person on grid.

Display Instructions:

Display first paragraph of question text in brackets and in lighter grayed out text.

BOX_30 (OE1051)

Route Details:

Continue with BOX_40.

Programmer Instructions:

Placeholder for MHOP specifications. This will be deleted once those specifications are available. (Data delivery needs to review to make sure these are the correct settings.)
Determine 'CONTINUOUS COVERAGE' (decide what is needed for CAPI vs. MHOP).
For any covered persons where OE30_01 is coded '2' (VOLUNTEERED, ENDED BEFORE (REF PERIOD START DATE)), flag person as not a covered person for even 1 day under this insurance (important for insurance verifications series).
For all covered persons where OE20_01 is coded '1' (YES, STILL COVERED), 'RF' (REFUSED) or 'DK' (DON'T KNOW), flag person as 'CONTINUOUS COVERAGE' from that person's start date to that person's end date.
For all covered persons where OE30_01 is coded '1' (ENTER DATE), flag person as 'CONTINUOUS COVERAGE' from that person's start date to the date entered at OE30_02-OE30_05 or person's end date (whichever is earlier).

BOX_40 (OE1065)

Route Details:

If Round 3, continue with BOX_50.
Otherwise, go to BOX_60.

BOX_50 (OE1070)

Route Details:

Continue with OE40 if insurance meets the following conditions:
If HP50 was coded '2' (NO, PLAN IS NOT EXCHANGE), 'RF' (REFUSED) or 'DK'(DON'T KNOW) the round the insurance was created (Preload.Insurance.HP50AnsRndCreated)
And
If insurance direct purchase or SE, FS=1 and is with an 'INSURANCE CO', 'INSURANCE CO.-FROM AGENT' or 'HMO' ((Insurance.DirectPurchTp=Agent, Insurance Co, HMO) or [(Insurance.HISrc=Employer and Jobs.SELFEMP=SelfEmpl and Jobs.EmpEstm= 1) and (HP40 is coded '4' (DIRECTLY FROM AN INSURANCE AGENT), '5' (DIRECTLY FROM AN INSURANCE COMPANY), or '6' (DIRECTLY FROM AN HMO) the round in which the insurance was first created (Preload.Insurance.HP40AnsRndCreated)])
And
Policyholder is 64 years of age or younger or in age categories 1-8 or Policyholder is "Policyholder deceased or "Policyholder outside the DU" (Insurance.Plcyhldr=901 or 902).
Otherwise, go to BOX_60.

OE40 (OE1075)

BLAISE NAME: OEStExCovg
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

Is this coverage through (STATE EXCHANGE NAME-A) (, [which may be known as (ALIAS B) (or (ALIAS C))])?

Responses:

YES 1 BOX_60 (OE1110)
NO 2 BOX_60 (OE1110)
REFUSED RF BOX_60 (OE1110)
DON'T KNOW DK BOX_60 (OE1110)

Display Instructions:

Display ', [which may also be known as (ALIAS B) (or (ALIAS C))]' if there is more than one exchange name associated with the state in which interview is being conducted.
Display 'or (ALIAS C)' if there are three exchange names associated with the state in which interview is being conducted.
For 'STATE EXCHANGE NAME-A', 'ALIAS B', and 'ALIAS C', display the exchange name(s) associated with the state in which interview is being conducted.

BOX_60 (OE1110)

Route Details:

If at least one current RU member not displayed at OE20_01, continue with OE50_01.
NOTE: This means at least one current RU member not covered by the insurance being looped on, (this includes all new RU members and previous RU members not covered by this insurance on the previous round's interview date, but excludes RU members just marked as no longer covered in OE20) (at least one person where Person.PersID not on covered person array where Person.MostRecentRU=RUID and Preload.CovdPers.LRndCovd () (previous round)].
Otherwise, go to BOX_80.

OE50_01 (OE1115)

BLAISE NAME: CovdHISrc
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

Now think about (PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N?) and whether they have been covered by (your/(POLICYHOLDER)'s) health insurance through (INSURANCE SOURCE NAME).
(Since (START DATE)/Between (START DATE) and (END DATE)), ((have/has)/(were/was))( you/(PERSON 1)) (been) covered by (your/(POLICYHOLDER)'s) health insurance through (INSURANCE SOURCE NAME)?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 2 - forced navigation including OE50_01, OE50_02, OE50_03, OE50_04, OE50_N.
At grid completion, if OE50 is coded '1' (YES), for at least one person, continue with OE60_01.
Otherwise (OE50 is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW) for all persons listed at OE50), go to BOX_90.
Note: Persons coded '1' (YES) are considered covered RU members for the current round.

Display Instructions:

Roster Report 1
Col #1 Header: RU member
Instructions: Display RU members' first, middle, and last names (Person.FullName)
Roster Filter:
Display all current RU members that were not displayed at OE20_01. That is, display persons who were not covered by the insurance being looped on, (this includes all new RU members and previous RU members not covered by this insurance on the previous round's interview date, but excludes RU members just marked as no longer covered in OE20) (at least one person where Person.PersID not on covered person array where Person.MostRecentRU=RUID and Preload.CovdPers.LRndCovd ()(previous round)].
For the display of person names in the first paragraph: (PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N?), display the list of RU members according to the above roster filter specifications.
Display first names only. Substitute "you" for the person's first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Col #2 Header: Covered?
Instructions: Entry field for OE50_01 - OE50_N
Variable text display. Replace "(Since (START DATE)/Between (START DATE) and (END DATE)), ((have/has)/(were/was))( you/(PERSON 1)) (been) covered by (your/(POLICYHOLDER)'s) health insurance through (INSURANCE SOURCE NAME)?" with:
OE50_02: What about (you/(PERSON 2))? ((Has/Have)/(Were/Was)) (you/he/she) (been) covered by (your/(POLICYHOLDER)'s) health insurance through (INSURANCE SOURCE NAME) (since (START DATE)/between (START DATE) and (END DATE))?
OE50_03: What about (PERSON 3)?
OE50_04: What about (PERSON 4)?
OE50_N: Repeat question text for OE50_02-OE50_N for as many RU members that fit the roster filter criteria.
Display 'since (START DATE)' if not round 5. Display 'between (START DATE) and (END DATE)' if round 5.
Display '(have/has)' if not Round 5. Display '(were/was)' if Round 5. Display 'been' if not Round 5. Otherwise, use a null display.

OE60_01 (OE1120)

BLAISE NAME: CovgStartDate
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

On what date since (START DATE) did the health insurance through (INSURANCE SOURCE NAME) begin for (you/(PERSON))?

Responses:

ENTER DATE 1 OE60_02 (OE1125)
VOLUNTEERED, BEGAN BEFORE (START DATE) 2

Programmer Instructions:

Preloaded grid type 2 - forced navigation including items OE60_01, OE60_02, OE60_03, OE60_04, OE60_05.
Only display OE60_01 and applicable follow-up items for row entries where OE50_01 is coded '1' (YES) for this person.
If coded '2' (VOLUNTEERED, BEGAN BEFORE (START DATE)), go to the next person in the grid. If no next person in grid, go to BOX_70.

Display Instructions:

Roster Report 1
Col #1 Header: RU Member
Instructions: Display RU members' full name. (Person.FullName)
Roster Filter:
Use OE50_01 filter.
Col #2 Header: Covered?
Instructions: Display the entered responses from OE50_01 for each person in a protected, uneditable field.
Col #3 Header: When Begin
Instructions: Item OE60_01. Only display as an active cell if OE50_01 is coded '1' (YES) for this person.
Col #4 Header: Month
Instructions: Item OE60_02. Only display as an active cell if OE60_01 is answered '1'.
Col #5 Header: Day
Instructions: Item OE60_03. Only display as an active cell if OE60_01 is answered '1' and OE60_02 () 'RF' (REFUSED) or 'DK' (DON'T KNOW).
Col#6 Header: Year
Instructions: Item OE60_04. Only display as an active cell if OE60_01 is answered '1'.
Col#7 Header: Whole Month?
Instructions: Item OE60_05. Only display as an active cell if OE60_02 ( ) RF, DK and OE60_03=RF, DK.

OE60_02 (OE1125)

BLAISE NAME: CovgStartMM
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

[On what date since (START DATE) did the health insurance through (INSURANCE SOURCE NAME) begin for (you/(PERSON))?]
ENTER MONTH

Responses:

1 OE60_03 (OE1130)
REFUSED RF OE60_04 (OE1135)
DON'T KNOW DK OE60_04 (OE1135)

Display Instructions:

Display question text in brackets and in lighter grayed out text.

OE60_03 (OE1130)

BLAISE NAME: CovgStartDD
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

[On what date since (START DATE) did the health insurance through (INSURANCE SOURCE NAME) begin for (you/(PERSON))?]
ENTER DAY

Responses:

1 OE60_04 (OE1135)
REFUSED RF OE60_04 (OE1135)
DON'T KNOW DK OE60_04 (OE1135)

Display Instructions:

Display question text in brackets and in lighter grayed out text.

OE60_04 (OE1135)

BLAISE NAME: CovgStartYYYY
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

[On what date since (START DATE) did the health insurance through (INSURANCE SOURCE NAME) begin for (you/(PERSON))?]
ENTER YEAR

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If OE60_03 (day) is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW) and OE60_02 (month) is NOT coded 'RF' (REFUSED) or 'DK' (DON'T KNOW), continue with OE60_05.
Otherwise, return to OE60_01 for next person on grid.
Hard checks:
Complete date entered at OE60_02-OE60_04 must not be prior to the current round's RU level reference period start date. If full date is prior to start date, display the following message: "IF COVERAGE BEGAN PRIOR TO (REF PERIOD START DATE), BACK- UP TO OE60_01 (CovgStartDate) AND CORRECT RESPONSE."
2. Complete date entered at OE60_02-OE60_04 must be on or before the person's reference period end date. If not, display the following message: "COVERAGE FOR (PERSON) CANNOT BEGIN AFTER (PERSON'S END DATE) (DATE PERSON NO LONGER IS PART OF RU). VERIFY AND CORRECT DATE ENTRIES OR BACK-UP TO OE50 (insert blaise name) AND CODE PERSON AS NOT COVERED."
Soft Check:
Complete date entered at OE60_02-OE60_04 should be on or before the complete date entered at OE30_02-OE30_04 for the policyholder (if applicable). If not, display the following message: "UNLIKELY RESPONSE. POLICYHOLDER'S COVERAGE ENDED ON (OE30_02-OE30_04 DATE). COVERAGE FOR (PERSON) BEGAN AFTER THAT DATE.
VERIFY AND CORRECT DATE ENTRIES IF NECESSARY."

Display Instructions:

Display question text in brackets and in lighter grayed out text.

OE60_05 (OE1140)

BLAISE NAME: OECovdWholeTime
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

[On what date since (START DATE) did the health insurance through (INSURANCE SOURCE NAME) begin for (you/(PERSON))?]
(Were/Was) (you/he/she) covered under that insurance the whole month or part of the month?

Responses:

WHOLE MONTH 1
PART OF THE MONTH 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Return to OE60_01 for next person on grid.

Display Instructions:

Display first paragraph of question text in brackets and in lighter grayed out text.

BOX_70 (OE1145)

Route Details:

Continue with BOX_80.

Programmer Instructions:

Placeholder for MHOP specifications. This will be deleted once those specifications are available. (Data delivery needs to review to make sure these are the correct settings.)
Determine 'CONTINUOUS COVERAGE' (decide what is needed for CAPI vs. MHOP).
If OE20 is coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW) for the policyholder, flag all persons where OE50 is coded '1' (YES) as 'CONTINUOUS COVERAGE' from the date entered at OE60_02-OE60_04 until the RU level reference period end date (interview date).
If OE20 is coded '2' (NO) for the policyholder, flag all persons where OE50 is coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW) as 'CONTINUOUS COVERAGE' from the date entered at OE60_02-OE60_04 until the date entered at OE30_02-OE30_04 for the policyholder.
If OE20 was not asked for the policyholder, use the OE20 value for the oldest PID with coverage to determine continuous coverage settings.

BOX_80 (OE1146)

Route Details:

If:
At least one current RU member is coded as still covered today or newly covered [(OE20_01 is coded '1' (YES), 'RF' (REFUSED) or 'DK' (DON'T KNOW) for at least one RU member) or (OE50_01 is coded '1' (YES) for at least one RU member)] and the insurance being looped on changed this round from a current main or current misc job to a former main or former misc job [(Insurance.HISrc=Employer) and (RJ10 or RJ60 is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW) in the current round)], go to OE70.
If:
No current RU member is coded as still covered today and no one is newly covered [(OE20_01 is coded '2' (NO) for all RU members listed) and (OE50_01 is coded '2' (NO), 'RF' (REFUSED) or 'DK' (DON'T KNOW) for all RU members listed)] and the insurance being looped on changed this round from a current main or current misc job to a former main or former misc job [(Insurance.HISrc=Employer) and (RJ10 or RJ60 is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW) in the current round)], go to OE80.
Otherwise, go to BOX_90.

OE70 (OE1147)

BLAISE NAME: OECOBRAPlan
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

Is (your/(POLICYHOLDER)'s) health insurance through (INSURANCE SOURCE NAME) that covers (PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N?) extended through COBRA?
HELP: F1

Responses:

YES 1 BOX_90 (OE1150)
NO 2 BOX_90 (OE1150)
REFUSED RF BOX_90 (OE1150)
DON'T KNOW DK BOX_90 (OE1150)

Display Instructions:

Roster 1-Report no add/edit/delete allowed.
Roster Definition: Display the covered person's name (Person.FullName).
Roster Filter:
Person or policyholder is on the covered person array and is currently covered by the insurance being looped on. [(OE20_01 is coded '1' (YES), 'RF' (REFUSED) or 'DK' (DON'T KNOW) for this RU member) or (OE50_01 is coded '1' (YES) for this RU member)]
For the display of person names in the first paragraph: (PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N?), display the list of RU members according to the above roster filter specifications.
Display full name. Substitute "you" for the person's first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed.
Between the last two names displayed, separate names using the word "and".

OE80 (OE1148)

BLAISE NAME: CovgContinAftEmp
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

Did the health insurance (you/(POLICYHOLDER)) had through (INSURANCE SOURCE NAME) continue for any period of time after (you/he/she) stopped working at (INSURANCE SOURCE NAME)?

Responses:

YES 1 OE90 (OE1149)
NO 2 OE90 (OE1149)
REFUSED RF OE90 (OE1149)
DON'T KNOW DK OE90 (OE1149)

Display Instructions:

OE90 (OE1149)

BLAISE NAME: CovgContinCOBRA
Context Header: (POLICYHOLDER?S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

Did that health insurance continue through COBRA?
HELP: F1

Responses:

YES 1 BOX_90 (OE1150)
NO 2 BOX_90 (OE1150)
REFUSED RF BOX_90 (OE1150)
DON'T KNOW DK BOX_90 (OE1150)

Display Instructions:

BOX_90 (OE1150)

Route Details:

If [policyholder is part of RU and at least one other current RU member is listed as a covered person with coverage during the reference period (Insurance.Plcyhldr=PersID where Person.MostRecentRU=RUUnit and at least one other RU member is on the covered person array where OE20_01 is coded '1' (YES), 'RF' (REFUSED) or 'DK' (DON'T KNOW) or OE50_01 is coded '1' (YES))] or [(if policyholder not part of the RU) and (at least one current RU member is listed as a covered person with coverage during the reference period) (Insurance.Plcyhldr=901 or 902 or PersID where
Person.MostRecentRu()RUID and at least one other RU member is on the covered person array where OE20_01 is coded '1' (YES), 'RF' (REFUSED) or 'DK' (DON'T KNOW) or OE50_01 is coded '1' (YES))], go to BOX_100.
Otherwise, continue with OE100.

OE100 (OE1155)

BLAISE NAME: OECovPersOutRU
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

(Does/Between (START DATE) and (END DATE), did) (your/(POLICYHOLDER)'s) health coverage through (INSURANCE SOURCE NAME) cover as dependents any persons who do not live here?
HELP: F1

Responses:

YES 1 BOX_100 (OE1160)
NO 2 BOX_100 (OE1160)
REFUSED RF BOX_100 (OE1160)
DON'T KNOW DK BOX_100 (OE1160)

Programmer Instructions:

If coded '1' (YES), set Insurance.CovPersOutRU=Yes.

Display Instructions:

Display 'does' if not round 5. Display 'between (START DATE) and (END DATE), did' if round 5.

BOX_100 (OE1160)

Route Details:

If [one or more current RU members are still covered by this insurance on the current round's interview date, that is, at least one person at OE20_01 is coded '1' (YES), 'RF' (REFUSED) or 'DK' (DON'T KNOW) or at least one person at OE50_01 is coded '1' (YES) (At least one RU member is on the covered person array where OE20_01 is coded '1' (YES), 'RF' (REFUSED) or 'DK' (DON'T KNOW) or OE50_01 is coded '1' (YES))] and [insurance is not treated as 'Dependent(s) Separated from Policyholder'(i.e., original RU member policyholder is still part of this RU)], continue with OE110.
Otherwise, go to END_LP10.

OE110 (OE1165)

BLAISE NAME: PlanNameChange
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

(Last time we recorded that (you/(POLICYHOLDER)) (were/was) covered by ( PRELOAD.INSURANCE.INSURER) .)
(Since (START DATE), has there been/Between (START DATE) and (END DATE), was there) any change in the plan name of the health insurance (you/(POLICYHOLDER)) ((have/has)/had) through (PRELOAD.INSURANCE.HISRCNAME)?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded '1' (YES) and insurance is an 'INSURANCE CO.', 'INSURANCE CO. - FROM AGENT', OR 'HMO' (Insurance.DirectPurchTp=Agent, Insurance Co, HMO), continue with OE120. Else, if coded '1' (YES), go to OE130.
If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW) and Round 3 and OE40 is coded '1' (YES), go to BOX_150. Else, if coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), go to BOX_160.
Note: If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), the Insurance Source Name and the Insurer Name stay the same as the preloaded values.

Display Instructions:

Display first paragraph if there is a value for PRELOAD.INSURANCE.INSURER (Preload.Insurance.Insurer () EMPTY, RF or DK]. Otherwise, use a null display.
For 'PRELOAD.INSURANCE.INSURER', display the name of this insurance's previous round's insurer. That is, display the name of the plan (providing Medicare Supplement/Medigap benefits or hospital/physician benefits) entered at HX630, HX640, or OE140 in the previous round (Preload.Insurance.Insurer).
For 'PRELOAD.INSURANCE.HISRCNAME', display the name of this insurance's previous round's insurance source name (Preload.Insurance.HISrcName).
Display 'Since (START DATE), has there been' and '(have/has)' if not round 5. Display 'Between (START DATE) and (END DATE), was there' and 'had' if round 5.

OE120 (OE1170)

BLAISE NAME: PlanName
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

What is the new plan name of (your/(POLICYHOLDER)'s) health insurance through (PRELOAD.INSURANCE.HISRCNAME)?

Responses:

1 OE130 (OE1175)
REFUSED RF OE130 (OE1175)
DON'T KNOW DK OE130 (OE1175)

Programmer Instructions:

Write correction to the insurance source name. [Set Insurance.HISrcName to OE120 entry]
Note: If a source of insurance was directly purchased from HMO, insurance company, or from an insurance agent, the insurance source name is the same as the insurer name.
Therefore, any change in plan name automatically dictates a change in the insurance source name and insurer name (which is automatically recorded at OE140 via BOX_110).

Display Instructions:

For 'PRELOAD.INSURANCE.HISRCNAME', display the name of this insurance's previous round's insurance source name (Preload.Insurance.HISrcName).

OE130 (OE1175)

BLAISE NAME: CodeAllOEHICovg
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

AND HX-7
Looking at card HX-7, what type of health insurance coverage ((do/does)/did) (you/(POLICYHOLDER)) (now) have through (INSURANCE SOURCE NAME)'s new plan (as of (END DATE))?
PROBE: Any other health coverage through this plan?
ENTER ALL THAT APPLY.
HELP: F1

Responses:

HOSPITAL AND PHYSICIAN BENEFITS, 1
INCLUDING COVERAGE THROUGH AN HMO
DENTAL 2
PRESCRIPTION DRUGS 3
VISION 4
MEDICARE SUPPLEMENT/MEDIGAP 5
LONG TERM CARE IN A NURSING HOME 6
EXTRA CASH FOR HOSPITAL STAYS 7
SERIOUS DISEASE OR DREAD DISEASE 8
DISABILITY 9
WORKER'S COMPENSATION 10
ACCIDENT 11
OTHER 91 OE130OS (OE1180)
REFUSED RF BOX_110 (OE1190)
DON'T KNOW DK BOX_110 (OE1190)

Programmer Instructions:

If coded '91' (OTHER), alone or in combination with any other codes, continue with OE130OS.
Otherwise, go to BOX_110.
For specifications purposes only: CAPI does not allow 'RF' (REFUSED) or 'DK' (DON'T KNOW) in combination with any other code.
If '1' (HOSPITAL AND PHYSICIAN BENEFITS, INCLUDING COVERAGE THROUGH AN
HMO) is one of the selections and '5' (MEDIGAP) is not one of the selections, set Insurance.HospHI=Yes and set Insurance.MedigapHI=EMPTY.
If '5' (MEDIGAP) is one of the selections, set Insurance.MedigapHI=Yes and set Insurance.HospHI=EMPTY.
If 'DK' (DON'T KNOW) or 'RF' (REFUSED), set both Insurance.HospHI and Insurance.MedigapHI to EMPTY.

Display Instructions:

Display '(do/does)'if not round 5. Display 'did' if round 5.
Display 'now' if not round 5 and if insurance is still current for at least one RU member (OE20 is coded '1' (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW) or OE50_01 is coded '1' (YES) for at least one RU member). Otherwise, use a null display.
Display 'as of (END DATE)' if round 5. Otherwise, use a null display.
Display OE130 and OE130OS on the same form pane.

OE130OS (OE1180)

BLAISE NAME: OEHICovgOS
Context Header: (POLICYHOLDER FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

SPECIFY:

Responses:

1 BOX_110 (OE1190)
REFUSED RF BOX_110 (OE1190)
DON'T KNOW DK BOX_110 (OE1190)

Display Instructions:

Display OE130 and OE130OS on the same form pane.

BOX_110 (OE1190)

Route Details:

If insurance is an 'INSURANCE CO.', 'INSURANCE CO. - FROM AGENT', OR 'HMO' (Insurance.DirectPurchTp=Agent, Insurance Co, HMO), automatically code OE140 with response entered at OE120 [Set Insurance.HISrcName=Insurance.Insurer], and go to BOX_140.
Otherwise, continue with BOX_120.

BOX_120 (OE1195)

Route Details:

If OE130 is coded '1' (HOSPITAL AND PHYSICIAN BENEFITS) or '5' (MEDICARE SUPPLEMENT/MEDIGAP), alone or with any other combination of codes (Insurance.MedigapHI=Yes or Insurance.HospHI=Yes), continue with OE140.
Otherwise, go to BOX_140.

Programmer Instructions:

If insurance is not an 'INSURANCE CO.', 'INSURANCE CO. - FROM AGENT', OR 'HMO' (Insurance.DirectPurchTp()Agent, Insurance Co, HMO) and if OE130 is not coded '1' (HOSPITAL AND PHYSICIAN BENEFITS) or '5' (MEDICARE SUPPLEMENT/MEDIGAP) (Insurance.MedigapHI()Yes and Insurance.HospHI()Yes), there is no longer an insurer associated with this insurance because the pair no longer provides either hospital and physician benefits or Medigap benefits [set Insurance.Insurer=Empty].
Note (To verify with data delivery): This instruction is not currently at OE130 because if the insurance is from an agent, an insurance company, or HMO, the insurer name is automatically set regardless of the coverage provided.

OE140 (OE1200)

BLAISE NAME: HospMedigapPlanName
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

What is the new plan name for (your/(POLICYHOLDER)'s) health insurance through (INSURANCE SOURCE NAME) which provides the (hospital and physician benefits/Medicare Supplement or Medigap benefits)?
IF MORE THAN ONE NAME, PROBE: What is the main new plan name?
ENTER NAME OF MAIN INSURER THAT PROVIDES THE (HOSPITAL AND PHYSICIAN/MEDIGAP) BENEFITS.

Responses:

1 BOX_130 (OE1205)
REFUSED RF BOX_130 (OE1205)
DON'T KNOW DK BOX_130 (OE1205)

Programmer Instructions:

Set Insurance.Insurer = OE140.

Display Instructions:

Display 'hospital and physician benefits' and 'HOSPITAL AND PHYSICIAN' if OE130 is coded '1' (HOSPITAL AND PHYSICIAN BENEFITS), but not coded '5' (MEDICARE SUPPLEMENT/MEDIGAP) (Insurance.HospHI=Yes and Insurance.MedigapHI()Yes). Display 'Medicare Supplement or Medigap benefits' and 'MEDIGAP' if OE130 is coded '5' (MEDICARE SUPPLEMENT/MEDIGAP) (Insurance.MedigapHI=Yes).

BOX_130 (OE1205)

Route Details:

Ask the Managed Care (MC) section for this insurer (Insurance.Insurer).
At completion of Managed Care (MC) section, continue with BOX_140.

BOX_140 (OE1210)

Route Details:

Small business determination
If insurance being asked about meets the following conditions:
Insurance is associated with an employer from the Employment (EM) section that provides health insurance (Insurance.HISrc=Employer), and Job is a 'CURRENT-MAIN-JOB' (Jobs.JobTp=CURRENT MAIN), and Job is 'SELF-EMPLOYED' (Jobs.SELFEMP=SelfEmpl), and EM740 (total employees) or RJ110 (total employees) is greater than 1 but less than or equal to 200 (Jobs.EmpEstm = 2-9 or 10-25 or 26-50 or 51-100 or 101-200), continue with OE150
Small business determination
If insurance being asked about meets the following conditions:
Insurance is associated with an employer from the Employment (EM) section that provides health insurance (Insurance.HISrc=Employer), and Job is a 'CURRENT-MAIN-JOB' (Jobs.JobTp=CURRENT MAIN), and
Job is 'NOT SELF-EMPLOYED' (Jobs.SELFEMP( )SelfEmpl), and Firm size is small (see determination below), and EM430 (firm size) is greater than 1 but less than or equal to 200 (Jobs.EmpEstm = 2-9 or 10-25 or 26-50 or 51-100 or 101-200), or · EM440 (firm size category) is coded '2' (2 TO 9), '3' (10 TO 25), '4' (26 TO 50), '5' (51 TO 100), or '6' (101 TO 200) (Jobs.EmpEstm = 2-9 or 10-25 or 26-50 or 51-100 or101-200) EM450 (multiple locations) is coded '2' (NO) (MORELOCTN=No), continue with OE150.
Otherwise, go to BOX_150.

OE150 (OE1215)

BLAISE NAME: OEStSHOP
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

In (RU STATE), (STATE SHOP NAME-A) (, [which may also be known as (ALIAS B) (or (ALIAS C))],) is a program where small businesses will be able to shop for health insurance plans for their employees. Is (your/(POLICYHOLDER)'s) health insurance coverage through (INSURANCE SOURCE NAME) related at all to a program like that?

Responses:

YES 1 BOX_150 (OE1220)
NO 2 BOX_150 (OE1220)
REFUSED RF BOX_150 (OE1220)
DON'T KNOW DK BOX_150 (OE1220)

Display Instructions:

For 'RU STATE', display the full state name associated with this RU's address.
Display ', [which may also be known as (ALIAS B) (or (ALIAS C))],' if there is more than one shop name associated with the state in which interview is being conducted.
Display 'or (ALIAS C)' if there are three shop names associated with the state in which interview is being conducted.
For 'STATE SHOP NAME-A' 'ALIAS B', and 'ALIAS C', display the small business health options program name associated with the state in which interview is being conducted.

BOX_150 (OE1220)

Route Details:

Continue with OE160 if the insurance meets the following conditions:
[If HP50 was coded '1' (YES, PLAN IS EXCHANGE) the round this insurance was created] or [if this insurance set to 'EXCHANGE COVERAGE' (Insurance.DirectPurchTp=Exchange) the round it was created] or [if insurance is exchange insurance through a SE, FS=1 job (Insurance.HISrc=Employer and HP40=8) the round it was created; Preload.Insurance.HP40AnsRndCreated] or [if insurance was made exchange in Round 3 (OE40 was coded '1' (YES)) during the current round or in a previous round (current OE40 value or if OE40=EMPTY, check Preload.Insurance.OE40AnsRnd3)]
And
Insurance provides HOSPITAL AND PHYSICIAN BENEFITS but not MEDIGAP benefits in the current or previous round [(Insurance.HospHI=Yes and Insurance.MedigapHI()Yes).
Use OE130 value if asked, otherwise use preloaded values set to current round values as described earlier.]
And
Policyholder is 64 years of age or younger or in age categories 1-8 or Policyholder is "Policyholder deceased or "Policyholder outside the DU" (Insurance.Plcyhldr=901 or 902).
Otherwise, go to BOX_160.

OE160 (OE1225)

BLAISE NAME: MetalPlan
Context Header: (POLICYHOLDER FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

Is (your/(POLICYHOLDER)'s) (INSURANCE.INSURER) plan a platinum, gold, silver, bronze, or catastrophic plan?
HELP: F1

Responses:

PLATINUM PLAN 1 BOX_160 (OE1230)
GOLD PLAN 2 BOX_160 (OE1230)
SILVER PLAN 3 BOX_160 (OE1230)
BRONZE PLAN 4 BOX_160 (OE1230)
CATASTROPHIC PLAN 5 BOX_160 (OE1230)
IF VOLUNTEERED: SOMETHING ELSE 6 BOX_160 (OE1230)
REFUSED RF BOX_160 (OE1230)
DON'T KNOW DK BOX_160 (OE1230)

Display Instructions:

For 'INSURANCE.INSURER' display the name of the plan's current round insurer if it has an entry other than 'RF' or 'DK' or EMPTY (Insurance.Insurer()RF, DK or EMPTY). Otherwise, use a null display.
Note: This may be the text entry made or auto-coded at OE140 if OE110 was coded '1' (YES) or it may be the name of the insurer from the preload that was set as the current round insurer if OE110 was coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW).

BOX_160 (OE1230)

Route Details:

If round 2 or round 4, continue with BOX_170.
If round 3, go to OE170.
Otherwise (if Round 5), go to END_LP10

BOX_170 (OE1240)

Route Details:

Note: You only are routed to BOX_170 in Rounds 2 and 4. This box specifies a "likely exchange" check. BOX_180 is a similar check made in Round 3.
Continue with OE170 if this insurance meets the following conditions:
[Is a 'PROFESSIONAL ASSOCIATION' (HP40=1), 'GROUP' (HX200 or HX300=1 or HP40=2) or 'INSURANCE COMPANY- FROM AN AGENT' (HX200 or HX300=3 or HP40=4) or 'INSURANCE COMPANY' (HX200 or HX300=4 or HP40=5) or 'HMO' (HX200 or HX300=5 or HP40=6) or 'EXCHANGE COVERAGE' (HX200 or HX300=11 or HP40=8) or 'UNKNOWN TYPE- COLLECTED AT OTHER' (HX200 or HX300=91 or HP40=91) in the round the pair was first created [(Insurance.DirectPurchTp=Group, Agent, Insurance Co, HMO, Exchange, Other) or (Insurance.HISrc=Employer and HP40= 1, 2, 4, 5, 6, 8, or 91) the round it was created; Preload.Insurance.HP40AnsRndCreated] And Insurance provides HOSPITAL AND PHYSICIAN BENEFITS but not MEDIGAP benefits in the current or previous round [(Insurance.HospHI=Yes and Insurance.MedigapHI()Yes).
Use OE130 value if asked, otherwise use preloaded values set to current round values as described earlier.]
And
Policyholder is 64 years of age or younger or in age categories 1-8 or Policyholder is "Policyholder deceased or "Policyholder outside the DU" (Insurance.Plcyhldr=901 or 902).
Otherwise, go to END_LP10.

OE170 (OE1245)

BLAISE NAME: OEFamPayPrem
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

For the coverage through (INSURANCE SOURCE NAME), does anyone in the family pay all of the premium or cost, some of the premium or cost, or none of the premium or cost?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]
[Do include any contribution made to the plan as part of a paycheck.]
HELP: F1

Responses:

YES, PAY ALL OF PREMIUM/COST 1
YES, PAY SOME OF PREMIUM/COST 2
YES, BUT DON'T KNOW IF PAY ALL OR 3
SOME OF PREMIUM/COST
NO, DO NOT PAY 4 BOX_190 (OE1280)
REFUSED RF BOX_190 (OE1280)
DON'T KNOW DK BOX_190 (OE1280)

Programmer Instructions:

If coded '1' (YES, PAY SOME OF PREMIUM/COST), '2' (YES, PAY SOME OF PREMIUM/COST) or '3' (YES, BUT DON'T KNOW IF PAY ALL OR SOME OF PREMIUM/COST) and Round 3, continue with OE180.
If coded '1' (YES, PAY SOME OF PREMIUM/COST), '2' (YES, PAY SOME OF PREMIUM/COST) or '3' (YES, BUT DON'T KNOW IF PAY ALL OR SOME OF PREMIUM/COST) and Rounds 2 or 4, go to OE200.

Display Instructions:

OE180 (OE1255)

BLAISE NAME: OEPayPremAmt
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

How much (do/does) (you/ (POLICYHOLDER)) pay for the (INSURANCE SOURCE NAME) coverage?
ENTER AMOUNT

Responses:

1 OE190 (OE1260)
REFUSED RF BOX_180 (OE1270)
DON'T KNOW DK BOX_180 (OE1270)

Programmer Instructions:

Allow for an entry of dollars and cents.

Display Instructions:

Display OE180, OE190, and OE190OS on the same form pane.

OE190 (OE1260)

BLAISE NAME: OEPayPremUnit
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

Is that per year, per month, per week, or what?
UNIT OF COVERAGE:

Responses:

PER YEAR 1 BOX_180 (OE1270)
EVERY 3 MONTHS (QUARTERLY) 2 BOX_180 (OE1270)
EVERY 2 MONTHS (BIMONTHLY) 3 BOX_180 (OE1270)
PER MONTH 4 BOX_180 (OE1270)
PER WEEK 5 BOX_180 (OE1270)
EVERY 2 WEEKS (BIWEEKLY) 6 BOX_180 (OE1270)
2 TIMES PER YEAR (SEMI-ANNUALLY) 7 BOX_180 (OE1270)
2 TIMES PER MONTH (SEMI-MONTHLY) 8 BOX_180 (OE1270)
OTHER 91 OE190OS (OE1265)
REFUSED RF BOX_180 (OE1270)
DON'T KNOW DK BOX_180 (OE1270)

Display Instructions:

Display OE180, OE190 and OE190OS on the same form pane.

OE190OS (OE1265)

BLAISE NAME: OEPayPremUnitOS
Context Header: (POLICYHOLDER FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

SPECIFY: UNIT OF COVERAGE

Responses:

1 BOX_180 (OE1270)
REFUSED RF BOX_180 (OE1270)
DON'T KNOW DK BOX_180 (OE1270)

Display Instructions:

Display OE180, OE190 and OE190OS on the same form pane.

BOX_180 (OE1270)

Route Details:

Note: You only are routed to BOX_180 in Round 3. This box specifies a "likely exchange" check. BOX_170 is a similar check made in Rounds 2 and 4.
Continue with OE200 if this insurance meets the following conditions:
[Is a 'PROFESSIONAL ASSOCIATION' (HP40=1), 'GROUP' (HX200 or HX300=1 or HP40=2) or 'INSURANCE COMPANY- FROM AN AGENT' (HX200 or HX300=3 or HP40=4) or 'INSURANCE COMPANY' (HX200 or HX300=4 or HP40=5) or 'HMO' (HX200 or HX300=5 or HP40=6) or 'EXCHANGE COVERAGE' (HX200 or HX300=11 or HP40=8) or 'UNKNOWN TYPE- COLLECTED AT OTHER' (HX200 or HX300=91 or HP40=91)in the round the pair was first created] [(Insurance.DirectPurchTp=Group, Agent, Insurance Co, HMO, Exchange, Other) or (Insurance.HISrc=Employer and HP40=1, 2, 4, 5, 6, 8, or 91) the round it was created; Preload.Insurance.HP40AnsRndCreated]
And
Insurance provides HOSPITAL AND PHYSICIAN BENEFITS but not MEDIGAP benefits in the current or previous round [(Insurance.HospHI=Yes and Insurance.MedigapHI()Yes).
Use OE130 value if asked, otherwise use preloaded values set to current round values as described earlier.]
And
Policyholder is 64 years of age or younger or in age categories 1-8 or Policyholder is "Policyholder deceased or "Policyholder outside the DU" (Insurance.Plcyhldr=901 or 902).
Otherwise, go to BOX_190.

OE200 (OE1275)

BLAISE NAME: OEPremSubsdz
Context Header: (POLICYHOLDER FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

Is the cost of the premium subsidized based on family income?

Responses:

YES 1 BOX_190 (OE1280)
NO 2 BOX_190 (OE1280)
REFUSED RF BOX_190 (OE1280)
DON'T KNOW DK BOX_190 (OE1280)

Display Instructions:

BOX_190 (OE1280)

Route Details:

If round 3, continue with BOX_200.
Otherwise, go to END_LP10.

BOX_200 (OE1285)
Route Details:

If insurance being asked about provides Medicare supplement/Medigap coverage [(Insurance.MedigapHI=Yes) use OE130 value if asked, otherwise use preloaded values set to current round values as described earlier], go to END_LP10.
Otherwise, continue with OE210.

OE210 (OE1290)

BLAISE NAME: OEAnnDeductAmt
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

Is the (family) annual deductible for medical care for this plan less than ($1,350/$2,700), or is it ($1,350/$2,700) or more? If there is a separate deductible for prescription drugs, hospitalization, or out-of-network care, do not include those deductible amounts here.
HELP:F1

Responses:

LESS THAN ($1,350/$2,700) 1 END_LP10 (OE1300)
($1,350/$2,700) OR MORE 2 OE220 (OE1295)
NO ANNUAL DEDUCTIBLE 3 END_LP10 (OE1300)
REFUSED RF END_LP10 (OE1300)
DON'T KNOW DK END_LP10 (OE1300)

Display Instructions:

Use a null display for 'family' and display '$1,350' in the question text and '$1,350' in the response category options if insurance meets the following conditions:
[The policyholder is the only covered person (PersID of Insurance.Plcyhldr = only PersID in covered person array)
OR
The policyholder is deceased and there is exactly one covered person (Insurance.Plcyhldr=901 and only one PersID in covered person array)]
AND
Insurance does not cover any persons outside the RU (Insurance.CovPersOutRU()Yes).
Otherwise, display 'family' and '$2,700' in the question text and '$2,700' in the response category options.

OE220 (OE1295)

BLAISE NAME: OEPlanHasHSA
Context Header: (POLICYHOLDER'S FIRST MIDDLE LAST NAME) INSURANCE THROUGH (NAME OF INSURANCE SOURCE)
Question Text:

With this plan, is there a special account or fund that can be used to pay for medical expenses? The accounts are sometimes referred to as Health Savings Accounts (HSAs), Health Reimbursement Accounts (HRAs), Personal Care Accounts, Personal Medical funds, or Choice funds, and are different from Flexible Spending Accounts.
HELP: F1

Responses:

YES 1 END_LP10 (OE1300)
NO 2 END_LP10 (OE1300)
REFUSED RF END_LP10 (OE1300)
DON'T KNOW DK END_LP10 (OE1300)

Display Instructions:

END_LP10 (OE1300)

Route Details:

Cycle on next insurance that meets the conditions stated in the loop definition.
If no other insurance meet the stated conditions, end LOOP_10 and continue with BOX_ 210.

BOX_210 (OE1305)

Route Details:

Return to original questionnaire section in HX.

Programmer Instructions:

LRndCovd
MHOP will need to set a flag on the Covered Person Array to determine if an RU member is considered covered for the following round. This flag will be called LRndCovd and will be used in the OE and PR sections to determine whether coverage is asked about for each eligible RU member. This setting will need to be made prior to rounds 2-5. The value of the Flag will be the current round. If the RU member was considered covered in Round 1, for review in Round 2, the flag will be set to '1'. If the RU member was considered covered in Round 2, for review in Round 3, the flag will be set to '2', etc.
Private Insurance [Insurance.HIPubPriv=Private, OrigRnd=current round] - Settings for private insurance that was created in the current round is included in the HQ section. To be eligible to be reviewed for private coverage, the RU member must have been covered on the interview date of the previous round.
Set CovdPers.LRndCovd = (current round) for this RU member for this insurance if:
OE20_01 = '1' (YES) or OE50_01 = '1' (YES) and OE20_01 = '1' (YES) for the policyholder (if the policyholder was current RU member and asked OE20_01). If OE20 was not asked for the policyholder, use the OE20 value for the oldest PID with coverage to determine whether the newly covered RU member should be considered as covered on the interview date of the previous round.

Off Path Navigation (OF) Section

BOX_00 (OF1000)

Route Details:

01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40
04 Single Select = OF10, OF90, OF120, OF130, OF150, OF160, OF170, OF180, OF190, OF210, OF220, OF230
05 Single Select with Display Roster = OF20, OF30, OF40, OF50, OF60
06 Single Select with Fill in Answer Text = OF70
12 Address - Newly Collected = OF200_02, OF200_03, OF200_04, OF200_05, OF200_06
14 Regular date entry = OF100_01, OF100_02, OF100_03, OF140_01, OF140_02, OF140_03
19 Numeric Field = OF110
23 Text Field = OF80_01, OF80_02, OF80_03, OF200_01
24 Information Screen = OF240, OF250, OF260

BOX_10 (OF1005)

Route Details:

Continue with OF10.
Programmer Instructions:
The OF section is a combination of Manipula pop-up boxes and Blaise screens with a green background (i.e., "green path"). The OF section is accessed with the F2 hot key or selection of "Review/Add" from the menu and runs "parallel" to the main interview.
Items OF10-OF60 are all Manipula pop-up boxes with the blue background. Items OF70-OF260 are traditional Blaise screens with a green (instead of beige) background. The color of the green background is: rgb(153, 255, 153).
If the FI doesn't complete the entire OF section, no data is saved for added person or added event(s).
The options available via the F2 function will be customized based on which section of the CAPI interview you are in.
The F2 function is disabled in the following sections:
Reenumeration (RE)
Off Path Navigation (OF)
Otherwise, F2 is enabled in all sections, but with limited functionality as described below and at applicable items in the OF section.
ST80 (only - F2 disabled at other items in ST) - F2 available for:
PERSONS (review only)
EVENTS (review only)
MEDICINES (review only)
JOBS (review only)
INSURANCE (review only)
PE ? F2 available for:
PERSONS (can review or add)
CA, PP, EV, PV, ED, Utilization, CP, FF, EF ? F2 available for:
PERSONS (can review or add)
EVENTS (review only; add is grayed out)
PM, OM, AH, CS ? F2 available for:
PERSONS (can review or add)
EVENTS (can review or add)
MEDICINES (review only; add is grayed out)
QS, AC ? F2 available for:
PERSONS (can review or add)
EVENTS (can review or add)
MEDICINES (can review or add in comments)
EM, RJ, EW ? F2 available for:
PERSONS (can review or add)
EVENTS (can review or add)
MEDICINES (can review or add in comments)
JOBS (review only; add is grayed out)
HX, HP, HQ, MC, OE, PR ? F2 available for:
PERSONS (can review or add)
EVENTS (can review or add)
MEDICINES (can review or add in comments)
JOBS (can review or add in comments)
INSURANCE (review only; add is grayed out)
IN, AS, RF, CL ? F2 available for:
PERSONS (can review or add)
EVENTS (can review or add)
MEDICINES (can review or add in comments)
JOBS (can review or add in comments)
INSURANCE (can review or add in comments)

OF10 (OF1010)

BLAISE NAME: AddRosterItem
Question Text:
WHAT WOULD YOU LIKE TO REVIEW?

Responses:
PERSONS 1 OF20 (OF1015)
EVENTS 2 OF30 (OF1020)
MEDICINES 3 OF40 (OF1025)
JOBS 4 OF50 (OF1030)
INSURANCE 5 OF60 (OF1035)
Programmer Instructions:
This is a Manipula pop-up box that allows FIs to choose what they would like to review.
It is called whenever the F2 hotkey is pressed or when Review/Add is selected from the menu.
The response options listed should be radio-buttons with two larger buttons at the bottom of the box labeled "OK" and "CANCEL".
If "OK" is selected, go to the item specified next to the response. If "CANCEL" is selected, go to BOX_40.
Display Instructions:
Customize the response options listed in the pop-up based on the section F2 is called.
PE - Display only response option '1' (PERSONS)
CA, PP, EV, PV, ED, Utilization, CP, FF, EF - Display response options '1' (PERSONS) and '2' (EVENTS) PM, OM, AH, CS, QS, AC - Display response options '1' (PERSONS), '2' (EVENTS), and '3' (MEDICINES) EM, RJ, EW - Display response options '1' (PERSONS), '2' (EVENTS), '3' (MEDICINES), and '4' (JOBS) HX, HP, HQ, MC, OE, PR, IN, AS, CL - Display response options '1' (PERSONS), '2' (EVENTS), '3' (MEDICINES), '4' (JOBS), and '5' (INSURANCE)

OF20 (OF1015)

BLAISE NAME: AddPers
Question Text:
Person Sex Age Keyness Ref Period Start Date Ref Period End Date Status
[Text] [M/F] [XXX] [Yes/No] [Text] [Text] [Text]
[Text] [M/F] [XXX] [Yes/No] [Text] [Text] [Text]
[Text] [M/F] [XXX] [Yes/No] [Text] [Text] [Text]

Responses:
ADD PERSON 1
CLOSE 2 BOX_40 (OF1205)
Programmer Instructions:
This is a Manipula pop-up box.
Display a list of all DU members (RE_Person.PERSID), including DU members from a multi-RU DU and including those with PriorRndInelig flag=YES and those who were just added off path via OF80_01-OF80_03. Display a blank line between RU members on the current Person array and other DU members.
Display grid as a Manipula look-up with two larger buttons at the bottom of the box labeled "ADD PERSON" and "CLOSE".
The pop-up should be scrollable.
The "ADD PERSON" button is always active when F2 is accessible.
If "ADD PERSON" is selected and only current RU members are listed in this pop-up, go to OF80_01. Otherwise (when ?ADD PERSON? is selected), go to OF70.
Display Instructions:
The following fields should be displayed in the DU Members Overview screen.
Format Columns headers: Person, Sex, Age, Keyness, Ref Period Start Date, Ref Period End Date, Status.
Col #1: Person
Display DU members' full name
Col #2: Sex
Display the sex of the DU member. Display "M" for male and "F" for female.
Col #3: Age
Display the age or age category of the DU member.
Col #4: Keyness
Display only for current RU members on the person array. Leave empty for all other DU members.
Display "Yes" if CtrlPersKey=Yes. Display "No" if CtrlPersKey=No.
Col #5: Ref Period Start Date
Display only for current RU members on the person array. Leave empty for all other DU members.
Display the person's reference period start date using BegRefM, BegRefD, BegRefY. Display as "Mon DD, YYYY" (3 letter month abbreviation in mixed case, then the day, then the year).
Col #6: Ref Period End Date
Display only for current RU members on the person array. Leave empty for all other DU members.
Display the person's reference period end date using EndRefM, EndRefD, EndRefY. Display as "Mon
DD, YYYY" (3 letter month abbreviation in mixed case, then the day, then the year).
Col #7: Status
Display a customized status for each person listed.
Display "Current RU Member" for all persons on the person array (anyone part of this RU).
For all other persons who are part of the DU, but not the RU, use the following status labels.
If person is already part of another RU within the DU (never merged into this RU), display their status as their RU letter. For example, "RU-B", "RUC", etc.
Display "Mover" if CtrlTrackSumm=7, 10 or 11 for this person.
Display "Student Mover" if CtrlNewStudent = YES for this person.
Display "Incorrectly Listed" if RemovedAtRE330=Yes for this person.
Display "Still Institutionalized" if RemovedatRE180=Yes for this person.
Display "Not Eligible" if MoverAtLoop10=No or MoverAtLoop20=No or MoverAtLoop30=NO or
MoverAtRE940=NO or StudentMoverAtLoop80 =NO or RemoveAtBOX_350=YES or
RemoveAtBOX_400=YES for this person or PriorRndInelig flag=YES for this person
Display "Added Off Path" if person added via OF80_01-OF80_03 during the current round.

OF30 (OF1020)

BLAISE NAME: AddEvnt
Question Text:
Person:
Sort Field:
RU Member Event Type Provider Doctor/ Dept (Admit/ Visit) Date Discharge Date Repeat Visit Util Status C/P Status
[Text] [XX] [Text] [Text] [MM/DD/YYYY] [MM/DD/YYYY] [XX] [Text] [Text]
[Text] [XX] [Text] [Text] [MM/DD/YYYY] [MM/DD/YYYY] [XX] [Text] [Text]
[Text] [XX] [Text] [Text] [MM/DD/YYYY] [MM/DD/YYYY] [XX] [Text] [Text]

Responses:
ADD EVENT 1 OF250 (OF1185)
CLOSE 2 BOX_40 (OF1205)
Programmer Instructions:
This is a Manipula pop-up box.
Display the events by person i.e., all events for one person listed in order (as described below), followed by the events for the next person, etc. Each person will be separated by a blank row.
Display grid as a Manipula look-up with two larger buttons at the bottom of the box labelled "ADD EVENT" and "CLOSE".
You should be able to sort by person and the column headers should be sortable and the pop-up should be scrollable.
The "ADD EVENT" button is:
INACTIVE (grayed-out) during: CA, PP, EV, PV, ED, Utilization, CP, FF, EF
ACTIVE during: PM, OM, AH, CS, QS, AC, EM sections, HX sections, IN, AS, CL
Display Instructions:
The following fields should be displayed in the RU Event Overview screen:
Format Columns headers: RU member, Event Type, Provider, Doctor/Dept, Date, Repeat Visit, Util Status, C/P Status.
Col #1: RU member
Display RU members' full name
Col#2: Event Type
Display the abbreviation for the event type associated with the event.
Col#3: Provider
Display the provider for the event
Col#4: Doctor/Dept
Display the doctor or department that was selected or added at PV70, if PV70 has a value other than 0.
Col#5: (Admit/Visit) Date
Display the date the event took place. For HS and IC events, display the admit date. For HH events, display the Month (3 letter abbreviation) the care took place. Dates should display as MM/DD/YYYY.
Col# 5a: Discharge Date
For HS and IC events, display the discharge date of the event. Leave this field empty if event type is not HS or IC.
Col# 6: Repeat Visit
Display the letter associated with the repeat visit group. Allow empty.
Col#7: Util Status
Display the status of the corresponding utilization section (Not Started, Started, Done, N/A)
Col# 8: C/P Status
Display the status of the C/P status. If applicable, display the status of the EF section (Not Started, Started, Done, N/A).
Display the rows on this pop-up in ascending event ID order within each RU member.
Display the RU members by ascending PID order.

OF40 (OF1025)

BLAISE NAME: AddPM
Question Text:
Person: Ú
RU Member Medicine Number of times obtained during ref period
[Text] [Text] [XXX]
[Text] [Text] [XXX]
[Text] [Text] [XXX]

Responses:
ADD/EDIT MEDICINE IN COMMENT 1
CLOSE 2 BOX_40 (OF1205)
Programmer Instructions:
This is a Manipula pop-up box.
Display all current round medicines by person i.e., all medicines for one person listed in order, followed by the medicines for the next person, etc. Each person will be separated by a blank row. If there are no medicines for this person, display their name with a blank entry next to it.
Display grid as a Manipula look-up with two larger buttons at the bottom of the box labelled "ADD/EDIT MEDICINE IN COMMENT" and "CLOSE".
You should be able to sort by person and the pop-up should be scrollable.
The "ADD/EDIT MEDICINE IN COMMENT" button is:
INACTIVE (grayed-out) during: PM, OM, AH, CS
ACTIVE during: QS, AC, EM sections, HX sections, IN, AS, CL
If "ADD/EDIT MEDICINE IN COMMENT" option is selected when it is active, go to the comments type box (where you select the topic for the comment) and then go to the comment area to record text. When routing to the comment type box - link the comment to the item where F2 was called from. When the comment box is closed, go to BOX_40.
Display Instructions:
The following fields should be displayed in the RU Medicines Overview screen.
Format Columns headers: RU member, Medicine, Number of times obtained during ref period.
Col #1: RU member
Display RU members' full name
Col #2: Medicine
Display the name of each medicine for this person that is flagged as selected this round. Display the full length of the allowable characters for a medicine = 60 characters.
Col #3: Number of times obtained during ref period
Display the value of PM140 for this medicine. Leave cell empty if PM140 not yet collected. Display the RU members by ascending PID order.

OF50 (OF1030)

BLAISE NAME: AddJob
Question Text:
Person: Ú
RU Member Age Job Job Start Job End
[Text] [XXX] [Text] [Text] [Text]
[Text] [XXX] [Text] [Text] [Text]
[Text] [XXX] [Text] [Text] [Text]

Responses:
ADD/EDIT JOB IN COMMENT 1
CLOSE 2 BOX_40 (OF1205)
Programmer Instructions:
This is a Manipula pop-up box.
Display all jobs by person who is = or > 16 years of age (or age categories 4-9), i.e., all jobs for one person listed in order, followed by the jobs for the next person, etc. Each person will be separated by a blank row. If there are no jobs for this person who is = or > 16 years of age (or age categories 4-9), display their name with a blank entry next to it.
Display grid as a Manipula look-up with two larger buttons at the bottom of the box labelled "ADD/EDIT JOB IN COMMENT" and "CLOSE".
You should be able to sort by person and the pop-up should be scrollable.
The "ADD/EDIT JOB IN COMMENT" button is:
INACTIVE (grayed-out) during: EM sections
ACTIVE during: HX sections, IN, AS, CL
If "ADD/EDIT JOB IN COMMENT" option is selected when it is active, go to the comments type box (where you select the topic for the comment) and then go to the comment area to record text. When routing to the comment type box - link the comment to the item where F2 was called from. When the comment box is closed, go to BOX_40.
Display Instructions:
The following fields should be displayed in the RU Jobs Overview screen.
Format Columns headers: RU member, Age, Job, Job Start, and Job End.
Col #1: RU member
Display RU members' full name. Display only RU members = or >16 years of age or in age categories (4-9).
Col #2: Age
Display the age or age category of the RU member.
Col #3: Job
Display all jobs on the jobs array for this person. No filter.
Col #3: Job Start
Display the Job start date using JobStartMM/DD/YYYY. Display as the "Mon DD, YYYY" (3 letter month abbreviation in mixed case, then the day, then the year). If MM or DD is missing for JobStart, display that piece as empty.
Col #4: Job End
Display the Job end date using JobStopMM/DD/YYYY. Display as the "Mon DD, YYYY" (3 letter month abbreviation in mixed case, then the day, then the year). If MM or DD is missing for JobStop, display that piece as empty. If JobStopYYYY is '0', display "Current Job".
Display the RU members by ascending PID order.

OF60 (OF1035)

BLAISE NAME: AddIns
Question Text:
Policyholder Insurance Source Plan Covered RU Members
[Text] [Text] [Text] [Text]
[Text] [Text] [Text] [Text]
[Text] [Text] [Text] [Text]

Responses:
ADD/EDIT INSURANCE IN COMMENT 1
CLOSE 2 BOX_40 (OF1205)
Programmer Instructions:
This is a Manipula pop-up box.
Display insurance in the insurance array. Display all insurance that is public insurance first, then all insurance that is private insurance. Separate public from private insurance with a blank row. Display insurance that is "active" and covers at least one person during the current round (at least one RU member is in the covered person array for this insurance).
Display grid as a Manipula look-up with two larger buttons at the bottom of the box labelled "ADD/EDIT INSURANCE IN COMMENT" and "CLOSE".
The pop-up should be scrollable.
The "ADD/EDIT INSURANCE IN COMMENT" button is:
INACTIVE (grayed-out) during: HX sections
ACTIVE during: IN, AS, CL
If "ADD/EDIT INSURANCE IN COMMENT" option is selected when it is active, go to the comments type box (where you select the topic for the comment) and then go to the comment area to record text. When routing to the comment type box - link the comment to the item where F2 was called from. When the comment box is closed, go to BOX_40.
Display Instructions:
The following fields should be displayed in the RU Insurance Overview screen.
Format Columns headers: Policyholder, Insurance Source, Plan, Covered RU Members.
Column Header #1: Policyholder
Display the first 35 characters of the full name (Person.FullName) of policyholder for this insurance source (Insurance.Plcyhldr). This includes the full name of any RU or DU member selected as the policyholder. If the policyholder is outside of the DU, display the policyholder name as 'PLCYHLDR NOT IN DU-' followed by the first 15 characters of the entry at HP100. If the policyholder is deceased, display the policyholder name as 'PLCYHLDR DECEASED-'followed by the first 15 characters of the entry at HP110.
Column Header #2: Insurance Source
Display the first 30 characters of the name of the insurance source name (Insurance.HISrcName)
Column Header #3: Plan
Display the first 25 characters of the plan name of the insurance source (Insurance.Insurer). Leave cell blank if plan name is empty.
Column Header #4: Covered RU Members
Display the first 11 characters of the first names (Pers.FName) of all current RU members listed in the covered person array for this insurance source (Pers.PersID =CovdPers.Depend). Separate each name with a comma. Do not substitute "you" for respondent. Allow up to 95 characters for this column (which would allow for the first 8 covered persons if each first name is truncated to 11 characters).

OF70 (OF1040)

BLAISE NAME: SelectPers
Question Text:
IF PERSON RESPONDENT INDICATED SHOULD BE PART OF THE HOUSEHOLD IS ALREADY LISTED, SELECT THAT PERSON BELOW.
OTHERWISE, SELECT '0' TO ADD A PERSON.

Responses:
ADD A PERSON 0 OF80_01 (OF1045)
[FIRST NAME, [MIDDLE NAME], LAST NAME]1 1 OF240 (OF1180)
[FIRST NAME, [MIDDLE NAME], LAST NAME]2 2 OF240 (OF1180)
[FIRST NAME, [MIDDLE NAME], LAST NAME]3 3 OF240 (OF1180)
[FIRST NAME, [MIDDLE NAME], LAST NAME]4 4 OF240 (OF1180)
[FIRST NAME, [MIDDLE NAME], LAST NAME]N 5 OF240 (OF1180)
Programmer Instructions:
Roster behavior:
1. Only single select allowed.
Display Instructions:
Roster 2 - no add/edit/delete
Roster definition:
Display the DU-Members-Roster for selection.
Roster filter:
Display all DU members (RE_Person.PERSID), including those with the flag PriorRndInelig flag=YES, but exclude any person marked as a current RU member (i.e., any person on the current person array)

OF80_01 (OF1045)

BLAISE NAME: AddPersFName
Question Text:
I'm going to pause the questions I was asking and make sure I have all the needed information about this person.
What is their first name?
VERIFY SPELLING.

Responses:
1 OF80_02 (OF1050)
Display Instructions:
Display OF80_01, OF80_02, and OF80_03 on the same form pane.

OF80_02 (OF1050)

BLAISE NAME: AddPersMName
Question Text:
What is [[FIRST NAME]'s/their] middle name or initial?
IF NO MIDDLE NAME, LEAVE FIELD BLANK.

Responses:
1 OF80_03 (OF1055)
EMPTY Empty OF80_03 (OF1055)
Display Instructions:
For "FIRST NAME", display the text entry from OF80_01.
Display OF80_01, OF80_02, and OF80_03 on the same form pane.

OF80_03 (OF1055)

BLAISE NAME: AddPersLName
Question Text:
What is [[FIRST NAME]'s/their] last name?

Responses:
1 OF90 (OF1060)
Display Instructions:
For "FIRST NAME", display the text entry from OF80_01.
Display OF80_01, OF80_02, and OF80_03 on the same form pane.

OF90 (OF1060)

BLAISE NAME: SexC
Question Text:
SELECT SEX.
IF NOT OBVIOUS, ASK: What is [PERSON]'s sex?

Responses:
MALE 1 OF100_01 (OF1065)
FEMALE 2 OF100_01 (OF1065)
REFUSED RF OF100_01 (OF1065)
DON'T KNOW DK OF100_01 (OF1065)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.

OF100_01 (OF1065)

BLAISE NAME: DOBMMC
Question Text:
What is [PERSON]'s date of birth?
ENTER MONTH.

Responses:
1 OF100_02 (OF1070)
REFUSED RF OF100_02 (OF1070)
DON'T KNOW DK OF100_02 (OF1070)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display OF100_01, OF100_02, and OF100_03 on the same form pane.

OF100_02 (OF1070)

BLAISE NAME: DOBDDC
Question Text:
[What is [PERSON]'s date of birth?]
ENTER DAY.

Responses:
1 OF100_03 (OF1075)
REFUSED RF OF100_03 (OF1075)
DON'T KNOW DK OF100_03 (OF1075)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display OF100_01, OF100_02, and OF100_03 on the same form pane.
Display question text in brackets and lighter "grayed-out" text.

OF100_03 (OF1075)

BLAISE NAME: DOBYYYYC
Question Text:
[What is [PERSON]'s date of birth?]
ENTER 4- DIGIT YEAR.

Responses:
1 OF110 (OF1080)
REFUSED RF OF110 (OF1080)
DON'T KNOW DK OF110 (OF1080)
Programmer Instructions:
Hard check:
1. Date entered must be between [YEAR] - 120 years where 'YEAR' is the current year and RU level reference period end date/interview date (RUEndM, RUEndD, RUEndY). If a date outside of this range is entered, display the following message: "UNLIKELY RESPONSE. DATE CANNOT BE AFTER TODAY'S DATE OR BEFORE [YEAR-120]. VERIFY WITH RESPONDENT AND RE-ENTER."
Control Variables Impacted during MHOP: CtrlCurrHere
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display OF100_01, OF100_02, and OF100_03 on the same form pane.
Display question text in brackets and lighter "grayed-out" text.

OF110 (OF1080)

BLAISE NAME: AgeRndC
Question Text:
[VERIFY [PERSON]'s AGE - IF AGE IS INCORRECT, RE-ENTER DATE OF BIRTH. IF DATE OF BIRTH UNKNOWN, ASK:] How old is [PERSON]?

Responses:
1 OF140_01 (OF1095)
REFUSED RF OF120 (OF1085)
DON'T KNOW DK OF120 (OF1085)
Programmer Instructions:
For Round 5, AGE is calculated as of DECEMBER 31, [YEAR], where 'YEAR' is the second calendar year of the panel.
If the interviewer enters an AGE that contradicts the DOB, CAPI will still calculate AGE (See GL spec) based on DOB when the interviewer leaves the screen. No error message is displayed.
Display Instructions:
Prefill OF110 with RU member's age as calculated from responses entered at OF100_01-OF100_03 if age can be calculated. If age cannot be calculated, do not prefill an age.
Display "VERIFY [PERSON]'s AGE - IF AGE IS INCORRECT, RE-ENTER DATE OF BIRTH. IF DATE OF BIRTH UNKNOWN, ASK:" if age can be calculated from responses entered at OF100_01-OF100_03. Otherwise, use a null display.
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.

OF120 (OF1085)

BLAISE NAME: AgeRngC
Question Text:
PROBE FOR RESPONDENT'S BEST ESTIMATE OF AGE.
Is [PERSON] less than 1 year old, 1-4, 5-15, 16-23, 24-34, 35-44, 45-54, 55-64, or 65 years or older?

Responses:
LESS THAN 1 YEAR OLD 1 OF140_01 (OF1095)
1 - 4 2 OF140_01 (OF1095)
5 - 15 3 OF140_01 (OF1095)
16 - 23 4 OF140_01 (OF1095)
24 - 34 5 OF140_01 (OF1095)
35 - 44 6 OF140_01 (OF1095)
45 - 54 7 OF140_01 (OF1095)
55 - 64 8 OF140_01 (OF1095)
65 YEARS OR OLDER 9 OF140_01 (OF1095)
REFUSED RF OF130 (OF1090)
DON'T KNOW DK OF130 (OF1090)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.

OF130 (OF1090)

BLAISE NAME: AgeGuessC
Question Text:
ENTER YOUR BEST GUESS FOR [PERSON]'S AGE.

Responses:
LESS THAN 1 YEAR OLD 1 OF140_01 (OF1095)
1 - 4 2 OF140_01 (OF1095)
5 - 15 3 OF140_01 (OF1095)
16 - 23 4 OF140_01 (OF1095)
24 - 34 5 OF140_01 (OF1095)
35 - 44 6 OF140_01 (OF1095)
45 - 54 7 OF140_01 (OF1095)
55 - 64 8 OF140_01 (OF1095)
65 YEARS OR OLDER 9 OF140_01 (OF1095)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.

OF140_01 (OF1095)

BLAISE NAME: LiveFamStartMM
Question Text:
On what date did [PERSON] start living with [[First Name,[Middle Name],Last Name]1 ,[First Name,[Middle Name],Last Name]2 ,[First Name,[Middle Name],Last Name]3, [First Name,[Middle Name],Last Name]4, [First Name,[Middle Name],Last Name]N]?
ENTER MONTH.

Responses:
1 OF140_02 (OF1100)
Programmer Instructions:
DK and RF disallowed for month.
Display Instructions:
Roster definition: Roster 1 - Report
This item displays current NHIS/previous round roster. Display RU member's first, middle, and last names.(PL_Person.FullName)
Roster filter:
If round 1 display all RU members on the original NHIS roster.
If round 2-5 display all RU members on the previous rounds roster (i.e. if round 2 display the roster from round 1.)
(RE_Person.PreloadRU = RUUnit)
Display OF140_01, OF140_02 and OF140_03 on the same form pane.
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.

OF140_02 (OF1100)

BLAISE NAME: LiveFamStartDD
Question Text:
[On what date did [PERSON] start living with [[First Name,[Middle Name],Last Name]1 ,[First Name,[Middle Name],Last Name]2 ,[First Name,[Middle Name],Last Name]3, [First Name,[Middle Name],Last Name]4, [First Name,[Middle Name],Last Name]N]?]
ENTER DAY.

Responses:
1 OF140_03 (OF1105)
REFUSED RF OF140_03 (OF1105)
DON'T KNOW DK OF140_03 (OF1105)
Display Instructions:
Roster definition:
Roster 1 - Report
This item displays current NHIS/previous round roster. Display RU member's first, middle, and last names.(PL_Person.FullName)
Roster filter:
If round 1 display all RU members on the original NHIS roster.
If round 2-5 display all RU members on the previous rounds roster (i.e. if round 2 display the roster from round 1.)
(RE_Person.PreloadRU = RUUnit)
Display OF140_01, OF140_02 and OF140_03 on the same form pane.
Display question text in brackets and lighter "grayed-out" text.
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.

OF140_03 (OF1105)

BLAISE NAME: LiveFamStartYYYY
Question Text:
[On what date did [PERSON] start living with [[First Name,[Middle Name],Last Name]1 ,[First Name,[Middle Name],Last Name]2 ,[First Name,[Middle Name],Last Name]3, [First Name,[Middle Name],Last Name]4, [First Name,[Middle Name],Last Name]N]?]
ENTER 4-DIGIT YEAR.

Responses:
1
Programmer Instructions:
If Round 1 date entered is [on or before NHIS date (NHISDt)] or if [(month is equal to NHIS month) and (day is RF or DK) and (year entered is equal to NHIS year)], go to OF150.
If Rounds 2-5 and date entered is [on or before NHIS date (NHISDt)] or if [month is equal to NHIS month) and (day is RF or DK) and (year entered is equal to NHIS year), autocode OF150 as '1' (YES) and go to OF240.
Otherwise, go to OF160.
DK and RF disallowed for year.
Hard Check:
(for Round 5): Date entered must be on or before 12/31/[YEAR], where 'YEAR' is the second calendar year of the panel. If a date after 12/31/[YEAR] is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/[YEAR]. VERIFY DATE ENTERED. ONLY PERSONS JOINING RU BEFORE 12/31/[YEAR] SHOULD BE ADDED. IF PERSON JOINED RU AFTER 12/31/[YEAR], CANCEL OUT OF OFF-PATH AND DO NOT ADD THIS PERSON TO THE RU."
Hard Check: Date entered must be between Person's DOB (DOBD, DOBM, DOBY) and the RU reference period end date/interview date (RUEndM, RUEndD, RUEndY). If a date outside of this range is entered, display the following message: DATE CANNOT BE AFTER [REFERENCE PERIOD END DATE] OR BEFORE PERSON'S DATE OF BIRTH. VERIFY WITH RESPONDENT AND RE-ENTER."
Control Variables Impacted during MHOP: BegRefM, BegRefD, and BegRefY
Display Instructions:
Roster definition:
Roster 1 - Report
This item displays current NHIS/previous round roster. Display RU member's first, middle, and last names. (PL_Person.FullName)
Roster filter:
If round 1 display all RU members on the original NHIS roster.
If round 2-5 display all RU members on the previous rounds roster (i.e. if round 2 display the roster from round 1.)
(RE_Person.PreloadRU = RUUnit)
Display OF140_01, OF140_02 and OF140_03 on the same form pane.
Display question text in brackets and lighter "grayed-out" text.
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.

OF150 (OF1110)

BLAISE NAME: VerfBegDate
Question Text:
I have recorded that [PERSON] began living at [NHIS ADDRESS] on [OF140_[1-3] DATE]. Is that correct?
IF NECESSARY SAY: We're trying to establish if [PERSON] was living with this household when they participated in the previous interview on [DATE OF NHIS INTERVIEW].

Responses:
YES 1 OF240 (OF1180)
NO 2
REFUSED RF OF160 (OF1115)
DON'T KNOW DK OF160 (OF1115)
Programmer Instructions:
Hard Check:
If coded '2' (NO), display message: 'BACKUP AND CORRECT DATE PERSON JOINED RU AT PREVIOUS SCREEN.' Control Variables Impacted during MHOP: CtrlPersKey, CtrlSampNHIS
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
For 'NHIS ADDRESS' display the NHIS full address, including city and state but not zip code. Use Preload.CurrStrt1, Preload.CurrStrt2, Preload.CurrCity, Preload.CurrState.
Separate address components with a comma, for example: "123 Main Street, Apt. 101, Rockville, MD".
For 'OF140_[1-3] DATE', display date entered at OF140_[01-03].
For 'DATE OF NHIS INTERVIEW', display date of NHIS interview. Use NHISDt.

OF160 (OF1115)

BLAISE NAME: Jan1Abroad
Question Text:
Was [PERSON] living within the U.S. or outside the U.S. on [MONTH, DAY, YEAR OF NHIS INTERVIEW/January 1, [YEAR]]?
HELP: F1

Responses:
WITHIN U.S. 1
OUTSIDE U.S. 2 OF240 (OF1180)
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
If coded '1' (WITHIN US), 'RF' (REFUSED), or 'DK' (DON'T KNOW), and person is 18 years old or older or in age categories 4-9 (use age variables collected at OF100 through OF130), continue with OF170. Otherwise, go to OF180.
Control Variables Impacted during MHOP: CtrlPersKey, CtrlSampNHIS
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'MONTH, DAY, YEAR OF NHIS INTERVIEW' if Round 1. Use NHISDt.
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.

OF170 (OF1120)

BLAISE NAME: Jan1Milit
Question Text:
Was [PERSON] serving on full-time active duty with the Armed Forces of the United States on [[MONTH, DAY, YEAR OF NHIS INTERVIEW]/January 1, [YEAR]]?
HELP: F1

Responses:
YES 1 OF180 (OF1125)
NO 2 OF180 (OF1125)
REFUSED RF OF180 (OF1125)
DON'T KNOW DK OF180 (OF1125)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'MONTH, DAY, YEAR OF NHIS INTERVIEW' if Round 1. Use NHISDt.
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.

OF180 (OF1125)

BLAISE NAME: WherePersJan1
Question Text:
[Was [PERSON] living away at school, living on a military facility, institutionalized, or living at a private residence when [[First Name,[Middle Name],Last Name]1, [First Name,[Middle Name],Last Name]2, [First Name,[Middle Name],Last Name]3, [First Name,[Middle Name],Last Name]4, [First Name,[Middle Name],Last Name]N ] participated in the National Health Interview Survey on [NHIS INTERVIEW DATE] at [NHIS ADDRESS]? / On January 1, [YEAR], was [PERSON] living away at school, living on a military facility, institutionalized, or living at a private residence?]
HELP: F1

Responses:
LIVING AWAY AT SCHOOL 1
LIVING ON A MILITARY FACILITY 2 OF240 (OF1180)
INSTITUTIONALIZED IN A FACILITY 3 OF190 (OF1130)
IN A PRIVATE RESIDENCE/HOUSEHOLD 4 OF240 (OF1180)
IF VOLUNTEERED: BORN AFTER [DATE] 5 OF240 (OF1180)
REFUSED RF OF240 (OF1180)
DON'T KNOW DK OF240 (OF1180)
Programmer Instructions:
If coded '1' (LIVING AWAY AT SCHOOL) and Round 1, calculate the age from NHIS interview date (NHISDt). If Rounds 2-5, calculate age from January 1, [YEAR] where year is the first calendar year of panel for 'YEAR'. This calculation is using the age-at-NHIS (or age-at-1/1/First Panel Year) rather than the age calculation described in the GL spec.
Therefore, age categories cannot be included in the check.
If calculated age at NHIS or 1/1/[YEAR] is less than = 23 , go to OF220.
If calculated age at NHIS or 1/1/[YEAR] is unknown or cannot be calculated, go to OF210.
Control Variables Impacted during MHOP: CtrlPersKey, CtrlSampNHIS
HARD CHECK: If coded '1' (LIVING AWAY AT SCHOOL) and calculated age at NHIS or 1/1/[YEAR] > 23, display the following message: "For the purposes of this survey, students older than 23 are considered living in a private household. INTERVIEWER: PLEASE CHANGE OF180 (WherePersJan1) TO CODE 4 (IN A PRIVATE RESIDENCE/HOUSEHOLD)."
Display Instructions:
Roster 1 - Report Roster definition:
This item displays the current NHIS roster. Display RU member's first, middle, and last names (PL_Person.FullName).
Roster filter:
Display all RU members on the current NHIS roster. (RE_Person.PreloadRU = RUUnit). Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display response category '5' (IF VOLUNTEERED: BORN AFTER [DATE]) if the person's date of If round 2-5, display "On January 1, [YEAR], was [PERSON] living away at school, living on a military facility, institutionalized, or living at a private residence?" Display the first calendar year of panel for 'YEAR'. birth year is on or after NHIS year (PesonDOBY=>NHISDt (year)) or if DOB is unknown and person is age category 1 (Person.AgeRng=1 or Person.AgeGuess=1).
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
For "DATE" in the response category display, display NHISDt (as a 3 character month DD, YYYY) if Round 1 or "Jan 1, [YEAR]" where "YEAR" is the first panel year if Rounds 2-5.
If round 1, display "Was [PERSON] living away at school, living on a military facility, institutionalized, or living at a private residence when [[First Name,[Middle Name],Last Name]1, [First Name,[Middle Name],Last Name]2, [First Name,[Middle Name],Last Name]3, [First Name,[Middle Name],Last Name]4, [First Name,[Middle Name],Last Name]N ] participated in the National Health Interview Survey on [NHIS INTERVIEW DATE] at [NHIS ADDRESS]?"
For '[NHIS ADDRESS]', display the NHIS full address, including city and state, but not zip code. Use Preload.CurrStrt1, Preload.CurrStrt2, Preload.CurrCity, Preload.CurrState. Separate address components with a comma, for example: "123 Main Street, Apt. 101, Rockville, MD".
For "[NHIS INTERVIEW DATE]", display the date of the NHIS interview. Use NHISDt.
If round 2-5, display "On January 1, [YEAR], was [PERSON] living away at school, living on a military facility, institutionalized, or living at a private residence?" Display the first calendar year of panel for 'YEAR'.

OF190 (OF1130)

BLAISE NAME: Jan1InstTp
Question Text:
Was [PERSON] living in a nursing home or any other long-term care institution that provides 24 hour skilled nursing care on [[MONTH, DAY, YEAR OF NHIS INTERVIEW]/January 1, [YEAR]]?
HELP: F1

Responses:
YES 1 OF200_01 (OF1135)
NO 2 OF240 (OF1180)
REFUSED RF OF200_01 (OF1135)
DON'T KNOW DK OF200_01 (OF1135)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'MONTH, DAY, YEAR OF NHIS INTERVIEW' if Round 1. Use NHISDt.
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.

OF200_01 (OF1135)

BLAISE NAME: BefFamPlaceName
Question Text:
Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?
What is the name?

Responses:
1 OF200_02 (OF1140)
REFUSED RF OF200_02 (OF1140)
DON'T KNOW DK OF200_02 (OF1140)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]' if Round 1. Use NHISDt
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.
Display OF200_01, OF200_02, OF200_03, OF200_04, OF200_05, and OF200_06 on the same form pane.

OF200_02 (OF1140)

BLAISE NAME: BefFamStrt1
Question Text:
[Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?]
What is the address?

Responses:
1 OF200_03 (OF1145)
REFUSED RF OF200_03 (OF1145)
DON'T KNOW DK OF200_03 (OF1145)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]' if Round 1. Use NHISDt
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.
Display OF200_01, OF200_02, OF200_03, OF200_04, OF200_05, and OF200_06 on the same form pane.
Display question text "Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?" in brackets and lighter "grayed out" text.

OF200_03 (OF1145)

BLAISE NAME: BefFamStrt2
Question Text:
[Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?]
What is the second address?
IF NONE, PRESS ENTER TO CONTINUE.

Responses:
1 OF200_04 (OF1150)
EMPTY Empty OF200_04 (OF1150)
REFUSED RF OF200_04 (OF1150)
DON'T KNOW DK OF200_04 (OF1150)
Programmer Instructions:
Allow empty.
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]' if Round 1. Use NHISDt
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.
Display OF200_01, OF200_02, OF200_03, OF200_04, OF200_05, and OF200_06 on the same form pane.
Display question text "Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?" in brackets and lighter "grayed out" text.

OF200_04 (OF1150)

BLAISE NAME: BefFamCity
Question Text:
[Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?]
What is the city?

Responses:
1 OF200_05 (OF1155)
REFUSED RF OF200_05 (OF1155)
DON'T KNOW DK OF200_05 (OF1155)
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]' if Round 1. Use NHISDt
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.
Display OF200_01, OF200_02, OF200_03, OF200_04, OF200_05, and OF200_06 on the same form pane.
Display question text "Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?" in brackets and lighter "grayed out" text.

OF200_05 (OF1155)

BLAISE NAME: BefFamSt
Question Text:
[Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?]
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.

Responses:
1 OF200_06 (OF1160)
REFUSED RF OF200_06 (OF1160)
DON'T KNOW DK OF200_06 (OF1160)
Programmer Instructions:
Use state lookup file.
Note: The entry Foreign country (FC) is allowed.
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]' if Round 1. Use NHISDt
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.
Display OF200_01, OF200_02, OF200_03, OF200_04, OF200_05, and OF200_06 on the same form pane.
Display question text "Please give me the name and address of the nursing home or long term care facility where [PERSON] was] [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?" in brackets and lighter "grayed out" text.

OF200_06 (OF1160)

BLAISE NAME: BefFamZip
Question Text:
[Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?]
What is the zip code?

Responses:
1 OF240 (OF1180)
REFUSED RF OF240 (OF1180)
DON'T KNOW DK OF240 (OF1180)
Programmer Instructions:
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 Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]' if Round 1. Use NHISDt
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.
Display OF200_01, OF200_02, OF200_03, OF200_04, OF200_05, and OF200_06 on the same form pane.
Display question text "Please give me the name and address of the nursing home or long term care facility where [PERSON] was [on January 1, [YEAR]/ living at the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]]?" in brackets and lighter "grayed out" text.

OF210 (OF1165)

BLAISE NAME: Age23orYounger
Question Text:
At that time, was [PERSON] 23 or younger?

Responses:
YES 1 OF220 (OF1170)
NO 2
REFUSED RF OF220 (OF1170)
DON'T KNOW DK OF220 (OF1170)
Programmer Instructions:
Control Variables Impacted during MHOP: CtrlPersKey, CtrlSampNHIS
HARD CHECK: If coded '2' (NO), display the following message: "For the purposes of this survey, students older than 23 are considered living in a private household.
INTERVIEWER: PLEASE BACK-UP TO OF180 (WherePersJan1) AND USE CODE 4 (IN A PRIVATE RESIDENCE/HOUSEHOLD)." Code '2' (NO) is disallowed as a final response option.
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.

OF220 (OF1170)

BLAISE NAME: SchlTpB
Question Text:
What grade or level of school was [PERSON] attending on [[MONTH, DAY, YEAR OF NHIS INTERVIEW]/January 1, [YEAR]]?
HELP: F1

Responses:
1st - 12th GRADE 1 OF240 (OF1180)
VOCATIONAL, COLLEGE, GRADUATE, PROFESSIONAL 2 OF230 (OF1175)
REFUSED RF OF230 (OF1175)
DON'T KNOW DK OF230 (OF1175)
Programmer Instructions:
Control Variables Impacted during MHOP: CtrlPersKey, CtrlSampNHIS
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
Display 'MONTH, DAY, YEAR OF NHIS INTERVIEW' if Round 1. Use NHISDt.
Otherwise, display 'January 1, [YEAR]' with 'YEAR' as the first calendar year of the panel.

OF230 (OF1175)

BLAISE NAME: Jan1ParentHh
Question Text:
[At the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW] / On January 1, [YEAR]], were either of [PERSON]'s parents living [at [NHIS ADDRESS]/in this household]?

Responses:
YES 1 OF240 (OF1180)
NO 2 OF240 (OF1180)
REFUSED RF OF240 (OF1180)
DON'T KNOW DK OF240 (OF1180)
Programmer Instructions:
Control Variables Impacted during MHOP: CtrlPersKey, CtrlSampNHIS
Display Instructions:
Display 'On January 1, [YEAR]' and 'in this household', if Rounds 2-5. Display the first calendar year of panel for 'YEAR'.
Display 'At the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW]' and 'at [NHIS ADDRESS]' if Round 1. Use NHISDt for 'MONTH, DAY, YEAR OF NHIS INTERVIEW'.
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03.
For 'NHIS ADDRESS' display the NHIS full address, including city and state but not zip code. Use Preload.CurrStrt1, Preload.CurrStrt2, Preload.CurrCity, Preload.CurrState. Separate address components with a comma, for example: "123 Main Street, Apt. 101, Rockville, MD".

OF240 (OF1180)

BLAISE NAME: AddPersConf
Question Text:
[PERSON] ADDED. HOWEVER, NO DATA WILL BE COLLECTED ABOUT [HIM/HER] DURING THE CURRENT INTERVIEW. WE WILL FOLLOW-UP ON [HIM/HER] NEXT TIME.
PRESS 1 AND ENTER TO RETURN TO MAIN INTERVIEW.

Responses:
CONTINUE 1 BOX_40 (OF1205)
Programmer Instructions:
During MHOP review/processing, set PersAddedBetweenRnds=YES for eligible persons added.
Display Instructions:
For '[PERSON]' display the first, middle, and last name entered at OF80_01-OF80_03 if '0' (ADD A PERSON) selected at OF70. Otherwise, display the name of the person selected at OF70.
Display 'HIM' if OF90 is coded '1' (MALE). Otherwise, display 'HER'.

OF250 (OF1185)

BLAISE NAME: AddEvntCont
Question Text:
Thank you. This information is very helpful. I'm going to pause the questions I was asking and make sure I have all the needed information about this health care visit.
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 BOX_20 (OF1190)
Display Instructions:

BOX_20 (OF1190)

Route Details:

Ask the Event Roster (EV) section.
At completion of EV section, continue with BOX_30.
Programmer Instructions:
The EV section, as well as all sections called within EV should present the traditional Blaise items with a green context header "OFF-PATH" located to the far left of the screen before any other information is presented. Any Manipula or other special items within these sections can remain the original color scheme.
For each event created in the EV section via OF30 and BOX_20, set the CreateQ for that event as OF30.

BOX_30 (OF1195)

Route Details:

Ask the Event Driver (ED) section for added events.
At completion of ED section, continue with OF260.
Programmer Instructions:
The ED section, as well as all sections called within ED should present the traditional Blaise items with a green context header "OFF-PATH" located to the far left of the screen before any other information is presented. Any Manipula or other special items within these sections can remain the original color scheme.

OF260 (OF1200)

BLAISE NAME: AddEvntConf
Question Text:
EVENT INFORMATION SUCCESSFULLY ADDED.
PRESS 1 AND ENTER TO RETURN TO MAIN INTERVIEW.

Responses:
CONTINUE 1 BOX_40 (OF1205)
Display Instructions:

BOX_40 (OF1205)

Route Details:

Return to the main interview item where the F2 was pressed (OF Section was launched).

Other Medical Expenses (OM) Section

BOX_00 (OM1005)

Route Details:

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60
02 Loop equal to LOOP_10
03 End Loop equal to END_LP10
04 Single Select equal to OM10, OM30, OM40, OM50, OM60, OM70
10 Multiple Select with Fill in Answer Text equal to OM80
23 Text Field equal to OM90
24 Information Screen equal to OM20
Grid Type 1 equal to OM80

BOX_10 (OM1010)

Route Details:

Context header display instructions:
Display PERS.FULLNAME, PRND.BEGREFMM, PRND.BEGREFDD, PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY
If PRND dates are missing, use RU dates:
RUBEGMM, RUBEGDD, RUENDMM, RUENDDD

BOX_20 (OM1015)

Route Details:

If person currently looping on has been asked EE40 or EE50, or has a record for GLASSES OR CONTACT LENSES created at EV20, where EV20 equal to 8 go to BOX_30.
Otherwise, if RU member has not been asked about glasses/contact purchases at EE40 or EE50 and does not have GLASSES OR CONTACT LENSES record created, go to OM10.

OM10 (OM1020)

BLAISE NAME: Glasses
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT)
(END-DT)

Question Text:

Did (you/(PERSON)) purchase eyeglasses or contact lenses (since (START DATE)/between (START DATE) and (END DATE))?
Responses: YES 1 BOX_30 (OM1025)
NO 2 BOX_30 (OM1025)
REFUSED RF BOX_30 (OM1025)
DON'T KNOW DK BOX_30 (OM1025)

Programmer Instructions:

If OM10 coded ?1? (YES), create a record as OM-record for ?GLASSES OR CONTACT LENSES?, go to BOX_30.

Display Instructions:

Display ?since (START DATE)? if not round 5. Display ?between (START DATE) and (END DATE)? if round 5.

BOX_30 (OM1025)

Route Details:

If CA30_01-CA30_N has at least 1 record for this person and this person is selected at EV10 and EV20 and coded ?9? (OTHER MEDICAL EXPENSES), go to OM20.
Otherwise, go to OM30.

OM20 (OM1030)

BLAISE NAME: HCareRec
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

Health care records were reported for (you/(PERSON)). Please look at these records while answering the next set of questions. (Earlier, you mentioned (you/PERSON) ) had medical purchases you wanted to talk about. This is the place where I can record that information. )
PRESS 1 AND ENTER TO CONTINUE.
Responses: CONTINUE 1 OM30 (OM1035)

Display Instructions:

If a person level variable was previously set at EV25 for the person currently looping on, display "Earlier you had mentioned (you/(PERSON) ) had medical purchases..." Otherwise, use a null display.

OM30 (OM1035)

BLAISE NAME: Ambulance
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

(Since (START DATE)/Between (START DATE) and (END DATE)), (have/has) (you/(PERSON)) used any ambulance services?
HELP:F1
Responses: YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded ?1?, (YES) create OM-record for "AMBULANCE SERVICES".

Display Instructions:

Display ?Since (START DATE)? if not round 5. Display ?Between (START DATE) and (END DATE)? if round 5.

OM40 (OM1040)

BLAISE NAME: DisposSupplies
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT)
(END-DT)

Question Text:

OM-1
Please look at card OM-1, (since (START DATE)/between (START DATE) and (END DATE)), (have/has) (you/(PERSON)) purchased any disposable supplies (that we haven?t already talked about as related to (your/(PERSON)?s) diabetes)?
Responses: YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded ?1? (YES), create OM-record for "DISPOSABLE SUPPLIES".

Display Instructions:

Display ?since (START DATE)? if not round 5. Display ?between (START DATE) and (END DATE)? if round 5.
Display ?that we haven?t already talked about as related?? if PM20 or PM40 is coded ?1? (YES) for this person during the current round. Otherwise, use a null display.

OM50 (OM1045)

BLAISE NAME: MedEquip
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT)
(END-DT)

Question Text:

OM-2
Please look at card OM-2, (since (START DATE)/between (START DATE) and (END DATE)), (have/has) (you/(PERSON)) purchased any long term medical equipment (that we haven?t already talked about as related to (your/(PERSON)?s) diabetes)?
Responses: YES 1 BOX_40 (OM1050)
NO 2 BOX_40 (OM1050)
REFUSED RF BOX_40 (OM1050)
DON'T KNOW DK BOX_40 (OM1050)

Programmer Instructions:

If OM50 coded ?1? (YES), create OM-record for "LONG-TERM MEDICAL EQUIPMENT", go to BOX_40 .

Display Instructions:

Display ?since (START DATE)? if not round 5. Display ?between (START DATE) and (END DATE)? if round 5.
Display ?that we haven?t already talked about as related...? if PM20 or PM40 is coded ?1? (YES) for this person during the current round. Otherwise, use a null display.

BOX_40 (OM1050)

Route Details:

If at least one OM-record has been reported for this person (GLASSES/CONTACT LENSES record created at EE40, EE50 or OM10 or OM30 equal to 1 ?AMBULANCE SERVICES?, OM40 equal to 1 ?DISPOSABLE SUPPLIES?, or OM50 equal to 1 ?LONG- TERM MEDICAL EQUIPMENT?), go to LOOP_10.
Otherwise, go to OM80.

LOOP_10 (OM1055)

Route Details:

For each OM- record reported, ask BOX_50-END_LP10.
Loop definition: LOOP_10 collects information on if glasses/contacts, ambulance services, disposable supplies, or long-term medical equipment were obtained at all during panel year 1 or 2, and collects charge payment information. This loop cycles on OM-record who meet the following condition:
-RU member reported any OM record type at OM30 equal to ?1? (AMBULANCE SERVICES), OM40 equal to ?1? (DISPOSABLE SUPPLIES), OM50 equal to ?3? (LONG-TERM MEDICAL EQUIPMENT) OR RU member has an OM-record for ?GLASSES/CONTACTS? created, at EE40, EE50, or OM10.
Loop by OM-record type in the following order: GLASSES OR CONTACT LENSES, AMBULANCE SERVICES, DISPOSABLE SUPPLIES, THEN LONG-TERM MEDICAL EQUIPMENT.

BOX_50 (OM1060)

Route Details:

If round 3 and persons reference period crosses between panel year 1 and panel year 2, continue with OM60. Otherwise, go to BOX_60.

OM60 (OM1065)

BLAISE NAME: OMEYear1
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (OME ITEM GROUP)

Question Text:

Did (you/(PERSON)) (obtain/use) (eyeglasses or contact lenses/ambulance services/long-term medical equipment/disposable supplies) in (PANEL YEAR 1)?
Responses: YES 1 OM70 (OM1070)
NO 2 OM70 (OM1070)
REFUSED RF OM70 (OM1070)
DON'T KNOW DK OM70 (OM1070)

Display Instructions:

If PERSON?s current OM-record being looped on is glasses/contacts, display ?eyeglasses or contact lenses?.
If PERSON?s current OM-record being looped on is ambulance services, display ?ambulance services?.
If PERSON?s current OM-record being looped on is disposable supplies, display ?disposable supplies?.
If PERSON?s current OM-record being looped on is long-term medical equipment, display ?long-term medical equipment?.
If PERSON?s current OM-record being looped on is ambulance services, display ?use?. Otherwise, display ?obtain?.
For ?PANEL YEAR 1? display the first calendar year of the panel.

OM70 (OM1070)

BLAISE NAME: OMEYear2
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (OME ITEM GROUP)

Question Text:

Did (you/(PERSON)) (obtain/use) (eyeglasses or contact lenses/ambulance services/long-term medical equipment/disposable supplies) in (PANEL YEAR 2)?
Responses: YES 1 BOX_60 (OM1075)
NO 2 BOX_60 (OM1075)
REFUSED RF BOX_60 (OM1075)
DON'T KNOW DK BOX_60 (OM1075)

Display Instructions:

BOX_60 (OM1075)

Route Details:

Go to the Charge Payment section for this person-OM record pair.
When the Charge Payment section is complete, go to END_LP10.

END_LP10 (OM1080)

Route Details:

If there are more OM records to loop on for this person, return to LOOP_10.
Otherwise, if there are no more OM records to loop on for this person, go to OM80.

OM80 (OM1085)

BLAISE NAME: CodeAllOMRec
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT)
(END-DT)

Question Text:

PLEASE INDICATE ANY (ADDITIONAL) RECORDS USED FOR (PERSON) DURING UTILIZATION, CHARGE/PAYMENT, PRESCRIBED MEDICINES, AND OTHER MEDICAL EXPENSES.
ENTER ALL THAT APPLY.
Responses: CALENDAR WITH HEALTH CARE ENTRIES FOR (PERSON) 1 BOX_70 (OM1091)
PROVIDER/INSURANCE STATEMENT 2 BOX_70 (OM1091)
PATIENT PORTAL 3 BOX_70 (OM1091)
PAYMENT RECORDS 4 BOX_70 (OM1091)
PRESCRIPTION MEDICINE BOTTLES, TUBES, CONTAINERS, ETC 5 BOX_70 (OM1091)
OTHER TYPE OF RECORD 7 OM90 (OM1090)
NO OTHER RECORDS USED 8 BOX_70 (OM1091)
REFUSED RF BOX_70 (OM1091)
DON'T KNOW DK BOX_70 (OM1091)

Programmer Instructions:

Preloaded grid type 1
Display "ADDITIONAL" if CA30_01 equal to 1, CA30_02 equal to 1, CA30_03 equal to 1, CA30_04 equal to 1, CA30_05 equal to 1, or CA_30_07 equal to 1. Otherwise, use a null display.

Display Instructions:

Col #1 Header: CA30 Responses
Instructions: Display the responses entered at the records grid CA30_01, CA30_02, CA30_03, CA30_04, CA30_05, and CA30_07. Do not display CA30_06. Display these previously recorded responses as prefilled values but not editable. Display the number associated with the event type: if CA30_01 equal to 1, display ?1?, if CA30_02 equal to 1, display ?2?, if CA30_03 equal to 1, display ?3?, if CA30_04 equal to 1, display ?4?, if CA30_05 equal to 1, display ?5?, if CA_30_07 equal to 1, display ?7?, if no records coded at CA30_01-CA30_07, use a null display. Display these numbers with a hyphen separating them for example: 1-3-5.
Col#2 Header: Additional Records
Instructions: Display the responses entered at OM80 (CodeAllOMRec).
Hard checks:
Cannot code OM80 (CodeAllOMRec) as 8 (NO OTHER RECORDS USED) in combination with any other codes. Display the following error message: ?CANNOT CHOOSE "NO OTHER RECORDS USED" IN COMBINATION WITH OTHER RESPONSES. REVIEW YOUR RESPONSES AND MAKE ANOTHER SELECTION.?

OM90 (OM1090)

BLAISE NAME: OthOMRec
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT)
(END-DT)

Question Text:

ENTER OTHER RECORD.
NOTE: BE AS SPECIFIC AS POSSIBLE.
Responses: 1 BOX_70 (OM1091)
REFUSED RF BOX_70 (OM1091)
DON'T KNOW DK BOX_70 (OM1091)

Display Instructions:

BOX_70 (OM1091)

Route Details: Go to next section of the questionnaire.

Outpatient Department (OP) Section

BOX_00 (OP1000)

Route Details:

01 Box equal to BOX_00, BOX_10 , BOX_20, BOX_30, BOX_40, BOX_50
04 Single Select equal to OP10, OP20, OP30, OP50, OP70, OP90
05 Single Select with Display Roster equal to OP110
06 Single Select with Fill in Answer Text equal to OP40
08 Multiple Select equal to OP80
30_Multiple Select with Fill in Answer Text and Display Roster equal to OP120
11 Multiple Select with Add/Edit/Delete equal to OP60, OP100
23 Text Field equal to OP130
28 Trigram Lookup equal to OP20LU
Roster 2 equal to OP120
Roster 3 equal to OP60, OP100

BOX_10 (OP1001)

Route Details:

Context header display instructions:
Display PERS.FULLNAME, PROV.LORPNAME, EVNT.EVNTBEGM, EVNT.EVNTBEGD, EVNT.EVNTBEGY.
If provider is flagged as facility provider, also display doctor or department linked to this facility provider for this event (if available).

OP10 (OP1010)

BLAISE NAME: OPSeeDoc
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

Did (you/(PERSON)) see a medical doctor during this particular visit?
HELP: F1

Responses:

YES 1 OP20 (OP1015)
NO 2 OP30 (OP1020)
REFUSED RF OP30 (OP1020)
DON'T KNOW DK OP30 (OP1020)

Display Instructions:

OP20 (OP1015)

BLAISE NAME: OPDocSpeclty
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

What was the doctor's specialty?
IF TALKED TO MORE THAN ONE DOCTOR, PROBE FOR MAIN PROVIDER.

Responses:

CARDIOLOGY (HEART) 3 OP40 (OP1030)
ENDOCRINOLOGY/METABOLISM (DIABETES, THYROID) 5 OP40 (OP1030)
FAMILY PRACTICE 6 OP40 (OP1030)
GASTROENTEROLOGY 7 OP40 (OP1030)
GENERAL PRACTICE 8 OP40 (OP1030)
GENERAL SURGERY 9 OP40 (OP1030)
GYNECOLOGY/OBSTETRICS 11 OP40 (OP1030)
INTERNAL MEDICINE (INTERNIST) 14 OP40 (OP1030)
NEPHROLOGY (KIDNEYS) 15 OP40 (OP1030)
NEUROLOGY 16 OP40 (OP1030)
ONCOLOGY (TUMORS, CANCER) 18 OP40 (OP1030)
OPHTHALMOLOGY (EYES) 19 OP40 (OP1030)
ORTHOPEDICS 20 OP40 (OP1030)
OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT) 22 OP40 (OP1030)
PEDIATRICIAN 24 OP40 (OP1030)
PHYSICAL MEDICINE/REHAB 25 OP40 (OP1030)
PSYCHIATRY/PSYCHIATRIST 28 OP40 (OP1030)
RADIOLOGY 30 OP40 (OP1030)
UROLOGY 33 OP40 (OP1030)
OTHER DR SPECIALTY 91 OP20LU (OP1017)
REFUSED RF OP40 (OP1030)
DON'T KNOW DK OP40 (OP1030)

Display Instructions:

Display OP20 and OP20LU on the same form pane.

OP20LU (OP1017)

BLAISE NAME: OPDocSpecltyLU
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

ENTER OTHER DOCTOR SPECIALTY.
TYPE THE FIRST 3 LETTERS OF THE SPECIALTY, THEN USE ARROW KEYS IF NEEDED TO LOCATE SPECIALTY, AND PRESS ENTER TO SELECT.

Responses:

Programmer Instructions:

Go to OP40.
Responses listed are part of the provider specialty look-up file that works similar to a trigram search.
Browser window should be labeled ?SELECT SPECIALTY?.
Response code numbers should be stored behind the scenes and not visible in the look- up window.

Display Instructions:

Display OP20 and OP20LU on the same form pane.

OP30 (OP1020)

BLAISE NAME: OPMPTp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

What type of medical person did (you/(PERSON)) talk to on (VISIT DATE)?
IF TALKED TO MORE THAN ONE MEDICAL PERSON, PROBE FOR MAIN PROVIDER.
HELP: F1

Responses:

ACUPUNCTURIST 1 OP40 (OP1030)
CHIROPRACTOR 2 OP40 (OP1030)
DENTIST/DENTAL CARE PERSON 3 OP40 (OP1030)
HOMEOPATHIC/NATUROPATHIC/HERBALIST/OTHER ALTERNATIVE/COMPLEMENTARY CARE PROVIDER 4 OP40 (OP1030)
MASSAGE THERAPIST 5 OP40 (OP1030)
MENTAL HEALTH COUNSELOR/MARITAL OR FAMILY THERAPIST 6 OP40 (OP1030)
MIDWIFE 7 OP40 (OP1030)
NURSE/NURSE PRACTITIONER 8 OP40 (OP1030)
OPTOMETRIST 9 OP40 (OP1030)
PHYSICAL/OCCUPATIONAL THERAPIST 10 OP40 (OP1030)
PHYSICIAN'S ASSISTANT 11 OP40 (OP1030)
PODIATRIST 12 OP40 (OP1030)
PSYCHOLOGIST 13 OP40 (OP1030)
SOCIAL WORKER 14 OP40 (OP1030)
TECHNICIAN 15 OP40 (OP1030)
OTHER 91 OP40 (OP1030)
REFUSED RF OP40 (OP1030)
DON'T KNOW DK OP40 (OP1030)

Display Instructions:

OP40 (OP1030)

BLAISE NAME: OPVstCat
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

OP-1.
Please look at card OP-1 and tell me which category best describes the care (you/(PERSON)) received during the visit to ((DOC OR DEPT)/the outpatient department) at (PROVIDER) on (VISIT DATE).
HELP: F1

Responses:

GENERAL CHECKUP 1 OP50 (OP1035)
DIAGNOSIS OR TREATMENT 2 OP50 (OP1035)
EMERGENCY (E.G., ACCIDENT OR INJURY) 3 OP50 (OP1035)
PSYCHOTHERAPY OR MENTAL HEALTH COUNSELING 4 OP50 (OP1035)
FOLLOW-UP OR POST-OPERATIVE VISIT 5 OP50 (OP1035)
IMMUNIZATIONS OR SHOTS 6 OP50 (OP1035)
VISION EXAM 7 OP50 (OP1035)
(PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)) 8 OP50 (OP1035)
(WELL CHILD EXAM) 9 OP50 (OP1035)
LASER EYE SURGERY 10 OP50 (OP1035)
OTHER 91 OP50 (OP1035)
REFUSED RF OP50 (OP1035)
DON'T KNOW DK OP50 (OP1035)

Display Instructions:

Display ?(DOC OR DEPT)? if PROVIDER linked to this event is flagged as a facility provider and there a doctor or department linked to this specific event. Otherwise, display ?the outpatient department?.
Display OP40 (OPVstCat) response option ?8? (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND DELIVERY)) if person is female and aged 15-55 inclusive (or age categories 3 to 8). Otherwise, use a null display.
Display OP40 (OPVstCat) response option ?9? (WELL CHILD EXAM)if PERSON IS less than 7 YEARS OLD (OR AGE CATEGORIES 1 TO 3). Otherwise, use a null display.

OP50 (OP1035)

BLAISE NAME: OPSpecCond
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

(Other than (your/his/her) (general checkup/well child exam), was/Was) this visit related to any specific health condition or were any conditions discovered during this visit?
HELP: F1

Responses:

YES 1 OP60 (OP1040)
NO 2 OP70 (OP1050)
REFUSED RF OP70 (OP1050)
DON'T KNOW DK OP70 (OP1050)

Display Instructions:

Display ?Other than (your/his/her) (general checkup/well child exam), was? if OP40 (OPVstCat) was coded ?1? (GENERAL CHECKUP) OR ?9? (WELL CHILD EXAM). Otherwise, display 'Was'.
Display ?general checkup? if OP40 (OPVstCat) was coded ?1? (GENERAL CHECKUP). Display ?well child exam? if OP40 (OPVstCat) was coded ?9? (WELL CHILD EXAM).

OP60 (OP1040)

BLAISE NAME: OPCondRoster
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

What conditions were discovered or led (you/ (PERSON)) to make this visit?
PROBE: Any other condition?
ENTER ALL THAT APPLY
CRTL-A:ADD
CRTL-E:EDIT
CRTL-D:DELETE
HELP: F1

Responses:

(MEDICAL CONDITION) 1 1 OP70 (OP1050)
(MEDICAL CONDITION) 2 2 OP70 (OP1050)
(MEDICAL CONDITION) 3 3 OP70 (OP1050)
(MEDICAL CONDITION) 4 4 OP70 (OP1050)
(MEDICAL CONDITION)N 5 OP70 (OP1050)

Programmer Instructions:

Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event.The link is created when the collection of utilization and/or charge/payment data is complete.

Display Instructions:

Roster 3- Add/Edit/Delete Allow
Roster definition:
Display the Person-Medical-Conditions-Roster for selection and addition of one or many medical condition(s) associated with this event. Display name of medical condition (COND.CONDNAM).
Roster filter:
Display all conditions on person's roster; no filter.

OP70 (OP1050)

BLAISE NAME: OPSurgProc
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

Was a surgical procedure performed on (you/(PERSON)) during this visit?
HELP: F1

Responses:

YES 1 OP80 (OP1060)
NO 2 OP80 (OP1060)
REFUSED RF OP80 (OP1060)
DON'T KNOW DK OP80 (OP1060)

Display Instructions:

OP80 (OP1060)

BLAISE NAME: CodeAllOPSvc
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

OP-2.
Looking at card OP-2, which of these services, if any, did (you/ (PERSON)) have during this visit?
ENTER ALL THAT APPLY
HELP: F1

Responses:

LABORATORY TESTS 1 OP90 (OP1070)
SONOGRAM OR ULTRASOUND 2 OP90 (OP1070)
X-RAYS 3 OP90 (OP1070)
MAMMOGRAM 4 OP90 (OP1070)
MRI OR CATSCAN 5 OP90 (OP1070)
EKG, ECG, OR EEG 6 OP90 (OP1070)
VACCINATION 7 OP90 (OP1070)
NONE OF THESE SERVICES RECEIVED 95 OP90 (OP1070)
REFUSED RF OP90 (OP1070)
DON'T KNOW DK OP90 (OP1070)

Programmer Instructions:

Soft check:
If OP80 (CodeAllOPSvc) is coded '4' (MAMMOGRAM) and person being asked about is male or is female and less than or equal to 17 years of age (or age categories 1-3), display the following message: "UNLIKELY RESPONSE FOR (MALE/CHILDREN 17 AND YOUNGER). VERIFY AND RE-ENTER."
Display 'MALES' in error message if person being asked about is a male greater than 17 years of age (or age categories 4 through 9). Display 'CHILDREN 17 AND YOUNGER' in the error message if person being asked about is male or female and less than or equal to 17 years of age (or age categories 1-3).
Allow OP80 (CodeAllOPSvc) code '95' (NONE OF THESE SERVICES RECEIVED), 'RF' (REFUSED), and 'DK' (DON'T KNOW) alone only. These responses may not be selected with any other response.
'NONE OF THESE SERVICES RECEIVED' is not displayed on show card.
Hard check:
Edit: If OP80 (CodeAllOPSvc) is coded ?95? (NONE OF THESE SERVICES RECEIVED), no other treatment categories can be coded. If interviewer selects another code with 'NONE OF THESE SERVICES', display the following message: "NONE OF THESE SERVICES RECEIVED CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE- ENTER."

Display Instructions:

OP90 (OP1070)

BLAISE NAME: OPPmed
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

During this visit, were any medicines prescribed for (you/(PERSON))? Please include only prescriptions which were filled.
HELP: F1

Responses:

YES 1 OP100 (OP1075)
NO 2 BOX_20 (OP1085)
REFUSED RF BOX_20 (OP1085)
DON'T KNOW DK BOX_20 (OP1085)

Display Instructions:

OP100 (OP1075)

BLAISE NAME: OPPmedRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

Question Text:

Please tell me the names of the prescriptions from this visit that were filled.
PROBE: Any other prescribed medicines from this visit that were filled?
ENTER ALL THAT APPLY
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(PRESCRIBED MEDICINE)1 1 BOX_20 (OP1085)
(PRESCRIBED MEDICINE)2 2 BOX_20 (OP1085)
(PRESCRIBED MEDICINE)3 3 BOX_20 (OP1085)
(PRESCRIBED MEDICINE)4 4 BOX_20 (OP1085)
(PRESCRIBED MEDICINE)N 5 BOX_20 (OP1085)

Programmer Instructions:

Display Instructions:

Roster 3- Add/Edit/Delete Allowed.
Roster definition:
This item displays the Person's-Prescription-Medicines-Roster for selection and addition of prescribed medicines. Display name of prescribed medicine (DRUG.DRUGMANE)
Roster filter:
Display all medicines on person's roster; no filter.

BOX_20 (OP1085)

Route Details:

If no condition is associated with this visit to this provider for this person, go to BOX_50. Otherwise, continue with BOX_30.

BOX_30 (OP1090)

Route Details:

If 1 or more visits to this provider for this person have not completed the Outpatient Department (OP) Utilization section, continue with BOX_40.
Note: If provider is a facility provider, check all events to the same facility provider regardless of the doctor or department linked to the specific events).
Otherwise, go to BOX_50.

BOX_40 (OP1095)

Route Details:

If this event is not part of a flat fee group, continue with OP110.
Otherwise, go to BOX_50. Otherwise, continue with BOX_30.

OP110 (OP1100)

BLAISE NAME: OPOthSameCond
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

Question Text:

Earlier I recorded that (you/(PERSON)) had some other visits to an outpatient department at (PROVIDER). (Were any of these visits related to (your/his/her) (PERSON?S OP MEDICAL CONDITION)?/Were any of the other visits also for (your/his/her) (PERSON?S OP MEDICAL CONDITION) or (PERSON?S OP MEDICAL CONDITION) (or (PERSON'S OP MEDICAL CONDITION))?/Were any of the other visits also for one of these conditions (READ CONDITIONS BELOW):)
(CONDITIONS
(PERSON'S OP MEDICAL CONDITION)1
(PERSON'S OP MEDICAL CONDITION)2
(PERSON'S OP MEDICAL CONDITION)3
(PERSON'S OP MEDICAL CONDITION)4
(PERSON'S OP MEDICAL CONDITION)N)

Responses:

YES 1 OP120 (OP1110)
NO 2 BOX_50 (OP1120)
REFUSED RF BOX_50 (OP1120)
DON'T KNOW DK BOX_50 (OP1120)

Display Instructions:

(DOC OR DEPT) should not display in context header.
Display ?Were any of these visits related to (your/his/her) (PERSON?S OP MEDICAL CONDITION)?? if only one condition selected or added to Person?s-Medical-Conditions-Roster at OP60. Display ?Were any of the other visits also for (your/his/her) (PERSON?S OP MEDICAL CONDITION) or (PERSON?S OP MEDICAL CONDITION) (or (PERSON?S OP MEDICAL CONDITION))?? if exactly 2 or 3 conditions selected or added to Person?s-Medical-Conditions-Roster at OP60. Otherwise, display ?Were any of the other visits also for one of these conditions (READ CONDITIONS BELOW):?
Display ?or (PERSON?S OP MEDICAL CONDITION? if exactly 3 conditions selected or added to Person?s-Medical-Conditions-Roster at OP60 (PCondRoster) Otherwise, use a null display.
For ?PERSON?S OP MEDICAL CONDITION? display the condition selected from or added to PERSON?S-MEDICAL-CONDITIONS-ROSTER AT OP60 (PCondRoster).
Display the header ?CONDITIONS? and the list of conditions if more than three conditions selected or added to Person?s-Medical-Conditions-Roster at OP60 (PCondRoster). Otherwise, use a null display. FOR ?PERSON?S OP MEDICAL CONDITION?, DISPLAY ALL CONDITIONS SELECTED FROM OR ADDED TO PERSON?S-MEDICAL-CONDITIONS-ROSTER AT OP60 (PCondRoster).

OP120 (OP1110)

BLAISE NAME: OPRepVstRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

Question Text:

(Which of the following visits were also for (your/(PERSON)?s) (PERSON?S OP MEDICAL CONDITION) ((or (your/his/her)/,) (PERSON?S OP MEDICAL CONDITION)) (or (your/his/her) (PERSON?S OP MEDICAL CONDITION))?/ Which of the following visits were also for one of these conditions (READ CONDITIONS BELOW)?)
PROBE: Any other visits for the same condition?
ENTER ALL THAT APPLY
(CONDITIONS
(PERSON'S OP MEDICAL CONDITION)1
(PERSON'S OP MEDICAL CONDITION)2
(PERSON'S OP MEDICAL CONDITION)3
(PERSON'S OP MEDICAL CONDITION)4
(PERSON'S OP MEDICAL CONDITION)N)

Responses:

(SELECT ALL EVENTS) 0 OP130 (OP1115)
(MONTH,DAY,YEAR) - (DOC OR DEPT)1 1 OP130 (OP1115)
(MONTH,DAY,YEAR) - (DOC OR DEPT)2 2 OP130 (OP1115)
(MONTH,DAY,YEAR) - (DOC OR DEPT)3 3 OP130 (OP1115)
(MONTH,DAY,YEAR) - (DOC OR DEPT)4 4 OP130 (OP1115)
(MONTH,DAY,YEAR) - (DOC OR DEPT)N 5 OP130 (OP1115)

Programmer Instructions:

If coded '0' SELECT ALL EVENTS, CAPI should automatically select all of the events displayed on the roster and flag as being part of the repeat visit group.
Flag each visit selected at OP120 as a repeat visit related to the event being asked about.
(NOTE: The event being cycled on through this OP section administration is the ?stem? repeat visit. The events selected at OP120 are the ?leaves?. The event driver (ED) section will not serve these repeat visits for the OP section.)
Assign next repeat visit number at the household level. (NOTE: Each repeat visit grouping, whether OP, MV, or HH is assigned this number at a household level. The number will start over every round.)
Roster behavior:
1. Multiple select allowed.

Display Instructions:

(DOC OR DEPT) should not display in context header.
Roster 2-no add/edit/delete
Roster filter:
Display only those event with the following characteristics.
Event was created this round.
Event has not been processed in utilization.
Event has event type ?OP?.
Event is associated with the same provider as the event being asked about (regardless of the doctor or department linked to the specific event if provider is a facility provider).
Event is not already flagged as part of a flat fee bundle.
Next to each event date, display the doctor or department linked to that specific visit date.
Display ?Which of the following visits were also for (your/(PERSON)?s) (PERSON?S OP MEDICAL CONDITION) ((or (your/his/her)/,) (PERSON'S OP MEDICAL CONDITION)) (or (your/his/her) (PERSON?S OP MEDICAL CONDITION))?? if three or less conditions selected or added to Person?s-Medical-Conditions-Roster at OP60. Otherwise display, ?Which of the following visits were also for one of these conditions (READ CONDITIONS BELOW)??
Display ?(or (your/his/her)/,) (PERSON?S OP MEDICAL CONDITION)? if two or three conditions selected or added to Person?s-Medical-Conditions-Roster at OP60 (PCondRoster). Otherwise, use a null display.
Display ?or (your/his/her)? if exactly two conditions selected or added to Person?s-Medical-Conditions-Roster at OP60 (PCondRoster). Otherwise, display ?,?.
Display ?or (your/his/her) (PERSON?S OP MEDICAL CONDITION)? if exactly three conditions selected or added to Person?s-Medical-Conditions-Roster at OP60 (PCondRoster). Otherwise, use a null display.
For ?PERSON?S OP MEDICAL CONDITION? display the condition selected from or added to Person?s-Medical-Conditions-Roster AT OP60 (PCondRoster).
Display the header ?CONDITIONS? and the list of conditions if more than three conditions selected or added to Person?s-Medical-Conditions-Roster at OP60. Otherwise, use a null display. For ?PERSON?S OP MEDICAL CONDITION?, display all conditions selected from or added to Person?s-Medical-Conditions-Roster at OP60 (PCondRoster).
For "MONTH,DAY,YEAR" in the response option area, display visit dates as "MON DD, YYYY". Abbreviate the month name as three letters.
Display the response option '0' SELECT ALL EVENTS when there is more than one event to display on the roster, otherwise use a null display.

OP130 (OP1115)

BLAISE NAME: OPEvntVstGrp
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) (EVN-DT)

Question Text:

INTERVIEWER: RECORD 'NAME OF REPEAT VISIT GROUP' FOR EVENTS SELECTED IN PREVIOUS QUESTION:

Responses: 1 BOX_50 (OP1120)
Display Instructions:

(DOC OR DEPT) should not display in context header.

BOX_50 (OP1120)

Route Details:

Go to the Charge/Payment (CP) section if it needs to be asked for this outpatient 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 Event Driver (ED) section.

Prescribed Medicines (PM) Section

BOX_00 (PM1000)

Route Details:

01 Box equal to BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100, BOX_110
02 Loop equal to LOOP_10
03 End Loop equal to END_LP10
04 Single Select equal to PM20, PM40, PM50, PM70, PM90, PM110, PM190
05 Single Select with Display Roster equal to PM180
06 Single Select with Fill in Answer Text equal to PM10
07_Single Select with Add/Edit/Delete equal to PM200
11 Multiple Select with Add/Edit/Delete equal to PM30, PM60, PM80, PM100, PM120
12 Address - Newly Collected equal to PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06, PM170_07
15 Regular Date Entry with Skips equal to PM130_01, PM130_02
19 Numeric Field equal to PM140, PM150
28 Trigram Lookup equal to PM160LU
Roster 3 equal to PM30, PM60, PM80, PM100, PM120, PM160LU, PM200

BOX_05 (PM1005)

Route Details:

All sections starting with and including PM that precede Employment in rounds 1, 3, 5 or precede Access in rounds 2 and 4, function as a single person level loop (e.g., ask PM, OM, AH, and CS, for person 1, then loop through those sections for person 2, then person 3, and person N.) CAPI will allow the interviewer to select CTRL-S at any time during the person loop, and select another RU member to loop on (including starting with someone other than the respondent/reference person).
For sections PM, OM, and AH, all current RU members, including those who are deceased and institutionalized should be asked these sections.
For the CS section, all RU members less than or equal to 17 years of age including those who are institutionalized, but excluding those RU members that are deceased.
The order of these sections follows the same ones specified in the GL section; respondent/reference person if the respondent is a proxy followed by RU members in PID order.

PMIntro (PM1006)

BLAISE NAME: PMIntro
Question Text:

PRESCRIBED MEDICINES (PM), OTHER MEDICAL (OM), (AND) ADDITIONAL HEALTHCARE (AH)(, AND CHILD HEALTH (CS)) SECTIONS - ASKED FOR EACH RU MEMBER AS A LOOP.
CTRL-S: SWITCH TO A DIFFERENT RU MEMBER.
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_10 (PM1010)
Programmer Instructions:

This item is presented only for the first person that goes through the PM, OM, AH and CS loop. Skip PMIntroduction for all other RU members.

Display Instructions:

Display "AND" if rounds 1, 3, or 5. Otherwise, use a null display.
Display ", AND CHILD HEALTH (CS)" if round 2 or round 4. Otherwise, use a null display.

BOX_10 (PM1010)

Route Details:

Context header display instructions:
Display PERS.FULLNAME, PRND.BEGREFMM,DD,YY and PRND.ENDREFMM,DD,YY.
Continue with PM10 (even if PM10 is prefilled with a response).

PM10 (PM1020)

BLAISE NAME: HasPmedRecords
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

(Earlier you mentioned that (you/(PERSON)) had prescription medicine bottles, containers, tubes, or bags available.) For these next questions, please have any bottles, containers, tubes, or bags, a pharmacy print out or patient portal information available for each of (your/PERSON)'s medicines we will be talking about.

Responses:

HAS PRESCRIPTION MEDICINE BOTTLES/RECORDS FOR (PERSON) 1 BOX_20 (PM1030)
DOES NOT HAVE ANY PRESCRIPTION MEDICINE BOTTLES/RECORDS FOR (PERSON) 2 BOX_20 (PM1030)
REFUSED TO USE ANY PRESCRIPTION MEDICINE BOTTLES/RECORDS FOR (PERSON) 3 BOX_20 (PM1030)

Programmer Instructions:

Refused and Don't Know are disallowed.
If CA30_05 is coded '1' (YES, HAS PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR (PERSON)), prefill the response entry field with '1' (HAS PRESCRIPTION MEDICINE BOTTLES/RECORDS) as selected, but the field should be editable.

Display Instructions:

Display 'Earlier you mentioned that (you/(PERSON)) had prescription medicine bottles, containers, tubes, or bags available.' If CA30_5 is coded '1' (YES, HAS PRESCRIPTION RECORDS/MEDICINE BOTTLES FOR (PERSON). Otherwise, use a null display.

BOX_20 (PM1030)

Route Details:

If person has 'DIABETES' on Persons-Medical-Conditions-Roster, created in PE in any round, continue with PM20.
Otherwise, go to BOX_30.

PM20 (PM1040)

BLAISE NAME: PmedDiab
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

(Since (START DATE)/Between (START DATE) and (END DATE)), (have/has) (you/(PERSON)) obtained insulin or any other prescribed medicines related to (your/his/her) diabetes?
HELP:F1

Responses:

YES 1 PM30 (PM1050)
NO 2 PM40 (PM1060)
REFUSED RF PM40 (PM1060)
DON'T KNOW DK PM40 (PM1060)

Programmer Instructions:
Display Instructions:

Display 'since (START DATE)' if not round 5. Display 'between (START DATE) and (END DATE)' if round 5.

PM30 (PM1050)

BLAISE NAME: PmedDiabRoster
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

What are the names of these medicines related to (your/his/her) diabetes?
PROBE: Any other medicines related to (your/his/her) diabetes?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(PRESCRIBED MEDICINE)1 1 PM40 (PM1060)
(PRESCRIBED MEDICINE)2 2 PM40 (PM1060)
(PRESCRIBED MEDICINE)3 3 PM40 (PM1060)
(PRESCRIBED MEDICINE)4 4 PM40 (PM1060)
(PRESCRIBED MEDICINE)N 5 PM40 (PM1060)

Programmer Instructions:

Roster Behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a medicine added at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be deleted until the end of interview.
Limited edit allowed. Interviewer may edit medicines added at this item at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be edited until the end of interview.
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.
When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.
When the CTRL-D or CTRL-E command is called, the pop-up manipula should display
60 characters for the medicine name.
General flag rules for medicines:
-Round medicine first created (by definition a medicine is selected the same time it is created)
-Question number medicine first created
-Round medicine selected

Display Instructions:

Roster 3- Add/Edit/Delete Allowed.
Roster Definition:
This item displays the person's-prescribed-medicines-roster for selection/addition. Display name of prescribed medicine (DRUG.DRUGNAME).
Roster Filter:
Display all; no filter.

PM40 (PM1060)

BLAISE NAME: DiabEquip
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

(Other than what we just listed, did/Did) (you/(PERSON)) obtain any other diabetic equipment or supplies, typically prescribed by a physician; for example, syringes, a blood glucose monitor machine, glucose meter, insulin pumps, lancets, alcohol swabs or control solution (since (START DATE)/between (START DATE) and (END DATE))?

Responses:

YES 1 BOX_30 (PM1070)
NO 2 BOX_30 (PM1070)
REFUSED RF BOX_30 (PM1070)
DON'T KNOW DK BOX_30 (PM1070)

Programmer Instructions:

If PM40 is coded '1' (YES), automatically select the entry 'OTHER DIABETIC EQUIPMENT/SUPPLIES' on person's-prescribed-medicines-roster. If 'OTHER DIABETIC EQUIPMENT/SUPPLIES' is not already on roster, create the entry and select it.
General flag rules for medicines:
- Round medicine first created (by definition a medicine is selected the same time it is created)
- Question number medicine first created
- Round medicine selected

Display Instructions:

Display 'Other than what we just listed, did' if PM20 was coded '1' (YES). Otherwise, display 'Did'.
Display 'since (START DATE)' if not round 5. Display 'between (START DATE) and (END DATE)' if round 5.

BOX_30 (PM1070)

Route Details:

If person has 'ASTHMA' on Persons-Medical-Conditions-Roster, created in PE in any round, continue with PM50.
Otherwise, go to PM70.

PM50 (PM1080)

BLAISE NAME: PmedAsthma
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

Including any medicines for quick relief of asthma symptoms, such as inhalers, and those that prevent symptoms over the long term, (have/has) (you/(PERSON)) obtained any prescribed medicines related to (your/his/her) asthma (since (START DATE)/between (START DATE) and (END DATE))?
HELP:F1

Responses:

YES 1 PM60 (PM1090)
NO 2 PM70 (PM1100)
REFUSED RF PM70 (PM1100)
DON'T KNOW DK PM70 (PM1100)

Display Instructions:

Display 'since (START DATE)' if not round 5. Display 'between (START DATE) and (END DATE)' if round 5.

PM60 (PM1090)

BLAISE NAME: PmedAsthmaRoster
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

What are the names of these medicines related to (your/his/her) asthma?
PROBE: Any other medicines related to (your/his/her) asthma?
ENTER ALL THAT APPLY
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(PRESCRIBED MEDICINE)1 1 PM70 (PM1100)
(PRESCRIBED MEDICINE)2 2 PM70 (PM1100)
(PRESCRIBED MEDICINE)3 3 PM70 (PM1100)
(PRESCRIBED MEDICINE)4 4 PM70 (PM1100)
(PRESCRIBED MEDICINE)N 5 PM70 (PM1100)

Programmer Instructions:

Roster Behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a medicine added at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be deleted until the end of interview.
Limited edit allowed. Interviewer may edit medicines added at this item at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be edited until the end of interview.
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.
When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.
When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name.
General flag rules for medicines:
-Round medicine first created (by definition a medicine is selected the same time it is created)
-Question number medicine first created
-Round medicine selected

Display Instructions:

PM70 (PM1100)

BLAISE NAME: NewMeds
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

In answering the next couple of questions, remember to think about prescriptions obtained at any pharmacy, including mail-order or on-line. (Since (START DATE)/Between (START DATE) and (END DATE)), (have/has) (you/(PERSON)) obtained any new prescription medicines or any refills (we have not yet talked about)?
HELP: F1

Responses:

YES 1 PM80 (PM1110)
NO 2 PM90 (PM1120)
REFUSED RF PM90 (PM1120)
DON'T KNOW DK PM90 (PM1120)

Display Instructions:

DISPLAY 'Since (START DATE)' IF NOT ROUND 5. DISPLAY 'Between (START DATE) and (END DATE)' IF ROUND 5.
Display "we have not yet talked about" if 1 or more medicines have been selected during this round.
Otherwise use a null display.

PM80 (PM1110)

BLAISE NAME: NewMedsRoster
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

What were the names of these medicines?
PROBE: Any other medicines?
ENTER ALL THAT APPLY
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(PRESCRIBED MEDICINE)1 1 PM90 (PM1120)
(PRESCRIBED MEDICINE)2 2 PM90 (PM1120)
(PRESCRIBED MEDICINE)3 3 PM90 (PM1120)
(PRESCRIBED MEDICINE)4 4 PM90 (PM1120)
(PRESCRIBED MEDICINE)N 5 PM90 (PM1120)

Programmer Instructions:

Roster Behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a medicine added at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be deleted until the end of interview.
Limited edit allowed. Interviewer may edit medicines added at this item at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be edited until the end of interview.
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.
When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.
When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name.
General flag rules for medicines:
- Round medicine first created (by definition a medicine is selected the same time it is created)
- Question number medicine first created
- Round medicine selected

Display Instructions:

PM90 (PM1120)

BLAISE NAME: PmedAsNeeded
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

(Since (START DATE)/Between (START DATE) and (END DATE)), did (you/(PERSON)) obtain any (other) prescriptions, even if (you/(PERSON)) (are/is) no longer taking the medicine or only take it as-needed?
HELP: F1

Responses:

YES 1 PM100 (PM1130)
NO 2 BOX_40 (PM1140)
REFUSED RF BOX_40 (PM1140)
DON'T KNOW DK BOX_40 (PM1140)

Display Instructions:

Display 'Since (START DATE)' if not round 5. Display 'Between (START DATE) and (END DATE)' if round 5.
Display 'other' if at least one medicine is flagged as selected for the current round (that is, at least one medicine was selected at HS100, ER70, OP100, MV120, PM30, PM60, or PM80 in the current round or PM40 was coded '1' (YES) in the current round). Otherwise, use a null display.

PM100 (PM1130)

BLAISE NAME: PmedAsNeededRoster
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

What were the names of these medicines?
PROBE: Any other medicines?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(PRESCRIBED MEDICINE)1 1 BOX_40 (PM1140)
(PRESCRIBED MEDICINE)2 2 BOX_40 (PM1140)
(PRESCRIBED MEDICINE)3 3 BOX_40 (PM1140)
(PRESCRIBED MEDICINE)4 4 BOX_40 (PM1140)
(PRESCRIBED MEDICINE)N 5 BOX_40 (PM1140)

Programmer Instructions:

Roster Behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a medicine added at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be deleted until the end of interview.
Limited edit allowed. Interviewer may edit medicines added at this item at this item as long as CAPI has not created a link between this medicine and an event. If a medicine, added in PMed section, is never linked to an event, that medicine can be edited until the end of interview.
NOTE: In order for the columns to display properly, 35 allowable characters for the medicines will be accepted for display on the roster.
When adding a medicine in the pop-up manipula, a maximum of 60 characters will be allowed.
When the CTRL-D or CTRL-E command is called, the pop-up manipula should display 60 characters for the medicine name.
General flag rules for medicines:
- Round medicine first created (by definition a medicine is selected the same time it is created)
- Question number medicine first created
- Round medicine selected

Display Instructions:

BOX_40 (PM1140)

Context Header:
Route Details:

Check person's-prescribed-medicines-roster for selections. If at least one medicine is flagged as selected for the current round (that is, at least one medicine was selected at HS100, ER70, OP100, MV120, PM30, PM60, PM80 or PM100 in the current round or PM40 was coded '1' (YES) in the current round), continue with LOOP_10.
Otherwise, go to BOX_110.

LOOP 10 (PM1150)

Context Header:
Route Details:

For each element in person's-prescribed-medicines-roster flagged as selected, ask BOX_50 -END_LP10.
Loop Definition: LOOP_10 collects information about each prescribed medicine selected during the current round. This loop cycles on prescribed medicines that meet one of the following conditions:
- Prescribed medicine was selected at HS100, ER70, OP100, MV120, PM30, PM60, PM80 or PM100 in the current round for this person
or
- PM40 is coded '1' (YES) and "OTHER DIABETIC EQUIPMENT/SUPPLIES' is flagged as selected for the current round

BOX_50 (PM1180)

Route Details:

If medicine being looped on was linked to a condition in a prior round (preload.PrescribedMed.PMedSpecCondFlag equal to Yes), go to BOX_60.
If medicine being looped on was selected at PM30 in the current round, autocode PM110 to '1' (YES) and autocode 'DIABETES' at PM120 and then go to BOX_60.
If looping on "OTHER DIABETIC EQUIPMENT/SUPPLIES", autocode PM110 to '1' (YES) and autocode 'DIABETES' at PM120 and then go to PM140.
If medicine being looped on was selected at PM60 in the current roundautocode PM110 to '1' (YES) and autocode 'ASTHMA' at PM120 and then go to BOX_60.
Otherwise (medicine created this round and related to neither diabetes nor asthma), continue with PM110.

PM110 (PM1190)

BLAISE NAME: PmedSpecCond
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF PRESCRIPTION MEDICINE.) (STR-DT) (END-DT)

Question Text:

Now, let's talk about (MEDICINE).
Is (MEDICINE) used for a specific health problem?

Responses:

YES 1 PM120 (PM1200)
NO 2 BOX_60 (PM1210)
REFUSED RF BOX_60 (PM1210)
DON'T KNOW DK BOX_60 (PM1210)

Display Instructions:

PM120 (PM1200)

BLAISE NAME: PmedCondRoster
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF PRESCRIPTION MEDICINE.) (STR-DT) (END-DT)

Question Text:

(Now, let's talk about (MEDICINE).)
What health problem is (MEDICINE) prescribed for?
PROBE: Any other health problems?
ENTER ALL THAT APPLY
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP:F1

Responses:

(MEDICAL CONDITION) 1 1 BOX_60 (PM1210)
(MEDICAL CONDITION) 2 2 BOX_60 (PM1210)
(MEDICAL CONDITION) 3 3 BOX_60 (PM1210)
(MEDICAL CONDITION) 4 4 BOX_60 (PM1210)
(MEDICAL CONDITION)N 5 BOX_60 (PM1210)

Programmer Instructions:

Roster Behavior:
Multiple select allowed. Selection should not impact the round flag of the condition.
Multiple add allowed. Interviewer should record condition name.
Limited delete allowed. Interviewer may delete a condition added at this item as long as CAPI has not created a link between this condition and an event. If a condition, added in PMed section, is never linked to an event, that condition can be deleted until a link is made between the condition and the medicine. The link between condition and the medicine is created at END_LP10 (the end of the cycle for the medicine being asked about).
Limited edit allowed. Interviewer may edit a condition name added at this item as long as CAPI has not created a link between this condition and an event. If a condition, added in PMed section, is never linked to an event, that condition can be edited until a link is made between the condition and the medicine. The link between the condition and the medicine is created at END_LP10 (the end of the cycle for the medicine being asked about).

Display Instructions:

Roster 3- Add/Edit/Delete allowed.
Roster Definition:
Display the person-medical-conditions-roster for the selection and addition of one or many medical condition(s) associated with this medicine.
Roster Filter:
Display all conditions on person's roster; no filter.
Display 'Now let's talk about (MEDICINE).' if this is the first question presented in LOOP_10, otherwise, use a null display.

BOX_60 (PM1210)

Context Header:
Route Details:

If medicine being asked about is flagged as 'CREATED' during the current round, continue with PM130_01.
Otherwise, go to PM140.

PM130_01 (PM1220)

BLAISE NAME: PMedStartYYYY
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF PRESCRIPTION MEDICINE.) (STR-DT) (END-DT)

Question Text:

(Now, let's talk about (MEDICINE).)
In what year did (you/(PERSON) first use (MEDICINE)?
ENTER ' XXXX' IF PERSON HAS NOT YET TAKEN/USED MEDICINE.
ENTER 4- DIGIT YEAR

Responses:

1
REFUSED RF PM140 (PM1240)
DON'T KNOW DK PM140 (PM1240)

Programmer Instructions:

If ' XXXX' (HAS NOT YET TAKEN/USED) entered, go to PM140.
If Rounds 1-3 and year entered is equal to or greater than person's begin reference period year or FirstPanYear minus 1, continue with PM130_02.
If Rounds 4-5 and year entered is equal to or greater than person's begin reference period year or SecondPanYear minus 1, continue with PM130_02.
Otherwise, go to PM140.
Range Check: Year equal to 1900 - 2100.

Display Instructions:

Display PM130_01 and PM130_02, on the same form pane.
Display 'Now let's talk about (MEDICINE).' if this is the first question presented in LOOP_10, otherwise, use a null display.

PM130_02 (PM1230)

BLAISE NAME: PMedStartMM
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT) (NAME OF PRESCRIPTION MEDICINE.)

Question Text:

[In what year did (you/(PERSON) first use (MEDICINE)?]
What month did (you/he/she) first use (MEDICINE)?
ENTER MONTH

Responses:

1 PM140 (PM1240)
REFUSED RF PM140 (PM1240)
DON'T KNOW DK PM140 (PM1240)

Programmer Instructions:

For specifications purposes only (CAPI handles automatically): allowable values for month are 1-12.
The complete date cannot be before the person's date of birth or after the reference period end date for this person.

Display Instructions:

Display PM130_01 and PM130_02, on the same form pane.
Display bracketed question text in lighter "grayed-out" text.

PM140 (PM1240)

BLAISE NAME: PmedXFill
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF PRESCRIPTION MEDICINE.) (STR-DT) (END-DT)

Question Text:

(Now, let's talk about (MEDICINE).)
How many times was (MEDICINE) obtained or purchased for (you/(PERSON)) (since (START DATE) /between (START DATE) and (END DATE))?
ENTER NUMBER OF TIMES

Responses:

1 BOX_70 (PM1250)
REFUSED RF BOX_70 (PM1250)
DON'T KNOW DK BOX_70 (PM1250)

Display Instructions:

DISPLAY 'since (START DATE)' if not Round 5.
DISPLAY 'between (START DATE) and (END DATE)' if Round 5.
Display 'Now let's talk about (MEDICINE).' if this is the first question presented in LOOP_10, otherwise, use a null display.

BOX_70 (PM1250)

Context Header:
Route Details:

If Round 3 and PM140 is not RF or DK, continue with BOX_80.
Otherwise, go to END_LP10.

BOX_80 (PM1260)

Route Details:

If person being looped on has a begin reference period date of YEAR 2, auto-code PM150 with '0' and then go to END_LP10.
If person being looped on has an end reference period date of YEAR 1, auto-code PM150 with the response entered at PM140 and then go to END_LP10.
Otherwise, continue with PM150.

PM150 (PM1270)

BLAISE NAME: PmedXFillLYr
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF PRESCRIPTION MEDICINE.) (STR-DT) (END-DT)

Question Text:

NUMBER OF TIMES OBTAINED/PURCHASED SINCE (START DATE): (NUMBER OF TIMES)
Of these times, how many were in (YEAR)?
ENTER NUMBER OF TIMES

Responses:

1 END_LP10 (PM1280)
REFUSED RF END_LP10 (PM1280)
DON'T KNOW DK END_LP10 (PM1280)

Programmer Instructions:

Display the first year of the panel for 'YEAR'.
Hard Check:
Number of times must be less than orequal to number of times obtained/purchased at PM140 (PmedXFill).

Display Instructions:

For 'NUMBER OF TIMES,' display the number entered at PM140 (PmedXFill).

END_LP10 (PM1280)

Context Header:
Route Details:

Cycle on next medicine in person's-prescribed-medicines-roster that meets the conditions stated in the loop definition.
If no other medicines meet the stated conditions, end LOOP_10 and continue with PM160LU.

PM160LU (PM1290)

BLAISE NAME: PharmRoster
Context Header: (

PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

Please tell me the name of the pharmacy or pharmacies that filled the prescription(s) for (you/(PERSON)) (since (START DATE)/between (START DATE) and (END DATE))
PROBE: Any other pharmacy?
PRESS ENTER WHEN DONE SELECTING OR ADDING PHARMACIES.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP:F1

Responses:

((PHARMACY), (STREET ADDRESS), (CITY), (ST))1 1 BOX_90 (PM1300)
((PHARMACY), (STREET ADDRESS ), (CITY), (ST))2 2 BOX_90 (PM1300)
((PHARMACY), (STREET ADDRESS), (CITY), (ST))3 3 BOX_90 (PM1300)
((PHARMACY), (STREET ADDRESS), (CITY), (ST))4 4 BOX_90 (PM1300)
((PHARMACY), (STREET ADDRESS), (CITY), (ST))N 5 BOX_90 (PM1300)
PHARMACY NOT IN LOOKUP 91 BOX_90 (PM1300)

Programmer Instructions:

Roster behavior:
Multiple select allowed.
Multiple add allowed. Interviewer adds one pharmacy at a time; interviewer uses CTRL-A to begin the add process for the each new pharmacy.
Limited delete allowed.
Limited edit allowed.
CTRL-A launches the pharmacy look-up. Whether a pharmacy is added through the look- up or via PM170, CAPI will return to PM160LU to allow the interviewer to add or select another pharmacy.
General flag rules for pharmacies:
- Round pharmacy first created (by definition a pharmacy is selected the same time it is created)
- Round pharmacy selected for this RU member
- RU member pharmacy is linked to (however, this is known by virtue that the medicine was selected at PM160 for this person).
NOTE: The round flag and which RU member the pharmacy is linked to, also known as a person-pharmacy-pair, is key for the collection of pharmacy authorization forms.

Display Instructions:

Roster 3- add/edit/delete allowed.
Roster Definition:
This item displays the RU-pharmacies-roster for selection/addition. Display pharmacy name (PHAR.PHARNAME), street address, city, and state.
Roster Filter:
Display all; no filter.
Display the roster in non-proportional text.
The allowable characters for each field should be as follow before truncation:
Pharmacy: 40 characters
Street Address: 35 characters
City: 23 characters
State: 2 characters
Phone: 10 characters - stored with pharmacy info but not displayed at PM160LU.
NOTE: When a pharmacy is selected from the lookup, the name of the pharmacy saved to the pharmacy array and will display on this roster under the 'Pharmacy' column header be pulled from the PharmName1 column in the NPI database.
DISPLAY 'since (START DATE)' if not Round 5.
DISPLAY 'between (START DATE) and (END DATE)' if Round 5.
Display only one column of pharmacy response option categories. Each response category should have pharmacy name, address, city, and state separated by commas.
Upon return to PM160LU, after CTRL-A has been launched at least once, display the question text "Please tell me the name of the pharmacy or pharmacies that filled the prescription(s) for (you/(PERSON)) (since (START DATE)/between (START DATE) and (END DATE))" in brackets and "grayed out" text. The instruction "PROBE: Any other pharmacy?" remains in bold black text.

BOX_90 (PM1300)

Route Details:

If 'PHARMACY NOT IN LOOKUP' selected, continue with PM170_01.
If a pharmacy is selected from the look-up, add that pharmacy to the roster at PM160LU and select it. Return to PM160LU for interviewer to continue to select pharmacies.
Otherwise, go to BOX_100.

PM170_01 (PM1310)

BLAISE NAME: PharmName
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

What is the name and address of the pharmacy that filled the prescription(s) for (you/(PERSON))?
ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED.
ENTER WEB ADDRESS ON STREET ADDRESS LINE(S).
[What is the pharmacy name?]
HELP:F1

Responses: 1 PM170_02 (PM1320)

Programmer Instructions: Refused and Don't Know are disallowed.
Display Instructions:

Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.

PM170_02 (PM1320)

BLAISE NAME: PharmStrt1
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for (you/(PERSON))?]
ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED.
ENTER WEB ADDRESS ON STREET ADDRESS LINE(S).
What is the address?

Responses:

1 PM170_03 (PM1330)
REFUSED RF PM170_03 (PM1330)
DON'T KNOW DK PM170_03 (PM1330)

Display Instructions:

Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.
Display question text "[What is the name...(you/(PERSON))?]" and interviewer instruction "ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED." in lighter "grayed-out" text.

PM170_03 (PM1330)

BLAISE NAME: PharmStrt2
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

Responses:

1 PM170_04 (PM1340)
EMPTY Empty PM170_04 (PM1340)
REFUSED RF PM170_04 (PM1340)
DON'T KNOW DK PM170_04 (PM1340)

Programmer Instructions: Allow empty.
Display Instructions:

Display question text "[What is the name...(you/(PERSON))?]" and interviewer instruction "ENTER COMPLETE NAME AND ADDRESS AND VERIFY SPELLING. IF PHARMACY HAS MORE THAN ONE LOCATION, RECORD LOCATION WHERE PERSON HAD PRESCRIPTION FILLED." in lighter "grayed-out" text.

PM170_04 (PM1340)

BLAISE NAME: PharmCity
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for (you/(PERSON))?]
What is the city?

Responses:

\1 PM170_05 (PM1350)
REFUSED RF PM170_05 (PM1350)
DON'T KNOW DK PM170_05 (PM1350)

Display Instructions:

Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.
Display question text "[What is the name...(you/(PERSON))?]" in lighter "grayed-out" text.

PM170_05 (PM1350)

BLAISE NAME: PharmSt
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for (you/(PERSON))?]
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.

Responses:

1 PM170_06 (PM1360)
REFUSED RF PM170_06 (PM1360)
DON'T KNOW DK PM170_06 (PM1360)

Programmer Instructions:

Use state look-up file.
NOTE: The entry Foreign Country (FC) is allowed.

Display Instructions:

Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.
Display question text "[What is the name...(you/(PERSON))?]" in lighter "grayed-out" text.

PM170_06 (PM1360)

BLAISE NAME: PharmZip

Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for (you/(PERSON))?]
What is the zip code?

Responses:

1 PM170_07 (PM1370)
REFUSED RF PM170_07 (PM1370)
DON'T KNOW DK PM170_07 (PM1370)

Programmer Instructions:

Hard check: Exactly 5 digit numeric entry required. If less than 5 numeric digits entered in PM170_06 (PharmZip) 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 Instructions:

Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.
Display question text "[What is the name...(you/(PERSON))?]" in lighter "grayed-out" text.

PM170_07 (PM1370)

BLAISE NAME: PharmPhone
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

[What is the name and address of the pharmacy that filled the prescription(s) for (you/(PERSON))?]
What is the telephone number?
IF NO TELEPHONE, ENTER DK.

Responses: 1

REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Ten digit entry required for this field.
Display hard check if less than 10 digits are entered in PM170_07 (PharmPhone) :
"PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."
Use number input mask (XXX-XXX-XXXX) in the response field.
Add the pharmacy created at PM170_01 through PM170_07 to the roster at PM160LU and select it. Return to PM160LU for interviewer to continue to select pharmacies.

Display Instructions:

Display PM170_01, PM170_02, PM170_03, PM170_04, PM170_05, PM170_06 and PM170_07 on the same form pane.
Display question text "[What is the name...(you/(PERSON))?]" in lighter "grayed-out" text.

BOX_100 (PM1380)

Context Header:
Route Details:

If at least one pharmacy selected at PM160LUfor this person where PharmTp is missing [(Preload.PharmTp equal to RF, DK, or Empty) and (PharmTp equal to Empty for the current round)], continue with PM180.
Otherwise, go to PM190.

PM180 (PM1390)

BLAISE NAME: PharmTp
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (PHARMACY NAME) (STR-DT) (END-DT)

Question Text:

What type of pharmacy is (PHARMACY)? Is it a mail-order pharmacy; a pharmacy located in another store such as a grocery or department store; a pharmacy located in an HMO, clinic, or hospital; a drug store that is not located within another facility; or is it an on-line pharmacy?
HELP: F1

Responses:

MAIL-ORDER 1
IN ANOTHER STORE 2
IN HMO/CLINIC/HOSPITAL 3
DRUG STORE 4
ON-LINE 5
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded Grid Type 1 including question PM180.
Continue with PM190 once grid is complete.

Display Instructions:

Roster 1 - Report
Roster Definition:
This item displays the RU-pharmacies-roster as the first two columns of the grid. Display only pharmacy name and first street address in these columns. These columns are protected and cannot be changed.
Roster Filter:
Display only pharmacies that are newly added to the roster (do not have a pharmacy type associated with them).
When on grid rows, 2-n, display the text "Is it a mail-order?on-line pharmacy?" in grayed out text.
The question "What type of pharmacy is (PHARMACY)?" will stay in bold black when on every row of the grid. Display the actual pharmacy name for the row the cursor is on for "PHARMACY".

PM190 (PM1400)

BLAISE NAME: PMed3Part
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

Now I'd like to ask you about the charges for (your/(PERSON)'s) prescription medicine(s).
Has (your/(PERSON)'s) health insurance or another source of coverage helped pay for any of (your/his/her) prescription medications (since (START DATE)/between (START DATE) and (END DATE))?
SELECT 'NO' IF PERSON REPORTS NO HEALTH INSURANCE OR ANOTHER SOURCE OF COVERAGE.
HELP: F1

Responses:

YES 1 PM200 (PM1410)
NO 2 BOX_110 (PM1420)
REFUSED RF BOX_110 (PM1420)
DON'T KNOW DK BOX_110 (PM1420)

Display Instructions:

Display Instructions:
DISPLAY 'since (START DATE)' IF NOT ROUND 5.
DISPLAY 'between (START DATE) and (END DATE)' IF ROUND 5.

PM200 (PM1410)

BLAISE NAME: PMed3Roster
Context Header:

(PERSON'S FIRST MIDDLE AND LAST NAME) (STR-DT) (END-DT)

Question Text:

Responses:

(NAME OF SOURCE OF DIRECT PAYMENT)1 1 BOX_110 (PM1420)
(NAME OF SOURCE OF DIRECT PAYMENT)2 2 BOX_110 (PM1420)
(NAME OF SOURCE OF DIRECT PAYMENT)3 3 BOX_110 (PM1420)
(NAME OF SOURCE OF DIRECT PAYMENT)4 4 BOX_110 (PM1420)
(NAME OF SOURCE OF DIRECT PAYMENT)N 5 BOX_110 (PM1420)

Programmer Instructions:

Write sources selected to the 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 Behavior:
Add one only or select one only.
Add allowed. Selecting CTRL-A displays a pop-up with a text entry field and a selectable list of 15 common sources of payment. (See BOX_20 in the Charge/Payment (CP) Section Specifications for a detailed list). The interviewer can type a new source or select one from the list. Upon return to PM200, 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 interviewer has not left the screen. If delete is attempted when it is not allowed, CAPI displays the following error message: 'Delete Allowed only when source of payment is first entered.'
Limited edit allowed. If interviewer adds a source of payment, editing is possible for that source only, as long as the interviewer has not left the screen. If edit is attempted when it is not allowed, CAPI displays the following error message: 'Edit allowed only when source of payment first entered.'

Display Instructions:

Roster 3 - Add/Edit/Delete allowed
Roster Definition:
Display the RU-Sources-Of-Payment-Roster for selection.
Roster Filter:
Display all sources of payment that are not "PERSON/FAMILY".

BOX_110 (PM1420)

Route Details:

Go to next questionnaire section.

Provider Probes (PP) Section

BOX_00 (PP1000)

Route Details:

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, 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_280, BOX_290, BOX_300, BOX_310, BOX_320, BOX_330, BOX_340, BOX_350, BOX_360, BOX_370
05 Single Select with Display Roster = PP10, PP20, PP30, PP40, PP50, PP60, PP70, PP80, PP90, PP100, PP110, PP120, PP130, PP140, PP150, PP160_01, PP160_02, PP160_03, PP160_04, PP320_01, PP320_02, PP320_03, PP320_04, PP325_01, PP325_02, PP325_03, PP325_04
10 Multiple Select with Fill in Answer Text = PP170, PP180, PP190, PP200. PP210, PP220, PP230, PP240, PP250, PP260, PP270, PP280, PP290, PP300, PP310
Grid 1 = PP10, PP20, PP30, PP40, PP50, PP60, PP70, PP80, PP90, PP100, PP110, PP120, PP130, PP140, PP150, PP160_01, PP160_02, PP160_03, PP160_04, PP320_01, PP320_02, PP320_03, PP320_04, PP325_01, PP325_02, PP325_03, PP325_04
Roster 2 = PP170, PP180, PP190, PP200. PP210, PP220, PP230, PP240, PP250, PP260, PP270, PP280, PP290, PP300, PP310

BOX_10 (PP1005)

Route Details:

The following definitions of family and non-family subunit are specified and created in RE930.
For family subunit, which consists only of respondent, respondent?s spouse/partner(RE900= ?7? HUSBAND/WIFE/SPOUSE or ?8? UNMARRIED PARTNER) , respondent?s dependent children under age 21 (RE900 = 5 DAUGHTER/ADOPTED DAUGHTER, ?6? SON/ADOPTED SON, ?17? STEPDAUGHTER, or ?18? STEPSON), children of partner under age 21 (RE900 = ?30'DAUGHTER OF [PERSON LOOPING ON]'s PARTNER, ?31? SON OF [PERSON LOOPING ON]'s PARTNER), and children under age 18 in a legal guardian relationship with the respondent (Respondent was selected as the legal guardian for child at RE920). If respondent is a proxy, Family Subunit is the reference person and the reference person?s spouse/partner (RE900= ?7? HUSBAND/WIFE/SPOUSE or ?8? UNMARRIED PARTNER), reference person?s dependent children under age 21 (RE900 = 5 DAUGHTER/ADOPTED DAUGHTER, ?6? SON/ADOPTED SON, ?17? STEPDAUGHTER, or ?18? STEPSON), reference person?s partners children under age 21 (RE900 = ?30? DAUGHTER OF [PERSON LOOPING ON]'s PARTNER, ?31? SON OF [PERSON LOOPING ON]'s PARTNER), and children under age 18 in a legal guardian relationship with the reference person (Reference person was selected as the legal guardian for child at RE920).
For all other situations that are not inclusive of the above definition for family subunit, they would be considered a non-Family Subunit- all other household members, not part of Family Subunit
For the Family Subunit ask PP10-PP160, which is to be administered with a forced choice format for each person on the household roster who is part of the Family Subunit. There will always be at least one person in the family subunit- the respondent at the very least.
For the non-family subunit: ask PP170-PP320 in a select-all-that-apply format for each person on the household roster who is part of the Non-Family Subunit. Option of ?other household member? and ?no one? are available.
Throughout this section, the [DISPLAY FAMILY SUBUNIT NAMES] and [DISPLAY NON-FAMILY SUBUNIT NAMES] refers to displaying the FIRST, MIDDLE, LAST NAME of each RU member in the corresponding subunit. For the first probe in each set (PP10 and PP170 respectively), display full names (FIRST, MIDDLE, LAST NAME) for each RU member in the subunit, otherwise only display FIRST name for each subsequent probe (PP20-PP160_01-N; PP180-PP325_01-N) for each RU member in the family or non-family subunit. This is different than other sections. Separate each name with a comma and before the last RU member?s name display an ?or?. 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.

PP10 (PP1010)

BLAISE NAME: ProbeHosp
Question Text:
and PP-1
The next set of questions [help make sure we haven?t missed any additional health care for any of the/ ask about health care received by the] people living here. [Earlier you mentioned that [DISPLAY NAME 1] [DISPLAY NAME 2] [DISPLAY NAME 3] [and DISPLAY NAME N] had some health care visits that we haven?t yet talked about. I can collect that information during these next series of questions]
[As I ask the questions, please look at the corresponding show cards and think about [any additional] health care each person received. / As I ask the questions, please look at the corresponding show cards. For now, I?d like you to think about [yourself/you/[REFERENCE PERSON]] [and [your/his/her] [spouse/partner]]/ [and [your/his/her] children] when answering. We?ll cover the other household members next. ]
Let?s start with hospitals. Looking at card PP-1, [since [START DATE]/between [START DATE] and [END DATE]], [were/was] [DISPLAY FAMILY SUBUNIT NAMES] admitted to the hospital for any period of time?
[VARIABLE QUESTION TEXT]

Responses:
YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Preloaded Grid Type 1: Forced navigation
If at least one person in the grid coded ?1? (YES), continue with BOX_20.
Otherwise, go to PP20.
Display Instructions:
Roster type 1- Report Roster definition:
Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members? First, Middle, Last Names Roster Filter: Display all RU members? part of the family subunit as defined in BOX_10.
Display ?since [START DATE]? if not round 5, otherwise display ?between [START DATE] and [END DATE]?.
Display ?was? if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ?were?.
Display ?help make sure we haven?t missed any additional health care for any of the? if at least one event record has already been created for any RU member.(e.g., EV20 in (1-7))
Display ?ask about health care received by the? if no event records exist for any RU member (e.g., EV20 not set)
Display ?As I ask the questions, please look at the corresponding show cards and think about [any additional] health care each person received? if all persons in the RU are part of the FAMILY SUBUNIT. Within this sentence, display ?any additional? if there are events enumerated on the roster for anyone in this family subfamily unit.
Display ?As I ask the questions, please look at the corresponding show cards. For now, I?d like you to think about [yourself/you/[REFERENCE PERSON]][and [your/his/her] [spouse/partner]] [and [your/his/her] children] when answering. We?ll cover the other household members next.? if 1 or more but not all RU members included in the FAMILY subunit. Within this sentence, use the following display logic:
[yourself/you/[REFERENCE PERSON]]
Display ?yourself? if the family subunit only includes the respondent.
Display ?you? if the family subunit only include the respondent and at least one other person.
Display ?[REFERENCE PERSON]? substituting the reference person?s name if the respondent is a proxy.
[and [your/his/her] [spouse/partner]]
Display ?and [your/his/her] [spouse/partner]? if the respondent/reference person has a spouse or partner (RE900= ?7? HUSBAND/WIFE/SPOUSE ) or (RE900= ?8? UNMARRIED PARTNER)
Otherwise use a null display.
[spouse/partner]
Display ?spouse? if the if RE900= ?7? HUSBAND/WIFE/SPOUSE
Display ?partner? if RE900= ?8? UNMARRIED PARTNER
[and [your/his/her] children]
Display ?and [your/his/her] children? if the respondent/reference person or the respondent/reference person?s partner has any children.
RE900=?5? (DAUGHTERADOPTED DAUGHTER), ?6? (SON/ADOPTED SON], ?17? (STEPDAUGHTER), ?18? (STEPSON) ?30? (DAUGHTER OF [PERSON LOOPING ON]?S PARTNER), ?31? (SON OF [PERSON LOOPING ON]?S PARTNER)
Otherwise use a null display.
Display ?Earlier you mentioned?? if EV15 has a value set for it for any person in the family subunit. For DISPLAY NAMES within that sentence, display only the first, middle, and last names of the persons within the FAMILY SUBUNIT for which EV15 value is set.
For [DISPLAY FAMILY SUBUNIT NAMES], display the first names of all RU members in the family subunit. Use the word ?or? before the last person's name.
For the fill ?VARIABLE QUESTION TEXT? Display the following:
For PERSON 1, always use a null display.
Display?What about [PERSON 2]?? in brackets when the cursor is on the second person in the grid.
Replace the fill for PERSON 2 and display ?What about [PERSON 3]?? in brackets when the cursor is on the third person in the grid.
Replace the fill for PERSON 3 and display ?What about [PERSON 4]? Since [START DATE]/between [START DATE] and [END DATE] has [he/she] been admitted to the hospital for any period of time?? when the cursor is on the fourth person in the grid.
Replace the fill for PERSON 4 and display ?What about [PERSON N]?? in brackets when the cursor is on the Nth person in the grid.
Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display.
Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.

BOX_20 (PP1015)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP20.

PP20 (PP1020)

BLAISE NAME: ProbeER
Question Text:
And PP-2
Now think about hospital emergency rooms. Looking at card PP-2, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] received any type of care in a hospital emergency room?
[VARIABLE QUESTION TEXT

BOX_30 (PP1025)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP30.

PP30 (PP1030)

BLAISE NAME: ProbeOP
Question Text:
And PP-3
Looking at card PP-3, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] received any type of care in a hospital outpatient department?
[VARIABLE QUESTION TEXT]

BOX_40 (PP1035)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP40.

PP40 (PP1040)

BLAISE NAME: ProbeGP
Question Text:
And PP-4
Now I?d like you to think about different kinds of medical doctors and health care professionals who provided care to [you/you and your family]/[REFERENCE PERSON]/[REFERENCE PERSON]?s family]] [[other than the] [hospital] [[and ]emergency room] [[and ]outpatient] [visit/visits] we already talked about]].
Looking at card PP-4, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] seen a primary care doctor such as a general practitioner, internist, pediatrician, or family medicine provider?
HELP: F1

Responses:
YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Preloaded Grid Type 1: Forced navigation
If at least one person in the grid coded ?1? (YES), continue with BOX_50.
Otherwise, go to PP50.
Display Instructions:
Roster type 1- Report Roster Definition: Display the RU-Members-Roster in the form pane. Col #1- RU Members Display RU members? First, Middle, Last Names
Roster Filter: Display all RU members? part of the family subunit as defined in BOX_10.
Display ?Since [START DATE]? if not round 5, otherwise display ?between [START DATE] and [END DATE]?.
Display ?has? if the respondent is a proxy and there is only 1 RU member in the family subunit, otherwise, display ?have?.
Display ?you/you and your family? if an RU member is the respondent. Otherwise, display ?[REFERENCE PERSON]/[REFERENCE PERSON]?s family?.
Display ?you? if RU member respondent is the only RU member in the family subunit. Otherwise, display ?you and your family?.
Display ?[REFERENCE PERSON]? if the reference person is the only RU member in the family subunit. Otherwise, display ?[REFERENCE PERSON]?s family.
Search the event array for RU members in the family subunit. If at least one person in the family subunit reported an HS, ER, and/or OP event, display ?other than the?we already talked about?, otherwise use a null display.
Display ?hospital? if a HS event is on the event array for at least one person in the family subunit. Otherwise, use a null display.
Display ?[and] emergency room? if an ER event is on the event array for at least one person in the family subunit. Otherwise, use a null display.
Display the ?[and]? ? only if both HS and ER events are on the event array for at least one person in the family subunit, but not an OP event. Otherwise, use a null display.
Display ?[and ]outpatient? if there is an OP event on the event array for at least one person in the family subunit. Otherwise, use a null display.
Display the ?and? only if there is a HS event and/or an ER event on the event array, along with an OP event for at least one person. Otherwise, use a null display.
Display ?visit? if there is only one HS, ER, or OP event for the family subunit reported on the event array. Display ?visits? if there are two or more events for the family subunit reported on the event array. Otherwise, use a null display.
For the fill ?VARIABLE QUESTION TEXT? display the following:
For PERSON 1, always use a null display. Display ?What about [PERSON 2]?? in brackets when the cursor is on the second person in the grid. Replace the fill for PERSON 2 and display ?What about [PERSON 3]?? in brackets when the cursor is on the third person in the grid. Replace the fill for PERSON 3 and display ?What about [PERSON 4]? Since [START DATE]/between [START DATE] and [END DATE] has [he/she] seen a primary care doctor?? when the cursor is on the fourth person in the grid.
Replace the fill for PERSON 4 and display ?What about [PERSON N]?? in brackets when the cursor is on the Nth person in the grid.
Repeat the variable text display for persons beyond that in the order specified above. Display first names only in the variable question text display.
Display the first three paragraphs in brackets and grayed out text after displaying the question for PERSON 1.

BOX_50 (PP1045)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP50.

PP50 (PP1050)

BLAISE NAME: ProbeSpeclt
Question Text:
And PP-5
Looking at card PP-5, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] seen any type of specialist such as an orthopedist, cardiologist, dermatologist, oncologist, neurologist, gynecologist, allergist or any other type of specialist?
[VARIABLE QUESTION TEXT]

BOX_60 (PP1055)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP60.

PP60 (PP1060)

BLAISE NAME: ProbeNurse
Question Text:
And PP-6
Looking at card PP-6, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] seen any other type of medical professional such as a nurse, nurse practitioner or nurse?s aide, a physician?s assistant or a midwife?
[VARIABLE QUESTION TEXT]
HELP: F1

BOX_70 (PP1065)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP70.

PP70 (PP1070)

BLAISE NAME: ProbeClinic
Question Text:
And PP-7
Looking at card PP-7, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] received care at any type of health clinic, such as a walk-in urgent care, a retail clinic at a pharmacy or grocery store, a family planning center or a clinic at a college or university?
[VARIABLE QUESTION TEXT]

BOX_80 (PP1075)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP80.

PP80 (PP1080)

BLAISE NAME: ProbeLab
Question Text:
And PP-8
Looking at card PP-8, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAME] been to any medical lab or testing facility for bloodwork, x-rays or other tests?
[VARIABLE QUESTION TEXT]

BOX_90 (PP1085)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP90.

PP90 (PP1090)

BLAISE NAME: ProbeMentalHlth
Question Text:
And PP-9
Looking at card PP-9, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] seen any type of mental health professional such as a psychiatrist, psychologist, a licensed clinical social worker or any other type of mental health therapist or counselor?
[VARIABLE QUESTION TEXT]

BOX_100 (PP1095)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP100.

PP100 (PP1100)

BLAISE NAME: ProbeTherap
Question Text:
And PP-10
Looking at card PP-10, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] had any visits to any other type of therapist such as a physical therapist, occupational therapist, speech therapist or chiropractor?
[VARIABLE QUESTION TEXT]

BOX_110 (PP1105)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP110.

PP110 (PP1110)

BLAISE NAME: ProbeDN
Question Text:
And PP-11
Looking at card PP-11, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] seen any type of dental care provider such as dentists, oral surgeons, orthodontists, or dental assistants?
[VARIABLE QUESTION TEXT]

BOX_120 (PP1115)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP120.

PP120 (PP1120)

BLAISE NAME: ProbeVision
Question Text:
Yes PP-12
Looking at card PP-12, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] seen any type of vision or eye care provider such as an optometrist, ophthalmologist or vision technician?
[VARIABLE QUESTION TEXT]

BOX_130 (PP1125)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP130.

PP130 (PP1130)

BLAISE NAME: ProbeAltCare
Question Text:
And PP-13
Looking at card PP-13, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] had any visits to someone who practices alternative care such as acupuncture, homeopathic care, massage therapy, hypnosis, or other treatments?
[VARIABLE QUESTION TEXT]

BOX_140 (PP1135)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP140.

PP140 (PP1140)

BLAISE NAME: ProbeHH
Question Text:
And PP-14
Now I would like you to think about care [DISPLAY FAMILY SUBUNIT NAMES] may have received at home. Please look at card PP-14. Because of a health problem, [since [START DATE]/between[START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] received any type of care at home, such as
? care from a home care nurse or any type of therapist or social worker?
? care from someone who helps with bathing, dressing, or taking medication?
? help with cooking or cleaning ?
? or companionship services?
[VARIABLE QUESTION TEXT]

BOX_150 (PP1145)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP150.

PP150 (PP1150)

BLAISE NAME: ProbeIC
Question Text:
And PP-15
Now let?s talk about health care provided in a residential setting. [Earlier we discussed that [DISPLAY NAMES FROM RE350 WITH VISIT OF LESS THAN 100 DAYS][was/were] institutionalized in a facility for less than 100 days. If [he/she/they] received care in a residential health care facility, I can record that care now.]
Looking at card PP-15, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY FAMILY SUBUNIT NAMES] received any type of care in a residential rehabilitation or treatment facility, such as for rehab after surgery, hospice or respite care, mental health treatment, or treatment for drug, alcohol or other addiction?
[VARIABLE QUESTION TEXT]

BOX_160 (PP1155)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with BOX_170.

BOX_170 (PP1160)

Route Details:

Check to see if any RU members in this family subunit reported no events during this round. If one or more RU members , but not all RU members, reported 0 events continue to PP160_01.
Otherwise, go to BOX_190.
If only one RU member in the family subunit, and that person reported 0 events, go to BOX 190.

PP160_01 (PP1165)

BLAISE NAME: ProbeOthEvnt
Question Text:
I see that we don?t have any health care recorded for [DISPLAY NAMES OF FAMILY SUBUNIT MEMBERS WITH NO
HEALTH CARE 1-N]. Please take a look at this card (RECORDS JOB AID-EVENT SIDE), and make sure that I didn?t miss anything.
Did [DISPLAY NAME 1] receive any care like that listed on the card, or any other kind of care?

Responses:
YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Preloaded grid type 1: forced navigation including PP160_01, PP160_02, PP160_03, PP160_ 04?,PP160_N on the same form pane.
If anyone coded ?1? (YES), go to BOX_180, otherwise go to BOX_190.
Display Instructions:
Roster 1- Report
Roster Definition: Col #1: RU Member?s name Display First, Middle, and Last name of RU members.
Roster Filter: Display names of RU members within the family subunit that have not reported any heath care events during the current round. Variable question text display for each person in the roster display the following: PP160_02, 2nd person on the roster: What about [DISPLAY NAME 2]? PP160_03, 3rd person on the roster: What about [DISPLAY NAME 3]? PP160_04, 4th person on the roster: What about [DISPLAY NAME 4]? Did [you/he/she] receive any health care like those listed on the card, or any other kind of care? PP160_ N: repeat question text from PP160_01-160_04
For [DISPLAY NAMES OF FAMILY SUBUNIT MEMBERS WITH NO HEALTHCARE 1-N], display all
RU members in the family subunit that have not reported any healthcare during this interview
Display the first paragraph ?I see that we don't have any health...and make sure that I didn't miss anything? in brackets and grayed out text when displaying the variable text PP160_02-PP160N.

BOX_180 (PP1170)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with BOX_190.

BOX_190 (PP1175)

Route Details:

Check for any RU members that fit the criteria for Non-family subunit members as defined in BOX_10. If there are any RU members that fit these criteria, go to PP170, otherwise go to BOX_370.

PP170 (PP1180)

BLAISE NAME: RosterHosp
Question Text:
And PP-1
Just to be sure I haven?t missed any health care for anyone else, now I?m going to ask those same questions again, but this time please think about [DISPLAY NAMES OF NONFAMILY SUBUNIT MEMBERS] when answering. [This is also where I can record information for [DISPLAY NAME 1] [DISPLAY NAME 2] [DISPLAY NAME 3] [DISPLAY NAME N], who you had mentioned earlier had health care that we haven?t talked about yet.]
Let?s start with hospitals. Looking at card PP-1, [since [START DATE]/between [START DATE] and [END DATE]], [was/were] [DISPLAY NON-FAMILY SUBUNIT NAMES] admitted to the hospital for any period of time?
ENTER ALL THAT APPLY.

BOX_200 (PP1185)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP180.

PP180 (PP1190)

BLAISE NAME: RosterER
Question Text:
And PP-2
Now think about hospital emergency rooms. Looking at card PP-2[since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] received any type of care in a hospital emergency room?
ENTER ALL THAT APPLY.

BOX_210 (PP1195)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP190.

PP190 (PP1200)

BLAISE NAME: RosterOP
Question Text:
And PP-3
Looking at card PP-3, [since [START DATE]/between [START DATE] and [END DATE]] [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] received any type of care in a hospital outpatient department?
ENTER ALL THAT APPLY.

BOX_220 (PP1205)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP200.

PP200 (PP1210)

BLAISE NAME: RosterGP
Question Text:
And PP-4
Now I?d like you to think about different kinds of medical doctors and health care professionals who provided care to [DISPLAY NAMES OF NON-FAMILY SUBUNIT], [[other than the] [hospital] [[and ]emergency room] [[and ] outpatient] [visit/visits] we already talked about].
Looking at card PP-4, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NONFAMILY SUBUNIT NAMES] seen a primary care doctor?
If R ISN?T LOOKING AT CARD: Primary care doctor, such as a general practitioner, internist, pediatrician or family medicine provider.
ENTER ALL THAT APPLY.
HELP: F1

Responses:
[FIRST NAME, [MIDDLE NAME], LAST NAME]1 1
[FIRST NAME, [MIDDLE NAME], LAST NAME]2 2
[FIRST NAME, [MIDDLE NAME], LAST NAME]3 3
[FIRST NAME, [MIDDLE NAME], LAST NAME]4 4
[FIRST NAME, [MIDDLE NAME], LAST NAME]N 5
OTHER RU MEMBER 98
NO ONE 99
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Roster Behavior:
1. Multiple select allowed.
If at least one RU member or code ?98? (OTHER RU MEMBER) is selected, go to BOX_230, otherwise go to PP210.
Hard check: If coded ?99? (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.
Display Instructions:
Roster 2- no add/edit/delete
Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.
Col #1- RU Members Display RU members? First, Middle, Last Names
Display ?since [START DATE]? if not round 5, otherwise display ?between [START DATE] and [END DATE]?.
Display ?have? if more than one person in the non-family subunit, otherwise, display ?has?.
Display first and last names for the first sentence ?DISPLAY NAMES OF NON-FAMILY SUBUNIT.?
Display only first names for the second sentence ?DISPLAY NON-FAMILY SUBUNIT NAMES?
Search the event array for RU members in the non-family subunit. If at least one person in the family subunit reported an HS, ER, and/or OP event, display ?other than at the...we already talked about?. Otherwise, use a null display.
Display ?hospital? if a HS event is on the event array type is coded for at least one person in the non-family subunit. Otherwise, use a null display.
Display ?[and ]emergency room? if an ER event is on the event array coded for at least one person in the non-family subunit. Otherwise, use a null display.
Display the ?and? only if both HS and ER events are on the event array for at least one person in the non-family subunit, but not an OP event. Otherwise, use a null display.
Display ?[and ]outpatient? if an OP event is on the event array for at least one person in the non- family subunit. Otherwise, use a null display.
Display the ?and? only if there is a HS event and/or ER event, along with an OP event for at least one person in the non-family subunit. Otherwise, use a null display.
Display ?visit? if there is only one event for the non-family subunit reported on the event array. Display ?visits? if there are two or more events for the non-family subunit on the event array. Otherwise, use a null display.

BOX_230 (PP1215)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP210.

PP210 (PP1220)

BLAISE NAME: RosterSpeclt
Question Text:
And PP-5
Looking at card PP-5, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] seen any type of specialist?
IF R ISN?T LOOKING AT CARD: Specialists, such as an orthopedist, cardiologist, dermatologist, oncologist, neurologist, gynecologist, allergist, or any other type of specialist.
ENTER ALL THAT APPLY.

BOX_240 (PP1225)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP220.

PP220 (PP1230)

BLAISE NAME: RosterNurse
Question Text:
And PP-6
Looking at card PP-6, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] seen any other type of medical professional?
IF R ISN?T LOOKING AT CARD: Other type of medical professional such as a nurse, nurse practitioner or nurse?s aide, a physician?s assistant or a midwife?
ENTER ALL THAT APPLY.
HELP: F1

BOX_250 (PP1235)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP230.

PP230 (PP1240)

BLAISE NAME: RosterClinic
Question Text:
And PP-7
Looking at card PP-7, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] received care at any type of health clinic?
IF R ISN?T LOOKING AT CARD: A health clinic, such as a walk-in urgent care, a retail clinic at a pharmacy or grocery store, a family planning center, or a clinic at a college or university?
ENTER ALL THAT APPLY.

BOX_260 (PP1245)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP240.

PP240 (PP1250)

BLAISE NAME: RosterLab
Question Text:
And PP-8
Looking at card PP-8, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] been to any medical lab or testing facility for bloodwork, x-rays or other tests?
ENTER ALL THAT APPLY.

BOX_270 (PP1255)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP250.

PP250 (PP1260)

BLAISE NAME: RosterMentalHlth
Question Text:
And PP-9
Looking at card PP-9, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] seen any type of mental health professional?
IF R ISN?T LOOKING AT CARD: Mental health professionals such as a psychiatrist, psychologist, a licensed clinical social worker or any other type of mental health therapist or counselor?
ENTER ALL THAT APPLY.

BOX_280 (PP1265)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP260.

PP260 (PP1270)

BLAISE NAME: RosterTherap
Question Text:
And PP-10
Looking at card PP-10, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] had any visits to any other type of therapist?
IF R ISN?T LOOKING AT CARD: Therapists, such as a physical therapist, occupational therapist, speech therapist or chiropractor?
ENTER ALL THAT APPLY.

BOX_290 (PP1275)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP270.

PP270 (PP1280)

BLAISE NAME: RosterDN
Question Text:
And PP-11
Looking at card PP-11, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] seen any type of dental care provider?
IF R ISN?T LOOKING AT CARD: Dental care providers such as dentists, oral surgeons, orthodontists, or dental assistants?
ENTER ALL THAT APPLY.

BOX_300 (PP1285)

Route Details:

Ask the EE section.
At completion of the EE section, continue with PP280.

PP280 (PP1290)

BLAISE NAME: RosterVision
Question Text:
And PP-12
Looking at card PP-12, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] seen any type of vision or eye care provider?
IF R ISN?T LOOKING AT CARD: Vision or eye care providers such as an optometrist, ophthalmologist or vision technician?
ENTER ALL THAT APPLY.

BOX_310 (PP1295)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP290.

PP290 (PP1300)

BLAISE NAME: RosterAltCare
Question Text:
And PP-13
Looking at card PP-13, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] had any visits to someone who practices alternative care?
IF R ISN?T LOOKING AT CARD: Alternative care such as acupuncture, homeopathic care, massage therapy, hypnosis, or other treatments?
ENTER ALL THAT APPLY.

BOX_320 (PP1305)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP300.

PP300 (PP1310)

BLAISE NAME: RosterHH
Question Text:
And PP-14
Now I would like you to think about care [DISPLAY NON-FAMILY SUBUNIT NAMES] may have received at home.
Please look at card PP-14. Because of a health problem, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] received any type of care at home, such as
? care from a home care nurse or any type of therapist or social worker?
? care from someone who helps with bathing, dressing, or taking medication?
? to help with cooking or cleaning ?
? to provide companionship services?
ENTER ALL THAT APPLY.

BOX_330 (PP1315)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with PP310.

PP310 (PP1320)

BLAISE NAME: RosterIC
Question Text:
And PP-15
Now let?s talk about health care provided in a residential setting. [Earlier we discussed that [DISPLAY NAMES sOF RU MEMBERS FROM RE350 WITH VISIT OF LESS THAN 100 DAYS] [was/were] institutionalized in a facility for less than 100 days. If [he/she/they] received care in a residential health care facility, I can record that care now.]
Looking at card PP-15, [since [START DATE]/between [START DATE] and [END DATE]], [have/has] [DISPLAY NON-FAMILY SUBUNIT NAMES] received care in any type of residential rehabilitation facility or treatment facility?
IF R ISN?T LOOKING AT CARD: Residential rehabilitation or treatment facilities such as for rehab after surgery, or mental health treatment, or treatment for drug, alcohol or other addiction, for hospice or respite care.
ENTER ALL THAT APPLY.

Responses:
[FIRST NAME, [MIDDLE NAME], LAST NAME]1 1
[FIRST NAME, [MIDDLE NAME], LAST NAME]2 2
[FIRST NAME, [MIDDLE NAME], LAST NAME]3 3
[FIRST NAME, [MIDDLE NAME], LAST NAME]4 4
[FIRST NAME, [MIDDLE NAME], LAST NAME]N 5
OTHER RU MEMBER 98
NO ONE 99
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Roster Behavior:
1. Multiple select allowed.
If at least one RU member or code ?98? (OTHER RU MEMBER) is selected, go to BOX_340, otherwise, go to BOX_350.
Hard check: If code?99? (NO ONE), selected with another code, display error message: YOU CANNOT SELECT NO ONE WITH ANOTHER RESPONSE OPTION. REVIEW YOUR ANSWERS AND SELECT THE CORRECT ONE.
Display Instructions:
Roster 2- no add/edit/delete
Roster Definition: Display RU members in the Non-Family Subunit as previously defined in BOX_10.
Col #1- RU Members Display RU members? First, Middle, Last Names
Display ?since [START DATE]? if not round 5, otherwise display ?between [START DATE] and [END DATE]?.
Display ?have? if more than one person in the non-family subunit, otherwise, display ?has?.
Display ?Earlier we discussed that [DISPLAY NAMES FROM RE350 WITH VISIT OF LESS THAN 100 DAYS] [was/were] institutionalized in a facility for less than 100 days. If [he/she/they] received care in a residential health care facility, I can record that care now? if RE350 was coded ?1?(100 DAYS OR LESS) for at least one RU member in this non- family subunit in the current round, otherwise use null display.
For [DISPLAY NAMES FROM RE350 WITH VISIT OF LESS THAN 100 DAYS] display the first and last names of all RU members, separated by a comma, in this subfamily where the person that was coded ?1? (100 DAYS OR LESS) at RE350 in the current round. Before the last person?s name, if displaying more than one person, use the word ?and.?
Display ?was? if only one name is displayed in the fill for ?DISPLAY NAMES FROM RE350??, otherwise, display ?were?.

BOX_340 (PP1325)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with BOX_350.

BOX_350 (PP1330)

Route Details:

Check to see if any RU members in this non-family subunit reported any events during this round. If one or more persons, but not all RU members of this non-family subunit reported 0 events, continue with PP320_01. If only one RU member in the non-family subunit and they reported 0 events, continue with PP320_01.
Otherwise, go to BOX_370.

PP320_01 (PP1335)

BLAISE NAME: AnyCare1
Question Text:
I see that we don?t have any health care recorded for [DISPLAY NAMES OF NON-FAMILY SUBUNIT MEMBERS WITH
NO HEALTHCARE REPORTED 1-N]. Please take a look at this card (RECORDS JOB AID-EVENT SIDE), and make sure that I didn?t miss anything.
Did [PERSON 1] receive any care like that listed on the card, or any other kind of care?

Responses:
YES 1
NO 2 PP325_01 (PP1336)
REFUSED RF PP325_01 (PP1336)
DON'T KNOW DK PP325_01 (PP1336)
Programmer Instructions:
Preloaded grid type 1: forced navigation including PP320_01, PP325_01, PP320_02, PP325_02, PP320_03, PP325_03, PP320_ 04, PP325_04...PP320_N on the same form pane.
PP325_01-PP325_04 should display on a separate column to the right after PP320_01 is asked. Only asking PP325_01... if PP320_01 is coded ?2? (NO), ?RF? (REFUSED, or ?DK? (DON?T KNOW).
At completion of grid, if anyone coded ?1? (YES) to PP320_01, PP320_02, PP320_03, PP320_04?.PP320_N go to BOX_360.
Display Instructions:
Roster 1- Report Roster Definition: Col #1 Header: RU Member?s name Display First, Middle, and Last name of RU members.
Display variable question text display for each question in the grid:
PP320_02: How about [PERSON 2]? PP320_03: How about [PERSON 3]? PP320_04: Did [PERSON 4] receive any care like that listed on the card, or any other kind of care?
PP320_N: Repeat the question text of PP320_02-PP320_04 for RU members beyond.
Display the first paragraph ?I see that we don?t have any health care recorded for?? in brackets and grayed out when on any row other than the first one. (PP320_02-PP320_N).
Roster Filter: Display names of RU members within the non-family subunit that have not reported any events during this interview.
For [DISPLAY NAMES OF NON-FAMILY SUBUNIT MEMBERS WITH NO HEALTHCARE REPORTED 1-N] display the names of the RU members that did not report any health care events during the current interview.

PP325_01 (PP1336)

BLAISE NAME: RespKnowsCare1
Question Text:
In general, would you say that [DISPLAY NAME] lets you know when [he/she] visits any kind of health care provider?

Responses:
YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Display PP325 as an active cell when PP320_01-PP320_N is ?2? (NO), ?RF? (REFUSED), or ?DK? (DON?T KNOW) for the corresponding person in this row.
Go to PP320 for next person in the grid. At the completion of the grid, if at least 1 person coded ?1? (YES) at PP320 go to BOX_360. Otherwise (if no one coded ?1? (YES) at PP320) go to BOX_370.
Display Instructions:

BOX_360 (PP1344)

Route Details:

Ask the EE section.
At the completion of the EE section, continue with BOX_370.

BOX_370 (PP1345)

Route Details:

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

Old Public Related Insurance (PR) Section

BOX_00 (PR1005)

Route Details:

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, BOX_160, BOX_170, BOX_180, BOX_190, BOX_200, BOX_210, BOX_220, BOX_ 230, BOX_240
02 Loop= LOOP_10
03 End Loop= END_LP10
05- Single select with Display Roster= PR10, PR30, PR40, PR50, PR70, PR80, PR90, PR100, PR110, PR130, PR140, PR150_01, PR160_01, PR170, PR180, PR190, PR210, PR240, PR250, PR260_01, PR270_01, PR290_01, PR300_01, PR310_01, PR320_01, PR330, PR340, PR350, PR370, PR400, PR410, PR420
09 -Multi select with Display Roster = PR280_01, PR380
10 Multiple Select with Fill in Answer Text= PR220
17 Dollar Items Allowing Cents= PR60, PR120, PR230, PR390
20 OS Text Field= PR70OS, PR130OS, PR240OS, PR400OS
23 Text Field= PR20, PR200, PR360

BOX_10 (PR1010)

Route Details:

Context header display instructions:
Display Person.FullName, Insurance.HISrcName
General Display Instructions for Question Text:
For '(START DATE)', 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable BegRefDt.
For '(END DATE)', 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). Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variable EndRefDt.
For '(PERSON'S START DATE)', display the person level reference period start date.
Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variables Person.BegRefM, Person.BegRefD, Person.BegRefY.
For '(PERSON'S END DATE)', display the person level reference period end date.
Display as full month, xx, YYYY - e.g., "January 1, 2016". Use variables Person.EndRefM, Person.EndRefD, Person.EndRefY.
Unless there is a more specific fill instruction provided at the item level, for any fill using the variable 'Insurance.Insurer', display the text entry stored or display "Refused Insurer" if Insurance.Insurer=RF or display "Don't Know Insurer" if Insurance.Insurer=DK. Items using Insurance.Insurer include PR170, PR210, PR230, PR240, PR240OS, PR250, PR330, PR370, PR390, PR400, PR400OS, PR410, PR420.

BOX_20 (PR1015)

Route Details:

If at least one person was covered by Medicare during the previous round (Insurance.HISrc=Medicare and Insurance.OrigRnd()Current round), continue with LOOP_10.
Otherwise, go to BOX_30.

LOOP_10 (PR1020)

Route Details:

For each insurance, ask PR10-END_LP10.
Loop definition: LOOP_10 collects information about the coverage provided through Medicare. This loop cycles on insurance that meets both of the following conditions:
Establishment is Medicare (Insurance.HISrc=Medicare) and Person was covered by Medicare at anytime during the previous round (Insurance.OrigRnd()Current round).

PR10 (PR1025)

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

((Are/Is) (you/(PERSON)) currently/As of (PERSON'S END DATE), (were/was) (you/(PERSON))) enrolled in a Medicare Advantage or managed care plan, such as an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) to receive (your/his/her) Medicare-funded health care? When answering, please include only insurance from Medicare, not any privately purchased or job-related insurance.
HELP: F1

Responses:

YES 1 PR20 (PR1030)
NO 2 PR90 (PR1070)
REFUSED RF PR90 (PR1070)
DON'T KNOW DK PR90 (PR1070)

Display Instructions:

Display '(Are/Is) (you/(PERSON)) currently' if not round 5. Display 'As of (PERSON'S END DATE), (were/was) (you/(PERSON))' if round 5.

PR20 (PR1030)

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

What (is/was) the name of (your/(PERSON)'s) Medicare managed care plan (as of (PERSON'S END DATE))?
ENTER PLAN NAME

Responses:

1 PR30 (PR1035)
REFUSED RF PR30 (PR1035)
DON'T KNOW DK PR30 (PR1035)

Programmer Instructions:

Set Insurance.Insurer to PR20.

Display Instructions:

Display 'is' if not round 5. Display 'was' if round 5.
Display 'as of (PERSON'S END DATE)' if round 5. Otherwise, use a null display.

PR30 (PR1035)

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

((Do/Does)/Did) (you/(PERSON)) have prescribed medicine coverage through ((NAME OF PLAN FROM PR20)/(your/his/her) Medicare managed care plan) (as of (PERSON'S END DATE))?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If Round 3, continue with PR40.
Otherwise, go to END_LP10.

Display Instructions:

Display '(Do/Does)' if not round 5. Display 'Did' if round 5.
Display '(NAME OF PLAN FROM PR20)' if a plan name was entered at PR20. Display '(your/his/her) Medicare managed care plan' if PR20 is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).
Display the actual plan name entered at PR20 for 'NAME OF PLAN FROM PR20' if a plan name was entered.
Display 'as of (PERSON'S END DATE)' if round 5. Otherwise, use a null display.

PR40 (PR1040)

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

Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, (do/does)(you/(PERSON)) (or anyone in the family) pay anything else for (the coverage with ((NAME OF PLAN FROM PR20)/ this Medicare managed care plan)?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]
HELP: F1

Responses:

YES 1 PR50 (PR1045)
NO 2 END_LP10 (PR1105)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

Display 'the coverage with (NAME OF PLAN FROM PR20)' if a Medicare plan name entered at PR20. Display 'this Medicare managed care plan' if PR20 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).
Display the actual plan name entered at PR20 for 'NAME OF PLAN FROM PR20' if a plan name was entered.

PR50 (PR1045)

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

How (do/does) (you/(PERSON)) pay for (your/his/her) ((NAME OF PLAN FROM PR20)/Medicare managed care)premium?
IF NECESSARY, SAY : Is the Medicare Advantage premium paid through (your/his/her) Social Security check, paid directly to the provider, or paid both ways?

Responses:

DEDUCTED FROM SOCIAL SECURITY 1 PR60 (PR1050)
PAY DIRECTLY 2 PR60 (PR1050)
BOTH 3 PR60 (PR1050)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

Display '(NAME OF PLAN FROM PR20)' if a Medicare plan name was entered at PR20. Display 'Medicare managed care' if PR20 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).
Display the actual plan name entered at PR20 for 'NAME OF PLAN FROM PR20' if a plan name was entered.

PR60 (PR1050)

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

How much (is (your/(PERSON)'s) Social Security deduction/(do/does) (you/(PERSON)) pay in premiums) for (your/his/her) (NAME OF PLAN FROM PR20) plan?
IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.
ENTER AMOUNT

Responses:

1 PR70 (PR1055)
REFUSED RF PR80 (PR1065)
DON'T KNOW DK PR80 (PR1065)

Programmer Instructions:

Allow for an entry of dollars and cents.

Display Instructions:

Display PR60, PR70 and PR70OS on the same form pane.
Display 'is (your/(PERSON)'s) Social Security deduction' if PR50 is coded '1' (DEDUCTED FROM SOCIAL SECURITY'. Display (do/does) (you/(PERSON)) pay in premiums' if PR50 is coded '2' (PAY DIRECTLY) or '3' (BOTH).
Display '(NAME OF PLAN FROM PR20)' if a Medicare plan name was entered at PR20. Otherwise (i.e., if PR20 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW)), use a null display.
Display the actual plan name entered at PR20 for 'NAME OF PLAN FROM PR20' if a plan name was entered.

PR70 (PR1055)

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

[How much (is (your/(PERSON)'s) Social Security deduction/(do/does) (you/(PERSON)) pay in premiums) for (your/his/her) (NAME OF PLAN FROM PR20) plan?]
Is that per year, per month, per week, or what?
ENTER UNIT OF COVERAGE

Responses:

PER YEAR 1 END_LP10 (PR1105)
EVERY 3 MONTHS (QUARTERLY) 2 END_LP10 (PR1105)
EVERY 2 MONTHS (BIMONTHLY) 3 END_LP10 (PR1105)
PER MONTH 4 END_LP10 (PR1105)
PER WEEK 5 END_LP10 (PR1105)
EVERY 2 WEEKS (BIWEEKLY) 6 END_LP10 (PR1105)
2 TIMES PER YEAR (SEMI-ANNUALLY) 7 END_LP10 (PR1105)
2 TIMES PER MONTH (SEMI-MONTHLY) 8 END_LP10 (PR1105)
OTHER 91 PR70OS (PR1060)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

Display PR60, PR70 and PR70OS on the same form pane.
Display the first paragraph of question text in brackets and grayed out text.
Display 'is (your/(PERSON)'s) Social Security deduction' if PR50 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '(do/does) (you/(PERSON)) pay in premiums' if PR50 is coded '2' (PAY DIRECTLY) or '3' (BOTH).
Display '(NAME OF PLAN FROM PR20)' if a Medicare plan name was entered at PR20. Otherwise (i.e., if PR20 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW)), use a null display.
Display the actual plan name entered at PR20 for 'NAME OF PLAN FROM PR20' if a plan name was entered.

PR70OS (PR1060)

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

[How much (is (your/(PERSON)'s) Social Security deduction/(do/does) (you/(PERSON)) pay in premiums) for (your/his/her) (NAME OF PLAN FROM PR20) plan?]
SPECIFY: OTHER UNIT OF COVERAGE

Responses:

1 END_LP10 (PR1105)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

PR80 (PR1065)

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

(PLAN NAME: (NAME OF PLAN FROM PR20))
and HX-5
Which category on card HX-5 best indicates the cost of this plan per month?

Responses:

$1-$50 1 END_LP10 (PR1105)
$51-$100 2 END_LP10 (PR1105)
$101-$200 3 END_LP10 (PR1105)
$201-$300 4 END_LP10 (PR1105)
$301 OR MORE 5 END_LP10 (PR1105)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

Display 'PLAN NAME: (NAME OF PLAN FROM PR20)' if a Medicare plan name was entered at PR20. Otherwise (i.e., if PR20 was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW)), use a null display.
Display the actual plan name entered at PR20 for 'NAME OF PLAN FROM PR20' if a plan name was entered.

PR90 (PR1070)

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

((Are/Is)/(Were/Was)) (you/(PERSON)) enrolled in Medicare Part D, also known as the Medicare Prescription Drug Plan (as of (PERSON'S END DATE))?
HELP: F1

Responses:

YES 1
NO 2 END_LP10 (PR1105)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Programmer Instructions:

If coded '1' (YES) and Round 3, continue with PR100.
Otherwise (if coded '1' (YES) and rounds 2, 4, or 5), go to END_LP10.

Display Instructions:

Display '(Are/Is)' if not round 5. Display '(Were/Was)' if round 5. Display 'as of (PERSON'S END DATE)' if round 5. Otherwise, use a null display.

PR100 (PR1075)

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

Most Medicare beneficiaries pay their Part B premiums through their Social Security checks. In addition, (do/does)(you/(PERSON)) (or anyone in this household) pay anything else for (your/his/her) Medicare Prescription Drug Plan (also known as Part D)?
[Do not include the cost of any copayments, coinsurance or deductibles anyone in the family may have had to pay.]
HELP: F1

Responses:

YES 1 PR110 (PR1080)
NO 2 END_LP10 (PR1105)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

PR110 (PR1080)

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

How (do/does) (you/(PERSON)) pay for (your/his/her) Part D premium?
IF NECESSARY, SAY: Is the Medicare drug coverage premium paid through (your/his/her) Social Security check, paid directly to the provider, or paid both ways?

Responses:

DEDUCTED FROM SOCIAL SECURITY 1 PR120 (PR1085)
PAY DIRECTLY 2 PR120 (PR1085)
BOTH 3 PR120 (PR1085)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

PR120 (PR1085)

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

How much (is (your/(PERSON)'s) Social Security deduction/(do/does) (you/(PERSON)) pay in premiums) for (your/his/her) Part D plan?
IF RESPONDENT IS NOT SURE, DO NOT PROBE. CODE 'DON'T KNOW'.
ENTER AMOUNT

Responses:

1 PR130 (PR1090)
REFUSED RF PR140 (PR1100)
DON'T KNOW DK PR140 (PR1100)

Programmer Instructions:

Allow for the entry of dollars and cents.

Display Instructions:

Display PR120, PR130, PR130OS on the same form pane.
Display 'is (your/(PERSON)'s) Social Security deduction' if PR110 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '(do/does) (you/(PERSON)) pay in premiums' if PR110 is coded '2' (PAY DIRECTLY) or '3' (BOTH).

PR130 (PR1090)

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

[How much (is (your/(PERSON)'s) Social Security deduction/(do/does) (you/(PERSON)) pay in premiums) for (your/his/her) Part D plan?]
Is that per year, per month, per week, or what?
ENTER UNIT OF COVERAGE

Responses:

PER YEAR 1 END_LP10 (PR1105)
EVERY 3 MONTHS (QUARTERLY) 2 END_LP10 (PR1105)
EVERY 2 MONTHS (BIMONTHLY) 3 END_LP10 (PR1105)
PER MONTH 4 END_LP10 (PR1105)
PER WEEK 5 END_LP10 (PR1105)
EVERY 2 WEEKS (BIWEEKLY) 6 END_LP10 (PR1105)
2 TIMES PER YEAR (SEMI-ANNUALLY) 7 END_LP10 (PR1105)
2 TIMES PER MONTH (SEMI-MONTHLY) 8 END_LP10 (PR1105)
OTHER 91 PR130OS (PR1095)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

Display PR120, PR130, PR130OS on the same form pane.
Display the "How much(is (your/(PERSON)'s) Social Security?" in brackets and grayed out text.
Display 'is (your/(PERSON)'s) Social Security deduction' if PR110 is coded '1' (DEDUCTED FROM SOCIAL SECURITY). Display '(do/does) (you/(PERSON)) pay in premiums' if PR110 is coded '2' (PAY DIRECTLY) or '3' (BOTH).

PR130OS (PR1095)

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

[How much (is (your/(PERSON)'s) Social Security deduction/(do/does) (you/(PERSON)) pay in premiums) for (your/his/her) Part D plan?]
SPECIFY: OTHER UNIT OF COVERAGE

Responses:

1 END_LP10 (PR1105)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

PR140 (PR1100)

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

and HX-6
Which category on card HX-6 best indicates the cost of this plan per month?

Responses:

$1-$30 1 END_LP10 (PR1105)
$31-$60 2 END_LP10 (PR1105)
$61-$90 3 END_LP10 (PR1105)
$91-$120 4 END_LP10 (PR1105)
$121 OR MORE 5 END_LP10 (PR1105)
REFUSED RF END_LP10 (PR1105)
DON'T KNOW DK END_LP10 (PR1105)

Display Instructions:

END_LP10 (PR1105)

Route Details:

Cycle on next insurance that meets the conditions stated in the loop definition.
If no other insurance meets the stated conditions, end LOOP_10 and continue with BOX_30.

BOX_30 (PR1110)

Route Details:

If any RU member had Medicaid/SCHIP as a source of insurance at any time during the previous round (at least one RU member where Preload.Insurance.HISrc=Medicaid, Preload.Insurance.Plcyhldr=PersID where Person.MostRecentRU=RUUnit and Preload.CovdPers.LRndCovd =(previous round number) and Preload.Insurance.OrigRnd()current round), continue with PR150_01.
Otherwise, go to BOX_90.

PR150_01 (PR1115)

BLAISE NAME: ConfCaid
Question Text:

During the last interview, we recorded that (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N)
(was/were) covered by (Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME).
(Have you/Has (PERSON 1)) been covered by (Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME) at any time (since (START DATE)/between (START DATE) and (END DATE))?
HELP: F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: forced navigation including PR150_01, PR150_02, PR150_03, PR150_04, PR150_N.
After grid completion, continue with BOX_40.

Display Instructions:

Roster 1-Report no add/edit/delete allowed.
Format the following columns on the form pane.
Col#1: RU Member
Instructions: Display RU members' First Middle and Last name (Person.FullName)
Roster Filter:
Display only those RU members who were "COVERED BY MEDICAID/SCHIP" at any time during the previous round (RU members where Preload.Insurance.HISrc=Medicaid, Preload.Insurance.Plcyhldr=PersID where Person.MostRecentRU=RUUnit and Preload.CovdPers.LRndCovd =(previous round number).
For the display of person names in the first paragraph: (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N), display the list of RU members who were "COVERED BY MEDICAID/SCHIP" at any time during the previous round. Display first names only. Substitute "you" for the person's first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed,separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display 'was' if only one name is listed and that person is not the current respondent. Otherwise, display 'were'.
Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the state name for the program) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific Medicaid program name by state to display, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions, substituting the real state name for program.
For the specific name to use by state, see the plan fill file.
Display 'since (START DATE)' if not round 5. Display 'between (START DATE) and (END DATE)' if round 5.
Display variable question text. Replace "(Have you/Has (PERSON 1)) been covered ? and (END DATE))?" with:
PR150_02: What about (PERSON 2)?
PR150_03: What about (PERSON 3)?
PR150_04: What about (PERSON N)? Has (he/she) been covered by (Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME) at any time (since (START DATE)/between (START DATE) and (END DATE))?
PR150_N: Repeat question text PR150_02-PR150_N for as many RU members that fit the roster filter criteria.
Display first names only in the variable question text display. Substitute "you" for the person's first name if the respondent is included in this list.
Display first paragraph of question text in brackets and grayed out text when on PR150_02 - PR150_N. Display in bold black and no brackets when on PR150_01. Display in bold black and no brackets when on PR150_01.

BOX_40 (PR1120)

Route Details:

If all current RU members are displayed at PR150_01-PR150_N, go to BOX_50.
Otherwise, continue with PR160_01.

PR160_01 (PR1125)

BLAISE NAME: OthMmbCaid
Question Text:

Besides the people we've just talked about, please think about whether any additional household members have been covered by (Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME) at any time (since (START DATE)/between (START DATE) and (END DATE)).
(Have you/Has (PERSON 1) been covered by (Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME) at any time (since (START DATE)/between (START DATE) and (END DATE))?
HELP: F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded Grid type 1: Forced navigation including PR160_01, PR160_02, PR160_03, PR160_04, PR160_N.
After grid completion, continue with BOX_50.
For each person coded '1' (YES), create insurance through Medicaid/SCHIP for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Medicaid and Insurance.HISrcName=(Medicaid/(STATE NAME FOR MEDICAID))/(STATE CHIP NAME) and Insurance.Plcyhldr= PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions:

BOX_50 (PR1130)

Route Details:

If at least one RU member is "COVERED BY MEDICAID/SCHIP" during the current round, that is, at least one RU member was coded as '1' (YES) at PR150_ 01-PR150_N or PR160_01-PR160_N, continue with BOX_60.
Otherwise, go to BOX_90.

BOX_60 (PR1135)

Route Details:

Ask the time period covered detail (HQ) section for this insurance.
This instance of the HQ section collects time period coverage detail for all RU members that are covered by Medicaid/SCHIP in the current round. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
-Insurance source is Medicaid/SCHIP [Insurance.HISrc=Medicaid] And
-Person is "COVERED BY MEDICAID/SCHIP" during the current round, that is, either PR150_01-PR150_N or PR160_01-PR160_N is coded '1' (YES) for this person.
At completion of HQ section, continue with PR170.

PR170 (PR1140)

BLAISE NAME: CaidNameChng
Question Text:

(Last time we recorded that (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) may be covered by (PRELOAD MEDICAID/SCHIP INSURER).)
(Since (START DATE)/Between (START DATE) and (END DATE)), has there been any change in the plan name of the health insurance (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) (has/have) through (Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME)?

Responses:

YES 1 PR180 (PR1145)
NO 2 BOX_70 (PR1160)
REFUSED RF BOX_70 (PR1160)
DON'T KNOW DK BOX_70 (PR1160)

Programmer Instructions:

If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set previous round's insurer as 'CURRENT RD'S MEDICAID/SCHIP INSURER'. [Set Preload.Insurance.Insurer to Insurance.Insurer]

Display Instructions:

Roster 1-Report
Roster definition:
This item uses the insurance array to display RU-members. (Person.FullName)
Roster filter:
Display only those RU members who are "COVERED BY MEDICAID/SCHIP" during the current round, that is, either PR150_01- PR150_N or PR160_01-PR160_N is coded '1' (YES) for this person.
Display first names only in the first sentence "Last time we recorded?."
Substitute "you" for the person's first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display RU members' first, middle, and last names (Person.FullName) in the second sentence "(Since (START DATE)/Between (START DATE) and (END DATE))?." Substitute "you" for the person's name if the respondent is included in this list. See instructions above about when to use commas vs. "and" to separate names.
Display 'Last time... (PRELOAD MEDICAID/SCHIP INSURER ).' If there was an insurer associated with Medicaid/SCHIP in the previous round (Preload.Insurance.Insurer () RF, DK or EMPTY).
Otherwise, use a null display.
For 'PRELOAD MEDICAID/SCHIP INSURER', display the insurer recorded for Medicaid/SCHIP during the previous round (Preload.Insurance.Insurer).
Display 'Since (START DATE)' if not round 5.
Display 'Between (START DATE)' and (END DATE)' if round 5.
Display 'has' if only one name is listed and that person is not the current respondent. Otherwise, display 'have'.
Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR
THE PROGRAM) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific Medicaid program name to display by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions, substituting the real state name for program.
For the specific name to display by state, see the plan fill file.

PR180 (PR1145)

BLAISE NAME: CaidHMO
Question Text:

Under (Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME) ((are/is)/(were/was)) (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) enrolled in an HMO, that is a Health Maintenance
Organization ((between (START DATE) and (END DATE))?
[With an HMO, you must generally receive care from HMO physicians. If another doctor is seen, the expense is not covered unless you were referred by the HMO, or there was a medical emergency.]
HELP: F1

Responses:

YES, ALL ARE 1 PR200 (PR1155)
YES, SOME ARE 2 PR200 (PR1155)
NO, NONE ARE 3 PR190 (PR1150)
REFUSED RF PR190 (PR1150)
DON'T KNOW DK PR190 (PR1150)

Display Instructions:

Roster 1 - Report Roster Definition:
Use PR170 definition.
Roster filter:
Use PR170 filter.
Display RU members' first, middle, and last names (Person.FullName) in the question text. Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed,separate names with the word "and" and no comma. If more than two names listed, separate name susing commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display '(are/is)' if not round 5. Display '(were/was)' if round 5.
Display 'is' or 'was' if the list includes 1 person who is not the respondent. Otherwise, display 'are' or 'were'.
Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (substituting the state name for the program) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific Medicaid program name by state to display, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions, substituting the real state name for program.
For the specific name to use by state, see the plan fill file.
Display 'between (START DATE) and (END DATE)' if round 5. Otherwise, use a null display.

PR190 (PR1150)

BLAISE NAME: CaidPrimaryMD
Question Text:

(Does /Between (START DATE) and (END DATE), did) (Medicaid/(STATE NAME FOR MEDICAID)) or (STATE
CHIP NAME) require (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) to sign up with a certain primary care doctor, group of doctors, or with a certain clinic which they must go to for all of their routine care?
PROBE: Do not include emergency care or care from a specialist they were referred to.
HELP: F1

Responses:

YES, ALL REQUIRED 1 PR200 (PR1155)
YES, SOME REQUIRED 2 PR200 (PR1155)
NO, NONE REQUIRED 3 BOX_70 (PR1160)
REFUSED RF BOX_70 (PR1160)
DON'T KNOW DK BOX_70 (PR1160)

Programmer Instructions:

Note: If coded '3' (NO, NONE REQUIRED), 'RF' (REFUSED), or 'DK' (DON'T KNOW),there is no insurer associated with the current round for Medicaid/SCHIP.

Display Instructions:

PR200 (PR1155)

BLAISE NAME: CaidPlanName
Question Text:

What is the name of the (Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME) (HMO/health insurance)?
ENTER PLAN NAME

Responses:

1 BOX_70 (PR1160)
REFUSED RF BOX_70 (PR1160)
DON'T KNOW DK BOX_70 (PR1160)

Programmer Instructions:

Set Insurance.Insurer= PR200

Display Instructions:

Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific Medicaid program name to display by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions, substituting the real state name for program.
For the specific name to display by state, see the plan fill file.
Display 'HMO' if PR180 is coded '1' (YES, ALL ARE) or '2' (YES, SOME ARE). Display 'health insurance' if PR190 is coded '1' (YES, ALL REQUIRED) or '2' (YES, SOME REQUIRED).

BOX_70 (PR1160)

Route Details:

If round 2, round 3, or round 4 continue with PR210.
Otherwise, (i.e. round 5), go to BOX_90.

PR210 (PR1165)

BLAISE NAME: CaidPayPrem
Question Text:

Is there a monthly premium for (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) for the coverage through ((CURRENT ROUND'S MEDICAID/SCHIP INSURER) /(Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME))?
[Do not include the cost of any copayments, coinsurance, or deductibles anyone in the family may have had to pay.]
READ IF NECESSARY: A monthly premium is a fixed amount of money people pay each month to have health coverage. It does not include copays or other expenses such as prescription costs.
HELP:F1

Responses:

YES, EVERYONE COVERED PAYS 1 BOX_80 (PR1175)
YES, SOME COVERED PAY 2 PR220 (PR1170)
NO, NO ONE COVERED PAYS 3 BOX_90 (PR1200)
REFUSED RF BOX_90 (PR1200)
DON'T KNOW DK BOX_90 (PR1200)

Programmer Instructions:

Placeholder for MHOP specifications. This will be deleted once those specifications are available.
If coded '1' (YES, EVERYONE COVERED PAYS) at PR210 (HOME.PRMEDPRE), code PRND.MEDMNTHP for each person in the roster at PR220 as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND.)
If coded '3' (NO, NO ONE COVERED PAYS) at PR210 (HOME.PRMEDPRE), code PRND.MEDMNTHP for each person in the roster at PR220 as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND.)
If coded RF or DK OR -9 (WHETHER EVERYONE IS COVERED IS MISSING) at PR210 (HOME.PRMEDPRE), code PRND.MEDMNTHP equal to the missing value HOME.PRMEDPRE for each person in the PR220 roster.
Leave PRND.MEDGOVP blank (NO VALUE) for any RU member not on the roster at PR220.

Display Instructions:

Roster 1- Report
Roster definition:
Use PR170 definition.
Roster filter:
Use PR170 filter.
Display RU members' first, middle, and last names (Person.FullName) in question text. Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed,separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display '(CURRENT ROUND'S MEDICAID/SCHIP INSURER)' if there is a current round insurer associated with the Medicaid/SCHIP insurance that is not 'RF' or 'DK' or EMPTY. (Check Insurance.Insurer - if PR170=2, RF, DK and there was a preloaded insurer, the preloaded insurer was set to the current insurer. Or if PR200 was answered, the current insurer was set there). Otherwise, display '(Medicaid/(STATE NAME FOR MEDICAID)) or (STATE CHIP NAME)'.
For '(CURRENT ROUND'S MEDICAID/SCHIP INSURER)', display the actual plan name for the current round Medicaid/SCHIP insurer (Insurance.Insurer). This may be a preloaded value set to the current value or the value entered at PR200.
Display 'Medicaid' if state in which interview is being conducted uses the name 'Medicaid'. Display 'STATE NAME FOR MEDICAID' (SUBSTITUTING THE STATE NAME FOR THE PROGRAM) if the state in which interview is being conducted does not use the name 'Medicaid'. For the specific Medicaid program name to display by state, see the plan fill file.
Display 'or STATE CHIP NAME' under all conditions, substituting the real state name for program.
For the specific name to display by state, see the plan fill file.

PR220 (PR1170)

BLAISE NAME: CaidPayPremRoster
Question Text:

Who has a monthly premium for that coverage?
PROBE: Anyone else?
ENTER ALL THAT APPLY.
HELP: F1

Responses:

(FIRST NAME [MIDDLE NAME] LAST NAME)1 1 BOX_80 (PR1175)
(FIRST NAME [MIDDLE NAME] LAST NAME)2 2 BOX_80 (PR1175)
(FIRST NAME [MIDDLE NAME] LAST NAME)3 3 BOX_80 (PR1175)
(FIRST NAME [MIDDLE NAME] LAST NAME)4 4 BOX_80 (PR1175)
(FIRST NAME [MIDDLE NAME] LAST NAME)N 5 BOX_80 (PR1175)

Programmer Instructions:

Roster Behavior:
1. Multiple select allowed.
Placeholder for MHOP specifications. This will be deleted once those specifications are available.
Code PRND.MEDMNTHP as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND) for all persons from the PR220 roster who are selected.
Code PRND.MEDMNTHP as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND) for all persons on the PR220 roster who are not selected.
Leave PRND.MEDGOVP blank (NO VALUE) for any RU member not on the roster at PR220.

Display Instructions:

Roster 2 - no add/edit/delete
Roster definition:
Use PR170 definition.
Roster filter:
Use PR170 filter.

BOX_80 (PR1175)

Route Details:

If round 3, continue with PR230.
Otherwise, go to PR250.

PR230 (PR1180)

BLAISE NAME: CaidCovgAmt
Question Text:

How much is the premium for (the (CURRENT ROUND'S MEDICAID/SCHIP INSURER)/that) coverage?
IF MORE THAN ONE PERSON PAYS A PREMIUM FOR THIS COVERAGE, SAY: Please give me the total amount for premiums paid by all individuals with this coverage.
USE CTRL+Z TO ACCESS CALCULATOR TO ADD ALL PREMIUMS.
ENTER AMOUNT

Responses:

1 PR240 (PR1185)
REFUSED RF PR250 (PR1195)
DON'T KNOW DK PR250 (PR1195)

Programmer Instructions:

Allow for the entry of dollars and cents.

Display Instructions:

Display PR230, PR240, and PR240OS on the same form pane.
Display 'the (CURRENT ROUND'S MEDICAID/SCHIP INSURER)' if there is a current round insurer associated with the Medicaid/SCHIP insurance that is not 'RF' or 'DK' or EMPTY. (Check Insurance.Insurer - if PR170=2, RF, DK and there was a preloaded insurer, the preloaded insurer was set to the current insurer. Or if PR200 was answered, the current insurer was set there). Otherwise, display 'that'.
For '(CURRENT ROUND'S MEDICAID/SCHIP INSURER)', display the actual plan name for the current round Medicaid/SCHIP insurer (Insurance.Insurer). This may be a preloaded set to the current value or the value entered at PR200.

PR240 (PR1185)

BLAISE NAME: CaidCovgUnit
Question Text:

[How much is the premium for (the (CURRENT ROUND'S MEDICAID/SCHIP INSURER)/that) coverage?
IF MORE THAN ONE PERSON PAYS A PREMIUM FOR THIS COVERAGE, SAY: Please give me the total amount for premiums paid by all individuals with this coverage.
USE CTRL+Z TO ACCESS CALCULATOR TO ADD ALL PREMIUMS.]
Is that per year, per month, per week, or what?
ENTER UNIT OF COVERAGE

Responses:

PER YEAR 1 PR250 (PR1195)
EVERY 3 MONTHS (QUARTERLY) 2 PR250 (PR1195)
EVERY 2 MONTHS (BIMONTHLY) 3 PR250 (PR1195)
PER MONTH 4 PR250 (PR1195)
PER WEEK 5 PR250 (PR1195)
EVERY 2 WEEKS (BIWEEKLY) 6 PR250 (PR1195)
2 TIMES PER YEAR (SEMI-ANNUALLY) 7 PR250 (PR1195)
2 TIMES PER MONTH (SEMI-MONTHLY) 8 PR250 (PR1195)
OTHER 91 PR240OS (PR1190)
REFUSED RF PR250 (PR1195)
DON'T KNOW DK PR250 (PR1195)

Display Instructions:

Display PR230, PR240, and PR240OS on the same form pane.
Display "How much ? ADD ALL PREMIUMS." in brackets and grayed out text.
Display 'the (CURRENT ROUND'S MEDICAID/SCHIP INSURER)' if there is a current round insurer associated with the Medicaid/SCHIP insurance that is not 'RF' or 'DK' or EMPTY. (Check Insurance.Insurer - if PR170=2, RF, DK and there was a preloaded insurer, the preloaded insurer was set to the current insurer. Or if PR200 was answered, the current insurer was set there). Otherwise, display 'that'.
For '(CURRENT ROUND'S MEDICAID/SCHIP INSURER)', display the actual plan name for the current round Medicaid/SCHIP insurer (Insurance.Insurer). This may be a preloaded set to the current value or the value entered at PR200.

PR240OS (PR1190)

BLAISE NAME: CaidCovgUnitOS
Type Class: String Field Size: 30
Question Text:

Responses:

1 PR250 (PR1195)
REFUSED RF PR250 (PR1195)
DON'T KNOW DK PR250 (PR1195)

Display Instructions:

PR250 (PR1195)

BLAISE NAME: CaidPremSubsdz
Question Text:

(PLAN NAME: (CURRENT ROUND'S MEDICAID/SCHIP INSURER))
Is the cost of the premium subsidized based on family income?

Responses:

YES 1 BOX_90 (PR1200)
NO 2 BOX_90 (PR1200)
REFUSED RF BOX_90 (PR1200)
DON'T KNOW DK BOX_90 (PR1200)

Display Instructions:

Display 'PLAN NAME: (CURRENT ROUND'S MEDICAID/SCHIP INSURER)' if there is a current round insurer associated with the Medicaid/SCHIP insurance that is not 'RF' or 'DK' or EMPTY. (Check Insurance.Insurer - if PR170=2, RF, DK and there was a preloaded insurer, the preloaded insurer was set to the current insurer. Or if PR200 was answered, the current insurer was set there).
Otherwise, use a null display.
For '(CURRENT ROUND'S MEDICAID/SCHIP INSURER)', display the actual plan name for the current round Medicaid/SCHIP insurer (Insurance.Insurer). This may be a preloaded set to the current value or the value entered at PR200.

BOX_90 (PR1200)

Route Details:

If any RU member had MILITARY HEALTH as a source of insurance at any time during previous round (at least one RU member where Preload.Insurance.HISrc=Military, Preload.Insurance.Plcyhldr=PersID where Person.MostRecentRU=RUUnit and Preload.CovdPers.LRndCovd =(previous round number) and Preload.Insurance.OrigRnd()current round), continue with PR260_01.
Otherwise, go to BOX_130.

PR260_01 (PR1205)

BLAISE NAME: ConfMilitHI
Question Text:

During the last interview, we recorded that (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) (was/were) covered by military health care, such as TRICARE, CHAMPVA, or VA coverage.
(Have you/Has (PERSON 1) been covered by military health care, such as TRICARE, CHAMPVA or VA coverage at any time (since (START DATE)/between (START DATE) and (END DATE))?
HELP:F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: forced navigation including PR260_01, PR260_02, PR260_03, PR260_04, PR260_N.
After grid completion, continue with BOX_100.

Display Instructions:

BOX_100 (PR1210)

Route Details:

If all current RU members are displayed at PR260_01-PR260_N, go to BOX_110.
Otherwise, continue with PR270_01.

PR270_01 (PR1215)

BLAISE NAME: OthMmbMilitHI
Question Text:

Besides the people we've just talked about, please think about whether any additional household members have been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage at any time (since (START DATE)/between (START DATE) and (END DATE))?
Previously, we've recorded that (MILITARY PERSON 1, MILITARY PERSON 2, MILITARY PERSON N) (is/are) (full-time active duty in the Armed Forces) (or) (honorably discharged from active duty).)
(Have you/Has (PERSON 1)) been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage at any time (since (START DATE)/between (START DATE) and (END DATE))?
HELP:F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: Forced navigation including PR270_01, PR270_02, PR270_03, PR270_04, PR270_N.
After grid completion, continue with BOX_110.
For each person coded '1' (YES), create insurance through Military health care for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=Military and Insurance.HISrcName=Military Health and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions:

Roster 1-Report no add/edit/delete allowed.
Format the following columns on the form pane.
Col#1: RU Member
Instructions: Display RU members' First Middle and Last name (Person.FullName)
Roster Filter:
Display only those RU members who were not covered by MILITARY HEALTH at any time during the previous round (including newly added RU members), that is any RU member not displayed at PR260_01.
Display 'since (START DATE)' if not round 5. Display 'between (START DATE) and (END DATE)' if round 5.
Display variable question text. Replace "(Have you/Has (PERSON 1)) been covered ? and (END DATE))?" with:
PR270_02: What about (PERSON 2)?
PR270_03: What about (PERSON 3)?
PR270_04: What about (PERSON N)? Has (he/she) been covered by military health care, such as TRICARE, CHAMPVA, or VA coverage at any time (since (START DATE)/between (START DATE) and (END DATE))?
PR270_N: Repeat question text PR270_02-PR270_N for as many RU members that fit the roster filter criteria.
Display first names only in the variable question text display. Substitute "you" for the person's first name if the respondent is included in this list.
Display first two paragraphs of question text in brackets and grayed out text when on PR270_ 02 - PR270_N. Display in bold black and no brackets when on PR270_01.
The second paragraph makes use of a separate list of names.
Display 'Previously, we've recorded that (MILITARY PERSON 1, MILITARY PERSON 2, MILITARY PERSON N) (is/are) (full-time active duty in the Armed Forces) (or) (honorably discharged from active duty).' if at least one current RU member eligible to be displayed at PR270_01 grid is currently FT active duty (Person.FTADuty=Yes) or honorably discharged from the Armed Forces in any round [Person.HonDisch=Yes (preloaded value or current round value)].
Otherwise, use a null display.
Display 'full-time active duty in the Armed Forces' if at least one current RU member eligible to be displayed at PR270_01 grid is currently FT active duty. Otherwise, use a null display.
Display 'honorably discharged from active duty' if at least one RU member eligible to be displayed at PR270_01 grid has been honorably discharged in any round. Otherwise, use a null display.
Display 'or' if there is at least one current RU member who is FT active duty and one current RU member who is honorably discharged in any round. Otherwise, use a null display.
For '(MILITARY PERSON 1, MILITARY PERSON 2, MILITARY PERSON N)', Display the first names of all RU members who are either currently FT active duty or honorably discharged from the Armed Forces in any round. Separate the names using a comma and substitute 'you' if the respondent's name is part of the list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display 'is' if only one person listed and that person is not selected as respondent. Otherwise, display 'are'.

BOX_110 (PR1220)

Route Details:

If at least one RU member "COVERED BY MILITARY HEALTH" during the current round,that is, at least one RU member was coded as '1' (YES) at PR260_ 01-PR260_N or PR270_01-PR270_N, continue with PR280_01.
Otherwise, go to BOX_130.

Programmer Instructions:

PR280_01 (PR1225)

BLAISE NAME: CodeAllMilitPlanPR
Question Text:

What types of military health coverage (do/does) (you/PERSON 1)) have? (Do you/Does (he/she)) have TRICARE Standard, TRICARE Prime, TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?
ENTER ALL THAT APPLY.
HELP:F1

Responses:

TRICARE STANDARD 1
TRICARE PRIME 2
TRICARE EXTRA 3
TRICARE FOR LIFE 4
CHAMPVA 5
VA (VETERAN'S ADMINISTRATION) 6

Programmer Instructions:

Preloaded grid type 1: Forced navigation including PR280_01, PR280_02, PR280_03, PR280_04, PR280_N
After grid completion, continue with BOX_120.

Display Instructions:

Roster 1-Report no add/edit/delete allowed. Format the following columns on the form pane.
Col#1: RU Member
Instructions: Display RU members' First Middle and Last name (Person.FullName)
Roster Filter:
Display only those RU members "COVERED BY MILITARY HEALTH" during the current round,that is, PR260_01 - PR260_N or PR270_01 - PR270_N is coded '1' (YES) for this person.
Display variable question text. Replace "What types ... Administration)?" with:
PR280_02: What about (PERSON 2)?
PR280_03: What about (PERSON 3)?
PR280_04: What about (PERSON N)? Does (he/she) have TRICARE Standard, TRICARE Prime, TRICARE Extra, TRICARE for Life, CHAMPVA, or VA (Veteran's Administration)?
PR280_N: Repeat question text PR280_02-PR280_N for as many RU members that fit the roster filter criteria.
Display first names only in the variable question text display. Substitute "you" for the person's first name if the respondent is included in this list.

BOX_120 (PR1230)

Route Details:

Ask the time period covered detail (HQ) section for this insurance.
This instance of the HQ section collects time period coverage detail for all RU members that are covered by MILITARY HEALTH in the current round. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
-Insurance source is Military Health [Insurance.HISrc=Military]
And
-Person is "COVERED BY MILITARY HEALTH" during the current round, that is, either PR260_01-PR260_N or PR270_01-PR270_N is coded '1' (YES) for this person.
At completion of HQ section, continue with BOX_130.

BOX_130 (PR1235)

Route Details:

If any RU member had INDIAN HEALTH SERVICE as a source of insurance at any time during the previous round (at least one RU member where Preload.Insurance.HISrc=IHS, Preload.Insurance.Plcyhldr=PersID where Person.MostRecentRU=RUUnit and Preload.CovdPers.LRndCovd =(previous round number) and Preload.Insurance.OrigRnd()current round), continue with PR290_01.
Otherwise, go to BOX_170.

PR290_01 (PR1240)

BLAISE NAME: ConfIHSPlan
Question Text:

During the last interview, we recorded that (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) (was/were) enrolled in the Indian Health Service (IHS). The Indian Health Service provides health care only to eligible Alaska Natives and American Indians at its Federal hospitals and clinics.
(Were you/Was(PERSON 1)) enrolled in the Indian Health Service (IHS) at any time (since (START DATE)/between (START DATE) and (END DATE))?

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: Forced navigation including PR290_01, PR290_02, PR290_03, PR290_04, PR290_N.
After grid completion, continue with BOX_140.

Display Instructions:

BOX_140 (PR1245)

Route Details:

If all current RU members are displayed at PR290_01-PR290_N, go to BOX_150.
Otherwise, continue with PR300_01.

PR300_01 (PR1250)

BLAISE NAME: OthMmbIHSPlan
Question Text:

Besides the people we've just talked about, please think about whether any additional household members have been enrolled in Indian Health Services (IHS) at any time (since (START DATE)/between (START DATE) and (END DATE))?
(Were you/Was (PERSON 1)) enrolled in Indian Health Services (IHS) at any time (since (START DATE)/between (START DATE) and (END DATE))?
IF NECESSARY, SAY: The Indian Health Service (IHS) is the health care system for federally recognized American Indian and Alaska Natives. The IHS is not a health insurance provider but rather, it provides healthcare only to eligible Alaska Natives and American Indians at its federal hospitals and clinics.

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: Forced navigation including PR300_01, PR300_02, PR300_03, PR300_04, PR300_N.
After grid completion, continue with BOX_150.
For each person coded '1' (YES), create insurance through Indian Health Service for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=IHS and Insurance.HISrcName=Indian Health Service and Insurance.Plcyhldr = PersID and

Display Instructions:

BOX_150 (PR1255)

Route Details:

If at least one RU member "COVERED BY INDIAN HEALTH SERVICE" during the current round, that is, at least one RU member was coded as '1' (YES) PR290_ 01- PR290_N or PR300_01-PR300_N, continue with BOX_160.
Otherwise, go to BOX_170.

BOX_160 (PR1260)

Route Details:

Ask the time period covered detail (HQ) section for this insurance.
This instance of the HQ section collects time period coverage detail for all RU members that are covered by Indian Health Services in the current round. The grid for the HQ section should be preloaded with insurance that meet both of the following conditions:
-Insurance source is Indian Health Service [Insurance.HISrc=IHS]
And
-Person is "COVERED BY INDIAN HEALTH SERVICE" during the current round, that is, either PR290_01-PR290_N or PR300_01-PR300_N is coded '1' (YES) for this person.
At completion of HQ section, continue with BOX_170.

BOX_170 (PR1265)

Route Details:

If any RU member had GOV'T-HOSPITAL/PHYSICIAN as a source of insurance at any time during the previous round (at least one RU member where Preload.Insurance.HISrc=GHP, Preload.Insurance.Plcyhldr=PersID where Person.MostRecentRU=RUUnit and Preload.CovdPers.LRndCovd=(previous round number) and Preload.Insurance.OrigRnd()current round), continue with PR310_01.
Otherwise, go to BOX_240.

PR310_01 (PR1270)

BLAISE NAME: ConfGovProg
Question Text:

During the last interview, we recorded that (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) (was/were) covered by (PRELOAD GOVT-HOSP/PHY NAME), a program sponsored by a state or local government agency which provided hospital and physician benefits.
(Have you/Has (PERSON 1)) been covered by this program or some other program sponsored by a state or local government agency which provided hospital and physician benefits at any time (since (START DATE)/between (START DATE) and (END DATE))?
HELP: F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: Forced navigation including PR310_01, PR310_02, PR310_03, PR310_04, PR310_N.
After grid completion, continue with BOX_180.

Display Instructions:

Roster 1-Report no add/edit/delete allowed.
Format the following columns on the form pane.
Col#1: RU Member
Instructions: Display RU members' First Middle and Last name (Person.FullName)
Roster Filter:
Display only those RU members who were "COVERED BY GOV'T- HOSPITAL/PHYSICIAN" at any time during the previous round (RU members where Preload.Insurance.HISrc=GHP, Preload.Insurance.Plcyhldr=PersID where Person.MostRecentRU=RUUnit and Preload.CovdPers.LRndCovd =(previous round number).
For the display of person names in the first paragraph: (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N), display the list of RU members who were "COVERED BY GOV'T- HOSPITAL/PHYSICIAN" at any time during the previous round. Display first names only.
Substitute "you" for the person's first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
For 'PRELOAD GOVT-HOSP/PHY NAME' display the name of the government program entered at HX160 or HX270 when the coverage was first created for this RU. (Preload.Insurance.GHPProgNameRndCreated)
Display 'was' if only one name is listed and that person is not the current respondent. Otherwise, display 'were'.
Display 'since (START DATE)' if not round 5. Display 'between (START DATE) and (END DATE)' if round 5.
Display variable question text. Replace "(Have you/Has (PERSON 1)) been covered ? and (END DATE))?" with:
PR310_02: What about (PERSON 2)? PR310_03: What about (PERSON 3)?
PR310_04: What about (PERSON N)? Has (he/she) been covered by a program sponsored by a state or local government agency which provided hospital and physician benefits at any time (since (START DATE)/between (START DATE) and (END DATE))?
PR310_N: Repeat question text PR310_02-PR310_N for as many RU members that fit the roster filter criteria.
Display first names only in the variable question text display. Substitute "you" for the person's first name if the respondent is included in this list.
Display first paragraph of question text in brackets and grayed out text when on PR310_02 - PR310_N. Display in bold black and no brackets when on PR310_01.

BOX_180 (PR1275)

Route Details:

If all current RU members are displayed in PR310_01-PR310_N, go to BOX_190.
Otherwise, continue with PR320_01.

PR320_01 (PR1280)

BLAISE NAME: OthMmbGovProg
Question Text:

Besides the people we've just talked about, please think about whether any additional household members have been covered by a program sponsored by a state or local government agency which provides physician benefits at any time (since (START DATE)/between (START DATE) and (END DATE))?
(Have you/Has (PERSON 1)) been covered by a program like this at any time (since (START DATE)/between (START
DATE) and (END DATE))?
HELP: F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded grid type 1: Forced navigation including PR320_01, PR320_02, PR320_03, PR320_04, PR320_N.
After grid completion, continue with BOX_190.
For each person coded '1' (YES), create insurance through Gov't-Hospital/Physician for this person [set Insurance.HIPubPriv=Public and Insurance.HISrc=GHP and Insurance.HISrcName= GOVT-HOS/PHY-(PROGRAM NAME FROM HX160/HX270)' (Preload.GHPProgNameRndCreated) and Insurance.Plcyhldr = PersID and CoverageFlagList.InsSrcN=YES for this PersID] [set Create Q and OrigRnd]

Display Instructions:

BOX_190 (PR1285)

Route Details:

If at least one RU member is "COVERED BY GOV'T- HOSPITAL/PHYSICIAN" during the current round, that is, at least one RU member was coded '1' (YES) at PR310_01-310_N or PR320_01-320_N, continue with BOX_200.
Otherwise, go to BOX_240.

BOX_200 (PR1290)

Route Details:

Ask the time period covered detail (HQ) section for this insurance.
This instance of the HQ section collects time period coverage detail for all RU members that are covered by Gov't-Hospital/Physician in the current round. The grid for the HQ section should be preloaded with insurance that meets both of the following conditions:
-Insurance source is GOV'T-HOSPITAL/PHYSICIAN [Insurance.HISrc=GHP] And
-Person is "COVERED BY GOV'T-HOSPITAL/PHYSICIAN" during the current round, that is, either PR310_01 - PR310_N or PR320_01-PR320_N is coded '1' (YES) for this person.
At completion of HQ section, continue with PR330.

PR330 (PR1295)

BLAISE NAME: GovProgNameChng
Question Text:

(Last time we recorded that (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) may be covered by (PRELOAD GOVT-HOSP/PHYS INSURER).)
(Since (START DATE)/Between (START DATE) and (END DATE)), has there been any change in the plan name of the health insurance (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) (has/have) through the program sponsored by a state or local government agency which provides hospital and physician benefits?

Responses:

YES 1 PR340 (PR1300)
NO 2 BOX_210 (PR1315)
REFUSED RF BOX_210 (PR1315)
DON'T KNOW DK BOX_210 (PR1315)

Programmer Instructions:

If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set previous round's insurer as 'CURRENT RD'S GOVT-HOSP/PHYS INSURER'. [Set Preload.Insurance.Insurer to Insurance.Insurer]

Display Instructions:

Roster 1- Report
Roster definition:
This item uses the insurance array to display RU-members. (Person.Fullname)
Roster filter:
Display only those RU members who are "COVERED BY GOVT- HOSPITAL/PHYSICIAN" during the current round, that is either PR310_01 - PR310_N or PR320_01-PR320_N is coded '1' (YES) for this person..
Display first names only in the first sentence "Last time we recorded?."
Substitute "you" for the person's first name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed,separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display RU members' first, middle, and last names (Person.FullName) in the second sentence "(Since (START DATE)/Between (START DATE) and (END DATE))?." Substitute "you" for the person's name if the respondent is included in this list. See instructions above about when to use commas vs. "and" to separate names.
Display 'Last time?. (PRELOAD GOVT-HOSP/PHYS INSURER).' if there was an insurer associated with Govt-Hospital/Physician in the previous round (Preload.Insurance.Insurer () RF, DK or EMPTY). Otherwise, use a null display.
For 'PRELOAD GOVT-HOSP/PHYS INSURER', display the insurer recorded for Govt-Hospital/Physician during the previous round (Preload.Insurance.Insurer).
Display 'Since (START DATE)' if not round 5.
Display 'Between (START DATE) and (END DATE)' if round 5.
Display 'has' if only one name is listed and that person is not the current respondent. Otherwise, display 'have'.

PR340 (PR1300)

BLAISE NAME: GovProgHMO
Question Text:

Under the program sponsored by a state or local government agency which provides hospital and physician benefits ((are/is)/(were/was)) (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) enrolled in an HMO, that is a Health Maintenance Organization (between(START DATE) and (END DATE))?
[With an HMO, you must generally receive care from HMO physicians. If another doctor is seen, the expense is not covered unless you were referred by the HMO, or there was a medical emergency.]
HELP:F1

Responses:

YES, ALL ARE 1 PR360 (PR1310)
YES, SOME ARE 2 PR360 (PR1310)
NO, NONE ARE 3 PR350 (PR1305)
REFUSED RF PR350 (PR1305)
DON'T KNOW DK PR350 (PR1305)

Display Instructions:

Roster 1- Report Roster definition:
Use PR330 definition.
Roster filter:
Use PR330 filter.
Display RU members' first, middle, and last names (Person.FullName)in the question text. Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display '(are/is)' if not round 5. Display '(were/was)' if round 5.
Display 'is' or 'was' if the list includes 1 person who is not the respondent. Otherwise, display 'are' or 'were'.
Display 'between (START DATE) and (END DATE)' if round 5. Otherwise, use a null display.

PR350 (PR1305)

BLAISE NAME: GovProgPrimaryMD
Question Text:

(Does/Between (START DATE) and (END DATE), did) the program sponsored by a state or local government agency which provides hospital and physician benefits require (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) to sign up with a certain primary care doctor, group of doctors, or with a certain clinic which they must go to for all of their routine care?
PROBE: Do not include emergency care or care from a specialist they were referred to.
HELP: F1

Responses:

YES, ALL REQUIRED 1 PR360 (PR1310)
YES, SOME REQUIRED 2 PR360 (PR1310)
NO, NONE REQUIRED 3 BOX_210 (PR1315)
REFUSED RF BOX_210 (PR1315)
DON'T KNOW DK BOX_210 (PR1315)

Programmer Instructions:

Note: If coded '3' (NO, NONE REQUIRED), 'RF' (REFUSED), or 'DK' (DON'T KNOW),there is no insurer associated with the current round for Govt-Hospital/Physician.

Display Instructions:

Roster 1- Report
Roster definition:
Use PR330 definition.
Roster filter:
Use PR330 filter.
Display RU members' first, middle, and last names (Person.FullName) in the question text. Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed, separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display 'Does' if not round 5. Display 'Between (START DATE) and (END DATE), did' if round 5.

PR360 (PR1310)

BLAISE NAME: GovProgPlanName
Type Class: String Field Size: 40
Question Text:

What is the name of the (HMO/health insurance) from the program sponsored by a state or local government agency which provides hospital and physician benefits?
ENTER PLAN NAME

Responses:

1 BOX_210 (PR1315)
REFUSED RF BOX_210 (PR1315)
DON'T KNOW DK BOX_210 (PR1315)

Programmer Instructions:

Set Insurance.Insurer to PR360

Display Instructions:

Display 'HMO' if PR330 is coded '1' (YES, ALL ARE) or '2' (YES, SOME ARE). Display 'health insurance' if PR350 coded '1' (YES, ALL REQUIRED) or '2' (YES, SOME REQUIRED).

BOX_210 (PR1315)

Route Details:

If round 2, round 3, or round 4, continue with PR370.
Otherwise, (i.e., if round 5), go to BOX_240.

PR370 (PR1320)

BLAISE NAME: GovProgPayPrem
Question Text:

Is there a monthly premium for (PERSON 1), (PERSON 2), (PERSON 3), (PERSON 4), (PERSON N) for the coverage through ((CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)/the program sponsored by a state or local government agency which provides hospital and physician benefits)?
[Do not include the cost of any copayments, coinsurance, or deductibles anyone in the family may have had to pay.]
READ IF NECESSARY: A monthly premium is a fixed amount of money people pay each month to have health coverage. It does not include copays or other expenses such as prescription costs.
HELP: F1

Responses:

YES, EVERYONE COVERED PAYS 1 BOX_220 (PR1330)
YES, SOME COVERED PAY 2 PR380 (PR1325)
NO, NO ONE COVERED PAYS 3 BOX_240 (PR1365)
REFUSED RF BOX_240 (PR1365)
DON'T KNOW DK BOX_240 (PR1365)

Programmer Instructions:

Placeholder for MHOP specifications. This will be deleted once those specifications are available.
If coded '1' (YES, EVERYONE COVERED PAYS) at PR370 (HOME.PRMEDPRE), code PRND.GOVMNTHP for each person in the roster at PR370 as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND.)
If coded '3' (NO, NO ONE COVERED PAYS) at PR370 (HOME.PRMEDPRE), code PRND.GOVMNTHP for each person in the roster at PR370 as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND.)
If coded RF or DK or -9 (WHETHER EVERYONE IS COVERED IS MISSING) at PR370 (HOME.PRMEDPRE), code PRND.GOVMNTHP equal to the missing value in HOME.PRMEDPRE for each person in the PR370 roster.
Leave PRND.MEDGOVP blank (no value) for any RU member not on the roster at PR370.

Display Instructions:

Roster 1- Report
Roster definition:
Use PR330 definition.
Roster filter:
Use PR330 filter.
Display RU members' first, middle, and last names (Person.FullName) in question text. Substitute "you" for the person's name if the respondent is included in this list. If exactly two names displayed,separate names with the word "and" and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word "and".
Display '(CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)' if there is a current round insurer associated with the Gov't-Hospital/Physician insurance that is not 'RF' or 'DK' or EMPTY. (Check Insurance.Insurer - if PR330=2, RF, DK and there was a preloaded insurer, the preloaded insurer was set to the current insurer. Or if PR360 was answered, the current insurer was set there). Otherwise, display 'the program sponsored by a state or local government agency which provides hospital and physician benefits '.
For '(CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)', display the actual plan name for the current round Gov't-Hospital/Physician insurer (Insurance.Insurer). This may be a preloaded value set to the current value or the value entered at PR360.

PR380 (PR1325)

BLAISE NAME: GovProgPayPremRoster
Question Text:

Who has a monthly premium for that coverage?
PROBE: Anyone else?
ENTER ALL THAT APPLY.

Responses:

(FIRST NAME [MIDDLE NAME] LAST NAME)1 1 BOX_220 (PR1330)
(FIRST NAME [MIDDLE NAME] LAST NAME)2 2 BOX_220 (PR1330)
(FIRST NAME [MIDDLE NAME] LAST NAME)3 3 BOX_220 (PR1330)
(FIRST NAME [MIDDLE NAME] LAST NAME)4 4 BOX_220 (PR1330)
(FIRST NAME [MIDDLE NAME] LAST NAME)N 5 BOX_220 (PR1330)

Programmer Instructions:

Roster Behavior:
1. Multiple select allowed.
Following settings may be required during MHOP rather than CAPI: Code PRND.GOVMNTHP as '1' (PAYS FOR COVERAGE DURING THE CURRENT ROUND) for all persons from the PR380 roster who are selected.
Code PRND.GOVMNTHP as '2' (DOES NOT PAY FOR COVERAGE DURING THE CURRENT ROUND) for all persons on the PR370 roster who are not selected.
Leave PRND.MEDGOVP blank (no value) for any RU member not on the roster at PR380.

Display Instructions:

Roster 2 - no add/edit/delete.
Roster definition:
Use PR330 definition.
Roster filter:
Use PR330 filter.

BOX_220 (PR1330)

Route Details:

If round 3, continue with PR390.
Otherwise, go to PR410.

PR390 (PR1335)

BLAISE NAME: GovProgAmt
Question Text:

How much is the premium for (the (CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)/that) coverage?
IF MORE THAN ONE PERSON PAYS A PREMIUM FOR THIS COVERAGE, SAY: Please give me the total amount for premiums paid by all individuals with this coverage.
USE CTRL+Z TO ACCESS CALCULATOR TO ADD ALL PREMIUMS.
ENTER AMOUNT

Responses:

1 PR400 (PR1340)
REFUSED RF PR410 (PR1350)
DON'T KNOW DK PR410 (PR1350)

Programmer Instructions:

Allow for the entry of dollars and cents.

Display Instructions:

Display PR390, PR400 and PR400OS on the same form pane.
Display 'the (CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)' if there is a current round insurer associated with the Gov't-Hospital/Physician insurance that is not 'RF' or 'DK' or EMPTY. (Check Insurance.Insurer - if PR330=2, RF, DK and there was a preloaded insurer, the preloaded insurer was set to the current insurer. Or if PR360 was answered, the current insurer was set there). Otherwise, display 'that'.
For '(CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)', display the actual plan name for the current round Gov't-Hospital/Physician insurer (Insurance.Insurer).
This may be a preloaded value set to the current value or the value entered at PR360.

PR400 (PR1340)

BLAISE NAME: GovProgUnit
Question Text:

[How much is the premium for (the (CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)/that) coverage?
IF MORE THAN ONE PERSON PAYS A PREMIUM FOR THIS COVERAGE, SAY: Please give me the total amount for premiums paid by all individuals with this coverage.
USE CTRL+Z TO ACCESS CALCULATOR TO ADD ALL PREMIUMS.]
Is that per year, per month, per week, or what?
ENTER UNIT OF COVERAGE

Responses:

PER YEAR 1 PR410 (PR1350)
EVERY 3 MONTHS (QUARTERLY) 2 PR410 (PR1350)
EVERY 2 MONTHS (BIMONTHLY) 3 PR410 (PR1350)
PER MONTH 4 PR410 (PR1350)
PER WEEK 5 PR410 (PR1350)
EVERY 2 WEEKS (BIWEEKLY) 6 PR410 (PR1350)
2 TIMES PER YEAR (SEMI-ANNUALLY) 7 PR410 (PR1350)
2 TIMES PER MONTH (SEMI-MONTHLY) 8 PR410 (PR1350)
OTHER 91 PR400OS (PR1345)
REFUSED RF PR410 (PR1350)
DON'T KNOW DK PR410 (PR1350)

Display Instructions:

Display PR390, PR400 and PR400OS on the same form pane.
Display "How much ? ADD ALL PREMIUMS." in brackets and grayed out text.
Display 'the (CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)' if there is a current round insurer associated with the Gov't-Hospital/Physician insurance that is not 'RF' or 'DK' or EMPTY. (Check Insurance.Insurer - if PR330=2, RF, DK and there was a preloaded insurer, the preloaded insurer was set to the current insurer. Or if PR360 was answered, the current insurer was set there). Otherwise, display 'that'.
For '(CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)', display the actual plan name for the current round Gov't-Hospital/Physician insurer (Insurance.Insurer).
This may be a preloaded value set to the current value or the value entered at PR360.

PR400OS (PR1345)

BLAISE NAME: GovProgUnitOS
Type Class: String Field Size: 30
Question Text:

Responses:

1 PR410 (PR1350)
REFUSED RF PR410 (PR1350)
DON'T KNOW DK PR410 (PR1350)

Display Instructions:

PR410 (PR1350)

BLAISE NAME: GovProgSubsdz
Question Text:

(PLAN NAME: (CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN))
Is the cost of the premium subsidized based on family income?

Responses:

YES 1 BOX_230 (PR1355)
NO 2 BOX_230 (PR1355)
REFUSED RF BOX_230 (PR1355)
DON'T KNOW DK BOX_230 (PR1355)

Display Instructions:

Display 'PLAN NAME: (CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)' if there is a current round insurer associated with the Gov't-Hospital/Physician insurance that is not 'RF' or 'DK' or EMPTY. (Check Insurance.Insurer - if PR330=2, RF, DK and there was a preloaded insurer, the preloaded insurer was set to the current insurer. Or if PR360 was answered, the current insurer was set there). Otherwise, use a null display.
For '(CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)', display the actual plan name for the current round Gov't-Hospital/Physician insurer (Insurance.Insurer).
This may be a preloaded value set to the current value or the value entered at PR360.

BOX_230 (PR1355)

Route Details:

[If round 3] and [If HX180 or HX280 was coded '1' (YES, PLAN IS EXCHANGE) the round the Gov't- Hospital/Physician insurance was created (Preload.Insurance.HX180AnsRndCreated or Preload.Insurance.HX280AnsRndCreated)] and [PR370 is coded '1' (YES, EVERYONE COVERED PAYS) or '2' (YES, SOME COVERED PAY),] continue with PR420.
Otherwise, go to BOX_240.

PR420 (PR1360)

BLAISE NAME: GovProgMetalPlan
Question Text:

Is (the (CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN) plan/this plan) a platinum, gold, silver, bronze, or catastrophic plan?
HELP: F1

Responses:

PLATINUM PLAN 1 BOX_240 (PR1365)
GOLD PLAN 2 BOX_240 (PR1365)
SILVER PLAN 3 BOX_240 (PR1365)
BRONZE PLAN 4 BOX_240 (PR1365)
CATASTROPHIC PLAN 5 BOX_240 (PR1365)
IF VOLUNTEERED: SOMETHING ELSE 6 BOX_240 (PR1365)
REFUSED RF BOX_240 (PR1365)
DON'T KNOW DK BOX_240 (PR1365)

Display Instructions:

Display 'the (CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN) plan' if there is a current round insurer associated with the Gov't-Hospital/Physician insurance that is not 'RF' or 'DK' or EMPTY. (Check Insurance.Insurer - if PR330=2, RF, DK and there was a preloaded insurer, the preloaded insurer was set to the current insurer. Or if PR360 was answered, the current insurer was set there). Otherwise, display 'this plan'.
For '(CURRENT ROUND'S INSURER FOR GOVT- HOSPITAL/PHYSICIAN)', display the actual plan name for the current round Gov't-Hospital/Physician insurer (Insurance.Insurer).
This may be a preloaded value set to the current value or the value entered at PR360.

BOX_240 (PR1365)

Route Details:

Return to the Health Insurance (HX) section.

Provider Roster (PV) Section

BOX_00 (PV1000)

Route Details:

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30
04 Single Select equal to PV10, PV40
06 Single Select with Fill in Answer Text equal to PV80
12 Address-Newly Confirmed equal to PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_07, PV50_08, PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06, PV60_07
24 Information Screen equal to PV15
28 Trigram Lookup equal to PV20LU, PV30LU
29 Single Select with Fill in Answer Text and Display Roster equal to PV70
Grid 1equal to PV20LU, PV30LU
Roster 3 equal to PV20LU, PV30LU, PV70, PV80

BOX_10 (PV1005)

Route Details:

Context Header Instructions:
Display PERS.FULLNAME and EVNT.EVNTTYPE.
If the Provider Roster section is launched from the Access to Care section, event type will not be displayed in the context header.

BOX_20 (PV1010)

Route Details:

If coming from the Event Roster and event type is MV, go to PV10.
If coming from the Event Roster section and event type is DN, go to PV80.
If coming from the Calendar section BOX_15, go to PV15. If coming from the Calendar section BOX_18, go to PV20LU.
If coming from the Access to Care section go to PV30LU. Otherwise, go to PV20LU.

PV10 (PV1015)

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

To the best of your knowledge, is the provider that provided the health care to (you/(PERSON)) associated with any group practice, HMO, or clinic?

Responses:

YES 1 PV20LU (PV1020)
NO 2 PV20LU (PV1020)
REFUSED RF PV20LU (PV1020)
DON?T KNOW DK PV20LU (PV1020)

Display Instructions:

PV15 (PV1016)

BLAISE NAME: IntroFromCA
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (EV)
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 in the hospital/was staying at a residential care facility/was receiving care at home/when you were (in the hospital/staying at a residential care facility/receiving care at home)) at the time of the last interview on (PREV RD INTV DT).
PRESS 1 AND ENTER TO CONTINUE.

Responses:

CONTINUE 1 PV20LU (PV1020)

Display Instructions:

Display 'Before we discuss the health care events..." if coming from the CA section and it?s the first open event being cycled on.
Otherwise, if it?s not the first open event being cycled on, display 'Next'.
Display ?who (was in the hospital... at home? if the person being looped on is not the respondent.
Otherwise, display ?when you were...at home?.

PV20LU (PV1020)

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

(I have a directory to look up medical providers.) To get us started, please tell me just the (last) name, the street name, city, or the telephone number of the (individual) (or) (hospital/facility/home health agency/group practice, HMO, or clinic) that provided health care to (you/(PERSON)).
(SELECT ONE PROVIDER - PRESS 1 AND ENTER TO SELECT A PROVIDER./TO ADD A PROVIDER PRESS CTRL-A.) VERIFY FULL PROVIDER NAME AND ADDRESS BEFORE SELECTING.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
((number of providers displayed) out of (total number of providers) providers shown ? scroll for more)

Responses:

CONTINUE 1
EMPTY Empty

Programmer Instructions:

Preloaded Grid Type 2 including PV20 - Flexible navigation, allow empty.
If PV20LU is EMPTY for all of the medical providers and interviewer tries to move off of this page display the message: ?YOU MUST SELECT A MEDICAL PROVIDER BEFORE CONTINUING. PRESS ENTER TO RETURN TO PV20LU.?
If coming from the CA section, after a provider is selected return immediately to the calendar section.
If provider selected (PV20LU equal to '1' for one provider) and event type is OP or MV and linked to a facility-provider (either facility provider was selected from NPI or from the roster or PV40 is coded equal to '2' (FACILITY PROVIDER)), immediately go to PV70.
Otherwise, after a provider is selected (PV20LUequal to'1' for one provider), immediately return to the Event Roster (EV) section.
Once a provider is added, that provider should be automatically selected. If the interviewer adds a provider, but then decides to ?unselect? it, another provider could be added. CTRL-A should not work if there is already a provider selected on this screen.
Hard Check:
If CTRL-E is pressed for a provider that is linked to a NPI ID or the provider was added during a previous round, display the following error message: "THIS PROVIDER CAN?T BE EDITED BECAUSE IT WAS ADDED DURING A PREVIOUS ROUND OR IT IS LINKED TO A NPI ID.?
If CTRL-D is pressed for a provider that was not added at the current question, display the following error message: ?THIS PROVIDER CAN?T BE DELETED. ONLY PROVIDERS ADDED AT THE CURRENT QUESTION CAN BE DELETED.?
If the provider selected is linked to a person-provider and the event type is HS, ER, OP or IC, display the following error message: ?A FACILITY PROVIDER MUST BE SELECTED FOR THIS EVENT TYPE. SELECT/ADD ANOTHER PROVIDER.?
CTRL-A: Only one provider can be selected per this instance of PV. If FI tries to back up and add another provider, display the following hard check: ?YOU MUST DESELECT THE CURRENT PROVIDER TO SELECT A DIFFERENT PROVIDER TO ASSOCIATE WITH THIS EVENT?. CAPI should go back to PV20LU.
Roster Behavior:
1. Display roster entries in the following order: Display by provider last name or facility name. Entries that are added during the current round will appear at the bottom of the list of entries until the next round.
Grid Behavior:
The ?Type of Provider?, ?Provider?, ?Address?, ?City?, ?State?, ?Zip Code?, ?Phone Number?, and ?Editable? are protected columns. No changes are allowed.
In the ?PV20? column, only one provider can be selected by pressing 1 and enter in the active field for that provider.
In the ?PV20? column a provider that is not linked to an NPI ID and was added during the current round, can be edited by navigating to that providers active field and pressing CTRL-E.
In the ?PV20? column a provider that was added at the current question, can be deleted by navigating to that providers active field and pressing CTRL-D.
The provider roster entries are displayed in the form pane. To maximize the number of rows that we can display in the form pane without vertical scrolling, reduce the size of the info pane to fit the question text displayed. Thirteen rows display at one time before scrolling is necessary.
When CTRL-A is selected the provider directory should pop-up. The following fields should be displayed in the look-up: Name1, Name 2, Address, City, Phone number, Taxonomy.
There should be an option on the look-up for ?PROVIDER NOT FOUND?. When 'PROVIDER NOT FOUND' is selected, go to BOX_30 to start the collect of provider information using PV50_01-PV50_08 or PV60_01-PV60_07. After the completion of these questions, the provider will be added to the medical provider roster and the interview should route back to PV20LU. At PV20LU, the provider that was just added from PV50_01-PV50_08 or PV60_01-PV60_07 should appear at the bottom of the grid with a '1' prefilled in the PV20 field. Interviewers must press Enter to confirm their selection.
If the provider selected (either at PV20LU or within the NPI look-up window) is linked to a person-provider and the event type is HS, ER, OP or IC, display the following error message: ?A FACILITY PROVIDER MUST BE SELECTED FOR THIS EVENT TYPE. SELECT ANOTHER PROVIDER.? After the FI has viewed the error message they will return to the provider directory pop-up. The same search string will still be listed in the field.
The following search rules should appear at the bottom of the pop-up:
?SEARCH RULES:
Fewer words often work better than lot of words ? but you must type at least 5 letters
Unusual or unique aspects of provider name or address finds better matches
Common identifiers (e.g., medical center, office, associates, group, health) can increase the number of ?extra? matches displayed
If searching by address ? include street number and name, but not office, suite, or room number
If searching by phone number ? do not include hyphens
Review the DETAILS line at the top to verify correct selection
After the FI picks a provider and presses ?SELECT?, the provider will appear at the bottom of the grid with a ?1? prefilled in the PV20 field for this provider. FI?s must press ENTER to confirm their selection.
When CTRL-E is selected for a person-provider that is not linked to a NPI ID and that was added during the current round, go to PV50_01. PV50_01-PV50_08 will be used to update the providers information. After PV50_08, update the provider roster entry and return to PV20LU.
When CTRL-E is selected for a facility-provider that is not linked to a NPI ID and that was added during the current round, go to PV60_01. PV60_01-PV60_09 will be used to update the provider?s information. After PV60_09, update the provider roster entry and return to PV20LU.
When CTRL-D is selected for a provider that was added at the current question, a verification screen will appear to confirm that the interviewer wants to delete this provider.

Display Instructions:

Roster 3 ? Add, Edit, Delete Allowed
Roster Definition:
Display the RU medical providers roster for selection of one medical provider. The ?medical providers roster? excludes dental providers which is now on the ?dental providers roster?. Display the following columns formatted on the form pane:
Column Header #1: PV20
This field is used to select, edit, or delete a provider.
Column Header #2: Type of Provider
Display ?P? to represent a person-provider, ?F? to represent a facility-provider, or ?F (p)? to represent a facility-provider ever linked to an MV or OP event AND a specific department or a doctor.
Column Header #3: Provider
Display the first and last name of the person-provider or the name of the facility. Set truncation length to 50 characters.
Column Header #4: Address
Display address 1 and address 2 for the provider. Set truncation length to 45 characters.
Column Header #5: City
Display the city for the provider. Set truncation length to 25 characters.
Column Header #6: State
Display the two letter state abbreviation for the provider.
Column Header #7: Zip code
Display the zip code for the provider.
Column Header #8: Phone Number
Display the telephone number for the provider
Column Header #9: Editable
Display ?Yes? if the provider is not linked to an NPI ID and added in the current round. Display ?No? if the provider is linked to an NPI ID or if the provider was added during a previous round (Provider[I].OrigRnd).
Roster Filter:
Exclude home health provider entries - ?FRIEND(S) OR NEIGHBOR(S)?, ?RELATIVE(S)?, and ?VOLUNTEER(S)?.
Display 'last' if PV10 was coded '2' NO and the event type is MV.
Display ?individual? if PV10 was coded ?2? NO, RF, or DK OR if the event type is HH Paid Independent.
Otherwise, use a null display.
Display ?or? if PV10 was coded DK or RF. Otherwise, use a null display. Display ?hospital? if the event type is HS. Display ?facility? if the event type is OP, ER, or IC. Display ?home health agency? if the event type is HH Agency. Display ?group practice, HMO, or clinic? if PV10 was coded ?1? YES, DK or RF. Otherwise, use a null display.
Display ?SELECT ONE PROVIDER - PRESS 1 AND ENTER TO SELECT A PROVIDER? if at least one provider appears on the roster, otherwise, if the roster is empty, display ?TO ADD A PROVIDER PRESS CTRL-A.
Display ?(number of providers displayed) OUT OF (total number of providers) PROVIDERS SHOWN - SCROLL TO SEE MORE" in red text only if there are more than the 13 providers, otherwise, use null display.
Note: The display for the CTRL-A, CTRL-E, CTRL-D instructions does not follow the UI rules for display. It will display as follows: CTRL-D will display on the same line as the second interviewer instruction. There will not be a line separating the two interviewer instructions. This is for maximum use of space for the form pane.

PV30LU (PV1025)

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

Please give me the name of the (medical person)(,) (doctor?s office, clinic, health center, or other place) that (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health.
PRESS 1 AND ENTER TO SELECT A PROVIDER.
VERIFY FULL PROVIDER NAME AND ADDRESS BEFORE SELECTING.
TO LAUNCH THE PROVIDER DIRECTORY AND ADD A NEW PROVIDER, PRESS CTRL-A.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
((number of providers displayed) out of (total number of providers) providers shown - scroll for more)

Responses:

CONTINUE 1
EMPTY Empty

Programmer Instructions:

Preloaded Grid Type 2 including PV30 - Flexible navigation, allow empty.
If PV30LU is EMPTY for all of the medical providers and interviewer tries to move off of this page, display the following message: ?YOU MUST SELECT A MEDICAL PROVIDER BEFORE CONTINUING. PRESS ENTER TO RETURN TO PV30LU.
If provider selected (PV30LU equal to '1' for one provider) and it is a person-provider, immediately return to the Access to Care section.
If provider selected (PV30LU equal to '1' for one provider) and it is a facility-provider (either facility provider was selected from NPI or from the roster or PV40 is coded equal to '2' (FACILITY PROVIDER)), immediately go to PV70.
Flag the providers selected to the RU level provider roster that displays at PV20LU and PV30LU.
Hard Check:
If CTRL-E is pressed for a provider that is linked to a NPI ID or the provider was added during a previous round, display the following error message: "THIS PROVIDER CAN?T BE EDITED BECAUSE IT WAS ADDED DURING A PREVIOUS ROUND OR IT IS LINKED TO A NPI ID.?
If CTRL-D is pressed for a provider that was not added at the current question, display the following error message: " THIS PROVIDER CAN?T BE DELETED. ONLY PROVIDERS ADDED AT THE CURRENT QUESTION CAN BE DELETED.?
Roster Behavior:
1. Display roster entries in the following order:
Display by provider last name or facility name. Entries that are added during the current round will appear at the bottom of the list of entries until the next round.
Grid Behavior:
The ?TYPE OF PROVIDER?, ?PROVIDER?, ?ADDRESS?, ?CITY?, ?STATE?, ?ZIP CODE?, ?PHONE NUMBER?, and ?EDITABLE? are protected columns. No changes are allowed.
In the ?PV30? column, only one provider can be selected by pressing 1 and enter in the active field for that provider.
In the ?PV30? column a provider that is not linked to an NPI ID and was added during the current round, can be edited by navigating to that providers active field and pressing CTRL-E.
In the ?PV30? column a provider that was added at the current question, can be deleted by navigating to that providers active field and pressing CTRL-D.
The provider roster entries are displayed in the form pane. To maximize the number of rows that we can display in the form pane without vertical scrolling, reduce the size of the info pane to fit the question text displayed. At a minimum, at least 10 rows should be displayed in the form pane but 15 rows would be ideal.
When CTRL-A is selected the provider directory should pop-up.
The following fields should be displayed in the look-up: Name1, Name 2, Address, City, Phone number, Taxonomy.
There should be an option on the look-up for ?PROVIDER NOT FOUND?. When 'PROVIDER NOT FOUND' is selected, go to BOX_30 to start the collection of provider information using PV50_01-PV50_08 or PV60_01-PV60_07. After the completion of thesequestions, the provider will be added to the medical provider roster and the interview should route back to PV30LU. At PV30LU the provider that as just added from PV50_01-PV50_08 or PV60_01-PV60_07 should appear at the bottom of the grid with a '1' prefilled in the PV30 field. Interviewers must press Enter to confirm their selection.
The following search rules should appear at the bottom of the pop-up:
?SEARCH RULES:
Fewer words often work better than lot of words ? but you must type at least 5 letters
Unusual or unique aspects of provider name or address finds better matches
Common identifiers (e.g., medical center, office, associates, group, health) can increase the number of ?extra? matches displayed
If searching by address ? include street number and name, but not office, suite, or room number
If searching by phone number ? do not include hyphens
Review the DETAILS line at the top to verify correct selection
After the FI picks a provider and presses ?SELECT?, the provider will appear at the bottom of the grid with a ?1? prefilled in the PV30 field for this provider. FI?s must press ENTER to confirm their selection.
When CTRL-E is selected for a facility-provider that is not linked to a NPI ID and that was added during the current round , go to PV60_01. PV50_01-PV50_08 will be used to update the provider?s information. After PV50_08, update the provider roster entry and return to PV30LU.
When CTRL-E is selected for a person-provider that is not linked to a NPI ID and that was added during the current round, go to PV50_01. PV50_01-PV50_08 will be used to update the provider?s information. After PV50_08, update the provider roster entry and return to PV30LU.
When CTRL-D is selected for a provider that was added at the current question, a verification screen will appear to confirm that the interviewer wants to delete this provider.

Display Instructions: Roster 3 ? Add, Edit, Delete Allowed

Roster Definition:
Display the RU medical providers roster for selection of one medical provider. The ?medical providers roster? excludes dental providers which is now on the ?dental providers roster?. Display the following columns formatted on the form pane:
Column Header #1: PV30
This field is used to select, edit, or delete a provider.
Column Header #2: Type of Provider
Display ?P? to represent a person-provider, ?F? to represent a facility-provider, or ?F (p)? to represent a facility-provider ever linked to an MV or OP event AND a specific department or a doctor.
Column Header #3: Provider
Display the first and last name of the person-provider or the name of the facility. Set truncation length to 50 characters.
Column Header #4: Address
Display address 1 and address 2 for the provider. Set truncation length to 45 characters.
Column Header #5: City
Display the city for the provider. Set truncation length to 25 characters.
Column Header #6: State
Display the two letter state abbreviation for the provider.
Column Header #7: Zip code
Display the zip code for the provider.
Column Header #8: Phone Number
Display the telephone number for the provider
Column Header #9: Editable
Display ?Yes? if the provider is not linked to an NPI ID. Display ?No? if the provider is linked to an NPI ID.
Roster Filter:
-Exclude home health provider entries - ?FRIEND(S) OR NEIGHBOR(S)?, ?RELATIVE(S)?, and ?VOLUNTEER(S)?.
Display ?medical person? if AC30 is coded ?1? (OWN PRACTICE, NOT PART OF GROUP/FACILITY), ?RF? (REFUSED) or ?DK? (DON?T KNOW). Otherwise, use a null display.
Display ?doctor?s office, clinic, health center, or other place? if AC30 is coded ?2? (PRACTICE IS ASSOCIATED WITH GROUP/FACILITY), ?RF? (REFUSED) or ?DK? (DON?T KNOW). Otherwise, use a null display.
Display "(,)" if AC30 is coded 'RF' (REFUSED) or 'DK' (DON?T KNOW). Otherwise, use a null display.
Display "((number of providers displayed) OUT OF (total number of providers) PROVIDERS SHOWN - SCROLL TO SEE MORE)" in red text only if there are more than 12 providers, otherwise, use a null display.

BOX_30 (PV1030)

Route Details:

If ?PROVIDER NOT FOUND? was selected from the provider directory and the event type is MV or HH or the provider roster section was launched from the access to care section, go to PV40.
If 'PROVIDER NOT FOUND? was selected from the provider directory and event type is HS, ER, OP, IC, code ?FACILITY-PROVIDER? at PV40 and go to PV60_01.

PV40 (PV1035)

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

INTERVIEWER: SELECT WHETHER (EVENT TYPE) HEALTH CARE FOR (PERSON) WAS TO A PERSON OR A FACILITY.

Responses:

PERSON-PROVIDER 1 PV50_01 (PV1040)
FACILITY-PROVIDER 2 PV60_01 (PV1085)

Programmer Instructions: Refused and Don?t Know are not allowed.
Display Instructions:

Display ?MV? for ?EVENT TYPE? if the current event is MV. Display ?HH? for ?EVENT TYPE? if the current event is HH. Otherwise, use a null display.

PV50_01 (PV1040)

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

(I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who (provided health care to (you/(PERSON)) (at home)?/(you/(PERSON) ) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?) )
What is the first name?
ENTER FIRST NAME AND VERIFY SPELLING.

Responses: 1 PV50_02 (PV1045)
Programmer Instructions: Refused and Don?t Know are not allowed.
Display Instructions:

Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_07 and PV50_08 on the same form pane.
Display "I was not able to...advice about (your/his/her) health?)" if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display "provided health care to (you/(PERSON))(at home)?" if PV section was launched from the EV section. Display "(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?" if PV section was launched from AC section.
Display ?at home? if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Prefill the provider?s first name in the info pane if an existing medical provider entry is being edited/updated.

PV50_02 (PV1045)

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

([I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who (provided health care to (you/(PERSON)) (at home)?/(you/(PERSON) ) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?)])
What is the last name?
ENTER LAST NAME AND VERIFY SPELLING.

Responses:

1 PV50_03 (PV1050)

Programmer Instructions: Refused and Don?t Know are not allowed.
Display Instructions:

Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_07 and PV50_08 on the same form pane.
Display ?I was not able to find...advice about (your/his/her) health?)' in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display "provided health care to (you/(PERSON))(at home)?" if PV section was launched from the EV section. Display "(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (you/his/her) health?" if PV section was launched from AC section.
Display ?at home? if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Prefill the provider?s last name in the info pane if an existing medical provider entry is being edited/updated.

PV50_03 (PV1050)
BLAISE NAME: MPStrt1
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (EV)
Question Text:

([I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who provided health care to (you/(PERSON)) (at home)?)?/(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?)])
What is the street address?
ENTER STREET ADDRESS.

Responses:

1 PV50_04 (PV1055)
REFUSED RF PV50_04 (PV1055)
DON?T KNOW DK PV50_04 (PV1055)

Display Instructions:

Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health?)? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?provided health care to (you/(PERSON)) (at home)?? if PV section was launched from the EV section. Display ?(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?? if PV section was launched from AC section.
Display ?at home? if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Prefill the provider?s street address in the info pane if an existing medical provider entry is being edited/updated.

PV50_04 (PV1055)

BLAISE NAME: MPStrt2
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (EV)
Question Text:

([I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who (provided health care to (you/(PERSON)) (at home)?/(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?)])
ENTER BUILDING OR ADDITIONAL ADDRESS INFORMATION, IF AVAILABLE. IF NONE, PRESS ENTER.

Responses:

1 PV50_05 (PV1060)
EMPTY Empty PV50_05 (PV1060)
REFUSED RF PV50_05 (PV1060)
DON?T KNOW DK PV50_05 (PV1060)

Display Instructions:

Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health?)? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?provided health care to (you/(PERSON)) (at home)?? if PV section was launched from the EV section. Display ?(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?? if PV section was launched from AC section.
Display ?at home? if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Prefill the provider?s second address, if available, in the info pane if an existing medical provider entry is being edited/updated.

PV50_05 (PV1060)

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

([I was not able to find that provider in my directory. What is the first and last name,

street address, city, state, zip code, and phone number of the person who (provided health care to (you/(PERSON)) (at home)?/(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?)])
What is the city?
ENTER CITY.

Responses:

1 PV50_06 (PV1065)
REFUSED RF PV50_06 (PV1065)
DON?T KNOW DK PV50_06 (PV1065)

Display Instructions:

Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health?)? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?provided health care to (you/(PERSON)) (at home)?? if PV section was launched from the EV section. Display ?(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?? if PV section was launched from AC section.
Prefill the provider?s city in the info pane if an existing medical provider entry is being edited/updated.

PV50_06 (PV1065)

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

([I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who (provided health care to (you/(PERSON)) (at home)?/(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?)])
What is the state?
ENTER STATE.
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND PRESS ENTER TO SELECT.

Responses:

1 PV50_07 (PV1070)
REFUSED RF PV50_07 (PV1070)
DON?T KNOW DK PV50_07 (PV1070)

Programmer Instructions:

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

Display Instructions:

Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health?)? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?provided health care to (you/(PERSON)) (at home)?? if PV section was launched from the EV section. Display ?(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?? if PV section was launched from AC section.
Display ?at home? if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Prefill the provider?s state in the info pane if an existing medical provider entry is being edited/updated.

PV50_07 (PV1070)

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

([I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who (provided health care to (you/(PERSON)) (at home)?/(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?)])
What is the zip code?
ENTER ZIP CODE.

Responses:

1 PV50_08 (PV1075)
REFUSED RF PV50_08 (PV1075)
DON?T KNOW DK PV50_08 (PV1075)

Programmer Instructions:

Display Instructions:

Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health?)? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?provided health care to (you/(PERSON)) (at home)?? if PV section was launched from the EV section. Display ?(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?? if PV section was launched from AC section.
Display ?at home? if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Prefill the provider?s zip code in the info pane if an existing medical provider entry is being edited/updated.

PV50_08 (PV1075)

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

([I was not able to find that provider in my directory. What is the first and last name, street address, city, state, zip code, and phone number of the person who (provided health care to (you/(PERSON)) (at home)?/(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?)])
What is the telephone number?
ENTER TELEPHONE NUMBER.

Responses:

1
REFUSED RF
DON?T KNOW DK

Programmer Instructions:

Ten digit entry required.
Use number input mask (xxx-xxx-xxxx) in the response field.
If the provider roster section was launched from the access to care section, go back to PV30LU. Otherwise, go back to PV20LU.

Display Instructions:

Display PV50_01, PV50_02, PV50_03, PV50_04, PV50_05, PV50_06, PV50_ 07 and PV50_08 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health?)? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?provided health care to (you/(PERSON)) (at home)?? if PV section was launched from the EV section. Display ?(you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health?? if PV section was launched from AC section.
Display ?at home? if event type is HH and a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Prefill the provider?s telephone number in the info pane if an existing medical provider entry is being edited/updated.

PV60_01 (PV1085)

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

(I was not able to find that provider in my directory. Please give me the name, street address, city, state, zip code, and phone number of the ((hospital/provider/facility) where (you/(PERSON)) received care/place that provided home care to (you/(PERSON))/ place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health))
What is the name of the (hospital/provider/facility/place) (that provided the care (at home))?
ENTER FACILITY NAME AND VERIFY SPELLING.

Responses: 1 PV60_02 (PV1090)
Programmer Instructions: Refused and Don?t Know are not allowed.
Display Instructions:

Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.
Display ?I was not able to... advice about (your/his/her) health).? if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?(hospital/provider/facility) where (you/(PERSON)) received care? if PV section was launched from the EV section and the event type is not HH. Display ?place that provided home care to (you/(PERSON))? if PV section was launched from the EV section and the event type is HH. Display ?place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health? if PV section was launched from AC section.
Display ?hospital? if event type is HS. Display ?provider? if event type is MV. Otherwise, display ?facility?.
Display ?hospital? if PV section was launched from the EV section and the event type is HS. Display ?provider? if PV section was launched from the EV section and the event type is MV. Display ?facility? if PV section was launched from the EV section and the event type is ER, OP, or IC. Otherwise, display ?place?.
Display ?that provided the care (at home)? if PV section was launched from the EV section. Otherwise, use a null display.
Display ?at home? if PV section was launched from the EV section and the event type is HH. Otherwise, use a null display.
Prefill the providers name in the info pane if an existing medical provider entry is being edited/updated.

PV60_02 (PV1090)

BLAISE NAME: FacMPStrt1
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (EV)
Question Text:

([I was not able to find that provider in my directory. Please give me the name, street address, city, state, zip code, and phone number of the ((hospital/provider/facility) where (you/(PERSON)) received care / place that provided home care to (you/(PERSON))/place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health).])
What is the street address?
ENTER STREET ADDRESS.

Responses:

1 PV60_03 (PV1095)
REFUSED RF PV60_03 (PV1095)
DON?T KNOW DK PV60_03 (PV1095)

Display Instructions:

Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health).? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?(hospital/provider/facility) where (you/(PERSON)) received care? if PV section was launched from the EV section and the event type is not HH. Display ?place that provided home care to (you/(PERSON))? if PV section was launched from the EV section and the event type is HH. Display ?place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health? if PV section was launched from AC section.
Display ?hospital? if event type is HS. Display ?provider? if event type is MV. Otherwise, display ?facility?.
Display ?hospital? if PV section was launched from the EV section and the event type is HS. Display ?provider? if PV section was launched from the EV section and the event type is MV. Display ?facility? if PV section was launched from the EV section and the event type is ER, OP, or IC. Otherwise, display ?place?.
Prefill the provider?s street address in the info pane if an existing medical provider entry is being edited/updated.

PV60_03 (PV1095)

BLAISE NAME: FacMPStrt2
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME) (EV)
Question Text:

([I was not able to find that provider in my directory. Please give me the name, street address, city, state, zip code, and phone number of the ((hospital/provider/facility) where (you/(PERSON)) received care/place that provided home care to (you/(PERSON))/ place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health).])
ENTER BUILDING OR ADDITIONAL ADDRESS INFORMATION, AS NECESSARY. IF NONE, PRESS ENTER.

Responses:

1 PV60_04 (PV1100)
EMPTY Empty PV60_04 (PV1100)
REFUSED RF PV60_04 (PV1100)
DON?T KNOW DK PV60_04 (PV1100)

Display Instructions:

Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health).? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?(hospital/provider/facility) where (you/(PERSON)) received care? if PV section was launched from the EV section and the event type is not HH. Display ?place that provided home care to (you/(PERSON))? if PV section was launched from the EV section and the event type is HH. Display ?place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health? if PV section was launched from AC section.
Display ?hospital? if event type is HS. Display ?provider? if event type is MV. Otherwise, display ?facility?.
Display ?hospital? if PV section was launched from the EV section and the event type is HS. Display ?provider? if PV section was launched from the EV section and the event type is MV. Display ?facility? if PV section was launched from the EV section and the event type is ER, OP, or IC. Otherwise, display ?place?.
Prefill the provider?s second street address, if available, in the info pane if an existing medical provider entry is being edited/updated.
Prefill the provider?s name in the info pane in an existing medical provider entry is being edited/updated.

PV60_04 (PV1100)

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

Responses:

1 PV60_05 (PV1105)
REFUSED RF PV60_05 (PV1105)
DON?T KNOW DK PV60_05 (PV1105)

Display Instructions:

Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health).? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?(hospital/provider/facility) where (you/(PERSON)) received care? if PV section was launched from the EV section and the event type is not HH. Display ?place that provided home care to (you/(PERSON))? if PV section was launched from the EV section and the event type is HH. Display ?place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health? if PV section was launched from AC section.
Display ?hospital? if event type is HS. Display ?provider? if event type is MV. Otherwise, display ?facility?.
Display ?hospital? if PV section was launched from the EV section and the event type is HS. Display ?provider? if PV section was launched from the EV section and the event type is MV. Display ?facility? if PV section was launched from the EV section and the event type is ER, OP, or IC. Otherwise, display ?place?.
Prefill the provider?s city in the info pane if an existing medical provider entry is being edited/updated.

PV60_05 (PV1105)

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

Responses:

1 PV60_06 (PV1110)
REFUSED RF PV60_06 (PV1110)
DON?T KNOW DK PV60_06 (PV1110)

Programmer Instructions:

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

Display Instructions:

Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health).? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?(hospital/provider/facility) where (you/(PERSON)) received care? if PV section was launched from the EV section and the event type is not HH. Display ?place that provided home care to (you/(PERSON))? if PV section was launched from the EV section and the event type is HH. Display ?place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health? if PV section was launched from AC section.
Display ?hospital? if event type is HS. Display ?provider? if event type is MV. Otherwise, display ?facility?.
Display ?hospital? if PV section was launched from the EV section and the event type is HS. Display ?provider? if PV section was launched from the EV section and the event type is MV. Display ?facility? if PV section was launched from the EV section and the event type is ER, OP, or IC. Otherwise, display ?place?.
Prefill the provider?s state in the info pane if an existing medical provider entry is being edited/updated.

PV60_06 (PV1110)

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

([I was not able to find that provider in my directory. Please give me the name, street

address, city, state, zip code, and phone number of the ((hospital/provider/facility) where (you/(PERSON)) received care / place that provided home care to (you/(PERSON))/place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health).])
What is the zip code?
ENTER ZIP CODE.

Responses:

1 PV60_07 (PV1115)
REFUSED RF PV60_07 (PV1115)
DON?T KNOW DK PV60_07 (PV1115)

Programmer Instructions:

Display Instructions:

Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health).? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?(hospital/provider/facility) where (you/(PERSON)) received care? if PV section was launched from the EV section and the event type is not HH. Display ?place that provided home care to (you/(PERSON))? if PV section was launched from the EV section and the event type is HH. Display ?place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health? if PV section was launched from AC section.
Display ?hospital? if event type is HS. Display ?provider? if event type is MV. Otherwise, display ?facility?.
Display ?hospital? if PV section was launched from the EV section and the event type is HS. Display ?provider? if PV section was launched from the EV section and the event type is MV. Display ?facility? if PV section was launched from the EV section and the event type is ER, OP, or IC. Otherwise, display ?place?.
Prefill the provider?s zip code in the info pane if an existing medical provider entry is being edited/updated.

PV60_07 (PV1115)

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

Responses:

1
REFUSED RF
DON?T KNOW DK

Programmer Instructions:

Display Instructions:

Display PV60_01, PV60_02, PV60_03, PV60_04, PV60_05, PV60_06 and PV60_07 on the same form pane.
Display ?I was not able to find... advice about (your/his/her) health).? in brackets and grayed-out text if a new provider is being added to the RU medical provider roster. Otherwise, use a null display.
Display ?(hospital/provider/facility) where (you/(PERSON)) received care? if PV section was launched from the EV section and the event type is not HH. Display ?place that provided home care to (you/(PERSON))? if PV section was launched from the EV section and the event type is HH. Display ?place (you/(PERSON)) usually (go/goes) if (you/he/she) (are/is) sick or (need/needs) advice about (your/his/her) health? if PV section was launched from AC section.
Display ?hospital? if event type is HS. Display ?provider? if event type is MV. Otherwise, display ?facility?. Display ?hospital? if PV section was launched from the EV section and the event type is HS. Display ?provider? if PV section was launched from the EV section and the event type is MV. Display ?facility? if PV section was launched from the EV section and the event type is ER, OP, or IC. Otherwise, display ?place?.
Prefill the provider?s telephone number in the info pane if an existing medical provider entry is being edited/updated.

PV70 (PV1130)

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

(If it will help you remember the details, I can enter the name of the particular medical doctor or health care provider (you/(PERSON)) saw or talked to, or the particular department (you/(PERSON)) visited / If there is a particular medical doctor or health care professional that (you/(PERSON)) (see/sees) at (PROVIDER), please give me that name. ).
(Previously, we have recorded ((PROVIDER DOCTOR OR DEPT)1, (PROVIDER DOCTOR OR DEPT)2, (PROVIDER DOCTOR OR DEPT)3, (PROVIDER DOCTOR OR DEPT)4, (PROVIDER DOCTOR OR DEPT)N) as health care providers or departments associated with (PROVIDER).) TO ADD A NEW DOCTOR OR DEPARTMENT, PRESS CTRL-A.
(DO NOT SELECT OR ADD A DEPARTMENT AS A USUAL SOURCE OF CARE PROVIDER.)
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(VISIT/USUAL SOURCE OF CARE) NOT LINKED TO SPECIFIC DOCTOR 0
(PROVIDER DOCTOR OR DEPT)1 1
(PROVIDER DOCTOR OR DEPT)2 2
(PROVIDER DOCTOR OR DEPT)3 3
(PROVIDER DOCTOR OR DEPT)4 4
(PROVIDER DOCTOR OR DEPT)N 5

Programmer Instructions:

If the provider roster section was launched from the EV section, return to the EV section.
If the provider roster section was launched from the AC section, return to the AC section.
Hard Check:
If CTRL-E is pressed for a doctor/department that was not added at the current question, display the following error message: " THIS DOCTOR/DEPARTMENT CAN?T BE EDITED. ONLY DOCTORS/DEPARTMENTS ADDED AT THE CURRENT QUESTION CAN BE EDITED.?
If CTRL-D is pressed for a doctor/department that was not added at the current question, display the following error message: " THIS DOCTOR/DEPARTMENT CAN?T BE DELETED. ONLY DOCTORS/DEPARTMENTS ADDED AT THE CURRENT QUESTION CAN BE DELETED.?
Roster 3 behavior:
Single select allowed.
Add allowed.
Delete is allowed for roster entries added at the current question.
Edit is allowed for roster entries added at the current question.

Display Instructions:

Roster 1 ? Report
Roster Definition:
Display the doctors and departments linked to this facility provider pair. For ?PROVIDER DOCTOR OR DEPT? display the doctors first and last name or the department name (Note that doctors name and department name are stored in the same variable).
Roster filter:
None. Display all doctors and departments
Roster 3 ? add/edit/delete allowed
Roster Definition:
Display the doctors and departments linked to this facility provider pair. For ?PROVIDER DOCTOR OR DEPT? display the doctors first and last name or the department name.
Roster filter:
None. Display all doctors and departments
Display ?If there is a particular medical doctor or health care professional that (you/(PERSON)) (see/sees) at (PROVIDER), I can enter that name now.? if the provider roster section was launched from the access to care section.
Otherwise, display ?If it will help you remember the details, I can enter the name of the particular medical doctor or health care provider (you/(PERSON)) saw or talked to, or the particular department (you/(PERSON)) visited?.
Display ?PREVIOUSLY, WE HAVE...WITH (PROVIDER)? if the provider roster section was not launched from the access to care section and there is at least one doctor/department entry on the roster. Otherwise, use a null display. Display the interviewer instruction, ?DO NOT SELECT OR ADD A DEPARTMENT AS A USUAL SOURCE OF CARE PROVIDER? only if the provider roster section was launched from the Access to Care section, otherwise use a null display
When CTRL-A selected, display the following customized question wording in the pop-up:
?Please give me the name of the (doctor or department/provider).
VERIFY SPELLING?
Display "doctor or department" if the provider roster section was launched from the event roster section. Display "provider" if the provider section was launched from the access to care section.
Display "USUAL SOURCE OF CARE" if PV30LU was asked (PV section was launched from Access to Care). Otherwise, display "VISIT".

PV80 (PV1135)

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

Can you please give me the name of the dental provider or dental practice (you/PERSON) visited?
VERIFY PROVIDER NAME BEFORE SELECTING.
TO ADD A NEW DENTAL PROVIDER, PRESS CTRL-A.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(DENTAL PROVIDER NAME)1 1
(DENTAL PROVIDER NAME)2 2
(DENTAL PROVIDER NAME)3 3
(DENTAL PROVIDER NAME)4 4
(DENTAL PROVIDER NAME)N 5

Programmer Instructions:

Note: MPTp equal to Facility for providers added to PV80 (dental providers)
Return to the Event Roster section.
Hard Check:
If CTRL-E is pressed for a provider that was not added at the current question, display the following error message: " THIS PROVIDER CAN?T BE EDITED. ONLY PROVIDERS ADDED AT THE CURRENT QUESTION CAN BE EDITED.?
If CTRL-D is pressed for a provider that was not added at the current question, display the following error message: " THIS PROVIDER CAN?T BE DELETED. ONLY PROVIDERS ADDED AT THE CURRENT QUESTION CAN BE DELETED.?
Roster behavior:
Single select allowed.
Add allowed.
Delete is allowed for roster entries added at the current question.
Edit is allowed for roster entries added at the current question.

Display Instructions:

Roster 3 ? add/edit/delete allowed
Roster Definition:
Display the RU dental providers roster.
Roster filter:
None. Display all dental providers.
When CTRL-A selected, display the following customized question wording in the pop-up:
?Please give me the name of the dental provider or dental practice.
VERIFY SPELLING?

Quality Supplement (QS) Section

BOX_00 (QS1000)

Route Details:

01 Box equal to BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60
02 Loop equal to LOOP_10
03 End Loop equal to END_LP10
04 Single Select equal to QS20_01, QS20_02, QS20_04, QS20_05, QS20_06
20 OS Text Field equal to QS20_03, QS20_07
24 Information Screen equal to QS10, QS20_08

Programmer Instructions: Placeholder for question types.

BOX_10 (QS1005)

Route Details:

Context header display instructions:
Display RU member?s first, middle, and last name (Person.FullName)

BOX_20 (QS1010)

Route Details:

Note: AHRQ will determine what hard copy materials are distributed and followed-up on during each round. This section needs to be configurable to allow for the addition of other supplemental materials as they are needed in future panels.
The QS section is currently asked in Rounds 2 ? 5. If it is Round 1, continue to the next section in the questionnaire.
DCS Collection Rules:
DCS: Distribution only in Rounds 3 and 5 for all panel years.
SAQ Collection Rules for Spring 2018 only:
SAQ (core + CAHPS): Follow-up in Panel 22, Round 3 and Panel 21, Round 5.
SAQ Collection Rules Beginning in Fall 2018 (P23R2/P22R4) and Later:
SAQ (core + CAHPS): Distribution in Rounds 2 and follow-up in Round 3 for Panels whose R1 collection occurred in an odd year (FirstPanYear equal to odd).
SAQ (core + CAHPS): Distribution in Rounds 4 and follow-up in Round 5 for Panels whose R1 collection occurred in an even year (FirstPanYear equal to even).
PSAQ (core + prevention): Distribution in Rounds 2 and follow-up in Round 3 for Panels whose R1 collection occurred in an even year (FirstPanYear equal to even).
PSAQ (core + prevention): Distribution in Rounds 4 and follow-up in Round 5 for Panels whose R1 collection occurred in an odd year (FirstPanYear equal to odd).

BOX_30 (QS1015)

Route Details:

If at least one RU member where
DCSFlag YES
OR
SAQFlag equal to YES
OR
SAQFlagFlwUp equal to YES
OR
PSAQFlag equal to YES
OR
PSAQFlagFlwUp equal to YES
Continue with QS10.
Otherwise, go to BOX_60.

Programmer Instructions:

Determine the number of DCS?s and (P)SAQ?s required for this household: Set flags as described for each RU member that meets the required criteria.
DCS (rounds 3 and 5)
-If Round 3 or Round 5
AND
-person is equal to or greater than 18 years of age or in age categories 4-9
AND
-person is a current RU member (included in person array)
AND
-person is Key (CtrlPersKey equal to Yes)
AND
-person is not deceased (PersRndStatus ? Deceased)
AND
- 'DIABETES' is on person's-medical-conditions-roster and was created in the PE section (in any round), then set Person.DCSFlag equal to YES.
SAQ (rounds 2 and 4, core+CAHPS)
-[(If round 2 and panel year is odd (FirstPanYear equal to odd)) OR (If round 4 and panel year is even (FirstPanYear equal to even))]
AND
-person is a current RU member (included in person array)
AND
- person is Key (CtrlPersKey equal to Yes)
AND
-person is not deceased or institutionalized (PersRndStatus ? Deceased or institutionalized)
AND
-person is in the RU at the round 2 or 4 interview date (EndRefDt equal to EndRefM, EndRefD, EndRefY).
AND
-RU member is equal to or greater than 18 years of age or in age categories 4-9 on July 1, (YEAR ), where ?YEAR? is the first calendar year of the panel (FirstPanYear), if round 2 or on July 1, (YEAR ), where ?YEAR? is the second calendar year of the panel (SecondPanYear), if round 4, or has turned 18 between July 1, (YEAR ), where ?YEAR? is the first calendar year of the panel, and the date of the interview if round 2, or July 1, (year ), where ?YEAR? is the second calendar year of the panel, and the date of the interview if round 4, then set Person.SAQFlag equal to YES.
SAQ Follow-up (rounds 3 and 5, core+CAHPS)
-[(If Panel 22, Round 3 or Panel 21, Round 5) or (If round 3 and panel year is odd (FirstPanYear equal to odd)) OR (If round 5 and panel year is even (FirstPanYear equal to even))]
AND
-person is a current RU member (included in person array)
AND
-person was prompted for an SAQ in Round 2 (if Round 3) or 4 (if Round 5) and that SAQ is outstanding [PL_Person.SAQRecCtrlStatus equal to ?3? (REFUSED), ?5? (BLANK), ?6? (WRONG TYPE), ?7? (WRONG YEAR USED), '8' (NOT RECEIVED)], then set Person.SAQFlagFlwUp equal to YES.
PSAQ (rounds 2 and 4, core+prevention)
-[(If round 2 and panel year is even (FirstPanYear equal to even)) OR (If round 4 and panel year is odd (FirstPanYear equal to odd))]
AND
-person is a current RU member (included in person array)
AND
- person is Key (CtrlPersKey equal to Yes)
AND
-person is not deceased or institutionalized (PersRndStatus ? Deceased or institutionalized)
AND
-person is in the RU at the round 2 or 4 interview date (EndRefDt equal to EndRefM, EndRefD, EndRefY).
AND
-RU member is equal to or greater than 18 years of age or in age categories 4-9 on July 1, (YEAR ), where ?YEAR? is the first calendar year of the panel (FirstPanYear), if round 2 or on July 1, (YEAR ), where ?YEAR? is the second calendar year of the panel (SecondPanYear), if round 4, or has turned 18 between July 1, (YEAR ), where ?YEAR? is the first calendar year of the panel, and the date of the interview if round 2, or July 1, (year ), where ?YEAR? is the second calendar year of the panel, and the date of the interview if round 4, then set Person.PSAQFlag equal to YES.
PSAQ Follow-up (rounds 3 and 5, core+prevention)
-[(If round 3 and panel year is even (FirstPanYear equal to even)) OR (If round 5 and panel year is odd (FirstPanYear equal to odd))]
AND
-person is a current RU member (included in person array)
AND
-person was prompted for an PSAQ in Round 2 (if Round 3) or 4 (if Round 5) and that PSAQ is outstanding [PL_Person.PSAQRecCtrlStatus equal to ?3? (REFUSED), ?5? (BLANK), ?6? (WRONG TYPE), ?7? (WRONG YEAR USED), '8' (NOT RECEIVED)], then set Person.PSAQFlagFlwUp equal to YES.

QS10 (QS1020)

BLAISE NAME: FormMatrl
Question Text:

FOR THIS SECTION, YOU WILL NEED THE FOLLOWING HARDCOPY MATERIALS FOR THIS HOUSEHOLD:
( (NUMBER 1 ) A SURVEY ABOUT YOUR DIABETES CARE FORMS (DCS) )
( (NUMBER 2 ) YOUR HEALTH AND HEALTH OPINION FORMS (SAQ) )
( (NUMBER 3 ) YOUR HEALTH AND HEALTH OPINION FORMS (PSAQ-MALE equal to BLUE) )
( (NUMBER 4 ) YOUR HEALTH AND HEALTH OPINION FORMS (PSAQ-FEMALE equal to PURPLE) )
PLEASE PULL THESE MATERIALS OUT NOW.
PRESS 1 AND ENTER TO CONTINUE.

Responses:

CONTINUE 1 LOOP_10 (QS1025)

Display Instructions:

Display ? (NUMBER 1 ) ... (DCS)? if at least one person where Person.DCSFlag equal to Yes. Otherwise, use a null display. For ?NUMBER 1?, display the count of Person.DCSFlag equal to Yes for this RU.
Display ? (NUMBER 2 ) ... (SAQ)? if at least one person where Person.SAQFlag equal to Yes or Person.SAQFlagFlwUp equal to Yes. Otherwise, use a null display. For ?NUMBER 2?, display the count of Person.SAQFlag equal to Yes and Person.SAQFlagFlwUp equal to Yes for this RU.
Display ? (NUMBER 3 ) ... (PSAQ-MALE equal to BLUE)? if at least one male RU member where Person.PSAQFlag equal to Yes or Person.PSAQFlagFlwUp equal to Yes. Otherwise, use a null display. For ?NUMBER 3?, display the count of male RU members where Person.PSAQFlag equal to Yes or Person.PSAQFlagFlwUp equal to Yes for this RU.
Display ? (NUMBER 4 ) ... (PSAQ-FEMALE equal to PURPLE)? if at least one female (or gender equal to DK/RF)
RU member where Person.PSAQFlag equal to Yes or Person.PSAQFlagFlwUp equal to Yes. Otherwise, use a null display. For ?NUMBER 4?, display the count of female (or gender equal to DK/RF) RU members where Person.PSAQFlag equal to Yes or Person.PSAQFlagFlwUp equal to Yes for this RU.

LOOP_10 (QS1025)

Route Details:

For each element in the RU-members-roster, ask BOX_40 - END_LP10.
Loop definition: LOOP_10 distributes all hardcopy materials to each eligible RU member. This loop cycles on persons who meet the following conditions:
RU member has at least one of the following flags set for in the current round:
Person.DCSFlag equal to YES
OR
Person.SAQFlag equal to YES
OR
Person.SAQFlagFlwUp equal to YES
OR
Person.PSAQFlag equal to YES
OR
Person.PSAQFlagFlwUp equal to YES
Continue with BOX_40

BOX_40 (QS1030)

Route Details:

Continue with QS20_01 if Person.DCSFlag equal to YES. Otherwise, go to QS20_04.

Display Instructions:

Each flag that has been set should display a row for the corresponding hardcopy questionnaire.
-Display ?DCS? on Col #1, Row #1 as an uneditable, protected cell
-Display ?SAQ? on Col#1, Row #2 as an uneditable, protected cell
-Display ?PSAQ? on Col#1, Row #3 as an uneditable, protected cell
Row #1 should display as active if Person.DCSFlag-YES.
Row #2 should display as active if Person.SAQFlag equal to Yes or Person.SAQFlwUpFlag equal to YES.
Row #3 should display as active if Person.PSAQFlag equal to Yes or Person.PSAQFlwUpFlag equal to YES.
(NOTE: An RU member will never have BOTH the SAQ and PSAQ active in the same round.)
Roster Report 1
Format the form pane column headers as follows:
Roster Definition: Display the hardcopy materials required for this RU member set at BOX_30
Col#2 Header: DCS Self or Proxy (QS20_01)
Col#3 Header: Proxy Reason (QS20_02)
Col#4 Header: Proxy Other (QS20_03)
Col#5 Header: (SAQ/PSAQ ) Prompt (QS20_04)
Col#6 Header: Status of (SAQ/PSAQ ) (QS20_05)
Col#7 Header: Reason for Refusal (QS20_06)
Col#8 Header: Other Reason for Refusal (QS20_07)
Col#9 Header: Distribute DCS/ (SAQ/PSAQ ) (QS20_08)

Programmer Instructions:

For each flag RU member has set (Person.DCSFlag equal to YES, Person.SAQFlag equal to YES, Person.SAQFlagFlwUp equal to YES, Person.PSAQFlag equal to YES, Person.PSAQFlagFlwUp equal to YES) configure the QS20 grid in the following manner:
The grid should be Preloaded Grid Type 1: forced navigation, including QS20_01, QS20_02, QS20_03, QS20_04, QS20_05, QS20_06, QS20_07, and QS20_08.
NOTE TO PROGRAMMERS: This grid needs to be configurable to accommodate the addition of other required hardcopy materials as requested by the client in future panels.

QS20_01 (QS1035)

BLAISE NAME: FormType
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME )

Question Text:

(In this next section, I will be distributing (and collecting ) some hardcopy materials for (you and ) members of your household. Let?s start with (you/ (PERSON ) )./I now have some hard copy materials for (you/ (PERSON ) ). )
(During an earlier interview, it/It ) was mentioned that (you/ (PERSON ) ) (have/has ) diabetes. To obtain more information on the care of adults with diabetes, we have a short questionnaire for (you/him/her ).
DETERMINE IF SELF OR PROXY DIABETES CARE SUPPLEMENT (DCS) SHOULD BE DISTRIBUTED: SELF DCS: FOR ANY CURRENT RU MEMBER (18 YEARS OR OLDER) WHO HAS DIABETES. PROXY DCS: FOR ANY RU MEMBER (18 OR OLDER) WHO IS INSTITUTIONALIZED, OR OTHERWISE INCAPACITATED.
ENTER TYPE OF DCS DISTRIBUTED NECESSARY FOR (PERSON ). (ACTION: PERSON IS INSTITUTIONALIZED AND MAY REQUIRE PROXY DCS. )
CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.

Responses:

SELF 1 QS20_08 (QS1070)
PROXY 2 QS20_02 (QS1040)

Programmer Instructions:

RF/DK not allowed.

Display Instructions:

Display ?CURRENT? if the person being asked about is a current RU member (Display ?CURRENT? if the person being asked about is a current RU member (person included on person array) and is not institutionalized or deceased (PersRndStatus ? Institutionalized or Deceased). Display ?INSTITUTIONALIZED? if the person being asked about is institutionalized (PersRndStatus equal to Institutionalized) for the current round.
Display ?In this next section, I will be distributing (and collecting ) some hardcopy materials for (you and ) members your household. Let?s start with (you/ (PERSON ) ).? If first cycle of Loop_10. Otherwise, display ?I now have some hard copy materials for (you/ (PERSON ) ).?
Display ?and collecting? if at least one person in the RU has Person.SAQFlag equal to YES, or Person.SAQFlagFlwUp equal to YES or Person.PSAQFlag equal to YES or Person.PSAQFlagFlwUp equal to YES in the current round. Otherwise, use a null display.
Display ?you and? if the respondent has a Person.DCSFlag equal to YES, or Person.SAQFlag equal to YES, or Person.SAQFlagFlwUp equal to YES or Person.PSAQFlag equal to YES or Person.PSAQFlagFlwUp equal to YES in the current round. Otherwise, use a null display.
Display ?During an earlier interview, it? if diabetes was not created during the current round for the person being looped on. Display ?It? if diabetes created during the current round for the person being looped on.
Display ?ACTION: PERSON IS INSTITUTIONALIZED AND MAY REQUIRE PROXY DCS.? if the person being asked about is institutionalized (PersRndStatus equal to Institutionalized) for the current round. Otherwise, use a null display.
The label ACTION: should be displayed in the traditional interviewer instruction font size ? but in red. The text after ?ACTION? should be displayed in the traditional blue interviewer instruction size and color.

QS20_02 (QS1040)

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

ENTER REASON FOR PROXY DCS.

Responses:

INSTITUTIONALIZED 2 QS20_08 (QS1070)
OTHER 3 QS20_03 (QS1045)

Programmer Instructions: RF/DK not allowed.
Display Instructions:

QS20_03 (QS1045)

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

SPECIFY OTHER REASON FOR PROXY DCS:

Responses: 1 QS20_08 (QS1070)
Programmer Instructions: RF/DK not allowed.
Display Instructions:

QS20_04 (QS1050)

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

(In this next section, I will be distributing (and collecting ) some hardcopy materials for (you and ) members of your household. Let?s start with (you/ (PERSON ) )./I now have some hard copy materials for (you/ (PERSON ) ). )
(Now ) I would like to ask (you/ (PERSON ) ) to complete a brief survey about health and health opinions. (You/ (PERSON ) ) may have already received this in the mail.
I want to check if (you/ (PERSON ) ) completed that questionnaire already or (need/needs ) a replacement.
( (SAQ/PSAQ ) STATUS FROM PREVIOUS ROUND: (PREVIOUS ROUND STATUS -40 ) )
(COLLECT (MALE (BLUE)/FEMALE (PURPLE) ) PSAQ. IF INCORRECT COLOR PSAQ COMPLETED, CODE ?2? (NEEDS REPLACEMENT) TO FILL OUT CORRECT COLOR PSAQ. )
(PERSON IS (DECEASED/INSTITUTIONALIZED/PARTIALLY ELIGIBLE - MOVED FROM RU ). IF (SAQ/PSAQ ) ALREADY COMPLETED BECAUSE IT WAS MAILED TO HOUSEHOLD, COLLECT IT. HOWEVER, IF NOT ALREADY COMPLETED, CODE ?3? AND DO NOT DISTRIBUTE NEW (SAQ/PSAQ ). )
(CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON. )

Responses:

COMPLETED /RETURNING QUESTIONNAIRE 1 QS20_05 (QS1055)
NEEDS REPLACEMENT 2 QS20_08 (QS1070)
(NOT COMPLETED-NO REPLACEMENT NECESSARY ) 3 BOX_50 (QS1075)

Programmer Instructions: RF/DK not allowed.
Display Instructions:

Display ?In this next section, I will be distributing (and collecting ) some hardcopy materials for (you and ) members your household. Let?s start with (you/ (PERSON ) ).? If first cycle of Loop_10 and QS20_01 was not on route for the person being looped on.
Display ?I now have some hard copy materials for (you/ (PERSON ) ).? If not first cycle of Loop_10 and QS20_01 was not on route for the person being looped on. Otherwise (i.e., QS20_01 was on route), use a null display.
Display ?and collecting? if at least one person in the RU has Person.SAQFlag equal to YES, or Person.SAQFlagFlwUp equal to YES or Person.PSAQFlag equal to YES or Person.PSAQFlagFlwUp equal to YES in the current round. Otherwise, use a null display.
Display ?you and? if the respondent has a Person.SAQFlag equal to YES, or Person.SAQFlagFlwUp equal to YES or Person.PSAQFlag equal to YES or Person.PSAQFlagFlwUp equal to YES in the current round. Otherwise, use a null display.
Display ?Now? if QS20_01 was on route for the person being looped on. Otherwise, use a null display.
Display " (SAQ/PSAQ ) STATUS FROM PREVIOUS ROUND: (PREVIOUS ROUND STATUS -40 )? if Round 3 or 5 and person was prompted for an SAQ/PSAQ in Round 2 or 4 and that SAQ/PSAQ is outstanding (Person.SAQFlagFlwUp equal to YES or Person.PSAQFlagFlwUp equal to Yes). Otherwise, use a null display.
Display ?SAQ? if Person.SAQFlag equal to YES or Person.SAQFlagFlwUp equal to YES for the person being looped on.
Display ?PSAQ? if Person.PSAQFlag equal to YES or Person.PSAQFlagFlwUp equal to YES for the person being looped on.
For ?PREVIOUS ROUND STATUS-40?, display the following text:
If PL_Person.SAQRecCtrlStatus equal to 3 display 'REFUSED'.
If PL_Person.SAQRecCtrlStatus equal to 5 display 'BLANK'.
If PL_Person.SAQRecCtrlStatus equal to 6 display 'WRONG TYPE'.
If PL_Person.SAQRecCtrlStatus equal to 7 display 'WRONG YEAR USED'.
If PL_Person.SAQRecCtrlStatus equal to 8 display 'NOT RECEIVED'.
If PL_Person.PSAQRecCtrlStatus equal to 3 display 'REFUSED'.
If PL_Person.PSAQRecCtrlStatus equal to 5 display 'BLANK'.
If PL_Person.PSAQRecCtrlStatus equal to 6 display 'WRONG TYPE'.
If PL_Person.PSAQRecCtrlStatus equal to 7 display 'WRONG YEAR USED'.
If PL_Person.PSAQRecCtrlStatus equal to 8 display 'NOT RECEIVED'.
Display ?COLLECT (MALE (BLUE)/FEMALE (PURPLE) ) PSAQ. IF INCORRECT COLOR PSAQ COMPLETED, CODE ?2? (NEEDS REPLACEMENT) TO FILL OUT CORRECT COLOR PSAQ..? If Person.PSAQFlag equal to YES or Person.PSAQFlagFlwUp equal to YES for the person being looped on. Otherwise, use a null display.
Display ?MALE (BLUE)? if person being looped on is male. Otherwise, display ?FEMALE (PURPLE)?.
If Person.SAQFlagFlwUp equal to YES or Person.PSAQFlagFlwUp equal to YES and (person is NOT in the RU at the round 3 or 5 interview date (EndRefDt ? EndRefM, EndRefD, EndRefY)), then display FI instruction ?PERSON?NEW DOCUMENT.? and response option ?3? (NOT COMPLETED, NO REPLACEMENT NECESSARY). Otherwise, use a null display.
Display ?DECEASED? if PersRndStatus equal to Deceased. Display ?INSTITUTIONALIZED? if PersRndStatus equal to Institutionalized. Otherwise, display ?PARTIALLY ELIGIBLE - MOVED FROM RU.?
Display ?CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.? If QS20_01 was not on route for the person being looped on. Otherwise, use a null display.

QS20_05 (QS1055)

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

COLLECT (PERSON )?S COMPLETED (SAQ/PSAQ ).

Responses:

COMPLETED AND GIVEN TO INTERVIEWER 1 BOX_50 (QS1075)
(NOT COMPLETED, WILL PICK UP AT A LATER DATE ) 2 BOX_50 (QS1075)
(NOT COMPLETED, WILL MAIL TO OFFICE ) 3 BOX_50 (QS1075)
(MAILED TO SAQ RESPONDENT ) 4 BOX_50 (QS1075)
REFUSED TO COMPLETE (NO FORM LEFT) 5 QS20_06 (QS1060)
NOT COMPLETED, COLLECT UPDATED STATUS AT RESPONDENT FORM SECTION 6 BOX_50 (QS1075)
OTHER 91

Programmer Instructions: RF/DK not allowed.
Display Instructions:

Do not display response categories 2, 3, or 4. Those are reserved for the Respondent Form (RF) Section.
Display ?SAQ? if Person.SAQFlag equal to YES or Person.SAQFlagFlwUp equal to YES for the person being looped on.
Display ?PSAQ? if Person.PSAQFlag equal to YES or Person.PSAQFlagFlwUp equal to YES for the person being looped on.

QS20_06 (QS1060)

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

SELECT MAIN REASON FOR REFUSAL:

Responses:

TOO BUSY/NOT INTERESTED 1 BOX_50 (QS1075)
TOO PERSONAL/SENSITIVE INFORMATION 2 BOX_50 (QS1075)
TOO MUCH OF A PHYSICAL/MENTAL HARDSHIP 3 BOX_50 (QS1075)
HAS ALREADY GIVEN ENOUGH INFORMATION 4 BOX_50 (QS1075)
WANTS MORE INFORMATION 5 BOX_50 (QS1075)
NOT INTERESTED 6 BOX_50 (QS1075)
NO REASON GIVEN 7 BOX_50 (QS1075)
OTHER 91 QS20_07 (QS1065)

Programmer Instructions: RF/DK not allowed.
Display Instructions:

QS20_07 (QS1065)

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

ENTER OTHER REASON FOR REFUSAL:

Responses: 1 END_LP10 (QS1080)
Programmer Instructions: RF/DK not allowed.
Display Instructions:

QS20_08 (QS1070)

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

(PREPARE (SELF/PROXY ) DIABETES CARE SUPPLEMENT (DCS) FOR (PERSON ): WRITE IN PERSON?S NAME, DOB, PID, AND RUID.
NAME: (FIRST NAME ) (MIDDLE NAME ) (LAST NAME )
DOB: (MM/DD/YYYY ) PID: (PID )
RU ID: (RU ID )
STATUS: (CURRENT/INSTITUTIONALIZED )
HAND PREPARED (SELF/PROXY ) DCS TO RESPONDENT AND SAY:
We hope that (you/ (PERSON ) )/you or someone else in the family ) would be able to fill out this short questionnaire on the care (you/ (PERSON ) ) (get/gets ) for diabetes. (You/He/She ) can give it to me before I leave today, or I can pick it up later.
(PREPARE (MALE (BLUE)/FEMALE (PURPLE) ) (SAQ/PSAQ ) FOR (PERSON ) USING THE INFORMATION BELOW:
REGION: (REGION ) RU ID: (RU ID ) PID: (PID )
NAME: (FIRST NAME ) (MIDDLE NAME ) (LAST NAME )
DOB: (MM/DD/YYYY )
HAND PREPARED (SAQ/PSAQ ) TO RESPONDENT AND SAY:
We hope (you/ (PERSON ) ) will be able to fill out this short questionnaire about (health and health opinions/health choices ). (You/He/She ) can give it to me before I leave today, or I can pick it up later.
PRESS 1 AND ENTER TO CONTINUE.
HELP:F1

Responses: CONTINUE 1 BOX_50 (QS1075)
Programmer Instructions:

When asking about DCS for this RU member display ?PREPARE (SELF/PROXY ) DIABETES? or I can pick it up later.? Do not display the other fills on SAQ. When asking about SAQ use a null display.
Display 'SELF' and ' (you/ (PERSON ) )' if QS10_01 is coded ?1? (SELF).
Display 'PROXY' and 'you or someone else in the family' if QS10_01 is coded ?2? (PROXY).
Display date of birth for person being asked about for 'MM/DD/YYYY.' Display PID of person being asked about for 'PID'.
Display the RU ID for the current case for 'RUID'.
Display ?CURRENT? if the person being asked about is a current RU member (person included on person array) and is not institutionalized or deceased (PersRndStatus ? Institutionalized or Deceased).
Display ?INSTITUTIONALIZED? if the person being asked about is institutionalized (PersRndStatus equal to Institutionalized).
When asking about SAQ/PSAQ for this RU member display ?PREPARE (MALE (BLUE)/FEMALE (PURPLE) ) (SAQ/PSAQ )FOR (PERSON )?or I can pick it up later.?
Do not display the other fills on DCS. When asking about DCS use a null display.
Display region for the current case being asked about for ?REGION?. Display the RU ID for the current case for 'RUID'.
Display PID of RU member being asked about for 'PID'.
Display date of birth for RU member being asked about for 'MM/DD/YYYY.'
RF/DK not allowed.

Display Instructions:

When asking about the DCS, display all the fill text in bold black, ?FIRST NAME?, ?MIDDLE NAME?, ?LAST NAME?, ?MM/DD/YYYY?, ?PID?, ?RUID? ?CURRENT/INSTITUTIONALIZED?. All other text should adhere to the UI document specifications.
When asking about the SAQ/PSAQ, display all the fill text in bold black: ?REGION?, ?RUID?, ?PID? ?FIRST NAME?, ?MIDDLE NAME?, ?LAST NAME?, ?MM/DD/YYYY?. All other text should adhere to the UI document specifications.
Display ? (MALE (BLUE)/FEMALE (PURPLE) )? If Person.PSAQFlag equal to YES or Person.PSAQFlagFlwUp equal to YES for the person being looped on. Otherwise, use a null display.
Display ?MALE (BLUE)? if person being looped on is male. Otherwise, display ?FEMALE (PURPLE)?.
Display ?SAQ? if Person.SAQFlag equal to YES or Person.SAQFlagFlwUp equal to YES for the person being looped on.
Display ?PSAQ? if Person.PSAQFlag equal to YES or Person.PSAQFlagFlwUp equal to YES for the person being looped on.
"Display 'health and health opinions' when asking about the SAQ. Display 'health choices' when asking about PSAQ.

BOX_50 (QS1075)

Route Details:

If Row #1 (DCS) completed and Person.SAQFlag equal to Yes or Person.SAQFlagFlwUp equal to Yes or Person.PSAQFlag equal to Yes or Person.PSAQFlagFlwUp equal to Yes, go to QS20_04 to complete Row #2/Row #3 (SAQ/PSAQ) for this person.
If all rows and cells are completed for this person, continue with END_LP10.

END_LP10 (QS1080)

Route Details:

Cycle on the next RU member that meets the conditions of LOOP_10.
If no more RU members meet those criteria, continue with BOX_60.

BOX_60 (QS1085)

Route Details: Go to the next questionnaire section.

Reenumeration A (REA) Section
Fall 2018

BOX_00 (REA1000)

Route Details:

01 Box equal to 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_215, BOX_220, BOX_225, BOX_230, BOX_240, BOX_250
02 Loop equal to LOOP_10, LOOP_20, LOOP_30, LOOP_40
03 End Loop equal to END_LP10, END_LP20, END_LP30, END_LP40
04 Single Select equal to RE50, RE85, RE90, RE100, RE110, RE160, RE170, RE180, RE190, RE250, RE260, RE270, RE280, RE290, RE320DONE, RE330, RE340, RE350, RE360, RE370, RE380, RE410, RE420, RE425, RE440, RE470, RE480, RE520, RE540, RE560, RE580, RE590, RE600, RE610, RE620, RE630, RE650_06, RE650_07, RE680_06, RE680_07, RE720, RE740, RE760, RE770, RE790, RE800, RE810, RE830, RE850, RE860, RE870
05 Single Select with Display Roster equal to RE310, RE320, RE390, RE510
06 Single Select with Fill in Answer Text equal to RE490
07 Single Select with Add/Edit/Delete equal to RE500
10 Multiple Select with Fill in Answer Text equal to RE400
11 Multiple Select with Add/Edit/Delete equal to RE530, RE550, RE570
12 Address - Newly Collected equal to RE450_01, RE450_02, RE450_03, RE450_04, RE450_05,
RE450_06, RE840_01, RE840_02, RE840_03, RE840_04, RE840_05, RE840_06
13 Address-Preloaded equal to RE40_01, RE40_02, RE40_03, RE40_04, RE40_05, RE40_06, RE40_07
14 Regular Date Entry equal to RE120_01, RE120_02, RE120_03, RE200_01, RE200_02, RE200_03, RE210_01, RE210_02, RE210_03, RE220_01, RE220_02, RE220_03, RE230_01, RE230_02, RE230_03, RE240_01, RE240_02, RE240_03, RE300_01, RE300_02, RE300_03, RE430_01, RE430_02, RE430_03, RE730_01, RE730_02, RE730_03, RE780_01, RE780_02, RE780_03
19 Numeric Field equal to RE750
23 Text Field equal to RE710_01, RE710_02, RE710_03
24 Information Screen equal to RE10, RE20, RE30, RE130, RE140, RE150, RE460, RE640
25 Single Select - Preloaded equal to RE60, RE650_01, RE680_01
26 Regular Date Entry - Preloaded equal to RE70_01, RE70_02, RE70_03, RE650_02, RE650_03, RE650_04, RE680_02, RE680_03, RE680_04
27 Numeric Field - Preloaded equal to RE80, RE650_05, RE680_05
29 Single Select with Fill in Answer Text and Display Roster equal to RE820
Grid 1 equal to RE710_[1-3], RE720, RE730_[1-3], RE740, RE750, RE760, RE770.
Grid 2 equal to RE320, RE650_01, RE650_02, RE650_03, RE650_04, RE650_05, RE650_06, RE650_07, RE680_01, RE680_02, RE680_03, RE680_04, RE680_05, RE680_06, RE680_07
Roster 2 equal to RE400, RE490
Roster 3 equal to RE500, RE530, RE550, RE570

BOX_05 (REA1002)

Route Details:

Date definitions
Birth Date:
Begin: RU reference period end date - 120 years End: RU Reference Period End Date/Interview Date (RUEndM, RUEndD, RUEndY) Items: RE70_01, RE70_02, RE70_03, RE650_02, RE650_03, RE650_04, RE680_02, RE680_03, RE680_04, RE730_01, RE730_02, RE730_03
Hard Check: Date entered must be between (YEAR)-120 years where ?YEAR? is the current year and today?s date. If a date outside of this range is entered, display the following message: ?UNLIKELY RESPONSE. DATE CANNOT BE AFTER REFERENCE PERIOD END DATE OR BEFORE (YEAR-120). VERIFY WITH RESPONDENT AND RE-ENTER.?
Life Span:
Begin: Person's DOB (DOBD, DOBM, DOBY)
End: Person?s reference period end date (EndRefM, EndRefD, EndRefY)
Items: RE120_01, RE120_02, RE120_03, RE1110_01, RE1110_02, RE1110_03
Hard Check: Date entered must be between Person's DOB (DOBD, DOBM, DOBY) and 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 DATE OF BIRTH. VERIFY WITH RESPONDENT AND RE-ENTER.?
RU Life Span:
Begin: Person's DOB (DOBD, DOBM, DOBY)
End: RU Reference Period End Date/Interview Date (RUEndM, RUEndD, RUEndY)
Hard Check: Date entered must be between Person's DOB (DOBD, DOBM, DOBY) and the RU reference period end date/interview date (RUEndM, RUEndD, RUEndY). If a date outside of this range is entered, display the following message: DATE CANNOT BE AFTER REFERENCE PERIOD END DATE OR BEFORE PERSON?S DATE OF BIRTH. VERIFY WITH RESPONDENT AND RE-ENTER.?
RU Reference Period:
Begin: RU reference period begin date
End: RU reference period end date/ Interview Date (RUEndM, RUEndD, RUEndY)
Items: RE200_01, RE200_02, RE200_03, RE220_01, RE220_02, RE220_03, RE240_01, RE240_02, RE240_03, RE1090_01, RE1090_02, RE1090_03
Hard Check: Date entered must be between the RU reference period begin date and the RU reference period end date. If a date outside of this range is entered, display the following message: DATE CANNOT BE AFTER REFERENCE PERIOD END DATE OR BEFORE REFERENCE PERIOD BEGIN DATE. VERIFY WITH RESPONDENT AND RE-ENTER.?
Person?s Reference Period:
Begin: Person?s reference period begin date (BegRefM, BegRefD, BegRefY)
End: Person?s reference period end date (EndRefM, EndRefD, EndRefY)
Items: None
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.?

BOX_10 (REA1003)

Route Details:

Context header display instructions: display FULLNAME

BOX_20 (REA1005)

Route Details:

If Round 1 and RUType equal to Standard RU, go to RE10.
If Round 1 and RUType equal to New Standard RU, go to RE20.
If Round 1 and RUType equal to New Student RU, go to RE30.
Otherwise, go to RE40_01.

RE10 (REA1020)

Context Header:

(REFERENCE PERSON?S FIRST MIDDLE AND LAST NAME)

Question Text:

(As I mentioned earlier,) (your family/(PERSON)'s household) took part in the National Health Interview Survey on (MONTH DAY, YEAR OF NHIS INTERVIEW) and, at that time, the Census Bureau interviewer mentioned that (you/(his/her) family) might be contacted again for another health related survey.
IF NEEDED, READ ALL OR PART OF THE FOLLOWING:
This survey, the Medical Expenditure Panel Survey, is also for the Department of Health and Human Services [specifically, the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention (CDC)]. The information you provide will be kept completely confidential and private as required by law.
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 RE40_01 (REA1080)
Programmer Instructions:

In Round 1, the name in the context header is the full name of the NHIS reference person for the current RU being interviewed. (Preload.NewRefPersPID)
Display Instructions: Display 'your family' and 'you' if ST30 is coded '1' (RU MEMBER).
Display '(PERSON)'s) household' and '(his/her) family' if ST30 is coded '2' (PROXY APPROVED BY SUPERVISOR).
Display the date of NHIS interview (Preload.NHISDt) for (MONTH DAY, YEAR OF NHIS INTERVIEW).

RE20 (REA1025)

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

(As I mentioned earlier,) (you/(PERSON)) (were/was) a member of a household that took part in the National Health Interview Survey on (MONTH DAY, YEAR OF NHIS INTERVIEW) and, at that time, the Census Bureau interviewer mentioned that members of that household might be contacted again for another health related survey. Since (you/he/she) (are/is) no longer living with that household, we will interview this new household separately.
IF NEEDED, READ ALL OR PART OF THE FOLLOWING:
This survey, the Medical Expenditure Panel Survey, is also for the Department of Human Services [specifically, the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention (CDC)]. The information you provide will be kept completely confidential and private as required by law.
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 RE40_01 (REA1080)
Programmer Instructions:

The name of the reference person displayed in Context header is the full name of the oldest RU member for the current RU being interviewed. (This may or may not be the respondent. This can be an RU member newly merged to this brand new RU.)

Display Instructions:

Display the date of NHIS interview (Preload.NHISDt) for (MONTH, DAY, YEAR OF NHIS INTERVIEW).

RE30 (REA1030)

BLAISE NAME: R1REStartStuRU
Context Header: (REFERENCE PERSON?S FIRST MIDDLE AND LAST NAME)
Question Text:

(As I mentioned earlier,) my records show that (you/(PERSON)) were a member of a household that took part in the National Health Interview Survey on (MONTH DAY, YEAR OF NHIS INTERVIEW) and, at that time, the Census Bureau interviewer mentioned that (you/(PERSON)) might be contacted again for another health related survey. Since (you/(PERSON)) are now a student and no longer living with that household, we will interview (you/(PERSON)) separately.
IF NEEDED, READ ALL OR PART OF THE FOLLOWING:
This survey, the Medical Expenditure Panel Survey, is also for the Department of Health and Human Services [specifically, the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention (CDC)]. The information you provide will be kept completely confidential and private as required by law.
PRESS 1 AND ENTER TO CONTINUE.
Responses: CONTINUE 1 RE40_01 (REA1080)
Programmer Instructions: Note: the name of the reference person displayed in the Context header is the full name of the student for the current RU being interviewed.
Display Instructions: Display the date of NHIS interview (Preload.NHISDt) for (MONTH, DAY, YEAR OF NHIS INTERVIEW).

RE40_01 (REA1080)

BLAISE NAME: CurrStrt1
Question Text:

VERIFY LOCATING ADDRESS, COUNTY, AND PHONE NUMBER WITH RESPONDENT.
(Is the street address:/What is the street address?)
(STREET ADDRESS1)
(STREET ADDRESS2)
(CITY), (STATE) (ZIP CODE)
(COUNTY)
(TELEPHONE NUMBER)

Responses:

1 RE40_02 (REA1081)
REFUSED RF RE40_02 (REA1081)
DON'T KNOW DK RE40_02 (REA1081)

Programmer Instructions:

Display Instructions:

Display RE40_01 through RE40_07 vertically on the same form pane.
Display address fields in the info pane with most recent address information. 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.
Display ?Is the street address:? if previous round or NHIS street address 1 information available. Otherwise, display ?What is the street address??

RE40_02 (REA1081)

BLAISE NAME: CurrStrt2
Question Text:

[VERIFY LOCATING ADDRESS, COUNTY, AND PHONE NUMBER WITH RESPONDENT.]
(VERIFY/ENTER) APARTMENT OR UNIT NUMBER, IF AVAILABLE. IF NONE, PRESS ENTER TO CONTINUE.
(STREET ADDRESS1)
(STREET ADDRESS2)
(CITY), (STATE) (ZIP CODE)
(COUNTY)
(TELEPHONE NUMBER)

Responses:

1 RE40_03 (REA1082)
EMPTY Empty RE40_03 (REA1082)
REFUSED RF RE40_03 (REA1082)
DON'T KNOW DK RE40_03 (REA1082)

Programmer Instructions:

Display Instructions:

Display RE40_01 through RE40_07 vertically on the same form pane.
Display ?VERIFY LOCATING?? instruction in brackets and lighter ?grayed-out? text.
Display address fields in the info pane with most recent address information. 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.
Display ?VERIFY:? if previous round or NHIS street address 2 information available. Otherwise, display ?ENTER?.

RE40_03 (REA1082)

BLAISE NAME: CurrCity
Question Text:

[VERIFY LOCATING ADDRESS, COUNTY, AND PHONE NUMBER WITH RESPONDENT.]
(Is the city:/What is the city?)
(STREET ADDRESS1)
(STREET ADDRESS2)
(CITY), (STATE) (ZIP CODE)
(COUNTY)
(TELEPHONE NUMBER)

Responses:

1 RE40_04 (REA1083)
REFUSED RF RE40_04 (REA1083)
DON'T KNOW DK RE40_04 (REA1083)

Programmer Instructions:

Display Instructions:

Display RE40_01 through RE40_07 vertically on the same form pane.
Display ?VERIFY LOCATING?? instruction in brackets and lighter ?grayed-out? text.
Display address fields in the info pane with most recent address information. 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.
Display ?Is the city:? if previous round or NHIS city address information available. Otherwise,
display ?What is the city??.

RE40_04 (REA1083)

BLAISE NAME: CurrSt
Question Text:

[VERIFY LOCATING ADDRESS, COUNTY, AND PHONE NUMBER WITH RESPONDENT.]
(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)
(COUNTY)
(TELEPHONE NUMBER)

Responses: 1 RE40_05 (REA1084)
Programmer Instructions:

Refused and don?t know disallowed for state. Prefill each available address field in the response pane entry fields with information from the NHIS or the previous round. Use Preload.CurrStrt1, Preload.CurrStrt2, Preload.CurrCity, Preload.CurrState, Preload.CurrZip, Preload.CurrCnty, Preload.CurrPhone. Use the state lookup file.

Display Instructions:

Display RE40_01 through RE40_07 vertically on the same form pane.
Display ?VERIFY LOCATING?? instruction in brackets and lighter ?grayed-out? text.
Display address fields in the info pane with most recent address information. 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.
Display ?Is the state:? if previous round or NHIS state address information available. Otherwise, display ?What is the state??.

RE40_05 (REA1084)

BLAISE NAME: CurrZip
Question Text:

[VERIFY LOCATING ADDRESS, COUNTY, AND PHONE NUMBER WITH RESPONDENT.]
(Is the zip code:/What is the zip code?)
(STREET ADDRESS1)
(STREET ADDRESS2)
(CITY), (STATE) (ZIP CODE)
(COUNTY)
(TELEPHONE NUMBER)

Responses:

1 RE40_06 (REA1085)
REFUSED RF RE40_06 (REA1085)
DON'T KNOW DK RE40_06 (REA1085)

Programmer Instructions:

Prefill each available address field in the response pane entry fields with information from the NHIS or the previous round. Use Preload.CurrStrt1, Preload.CurrStrt2, Preload.CurrCity, Preload.CurrState, Preload.CurrZip, Preload.CurrCnty, Preload.CurrPhone.
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 Instructions:

Display RE40_01 through RE40_07 vertically on the same form pane.
Display ?VERIFY LOCATING?? instruction in brackets and lighter ?grayed-out? text.
Display address fields in the info pane with most recent address information. 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.
Display ?Is the zip code:? if previous round or NHIS zip code address information available. Otherwise, display ?What is the zip code??.

RE40_06 (REA1085)

BLAISE NAME: CurrCnty
Question Text:

[VERIFY LOCATING ADDRESS, COUNTY, AND PHONE NUMBER WITH RESPONDENT.]
(Is the county:/What is the county?)
(STREET ADDRESS1)
(STREET ADDRESS2)
(CITY), (STATE) (ZIP CODE)
(COUNTY)
(TELEPHONE NUMBER)

Responses:

1 RE40_07 (REA1086)
REFUSED RF RE40_07 (REA1086)
DON'T KNOW DK RE40_07 (REA1086)

Programmer Instructions:

Display Instructions:

Display RE40_01 through RE40_07 vertically on the same form pane.
Display ?VERIFY LOCATING?? instruction in brackets and lighter ?grayed-out? text.
Display address fields in the info pane with most recent address information. As entries are updated in the current round, the display in the info pane should also be updated.
Display (COUNTY) in the info pane in bold, black, but all other address display fields in lighter ?grayed-out? text.
Display ?Is the county:? if previous round or NHIS county information available. Otherwise, display ?What is the county??.

RE40_07 (REA1086)

BLAISE NAME: CurrPhone
Question Text:

[VERIFY LOCATING ADDRESS, COUNTY, AND PHONE NUMBER WITH RESPONDENT.]
(Is the telephone number:/What is the telephone number?)
IF NO TELEPHONE, ENTER DON?T KNOW.
(STREET ADDRESS1)
(STREET ADDRESS2)
(CITY), (STATE) (ZIP CODE)
(COUNTY)
(TELEPHONE NUMBER)

Responses:

1 BOX_30 (REA1125)
REFUSED RF BOX_30 (REA1125)
DON'T KNOW DK BOX_30 (REA1125)

Programmer Instructions:

Prefill each available address field in the response pane entry fields with information from the NHIS or the previous round. Use Preload.CurrStrt1, Preload.CurrStrt2, Preload.CurrCity, Preload.CurrState, Preload.CurrZip, Preload.CurrCnty, Preload.CurrPhone.
10-digit entry require; use number input mask (xxx-xxx-xxxx) in response field.
Hard check:
"PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."

Display Instructions:

Display RE40_01 through RE40_07 vertically on the same form pane.
Display ?VERIFY LOCATING?? instruction in brackets and lighter ?grayed-out? text.
Display address fields in the info pane with most recent address information. 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.
Display ?Is the telephone number:? if previous round or NHIS phone number available. Otherwise, display ?What is the telephone number??.

BOX_30 (REA1125)

Route Details:

If Round 1 and [RUType equal to Standard RU] and PreloadRUNum equal to 1 (single person RU) and ST30 is coded '1' (RESPONDENT IS AN RU MEMBER), go to RE520.
If Round 1 and [RUType equal to New Standard RU] and Preload RU Num equal to 1 (single person RU) and ST30 is coded '1' (RESPONDENT IS AN RU MEMBER), go to BOX_160.
If Round 1 and [RUType equal to Standard RU or New Standard RU] and PreloadRUNum equal to 1 (single person RU)and ST30 coded '2' (RESPONDENT IS A PROXY APPROVED BY SUPERVISOR), go to RE310.
If Round 1 and [RUType equal to Standard RU or New Standard RU] and PreloadRUNum greater than 1 (multi-person RU), go to RE310.
If Rounds 2-5 and [RUType equal to Standard RU or New Standard RU], go to BOX_90.
Otherwise (RUType equal to Student RU or New Student RU), continue with RE50.

RE50 (REA1135)

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

My records show that (you/(PERSON)) (are/is) a student at post-secondary school. (Are/Is) (you/he/she) attending school full-time or part-time?
HELP: F1

Responses:

FULL-TIME 1 RE60 (REA1150)
PART-TIME 2 RE60 (REA1150)
NOT ATTENDING SCHOOL 3 BOX_40 (REA1140)
REFUSED RF RE60 (REA1150)
DON'T KNOW DK RE60 (REA1150)

Display Instructions:

BOX_40 (REA1140)

Route Details: If RUType equal to New Student RU, go to RE60. Otherwise, continue with BOX_50.

BOX_50 (REA1145)

Route Details:

Set RUType equal to Standard RU. RU classification changes from student RU to standard RU since person is no longer attending school.
Go to RE520.

RE60 (REA1150)

BLAISE NAME: Sex
Question Text:

VERIFY (PERSON) IS (SEX).
IF NOT OBVIOUS, ASK: What is (your/(PERSON)?s) sex?

Responses:

MALE 1 RE70_01 (REA1153)
FEMALE 2 RE70_01 (REA1153)
REFUSED RF RE70_01 (REA1153)
DON'T KNOW DK RE70_01 (REA1153)

Programmer Instructions:

Prefill entry field with PL_Person.Sex from previous round.
Compare entry with preloaded data. Replacing ?real? data with RF or DK is disallowed. If the interviewer tries to do so, display the message "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON?T KNOW."
Display Instructions: For ?SEX?, display sex from previous round. If preload has 'DK' (DON'T KNOW) or 'RF' (REFUSED), show that as empty.

RE70_01 (REA1153)

BLAISE NAME: DOBMM
Question Text:

[(VERIFY (PERSON)?s DATE OF BIRTH IS (MONTH, DAY, YEAR). CORRECT IF NECESSARY./What is (your/(PERSON)?s) date of birth?)]
ENTER MONTH.

Responses:

1 RE70_02 (REA1154)
REFUSED RF RE70_02 (REA1154)
DON'T KNOW DK RE70_02 (REA1154)

Programmer Instructions:

Prefill entry field with RU members? month of birth (PL_Person.DOBM) when available.
If preload has 'DK' (DON'T KNOW) or 'RF' (REFUSED), show that as empty
Compare entry with preloaded data. Replacing ?real? data with RF or DK is disallowed. If the interviewer tries to do so, display the message "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON?T KNOW."

Display Instructions:

RE70_01, RE70_02, and RE70_03 must appear on the same form pane.
Display ?VERIFY (PERSON)?s DATE OF BIRTH IS (MONTH, DAY, YEAR). CORRECT IF NECESSARY.? if any part of the student?s DOB is not 'RF' (REFUSED), 'DK' (DON'T KNOW), or missing. Otherwise (e.g., all parts of DOB are RF, DK, or missing), display ?What is (your/(PERSON)?s) date of birth??.
For ?MONTH, DAY, YEAR? display the student?s DOB as recorded in the previous round. Use PL_Person.DOBM, PL_Person.DOBD, PL_Person.DOBY. Spell out the month name.

RE70_02 (REA1154)

BLAISE NAME: DOBDD
Question Text:

[(VERIFY (PERSON)?s DATE OF BIRTH IS (MONTH, DAY, YEAR). CORRECT IF NECESSARY./What is (your/(PERSON)?s) date of birth?)]
ENTER DAY.

Responses:

1 RE70_03 (REA1155)
REFUSED RF RE70_03 (REA1155)
DON'T KNOW DK RE70_03 (REA1155)

Programmer Instructions:

Prefill with RU members? day of birth (PL_Person.DOBD) when available. If preload has 'DK' (DON'T KNOW) or 'RF' (REFUSED), show that as empty. Compare entry with preloaded data. Replacing ?real? data with RF or DK is disallowed. If the interviewer tries to do so, display the message "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON?T KNOW."

Display Instructions:

RE70_01, RE70_02, and RE70_03 must appear on the same form pane.
Display ?[VERIFY (PERSON)?s DATE OF BIRTH IS (MONTH, DAY, YEAR). CORRECT IF NECESSARY.]? if any part of the student?s DOB is not 'RF' (REFUSED), 'DK' (DON'T KNOW), or missing. Otherwise (e.g., all parts of DOB are RF, DK, or missing), display ?[What is (your/(PERSON)?s) date of birth?]?. Display in brackets and lighter ?grayed-out? text.
For ?MONTH, DAY, YEAR? display the student?s DOB as recorded in the previous round. Use PL_Person.DOBM, PL_Person.DOBD, PL_Person.DOBY. Spell out the month name.

RE70_03 (REA1155)

BLAISE NAME: DOBYYYY
Question Text:

[(VERIFY (PERSON)?s DATE OF BIRTH IS (MONTH, DAY, YEAR). CORRECT IF NECESSARY./What is (your/(PERSON)?s) date of birth?)]
ENTER 4-DIGIT YEAR.

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If RE70_03 is coded ?RF? (REFUSED) or ?DK? (DON?T KNOW), go to RE80.
If age can be calculated (see GL specs) from DOB or partial DOB, go to RE85
Prefill entry field with RU members? year of birth (PL_Person.DOBY) when available. If preload has 'DK' (DON'T KNOW) or 'RF' (REFUSED), show that as empty.
Compare entry with preloaded data. Replacing ?real? data with RF or DK is disallowed. If the interviewer tries to do so, display the message "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON?T KNOW."
Hard check:
Date entered must be between (YEAR)-120 years where ?YEAR? is the current year and today?s date. If a date outside of this range is entered, display the following message: ?UNLIKELY RESPONSE. DATE CANNOT BE AFTER TODAY?S DATE OR BEFORE (YEAR-120). VERIFY WITH RESPONDENT AND RE-ENTER.?

Display Instructions:

RE70_01, RE70_02, and RE70_03 must appear on the same form pane.
Display ?[VERIFY (PERSON)?s DATE OF BIRTH IS (MONTH, DAY, YEAR). CORRECT IF NECESSARY.]? if any part of the student?s DOB is not 'RF' (REFUSED), 'DK' (DON'T KNOW), or missing. Otherwise (e.g., all parts of DOB are RF, DK , or missing), display ?[What is (your/(PERSON)?s) date of birth?]?. Display in brackets and lighter ?grayed-out? text.
For ?MONTH, DAY, YEAR? display the student?s DOB as recorded in the previous round. Use PL_Person.DOBM, PL_Person.DOBD, PL_Person.DOBY. Spell out the month name.

RE80 (REA1156)

BLAISE NAME: AgeRnd
Question Text:

What is (your/(PERSON)?s) age?

Responses:

1 BOX_60 (REA1170)
REFUSED RF BOX_60 (REA1170)
DON'T KNOW DK BOX_60 (REA1170)

Programmer Instructions:

Prefill entry field with RU members? age (PL_Person.AgeRnd) when available if age cannot be calculated. If preload has 'DK' (DON'T KNOW) or 'RF' (REFUSED), show that as empty.
Compare entry with preloaded data. Replacing ?real? data with RF or DK is disallowed. If the interviewer tries to do so, display the message "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON?T KNOW."

Display Instructions:

RE85 (REA1157)

BLAISE NAME: ConfAge
Question Text:

So (you/(PERSON)) (are/is) (AGE CALCULATED FROM DATE OF BIRTH AT RE70_ [01-03]) years old. Is that correct?
(NOTE FOR ROUND 5, AGE IS CALCULATED AS OF DECEMBER, 31(YEAR).)

Responses:

YES 1 BOX_60 (REA1170)
NO 2

Programmer Instructions:

If coded ?2? (NO), display message: "IF AGE INCORRECT, BACKUP AND CORRECT DATE OF BIRTH AT PREVIOUS SCREEN."
For Round 5, age is calculated as of December 31, (YEAR), where ?YEAR? is the second calendar year of the panel. All age skips (throughout the questionnaire ) will be based on this age.

Display Instructions:

Display ?NOTE: FOR ROUND 5, AGE IS CALCULATED AS OF DEC 31, (YEAR)? where ?YEAR? is the second calendar year of the panel, if Round 5. Otherwise, use a null display.

BOX_60 (REA1170)

Route Details:

If RUType equal to Student RU and age at RE80 (AgeRnd) greater than 23 or preloaded age categories (PL_Person.AgeRng or PL_Person.AgeGuess) equal to 5 - 9, continue with BOX_70.
Otherwise, go to RE90.

BOX_70 (REA1175)

Route Details:

Set RUType equal to Standard RU. RU classification changes from student RU to standard RU since student is outside of designated student RU age range.
Go to RE520.

RE90 (REA1180)

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

My records show that (as of December 31, (YEAR)) (you/(PERSON)) ((have/has)/had) never been married.
Is that correct?

Responses:

YES 1 RE110 (REA1195)
NO 2 RE100 (REA1185)
REFUSED RF RE110 (REA1195)
DON'T KNOW DK RE110 (REA1195)

Display Instructions:

Display 'as of December 31, (YEAR)' if round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display.
Display '(have/has)' if not round 5. If round 5, display 'had'.

RE100 (REA1185)

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

((Are/Is)/On December 31, (YEAR), (were/was)) (you/(PERSON)) (now) married, widowed, divorced, or separated?)
HELP: F1

Responses:

MARRIED 1 BOX_80 (REA1190)
WIDOWED 2 BOX_80 (REA1190)
DIVORCED 3 BOX_80 (REA1190)
SEPARATED 4 BOX_80 (REA1190)
REFUSED RF BOX_80 (REA1190)
DON'T KNOW DK BOX_80 (REA1190)

Display Instructions:

Display ?(Are/Is)? if not Round 5. Display ?On December 31, (YEAR), (were/was)? if Round 5, where 'YEAR' is the second calendar year of the panel. Display ?now? if not Round 5. Otherwise (if Round 5), use a null display.

BOX_80 (REA1190)

Route Details:

If RUType equal to New Student RU, continue with RE110.
Otherwise, (if RUType equal to Student RU), set RUType equal to Standard RU. RU classification changes from student RU to standard RU since student's marital status has changed to a status other than 'NEVER MARRIED'. Then go to RE520.

RE110 (REA1195)

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

((Are/Is)/(Were/Was)) (you/(PERSON)) on full-time active duty with the Armed Forces of the United States (on December 31, (YEAR))?
HELP: F1

Responses:

YES 1 RE120_01 (REA1200)
NO 2 RE170 (REA1225)
REFUSED RF RE170 (REA1225)
DON'T KNOW DK RE170 (REA1225)

Programmer Instructions: Control Variables Impacted: CtrlCurrHere, CtrlPersEligible

Display Instructions:

Display ?(Are/Is)? if not round 5. Display ?(Were/Was)? if round 5. Display ?on December 31, (YEAR)? if round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display

.

RE120_01 (REA1200)

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

On what date did (you/(PERSON)) enter full-time active duty service in the Armed Forces?
ENTER MONTH.
HELP: F1

Responses:

1 RE120_02 (REA1201)
REFUSED RF RE120_02 (REA1201)
DON'T KNOW DK RE120_02 (REA1201)

Display Instructions: Display RE120_01, RE120_02, and RE120_03 on the same form pane.

RE120_02 (REA1201)

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

[On what date did (you/(PERSON)) enter full-time active duty service in the Armed Forces?]
ENTER DAY.
HELP: F1

Responses:

1 RE120_03 (REA1202)
REFUSED RF RE120_03 (REA1202)
DON'T KNOW DK RE120_03 (REA1202)

Display Instructions:

Display RE120_01, RE120_02, and RE120_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE120_03 (REA1202)

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

[On what date did (you/(PERSON)) enter full-time active duty service in the Armed Forces?]
ENTER 4-DIGIT YEAR.
HELP: F1

Responses:

1 RE130 (REA1205)
REFUSED RF RE130 (REA1205)
DON'T KNOW DK RE130 (REA1205)

Programmer Instructions:

Control Variables Impacted: CtrlPersEligible
Note: Student becomes full-time military. This person is not currently here, they may have some period of eligibility, but for the purposes of this data collection effort we are choosing not to pursue them and calling them out-of-scope. The RE section will NOT collect locating information for this person; person will not be included in the rest of the interview and will not be followed.

Display Instructions:

Display RE120_01, RE120_02, and RE120_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE130 (REA1205)

BLAISE NAME: EndFTADuty
Question Text:

At this time, we are only collecting information about persons who are not on full-time active duty with the Armed Forces of the United States. Therefore, that is all the information we need.
PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 RE140 (REA1210)
Display Instructions:

RE140 (REA1210)

BLAISE NAME: ThankYouFTADuty
Question Text:

Thank you for your participation in this important study.
PRESS 1 ENTER TO CONTINUE.

Responses: CONTINUE 1 RE150 (REA1215)
Display Instructions:

RE150 (REA1215)

BLAISE NAME: REEndInterviewFTADuty
Question Text:

INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS 1 ENTER TO END THE INTERVIEW.

Responses: CONTINUE 1 RE160 (REA1220)
Display Instructions:

RE160 (REA1220)

BLAISE NAME: HowIntvCompFTADuty
Question Text:

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

Responses:

IN-PERSON 1 BOX_250 (REA2050)
TELEPHONE 2 BOX_250 (REA2050)

Display Instructions:

RE170 (REA1225)

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

(Have/Has) (you/(PERSON)) ever been honorably discharged from active duty in the U.S. Army, Navy, Air Force, Marine Corps, or Coast Guard?
HELP: F1

Responses:

YES 1 BOX_250 (REA2050)
NO 2 BOX_250 (REA2050)
REFUSED RF BOX_250 (REA2050)
DON'T KNOW DK BOX_250 (REA2050)

Display Instructions:

BOX_90 (REA1235)

Route Details:

If on date of previous round interview at least one Key RU member (CtrlPersKey equal to Yes) was coded as INSTITUTIONALIZED IN A HEALTH CARE FACILITY (InstAtTimeOfPrevint equal to YES), continue with LOOP_10.
Else if [RUType equal to Standard RU] and RUNum equal to 1 (single person RU), and ST30 coded '1' (RESPONDENT IS AN RU MEMBER), go to RE520.
Else if [RUType equal to New Standard RU] and RUNum equal to 1 (single person RU), and ST30 coded '1' (RESPONDENT IS AN RU MEMBER), go to BOX_160.
Otherwise, go to RE310.

LOOP_10 (REA1240)

Route Details:

For each person in the RU-Members-Roster who has CtrlPersKey equal to Yes and InstAtTimeOfPrevInt equal to Yes, ask BOX_100 to END_LP10.
Loop definition: LOOP_10 collects information to determine the location and eligibility of key RU members who were institutionalized at a health care facility on the date of the previous round interview. This loop cycles on RU members who meet all of the following conditions:
-Person is key
-Person was institutionalized at a health care facility on the date of the previous round interview [RE440 equal to '1' (YES) or RE180 equal to '1' (YES)].

BOX_100 (REA1245)

Route Details:

If person being asked about is an RU member respondent (RU Roster Number equal to RespondentPersID), auto code '2' (NO) at RE180, then go to BOX_110.
Otherwise, continue with RE180.

RE180 (REA1250)

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

My records indicate that (PERSON) was institutionalized in a health care facility at the time of the last interview. (Is/On December 31, (YEAR), was) (he/she) still institutionalized in a health care facility?
HELP: F1

Responses:

YES 1 END_LP10 (REA1320)
NO 2 BOX_110 (REA1255)
REFUSED RF END_LP10 (REA1320)
DON'T KNOW DK END_LP10 (REA1320)

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm, CtrlPersEligible, and CtrlCurrHere

Display Instructions:

Display ?Is? if not round 5. Display ?On December 31, (YEAR), was? if round 5, where 'YEAR' is the second calendar year of the panel.

BOX_110 (REA1255)

Route Details:

If person being asked about is an RU member respondent (RU Roster Number equal to RespondentPersID), auto code '1' (LIVING WITH THIS FAMILY) at RE190, then go to RE200_01.
Otherwise, continue with RE190.

RE190 (REA1260)

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

IF RESPONDENT VOLUNTEERS THAT PERSON IS DECEASED, SELECT 'DECEASED' WITHOUT ASKING.
(Is/On December 31, (YEAR), was) (PERSON) (now) living here with this family, or (does/did) (he/she) have a usual place of residence somewhere else?
HELP: F1

Responses:

LIVING WITH THIS FAMILY 1 RE200_01 (REA1265)
USUAL PLACE OF RESIDENCE SOMEWHERE ELSE 2 RE240_01 (REA1285)
DECEASED 3 RE220_01 (REA1275)
REFUSED RF RE240_01 (REA1285)
DON'T KNOW DK RE240_01 (REA1285)

Programmer Instructions: Control Variables Impacted: CtrlTrackSumm and/or CtrlCurrHere
Display Instructions:

Display 'Is' and 'does' if not round 5. Display 'On December 31, (YEAR), was' and 'did' if round 5, where 'YEAR' is the second calendar year of the panel. Display 'now' if not round 5. Otherwise, use a null display.

RE200_01 (REA1265)

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

On what date did (you/(PERSON)) leave the health care facility?
ENTER MONTH.
HELP: F1
Responses: 1 RE200_02 (REA1266)

Programmer Instructions: DK and RF disallowed for month.
Display Instructions: Display RE200_01, RE200_02, and RE200_03 on the same form pane.

E200_02 (REA1266)

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

[On what date did (you/(PERSON)) leave the health care facility?]
ENTER DAY.
HELP: F1

Responses:

1 RE200_03 (REA1267)
REFUSED RF RE200_03 (REA1267)
DON'T KNOW DK RE200_03 (REA1267)

Display Instructions:

Display RE200_01, RE200_02, and RE200_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE200_03 (REA1267)

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

[On what date did (you/(PERSON)) leave the health care facility?]
ENTER 4-DIGIT YEAR.
HELP: F1

Responses: 1 RE210_01 (REA1270)

Programmer Instructions:

Control Variables Impacted: BegRefM, BegRefD, and BegRefY DK and RF disallowed for year.
Hard check:
Edit (for Round 5): date entered must be on or before 12/31/(YEAR), where 'YEAR' is the second calendar year of the panel. If a date after 12/31/(YEAR) is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/(YEAR). IF LEFT INSTITUTION AFTER 12/31/(YEAR), BACK-UP AND RE-CODE RE180 (CurrInstd) TO '1' (YES)."

Display Instructions:

Display RE200_01, RE200_02, and RE200_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE210_01 (REA1270)

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

On what date did (you/(PERSON)) return to live with this family?
ENTER MONTH.

Responses:

1 RE210_02 (REA1271)
REFUSED RF RE210_02 (REA1271)
DON'T KNOW DK RE210_02 (REA1271)

Display Instructions: Display RE210_01, RE210_02, and RE210_03 on the same form pane.

RE210_02 (REA1271)

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

[On what date did (you/(PERSON)) return to live with this family?]
ENTER DAY.

Responses:

1 RE210_03 (REA1272)
REFUSED RF RE210_03 (REA1272)
DON'T KNOW DK RE210_03 (REA1272)

Display Instructions:

Display RE210_01, RE210_02, and RE210_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE210_03 (REA1272)

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

[On what date did (you/(PERSON)) return to live with this family?]
ENTER 4-DIGIT YEAR.

Responses:

1 END_LP10 (REA1320)
REFUSED RF END_LP10 (REA1320)
DON'T KNOW DK END_LP10 (REA1320)

Programmer Instructions:

Hard check: Date entered must be on or after RE200_01, RE200_02, RE200_03. If a date outside of this range is entered, display the following message: "DATE CANNOT BE BEFORE THE DATE THE PERSON LEFT THE FACILITY. VERIFY WITH RESPONDENT AND RE-ENTER OR BACK-UP AND RE-CODE RE200_01,_02,_03 (LeftInstMMFam)."
Hard check:
Edit (for Round 5): date entered must be on or before 12/31/(YEAR), where 'YEAR' is the second calendar year of the panel. If a date after 12/31/(YEAR) is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/(YEAR). IF JOINED RU AFTER 12/31/(YEAR), BACK-UP AND RE-CODE RE190 (PersWithFamNow)."

Display Instructions:

Display RE210_01, RE210_02, and RE210_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE220_01 (REA1275)

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

On what date did (PERSON) leave the health care facility?
ENTER MONTH.
HELP: F1

Responses: 1 RE220_02 (REA1276)
Programmer Instructions: DK and RF disallowed for month.
Display Instructions: Display RE220_01, RE220_02, and RE220_03 on the same form pane.

RE220_02 (REA1276)

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

[On what date did (PERSON) leave the health care facility?]
ENTER DAY.
HELP: F1

Responses:

1 RE220_03 (REA1277)
REFUSED RF RE220_03 (REA1277)
DON'T KNOW DK RE220_03 (REA1277)

Display Instructions:

Display RE220_01, RE220_02, and RE220_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE220_03 (REA1277)

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

[On what date did (PERSON) leave the health care facility?]
ENTER 4-DIGIT YEAR.
HELP: F1

Responses: 1 RE230_01 (REA1280)
Programmer Instructions:

Control Variables Impacted: BegRefM, BegRefD, and BegRefY
DK and RF disallowed for year.
Hard check:
Edit (for Round 5): date entered must be on or before 12/31/(YEAR), where 'YEAR' is the second calendar year of the panel. If a date after 12/31/(YEAR) is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/(YEAR). IF LEFT INSTITUTION AFTER 12/31/(YEAR), BACK-UP AND RE-CODE RE180 (CurrInstd) TO '1' (YES)."

Display Instructions:

Display RE220_01, RE220_02, and RE220_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE230_01 (REA1280)

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

On what date did (PERSON) die?
ENTER MONTH.

Responses: 1 RE230_02 (REA1281)
Programmer Instructions: DK and RF disallowed for month.
Display Instructions: Display RE230_01, RE230_02, and RE230_03 on the same form pane.

RE230_02 (REA1281)

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

[On what date did (PERSON) die?]
ENTER DAY.

Responses:

1 RE230_03 (REA1282)
REFUSED RF RE230_03 (REA1282)
DON'T KNOW DK RE230_03 (REA1282)

Display Instructions:

Display RE230_01, RE230_02, and RE230_03 on the same form pane.
Display question text in brackets and lighter "grayed-out" text.

RE230_03 (REA1282)

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

[On what date did (PERSON) die?]
ENTER 4-DIGIT YEAR.

Responses: 1 END_LP10 (REA1320)
Programmer Instructions:

Control Variables Impacted: EndRefM, EndRefD, and EndRefY
DK and RF disallowed for year.
Hard check:
Edit (for Round 5): date entered must be on or before 12/31/(YEAR), where 'YEAR' is the second calendar year of the panel. if a date after 12/31/(YEAR) is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/(YEAR). IF DIED AFTER 12/31/(YEAR), BACK-UP AND RE-CODE RE190 (PersWithFamNow)."

Display Instructions:

Display RE230_01, RE230_02, and RE230_03 on the same form pane.
Display question text in brackets and lighter "grayed-out" text.

RE240_01 (REA1285)

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

On what date did (PERSON) leave the health care facility?
ENTER MONTH.
HELP: F1

Responses: 1 RE240_02 (REA1286)
Programmer Instructions: DK and RF disallowed for month.
Display Instructions: Display RE240_01, RE240_02, and RE240_03 on the same form pane.

RE240_02 (REA1286)

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

[On what date did (PERSON) leave the health care facility?]
ENTER DAY.
HELP: F1

Responses:

1 RE240_03 (REA1287)
REFUSED RF RE240_03 (REA1287)
DON'T KNOW DK RE240_03 (REA1287)

Display Instructions:

Display RE240_01, RE240_02, and RE240_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE240_03 (REA1287)

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

[On what date did (PERSON) leave the health care facility?]
ENTER 4-DIGIT YEAR.
HELP: F1

Responses: 1 RE250 (REA1290)
Programmer Instructions:

Control Variables Impacted: BegRefM, BegRefD, and BegRefY
DK and RF disallowed for year.
Hard check:
Edit (for Round 5): date entered must be on or before 12/31/(YEAR), where 'YEAR' is the second calendar year of the panel. if a date after 12/31/(YEAR) is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/(YEAR). IF LEFT INSTITUTION AFTER 12/31/(YEAR), BACK-UP AND RE-CODE RE180 (CurrInstd) TO '1' (YES)."

Display Instructions:

Display RE240_01, RE240_02, and RE240_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.

RE250 (REA1290)

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

Where (is (PERSON) now/was (PERSON) on December 31, (YEAR))?
HELP: F1

Responses:

INSTITUTIONALIZED IN A HEALTH CARE FACILITY 1
INSTITUTIONALIZED IN A NON-HEALTH CARE FACILITY 2 RE300_01 (REA1315)
STUDENT UNDER 24 LIVING AWAY AT SCHOOL IN GRADES 1-12 3 RE300_01 (REA1315)
STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL 4 RE260 (REA1295)
ANOTHER HOUSEHOLD - CURRENTLY NOT FULL-TIME MILITARY 5 RE260 (REA1295)
ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME MILITARY 6 RE280 (REA1305)
REFUSED RF RE260 (REA1295)
DON'T KNOW DK RE260 (REA1295)

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm, and/or CtrlCurrHere
Hard check:
Disallow final entry of code ?1? (INSTITUTIONALIZED IN HEALTH CARE FACILITY). If interviewer enters code ?1?, display the following message: "VERIFY FACILITY TYPE. IF HEALTH CARE FACILITY, USE BACK UP TO CORRECT RE180 (CurrInstd) TO '1' (YES)."

Display Instructions:

Note: the following answer text is to be underlined:
"HEALTH CARE" for code 1
"NON-HEALTH CARE" for code 2
"CURRENTLY NOT FULL-TIME MILITARY" for code 5
"CURRENTLY FULL-TIME MILITARY" for code 6
Display ?is (PERSON) now? if not round 5. Display ?was (PERSON) on December 31, (YEAR), where 'YEAR' is the second calendar year of the panel, if round 5.

RE260 (REA1295)

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

(Is/Was) (PERSON) living within the U.S. or outside the U.S. (on December 31, (YEAR))?
HELP: F1

Responses:

WITHIN U.S. 1
OUTSIDE U.S. 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If person coded ?4? (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL AT RE250), continue with RE270. Otherwise, go to RE300_01.
Control Variables Impacted: CtrlTrackSumm, CtrlPersEligible, and/or CtrlCurrHere

Display Instructions:

Display ?Is? if not round 5. Display ?Was? if round 5. Display ?on December 31, (YEAR)', where 'YEAR' is the second calendar year of the panel, if round 5. Otherwise, use a null display.

RE270 (REA1300)

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

(Is/On December 31, (YEAR), was) (PERSON) attending grades 1-12, a college or university, or some other training
school after high school?
HELP: F1

Responses:

GRADES 1-12 1
A COLLEGE OR UNIVERSITY 2 RE300_01 (REA1315)
SOME OTHER TRAINING SCHOOL AFTER HIGH SCHOOL 3 RE300_01 (REA1315)
REFUSED RF RE300_01 (REA1315)
DON'T KNOW DK RE300_01 (REA1315)

Programmer Instructions:

Hard check:
Disallow final entry of code ?1? (GRADES 1-12). If interviewer enters code ?1?, display the following message: 'BACK UP TO CORRECT RE250 (PersLoctnNow) TO '3' (STUDENT UNDER 24 LIVING AWAY AT SCHOOL IN GRADES 1-12).'

Display Instructions

Display ?Is? if not round 5. Display ?On December 31, (YEAR), was? if round 5, where 'YEAR' is the second calendar year of the panel.

RE280 (REA1305)

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

(Is/Was) (PERSON) living in another household or in a military facility (on December 31, (YEAR))?
HELP: F1

Responses:

ANOTHER HOUSEHOLD 1 RE290 (REA1310)
MILITARY FACILITY 2 RE300_01 (REA1315)
REFUSED RF RE290 (REA1310)
DON'T KNOW DK RE290 (REA1310)

Programmer Instructions: Control Variables Impacted: CtrlTrackSumm and/or CtrlCurrHere
Display Instructions:

Display ?Is? if not round 5. Display ?Was? if round 5. Display ?on December 31, (YEAR)? if round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display.

RE290 (REA1310)

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

(Is/Was) (PERSON) living within the U.S. or outside the U.S. (on December 31, (YEAR))?
HELP: F1

Responses:

WITHIN U.S. 1 RE300_01 (REA1315)
OUTSIDE U.S. 2 RE300_01 (REA1315)
REFUSED RF RE300_01 (REA1315)
DON'T KNOW DK RE300_01 (REA1315)

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm and/or CtrlCurrHere

Display Instructions:

Display 'Is' if not Round 5. Display 'Was' if round 5. Display 'on December 31, (YEAR)' if round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display.

RE300_01 (REA1315)
BLAISE NAME: MmbEndMMOth
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

On what date did (PERSON) (enter the non-health care facility/start living away at school/start living in another household/start living at a military facility/leave the United States)?
ENTER MONTH.

Responses:

1 RE300_02 (REA1316)
REFUSED RF RE300_02 (REA1316)
DON'T KNOW DK RE300_02 (REA1316)

Display Instructions:

Display RE300_01, RE300_02, and RE300_03 on the same form pane.
Display ?enter the non-health care facility? if RE250 coded ?2? (INSTITUTIONALIZED IN NON-HEALTH CARE FACILITY).
Display ?start living away at school? if RE250 coded ?3? (STUDENT UNDER 24 LIVING AWAY AT SCHOOL IN GRADES 1-12) or if RE250 coded ?4? (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) and RE260 coded ?1? (WITHIN U.S.), ?RF? (REFUSED), or ?DK? (DON'T KNOW).
Display ?start living in another household? if [RE250 coded ?5? (ANOTHER HOUSEHOLD - CURRENTLY NOT FULL-TIME MILITARY) and RE260 coded ?1? (WITHIN U.S.), ?RF? (REFUSED), or ?DK? (DON'T KNOW)] or [RE250 CODED ?6? (ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL- TIME MILITARY and RE280 coded ?1? (ANOTHER HOUSEHOLD), ?RF? (REFUSED), or ?DK? (DON'T KNOW) and RE290 coded ?1? (WITHIN U.S.), ?RF? (REFUSED), or ?DK? (DON'T KNOW)] or [RE250 coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).]
Display ?start living at a military facility? if RE250 coded ?6? (ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME MILITARY and RE280 coded ?2? (MILITARY FACILITY).
Display ?leave the United States? if [RE250 coded ?4? (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) and RE260 coded ?2? (OUTSIDE U.S.)] or if [RE250 coded ?5? (ANOTHER HOUSEHOLD - CURRENTLY NOT FULL-TIME MILITARY) and RE260 coded ?2? (OUTSIDE U.S.)] or if [RE250 coded ?6? (ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME MILITARY) and RE280 is coded ?1? (ANOTHER HOUSEHOLD), ?RF? (REFUSED), ?DK? (DON?T KNOW) and RE290 coded ?2? (OUTSIDE U.S.)].

RE300_02 (REA1316)

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

[On what date did (PERSON) (enter the non-health care facility/start living away at school/start living in another household/start living at a military facility/leave the United States)?]
ENTER DAY.

Responses:

1 RE300_03 (REA1317)
REFUSED RF RE300_03 (REA1317)
DON'T KNOW DK RE300_03 (REA1317)

Display Instructions:

Display RE300_01, RE300_02, and RE300_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.
Use same display instructions as RE300_01.

RE300_03 (REA1317)

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

[On what date did (PERSON) (enter the non-health care facility/start living away at school/start living in another household/start living at a military facility/leave the United States)?]
ENTER 4-DIGIT YEAR.

Responses:

1 END_LP10 (REA1320)
REFUSED RF END_LP10 (REA1320)
DON'T KNOW DK END_LP10 (REA1320)

Programmer Instructions:

Hard check:
Edit (for Round 5): date entered must be on or before 12/31/(YEAR), where 'YEAR' is the second calendar year of the panel. If a date after 12/31/(YEAR) is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/(YEAR). IF DATE IS AFTER 12/31/(YEAR), BACK- UP AND RE-CODE RE190 (PersWithFamNow)."

Display Instructions:

Display RE300_01, RE300_02, and RE300_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.
Use same display instructions as RE300_01

END_LP10 (REA1320)

Route Details:

Cycle on next person in the RU-members-roster that meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_10 and continue with BOX_120.

Programmer Instructions:

Set RemovedAtLoop10 equal to YES and RemovedAtRE180 equal to YES if:
Institutionalized (CtrlTrackSumm equal to 2): RE180 is coded ?1? (YES) or ?RF? (REFUSED), or ?DK? (DON?T KNOW)
Note: Person is still institutionalized and out-of-scope for the entire round. The RE section will NOT collect locating information for this person; person will not be included in the rest of the interview, but we will follow up on this person in the next round to determine if person has rejoined the community
Set RemovedAtLoop10 equal to YES and MoverAtLoop10 equal to YES if:
Moved Inside U.S.; Not FT military; private residence (CtrlTrackSumm equal to 10): [RE250 is coded '5' (ANOTHER HOUSEHOLD - CURRENTLY NOT FULL-TIME MILITARY) and RE260 is coded '1' (WITHIN U.S.), 'RF' (REFUSED), or 'DK' (DON'T KNOW)] or [RE250 is coded ?4? (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) and RE260 is coded '1' (WITHIN U.S.), 'RF' (REFUSED), or 'DK' (DON'T KNOW)]
OR
Moved Inside U.S.; Not FT military; private residence (CtrlTrackSumm equal to 10): [RE250 is coded ?4? (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) and RE260 is coded '1' (WITHIN U.S.), 'RF' (REFUSED), or 'DK' (DON'T KNOW)]
Note: This person is not currently here, but is in-scope and eligible to be interviewed as part of another RU from the time they left the institution until that new interview date. The RE section will collect locating information for this person, but person will not be included in this interview after the RE section. Information for person will be collected as part of another RU.
Set RemovedAtLoop10 equal to YES and MoverAtLoop10 equal to NO if:
Deceased and died the same day left institution: RE190 is coded '3' (DECEASED) and RE230 date (deceased) is on or before RE220 date (left institution)
OR
FT Military Outside U.S.; private residence (CtrlTrackSumm equal to 4): RE250 is coded ?6? (ANOTHER HOUSEHOLD/MILITARY FACILITY-CURRENTLY FULL-TIME MILITARY) and RE280 is coded ?1? (ANOTHER HOUSEHOLD), ?RF (REFUSED), or ?DK? (DON?T KNOW) and RE290 is coded ?2? (OUTSIDE U.S.)
OR
FT Military in U.S.; Not on military facility (CtrlTrackSumm equal to 5): RE250 is coded '6' (ANOTHER HOUSEHOLD/MILITARY FACILITY - CURRENTLY FULL-TIME MILITARY) and RE280 is coded '1' (ANOTHER HOUSEHOLD), 'RF' (REFUSED), or 'DK' (DON'T KNOW) and RE290 is coded '1' (WITHIN U.S.), 'RF'(REFUSED), or 'DK' (DON'T KNOW)
OR
FT Military Living at a Military Facility Alone (CtrlTrackSumm equal to 6): RE250 is coded ?6? (ANOTHER HOUSEHOLD/MILITARY FACILITY-CURRENTLY FULL-TIME MILITARY) and RE280 is coded ?2? (MILITARY FACILITY)
OR
Moved Outside U.S.; Not FT Military; Private Residence (CtrlTrackSumm equal to 8): RE250 is coded ?5? (ANOTHER HOUSEHOLD-CURRENTLY NOT FULL-TIME MILITARY) and RE260 is coded ?2? (OUTSIDE U.S.)
OR
Student Outside U.S. (CtrlTrackSumm equal to 12): RE250 is coded ?4? (STUDENT UNDER 24 LIVING AWAY AT POST-SECONDARY SCHOOL) and RE260 is coded ?2? (OUTSIDE U.S.)
OR
Whereabouts are Unknown (CtrlTrackSumm equal to 13): RE250 is coded ?2? (INSTITUTIONALIZED IN A NON-HEALTH CARE FACILITY) or ?RF? (REFUSED), or ?DK? (DON?T KNOW)
Note: This person is not currently here, they may have some period of eligibility, but for the purposes of this data collection effort we are choosing not to pursue them and calling them out-of-scope. The RE section will NOT collect locating information for this person; person will not be included in the rest of the interview and will not be followed.
Note: Any person with any period of partial eligibility is considered currently here and is eligible and in-scope for data collection as part of this RU. They do NOT have a RemovedAtLoop10 set. This includes persons who returned to this RU or are deceased or are students in grades 1-12 living away.

BOX_120 (REA1325)

Route Details:

If RUType equal to Standard RU or New Standard RU and PreloadRUNum equal to 1 (single person RU) and ST30 coded '1' (RU MEMBER) and that preloaded person is selected at ST50, go to RE520.
If the current respondent is an original RU member [ST30 coded ?1? (RU MEMBER)] and [RE_Person[].PreloadOrd not equal to EMPTY AND RE_Person[].PreloadRU equal to RUUnit AND RE_Person[].MostRecentRU equal to RUUnit for PersID equal to RespondentPersID] AND all other preloaded persons have a value set at RE180, auto-code RE310 as ?1? (YES) and go to BOX_160.
If the current respondent is a proxy and all preloaded RU members have RemovedAtLoop10 equal to YES and RemovedAtRE180 equal to YES, go to BOX_150.
Otherwise, continue with RE310.

RE310 (REA1330)

BLAISE NAME: VerfRoster
Question Text:

(INTERVIEWER: IF ALL RU MEMBERS DEAD OR INSTITUTIONALIZED, CODE NO WITHOUT ASKING.)
(Think about the people living here on December 31, (YEAR), regardless of whether they are living here now.) ((Are/Were) (READ NAMES BELOW) still living together as a family/(Is/Was) (READ NAMES BELOW) still living here) (on December 31, (YEAR))?
(1. First Name,[Middle Name],Last Name)1
(2. First Name,[Middle Name],Last Name)2
(3. First Name,[Middle Name],Last Name)3
(4. First Name,[Middle Name],Last Name)4
(5. First Name,[Middle Name],Last Name)N

Responses:

YES 1
NO 2 RE320 (REA1335)
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If RE310 coded ?1? (YES), ?RF? (REFUSED), or ?DK? (DON?T KNOW), code RE320 as ?1? (YES, IN RU) for all RU members automatically by CAPI, and go to BOX_160.

Display Instructions:

Roster 1 - Report Roster definition:
This item displays RU-members-roster. Display RU member's First, Middle, and Last names (RE_Person.FullName)
Roster filter:
Display original RU roster minus persons institutionalized in the previous round: RE_Person Array where MostRecentRU equal to RUUnit and RE_Person.MostRecentRU equal to PL_Person.MostRecentRU, including persons where PersAddedBetweenRnds equal to YES, then exclude persons where InstAtTimeOfPrevint equal to YES.
Display Interviewer Instruction 'INTERVIEWER: IF ALL RU MEMBERS?' if respondent is a proxy (ST30 is coded ?2? (PROXY APPROVED BY SUPERVISOR) during current interviewing session). Otherwise, use null display.
Display ?Think about ... here now.?, where 'YEAR' is the second calendar year of the panel, if round 5. Otherwise, use a null display.
Display ?(Are/Were) (READ NAMES BELOW) still living together as a family? if PreloadRUNum greater than 1 (multi person RU). Otherwise, display ?(Is/Was) (READ NAMES BELOW) still living here)? Display ?Are? or ?Is? if Rounds 1 - 4. Display 'Were' or ?Was? If Round 5.
Display ?on December 31, (YEAR)? if Round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display.

RE320 (REA1335)

BLAISE NAME: InRUStat
Question Text:

(Thinking about the people living here on December 31, (YEAR), regardless of where they live now, was/Is) (PERSON) (still) living here?
CHANGE RU STATUS AS NECESSARY TO: "YES, IN RU" OR "NO, NOT IN RU"
HELP: F1

Responses:

YES, IN RU 1 RE320DONE (REA1337)
NO, NOT IN RU 2 RE320DONE (REA1337)

Programmer Instructions:

Preloaded Grid Type 2 including RE320, and RE320DONE.
Hard check:
If respondent is coded as 2 , display the following error message: "THE RESPONDENT CANNOT BE MARKED HERE AS HAVING LEFT THE RU."
Grid behavior:
The RU members column is protected; no changes are allowed.
The keyness column is protected. no changes are allowed.
The date of birth column is protected. no changes are allowed.
The age column is protected. no changes are allowed.
Each row initially has RU status set to ?1?.
Select, add, edit, and delete of persons disallowed.

Display Instructions:

Roster 1 - Report
Roster definition:
Col # 1 Header: DONE
Col # 2 Header: RU member
Instructions: display RU members? First, Middle, and Last names (RE_Person.FullName)
Col # 3 Header: Keyness
Instructions: display the RU member's keyness as either 'key' or 'non-key' (CtrlPersKey)
Col # 4 Header: Date of Birth
Instructions: display the RU member's date of birth (RE_Person.DOBM, RE_Person.DOBD, RE_Person.DOBY)
Col # 5 Header: Age
Instructions: display the RU member's age (RE_Person.AgeRnd)
Col # 6 Header: Status
Instructions: Each row initially has RU status set to ?1? (YES, IN RU). Interviewer is able to update this entry.
Display the RU-members-roster for entry.
Roster filter:
Display original RU roster minus persons institutionalized in the previous round:
RE_Person Array where MostRecentRU equal to RUUnit and RE_Person.MostRecentRU equal to PL_Person.MostRecentRU, including persons where PersAddedBetweenRnds equal to YES, then exclude persons where InstAtTimeOfPrevint equal to YES
Display ?still? if person was recorded as living in the RU in the previous round or on NHIS date. Otherwise, use a null display.
Display ?Thinking about the people living here on December 31, (YEAR), regardless of where they live now, was?, where 'YEAR' is the second calendar year of the panel, if Round 5. Otherwise, display 'Is'.

RE320DONE (REA1337)

BLAISE NAME: InRUStatGridDone
Question Text:

DO ALL FIELDS IN THE GRID HAVE AN ANSWER ENTERED?

Responses:

YES 1 LOOP_20 (REA1350)
NO 2 LOOP_20 (REA1350)

Programmer Instructions:

If '1' (YES), 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 (ENTER) TO GO TO THE FIRST UNANSWERED QUESTION." 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.
If '2' (NO), CAPI should return 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.
Interviewers should not be allowed to leave the screen if no person's RU status is updated from '1' (YES). If the interviewer attempts to leave the screen without making any updates, display the message: "IF EVERYONE IS STILL IN RU, BACKUP TO RE310 AND CORRECT."

Display Instructions: Display as an interviewer instruction.

LOOP_20 (REA1350)

Route Details:

For each element in the RU-members-roster, ask BOX_130-END_LP20.
Loop definition: LOOP_20 determines the location of RU members who have left the RU and the date such persons left. This information is used to determine whether such persons are eligible for this interview (that is, remain on the RU-members-roster) and to define the reference period, if any, for such persons. This loop cycles on RU members who meet the following condition:
- Person left RU (RE320 coded ?2?)

BOX_130 (REA1352)

Route Details:

If Round 1, continue with RE330.
If Rounds 2-5, go to RE340.

RE330 (REA1354)

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

To the best of your knowledge, on (NHIS DATE) was (PERSON) living at (NHIS ADDRESS)?

Responses:

YES 1 RE340 (REA1355)
NO 2 END_LP20 (REA1425)
REFUSED RF RE340 (REA1355)
DON'T KNOW DK RE340 (REA1355)

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm, CtrlPersKey, CrlPersEligible, and/or CtrlCurrHere.

Display Instructions:

For ?NHIS DATE? (Preload.NHISDt) , display the date of the NHIS interview. For ?NHIS ADDRESS?, display the NHIS full address, including city and state, but not zip code. (Preload.CurrStrt1, Preload.CurrStrt2, Preload.CurrCity, Preload.CurrState)

RE340 (REA1355)

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

(On December 31, (YEAR), was/Is) (PERSON) (currently) living away at school, living on a military facility,
institutionalized, or living at another private residence?
HELP: F1

Responses:

LIVING AWAY AT SCHOOL 1 RE360 (REA1365)
LIVING ON A MILITARY FACILITY 2
INSTITUTIONALIZED IN A FACILITY 3 RE350 (REA1360)
IN A PRIVATE RESIDENCE/HOUSEHOLD 4
IF VOLUNTEERED: DECEASED 5
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm and/or CtrlPersEligible
Soft check:
If coded ?1? (LIVING AWAY AT SCHOOL), and person is age 24 or older or in age categories 5-9, display the message: "CODE '1' (LIVING AWAY AT SCHOOL) RESERVED FOR PERSONS 24 OR YOUNGER. (PERSON'S FIRST MIDDLE AND LAST NAME) IS OVER 24 YEARS OF AGE. VERIFY THAT (HE/SHE) IS 24 OR YOUNGER OR CHANGE RESPONSE TO '4' (IN A PRIVATE RESIDENCE/HOUSEHOLD)."
If round 1and coded ?5? (DECEASED), ?RF? (REFUSED) or ?DK? (DON'T KNOW), go to RE420.
If round 2-5 and coded ?5? (DECEASED), ?RF? (REFUSED) or ?DK? (DON'T KNOW), go to RE430_01.
If coded '2' (LIVING ON A MILITARY FACILITY) OR '4' (IN A PRIVATE RESIDENCE/HOUSEHOLD), and person being asked about is less than 16 years of age or in age categories 1-3, go to RE410.
If coded '2' (LIVING ON A MILITARY FACILITY) OR '4' (IN A PRIVATE RESIDENCE/HOUSEHOLD), and person being asked about is 16 years of age or older or in age categories 4-9, go to RE380.

Display Instructions:

Display ?is?and ?currently? if not Round 5. Display ?was? if Round 5. Display ?on December 31, (YEAR), was? if Round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display.

RE350 (REA1360)

BLAISE NAME: GTLT100DInst
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Is (PERSON) expected to stay in the institution 100 days or less, or more than 100 days?

Responses:

100 DAYS OR LESS 1 END_LP20 (REA1425)
MORE THAN 100 DAYS 2
REFUSED RF END_LP20 (REA1425)
DON'T KNOW DK END_LP20 (REA1425)

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm, CrlPersEligible, and/or CtrlCurrHere. If coded '1' (100 DAYS OR LESS), 'RF' (REFUSED), or 'DK' (DON'T KNOW), display the following message: "(PERSON'S FIRST MIDDLE AND LAST NAME) WILL BE CONSIDERED "IN RU" AND INCLUDED AS PART OF THIS INTERVIEW FOR ENTIRE REFERENCE PERIOD. PRESS SUPPRESS TO CONTINUE."
If coded ?2? (MORE THAN 100 DAYS) and round 1, go to RE420
If coded ?2? (MORE THAN 100 DAYS) and round 2-5, go to RE430_01.

Display Instructions:

RE360 (REA1365)

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

What grade or level of school (is (PERSON) attending?/was (PERSON) attending on December 31, (YEAR)? )
HELP: F1

Responses:

1st - 12th GRADE 1 END_LP20 (REA1425)
VOCATIONAL, COLLEGE, GRADUATE, PROFESSIONAL 2 RE370 (REA1370)
REFUSED RF RE370 (REA1370)
DON'T KNOW DK RE370 (REA1370)

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm, CtrlPersKey, CrlPersEligible, and/or CtrlCurrHere.

Display Instructions:

Display ?is (PERSON) attending?? if not Round 5. Display ?was (PERSON) attending on December 31, (YEAR))?? if round 5, where ?YEAR? is the second calendar year of the panel.

RE370 (REA1370)

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

(Is (PERSON) attending a school within the U.S. or outside of the U.S.? / Was (PERSON) attending a school within the U.S. or outside of the U.S. on December 31, (YEAR)?)
HELP: F1

Responses:

WITHIN U.S. 1 END_LP20 (REA1425)
OUTSIDE U.S. 2
REFUSED RF END_LP20 (REA1425)
DON'T KNOW DK END_LP20 (REA1425)

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm, CtrlCurrHere and/or CtrlNewStudent
If coded ?2? (OUTSIDE THE U.S.) and Round 1, go to RE420.
If coded ?2? (OUTSIDE THE U.S.) and Rounds 2-5, go to RE430_01.

Display Instructions:

Display ?Is (PERSON) attending a school within the U.S. or outside of the U.S.? If not Round 5.
Display ?Was (PERSON) attending a school within the U.S. or outside of the U.S. on December 31, (YEAR)??, where 'YEAR' is the second calendar year of the panel, if Round 5.

RE380 (REA1375)

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

(Is/Was) (PERSON) serving on full-time active duty with the Armed Forces of the United States (on December 31, (YEAR))?
HELP: F1

Responses:

YES 1
NO 2 RE410 (REA1380)
REFUSED RF RE410 (REA1380)
DON'T KNOW DK RE410 (REA1380)

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm
If coded ?1? (YES) and at least one other person in the RU has [RE320 coded ?2? (NO, NOT IN RU)], continue with RE390.
Otherwise, (if coded ?1? (YES)), then autocode RE390 ?2? as (NO) for this person, then go to (RE420 if Round 1) or go to (RE430_01 if Rounds 2-5).

Display Instructions:

Display ?Is? if not Round 5. Display ?Was? if Round 5. Display ?on December 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, if Round 5. Otherwise, use a null display.

RE390 (REA1377)

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

(Is/Was) (PERSON) living at (the military facility/that private residence) with at least one of these other household members - ((First Name,[Middle Name],Last Name)1, (First Name,[Middle Name],Last Name)2, (First Name,[Middle Name],Last Name)3,(First Name,[Middle Name],Last Name)4, (First Name,[Middle Name],Last Name)N) (on December 31, (YEAR))?

Responses:

YES 1 RE400 (REA1378)
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Control Variables Impacted: CtrlTrackSumm
If coded ?2? (NO), ?RF?, or ?DK? and Round 1, go to RE420.
If coded ?2? (NO), ?RF?, or ?DK? and Rounds 2-5, go to RE430_01.

Display Instructions:

Roster Definition:
Roster 1 ? Report
This item displays RU-members-roster. Display RU member's first, middle, and last names (RE_Person.FullName)
Roster filter:
Display persons marked as ?2? (NO, NOT IN RU) at RE320.
Display ?Is? if not round 5. Display ?Was? if round 5.
Display 'the military facility' if RE340 is coded '2' (LIVING ON A MILITARY FACILITY) for the person being looped on. Display 'that private residence' if RE340 is coded '4' (IN A PRIVATE RESIDENCE/HOUSEHOLD) for the person being looped on.
Display ?on December 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, if round 5. Otherwise, use a null display.

RE400 (REA1378)

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

Which household member(s) (is/was) (PERSON) living with at the military facility (on December 31, (YEAR))?
ENTER ALL THAT APPLY.

Responses:

(FIRST NAME [MIDDLE NAME] LAST NAME)1 1 RE430_01 (REA1395)
(FIRST NAME [MIDDLE NAME] LAST NAME)2 2 RE430_01 (REA1395)
(FIRST NAME [MIDDLE NAME] LAST NAME)3 3 RE430_01 (REA1395)
(FIRST NAME [MIDDLE NAME] LAST NAME)4 4 RE430_01 (REA1395)
(FIRST NAME [MIDDLE NAME] LAST NAME)N 5 RE430_01 (REA1395)

Programmer Instructions:

Roster Behavior:
1. Multiple select allowed.

Display Instructions:

Roster 2 ? no add/edit/delete
Roster Definition:
Display the RU-members-roster for selection. (RE_Person.FullName)
Roster Filter:
Display persons marked as ?2? (NO, NOT IN RU) at RE320.
Display ?is? if not round 5. Display ?was? if round 5. Display ?on December 31, (YEAR)?, where
'YEAR' is the second calendar year of the panel, if round 5. Otherwise, use a null display.

RE410 (REA1380)

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

(Is/Was) (PERSON) living (in another private residence/at a military facility) that (is/was) within the U.S. or outside of the U.S. (on December 31, (YEAR))?
HELP: F1

Responses:

WITHIN U.S. 1
OUTSIDE U.S. 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded ?2? (OUTSIDE THE U.S.) and Round 1, go to RE420.
If coded ?2? (OUTSIDE THE U.S.) and Rounds 2-5, go to RE430_01.
If coded ?1? (WITHIN THE U.S.), ?RF? (REFUSED), or ?DK? (DON?T KNOW) and Rounds 1, 2, 4 or 5, go to END_LP20.
If coded ?1? (WITHIN THE U.S.), ?RF? (REFUSED), or ?DK? (DON?T KNOW) and Round 3, go to RE425.

Display Instructions:

Display ?Is? if not Round 5. Display ?Was? if Round 5. Display ?on December 31, (YEAR)', where 'YEAR' is the second calendar year of the panel, if Round 5. Otherwise, use a null display.
Display ?in another private residence? if RE340 is coded ?4? (IN A PRIVATE RESIDENCE/HOUSEHOLD). Display ?at a military facility? if RE340 is coded ?2? (LIVING ON A MILITARY FACILITY).

RE420 (REA1391)

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

(Was (PERSON) institutionalized/Did (PERSON) (pass away/stop living with (your/ (NHIS REFERENCE PERSON)?s) household)) before January 1, (YEAR)?

Responses:

YES 1 END_LP20 (REA1425)
NO 2 RE430_01 (REA1395)
REFUSED RF RE430_01 (REA1395)
DON'T KNOW DK RE430_01 (REA1395)

Display Instructions:

Display ?Was (PERSON) institutionalized? if RE340 is coded ?3? (INSTITUTIONALIZED IN A FACILITY). Otherwise, display ?Did (PERSON) ((pass away/stop living with (NHIS REFERENCE PERSON)?s) household)?.
Display ?pass away? if RE340 is coded ?5? (IF VOLUNTEERED: DECEASED). Otherwise, display ?stop living with (your/(NHIS REFERENCE PERSON)?s) household?.
Display 'your' if the NHIS reference person is the same as the current round respondent. (RespondentPersID equal to Preload.NewRefPersPID) Otherwise, display '(NHIS REFERENCE PERSON)?s household'.
For ?NHIS REFERENCE PERSON?, display the name of the NHIS reference person (Preload.NewRefPersPID).
For ?YEAR?, display the first calendar year of the panel.

RE425 (REA1392)

BLAISE NAME: LeftHhBefDec31
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Did (PERSON) stop living with (your/(REFERENCE PERSON)?s) household before December 31, (YEAR)?

Responses:

YES 1 END_LP20 (REA1425)
NO 2 END_LP20 (REA1425)
REFUSED RF END_LP20 (REA1425)
DON'T KNOW DK END_LP20 (REA1425)

Display Instructions:

Display 'your' if the preloaded current round reference person is the same as the current round respondent. (RespondentPersID equal to Preload.NewRefPersPID). Otherwise, display '(REFERENCE PERSON)?s?.
For ?REFERENCE PERSON?, display the name of the current round preloaded reference person (Preload.NewRefPersPID).
For ?YEAR?, display the first calendar year of the panel.

RE430_01 (REA1395)

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

On what date (was (PERSON) institutionalized/ did (PERSON) (pass away/stop living with (your/((NHIS REFERENCE PERSON)/ (REFERENCE PERSON))?s) household)?
ENTER MONTH.

Responses: 1 RE430_02 (REA1396)
Programmer Instructions: DK and RF disallowed for month.
Display Instructions:

Display RE430_01, RE430_02, and RE430_03 on the same form pane.
Display ?was (PERSON) institutionalized? if RE340 is coded ?3? (INSTITUTIONALIZED IN A FACILITY). Otherwise, display ?did (PERSON) (pass away/stop living with (your/ ((NHIS REFERENCE PERSON)/(REFERENCE PERSON))'s) household'.
Display ?pass away? if RE340 is coded ?5? (IF VOLUNTEERED: DECEASED).
Otherwise, display ?stop living with (your/((NHIS REFERENCE PERSON)/(REFERENCE PERSON))?s) household?.
Display 'your' if the preloaded reference person (NHIS reference person if Round 1, preloaded current round reference person if Rounds 2-5) is the same as the current round respondent. (RespondentPersID equal to Preload.NewRefPersPID) Otherwise, display '((NHIS REFERENCE PERSON/REFERENCE PERSON)) household?.
Display ?NHIS REFERENCE PERSON?/'REFERENCE PERSON', inserting the name of the NHIS or current round preloaded reference person (Preload.NewRefPersPID).

RE430_02 (REA1396)

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

[On what date (was (PERSON) institutionalized/ did (PERSON) (pass away/stop living with (your/((NHIS REFERENCE PERSON)/ REFERENCE PERSON))?s) household )?]
ENTER DAY.

Responses:

1 RE430_03 (REA1397)
REFUSED RF RE430_03 (REA1397)
DON'T KNOW DK RE430_03 (REA1397)

Display Instructions:

Display RE430_01, RE430_02, and RE430_03 on the same form pane.
Use same display instructions as RE430_01.
Display question text in brackets and lighter "grayed-out" text.

RE430_03 (REA1397)

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

[On what date (was (PERSON) institutionalized/ did (PERSON) (pass away/stop living with (your/((NHIS REFERENCE PERSON)/ REFERENCE PERSON))?s) household )?]
ENTER 4-DIGIT YEAR.

Responses: 1
Programmer Instructions:

If date is equal to or after 01/01/(YEAR) and RE340 is coded ?3? (INSTITUTIONALIZED IN A FACILITY) for person, continue with RE440. Otherwise, go to END_LP20.
Disallow RF/DK for year.
Hard check:
Edit (for Round 1 if RE420 was asked. If RE420 was not asked, do not invoke hard check): Date entered must be on or after 1/1/(YEAR) where ?YEAR? is first calendar year of the panel. If a date before 1/1/(YEAR) is entered, display the following message: ?DATE MUST BE ON OR AFTER 1/1/(YEAR). IF LEFT RU BEFORE 1/1/(YEAR), BACK-UP AND RE-CODE RE420 (StopLivingNHISHH).?
Hard check:
Edit (for Round 5): date entered must be on or before 12/31/(YEAR) where 'YEAR' is the second calendar year of the panel. If a date after 12/31/(YEAR) is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/(YEAR). IF LEFT RU AFTER 12/31/(YEAR), BACK- UP AND RE-CODE RE320 (InRUStat)."
Hard check:
Edit: date entered must be on or before EndRefDt (Interview date). If date entered at RE430_01, RE430_02, and RE430_03 is greater than EndRefDt (Interview date), display the following message: "UNLIKELY RESPONSE. DATE CANNOT BE AFTER TODAY'S DATE OR BEFORE 1893. VERIFY WITH RESPONDENT AND RE-ENTER."

Display Instructions:

Display RE430_01, RE430_02, and RE430_03 on the same form pane.
Use same display instructions as RE430_01.
Display question text in brackets and lighter "grayed-out" text.

RE440 (REA1400)

BLAISE NAME: InstPrvd24HrCare
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

(Is/Was) (PERSON) (now) living in a nursing home or any other long-term care institution that provides 24 hour skilled nursing care (on December 31, (YEAR))?
HELP: F1

Responses:

YES 1 RE450_01 (REA1401)
NO 2 END_LP20 (REA1425)
REFUSED RF RE450_01 (REA1401)
DON'T KNOW DK RE450_01 (REA1401)

Programmer Instructions:

Ctrl Variables Impacted: CtrlTrackSumm
Note: Key persons coded as institutionalized in a place that provides 24 hour skilled nursing care will be followed in the next round.
Display Instructions: Display ?Is? if not Round 5. DISPLAY ?Was? if Round 5. Display ?now? if not Round 5. Display ?on December 31, (YEAR)? if Round 5, where 'YEAR' is the second calendar year of the panel.

RE450_01 (REA1401)

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

Please give me the name and address of the nursing home or long term care facility where (PERSON) (is/was) living (now/on December 31, (YEAR)).
What is the name?
ENTER NAME.

Responses:

1 RE450_02 (REA1402)
REFUSED RF RE450_02 (REA1402)
DON'T KNOW DK RE450_02 (REA1402)

Programmer Instructions:
Display Instructions:

Display RE450_01, RE450_02, RE450_03, RE450_04, RE450_05, and RE450_6 on the same form pane.
Display ?is? if not Round 5. Display ?was? if round 5. Display ?now? if not Round 5. Display ?on December 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, if Round 5.

RE450_02 (REA1402)

BLAISE NAME: InstStrtAddr1
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

[Please give me the name and address of the nursing home or long term care facility where (PERSON) (is/was) living (now/on December 31, (YEAR)).]
ENTER STREET ADDRESS.

Responses:

1 RE450_03 (REA1403)
REFUSED RF RE450_03 (REA1403)
DON'T KNOW DK RE450_03 (REA1403)

Display Instructions:

Display RE450_01, RE450_02, RE450_03, RE450_04, RE450_05, and RE450_6 on the same form pane.
Use same display instructions as RE450_01.
Display question text "Please give me...December 31, (YEAR))." in brackets and "grayed-out" text.

RE450_03 (REA1403)

BLAISE NAME: InstStrtAddr2
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

[Please give me the name and address of the nursing home or long term care facility where (PERSON) (is/was) living (now/on December 31, (YEAR)).]
ENTER BUILDING OR ADDITIONAL ADDRESS INFORMATION, AS NECESSARY. IF NONE, PRESS ENTER.

Responses:

1 RE450_04 (REA1404)
EMPTY Empty RE450_04 (REA1404)
REFUSED RF RE450_04 (REA1404)
DON'T KNOW DK RE450_04 (REA1404)

Programmer Instructions:

Allow EMPTY.

Display Instructions:

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

[Please give me the name and address of the nursing home or long term care facility where (PERSON) (is/was) living (now/on December 31, (YEAR)).]
ENTER CITY.

Responses:

1 RE450_05 (REA1405)
REFUSED RF RE450_05 (REA1405)
DON'T KNOW DK RE450_05 (REA1405)

Display Instructions:

RE450_05 (REA1405)

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

[Please give me the name and address of the nursing home or long term care facility where (PERSON) (is/was) living (now/on December 31, (YEAR)).]
ENTER STATE.
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND PRESS ENTER TO SELECT.

Responses:

1 RE450_06 (REA1406)
REFUSED RF RE450_06 (REA1406)
DON'T KNOW DK RE450_06 (REA1406)

Programmer Instructions:

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

Display Instructions:

RE450_06 (REA1406)

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

[Please give me the name and address of the nursing home or long term care facility where (PERSON) (is/was) living (now/on December 31, (YEAR)).]
ENTER ZIP CODE.

Responses:

1 END_LP20 (REA1425)
REFUSED RF END_LP20 (REA1425)
DON'T KNOW DK END_LP20 (REA1425)

Programmer Instructions:

Display Instructions:

END_LP20 (REA1425)

Route Details:

Cycle on next person in the RU-members-roster who meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_20 and continue with BOX_140.

Programmer Instructions:

Control Variables Impacted: CtrlPersKey, CtrlPersEligible, CtrlTrakSumm, CtrlNewStudent, CtrlCurrHere
Set RemovedATLoop20 equal to YES and RemovedAtRE330 equal to YES (Incorrectly Listed) if: RE330 coded ?2? (NO)
Note: This person is not currently here, and was not here at NHIS. They are not key, ineligible and out-of-scope for the entire reference period. The RE section will NOT collect locating information for this person; person will not be included in the rest of the interview and will not be followed.
SetRemovedAtLoop20 equal to YES and StudentMoverALoop20 equal to YES (New Student) if: If RE340 coded ?1? (LIVING AWAY AT SCHOOL) and RE360 is coded ?2? (VOCATIONAL, COLLEGE, GRADUATE, PROFESSIONAL), ?RF? (REFUSED) or ?DK' (DON'T KNOW) and RE370 coded ?1? (WITHIN U.S.), ?RF? (REFUSED), or ?DK? (DON?T KNOW)
Note: This person is not currently here, but at this point in the interview the student is eligible and in-scope for data collection in a student RU. The RE section will later determine if locating information for this student is necessary. Students are included for some items in RE but not the rest of the interview.
If [RE420 is coded ?1? (YES)] or if [date at RE430_01 ? RE430_03 is prior to 1/1/(YEAR) if Round 1] or if [date at RE430_01-RE430_03 is prior to date of previous RU interview date (RUEndM, RUEndD, RUEndY) if Rounds 2-5], set RemovedATLoop20 equal to YES and MoverAtLoop20 equal to NO (out of scope) if: RE340 is coded ?4? (IN A PRIVATE RESIDENCE/HOUSEHOLD) and RE380 is coded ?2? (NO), ?RF?, ?DK? or EMPTY AND RE410 is coded ?2? (OUTSIDE THE U.S.) (Moved outside the U.S., NOT FT MILITARY; PRIVATE RESIDENCE) (CtrlTrackSumm equal to 8)
OR
RE340 is coded ?2? (LIVING ON A MILITARY FACILITY) and RE380 is coded ?2? (NO), ?RF?, ?DK? or EMPTY AND RE410 is coded ?2? (OUTSIDE THE U.S.), (MOVED OUTSIDE U.S.; NOT FT MILITARY; AT MILITARY FACILITY (CtrlTrackSumm equal to 9).
OR
RE340 is coded ?3? (INSTITUTIONALIZED IN A FACILITY), ?5? (IF VOLUNTEERED: DECEASED), ?RF? (REFUSED), or ?DK? (DON?T KNOW)
OR
RE380 is coded ?1? (YES) and RE390 is coded ?2? (NO), ?RF?, ?DK?
OR
RE340 is ?1? (LIVING AWAY AT SCHOOL) and RE360 is coded ?2? (VOCATIONAL, COLLEGE, GRADUATE, PROFESSIONAL), ?RF?, or ?DK?, and RE370 is coded ?2? (OUTSIDE THE U.S.)
Note: This person is not currently here, has no period of eligibility and is out-of-scope. The RE section will NOT collect locating information for this person; person will not be included in the rest of the interview and will not be followed.
Set RemovedATLoop20 equal to YES and MoverAtLoop20 equal to YES (MOVERS) If RE340 is coded ?4? (IN A PRIVATE RESIDENCE/HOUSEHOLD) AND RE380 is coded ?2? (NO), ?RF?, ?DK?, or EMPTY and RE410 is coded ?1? (WITHIN THE U.S.), ?RF? or ?DK? (MOVED INSIDE THE U.S.; NOT FT MILITARY; PRIVATE RESIDENCE (CtrlTrackSumm equal to 10)
OR
If RE340 is coded ?2? (LIVING ON A MILITARY FACILITY) AND RE380 is coded ?2? (NO), ?RF?, ?DK? or EMPTY AND RE410 is coded ?1? (WITHIN THE U.S.), ?RF? or ?DK? (MOVED INSIDE U.S.; NOT FT MILITARY; AT MILITARY FACILITY (CtrlTrackSumm equal to 11)
Note: This person is not currently here, but is in-scope and eligible to be interviewed as part of another RU from the date of their previous interview until that new interview date. The RE section will collect locating information for this person, but person will not be included in this interview after the RE section. Information for person will be collected as part of another RU
Evaluated after looping through everyone:
? Person is full-time military but is not living with an RU member who is key, civilian, and living in the U.S. (will need to be determined later after all looping- see BOX_140).
Note: Any person with any period of partial or full eligibility is considered currently here and is eligible and in-scope for data collection as part of this RU. They do NOT have a RemovedAtLoop20 set. This includes persons leaving the RU after January 1, including those who are deceased, institutionalized, or who have moved outside the U.S. or are now full-time military living alone.
Note: IF RE350 is coded '1' (100 DAYS OR LESS), 'RF' (REFUSED), or 'DK' (DON'T KNOW), this person has a status of ?in-scope, eligible, entire reference period.? Person is treated as a current RU member.
Note: If RE360 coded ?1? (1st-12th GRADE), this person has a status of ?in-scope, eligible, entire reference period.? Person is treated as a current RU member

BOX_140 (REA1427)

Route Details:

Control Variables Impacted: CtrlPersTrackSumm, CtrlPersEligible
Check RE390 response for all RU members. For each RU member with RE390 equal to 1 (YES), evaluate status of other RU members who moved with this person (RU members selected at RE400).
If at least one person selected at RE400 for this person is marked as key and has a status of ?NON-MILITARY MOVER IN THE U.S.? or ?NON-MILITARY MOVER IN U.S. AT A MILITARY FACILITY? [at least one person selected at RE400 for this RU member has a status of (CtrlPersKeyatEnd_LP20 equal to Yes) and (CtrlTrackSummatEnd_LP20 equal to 10 or 11)], then RU member with RE390 equal to 1 is ?FT MILITARY ON MILITARY FACILITY WITH OTHERS? (CtrlTrackSumm equal to 7). Set RemovedAtLoop20 equal to YES and MoverAtLoop20 equal to YES.
Note: Persons who are full-time military, regardless of location or date entered at RE430, who have moved with other key civilians will not be included in the interview after the RE section. They will be treated as regular movers and information for this person will be collected as part of another RU.
Otherwise, if no one selected at RE400 as moving with this person is marked as key and has a status of ?NON-MILITARY MOVER IN THE U.S.? or ?NON-MILITARY MOVER IN U.S. AT A MILITARY FACILITY? [no one selected at RE400 for this RU member has a status of (CtrlPersKeyatEnd_LP20 equal to YES) and (CtrlTrackSummatEnd_LP20 equal to 10 or 11)] then RU member with RE390 equal to 1 is ?FT MILITARY ON MILITARY FACILITY ALONE.? (CtrlTrackSumm equal to 6)
Then, evaluate date entered at RE430 for individuals where CtrlTrackSumm was just set to 6.
If [date at RE430_01 ? RE430_03 is prior to 1/1/(YEAR) if Round 1] or if [date at RE430_01-RE430_03 is prior to date of previous RU interview date (RUEndM, RUEndD, RUEndY) if Rounds 2-5], then set RemovedATLoop20 equal to YES and MoverAtLoop20 equal to NO (out of scope). If [date at RE430_01 ? RE430_03 is on or after 1/1/(YEAR) if Round 1] or if [date at RE430_01-RE430_03 is on or after date of previous RU interview date (RUEndM, RUEndD, RUEndY) if Rounds 2-5] keep RemovedatLoop20 equal to Empty.
Note: Persons who are full-time military, regardless of location, who have not moved with other key civilians are eligible depending on the date they moved.
If the person moved prior to the reference period start date, this person is not currently here, has no period of eligibility and is out-of-scope. The RE section will NOT collect locating information for this person; person will not be included in the rest of the interview and will not be followed.
If the person moved on or after the reference period start date, person is in scope and partially eligible for data collection until the date left the RU.
Continue with BOX_150.

BOX_150 (REA1430)

Route Details:

If all RU members left the RU and are not eligible for the study as part of any RU (therefore, locating information is not required); that is:
Everyone is (RemovedAtLoop10 equal to YES or RemovedAtLoop20 equal to YES)
and
[(MoverAtLoop10 equal to NO or RemovedAtRE180 equal to YES)
OR
(MoverAtLoop20 equal to NO or RemovedAtRE330 equal to Yes)]
Continue with RE460.
Otherwise if at least one RU member is currently living in the RU (that is, if at least one person on the RE_Person array where CtrlTrackSummAtEnd_LP20 is empty and CtrlNewStudentAtEnd_LP20 is empty) go BOX_160.
Otherwise, go to BOX_210.

RE460 (REA1435)

BLAISE NAME: EndNoElg
Question Text:

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

Responses: CONTINUE 1 RE470 (REA1440)
Display Instructions:

RE470 (REA1440)

BLAISE NAME: HowIntvCompNoElg
Question Text:

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

Responses:

IN-PERSON 1 BOX_250 (REA2050)
TELEPHONE 2 BOX_250 (REA2050)

Display Instructions:

BOX_160 (REA1445)

Route Details:

If RU Type equal to New Standard RU, continue with RE480.
If RU Type not equal to New Standard RU, and if previous round reference person (or NHIS reference person if Round 1) is still in RU on date of interview (or as of December 31, (YEAR) where 'YEAR' is the second calendar year of the panel, if Round 5), that is if previous round reference person meets all of the following conditions:
Person equal to greater than 16 years old or age category 4-9 AND CtrlTrackSummAtEnd_LP20 is empty and CtrlNewStudentAtEnd_LP20 is empty
Then flag previous round reference person (or NHIS reference person if Round 1) as current round reference person (set RefPersPID equal to Preloaded RefPersPID) and go to BOX_170.
Otherwise, continue with RE480.

RE480 (REA1450)

BLAISE NAME: OwnRentHome
Question Text:

Of all the people who (live/lived) in this household (on December 31, (YEAR)), (does/did) anyone own or rent this home?

Responses:

YES 1 RE490 (REA1455)
NO 2 RE500 (REA1465)
REFUSED RF RE500 (REA1465)
DON'T KNOW DK RE500 (REA1465)

Display Instructions:

Display ?live? if not Round 5. Display ?lived? if Round 5.
Display ?does? if not Round 5. Display ?did? if Round 5.
Display ?on December 31, (YEAR), where 'YEAR' is the second calendar year of the panel, if Round 5.
Otherwise, use a null display.

RE490 (REA1455)

BLAISE NAME: NewRefPersPID
Question Text:

Of the people in this family, 16 and older, who (live/lived) here (now /on December 31, (YEAR)), who (owns/owned) or (rents/rented) this home?)
IF NAME GIVEN NOT LISTED, PROBE TO DETERMINE IF NEW RU MEMBER (I.E., RELATED) OR PERSON NOT IN RU.
HELP: F1

Responses:

PERSON NOT IN RU 0 RE500 (REA1465)
(FIRST NAME [MIDDLE NAME] LAST NAME)1 1 BOX_170 (REA1475)
(FIRST NAME [MIDDLE NAME] LAST NAME)2 2 BOX_170 (REA1475)
(FIRST NAME [MIDDLE NAME] LAST NAME)3 3 BOX_170 (REA1475)
(FIRST NAME [MIDDLE NAME] LAST NAME)4 4 BOX_170 (REA1475)
(FIRST NAME [MIDDLE NAME] LAST NAME)N 5 BOX_170 (REA1475)

Programmer Instructions:

Set RefPersPID equal to PID selected at RE490
Roster behavior:
Select allowed.
Multiple select, add, delete, and edit disallowed.

Display Instructions:

Roster 2 ? no add/edit/delete
Roster definition:
This item displays the RU-members-roster for selection of the person who owns or rents the home. (RE_Person.FullName). Persons who are new students or have left the RU are excluded.
Roster filter:
Display RE_Person Array where MostRecentRU equal to RUUnit where CtrlTrackSummAtEnd_LP20 is empty and CtrlNewStudentAtEnd_LP20 is empty
Display ?live? and ?now? and ?owns? and ?rents? if not round 5. Display ?lived? and ?on December 31, (YEAR)?, where ?YEAR? is the second calendar year of the panel, if round 5 and ?owned? and ?rented? if round 5.

RE500 (REA1465)

BLAISE NAME: NewRefPersPIDAdded
Question Text:

Of all the people in this family who (live/lived) here (now/on December 31, (YEAR)), who (is/was) considered the head of household?
TO ADD A NEW RU MEMBER AS HEAD OF HOUSEHOLD, PRESS CTRL-A.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

Responses:

(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)1 1 BOX_170 (REA1475)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)2 2 BOX_170 (REA1475)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)3 3 BOX_170 (REA1475)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)4 4 BOX_170 (REA1475)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)N 5 BOX_170 (REA1475)

Programmer Instructions:

Control Variables Impacted: CtrlCurrHere
Set RefPersPID equal to PID selected at RE500
If person from another RU selected and verified as the head of household, add person to RU- Members-Roster.
Roster behavior:
1. Only single select or single add allowed.
Soft checks:
If a person from another RU selected (RE_Person.MostRecentRU does not equal RUUnit), display the message: "PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION."
2. If the preload age is not empty and the person selected as the head of household is under 16 or in age categories 1-3, (PL_Person.AgeRnd less than 16 or PL_Person.AgeRnd in (1-3)) display message: "HEAD OF HOUSEHOLD less than 16. S/HE MUST BE APPROVED BY SUPERVISOR. RESELECT TO VERIFY."
Hard checks:
If person who has left the RU selected (where CtrlTrackSummAtEnd_LP20 is not empty or CtrlNewStudentAtEnd_LP20 is not empty), display the message: "SELECTION IS INAPPROPRIATE. YOU MUST SELECT SOMEONE CURRENTLY LIVING IN RU."
2. If a person(s) was/were added at RE500 [CREATEQ equal to RE500 and OrigRnd equal to Current Round and DeleteFlg equal to empty], but not any of these newly added persons was selected when interviewer leaves the screen, display the following message: ?YOU HAVE ADDED (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) AND DID NOT SELECT ANY OF THEM AS THE HEAD OF THE HOUSEHOLD. IF ANY OF THESE NEWLY ADDED PERSON (S) IS NOT THE HEAD OF THE HOUSEHOLD, USE CTRL-D TO DELETE THE PERSON (S) AND THEN SELECT THE CORRECT HOUSEHOLD HEAD.?

Display Instructions:

Roster 3 ? add/edit/delete allowed
Roster definition:
Display the DU-Members-Roster for selection of head of household.
Roster filter:
None. Display all DU members (RE_Person.PERSID)
Display any RU members marked as having left the RU (where CtrlTrackSummAtEnd_LP20 is not empty or CtrlNewStudentAtEnd_LP20 is not empty) as grayed out text.
For ?AGE?, display person's age calculated according to age calculation specifications in the GL section.
For ?SEX?, display person's sex as collected during previous interview (RE_Person.Sex).
For ?RUID?, display the RUID (RE_Person.MostRecentRU) associated with this person.
When CTRL-A selected, display the following customized question wording in the pop-up: ENTER NAME OF NEW RU MEMBER WHO OWNS OR RENTS HOME OR IS HEAD OF HOUSEHOLD.
May I have your full name? VERIFY SPELLING.
IF NO MIDDLE NAME OR INITIAL, LEAVE FIELD BLANK.
Display first interviewer instruction and question text in lighter "grayed-out" text when cursor in middle name or last name entry field. Display the second interviewer instruction when cursor in middle name entry field.
Display ?live? and ?now? and ?is? if not Round 5. Display ?lived? and ?on December 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, and ?was? if Round 5.

BOX_170 (REA1475)

Route Details:

If Round 1 and [RUType equal to New Standard RU] and Preload RU Num equal to 1 (single person RU) and ST30 is coded '1' (RESPONDENT IS AN RU MEMBER), go to RE520.
If Rounds 2-5 and if [RUType equal to New Standard RU] and RUNum equal to 1 (single person RU), and ST30 coded '1' (RESPONDENT IS AN RU MEMBER), go to RE520.
Else, if at least one person is an original RU member who is still living in the RU at the time of the current interview (RE_Person.PreloadRU equal to RUUnit where
CtrlTrackSummAtEnd_LP20 is empty or CtrlNewStudentAtEnd_LP20 is empty) then continue with RE510.
Otherwise, go to BOX_210.

RE510 (REA1480)

BLAISE NAME: AddPersNotNew
Question Text:

(Please think about the people living here as of December 31, (YEAR) for the next few questions.) Other than (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N), (is/was) there anyone who (is/was) living here (now/on December 31, (YEAR)) related to (you/(REFERENCE PERSON)) by blood, marriage, living together as married, adoption or foster care relationship? Do not include anyone (who was) staying here temporarily who usually (lives/lived) somewhere else.
HELP: F1

Responses:

YES 1 RE530 (REA1490)
NO 2 RE540 (REA1535)
REFUSED RF RE540 (REA1535)
DON'T KNOW DK RE540 (REA1535)

Programmer Instructions:

Hard check:
If answer to RE510 was changed from ?1? (YES) to ?2? (No) upon back-up and only one person was added at RE530 [CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty], display the following message as a Manipula pop-up when the interviewer leaves the screen: ?CHANGING ANSWER TO ?NO? WILL DELETE (PERSON) AS PART OF THE RU. ARE YOU SURE YOU STILL WANT TO CHANGE THE ANSWER TO ?NO??? CAPI provides the options: YES, DELETE (PERSON) or NO, KEEP (PERSON). If ?YES, DELETE (PERSON)? is selected, set RE510 to ?2? (No) and then set a delete flag to that one person with a CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty. Then put FI back to the RE510 entry field (which is still coded ?2? (NO)). If ?NO, KEEP (PERSON)? is selected, set RE510 back to ?1? (YES). Auto-select person at RE530 and put FI at the RE530 entry field with person already selected by CAPI.
2. If answer to RE510 was changed from ?1? (YES) to ?2? (No) upon back-up and more than one person was added at RE530 [greater than1 person with a CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty], display the following message as a Manipula pop-up when the interviewer leaves the screen: ?CHANGING ANSWER TO ?NO? WILL DELETE (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) AS PART OF THE RU. DO YOU WANT TO DELETE ALL OF THEM?? CAPI provides the options:
YES, DELETE ALL OF THEM
NO, I WILL DELETE SELECT PERSON(S)
NO, KEEP ALL OF THEM
If ?YES, DELETE ALL OF THEM? is selected, set RE510 to ?2? (No) and then set a delete flag to all the persons with a CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty. Then put FI back to the RE510 entry field (which is still coded ?2? (NO)).
If ?NO, I WILL DELETE SELECT PERSON(S)? is selected, set RE510 back to ?1? (Yes) and display a second Manipula pop-up message: "INTERVIEWER: AT THE NEXT SCREEN, USE CTRL-D TO DELETE THE PERSON(S) YOU WANT REMOVED FROM THE RU?. After the FI presses OK to clear this message, auto-select all the persons with CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty at RE530 and then put FI at the RE530 entry field with persons already selected by CAPI.

If ?NO, KEEP ALL OF THEM? is selected, set RE510 back to ?1? (YES). Auto-select all the persons with CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty at RE530 and then put FI at the RE530 entry field with persons already selected by CAPI.

Display Instructions:

2Display RU members? first, middle, and last names (Person.FullName) in question text. Substitute ?you? for the person?s name if the respondent is included in this list. If exactly two names displayed, separate names with the word ?and? and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word ?and?.
Roster 1 - Report
Roster definition:
This item displays RU-Members-Roster. Display RU member's First, Middle, and Last names (RE_Person.FullName)
Roster filter:
Display persons currently living here including new persons (except people who are students or who have moved or are now out of scope) RE_Person Array where MostRecentRU equal to RUUnit except for persons where RemovedAtLoop10 equal to YES or RemovedAtLoop20 equal to Yes
Display ?Please .. questions.? if Round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display.
Display ?is? and ?is? and ?now? if not Round 5. Display ?was? and ?was? and ?on December 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, if Round 5.
Display 'who was' if Round 5. Otherwise, use a null display. Display 'lives' if Round 1-4. Display 'lived' if Round 5.
Display ?you? if the current round reference person is the same as the current round respondent. (RespondentPersID equal to RefPersPID) Otherwise, display ?(REFERENCE PERSON)? substituting the full name of the current round reference person (RefPersPID).

RE520 (REA1485)

BLAISE NAME: AddPersAny
Question Text:

We would like to include the other members of (your/(REFERENCE PERSON)'s) household who are related to (you/him/her) in this interview.
(Is/Was) there anyone else who (is/was) living here (now/on December 31, (YEAR)) related to (you/(REFERENCE PERSON))by blood, marriage, living together as married, adoption, or foster care relationship? Do not include anyone staying here temporarily who usually lives somewhere else.
HELP: F1

Responses:

YES 1 RE530 (REA1490)
NO 2 RE540 (REA1535)
REFUSED RF RE540 (REA1535)
DON'T KNOW DK RE540 (REA1535)

Programmer Instructions:

Hard-check:
If answer to RE520 was changed from ?1? (YES) to ?2? (No) upon back-up and only one person was added at RE530 [CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty], display the following message as a Manipula pop-up when the interviewer leaves the screen: ?CHANGING ANSWER TO ?NO? WILL DELETE (PERSON) AS PART OF THE RU. ARE YOU SURE YOU STILL WANT TO CHANGE THE ANSWER TO ?NO??? CAPI provides the options: YES, DELETE (PERSON) or NO, KEEP (PERSON). If ?YES, DELETE (PERSON)? is selected, set RE520 to ?2? (No) and then set a delete flag to that one person with a CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty. Then put FI back to the RE520 entry field (which is still coded ?2? (NO)). If ?NO, KEEP (PERSON)? is selected, set RE520 back to ?1? (YES). Auto-select person at RE530 and put FI at the RE530 entry field with person already selected by CAPI.
If answer to RE520 was changed from ?1? (YES) to ?2? (No) upon back-up and more than one person was added at RE530 [greater than1 person with a CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty], display the following message as a Manipula pop-up when the interviewer leaves the screen: ?CHANGING ANSWER TO ?NO? WILL DELETE (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) AS PART OF THE RU. DO YOU WANT TO DELETE ALL OF THEM?? CAPI provides the options:
YES, DELETE ALL OF THEM
NO, I WILL DELETE SELECT PERSON(S)
NO, KEEP ALL OF THEM
If ?YES, DELETE ALL OF THEM? is selected, set RE520 to ?2? (No) and then set a delete flag to all the persons with a CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty. Then put FI back to the RE520 entry field (which is still coded ?2? (NO)).
If ?NO, I WILL DELETE SELECT PERSON(S)? is selected, set RE520 back to ?1? (Yes) and display a second Manipula pop-up message: "INTERVIEWER: AT THE NEXT SCREEN, USE CTRL-D TO DELETE THE PERSON(S) YOU WANT REMOVED FROM THE RU?. After the FI presses OK to clear this message, auto-select all the persons with CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty at RE530 and then put FI at the RE530 entry field with persons already selected by CAPI.
If ?NO, KEEP ALL OF THEM? is selected, set RE520 back to ?1? (YES). Auto-select all the persons with CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty at RE530 and then put FI at the RE530 entry field with persons already selected by CAPI.

Display Instructions:

Display ?Is? if not Round 5. Display ?Was? if Round 5. Display ?now? if not Round 5. Display ?on December 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, if Round 5.
Display ?you? if the current round reference person is the same as the current round respondent. (RespondentPersID equal to RefPersPID) Otherwise, display ?(REFERENCE PERSON)? substituting the full name of the current round reference person (RefPersPID).

RE530 (REA1490)

BLAISE NAME: AddPersRoster
Question Text:

(INTERVIEWER: IF ALL PERSONS WHO HAVE JOINED THE RU ARE ALREADY SELECTED, BACKUP AND CHANGE PREVIOUS SCREEN TO ?NO?.)
Who else living here (now/on December 31, (YEAR) (is/was) related to (you/(REFERENCE PERSON))?
PROBE: Anyone else?
TO ADD A NEW RU MEMBER, PRESS CTRL-A.
IF NO NEW PERSON HAS JOINED THE RU, BACKUP TO CORRECT PREVIOUS SCREEN(S).
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)1 1 RE540 (REA1535)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)2 2 RE540 (REA1535)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)3 3 RE540 (REA1535)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)4 4 RE540 (REA1535)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)N 5 RE540 (REA1535)

Programmer Instructions

If a person from another RU verified, add that person to the RU-Members-Roster.
Control Variables Impacted: CtrlCurrHere
Roster behavior:
Multiple select and multiple add allowed.
Limited edit and delete allowed. RU members that have been ?preloaded? for this case (RU members that are from the NHIS or the previous round) cannot be edited or deleted at any person roster. Only newly added RU members that have been added at this screen during the current interviewing session can be edited or deleted. FIs may back up and return to this screen to use edit or delete functionality, but may not edit or delete an RU member added at this screen at any other person roster.
Soft check:
1. If a person from another RU selected (RE_Person.MostRecentRU does not equal RUUnit), display the message: "PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION."
Hard checks:
If person is marked as a current RU member [where (CtrlTrackSummAtEnd_LP20 is empty or CtrlNewStudentAtEnd_LP20 is empty) and (RE_Person.MostRecentRU equal to RUUnit)], display message: "PERSON CANNOT BE SELECTED. S/HE HAS ALREADY BEEN IDENTIFIED AS PART OF THIS RU." If person who has left the RU selected (where CtrlTrackSummAtEnd_LP20 is not empty or CtrlNewStudentAtEnd_LP20 is not empty), display the message: "SELECTION IS INAPPROPRIATE. YOU MUST SELECT SOMEONE CURRENTLY LIVING IN RU."
3. If a person was added at RE530 [CREATEQ equal to RE530 and OrigRnd equal to Current Round and DeleteFlg equal to empty], but that same person was not selected when interviewer leaves the screen, display the following message: ?NEWLY ADDED PERSONS MUST BE SELECTED. YOU HAVE ADDED (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) AND DID NOT SELECT THEM. IF NEWLY ADDED PERSON(S) (IS/ARE) NOT PART OF THE RU, USE CTRL-D TO DELETE THEM.?
Display Instructions: Roster 3 - add/edit/delete allowed
Roster definition:
Display the DU-Members-Roster for selection of new RU members.
Roster filter:
None. Display all DU members. (RE_Person.PERSID)
Display any current RU members [where (CtrlTrackSummAtEnd_LP20 is empty or CtrlNewStudentAtEnd_LP20 is empty) and (RE_Person.MostRecentRU equal to RUUnit)] and any RU members marked as having left the RU (where CtrlTrackSummAtEnd_LP20 is not empty or CtrlNewStudentAtEnd_LP20 is not empty) as grayed out text.
For ?AGE?, display person's age calculated according to age calculation specifications in the GL section.
For ?SEX?, display person's sex as collected during previous interview (RE_Person.Sex) .
For ?RUID?, display the RU letter associated with this person (RE_Person.MostRecentRU).
When CTRL-A selected, display the following customized question wording in the pop-up:
ENTER NAME OF NEW RU MEMBER WHO IS RELATED AND LIVING WITH THIS HOUSEHOLD.
May I have their full name? VERIFY SPELLING.
IF NO MIDDLE NAME OR INITIAL, LEAVE FIELD BLANK.
Display first interviewer instruction and question text in lighter "grayed-out" text when cursor in middle name or last name entry field. Display the second interviewer instruction when cursor in middle name entry field.
Display ?is? if not Round 5. Display ?was? if Round 5. Display ?now? if not Round 5.
Display ?on December 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, if Round 5. Display 'INTERVIEWER?' if not Round 1. Otherwise, use null display.
Display ?you? if the current round reference person is the same as the current round respondent. (RespondentPersID equal to RefPersPID) Otherwise, display ?(REFERENCE PERSON)? substituting the full name of the current round reference person (RefPersPID).

RE540 (REA1535)

BLAISE NAME: MissedPers
Question Text:

Have we missed anyone? For example, babies born or adopted (since/between) (DATE OF PREVIOUS ROUND INTERVIEW) (and December 31, (YEAR)), anyone related who usually (lives/lived) here but (is/was) traveling, away on business, or in the hospital?

Responses:

YES 1 RE550 (REA1540)
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If Round 1 and RE540 coded ?2? (NO), ?RF? (REFUSED), or ?DK? (DON'T KNOW), go to RE560.
If not Round 1 and RE540 coded ?2? (NO), ?RF? (REFUSED), or ?DK? (DON'T KNOW), go to BOX_210.
Otherwise (RE540 coded ?1? (YES)), continue with RE550.
Hard Check:
If answer to RE540 was changed from ?1? (YES) to ?2? (No) upon back-up and only one person was added at RE550 [CREATEQ equal to RE550 and OrigRnd equal to Current Round and DeleteFlg equal to empty], display the following message as a Manipula pop-up when the interviewer leaves the screen: ?CHANGING ANSWER TO ?NO? WILL DELETE (PERSON) AS PART OF THE RU. ARE YOU SURE YOU STILL WANT TO CHANGE THE ANSWER TO ?NO??? CAPI provides the options: YES, DELETE (PERSON) or NO, KEEP (PERSON). If ?YES, DELETE (PERSON)? is selected, set RE540 to ?2? (No) and then set a delete flag to that one person with a CREATEQ equal to RE550 and OrigRnd equal to Current Round and DeleteFlg equal to empty. Then put FI back to the RE540 entry field (which is still coded ?2? (NO)). If ?NO, KEEP (PERSON)? is selected, set RE540 back to ?1? (YES). Auto-select person at RE550 and put FI at the RE550 entry field with person already selected by CAPI.
2. If answer to RE540 was changed from ?1? (YES) to ?2? (No) upon back-up and more than one person was added at RE550 [greater than1 person with a CREATEQ equal to RE550 and OrigRnd equal to Current Round and DeleteFlg equal to empty], display the following message as a Manipula pop-up when the interviewer leaves the screen: ?CHANGING ANSWER TO ?NO? WILL DELETE (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) AS PART OF THE RU. DO YOU WANT TO DELETE ALL OF THEM?? CAPI provides the options:
YES, DELETE ALL OF THEM
NO, I WILL DELETE SELECT PERSON(S)
NO, KEEP ALL OF THEM
If ?YES, DELETE ALL OF THEM? is selected, set RE540 to ?2? (No) and then set a delete flag to all the persons with a CREATEQ equal to RE550 and OrigRnd equal to Current Round and DeleteFlg equal to empty. Then put FI back to the RE540 entry field (which is still coded ?2? (NO)).
If ?NO, I WILL DELETE SELECT PERSON(S)? is selected, set RE540 back to ?1? (Yes) and display a second Manipula pop-up message: "INTERVIEWER: AT THE NEXT SCREEN, USE CTRL-D TO DELETE THE PERSON(S) YOU WANT REMOVED FROM THE RU?. After the FI presses OK to clear this message, auto-select all the persons with CREATEQ equal to RE550 and OrigRnd equal to Current Round and DeleteFlg equal to empty at RE550 and then put FI at the RE550 entry field with persons already selected by CAPI.
If ?NO, KEEP ALL OF THEM? is selected, set RE540 back to ?1? (YES). Auto-select all the persons with CREATEQ equal to RE550 and OrigRnd equal to Current Round and DeleteFlg equal to empty at RE550 and then put FI at the RE550 entry field with persons already selected by CAPI.

Display Instructions:

Display ?since? and ?lives? and ?is? if not Round 5. Display ?between? and ?lived? and ?was? if Round 5.
For ?(DATE OF PREVIOUS ROUND INTERVIEW)? display date of NHIS interview (Preload. NHISDt) if Round 1. Otherwise, display date of previous round MEPS interview (Preload.RUEndM, RUEndD, RUEndY).
Display ?and December 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, if Round 5. Otherwise, use a null display.

RE550 (REA1540)

BLAISE NAME: MissedPersRoster
Question Text:

Who else (is/was) related and living here (now/on December 31, (YEAR))?
PROBE: Anyone else?
TO ADD A NEW RU MEMBER, PRESS CTRL-A.
IF NO NEW PERSON HAS JOINED THE RU, BACKUP TO CORRECT PREVIOUS SCREEN(S).
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)1 1
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)2 2
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)33
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)4 4
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)N 5

Programmer Instructions:

If round 1, go to RE560. Otherwise, go to BOX_210.
If a person from another RU verified, add that person to the RU-Members-Roster.
Control Variables Impacted: CtrlCurrHere
Roster behavior:
Multiple select and multiple add allowed.
2. Limited edit and delete allowed. RU members that have been ?preloaded? for this case (RU members that are from the NHIS or the previous round) cannot be edited or deleted at any person roster. Only newly added RU members that have been added at this screen during the current interviewing session can be edited or deleted. FIs may back up and return to this screen to use edit or delete functionality, but may not edit or delete an RU member added at this screen at any other person roster.
Hard checks:
If person is marked as a current RU member [where (CtrlTrackSummAtEnd_LP20 is empty or CtrlNewStudentAtEnd_LP20 is empty) and (RE_Person.MostRecentRU equal to RUUnit)], display message: "PERSON CANNOT BE SELECTED. S/HE HAS ALREADY BEEN IDENTIFIED AS PART OF THIS RU."
2. If person is marked as having left the RU (where CtrlTrackSummAtEnd_LP20 is not empty or CtrlNewStudentAtEnd_LP20 is not empty), display message: "PERSON CANNOT BE SELECTED. S/HE HAS ALREADY BEEN IDENTIFIED AS HAVING LEFT THE RU."
3. If a person was added at RE550 [CREATEQ equal to RE550 and OrigRnd equal to Current Round and DeleteFlg equal to empty], but that same person was not selected when interviewer leaves the screen, display the following message: ?NEWLY ADDED PERSONS MUST BE SELECTED. YOU HAVE ADDED (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) AND DID NOT SELECT THEM. IF NEWLY ADDED PERSON(S) (IS/ARE) NOT PART OF THE RU, USE CTRL-D TO DELETE THEM.?
Soft check:
1. If a person from another RU selected (RE_Person.MostRecentRU does not equal RUUnit), display the message: "PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION."
Display Instructions: Roster 3 - add/edit/delete allowed
Roster definition:
Display the DU-Members-Roster for selection of new RU members.
Roster filter:
None. Display all DU members. (RE_Person.PERSID)
Display any current RU members [where (CtrlTrackSummAtEnd_LP20 is empty or CtrlNewStudentAtEnd_LP20 is empty) and (RE_Person.MostRecentRU equal to RUUnit)] and any RU members marked as having left the RU (where CtrlTrackSummAtEnd_LP20 is not empty or CtrlNewStudentAtEnd_LP20 is not empty) as grayed out text.
For ?AGE?, display person's age calculated according to age calculation specifications in the GL section. If age has not been collected, display '- -'
For ?SEX?, display person's sex as collected during previous interview (RE_Person.Sex). If sex has not been collected, display '- -'
For ?RUID?, display the RUID associated with this person (RE_Person.MostRecentRU).
When CTRL-A selected, display the following customized question wording in the pop-up:
ENTER NAME OF NEW RU MEMBER WHO IS RELATED AND LIVING WITH THIS HOUSEHOLD.
May I have their full name? VERIFY SPELLING.
IF NO MIDDLE NAME OR INITIAL, LEAVE FIELD BLANK.
Display first interviewer instruction and question text in lighter "grayed-out" text when cursor in middle name or last name entry field. Display the second interviewer instruction when cursor in middle name entry field.
Display ?is? if not round 5. Display ?was? if round 5. Display ?now? if not round 5. Display ?on December 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, if round 5.

RE560 (REA1585)

BLAISE NAME: StuLiveAway
Question Text:

Are there any children or young people under 24 years of age related to (you/(REFERENCE PERSON)) and who usually live here but are currently living away from home in the U.S., never married, going to school? Please include any new member you may have just mentioned (who is under 24, never married, and living away from home going to school in the

Responses:

YES 1 RE570 (REA1590)
NO 2 BOX_220 (REA1735)
REFUSED RF BOX_220 (REA1735)
DON'T KNOW DK BOX_220 (REA1735)

Programmer Instructions:

Hard-check:
If answer to RE560 was changed from ?1? (YES) to ?2? (No) upon back-up and only one person was added at RE570 [CREATEQ equal to RE570 and OrigRnd equal to Current Round and DeleteFlg equal to empty], display the following message as a Manipula pop-up when the interviewer leaves the screen: ?CHANGING ANSWER TO ?NO? WILL DELETE (PERSON) AS PART OF THE RU. ARE YOU SURE YOU STILL WANT TO CHANGE THE ANSWER TO ?NO??? CAPI provides the options: YES, DELETE (PERSON) or NO, KEEP (PERSON). If ?YES, DELETE (PERSON)? is selected, set RE560 to ?2? (No) and then set a delete flag to that one person with a CREATEQ equal to RE570 and OrigRnd equal to Current Round and DeleteFlg equal to empty. Then put FI back to the RE560 entry field (which is still coded ?2? (NO)). If ?NO, KEEP (PERSON)? is selected, set RE560 back to ?1? (YES). Auto-select person at RE570 and put FI at the RE570 entry field with person already selected by CAPI.
2. If answer to RE560 was changed from ?1? (YES) to ?2? (No) upon back-up and more than one person was added at RE570 [greater than1 person with a CREATEQ equal to RE570 and OrigRnd equal to Current Round and DeleteFlg equal to empty], display the following message as a Manipula pop-up when the interviewer leaves the screen: ?CHANGING ANSWER TO ?NO? WILL DELETE (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) AS PART OF THE RU. DO YOU WANT TO DELETE ALL OF THEM?? CAPI provides the options:
YES, DELETE ALL OF THEM
NO, I WILL DELETE SELECT PERSON(S)
NO, KEEP ALL OF THEM
If ?YES, DELETE ALL OF THEM? is selected, set RE560 to ?2? (No) and then set a delete flag to all the persons with a CREATEQ equal to RE570 and OrigRnd equal to Current Round and DeleteFlg equal to empty. Then put FI back to the RE560 entry field (which is still coded ?2? (NO)).
If ?NO, I WILL DELETE SELECT PERSON(S)? is selected, set RE560 back to ?1? (Yes) and display a second Manipula pop-up message: "INTERVIEWER: AT THE NEXT SCREEN, USE CTRL-D TO DELETE THE PERSON(S) YOU WANT REMOVED FROM THE RU?. After the FI presses OK to clear this message, auto-select all the persons with CREATEQ equal to RE570 and OrigRnd equal to Current Round and DeleteFlg equal to empty at RE570 and then put FI at the RE570 entry field with persons already selected by CAPI.
If ?NO, KEEP ALL OF THEM? is selected, set RE560 back to ?1? (YES). Auto-select all the persons with CREATEQ equal to RE570 and OrigRnd equal to Current Round and DeleteFlg equal to empty at RE570 and then put FI at the RE570 entry field with persons already selected by CAPI.

Display Instructions:

Display ?you? if the current round reference person is the same as the current round respondent. (RespondentPersID equal to RefPersPID) Otherwise, display ?(REFERENCE PERSON)? substituting the full name of the current round reference person (RefPersPID).

RE570 (REA1590)

BLAISE NAME: StuLiveAwayRoster
Question Text:

Who is under 24, never married, and living away at school in the U.S.?
PROBE: Anyone else?
TO ADD A NEW RU MEMBER, PRESS CTRL-A.
IF NO NEW PERSON HAS JOINED THE RU, BACKUP TO CORRECT PREVIOUS SCREEN(S).
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)1 1 BOX_180 (REA1635)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)2 2 BOX_180 (REA1635)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)3 3 BOX_180 (REA1635)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)4 4 BOX_180 (REA1635)
(FIRST NAME [MIDDLE NAME] LAST NAME) is a (AGE)-year-old (SEX) part of (RUID)N 5 BOX_180 (REA1635)

Programmer Instructions:

If a person from another RU verified, add that person to the RU-Members-Roster.
Control Variables Impacted: CtrlCurrHere
Add each successfully selected (or added) person set AddAtRE570 equal to YES.
Roster Behavior:
Multiple select and multiple add allowed.
Limited edit and delete allowed. RU members that have been ?preloaded? for this case (RU members that are from the NHIS or the previous round) cannot be edited or deleted at any person roster. Only newly added RU members that have been added at this screen during the current interviewing session can be edited or deleted. FIs may back up and return to this screen to use edit or delete functionality, but may not edit or delete an RU member added at this screen at any other person roster.
Hard checks:
If person is marked as a current RU member [where (CtrlTrackSummAtEnd_LP20 is empty or CtrlNewStudentAtEnd_LP20 is empty) and (RE_Person.MostRecentRU equal to RUUnit)], display message: "PERSON CANNOT BE SELECTED. S/HE HAS ALREADY BEEN IDENTIFIED AS PART OF THIS RU."
If person is marked as having left the RU (where CtrlTrackSummAtEnd_LP20 is not empty or CtrlNewStudentAtEnd_LP20 is not empty), display message: "PERSON CANNOT BE SELECTED. S/HE HAS ALREADY BEEN IDENTIFIED AS HAVING LEFT THE RU."
If a person was added at RE570 [CREATEQ equal to RE570 and OrigRnd equal to Current Round and DeleteFlg equal to empty], but that same person was not selected when interviewer leaves the screen, display the following message: ?NEWLY ADDED PERSONS MUST BE SELECTED. YOU HAVE ADDED (PERSON 1), (PERSON 2), (PERSON 3), (PERSON N) AND DID NOT SELECT THEM. IF NEWLY ADDED PERSON(S) (IS/ARE) NOT PART OF THE RU, USE CTRL-D TO DELETE THEM.?
Soft check:
If a person from another RU selected (RE_Person.MostRecentRU does not equal RUUnit), display the message: "PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION."

Display Instructions:

Roster 3 - add/edit/delete allowed
Roster definition:
Display the DU-Members-Roster for selection of students under 24 living away at school.
Roster filter:
None. Display all DU members. (RE_Person.PERSID)
Display any current RU members [where (CtrlTrackSummAtEnd_LP20 is empty or CtrlNewStudentAtEnd_LP20 is empty) and (RE_Person.MostRecentRU equal to RUUnit)] and any RU members marked as having left the RU [where (CtrlTrackSummAtEnd_LP20 is not empty or CtrlNewStudentAtEnd_LP20 is not empty) as grayed out text.
For ?AGE?, display person's age calculated according to age calculation specifications in the GL section. If age has not been collected, display '- -'
For ?SEX?, display person's sex as collected during previous interview (RE_Person.Sex). If sex has not been collected, display '- -'
For ?RUID?, display the RUID letter associated with this person (RE_Person.MostRecentRU).
When CTRL-A selected, display the following customized question wording in the pop-up:
ENTER NAME OF NEW RU MEMBER WHO IS RELATED AND IS A STUDENT, UNDER 24, NEVER MARRIED, AND LIVING AWAY AT SCHOOL.
May I have their full name? VERIFY SPELLING.
IF NO MIDDLE NAME OR INITIAL, LEAVE FIELD BLANK.
Display first interviewer instruction and question text in lighter "grayed-out" text when cursor in middle name or last name entry field. Display the second interviewer instruction when cursor in middle name entry field.

BOX_180 (REA1635)

Route Details:

If at least one person added to the RU-members-roster at RE570 (RE560 is coded ?1? (YES)), continue with LOOP_30. Otherwise, go to BOX_220.

LOOP_30 (REA1640)

Route Details:

For each element in the RU-members-roster, ask RE580-END_LP30.
Loop definition: LOOP_30 collects information that CAPI requires to determine the keyness and eligibility of persons identified as under 24 living away at school.
LOOP_30 cycles on RU members selected at RE570 (AddAtRE570 equal to YES).

RE580 (REA1645)

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

(Are/Is) (you/(PERSON)) attending grades 1-12, a college or university, or some other training school after high school?
HELP: F1

Responses:

GRADES 1-12 1
A COLLEGE OR UNIVERSITY 2 RE590 (REA1647)
SOME OTHER TRAINING SCHOOL AFTER HIGH SCHOOL 3 RE590 (REA1647)
REFUSED RF RE590 (REA1647)
DON'T KNOW DK RE590 (REA1647)

Programmer Instructions:

If coded ?1? (Grades 1-12), autocode RE610 to ?5? (VOLUNTEERED LEFT OFF THE ROSTER AT NHIS) and then go to END_LP30.
Control variables impacted: CtrlCurrHere, CtrlTrackSumm

Display Instructions:

RE590 (REA1647)

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

(Were/Was) (you/(PERSON)) living within the U.S. or outside of the U.S. on (MONTH, DAY, YEAR OF NHIS INTERVIEW)?
HELP: F1

Responses:

WITHIN U.S. 1 RE600 (REA1648)
OUTSIDE U.S. 2 END_LP30 (REA1670)
REFUSED RF RE600 (REA1648)
DON'T KNOW DK RE600 (REA1648)

Programmer Instructions:

Control variables impacted: CtrlCurrHere, CtrlTrackSumm, CtrlNewStudent, CtrlSampNHIS

Display Instructions:

Display the date of the NHIS interview (Preload.NHISDt) for (MONTH DAY, YEAR OF NHIS INTERVIEW).

RE600 (REA1648)

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

(Were/Was) (you/(PERSON)) serving on full-time active duty with the Armed Forces of United States on (MONTH, DAY, YEAR OF NHIS INTERVIEW)?
HELP: F1

Responses:

YES 1 RE610 (REA1650)
NO 2 RE610 (REA1650)
REFUSED RF RE610 (REA1650)
DON'T KNOW DK RE610 (REA1650)

Programmer Instructions: Control variables impacted: CtrlPersEligible

Display Instructions:

Display the date of the NHIS interview (Preload.NHISDt) for (MONTH, DAY, YEAR OF NHIS, INTERVIEW).

RE610 (REA1650)

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

When this household participated in the National Health Interview Survey on (MONTH, DAY, YEAR OF NHIS INTERVIEW), (were/was) (you/(PERSON)) living away at school, living on a military facility, institutionalized, or living at another private residence?
HELP: F1

Responses:

LIVING AWAY AT SCHOOL 1 RE620 (REA1655)
LIVING ON A MILITARY FACILITY 2
INSTITUTIONALIZED IN A FACILITY 3 END_LP30 (REA1670)
IN ANOTHER PRIVATE RESIDENCE/HOUSEHOLD 4 RE620 (REA1655)
VOLUNTEERED LEFT OFF THE ROSTER AT NHIS 5 END_LP30 (REA1670)
REFUSED RF RE620 (REA1655)
DON'T KNOW DK RE620 (REA1655)

Programmer Instructions:

Control variables impacted: CtrlTrackSumm, CtrlNewStudent, CtrlSampNHIS, CtrlPersKey, CtrlPersEligible, CtrlCurrHere
If coded '2' (LIVING ON A MILITARY FACILITY) and RE600 is coded '1' (YES), go to END_LP30.
If coded '2' (LIVING ON A MILITARY FACILITY) and RE600 is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), go to RE620.

Display Instructions: For (MONTH ?), display the NHIS interview date (Preload.NHISDt).

RE620 (REA1655)

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

At the time of the National Health Interview Survey on (MONTH, DAY, YEAR OF NHIS INTERVIEW), (were/was) (you/(PERSON)) 17 to 23 years old?

Responses:

YES 1
NO 2 END_LP30 (REA1670)
REFUSED RF END_LP30 (REA1670)
DON'T KNOW DK END_LP30 (REA1670)

Programmer Instructions:

Control variables affected: CtrlTrackSumm, CtrlPersEligible
If coded ?1? (YES) AND
RE610 coded ?1? (LIVING AWAY AT SCHOOL), continue with RE630.
If coded ?1? (YES) AND
RE610 not coded ?1? (LIVING AWAY AT SCHOOL), go to END_LP30.

Display Instructions: For (MONTH ?), display the NHIS interview date (Preload.NHISDt).

RE630 (REA1660)

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

At the time of the National Health Interview Survey on (MONTH DAY, YEAR OF NHIS INTERVIEW) were either of (your/(PERSON)'s) parents living at (NHIS ADDRESS)?

Responses:

YES 1 END_LP30 (REA1670)
NO 2 END_LP30 (REA1670)
REFUSED RF END_LP30 (REA1670)
DON'T KNOW DK END_LP30 (REA1670)

Programmer Instructions:

Control variables impacted: CtrlNewStudent, CtrlTrackSumm, CtrlPersKey, CtrlCurrHere

Display Instructions:

For (MONTH DAY, YEAR OF NHIS INTERVIEW), display the NHIS interview date (Preload.NHISDt).
For (NHIS ADDRESS) display the NHIS full address, including city and state but not zip code.

END_LP30 (REA1670)

Route Details:

Cycle on next person in the RU-members-roster who meets the conditions stated in the loop definition. If no more persons meet the stated conditions, continue with BOX_200.

Programmer Instructions:

Control Variables Impacted: CtrlSampNHIS, CtrlNewStudent
Keep RemovedAtLoop30 equal to Empty if: RE580 is coded ?1? (GRADES 1-12).
Note: Person remains a current member of this RU. This person is currently here, in-scope, and eligible for the entire reference period.
Set RemovedAtLooop30 equal to YES and MoverAtLoop30 equal to YES if:
RE580 is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW) and RE610 is coded ?2? (LIVING ON A MILITARY FACILITY), ?3? (INSTITUTIONALIZED IN A FACILITY), or ?5? (VOLUNTEERED LEFT OFF THE ROSTER AT NHIS)
OR
RE580 is coded 'RF' (REFUSED) or 'DK' (DON'T KNOW) and RE590 is coded '2' (OUTSIDE U.S.)
Note: Persons did not have a chance of selection at NHIS and are not students now, so they will be followed as movers. This person is not currently here, but is in-scope and eligible to be interviewed as part of another RU from January 1 until that new interview date. The RE section will collect locating information for this person, but person will not be included in this interview after the RE section. Information for person will be collected as part of another RU.
Set RemovedAtLoop30 equal to YES and StudentMoverAtLoop30 equal to YES if:
If RE580 is coded is coded '2' (A COLLEGE OR UNIVERSITY) or '3' (SOME OTHER TRAINING SCHOOL AFTER HIGH SCHOOL) and RE610 is coded ?2? (LIVING ON A MILITARY FACILITY), ?3? (INSTITUTIONALIZED IN A FACILITY), or ?5? (VOLUNTEERED LEFT OFF THE ROSTER AT NHIS)
OR
If RE580 is coded '2' (A COLLEGE OR UNIVERSITY) or '3' (SOME OTHER TRAINING SCHOOL AFTER HIGH SCHOOL) and RE590 is coded '2' (OUTSIDE U.S.)
OR
If RE630 is coded ?1? (YES)
Note: Persons did not have a chance of selection at NHIS (left off roster) and are students now, so they will be followed as student movers. This person is not currently here, but at this point in the interview the student is eligible and in-scope for data collection in a student RU. The RE section will later determine if locating information for this student is necessary. Students are included for some items in RE but not the rest of the interview.
.Set RemovedAtLoop30 equal to YES and MoverAtLoop30 equal to NO if:
If RE620 is coded ?2? (NO), 'RF' (REFUSED) or 'DK' (DON'T KNOW)
OR
If RE630 is coded ?2? (NO), 'RF' (REFUSED) or 'DK' (DON'T KNOW)
OR
If RE610 is coded ?4? (PRIVATE RESIDENCE), 'RF' (REFUSED) or 'DK' (DON'T KNOW)
Note: Persons did have a chance of selection at NHIS so they are out of scope and will not have data collected during this interview and will not be followed. This person is not currently here, they have no period of eligibility and are out-of-scope. The RE section will NOT collect locating information for this person; person will not be included in the rest of the interview and will not be followed.

BOX_200 (REA1675)

Route Details:

If at at least one person where RemovedAtLoop30 equal to YES and MoverAtLoop30 equal to NO, continue with RE640.
Otherwise, go to BOX_ 220.

RE640 (REA1680)

BLAISE NAME: NoQuexForStu
Question Text:

At the time we are only collecting information about some of the students you just now identified. Therefore, the remaining
questions will not be asked about (READ NAMES BELOW).

[1. [First Name,[Middle Name],Last Name]1
[2. [First Name,[Middle Name],Last Name]2
[3. [First Name,[Middle Name],Last Name]3
[4. [First Name,[Middle Name],Last Name]4
[5. [First Name,[Middle Name],Last Name]N

PRESS 1 AND ENTER TO CONTINUE.

Responses: CONTINUE 1 BOX_220 (REA1735)
Display Instructions:

Roster 1 - Report
Roster definition:
This item displays RU-members-roster. Display RU member's first, middle, and last names
(RE_Person.FullName)
Roster filter:
Display all persons where RemovedAtLoop30 equal to YES and MoverAtLoop30 equal to NO

BOX_210 (REA1685)

Route Details:

If Round 1, go to BOX_230.
Otherwise (Rounds 2 - 5), continue with RE650_01.

RE650_01 (REA1690)

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

VERIFY DISPLAYED INFORMATION.
SELECT SEX.
IF NOT OBVIOUS, ASK: What is (your/(PERSON)'s) sex?

Responses:

MALE 1
FEMALE 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded Grid Type 2 including RE650_01, RE650_02, RE650_03, RE650_04, RE650_05, RE650_06, RE650_07, and BOX_215.
Roster behavior:
RE650_01, RE650_02, RE650_03, RE650_04, and RE650_05 uses preloaded data in the form pane. When that data has a value of RF or DK, display the entry field as empty. Interviewer will be required to enter another response even if that response is RF or DK again.
Enable movement on screen so that interviewer can enter/update sex, date of birth and age for all persons by row.
SEX, DATE OF BIRTH, and AGE (when age is not calculated by CAPI) can be edited.
Replacing ?real? data with RF or DK is disallowed. If the interviewer tries to do so, display the message: "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON?T KNOW".
If DATE OF BIRTH is changed, CAPI will calculate the new age automatically and display in the AGE column. See the Global Spec for how to calculate age.

Display Instructions:

Roster 1 - Report
Roster definition:
Display the RU-members-roster for verification and correction. This will include all original RU members not removed, persons added between rounds (not removed this round), persons merged from the DU, and persons who may have been ineligible in a prior round but were merged back into this RU. Format response pane in columns with headers: RU Member, Sex, Month of Birth, Day of Birth, Year of Birth, Age, Estimated Age, Age Guess.
For RU MEMBER display RU members' first, middle, and last names (RE_Person.FullName)
Roster filter:
Display all persons in RE_Person Array where MostRecentRU equal to RUUnit excluding persons where RemovedatRE180 equal to YES, MoverAtLoop10 equal to YES or NO, RemovedatRE330 equal to YES, MoverAtLoop20 equal to YES or NO, or MoverAtLoop30 equal to YES or NO.
Prefill with RU members' sex (PL_Person.Sex) when available.

RE650_02 (REA1691)

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

VERIFY DISPLAYED INFORMATION. ASK QUESTION FOR EACH BLANK FIELD.
What is (your/(PERSON)'s) date of birth?
ENTER MONTH.

Responses: 1

REFUSED RF
DON'T KNOW DK

Display Instructions: Prefill with RU member?s month of birth (PL_Person.DOBM) when available.

RE650_03 (REA1692)

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

VERIFY DISPLAYED INFORMATION. ASK QUESTION FOR EACH BLANK FIELD.
[What is (your/(PERSON)'s) date of birth?]
ENTER DAY.

Responses:

1
REFUSED RF
DON'T KNOW DK

Display Instructions:

Prefill with RU member?s day of birth (PL_Person.DOBD) when available. Display question text in brackets and lighter ?grayed-out? text.

RE650_04 (REA1693)

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

VERIFY DISPLAYED INFORMATION. ASK QUESTION FOR EACH BLANK FIELD.
[What is (your/(PERSON)'s) date of birth?]
ENTER 4- DIGIT YEAR.

Responses: 1

REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Hard check:
Date entered must be between (YEAR) - 120 years where 'YEAR' is the current year and today's date. If a date outside of this range is entered, display the following message: "UNLIKELY RESPONSE. DATE CANNOT BE AFTER TODAY'S DATE OR BEFORE (YEAR-120). VERIFY WITH RESPONDENT AND RE-ENTER."
Control Variables Impacted: CtrlCurrHere

Display Instructions:

Prefill with RU member?s year of birth (PL_Person.DOBY) when available. Display question text in Instructions: brackets and lighter ?grayed-out? text.

RE650_05 (REA1694)

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

VERIFY DISPLAYED INFORMATION. ASK QUESTION FOR EACH BLANK FIELD.
VERIFY (PERSON)'s AGE - IF AGE IS INCORRECT, RE-ENTER DATE OF BIRTH. IF DATE OF BIRTH UNKNOWN, PROBE FOR AGE AND ENTER IF KNOWN.

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

For Round 5, AGE is calculated as of DECEMBER 31, (YEAR), where 'YEAR' is the second calendar year of the panel.
If the interviewer enters an age that contradicts the DOB, CAPI will still calculate age (See GL specs for age calculation instructions) based on DOB when the interviewer leaves the screen. No error message is displayed.

Display Instructions:

Prefill with RU member?s age (PL_Person.AGERND) when available if age cannot be calculated.
Note: for Round 5, age is calculated as of December 31, (YEAR), where 'YEAR' is the second calendar year of the panel if round 5.
Otherwise, use a null display.

RE650_06 (REA1695)

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

PROBE FOR RESPONDENT'S BEST ESTIMATE OF AGE.
((Are/Is)/As of December 31, (YEAR), were/was)) (you/(PERSON)) less than 1 year old, 1-4, 5-15, 16-23, 24-34, 35-44, 45-54, 55-64, or 65 years or older?

Responses:

LESS THAN 1 YEAR OLD 1
1 - 4 2
5 - 15 3
16 - 23 4
24 - 34 5
35 - 44 6
45 - 54 7
55 - 64 8
65 YEARS OR OLDER 9
REFUSED RF
DON'T KNOW DK

Programmer Instructions

Display RE650_06 as an active cell for RU members if RE650_05 equal to DK or RF. Otherwise, RE650_06 is an inactive cell for RU member.

Display Instructions:

Display ?(Are/Is)? if not Round 5. Display ?As of December 31, (YEAR), where 'YEAR' is the second calendar year of the panel, and (were/was)? if Round 5.

RE650_07 (REA1696)

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

ENTER YOUR BEST GUESS FOR (PERSON)'S AGE (AS OF DECEMBER 31, (YEAR)).

Responses:

LESS THAN 1 YEAR OLD 1 BOX_215 (REA1700)
1 - 4 2 BOX_215 (REA1700)
5 - 15 3 BOX_215 (REA1700)
16 - 23 4 BOX_215 (REA1700)
24 -34 5 BOX_215 (REA1700)
35 - 44 6 BOX_215 (REA1700)
45 - 54 7 BOX_215 (REA1700)
55 - 64 8 BOX_215 (REA1700)
65 YEARS OR OLDER 9 BOX_215 (REA1700)

Programmer Instructions:

Refused and Don?t Know disallowed.
Display RE650_07 as an active cell for RU members if RE650_06 equal to RF or DK. Otherwise, RE650_07 is an inactive cell for RU member.

Display Instructions:

Display ?AS OF DECEMBER 31, (YEAR)?, where 'YEAR' is the second calendar year of the panel, if Round 5. Otherwise, use a null display.

BOX_215 (REA1700)

Route Details: Go to BOX_240.
Programmer Instructions:

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 (PERSON?S FIRST, MIDDLE AND LAST NAME)?. 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.

BOX_220 (REA1735)

Route Details:

If at least one person in the RU-members-roster meets all of the following conditions:
- Added to the RU this round (RE_Person[].PreloadOrd equal to EMPTY AND RE_Person[].MostRecentRU equal to RUUnit)
AND
- Not a DU member at the time of NHIS, that is, a new RU member not selected from the DU-members-roster (RE_Person.PERSID not equal to any PL_Person.PERSID), AND
- Not newly added out-of-scope student (not [RemovedAtLoop30 equal to YES and MoverAtLoop equal to NO])
Continue with RE680_01.
Otherwise, go to BOX_230.

RE680_01 (REA1740)

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

ASK QUESTION FOR EACH BLANK FIELD.
SELECT SEX. IF NOT OBVIOUS, ASK: What is (PERSON)'s sex?

Responses:

MALE 1
FEMALE 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Preloaded Grid Type 2 including RE680_01, RE680_02, RE680_03, RE680_04, RE680_05, Instructions: RE680_06, RE680_07, and BOX_225.
Roster behavior:
RE680_01, RE680_02, RE680_03, RE680_04, and RE680_05 uses preloaded data in the form pane. When that data has a value of RF or DK, display the entry field as empty. Interviewer will be required to enter another response even if that response is RF or DK again.
Enable movement on screen so that interviewer can enter/update SEX, DATE OF BIRTH and AGE for all persons by row.
SEX, DATE OF BIRTH, and AGE (when AGE is not calculated by CAPI) can be edited.
Replacing 'real' data with RF or DK is disallowed. If the interviewer tries to do so, display the message: "DO NOT REPLACE EXISTING INFORMATION WITH REFUSED OR DON'T KNOW."
If DATE OF BIRTH is changed, CAPI will calculate the new AGE automatically and display the AGE in the AGE column. See GL spec on how to calculate age.
Select, Add, and Delete disallowed in all columns.

Display Instructions:

Roster 1 - Report
Roster definition:
Display the RU-members-roster for verification and correction. Format response pane in columns with headers: RU Member, Sex, Month of Birth, Day of Birth, Year of Birth, Age, Estimated Age, Age Guess.
For RU MEMBER display RU members' first, middle, and last names (RE_Person.FullName)
Roster filter:
Display persons who meet the following conditions:
- Added to the RU this round (RE_Person[].PreloadOrd equal to EMPTY AND RE_Person[].MostRecentRU equal to RUUnit)
AND
- Not a DU member at the time of NHIS, that is, a new RU member not selected from the DU-members-roster (RE_Person.PERSID not equal to any PL_Person.PERSID)
Of the persons who meet the above conditions, exclude any persons where
-[RemovedAtLoop30 equal to YES and MoverAtLoop equal to NO]

RE680_02 (REA1741)

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

VERIFY DISPLAYED INFORMATION. ASK QUESTION FOR EACH BLANK FIELD.
What is (PERSON)'s date of birth?
ENTER MONTH.

Responses:

1
REFUSED RF
DON'T KNOW DK

Display Instructions: Prefill with RU member?s month of birth (RE_Person.DOBM) when available.

RE680_03 (REA1742)

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

VERIFY DISPLAYED INFORMATION. ASK QUESTION FOR EACH BLANK FIELD.
[What is (PERSON)'s date of birth?]
ENTER DAY.

Responses:

1
REFUSED RF
DON'T KNOW DK
Display Instructions: Prefill with RU member?s day of birth (RE_Person.DOBD) when available. Display question text in Instructions: brackets and lighter ?grayed-out? text.

RE680_04 (REA1743)

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

VERIFY DISPLAYED INFORMATION. ASK QUESTION FOR EACH BLANK FIELD.
[What is (PERSON)'s date of birth?]
ENTER 4- DIGIT YEAR.

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Display Instructions:

Prefill with RU member?s year of birth (RE_Person.DOBY) when available. Display question text in brackets and lighter ?grayed-out? text.

RE680_05 (REA1744)

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

VERIFY DISPLAYED INFORMATION. ASK QUESTION FOR EACH BLANK FIELD.
VERIFY (PERSON)'s AGE - IF AGE IS INCORRECT, RE-ENTER DATE OF BIRTH. IF DATE OF BIRTH UNKNOWN, PROBE FOR AGE AND ENTER IF KNOWN.

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

For Round 5, AGE is calculated as of DECEMBER 31, (YEAR), where 'YEAR' is the second calendar year of the panel.
If the interviewer enters an AGE that contradicts the DOB, CAPI will still calculate AGE (See GL spec) based on DOB when the interviewer leaves the screen. No error message is displayed.

Display Instructions:

Prefill with RU member?s age (RE_Person. AGERND) when available if age cannot be calculated.
Note: For Round 5, AGE is calculated as of DECEMBER 31, (YEAR), where 'YEAR' is the second calendar year of the panel if Round 5. Otherwise, use a null display.

RE680_06 (REA1745)

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

PROBE FOR RESPONDENT'S BEST ESTIMATE OF AGE.
(Are/Is) (you/(PERSON)) less than 1 year old, 1-4, 5-15, 16-23, 24-34, 35-44, 45-54, 55-64, or 65 years or older?

Responses:

LESS THAN 1 YEAR OLD 1
1 - 4 2
5 - 15 3
16 - 23 4
24 - 34 5
35 - 44 6
45 - 54 7
55 - 64 8
65 YEARS OR OLDER 9
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

Display RE680_06 as an active cell for RU member if RE680_05 equal to DK or RF. Otherwise RE680_06 is an inactive cell for RU member.

Display Instructions:

RE680_07 (REA1746)

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

ENTER YOUR BEST GUESS FOR (PERSON)'S AGE.

Responses:

LESS THAN 1 YEAR OLD 1 BOX_225 (REA1750)
1 - 4 2 BOX_225 (REA1750)
5 - 15 3 BOX_225 (REA1750)
16 - 23 4 BOX_225 (REA1750)
24 -34 5 BOX_225 (REA1750)
35 - 44 6 BOX_225 (REA1750)
45 - 54 7 BOX_225 (REA1750)
55 - 64 8 BOX_225 (REA1750)
65 YEARS OR OLDER 9 BOX_225 (REA1750)

Programmer Instructions:

Display RE680_07 as an active cell for RU member if RE680_06 equal to DK or RF. Otherwise RE680_07 is an inactive cell for RU member.

Display Instructions:

BOX_225 (REA1750)

Route Details: Go to BOX_230.
Programmer Instructions:

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 (PERSON?S FIRST, MIDDLE AND LAST NAME).? 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.

BOX_230 (REA1785)

Route Details:

If Round 1
and
At least one person on RE_Person Array where MostRecentRU equal to RUUnit meets the following conditions:
- Was an NHIS RU member (RE_Person.PERSID equal to PL_Person.PERSID)
And
- Was not removed from the RU or is a student ([RemovedAtLoop10 equal to empty and RemovedAtLoop20 equal to Empty and RemovedAtLoop30 equal to Empty] OR [StudentMoverAtLoop20 equal to YES or StudentMoverAtLoop30 equal to YES])
Continue with RE710_01.

Otherwise, go to BOX_240.

RE710_01 (REA1795)

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

Let's review some information about (you/(PERSON)), starting with (your/his/her) name. Is (NHIS FIRST NAME) (NHIS MIDDLE NAME) (NHIS LAST NAME) spelled correctly?
VERIFY FULL NAME AND SPELLING. MAKE CORRECTIONS AS NECESSARY.

Responses:

1 RE710_02 (REA1796)
REFUSED RF RE710_02 (REA1796)
DON'T KNOW DK RE710_02 (REA1796)

Programmer Instructions:

Preloaded Grid Type 1 including question RE710_[1-3], RE720, RE730_[1-3], RE740, RE750, RE760, and RE770.
Refused and Don?t Know allowed. Hard Check. Do not allow interviewer to change ?real data? to ?RF? (REFUSED) or ?DK? (DON?T KNOW). If attempted, display the following message: "CHANGING NHIS DATA TO REFUSED OR DON'T KNOW IS NOT ALLOWED."
As the interviewer makes an update to grid entry field, the corresponding display in the info pane is also updated.

Display Instructions:

Roster 1 ? Report
Roster definition:
Displays RU members who were part of the original RU or DU and are part of the current RU and includes any RU members who are ?NEW STUDENTS? for entry/verification of NAME, SEX, DOB, and AGE (as collected during the NHIS) in the form pane. Format response pane in columns with headers: RU Member, First Name, Middle Name, Last Name, Sex, Month of Birth, Day of Birth, Year of Birth, Age Calculation, Self Report Age, Estimated Age, Age Guess.
Roster filter:
Display all persons on RE_Person Array where MostRecentRU equal to RUUnit who meet the following conditions::
- RE_Person.PERSID equal to PL_Person.PERSID
And
- ([RemovedAtLoop10 equal to empty and RemovedAtLoop20 equal to Empty and RemovedAtLoop30 equal to Empty] OR [StudentMoverAtLoop20 equal to YES or StudentMoverAtLoop30 equal to YES])
For ?(NHIS FIRST NAME)?, ?(NHIS MIDDLE NAME)?, and ?(NHIS LAST NAME)?, display the person's name as recorded in the NHIS. Use PL_Person.FName, PL_Person.MName, and PL_Person.LName.
Prefill RE710_01 response entry field in the grid with person?s first name as recorded in the NHIS when available (PL_Person.FName).

RE710_02 (REA1796)

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

[Let's review some information about (you/(PERSON)), starting with the name. Is (NHIS FIRST NAME) (NHIS MIDDLE NAME) (NHIS LAST NAME) spelled correctly?]
(What is (NHIS FIRST NAME)'s middle name or initial?)
VERIFY FULL NAME AND SPELLING. MAKE CORRECTIONS AS NECESSARY.
IF NO MIDDLE NAME, LEAVE FIELD BLANK.

Responses:

1 RE710_03 (REA1797)
EMPTY Empty RE710_03 (REA1797)
REFUSED RF RE710_03 (REA1797)
DON'T KNOW DK RE710_03 (REA1797)

Programmer Instructions:

Refused and Don?t Know allowed. Hard Check. Do not allow interviewer to change ?real data? to ?RF? (REFUSED) or ?DK? (DON?T KNOW). If attempted, display the following message: "CHANGING NHIS DATA TO REFUSED OR DON'T KNOW IS NOT ALLOWED."
As the interviewer makes an update to grid entry field, the corresponding display in the info pane is also updated.

Display Instructions:

Display the question text "Let's review...spelled correctly?" in brackets and lighter ?grayed out? text.
For ?(NHIS FIRST NAME)?, ?(NHIS MIDDLE NAME)?, and ?(NHIS LAST NAME)?, display the person's name as recorded in the NHIS. Use PL_Person.FName, PL_Person.MName, and PL_Person.LName.
Display "What is (your/(NHIS FIRST NAME)'s) middle name or initial?" if PL_Person.MName equal to Empty. Otherwise, use a null display.
Prefill RE710_02 response entry field in the grid with person?s middle name as recorded in the NHIS when available (PL_Person.MName).

RE710_03 (REA1797)

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

[Let's review some information about (you/(PERSON)), starting with the name. Is (NHIS FIRST NAME) (NHIS MIDDLE NAME) (NHIS LAST NAME) spelled correctly?]
VERIFY FULL NAME AND SPELLING. MAKE CORRECTIONS AS NECESSARY.

Responses:

1 RE720 (REA1815)
REFUSED RF RE720 (REA1815)
DON'T KNOW DK RE720 (REA1815)

Programmer Instructions:

Display Instructions:

Display the question text in brackets and lighter ?grayed out? text.
For ?(NHIS FIRST NAME)?, ?(NHIS MIDDLE NAME)?, and ?(NHIS LAST NAME)?, display the person's name as recorded in the NHIS. Use PL_Person.FName, PL_Person.MName, and PL_Person.LName.
Prefill RE710_03 response entry field in the grid with person?s last name as recorded in the NHIS when available (PL_Person.LName).

RE720 (REA1815)

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

ASK IF NOT OBVIOUS: So (you/(PERSON)) (are/is) (NHIS SEX). Is that correct?
MAKE CORRECTIONS TO SEX BELOW AS NECESSARY.

Responses:

MALE 1 RE730_01 (REA1820)
FEMALE 2 RE730_01 (REA1820)
REFUSED RF RE730_01 (REA1820)
DON'T KNOW DK RE730_01 (REA1820)

Programmer Instructions:

Display Instructions:

For '(NHIS SEX)' display the person's sex as recorded in the NHIS. Use PL_Person.Sex. Prefill RE720 response entry field in the grid with DU members' sex (PL_Person.Sex).

RE730_01 (REA1820)

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

I have recorded that (you/(PERSON)) (were/was) born on (NHIS DATE OF BIRTH). Is that correct?
MAKE CORRECTIONS TO BIRTHDATE AS NECESSARY.
ENTER MONTH.

Responses:

1 RE730_02 (REA1821)
REFUSED RF RE730_02 (REA1821)
DON'T KNOW DK RE730_02 (REA1821)

Programmer Instructions:

If current info is not available, entry for DATE OF BIRTH is required. (RF and DK are allowed.) Refused and Don?t Know allowed. Hard Check. Do not allow interviewer to change ?real data? to ?RF? (REFUSED) or ?DK? (DON?T KNOW). If attempted, display the following message: "CHANGING NHIS DATA TO REFUSED OR DON'T KNOW IS NOT ALLOWED."
As the interviewer makes an update to grid entry field, the corresponding display in the info pane is also updated.

Display Instructions:

For '(NHIS DATE OF BIRTH)' display the person's date of birth as recorded in the NHIS. Use PL_Person.DOBM, PL_Person.DOBD, and PL_Person.DOBY
Prefill RE730_01 response entry field in the grid with person?s DOB month as recorded in the NHIS when available (PL_Person.DOBM).

RE730_02 (REA1821)

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

[I have recorded that (you/(PERSON)) (were/was) born on (NHIS DATE OF BIRTH). Is that correct?
MAKE CORRECTIONS TO BIRTHDATE AS NECESSARY.]
ENTER DAY.

Responses:

1 RE730_03 (REA1822)
REFUSED RF RE730_03 (REA1822)
DON'T KNOW DK RE730_03 (REA1822)

Programmer Instructions:

Display Instructions:

Display question text in brackets and lighter ?grayed- out? text.
For '(NHIS DATE OF BIRTH)' display the person's date of birth as recorded in the NHIS. Use PL_Person.DOBM, PL_Person.DOBD, and PL_Person.DOBY.
Prefill RE730_02 response entry field in the grid with person?s DOB day as recorded in the NHIS when available (PL_Person.DOBD).

RE730_03 (REA1822)

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

[I have recorded that (you/(PERSON)) (were/was) born on (NHIS DATE OF BIRTH). Is that correct?
MAKE CORRECTIONS TO BIRTHDATE AS NECESSARY.]
ENTER 4-DIGIT YEAR.

Responses:

1
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If RE730_03 coded ?RF? (REFUSED) or ?DK? (DON?T KNOW), go to RE750. ?Gray-out? and don?t allow edits to the RE740 cell for this person.
If age can be calculated (see GL specs) from DOB or partial DOB, continue with RE740.
If current info is not available, entry for DATE OF BIRTH is required. (RF and DK are allowed.) . Hard Check. Do not allow interviewer to change ?real data? to ?RF? (REFUSED) or ?DK? (DON?T KNOW). If attempted, display the following message: "CHANGING NHIS DATA TO REFUSED OR DON'T KNOW IS NOT ALLOWED."
As the interviewer makes an update to grid entry field, the corresponding display in the info pane is also updated.
Hard Check:
Date entered from RE730_[01-03] must be between (YEAR) - 120 years where 'YEAR' is the current year and today's date. If a date outside of this range is entered, display the following message: "UNLIKELY RESPONSE. DATE CANNOT BE AFTER TODAY'S DATE OR BEFORE (YEAR-120). VERIFY WITH RESPONDENT AND RE-ENTER."

Display Instructions:

Display question text in brackets and lighter ?grayed- out? text.
For '(NHIS DATE OF BIRTH)' display the person's date of birth as recorded in the NHIS. Use PL_Person.DOBM, PL_Person.DOBD, and PL_Person.DOBY.
Prefill RE730_03 response entry field in the grid with person?s DOB year as recorded in the NHIS when available (PL_Person.DOBY).

RE740 (REA1825)

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

So (you/(PERSON)) (are/is) (AGE CALCULATED FROM DATE OF BIRTH AT RE730_ [1-3]) years old. Is that correct?

Responses:

YES 1 BOX_240 (REA1850)
NO 2

Programmer Instructions:

If coded ?2? (NO), display message: "IF AGE INCORRECT, BACKUP AND CORRECT DATE OF BIRTH AT PREVIOUS SCREEN."
If RE740 is coded '1' (YES), ?gray-out? RE750, RE760, and RE770 cells for this person. RE750 can show the person?s calculated age, but is not available for edits. RE760 and RE770 should be shown as not on path.

Display Instructions:

RE750 (REA1830)

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

How old (are/is) (you/(PERSON))?
ENTER AGE.

Responses:

1 BOX_240 (REA1850)
REFUSED RF RE760 (REA1835)
DON'T KNOW DK RE760 (REA1835)

Programmer Instructions:

If RE740 is coded ?1? (YES), show the person?s calculated age, but the cell is not available for edits. If RE730_03 is coded ?RF? (REFUSED) or ?DK? (DON?T KNOW), RE750 is an active field.
Refused and Don?t Know allowed. Hard Check. Do not allow interviewer to change ?real data? to ?RF? (REFUSED) or ?DK? (DON?T KNOW). If attempted, display the following message: "CHANGING NHIS DATA TO REFUSED OR DON'T KNOW IS NOT ALLOWED."

Display Instructions:

RE760 (REA1835)

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

PROBE FOR RESPONDENT?S BEST ESTIMATE OF AGE.
(Are/Is) (you/(PERSON)) less than 1 year old, 1-4, 5-15, 16-23, 24-34, 35-44, 45-54, 55-64, or 65 years or older?

Responses:

LESS THAN 1 YEAR OLD 1 BOX_240 (REA1850)
1 - 4 2 BOX_240 (REA1850)
5 - 15 3 BOX_240 (REA1850)
16 - 23 4 BOX_240 (REA1850)
24 - 34 5 BOX_240 (REA1850)
35 - 44 6 BOX_240 (REA1850)
45 - 54 7 BOX_240 (REA1850)
55 - 64 8 BOX_240 (REA1850)
65 YEARS OR OLDER 9 BOX_240 (REA1850)
REFUSED RF RE770 (REA1840)
DON'T KNOW DK RE770 (REA1840)

Programmer Instructions:

If RE750 is coded ?RF? (REFUSED) or ?DK? (DON?T KNOW), display RE760 as an active field. Otherwise, RE760 is an inactive field.

Display Instructions:

RE770 (REA1840)

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

ENTER YOUR BEST GUESS FOR (PERSON)'S AGE.

Responses:

LESS THAN 1 YEAR OLD 1 BOX_240 (REA1850)
1 - 4 2 BOX_240 (REA1850)
5 - 15 3 BOX_240 (REA1850)
16 - 23 4 BOX_240 (REA1850)
24 -34 5 BOX_240 (REA1850)
35 - 44 6 BOX_240 (REA1850)
45 - 54 7 BOX_240 (REA1850)
55 - 64 8 BOX_240 (REA1850)
65 YEARS OR OLDER 9 BOX_240 (REA1850)

Programmer Instructions:

If RE760 is coded ?RF? (REFUSED) or ?DK? (DON?T KNOW), display RE770 as an active field. Otherwise, RE770 is an inactive field.

Display Instructions:

BOX_240 (REA1850)

Route Details:

If at least one person meets all the following conditions:
- Added to the RU this round (RE_Person[].PreloadOrd equal to EMPTY AND RE_Person[].MostRecentRU equal to RUUnit) and
- Not a DU member at the time of NHIS, that is, a new RU member not selected from the DU-members-roster,(RE_Person.PERSID not equal to any PL_Person.PERSID) and
[- If Round 1 and Not a newborn (Person?s DOBD, DOBM, DOBY is not between NHISDt and InterviewDate), or
- If Rounds 2-5 and not a newborn (Person?s DOBD, DOBM, DOBY is not between 1/1/FirstPanYear and InterviewDate)] go to LOOP_40.
Note: If DOB has missing data and newborn status cannot be calculated, assume person is not a newborn and continue with LOOP_40.
Otherwise, go to BOX_250.

LOOP_40 (REA1855)

Route Details:

For each element in the RU-members-roster, ask RE780_01- END_LP40.
Loop definition: LOOP_40 cycles on persons who meet the following conditions:
- Added to the RU this round (RE_Person[].PreloadOrd equal to EMPTY AND RE_Person[].MostRecentRU equal to RUUnit) and
- Not a DU member at the time of NHIS, that is, a new RU member not selected from the DU-members-roster, (RE_Person.PERSID not equal to any PL_Person.PERSID) and [- If Round 1 and Not a newborn (Person?s DOBD, DOBM, DOBY is not between NHISDt and InterviewDate), or
- If Rounds 2-5 and not a newborn (Person?s DOBD, DOBM, DOBY is not between 1/1/FirstPanYear and InterviewDate)]
Loop 40 also cycles on persons who meet the following condition:
- Former RU members out of scope in a previous round and now back in the RU: RE_Person[].PreloadOrd not equal to EMPTY AND RE_Person[].PreloadRU equal to EMPTY AND RE_Person[].MostRecentRU equal to RUUnit AND PriorRndInelig equal to Yes
Note: In Round 1 LOOP_40 collects information on the location at the time of NHIS of new RU members who are not newborn to determine their keyness and eligibility.
Note: In Rounds 2-5 LOOP_40 collects information on the location of new RU members (or RU members who were merged into the RU after being ineligible in some previous round for a reason other than being in a health care institution) on 1/1/(YEAR), where 'YEAR' is the first calendar year of the panel, to determine their keyness and eligibility.
Note: If DOB has missing data and newborn status cannot be calculated, assume person is not a newborn and is eligible for LOOP_40.

RE780_01 (REA1860)

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

On what date did (you/(PERSON)) start living with ((First Name,[Middle Name],Last Name)1 ,(First Name,[Middle Name],Last Name)2 ,(First Name,[Middle Name],Last Name)3, (First Name,[Middle Name],Last Name)4, (First Name,[Middle Name],Last Name)N) (before leaving to live at school)?
ENTER MONTH.

Responses: 1 RE780_02 (REA1861)
Programmer Instructions: DK and RF disallowed for month.
Display Instructions:

Roster definition: Roster 1 ? Report
This item displays current NHIS/previous round roster. Display RU member's first, middle, and last names.(PL_Person.FullName)
Roster filter:
If round 1 display all RU members on the original NHIS roster.
If round 2-5 display all RU members on the previous rounds roster (i.e. if round 2 display the roster from round 1.) (RE_Person.PreloadRU equal to RUUnit)
Display RE780_01, RE780_02, RE780_03 on the same form pane.
Display (before leaving to live at school) if the person being looped where StudentMoverAtLoop30 equal to YES.

RE780_02 (REA1861)

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

[On what date did (you/(PERSON)) start living with ((First Name,[Middle Name],Last Name)1 ,(First Name,[Middle Name],Last Name)2 ,(First Name,[Middle Name],Last Name)3, (First Name,[Middle Name],Last Name)4, (First
Name,[Middle Name],Last Name)N) (before leaving to live at school)?]
ENTER DAY.

Responses:

1 RE780_03 (REA1862)
REFUSED RF RE780_03 (REA1862)
DON'T KNOW DK RE780_03 (REA1862)

Display Instructions:

Roster definition:
Roster 1 ? Report
This item displays current NHIS/previous round roster. Display RU member's first, middle, and last names.(PL_Person.FullName)
Roster filter:
If round 1 display all RU members on the original NHIS roster.
If round 2-5 display all RU members on the previous rounds roster (i.e. if round 2 display the roster from round 1.) (RE_Person.PreloadRU equal to RUUnit)
Display RE780_01, RE780_02, RE780_03 on the same form pane.
Display question text in brackets and lighter ?grayed-out? text.
Display (before leaving to live at school) if the person being looped where StudentMoverAtLoop30 equal to YES.

RE780_03 (REA1862)

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

[On what date did (you/(PERSON)) start living with ((First Name,[Middle Name],Last Name)1 ,(First Name,[Middle Name],Last Name)2 ,(First Name,[Middle Name],Last Name)3, (First Name,[Middle Name],Last Name)4, (First Name,[Middle Name],Last Name)N) (before leaving to live at school)?]
ENTER 4-DIGIT YEAR.

Responses: 1
Programmer Instructions:

If Round 1 date entered is [on or before NHIS date (NHISDt)] or if [(month is equal to NHIS month) and (day is RF or DK) and (year entered is equal to NHIS year)], go to RE790.
If Rounds 2-5 and Former RU members out of scope in a previous round and now back in the RU (RE_Person[].PreloadOrd not equal to EMPTY AND RE_Person[].PreloadRU equal to EMPTY AND RE_Person[].MostRecentRU equal to RUUnit AND PriorRndInelig equal to Yes), go to END_LP40.
If Rounds 2-5 and date entered is [on or before NHIS date (NHISDt)] or if [month is equal to NHIS month) and (day is RF or DK) and (year entered is equal to NHIS year), autocode RE790 as ?1? (YES) and go to END_LP40.
Otherwise, go to RE800.
DK and RF disallowed for year.
Hard check:
Edit (for Round 5): Date entered must be on or before 12/31/(YEAR), where 'YEAR' is the second calendar year of the panel. If a date after 12/31/(YEAR) is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/(YEAR). VERIFY DATE ENTERED. IF PERSON JOINED RU AFTER 12/31/(YEAR), BACKUP TO WHERE PERSON WAS FIRST ADDED AND REVIEW ENTRIES. ONLY PERSONS JOINING RU BEFORE 12/31/(YEAR) SHOULD BE ADDED."
Control Variables Impacted: BegRefM, BegRefD, and BegRefY
Note: If Rounds 2-5 AND if date is on or before reference period start date or if month and day are RF or DK and year entered is equal to reference period start date year, the person's begin date is the first day of the reference period start date.

Display Instructions:

Roster definition:
Roster 1 ? Report
This item displays current NHIS/previous round roster. Display RU member's first, middle, and last names. (PL_Person.FullName)
Roster filter:
If round 1 display all RU members on the original NHIS roster.
If round 2-5 display all RU members on the previous rounds roster (i.e. if round 2 display the roster from round 1.) (RE_Person.PreloadRU equal to RUUnit)
Display RE780_01, RE780_02, RE780_03 on the same form pane.
Display question text in brackets and lighter "grayed-out" text.
Display (before leaving to live at school) if the person being looped on where StudentMoverAtLoop30 equal to YES.

RE790 (REA1865)

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

I have recorded that (you/(PERSON)) began living at (NHIS ADDRESS) on (RE780_[1-3] DATE). Is that correct?
IF NECESSARY SAY: We?re trying to establish if (you/(PERSON)) (were/was) living with this household when they participated in the previous interview on (DATE OF NHIS INTERVIEW).

Responses:

YES 1 END_LP40 (REA1955)
NO 2
REFUSED RF RE800 (REA1880)
DON'T KNOW DK RE800 (REA1880)

Programmer Instructions:

Hard Check:
If coded '2' (NO), display message: 'BACKUP AND CORRECT DATE PERSON JOINED RU AT PREVIOUS SCREEN.?
Control Variables Impacted: CtrlPersKey, CtrlSampNHIS
Note: If coded ?1? (YES), person is treated as if he/she was left off the roster at the NHIS and becomes key and eligible.

Display Instructions:

For ?NHIS ADDRESS? display the NHIS full address, including city and state but not zip code. Use Preload.CurrStrt1, Preload. CurrStrt2, Preload.CurrCity, Preload.CurrState. Separate address components with a comma, for example: ?123 Main Street, Apt. 101, Rockville, MD?.
For 'RE780_[1-3] DATE', display date entered at RE780_[01-03].
For ?DATE OF NHIS INTERVIEW?, display date of NHIS interview. Use NHISDt.

RE800 (REA1880)

BLAISE NAME: Jan1Abroad
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

(Were/Was) (you/(PERSON)) living within the U.S. or outside the U.S. on (MONTH, DAY, YEAR OF NHIS INTERVIEW/January 1, (YEAR))?
HELP: F1

Responses:

WITHIN U.S. 1
OUTSIDE U.S. 2 END_LP40 (REA1955)
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If coded '1' (WITHIN US), 'RF' (REFUSED), or 'DK' (DON'T KNOW), and person is 18 years old or older or in age categories 4-9, go to RE810. Otherwise, go to RE820.
Control Variables Impacted: CtrlPersKey, CtrlSampNHIS
Note: If coded '2' (OUTSIDE US) person did not have a chance for selection at NHIS and may become key and eligible.

Display Instructions:

Display ?MONTH, DAY, YEAR OF NHIS INTERVIEW? if Round 1. Use NHISDt.
Otherwise, display ?January 1, (YEAR)' with 'YEAR' as the first calendar year of the panel.

RE810 (REA1885)

BLAISE NAME: Jan1Milit
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

(Were/Was) (you/(PERSON)) serving on full-time active duty with the Armed Forces of the United States on ((MONTH, DAY, YEAR OF NHIS INTERVIEW)/January 1, (YEAR))?
HELP: F1

Responses:

YES 1 RE820 (REA1890)
NO 2 RE820 (REA1890)
REFUSED RF RE820 (REA1890)
DON'T KNOW DK RE820 (REA1890)

Display Instructions:

Display ?MONTH, DAY, YEAR OF NHIS INTERVIEW? if Round 1. Use NHISDt.
Otherwise, display ?January 1, (YEAR)' with 'YEAR' as the first calendar year of the panel.

RE820 (REA1890)

BLAISE NAME: WherePersJan1
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

(Were/Was (you/PERSON)) living away at school, living on a military facility, institutinoalized, or living at a private residence (when ((First Name,[Middle Name],Last Name)1, (First Name,[Middle Name],Last Name)2, (First Name,[Middle Name],Last Name)3, (First Name,[Middle Name],Last Name)4, (First Name,[Middle Name],Last Name)N ) participated in the National Health Interview Survey on (NHIS INTERVIEW DATE) at (NHIS ADDRESS)? / On January 1, (YEAR), (were/was) (you/(PERSON)) living away at school, living on a military facility, institutionalized, or living at a private residence?)
HELP: F1

Responses:

LIVING AWAY AT SCHOOL 1
LIVING ON A MILITARY FACILITY 2 END_LP40 (REA1955)
INSTITUTIONALIZED IN A FACILITY 3 RE830 (REA1900)
IN A PRIVATE RESIDENCE/HOUSEHOLD 4 END_LP40 (REA1955)
IF VOLUNTEERED: BORN AFTER (DATE) 5 END_LP40 (REA1955)
REFUSED RF END_LP40 (REA1955)
DON'T KNOW DK END_LP40 (REA1955)

Programmer Instructions:

If coded ?1? (LIVING AWAY AT SCHOOL) and Round 1, calculate the age from NHIS interview date (NHISDt). If Rounds 2-5, calculate age from January 1, (YEAR) where year is the first calendar year of panel for ?YEAR?. This calculation is using the age-at-NHIS (or age-at-1/1/First Panel Year) rather than the age calculation described in the GL spec. Therefore, age categories cannot be included in the check.
If calculated age at NHIS or 1/1/(YEAR) is less than or equal to 23 , go to RE860.
If calculated age at NHIS or 1/1/(YEAR) is unknown or cannot be calculated, go to RE850.
Control Variables Impacted: CtrlPersKey, CtrlSampNHIS
HARD CHECK: If coded ?1? (LIVING AWAY AT SCHOOL) and calculated age at NHIS or 1/1/(YEAR) greater than 23, display the following message: ?For the purposes of this survey, students older than 23 are considered living in a private household. INTERVIEWER: PLEASE CHANGE RE820 (WherePersJan1) TO CODE 4 (IN A PRIVATE RESIDENCE/HOUSEHOLD).?
Note: If coded ?2? (LIVING ON A MILITARY FACILITY), ?3? (INSTITUTIONALIZED IN A FACILITY), or ?5? (IF VOLUNTEERED: BORN AFTER (DATE)), person did not have a chance for selection at NHIS and may become key and eligible from the date entered at RE780_[01-03] until the interview date. If coded ?1? (LIVING AWAY AT SCHOOL) and person is older than 23 or coded ?4? (IN A PRIVATE RESIDENCE/HOUSEHOLD), ?RF? (Refused) or ?DK? (Don?t Know), person did have a chance for selection at the NHIS and may become not-key and eligible from the date entered at RE780_[01-03] until the interview date.

Display Instructions

Roster 1 ? Report Roster definition:
This item displays the current NHIS roster. Display RU member's first, middle, and last names.(PL_Person.FullName)
Roster filter:
Display all RU members on the current NHIS roster. (RE_Person.PreloadRU equal to RUUnit). Substitute ?you? for the person?s name if the respondent is included in this list. If exactly two names displayed, separate names with the word ?and? and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word ?and?.
Display response category ?5? (IF VOLUNTEERED: BORN AFTER (DATE)) if the person?s date of birth year is on or after NHIS year (PesonDOBY equal to or greater thanNHISDt (year)) or if DOB is unknown and person is age category 1 (Person.AgeRng equal to 1 or Person.AgeGuess equal to 1) or if DOB is unknown and age is 0 (PersonDOBY equal to DK or RF and AgeRnd equal to 0).
For ?DATE? in the response category display, display NHISDt (as a 3 character month DD, YYYY) if Round 1 or ?Jan 1, (YEAR)? where ?YEAR? is the first panel year if Rounds 2-5.
If round 1, display ?(Were/Was) (PERSON) living away at school, living on a military facility, institutionalized, or living at a private residence when ((First Name,[Middle Name],Last Name)1, (First Name,[Middle Name],Last Name)2, (First Name,[Middle Name],Last Name)3, (First Name,[Middle Name],Last Name)4, (First Name,[Middle Name],Last Name)N ) participated in the National Health Interview Survey on (NHIS INTERVIEW DATE) at (NHIS ADDRESS)??
For ?(NHIS ADDRESS)?, display the NHIS full address, including city and state, but not zip code. Use Preload.CurrStrt1, Preload.CurrStrt2, Preload.CurrCity, Preload.CurrState. Separate address components with a comma, for example: ?123 Main Street, Apt. 101, Rockville, MD?.
For ?(NHIS INTERVIEW DATE)?, display the date of the NHIS interview. Use NHISDt.
If round 2-5, display ?On January 1, (YEAR), (were/was) (you/(PERSON)) living away at school, living on a military facility, institutionalized, or living at a private residence?? Display the first calendar year of panel for 'YEAR'.

RE830 (REA1900)

BLAISE NAME: Jan1InstTp
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

(Were/Was) (you/(PERSON)) living in a nursing home or any other long-term care institution that provides 24 hour skilled nursing care on ((MONTH, DAY, YEAR OF NHIS INTERVIEW)/January 1, (YEAR))?
HELP: F1

Responses:

YES 1 RE840_01 (REA1905)
NO 2 END_LP40 (REA1955)
REFUSED RF RE840_01 (REA1905)
DON'T KNOW DK RE840_01 (REA1905)

Display Instructions:

Display ?MONTH, DAY, YEAR OF NHIS INTERVIEW? if Round 1. Use NHISDt.
Otherwise, display ?January 1, (YEAR)' with 'YEAR' as the first calendar year of the panel.

RE840_01 (REA1905)

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

Please give me the name and address of the nursing home or long term care facility where (you/(PERSON)) (were/was) (on January 1, (YEAR)/ living at the time of the National Health Interview Survey on (MONTH, DAY, YEAR OF NHIS INTERVIEW))?
What is the name?

Responses:

1 RE840_02 (REA1906)
REFUSED RF RE840_02 (REA1906)
DON'T KNOW DK RE840_02 (REA1906)

Display Instructions:

Display ?living at the time of the National Health Interview Survey on (MONTH, DAY, YEAR OF
Instructions: NHIS INTERVIEW)? if Round 1. Use NHISDt
Otherwise, display ?January 1, (YEAR)' with 'YEAR' as the first calendar year of the panel.
Display RE840_01, RE840_02, RE840_03, RE840_04, RE840_05, and RE840_06 on the same form pane.

RE840_02 (REA1906)

BLAISE NAME: BefFamStrt1
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

[Please give me the name and address of the nursing home or long term care facility where (you/(PERSON)) (were/was) (on January 1, (YEAR)/ living at the time of the National Health Interview Survey on (MONTH, DAY, YEAR OF NHIS INTERVIEW))?]
What is the address?

Responses:

1 RE840_03 (REA1907)
REFUSED RF RE840_03 (REA1907)
DON'T KNOW DK RE840_03 (REA1907)

Display Instructions:

Display ?living at the time of the National Health Interview Survey on (MONTH, DAY, YEAR OF NHIS INTERVIEW)? if Round 1. Use NHISDt
Otherwise, display ?January 1, (YEAR)' with 'YEAR' as the first calendar year of the panel.
Display RE840_01, RE840_02, RE840_03, RE840_04, RE840_05, and RE840_06 on the same form pane.
Display question text ?Please give me the name and address of the nursing home or long term care facility where (you/(PERSON)) (were/was) (on January 1, (YEAR)/ living at the time of the National Health Interview Survey on (MONTH, DAY, YEAR OF NHIS INTERVIEW))?? in brackets and lighter ?grayed out? text.

RE840_03 (REA1907)

BLAISE NAME: BefFamStrt2
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:

Responses:

1 RE840_04 (REA1908)
EMPTY Empty RE840_04 (REA1908)
REFUSED RF RE840_04 (REA1908)
DON'T KNOW DK RE840_04 (REA1908)

Programmer Instructions: Allow empty.
Display Instructions:

RE840_04 (REA1908)

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

Responses:

1 RE840_05 (REA1909)
REFUSED RF RE840_05 (REA1909)
DON'T KNOW DK RE840_05 (REA1909)

Display Instructions:

RE840_05 (REA1909)

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

Responses:

1 RE840_06 (REA1910)
REFUSED RF RE840_06 (REA1910)
DON'T KNOW DK RE840_06 (REA1910)

Programmer Instructions:

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

Display Instructions:

RE840_06 (REA1910)

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

Responses:

1 END_LP40 (REA1955)
REFUSED RF END_LP40 (REA1955)
DON'T KNOW DK END_LP40 (REA1955)

Programmer Instructions:

Display Instructions:

RE850 (REA1935)

BLAISE NAME: Age23orYounger
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME)
Question Text:

At that time, (were/was) (you/PERSON)) 23 or younger?

Responses:

YES 1 RE860 (REA1940)
NO 2
REFUSED RF RE860 (REA1940)
DON'T KNOW DK RE860 (REA1940)

Programmer Instructions:

Control Variables Impacted: CtrlPersKey, CtrlSampNHIS HARD CHECK: If coded ?2? (NO), display the following message: ?For the purposes of this survey, students older than 23 are considered living in a private household.
INTERVIEWER: PLEASE BACK-UP TO RE820 (WherePersJan1) AND USE CODE 4 (IN A PRIVATE RESIDENCE/HOUSEHOLD).? Code ?2? (NO) is disallowed as a final response option.
Note: If coded ?2? (NO), person was coded as living away at school but over 23 years of age, so person did have a chance for selection at the NHIS and may become not-key and eligible from the date entered at RE780_[01-03] until the interview date.

Display Instructions:

RE860 (REA1940)

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

What grade or level of school (were/was) (you/(PERSON)) attending on ((MONTH, DAY, YEAR OF NHIS INTERVIEW)/January 1, (YEAR))?
HELP: F1

Responses:

1st - 12th GRADE 1 END_LP40 (REA1955)
VOCATIONAL, COLLEGE, GRADUATE, PROFESSIONAL 2 RE870 (REA1945)
REFUSED RF RE870 (REA1945)
DON'T KNOW DK RE870 (REA1945)

Programmer Instructions:

Control Variables Impacted: CtrlPersKey, CtrlSampNHIS
Note: If coded ?1? (1st ? 12th GRADE), person did not have a chance for selection at NHIS and may become key and eligible from the date entered at RE780_[01-03] until the interview date.

Display Instructions:

Display ?MONTH, DAY, YEAR OF NHIS INTERVIEW? if Round 1. Use NHISDt.
Otherwise, display ?January 1, (YEAR)' with 'YEAR' as the first calendar year of the panel.

RE870 (REA1945)

BLAISE NAME: Jan1ParentHh
Context Header: (PERSON?S FIRST MIDDLE AND LAST NAME)
Question Text:

At the time of the National Health Interview Survey on (MONTH, DAY, YEAR OF NHIS INTERVIEW / On January 1,
(YEAR), were either of (your/(PERSON)'s) parents living (at (NHIS ADDRESS)/in this household)?

Responses:

YES 1 END_LP40 (REA1955)
NO 2 END_LP40 (REA1955)
REFUSED RF END_LP40 (REA1955)
DON'T KNOW DK END_LP40 (REA1955)

Programmer Instructions:

Control Variables Impacted: CtrlPersKey, CtrlSampNHIS
Note: If coded ?1? (YES), ?RF? (REFUSED), or ?DK? (DON?T KNOW), person did not have a chance for selection at NHIS and may become key and eligible from the date entered at RE780_[01-03] until the interview date. If coded ?2? (NO), person did have a chance for selection at the NHIS and may become not-key and eligible from the date entered at RE780_[01-03] until the interview date.

Display Instructions:

Display ?On January 1, (YEAR)? and ?in this household?, if Rounds 2-5. Display the first calendar year of panel for 'YEAR'.
Display ?At the time of the National Health Interview Survey on (MONTH, DAY, YEAR OF NHIS INTERVIEW)? and ?at (NHIS ADDRESS)? if Round 1. Use NHISDt for ?MONTH, DAY, YEAR OF NHIS INTERVIEW?.
For ?NHIS ADDRESS? display the NHIS full address, including city and state but not zip code. Use Preload.CurrStrt1, Preload.CurrStrt2, Preload.CurrCity, Preload.CurrState. Separate address components with a comma, for example: ?123 Main Street, Apt. 101, Rockville, MD?.

END_LP40 (REA1955)

Route Details:

Cycle on next person that meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_40 and go to BOX_250.

BOX_250 (REA2050)

Route Details: Continue with REENUMERATION-B (RE-B) subsection.

Reenumeration B (REB) Section

BOX_00 (REB1000)

Route Details:

01 Box = BOX_260, BOX_270, BOX_280, BOX_290, BOX_320, BOX_330, BOX_340, BOX_350, BOX_360, BOX_370, BOX_380, BOX_390, BOX_400, BOX_405, BOX_410, BOX_420, BOX_430, BOX_440, BOX_450, BOX_460, BOX_470
02 Loop = LOOP_70, LOOP_80, LOOP_90, LOOP_100, LOOP_110, LOOP_140
03 End Loop = END_LP70, END_LP80, END_LP90, END_LP100, END_LP110, END_LP120, END_LP130, END_LP140
04 Single Select = RE900, RE910, RE950, RE960, RE970, RE980, RE990, RE1000, RE1030, RE1055, RE1085, RE1100, RE1150, RE1170_01, RE1170_02, RE1170_03, RE1170_07, RE1170_08, RE1170_09, RE1170_10, RE1180, RE1190, RE1200, RE1210
05 Single Select with Display Roster = RE880, RE1040, RE1070, RE1120, RE1270
06 Single Select with Fill in Answer Text = RE920
08 Multiple Select = RE1170_04, RE1170_05
10 Multiple Select with Fill in Answer Text = RE1050, RE1080, RE1130, RE1280
12 Address - Newly Collected = RE1240_01, RE1240_02, RE1240_03, RE1240_04, RE1240_05, RE1240_06, RE1260_01, RE1260_02, RE1260_03, RE1260_04, RE1260_05, RE1260_06
14 Regular Date Entry = RE1060_01, RE1060_02, RE1060_03, RE1090_01, RE1090_02, RE1090_03, RE1110_01, RE1110_02, RE1110_03, RE1170_11
19 Numeric Field = RE1170_12
20 OS Text Field = RE1170_06
24 Information Screen = RE890, RE930, RE940, RE1010, RE1020, RE1140, RE1160, RE1220, RE1230, RE1250
Grid 1 = RE1210 Grid 2 = RE1170_01, RE1170_02, RE1170_03, RE1170_04, RE1170_05, RE1170_06,
RE1170_07, RE1170_08, RE1170_09, RE1170_10, RE1170_11, RE1170_12
Roster 2 = RE920, RE1050, RE1080, RE1130

BOX_260 (REB1003)

Route Details:

Go to BOX_270.
Note: The RU-Members-Roster has been updated throughout the ST and RE-A section as follows:
- New RU members have been added
- DU members selected have been merged
- RU members who meet any one of the following conditions have been set as movers:
- Non-military persons identified as moving to a military facility or private residence within the U.S.
- Full-time military persons identified as moving to a private residence within the U.S. or moving to a military facility within the U.S. with other non-military, key RU members
- RU members who have been set as student movers
- RU members who have been identified as out of scope and will not have data collected
- RU members who have been identified as not being in the RU on the interview date, but have partial eligibility and will have data collected for them
- RU members who have returned to this RU from being previously institutionalized in a health care facility

BOX_270 (REB1005)

Route Details:

If student RU (RUType = Student RU or New Student RU) and RE110 is coded '1' (YES), go to BOX_470.
If student RU (RUtype = Student RU or New Student RU) and RE110 is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), and RE90=EMPTY, go to RE1170_01.
If student RU (Rutype = Student RU or New Student RU) and RE110 is coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), and RE90()EMPTY go to RE1170_03
Else if standard or new RU (RUType = Standard RU or New Standard RU)
AND
All persons are set as out-of-scope [RemovedAtRE180 = YES or MoveratLoop10 = NO or RemovedAtRE330 = YES or MoverAtLoop20 = No or MoverAtLoop30 = NO], go to BOX_470.
Else if standard or new RU (RUType = Standard RU or New Standard RU)
AND
At least one person is a student that was present in the DU at the time of the NHIS [(StudentMoverAtLoop20 = YES or StudentMoverAtLoop30 = YES) and OrigRnd = 0]
AND
All other persons are set as out-of-scope [RemovedAtRE180 = YES or MoverAtLoop10 = NO or RemovedAtRE330 = YES or MoverAtLoop20 = NO or MoverAtLoop30 = NO], go to BOX_330.
Else if standard or new RU (RUType = Standard RU or New Standard RU)
AND
At least one person is a student that was identified for the first time in this round [(StudentMoverAtLoop20 = YES or StudentMoverAtLoop30 = YES) and (RE_Person.PERSID () any PL_Person.PERSID)]
AND
All other persons are set as out-of-scope [RemovedAtRE180 = YES or MoverAtLoop10 = No or RemovedAtRE330 = YES or MoverAtLoop20 = No or MoverAtLoop30 = NO], go to RE1170_03.
Else if standard or new RU (RUType = Standard RU or New Standard RU)
AND
At least one person is a mover [MoverAtLoop10 = YES or MoverAtLoop20 = YES or MoverAtLoop30 = YES]
AND
All other persons are set as out-of-scope [RemovedAtRE180 = YES or MoverAtLoop10 = NO or RemovedAtRE330 = YES or MoverAtLoop20 = NO or MoverAtLoop30 = NO], go to RE1020.
If exactly one person on RE_Person Array where MostRecentRU = RUUnit where CtrlCurrHere_AtBOX270 = YES
AND
No person on RE_Person Array where MostRecentRU = RUUnit is a new student [StudentMoverAtLoop20 = NO or empty and StudentMoverAtLoop30 = NO or empty], go to BOX_330.
Otherwise, continue with BOX_280.

BOX_280 (REB1010)

Route Details:

If Round 1
OR
Any new persons have been merged this round (RE_Person[].PreloadOrd () EMPTY AND RE_Person[].PreloadRU () RUUnit AND RE_Person[].MostRecentRU = RUUnit)
OR
Any new persons have been added this round (RE_Person[].PreloadOrd = EMPTY AND RE_Person[].MostRecentRU = RUUnit)
OR
Any relationships are coded 'RF' (REFUSED), 'DK' (DON'T KNOW), or missing from the previous round (preloaded RelCode = RF, DK or empty)
Go to RE890

RE880 (REB1015)

Responses:
YES 1 RE900 (REB1027)
NO 2 BOX_330 (REB1115)
REFUSED RF BOX_330 (REB1115)
DON'T KNOW DK BOX_330 (REB1115)
Programmer Instructions:
Roster Behavior:
The column heading ?MEMBER NAME? should display the respondent or the reference person if proxy respondent and then all remaining RU members from oldest to youngest using the Age Order specifications in the GL section.
Display relationships that were coded in the previous round and are still applicable, including reciprocal relationships (preloaded RelCode).
Display Instructions:
Roster definition: Roster 1- report
This item displays the RU-members-roster and all persons flagged as ?NEW STUDENTS?. The column headings 'RU MEMBER N' are filled with the RU members first name (RE_Person.Fname) and age (RE_Person.agernd) in parentheses. The column heading ?MEMBER NAME? is filled with the first name of the person being looped on (RE_Person.Fname) and age (RE_Person.agernd) in parentheses. Display MEMBER NAME?s relationship to RU MEMBER N. Display the preloaded (from the previous round, as available) relationship.
Roster filter:
Display persons on the RE_Person Array where MostRecentRU = RUUnit who meet either of the following conditions:
Person is a member of the RU (CtrlCurrHere_AtBOX270 = YES) or
Person is a 'NEW STUDENT' (StudentMoverAtLoop20 = YES or StudentMoverAtLoop30 = YES).
Display 'Since [START DATE]' if not round 5.
Display 'Between [START DATE] and December 31, [YEAR]' where 'YEAR' is the second calendar year of the panel, if round 5.
Display "TO VIEW RELATIONSHIP GRID PRESS CTRL-X TO CLOSE RELATIONSHIP GRID PRESS ESC" if the the number of RU members displayed is greater than=7 otherwise use a null display.

RE890 (REB1020)

Responses:
CONTINUE 1 LOOP_70 (REB1025)
Programmer Instructions:
Roster Behavior:
The column heading ?MEMBER NAME? should display the respondent or the reference person if proxy respondent and then all remaining RU members from oldest to youngest using the Age Order specifications in the GL section.
Display relationships that were coded in the previous round and are still applicable, including reciprocal relationships. Note that the relationships collected in the NHIS will not be pre-filled in the round 1 CAPI (preloaded RelCode).
Display question mark for relationships not yet coded or where relationship was coded 'RF' (REFUSED) or 'DK' (DON'T KNOW) in previous round.
Display Instructions:
Roster definition: Roster 1- report
This item displays the RU-members-roster and all persons flagged as ?NEW STUDENTS?. The column headings 'RU MEMBER N' are filled with the RU members first name (RE_Person.Fname) and age (RE_Person.agernd) in parentheses. The column heading ?MEMBER NAME? is filled with the first name of the person being looped on (RE_Person.Fname) and age (RE_Person.agernd) in parentheses. Display MEMBER NAME?s relationship to RU MEMBER N. Display the preloaded (from the previous round, as available) relationship.
Roster filter:
Display persons on the RE_Person Array where MostRecent RU = RUUnit who meet either of the following conditions:
1. Person is a member of the RU (CtrlCurrHere_AtBOX270 = YES)
or
2. Person is a ?NEW STUDENT? (StudentMoverAtLoop20 = YES or StudentMoverAtLoop30 = YES).
Display ?Now I would like to collect information about how the [new] members of this household are related [to the family].? If Round 1 or if Rounds 2-5 and at least one new RU member was added this round.
Display ?new? if Rounds 2-5 and at least one new RU member was added this round. Otherwise, use a null display.
Display ?to the family? if Rounds 2-5 and at least one new RU member was added this round. Otherwise, use a null display.
Display ?Please tell me whose relationships have changed.' If Rounds 2-5 and RE880 was coded ?1?(YES).
Display ?INTERVIEWER: FILL IN MISSING RELATIONSHIPS.? if Rounds 2-5 and no new RU members have been added this round, and at least one relationship is coded ?RF? (REFUSED) or ?DK? (DON?T KNOW) from a previous round.
Display ?READ GRID STARTING FROM LEFT. EXAMPLE: "(NAME ON LEFT) IS (NAME ON TOP)?S (RELATIONSHIP)." if rounds 2-5. Otherwise, use a null display.
Display "TO VIEW RELATIONSHIP GRID PRESS CTRL-X TO CLOSE RELATIONSHIP GRID PRESS ESC" if the the number of RU members displayed is greater than=7 otherwise use a null display.

LOOP_70 (REB1025)

Route Details:

For each person, ask LOOP_75-END_LP70.
Loop definition: LOOP_70 cycles on all RU members and NEW STUDENTS. The loop begins with the respondent or the reference person if proxy respondent and then loops on the remaining RU members from oldest to youngest using the Age Order specifications in the GL section. The loop cycles on all persons in the RE_Person Array where MostRecentRU=RUUnit who meet either of the following conditions:
-Person is a member of the RU for this case (CtrlCurrHere_AtBOX270=Yes)
OR
-Person is a ?NEW STUDENT' (StudentMoverAtLoop20=YES or StudentMoverAtLoop30=YES)

LOOP_75 (REB1026)

Route Details:

For each person, ask RE900-END_LP75.
Loop definition: LOOP_75 collects the relationship between the person being looped on at LOOP_70 and all RU members, including NEW STUDENTS. The loop begins with the respondent or the reference person if proxy respondent and then loops on the remaining RU members from oldest to youngest using the Age Order specifications in the GL section. The loop cycles on all persons in the RE_Person Array where MostRecentRU=RUUnit who meet the following conditions:
- Person is a member of the RU for this case (CtrlCurrHere_AtBOX270=Yes)
OR
-Person is a ?NEW STUDENT' (StudentMoverAtLoop20=YES or StudentMoverAtLoop30=YES).
Note: Loop_70 and Loop_75 are the identical loops that allow you not to ask relationship to SELF.

RE900 (REB1027)

BLAISE NAME: RelCode
Question Text:
[I would like to know how everyone is related to [you/[PERSON]].]
[RU MEMBER] [is/was] [your/[PERSON]'s]
HELP: F1

Responses:
MOTHER (BIOLOGICAL/ADOPTIVE) 1
FATHER (BIOLOGICAL/ADOPTIVE) 2
SISTER/STEP-/HALF- 3
BROTHER/STEP-/HALF- 4
DAUGHTER/ADOPTED DAUGHTER 5
SON/ADOPTED SON 6
HUSBAND/WIFE/SPOUSE 7
UNMARRIED PARTNER 8
MOTHER-IN-LAW 9
FATHER-IN-LAW 10
SISTER-IN-LAW 11
BROTHER-IN-LAW 12
DAUGHTER-IN-LAW 13
SON-IN-LAW 14
STEPMOTHER 15
STEPFATHER 16
STEPDAUGHTER 17
STEPSON 18
GRANDMOTHER 19
GRANDFATHER 20
AUNT 21
UNCLE 22
NIECE 23
NEPHEW 24
COUSIN 25
GRANDSON 26
GRANDDAUGHTER 27
PARTNER OF [PERSON]'s PARENT 28
DAUGHTER OF [PERSON LOOPING ON]'s 30
PARTNER
SON OF [PERSON LOOPING ON]'s 31
PARTNER
GREAT GRANDMOTHER 32
GREAT GRANDFATHER 33
FOSTER MOTHER 34
FOSTER FATHER 35
FOSTER DAUGHTER 36
FOSTER SON 37
GREAT GRANDDAUGHTER 38
GREAT GRANDSON 39
GREAT AUNT 40
GREAT UNCLE 41
GREAT NIECE 42
GREAT NEPHEW 43
FOSTER SISTER 44
FOSTER BROTHER 45
OTHER RELATED (NO SPECIFY) 91
NOT RELATED 99
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Go to END_LP75.CAPI should not present a question asking about reciprocal relationships or relationships that would be flagged as ?SELF?. Reciprocal relationships should be autocoded as follows:
If the [RU MEMBER] is [PERSONS] '1' (MOTHER (BIOLOGICAL/ADOPTIVE)) then autocode the reciprocal relationship to '5' (DAUGHTER/ADOPTED DAUGHTER) if the [PERSON] is female, or '6' (SON/ADOPTED SON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '2' (FATHER (BIOLOGICAL/ADOPTIVE)) then autocode the reciprocal relationship to '5' (DAUGHTER/ADOPTED DAUGHTER) if the [PERSON] is female, or '6' (SON/ADOPTED SON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '3' (SISTER/STEP-/HALF-) then autocode the reciprocal relationship to '3' (SISTER/STEP-/HALF-) if the [PERSON] is female, or '4' (BROTHER/STEP-/HALF-) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '4' (BROTHER/STEP-/HALF-) then autocode the reciprocal relationship to '3' (SISTER/STEP-/HALF-) if the [PERSON] is female, or '4' (BROTHER/STEP-/HALF-) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '5' (DAUGHTER/ADOPTED DAUGHTER) then autocode the reciprocal relationship to '1' (MOTHER (BIOLOGICAL/ADOPTIVE)) if the [PERSON] is female, or '2' (FATHER (BIOLOGICAL/ADOPTIVE)) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '6' (SON/ADOPTED SON) then autocode the reciprocal relationship to '1' (MOTHER (BIOLOGICAL/ADOPTIVE)) if the [PERSON] is female, or '2' (FATHER (BIOLOGICAL/ADOPTIVE)) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '7' (HUSBAND/WIFE/SPOUSE) then autocode the reciprocal relationship to '7' (HUSBAND/WIFE/SPOUSE).
If the [RU MEMBER] is [PERSONS] '8' (UNMARRIED PARTNER) then autocode the reciprocal relationship to '8' (UNMARRIED PARTNER).
If the [RU MEMBER] is [PERSONS] '9' (MOTHER-IN-LAW) then autocode the reciprocal relationship to '13' (DAUGHTER-IN-LAW) if the [PERSON] is female, or '14' (SON-IN-LAW) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '10' (FATHER-IN-LAW) then autocode the reciprocal relationship to '13' (DAUGHTER-IN-LAW) if the [PERSON] is female, or '14' (SON-IN-LAW) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '11' (SISTER-IN-LAW) then autocode the reciprocal relationship to '11' (SISTER-IN-LAW) if the [PERSON] is female, or '12' (BROTHER-IN-LAW) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '12' (BROTHER-IN-LAW) then autocode the reciprocal relationship to '11' (SISTER-IN-LAW) if the [PERSON] is female, or '12' (BROTHER-IN-LAW) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '13' (DAUGHTER-IN-LAW) then autocode the reciprocal relationship to '9' (MOTHER-IN-LAW) if the [PERSON] is female, or '10' (FATHER-IN-LAW) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '14' (SON-IN-LAW) then autocode the reciprocal relationship to '9' (MOTHER-IN-LAW) if the [PERSON] is female, or '10' (FATHER-IN-LAW) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '15' (STEPMOTHER) then autocode the reciprocal relationship to '17' (STEPDAUGHTER) if the [PERSON] is female, or '18' (STEPSON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '16' (STEPFATHER) then autocode the reciprocal relationship to '17' (STEPDAUGHTER) if the [PERSON] is female, or '18' (STEPSON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '17' (STEPDAUGHTER) then autocode the reciprocal relationship to '15' (STEPMOTHER) if the [PERSON] is female, or '16' (STEPFATHER) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '18' (STEPSON) then autocode the reciprocal relationship to '15' (STEPMOTHER) if the [PERSON] is female, or '16' (STEPFATHER) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '19' (GRANDMOTHER) then autocode the reciprocal relationship to '27' (GRANDDAUGHTER) if the [PERSON] is female, or '26' (GRANDSON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '20' (GRANDFATHER) then autocode the reciprocal relationship to '27' (GRANDDAUGHTER) if the [PERSON] is female, or '26' (GRANDSON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '21' (AUNT) then autocode the reciprocal relationship to '23' (NIECE) if the [PERSON] is female, or '24' (NEPHEW) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '22' (UNCLE) then autocode the reciprocal relationship to '23' (NIECE) if the [PERSON] is female, or '24' (NEPHEW) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '23' (NIECE) then autocode the reciprocal relationship to '21' (AUNT) if the [PERSON] is female, or '22' (UNCLE) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '24' (NEPHEW) then autocode the reciprocal relationship to '21' (AUNT) if the [PERSON] is female, or '22' (UNCLE) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '25' (COUSIN) then autocode the reciprocal relationship to '25' (COUSIN).
If the [RU MEMBER] is [PERSONS] '26' (GRANDSON) then autocode the reciprocal relationship to '19' (GRANDMOTHER) if the [PERSON] is female, or '20' (GRANDFATHER) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '27' (GRANDDAUGHTER) then autocode the reciprocal relationship to '19' (GRANDMOTHER) if the [PERSON] is female, or '20' (GRANDFATHER) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '28' (PARTNER OF [PERSON]?S PARENT) then autocode the reciprocal relationship to '30' (DAUGHTER OF [PERSON LOOPING ON]'s PARTNER) if the [PERSON] is female, or '31' (SON OF [PERSON LOOPING ON]'s PARTNER) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '30' (DAUGHTER OF [PERSON LOOPING ON]'s PARTNER) then autocode the reciprocal relationship to '28' (PARTNER OF [PERSON]?S PARENT).
If the [RU MEMBER] is [PERSONS] '31' (SON OF [PERSON LOOPING ON]'s PARTNER) then autocode the reciprocal relationship to '28' (PARTNER OF [PERSON]?S PARENT).
If the [RU MEMBER] is [PERSONS] '32' (GREAT GRANDMOTHER) then autocode the reciprocal relationship to '38' (GREAT GRANDDAUGHTER) if the [PERSON] is female, or '39' (GREAT GRANDSON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '33' (GREAT GRANDFATHER) then autocode the reciprocal relationship to '38' (GREAT GRANDDAUGHTER) if the [PERSON] is female, or '39' (GREAT GRANDSON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '38' (GREAT GRANDDAUGHTER) then autocode the reciprocal relationship to '32' (GREAT GRANDMOTHER) if the [PERSON] is female, or '33' (GREAT GRANDFATHER) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '39' (GREAT GRANDSON) then autocode the reciprocal relationship to '32' (GREAT GRANDMOTHER) if the [PERSON] is female, or '33' (GREAT GRANDFATHER) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '34' (FOSTER MOTHER) then autocode the reciprocal relationship to '36' (FOSTER DAUGHTER) if the [PERSON] is female, or '37' (FOSTER SON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '35' (FOSTER FATHER) then autocode the reciprocal relationship to '36' (FOSTER DAUGHTER) if the [PERSON] is female, or '37' (FOSTER SON) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '36' (FOSTER DAUGHTER) then autocode the reciprocal relationship to '34' (FOSTER MOTHER) if the [PERSON] is female, or '35' (FOSTER FATHER) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '37' (FOSTER SON) then autocode the reciprocal relationship to '34' (FOSTER MOTHER) if the [PERSON] is female, or '35' (FOSTER FATHER) if the [PERSON] is male.
If the [RU MEMBER] is [PERSONS] '91' (OTHER RELATED (NO SPECIFY)) then autocode the reciprocal relationship to '91' (OTHER RELATED (NO SPECIFY) ). If the [RU MEMBER] is [PERSONS] '99' (NOT RELATED) then autocode the reciprocal relationship to '99' (NOT RELATED).
Soft check:
If code '1' (MOTHER (BIOLOGICAL/ADOPTIVE)) or '2' (FATHER (BIOLOGICAL/ADOPTIVE)) is used more than once to describe the relationship between a RU member and the person being looped on at LOOP_70, display the following message: "MOTHER/FATHER ALREADY USED. VERIFY AND RE-ENTER."
If code '7' (HUSBAND/WIFE/SPOUSE) is used more than once to describe the relationship between a RU member and the person being looped on at LOOP_70, display the following message: "HUSBAND/WIFE/SPOUSE ALREADY USED. VERIFY AND RE- ENTER."
If code '15' (STEPMOTHER) or '16' (STEPFATHER) and the age of the ?RU MEMBER? associated with code is younger than person being looped on at LOOP_70, display the following message: "UNLIKELY RESPONSE DUE TO AGE. VERIFY AND RE-ENTER." Do not display the message for age ranges or age guesses.
If code '99' (NOT RELATED) is selected, display the following message: "THIS PERSON HAS BEEN CODED AS NOT RELATED. PROBE RESPONDENT AND REVIEW CODES. IF APPLICABLE, USE A MORE DESCRIPTIVE CODE OR USE CODE '91' (OTHER RELATED, NO SPECIFY). IF RESPONDENT CONFIRMS PERSON IS NOT RELATED, CONTINUE ENTERING OTHER RELATIONSHIPS."
Hard check:
If code '1' (MOTHER (BIOLOGICAL/ADOPTIVE)), '2' (FATHER (BIOLOGICAL/ADOPTIVE)), '19' (GRANDMOTHER), '20' (GRANDFATHER), '32' (GREAT GRANDMOTHER), '33' (GREAT GRANDFATHER), '34' (FOSTER MOTHER), or '35' (FOSTER FATHER), the age of the 'RU MEMBER' associated with the code must be older than the person being looped on at LOOP_70. Display the following error message: "DISALLOWED RELATIONSHIP. [RU MEMBER] CAN'T BE [PERSON]'S [RELATION] GIVEN THAT THE AGE OF [RU MEMBER ] IS LESS THAN THE AGE OF [PERSON ]. VERIFY AND RE-ENTER." 'RELATION' should be filled with the relationship that was selected at RE900. 'RU MEMBER NAME' should be filled with the RU members first and last name (RU member from LOOP_75). 'PERSON' should be filled with the person being looped on's first and last name from LOOP_70. Do not display the message for age ranges or age guesses.
If code '36' (FOSTER DAUGHTER) or '37' (FOSTER SON), the age of the 'RU MEMBER' associated with the code must be 18 years of age or younger or in age categories 1-4. Display the following error message: "A FOSTER DAUGHTER/SON CAN'T BE MORE THAN 18 YEARS OLD. VERIFY AND RE-ENTER."
If code '5' (DAUGHTER/ADOPTED DAUGHTER), '6' (SON/ADOPTED SON), '27' (GRANDDAUGHTER), '26' (GRANDSON), '38' (GREAT GRANDDAUGHTER), '39' (GREAT GRANDSON), '36' (FOSTER DAUGHTER), or '37' (FOSTER SON), the age of the 'RU MEMBER' associated with the code must be younger than the person being looped on at LOOP_70. Display the following error message: "DISALLOWED RELATIONSHIP. [RU MEMBER] CAN'T BE [PERSON]'S [RELATION] GIVEN THAT THE AGE OF [RU MEMBER ] IS GREATER THAN THE AGE OF [PERSON ]. VERIFY AND RE-ENTER." Do not display the message for age ranges or age guesses. 'RELATION' should be filled with the relationship that was selected at RE900. 'RU MEMBER NAME' should be filled with the RU members first and last name (RU member from LOOP_75). 'PERSON' should be filled with the person being looped on's first and last name from LOOP_70.
Display Instructions:
Display all instances of RE900 for the person being looped on at LOOP_70 in the same form pane.
Display first, middle, and last name for [PERSON] in ?I would like to know how everyone is related to [you/[PERSON]].?
For ?[RU MEMBER] [is/was] (PERSON)'s? in the question text, display the first, middle, and last name of the person being looped on at LOOP_75 for [RU MEMBER] and display the first name of the person being looped on at LOOP_70 for [PERSON].
Display ?I would like to know how everyone is related to [you/[PERSON]].? in lighter ?grayed-out? text and brackets, after the first relationship question for person being looped on at LOOP_70.
Display ?is? if both persons are living. Display ?was? if both or either person is deceased.
Display only the gender appropriate set of response codes, dependent on the gender of the changing RU member or NEW STUDENT when the gender is known (Gender ()DK, RF or EMPTY). When gender is unknown display all codes other display gender appropriate response codes.
The female appropriate codes are ?5? (DAUGHTER/ADOPTED DAUGHTER), ?1? (MOTHER (BIOLOGICAL/ADOPTIVE)), ?3? (SISTER/STEP-/HALF-), ?19? (GRANDMOTHER), ?27? (GRANDDAUGHTER), ?21? (AUNT), ?23? (NIECE), ?15? (STEPMOTHER), ?17? (STEPDAUGHTER), ?9? (MOTHER-IN-LAW), ?11? (SISTER-IN- LAW), ?13? (DAUGHTER-IN-LAW), ?30? (DAUGHTER OF [PERSON LOOPING ON]?s PARTNER), ?32? (GREAT GRANDMOTHER), ?34? (FOSTER MOTHER), ?36? (FOSTER DAUGHTER), '38' (GREAT GRANDDAUGHTER), and '44' (FOSTER SISTER). The male appropriate codes are ?6? (SON/ADOPTED SON), ?2? (FATHER (BIOLOGICAL/ADOPTIVE)), ?4? (BROTHER/STEP-/HALF-), ?20? (GRANDFATHER), ?26? (GRANDSON), ?22? (UNCLE), ?24? (NEPHEW), ?16? (STEPFATHER), ?18? (STEPSON), ?10? (FATHER-IN-LAW), ?12? (BROTHER-IN-LAW), ?14? (SON-IN-LAW), ?31? (SON OF [PERSON LOOPING ON]?s PARTNER), ?33? (GREAT GRANDFATHER), ?35? (FOSTER FATHER), ?37? (FOSTER SON), '39' (GREAT GRANDSON), and '45' (FOSTER BROTHER).
Categories ?7? (HUSBAND/WIFE/SPOUSE), ?8? (UNMARRIED PARTNER), ?25? (COUSIN), ?28? (PARTNER OF [PERSON]?S PARENT), ?91? (OTHER RELATED (NO SPECIFY)) and ?99? (NOT RELATED) are always displayed regardless of gender.
For categories ?28? (PARTNER OF [PERSON]?S PARENT), ?31? (SON OF [PERSON LOOPING ON]'s PARTNER), and ?30? (DAUGHTER OF [PERSON LOOPING ON]'s PARTNER) fill [PERSON] with the first name of the person being looped on at LOOP_70.
Display two balanced columns of 13 options each without scrolling.
Do not display '40' (GREAT AUNT), '41' (GREAT UNCLE), '42' (GREAT NIECE), and '43' (GREAT NEPHEW) in the answer pane.

END_LP75 (REB1028)

Route Details:

Cycle on next person who meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, then end LOOP_75 and continue with BOX_290.

BOX_290 (REB1045)

Route Details:

If person is being looped on is:
-Age is equal to or less than 17 years or in age categories 1-4
AND
-If there is no entry for MOTHER (RE900 = 1), STEP-MOTHER (RE900 = 15), FOSTER MOTHER (RE900 = 34), FATHER (RE900 = 2), STEP-FATHER (RE900 = 16), FOSTER FATHER (RE900 = 35), or HUSBAND/WIFE/SPOUSE (RE900 = 7)
AND
-If there is at least one RU member who is 18 years of age or older or is in age categories 4-9, not deceased, and they are not the person being looped on, go to RE910.
Else, go to END_LP70.

RE910 (REB1085)

BLAISE NAME: Guardian
Context Header:
[PERSON?S FIRST, MIDDLE AND LAST NAME]
Question Text:
I have recorded that [you/[PERSON]] [do/does] not have a mother or father living in this household. [Do/Does] [you/he/she] have a legal guardian living in this household?
HELP: F1

Responses:
YES 1 RE920 (REB1090)
NO 2 END_LP70 (REB1095)
REFUSED RF END_LP70 (REB1095)
DON'T KNOW DK END_LP70 (REB1095)
Display Instructions:

RE920 (REB1090)

BLAISE NAME: GuardianPID
Context Header:
[PERSON?S FIRST, MIDDLE AND LAST NAME]
Question Text:
Who is [your/[PERSON]'s legal guardian?

Responses:
[FIRST NAME, [MIDDLE NAME], LAST NAME]1 1 END_LP70 (REB1095)
[FIRST NAME, [MIDDLE NAME], LAST NAME]2 2 END_LP70 (REB1095)
[FIRST NAME, [MIDDLE NAME], LAST NAME]3 3 END_LP70 (REB1095)
[FIRST NAME, [MIDDLE NAME], LAST NAME]4 4 END_LP70 (REB1095)
[FIRST NAME, [MIDDLE NAME], LAST NAME]N 5 END_LP70 (REB1095)
Programmer Instructions:
Display Instructions:
Roster 2- no add/edit/delete
Roster definition:
This item displays RU-members-roster for selection of legal guardian.
Roster Filter:
Display only those persons who are 18 years of age or older or in age categories 4-9 on the RE_Person Array where MostRecentRU=RUUnit who meet the following conditions:
-CtrlCurrHere_AtBOX270 = YES
AND
-[RE190 is NOT coded ?3? (DECEASED) or RE340 is NOT coded ?5? (IF VOLUNTEERED:
DECEASED)]
AND
-is not the person being looped on.

END_LP70 (REB1095)

Route Details:

Cycle on next person who meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, then end LOOP_70 and continue with RE930.

RE930 (REB1100)

Responses:
CONTINUE 1 BOX_320 (REB1105)
Programmer Instructions:
Roster Behavior:
The column heading ?MEMBER NAME? should display the respondent or the reference person if proxy respondent and then all remaining RU members from oldest to youngest using the Age Order specifications in the GL section.
Display all relationships coded previously and up to this point, including reciprocal relationships.
Display RF or DK for relationships coded 'RF' (REFUSED) or 'DK' (DON'T KNOW).
If RU member respondent, create a family subunit based on RU members relationship to the respondent; if proxy respondent, create family subunit based on RU members relationship to reference person.
Include the RU member in the subunit if they are:
- Respondent/reference person
- Spouse/partner of the respondent/reference person (RE900= ?7? HUSBAND/WIFE/SPOUSE or ?8? UNMARRIED PARTNER)
- Bio/step/adopted children ? 20 of the respondent/reference person (RE900 = 5 DAUGHTER/ADOPTED DAUGHTER, ?6? SON/ADOPTED SON, ?17?STEPDAUGHTER, or ?18?, STEPSON and person is younger than 21 or in age categories 1-4.)
- If respondent/reference person has an UNMARRIED PARTNER, include the children less than 20 of the unmarried partner (RE900 = '30' DAUGHTER OF [PERSON LOOPING ON]'s PARTNER, '31' SON OF [PERSON LOOPING ON]'s PARTNER) and person is younger than 21 or in age categories 1-4.)
- Children ? 17 in a legal guardian relationship with the respondent/reference person (Person is younger than 18 or in age categories 1-4 and at RE920 the respondent/reference person is selected as the legal guardian)
Otherwise, group all other RU members into a non-family subunit.
Display Instructions:
Roster Definition: Roster 1- Report
This item displays the RU-members-roster and all persons flagged as ?NEW STUDENTS?. The column headings 'RU MEMBER N' are filled with the RU members first name (RE_Person.Fname) and age (RE_Person.agernd) in parentheses. The column heading ?MEMBER NAME? is filled with the first name of the person being looped on (RE_Person.Fname) and age (RE_Person.agernd) in parentheses. Display MEMBER NAME?s relationship to RU MEMBER N. Display the preloaded (from the previous round, as available) relationship.
Roster Filter:
Display persons on the RE_Person Array where MostRecentRU=RUUnit who meet either of the
following conditions:
Person is a member of the RU (CtrlCurrHere_AtBOX270=Yes) or
Person is a ?new student? (StudentMoverAtLoop20=YES or StudentMoverAtLoop30=YES).
Display "TO VIEW RELATIONSHIP GRID PRESS CTRL-X TO CLOSE RELATIONSHIP GRID
PRESS ESC" if the number of RU members displayed is greater than=7 otherwise use a null display.

BOX_320 (REB1105)

Route Details:

If at least one person meets the following condition:
- Coded ?99? (NOT RELATED FOR RELATIONSHIP WITH REFERENCE PERSON), '36' (Foster Daughter) or '37' (Foster Son) at RE900, continue with RE940.
Otherwise, go to BOX_330.

RE940 (REB1110)

BLAISE NAME: NoInfoPersA
Question Text:
At this time, we are only collecting information about the people in this family. Therefore, that is all the information we will need about the non-related people who live here. We will not collect any additional information about (READ NAMES BELOW).
[1. First Name, [Middle Name], Last Name]1
[2. First Name, [Middle Name], Last Name]2
[3. First Name, [Middle Name], Last Name]3
[4. First Name, [Middle Name], Last Name]4
[5. First Name, [Middle Name], Last Name]N
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 BOX_330 (REB1115)
Programmer Instructions:
Ctrl Variables impacted: CtrlEligible, CtrlCurrHere.
For each person displayed at RE940:
Set RemovedAtRE940=YES
Set MoverAtRE940=YES if person is key and not related (CtrlPersKey=YES and ?99? NOT RELATED FOR RELATIONSHIP WITH REFERENCE PERSON at RE900). Person is treated as a mover.
Note: Person is treated as a mover. This person is not currently here, but in-scope and eligible to be interviewed as part of another RU from the date of their previous interview until that new interview date. The RE section will collect locating information for this person, but person will not be included in this interview after the RE section. Information for person will be collected as part of another RU.
Set MoverAtRE940=NO if [StudentMoverAtLoop30=YES] and [OrigRnd=Current] and [?99? NOT RELATED FOR RELATIONSHIP WITH REFERENCE PERSON at RE900]
OR
Person is not key and not related (CtrlPersKey=NO and ?99? NOT RELATED FOR RELATIONSHIP WITH REFERENCE PERSON at RE900). Person is out-of-scope for this study. No information will be collected for this person.
OR
Person is a foster child (RE900 is coded ?36? (FOSTER DAUGHTER) or ?37? (FOSTER SON))
- Note: Person is not related to reference person and does not meet requirements of ?New Student.? Or Split. Person is not eligible, not currently here, and is out of scope for this study. No information will be collected for person in this RU or another RU.
Otherwise
- Keep MoverAt940 empty
Note if [StudentMoverAtLoop20=YES or StudentMoverAtLoop30 =YES] and [OrigRnd=0] and [?99? NOT RELATED FOR RELATIONSHIP WITH REFERENCE PERSON at RE900] (person remains a ?New Student?)
Person remains a ?New Student?. This person is not currently here, but at this point in the interview the student is eligible and in-scope for data collection in a student RU. The RE section will later determine if locating information for this student is necessary. Students are included for some items in RE but not the rest of the interview.
Display Instructions:
Roster 1 - Report
Roster Definition:
This item displays persons for display only. Display the person?s first name, middle, and last names (RE_Person.FullName).
Roster Filter:
Display only persons who are not related to reference person (relationship to reference person coded ?99? (NOT RELATED)) at RE900
And
Persons where RE900 is coded ?36? (Foster Daughter) or ?37? (Foster Son).

BOX_330 (REB1115)

Route Details:

If round 1 and at least one person meets either of the following sets of conditions:
Person is:
-On RE_Person Array where MostRecentRU=RUUnit where CtrlCurrHere_AtBOX330 =YES
and
-Age 17 - 23, inclusive, or in age category 4 at the time of NHIS (PL_Person.AgeRnd)
AND
-An original RU or DU member (that is, on the RU-Members- Roster or the DU-Members- Roster at the start of this round) (OrigRnd=0)
OR person is:
-a 'NEW STUDENT' and an original RU member (that is, on the RU-Members-Roster at the start of this round), [StudentMoverAtLoop20=YES or StudentMoverAtLoop30=YES] and MoverAtRE940=Empty continue with LOOP_80.
Otherwise, go to BOX_350.

LOOP_80 (REB1120)

Route Details:

For each person who meets the loop definition, ask RE950-END_LP80.
Loop definition: LOOP_80 collects information to identify the following types of students:
- Students sampled by NHIS apart from their parents and
- Students who are living ?PERMANENTLY? apart from their parents and who do not receive health care benefits through the current RU
This loop cycles on persons who meet either of the following sets of conditions:
Person is:
- On RE_Person Array where MostRecentRU=RUUnit where CtrlCurrHere_AtBOX330=YES
and
- Age 17 - 23, inclusive, or in age category 4 at the time of NHIS (PL_Person.AgeRnd)
AND
- An original RU or DU member (that is, on the RU-Members- Roster or the DU-Members- Roster at the start of this round) (OrigRnd=0)
OR person is:
- a 'NEW STUDENT' and an original RU member (that is, on the RU-Members-Roster at the start of this round), [StudentMoverAtLoop20=YES or StudentMoverAtLoop30=YES] and MoverAtRE940=Empty

RE950 (REB1125)

BLAISE NAME: NHISAtSch
Context Header:
[PERSON?S FIRST MIDDLE LAST NAME]
Question Text:
At the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW] [were/was] [you/[PERSON]] attending school?

Responses:
YES 1 RE960 (REB1130)
NO 2 END_LP80 (REB1155)
REFUSED RF END_LP80 (REB1155)
DON'T KNOW DK END_LP80 (REB1155)
Display Instructions:
For ?[MONTH, DAY, YEAR OF NHIS INTERVIEW]?display the NHIS interview date (Preload.NHISDt).

RE960 (REB1130)

BLAISE NAME: NHISSchLevel
Context Header:
[PERSON?S FIRST MIDDLE LAST NAME]
Question Text:
[Were/Was] [you/[PERSON]] attending grades 1-12, a college or university, or some other training school after high school?
HELP: F1

Responses:
GRADES 1-12 1 END_LP80 (REB1155)
A COLLEGE OR UNIVERSITY 2
SOME OTHER TRAINING SCHOOL AFTER HIGH SCHOOL 3
REFUSED RF END_LP80 (REB1155)
DON'T KNOW DK END_LP80 (REB1155)
Programmer Instructions:
If coded ?2? (COLLEGE) or ?3? (OTHER TRAINING SCHOOL) AND Person was not coded ?NEVER MARRIED? at NHIS interview (PL_Person.MaritalStatusR?5), go to END_LP80.
If coded ?2? (COLLEGE) or ?3? (OTHER TRAINING SCHOOL) AND Person was coded ?NEVER MARRIED? at NHIS interview (PL_Person.MaritalStatusR=5), continue with RE970.
Display Instructions:

RE970 (REB1135)

BLAISE NAME:NHISParentRU2
Context Header:
[PERSON?S FIRST MIDDLE LAST NAME]
Question Text:
At the time of the National Health Interview Survey on [MONTH, DAY, YEAR OF NHIS INTERVIEW] were either of [your/[PERSON]'s] parents living in this household?

Responses:
YES 1 END_LP80 (REB1155)
NO 2 RE980 (REB1140)
REFUSED RF END_LP80 (REB1155)
DON'T KNOW DK END_LP80 (REB1155)
Display Instructions:
For ?[MONTH, DAY, YEAR OF NHIS INTERVIEW]? display the NHIS interview date (Preload.NHISDt).

RE980 (REB1140)

BLAISE NAME: ParentOutHh
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[Do/Does] [you/[PERSON]] have parents who live somewhere else?

Responses:
YES 1 RE990 (REB1145)
NO 2 END_LP80 (REB1155)
REFUSED RF RE990 (REB1145)
DON'T KNOW DK RE990 (REB1145)
Display Instructions:

RE990 (REB1145)

BLAISE NAME: UsualResOrStu
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
Is this [your/[PERSON]'s] usual year-round place of residence or is this [your/his/her] place of residence only during the school year?
HELP: F1

Responses:
USUAL YEAR-ROUND PLACE OF RESIDENCE 1 END_LP80 (REB1155)
RESIDENCE ONLY DURING SCHOOL YEAR 2 END_LP80 (REB1155)
SOME OTHER ARRANGEMENT 91 RE1000 (REB1150)
REFUSED RF RE1000 (REB1150)
DON'T KNOW DK RE1000 (REB1150)
Programmer Instructions:
Control Variables Impacted: CtrlNewStudent, CtrlPersKey
Display Instructions:

RE1000 (REB1150)

BLAISE NAME: RspbHCare
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
Does someone in this household have primary responsibility for [your/[PERSON]'s] health and health care?

Responses:
YES 1 END_LP80 (REB1155)
NO 2 END_LP80 (REB1155)
REFUSED RF END_LP80 (REB1155)
DON'T KNOW DK END_LP80 (REB1155)
Programmer Instructions:
Control Variables Impacted: CtrlNewStudent, CtrlPersKey
Display Instructions:

END_LP80 (REB1155)

Route Details:

Set RemovedAtLoop80=YES and StudentMoverAtLoop80=NO if:
- If RE990 coded ?2? (RESIDENCE ONLY DURING SCHOOL YEAR)
OR
-If RE1000 coded ?2? (NO), ?RF? (REFUSED), or ?DK? (DON'T KNOW)
Note: Person does not meet the requirements for a ?NEW STUDENT? associated with this RU. Person is not key, not eligible, not currently here, and is out of scope for this study. No information will be collected for person. Clean of all related variables.
Cycle on next person who meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_80 and continue with BOX_340.

BOX_340 (REB1160)

Route Details:

If at least one person with RemovedAtLoop80=YES and StudentMoverAtLoop80=NO,
Continue with RE1010. Otherwise, go to BOX_350.

RE1010 (REB1165)

BLAISE NAME: NoInfoPersB
Question Text:
At this time, we are only collecting information about persons who are usual year-round residents of this household and for whom we can collect health care information. Therefore, the remaining questions will not be asked about (READ NAMES BELOW).
[1. First Name, [Middle Name], Last Name] 1
[2. First Name, [Middle Name], Last Name] 2
[3. First Name, [Middle Name], Last Name] 3
[4. First Name, [Middle Name], Last Name] 4
[5. First Name, [Middle Name], Last Name] N
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 BOX_350 (REB1170)
Programmer Instructions:
Display Instructions:
Roster 1 ? Report Roster definition:
This item displays persons for display only. Display the person?s first, middle, and last names (RE_Person.FullName)
Roster filter:
Display only persons where RemovedAtLoop80=YES and StudentMoverAtLoop80=NO

BOX_350 (REB1170)

Route Details:

(Set CtrlPersKeyatBOX_350 and CtrlPersEligibleatBOX_350 and CtrlCurrHere_AtBOX_350)
Set RemovedAtBOX_350 = YES if CtrlPersEligibleatBOX_350 = NO
Note: People who are not key where there are no other key, eligible persons in this RU are no longer currently here, or eligible for data collection. They are out-of-scope.
If at least one person remains eligible for the survey in the current round ? at least one person where (CtrlPersKeyatBOX_350=YES and CtrlCurrHere_AtBOX350=Yes and
CtrlPersEligibleatBOX_350=YES), go to BOX_360.
Otherwise, continue with RE1020.

RE1020 (REB1180)

BLAISE NAME: EndInterviewStu
Question Text:
INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS 1 AND ENTER TO END THE INTERVIEW.

Responses:
CONTINUE 1
Display Instructions:

RE1030 (REB1190)

BLAISE NAME: HowIntvCompStu
Question Text:
INTERVIEWER: DID YOU COMPLETE THIS INTERVIEW IN-PERSON OR BY TELEPHONE? (YOU MUST HAVE SUPERVISOR APPROVAL PRIOR TO INTERVIEWING BY TELEPHONE.)

Responses:
IN-PERSON 1
TELEPHONE 2
Programmer Instructions:
If at least one person on RE_Person Array where MostRecentRU=RUUnit who is a ?NEW STUDENT? (CtrlNewStudent=Yes), go to RE1170_01.
Else if at least one person on RE_Person Array where MostRecentRU=RUUnit is a mover (MoverAtLoop10=YES, or MoverAtLoop20=YES, or MoverAtLoop_30=YES or MoverAtRE940= YES), go to RE1250.
Otherwise, go to BOX_470.
Display Instructions:

BOX_360 (REB1195)

Route Details:

If Round 1 AND [At least one person meets the following conditions:
-Is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBox350=Yes and CtrlPersEligibleatBOX_350 =Yes) and
- Is older than 16 and younger than 60 years of age or in age categories 4-8 and
- Is not already coded as Full Time Military (CtrlTrackSummAtEnd_LP70?4, 5, or 6) and
- Is not deceased or institutionalized (CtrlTrackSummAtEnd_LP70 ?1 or 2)],
- Continue with RE1040.
If Rounds 2-5 AND
- At least one person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleatBOX_350=Yes) and
- Is older than 16 and younger than 60 years of age or in age categories 4-8 and
- Added to the RU this round, excluding merges [(RE_Person[].PreloadOrd = EMPTY) or (PersAddedBetweenRnds=YES)] AND (RE_Person[].MostRecentRU = RUUnit), and
- Is not deceased or institutionalized (CtrlTrackSummAtEnd_LP70 ?1 or 2)], go to RE1070.
Otherwise, go to BOX_380.

RE1040 (REB1200)

BLAISE NAME: AnyFTADutyR1
Question Text:
[In addition to (READ NAMES BELOW), is/Is] anyone in the family currently serving on active duty in the Armed Forces of the United States?
[1. First Name, [Middle Name], Last Name] 1
[2. First Name, [Middle Name], Last Name] 2
[3. First Name, [Middle Name], Last Name] 3
[4. First Name, [Middle Name], Last Name] 4
[5. First Name, [Middle Name], Last Name] N
HELP: F1

Responses:
YES 1 RE1050 (REB1205)
NO 2 BOX_390 (REB1305)
REFUSED RF BOX_390 (REB1305)
DON'T KNOW DK BOX_390 (REB1305)
Display Instructions:
Roster 1 - Report
Roster definition:
This item displays RU-members-roster for display of RU-members. Display RU member's first, middle, and last names (RE_Person.FullName).
Roster filter:
Display persons who are coded as on full-time active duty in the military (CtrlTrackSummAtEnd_LP70=4, 5, or 6) display
If at least one person on the RU-members-roster is coded as on full-time active duty in the military (CtrlTrackSummAtEnd_LP70=4, 5, or 6) display 'In addition to?' and the screen instructions and roster. Otherwise, display 'Is' and do not display the screen instructions and roster.

RE1050 (REB1205)

BLAISE NAME: FTADutyR1
Question Text:
Who [else] is currently serving on active duty in the Armed Forces?
PROBE: Anyone else?
ENTER ALL THAT APPLY.
HELP: F1

Responses:
[FIRST NAME, [MIDDLE NAME], LAST NAME]1 1 LOOP_90 (REB1210)
[FIRST NAME, [MIDDLE NAME], LAST NAME]2 2 LOOP_90 (REB1210)
[FIRST NAME, [MIDDLE NAME], LAST NAME]3 3 LOOP_90 (REB1210)
[FIRST NAME, [MIDDLE NAME], LAST NAME]4 4 LOOP_90 (REB1210)
[FIRST NAME, [MIDDLE NAME], LAST NAME]N 5 LOOP_90 (REB1210)
Programmer Instructions:
Control Variables Impacted: CtrlTrackSumm.
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 names (RE_Person.FullName)
Roster filter:
Display only those persons who meet the following conditions:
- Is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleatBOX_350=Yes) and
- Is older than 16 and younger than 60 years of age or in age categories 4-8 and
- Is not already coded as Full Time Military (CtrlTrackSummAtEnd_LP70?4, 5, or 6) and
- Is not deceased or institutionalized (CtrlTrackSummAtEnd_LP70 ?1 or 2)], Display ?else? if a roster was displayed at RE1040.
Otherwise, use null display.

LOOP 90 (REB1210)

Route Details:

For each person, ask 1055-END_LP190.
Loop definition: LOOP_90 collects information on when persons (in Round 1) entered full-time active duty in the armed forces. This loop cycles on persons selected at RE1050.

RE1055 (REB1215)

BLAISE NAME: FTADutyBefR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
Did [you/[PERSON]] enter full-time active duty service in the Armed Forces before January 1, [YEAR]?

Responses:
YES 1 END_LP90 (REB1235)
NO 2 RE1060_01 (REB1230)
Programmer Instructions:
DK and RF disallowed.
Display Instructions:
For ?YEAR? display first calendar year of the panel.

RE1060_01 (REB1230)

BLAISE NAME: FTADutyBegMMR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
On what date did [you/[PERSON]] enter full-time active duty service in the Armed Forces?
ENTER MONTH.

Responses:
1 RE1060_02 (REB1231)
Programmer Instructions:
DK and RF disallowed for month.
Display Instructions:
Display RE1060_01, RE1060_02, and RE1060_03 on same form pane.

RE1060_02 (REB1231)

BLAISE NAME: FTADutyBegDDR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[On what date did [you/[PERSON]] enter full-time active duty service in the Armed Forces?]
ENTER DAY.

Responses:
1 RE1060_03 (REB1232)
REFUSED RF RE1060_03 (REB1232)
DON'T KNOW DK RE1060_03 (REB1232)
Display Instructions:
Display RE1060_01, RE1060_02, and RE1060_03 on same form pane.
Display ?On what date?Armed Forces? in lighter ?grayed-out? text.

RE1060_03 (REB1232)

BLAISE NAME: FTADutyBegYYYYR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[On what date did [you/[PERSON]] enter full-time active duty service in the Armed Forces?]
ENTER 4-DIGIT YEAR.

Responses:
1 END_LP90 (REB1235)
Programmer Instructions:
Hard check: Date entered at RE1060_01 through RE1060_03 must be on or after January 1, [YEAR] (where [YEAR] is the first calendar year of the panel) and on or before interview date. If a date entered prior to January 1, [YEAR], display the following message: "IF [PERSON] ENTERED FULL-TIME ACTIVE DUTY SERVICE PRIOR TO JANUARY 1, [YEAR], BACK- UP TO RE1055 (FTADutyBefR1) AND REVIEW ENTRIES."
If a date after the interview date (EndRefDt) is entered, display the following message: "DATE MUST NOT BE AFTER [EndRefDt]. PLEASE ENTER A VALID DATE."
DK and RF disallowed for year.
Display Instructions:
Display RE1060_01, RE1060_02, and RE1060_03 on same form pane.
Display ?On what date?Armed Forces? in lighter ?grayed-out? text.

END_LP90 (REB1235)

Route Details:

Cycle on next person that meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_90 and go to BOX_390.

RE1070 (REB1245)

BLAISE NAME: AnyFTADutyNewNotR1
Question Text:
(Is/Are) (READ NAMES BELOW) currently serving on active duty in the Armed Forces of the United States?
[1. First Name, [Middle Name], Last Name] 1
[2. First Name, [Middle Name], Last Name] 2
[3. First Name, [Middle Name], Last Name] 3
[4. First Name, [Middle Name], Last Name] 4
[5. First Name, [Middle Name], Last Name] N
HELP: F1

Responses:
YES 1 RE1080 (REB1250)
NO 2 BOX_380 (REB1280)
REFUSED RF BOX_380 (REB1280)
DON'T KNOW DK BOX_380 (REB1280)
Programmer Instructions:
Display Instructions:
Roster 1 - Report
Roster definition:
This item displays RU-members-roster for display of RU-members. Display RU member's first, middle, and last names (RE_Person.FullName)
Roster filter:
Display only those persons who meet the following conditions:
-Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleatBOX_350=Yes) and
-Is older than 16 and younger than 60 years of age or in age categories 4-8 and
- Added to the RU this round, excluding merges [(RE_Person[].PreloadOrd = EMPTY) or (PersAddedBetweenRnds=YES)] AND (RE_Person[].MostRecentRU = RUUnit), and
- Is not deceased or institutionalized (CtrlTrackSummAtEnd_LP70 ?1 or 2)].

RE1080 (REB1250)

BLAISE NAME: FTADutyNewNotR1
Question Text:
Who is currently serving on active duty in the Armed Forces?
PROBE: Anyone else?
ENTER ALL THAT APPLY.
HELP: F1

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 LOOP_100 (REB1255)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 LOOP_100 (REB1255)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 LOOP_100 (REB1255)
[FIRST NAME [MIDDLE NAME] LAST 4 NAME]4 4 LOOP_100 (REB1255)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 LOOP_100 (REB1255)
Programmer Instructions:
Control variables impacted: CtrlTrackSumm
Roster behavior:
1. Multiple select allowed.
Display Instructions:
Roster 2 - Report
Roster definition:
This item displays RU-members-roster for display of RU-members. Display RU member's first, middle, and last names (RE_Person.FullName)
Roster filter:
Display only those persons who meet the following conditions:
-Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleatBOX_350=Yes) and
-Is older than 16 and younger than 60 years of age or in age categories 4-8 and
-Added to the RU this round, excluding merges [(RE_Person[].PreloadOrd = EMPTY) or
(PersAddedBetweenRnds=YES)] AND (RE_Person[].MostRecentRU = RUUnit), and
-Is not deceased or institutionalized (CtrlTrackSummAtEnd_LP70 ?1 or 2)],

LOOP_100 (REB1255)

Route Details:

For each person, ask RE1085-END_LP100.
Loop definition: LOOP_100 collects information on when newly added persons (in Rounds 2-5) entered full-time active duty in the armed forces. This loop cycles on persons selected at RE1080.

RE1085 (REB1265)

BLAISE NAME: FTADutyPrevR
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
Did [you/[PERSON]] enter full-time active duty service in the Armed Forces before [DATE OF PREVIOUS ROUND INTERVIEW ]?

Responses:
YES 1 END_LP100 (REB1275)
NO 2 RE1090_01 (REB1270)
Programmer Instructions:
DK and RF disallowed.
Display Instructions:
For ?DATE OF PREVIOUS ROUND INTERVIEW?, display date of previous round MEPS interview (Preload.RUEndM, RUEndD, RUEndY).

RE1090_01 (REB1270)

BLAISE NAME: FTADutyBegNewMMNotR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
On what date did [you/[PERSON]] enter full-time active duty service in the Armed Forces?
ENTER MONTH.

Responses:
1 RE1090_02 (REB1271)
Programmer Instructions:
DK and RF disallowed for month.
Display Instructions:
Display RE1090_01, RE1090_02, and RE1090_03 on same form pane.

RE1090_02 (REB1271)

BLAISE NAME: FTADutyBegNewDDNotR1
Context Header: [PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[On what date did [you/[PERSON]] enter full-time active duty service in the Armed Forces?]
ENTER DAY.

Responses:
1 RE1090_03 (REB1272)
REFUSED RF RE1090_03 (REB1272)
DON'T KNOW DK RE1090_03 (REB1272)
Display Instructions:
Display RE1090_01, RE1090_02, and RE1090_03 on same form pane.
Display ?On what date?Armed Forces? in lighter ?grayed-out? text.

RE1090_03 (REB1272)

BLAISE NAME: FTADutyBegNewYYYYNotR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[On what date did [you/[PERSON]] enter full-time active duty service in the Armed Forces?]
ENTER 4-DIGIT YEAR.

Responses:
1 END_LP100 (REB1275)
Programmer Instructions:
DK and RF disallowed for year.
Hard check:
Edit (for round 5): date must be on or before 12/31/[YEAR], where 'YEAR' is the second calendar year of the panel. If a date after 12/31/[YEAR] is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/[YEAR]. IF PERSON WAS ONLY FULL-TIME MILITARY AFTER 12/31/[YEAR], BACK-UP AND CHANGE RESPONSE TO RE1080 (FTADutyNewNotR1)."
Display Instructions:
Display RE1090_01, RE1090_02, and RE1090_03 on same form pane.
Display ?On what date?Armed Forces? in lighter ?grayed-out? text.

END_LP100 (REB1275)

Route Details:

Cycle on next person that meets the conditions stated in the loop definition. If no more persons meet the stated conditions, end LOOP_100 and continue with BOX_ 380.

BOX_380 (REB1280)

Route Details:

If not Round 1 AND at least one person meets the following conditions:
- [Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and
CtrlPersEligibleatBOX_350=Yes) and
- Is older than 16 and younger than 60 years of age or in age categories 4-8 and
- Is not new to the RU or DU [(RE_Person[].PreloadOrd () EMPTY) AND (PersAddedBetweenRnds=Empty)] AND ( RE_Person[].MostRecentRU = RUUnit) and
- Is not deceased or institutionalized (CtrlTrackSummAtEnd_LP70 ?1 or 2)], go to LOOP_110.
Otherwise, go to BOX_390.

LOOP_110 (REB1285)

Route Details:

For each person, ask RE1100-END_LP110.
Loop definition: LOOP_110 collects information to determine whether in Rounds 2-5, persons included in a prior round interview are currently on full-time active duty in the military and if "YES" when person entered active duty in the armed forces. This loop cycles on persons who meet the following conditions:
- Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleAtBOX_350=Yes) and
- Is older than 16 and younger than 60 years of age or in age categories 4-8 and
- Is not new to the RU or DU [(RE_Person[].PreloadOrd () EMPTY AND PersAddedBetweenRnds=Empty] AND RE_Person[].MostRecentRU = RUUnit) and
-Is not deceased or institutionalized (CtrlTrackSummAtEnd_LP70 ?1 or 2)],

RE1100 (REB1290)

BLAISE NAME: FTADutyNotNewNotR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[[Is/Are]/[Was/Were]] [you/[PERSON]] currently serving on full-time active duty in the Armed Forces of the United States [on December 31, [YEAR]]?
HELP: F1

Responses:
YES 1
NO 2 END_LP110 (REB1300)
REFUSED RF END_LP110 (REB1300)
DON'T KNOW DK END_LP110 (REB1300)
Programmer Instructions:
Control Variables Impacted: CtrlTrackSumm
If coded ?1? (YES) and person had a previous round status of full-time military (PL_Person.FTADuty=YES) go to END_LP110.
Otherwise, continue with RE1110_01.
Display Instructions:
Display ?(Is/Are)? if not round 5. Display ?(Was/Were)? if round 5.
Display ?on December 31, [YEAR], where 'YEAR' is the second calendar year of the panel, if round 5.
Otherwise, use a null display.

RE1110_01 (REB1295)

BLAISE NAME: FTADutyBegNotNewMMNotR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
On what date did [you/[PERSON]] enter full-time active duty service in the Armed Forces?
ENTER MONTH.

Responses:
1 RE1110_02 (REB1296)
Programmer Instructions:
DK and RF disallowed for month.
Display Instructions:
Display RE1110_01, RE1110_02, and RE1110_03 on same form pane.

RE1110_02 (REB1296)

BLAISE NAME: FTADutyBegNotNewDDNotR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[On what date did [you/[PERSON]] enter full-time active duty service in the Armed Forces?]
ENTER DAY.

Responses:
1 RE1110_03 (REB1297)
REFUSED RF RE1110_03 (REB1297)
DON'T KNOW DK RE1110_03 (REB1297)
Display Instructions:
Display RE1110_01, RE1110_02, and RE1110_03 on same form pane.
Display ?On what date?Armed Forces? in lighter ?grayed-out? text.

RE1110_03 (REB1297)

BLAISE NAME: FTADutyBegNotNewYYYYNotR1
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[On what date did [you/[PERSON]] enter full-time active duty service in the Armed Forces?]
ENTER 4-DIGIT YEAR.

Responses:
1 END_LP110 (REB1300)
Programmer Instructions:
DK and RF disallowed for year.
Hard check:
Edit (for round 5): date must be on or before 12/31/[YEAR], where 'YEAR' is the second calendar year of the panel. If a date after 12/31/[YEAR] is entered, display the following message: "DATE MUST BE ON OR BEFORE 12/31/[YEAR]. IF PERSON WAS ONLY FULL-TIME MILITARY AFTER 12/31/[YEAR], BACK-UP AND CHANGE RESPONSE TO RE1100 (FTADutyNotNewNotR1)."
Display Instructions:
Display RE1110_01, RE1110_02, and RE1110_03 on same form pane.
Display ?On what date?Armed Forces? in lighter ?grayed-out? text.

END_LP110 (REB1300)

Route Details:

Cycle on next person that meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_110 and continue with BOX_ 390.

BOX_390 (REB1305)

Route Details:

If at least one person meets all of the following conditions,
If round 1 AND:
- Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleatBOX_350=Yes) and - Is older than 16 years of age or in age categories 4-9 and
- Is not coded as full time active duty (CtrlTrackSumm ?4, 5, 6, or 14)
OR
If round 2-5: AND
- Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_atBOX350 =Yes and CtrlPersEligibleatBOX_350=Yes) and
- Is older than 16 years of age or age in categories 4-9
AND Person in rounds 2-5 meets one of the following sets of conditions:
- Person added to the RU this round [(RE_Person[].PreloadOrd = EMPTY or (PersAddedBetweenRnds=YES)] AND (RE_Person[].MostRecentRU = RUUnit) and
- Is not coded as full time active duty (CtrlTrackSumm ?4, 5, 6, or 14)
OR
- Person not added to the RU or is a merge this round (RE_Person[].PreloadOrd () EMPTY AND RE_Person[].PreloadRU () EMPTY AND RE_Person[].MostRecentRU = RUUnit) and
- full-time activity duty in the previous round (PL_Person.FTADuty=YES) and
- not full-time active duty this round (CtrlTrackSumm ?4, 5, 6, or 14), continue with RE1120.
Otherwise, go to BOX_400.

RE1120 (REB1310)

BLAISE NAME: HonDischADuty
Question Text:
[Have/Has] (READ NAMES BELOW) ever been honorably discharged from active duty in the U.S. Army, Navy, Air Force,
Marine Corps or Coast Guard?
[1. First Name, [Middle Name], Last Name] 1
[2. First Name, [Middle Name], Last Name] 2
[3. First Name, [Middle Name], Last Name] 3
[4. First Name, [Middle Name], Last Name] 4
[5. First Name, [Middle Name], Last Name] N
HELP: F1

Responses:
YES 1 RE1130 (REB1315)
NO 2 BOX_400 (REB1320)
REFUSED RF BOX_400 (REB1320)
DON'T KNOW DK BOX_400 (REB1320)
Display Instructions:
Display "Has" when only one name listed; Display "Have" when more than one name listed.
Roster 1 - Report
Roster definition:
This item displays the RU-members-roster for display of RU- members. Display RU member's first, middle, and last names (RE_Person.FullName)
Roster filter:
This item displays all persons who meet all of the following conditions:
If round 1 AND:
- Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleatBOX_350=Yes) and
- Is older than 16 years of age or in age categories 4-9 and
- Is not coded as full time active duty (CtrlTrackSumm ?4, 5, 6, or 14)
OR
If round 2-5: AND
- Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleAtBOX350=Yes)
AND
- Is older than 16 years of age or age in categories 4-9 AND Person in rounds 2-5 meets one of the following sets of conditions:
- Person added to the RU this round [(RE_Person[].PreloadOrd = EMPTY) or (PersAddedBetweenRnds=YES)] AND (RE_Person[].MostRecentRU = RUUnit) and
- Is not coded as full time active duty (CtrlTrackSumm ?4, 5, 6, or 14)
OR
- Person not added to the RU or is a merge (RE_Person[].PreloadOrd () EMPTY AND RE_Person[].PreloadRU () EMPTY AND RE_Person[].MostRecentRU = RUUnit) and
- Was full-time activity duty in the previous round (PL_Person.FTADuty=YES) and
- Is not full-time active duty this round (CtrlTrackSumm ?4, 5, 6, or 14)

RE1130 (REB1315)

BLAISE NAME: HonDischWho
Question Text:
Who was this?
PROBE: Anyone else?
ENTER ALL THAT APPLY.

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 BOX_400 (REB1320)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 BOX_400 (REB1320)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 BOX_400 (REB1320)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 BOX_400 (REB1320)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 BOX_400 (REB1320)
Programmer Instructions:
Roster behavior:
1. Multiple select allowed.
Display Instructions:
Roster 2 - no add/edit/delete
Roster definition:
This item displays the RU-Members-Roster for display of RU-members. Display RU member's first, middle, and last names (RE_Person.FullName)
Roster filter:
This item displays all persons who meet all of the following conditions:
If round 1 AND:
- Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleatBOX350=Yes) and
- Is older than 16 years of age or in age categories 4-9 and
- Is not coded as full time active duty (CtrlTrackSumm ?4, 5, 6, or 14)
OR
If round 2-5: AND
- Person is on the RE_Person Array where MostRecentRU=RUUnit and eligible to be interviewed as part of this RU (CtrlCurrHere_AtBOX350 =Yes and CtrlPersEligibleatBOX_350=Yes) and
- Is older than 16 years of age or age in categories 4-9 AND Person in rounds 2-5 meets one of the following sets of conditions:
-Person added to the RU this round [(RE_Person[].PreloadOrd = EMPTY) or (PersAddedBetweenRnds=YES)] AND (RE_Person[].MostRecentRU = RUUnit) and
- Is not coded as full time active duty (CtrlTrackSumm ?4, 5, 6, or 14)
OR
- Person not added to the RU or is a merge (RE_Person[].PreloadOrd () EMPTY AND RE_Person[].PreloadRU () EMPTY AND RE_Person[].MostRecentRU = RUUnit) and
- Was full-time activity duty in the previous round (PL_Person.FTADuty=YES) and
- Is not full-time active duty this round (CtrlTrackSumm ?4, 5, 6, or 14)

BOX_400 (REB1320)

Route Details:

Control Variables Impacted: CtrlPersEligible, CtrlCurrHere, EndRefM, EndRefD, EndRefY
If any person meets all the following conditions, then set RemovedAtBOX_400=YES.
CtrlTrackSumm = 14 (FT MILITARY, LIVING IN RU)
AND
The date the person joined the military is prior to the reference period start date. That is, RE1055 or RE1085 is coded ?1? (YES) OR Date at RE1060, RE1090, or RE1110 is prior to 1/1/YEAR where YEAR is the first calendar year of the panel (FirstPanYear) OR Date at RE1060, RE1090, or RE1110 is prior to date of previous RU interview (RUEndM, RUEndD, RUEndY)] OR PL_Person.FTADuty=YES
AND
No other PERSON on RE_Person Array where MostRecentRU=RUUnit has CtrlPersKey = YES and CtrlPersEligibleatBOX350=YES and CtrlCurrHere = YES.
Note: This person is FT military but joined the military prior to the reference period start date and there are no other key RU members. This person is not currently here, out-of-scope, and ineligible for data collection as part of this RU or any other RU. Person will not be followed.
If any person meets all the following conditions, then set RemovedAtBOX_400=YES.
Person is full time military, living in the RU (CtrlTrackSumm = 14) AND
Person is not key (CtrlPersKey=NO) AND
There isn?t another PERSON on RE_Person Array where MostRecentRU=RUUnit who is key and not full time military and eligible for this interview (No one where CtrlPersKey=YES and CtrlCurrHere =YES and CtrlPersEligibleatBox350=YES and CtrlTrackSumm?4, 5, 6 or 14)
Note: This person is FT military and not key and there are no other key, civilian RU members. This person is not currently here, out-of-scope, and ineligible for data collection as part of this RU or any other RU. Person will not be followed.
If all persons on RE_Person Array where MostRecentRU=RUUnit where RemovedAtBOX_ 400=empty, go to RE1170_01.
If at least one person on RE_Person Array where MostRecentRU=RUUnit where RemovedAtBOX_400=YES and at least one person where CtrlPersKey=YES and CtrlCurrHere=YES and CtrlPersEligible=YES, go to RE1160.
Otherwise, continue with RE1140.

RE1140 (REB1325)

BLAISE NAME: EndInterviewFTADuty
Question Text:
INTERVIEWER: THERE ARE NO ELIGIBLE INDIVIDUALS REMAINING IN THIS RU. PLEASE REPORT THIS SITUATION TO YOUR SUPERVISOR.
PRESS 1 AND ENTER TO END THE INTERVIEW.

Responses:
CONTINUE 1 RE1150 (REB1330)
Display Instructions:

RE1150 (REB1330)

BLAISE NAME: IntvwPersPhone
Question Text:
INTERVIEWER: DID YOU COMPLETE THIS INTERVIEW IN-PERSON OR BY TELEPHONE? (YOU MUST HAVE SUPERVISOR APPROVAL PRIOR TO INTERVIEWING BY TELEPHONE.)

Responses:
IN-PERSON 1
TELEPHONE 2
Programmer Instructions:
If at least one person who is key, eligible, and here on RE_Person Array where MostRecentRU=RUUnit where CtrlPersKey=YES, CtrlCurrHere=Yes, and CtrlPersEligible=YES, go to RE1170_01.
Otherwise, go to BOX_450.
Display Instructions:

RE1160 (REB1345)

BLAISE NAME: NoInfoPersC
Question Text:
At this time, we are collecting information only about some of the people in this family. Therefore, we will not collect any additional information about (READ NAMES BELOW).
[1. First Name, [Middle Name], Last Name] 1
[2. First Name, [Middle Name], Last Name] 2
[3. First Name, [Middle Name], Last Name] 3
[4. First Name, [Middle Name], Last Name] 4
[5. First Name, [Middle Name], Last Name] N
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 RE1170_01 (REB1355)
Programmer Instructions:
Display Instructions:
Roster 1 - Report
Roster definition:
This item displays persons for display only. Display the person?s first, middle, and last names (RE_Person.FullName)
Roster filter:
Display persons who are Full-time military living in the RU without any other key civilians (RemovedAtBOX_400=YES) .

RE1170_01 (REB1355)

BLAISE NAME: MaritalStatRnd
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[[Are/Is] [you/[PERSON]] now/As of December 31, [YEAR], [were/was] [you/[PERSON]]] married, widowed, divorced, separated, or never married?
IF RESPONDENT SAYS 'SINGLE', PROBE: [[Are/Is] / [Were/Was]] [you/he/she] married, widowed, divorced, separated, or never married?
[PREVIOUS ROUND MARITAL STATUS: [DISPLAY PREVIOUS ROUND SELECTION]]
NAVIGATION: Complete the grid in order of respondent's answers.
HELP: F1

Responses:
MARRIED 1
WIDOWED 2
DIVORCED 3
SEPARATED 4
NEVER MARRIED 5
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Preloaded Grid Type 2 including question RE1170_01, RE1170_02, RE1170_03, RE1170_04, RE1170_05, RE1170_06, RE1170_07, RE1170_08, RE1170_09, RE1170_10, RE1170_11, RE1170_12, and BOX_405.
Display RE1170_01 as an active cell for RU member, if RU member is age 16 or older or in age categories 4-9 and RE90=EMPTY. Otherwise, RE1170_01 is an inactive cell for RU member.
Display Instructions:
Roster 1 - Report
Roster definition:
This item displays persons for entry of marital status, ethnicity, race, spoken language, and residency in the U.S. in the form pane.
Format form pane in columns with headers: RU Member, Marital Status, Ever Married, Hispanic Origin, Ethnicity, Race, Race Other Specify, Spoken Language, Other Language, Fluency, Born in U.S., Year Came to U.S., and Length in U.S. For RU Member: display RU member's first, middle, and last names (RE_Person.FullName)
Roster filter for RE1170_01 ? RE1170_12:
Display person on the RE_Person Array where MostRecentRU=RUUnit who meet the following conditions:
-CtrlCurrHere=YES OR
-CtrlNewStudent=YES
Display '[Are/Is] [you/[PERSON]] now' AND '[Are/ Is]' if not round 5. Display 'As of December 31,[YEAR], [were/was] [you/[PERSON]]' and '[Were/Was]', where 'YEAR' is the second calendar year of the panel, if round 5.
Display ?[PREVIOUS ROUND MARITAL STATUS: [DISPLAY PREVIOUS ROUND SELECTION]]?, where [DISPLAY PREVIOUS ROUND SELECTION] is filled with the RU members marital status from the previous round (PL_Person.MaritalStatusR), if round 2-5. Otherwise use a null display.
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_02 (REB1360)

BLAISE NAME: PastMarriage
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
I have recorded that [you/[PERSON]] [are/is] not married now. [Were/Was] [you/[PERSON]] ever married in the past?
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Leave marital status for this round the same as it was in the previous round, if ?1? (YES), 'RF' (REFUSED), or 'DK' (DON'T KNOW) selected.
Note: During MHOP, if RE1170_02 is coded ?2? (NO), set Person.MaritalStatusR to ?5? (NEVER MARRIED).
Display RE1170_02 as an active cell for RU member, if rounds 2-5 and RU members marital status changes from a code '1' (MARRIED), '2' (WIDOWED), '3' (DIVORCED), or '4' (SEPARATED) at RE1170_01 in the previous round to a code ?5? (NEVER MARRIED) at RE1170_01 for the current round. Otherwise, RE1170_02 is an inactive cell for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_03 (REB1370)

BLAISE NAME: PersHispLat
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
And RE-1;
Looking at show card RE-1, [are/is] [you/[PERSON]] Hispanic, Latino, or of Spanish origin?
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Display RE1170_03 as an active cell for person if ethnicity is missing (AskSpanEthnicity=Yes or Empty), Otherwise, RE1170_03 is an inactive cell for person.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_04 (REB1375)

BLAISE NAME: CodeAllHispLat
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
And RE-1;
Please look at this card RE-1 and tell me which group or groups best describes [your/[PERSON]'s] ethnic background.
ENTER ALL THAT APPLY.
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
MEXICAN 1
MEXICAN-AMERICAN/CHICANO 2
PUERTO RICAN 3
CUBAN/CUBAN AMERICAN 4
DOMINICAN 5
CENTRAL OR SOUTH AMERICAN 6
OTHER LATIN AMERICAN 7
OTHER HISPANIC, LATINO, OR SPANISH ORIGIN 8
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
For specifications purposes only: CAPI does not allow 'RF' (REFUSED) or 'DK' (DON'T KNOW) in combination with any other code.
Display RE1170_04 as an active cell for RU member, if RE1170_03 coded ?1? (YES).
Otherwise, RE1170_04 is an inactive cell for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_05 (REB1425)

BLAISE NAME: CodeAllRace
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
And RE-2;
For this survey, Hispanic origins are not races.
What is [your/[PERSON]'s] race? Please select one or more of the categories on card RE-2.
ENTER ALL THAT APPLY.
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
WHITE 1
BLACK OR AFRICAN AMERICAN 2
AMERICAN INDIAN OR ALASKA NATIVE 3
ASIAN INDIAN 4
CHINESE 5
FILIPINO 6
JAPANESE 7
KOREAN 8
VIETNAMESE 9
OTHER ASIAN 10
NATIVE HAWAIIAN 11
GUAMANIAN OR CHAMORRO 12
SAMOAN 13
OTHER PACIFIC ISLANDER 14
OTHER: SPECIFY 91
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
For specifications purposes only (CAPI handles automatically): 'RF' (REFUSED) and 'DK' (DON'T KNOW) not allowed in combination with any other codes.
Display RE1170_05 as an active cell for person if race is missing(AskRace=Yes or Empty). . Otherwise, RE1170_05 is an inactive cell for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_06 (REB1430)

BLAISE NAME: OthRaceOS
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
SPECIFY: OTHER RACE
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
1
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Display RE1170_06 as an active cell for RU member, if RE1170_05 is coded '91' (OTHER: SPECIFY) alone or in combination with other codes. Otherwise, RE1170_06 is inactive cell for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_07 (REB1460)

BLAISE NAME: LangNotEng
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[Do/Does] [you/[PERSON]] speak a language other than English at home?
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Display RE1170_07 as an active cell for persons who is 5 years of age or older or in age categories 3-9 and is not deceased or institutionalized (CtrlTrackSumm?1 or 2) and if [(Round 1) or [(Rounds 2-5) and [(RE_Person[].PreloadOrd = EMPTY) or (PersAddedBetweenRnds = YES)] AND (RE_Person[].MostRecentRU = RUUnit)]] Otherwise, RE1170_07 is an inactive cell for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_08 (REB1465)

BLAISE NAME: OthLang
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
What is this language?
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
SPANISH 1
ANOTHER LANGUAGE 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Display RE1170_08 as an active cell for RU member, if RE1170_07 is coded = ?1? (YES).
Otherwise, RE1170_08 is an inactive cell for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_09 (REB1480)

BLAISE NAME: EngCompLevel
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
How well [do/does] [you/[PERSON]] speak English?
Would you say very well, well, not well, or not at all?
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
VERY WELL 1
WELL 2
NOT WELL 3
NOT AT ALL 4
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Display RE1170_09 as an active cell for RU member, if RE1170_07 is coded = '1' (YES).
Otherwise, RE1170_09 is an inactive cell for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_10 (REB1500)

BLAISE NAME: BornInUS
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[Were/Was] [you/[PERSON]] born in the United States?
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
YES 1
NO 2
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Display RE1170_10 as an active cell for persons who is 5 years of age or older or in age categories 3-9 and is not deceased or institutionalized (CtrlTrackSumm?1 or 2) and if [(Round 1) or [(Rounds 2-5) and [(RE_Person[].PreloadOrd = EMPTY) or (PersAddedBetweenRnds = YES)] AND (RE_Person[].MostRecentRU = RUUnit)]]
Otherwise, RE1170_10 is an inactive cell for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_11 (REB1505)

BLAISE NAME: YearEnterUS
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
In what year did [you/[PERSON]] come to the United States to stay?
IF NEEDED SAY:
Please give me only the most recent year that [you/[PERSON]] came to the United States to stay.
ENTER 4-DIGIT YEAR.
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
1
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Hard edit:
Edit: If rounds 1-4, the year entered must be less than or equal to the current year and must be greater than or equal to the person?s birth year, if known. If round 5, year must be less than or equal to the second calendar year of the panel and must be greater than or equal to the person's birth year, if known. If year entered is greater than the current year or the second calendar year of the panel (if round 5), display the following message:"YEAR CANNOT BE AFTER [YEAR].VERIFY AND RE-ENTER." For ?YEAR? in the message, display the current year if Rounds 1-4. Display SecondPanYear if Round 5. If year entered is less than person?s year of birth, display the following message: "YEAR CANNOT BE BEFORE PERSON?S YEAR OF BIRTH. VERIFY AND RE-ENTER."
Display RE1170_11 as an active cell for RU members if RE1170_10 is coded = ?2? (NO).
Otherwise the RE1170_11 cell is inactive for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

RE1170_12 (REB1510)

BLAISE NAME: HowLongUS
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
About how long [have/has] [you/[PERSON]] lived in United States?
IF LESS THAN 1 YEAR, CODE 0.
ENTER YEARS.
NAVIGATION: Complete the grid in order of respondent's answers.

Responses:
1
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Hard range: 0-120
Range check: Number of years entered must be less than or equal to person?s age. If person?s age is represented by an age category, the number of years must be less than or equal to the top age limit for that category. If number of years entered is greater than person?s age, display the following message: "PERSON IS [XXX] YEARS OLD. NUMBER OF YEARS LIVING IN THE U.S. CANNOT BE MORE THAN PERSON?S AGE. VERIFY AND RE-ENTER."
Display RE1170_12 as an active cell for RU member, if RE1170_11 is coded DK = (DON?T KNOW). Otherwise RE1170_12 is an inactive cell for RU member.
Display Instructions:
Display the interviewer instruction ?NAVIGATION: Complete the grid in order of respondent's answers.? In red text.

BOX_405 (REB1515)

Route Details:

Go to LOOP_120.
Programmer Instructions:
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 less thanOKgreater than TO GO TO THE FIRST UNANSWERED QUESTION: [Question Tag] FOR [PERSON?S FIRST, MIDDLE AND LAST NAME]?. 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.

LOOP_120 (REB1520)

Route Details:

For each element in the RU-Members-Roster and all persons flagged as ?NEW STUDENTS?, ask BOX_410-END_LP120.
Loop definition: LOOP_120 collects information on education level of all persons on the RE_Person Array where MostRecentRU=RUUnit who meet either of the following conditions:
-CtrlCurrHere=YES OR
-CtrlNewStudent=YES

BOX_410 (REB1525)

Route Details:

If person's age less than= 4 years or in age categories 1-2, autocode RE1180 as '0' (NEVER ATTENDED SCHOOL/KINDERGARTEN ONLY), then go to END_LP120.
If round 1, continue with RE1180.
-If Rounds 2-5 and [(RE_Person[].PreloadOrd = EMPTY) or (PersAddedBetweenRnds = YES)] AND (RE_Person[].MostRecentRU = RUUnit), continue with RE1180.
Otherwise, go to END_LP120.

RE1180 (REB1535)

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

Responses:
NEVER ATTENDED SCHOOL/KINDERGARTEN ONLY 0
FIRST GRADE 1
SECOND GRADE 2
THIRD GRADE 3
FOURTH GRADE 4
FIFTH GRADE 5
SIXTH GRADE 6
SEVENTH GRADE 7
EIGHTH GRADE 8
NINTH GRADE 9
TENTH GRADE 10
ELEVENTH GRADE 11
TWELFTH GRADE (HIGH SCHOOL DIPLOMA) 12
FIRST YEAR 13
SECOND YEAR 14
THIRD YEAR 15
FOURTH YEAR (BACHELOR'S DEGREE) 16
FIVE OR MORE YEARS (GRADUATE DEGREE) 17
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
If coded '0' (NEVER ATTENDED SCHOOL/KINDERGARTEN ONLY) through '12' (TWELFTH GRADE (HIGH SCHOOL DIPLOMA)) and person = or greater than 16 or in age categories 4-9, continue with RE1190.
If coded '13' through '17' (college level), 'RF' (REFUSED), or 'DK' (DON'T KNOW), go to RE1200.
Otherwise, go to END_LP120.
Soft check: if coded '16' (FOURTH YEAR (BACHELOR'S DEGREE)) or '17' (FIVE OR MORE YEARS (GRADUATE DEGREE)) and person is less than = 18 years of age (or in age categories 1-3), display the following message: "UNLIKELY RESPONSE DUE TO AGE. VERIFY AND RE-ENTER."
Display Instructions:
Underline ?highest?, ?regular?, and ?completed? in the question text.
Display ?What? if not round 5. Display ?As of December 31, [YEAR], what? if round 5, where 'year' is the second calendar year of the panel.
In addition:
Display the header "KINDERGARTEN OR LESS:" directly above answer text 'NEVER ATTENDED SCHOOL/KINDERGARTEN ONLY'.
Display the header "ELEMENTARY:" directly above answer text 'FIRST GRADE'. Indent each answer text a few spaces under this header.
Display the header "HIGH SCHOOL:" directly above answer text 'NINTH GRADE'. Indent each answer text a few spaces under this header.
Display the header "COLLEGE:" directly above answer text 'FIRST YEAR'. Indent each answer text a few spaces under this header.

RE1190 (REB1540)

BLAISE NAME: HghSchDiploma
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
[[Do/Does/Did]/As of December 31, [YEAR] did] [you/[PERSON]] have a high school diploma or [have/has/had] [you/[PERSON]] passed the GED equivalency test?
HELP: F1

Responses:
HAVE HIGH SCHOOL DIPLOMA 1 END_LP120 (REB1550)
PASSED GED 2 END_LP120 (REB1550)
NEITHER HIGH SCHOOL DIPLOMA OR GED 3 END_LP120 (REB1550)
REFUSED RF END_LP120 (REB1550)
DON'T KNOW DK END_LP120 (REB1550)
Display Instructions:
Display '[Do/Does/Did]' if not round 5. If round 5, display 'As of December 31, [YEAR], did', where 'YEAR' is the second calendar year of the panel.
Display ?Do? if person is respondent and if round 1-4. Display ?Does? if person is not respondent and living and if Round 1-4. Display ?Did? if person is deceased and if round 1-4.
Display 'have' if person is respondent and if Round 1-4. Display 'has' if person is not respondent and living and if Round 1-4. Otherwise, display 'had'.

RE1200 (REB1545)

BLAISE NAME: HghestEduLevel
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
What is the highest educational degree [you/[PERSON]] obtained [as of December 31, [YEAR]]?
HELP: F1

Responses:
BACHELOR'S DEGREE 1 END_LP120 (REB1550)
MASTER'S DEGREE 2 END_LP120 (REB1550)
DOCTORATE DEGREE 3 END_LP120 (REB1550)
NO DEGREE 4 END_LP120 (REB1550)
OTHER 91 END_LP120 (REB1550)
REFUSED RF END_LP120 (REB1550)
DON'T KNOW DK END_LP120 (REB1550)
Display Instructions:
Display ?as of December 31, [YEAR]? if round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display.

END_LP120 (REB1550)

Route Details:

Cycle on next person who meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_120 and continue with BOX_ 420.

BOX_420 (REB1555)

Route Details:

If RU type=StandardRU or NewStandardRU AND
If at least one person on RE_Person Array where [MostRecentRU=RUUnit where CtrlCurrHere=YES and CtrlPersEligible=YES] and that person meets either of the following conditions:
- Age 17-23, inclusive or in age category 4, or
- Coded as LIVING AWAY AT SCHOOL IN GRADES 1-12 (RE250=3, RE360=1, or RE580=1), continue with RE1210.
Otherwise, go to BOX_430.

RE1210 (REB1575)

BLAISE NAME: AttendSch
Question Text:
[[Earlier you mentioned [you/[PERSON]] [were/was] living away at school in grades 1-12.]] [[Are/Is]/As of December 31,
[YEAR], [were/was]] [you/[PERSON]] attending school full-time, part-time, or not attending school at all?
HELP: F1

Responses:
FULL-TIME 1
PART-TIME 2
NOT IN SCHOOL 3
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
Preloaded Grid Type 1 including question RE1210.
Continue with BOX_430 once grid is complete.
Roster behavior:
Display persons who are age 17-23 inclusive or in age category 4 first on the roster.
Then display persons coded as living away at school grades 1-12.
Roster filter:
Display all persons on [(RE_Person Array where MostRecentRU=RUUnit where
CtrlCurrHere=YES and CtrlPersElgible=YES) and (that person meets one of the following conditions)]:
- Age 17-23, inclusive or in age category 4, or
- Coded as LIVING AWAY AT SCHOOL IN GRADES 1-12 (RE250=3, RE360=1, or RE580=1)
Display Instructions:
Roster 1 - Report
Roster definition:
Display the RU-members-roster for entry of school status.
Col #1 Header: Name
Instructions: Display RU Members? first, middle, and last names (RE_Person.FullName)
Col #2 header: School Status
Roster filter:
Display all persons who meet one of the following conditions:
- Age 17-23, inclusive or in age category 4, or
- Coded as LIVING AWAY AT SCHOOL IN GRADES 1-12 (RE250=3, RE360=1, or RE580=1),
Display '[Earlier you mentioned [you/[PERSON]] [were/was] living away at school in grades
1-12.]' if person being asked about is coded as living away at school in grades 1-12 (RE250=3, RE360=1, or RE580=1),. Otherwise, use null display.
Display '[Are/Is]' if not round 5. Display 'As of December 31, [YEAR], [were/was]', where 'YEAR' is the second calendar year of the panel, if round 5.

BOX_430 (REB1580)

Route Details:

Evaluate the keyness and eligibility of all persons on RE_Person Array where MostRecentRU=RUUnit. (See CtrlPersKey and CtrlPersEligible) and calculate reference periods.
Continue with RE1220.

RE1220 (REB1585)

Responses:
CONTINUE 1 BOX_440 (REB1600)
Display Instructions:
Roster 1 - Report
Roster definition:
Col # 1 Header: RU MEMBER
Instructions: display RU members? First, Middle, and Last names (RE_Person.FullName)
Col # 2 Header: KEYNESS
Instructions: display the RU member's keyness. Display ?KEY? if CtrlPersKey=YES; display ?NOT
KEY? if CtrlPersKey=NO.
Col # 3 Header: REFERENCE PERIOD
Instructions: Display RU member?s reference period begin and end dates displayed as ?Month-3, DD, Year-4? (RE_Person.BegRefM, RE_Person.BegRefD, RE_Person.BegRefY, RE_Person.EndRefM, RE_Person.EndRefD, RE_Person.EndRefY).
Roster filter:
Display all persons on RE_Person Array where MostRecentRU=RUUnit where CtrlCurrHere=YES and CtrlPersEligible=YES.
For 'FULL NAME OF REFERENCE PERSON' display the current round reference person's full name (first, middle, and last name) (RefPersPID). Do NOT substitute ?you? if for reference person?s name.

BOX_440 (REB1600)

Route Details:

If at least one person on RE_Person Array where MostRecentRU=RUUnit is a 'NEW STUDENT' (CtrlNewStudent=YES), continue with RE1230.
Otherwise, go to BOX_450.

RE1230 (REB1605)

BLAISE NAME: StudSplit
Question Text:
We may conduct a separate interview with (READ NAMES BELOW) so I will not ask any further questions about them today.
[1. First Name, [Middle Name], Last Name] 1
[2. First Name, [Middle Name], Last Name] 2
[3. First Name, [Middle Name], Last Name] 3
[4. First Name, [Middle Name], Last Name] 4
[5. First Name, [Middle Name], Last Name] N
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 LOOP_130 (REB1610)
Display Instructions:
Roster 1 - Report Roster definition:
This item displays persons for display only. Display person?s first, middle, and last names (RE_Person.FullName)
Roster filter:
Display all persons on RE_Person Array where MostRecentRU=RUUnit is a 'NEW STUDENT' (CtrlNewStudent=YES)

LOOP_130 (REB1610)

Route Details:

For each person meeting the loop definition, ask RE1240_01-END_LP130.
Loop definition: LOOP_130 collects locating address and phone number for each student RU. This loop cycles on persons who on RE_Person Array where MostRecentRU=RUUnit is a 'NEW STUDENT' (CtrlNewStudent=YES)

RE1240_01 (REB1615)

BLAISE NAME: StuStrt1
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
Please give me the address and telephone number where [PERSON] can be reached at school.
What is the address?
ENTER STREET ADDRESS.

Responses:
1 RE1240_02 (REB1616)
REFUSED RF RE1240_02 (REB1616)
DON'T KNOW DK RE1240_02 (REB1616)
Display Instructions:
Display RE1240_01, RE1240_02, RE1240_03, RE1240_04, RE1240_05, and RE1240_06 on the same form pane.

RE1240_02 (REB1616)

BLAISE NAME: StuStrt2
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] can be reached at school.]
ENTER BUILDING OR ADDITIONAL ADDRESS INFORMATION, AS NECESSARY. IF NONE, PRESS ENTER.

Responses:
1 RE1240_03 (REB1617)
EMPTY Empty RE1240_03 (REB1617)
REFUSED RF RE1240_03 (REB1617)
DON'T KNOW DK RE1240_03 (REB1617)
Programmer Instructions:
Allow empty as final response.
Display Instructions:
Display RE1240_01, RE1240_02, RE1240_03, RE1240_04, RE1240_05, and RE1240_06 on the same form pane.
Display question text ?Please give me?school? in brackets and ?grayed-out? text.

RE1240_03 (REB1617)

BLAISE NAME: StuCity
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] can be reached at school.]
ENTER CITY.

Responses:
1 RE1240_04 (REB1618)
REFUSED RF RE1240_04 (REB1618)
DON'T KNOW DK RE1240_04 (REB1618)
Display Instructions:
Display RE1240_01, RE1240_02, RE1240_03, RE1240_04, RE1240_05, and RE1240_06 on the same form pane.
Display question text ?Please give me?school? in brackets and ?grayed-out? text.

RE1240_04 (REB1618)

BLAISE NAME: StuSt
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] can be reached at school.]
ENTER STATE.
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND PRESS ENTER TO SELECT.

Responses:
1 RE1240_05 (REB1619)
REFUSED RF RE1240_05 (REB1619)
DON'T KNOW DK RE1240_05 (REB1619)
Programmer Instructions:
Use state lookup file.
Display Instructions:
Display RE1240_01, RE1240_02, RE1240_03, RE1240_04, RE1240_05, and RE1240_06 on the same form pane.
Display question text ?Please give me?school? in brackets and ?grayed-out? text.

RE1240_05 (REB1619)

BLAISE NAME: StuZip
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] can be reached at school.]
ENTER ZIP CODE.

Responses:
1 RE1240_06 (REB1620)
REFUSED RF RE1240_06 (REB1620)
DON'T KNOW DK RE1240_06 (REB1620)
Programmer Instructions:
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 Instructions:
Display RE1240_01, RE1240_02, RE1240_03, RE1240_04, RE1240_05, and RE1240_06 on the same form pane.
Display question text ?Please give me?school? in brackets and ?grayed-out? text.

RE1240_06 (REB1620)

BLAISE NAME: StuPhone
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] can be reached at school.]
ENTER TELEPHONE NUMBER. IF NO TELEPHONE, ENTER DK.

Responses:
1 END_LP130 (REB1621)
REFUSED RF END_LP130 (REB1621)
DON'T KNOW DK END_LP130 (REB1621)
Programmer Instructions:
10 digit entry required.
Use number input mask (xxx-xxx-xxxx) in the response field.
Hard check:
"PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR
ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."
Display Instructions:
Display RE1240_01, RE1240_02, RE1240_03, RE1240_04, RE1240_05, and RE1240_06 on the same form pane.
Display question text ?Please give me?school? in brackets and ?grayed-out? text.

END_LP130 (REB1621)

Route Details:

Cycle on the next person who meets the conditions stated in the loop definition.
If no more persons meet the stated conditions, end LOOP_130 and continue with BOX_

BOX_450 (REB1625)

Route Details:

If at least one person who is a mover on RE_Person Array where MostRecentRU=RUUnit who meets any of the following conditions: :
-MoverAtLoop10=YES
-MoverAtLoop20=YES
-MoverAtLoop30=YES
-MoverAtRE940=YES
continue with RE1250. Otherwise, go to BOX_470.

RE1250 (REB1630)

BLAISE NAME: FTADutySplit
Question Text:
We may (also) conduct a separate interview with (READ NAMES BELOW) so I will not ask any further questions about them today.
[1. First Name, [Middle Name], Last Name] 1
[2. First Name, [Middle Name], Last Name] 2
[3. First Name, [Middle Name], Last Name] 3
[4. First Name, [Middle Name], Last Name] 4
[5. First Name, [Middle Name], Last Name] N
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 LOOP_140 (REB1635)
Display Instructions:
Roster 1 - Report Roster definition:
This item displays persons for display only. Display person?s first, middle, and last name (RE_Person.Fullname).
Roster filter:
Display all persons who are movers on RE_Person Array where MostRecentRU=RUUnit who meets any of the following conditions: :
-MoverAtLoop10=YES
-MoverAtLoop20=YES
-MoverAtLoop30=YES
-MoverAtRE940=YES

LOOP_140 (REB1635)

Route Details:

For each person who meets the conditions stated in the loop definition, ask RE1260_01- END_LP140.
Loop definition: LOOP_140 collects locating information for each person who has left the RU and moved to another household in the U.S. This loop cycles on persons who meet both of the following conditions:
Person has not been processed as part of another iteration of Loop_140, meaning, Loop_140 has not been called for this Person AND Person was not selected at RE1280 during another iteration of Loop_140
AND
Person is on RE_Person Array where MostRecentRU=RUUnit who meets any of the
following conditions: :
-MoverAtLoop10=YES
-MoverAtLoop20=YES
-MoverAtLoop30=YES
-MoverAtRE940=YES

RE1260_01 (REB1640)

BLAISE NAME: MoveStrt1
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
Please give me the address and telephone number where [PERSON] has moved.
What is the address?
ENTER STREET ADDRESS.

Responses:
1 RE1260_02 (REB1641)
REFUSED RF RE1260_02 (REB1641)
DON'T KNOW DK RE1260_02 (REB1641)
Display Instructions:
Display RE1260_01, RE1260_02, RE1260_03, RE1260_04, RE1260_05, and RE1260_06 on the same form pane.

RE1260_02 (REB1641)

BLAISE NAME: MoveStrt2
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] has moved.]
ENTER BUILDING OR ADDITIONAL ADDRESS INFORMATION, AS NECESSARY. IF NONE, PRESS ENTER.

Responses:
1 RE1260_03 (REB1642)
EMPTY Empty RE1260_03 (REB1642)
REFUSED RF RE1260_03 (REB1642)
DON'T KNOW DK RE1260_03 (REB1642)
Programmer Instructions:
Allow empty.
Display Instructions:
Display RE1260_01, RE1260_02, RE1260_03, RE1260_04, RE1260_05, and RE1260_06 on the same form pane.
Display question text ?Please give me?moved? in brackets and ?grayed out? text.

RE1260_03 (REB1642)

BLAISE NAME: MoveCity
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] has moved.]
ENTER CITY.

Responses:
1 RE1260_04 (REB1643)
REFUSED RF RE1260_04 (REB1643)
DON'T KNOW DK RE1260_04 (REB1643)
Display Instructions:
Display RE1260_01, RE1260_02, RE1260_03, RE1260_04, RE1260_05, and RE1260_06 on the same form pane.
Display question text ?Please give me?moved? in brackets and ?grayed out? text.

RE1260_04 (REB1643)

BLAISE NAME: MoveSt
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] has moved.]
ENTER STATE.
TYPE THE FIRST LETTER OF THE STATE, THEN USE ARROW KEYS IF NEEDED TO LOCATE STATE, AND
PRESS ENTER TO SELECT.

Responses:
1 RE1260_05 (REB1644)
REFUSED RF RE1260_05 (REB1644)
DON'T KNOW DK RE1260_05 (REB1644)
Programmer Instructions:
Use state lookup file.
Display Instructions:
Display RE1260_01, RE1260_02, RE1260_03, RE1260_04, RE1260_05, and RE1260_06 on the same form pane.
Display question text ?Please give me?moved? in brackets and ?grayed out? text.

RE1260_05 (REB1644)

BLAISE NAME: MoveZip
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] has moved.]
ENTER ZIP CODE.

Responses:
1 RE1260_06 (REB1645)
REFUSED RF RE1260_06 (REB1645)
DON'T KNOW DK RE1260_06 (REB1645)
Programmer Instructions:
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 Instructions:
Display RE1260_01, RE1260_02, RE1260_03, RE1260_04, RE1260_05, and RE1260_06 on the same form pane.
Display question text ?Please give me?moved? in brackets and ?grayed out? text.

RE1260_06 (REB1645)

BLAISE NAME: MovePhone
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
[Please give me the address and telephone number where [PERSON] has moved.]
ENTER TELEPHONE NUMBER. IF NO TELEPHONE, ENTER DK.

Responses:
1
REFUSED RF
DON'T KNOW DK
Programmer Instructions:
10 digit entry required.
Use number input mask (xxx-xxx-xxxx) in response field.
Hard check:
"PHONE ENTRY REQUIRES EXACTLY 10 NUMBERS. PROBE AND RE-ENTER OR ENTER F5 (DON'T KNOW) IF FULL PHONE NUMBER IS NOT KNOWN."
If all persons eligible to be looped on in Loop_140 are set to auxPersProcessed=YES, go to END_LP140.
Otherwise (at least one mover not processed), continue with RE1270.
Display Instructions:
Display RE1260_01, RE1260_02, RE1260_03, RE1260_04, RE1260_05, and RE1260_06 on the same form pane.
Display question text ?Please give me?moved? in brackets and ?grayed out? text.

RE1270 (REB1646)

BLAISE NAME: AnyPersMover
Context Header:
[PERSON?S FIRST MIDDLE AND LAST NAME]
Question Text:
IF KNOWN, CODE WITHOUT ASKING.
Is [PERSON] living with any of the following family members? (READ NAMES BELOW)
[1. First Name, [Middle Name], Last Name] 1
[2. First Name, [Middle Name], Last Name] 2
[3. First Name, [Middle Name], Last Name] 3
[4. First Name, [Middle Name], Last Name] 4
[5. First Name, [Middle Name], Last Name] N

Responses:
YES 1 RE1280 (REB1650)
NO 2 END_LP140 (REB1655)
REFUSED RF END_LP140 (REB1655)
DON'T KNOW DK END_LP140 (REB1655)
Display Instructions:
Roster 1 ? Report
Roster definition:
This item displays persons for display only. Display person?s first, middle, and last names (RE_Person.FullName).
Roster filter:
Display all person who meet the following conditions:
- auxPersProcessed () YES for person AND - Person is on RE_Person Array where MostRecentRU=RUUnit who meets any of the following conditions: :
- -MoverAtLoop10=YES
- -MoverAtLoop20=YES
- -MoverAtLoop30=YES
- -MoverAtRE940=YES

RE1280 (REB1650)

BLAISE NAME: Movers
Context Header:
[PERSON'S FIRST MIDDLE AND LAST NAME]
Question Text:
Who lives with [PERSON]?
ENTER ALL THAT APPLY.

Responses:
[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 END_LP140 (REB1655)
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 END_LP140 (REB1655)
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 END_LP140 (REB1655)
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 END_LP140 (REB1655)
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 END_LP140 (REB1655)
Programmer Instructions:
Set auxProcessedMover=YES and auxPersProcessed=YES for all persons selected at RE1280.
Roster behavior:
1. Multiple select allowed.
Display Instructions:
Roster 2 ? no add/edit/delete.
Roster definition:
This item displays persons for display only. Display person?s first, middle, and last names (RE_Person.FullName).
Roster filter:
Display all person who meet the following conditions:
- auxPersProcessed () YES for person AND
- Person is on RE_Person Array where MostRecentRU=RUUnit who meets any of the following conditions: :
- -MoverAtLoop10=YES
- -MoverAtLoop20=YES
- -MoverAtLoop30=YES
- -MoverAtRE940=YES

END_LP140 (REB1655) :

Route Details:

Cycle on next person who meets the conditions stated in the loop definition.
IF no more persons meet the stated conditions, end LOOP_140 and continue with BOX_ 470.

BOX_470 (REB1665)

Route Details:

If at least one person who is key and here and eligible (CtrlPersKey=YES and CtrlCurrHere=YES and CtrlPersEligible=YES), continue with EndofRE.
Otherwise, exit interview.

EndofRE (REB1670)

BLAISE NAME: EndofRE
Question Text:
THIS IS THE LAST SCREEN WHERE YOU CAN STILL BACK UP.
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1
Programmer Instructions:
Continue with next questionnaire section.
Display Instructions:

REWall (REB1675)

Route Details:

At the RE Wall all relevant RU and Person level data established in Re-enumeration are copied to areas (arrays and external databases) more readily accessible by the various parts of the instrument to facilitate programming and reduce performance issues. Preloaded data is also added to these areas creating a static quick reference library for the rest of the program. This is done once and a virtual ?wall? is dropped so users cannot go back to Re-Enumeration and change primary data points (name, age, gender, etc.) that could, in turn, take large swaths of data off.
In addition to copying person level data and preloaded data to other areas, the RE Wall also performs settings for use in later interview sections and for home office processing.
Link to file with logic for processing at RE Wall:
https://mepspm.westat.com/Final%20Design%20Docs%20by%20Group/RE%20Wall/R

Respondent Forms (RF) Section

BOX_00 (RF1000)

Route Details:

01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70, BOX_80, BOX_90, BOX_100
02 Loop = LOOP_10, LOOP_20
03 End Loop = END_LP10, END_LP20
04 Single Select = RF50_01, RF50_05, RF60, RF100, RF120_01, RF120_05, RF130_01, RF130_03
13 Address - Preloaded = RF70_01, RF70_02, RF70_03, RF70_04, RF70_05, RF70_06, RF70_07
14 Regular Date Entry = RF50_04, RF90_01, RF90_02, RF90_03, RF120_04
20 OS Text Field = RF50_02, RF50_06, RF120_02, RF120_06, RF130_02, RF130_04
23 Text Field = RF50_03, RF120_03
24 Information Screen = RFIntro, RF10, RF20, RF30, RF40_01, RF110_01
26 Regular Date Entry - Preloaded = RF80_01, RF80_02, RF80_03

BOX_10 (RF1005)

Route Details:

Placeholder for Context header display instructions:
Authorization Form Colors:
Panel MPC Pharmacy
P21 Green Gray
P22 White Orchid
P23 Blue Pink
P24 Green Gray
P25 White Orchid
P26 Blue Pink

RFIntro (RF1006)

BLAISE NAME: RFIntro
Question Text:
CAPI WILL NOW DETERMINE WHICH, IF ANY, AUTHORIZATION FORMS AND HARD COPY DOCUMENTS ARE REQUIRED FOR THIS HOUSEHOLD. THIS PROCESS MAY TAKE A FEW MOMENTS.
ANY EVENTS ADDED AFTER THIS POINT WILL NOT GENERATE NEW AUTHORIZATION FORMS UNTIL THE NEXT ROUND.
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 BOX_20 (RF1010)
Programmer Instructions:
After ?1? is entered, CAPI will use the AF Rules to populate the AF array.
The rules for creating records that meet the authorization form (AF) definition are included here:
https://mepspm.westat.com/Final%20Design%20Docs%20by%20Group/Respondent%20Form%20(RF)%20Section%20Supporting%20Documents/AF%20Rules.xlsx
The specifications for the AF array are included here:
(https://mepspm.westat.com/Final%20Design%20Docs%20by%20Group/Respondent%20Form%20(RF)%20Section%20Supporting%20Documents/AF%20array.xlsx)
Display Instructions:

BOX_20 (RF1010)

Route Details:

If:
Round 1 and at least one person-provider-pair eligible for MPC authorization form collection for the current round [at least one record where (AF.AFType=MPC) and (AF.RequestRd1=Yes)]
OR
Rounds 2 ? 5 and at least one person-provider-pair eligible for MPC or Pharmacy authorization form collection for the current round [at least one record where (AF.AFType=MPC or Pharmacy) and (AF.AFSuperceded=Empty)]
OR
Rounds 2-5 and at least one person that is part of this RU (MostRecentRU=RUUnit) rejoined the community this round from previously being institutionalized in a health care setting [at least one record where (AF.AFType=MPC-HCI (original)) and (AF.AFInstStatus=1 or 2)]
OR
At least one Person eligible for SAQ status collection [(Person.SAQFlag=Yes or Person.SAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)]
OR
At least one Person eligible for PSAQ status collection [(Person.PSAQFlag=Yes or Person.PSAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)]
OR
At least one Person eligible for DCS status collection (Person.DCSFlag=YES), Continue with RF10.
Otherwise, go to BOX_100.

RF10 (RF1015)

BLAISE NAME: AFSumm
Question Text:
FORM COLLECTION SUMMARY.
RU Member Age SAQ DCS Medical AFs Pharmacy AFs
(Preprinted) (Preprinted)
[MPCColor] [PharColor]
[PERSON FIRST NAME] [Age] [Text] [Text] [SS] ([TT]) [WW] ([XX])
[PERSON FIRST NAME] [Age] [Text] [Text] [SS] ([TT]) [WW] ([XX])
[PERSON FIRST NAME] [Age] [Text] [Text] [SS] ([TT]) [WW] ([XX])
[PERSON FIRST NAME] [Age] [Text] [Text] [SS] ([TT]) [WW] ([XX])
[PERSON FIRST NAME] [Age] [Text] [Text] [SS] ([TT]) [WW] ([XX])
Total [QQ [RR [UU] [(VV)] [YY] [(ZZ)] (Pending)] (Pending)
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 BOX_30 (RF1020)
Programmer Instructions:
Roster behavior:
1. Add, edit, select disallowed.
Display Instructions:
Roster 1 - Report Roster Definition:
This item displays the RU members roster for display only in the info pane.
Roster Filter
Display only RU members who are key (CtrlPersKey=Yes) or who were deceased in a previous round or institutionalized in a previous round and still institutionalized and have an outstanding authorization form [(AF.AFPersonStatus=5 or 6) and [at least one record where (AF.AFType=MPC or Pharmacy) and (AF.AFSuperceded=Empty)]].
Display the following columns formatted in the info pane: Column Header #1: RU Member
Display the first name (Pers. FName) of each RU member meeting the roster filter definition.
Column Header #2: Age
Display the age of the person. If age is missing, display the range for the age category.
Column Header #3: SAQ
This cell is active for this row if [(Person.SAQFlag=Yes or Person.SAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)] or if [(Person.PSAQFlag=Yes or Person.PSAQFlwUpFlag=YES) and (QS20_ 04 = 1 or 2)]. Otherwise, leave cell empty. Cell display uses the value from QS20_04 (FormCmpl) or QS20_05 (FormCollect) for this person during the current round. Display ?Completed? if QS20_05 was coded ?1? (COMPLETED AND GIVEN TO INTERVIEWER). Display ?Refused? if QS20_05 was coded ?5? (REFUSED TO COMPLETE). Display ?Pending? if QS20_ 04 was coded ?2? (NEEDS REPLACEMENT) or QS20_05 was coded ?6? (NOT COMPLETED, COLLECT UPDATED STATUS AT RESPONDENT FORM SECTION).
For ?QQ?, display the count of the number of persons where the SAQ/PSAQ status is ?pending?. Display ?0? if none. The word ?(Pending)? will display next to this count. (Note: The SAQ and PSAQ are never collected in the same round, thus they can share a column.)
Column Header #4: DCS
Display ?Pending? if Person.DCSFlag=YES. Otherwise, leave cell empty.
For ?RR?, display the count of the number of persons where Person.DCSFlag=YES. Display ?0? if none. The word ?(Pending)? will display next to this count. (Note: The DCS is only being distributed in the QS section and never statused. The RF section is the first time we will get a status for the DCS.)
Column Header #5: Medical AFs (Preprinted) [MPCColor]
For ?MPCColor?, display the color of the MPC form for that panel. See BOX_10 for specifications on color.
For ?SS?, display the count of the total number of MPC AFs for this RU Member. This count is the number of records for this RU member where [(Round 1) and (AF.AFType=MPC) and (AF.RequestRd1=Yes)] or [(Rounds 2-5) and (AF.AFType=MPC) and (AF.AFSuperceded=Empty)]. Display ?0? if none.
For ?TT?, display the count of the number of MPC preprinted AFs that are available for this RU member. This count is the number of records for this RU member where [(Rounds 2-5) and (AF.AFType=MPC) and (AF.AFSuperceded=Empty) and (AF.AFPreprinted=1 or 2)]. Display ?0? if none. Note: This count will always be ?0? in Round 1.
For ?UU?, sum all the counts in ?SS?. For ?VV?, sum all the counts in ?TT?.
Column Header #6: Pharmacy AFs (Preprinted) [PharColor]
For ?PharColor?, display the color of the Pharmacy form for that panel. See BOX_10 for specifications on color.
For ?WW?, display the count of the total number of Pharmacy AFs for this RU Member. This count is the number of records for this RU member where [(Rounds 2-5) and (AF.AFType=Pharmacy) and (AF.AFSuperceded=Empty)]. Display ?0? if none. Note: This count will always be ?0? in Round 1. For ?XX?, display the count of the number of Pharmacy preprinted AFs that are available for this RU member. This count is the number of records for this RU member where [(Rounds 2-5) and (AF.AFType=Pharmacy) and (AF.AFSuperceded=Empty) and (AF.AFPreprinted=1 or 2)]. Display ?0? if none. This count will always be ?0? in Round 1.
For ?YY?, sum all the counts in ?WW?.
For ?ZZ?, sum all the counts in ?XX?.
Display the grid in the info pane in nonproportional text.

BOX_30 (RF1020)

Route Details:

If Rounds 2-5 and at least one person that is part of this RU (MostRecentRU=RUUnit) rejoined the community this round from previously being institutionalized in a health care setting [at least one record where (AF.AFType=MPC-HCI (original)) and (AF.AFInstStatus=1 or 2)], continue with RF20.
Otherwise, go to BOX_40.

RF20(RF1025)

BLAISE NAME: AFSumm2
Question Text:
FORM COLLECTION SUMMARY, CONTINUED.
[PERSON 1], [PERSON 2], [PERSON 3], [PERSON 4], [PERSON N] [HAVE/HAS] [REJOINED THE HOUSEHOLD] [OR] [DIED] AFTER BEING IN A HEALTH CARE FACILITY.
CAPI WILL ALSO PROMPT YOU TO COMPLETE AUTHORIZATION FORMS FOR INSTITUTIONAL STAYS THAT OCCURRED DURING THE TIME [HE/SHE/THEY] [WERE/WAS] AWAY AT A HEALTH CARE FACILITY.
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 BOX_40 (RF1030)
Programmer Instructions:
Display Instructions:
Roster 1- Report
Roster definition:
This item uses the authorization form array to display RU-members. (AF.FName, AF.MName, AF.LName)
Roster filter:
Display only those RU members who have returned from being institutionalized in a previous round [persons where (AF.AFType=MPC-HCI (original)) and (AF.AFInstStatus=1 or 2)].
Display RU members? first, middle, and last names (AF.FName, AF.MName, AF.LName) in question text. If exactly two names displayed, separate names with the word ?and? and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word ?and?.
Display ?HAVE? and ?WERE? if more than one name displayed. Otherwise, display ?HAS? and ?WAS?.
Display ?REJOINED THE HOUSEHOLD? if there is at least one RU member listed who is living with the family after leaving the institution (AF.AFInstStatus=2). Otherwise, use a null display.
Display ?DIED? if there is at least one RU member listed who died after leaving the institution (AF.AFInstStatus=1). Otherwise, use a null display.
Display ?OR? if there is at least one RU member listed who is living with household and at least one RU member who is listed died after leaving institution. Otherwise, use a null display.
Display ?HE? if only one RU member meets the roster filter conditions and that RU member is male.
Display ?SHE? if only one RU member meets the roster filter conditions and that RU member is female. Otherwise, display ?THEY?.

BOX_40 (RF1030)

Route Details:

RF30 (RF1035)

BLAISE NAME: AFRequest
Question Text:
[[As I mentioned during the last interview], we/We] request written authorization to contact [medical providers] [and] [pharmacies] to obtain complete and accurate information about health care use and expenditures.
[I would like to get authorization from [MPC_PERSON 1, MPC_PERSON 2, MPC_PERSON 3, MPC_PERSON 4, MPC_PERSON N?.] to contact medical providers for more information about the services they provide.]
[I would [also] like to get authorization from [PHAR_PERSON 1, PHAR_PERSON 2, PHAR_PERSON 3, PHAR_PERSON 4, PHAR_PERSON N?.] to contact pharmacies to obtain a printed summary.]
[HAND RESPONDENT THE AUTHORIZATION FORM BOOKLET.]
[These materials explain more about why we contact [medical providers] [and] [pharmacies] and answer questions people sometimes ask about this part of the study. Please take a minute to review this information while I prepare the forms.]
PRESS 1 AND ENTER TO CONTINUE.

Responses:
CONTINUE 1 LOOP_10 (RF1040)
Display Instructions:
DISPLAY ?[As I mentioned during the last interview], we? if not round 1. Otherwise, display ?We?.
Display ?medical providers? if at least one person in the RU has at least one active MPC AF in the current round [at least one record where [(Round 1) and (AF.AFType=MPC) and (AF.RequestRd1=Yes)]] or [at least one record where [(Rounds 2-5) and (AF.AFType=Pharmacy) and (AF.AFSuperceded=Empty)]]. Otherwise, use a null display.
Display ?and? if there is at least at least one active MPC and one active Phamacy AF in the current round. Otherwise, use a null display. Display ?pharmacies? if at least one person in the RU has at least one active Pharmacy AF in the current round [at least one record where (Rounds 2-5) and (AF.AFType=Pharmacy) and (AF.AFSuperceded=Empty)]. Otherwise, use a null display.
Display ?I would like to get authorization from [MPC_PERSON 1, MPC_PERSON 2, MPC_PERSON 3, MPC_PERSON 4, MPC_PERSON N?.] to contact medical providers for more information about the services they provide.? if at least one person in the RU has at least one active MPC AF in the current round. Otherwise, use a null display.
For ?[MPC_PERSON 1, MPC_PERSON 2, MPC_PERSON 3, MPC_PERSON 4, MPC_PERSON N?.],? display the first names (AF.FName) of all RU members where that person has at least one active MPC AF in the current round. Substitute ?you? for the person?s first name if the respondent is included in this list. If exactly two names displayed, separate names with the word ?and? and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word ?and?.
Display ?I would [also] like to get authorization from [PHAR_PERSON 1, PHAR_PERSON 2, PHAR_PERSON 3, PHAR_PERSON 4, PHAR_PERSON N?.] to contact pharmacies to obtain a printed summary.? if at least one person in the RU has at least one active Pharmacy AF in the current round. Otherwise, use a null display.
Display ?also? if there is at least at least one active MPC and one active Phamacy AF in the current round. Otherwise, use a null display.
For ?[PHAR_PERSON 1, PHAR_PERSON 2, PHAR_PERSON 3, PHAR_PERSON 4, PHAR_PERSON N?.],? display the first names (AF.FName) of all RU members where that person has at least one active Pharmacy AF in the current round. Substitute ?you? for the person?s first name if the respondent is included in this list. If exactly two names displayed, separate names with the word ?and? and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word ?and?.

LOOP_10 (RF1040)

Route Details:

For each RU member, ask BOX_50 ? END_LP10.
Loop definition: LOOP_10 collects the status of all eligible MPC and Pharmacy Authorization Forms and any outstanding hard-copy forms. This loop also cycles on RU members who have returned from the institution. This loop cycles on RU members that meet one of the following conditions:
Round 1 and person eligible for MPC authorization form collection for the current round [person has at least one record where (AF.AFType=MPC) and (AF.RequestRd1=Yes)]
OR
Rounds 2 ? 5 and person eligible for MPC or Pharmacy authorization form collection for the current round [person has at least one record where (AF.AFType=MPC or Pharmacy) and (AF.AFSuperceded=Empty)]
OR
Rounds 2-5 and person that is part of this RU (MostRecentRU=RUUnit) rejoined the community this round from previously being institutionalized in a health care setting [person has record where (AF.AFType=MPC-HCI (original)) and (AF.AFInstStatus=1 or 2)]
OR
Person is eligible for SAQ status collection [(Person.SAQFlag=Yes or Person.SAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)]
OR
Person is eligible for PSAQ status collection [(Person.PSAQFlag=Yes or Person.PSAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)]
OR
Person is eligible for DCS status collection (Person.DCSFlag=YES)

BOX_50 (RF1045)

Route Details:

If:
Round 1 and person (being looped on) eligible for MPC authorization form collection for the current round [person has at least one record where (AF.AFType=MPC) and (AF.RequestRd1=Yes)]
OR
Rounds 2 ? 5 and person (being looped on) eligible for MPC or Pharmacy authorization form collection for the current round [person has at least one record where (AF.AFType=MPC or Pharmacy) and (AF.AFSuperceded=Empty)],
Continue with RF40_01.
Otherwise, go to BOX_60.

RF40_01 (RF1050)

BLAISE NAME: AFInfo
Question Text:
INTERVIEWER: [COMPLETE A NEW AF FOR THIS PAIR./TAKE OUT PREPRINTED AF FOR THIS PAIR. IF NOT AVAILABLE, FILL OUT A BLANK AF.]
[AF STATUS FROM PREVIOUS ROUND: [DISPLAY RECEIPT CONTROL STATUS]]
PROVIDER NAME: [Provider/Pharmacy Full Name]
ADDRESS: [Combined Street Address] [City], [ST] [Zip Code] [Telephone]
PATIENT: [First,[Middle],Last Name]
DOB: [MM/DD/YYYY] AGE: [XXX] [ACTION: [Status Action]]
RU ID: [RUID] REGION: [Reg ID] PROVIDER ID: [ProvID] PID: [PID]
SIGNATURE DATE ON AF MUST BE ON OR AFTER: [MM/DD/YYYY]
[IF NECESSARY, SAY: Since [LINKED PROV NAMES] (is/are) associated with a larger practice, we will ask for authorization for just [PROVIDER FULL NAME].]
PRESS 1 AND ENTER WHEN FORM IS PREPARED.
CTRL-S: SWITCH TO A DIFFERENT RU MEMBER.
HELP: F1

Responses:
AF FORM PREPARED 1
Programmer Instructions:
Preloaded grid type ? flexible navigation including RF40_01, RF40_02, RF40_03, RF40_04, RF40_N, as well as RF50_01, RF50_02, RF50_03, RF50_04, RF50_05, and RF50_06.
At grid completion, continue with RF50_01.
Display Instructions:
Roster 1 ? Report
Col #1 Header: Provider
Instructions: Display the name of the medical or pharmacy provider for this row. This column is protected and uneditable. (use AF.ProvName from the AF array. Variable may need to be truncated for display in grid.)
Roster Filter:
Display only MPC and Pharmacy authorization forms that are active for this person for this round [records where [(Round 1) and (AF.AFType=MPC) and (AF.RequestRd1=Yes)] or [(Rounds 2-5) and (AF.AFType=MPC or Pharmacy) and (AF.AFSuperceded=Empty)]]. This column is protected and uneditable.
Col #2 Header: Type
Instructions: Display the Authorization form type ? either ?MPC? or ?Pharmacy?. This column is protected and uneditable. (use AF.AFType)
Col #3 Header: Color
Instructions: Display the color linked to this authorization form. (see BOX_10 rules)
Col #4 Header: Prep
Instructions: RF40_01, RF40_02, RF40_03, RF40_04, RF40_N entry field.
Display ?COMPLETE A NEW AF FOR THIS PAIR.? If no preprinted AF exists for this record (AF.AFPreprinted=Empty). Otherwise display, ?TAKE OUT PREPRINTED AF FOR THIS PAIR. IF NOT AVAILABLE, FILL OUT A BLANK AF.?
Display ?AF STATUS FROM PREVIOUS ROUND: [DISPLAY RECEIPT CONTROL STATUS]? if this AF record was outstanding from the previous round and not replaced by a new person- provider pair record [(AF.AFSuperceded=Empty) and (AF.OrigRndless than greater than current round) and (AF.PL_AFRecCtrlStatus()Empty)]. Otherwise, use a null display.
For ?[DISPLAY RECEIPT CONTROL STATUS]?, display the label associated with the receipt control status. If the receipt control status is ?Other, specify?, display the other specify status text entry field. (Use AF.PL_AFRecCtrlStatus and AF.PL_AFRecCtrlStatusOS)
The labels PROVIDER NAME:, ADDRESS:, PATIENT:, DOB:, AGE:, RU ID:, REGION:, PROVIDER ID:, PID, AND SIGNATURE DATE?: should be displayed in the traditional blue font and size of interviewer instructions. However, display the contents after that label (i.e., the provider/pharmacy name, person name, etc.) in bold black. This will make the screen easier to read.
The label ACTION: should be displayed in the traditional interviewer instruction font size ? but in red. However, display the contents after that label (i.e., status action) in bold black.
For ?[Provider/Pharmacy Full Name]? display the full name of the provider or pharmacy for this AF record. (Use AF.ProvName with no truncation).
For ?[Combined Street Address]? display the street address of the provider or pharmacy for this AF record. (Concatenate AF.StrtAddr1 and AF.StrtAddr2 into one line separated with a space)
For ?[City], [ST] [Zip Code] [Telephone]? display the rest of the address of the provider or pharmacy for this AF record. (Use AF.City, AF.State, AF.Zip and AF.Phone)
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record. (Use AF.FName, AF.MName, and AF.LName)
For (DOB) ?[MM/DD/YYYY]? display the DOB of the RU member for this AF record. (Use AF.DOBM, AF.DOBD, AF.DOBY). If complete DOB is RF/DK/empty, leave the display empty. If part of the DOB is RF/DK/empty, display "RF" or "DK" or leave empty as appropriate for that field.
For ?[XXX]? display the age or age range of the RU member for this AF record. (Use AF.Age. If Age=RF/DK/empty, use AF.AgeCat. If AF.AgeCat= RF/DK/empty, use AF.AgeGuess.)
Display ?ACTION: [Status Action]? if (AF.AFPersonStatus=3, 4, 5, or 6) or if [(AF.AFPersonStatus=1 or 2) and [(AF.Age less than=17) or (AF.AgeCat or AF.AgeGuess=1-4)]]. Otherwise, use a null display.
For ?[Status Action]? display the following:
?[Verify] Child less than=13. [If so,] Need Parent/Guardian Signature? if [(AF.AFPersonStatus=1 or 2) and [(AF.Age less than=13) or (AF.AgeCat or AF.AgeGuess=1-3)]].
Display ?Verify? and ?If so,? AF.Age is RF/DK/empty and AF.AgeCat or AF.AgeGuess=1-3.
Otherwise, use a null display.
?[Verify] Child 14-17. [If so,] Need Patient and Parent/Guardian Signature? if [(AF.AFPersonStatus=1 or 2) and [(AF.Age 14-17) or (AF.AgeCat or AF.AgeGuess=4)]].
Display ?Verify? and ?If so,? AF.Age is RF/DK/empty and AF.AgeCat or AF.AgeGuess=4. Otherwise, use a null display.
?Patient Deceased [In Prior Round]. Need Proxy Signature? if AF.AFPersonStatus=3 or 5.
Display ?In Prior Round? if AF.AFPersonStatus=5.?Patient [Still] Institutionalized. Need Proxy Signature? if AF.AFPersonStatus=4 or 6.
Display ?Still? if AF.AFPersonStatus=6.
For ?[RUID]?, display the CaseID.
For ?[Reg ID]?, display the region of this CaseID. (May need to get from BFOS?)
For ?[ProvID]?, display the provider ID of the provider or pharmacy for this AF record (ProvID).
For ?[PID]?, display the AF.PersID of the RU member for this AF record.
For (SIGNATURE DATE) ?[MM/DD/YYYY]?, display the required signature date for this AF record (Use AF.ReqSignDt).
Display ?IF NECESSARY, SAY: Since [LINKED PROV NAMES] (is/are) associated with a larger practice, we will ask for authorization for just [PROV NAME].? if there are linked provider names for this AF record (AF.LinkedAF.ProvNames less than greater than Empty). Otherwise, use a null display.
For ?[LINKED PROV NAMES]? display the text entry associated with this field for this AF record. This will be a string of provider first and last names. (Use AF.LinkedAF.ProvNames).
For ?[PROVIDER FULL NAME]? display the full name of the provider for this AF record. (Use AF.ProvName, truncation is okay).

RF50_01 (RF1055)

BLAISE NAME: AFStat
Question Text:
PROVIDER NAME: [Provider/Pharmacy Full Name]
PATIENT: [First,[Middle],Last Name]
REQUEST SIGNATURE AND THEN ENTER THE AUTHORIZATION FORM STATUS.
[IF NECESSARY, SAY: Since [LINKED PROV NAMES] (is/are) associated with a larger practice, we will ask for authorization for just [PROVIDER FULL NAME].]
HELP: F1

Responses:
SIGNED 1 RF50_03 (RF1065)
LEFT WITH RESPONDENT 2
MAILED TO RESPONDENT 3
REFUSED (NO FORM LEFT) 4 RF50_05 (RF1075)
OTHER (NOT SIGNED) 91 RF50_02 (RF1060)
Programmer Instructions:
Preloaded Grid type 2 ? flexible navigation, including items RF50_01, RF50_02, RF50_03, RF50_04, RF50_05, and RF50_06, as well as RF40_01, RF40_02, RF40_03, RF40_04, RF40_N.
Refused and Don?t Know disallowed.
If RF50_01 is coded ?2? (LEFT WITH RESPONDENT) or ?3? (MAILED TO RESPONDENT), return to RF50_01 for next authorization form on grid. At grid completion, go to BOX_60. Set AF.AFCAPIStatus=RF50_01.
Display Instructions:
Roster 1 ? Report
Col #1 Header: Provider
Instructions: Display the name of the medical or pharmacy provider for this row. This column is protected and uneditable. (use AF.ProvName from the AF array. Variable may need to be truncated for display in grid.)
Roster Filter:
Display only MPC and Pharmacy authorization forms that are active for this person for this round [records where [(Round 1) and (AF.AFType=MPC) and (AF.RequestRd1=Yes)] or [(Rounds 2-5) and (AF.AFType=MPC or Pharmacy) and (AF.AFSuperceded=Empty)]]. This column is protected and uneditable.
Col #2 Header: Type
Instructions: Display the Authorization form type ? either ?MPC? or ?Pharmacy?. This column is protected and uneditable. (use AF.AFType)
Col #3 Header: Color
Instructions: Display the color linked to this authorization form. (see BOX_10 rules)
Col #4 Header: Prep
Instructions: Display the entered responses from RF40_01-RF40_N for each authorization form in a protected, uneditable field.
Col #5 Header: Status
Instructions: Item RF50_01. Always an active cell for every row.
Col #6 Header: Specify Status
Instructions: Item RF50_02. Display as an active cell if RF50_01 is coded ?91? (OTHER).
Col #7 Header: AF Number
Instructions: Item RF50_03. Display as an active cell if RF50_01 is coded ?1? (SIGNED).
Col #8 Header: Signature Date
Instructions: Item RF50_04. Display as an active cell if RF50_01 is coded ?1? (SIGNED).
Col #9 Header: Refusal Reason
Instructions: Item RF50_05. Display as an active cell if RF50_01 is coded ?4? (REFUSED)
Col #10 Header: Specify Refusal
Instructions: Item RF50_06. Display as an active cell if RF50_05 is coded ?91? (OTHER SPECIFY).
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider/Pharmacy Full Name]? display the full name of the provider or pharmacy for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)
Display ?IF NECESSARY, SAY: Since [LINKED PROV NAMES] (is/are) associated with a larger practice, we will ask for authorization for just [PROV NAME].? if there are linked provider names for this AF record (AF.LinkedAF.ProvNames less than greater than Empty). Otherwise, use a null display.
For ?[LINKED PROV NAMES]? display the text entry associated with this field for this AF record.
This will be a string of provider first and last names. (Use AF.LinkedAF.ProvNames).
For ?[PROVIDER FULL NAME]? display the full name of the provider for this AF record. (Use AF.ProvName, truncation is okay).

RF50_02 (RF1060)

BLAISE NAME: AFStatOS
Question Text:
PROVIDER NAME: [Provider/Pharmacy Full Name]
PATIENT: [First,[Middle],Last Name]
SPECIFY OTHER AUTHORIZATION FORM STATUS:

Responses:
1
Programmer Instructions:
Return to RF50_01 for next authorization form on grid.
Refused and Don?t Know disallowed.
Set AF.AFCAPIStatusOS=RF50_02.
Display Instructions:
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider/Pharmacy Full Name]? display the full name of the provider or pharmacy for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)

RF50_03 (RF1065)

BLAISE NAME: AFNum
Question Text:
PROVIDER NAME: [Provider/Pharmacy Full Name]
PATIENT: [First,[Middle],Last Name]
ENTER AUTHORIZATION FORM NUMBER:

Responses:
1 RF50_04 (RF1070)
Programmer Instructions:
Refused and Don?t Know disallowed.
Set AF.AFFormID=RF50_03.
Note: Each authorization form has a pre-assigned authorization form number. This number is linked to the authorization form type, panel and round.
Hard check: Exactly 8 digit alpha-numeric entry required. If less than 8 characters entered, display the following message: "AUTHORIZATION FORM NUMBER REQUIRES EXACTLY 8 LETTERS/NUMBERS. VERIFY FORM NUMBER AND FORM TYPE AND RE-ENTER."
Hard Check ? MPC/Pharmacy Authorization Forms: The Authorization form number entered must follow the conventions noted below for the panel and AF type. If an authorization form number is entered that does not meet the conventions, display the following message: ?INVALID AUTHORIZATION FORM NUMBER ENTERED. VERIFY FORM NUMBER AND FORM TYPE AND RE-ENTER.?
MPC Authorization Form Number Conventions Origin Letter 5-Number Check Digit Round Identifier Sequence P21 P22 P23
Pre-Generated A-M 00001-29499 Random (0-9) 1, 2, 3, 4, 5 A, B, C, D, E G, H, J, K, L
Field Generated A-M 29500-44999 Random (0-9) 1, 2, 3, 4, 5 A, B, C, D, E G, H, J, K, L
Home Office T 45000-49999 Random (0-9) 1, 2, 3, 4, 5 A, B, C, D, E G, H, J, K, L
Training/QC Y 96000-96399 Random (0-9) 1, 2, 3, 4, 5 A, B, C, D, E G, H, J, K, L
Pharmacy Authorization Form Number Conventions Origin Letter 5-Number Check Digit Round Identifier Sequence P21 P22 P23
Pre-Generated Q, R, S 70000-79999 Random (0-9) 1, 2, 3, 4, 5 A, B, C, D, E G, H, J, K, L
Field Generated Q, R, S 80000-89999 Random (0-9) 1, 2, 3, 4, 5 A, B, C, D, E G, H, J, K, L
Home Office Z 90000-95999 Random (0-9) 1, 2, 3, 4, 5 A, B, C, D, E G, H, J, K, L
Training/QC Y 96600-96799 Random (0-9) 1, 2, 3, 4, 5 A, B, C, D, E G, H, J, K, L
Note:
P24 will use round identifiers: M, N, P, Q, R. P25 will use round identifiers: S, T, U, V, W. P26 will use round identifiers: 1, 2, 3, 4, 5.
Display Instructions:
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider/Pharmacy Full Name]? display the full name of the provider or pharmacy for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)

RF50_04 (RF1070)

BLAISE NAME: AFDate
Question Text:
PROVIDER NAME: [Provider/Pharmacy Full Name]
PATIENT: [First,[Middle],Last Name]
SIGNATURE DATE ON AF MUST BE ON OR AFTER: [MM/DD/YYYY]
ENTER AUTHORIZATION FORM SIGNATURE DATE:
PRESS THE ALT AND DOWN ARROW KEY TO SELECT THE DATE FROM THE CALENDAR.
PRESS ENTER TO CONTINUE.

Responses:
1
Programmer Instructions:
Return to RF50_01 for next authorization form on grid.
Refused and Don?t Know disallowed.
Hard check: Date entered must be on or after the interview date of the most recent round?s interview for which the pair is/was eligible for authorization form collection (use AF.ReqSignDt), but cannot be after ?Today?s? Date? (the current date set on the laptop, which may be different from RU reference period end date). If date is before correct date, display the following message: ?AUTHORIZATION FORM MUST BE SIGNED ON OR AFTER ABOVE DATE. VERIFY AND RE-ENTER DATE OR COMPLETE NEW AF.?
Display Instructions:
Display the date field for the signature date here.
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider/Pharmacy Full Name]? display the full name of the provider or pharmacy for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)
For (SIGNATURE DATE) ?[MM/DD/YYYY]?, display the required signature date for this AF record (Use AF.ReqSignDt). This date should be displayed in bold black.

RF50_05 (RF1075)

BLAISE NAME: AFRfResn
Question Text:
PROVIDER NAME: [Provider/Pharmacy Full Name]
PATIENT: [First,[Middle],Last Name]
SELECT MAIN REASON FOR REFUSAL:

Responses:
DOESN'T WANT TO BOTHER PROVIDER 1
CONFIDENTIALITY/SENSITIVE INFO 2
PAYMENT PROBLEM WITH PROVIDER 3
HAS ALREADY GIVEN ENOUGH INFORMATION 4
WANTS MORE INFO BEFORE SIGNING 5
NOT INTERESTED IN STUDY 6
NO REASON GIVEN 7
OTHER SPECIFY 91 RF50_06 (RF1080)
Programmer Instructions:
If coded ?1?, ?2?, ?3?, ?4?, ?5?, ?6?, or ?7?, return to RF50_01 for next authorization form on grid.
Refused and Don?t Know disallowed.
Display Instructions: Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider/Pharmacy Full Name]? display the full name of the provider or pharmacy for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)

RF50_06 (RF1080)

BLAISE NAME: AFRfOS
Question Text:
PROVIDER NAME: [Provider/Pharmacy Full Name]
PATIENT: [First,[Middle],Last Name]
SPECIFY OTHER REASON FOR REFUSAL:

Responses:
1
Programmer Instructions:
Return to RF50_01 for next authorization form on grid.
Refused and Don?t Know disallowed.
Display Instructions:
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider/Pharmacy Full Name]? display the full name of the provider or pharmacy for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)

BOX_60 (RF1085)

Route Details:

If Rounds 2-5 and person (being looped on) that is part of this RU (MostRecentRU=RUUnit) rejoined the community this round from previously being institutionalized in a health care setting [person has record where (AF.AFType=MPC-HCI (original)) and (AF.AFInstStatus=1 or 2)], continue with RF60.
Otherwise, go to BOX_90.

LOOP_20 (RF1090)

Route Details:

For each of the following:
Institution 1
Institution 2
Institution 3
Institution 4
Institution 5
Ask BOX_70-END_LP20.
Loop definition: LOOP_20 collects/verifies the name, address, admit and discharge dates of every health care institution a person who has rejoined the community resided in during the time they were not part of the MEPS interview. The response to RF100 determines if the loop cycles again. If RF100 is coded ?1? (YES), the loop cycles to collect the next health care institution. If RF100 is coded ?2? (NO), ?RF? (REFUSED), or ?DK? (DON?T KNOW), the loop ends. However, there can only be a maximum of 5 health care institutions, so RF100 will not be asked once there are 5 institutions.

BOX_70 (RF1095)

Route Details:

If first cycle of LOOP_20, continue with RF60.
Otherwise, go to RF70_01.

RF60 (RF1100)

BLAISE NAME: HCIConf
Question Text:
I have recorded that [you/[PERSON]] [rejoined the household/passed away] after being in a health care facility. I would like to collect the name, address, and telephone number for each nursing home or other long-term care institution that provided 24 hour skilled nursing care where [you/[PERSON]] resided between [DATE ORIG INSTITUTIONALIZED] and [DATE REJOINED COMMUNITY].
In an earlier interview, I recorded that [you/[PERSON]] entered [ORIG INSTITUTION NAME]. Is that correct?

Responses:
YES 1 RF70_01 (RF1105)
NO 2 RF70_01 (RF1105)
REFUSED RF RF70_01 (RF1105)
DON'T KNOW DK RF70_01 (RF1105)
Programmer Instructions:
If coded ?2? (NO), ?RF? (REFUSED), or ?DK? (DON?T KNOW), set AF.AFSuperceded=Yes for the record where AF.AFType=MPC-HCI (original). Create a new record where: AF.AFType=MPC-HCI (additional). Set AF.OrigRnd and AF.AFYear. From the MPC-HCI (original) record, copy over all the ?info about person? variables to the new record.
Set AF.ReqSignDt to RU reference period end date regardless of response to RF60.
Set AFYear to 1 if current round =1 or 2. Set AFYear to 2 if current round =3, 4 or 5 regardless of response to RF60.
Display Instructions:
For ?[PERSON]? display the full name of the person being looped on (Person.FullName). Display ?rejoined the household? if person has returned to live in this RU [(AF.AFInstStatus=2) for the record where AF.AFType=MPC-HCI (original)]. Display ?passed away? if person died after leaving the institution [(AF.AFInstStatus=1) for the record where AF.AFType=MPC- HCI (original)].
For ?[DATE ORIG INSTITUTIONALIZED]?, display the date the person was first institutionalized [(AF.OrigInstMM, DD, YYYY) for the record where AF.AFType=MPC-HCI (original)]. Display as full month, xx, YYYY - e.g., "January 1, 2016". Display ?DK? or ?RF? for missing values.
For ?[DATE REJOINED COMMUNITY]?, display the date the person left the health care facility [(AF.DtRejoinedMM, DD, YYYY) for the record where AF.AFType=MPC-HCI (original)]. (This is the date collected at RE200/RE220/RE240). Display as full month, xx, YYYY - e.g., "January 1, 2016". Display ?DK? or ?RF? for missing values.
For ?[ORIG INSTITUTION NAME]?, display the name of the health care facility the person reported when he/she was first institutionalized [Use AF.ProvName for the AF record where AF.AFType=MPC-HCI (orginal)].

RF70_01 (RF1105)

BLAISE NAME: HCIName
Question Text:
[VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING./Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.]
[Is the name:/What is the name?]
[INSTITUTION NAME]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

Responses:
1 RF70_02 (RF1110)
Programmer Instructions:
Refused and Don?t Know disallowed.
General programming instructions for RF70_01 to RF70_06: If first cycle through LOOP_20 and RF60 is coded ?1? (YES), prefill each available address field in the response pane entry fields with health care institution information from the round the person was first institutionalized (RE450_01-RE450_06). Use AF.ProvName, AF.StrtAddr1, AF.StrtAddr2, AF.City, AF.State, and AF.Zip for the AF record where AF.AFType=MPC-HCI (orginal).
General programming instructions for RF70_01 to RF70_06: If first cycle through LOOP_20 and RF60 is coded ?2? (YES), ?RF? (REFUSED) or ?DK? (DON?T KNOW) or if not first cycle through LOOP_20, leave the response pane entry fields empty for completion. As name, address, and phone are collected, these values must be added to both the provider fields in the AF array as well as the provider array so that a ProvID can be created.
General programming instructions for RF70_07: Leave the response pane entry field empty for completion for all cycles of LOOP_20.
Set Provider.ProvID and AF.ProvID to MaxProvID +1. Set Provider.MPTP to 1 (Facility).
Set Provider.CreateQ to RF70. Set Provider.OrigRnd to current round. Set Provider.OrigRU to current RU. Set Provider.MPLName and AF.ProvName = RF70_01.
Display Instructions:
Display RF70_01 through RF70_07 vertically on the same form pane.
Display ?VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING.? and ?Is the name:? if first cycle through LOOP_20 and RF60 is coded ?1? (YES). Otherwise, display ?Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.? and ?What is the name??
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, AF.LName).
Display address fields in the info pane with most recent health care institution 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 [INSTITUTION NAME] in the info pane in bold, black, but all other address display fields in lighter ?grayed-out? text.

RF70_02 (RF1110)

BLAISE NAME: HCIStrt
Question Text:
[VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING./Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.]
[Is the street address:/What is the street address?]
[INSTITUTION NAME]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

Responses:
1 RF70_03 (RF1115)
REFUSED RF RF70_03 (RF1115)
DON'T KNOW DK RF70_03 (RF1115)
Programmer Instructions:
See general programming instructions at RF70_01.
Set Provider.MPStrt and AF.StrtAddr1 = RF70_02.
Display Instructions:
Display RF70_01 through RF70_07 vertically on the same form pane.
Display ?VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING.? and ?Is the street address:? if first cycle through LOOP_20 and RF60 is coded ?1? (YES). Otherwise, display ?Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.? and ?What is the street address??
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, AF.LName).
Display ?VERIFY THE NAME?? or ?Please give me?? in brackets and lighter ?grayed-out? text when on RF70_02 through RF70_07.
Display address fields in the info pane with most recent health care institution 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.

RF70_03 (RF1115)

BLAISE NAME: HCIStrt2
Question Text:
[VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING./Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.]
[VERIFY/ENTER] BUILDING OR ADDITIONAL ADDRESS INFORMATION, AS NECESSARY. IF NONE, PRESS ENTER TO CONTINUE.
[INSTITUTION NAME]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

Responses:
1 RF70_04 (RF1120)
EMPTY Empty RF70_04 (RF1120)
REFUSED RF RF70_04 (RF1120)
DON'T KNOW DK RF70_04 (RF1120)
Programmer Instructions:
See general programming instructions at RF70_01.
Set AF.StrtAddr2 = RF70_03. (There is no street address 2 in the provider array.)
Display Instructions:
Display RF70_01 through RF70_07 vertically on the same form pane.
Display ?VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING.? and ?VERIFY:? if first cycle through LOOP_20 and RF60 is coded ?1? (YES). Otherwise, display ?Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.? and ?ENTER?.
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, AF.LName).
Display ?VERIFY THE NAME?? or ?Please give me?? in brackets and lighter ?grayed-out? text when on RF70_02 through RF70_07.
Display address fields in the info pane with most recent health care institution 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.

RF70_04 (RF1120)

BLAISE NAME: HCICity
Question Text:
[VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING./Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.]
[Is the city:/What is the city?]
[INSTITUTION NAME]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

Responses:
1 RF70_05 (RF1125)
REFUSED RF RF70_05 (RF1125)
DON'T KNOW DK RF70_05 (RF1125)
Programmer Instructions:
See general programming instructions at RF70_01.
Set Provider. ProvCity and AF.City = RF70_04.
Display Instructions:
Display RF70_01 through RF70_07 vertically on the same form pane.
Display ?VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING.? and ?Is the city:? if first cycle through LOOP_20 and RF60 is coded ?1? (YES). Otherwise, display ?Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.? and ?What is the city??
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, AF.LName).
Display ?VERIFY THE NAME?? or ?Please give me?? in brackets and lighter ?grayed-out? text when on RF70_02 through RF70_07.
Display address fields in the info pane with most recent health care institution 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.

RF70_05 (RF1125)

Question Text:
[VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING./Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.]]
[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.
[INSTITUTION NAME]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

Responses:
1 RF70_06 (RF1130)
REFUSED RF RF70_06 (RF1130)
DON'T KNOW DK RF70_06 (RF1130)
Programmer Instructions:
See general programming instructions at RF70_01.
Use the state lookup file.
Set Provider.MPST and AF.State = RF70_05.
Note: The entry Foreign country (FC) is allowed.
Display Instructions:
Display RF70_01 through RF70_07 vertically on the same form pane.
Display ?VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING.? and ?Is the state:? if first cycle through LOOP_20 and RF60 is coded ?1? (YES). Otherwise, display ?Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.? and ?What is the state??
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, AF.LName).
Display ?VERIFY THE NAME?? or ?Please give me?? in brackets and lighter ?grayed-out? text when on RF70_02 through RF70_07.
Display address fields in the info pane with most recent health care institution 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.

RF70_06 (RF1130)

BLAISE NAME: HCIZip
Question Text:
[VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING./Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.]
[Is the zip code:/What is the zip code?]
[INSTITUTION NAME]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

Responses:
1 RF70_07 (RF1135)
REFUSED RF RF70_07 (RF1135)
DON'T KNOW DK RF70_07 (RF1135)
Programmer Instructions:
See general programming instructions at RF70_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."
Set Provider.ProvZip and AF.Zip = RF70_06.
Display Instructions:
Display RF70_01 through RF70_07 vertically on the same form pane.
Display ?VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING.? and ?Is the zip code:? if first cycle through LOOP_20 and RF60 is coded ?1? (YES). Otherwise, display ?Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.? and ?What is the zip code??
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, AF.LName).
Display ?VERIFY THE NAME?? or ?Please give me?? in brackets and lighter ?grayed-out? text when on RF70_02 through RF70_07.
Display address fields in the info pane with most recent health care institution 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.

RF70_07 (RF1135)

BLAISE NAME: HCIPhone
Question Text:
[VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING./Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.]
What is the telephone number?
IF NO TELEPHONE, ENTER DON?T KNOW.
[INSTITUTION NAME]
[STREET ADDRESS1]
[STREET ADDRESS2]
[CITY], [STATE] [ZIP CODE]
[TELEPHONE NUMBER]

Responses:
1 RF80_01 (RF1140)
REFUSED RF RF80_01 (RF1140)
DON'T KNOW DK RF80_01 (RF1140)
Programmer Instructions:
See general programming instructions at RF70_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."
Set Provider.ProvPhone and AF.Phone = RF70_07.
Display Instructions:
Display RF70_01 through RF70_07 vertically on the same form pane.
Display ?VERIFY THE NAME AND ADDRESS OF THE NURSING HOME OR LONG TERM CARE FACILITY WHERE [PERSON] WAS LIVING.? if first cycle through LOOP_20 and RF60 is coded ?1? (YES). Otherwise, display ?Please give me the name, address and telephone number of the nursing home or long term care institution (that provided 24 hour skilled nursing care) where [you were/[PERSON] was] living.?
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, AF.LName).
Display ?VERIFY THE NAME?? or ?Please give me?? in brackets and lighter ?grayed-out? text when on RF70_02 through RF70_07.
Display address fields in the info pane with most recent health care institution 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.

RF80_01 (RF1140)

BLAISE NAME: HCIAdmitMM
Question Text:
[I recorded that [you/[PERSON]] entered [ORIG INSTITUTION NAME] on [DATE ORIG INSTITUTIONALIZED]. Is that correct?/What date [were you/was [PERSON]] admitted to [INSTITUTION NAME]?]
[VERIFY/ENTER] MONTH.

Responses:
1 RF80_02 (RF1145)
Programmer Instructions:
DK AND RF disallowed for month.
If first cycle through LOOP_20 and RF60 is coded ?1? (YES), prefill RF80_01 with AF.OrigInstMM.
Display Instructions:
Display ?I recorded that [you/[PERSON]] entered [ORIG INSTITUTION NAME] on [DATE ORIG INSTITUTIONALIZED]. Is that correct?? and ?VERIFY? if first cycle through LOOP_20 and RF60 is coded ?1? (YES). Otherwise, display ?What date [were you/was [PERSON]] admitted to [INSTITUTION NAME]?? and ?ENTER?.
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, AF.LName).
For ?[DATE ORIG INSTITUTIONALIZED]?, display the date the person was first institutionalized [(AF.OrigInstMM, DD, YYYY) for the record where AF.AFType=MPC-HCI (original)]. Display as full month, xx, YYYY - e.g., "January 1, 2016". Display ?DK? or ?RF? for missing values.
For ?[ORIG INSTITUTION NAME]?, display the name of the health care facility the person reported when he/she was first institutionalized [Use AF.ProvName for the AF record where AF.AFType=MPC-HCI (orginal)].
For ?[INSTITUTION NAME]?, display the name of the institution verified/entered at RF70_01 during this loop (also AF.ProvName for this record).
Display RF80_01 - RF80_03 and RF90_01-RF90_03 on the same form pane.

RF80_02 (RF1145)

BLAISE NAME: HCIAdmitDD
Question Text:
[I recorded that [you/[PERSON]] entered [ORIG INSTITUTION NAME] on [DATE ORIG INSTITUTIONALIZED]. Is that correct?/What date [were you/was [PERSON]] admitted to [INSTITUTION NAME]?]
[VERIFY/ENTER] DAY.

Responses:
1 RF80_03 (RF1150)
REFUSED RF RF80_03 (RF1150)
DON'T KNOW DK RF80_03 (RF1150)
Programmer Instructions:
If first cycle through LOOP_20 and RF60 is coded ?1? (YES), prefill RF80_02 with AF.OrigInstDD.
Display Instructions:
See display instructions at RF80_01.
Display the first paragraph in grayed-out text.
Display RF80_01 - RF80_03 and RF90_01-RF90_03 on the same form pane.

RF80_03 (RF1150)

BLAISE NAME: HCIAdmitYYYY
Question Text:
[I recorded that [you/[PERSON]] entered [ORIG INSTITUTION NAME] on [DATE ORIG INSTITUTIONALIZED]. Is that correct?/What date [were you/was [PERSON]] admitted to [INSTITUTION NAME]?]
[VERIFY/ENTER] 4-DIGIT YEAR.

Responses:
1 RF90_01 (RF1155)
Programmer Instructions:
DK and RF disallowed for year.
If first cycle through LOOP_20 and RF60 is coded ?1? (YES), prefill RF80_03 with AF.OrigInstYYYY.
Hard check: Month and Year entered at RF80_01 and RF80_03 must be on or after month and year originally institutionalized (AF.OrigInstMM, YYYY) and on or before month and year rejoined community (AF.DtRejoinedMM, YYYY). If the month and year entered fall outside of this range, display the following message: ?DATE ADMITTED TO HEALTH CARE FACILITY MUST BE BETWEEN THE DATE FIRST INSTITUTIONALIZED ([AF.OrigInstMM, DD, YYYY]) AND DATE [REJOINED COMMUNITY/DIED] ([AF.DtRejoinedMM, DD, YYYY]). VERIFY AND RE-ENTER DATE.? Note: If any part of the dates are DK, RF, or empty, do not invoke the hard check. Only using month and year since those fields are required at these three items, whereas day is not.
Display Instructions:
See display instructions at RF80_01.
Display the first paragraph in grayed-out text.
Display RF80_01 - RF80_03 and RF90_01-RF90_03 on the same form pane.
In the hard check message, display ?REJOINED COMMUNITY? IF [(AF.AFInstStatus=2) for the record where AF.AFType=MPC-HCI (original)]. Display ?DIED? if person died after leaving the institution [(AF.AFInstStatus=1) for the record where AF.AFType=MPC-HCI (original)].

RF90_01 (RF1155)

BLAISE NAME: HCIDischMM
Question Text:
What date [were you/was [PERSON]] discharged from [INSTITUTION NAME]?
ENTER MONTH.

Responses:
1 RF90_02 (RF1160)
Programmer Instructions:
DK AND RF disallowed for month.
Display Instructions:
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, Instructions: AF.LName).
For ?[INSTITUTION NAME]?, display the name of the institution verified/entered at RF70_01 during this loop (also AF.ProvName for this record).
Display RF80_01 - RF80_03 and RF90_01-RF90_03 on the same form pane.

RF90_02 (RF1160)

BLAISE NAME: HCIDischDD
Question Text:
What date [were you/was [PERSON]] discharged from [INSTITUTION NAME]?
ENTER DAY.

Responses:
1 RF90_03 (RF1165)
REFUSED RF RF90_03 (RF1165)
DON'T KNOW DK RF90_03 (RF1165)
Display Instructions:
See display instructions at RF90_01.
Display the first paragraph in grayed-out text.
Display RF80_01 - RF80_03 and RF90_01-RF90_03 on the same form pane.

RF90_03 (RF1165)

BLAISE NAME: HCIDischYYYY
Question Text:
What date [were you/was [PERSON]] discharged from [INSTITUTION NAME]?
ENTER 4-DIGIT YEAR.

Responses:
1 BOX_80 (RF1170)
Programmer Instructions:
DK AND RF disallowed for year.
Hard check: Month and Year entered at RF90_01 and RF90_03 must be on or after month and year originally institutionalized (AF.OrigInstMM, YYYY) and on or before month and year rejoined community (AF.DtRejoinedMM, YYYY). If the month and year entered fall outside of this range, display the following message: ?DATE DISCHARGED FROM HEALTH CARE FACILITY MUST BE BETWEEN THE DATE FIRST INSTITUTIONALIZED ([AF.OrigInstMM, DD, YYYY]) AND DATE [REJOINED COMMUNITY/DIED] ([AF.DtRejoinedMM, DD, YYYY]). VERIFY AND RE-ENTER DATE.? Note: If any part of the dates are DK, RF, or empty, do not invoke the hard check. Only using month and year since those fields are required at these three items, whereas day is not.
Display Instructions:
See display instructions at RF90_01.
Display the first paragraph in grayed-out text.
Display RF80_01 - RF80_03 and RF90_01-RF90_03 on the same form pane.
In the hard check message, display ?REJOINED COMMUNITY? IF [(AF.AFInstStatus=2) for the record where AF.AFType=MPC-HCI (original)]. Display ?DIED? if person died after leaving the institution [(AF.AFInstStatus=1) for the record where AF.AFType=MPC-HCI (original)].

BOX_80 (RF1170)

Route Details:

If [(first cycle of LOOP_20) and (RF60 is coded ?1? (YES)) and (month and year at RF90_01 And RF90_03=AF.DtRejoinedMM, YYYY)], go to END_LP20 (Loop 20 will cycle only once).
Else, continue with RF100 if there are less than 5 health care institutions already.

RF100 (RF1175)

BLAISE NAME: HCIOth
Question Text:
Between [DATE ORIG INSTITUTIONALIZED] and [DATE REJOINED COMMUNITY], did [you/[PERSON]] stay in another nursing home or other long-term care institution that provided 24 hour skilled nursing care [other than [INSTITUTION NAME]]?

Responses:
YES 1 END_LP20 (RF1180)
NO 2 END_LP20 (RF1180)
REFUSED RF END_LP20 (RF1180)
DON'T KNOW DK END_LP20 (RF1180)
Programmer Instructions:
If coded ?1? (YES), create a new record where: AF.AFType=MPC-HCI (additional). Set AF.OrigRnd and AF.AFYear. Set AF.ReqSignDt to RU reference period end date. From the MPC-HCI (original) record, copy over all the ?info about person? variables to the new record. The next cycle of LOOP_20 will cycle to set the info about provider information for this newly created record.
Display Instructions:
For ?[DATE ORIG INSTITUTIONALIZED]?, display the date the person was first institutionalized [(AF.OrigInstMM, DD, YYYY) for the record where AF.AFType=MPC-HCI (original)]. Display as full month, xx, YYYY - e.g., "January 1, 2016". Display ?DK? or ?RF? for missing values.
For ?[DATE REJOINED COMMUNITY]?, display the date the person left the health care facility [(AF.DtRejoinedMM, DD, YYYY) for the record where AF.AFType=MPC-HCI (original)]. (This is the date collected at RE200/RE220/RE240). Display as full month, xx, YYYY - e.g., "January 1, 2016". Display ?DK? or ?RF? for missing values.
For ?[PERSON]? display the full name of the person being looped on (AF.FName, AF.MName, AF.LName).
For ?[INSTITUION NAME]?, display the name of the institution at RF70_01 verified/entered during this cycle of LOOP_20 (also AF.ProvName for this record).

END_LP20 (RF1180)

Route Details:

If RF100 is coded ?1? (YES), cycle to collect next institution if there are less than 5 health care institutions already recorded.
Otherwise, end loop 20 and continue with RF110_01.

RF110_01 (RF1185)

BLAISE NAME: HCIInfo
Question Text:
INTERVIEWER: COMPLETE A NEW MPC AF FOR THIS PAIR. ON TOP LEFT CORNER OF FORM, PRINT ?HCI?.
PROVIDER NAME: [Provider]
ADDRESS: [Combined Street Address] [City], [ST] [Zip Code] [Telephone]
PATIENT: [First,[Middle],Last Name]
DOB: [MM/DD/YYYY] AGE: [XXX] ACTION: [Status Action]
RU ID: [RUID] REGION: [Reg ID] PROVIDER ID: [ProvID] PID: [PID]
SIGNATURE DATE ON AF MUST BE ON OR AFTER: [MM/DD/YYYY]
PRESS 1 AND ENTER WHEN FORM IS PREPARED.
HELP: F1

Responses:
AF FORM PREPARED 1
Programmer Instructions:
Preloaded grid type ? flexible navigation including RF110_01, RF110_02, RF110_03, RF110_ 04, RF110_N, as well as RF120_01, RF120_02, RF120_03, RF120_04, RF120_05, and RF120_06.
At grid completion, continue with RF120_01.
Display Instructions:
Roster 1 ? Report
Col #1 Header: Provider
Instructions: Display the name of the institutional provider for this row. This column is protected and uneditable. (AF.ProvName) Variable may need to be truncated for display in grid.)
Roster Filter:
Display only MPC authorization forms for health care institutions that are active for this person for this round [records where [(AF.AFType=MPC-HCI (original)) and (AF.Superceded=Empty)] or [AF.AFType=MPC-HCI (additional)]. This column is protected and uneditable.
Col #2 Header: Type
Instructions: Display the Authorization form type ? ?MPC-HCI?. This column is protected and uneditable.
Col #3 Header: Color
Instructions: Display the color linked to this authorization form. (see BOX_10 rules for regular MPC forms)
Col #4 Header: Prep
Instructions: RF110_01, RF110_02, RF110_03, RF110_04, RF110_N entry field.
The labels PROVIDER NAME:, ADDRESS:, PATIENT:, DOB:, AGE:, RU ID:, REGION:, AGE:, PROVIDER ID:, PID, AND SIGNATURE DATE?: should be displayed in the traditional blue font and size of interviewer instructions. However, display the contents after that label (i.e., the provider/pharmacy name, person name, etc.) in bold black. This will make the screen easier to read.
The label ACTION: should be displayed in the traditional interviewer instruction font size ? but in red. However, display the contents after that label (i.e., status action) in bold black.
For ?[Provider]? display the full name of the provider for this AF record. (Use AF.ProvName with no truncation).
For ?[Combined Street Address]? display the street address of the provider for this AF record. (Concatenate AF.StrtAddr1 and AF.StrtAddr2 into one line separated with a space)
For ?[City], [ST] [Zip Code] [Telephone]? display the rest of the address of the provider for this AF record. (Use AF.City, AF.State, AF.Zip and AF.Phone)
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record. (Use AF.FName, AF.MName, and AF.LName)
For (DOB) ?[MM/DD/YYYY]? display the DOB of the RU member for this AF record. (Use AF.DOBM, AF.DOBD, AF.DOBY). If complete DOB is RF/DK/empty, leave the display empty. If part of the DOB is RF/DK/empty, display "RF" or "DK" or leave empty as appropriate for that field.
For ?[XXX]? display the age or age range of the RU member for this AF record. (Use AF.Age. If Age=RF/DK/empty, use AF.AgeCat. If AF.AgeCat= RF/DK/empty, use AF.AgeGuess.)
Display ?ACTION: [Status Action]? if (AF.AFPersonStatus=3) or if [(AF.AFPersonStatus=1 or 2) and [(AF.Age less than=17) or (AF.AgeCat or AF.AgeGuess=1-4)]]. Otherwise, use a null display.
For ?[Status Action]? display the following:
?[Verify] Child less than=13. [If so,] Need Parent/Guardian Signature? if [(AF.AFPersonStatus=1 or 2) and [(AF.Age less than=13) or (AF.AgeCat or AF.AgeGuess=1-3)]].
Display ?Verify? and ?If so,? AF.Age is RF/DK/empty and AF.AgeCat or AF.AgeGuess=1-3.
Otherwise, use a null display.
?[Verify] Child 14-17. [If so,] Need Patient and Parent/Guardian Signature? if [(AF.AFPersonStatus=1 or 2) and [(AF.Age 14-17) or (AF.AgeCat or AF.AgeGuess=4)]].
Display ?Verify? and ?If so,? AF.Age is RF/DK/empty and AF.AgeCat or AF.AgeGuess=4. Otherwise, use a null display.
?Patient Deceased. Need Proxy Signature? if AF.AFPersonStatus=3.
For ?[RUID]?, display the CaseID.
For ?[Reg ID]?, display the region of this CaseID. (May need to get from BFOS?)
For ?[ProvID]?, display the provider ID of the provider or pharmacy for this AF record (ProvID).
For ?[PID]?, display the AF.PersID of the RU member for this AF record.
For (SIGNATURE DATE) ?[MM/DD/YYYY]?, display the required signature date for this AF record (Use AF.ReqSignDt).

RF120_01 (RF1190)

BLAISE NAME: HCIStat
Question Text:
PROVIDER NAME: [Provider Full Name]
PATIENT: [First,[Middle],Last Name]
REQUEST SIGNATURE AND THEN ENTER THE AUTHORIZATION FORM STATUS.
HELP: F1

Responses:
SIGNED 1 RF120_03 (RF1200)
LEFT WITH RESPONDENT 2
MAILED TO RESPONDENT 3
REFUSED (NO FORM LEFT) 4 RF120_05 (RF1210)
OTHER (NOT SIGNED) 91 RF120_02 (RF1195)
Programmer Instructions:
Preloaded Grid type 2 ? flexible navigation, including items RF120_01, RF120_02, RF120_03, RF120_04, RF120_05, and RF120_06 as well as RF110_01, RF110_02, RF110_03, RF110_ 04, RF110_N.
Refused and Don?t Know disallowed.
If RF120_01 is coded ?2? (LEFT WITH RESPONDENT) or ?3? (MAILED TO
RESPONDENT), return to RF120_01 for next authorization form on grid. At grid completion, go to BOX_90.
Set AF.AFCAPIStatus=RF120_01.
Display Instructions:
Roster 1 ? Report
Col #1 Header: Provider
Instructions: Display the name of the institutional provider for this row. This column is protected and uneditable. (AF.ProvName) Variable may need to be truncated for display in grid.)
Roster Filter:
Display only MPC authorization forms for health care institutions that are active for this person for this round [records where [(AF.AFType=MPC-HCI (original)) and (AF.Superceded=Empty)] or [AF.AFType=MPC-HCI (additional)]. This column is protected and uneditable.
Col #2 Header: Type
Instructions: Display the Authorization form type ? ?MPC-HCI?. This column is protected and uneditable.
Col #3 Header: Color
Instructions: Display the color linked to this authorization form. (see BOX_10 rules for regular MPC forms)
Col #4 Header: Prep
Instructions: Display the entered responses from RF110_01-RF110_N for each authorization form in a protected, uneditable field.
Col #5 Header: Status
Instructions: Item RF120_01. Always an active cell for every row.
Col #6 Header: Specify Status
Instructions: Item RF120_02. Display as an active cell if RF120_01 is coded ?91? (OTHER).
Col #7 Header: AF Number
Instructions: Item RF120_03. Display as an active cell if RF120_01 is coded ?1? (SIGNED).
Col #8 Header: Signature Date
Instructions: Item RF120_04. Display as an active cell if RF120_01 is coded ?1? (SIGNED).
Col #9 Header: Refusal Reason
Instructions: Item RF120_05. Display as an active cell if RF120_01 is coded ?4? (REFUSED)
Col #10 Header: Specify Refusal
Instructions: Item RF50_06. Display as an active cell if RF120_05 is coded ?91? (OTHER SPECIFY).
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider Full Name]? display the full name of the provider for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)

RF120_02 (RF1195)

BLAISE NAME: HCIStatOS
Question Text:
PROVIDER NAME: [Provider Full Name]
PATIENT: [First,[Middle],Last Name]
SPECIFY OTHER AUTHORIZATION FORM STATUS:

Responses:
1
Programmer Instructions:
Return to RF120_01 for next authorization form on grid.
Refused and Don?t Know disallowed.
Set AF.AFCAPIStatusOS=RF120_02.
Display Instructions:
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider Full Name]? display the full name of the provider for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)

RF120_03 (RF1200)

BLAISE NAME: HCINum
Question Text:
PROVIDER NAME: [Provider Full Name]
PATIENT: [First,[Middle],Last Name]
ENTER AUTHORIZATION FORM NUMBER:

Responses:
1 RF120_04 (RF1205)
Programmer Instructions:
Refused and Don?t Know disallowed.
Set AF.AFFormID=RF120_03.
Note: Each authorization form has a pre-assigned authorization form number. This number is linked to the authorization form type, panel and round.
Hard check: Exactly 8 digit alpha-numeric entry required. If less than 8 characters entered, display the following message: "AUTHORIZATION FORM NUMBER REQUIRES EXACTLY 8 LETTERS/NUMBERS. VERIFY FORM NUMBER AND FORM TYPE AND RE-ENTER."
Hard Check ? MPC-HCI: The Authorization form number entered must follow the conventions noted at RF50_03 (see earlier) for regular MPC forms. If an authorization form number is entered that does not meet the conventions, display the following message: ?INVALID AUTHORIZATION FORM NUMBER ENTERED. VERIFY FORM NUMBER AND FORM TYPE AND RE-ENTER.?
Display Instructions:
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider Full Name]? display the full name of the provider for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)

RF120_04 (RF1205)

BLAISE NAME: HCIDate
Question Text:
PROVIDER NAME: [Provider Full Name]
PATIENT: [First,[Middle],Last Name]
SIGNATURE DATE ON AF MUST BE ON OR AFTER: [MM/DD/YYYY]
ENTER AUTHORIZATION FORM SIGNATURE DATE:
PRESS THE ALT AND DOWN ARROW KEY TO SELECT THE DATE FROM THE CALENDAR.
PRESS ENTER TO CONTINUE.

Responses:
1
Programmer Instructions:
Return to RF120_01 for next authorization form on grid.
Refused and Don?t Know disallowed.
Hard check: Date entered must be on or after the interview date of the most recent round?s interview for which the pair is/was eligible for authorization form collection (use AF.ReqSignDt), but cannot be after ?Today?s? Date? (the current date set on the laptop, which may be different from RU reference period end date). If date is before correct date, display the following message: ?AUTHORIZATION FORM MUST BE SIGNED ON OR AFTER ABOVE DATE. VERIFY AND RE-ENTER DATE OR COMPLETE NEW AF.?
Display Instructions:
Display the date field for the signature date here
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider Full Name]? display the full name of the provider for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)
For (SIGNATURE DATE) ?[MM/DD/YYYY]?, display the required signature date for this AF record (Use AF.ReqSignDt). This date should be displayed in bold black.

RF120_05 (RF1210)

BLAISE NAME: HCIRfResn
Question Text:
PROVIDER NAME: [Provider Full Name]
PATIENT: [First,[Middle],Last Name]
SELECT MAIN REASON FOR REFUSAL:

Responses:
DOESN'T WANT TO BOTHER PROVIDER 1
CONFIDENTIALITY/SENSITIVE INFO 2
PAYMENT PROBLEM WITH PROVIDER 3
HAS ALREADY GIVEN ENOUGH INFORMATION 4
WANTS MORE INFO BEFORE SIGNING 5
NOT INTERESTED IN STUDY 6
NO REASON GIVEN 7
OTHER SPECIFY 91 RF120_06 (RF1215)
Programmer Instructions:
Refused and Don?t Know disallowed.
If coded ?1?, ?2?, ?3?, ?4?, ?5?, ?6?, or ?7?, return to RF120_01 for next authorization form on grid.
Display Instructions:
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider Full Name]? display the full name of the provider for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)

RF120_06 (RF1215)

BLAISE NAME: HCIRfOS
Question Text:
PROVIDER NAME: [Provider Full Name]
PATIENT: [First,[Middle],Last Name]
SPECIFY OTHER REASON FOR REFUSAL:

Responses:
1
Programmer Instructions:
Return to RF120_01 for next authorization form on grid.
Refused and Don?t Know disallowed.
Display Instructions:
Display the labels PROVIDER NAME: and PATIENT: as grayed out text.
For ?[Provider Full Name]? display the full name of the provider for this AF record as grayed out text. (Use AF.ProvName with no truncation).
For ?[First,[Middle],Last Name]? display the name of the RU member for this AF record as grayed out text. (Use AF.FName, AF.MName, and AF.LName)

BOX_90 (RF1220)

Route Details:

If:
At least one Person eligible for SAQ status collection [(Person.SAQFlag=Yes or Person.SAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)]
OR
At least one Person eligible for PSAQ status collection [(Person.PSAQFlag=Yes or Person.PSAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)]
OR
At least one Person eligible for DCS status collection (Person.DCSFlag=YES)
Continue with RF130_01.
Otherwise go to BOX_100.

RF130_01 (RF1225)

BLAISE NAME: FormCollectFinal
Question Text:
PERSON: [First Middle Last Name] PID: [PID] FORM: [SAQ/PSAQ ([BLUE/PURPLE])/DCS]
[Earlier we asked [you/[PERSON]] to complete a brief survey about health and health opinions./Earlier we asked [you/[PERSON]] to complete a few questions about the care received for diabetes./Earlier we asked that someone knowledgeable about [your/[PERSON]?s] diabetes to complete a few questions about the care received.] I would like to collect that form now.
COLLECT COMPLETED [MALE (BLUE)/FEMALE (PURPLE)] [SAQ/PSAQ/DCS].
[[SAQ/PSAQ] WAS CODED AS [COMPLETED/REFUSED] EARLIER IN THE INTERVIEW. ENTER THROUGH THE FIELDS IF NO UPDATE TO STATUS IS NECESSARY.]
SELECT THE STATUS OF THE [SAQ/PSAQ/DCS]:

Responses:
COMPLETED AND GIVEN TO INTERVIEWER 1
NOT COMPLETED, WILL PICK UP AT A LATER DATE 2
NOT COMPLETED, WILL MAIL TO OFFICE 3
MAILED TO RESPONDENT 4
REFUSED TO COMPLETE (NO FORM LEFT) 5 RF130_03 (RF1235)
[NOT COMPLETED, COLLECT UPDATED STATUS AT RESPONDENT FORM SECTION] 6
OTHER 91 RF130_02 (RF1230)
Programmer Instructions:
The grid should be Preloaded Grid Type 1: forced navigation, including RF130_01, RF130_02, RF130_03, and RF130_04.
If coded ?1?, ?2?, ?3?, or ?4?, return to RF130_01 for next hard copy form on grid.
At grid completion, continue with BOX_100.
Refused and Don?t Know disallowed.
The number of rows in the grid will correspond to the hard copy flags set for this RU member (Person.DCSFlag= YES, [(Person.SAQFlag=Yes or Person.SAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)], [(Person.PSAQFlag=Yes or Person.PSAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)]
NOTE TO PROGRAMMERS: An RU member will never have BOTH the SAQ and PSAQ active in the same round. The maximum number of rows in the grid will be two. This grid needs to be configurable to accommodate the addition of other required hardcopy materials as requested by the client in future panels.
Display Instructions:
Do not display response category 6. It is reserved for the Quality Supplement (QS) Section.
Roster Report 1
Roster Definition: Display the hardcopy materials required for this RU member as described below.
Row #1 (DCS) should display as active if Person.DCSFlag-YES.
Row #2 (SAQ) should display as active if [(Person.SAQFlag=Yes or Person.SAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)].
Row #3 (PSAQ) should display as active if [(Person.PSAQFlag=Yes or Person.PSAQFlwUpFlag=YES) and (QS20_04 = 1 or 2)].
NOTE: If QS20_04 was coded ?3? (NOT COMPLETED-NO REPLACEMENT NECESSARY) for the SAQ/PSAQ for this person, this row is not eligible for display in the RF section. We will not update the status at all from the QS section for forms with this code.
Format the form pane column headers as follows:
Col #1 Header: Form Type Instructions:
-Display ?DCS? on Col #1, Row #1 as an uneditable, protected cell
-Display ?SAQ? on Col#1, Row #2 as an uneditable, protected cell
-Display ?PSAQ? on Col#1, Row #3 as an uneditable, protected cell
Col #2 Header: QS Status
Instructions: Display the status from the QS section as an uneditable, protected field. Display ?Completed/Given to FI? if QS 20_05 was coded ?1? for this form. Display ?Refused? if QS20_05 was coded ?5? for this form. Display ?Pending? [if form type is DCS] or [if QS20_05 was coded ?6? for this form] or [if QS20_04 was coded ?2? for this form].
Col#3 Header: Final Status
Instructions: Item RF130_01. If QS Status (Col #2)=Pending, display this cell as empty and ready for completion. If QS Status (Col #2)=Completed/Given to FI or Refused, prefill this cell with the numeric value from QS20_05 (FormCollect) for this form. This cell is still editable and can be updated by the FI.
Col#4 Header: Specify Status
Instructions: Item RF130_02. Display as an active cell if RF130_01 is coded ?91? (OTHER).
Col#5 Header: Refusal Reason
Instructions: Item RF130_03. Display as an active cell if RF130_01 is coded ?5? (REFUSED TO COMPLETE). If QS Status (Col #2)=Pending, display this cell as empty and ready for completion (if RF130_01=5). If QS Status (Col #2)=Refused, prefill this cell with the numeric value from QS20_06 (FormRfResn) for this form. This cell is still editable and can be updated by the FI.
Col#6 Header: Specify Refusal
Instructions: Item RF130_04. Display as an active cell if RF130_03 is coded ?91? (OTHER). If QS Status (Col #2)=Pending, display this cell as empty and ready for completion (if RF130_03=91). If QS Status (Col #2)=Refused, prefill this cell with the text entry from QS20_07 (FormRfOS) for this form. This cell is still editable and can be updated by the FI.
For ?[First Middle Last Name]?, display the first, middle and last names of the person being looped on. Use Person.FName, Person.MName, and Person.LName.
For ?[PID]?, display the Person ID for the person being looped on. Use PersID.
Display ?SAQ? if on row for SAQ.
Display ?PSAQ ([BLUE/PURPLE])? if on row for PSAQ. Display ?(BLUE)? if person being looped on is male. Otherwise, display ?(PURPLE)?.
Display ?DCS? if on row for DCS.
Display the first line of interviewer instructions, PERSON, PID, FORM, in grayed out text.
Display ?Earlier we asked [you/[PERSON]] to complete a brief survey about health and health opinions.? if on row for SAQ or PSAQ.
Display ?Earlier we asked [you/[PERSON]] to complete a few questions about the care received for diabetes.? if on row for DCS and QS20_01 was coded ?1? (SELF) for the person being looped on.
Display ?Earlier we asked that someone knowledgeable about [your/[PERSON]?s] diabetes to complete a few questions about the care received.? if on row for DCS and QS20_01 was coded ?2? (PROXY) for the person being looped on.
Display ?[MALE (BLUE)/FEMALE (PURPLE)]? if on row for PSAQ. Otherwise, use a null display.
Display ?MALE (BLUE)? if person being looped on is male. Otherwise, display ?FEMALE (PURPLE)?.
Display ?[SAQ/PSAQ] WAS CODED AS [COMPLETED/REFUSED] EARLIER IN THE INTERVIEW. ENTER THROUGH THE FIELDS IF NO UPDATE TO STATUS IS NECESSARY.? if QS Status (Col #2)=Completed/Given to FI or Refused. Otherwise, use a null display.
Display ?COMPLETED? if QS Status (Col #2)=Completed/Given to FI. Display ?REFUSED? if QS Status (Col #2)= Refused.
If QS Status (Col #2)=Completed/Given to FI or Refused, display the first paragraph ?Earlier ? collect that form now.?, the interviewer instructions ?COLLECT?/DCS]?, and the interviewer instruction ?SELECT ? /DCS]? in grayed out text. Otherwise, first paragraph and interviewer instructions should be formatted as specified in UI documentation.

RF130_02 (RF1230)

BLAISE NAME: FormCollectOSFinal
Question Text:
PERSON: [First Middle Last Name] PID: [PID] FORM: [SAQ/PSAQ ([BLUE/PURPLE])/DCS]
SPECIFY OTHER STATUS:

Responses:
1
Programmer Instructions:
Return to RF130_01 for next hardcopy form on grid.
Refused and Don?t Know disallowed.
Display Instructions: For ?[First Middle Last Name]?, display the first, middle and last names of the person being looped on. Use Person.FName, Person.MName, and Person.LName.
For ?[PID]?, display the Person ID for the person being looped on. Use PersID. Display ?SAQ? if on row for SAQ.
Display ?PSAQ ([BLUE/PURPLE])? if on row for PSAQ. Display ?(BLUE)? if person being looped on is male. Otherwise, display ?(PURPLE)?.
Display ?DCS? if on row for DCS.
Display the first line of interviewer instructions, PERSON, PID, FORM, in grayed out text.

RF130_03 (RF1235)

BLAISE NAME: FormRFResnFinal
Question Text:
PERSON: [First Middle Last Name] PID: [PID] FORM: [SAQ/PSAQ ([BLUE/PURPLE])/DCS]
SELECT MAIN REASON FOR [SAQ/PSAQ/DCS] REFUSAL:

Responses:
TOO BUSY/NOT INTERESTED1
TOO PERSONAL/SENSITIVE INFORMATION 2
TOO MUCH OF A PHYSICAL/MENTAL HARDSHIP 3
HAS ALREADY GIVEN ENOUGH INFORMATION 4
WANTS MORE INFORMATION 5
NOT INTERESTED 6
NO REASON GIVEN 7
OTHER 91 RF130_04(RF1240)
Programmer Instructions:
If coded ?1?, ?2?, ?3?, ?4?, ?5?, ?6?, or ?7?, return to RF130_01 for next hard copy form on grid.
Refused and Don?t Know disallowed.
Display Instructions:
For ?[First Middle Last Name]?, display the first, middle and last names of the person being looped Instructions: on. Use Person.FName, Person.MName, and Person.LName.
For ?[PID]?, display the Person ID for the person being looped on. Use PersID. Display ?SAQ? if on row for SAQ.
Display ?PSAQ ([BLUE/PURPLE])? if on row for PSAQ. Display ?(BLUE)? if person being looped on is male. Otherwise, display ?(PURPLE)?.
Display ?DCS? if on row for DCS.
Display the first line of interviewer instructions, PERSON, PID, FORM, in grayed out text.

RF130_04 (RF1240)

BLAISE NAME: FormRFOSFinal
Question Text:
PERSON: [First Middle Last Name] PID: [PID] FORM: [SAQ/PSAQ ([BLUE/PURPLE])/DCS]
SPECIFY OTHER REASON FOR REFUSAL:

Responses:
1
Programmer Instructions:
Return to RF130_01 for next hardcopy form on grid.
Refused and Don?t Know disallowed.
Display Instructions:
For ?[First Middle Last Name]?, display the first, middle and last names of the person being looped on. Use Person.FName, Person.MName, and Person.LName.
For ?[PID]?, display the Person ID for the person being looped on. Use PersID. Display ?SAQ? if on row for SAQ.
Display ?PSAQ ([BLUE/PURPLE])? if on row for PSAQ. Display ?(BLUE)? if person being looped on is male. Otherwise, display ?(PURPLE)?.
Display ?DCS? if on row for DCS.
Display the first line of interviewer instructions, PERSON, PID, FORM, in grayed out text.

END_LP10 (RF1245)

Route Details:

Cycle on next person who meets the conditions state in the loop definition.
If no other persons meet the stated conditions, end LOOP_10 and continue with BOX_100.

BOX_100 (RF1250)

Route Details:

Go to next questionnaire section.

Review of Employment (RJ) Section

BOX_00 (RJ1000)

Route Details:

01 Box = BOX_00, BOX_10, BOX_ 20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_70
02 Loop = LOOP_10
03 End Loop = END_LP10
04 Single Select = RJ10, RJ20, RJ30, RJ40, RJ50, RJ55, RJ60, RJ70, RJ80, RJ90, RJ100, RJ130
14 Regular Date Entry = RJ120_01, RJ120_02, RJ120_03
19 Numeric Field = RJ110
20 OS Text Field = RJ50OS, RJ55OS, RJ130OS

BOX_10 (RJ1001)

Route Details:

Context header display instructions:
Display FULLNAME, JobsEstbName, JobStartMM/DD/YYYY, JobStopMM/DD/YYYY

BOX_20 (RJ1005)

Route Details:

If information about at least one current job was collected for person during the previous round, ask the review of employment information (RJ) section. That is, if:
-is rounds 2-5,
Person not added to the RU this round,
Person was greater than or equal to 16 years old or in age categories 4-9 during the previous round, and Person had a job with a job type set as 'current main' or 'current miscellaneous job within reference period' during the previous round, (PR_JobTP=CURRENT MAIN OR PR_JobTP=CURRENT MISC
Continue with LOOP_10.
Otherwise, skip the RJ section, that is, go to BOX_70.

LOOP_10 (RJ1010)

Route Details:

For each element in PERSON'S-JOBS-ROSTER, ask BOX_30 - END_LP10.
Loop definition: LOOP_10 reviews and updates information about current jobs collected during the previous round. This loop cycles on the jobs that meet the following conditions:
Job type is set as either 'current main' (PR_JobTP=CURRENT MAIN). or 'current miscellaneous job within reference period' during the previous round (PR_JobTP=CURRENT MISC)
Navigator details: LOOP_10 uses BOX_30 to control the flow of the loop.

BOX_30 (RJ1020)

Route Details:

If job set as 'current main', (PR_JobTP=CURRENT MAIN) continue with RJ10.
Otherwise (if job type set as 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD')(PR_JobTP=CURRENT MISC) go to RJ60.

RJ10 (RJ1025)

BLAISE NAME: StillAtMainJob
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] worked at [JobsEstbName]. [[Do/Does]/Did] [you/he/she] still work at [JobsEstbName] [on [END DATE]]?

Responses:

YES 1 RJ20 (RJ1045)
NO 2 RJ120_01 (RJ1160)
REFUSED RF RJ120_01 (RJ1160)
DON'T KNOW DK RJ120_01 (RJ1160)

If RJ10 coded '2' (NO), DK or RF set JobTp=FORMER MAIN.
Display Instructions:

For [PREV RD INTV DT] display the interview date of the previous round. (Preload.RUEndM, RUEndD, RUEndY).
Display 'on [END DATE]' if round 5. Otherwise, use null display.
Display '[Do/Does]' if not round 5. Display 'Did' if round 5.
For [END DATE], display the round 5 reference period end date for that person.

RJ20 (RJ1045)

BLAISE NAME: MainJob
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

[Is/Was] [JobsEstbName] still [your/[PERSON]'s] main job or business?
HELP : F1

Responses:

YES 1
NO 2
REFUSED RF
DON'T KNOW DK

Programmer Instructions:

If job being asked about set as 'SELF-EMPLOYED' (SelfEmp=SelfEmpl) go to RJ40. Else go to RJ30
If RJ20 coded '1' (YES), DK, or RF, set job type to 'CURRENT MAIN JOB WITHIN REFERENCE PERIOD' (JobTp=CURRENT MAIN)
If RJ20 coded '2' (NO), set job type to 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' (JobTp=CURRENT MISC)

Display Instructions: Display 'Is' if not round 5. Display 'Was' if round 5.

RJ30 (RJ1050)

BLAISE NAME: ChngWageAmt

Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

[During our last interview, we recorded that [you/[PERSON]] made [PR_SalaryDisplay.] [Since [PREV RD INT DT], has/Between [START DATE] and [END DATE], was] there [been] any change in the amount [you/[PERSON]] [[make/makes]/made] through[JobsEstbName]?
INTERVIEWER NOTE: THIS INCLUDES CHANGES IN BOTH DIRECTIONS.

Responses:

YES 1 BOX_40 (RJ1065)
NO 2 RJ40 (RJ1070)
REFUSED RF RJ40 (RJ1070)
DON'T KNOW DK RJ40 (RJ1070)

Display Instructions:

[During our last interview, we recorded that [you/[PERSON]] made [PR_SalaryDisplay.]: Display sentence if PR_SalaryDisplay?EMPTY.
[Since [PREV RD INTR DT], has/Between [START DATE]] and [END DATE was]: DISPLAY 'Since [PREV RD INTDT], has' if not round 5. Display 'Between [START DATE] and [END DATE], was' if round 5.
[START DATE]: Display the round 5 reference period for start date for this person.
[END DATE]: Display the round 5 reference period end date for this person.
[been]: Display 'been' if not round 5. Otherwise, use a null display.
[[make/makes]/made]: Display '[make/makes]' if not round 5. Display 'made' if round 5. For [PREV RD INT DT], display the interview date of the previous round. (Preload.RUEndM, RUEndD, RUEndY).

BOX_40 (RJ1065)

Route Details:

Ask the Employment Wage (EW) section.
At completion of Employment Wage (EW) section, continue with RJ40.

RJ40 (RJ1070)

BLAISE NAME: StillWorkFTPT
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] worked [full-time/part- time], that is [35 hours or more/less than 35 hours] per week at [JobsEstbName]. [[Do/Does]/Did] [you/he/she] still work [35 hours or more/less than 35 hours] per week at [JobsEstbName] [on [END DATE]]?

Responses:

YES 1 BOX_50 (RJ1105)
NO 2
REFUSED RF BOX_50 (RJ1105)
DON'T KNOW DK BOX_50 (RJ1105)

Programmer Instructions:

If the classification of number of hours worked per week has changed since the previous round, that is,:
If coded '2' And PR_FTPTStatus=PART TIME
Set FTPTStatus=FULL TIME (part-time to full time)
Otherwise set FTPTStatus=PART TIME
Then go to RJ50.
If Coded '2' And PR_FTPTStatus=FULL TIME
Set FTPTStatus=PART TIME (full-time to part-time)
Otherwise set FTPTStatus=FULL TIME
Then go to RJ55.

Display Instructions:

For [PREV RD INTV DT] display the interview date of the previous round. Preload.RUEndM, RUEndD, RUEndY).
Display 'full-time' If PR_FTPTStatus=FULL TIME
Display 'part-time' if PR_FTPTStatus=PART TIME.
Display '[Do/Does]' if not round 5. Display 'did' if round 5.
Display '35 hours or more' if if PR_FTPTStatus=FULL TIME
Display 'less than 35 hours' if PR_FTPTStatus=PART TIME
Display 'on [END DATE]' if round 5, displaying the round 5 end date for this person for 'END
DATE. Otherwise, use null display.

RJ50 (RJ1075)

BLAISE NAME: WhyChngPTToFT
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

What is the main reason [you/[PERSON]] changed from part-time to full-time at [(JobsEstbName)]?

Responses:

CHANGE IN SCHEDULE OR SHIFT 1 BOX_50 (RJ1105)
CHANGE IN PAY 2 BOX_50 (RJ1105)
BENEFITS/HEALTH INSURANCE 3 BOX_50 (RJ1105)
FAMILY, SCHOOL, TEMPORARY LEAVE 4 BOX_50 (RJ1105)
OTHER-SPECIFY 91 RJ50OS (RJ1080)
REFUSED RF BOX_50 (RJ1105)
DON'T KNOW DK BOX_50 (RJ1105)

Display Instructions: Display RJ50 and RJ50OS on the same form pane.

RJ50OS (RJ1080)

BLAISE NAME: WhyChngPTToFTOS
Question Text:

SPECIFY: MAIN REASON

Responses:

1 BOX_50 (RJ1105)
REFUSED RF BOX_50 (RJ1105)
DON'T KNOW DK BOX_50 (RJ1105)

Display Instructions: Display RJ50 and RJ50OS on the same form pane.

RJ55 (RJ1081)

BLAISE NAME: WhyChngFTToPT
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

What is the main reason [you/[PERSON]] changed from full-time to part-time at [JobsEstbName]?

Responses:

HOURS CUT, BUSINESS SLOW 1 BOX_50 (RJ1105)
CHANGE IN SCHEDULE OR SHIFT 2 BOX_50 (RJ1105)
ILLNESS, INJURY, HEALTH PROBLEM 3 BOX_50 (RJ1105)
FAMILY, SCHOOL, TEMPORARY LEAVE 4 BOX_50 (RJ1105)
OTHER-SPECIFY 91 RJ55OS (RJ1082)
REFUSED RF BOX_50 (RJ1105)
DON'T KNOW DK BOX_50 (RJ1105)

Display Instructions: Display RJ55 and RJ55OS on the same form pane.

RJ55OS (RJ1082)

BLAISE NAME: WhyChngFTToPTOS
Question Text:

SPECIFY: MAIN REASON

Responses:

1 BOX_50 (RJ1105)
REFUSED RF BOX_50 (RJ1105)
DON'T KNOW DK BOX_50 (RJ1105)

Display Instructions: Display RJ55 and RJ55OS on the same form pane.

RJ60 (RJ1085)

BLAISE NAME: StillAtMiscJob
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] worked at [JobsEstbName]. [[Do/Does]/Did] [you/he/she] still work there [on [END DATE]]?

Responses:

YES 1 BOX_50 (RJ1105)
NO 2 RJ120_01 (RJ1160)
REFUSED RF RJ120_01 (RJ1160)
DON'T KNOW DK RJ120_01 (RJ1160)

Programmer Instructions:

If RJ60 coded '1' (YES) Set JobTp=CURRENT MISC
If RJ60 coded '2' (NO), 'DK' or 'RF' Set JobTp=FORMER MISC

Display Instructions:

For [PREV RD INTV DT] display the interview date of the previous round (Preload.RUEndM, RUEndD, RUEndY).
Display '[Do/Does]' if not round 5. Display 'Did' if round 5.
For [on [END DATE]]: display if round 5. Otherwise, use a null display.
For [END DATE]: display the round 5 reference period end date for this person.

BOX_50 (RJ1105)

Route Details:

If RJBox50Flag=1 (INSURANCE AT END OF PREVIOUS ROUND) then go to BOX_60
If RJBox50Flag=2 (INSURANCE ENDED IN PREVIOUS ROUND BUT OFFERED NOT TAKEN ON FIRST JOB REPORT) then go to RJ70
If RJBox50Flag=3 (NO INSURANCE AT END OF PREVIOUS ROUND) then go to RJ80
If RJBox50Flag=4 (MILITARY CURRENT MAIN JOB) go to END_LP10
Note: RJBox50Flag is set in inter-round processing (MHOP)

RJ70 (RJ1110)

BLAISE NAME: OffrdHINowTake
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] [were/was] offered health insurance through [JobsEstbName] but chose not to take that insurance. [[Do/Does]/Did] [you/he/she][now] have health insurance through [JobsEstbName] [on [END DATE]]?
HELP: F1

Responses:

YES 1 BOX_60 (RJ1150)
NO 2 RJ90 (RJ1120)
REFUSED RF RJ90 (RJ1120)
DON'T KNOW DK RJ90 (RJ1120)

Programmer Instructions:

If coded '1' (YES), set this jobholder-job pair as 'PROVIDES HEALTH INSURANCE'(EmpHI=YES) and to be asked about in the health insurance section.
If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set this jobholder-job pair as not providing health insurance (EmpHI=EMPTY).

Display Instructions:

[PREV RD INTV DT]: display the interview date of the previous round (Preload.RUEndM, RUEndD, RUEndY).
Display '[Do/Does]' if not round 5. Display 'Did' if round 5. Display 'now' if not round 5. if round 5, display null.
For [on [END DATE]]: display if round 5. Otherwise use a null display.
For [END DATE]: display the round 5 reference period end date for this person.

RJ80 (RJ1115)

BLAISE NAME: NowOffrdTakeHI
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

During our last interview on [PREV RD INTV DT], we recorded that [you/[PERSON]] [were/was] not [offered/receiving] health insurance through [JobsEstbName]. [[Do/Does]/Did] [you/he/she] [now] have health insurance through[JobsEstbName] [on [END DATE]]?
HELP: F1

Responses:

YES 1 BOX_60 (RJ1150)
NO 2 RJ90 (RJ1120)
REFUSED RF BOX_60 (RJ1150)
DON'T KNOW DK BOX_60 (RJ1150)

Programmer Instructions:

If coded '1' (YES) flag this jobholder-establishment pair as 'PROVIDES HEALTH INSURANCE' (EmpHI=YES)and to be asked about in the health insurance section.
If coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW), set this jobholder-job pair as not providing health insurance (EmpHI=EMPTY).

Display Instructions:

[PREV RD INTV DT]: display the interview date of the previous round (Preload.RUEndM, RUEndD, RUEndY).
Display 'offered' if PR_EmpHI=EMPTY and PR_OffrdHIChoseNot () 1 and PR_ConfCovd = EMPTY. Otherwise, display 'receiving'.
Display '[Do/Does]' if not round 5. Display 'Did' if round 5. Display 'now' if not round 5. If round 5, display null.
For [on [END DATE]]: display if round 5. Otherwise, use a null display.
For [END DATE]: display the round 5 reference Period end date for this person.

RJ90 (RJ1120)

BLAISE NAME: OffrdHIThruJob
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

[Were/Was] [you/[PERSON]] offered health insurance through [JobsEstbName]?
HELP: F1

Responses:

YES 1 BOX_60 (RJ1150)
NO 2 RJ100 (RJ1125)
REFUSED RF BOX_60 (RJ1150)
DON'T KNOW DK BOX_60 (RJ1150)

Display Instructions:

RJ100 (RJ1125)

BLAISE NAME: RvwAnyOffrdHI
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

Was health insurance offered to any employees at [JobsEstbName]?

Responses:

YES 1 BOX_60 (RJ1150)
NO 2 BOX_60 (RJ1150)
REFUSED RF BOX_60 (RJ1150)
DON'T KNOW DK BOX_60 (RJ1150)

Display Instructions:

BOX_60 (RJ1150)

Route Details:

If employer set as 'SELF-EMPLOYED', (SelfEmp=SelfEmpl) continue with RJ110.
Otherwise, Set EmpEstm=PR_EmpEstm and go to END_LP10.

RJ110 (RJ1155)

BLAISE NAME: RvwTotNumEmp
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

[During our last interview we recorded that [ PR_TotNumEmp] [employee/employees], including [you/[PERSON]], worked at [JobsEstbName].]
What is the total number of employees who worked at the business [last week/[on [END DATE]]]? Be sure to include the owner and all other household members that may [work/have worked] there.
ENTER AT LEAST 1 TO COUNT THE OWNER. ENTER NUMBER OF EMPLOYEES

Responses:

1 END_LP10 (RJ1175)
REFUSED RF END_LP10 (RJ1175)
DON'T KNOW DK END_LP10 (RJ1175)

Programmer Instructions:

Range check:
Numeric value entered must be equal to or greater than 1. If '0' is entered, display the following message: "Since [you/[PERSON'S FIRST MIDDLE AND LAST NAME]] [is/are] the owner, I am going to enter 1 to count [you/him/her].
ENTER 1 AT RJ110 (RvwTotNumEmp) FOR NUMBER OF EMPLOYEES TO CONTINUE."
Set TotNumEmp=the value entered at RJ110.
If the value entered for the number of employees=1 set EmpEstm= '1'
If the value entered for the number of employees=2-9, inclusive, set EmpEstm= '2-9'
If the value entered for the number of employees=10-25, inclusive, set EmpEstm= '10-25'
If the value entered for the number of employees=26-50, inclusive, set EmpEstm= '26-50'
If the value entered for the number of employees=51-100, inclusive, set EmpEstm= '51-100'
If the value entered for the number of employees=101-200, inclusive, set EmpEstm= '101-200'
If the value entered for the number of employees =201-500, inclusive, set EmpEstm='201-500'
If the value entered for the numbe of employees is greater than 500 set EmpEstm='500+'
If coded 'RF' or 'DK' retain EmpEstm used during the previous round

Display Instructions:

[During our last interview we recorded that [ PR_TotNumEmp] [employee/employees], including [you/[PERSON]], worked at [JobsEstbName].]: display sentence if PR_TotNumEmp was not coded 'RF' or 'DK' during the previous round for the job being asked about. Otherwise, use a null display.
Display 'employee' if PR_TotNumEmp=1 otherwise display 'employees'.
Display 'on [END DATE]' if round 5. Otherwise, display 'last week'. Display 'work' if not round 5.
Otherwise, display 'have worked'.
For [END DATE]: display the round 5 reference period end date for this person.

RJ120_01 (RJ1160)

BLAISE NAME: RvwJobStopMM
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

When did [you/[PERSON]] stop working at [JobsEstbName)] for pay?
[IF JOB ENDED AFTER DECEMBER 31, [YEAR], BACKUP TO [RJ10/RJ60] AND SELECT 'YES'.]
ENTER MONTH.

Responses:

1 RJ120_02 (RJ1162)
REFUSED RF RJ120_02 (RJ1162)
DON'T KNOW DK RJ120_02 (RJ1162)

Programmer Instructions: Set JobStopMM
Display Instructions:

Display RJ120_1, RJ120_2, and RJ120_3 on the same form pane.
Display 'IF JOB ENDED... SELECT 'YES'.' if round 5. Otherwise, use a null display.
Display 'RJ10' if looping on 'CURRENT MAIN JOB'(PR_JobTP=CURRENT MAIN). Display 'RJ60' if looping on 'CURRENT MISCELLANEOUS JOB WITHIN REFERENCE PERIOD' (PR_JobTP=CURRENT MISC)
Note: For specification purposes only; CAPI handles automatically: 'YEAR' in question text is second calendar year of panel.

RJ120_02 (RJ1162)

BLAISE NAME: RvwJobStopDD
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

[When did [you/[PERSON]] stop working at [JobsEstbName] for pay?
[IF JOB ENDED AFTER DECEMBER 31, [YEAR], BACKUP TO [RJ10/RJ60] AND SELECT 'YES'.]]
ENTER DAY.

Responses:

1 RJ120_03 (RJ1163)
REFUSED RF RJ120_03 (RJ1163)
DON'T KNOW DK RJ120_03 (RJ1163)

Programmer Instructions: Set JobStopDD
Display Instructions:

Display RJ120_1, RJ120_2, and RJ120_3 on the same form pane. Display bracketed question text in lighter "grayed out" text.
Display 'IF JOB ENDED... SELECT 'YES'.' if round 5. Otherwise, use a null display.
Display 'RJ10' if looping on 'CURRENT-MAIN-JOB' (PR_JobTP=CURRENT MAIN).
Display 'RJ60' if looping on 'CURRENT-MISCELLANEOUS-JOB-WITHIN- REFERENCE- PERIOD' (PR_JobTP=CURRENT MISC).'

RJ120_03 (RJ1163)

BLAISE NAME: RvwJobStopYYYY
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

[When did [you/[PERSON]] stop working at [JobsEstbName] for pay?
[IF JOB ENDED AFTER DECEMBER 31, [YEAR], BACKUP TO [RJ10/RJ60] AND SELECT 'YES'.]]
ENTER YEAR.

Responses:

1 RJ130 (RJ1165)
REFUSED RF RJ130 (RJ1165)
DON'T KNOW DK RJ130 (RJ1165)

Programmer Instructions:

Set JobStopYYYY
Hard Check:
Job end date entered at RJ120_1, RJ120_2, RJ120_3 must be greater than or equal to reference period start date and less than or equal to to reference period end date. If job end date is less than start date or greater than end date display the message "THE DATE MUST BE ON OR AFTER [START DATE]] AND ON OR BEFORE [END DATE]. VERIFY WITH RESPONDENT AND RE- CODE"
For [Start Date] display Person's reference period start date (BegRefM, BegRefD, BegRefY).
For [END DATE] display person's reference period end date (EndRefM, EndRefD, EndRefY)

Display Instructions:

Display RJ120_1, RJ120_2, and RJ120_3 on the same form pane. Display bracketed question text in lighter "grayed out" text.
Display 'RJ10' if looping on 'CURRENT-MAIN-JOB'(PR_JobTP=CURRENT MAIN).
Display 'RJ60' if looping on 'CURRENT-MISCELLANEOUS-JOB-WITHIN- REFERENCE- PERIOD' (PR_JobTP=CURRENT MISC).

RJ130 (RJ1165)

BLAISE NAME: WhyLeftJob
Context Header:

[PERSON'S FIRST MIDDLE AND LAST NAME] [JobsEstbName]
[JobStartMM/DD/YYYY]
[JobStopMM/DD/YYYY]

Question Text:

What is the main reason [you/[PERSON]] no longer [have/has] this job?
HELP: F1

Responses:

JOB ENDED, TEMPORARY, SEASONAL, CONTRACT, ETC. 1 END_LP10 (RJ1175)
BUSINESS CLOSED OR SOLD 2 END_LP10 (RJ1175)
RETIRED 3 END_LP10 (RJ1175)
ILLNESS, INJURY, ANY HEALTH PROBLEM 4 END_LP10 (RJ1175)
TERMINATED, FIRED, DISMISSED 5 END_LP10 (RJ1175)
LAID OFF, LET GO 6 END_LP10 (RJ1175)
QUIT ? FAMILY REASON, MATERNITY LEAVE 7 END_LP10 (RJ1175)
QUIT ? SCHOOL 8 END_LP10 (RJ1175)
QUIT ? JOB RELATED REASON 9 END_LP10 (RJ1175)
QUIT ? ANY OTHER REASON 10 END_LP10 (RJ1175)
OTHER 91 RJ130OS (RJ1170)
REFUSED RF END_LP10 (RJ1175)
DON'T KNOW DK END_LP10 (RJ1175)

Display Instructions:

RJ130OS (RJ1170)

BLAISE NAME: WhyLeftJobOS
Question Text:

SPECIFY: MAIN REASON

Responses:

1 END_LP10 (RJ1175)
REFUSED RF END_LP10 (RJ1175)
DON'T KNOW DK END_LP10 (RJ1175)

Display Instructions: Display RJ130 and RJ130OS on the same form pane.

END_LP10 (RJ1175)

Route Details:

Cycle on next job in the PERSON'S-JOBS-ROSTER that meets the conditions stated in the loop definition.
If no other jobs meet the stated conditions, end LOOP_10 and continue with BOX_70.

BOX_70 (RJ1180)

Route Details:

CONTINUE WITH EMPLOYMENT A SUBSECTION (EM).

Start/Restart [ST] Section

Fall 2018BOX_00 [ST1000]

Route Details:

01 Box = BOX_10, BOX_20, BOX_30
04 Single Select = ST20, ST30, ST70
05 Single Select with Display Roster = ST10ki
07 Single Select with Add/Edit/Delete = ST50, ST60
08 Multiple Select = ST40
24 Information Screen = ST80
Roster 3 = ST50, ST60

BOX_10 [ST1005]

Route Details:

RU Classifications: The following RU classifications are used throughout the reenumeration section in skip and word fill specifications:
Standard RU - An RU [other than a student RU] that existed in the previous round. During the interview with the standard RU, information may be obtained that identifies a ?NEW RU? or a ?STUDENT RU? and a new case is created. See definitions below.
New RU - When one or more RU members are identified as having left the RU and formed one or more new RUs, a new case is created for each of the new RUs where at least one key RU member lives. In the current round, the case is classified as a ?NEW RU? unless it satisfies the conditions for a ?STUDENT RU? [see definition below]. In the next round, the new RU will be reclassified as a ?STANDARD RU? since it existed in the previous round.
Student RU - When an RU member is identified in a standard or new RU as being age 17-23 [inclusive], NEVER MARRIED, NON-MILITARY, and LIVING AWAY FROM THE STANDARD/NEW RU AT POST- SECONDARY SCHOOL WITHIN THE U.S., an RU is created and classified as a ?STUDENT RU?. The ?STUDENT RU? remains classified as a ?STUDENT RU? until one of the criteria for a student RU classification is violated [e.g., age range or marital status]. [Note: a student RU is always a single-person RU.]
Note: The NHIS original RUs are determined from In-House Pre- Processing and are classified as standard RUs.
Note: References to the RU-members-roster and ?RU MEMBERS? in these specifications indicate the roster in its current state; that is, including all additions to and deletions from the roster that occur up to the point at which the reference is made.
Therefore, if Round 1, the first time a case is worked during the round, at the beginning of the RE section, the roster includes all original NHIS RU members. If not round 1, the first time a case is worked in the round, at the beginning of the RE section, the roster includes all RU members who were eligible or institutionalized on the date of the previous round interview.
In all rounds, for a case that has had a breakoff after the RE section, the roster includes persons eligible or institutionalized at the end of RE. For a split RU, the roster includes RU members who split from the original RU.
Restart Definition:
A case is a ?restart? if the FI has passed RE40_07 [updated RU address/phone]. Any break off prior to or at RE40_07 should wipe out all the data and assume that the case wasn?t worked for that session.
Exit the case, but don?t save data for current session. This includes any new RU member respondent, proxy, or merged DU member who may have been selected as the respondent [it is not saved].
For next start/restart, start with the exact data you started this session with.
If FI Breakoffs prior to or at RE40_07, display the following message: ?The data for this interviewing session will not be saved.? BFOS will handle cleaning out the data for the case.

ST10 [ST1010]

BLAISE NAME: CorrectCase
Question Text:

YOU HAVE SELECTED THE [STUDENT RU] CASE FOR [FULL NAME OF REFERENCE PERSON]. THE RU MEMBERS ARE LISTED BELOW.
[1. First Name [Middle Name] Last Name]1
[2. First Name [Middle Name] Last Name]2
[3. First Name [Middle Name] Last Name]3
[4. First Name [Middle Name] Last Name]4
[5. First Name [Middle Name] Last Name]N
HAVE YOU SELECTED THE CORRECT CASE?
IF YOU HAVE SELECTED THE WRONG CASE, PRESS ALT+F10 TO BREAKOFF AND RETURN TO THE IMS.

Responses:

YES

Programmer Instructions:

If coded ?1? [YES], and case is a restart after the RE section has been completed, continue with ST20. Otherwise, go to ST30.

Display Instructions:

Roster 1 ? Report
This item displays RU-members-roster for display of RU-members. Display RU member's First, Middle, and Last names [Person[i].FullName].
Roster filter:
None. Display all RU members.
Display ?STUDENT RU? if student RU. Otherwise, use null display.
For ?[FULL NAME OF REFERENCE PERSON]? display the full name of previous round reference person if standard RU or student RU. Display full name of oldest person in RU, if new RU.

ST20 [ST1015]

BLAISE NAME: SameResp
Question Text:

IS [NAME OF RESPONDENT/PROXY SELECTED DURING LAST SESSION] STILL THE [RESPONDENT/PROXY] ?
[IF ?YES? SELECTED, ?YOU? WILL BE DISPLAYED FOR [NAME OF RESPONDENT SELECTED DURING LAST
SESSION] THROUGHOUT INTERVIEW.]

Responses:

YES 1 ST80 [ST1050]
NO 2 ST30 [ST1020]

Programmer Instructions:

Refused and Don?t Know disallowed.
Flag Respondent/Proxy from most recent interviewing session for this round as the respondent for the current interviewing session.
Set CARI recording status to the same status as the previous session with this respondent/proxy.

Display Instructions:

For ?NAME OF RESPONDENT/PROXY SELECTED DURING LAST SESSION?, display the name of the respondent or proxy associated with the most recent interviewing session for this round.
Display ?RESPONDENT? if ST30 coded ?1? [RU MEMBER] for the most recent interviewing session for this round. Otherwise, display ?PROXY?.
Display ?IF ?YES? SELECTED, ?YOU? WILL BE DISPLAYED FOR [NAME OF RESPONDENT SELECTED DURING LAST SESSION] THROUGHOUT INTERVIEW.? if ST30 coded ?1? [RU MEMBER] for the most recent interviewing session for this round. Otherwise, use a null display

ST30 [ST1020]

BLAISE NAME: RespMmbProxy
Question Text:

[PLEASE NOTE: THIS IS A ROUND 5 INTERVIEW. QUESTIONS ARE ASKED AS OF DEC 31, [YEAR] RATHER THAN ?TODAY?.]
[THE RESPONDENT MUST HAVE BEEN LIVING IN THE RU ON DEC 31, [YEAR] TO BE CODED AS AN RU MEMBER RESPONDENT. OTHERWISE, CODE AS A PROXY.]
IS RESPONDENT:
HELP: F1

Responses:

RU MEMBER OR 1
PROXY APPROVED BY SUPERVISOR? 2 ST40 [ST1025]

Programmer Instructions:

If coded ?1? [RU MEMBER] and student RU, select student automatically by CAPI at ST50, then go to ST70.
If coded ?1? [RU member] and standard or new RU, go to ST50.

Display Instructions:

Display ?PLEASE NOTE: THIS IS A ROUND 5 INTERVIEW. QUESTIONS ARE ASKED AS OF DEC 31, [YEAR] RATHER THAN ?TODAY?.? if Round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display.
Display 'THE RESPONDENT ?' if Round 5, where 'YEAR' is the second calendar year of the panel. Otherwise, use a null display.

ST40 [ST1025]

BLAISE NAME: CodeAllResnNotResp
Question Text:

WHY IS A PROXY RESPONDENT NECESSARY?
ENTER ALL THAT APPLY

Responses:

RU MEMBER[S] IS SERIOUSLY ILL 1 ST60 [ST1035]
RU MEMBER[S] IS BLIND 2 ST60 [ST1035]
RU MEMBER[S] CAN'T SPEAK OR HEAR 3 ST60 [ST1035]
RU MEMBER[S] HAS A MEMORY OR OTHER COGNITIVE IMPAIRMENT 4 ST60 [ST1035]
RU MEMBER[S] DECEASED 5 ST60 [ST1035]
RU MEMBER[S] INSTITUTIONALIZED 6 ST60 [ST1035]
TEMP RU: MISSED CHILD UNDER 16 [USE ONLY WHEN INSTRUCTED] 7 ST60 [ST1035]

Programmer Instructions:

Refused and Don?t Know not allowed.

Display Instructions:

ST50 [ST1030]

BLAISE NAME: RespRoster
Question Text:

SELECT THE RESPONDENT.
[TO ADD A NEW RU MEMBER AS A RESPONDENT, PRESS CTRL-A.]
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME] is a [AGE] - year-old [SEX] part of [RUID],1 1 ST70 [ST1040]
[FIRST NAME [MIDDLE NAME] LAST NAME] is a [AGE] - year-old [SEX] part of [RUID],2 2 ST70 [ST1040]
[FIRST NAME [MIDDLE NAME] LAST NAME] is a [AGE] - year-old [SEX] part of [RUID],3 3 ST70 [ST1040]
[FIRST NAME [MIDDLE NAME] LAST NAME] is a [AGE] - year-old [SEX] part of [RUID],4 4 ST70 [ST1040]
[FIRST NAME [MIDDLE NAME] LAST NAME] is a [AGE] - year-old [SEX] part of [RUID],N 5 ST70 [ST1040]

Programmer Instructions:

If person from another RU is selected and verified as the respondent, add person to RU-members-roster.
Roster behavior:
Only single select or single add allowed.
Limited edit and delete allowed. RU members that have been ?preloaded? for this case [RU members that are from the NHIS or the previous round] cannot be edited or deleted at any person roster. Only newly added RU members that have been added at this screen during the current interviewing session can be edited or deleted [except as described below when add, edit, and delete are disallowed and not shown]. FIs may back up and return to this screen to use edit or delete functionality, but may not edit or delete an RU member added at this screen at any other person roster.
Soft checks:
If person from another RU selected, display the message: "PERSON IS MEMBER OF ANOTHER RU. VERIFY THAT PERSON JOINED OR CORRECT SELECTION."
If a preloaded RU member under 18 or in age categories 1-4 is selected as the respondent, display message "RESPONDENT UNDER 18. S/HE MUST BE APPROVED BY SUPERVISOR. RESELECT TO VERIFY."
If a preloaded RU member's age is Refused, Don't Know, or Missing and is selected as the respondent, display message: "VERIFY RESPONDENT IS 18 YEARS OF AGE OR OLDER. IF LESS THAN 18, S/HE MUST BE APPROVED BY SUPERVISOR. RESELECT TO VERIFY."
If Round 5 and if an RU member who was previously institutionalized is selected as the respondent, display message: "[PERSON] WAS INSTITUTIONALIZED IN THE PRIOR ROUND. CONFIRM [PERSON] LEFT INSTITUTION BEFORE 12/31/[YEAR]. IF [HE/SHE] LEFT THE INSTITUTION AFTER 12/31/[YEAR], SELECT ANOTHER RESPONDENT AT ST50 [RespRoster] OR BACK-UP AND SELECT A PROXY RESPONDENT AT ST30 [RespMmbProxy]."
Hard check:
If person is marked as already having an interview completed this round, display message: "PERSON CANNOT BE SELECTED. S/HE HAS ALREADY BEEN INTERVIEWED WITH ANOTHER RU."
If ST20 is coded ?2? [NO] and same person selected as respondent as in previous interviewing session [e.g., that person?s name was displayed as respondent at ST20], display message: IF SAME RESPONDENT AS PREVIOUS INTERVIEWING SESSION, BACK-UP TO ST20 [SameResp] AND CORRECT RESPONSE.
If case is a restart and the RE section has been completed, person selected as the respondent cannot have already been marked as having left the RU prior to the interview date [i.e., deceased, institutionalized, FT military outside US, FT military inside US, FT military alone, not FT military outside US, Student outside US, whereabouts unknown] [CtrlTrackSumm=1, 2, 4, 5, 6, 8, 9, 12, 13]. If person selected as respondent, display the following message: ?[PERSON] MARKED AS [DECEASED/NOT LIVING HOUSEHOLD ON INTERVIEW DATE]. MAKE ANOTHER SELECTION.? Substitute RU member selected for [PERSON]. Display ?DECEASED? if person?s CtrlTrackSumm=1, otherwise display ?NOT LIVING HOUSEHOLD ON INTERVIEW DATE?.
If a person was added during this interviewing session [CREATEQ=ST50 and OrigRnd=Current Round and DeleteFlg=empty], but was not selected at ST50 when interviewer leaves the screen, display the following message: ?you HAVE just added [PERSON], but did not select [HIM/HER] as the respondent. IF NEWLY ADDED PERSON IS NOT THE RESPONDENT, USE Ctrl-D TO DELETE THAT PERSON AND THEN SELECT/ADD THE CORRECT RESPONDENT. NEW RU MEMBERS CAN BE ADDED AT RE520.?

Display Instructions:

Roster 3 ? add/edit/delete allowed
Roster definition:
The first time the case is launched [no previous re-starts], the roster at ST50 is displays the DU-Members-Roster for selection. Roster filter: None, display all DU members. After a re-start, the roster at ST50 changes definitions:
If RE has been completed [passed the RE wall], display the current RU-members-roster as finalized in RE. Roster filter: None, display all RU members. [No longer display the DU roster.] However, RU members marked as having left the RU prior to the interview date [i.e., deceased, institutionalized, FT military outside US, FT military inside US, FT military alone, not FT military outside US, Student outside US, whereabouts unknown] [CtrlTrackSumm=1, 2, 4, 5, 6, 8, 9, 12, 13] should be displayed in grayed out text.
If RE has not yet been completed:
If RE520 does not have a response: Display the full DU-members-roster; roster filter: None, display all DU members. If any RU members have been added to the RU during the earlier session[s], they should also be displayed at ST50.
If RE520 is ?2? [NO] ?RF? [REFUSED] or ?DK? [DON?T KNOW] or RE530 has a response: display the current RU-members-roster as it stands. Roster filter: None, display all RU members, including any new persons who have been added to the RU during the earlier session[s].
Rules for allowing RU members to be added as a respondent at ST50:
If case is a ?Student RU? ? the FI can never add a new RU member as a respondent at ST50 [via CTRL-A]. Student is automatically selected at ST50 by CAPI. Do not display the instruction ?TO ADD A NEW RU MEMBER AS A RESPONDENT, PRESS CTRL-A.? or the CTRL-A, CTRL-E, CTRL-D instructions.
If case is a ?New RU? or ?Standard? RU ? the FI is allowed to add a new RU member as a respondent at ST50 [via CTRL-A] until RE520 is coded ?2? [NO] ?RF? [REFUSED] or ?DK? [DON?T KNOW] or RE530 has a response. In those instances, display the instruction ?TO ADD A NEW RU MEMBER AS A RESPONDENT, PRESS CTRL-A.? and display CTRL-A, CTRL-E, CTRL-D instructions.
Once RE520 is coded ?2? [NO] ?RF? [REFUSED] or ?DK? [DON?T KNOW] or RE530 has a response, ST50 cannot allow a new RU member to be added as a respondent and the instruction ?TO ADD A NEW RU MEMBER AS A RESPONDENT, PRESS CTRL-A.? is not displayed and the options for CTRL-A, CTRL-E, and CTRL-D should be grayed out. This rule applies to both the current interviewing session [e.g., if an FI were to back all the way up from the end of RE and go back to ST50] and after a restart.
For ?AGE?, display person's age calculated according to age calculation specifications in the GL section.
For ?SEX?, display person's sex as collected during previous interview. For ?RUID?, display the RUID associated with this person. If person is marked as PriorRndEnelig=Yes, the RUID will not display.
When CTRL-A selected, display the following customized question wording in the pop-up at ST50: ENTER NAME OF RU MEMBER RESPONDENT.
VERIFY RESPONDENT IS 18 YEARS OF AGE OR OLDER. IF LESS THAN 18, S/HE MUST BE APPROVED BY SUPERVISOR.
May I have your full name? VERIFY SPELLING. IF NO MIDDLE NAME OR INITIAL, LEAVE FIELD BLANK.
Display ?ENTER NAME OF RU MEMBER RESPONDENT? and ?May I have your full name?
VERIFY SPELLING.? in lighter "grayed-out" text when cursor in middle name or last name entry field. Display ?IF NO MIDDLE NAME OR INITIAL, LEAVE FIELD BLANK.? when cursor in middle name entry field.
Display "VERIFY RESPONDENT IS 18 YEARS OF AGE OR OLDER. IF LESS THAN 18, S/HE MUST BE APPROVED BY SUPERVISOR." in red when on any entry field in the pop-up.

ST60 [ST1035]

BLAISE NAME: ProxyRoster
Question Text:

[SELECT PROXY.]
TO ADD A NEW PROXY APPROVED BY SUPERVISOR, PRESS CTRL-A.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

Responses:

[FIRST NAME [MIDDLE NAME] LAST NAME]1 1 ST70 [ST1040]
[FIRST NAME [MIDDLE NAME] LAST NAME]2 2 ST70 [ST1040]
[FIRST NAME [MIDDLE NAME] LAST NAME]3 3 ST70 [ST1040]
[FIRST NAME [MIDDLE NAME] LAST NAME]4 4 ST70 [ST1040]
[FIRST NAME [MIDDLE NAME] LAST NAME]N 5 ST70 [ST1040]

Programmer Instructions:

Roster behavior:
Only single select or single add allowed.
Roster has an upper limit of 10 proxy names.
Limited edit and delete allowed. Proxies that have been ?preloaded? for this case [proxies that are from the previous round] cannot be edited or deleted. Newly added proxies during the current interviewing session may only be edited or deleted at ST60. FIs may back up and return to this screen to use edit or delete functionality.
Set a three-byte proxy identifier [P01, P02, etc.] for the person added/selected as a proxy.
Hard check:
If ST20 is coded ?2? [NO] and same proxy is selected as in previous interviewing session [e.g., that person?s name was displayed as proxy at ST20], display message: ?IF SAME PROXY AS PREVIOUS INTERVIEWING SESSION, BACK-UP TO ST20 [SameResp] AND CORRECT RESPONSE.?
NOTE: The DU roster is only displayed when adding RU member respondents. A DU member can be added as a new proxy respondent, but it will be without a link to the DU-Members-Roster.

Display Instructions:

Display "SELECT PROXY." if at least one proxy is already listed on the RU-Proxy-Roster. Otherwise, use a null display.
Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays RU-Proxy-Roster for selection of proxy.
Roster filter:
None
When CTRL-A selected, display the following customized question wording in the pop-up:
ENTER NAME OF PROXY RESPONDENT.
May I have your full name? VERIFY SPELLING.
IF NO MIDDLE NAME OR INITIAL, LEAVE FIELD BLANK.
Display ?ENTER NAME OF PROXY RESPONDENT? and ?May I have your full name? VERIFY SPELLING.? in lighter "grayed-out" text when cursor in middle name or last name entry field. Display ?IF NO MIDDLE NAME OR INITIAL, LEAVE FIELD BLANK.? when cursor in middle name entry field.

ST70 [ST1040]

BLAISE NAME: ForQC
Question Text:

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

Responses:

CONTINUE WITH RECORDING 1 BOX_20 [ST1045]
CONTINUE, RECORDING REFUSED 2 BOX_20 [ST1045]

Programmer Instructions:

If ?CONTINUE WITH RECORDING?, set CARI recording status to ON for the respondent/proxy selected for this interviewing session.
If ?CONTINUE, RECODING REFUSED?, set CARI recording status to OFF for the respondent/proxy selected for this interviewing session.

Display Instructions:

BOX_20 [ST1045]

Route Details:

If case is a restart after the RE section has been completed, continue with ST80.
Otherwise, go to BOX_30.

ST80 [ST1050]

BLAISE NAME: EndSTSection
Question Text:

CAPI WILL NOW TAKE YOU TO THE QUESTION YOU LEFT OFF AT DURING THE LAST INTERVIEWING SESSION.
PRESS F2 TO REVIEW WHAT HAS HAPPENED SO FAR IN INTERVIEW.
PRESS 1 AND ENTER TO CONTINUE.

Responses:

CONTINUE 1 BOX_30 [ST1055]

Display Instructions:

BOX_30 [ST1055]

Route Details:

If interview is a restart after the RE section, go to the field in CAPI interview where most recent break-off occurred.
If interview is a restart during the RE section [e.g., RE is not yet completed] and RU is a Student RU go to the field in the RE section where most recent break-off occurred.
If interview is a restart during the RE section [e.g., RE is not yet completed] and RU is a New RU or a Standard RU, go to:

If single person RU, go to the first unanswered question in the RE section.
If preloaded number of RU members, excluding persons who were institutionalized at the time of the last interview [InstAtTimeOfPrevint=Yes] is >1, and break-off occurred prior to the completion of LOOP_20 [if LOOP_20 was on route], go to RE310. Otherwise, go to the field in the RE section where most recent break-off occurred. If any answers now fail the Blaise ?rules? [e.g., because you?ve now selected a respondent that you previously said left the RU], go to the first place where the rules failed.
Otherwise, go to RE-A.

Form Approved
OMB# 0935-0118
Exp. Date 12/31/2018

Your Health and Health Opinions

Your opinion matters!
Medical Expenditure Panel Survey (MEPS)
There are a lot of clinical preventive care services available, such as screening tests for different types of cancer or heart disease. Not everyone makes the same choices about which tests to have, when to have a particular test or how often. By answering this questionnaire, you will help MEPS learn about the different choices different people make about preventive care.

This Booklet Should Be Completed By

REGION: RUID: PID:

NAME:

DOB: SEX:

This survey is authorized under 42 U.S.C. 299a. The confidentiality of your responses to this survey is protected by Sections 944(c) and 308(d) of the Public Health Service Act [42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)]. Information that could identify you will not be disclosed unless you have consented to that disclosure. Public reporting burden for this collection of information is estimated to average 7 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-0118) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Department of Health and Human Services (HHS) logo
The Agency for Healthcare Research and Quality and
The Centers for Disease Control and Prevention of the
U.S. Department of Health and Human Services

Your Health and Health Choices

1.
Are you male or female?

() Male
() Female

What is your age?

() Under 18
() 18 to 34
() 35 to 49
() 50 or older

In general, would you say your health is:

() Excellent
() Very good
() Good
() Fair
() Poor

4.
The following items are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?

a.
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf

() Yes, limited a lot
() Yes, limited a little
() No, not limited at all

b.
Climbing several flights of stairs

() Yes, limited a lot
() Yes, limited a little
() No, not limited at all

5.
During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

a.
Accomplished less than you would like as a result of your physical health

() No, none of the time
() Yes, a little of the time
() Yes, some of the time
() Yes, most of the time
() Yes, all of the time

b.
Were limited in the kind of work or other activities as a result of your physical health

() No, none of the time
() Yes, a little of the time
() Yes, some of the time
() Yes, most of the time
() Yes, all of the time

6.
During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?

a.
Accomplished less than you would like as a result of any emotional problems

() No, none of the time
() Yes, a little of the time
() Yes, some of the time
() Yes, most of the time
() Yes, all of the time

b.
Didn't do work or other activities as carefully as usual as a result of any emotional problems

() No, none of the time
() Yes, a little of the time
() Yes, some of the time
() Yes, most of the time
() Yes, all of the time

During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)?

() Not at all
() A little bit
() Moderately
() Quite a bit
() Extremely

These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling.

8.
How much of the time during the past 4 weeks:

a.
Have you felt calm and peaceful?

() All of the time
() Most of the time
() A good bit of the time
() Some of the time
() A little of the time
() None of the time

b.
Did you have a lot of energy?

() All of the time
() Most of the time
() A good bit of the time
() Some of the time
() A little of the time
() None of the time

c.
Have you felt downhearted and blue?

() All of the time
() Most of the time
() A good bit of the time
() Some of the time
() A little of the time
() None of the time

9.
During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)?

() All of the time
() Most of the time
() Some of the time
() A little of the time
() None of the time

10.
The following questions ask about how you have been feeling during the past 30 days. For each question, please mark the box that best describes how often you had this feeling.
During the past 30 days, about how often did you feel...

a. nervous?

() All of the time
() Most of the time
() Some of the time
() A little of the time
() None of the time

b. hopeless?

() All of the time
() Most of the time
() Some of the time
() A little of the time
() None of the time

c. restless or fidgety?

() All of the time
() Most of the time
() Some of the time
() A little of the time
() None of the time

d. so sad that nothing could cheer you up?

() All of the time
() Most of the time
() Some of the time
() A little of the time
() None of the time

e. that everything was an effort?

() All of the time
() Most of the time
() Some of the time
() A little of the time
() None of the time

f. worthless?

() All of the time
() Most of the time
() Some of the time
() A little of the time
() None of the time

11.
The following two questions ask about how you have been feeling in the past 2 weeks.
Over the last 2 weeks, how often have you been bothered by any of the following problems?

Nearly every day
More than half the days
Several days
Not at all

a. Little interest or pleasure in doing things...

()
()
()
()

b. Feeling down, depressed, or hopeless...

()
()
()
()

Your Choices about Your Health
12.
In the past 12 months, have you received counseling or information about birth control from a doctor or other medical care provider?

() Yes
() No

13.
When was the last time you visited a doctor or nurse for a check-up, follow-up care for an ongoing problem, or a concern that you have about your health? Do not include times you were hospitalized overnight or visits to the hospital emergency room.

() Within the past 12 months
() Within the past one to two years
() Within the past two to five years
() More than five years ago
() Never

14.
During the past 12 months, have you had either a flu shot (directly in the arm or into the skin) or a flu vaccine that was sprayed in your nose?

() Yes
() No

15.
In the past 12 months, has a doctor, nurse, or other health care professional weighed you?

() Yes
() No

16.
About how much do you weigh without shoes?

() Weight (pounds)

17.
About how tall are you without shoes?

() Feet () Inches

18.
In the past 12 months, has a doctor, nurse, or other health care professional given you advice about how to manage your weight, discussed weight loss goals with you, or referred you to a weight loss program to help with your diet and exercise?

() Yes
() No

19.
In the last 12 months, has a doctor, nurse, or other health professional asked you how much and how often you drink alcohol? You may have answered in person, on paper, or on a computer.

() Yes
() No

20.
In the last 12 months, have you had 4 or more drinks in one day? (A drink refers to one 12 oz. beer, 5 oz. glass of wine, or 1.5 oz. shot of hard liquor.)

() Yes
() No

21.
In the last 12 months, has a doctor, nurse, or other health care professional advised you to cut back or stop drinking alcohol?

() Yes
() No

22.
Has a doctor, nurse, or other health care professional ever asked you if you smoke or use tobacco? You may have answered in person, on paper, or on a computer.

() Yes
() No

23.
In the last 12 months, on average, would you say you smoked cigarettes or used tobacco every day, some days, or not at all?

() Every day
() Some days
() Not at all Skip to Question 27

24.
In the past 12 months, were you advised by a doctor, nurse, or other health care professional to quit smoking or quit using tobacco?

() Yes
() No

25.
In the past 12 months, were you advised by a doctor, nurse, or other health care professional to take a medication to assist you with quitting smoking or using tobacco? Some medications that can be used are: nicotine gum, patch, nasal spray, inhaler, or prescription medicine.

() Yes
() No

26.
In the past 12 months, has a doctor, nurse, or other health care professional discussed or provided methods and strategies other than medication to assist you with quitting smoking or using tobacco? Examples of methods and strategies are: telephone helpline, individual or group counseling, or program to help stop smoking.

() Yes
() No

27.
In the past 12 months, has your doctor, nurse, or other health care professional asked you about your mood, such as whether you are anxious or depressed? You may have answered in person, on paper, or on a computer.
() Yes
() No

28.
During the past 24 months, have you had your blood pressure checked by a doctor, nurse, or other health care professional?

() Yes
() No

29.
Within the past 5 years, have you had your blood cholesterol checked by a doctor, nurse, or other health care professional?

() Yes
() No

30.
Have you had a hysterectomy or have you ever had cervical cancer?
arrow pointing to next question

() Yes Skip to Question 33
() No

31.
Within the past 5 years, have you had a Pap test? A Pap smear or Pap test is a routine test in which the doctor takes a cell sample from the cervix with a small stick or brush, and sends it to the lab.

() Yes
() No

32.
About how old were you the last time you had a Pap test?

() Younger than 35
() 35 to 44 years old
() 45 to 54 years old
() 55 to 64 years old
() 65 to 74 years old
() 75 or older
() I have never had a Pap or HPV test

If you are 50 or older, please continue with the questions.
If you are under 50 years old, please go to the ?Date Completed? box on the last page.
33.
Have you ever had a pneumonia shot? A pneumonia shot or pneumococcal vaccine is usually only given once or twice in a person's lifetime.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

34.
Have you had the shingles vaccine? The vaccine is called Zostavax®, the zoster vaccine, or the shingles vaccine. The chicken pox virus causes shingles. The vaccine has been available since May 2006.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

35.
Is there any medical reason why you cannot take aspirin, such as an allergy, another medication you take, or other side effect?
arrow pointing to next question

() Yes Skip to Question 37
() No

36.
Has a doctor, nurse, or other health care professional ever discussed with you the use of aspirin to prevent heart attack or stroke?

() Yes
() No

37.
Have you ever been told by a doctor, nurse, or other health care professional that you have osteoporosis? Osteoporosis is when the bones become fragile and break easily.
arrow pointing to next question
() Yes If Yes, go to 39
() No

38.
There are several tests to measure bone density and detect osteoporosis at an early stage, including a DEXA scan. Have you ever had your bone density measured?

() Yes
() No

39.
Have you had both breasts removed or have you ever had breast cancer?
arrow pointing to next question

() Yes Skip to Question 41
() No

40.
Within the past 2 years, have you had a mammogram? A mammogram is an x-ray taken only of the breast by a machine that presses against the breast.

() Yes
() No

41.
Have you had colon cancer or your entire colon removed?
arrow pointing to next question

() Yes If Yes, go to the ?Date Completed? box
() No

42.
Within the past 10 years, have you had a colonoscopy? A colonoscopy test examines the bowel by inserting a tube into the rectum. After a colonoscopy, you feel tired and usually need someone to drive you home.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

43.
Within the past 5 years, have you had a sigmoidoscopy? A sigmoidoscopy test also examines the bowel by inserting a tube into the rectum. You are awake during this test and can drive yourself home.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

44.
Within the past 12 months, have you had a blood stool test using a home kit? A doctor, nurse, or other health professional provides you a special kit or cards to use at home to determine whether the stool contains blood.

() Yes
() No, it was offered to me by a doctor, nurse, or other health care professional but I chose not to receive it
() No, for any other reason

Date completed:

Who completed this form?

arrow pointing to next question () Person named on front of this form
() Someone else,

If Someone Else, what is person?s relationship to the person named on the front of this form?

() Husband or wife
() Unmarried partner
() Mother, father, or guardian
() Son or daughter
() Other relative
() Not related

THANK YOU FOR COMPLETING THE QUESTIONNAIRE!
Please place this survey in the envelope provided to you and give it to the MEPS interviewer.

If the interviewer is no longer available, place the survey in the return envelope provided to you by the interviewer. If the envelope is missing, mail this survey to:

MEPS
c/o Westat
1600 Research Blvd, Room GA51
Rockville, MD 20850

Data Year 2015
15-233.F

Your Health and Health Opinions

This Booklet Should Be Completed By

REGION: RUID: PID:

NAME:

DOB: SEX:

Your Health and Health Choices

1.
Are you male or female?

() Male
() Female

2.
What is your age?

() Under 18
() 18 to 34
() 35 to 49
() 50 or older

3.
In general, would you say your health is: