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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: 
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?.

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: 
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.

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: 
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.

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:
> [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 AC310.
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.

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: 
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.

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:

 

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_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: 
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_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: 
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_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: 
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.

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:
CS-1.
[Please rate on a scale of 0 to 4 where 0 indicates no problem and 4 indicates a very big problem.]
[In general, how much of a problem do you think (you/(PERSON)) (have/has) with:]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
c. Getting along with (your/his/her) father?
Responses: 1 CS150D (CS1160)
REFUSED RF CS150D (CS1160)
DON'T KNOW DK CS150D (CS1160)
Programmer Instructions: Range check:
The values for FATHPROB should be between 0 and 4 and should also include 99. A check should be conducted to ensure that any values outside of these defined produce an error and prohibit the interviewer from continuing until corrected. If a value entered is outside the allowable range, display the following hard error message: "VALUE MUST BE BETWEEN 0 AND 4 OR 99 TO INDICATE INAPPLICABLE QUESTION. VERIFY AND CORRECT."
Display Instructions: See CS150A for display instructions.

CS150D (CS1160)
BLAISE NAME: ProbSad
Context Header: (PERSON'S FIRST MIDDLE AND LAST NAME)
Question Text:
CS-1.
[Please rate on a scale of 0 to 4 where 0 indicates no problem and 4 indicates a very big problem.]
[In general, how much of a problem do you think (you/(PERSON)) (have/has) with:]
CODE 99 IF RESPONDENT INDICATES THE QUESTION IS INAPPLICABLE.
d. Feeling unhappy or sad?
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: 
Display 'or (PERSON)' and '(him/her)' if RU member being asked about is not selected as the respondent. Otherwise, (RU member being asked about is selected as the respondent), use a null display.
Display CS460 and CS470 on the same form pane.

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: 
Display 'or (PERSON)' and '(him/her)' if RU member being asked about is not selected as the respondent. Otherwise, (RU member being asked about is selected as the respondent), use a null display.
Display CS480 and CS490 on the same form pane.

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:
 Go to the Charge/Payment (CP) section if it needs to be asked for this event, i.e. its status wasn?t set to ?Completed? because it was part of a Flat Fee situation where the charges were collected in the CP section for another event in that Flat Fee group.
Otherwise, go to the event driver (ED) section.

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: 
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.

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: 
Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
When CTRL-A selected, display the following customized question wording in the pop-up:ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.
Display (that (you/he/she) could return to) if EM30 coded ?1? (YES).

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: 
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.

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
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 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: 
Roster behavior: Roster 3 ? add/edit/delete allowed
Only single select or single add allowed.
Limited edit allowed.
Limited delete allowed.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ and DeDupOrgTp].
Regardless of whether organization is selected or added, set Job.DeDupOrgID equal to DedupOrg.DedupOrgID and Job.JobsEstbName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Employer.
Allow 40 characters for DeDupOrgName roster entries.
Display Instructions: Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
When CTRL-A selected, display the following customized question wording in the pop-up:ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.
Display ?now? if not round 5.
Display ?on December 31, (YEAR)? if round 5.
Display ?(have/has)? if not round 5.
Display ?had? if round 5.

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: 
Roster behavior: Roster 3 ? add/edit/delete allowed
Only single select or single add allowed.
Limited edit allowed.
Limited delete allowed.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ and DeDupOrgTp].
Regardless of whether organization is selected or added, set Job.DeDupOrgID equal to DedupOrg.DedupOrgID and Job.JobsEstbName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Employer.
Allow 40 characters for DeDupOrgName roster entries.
Display Instructions: Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
When CTRL-A selected, display the following customized question wording in the pop-up:ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.
Display ?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: 
Roster behavior: Roster 3 ? add/edit/delete allowed
Only single select or single add allowed.
Limited edit allowed.
Limited delete allowed.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ and DeDupOrgTp].
Regardless of whether organization is selected or added, set Job.DeDupOrgID equal to DedupOrg.DedupOrgID and Job.JobsEstbName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Employer.
Allow 40 characters for DeDupOrgName roster entries.
Display Instructions: 
Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
When CTRL-A selected, display the following customized question wording in the pop-up:
ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.
(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
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 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:
Roster behavior: Roster 3 ? add/edit/delete allowed
Only single select or single add allowed.
Limited edit allowed.
Limited delete allowed.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ and DeDupOrgTp].
Regardless of whether organization is selected or added, set Job.DeDupOrgID equal to DedupOrg.DedupOrgID and Job.JobsEstbName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Employer.
Allow 40 characters for DeDupOrgName roster entries.
Display Instructions: 
Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
When CTRL-A selected, display the following customized question wording in the pop-up:
ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.
Display ?next most recent? if not first cycle through LOOP_10. Otherwise, use a null display.
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
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 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: 
Roster behavior: Roster 3 ? add/edit/delete allowed
Only single select or single add allowed.
Limited edit allowed.
Limited delete allowed.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ and DeDupOrgTp].
Regardless of whether organization is selected or added, set Job.DeDupOrgID equal to DedupOrg.DedupOrgID and Job.JobsEstbName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Employer.
Allow 40 characters for DeDupOrgName roster entries.
Display Instructions: 
Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
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: 
Roster behavior: Roster 3 ? add/edit/delete allowed
Only single select or single add allowed.
Limited edit allowed.
Limited delete allowed.
If a new organization is added, create a new record on the DeDupOrg array [set DeDupOrgID, DeDupOrgName, OrigRnd, CreateQ and DeDupOrgTp].
Regardless of whether organization is selected or added, set Job.DeDupOrgID equal to DedupOrg.DedupOrgID and Job.JobsEstbName equal to DedupOrg.DeDupOrgName
Set DeDupOrgTp equal to Employer.
Allow 40 characters for DeDupOrgName roster entries.
Display Instructions: Roster 3 ? add/edit/delete allowed
Roster definition:
This item displays the RU JOBS ROSTER for selection of person's job or business.
Display DeDupOrgName
Roster filter: DeDupOrgTp equal to Employer, DirectPurchase_Employer
When CTRL-A selected, display the following customized question wording in the pop-up:ENTER COMPLETE NAME OF EMPLOYER/BUSINESS AND VERIFY SPELLING.
Display ?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:
(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 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: 
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 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: 
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 5 years of age or in age categories 3-9
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: 
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 5 years of age or in age categories 3-9
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: 
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 5 years of age or in age categories 3-9
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: 
[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 (RU_MEMBERS_1/FULLNAME) for selection.
Roster filter:
Display only RU members who meet the following conditions:
person is greater than or equal to 15 years of age or in age categories 4-9
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: 
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 1-6 represented providers who are unskilled. If HH10 and HH20 are only some combination of codes ?95? (NONE OF THESE), ?RF? (REFUSED), and ?DK? (DON?T KNOW), the provider is also unskilled.
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: 
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".
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)

e

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)

i1

[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: 
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_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: 
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).
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: 
[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 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:
[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.
SPECIFY: UNIT OF COVERAGE
Responses: 
1 HX600 (HX1650)
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.
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 ASSOCIATI