top

2021

No questionnaire text is available for this sample.

top

2020

No questionnaire text is available for this sample.

top

2019

No questionnaire text is available for this sample.

top

2018

Survey form view entire document: text image

CN01A
=====

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

[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
HELP AVAILABLE FOR DEFINITION OF ACCIDENT/INJURY.
----------------------------------------------------
FLAG ALL CONDITIONS SELECTED AT CN01A AS ?DUE TO ACCIDENT/INJURY?.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_05
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY CONDITIONS THAT MEET THE FOLLOWING:
1. CONDITION IS FLAGGED AS ?CREATED? DURING THE CURRENT ROUND.
2. CONDITION IS NOT A PRIORITY CONDITION, THAT IS, THE CONDITION IS NOT FLAGGED AS CREATED IN THE PE SECTION.
----------------------------------------------------

top

2017

Survey form view entire document: text image

CN01A
=====

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

[1. Medical Condition] .................
[2. Medical Condition] .................
[3. Medical Condition] .................
HELP AVAILABLE FOR DEFINITION OF ACCIDENT/INJURY.
----------------------------------------------------
FLAG ALL CONDITIONS SELECTED AT CN01A AS ?DUE TO ACCIDENT/INJURY?.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_05
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR SELECTION.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. ADD, EDIT, AND DELETE DISALLOWED.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY CONDITIONS THAT MEET THE FOLLOWING:
1. CONDITION IS FLAGGED AS ?CREATED? DURING THE CURRENT ROUND.
2. CONDITION IS NOT A PRIORITY CONDITION, THAT IS, THE CONDITION IS NOT FLAGGED AS CREATED IN THE PE SECTION.
----------------------------------------------------

top

2016

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2015

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2014

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2013

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2012

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2011

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2010

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2009

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2008

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2007

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2006

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2005

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2004

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2003

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2002

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2001

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

2000

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

1999

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

1998

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

1997

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

top

1996

Survey form view entire document: text image

CN02
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
[Was the (CONDITION) due to an accident or injury?/INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.]
IF OBVIOUS, CODE WITHOUT ASKING.
TO LEAVE, PRESS ESC.
1 = YES 2 = NO

ROSTER. CONDITION
CN02_02. ACCIDENT/ INJURY?
CN02_03. ON LIST?
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
[PERSON'S CN MEDICAL CONDITION.] ( ) ( )
PRESS F1 FOR DEFINITION OF ACCIDENT/INJURY AND LIST OF PRIORITY CONDITIONS.
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL CONDITIONS IN THE PERSON'S-MEDICAL-CONDITIONS- ROSTER THAT MEET THE FOLLOWING CONDITION:

- MEDICAL CONDITION IS FLAGGED AS 'CREATED' FOR PERSON DURING THE CURRENT ROUND.
----------------------------------------------------
----------------------------------------------------
CN02 SCREEN BEHAVIOR AND FILL SPECIFICATIONS:

1. DO NOT ALLOW CONDITIONS TO BE ADDED, EDITED, OR DELETED.
2. ESC CANNOT BE USED ON THIS SCREEN UNTIL ALL ANSWER FIELDS ARE ACCOUNTED FOR. IF ESC IS USED BEFORE ALL FIELDS ARE COMPLETED, DISPLAY THE FOLLOWING MESSAGE: 'CANNOT LEAVE SCREEN UNLESS ALL FIELDS COMPLETED. CHECK FOR BLANK FIELDS. PRESS ENTER TO CONTINUE.'
3. THE CURSOR WILL MOVE FROM CN02_02 TO CN02_03 FOR THE SAME CONDITION AND THEN WILL MOVE TO CN02_02 FOR THE NEXT CONDITION ON THE ROSTER, ETC. THE CURSOR MOVES IN THIS FASHION UNTIL ALL FIELDS ARE COMPLETED. IF 'PREGNANCY' IS THE CONDITION, THE CURSOR SKIPS TO THE NEXT CONDITION. IF CONDITION WAS SELECTED AT DN02, THUS CN02_02 IS ALREADY PRECODED, THE CURSOR SKIPS TO CN02_03 FOR THAT CONDITION.
4. WHEN THE CURSOR IS IN COLUMN CN02_02 THE FOLLOWING QUESTION SHOULD BE DISPLAYED: 'Was the (CONDITION) due to an accident or injury?'.
WHEN THE CURSOR IS IN COLUMN CN02_03 THE FOLLOWING TEXT SHOULD BE DISPLAYED:
'INTERVIEWER: CHECK (CONDITION) AGAINST PRIORITY LIST JOB AID.'
----------------------------------------------------
----------------------------------------------------
REFUSED ('-7') AND DON'T KNOW ('-8') DISALLOWED AT BOTH CN02_02 AND CN02_03.
----------------------------------------------------
----------------------------------------------------
NOTE: CAPI WILL PRECODE PREGNANCY AS '2' (NO) IN BOTH CN02_02 AND CN02_03. THESE PRECODED RESPONSES WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.

CAPI WILL ALSO PRECODE ALL CONDITIONS SELECTED AT DN02 AS '1' (YES) IN CN02_02. THIS PRECODED RESPONSE WILL ALREADY APPEAR AT CN02 BEFORE THE INTERVIEWER ENTERS ANY RESPONSES.
----------------------------------------------------
----------------------------------------------------
FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_02 AS 'DUE TO ACCIDENT/INJURY'. FLAG ALL CONDITIONS CODED '1' (YES) AT CN02_03 AS 'ON PRIORITY LIST'.
----------------------------------------------------

2021	2014	2007	2000
2020	2013	2006	1999
2019	2012	2005	1998
2018	2011	2004	1997
2017	2010	2003	1996
2016	2009	2002
2015	2008	2001

Survey Text