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2022

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2021

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2020

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2019

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2018
Survey form view entire document:  text  image
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.