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2021
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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
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.