Survey Text
2021
No questionnaire text is available for this sample.
2020
No questionnaire text is available for this sample.
2019
No questionnaire text is available for this sample.
2018
No questionnaire text is available for this sample.
2017
No questionnaire text is available for this sample.
2016
No questionnaire text is available for this sample.
2015
No questionnaire text is available for this sample.
2014
No questionnaire text is available for this sample.
2013
No questionnaire text is available for this sample.
2012
No questionnaire text is available for this sample.
2011
No questionnaire text is available for this sample.
2010
No questionnaire text is available for this sample.
2009
No questionnaire text is available for this sample.
2008
No questionnaire text is available for this sample.
2007
No questionnaire text is available for this sample.
2006
No questionnaire text is available for this sample.
2005
No questionnaire text is available for this sample.
2004
No questionnaire text is available for this sample.
2003
No questionnaire text is available for this sample.
2002
No questionnaire text is available for this sample.
2001
Survey form
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CP07
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
To whom was the bill sent?
RECORD VERBATIM:
[Enter Text]
CP07OV1
=======
INTERVIEWER: ENTER CODE FOR TYPE OF ORGANIZATION TO WHOM BILL WAS SENT:
HMO .................................... 1
VA ..................................... 2
TRICARE (CHAMPUS/CHAMPVA) .............. 3 [CP08]
OTHER MILITARY ......................... 4
WELFARE/MEDICAID ....................... 5
WORKER'S COMPENSATION .................. 6
PRIVATE INSURANCE COMPANY .............. 7
OTHER ................................. 91 [CP08]
REF ................................... -7 [CP08]
DK .................................... -8 [CP08]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
2000
No questionnaire text is available for this sample.
1999
No questionnaire text is available for this sample.
1998
No questionnaire text is available for this sample.
1997
Survey form
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text
image
CP07
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
[REPEAT VISIT: [NAME OF REPEAT VISIT GROUP....]/FLAT FEE
GROUP: [NAME OF FLAT FEE EVENT GROUP..]]
[NAME OF PRESCRIBED MEDICINE...] [OME ITEM GROUP NAME...........]
To whom was the bill sent?
RECORD VERBATIM:
[Enter Text]
CP07OV1
=======
INTERVIEWER: ENTER CODE FOR TYPE OF ORGANIZATION TO WHOM BILL WAS SENT:
HMO .................................... 1
VA ..................................... 2
CHAMPUS/CHAMPVA ........................ 3 [CP08]
OTHER MILITARY ......................... 4
WELFARE/MEDICAID ....................... 5
WORKER'S COMPENSATION .................. 6
PRIVATE INSURANCE COMPANY .............. 7
OTHER ................................. 91 [CP08]
REF ................................... -7 [CP08]
DK .................................... -8 [CP08]
[Code One]
PRESS F1 FOR DEFINITIONS OF ANSWER CATEGORIES.
1996
No questionnaire text is available for this sample.