FF01
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
Let me review the groups of health care events I have recorded for (PERSON). Please tell me if any of these groups include the charge that covered [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)].
REVIEW FLAT FEE GROUPS WITH RESPONDENT.
SELECT FLAT FEE GROUP COVERED BY SAME CHARGE AS EVENT BEING ASKED ABOUT.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
[1. Flat Fee Group] ....................
[2. Flat Fee Group] ....................
[3. Flat Fee Group] ....................
[Code One]
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL FLAT FEE GROUPS ON THE PERSON'S-FLAT-FEE-GROUPS-ROSTER CREATED IN THIS ROUND AND IN THE PREVIOUS ROUNDS.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'NONE OF THE ABOVE' AS THE LAST ENTRY ON THE ROSTER.
----------------------------------------------------
----------------------------------------------------
IF A FLAT FEE GROUP IS SELECTED, GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
IF 'NONE OF THE ABOVE' IS SELECTED, CONTINUE WITH FF02
----------------------------------------------------
----------------------------------------------------
NOTE: 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.
----------------------------------------------------
FF02
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER.] [EV] [EVN-DT]
Let me review the list of health care events I have recorded for (PERSON). Please tell me which of these were included in the same charge that covered [(PERSON)'s stay at (HOSPITAL) that began on (ADMIT DATE)/(PERSON)'s visit to (PROVIDER) on (VISIT DATE)/the [OME ITEM GROUP NAME] used by (PERSON) since (START DATE)/services received at home from (PROVIDER) during (MONTH) for (PERSON)/(PROVIDER)'s services as part of the visit made on (VISIT DATE)].
REVIEW EVENTS WITH RESPONDENT.
SELECT EVENTS COVERED BY SAME CHARGE AS EVENT BEING ASKED ABOUT.
TO TURN CHECK MARK ON/OFF, USE ARROW KEYS, PRESS ENTER.
TO LEAVE, PRESS ESC.
------------------------------------------------------------------------------------
ROSTER. PROVIDER FF02_02. STAY TYPE FF02_03. ADMIT DATE FF02_04 DISCH DATE
------------------------------------------------------------------------------------
[Display Medical [Display Event Code] [Display Month [Display Month
Provider-35] Day Year-2] Day Year-2]
------------------------------------------------------------------------------------
[Display Medical [Display Event Code] [Display Month [Display Month
Provider-35] Day Year-2] Day Year-2]
------------------------------------------------------------------------------------
[Display Medical [Display Event Code] [Display Month [Display Month
Provider-35] Day Year-2] Day Year-2]
------------------------------------------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION: THIS ITEM DISPLAYS ALL MEDICAL EVENTS ON PERSON'S-MEDICAL-EVENTS-ROSTER THAT MEET THE FOLLOWING CONDITIONS:
- EVENT HAS CP STATUS OF 'PROCESSED' OR 'UNPROCESSED'
- 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 PM, IC, OM TYPE 2 (INSULIN), OR OM TYPE 3 (OTHER DIABETIC SUPPLIES OR EQUIPMENT)
- EVENT IS NOT AN HS EVENT WITH A DISCHARGE DATE CODED '95' (STILL IN HOSPITAL)
- EVENT IS NOT AN MV OR OP EVENT THAT WAS A TELEPHONE CALL (OP02 OR MV01 CODED '2')
- EVENT IS NOT A HH EVENT WITH EVENT DATE = INTERVIEW MONTH
----------------------------------------------------
----------------------------------------------------
DISPLAY 'OUTSIDE REFERENCE PERIOD' AS THE LAST ENTRY IN THE 'EVENT DATE' COLUMN.
----------------------------------------------------