Survey Text

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
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2021

No questionnaire text is available for this sample.


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2020

No questionnaire text is available for this sample.


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2019

No questionnaire text is available for this sample.


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2018
Survey form view entire document:  text  image
HH20 (HH1020)
BLAISE NAME: CodeAllHcarWrkrOth
Context Header: 
(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)
Question Text:
HH-2
Please look at card HH-2. (Which/Other than what we have discussed, which) of these types of health care workers from (PROVIDER) provided home care services for (you/(PERSON)) during (VISIT MONTH)?
ENTER ALL THAT APPLY.
HELP: F1
Responses: 
COMPANION 1 HH30 (HH1025)
HOMEMAKER/HOUSE CLEANER 2 HH30 (HH1025)
HOME HEALTH AIDE/HOME CARE AIDE 3 HH30 (HH1025)
HOSPICE WORKER 4 HH30 (HH1025)
NURSE'S AIDE 5 HH30 (HH1025)
PERSONAL CARE ATTENDANT 6 HH30 (HH1025)
NONE OF THESE 95 HH30 (HH1025)
REFUSED RF HH30 (HH1025)
DON'T KNOW DK HH30 (HH1025)
Programmer Instructions: 
For specifications purposes only (this check is automatic): CAPI does not allow ?95? (NONE OF THESE), 'RF' (REFUSED) or 'DK' (DON'T KNOW) in combination with any other code.
Display the following message if these codes are selected in combination with any other code ?THIS CODE CANNOT BE SELECTED WITH OTHER OPTIONS. VERIFY AND RE-ENTER.?
MHOP NOTE: Codes 1-6 represented providers who are unskilled. If HH10 and HH20 are only some combination of codes ?95? (NONE OF THESE), ?RF? (REFUSED), and ?DK? (DON?T KNOW), the provider is also unskilled.
Display Instructions: 
Display ?Which? if HH10 is coded ?95? (NONE OF THESE), ?RF? (REFUSED) or ?DK? (DON'T KNOW). Otherwise, display ?Other than what we have discussed, which?.

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2017
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During [VISIT MONTH], what types of health care workers from [PROVIDER] provided home care services for [you/[PERSON]]?
CHECK ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA) ...... 1
COMPANION .............................. 2
DIETITIAN/NUTRITIONIST ................. 3
HOME HEALTH/HOME CARE AIDE ............. 4
HOSPICE WORKER ......................... 5
HOMEMAKER .............................. 6
I.V. OR INFUSION THERAPIST ............. 7
MEDICAL DOCTOR ......................... 8
NURSE/NURSE PRACTITIONER ............... 9
NURSE?S AIDE .......................... 10
OCCUPATIONAL THERAPIST ................ 11
PERSONAL CARE ATTENDANT ............... 12
PHYSICAL THERAPIST .................... 13
RESPIRATORY THERAPIST ................. 14
SOCIAL WORKER ......................... 15
SPEECH THERAPIST ...................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER . 91 [HH02]
REF ................................... -7 [HH03]
DK .................................... -8 [HH03]
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
?SOME OTHER TYPE OF HEALTH CARE WORKER? NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
FOR SPECIFICATIONS PURPOSES ONLY (THIS CHECK IS AUTOMATIC): CAPI DOES NOT ALLOW -7 OR -8 IN COMBINATION WITH ANY OTHER CODE.
----------------------------------------------------
----------------------------------------------------
IF CODED ?91? (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2016
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2015
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2014
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2013
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2012
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2011
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2010
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2009
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2008
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2007
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2006
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

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2005
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

top
2004
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

top
2003
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

top
2002
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

top
2001
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

top
2000
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

top
1999
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

top
1998
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

top
1997
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------

top
1996
Survey form view entire document:  text  image
HH01
====

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
SHOW CARD HH-1.
Please look at this card. During (VISIT MONTH), what types of health care workers from (PROVIDER) provided home care services for (PERSON)?
CODE ALL THAT APPLY.
CERTIFIED NURSING ASSISTANT (CNA)....... 1
COMPANION............................... 2
DIETITIAN/NUTRITIONIST.................. 3
HOME HEALTH/HOME CARE AIDE.............. 4
HOSPICE WORKER.......................... 5
HOMEMAKER............................... 6
I.V. OR INFUSION THERAPIST.............. 7
MEDICAL DOCTOR.......................... 8
NURSE/NURSE PRACTITIONER................ 9
NURSE'S AIDE........................... 10
OCCUPATIONAL THERAPIST................. 11
PERSONAL CARE ATTENDANT................ 12
PHYSICAL THERAPIST..................... 13
RESPIRATORY THERAPIST.................. 14
SOCIAL WORKER.......................... 15
SPEECH THERAPIST....................... 16
SOME OTHER TYPE OF HEALTH CARE WORKER.. 91
REF.................................... -7
DK..................................... -8
PRESS F1 FOR DEFINITION OF ANSWER CATEGORIES.
[Code All That Apply]
----------------------------------------------------
IF '-7' (REFUSED) OR '-8' (DON'T KNOW) ENTERED IN OTHER THAN FIRST FIELD, DISPLAY THE FOLLOWING MESSAGE AT THE BOTTOM OF THE SCREEN:
'RESPONSE ALLOWED ON FIRST FIELD ONLY. PLEASE RE-ENTER.'
----------------------------------------------------
----------------------------------------------------
NOTE: 'SOME OTHER TYPE OF HEALTHCARE WORKER' NOT DISPLAYED ON SHOW CARD.
----------------------------------------------------
----------------------------------------------------
IF CODED '91' (ALONE OR IN COMBINATION WITH ANY OTHER CODE), CONTINUE WITH HH02
----------------------------------------------------
----------------------------------------------------
IF CODED '-7' (REFUSED) OR '-8' (DON'T KNOW) ALONE, GO TO HH03
----------------------------------------------------
----------------------------------------------------
OTHERWISE, GO TO HH03
----------------------------------------------------