BLAISE NAME: ERCondRoster
Context Header: 
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
Question Text:
What conditions were discovered or led [you/[PERSON]] to make this visit?
PROBE: Any other condition?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

Responses:
[MEDICAL CONDITION] 1 1 ER50 (ER1025)
[MEDICAL CONDITION] 2 2 ER50 (ER1025)
[MEDICAL CONDITION] 3 3 ER50 (ER1025)
[MEDICAL CONDITION] 4 4 ER50 (ER1025)
[MEDICAL CONDITION]N 5 ER50 (ER1025)
Programmer Instructions: 
Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Display Instructions:
Roster 3 - add/edit/delete allowed
Roster definition:
Display the person-medical-conditions-roster for the selection and addition of one or many medical condition(s) associated with this event. Display name of medical condition (COND.CONDNAM)
Roster filter:
Display all conditions on person's roster; no filter.

BLAISE NAME: HHCondRoster
Context Header: 

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (EVN-MO)

What health condition led (you/(PERSON)) to receive home health care services from (someone from) (PROVIDER) during (VISIT MONTH)?
PROBE: Any other health condition?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

(MEDICAL CONDITION) 1 1 HH90 (HH1085)
(MEDICAL CONDITION) 2 2 HH90 (HH1085)
(MEDICAL CONDITION) 3 3 HH90 (HH1085)
(MEDICAL CONDITION) 4 4 HH90 (HH1085)
(MEDICAL CONDITION)N 5 HH90 (HH1085)

Roster Behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event.
The link is created when the collection of utilization and/or charge/payment data is complete.

Roster 3 - Add/Edit/Delete Allowed
Roster Definition:
Display the Person's-Medical-Conditions Roster for the selection and/or addition of one or more medical condition (s) associated with this event. Display name of medical condition (COND.CONDNAM).
Roster Filter:
Display all conditions on person's roster; no filter.
Display ?someone from? if provider is flagged as ?AGENCY?.

BLAISE NAME: IPCondRoster
Context Header:

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER......) (ADM-DT)
(DIS-DT)

What conditions were discovered or led (you/(PERSON)) to enter the hospital?
PROBE: Any other condition?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP: F1

(MEDICAL CONDITION) 1 1 HS50 (HS1025)
(MEDICAL CONDITION) 2 2 HS50 (HS1025)
(MEDICAL CONDITION) 3 3 HS50 (HS1025)
(MEDICAL CONDITION) 4 4 HS50 (HS1025)
(MEDICAL CONDITION)N 5 HS50 (HS1025)

Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.

Roster 3 - add/edit/delete allowed
Roster definition:
This item displays person-medical-conditions-roster for selection and addition of one or many medical conditions associated with this event. Display name of medical condition (COND.CONDNAM)
Roster filter:
Display all conditions on person's roster; display all.

BLAISE NAME: MVCondRoster
Context Header: 

(PERSON?S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER) - (DOC OR DEPT) (EVN-DT)

What conditions were discovered or led (you/ (PERSON)) to make this visit?
PROBE: Any other condition?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP:F1

(MEDICAL CONDITION) 1 1 MV80 (MV1055)
(MEDICAL CONDITION) 2 2 MV80 (MV1055)
(MEDICAL CONDITION) 3 3 MV80 (MV1055)
(MEDICAL CONDITION) 4 4 MV80 (MV1055)
(MEDICAL CONDITION)N 5 MV80 (MV1055)

Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.

Roster 3-add/edit/delete allowed.
Roster definition:
Display the Person-Medical-Conditions-Roster for selection and addition of one or many medical condition (s) associated with this event. Display name of medical condition (COND.CONDNAM)
Roster filter:
Display all conditions on person's roster; no filter.

BLAISE NAME: OPCondRoster
Context Header: 

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF MEDICAL CARE PROVIDER)-(DOC OR DEPT) (EVN-DT)

What conditions were discovered or led (you/ (PERSON)) to make this visit?
PROBE: Any other condition?
ENTER ALL THAT APPLY
CRTL-A:ADD
CRTL-E:EDIT
CRTL-D:DELETE
HELP: F1

(MEDICAL CONDITION) 1 1 OP70 (OP1050)
(MEDICAL CONDITION) 2 2 OP70 (OP1050)
(MEDICAL CONDITION) 3 3 OP70 (OP1050)
(MEDICAL CONDITION) 4 4 OP70 (OP1050)
(MEDICAL CONDITION)N 5 OP70 (OP1050)

Roster behavior:
Multiple select allowed.
Multiple add allowed.
Limited delete allowed. Interviewer may delete a condition added at this item until CAPI creates the link between this condition and the event. The link is created when the collection of utilization and/or charge/payment data is complete.
Limited edit allowed. Interviewer may edit a condition name newly added at this item until CAPI creates the link between this condition and the event.The link is created when the collection of utilization and/or charge/payment data is complete.

Roster 3- Add/Edit/Delete Allow
Roster definition:
Display the Person-Medical-Conditions-Roster for selection and addition of one or many medical condition(s) associated with this event. Display name of medical condition (COND.CONDNAM).
Roster filter:
Display all conditions on person's roster; no filter.

BLAISE NAME: PmedCondRoster
Context Header: 

(PERSON'S FIRST MIDDLE AND LAST NAME) (NAME OF PRESCRIPTION MEDICINE.) (STR-DT) (END-DT)

(Now, let's talk about (MEDICINE).)
What health problem is (MEDICINE) prescribed for?
PROBE: Any other health problems?
ENTER ALL THAT APPLY
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
HELP:F1

(MEDICAL CONDITION) 1 1 BOX_60 (PM1210)
(MEDICAL CONDITION) 2 2 BOX_60 (PM1210)
(MEDICAL CONDITION) 3 3 BOX_60 (PM1210)
(MEDICAL CONDITION) 4 4 BOX_60 (PM1210)
(MEDICAL CONDITION)N 5 BOX_60 (PM1210)

Roster Behavior:
Multiple select allowed. Selection should not impact the round flag of the condition.
Multiple add allowed. Interviewer should record condition name.
Limited delete allowed. Interviewer may delete a condition added at this item as long as CAPI has not created a link between this condition and an event. If a condition, added in PMed section, is never linked to an event, that condition can be deleted until a link is made between the condition and the medicine. The link between condition and the medicine is created at END_LP10 (the end of the cycle for the medicine being asked about).
Limited edit allowed. Interviewer may edit a condition name added at this item as long as CAPI has not created a link between this condition and an event. If a condition, added in PMed section, is never linked to an event, that condition can be edited until a link is made between the condition and the medicine. The link between the condition and the medicine is created at END_LP10 (the end of the cycle for the medicine being asked about).

Roster 3- Add/Edit/Delete allowed.
Roster Definition:
Display the person-medical-conditions-roster for the selection and addition of one or many medical condition(s) associated with this medicine.
Roster Filter:
Display all conditions on person's roster; no filter.
Display 'Now let's talk about (MEDICINE).' if this is the first question presented in LOOP_10, otherwise, use a null display.

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What did [you/[PERSON]] have?
PROBE: Did [you/he/she] have any other health problems, accidents, or injuries?

IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.
[Medical Condition]
[Medical Condition]
[Medical Condition] [END_LP01]
----------------------------------------------------
AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
----------------------------------------------------
----------------------------------------------------
DISPLAY ?ADD CONDITION? AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ANY CONDITION ADDED TO THE ROSTER SHOULD BE FLAGGED AS ?CREATED? THIS ROUND (WITH THE ROUND STATUS). ANY CONDITION SELECTED AT THE ROSTER SHOULD BE FLAGGED AS ?SELECTED? THIS ROUND (WITH THE ROUND STATUS). THIS FLAGGING SHOULD OCCUR, AT ALL OF THE PERSON?S-MEDICAL-CONDITIONS-ROSTERS THROUGHOUT THE INSTRUMENT, THE FIRST TIME THE CONDITION IS ADDED OR SELECTED DURING THE ROUND. FOR EXAMPLE, IF IT IS ROUND 1, ALL CONDITIONS ON THE ROSTER WOULD HAVE THE FLAG ?CREATED - ROUND 1?. IF A CONDITION IS CREATED IN CE, BUT SELECTEDIN MV, ALL DURING ROUND 1, IT WOULD ONLY HAVE THE FLAG ?CREATED - ROUND 1?. THUS, FOR ANY ONE ROUND, A CONDITION CAN ONLY BE FLAGGED AS ?CREATED? OR ?SELECTED?. IF IT IS ROUND 2 AND A CONDITION THAT WAS CREATED IN ROUND 1 IS SELECTED, IT SHOULD BE FLAGGED AS ?SELECTED - ROUND 2?. THIS FLAG IS IN ADDITION TO THE ORIGINAL ?CREATED
- ROUND 1? FLAG.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE CONDITION NAME.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET ?RECORDED? THE CONDITION.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET ?RECORDED? THE CONDITION.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL CONDITIONS ON PERSON?S ROSTER.
----------------------------------------------------

[PERSON?S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
What conditions were discovered or led [you/[PERSON]] to enter the hospital?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
DISPLAY ?ADD CONDITION? AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS-COND-1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON-MEDICAL-CONDITIONS-ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITIONS ASSOCIATED WITH THIS EVENT
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. MULTIPLE ADD ALLOWED.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON?S ROSTER; DISPLAY ALL.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
What conditions were discovered or led [you/[PERSON]] to make this visit?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
DISPLAY ?ADD CONDITION? AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
GO TO ER05
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORDTHE CONDITION NAME.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT. IF THE INTERVIEWER ATTEMPTS TO DELETE A CONDITION WHEN DELETE IS NOT ALLOWED, DISPLAY THE FOLLOWING MESSAGE: ?DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.?
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON?S ROSTER; NO FILTER.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
What conditions were discovered or led [you/[PERSON]] to make this [visit/telephone call]?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
DISPLAY ?visit? IF OP02 IS CODED ?1? (SAW PROVIDER), ?-7? (REFUSED), OR ?-8? (DON?T KNOW) FOR THIS EVENT. DISPLAY ?telephone call? IF OP02 IS CODED ?2?(TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
DISPLAY ?ADD CONDITION? AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. MULTIPLE ADD ALLOWED.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON?S ROSTER; NO FILTER.
----------------------------------------------------

[PERSON?S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
What conditions were discovered or led [you/[PERSON]] to make this [visit/telephone call]?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
DISPLAY ?visit? IF MV01 IS CODED ?1? (SAW PROVIDER), ?-7? (REFUSED), OR ?-8? (DON?T KNOW) FOR THIS EVENT. DISPLAY ?telephone call? IF MV01 IS CODED ?2?(TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
DISPLAY ?ADD CONDITION? AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. MULTIPLE ADD ALLOWED.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON?S ROSTER; NO FILTER.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
What health condition led [you/[PERSON]] to receive home health care services from [someone from] [PROVIDER] during [VISIT MONTH]?
PROBE: Any other health condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
DISPLAY ?someone from? IF PROVIDER IS FLAGGED AS ?AGENCY?. OTHERWISE, USE A NULL DISPLAY.
----------------------------------------------------
----------------------------------------------------
DISPLAY ?ADD CONDITION? AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
CONTINUE WITH BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS-COND-1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON?S-MEDICAL-CONDITIONS ROSTER FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE CONDITION NAME.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT. IF THE INTERVIEWER ATTEMPTS TO DELETE A CONDITION WHEN DELETE IS NOT ALLOWED, DISPLAY THE FOLLOWING MESSAGE: ?DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED.?
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON?S ROSTER; NO FILTER.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF PRESCRIPTION MEDICINE.] [STR-DT] [END-DT]
What health problem is [MEDICINE] prescribed for?
PROBE: Any other health problems?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

[1. Medical Condition]
[2. Medical Condition]
[3. Medical Condition]
----------------------------------------------------
GO TO BOX_02A
----------------------------------------------------
----------------------------------------------------
DISPLAY ?ADD CONDITION? AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD CONDITION NAME.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON?S ROSTER; NO FILTER.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [STR-DT] [END-DT]
What did [you/[PERSON]] have?
PROBE: Did [you/he/she] have any other health problems, accidents, or injuries?

IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.
[Medical Condition]
[Medical Condition]
[Medical Condition]
[END_LP01]
AS CONDITIONS ARE ENTERED, THEY SHOULD BE FLAGGED WITH THE NUMBER OF THE ROUND IN WHICH THEY WERE FIRST CREATED. THIS ROUND FLAG WILL BE USED LATER IN THE INTERVIEW TO DETERMINE WHICH QUESTIONS SHOULD BE ASKED.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ANY CONDITION ADDED TO THE ROSTER SHOULD BE FLAGGED AS 'CREATED' THIS ROUND (WITH THE ROUND STATUS). ANY CONDITION SELECTED AT THE ROSTER SHOULD BE FLAGGED AS 'SELECTED' THIS ROUND (WITH THE ROUND STATUS). THIS FLAGGING SHOULD OCCUR, AT ALL OF THE PERSON'S-MEDICAL-CONDITIONS-ROSTERS THROUGHOUT THE INSTRUMENT, THE FIRST TIME THE CONDITION IS ADDED OR SELECTED DURING THE ROUND.
FOR EXAMPLE, IF IT IS ROUND 1, ALL CONDITIONS ON THE ROSTER WOULD HAVE THE FLAG 'CREATED - ROUND 1'. IF A CONDITION IS CREATED IN CE, BUT SELECTED IN MV, ALL DURING ROUND 1, IT WOULD ONLY HAVE THE FLAG 'CREATED - ROUND 1'. THUS, FOR ANY ONE ROUND, A CONDITION CAN ONLY BE FLAGGED AS 'CREATED' OR 'SELECTED'. IF IT IS ROUND 2 AND A CONDITION THAT WAS CREATED IN ROUND 1 IS SELECTED, IT SHOULD BE FLAGGED AS 'SELECTED - ROUND 2'.
THIS FLAG IS IN ADDITION TO THE ORIGINAL 'CREATED
- ROUND 1' FLAG.
----------------------------------------------------
----------------------------------------------------
GO TO END_LP01
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE CONDITION NAME.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET "RECORDED" THE CONDITION.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET "RECORDED" THE CONDITION.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
NO FILTER; DISPLAY ALL CONDITIONS ON PERSON'S ROSTER.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
What conditions were discovered or led [you/[PERSON]] to enter the hospital?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

Medical Condition]
Medical Condition]
Medical Condition]
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS-COND-1
COL #1 HEADER: MEDICAL CONDITION NSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
THIS ITEM DISPLAYS PERSON-MEDICAL-CONDITIONS- ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITIONS ASSOCIATED WITH THIS EVENT
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. MULTIPLE ADD ALLOWED.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; DISPLAY ALL.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
What conditions were discovered or led [you/[PERSON]] to make this visit?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

Medical Condition]
Medical Condition]
Medical Condition]
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
GO TO ER05
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE CONDITION NAME.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT. IF THE INTERVIEWER ATTEMPTS TO DELETE A CONDITION WHEN DELETE IS NOT ALLOWED, DISPLAY THE FOLLOWING MESSAGE:
"DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED."
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
What conditions were discovered or led [you/[PERSON]] to make this [visit/telephone call]?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

Medical Condition]
Medical Condition]
Medical Condition]
----------------------------------------------------
DISPLAY 'visit' IF OP02 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT. DISPLAY 'telephone call' IF OP02 IS CODED '2'(TELEPHONE CALL) FOR THIS EVENT.
----------------------------------------------------
----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
GO TO BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
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ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. MULTIPLE ADD ALLOWED.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
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ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER] [EVN-DT]
What conditions were discovered or led [you/[PERSON]] to make this [visit/telephone call]?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

Medical Condition]
Medical Condition]
[3. Medical Condition]
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DISPLAY 'visit' IF MV01 IS CODED '1' (SAW PROVIDER), '-7' (REFUSED), OR '-8' (DON'T KNOW) FOR THIS EVENT. DISPLAY 'telephone call' IF MV01 IS CODED '2'(TELEPHONE CALL) FOR THIS EVENT.
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DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
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GO TO BOX_02
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ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
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----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED.
2. MULTIPLE ADD ALLOWED.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
What health condition led [you/[PERSON]] to receive home health care services from [someone from] [PROVIDER] during [VISIT MONTH]?
PROBE: Any other health condition?

IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.
Medical Condition]
Medical Condition]
Medical Condition]
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DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'. OTHERWISE, USE A NULL DISPLAY.
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DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
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CONTINUE WITH BOX_02
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
TITLE: PERS-COND-1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON'S-MEDICAL-CONDITIONS ROSTER FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD THE CONDITION NAME.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT. IF THE INTERVIEWER ATTEMPTS TO DELETE A CONDITION WHEN DELETE IS NOT ALLOWED, DISPLAY THE FOLLOWING MESSAGE:
"DELETE ALLOWED ONLY WHEN CONDITION IS FIRST ENTERED."
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------

[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF PRESCRIPTION MEDICINE.] [STR-DT] [END-DT]
What health problem is [MEDICINE] prescribed for? PROBE: Any other health problems?
IF CONDITION IS ALREADY LISTED, SELECT ENTRY ON ROSTER.

Medical Condition]
Medical Condition]
Medical Condition]
GO TO BOX_02A
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----------------------------------------------------
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
----------------------------------------------------
----------------------------------------------------
ROSTER DETAILS:
Title: PERS_COND_1
COL #1 HEADER: MEDICAL CONDITION INSTRUCTIONS: DISPLAY NAME OF MEDICAL CONDITION (COND.CONDNAM)
----------------------------------------------------
----------------------------------------------------
ROSTER DEFINITION:
DISPLAY THE PERSON-MEDICAL-CONDITIONS-ROSTER FOR THE SELECTION AND ADDITION OF ONE OR MANY MEDICAL CONDITION(S) ASSOCIATED WITH THIS EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER BEHAVIOR:
1. MULTIPLE SELECT ALLOWED. SELECTION SHOULD NOT IMPACT THE ROUND FLAG OF THE CONDITION.
2. MULTIPLE ADD ALLOWED. INTERVIEWER SHOULD RECORD CONDITION NAME.
3. LIMITED DELETE ALLOWED. INTERVIEWER MAY DELETE A CONDITION ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS ONDITION AND THE EVENT.
4. LIMITED EDIT ALLOWED. INTERVIEWER MAY EDIT A CONDITION NAME NEWLY ADDED ON THIS SCREEN AS LONG AS CAPI HAS NOT YET CREATED THE LINK BETWEEN THIS CONDITION AND THE EVENT.
----------------------------------------------------
----------------------------------------------------
ROSTER FILTER:
DISPLAY ALL CONDITIONS ON PERSON'S ROSTER; NO FILTER.
----------------------------------------------------