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
EV60 (EV1055)
BLAISE NAME: EvntAgencySelf
Context Header: [PERSON?s FIRST MIDDLE AND LAST NAME] [STR-DT][END-DT]
Question Text:
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
Responses: 
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME 1 BOX_50 (EV1060)
WORKED FOR SELF 2 BOX_50 (EV1060)
REFUSED RF BOX_50 (EV1060)
DON?T KNOW DK BOX_50 (EV1060)
Display Instructions:

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2017
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BOX_17
======

----------------------------------------------------
ASK THE EVENT ROSTER (EV) SECTION
----------------------------------------------------
----------------------------------------------------
AT COMPLETION OF THE EV SECTION, CONTINUE WITH PP28
----------------------------------------------------

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2016
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2015
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2014
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2013
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2012
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2011
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2010
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2009
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2008
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2007
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2006
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2005
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2004
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2003
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2002
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2001
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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2000
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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1999
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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1998
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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1997
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]

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1996
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EV06A
=====

[PERSON'S FIRST MIDDLE AND LAST NAME] [EV] [STR-DT] [END-DT]
Did this person work for a home health agency, hospital, or nursing home or did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing, or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME ........................... 1 [B0X_04]
WORKED FOR SELF ........................ 2 [B0X_04]
REF ................................... -7 [B0X_04]
DK .................................... -8 [B0X_04]
[Code One]