HS03
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [ADM-DT] [DIS-DT]
Was this hospital stay related to any specific health condition or were any conditions discovered during this hospital stay?
YES .................................... 1
NO ..................................... 2 [HS05]
REF ................................... -7 [HS05]
DK .................................... -8 [HS05]
ER03
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was this visit related to any specific health condition or were any conditions discovered during this visit?
YES .................................... 1
NO ..................................... 2 [ER05]
REF ................................... -7 [ER05]
DK .................................... -8 [ER05]
OP08
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was this [visit/telephone call] related to any specific health condition or were any conditions discovered during this [visit/ telephone call]?
YES .................................... 1
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
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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.
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MV08
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-DT]
Was this [visit/telephone call] related to any specific health condition or were any conditions discovered during this [visit/ telephone call]?
YES .................................... 1
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
----------------------------------------------------
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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HH04
====
[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EVN-MO]
Thinking about all of the home care services (PERSON) (have/has) received from [someone from] (PROVIDER) during (VISIT MONTH), were any of these home care services related to any specific health problem?
IF OLD AGE MENTIONED, CODE 1 FOR YES AND ENTER 'OLD AGE' AS CONDITION.
YES .................................... 1
NO ..................................... 2 [BOX_02]
REF ................................... -7 [BOX_02]
DK .................................... -8 [BOX_02]
PRESS F1 FOR DEFINITION OF HEALTH PROBLEM.
[Code One]
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DISPLAY 'someone from' IF PROVIDER IS FLAGGED AS 'AGENCY'.
----------------------------------------------------