EV04
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[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [STR-DT] [END-DT]
IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS PERSON-PROVIDER PAIR WITH THE EVENT TYPE (EV).
IF DATES NOT KNOWN, ASK: When (were/was) (PERSON) admitted to and discharged from (PROVIDER)? Please tell me the dates of all stays between (START DATE) and (END DATE).
IF NECESSARY, PROBE: On what date did (PERSON) enter (PROVIDER)? On what date did (PERSON) leave (PROVIDER)?
IF STILL IN (PROVIDER), ENTER 95 IN MONTH FOR DISCHARGE DATE.
PROBE: Any other stays?
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[Enter Month,Day,Year-2] - [Enter Month,Day,Year-2] .....
[Enter Month,Day,Year-2] - [Enter Month,Day,Year-2] .....
[Enter Month,Day,Year-2] - [Enter Month,Day,Year-2] .....
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ROSTER DEFINITION: THIS ITEM USES PERSON'S- MEDICAL-EVENTS-ROSTER TO COLLECT ALL EVENTS (DATE RANGES) THAT ARE EVENT TYPE HS OR EVENT TYPE IC, DEPENDING ON THE TYPE OF EVENT BEING ASKED ABOUT.
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PERSON'S EVENT ROSTER BEHAVIOR SPECIFICATIONS:
1. THIS ROSTER WILL APPEAR BLANK WHEN DISPLAYED.
INTERVIEWER CAN ADD ANY NUMBER OF EVENTS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF EVENTS).
2. INTERVIEWER CAN DELETE AN EVENT THAT WAS ENTERED ON THE SCREEN WHERE DELETE IS USED.
THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE AN EVENT ENTERED IN ERROR.
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REF AND DK ARE ALLOWED IN THE DAY AND YEAR FIELDS BUT ARE DISALLOWED IN THE MONTH FIELD.
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GO TO BOX_06
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EV05
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[PERSON'S FIRST MIDDLE AND LAST NAME] [NAME OF MEDICAL CARE PROVIDER......] [EV] [STR-DT] [END-DT]
IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS PERSON-PROVIDER PAIR WITH THE EVENT TYPE (EV).
IF DATES NOT KNOWN, ASK: When did (PERSON) visit (PROVIDER)?
Please tell me all the dates between (START DATE) and (END DATE).
PROBE: Any other dates?
TO ADD, PRESS CTRL/A. TO DELETE, PRESS CTRL/D.
TO LEAVE, PRESS ESC.
[Enter Month,Day,Year-2] ...............
[Enter Month,Day,Year-2] ...............
[Enter Month,Day,Year-2] ...............
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ROSTER DEFINITION: THIS ITEM USES PERSON'S- MEDICAL-EVENTS-ROSTER TO COLLECT ALL EVENTS (DATES) THAT ARE THE SAME EVENT TYPE AND SAME PROVIDER AS THE EVENT BEING ASKED ABOUT.
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PERSON'S EVENT ROSTER BEHAVIOR SPECIFICATIONS:
1. THIS ROSTER WILL APPEAR BLANK WHEN DISPLAYED.
INTERVIEWER CAN ADD ANY NUMBER OF EVENTS AT THE ROSTER QUESTIONS (I.E., NO LIMIT TO THE NUMBER OF EVENTS).
2. INTERVIEWER CAN DELETE AN EVENT THAT WAS ENTERED ON THE SCREEN WHERE DELETE IS USED.
THAT IS, AS LONG AS THE INTERVIEWER HAS NOT LEFT THE SCREEN, SHE SHOULD BE ABLE TO DELETE AN EVENT ENTERED IN ERROR.
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REF AND DK ARE ALLOWED IN THE DAY AND YEAR FIELDS BUT ARE DISALLOWED IN THE MONTH FIELD.
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GO TO BOX_06
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