Provider Probes (PP) Section
BOX_01A
=======
----------------------------------------------------
| THE PROVIDER PROBES (PP) SECTION (INCLUDING THE |
| EVENT ROSTER (EV) AND PROVIDER ROSTER (PV) |
| SECTIONS WHICH ARE CALLED IN THE COURSE OF PP) |
| COLLECTS THE INFORMATION REQUIRED TO CREATE AN |
| EVENT. THIS INFORMATION INCLUDES THE EVENT TYPE, |
| PERSON, PROVIDER, AND DATE OR DATE RANGE. ONCE |
| THE EV SECTION IS COMPLETED FOR AN EVENT, THE |
| INTERVIEWER CANNOT BACK UP TO EDIT THAT EVENT OR |
| ANY OTHER EVENTS THAT WERE CREATED PREVIOUSLY. |
| HOWEVER, EVENTS CAN BE EDITED IN THE EVENT DRIVER |
| (ED) SECTION OF THE QUESTIONNAIRE. |
----------------------------------------------------
BOX_01
======
----------------------------------------------------
| IF DISCHARGE DATE CODED '95' (STILL IN HOSPITAL) |
| FOR ANY HOSPITAL STAY (HS) EVENT REPORTED IN |
| PREVIOUS ROUND FOR ANY RU MEMBER, CONTINUE WITH |
| LOOP_01 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_02 |
----------------------------------------------------
LOOP_01
=======
----------------------------------------------------
| FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK |
| PP01 - END_LP01 |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_01 COLLECTS THE DISCHARGE |
| DATE OF A HOSPITAL STAY FOR ANY PERSON STILL IN |
| THE HOSPITAL AT THE END OF THE PREVIOUS ROUND. |
| THIS LOOP CYCLES ON PERSONS THAT MEET BOTH OF THE |
| FOLLOWING CONDITIONS: |
| - PERSON HAD AN HS EVENT DURING THE PREVIOUS ROUND|
| AND |
| - ONE OF PERSON’S HS EVENTS HAD A DISCHARGE DATE |
| CODED ‘95’ (STILL IN HOSPITAL). |
----------------------------------------------------
PP01
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
Last time, we recorded that (PERSON) entered (PROVIDER) on
(ADMIT DATE) and was still in the hospital at the time of our
interview on {PREV RD INTV DT}.
On what date was (PERSON) discharged from (PROVIDER)?
IF STILL IN HOSPITAL {OR RELEASED IN 2007}, ENTER 95 IN MONTH
FOR DISCHARGE DATE.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
| {Display Month,Day,Year-4} |
[Enter Month,Day,Year-4] |
| {Display Month,Day,Year-4} |
[Enter Month,Day,Year-4] |
| {Display Month,Day,Year-4} |
[Enter Month,Day,Year-4] |
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES PERSON’S- |
| MEDICAL-EVENTS-ROSTER TO DISPLAY ALL HS EVENTS |
| THAT WERE CODED ‘95’ (STILL IN HOSPITAL) DURING |
| THE PREVIOUS ROUND. |
----------------------------------------------------
----------------------------------------------------
| PERSON’S EVENT ROSTER BEHAVIOR SPECIFICATIONS: |
| |
| ADMIT DATE IS A PROTECTED FIELD. INTERVIEWER |
| CAN ENTER DISCHARGE DATE ONLY. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY THE DATE OF THE PREVIOUS ROUND’S INTERVIEW|
| FOR ‘{PREV RD INTV DT}’. |
| DISPLAY ‘OR RELEASED IN 2007’ IF ROUND 5. |
| OTHERWISE, USE A NULL DISPLAY. |
| FOR ‘Display Month,Day,Year-4’, DISPLAY THE ADMIT |
| DATE OF THE HS EVENT WITH A DISCHARGE DATE OF ‘95’|
| (STILL IN HOSPITAL) FOR THIS PERSON. |
----------------------------------------------------
END_LP01
========
----------------------------------------------------
| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |
| WHO MEETS THE CONDITIONS STATED IN THE LOOP |
| DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |
| END LOOP_01 AND CONTINUE WITH BOX_02 |
----------------------------------------------------
BOX_02
======
----------------------------------------------------
| IF DISCHARGE DATE CODED '95' (STILL IN |
| INSTITUTION) FOR ANY INSTITUTIONAL STAY (IC) EVENT|
| REPORTED IN PREVIOUS ROUND FOR ANY RU MEMBER, |
| CONTINUE WITH LOOP_02 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_03 |
----------------------------------------------------
LOOP_02
=======
----------------------------------------------------
| FOR EACH ELEMENT IN RU-MEMBERS-ROSTER, ASK |
| PP02 - END_LP02 |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_02 COLLECTS THE DISCHARGE |
| DATE OF AN INSTITUTIONAL STAY FOR ANY PERSON STILL|
| IN THE INSTITUTION AT THE END OF THE PREVIOUS |
| ROUND. THIS LOOP CYCLES ON PERSONS THAT MEET THE |
| FOLLOWING CONDITIONS: |
| - PERSON HAD AT LEAST ONE IC EVENT DURING THE |
| PREVIOUS ROUND |
| AND |
| - ONE OF PERSON’S IC EVENTS HAD A DISCHARGE DATE |
| CODED ‘95’ (STILL IN INSTITUTION). |
----------------------------------------------------
PP02
====
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {ADM-DT}
Last time we recorded that (PERSON) entered (PROVIDER) on
(ADMIT DATE) and was still there at the time of our interview
on {PREV RD INTV DT}.
On what date was (PERSON) discharged from (PROVIDER)?
IF STILL IN AN INSTITUTION OR LONG-TERM CARE FACILITY, {OR
RELEASED IN 2007}, ENTER 95 IN MONTH FOR DISCHARGE DATE.
TO MOVE CURSOR, USE ARROW KEYS. TO LEAVE, PRESS ESC.
| {Display Month,Day,Year-4} |
[Enter Month,Day,Year-4] |
| {Display Month,Day,Year-4} |
[Enter Month,Day,Year-4] |
| {Display Month,Day,Year-4} |
[Enter Month,Day,Year-4] |
----------------------------------------------------
| ROSTER DEFINITION: THIS ITEM USES PERSON’S- |
| MEDICAL-EVENTS-ROSTER TO DISPLAY ALL IC EVENTS |
| THAT WERE CODED ‘95’ (STILL IN INSTITUTION) |
| DURING THE PREVIOUS ROUND. |
----------------------------------------------------
----------------------------------------------------
| PERSON’S EVENT ROSTER BEHAVIOR SPECIFICATIONS: |
| |
| ADMIT DATE IS A PROTECTED FIELD. INTERVIEWER |
| CAN ENTER DISCHARGE DATE ONLY. |
----------------------------------------------------
----------------------------------------------------
| DISPLAY THE DATE OF THE PREVIOUS ROUND’S INTERVIEW|
| FOR ‘{PREV RD INTV DT}’. |
| DISPLAY ‘OR RELEASED IN 2007’ IF ROUND 5. |
| OTHERWISE, USE A NULL DISPLAY. |
| FOR ‘Display Month,Day,Year-4’, DISPLAY THE ADMIT |
| DATE OF THE IC EVENT WITH A DISCHARGE DATE OF ‘95’|
| (STILL IN INSTITUTION) FOR THIS PERSON. |
----------------------------------------------------
END_LP02
========
----------------------------------------------------
| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |
| WHO MEETS THE CONDITIONS STATED IN THE LOOP |
| DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |
| END LOOP_02 AND CONTINUE WITH BOX_03 |
----------------------------------------------------
BOX_03
======
----------------------------------------------------
| IF CA03 IS CODED ‘5’ (VOLUNTEERED NO EVENTS TO |
| RECORD), GO TO PP03A |
----------------------------------------------------
----------------------------------------------------
| IF CA03 IS CODED ‘3’ (SOME VISITS RECORDED), ‘4’ |
| (DID NOT USE), ‘-7’ (REFUSED), ‘-8’ (DON’T KNOW), |
| OR IS NOT ASKED (CALENDAR NEVER USED), GO TO PP14 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH LOOP_03 |
----------------------------------------------------
LOOP_03
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_04 - END_LP03 |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_03 ASKS THE EVENT ROSTER |
| (EV) SECTION FOR EACH EVENT RECORDED ON THE |
| CALENDAR. THE RESPONSE TO PP03 DETERMINES WHETHER|
| THE LOOP CYCLES AGAIN. IF PP03 IS CODED ‘1’ |
| (YES), THE LOOP CYCLES TO COLLECT THE NEXT EVENT. |
| IF PP03 IS CODED ‘2’ (NO) OR ‘3’ (NO EVENTS ON |
| CALENDAR TO RECORD), THE LOOP ENDS. |
----------------------------------------------------
BOX_04
======
----------------------------------------------------
| IF FIRST CYCLE OF LOOP_03, GO TO PP03 |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, CONTINUE WITH BOX_05 |
----------------------------------------------------
BOX_05
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP03 |
----------------------------------------------------
PP03
====
INTERVIEWER: ADD (AN/ANOTHER) EVENT?
YES .................................... 1
NO ..................................... 2
{NO EVENTS ON CALENDAR TO RECORD ........ 3}
----------------------------------------------------
| DISPLAY CODE 3 (NO EVENTS ON CALENDAR TO RECORD), |
| ONLY IF FIRST CYCLE OF LOOP_03. OTHERWISE, USE A |
| NULL DISPLAY. |
----------------------------------------------------
END_LP03
========
----------------------------------------------------
| IF PP03 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP03 IS CODED ‘2’ (NO) OR ‘3’ (NO EVENTS ON |
| CALENDAR TO RECORD), END LOOP_03 AND CONTINUE |
| WITH PP03A |
----------------------------------------------------
PP03A
=====
{STR-DT}
{END-DT}
As you know, it is important for us to get complete and
accurate information of all of the family’s health care events.
I’d like you to take a few minutes to look at several lists of
health care providers, to be sure we haven’t missed any visits
or calls, including those made just for advice, prescriptions,
tests, shots, or x-rays.
PRESS ENTER TO CONTINUE.
PP04
====
{STR-DT}
{END-DT}
SHOW CARD PP-1.
{Since (START DATE)/Between (START DATE) and (END DATE)}, has
anyone in the family seen or spoken with a medical or mental
health professional, dentist, or other health care provider
listed on this card [other than what we have already talked about]?
YES .................................... 1
NO ..................................... 2 {PP06}
REF ................................... -7 {PP06}
DK .................................... -8 {PP06}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
LOOP_04
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_06 - END_LP04 |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_04 COLLECTS ALL DENTAL (DN)|
| AND MEDICAL PROVIDER VISIT (MV) EVENTS NOT ALREADY|
| RECORDED. |
| |
| THE RESPONSE TO PP05 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP05 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP05 IS|
| CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_06
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP05 |
----------------------------------------------------
PP05
====
{STR-DT}
{END-DT}
SHOW CARD PP-1.
Has {PERSON’S FIRST MIDDLE AND LAST NAME} had any other visits
or calls to health care providers listed on this card? Or has
anyone else in the family visited or called a health care
provider listed here? [Please include any visits or calls
we have not yet talked about.]
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT |
| WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND |
| LAST NAME}’. |
----------------------------------------------------
END_LP04
========
----------------------------------------------------
| IF PP05 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP05 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_04 AND CONTINUE WITH PP06 |
----------------------------------------------------
PP06
====
{STR-DT}
{END-DT}
SHOW CARD PP-2.
{Has/Between (START DATE) and (END DATE), has} anyone in the
family been a patient in a hospital or been seen in a hospital
emergency room or outpatient department? Or has anyone been a
patient in any type of long term care facility? [Please include
any hospital care we have not yet talked about.]
YES .................................... 1
NO ..................................... 2 {PP07A}
REF ................................... -7 {PP07A}
DK .................................... -8 {PP07A}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Has’ IF NOT ROUND 5. DISPLAY ‘Between |
| (START DATE) and (END DATE), has’ IF ROUND 5. |
----------------------------------------------------
LOOP_05
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_07 - END_LP05. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_05 COLLECTS ALL HOSPITAL |
| BASED AND INSTITUTIONAL STAY EVENTS (I.E., HS, |
| ER, OP, AND IC EVENTS) NOT ALREADY RECORDED. |
| |
| THE RESPONSE TO PP07 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP07 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07 IS|
| CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_07
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP07 |
----------------------------------------------------
PP07
====
{STR-DT}
{END-DT}
SHOW CARD PP-2.
Has {PERSON’S FIRST MIDDLE AND LAST NAME} had any other visits
to a hospital or long term care facility? Or has anyone else
in the family been a patient in or seen at a hospital or long
term care facility? [Please include any hospital care we have
not yet talked about.]
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT |
| WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND |
| LAST NAME}’. |
----------------------------------------------------
END_LP05
========
----------------------------------------------------
| IF PP07 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP07 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_05 AND CONTINUE WITH PP07A |
----------------------------------------------------
PP07A
=====
{STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, has
anyone in the family had any visits to an independent lab or
testing facility for x-rays or other tests?
YES .................................... 1
NO ..................................... 2 {PP07B}
REF ................................... -7 {PP07B}
DK .................................... -8 {PP07B}
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ |
| IF ROUND 5. |
----------------------------------------------------
LOOP_05A
========
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_07A - END_LP05A. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_05A COLLECTS ALL LAB EVENTS|
| (I.E., OP, OR MV EVENTS) NOT ALREADY RECORDED. |
| |
| THE RESPONSE TO PP07AA DETERMINES WHETHER THE LOOP|
| CYCLES AGAIN. IF PP07AA IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07AA |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_07A
=======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP07AA |
----------------------------------------------------
PP07AA
======
{STR-DT}
{END-DT}
Has {PERSON’S FIRST MIDDLE AND LAST NAME} had any other visits
to an independent lab or testing facility? Or has anyone else
in the family been seen at an independent lab or testing facility?
[Please include any care we have not yet talked about.]
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
| DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT |
| WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND |
| LAST NAME}’. |
----------------------------------------------------
END_LP05A
=========
----------------------------------------------------
| IF PP07AA IS CODED ‘1’ (YES), CYCLE TO COLLECT |
| NEXT EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP07AA IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR |
| ‘-8’ (DON’T KNOW), END LOOP_05A AND CONTINUE WITH |
| PP07B |
----------------------------------------------------
PP07B
=====
{STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, has
anyone in the family had any visits to someone who practices
alternative care such as acupuncture, massage therapy, hypnosis,
or other treatments?
YES .................................... 1
NO ..................................... 2 {PP08}
REF ................................... -7 {PP08}
DK .................................... -8 {PP08}
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ |
| IF ROUND 5. |
----------------------------------------------------
LOOP_05B
========
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_07B - END_LP05B. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_05B COLLECTS ALL |
| ALTERNATIVE CARE EVENTS (I.E., MV EVENTS) NOT |
| ALREADY RECORDED. |
| |
| THE RESPONSE TO PP07BB DETERMINES WHETHER THE LOOP|
| CYCLES AGAIN. IF PP07BB IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP07BB |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_07B
=======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP07BB |
----------------------------------------------------
PP07BB
======
{STR-DT}
{END-DT}
Has {PERSON’S FIRST MIDDLE AND LAST NAME} had any other visits
to someone who practices alternative care? Or has anyone else
in the family been seen by someone who practices alternative care?
[Please include any alternative care we have not yet talked about.]
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
| DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT |
| WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND |
| LAST NAME}’. |
----------------------------------------------------
END_LP05B
=========
----------------------------------------------------
| IF PP07BB IS CODED ‘1’ (YES), CYCLE TO COLLECT |
| NEXT EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP07BB IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR |
| ‘-8’ (DON’T KNOW), END LOOP_05B AND CONTINUE WITH |
| PP08 |
----------------------------------------------------
PP08
====
{STR-DT}
{END-DT}
SHOW CARD PP-3.
What about visits to the home because of a health problem for
any of these services {between (START DATE) and (END DATE)}?
[Please include any home care services we have not yet talked
about.]
YES .................................... 1
NO ..................................... 2 {PP12}
REF ................................... -7 {PP12}
DK .................................... -8 {PP12}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘between (START DATE) and (END DATE)’ IF |
| ROUND 5. OTHERWISE, USE A NULL DISPLAY. |
----------------------------------------------------
LOOP_06
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_08 - END_LP06. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_06 COLLECTS ALL HOME |
| HEALTH (HH) EVENTS NOT ALREADY RECORDED. |
| |
| THE RESPONSE TO PP09 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP09 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP09 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_08
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP09 |
----------------------------------------------------
PP09
====
{STR-DT}
{END-DT}
SHOW CARD PP-3.
Because of a health problem, has {PERSON’S FIRST MIDDLE AND LAST
NAME} received any other home care services? Or has anyone
else in the family received home care services such as those
listed on this card? [Please include any home care services we
have not yet talked about.]
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY THE NAME OF THE PERSON FOR WHOM AN EVENT |
| WAS JUST ADDED FOR ‘{PERSON’S FIRST MIDDLE AND |
| LAST NAME}’. |
----------------------------------------------------
END_LP06
========
----------------------------------------------------
| IF PP09 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP09 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_06 AND CONTINUE WITH PP12 |
----------------------------------------------------
PP12
====
{STR-DT}
{END-DT}
SHOW CARD PP-4.
{And finally/Between (START DATE) and (END DATE)}, did anyone
in the family obtain eyeglasses, contact lenses, or diabetic
equipment {since (START DATE)} [other than what we have already
talked about]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘And finally’ IF NOT ROUND 5. DISPLAY |
| ‘Between (START DATE) and (END DATE)’ IF ROUND 5. |
| |
| DISPLAY ‘since (START DATE)’ IF NOT ROUND 5. |
| OTHERWISE, USE A NULL DISPLAY. |
----------------------------------------------------
----------------------------------------------------
| IF PP12 IS CODED ‘1’ (YES), CONTINUE WITH LOOP_07 |
----------------------------------------------------
----------------------------------------------------
| IF PP12 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR |
| ‘-8’ (DON’T KNOW) AND CURRENT ROUND IS ROUND 3 OR |
| ROUND 5, GO TO PP13A |
----------------------------------------------------
-----------------------------------------------------
| OTHERWISE, GO TO BOX_10 |
-----------------------------------------------------
LOOP_07
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_09 - END_LP07. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_07 COLLECTS ALL OTHER |
| MEDICAL EXPENSE (OM) EVENTS NOT ALREADY RECORDED. |
| |
| THE RESPONSE TO PP13 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP13 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP13 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_09
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP13 |
----------------------------------------------------
PP13
====
{STR-DT}
{END-DT}
SHOW CARD PP-4.
Has anyone else in the family obtained eyeglasses, contact
lenses, or diabetic equipment [other than what we have already
talked about]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
END_LP07
========
----------------------------------------------------
| IF PP13 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP13 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_07 AND CONTINUE WITH |
| BOX_09A |
----------------------------------------------------
BOX_09A
=======
----------------------------------------------------
| IF ROUND 3 OR ROUND 5, CONTINUE WITH PP13A |
----------------------------------------------------
----------------------------------------------------
| OTHERWISE, GO TO BOX_10 |
----------------------------------------------------
PP13A
=====
JAN 01
DEC 31
SHOW CARD PP-4A.
Now I would like you to think about the entire calendar year
2006, that is from January 1, 2006 until December 31, 2006.
Please look at the types of other medical expenses listed on
this card. Did anyone in the family obtain any of these types
of other medical expenses during the year 2006?
PROBE: These could include ambulance services, canes,
wheelchairs, corrective shoes, hearing aids or amplifiers for a
telephone, artificial limbs, raised toilet seats, a
modification to the house or a car because of some illness or
injury, for example ramps or handrails, etc.
YES .................................... 1
NO ..................................... 2 {BOX_10}
REF ................................... -7 {BOX_10}
DK .................................... -8 {BOX_10}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
LOOP_07A
========
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_09B - END_LP07A. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_07A COLLECTS ALL OTHER |
| TYPES OF MEDICAL EXPENSE (OM) EVENTS FOR THE YEAR |
| 2006 NOT ALREADY RECORDED. |
| |
| THE RESPONSE TO PP13B DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP13B IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP13B |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_09B
=======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP13B |
----------------------------------------------------
PP13B
=====
JAN 01
DEC 31
SHOW CARD PP-4A.
During the calendar year 2006, has anyone else in the family
obtained, purchased, or rented any of the types of other
medical expenses listed on this card [other than what we have
already talked about]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| NOTE: IN ROUND 3, QUESTION REFERRED TO ‘2005’, |
| NOT ‘2006’. |
----------------------------------------------------
END_LP07A
=========
----------------------------------------------------
| IF PP13B IS CODED ‘1’ (YES), CYCLE TO COLLECT |
| NEXT EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP13B IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR |
| ‘-8’ (DON’T KNOW), END LOOP_07A AND CONTINUE WITH |
| BOX_10 |
----------------------------------------------------
BOX_10
======
----------------------------------------------------
| GO TO BOX_18 |
----------------------------------------------------
PP14
====
{STR-DT}
{END-DT}
These next questions ask about the different medical and
dental care anyone in the family has received {since (START
DATE)/between (START DATE) and (END DATE)}. It is sometimes
hard to remember dates accurately so take your time. You might
want to look at any calendar you may keep, checkbook, or
receipts to help you remember. We are interested in any type of
visit or call, including those made just for advice,
prescriptions, tests, shots, or x-rays.
PRESS ENTER TO CONTINUE.
----------------------------------------------------
| DISPLAY ‘since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
LOOP_08
=======
----------------------------------------------------
| FOR EACH ELEMENT ON THE RU-MEMBERS-ROSTER, ASK |
| PP15 - END_LP08. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_08 COLLECTS ALL EVENTS FOR |
| EACH RU MEMBER WHEN THE CALENDAR IS INCOMPLETE OR |
| WAS NOT USED. THIS LOOP CYCLES ON ALL RU MEMBERS |
| INCLUDING PERSONS WHO WERE DECEASED OR |
| INSTITUTIONALIZED AFTER THE REFERENCE PERIOD START|
| DATE. |
----------------------------------------------------
PP15
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-5.
Now think about the health care (PERSON) has received {since
(START DATE)/between (START DATE) and (END DATE)}.
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) see or talk to any type of dental care provider, such
as the types listed on this card, for dental care or a dental
check-up?
YES .................................... 1
NO ..................................... 2 {PP17}
REF ................................... -7 {PP17}
DK .................................... -8 {PP17}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘since (START DATE)’ AND ‘Since (START |
| DATE) IF NOT ROUND 5. DISPLAY ‘between (START |
| DATE) and (END DATE)’ AND ‘Between (START DATE) |
| and (END DATE)’ IF ROUND 5. |
----------------------------------------------------
LOOP_09
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_11- END_LP09. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_09 COLLECTS ALL DENTAL (DN)|
| EVENTS NOT ALREADY RECORDED FOR PERSON BEING |
| ASKED ABOUT. |
| |
| THE RESPONSE TO PP16 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP16 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP16 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_11
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP16 |
----------------------------------------------------
PP16
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-5.
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) see or talk to any other type of dental care provider,
such as the types listed on this card (other than what you’ve
already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
END_LP09
========
----------------------------------------------------
| IF PP16 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP16 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_09 AND CONTINUE WITH PP17 |
----------------------------------------------------
PP17
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-6.
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) see or talk to any medical doctor or nurse, such as
those types listed on this card? [Please include telephone
calls or visits where (PERSON) received advice, prescriptions,
or test results.]
YES .................................... 1
NO ..................................... 2 {PP19}
REF ................................... -7 {PP19}
DK .................................... -8 {PP19}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
LOOP_10
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_12 - END_LP10. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_10 COLLECTS ALL MEDICAL |
| PROVIDER VISIT (MV) EVENTS NOT ALREADY RECORDED |
| FOR PERSON BEING ASKED ABOUT. |
| |
| THE RESPONSE TO PP18 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP18 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP18 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_12
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, CONTINUE WITH |
| PP18 |
----------------------------------------------------
PP18
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-6.
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) see or talk to any other type of medical professional,
such as the types listed on this card (other than what you’ve
already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
END_LP10
========
----------------------------------------------------
| IF PP18 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP18 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_10 AND CONTINUE WITH PP19 |
----------------------------------------------------
PP19
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-7.
{Since (START DATE)/Between (START DATE) and (END DATE)}, was
(PERSON) a patient in a hospital or receive care in a hospital
emergency room or hospital outpatient department?
YES .................................... 1
NO ..................................... 2 {PP21}
REF ................................... -7 {PP21}
DK .................................... -8 {PP21}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
LOOP_11
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_13 - END_LP11. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_11 COLLECTS ALL HOSPITAL |
| BASED EVENTS (I.E., HS, ER, AND OP EVENTS) NOT |
| ALREADY RECORDED FOR PERSON BEING ASKED ABOUT. |
| |
| THE RESPONSE TO PP20 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP20 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP20 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_13
======
---------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, CONTINUE WITH |
| PP20 |
----------------------------------------------------
PP20
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-7.
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) receive any other care as a patient in a hospital or
from a hospital emergency room or outpatient department (other
than what you’ve already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
END_LP11
========
----------------------------------------------------
| IF PP20 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP20 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_11 AND CONTINUE WITH PP21 |
----------------------------------------------------
PP21
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-8.
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) see or talk to any of the health care providers listed
on this card?
YES .................................... 1
NO ..................................... 2 {PP22A}
REF ................................... -7 {PP22A}
DK .................................... -8 {PP22A}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
LOOP_12
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_14 - END_LP12. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_12 COLLECTS ALL MEDICAL |
| PROVIDER VISIT (MV) EVENTS NOT ALREADY RECORDED |
| FOR PERSON BEING ASKED ABOUT. |
| |
| THE RESPONSE TO PP22 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP22 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_14
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP22 |
----------------------------------------------------
PP22
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-8.
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) see or talk to any other type of health care provider,
such as the types listed on this card (other than what you’ve
already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
END_LP12
========
----------------------------------------------------
| IF PP22 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP22 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_12 AND CONTINUE WITH PP22A |
----------------------------------------------------
PP22A
=====
{PERSON’S FIRST MIDDLE AND LAST NAME}
{STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)},
did (PERSON) have any visits to an independent lab or testing
facility for x-rays or other tests?
YES .................................... 1
NO ..................................... 2 {PP22B}
REF ................................... -7 {PP22B}
DK .................................... -8 {PP22B}
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ |
| IF ROUND 5. |
----------------------------------------------------
LOOP_12A
========
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_14A - END_LP12A. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_12A COLLECTS ALL LAB EVENTS|
| (I.E., OP, OR MV EVENTS) NOT ALREADY RECORDED. |
| |
| THE RESPONSE TO PP22AA DETERMINES WHETHER THE LOOP|
| CYCLES AGAIN. IF PP22AA IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22AA |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_14A
=======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP22AA |
----------------------------------------------------
PP22AA
======
{PERSON’S FIRST MIDDLE AND LAST NAME}
{STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) have any other visits to an independent lab or testing
facility (other than what you’ve already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ |
| IF ROUND 5. |
----------------------------------------------------
END_LP12A
=========
----------------------------------------------------
| IF PP22AA IS CODED ‘1’ (YES), CYCLE TO COLLECT |
| NEXT EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP22AA IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR |
| ‘-8’ (DON’T KNOW), END LOOP_12A AND CONTINUE WITH |
| PP22B |
----------------------------------------------------
PP22B
=====
{PERSON’S FIRST MIDDLE AND LAST NAME}
{STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) have any visits to someone who practices alternative
care such as acupuncture, massage therapy, hypnosis, or other
treatments?
YES .................................... 1
NO ..................................... 2 {PP23}
REF ................................... -7 {PP23}
DK .................................... -8 {PP23}
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ |
| IF ROUND 5. |
----------------------------------------------------
LOOP_12B
========
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_14B - END_LP12B. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_12B COLLECTS ALL |
| ALTERNATIVE CARE EVENTS (I.E., MV EVENTS) NOT |
| ALREADY RECORDED. |
| |
| THE RESPONSE TO PP22BB DETERMINES WHETHER THE LOOP|
| CYCLES AGAIN. IF PP22BB IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP22BB |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_14B
=======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, |
| CONTINUE WITH PP22BB |
----------------------------------------------------
PP22BB
======
{PERSON’S FIRST MIDDLE AND LAST NAME}
{STR-DT}
{END-DT}
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) have any other visits to someone who practices alternative
care (other than what you’ve already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ |
| IF ROUND 5. |
----------------------------------------------------
END_LP12B
=========
----------------------------------------------------
| IF PP22BB IS CODED ‘1’ (YES), CYCLE TO COLLECT |
| NEXT EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP22BB IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR |
| ‘-8’ (DON’T KNOW), END LOOP_12B AND CONTINUE WITH |
| PP23 |
----------------------------------------------------
PP23
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-9.
{Since (START DATE)/Between (START DATE) and (END DATE)},
because of a health problem, did (PERSON) receive any home care
services such as the types listed on this card? Please include
home care services received for medical care, personal care,
supervision, and household help.
YES .................................... 1
NO ..................................... 2 {PP25}
REF ................................... -7 {PP25}
DK .................................... -8 {PP25}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
LOOP_13
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_15 - END_LP13. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_13 COLLECTS ALL HOME |
| HEALTH (HH) EVENTS NOT ALREADY RECORDED FOR PERSON|
| BEING ASKED ABOUT. |
| |
| THE RESPONSE TO PP24 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP24 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP24 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_15
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, CONTINUE WITH |
| PP24 |
----------------------------------------------------
PP24
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-9.
{Since (START DATE)/Between (START DATE) and (END DATE)},
because of a health problem, did (PERSON) receive home care
services such as the types listed on this card (other than what
you’ve already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
END_LP13
========
----------------------------------------------------
| IF PP24 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP24 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_13 AND CONTINUE WITH PP25 |
----------------------------------------------------
PP25
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-10.
{Since (START DATE)/Between (START DATE) and (END DATE)},
(were/was) (PERSON) a patient in any long term care facility,
such as the types of places listed on this card?
YES .................................... 1
NO ..................................... 2 {PP27}
REF ................................... -7 {PP27}
DK .................................... -8 {PP27}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
LOOP_14
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_16 - END_LP14. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_14 COLLECTS ALL |
| INSTITUTIONAL (IC) EVENTS NOT ALREADY RECORDED FOR|
| PERSON BEING ASKED ABOUT. |
| |
| THE RESPONSE TO PP26 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP26 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP26 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_16
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, CONTINUE WITH |
| PP26 |
----------------------------------------------------
PP26
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-10.
{Since (START DATE)/Between (START DATE) and (END DATE)},
(were/was) (PERSON) a patient in any other long term care
facility, such as the types of places listed on this card
(other than what you’ve already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
END_LP14
========
----------------------------------------------------
| IF PP26 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP26 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_14 AND CONTINUE WITH PP27 |
----------------------------------------------------
PP27
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-11.
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) obtain eyeglasses, contact lenses, or diabetic equipment?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
-----------------------------------------------------
| IF PP27 IS CODED ‘1’ (YES), CONTINUE WITH LOOP_15 |
-----------------------------------------------------
-----------------------------------------------------
| IF PP27 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR |
| ‘-8’ (DON’T KNOW) AND CURRENT ROUND IS ROUND 3 OR |
| ROUND 5, GO TO PP29 |
-----------------------------------------------------
-----------------------------------------------------
| OTHERWISE, GO TO END_LP08 |
-----------------------------------------------------
LOOP_15
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_17 - END_LP15. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_15 COLLECTS ALL OTHER |
| MEDICAL EXPENSE (OM) EVENTS NOT ALREADY RECORDED |
| FOR PERSON BEING ASKED ABOUT. |
| |
| THE RESPONSE TO PP28 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP28 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP28 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_17
======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, CONTINUE WITH |
| PP28 |
----------------------------------------------------
PP28
====
{PERSON’S FIRST MIDDLE AND LAST NAME} {STR-DT}
{END-DT}
SHOW CARD PP-11.
{Since (START DATE)/Between (START DATE) and (END DATE)}, did
(PERSON) obtain any other medical supplies listed on this card
(other than what you’ve already told me about)?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| DISPLAY ‘Since (START DATE)’ IF NOT ROUND 5. |
| DISPLAY ‘Between (START DATE) and (END DATE)’ IF |
| ROUND 5. |
----------------------------------------------------
END_LP15
========
----------------------------------------------------
| IF PP28 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP28 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_15 AND CONTINUE WITH |
| BOX_17A |
----------------------------------------------------
BOX_17A
=======
-----------------------------------------------------
| IF ROUND 3 OR ROUND 5, CONTINUE WITH PP29 |
-----------------------------------------------------
-----------------------------------------------------
| OTHERWISE, GO TO END_LP08 |
-----------------------------------------------------
PP29
====
{PERSON’S FIRST MIDDLE AND LAST NAME} JAN 01
DEC 31
SHOW CARD PP-12.
Now I would like you to think about the entire calendar year
2006, that is from January 1, 2006 until December 31, 2006.
Please look at the types of other medical expenses listed on
this card. Did (PERSON) obtain any of these types of other
medical expenses during the year 2006?
PROBE: These could include ambulance services, canes,
wheelchairs, corrective shoes, hearing aids or amplifiers for a
telephone, artificial limbs, raised toilet seats, a
modification to the house or a car because of some illness or
injury, for example ramps or handrails, etc.
YES .................................... 1
NO ..................................... 2 {END_LP08}
REF ................................... -7 {END_LP08}
DK .................................... -8 {END_LP08}
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
----------------------------------------------------
| NOTE: IN ROUND 3, QUESTION REFERRED TO ‘2005’, |
| NOT ‘2006’. |
----------------------------------------------------
LOOP_16
=======
----------------------------------------------------
| For each of the following: |
| |
| EVENT 1 |
| EVENT 2 |
| EVENT 3 |
| EVENT 4 |
| |
| ask BOX_17B - END_LP16. |
----------------------------------------------------
----------------------------------------------------
| LOOP DEFINITION: LOOP_16 COLLECTS ALL OTHER |
| TYPES OF MEDICAL EXPENSE (OM) EVENTS FOR THE YEAR |
| 2006 NOT ALREADY RECORDED. |
| |
| THE RESPONSE TO PP30 DETERMINES WHETHER THE LOOP |
| CYCLES AGAIN. IF PP30 IS CODED ‘1’ (YES), THE |
| LOOP CYCLES TO COLLECT THE NEXT EVENT. IF PP30 |
| IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’ (DON’T |
| KNOW), THE LOOP ENDS. |
----------------------------------------------------
BOX_17B
=======
----------------------------------------------------
| ASK THE EVENT ROSTER (EV) SECTION |
----------------------------------------------------
----------------------------------------------------
| AT COMPLETION OF THE EV SECTION, CONTINUE WITH |
| PP30 |
----------------------------------------------------
PP30
====
{PERSON’S FIRST MIDDLE AND LAST NAME} JAN 01
DEC 31
SHOW CARD PP-12.
During the calendar year 2006, (have/has) (PERSON) obtained,
purchased, or rented any of the types of other medical expenses
listed on this card [other than what we have already talked
about]?
YES .................................... 1
NO ..................................... 2
REF ................................... -7
DK .................................... -8
PRESS F1 FOR DEFINITION OF ITEMS ON SHOW CARD.
[Code One]
END_LP16
========
----------------------------------------------------
| IF PP30 IS CODED ‘1’ (YES), CYCLE TO COLLECT NEXT |
| EVENT. |
----------------------------------------------------
----------------------------------------------------
| IF PP30 IS CODED ‘2’ (NO), ‘-7’ (REFUSED), OR ‘-8’|
| (DON’T KNOW), END LOOP_16 AND CONTINUE WITH |
| END_LP08 |
----------------------------------------------------
END_LP08
========
----------------------------------------------------
| CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER |
| WHO MEETS THE CONDITIONS STATED IN THE LOOP |
| DEFINITION. |
----------------------------------------------------
----------------------------------------------------
| IF NO OTHER PERSONS MEET THE STATED CONDITIONS, |
| END LOOP_08 AND CONTINUE WITH BOX_18 |
----------------------------------------------------
BOX_18
======
----------------------------------------------------
| GO TO NEXT QUESTIONNAIRE SECTION. |
----------------------------------------------------
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