Fall 2023
BOX_00 (QS1000)
Route Details: 01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_35, BOX_40, BOX_50, BOX_60
02 Loop = LOOP_10
03 End Loop = END_LP10
04 Single Select = QS05, QS07, QS20_01, QS20_02, QS20_04, QS20_06, QS20_07
20 OS Text Field = QS20_03, QS20_06OS, QS20_08
24 Information Screen = QSIntro, QS03, QS10, QS20_05
BOX_10 (QS1005)
Route Details: Context Header Display Instructions: SEE CONTEXT HEADER SPEC
QSIntro (QS1007)
BLAISE NAME: QSIntro
Question Text:
CAPI WILL NOW DETERMINE IF ANY SAQS ARE REQUIRED FOR THIS HOUSEHOLD.
PRESS 1 AND ENTER TO CONTINUE.
Responses: CONTINUE 1 BOX_20 (QS1010)
Display Instructions:
BOX_20 (QS1010)
Route Details: Note: AHRQ will determine what hard copy materials are distributed and followed-up on during each round. This section needs to be configurable to allow for the addition of other supplemental materials as they are needed in future panels.
The QS section is currently asked in any round with a hard copy supplement that is eligible for data collection and Panel 24 Round 1 (Spring 2019 only). If there are no hard copy supplements eligible for data collection, CAPI will continue to the next section in the questionnaire.
DCS Collection Rules:
DCS: Distribution only in rounds that cross two calendar years or the final round of the panel (RndType=Cross or Final) for all panel years.
SAQ Collection Rules for Spring 2018 only:
SAQ (core+CAHPS): Follow-up in Panel 22, Round 3 and Panel 21, Round 5.
SAQ Collection Rules Beginning in Fall 2018 (P23R2/P22R4) and Later:
SAQ (core+CAHPS): Distribution in Rounds 2 and follow-up in Round 3 for Panels whose R1 collection occurred in an odd year (FirstPanYear=odd).
SAQ (core+CAHPS): Distribution in Rounds 4 and follow-up in Round 5 for Panels whose R1 collection occurred in an even year (FirstPanYear=even).
SAQ (core+CAHPS): Distribution in Rounds 6 and follow-up in Round 7 for Panels whose R1 collection occurred in an odd year (FirstPanYear=odd).
SAQ (core+CAHPS): Distribution in Rounds 8 and follow-up in Round 9 for Panels whose R1 collection occurred in an even year (FirstPanYear=even).
PSAQ (core + prevention): Distribution in Rounds 2 and follow-up in Round 3 for Panels whose R1 collection occurred in an even year (FirstPanYear=even).
PSAQ (core + prevention): Distribution in Rounds 4 and follow-up in Round 5 for Panels whose R1 collection occurred in an odd year (FirstPanYear=odd).
PSAQ (core + prevention): Distribution in Rounds 6 and follow-up in Round 7 for Panels whose R1 collection occurred in an even year (FirstPanYear=even).
PSAQ (core + prevention): Distribution in Rounds 8 and follow-up in Round 9 for Panels whose R1 collection occurred in an odd year (FirstPanYear=odd).
VSAQ (Veteran's SAQ): Collection Rules for Spring 2019 (P24R1, P23R3, P22R5) only:
VSAQ: Distribution only in Rounds 1, 3, and 5 for just Spring 2019.
SDOH (Social Determinants of Health): Follow-up Rules for Fall 2021 only (P26R2, P25R4, P24R6, P23R8): SDOH: Follow-up only in Rounds 2, 4, 6, and 8 Fall 2021. (Distribution occurred during the SD section in Spring 2021)
BOX_30 (QS1015)
Route Details: If at least one RU member where SAQFlag=Yes
Continue with BOX_35.
If at least one RU member where DCSFlag=YES
OR
SAQFlagFlwUp=YES
OR
PSAQFlag=YES
OR
PSAQFlagFlwUp=YES
OR
VSAQFlag=YES
OR
SDOHFlagFlwUp=YES
Go to QS10.
Otherwise, go to BOX_60.
Programmer Instructions: Determine the number of DCS’s and (P)SAQ’s required for this household: Refer to the Global
Spec item: AgeCalculation for all age calculations required for the flags. Set flags as described for each RU member that meets the required criteria.
DCS (RndType=Cross or Final)
-If current round crosses two calendar years OR is the final round of the panel (RndType=Cross or final)
AND
-person is => 18 years of age or in age categories 4-9
AND
-person is a current RU member (included in person array)
AND
-person is Key (CtrlPersKey=Yes)
AND
-person is not deceased (PersRndStatus ≠Deceased)
AND
- 'DIABETES' is on person's-medical-conditions-roster and was created in the PE section (in any round), then set Person.DCSFlag=YES. SAQ (RndType=Within), core+CAHPS)
-[(If round 2 and panel year is odd (FirstPanYear=odd)) OR (If round 4 and panel year is even (FirstPanYear=even)) OR (If round 6 and panel year is odd (FirstPanYear=odd)) OR (If round 8 and panel year is even (FirstPanYear=even))]
AND
-person is a current RU member (included in person array)
AND
- person is Key (CtrlPersKey=Yes)
AND
-person is not deceased or institutionalized (PersRndStatus ≠Deceased or institutionalized)
AND
-person is in the RU at the current round's interview date (EndRefDt = EndRefM, EndRefD, EndRefY).
AND
-RU member is = > 18 years of age or in age categories 4-9 on July 1, {YEAR}, where ‘YEAR’ is the first calendar year of the panel (FirstPanYear), if round 2 or on July 1, {YEAR}, where ‘YEAR’ is the second calendar year of the panel (SecondPanYear), if round 4, or on July 1, {YEAR}, where 'YEAR' is the third calendar year of the panel (ThirdPanYear), if round 6, or on July 1, {YEAR} where 'YEAR' is the fourth calendar year of the panel (FourthPanYear), if round 8, or has turned 18 between July 1, {YEAR}, where ‘YEAR’ is the first calendar year of the panel, and the date of the interview if round 2, or July 1, {year}, where ‘YEAR’ is the second calendar year of the panel, and the date of the interview if round 4, or July 1, {YEAR}, where 'YEAR' is the third calendar year of the panel, and the date of the interview if round 6, or July 1, {YEAR}, where 'YEAR' is the fourth calendar year of the panel, and the date of the interview if round 8, then set Person.SAQFlag=YES. SAQ Follow-up (RndType=Cross or Final, core+CAHPS)
-[(If Panel 22, Round 3 or Panel 21, Round 5) or (If current round is a round that crosses two calendar years (RndType=Cross) and panel year is odd (FirstPanYear=odd)) OR (If current round is the final round of the panel (RndType=Final) and panel year is even (FirstPanYear=even))]
AND
-person is a current RU member (included in person array)
AND
-person was prompted for an SAQ in Round 2 (if Round 3) or 4 (if Round 5) or 6 (if Round 7) or 8 (if Round 9) and that SAQ is outstanding [PL_Person.SAQRecCtrlStatus= ‘3’ (REFUSED), ‘5’ (BLANK), ‘6’ (WRONG TYPE), ‘7’ (WRONG YEAR USED), '8' (NOT RECEIVED)], then set Person.SAQFlagFlwUp=YES. PSAQ (RndType=Within, core+prevention)
-[(If round 2 or round 6 and panel year is even (FirstPanYear=even)) OR (If round 4 or round 8 and panel year is odd (FirstPanYear=odd))]
AND
-person is a current RU member (included in person array)
AND
- person is Key (CtrlPersKey=Yes)
AND
-person is not deceased or institutionalized (PersRndStatus ≠Deceased or institutionalized)
AND
-person is in the RU at the current round's interview date (EndRefDt = EndRefM, EndRefD, EndRefY).
AND
-RU member is = > 18 years of age or in age categories 4-9 on July 1, {YEAR}, where ‘YEAR’ is the first calendar year of the panel (FirstPanYear), if round 2 or on July 1, {YEAR}, where ‘YEAR’ is the second calendar year of the panel (SecondPanYear), if round 4, or on July 1, {YEAR}, where 'YEAR' is the third calendar year of the panel (ThirdPanYear), if round 6, or on July 1, {YEAR}, where 'YEAR' is the fourth calendar year of the panel (FourthPanYear), if round 8, or has turned 18 between July 1, {YEAR}, where ‘YEAR’ is the first calendar year of the panel, and the date of the interview if round 2, or July 1, {year}, where ‘YEAR’ is the second calendar year of the panel, and the date of the interview if round 4, or July 1, {YEAR}, where 'YEAR' is the third calendar year of the panel, and the date of the interview if round 6, or July 1, {YEAR}, where 'YEAR' is the fourth calendar year of the panel, and the date of the interview if round 8 then set Person.PSAQFlag=YES. PSAQ Follow-up (RndType=Cross or Final), core+prevention)
-[(If current round is a round that crosses two calendar years (RndType=Cross)
OR
(If current round is the final round of the panel (RndType=Final) and panel year is odd (FirstPanYear=odd))]
AND
-person is a current RU member (included in person array)
AND
-person was prompted for an PSAQ in Round 2 (if Round 3) or 4 (if Round 5) or 6 (if Round 7) or 8 (if Round 9) and that PSAQ is outstanding [PL_Person.PSAQRecCtrlStatus= ‘3’ (REFUSED), ‘5’ (BLANK), ‘6’ (WRONG TYPE), ‘7’ (WRONG YEAR USED), '8' (NOT RECEIVED)], then set Person.PSAQFlagFlwUp=YES.
BOX_35 (QS1016)
Route Details: Continue with QS03.
Programmer Instructions: For all RU members with Person.SAQFlag=1, set Person.SAQMode:
If contact information recorded for person [(Person.EmailAddr<>Empty) OR (Person.Cellphone<>Empty and (Person.CMTextCell=1 (YES) or Person.CMTextCell=3 (PENDING)))] set Person.SAQMode=1 (Web).
Otherwise, set Person.SAQMode=2 (Paper).
For all RU members with Person.SAQMode=1 (Web), set Person.ContactMode:
If email recorded for person (Person.EmailAddr<>Empty) AND cellphone recorded with text permissions yes or pending (Person.Cellphone<>Empty and (Person.CMTextCell=1 (YES) or Person.CMTextCell=3 (PENDING))), set Person.ContactMode=1 (Both).
If email recorded for person (Person.EmailAddr<>Empty) AND no cellphone or text permissions recorded (Person.Cellphone<>Empty or (Person.CMTextCell<>1,3)), set Person.ContactMode=2 (Email).
If no email recorded for person (Person.EmailAddr=Empty) AND cellphone recorded with text permissions yes or pending (Person.Cellphone<>Empty and (Person.CMTextCell=1 (YES) or Person.CMTextCell=3 (PENDING))), set Person.ContactMode=3 (SMS).
If Person.SAQMode=2 (Paper), set Person.ContactMode=4 (Paper).
QS03 (QS1017)
BLAISE NAME: SAQSumm
Question Text:
RU Member SAQ Mode Contact Mode
{FULLNAME_1} {SAQ MODE} {CONTACT MODE}
{FULLNAME_2} {SAQ MODE} {CONTACT MODE}
{FULLNAME_3} {SAQ MODE} {CONTACT MODE}
{FULLNAME_4} {SAQ MODE} {CONTACT MODE}
{FULLNAME_N} {SAQ MODE} {CONTACT MODE}
PRESS 1 AND ENTER TO CONTINUE.
Responses: CONTINUE 1
Programmer Instructions: If any RU member has Person.SAQMode=1 (Web), continue with QS05. Otherwise, go to QS10.
Display Instructions: Roster 1 - Report
Roster definition:
This item displays RU-members-roster for display of RU-members. Display RU members’ first, middle, and last names (Person.FullName).
Roster filter:
Display RU-members who meet the following conditions:
1. Person is eligible for the SAQ (Person.SAQFlag=YES) or PSAQ (Person.PSAQFlag=YES)
Display the following columns formatted in the info in nonproportional text:
Column Header #1: RU Member
Display the full name (Person.FullName) of each RU member meeting the roster filter definition.
Column Header #2: SAQ Mode
For {SAQ MODE}, display Person.SAQMode for each RU member. Display “Web” if Person.SAQMode=1 (Web). Display “Paper” if Person.SAQMode=2 (Paper).
Column Header #3: Contact Mode
For {CONTACT MODE}, display the SAQ contact mode (Person.ContactMode) for each RU member. Display “Email/Text” if Person.ContactMode=1 (Both). Display “Email” if Person.ContactMode=2 (Email). Display “Text” if Person.ContactMode=3 (SMS). Display “Paper” if Person.ContactMode=4 (Paper).
QS05 (QS1018)
BLAISE NAME: SAQWebIntro
Question Text:
We have a request for {PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N }.
We are asking {you/each of you/them} to complete a short online survey about health and health opinions. The survey is voluntary, and all of {your/their} responses will be kept private.
In a few days, invitations will be sent by text or email using the contact information we have on file. {Would you please share this card so they know to expect the survey?
PERSONALIZE SAQ CARD AND GIVE TO RESPONDENT.}
Responses: CONTINUE 1
IF VOLUNTEERED: UNWILLING TO 2
ACCESS ONLINE SURVEY
Programmer Instructions: If coded ‘2’, continue with QS07.
Else, if any RU member has SAQMode=2 (Paper), go to QS10.
Otherwise, go to BOX_60.
Display Instructions: For “PERSON 1, PERSON 2, PERSON 3, PERSON 4, PERSON N” display the first names (Person.FName) of all RU members with SAQMode=1 (Web). Substitute “you” for the person’s first name if the respondent is included in this list. If exactly two names displayed, separate names with the word “and” and no comma. If more than two names listed, separate names using commas, except for between the last two names displayed. Between the last two names displayed, separate names using the word “and”.
Display “you” if the only eligible person for the SAQ is the respondent. Display “each of you” if at least two RU members are eligible for the SAQ and one of them is the respondent. Otherwise, display “them”.
Display “your” if the eligible RU members include the respondent. Otherwise, display “their”.
Display ‘Would you please share this card... PERSONALIZE SAQ CARD AND GIVE TO RESPONDENT.’ if at least one RU member besides the respondent has SAQMode=1 (Web).
Otherwise, (the only RU member with SAQMode=1 (Web) is the respondent), use a null display.
QS07 (QS1019)
BLAISE NAME: PaperSAQ
Question Text:
INTERVIEWER: SELECT RU MEMBERS TO RECEIVE PAPER QUESTIONNAIRE.
ENTER ALL THAT APPLY.
Responses: {FIRST NAME [MIDDLE NAME] LAST NAME}1 1
{FIRST NAME [MIDDLE NAME] LAST NAME}2 2
{FIRST NAME [MIDDLE NAME] LAST NAME}3 3
{FIRST NAME [MIDDLE NAME] LAST NAME}4 4
{FIRST NAME [MIDDLE NAME] LAST NAME}N 5
Programmer Instructions: Roster Behavior
1. Multiple select allowed.
For anyone selected, change Person.SAQMode to ‘2’ (Paper) and Person.ContactMode to ‘4’ (Paper). Then go to QS10.
Display Instructions: Roster 2- No Add/Edit/Delete Roster Definition:
Roster definition:
This item displays RU-members-roster for display of RU-members. Display RU members’ first, middle, and last names (Person.FullName).
Roster filter:
Display RU-members who meet the following condition:
1. Person is eligible for web SAQ (Person.SAQMode=1 (Web) Refused and Don’t Know disallowed.
QS10 (QS1020)
BLAISE NAME: FormMatrl
Question Text:
FOR THIS SECTION, YOU WILL NEED THE FOLLOWING HARDCOPY MATERIALS FOR THIS HOUSEHOLD:
{{NUMBER 1} A SURVEY ABOUT YOUR DIABETES CARE FORMS (DCS) }
{{NUMBER 2} YOUR HEALTH AND HEALTH OPINION FORMS (SAQ) }
{{NUMBER 3} YOUR HEALTH AND HEALTH OPINION FORMS (PSAQ-MALE=BLUE)}
{{NUMBER 4} YOUR HEALTH AND HEALTH OPINION FORMS (PSAQ-FEMALE=PURPLE)}
{{NUMBER 5} A SURVEY FOR VETERANS (VSAQ) }
{{NUMBER 6} Social and Health Experiences Survey (SDOH) }
PLEASE PULL THESE MATERIALS OUT NOW.
In this next section, I will be distributing {and collecting} some hardcopy materials.
PRESS 1 AND ENTER TO CONTINUE.
Responses: CONTINUE 1 LOOP_10 (QS1025)
Display Instructions: Display “{NUMBER 1} ... (DCS)” if at least one person where Person.DCSFlag=Yes. Otherwise, use a null display. For “NUMBER 1”, display the count of Person.DCSFlag=Yes for this RU.
Display “{NUMBER 2} ... (SAQ)” if [at least one person where Person.SAQFlag=Yes AND Person.SAQMode=2 (Paper)] or [Person.SAQFlagFlwUp=Yes]. Otherwise, use a null display. For “NUMBER 2”, display the count of Person.SAQMode=2 and Person.SAQFlagFlwUp=Yes for this RU.
Display “{NUMBER 3} ... (PSAQ-MALE=BLUE)” if at least one male RU member where Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes. Otherwise, use a null display. For “NUMBER 3”, display the count of male RU members where Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes for this RU.
Display “{NUMBER 4} ... (PSAQ-FEMALE=PURPLE)” if at least one female (or gender=DK/RF) RU member where Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes. Otherwise, use a null display. For “NUMBER 4”, display the count of female (or gender=DK/RF) RU members where Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes for this RU.
Display “{NUMBER 5} ... (VSAQ)” if at least one person where Person.VSAQFlag=Yes. Otherwise, use a null display. For “NUMBER 5”, display the count of Person.VSAQFlag=Yes for this RU.
Display “{NUMBER 6} ... (SDOH)” if at least one person where Person.SDOHFlagFlwUp=Yes. Otherwise, use a null display. For “NUMBER 6”, display the count of Person.SDOHFlagFlwUp=Yes for this RU.
Display “and collecting” if at least one person in the RU has Person.SAQFlagFlwUp=YES or Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES or Person.SDOHFlagFlwUp=Yes in the current round. Otherwise, use a null display.
LOOP_10 (QS1025)
Route Details: For each element in the RU-members-roster, ask BOX_40 - END_LP10.
Loop definition: LOOP_10 distributes all hardcopy materials to each eligible RU member.
This loop cycles on persons who meet the following conditions:
RU member has at least one of the following flags set for in the current round:
Person.DCSFlag=YES
OR
Person.SAQFlag=YES and PERSON.SAQMode=2 (Paper)
OR
Person.SAQFlagFlwUp=YES
OR
Person.PSAQFlag=YES
OR
Person.PSAQFlagFlwUp=YES
OR
Person.VSAQFlag=YES
OR
Person.SDOHFlagFlwUp=YES
Continue with BOX_40
BOX_40 (QS1030)
Route Details: If Person.DCSFlag=YES, continue with QS20_01. If [Person.SAQFlag=YES and PERSON.SAQMode=2 (Paper)] or [Person.VSAQFlag=YES], go to QS20_05.
Otherwise, go to QS20_04.
Display Instructions:
Each flag that has been set should display a row for the corresponding hardcopy questionnaire.
-Display “DCS” on Col #1, Row #1 as an uneditable, protected cell
-Display “SAQ” on Col#1, Row #2 as an uneditable, protected cell
-Display “PSAQ” on Col#1, Row #3 as an uneditable, protected cell
-Display “SDOH” on Col#1, Row #4 as an uneditable, protected cell
Row #1 should display as active if Person.DCSFlag-YES.
Row #2 should display as active if Person.SAQFlag=Yes or Person.SAQFlwUpFlag=YES.
Row #3 should display as active if Person.PSAQFlag=Yes or Person.PSAQFlwUpFlag=YES.
Row #4 should display as active if Person.VSAQFlag=Yes and if P22R4, P23R1, P22R5.
Row #4 should display as active if Person.SDOHFlwUpFlag=YES and if P26R2, P25R4, P24R6, or P23R8.
(NOTE: An RU member will never have BOTH the SAQ and PSAQ active in the same round.)
Roster Report 1
Format the form pane column headers as follows:
Roster Definition: Display the hardcopy materials required for this RU member set at BOX_30
Col#2 Header: DCS Type (QS20_01) Col#3 Header: Proxy Reason (QS20_02) Col#4
Header: Proxy Other (QS20_03)
Col#5 Header: Form Available? (QS20_04)
Col#6 Header: Distribute Form (QS20_05)
Col#7 Header: Final Status (QS20_06)
Col#8 Header: Specify Status (QS20_06OS)
Col#9 Header: Refusal Reason (QS20_07)
Col#10 Header: Specify Refusal (QS20_08)
Programmer Instructions: For each flag RU member has set (Person.DCSFlag= YES, Person.SAQFlag=YES, Person.SAQFlagFlwUp=YES, Person.PSAQFlag=YES, Person.PSAQFlagFlwUp=YES, Person.VSAQ=YES, Person.SDOHFlagFlwUp=Yes) configure the QS20 grid in the following manner:
The grid should be Preloaded Grid Type 1: forced navigation, including QS20_01, QS20_02, QS20_03, QS20_04, QS20_05, QS20_06, QS20_06OS, QS20_07, and QS20_08.
NOTE TO PROGRAMMERS: This grid needs to be configurable to accommodate the addition of other required hardcopy materials as requested by the client in future panels.
QS20_01 (QS1035)
BLAISE NAME: FormType
Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}
Question Text:
{During an earlier interview, it/It} was mentioned that {you/{PERSON}} {have/has} diabetes. To obtain more information on the care of adults with diabetes, we have a short questionnaire for {you/him/her}.
DETERMINE IF SELF OR PROXY DIABETES CARE SUPPLEMENT (DCS) SHOULD BE DISTRIBUTED: SELF DCS: FOR ANY CURRENT RU MEMBER (18 YEARS OR OLDER) WHO HAS DIABETES.
PROXY DCS: FOR ANY RU MEMBER (18 OR OLDER) WHO IS INSTITUTIONALIZED, OR OTHERWISE INCAPACITATED.
ENTER TYPE OF DCS DISTRIBUTED NECESSARY FOR {PERSON}. {ACTION: PERSON IS INSTITUTIONALIZED AND MAY REQUIRE PROXY DCS.}
CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.
Responses: SELF 1 QS20_05 (QS1054)
PROXY 2 QS20_02 (QS1040)
Programmer Instructions: RF/DK not allowed.
Display Instructions: Display ‘During an earlier interview, it’ if diabetes was not created during the current round for the person being looped on. Display ‘It’ if diabetes created during the current round for the person being looped on.
Display “ACTION: PERSON IS INSTITUTIONALIZED AND MAY REQUIRE PROXY DCS.” if the person being asked about is institutionalized (PersRndStatus=Institutionalized) for the current round.
Otherwise, use a null display.
The label ACTION: should be displayed in the traditional interviewer instruction font size – but in red.
The text after “ACTION” should be displayed in the traditional blue interviewer instruction size and color.
QS20_02 (QS1040)
BLAISE NAME: FormProxyResn
Context Header: {PERSON'S FIRST MIDDLE AND LAST NAME}
Question Text:
ENTER REASON FOR PROXY DCS.
Responses: INSTITUTIONALIZED 2 QS20_05 (QS1054)
OTHER 3 QS20_03 (QS1045)
Programmer Instructions: RF/DK not allowed.
Display Instructions:
QS20_03 (QS1045)
BLAISE NAME: FormProxyResnOS
Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}
Question Text:
SPECIFY OTHER REASON FOR PROXY DCS:
Responses: 1 QS20_05 (QS1054)
Programmer Instructions: RF/DK not allowed.
Display Instructions:
QS20_04 (QS1050)
BLAISE NAME: FormCmpl
Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}
Question Text:
{Now} I would like to ask {you/{PERSON}} to complete a brief survey about {health and health opinions/social and health experiences}. {You/{PERSON}} may have already received this in the mail.
I want to check if {you/{PERSON}} completed that questionnaire already or {need/needs} a replacement.
{IF SDOH SAQ COLLECTED, SAY: We will mail {you/him/her} $20 after the MEPS office receives the completed survey.}
{{SAQ/PSAQ/SDOH} STATUS FROM PREVIOUS ROUND: {PREVIOUS ROUND STATUS -40}}
{COLLECT {MALE (BLUE)/FEMALE (PURPLE)} PSAQ. IF INCORRECT COLOR PSAQ COMPLETED, CODE ‘2’ (NEEDS REPLACEMENT) TO FILL OUT CORRECT COLOR PSAQ.}
{PERSON IS {DECEASED/INSTITUTIONALIZED/PARTIALLY ELIGIBLE - MOVED FROM RU}. IF {SAQ/PSAQ/SDOH} ALREADY COMPLETED BECAUSE IT WAS MAILED TO HOUSEHOLD, COLLECT IT. HOWEVER, IF NOT ALREADY COMPLETED, CODE ‘3’ AND DO NOT DISTRIBUTE NEW {SAQ/PSAQ/SDOH}.}
{CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.}
Responses: COMPLETED /RETURNING QUESTIONNAIRE 1 QS20_06 (QS1055)
NEEDS REPLACEMENT 2 QS20_05 (QS1054)
{NOT COMPLETED-NO REPLACEMENT NECESSARY} 3 BOX_50 (QS1075)
Programmer Instructions: RF/DK not allowed.
Display Instructions: Display “Now” if QS20_01 was on route for the person being looped on. Otherwise, use a null display.
Display “health and health opinions” if asking about SAQ or PSAQ (Person.SAQFlag=YES or Person.SAQFlagFlwUp=YES or Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES) for the person being looped on. Display “social and health experiences” if asking SDOH (Person.SDOHFlagFlwUp=YES) for the person being looped on.
Display ‘IF SDOH SAQ COLLECTED, SAY: We will mail {you/him/her} $20 after the MEPS office receives the completed survey.’ if asking about SDOH (Person.SDOHFlagFlwUp=YES). Otherwise, use a null display.
Display "{SAQ/PSAQ/SDOH} STATUS FROM PREVIOUS ROUND: {PREVIOUS ROUND STATUS -40}” if person was prompted for an SAQ/PSAQ/SDOH in previous round and that SAQ/PSAQ/SDOH is outstanding (Person.SAQFlagFlwUp=YES or Person.PSAQFlagFlwUp=Yes or Person.SDOHFlagFlwUp=YES). Otherwise, use a null display.
Display “SAQ” if Person.SAQFlag=YES or Person.SAQFlagFlwUp=YES for the person being looped on.
Display “PSAQ” if Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on.
Display “SDOH” if Person.SDOHFlagFlwUp=YES for the person being looped on.
For ‘PREVIOUS ROUND STATUS-40’, display the following text:
If PL_Person.SAQRecCtrlStatus=3 display 'REFUSED'.
If PL_Person.SAQRecCtrlStatus=5 display 'BLANK'.
If PL_Person.SAQRecCtrlStatus=6 display 'WRONG TYPE'.
If PL_Person.SAQRecCtrlStatus=7 display 'WRONG YEAR USED'.
If PL_Person.SAQRecCtrlStatus=8 display 'NOT RECEIVED'.
If PL_Person.PSAQRecCtrlStatus=3 display 'REFUSED'.
If PL_Person.PSAQRecCtrlStatus=5 display 'BLANK'.
If PL_Person.PSAQRecCtrlStatus=6 display 'WRONG TYPE'.
If PL_Person.PSAQRecCtrlStatus=7 display 'WRONG YEAR USED'.
If PL_Person.PSAQRecCtrlStatus=8 display 'NOT RECEIVED'.
If PL_Person.SDOHRecCtrlStatus=3 display 'REFUSED'.
If PL_Person.SDOHRecCtrlStatus=5 display 'BLANK'.
If PL_Person.SDOHRecCtrlStatus=8 display 'NOT RECEIVED'.
Display “COLLECT {MALE (BLUE)/FEMALE (PURPLE)} PSAQ. IF INCORRECT COLOR PSAQ COMPLETED, CODE ‘2’ (NEEDS REPLACEMENT) TO FILL OUT CORRECT COLOR PSAQ..” If Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on.
Otherwise, use a null display.
Display “MALE (BLUE)” if person being looped on is male. Otherwise, display “FEMALE (PURPLE)”.
If Person.SAQFlagFlwUp=YES or Person.PSAQFlagFlwUp=YES or SDOHFlagFlwUp and (person is NOT in the RU at the current round's interview date (EndRefDt ≠ EndRefM, EndRefD, EndRefY)), then display FI instruction “PERSON…NEW DOCUMENT.” and response option ‘3’ (NOT COMPLETED, NO REPLACEMENT NECESSARY). Otherwise, use a null display.
Display “DECEASED” if PersRndStatus=Deceased. Display “INSTITUTIONALIZED” if PersRndStatus=Institutionalized. Otherwise, display “PARTIALLY ELIGIBLE - MOVED FROM RU.”
Display “CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.” If QS20_01 was not on route for the person being looped on. Otherwise, use a null display.
QS20_05 (QS1054)
BLAISE NAME: FormPrep
Context Header: {PERSON’S FIRST, MIDDLE, AND LAST NAME}
Question Text:
{PREPARE {SELF/PROXY} DIABETES CARE SUPPLEMENT (DCS) FOR {PERSON}: WRITE IN PERSON’S NAME, DOB, PID, AND RUID.
NAME: {FIRST NAME} {MIDDLE NAME} {LAST NAME}
DOB: {MM/DD/YYYY} PID: {PID}
RU ID: {RU ID}
STATUS: {CURRENT/INSTITUTIONALIZED}
HAND PREPARED {SELF/PROXY} DCS TO RESPONDENT AND SAY:
We hope that {{you/{PERSON}}/you or someone else in the family} would be able to fill out this short questionnaire on the care {{you/{PERSON}}/{PERSON}} {{get/gets}/gets} for diabetes. {{You/He/She}/You} can give it to me before I leave today, or I can pick it up later.}
{PREPARE {MALE (BLUE)/FEMALE (PURPLE)} {SAQ/PSAQ/VSAQ/SDOH} FOR {PERSON} USING THE INFORMATION BELOW:
REGION: {REGION} RU ID: {RU ID} PID: {PID}
NAME: {FIRST NAME} {MIDDLE NAME} {LAST NAME}
{SDOH NAME: {SDOHFNAME} {SDOHLNAME}}
DOB: {MM/DD/YYYY}
HAND PREPARED {SAQ/PSAQ/VSAQ/SDOH} {AND RETURN ENVELOPE} TO RESPONDENT AND SAY:
We hope {you/{PERSON}} will be able to fill out this short questionnaire about {health and health opinions/health choices/health care needs of military veterans/social and health experiences}. {You/He/She} can give it to me before I leave today, or I can pick it up later./Once {you are finished, please/he is finished, he should/she is finished, she should} place it back in the return envelope and seal it. {You/He/She} can give it to me before I leave today, or drop it in the mail once it’s completed. We will mail {you/him/her} $20 after the MEPS office receives the completed survey.}
{CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.}
PRESS 1 AND ENTER TO CONTINUE.
HELP:F1
Responses: CONTINUE 1 QS20_06 (QS1055)
Programmer Instructions: When asking about DCS for this RU member display ‘PREPARE {SELF/PROXY} DIABETES… {{You/He/She}/You} can give it to me before I leave today, or I can pick it up later.’ Do not display the other fills on SAQ. When asking about SAQ use a null display.
Display 'SELF', '{you/{PERSON}}', '{you/{PERSON}}', ‘{get/gets}’ and ‘{You/He/She}’ if QS20_01 is coded ‘1’ (SELF).
Display 'PROXY', 'you or someone else in the family', ‘{Person}’, ‘gets’ and ‘You’ if QS20_01 is coded ‘2’ (PROXY).
Display date of birth for person being asked about for 'MM/DD/YYYY.' Display PID of person being asked about for 'PID'.
Display the RU ID for the current case for 'RUID'.
Display ‘CURRENT’ if the person being asked about is a current RU member (person included on person array) and is not institutionalized or deceased (PersRndStatus≠ Institutionalized or Deceased). Display “INSTITUTIONALIZED” if the person being asked about is institutionalized (PersRndStatus=Institutionalized).
When asking about SAQ/PSAQ/SDOH for this RU member display ‘PREPARE {MALE (BLUE)/FEMALE (PURPLE)} {SAQ/PSAQ/SDOH} FOR {PERSON}…or I can pick it up later.’ Do not display the other fills on DCS. When asking about DCS use a null display.
Display region for the current case being asked about for ‘REGION’. Display the RU ID for the current case for 'RUID'.
Display PID of RU member being asked about for 'PID'.
Display date of birth for RU member being asked about for 'MM/DD/YYYY.' RF/DK not allowed.
Display Instructions: When asking about the DCS, display all the fill text in bold black, “FIRST NAME”, “MIDDLE NAME”, “LAST NAME”,“MM/DD/YYYY”,“PID”,“RUID” “CURRENT/INSTITUTIONALIZED”. All other text should adhere to the UI document specifications.
Display “SDOH NAME: {SDOHFNAME} {SDOHLNAME}”, if the person whose cell the cursor is in has an alias (Person.SDOHAliasFlag=Yes). If Person.SDOHAliasFlag<>Yes, use a null display.
When asking about the SAQ/PSAQ/VSAQ/SDOH, display all the fill text in bold black: “REGION”, “RUID”, “PID” “FIRST NAME”, “MIDDLE NAME”, “LAST NAME”, “MM/DD/YYYY”. All other text should adhere to the UI document specifications.
Display “{MALE (BLUE)/FEMALE (PURPLE)}” If Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on. Otherwise, use a null display.
Display “MALE (BLUE)” if person being looped on is male. Otherwise, display “FEMALE (PURPLE)”.
Display “SAQ” if Person.SAQFlag=YES or Person.SAQFlagFlwUp=YES for the person being looped on.
Display “PSAQ” if Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on.
Display “VSAQ” if Person.VSAQFlag=YES for the person being looped on.
Display “SDOH” if Person.SDOHFlagFlwUp=YES for the person being looped on.
Display ‘AND RETURN ENVELOPE’ when asking about the SDOH. Otherwise, use a null display.
Display 'health and health opinions' when asking about the SAQ. Display 'health choices' when asking about PSAQ. Display ‘health care needs of military veterans’ when asking about the VSAQ. Display ‘social and health experiences’ when asking about the SDOH.
Display ‘{You/He/She} can give it to me before I leave today, or I can pick it up later.’ if asking about a form other than the SDOH. Display ‘Once {you are finished, please/he is finished, he should/she is finished, she should} place it back in the return envelope and seal it. {You/He/She} can give it to me before I leave today, or drop it in the mail once it’s completed. We will mail {you/him/her} $20 after the MEPS office receives the completed survey.’ if asking about the SDOH.
Display “CTRL-S: SWITCH TO DISTRIBUTE DOCS FOR A DIFFERENT PERSON.” If both QS20_01 and QS20_04 were not on route for the person being looped on. Otherwise, use a null display.
QS20_06 (QS1055)
BLAISE NAME: FormCollect
Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}
Question Text:
COLLECT {PERSON}’S COMPLETED {SAQ/PSAQ/SDOH/DCS}.
Responses: COMPLETED AND GIVEN TO INTERVIEWER 1 BOX_50 (QS1075)
NOT COMPLETED, WILL PICK UP AT A LATER DATE 2 BOX_50 (QS1075)
NOT COMPLETED, WILL MAIL TO OFFICE 3 BOX_50 (QS1075)
MAILED TO SAQ RESPONDENT 4 BOX_50 (QS1075)
REFUSED TO COMPLETE (NO FORM LEFT) 5 QS20_07 (QS1060)
NOT COMPLETED, WILL COLLECT AFTER INTERVIEW 6 BOX_50 (QS1075)
OTHER 91 QS20_06OS (QS1057)
Programmer Instructions: RF/DK not allowed.
Display Instructions: Display “SAQ” if Person.SAQFlag=YES or Person.SAQFlagFlwUp=YES for the person being looped on.
Display “PSAQ” if Person.PSAQFlag=YES or Person.PSAQFlagFlwUp=YES for the person being looped on.
Display “SDOH” if Person.SDOHFlagFlwUp=YES for the person being looped on.
Display “DCS” if Person.DCSFlag=YES for the person being looped on.
QS20_06OS (QS1057)
BLAISE NAME: FormCollectOS
Question Text:
PERSON: {First Middle Last Name} PID: {PID} FORM: {SAQ/PSAQ ({BLUE/PURPLE})/DCS/VSAQ/SDOH}
SPECIFY OTHER STATUS: .........................................1
Responses: 1
Programmer Instructions: Go to BOX_50.
Refused and Don’t Know disallowed.
Display Instructions: For "{First Middle Last Name}", display the first, middle and last names of the person being looped on. Use Person.FName, Person.MName, and Person.LName.
For "{PID}", display the Person ID for the person being looped on. Use PersID. Display "SAQ" if on row for SAQ.
Display "PSAQ ({BLUE/PURPLE})" if on row for PSAQ. Display "(BLUE)" if person being looped on is male. Otherwise, display "(PURPLE)".
Display "DCS" if on row for DCS.
Display "VSAQ" if on row for VSAQ.
Display "SDOH" if on row for SDOH.
Display the first line of interviewer instructions, PERSON, PID, FORM, in grayed out text.
QS20_07 (QS1060)
BLAISE NAME: FormRfResn
Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}
Question Text:
SELECT MAIN REASON FOR REFUSAL:
Responses: TOO BUSY 1 BOX_50 (QS1075)
TOO PERSONAL/SENSITIVE INFORMATION 2 BOX_50 (QS1075)
TOO MUCH OF A PHYSICAL/MENTAL HARDSHIP 3 BOX_50 (QS1075)
HAS ALREADY GIVEN ENOUGH INFORMATION 4 BOX_50 (QS1075)
WANTS MORE INFORMATION 5 BOX_50 (QS1075)
NOT INTERESTED 6 BOX_50 (QS1075)
NO REASON GIVEN 7 BOX_50 (QS1075)
OTHER 91 QS20_08 (QS1065)
Programmer Instructions: RF/DK not allowed.
Display Instructions:
QS20_08 (QS1065)
BLAISE NAME: FormRfOS
Context Header: {PERSON’S FIRST MIDDLE AND LAST NAME}
Question Text:
ENTER OTHER REASON FOR REFUSAL:
Responses: 1 END_LP10 (QS1080)
Programmer Instructions: RF/DK not allowed.
Display Instructions:
BOX_50 (QS1075)
Route Details: If Row #1 (DCS) completed and [Person.SAQFlagFlwUp=Yes or Person.PSAQFlag=Yes or Person.PSAQFlagFlwUp=Yes, go to QS20_04 to complete Row #2/Row #3 (SAQ/PSAQ) for this person.
If Row #1 (DCS) completed and Row #2/Row #3 (SAQ/PSAQ) also completed and Person.SDOHFlagFlwUp=YES, go to QS20_04 to complete Row #4 for this person.
If all rows and cells are completed for this person, continue with END_LP10.
END_LP10 (QS1080)
Route Details: Cycle on the next RU member that meets the conditions of LOOP_10.
If no more RU members meet those criteria, continue with BOX_60.
BOX_60 (QS1085)
Route Details: Go to the next questionnaire section.