MEPS-HC Survey Instrument

Accident/Injury and Conditions (CN) Section
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BOX_01
IF AT LEAST ONE CONDITION ON PERSON’S-MEDICAL-CONDITIONS-ROSTER MEETS THE
FOLLOWING CONDITIONS:
- CONDITION IS FLAGGED AS ‘CREATED’ DURING THE CURRENT ROUND
- CONDITION IS NOT A PRIORITY CONDITION, THAT IS, IT IS NOT FLAGGED AS
CREATED IN THE PE SECTION
- CONDITION IS NOT FLAGGED AS ‘UNLIKELY ACCIDENT/INJURY’ (THIS FLAG WILL
BE DETERMINED LATER AS IT MAY BE SET FOR CERTAIN CONDITIONS THAT ARE
PART OF A CONDITION LOOK-UP TABLE AND ARE DETERMINED TO BE UNLIKELY
DUE TO AN ACCIDENT OR INJURY)
CONTINUE WITH CN01.
OTHERWISE, GO TO BOX_12.

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Accident/Injury and Conditions (CN) Section
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CN01

Help Enabled (ACDNTINJUR)

Comment Enabled

Variable Name
PRND.CONDINJ

Jump Back Enabled

Label

Size

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Now I’m going to read you a list of some of the health conditions that were
reported for (PERSON) between (START DATE) and (END DATE).
READ CONDITIONS BELOW.
{Condition}
{Condition}
{Condition}
Were any of these health conditions due to an accident or injury?
YES
NO

1
2

{CN01A}
{BOX_12}

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Refused
Don't Know

RF
DK

{BOX_12}
{BOX_12}

HELP AVAILABLE FOR DEFINITION OF ACCIDENT/INJURY.
PROGRAMMER NOTES:
THE THIRD CRITERION FOR DISPLAY IN THE ROSTER WILL BE
DETERMINED LATER AS THE FLAG MAY BE SET FOR CERTAIN CONDITIONS
THAT ARE PART OF A CONDITION LOOK-UP TABLE AND ARE DETERMINED
TO BE UNLIKELY DUE TO AN ACCIDENT/INJURY.

Roster Details
Title:

PERS_COND_1

Col #

Header

Instructions

CONDITION

Display name of medical condition COND.CONDNAM

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Accident/Injury and Conditions (CN) Section
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Roster Definition:
This item displays the PERSON'S-CONDITIONS-ROSTER.
Roster Behavior:
1. Display only.
2. Add, delete, select, and edit disallowed.
Roster Filter:
' DISPLAY ONLY THE CONDITIONS FOR PERSON THAT ARE
- CREATED THIS ROUND
- NOT FLAGGED AS PRIORITY CONDITIONS (THAT IS, THOSE NOT
FLAGGED AS CREATED IN THE PE SECTION)
- NOT FLAGGED AS 'UNLIKELY ACCIDENT/INJURY' THE CONDITIONS ARE
LISTED FOR DISPLAY ONLY; THEY ARE NOT SELECTABLE.

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Accident/Injury and Conditions (CN) Section
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CN01A

Help Enabled (ACDNTINJUR)
Variable Name
COND.INJURY

Comment Enabled

Jump Back Enabled

Label
WAS CONDITION DUE TO ACCIDENT/INJURY

Size
2

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Which of (PERSON)’s health conditions were due to an accident or injury?
PROBE: Any other health conditions due to an accident or injury?

CONDITION
CONDITION
CONDITION

{BOX_03}

HELP AVAILABLE FOR DEFINITION OF ACCIDENT/INJURY.
PROGRAMMER NOTES:
FLAG ALL CONDITIONS SELECTED AT CN01A AS 'DUE TO
ACCIDENT/INJURY'.
THE THIRD CRITERION FOR DISPLAY IN THE ROSTER WILL BE
DETERMINED LATER AS THE FLAG MAY BE SET FOR CERTAIN CONDITIONS
THAT ARE PART OF A CONDITION LOOK-UP TABLE AND ARE DETERMINED
TO BE UNLIKELY DUE TO AN ACCIDENT/INJURY.

Roster Details
Title:

PERS_COND_1

Col #

Header

Instructions

CONDITION

Display name of medical condition COND.CONDNAM

1

Roster Definition:
Display the PERSON-MEDICAL-CONDITIONS-ROSTER for selection.
Roster Behavior:
1. Multiple select allowed.
2. Add, edit, and delete disallowed.

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Accident/Injury and Conditions (CN) Section
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Roster Filter:
Display conditions that meet the following:
1. Condition is flagged as ‘Created’ during the current
round.
2. Condition is not a priority condition, that is, the
condition is not flagged as created in the PE section.
3. Condition is not flagged as ‘Unlikely Accident/Injury’.

BOX_03
IF ANY CONDITIONS FLAGGED AS 'DUE TO ACCIDENT/INJURY', CONTINUE WITH
LOOP_01.
OTHERWISE, GO TO BOX_12.

LOOP_01
FOR EACH ELEMENT IN PERSON’S-MEDICAL-CONDITIONS-ROSTER, ASK CN06-END_LP01
LOOP DEFINITION: LOOP_01 COLLECTS INFORMATION ABOUT MEDICAL CONDITIONS
CREATED DURING THE CURRENT ROUND THAT ARE DUE TO AN ACCIDENT OR INJURY.
THIS LOOP CYCLES ON MEDICAL CONDITIONS THAT MEET THE FOLLOWING CONDITIONS:
- MEDICAL CONDITION IS FLAGGED AS ‘DUE TO AN ACCIDENT OR INJURY’
(CONDITION SELECTED AT CN01A)
- MEDICAL CONDITION IS FLAGGED AS ‘CREATED’ DURING THE CURRENT ROUND

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Accident/Injury and Conditions (CN) Section
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CN06

Help Enabled
Variable Name
COND.ACCDENTY

Comment Enabled

Jump Back Enabled

Label

Size
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DATE OF ACCIDENT - YEAR

{PERSON'S FIRST MIDDLE AND LAST NAME} {PERSON'S CN MEDICAL
CONDITION} {STR-DT} {END-DT}
When did the accident or injury happen?
{PROBE IF ANY EVENTS LISTED: The dates we have recorded for the
medical care for (CONDITION) include (READ EVENT DATES BELOW).}
{[Provider], [Event Date], [Event Type]}
{[Provider], [Event Date], [Event Type]}
{[Provider], [Event Date], [Event Type]}
YYYY: _______
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Refused
Don't Know

RF
DK

{CN06A}
{CN06A}

DISPLAY INSTRUCTIONS:
IF THERE ARE NO EVENTS CREATED THIS ROUND RELATED TO THE
CONDITION BEING ASKED ABOUT, DO NOT DISPLAY THE PROBE OR EVENT
ROSTER. OTHERWISE, DISPLAY THE PROBE AND EVENTS ROSTER.
ROUTING INSTRUCTION:
IF YEAR IS REFERENCE YEAR OR REFERENCE YEAR MINUS 1,
CONTINUE WITH CN06OV1.
OTHERWISE, GO TO BOX_05.

Hard CHECK:
EDIT: THE COMPLETE DATE CANNOT BE BEFORE THE PERSON’S DATE OF BIRTH OR AFTER
THE CURRENT REFERENCE PERIOD END DATE FOR THIS PERSON.

Roster Details
Title:

PERS_EVNT_2

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Accident/Injury and Conditions (CN) Section
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Col #

Header

Instructions

1

PROVIDER

Display Medical Provider
EVPV.LORPNAME
EVPV.DRFNAM
EVPV.DRMNAM

2

EVENT DATE

Display Event Date
EVPV.EVNTBEGM
EVPV.EVNTBEGD
EVPV.EVNTBEGY

3

EVENT TYPE

Display Event Code
EVPV.EVNTTYPE

Roster Definition:
Display the PERSON-MEDICAL-EVENTS-ROSTER for display as the
second column. Include the PROVIDER as the first column and
the Event Type as the third column.
Roster Behavior:
1. Display only.
2. Add, delete, select, and edit disallowed.
Roster Filter:
Display events created this round that are linked to the
condition being asked about.

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Accident/Injury and Conditions (CN) Section
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CN06OV1

Help Enabled
Variable Name
COND.ACCDENTM

Comment Enabled

Jump Back Enabled

Label

Size
2

DATE OF ACCIDENT - MONTH

MM: _______________________
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Refused
Don't Know

RF
DK

{BOX_05}
{BOX_05}

ROUTING INSTRUCTION:
IF YEAR IS REFERENCE YEAR, CONTINUE WITH CN06OV2.
OTHERWISE, GO TO BOX_05.

Hard CHECK:
ENTRIES FOR MONTH FIELD MUST CORRESPOND TO CALENDAR MONTHS.
THAT IS, ALLOWABLE VALUES = 01 - 12.
MISSING VALUES = RF AND DK ALLOWED.
EDIT: THE COMPLETE DATE CANNOT BE BEFORE THE PERSON’S DATE OF BIRTH OR AFTER
THE CURRENT REFERENCE PERIOD END DATE FOR THIS PERSON.

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Accident/Injury and Conditions (CN) Section
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CN06OV2

Help Enabled
Variable Name
COND.ACCDENTD

Comment Enabled

Jump Back Enabled

Label

Size
2

DATE OF ACCIDENT - DAY

DD: _______________________

{BOX_05}

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Refused
Don't Know

RF
DK

{BOX_05}
{BOX_05}

Hard CHECK:
ENTRIES FOR DAY FIELD MUST CORRESPOND TO CALENDAR DAYS. THAT IS,
- ALLOWABLE VALUES = 01 - 31 IF MONTH CODED ‘01’, ‘03’, ‘05’, ‘07’, ‘08’,
‘10’, ‘12’;
- ALLOWABLE VALUES = 01 - 30 IF MONTH CODED ‘04’, ‘06’, ‘09’, ‘11’;
- ALLOWABLE VALUES = 01 - 29 IF MONTH CODED ‘02’ AND YEAR IS 1996, 2000,
2004, OR 2008 (LEAP YEAR);
- ALLOWABLE VALUES = 01 - 28 IF MONTH CODED ‘02’ AND YEAR IS NOT 1996,
2000, 2004, OR 2008 (I.E., NOT LEAP YEAR).
MISSING VALUES = RF AND DK ALLOWED.
EDIT: THE COMPLETE DATE CANNOT BE BEFORE THE PERSON’S DATE OF BIRTH OR AFTER
THE CURRENT REFERENCE PERIOD END DATE FOR THIS PERSON.

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Accident/Injury and Conditions (CN) Section
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CN06A

Help Enabled

Comment Enabled

Variable Name
COND.ACCDNJAN

Jump Back Enabled

Label

Size

{PERSON'S FIRST MIDDLE AND LAST NAME} {PERSON'S CN MEDICAL
CONDITION} {STR-DT} {END-DT}
Did the accident or injury occur before or after January 1, {YEAR}?
BEFORE

1

{BOX_05}

AFTER

2

{BOX_05}

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Refused
Don't Know

RF
DK

{BOX_05}
{BOX_05}

DISPLAY INSTRUCTIONS:
(FOR SPECIFICATIONS PURPOSES ONLY; CAPI HANDLES
AUTOMATICALLY.) IF ROUNDS 1 AND 2, DISPLAY THE FIRST YEAR OF
THE PANEL FOR 'YEAR'. IF ROUNDS 3, 4, AND 5, DISPLAY THE
SECOND YEAR OF THE PANEL FOR 'YEAR'.

BOX_05
IF PERSON IS = OR > 16 YEARS OF AGE OR IN AGE CATEGORIES 4-9, CONTINUE
WITH CN07.
OTHERWISE, GO TO END_LP01.

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Accident/Injury and Conditions (CN) Section
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CN07

Help Enabled
Variable Name
COND.ACCDNWRK

Comment Enabled

Jump Back Enabled

Label

Size
2

DID ACCIDENT OCCUR AT WORK

{PERSON'S FIRST MIDDLE AND LAST NAME} {PERSON'S CN MEDICAL
CONDITION} {STR-DT} {END-DT}
Did the accident or injury happen while (PERSON) (were/was) at work?
YES

1

{END_LP01}

NO
DOES NOT WORK

2
3

{END_LP01}
{END_LP01}

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Refused
Don't Know

RF
DK

{END_LP01}
{END_LP01}

END_LP01
CYCLE ON NEXT CONDITION IN PERSON’S-MEDICAL-CONDITIONS-ROSTER THAT MEETS
THE CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO OTHER CONDITIONS MEET THE STATED CONDITIONS, END LOOP_01 AND
CONTINUE WITH BOX_12.

BOX_12
GO TO NEXT QUESTIONNAIRE SECTION.

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