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pdfAccess to Care (AC) Section
Beta
AC01
Help Enabled
Variable Name
HOME.HOMELANG
Comment Enabled
Jump Back Enabled
Label
LANGUAGE PREFERRED TO SPEAK AT HOME
Size
2
What language is spoken in your home most of the time?
ENGLISH
1
{LOOP_01}
SPANISH
ANOTHER LANGUAGE
2
3
{AC02}
{AC02}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
1
{LOOP_01}
{LOOP_01}
Access to Care (AC) Section
Beta
AC02
Help Enabled
Variable Name
HOME.CONVENG
Comment Enabled
Jump Back Enabled
Label
COMFORTABLE CONVERSING IN ENGLISH
Size
2
Are all members of your household comfortable conversing in English?
YES
1
NO
2
{LOOP_01}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{LOOP_01}
{LOOP_01}
ROUTING INSTRUCTION:
IF SINGLE-PERSON RU AND AC02 CODED ‘2’ (NO), SELECT PERSON
AUTOMATICALLY FOR AC02A AND GO TO LOOP_01A.
IF MULTI-PERSON RU AND AC02 CODED ‘2’ (NO), CONTINUE WITH
AC02A.
2
Access to Care (AC) Section
Beta
AC02A
Help Enabled
Variable Name
PRND.CONFENG
Comment Enabled
Jump Back Enabled
Label
NOT CONFORTABLE CONVERSING IN ENGLISH
Size
2
Who is not comfortable conversing in English?
PROBE: Is anyone else not comfortable conversing in English?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_01A}
PROGRAMMER NOTES:
FLAG ALL SELECTED PERSONS TO BE INCLUDED ON ROSTER FOR AC31.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Display all persons on the RU-Members-Roster excluding
deceased and institutionalized RU members
3
Access to Care (AC) Section
Beta
LOOP_01A
FOR EACH ELEMENT IN THE RU-MEMBERS ROSTER, ASK AC03-END_LP01A.
LOOP DEFINITION: LOOP_01A COLLECTS WHETHER OR NOT PERSON WAS BORN IN THE
U.S., AND IF NOT, HOW LONG PERSON HAS LIVED IN THE U.S. THIS LOOP CYCLES
ON PERSONS THAT MEET THE FOLLOWING CONDITION:
- PERSON WAS SELECTED AT AC02A (NOT COMFORTABLE CONVERSING IN ENGLISH).
AC03
Help Enabled
Variable Name
PRND.BORNUS
Comment Enabled
Jump Back Enabled
Label
Size
2
BORN IN THE UNITED STATES
{PERSON’S FIRST MIDDLE AND LAST NAME}
(Were/Was) (PERSON) born in the United States?
YES
1
{END_LP01A}
NO
2
{AC04}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
4
{AC04}
{AC04}
Access to Care (AC) Section
Beta
AC04
Help Enabled
Variable Name
PRND.LNGLIVUS
Comment Enabled
Jump Back Enabled
Label
Size
2
HOW LONG LIVED IN U.S.
{PERSON’S FIRST MIDDLE AND LAST NAME}
How long (have/has) (PERSON) lived in the United States?
LESS THAN 1 YEAR
1
{END_LP01A}
1 - 4 YEARS
5 - 9 YEARS
2
3
{END_LP01A}
{END_LP01A}
10 - 14 YEARS
15 YEARS OR MORE
4
5
{END_LP01A}
{END_LP01A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP01A}
{END_LP01A}
END_LP01A
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 CONDITION, END LOOP_01A AND CONTINUE
WITH LOOP_01
LOOP_01
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK AC05-END_LP01
LOOP DEFINITION: LOOP_01 COLLECTS THE NAME OF THE USUAL SOURCE OF CARE
PROVIDER, IF ANY, FOR EACH CURRENT RU MEMBER. THIS LOOP CYCLES ON PERSONS
WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS A CURRENT RU MEMBER
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
5
Access to Care (AC) Section
Beta
AC05
Help Enabled (USULSRCE)
Variable Name
PRND.HAVE_USC
Comment Enabled
Jump Back Enabled
Label
DOES PERSON HAVE A USC PROVIDER?
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
Is there a particular doctor’s office, clinic, health center, or other place that
(PERSON) usually (go/goes) if (PERSON) (are/is) sick or (need/needs) advice
about (PERSON)’s health?
YES
NO
1
2
{AC09}
{AC07}
MORE THAN ONE PLACE
3
{AC06}
----------------------------------------------------------------------------------------------------------------------------------
Refused
RF
{END_LP01}
Don't Know
DK
{END_LP01}
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF HEALTH
CARE.
6
Access to Care (AC) Section
Beta
AC06
Help Enabled
Variable Name
PRND.GOTOFRST
Comment Enabled
Jump Back Enabled
Label
WOULD PERS GOTO USC FRST/MOST IF SICK?
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
Would (PERSON) go to one of these places first or most often if (PERSON)
(are/is) sick?
YES
NO
1
2
{AC09}
{AC07}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
7
{END_LP01}
{END_LP01}
Access to Care (AC) Section
Beta
AC07
Help Enabled (USULSRCE)
Variable Name
PRND.Y_NO_USC
Comment Enabled
Jump Back Enabled
Label
MAIN REASON PERS DOESN'T HAVE A USC
Size
3
{PERSON’S FIRST MIDDLE AND LAST NAME}
What is the main reason (PERSON) (do/does) not have a usual source of
health care?
SELDOM OR NEVER GETS SICK
RECENTLY MOVED INTO AREA
1
2
{AC08}
{AC08}
DON'T KNOW WHERE TO GO FOR CARE 3
{AC08}
USUAL SOURCE OF MEDICAL CARE IN
THIS AREA IS NO LONGER AVAILABLE
CAN'T FIND A PROVIDER WHO SPEAKS
(PERSON)'S LANGUAGE
4
{AC08}
5
{AC08}
LIKES TO GO TO DIFFERENT PLACES
FOR DIFFERENT HEALTH NEEDS
JUST CHANGED INSURANCE PLANS
6
{AC08}
7
{AC08}
DON'T USE DOCTORS/TREAT MYSELF
8
{AC08}
COST OF MEDICAL CARE
OTHER REASON
9
91
{AC08}
{AC07OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP01}
{END_LP01}
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF HEALTH
CARE.
PROGRAMMER NOTES:
"(PERSON)" IN THE TEXT FOR ANSWER CATEGORY 5 SHOULD BE PURPLE.
8
Access to Care (AC) Section
Beta
AC07OV
Help Enabled
Variable Name
PRND.NO_USCOS
Comment Enabled
Jump Back Enabled
Label
MAIN REASON NO USC: OTHER SPECIFY
Size
25
ENTER OTHER _______________________
REASON:
{AC08}
----------------------------------------------------------------------------------------------------------------------------------
Refused
RF
{AC08}
Don't Know
DK
{AC08}
9
Access to Care (AC) Section
Beta
AC08
Help Enabled (USULSRCE)
Comment Enabled
Jump Back Enabled
Variable Name
PRND.NOREASON
Label
OTH REAS NO USC: NO OTHER REASONS
Size
2
PRND.SELDSICK
PRND.NEWAREA
OTH REAS NO USC: SELDOM OR NEVER SICK
OTH REAS NO USC: RECENTLY MOVED TO AREA
2
2
PRND.DKWHERE
PRND.USC_NA
OTH REAS NO USC: DK WHERE TO GO FOR CARE
OTH REAS NO USC: USC NO LONGER AVAILABLE
2
2
PRND.PERSLANG
OTH REAS NO USC: PROV DOESN'T SPEAK LANG
2
PRND.DIFFPLCS
PRND.INSPLAN
OTH REAS NO USC: GOTO DIFF PLCS/DIFF NEE
OTH REAS NO USC: JUST CHANGED INS PLANS
2
2
PRND.MYSELF
OTH REAS NO USC: DON'T USE/TREAT MYSELF
2
PRND.CARECOST
PRND.OTH_REAS
OTH REAS NO USC: COST OF MED CARE
OTH REAS NO USC: OTHER REASON
2
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
What are the other reasons (PERSON) (do/does) not have a usual source of
health care?
CHECK ALL THAT APPLY.
NO OTHER REASONS
0
{END_LP01}
SELDOM OR NEVER GETS SICK
1
{END_LP01}
RECENTLY MOVED INTO AREA
DON'T KNOW WHERE TO GO FOR CARE
USUAL SOURCE OF MEDICAL CARE IN
THIS AREA IS NO LONGER AVAILABLE
CAN'T FIND A PROVIDER WHO SPEAKS
(PERSON)'S LANGUAGE
2
3
4
{END_LP01}
{END_LP01}
{END_LP01}
5
{END_LP01}
LIKES TO GO TO DIFFERENT PLACES
FOR DIFFERENT HEALTH NEEDS
JUST CHANGED INSURANCE PLANS
DON'T USE DOCTORS/TREAT MYSELF
6
{END_LP01}
7
8
{END_LP01}
{END_LP01}
COST OF MEDICAL CARE
OTHER REASON
9
91
{END_LP01}
{AC08OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
10
{END_LP01}
{END_LP01}
Access to Care (AC) Section
Beta
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF HEALTH
CARE.
PROGRAMMER NOTES:
(PERSON) IN THE TEXT FOR ANSWER CATEGORY '5' SHOULD BE PURPLE.
ROUTING INSTRUCTION:
IF CODED ‘91’ (OTHER REASON) ALONE OR IN COMBINATION WITH
OTHER CODES, CONTINUE WITH AC08OV
OTHERWISE, GO TO END_LP01
Hard CHECK:
CODES ‘0’ (NO OTHER REASONS), ‘RF’ (REFUSED), OR ‘DK (DON’T KNOW) CANNOT BE
USED IN COMBINATION WITH ANY OTHER CODES. IF '0', 'RF', OR 'DK' SELECTED
AND THEN ANOTHER RESPONSE IS SELECTED, DISPLAY THE FOLLOWING MESSAGE: 'NO
OTHER REASONS', 'RF', AND 'DK' CANNOT BE USED WITH ANY OTHER CODE.'
AC08OV
Help Enabled
Variable Name
PRND.OTHRSOS
Comment Enabled
Jump Back Enabled
Label
OTH REASON NO USC: OTHER SPECIFY
Size
25
ENTER OTHER _______________________
REASON:
{END_LP01}
----------------------------------------------------------------------------------------------------------------------------------
Refused
RF
{END_LP01}
Don't Know
DK
{END_LP01}
11
Access to Care (AC) Section
Beta
AC09
Help Enabled (USULSRCE)
Comment Enabled
Jump Back Enabled
{PERSON’S FIRST MIDDLE AND LAST NAME}
Please give me the name of the medical person, doctor’s office, clinic, health
center, or other place that (PERSON) usually (go/goes) if (PERSON) (are/is)
sick or (need/needs) advice about (PERSON)’s health.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
HELP AVAILABLE FOR DEFINITION OF USUAL SOURCE OF HEALTH
CARE.
BOX_01
ASK THE PROVIDER ROSTER (PV) SECTION
AT THE COMPLETION OF THE PROVIDER ROSTER (PV) SECTION, CONTINUE WITH BOX_02
BOX_02
FLAG THE PROVIDER ADDED OR SELECTED AS THE ‘USC (USUAL SOURCE OF CARE)
PROVIDER’ FOR THIS PERSON FOR THIS PARTICULAR ROUND.
IF THIS USC PROVIDER IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER’, CONTINUE WITH
AC10
IF THIS USC PROVIDER IS FLAGGED AS ‘PERSON-IN-FACILITY-PROVIDER’ AND AC11
WAS NOT ALREADY ASKED FOR THIS USC PROVIDER IN AN EARLIER LOOP, GO TO AC11
OTHERWISE, (THAT IS, IF THIS USC PROVIDER IS FLAGGED AS ‘PERSON-TYPEPROVIDER’ OR IF THIS USC PROVIDER IS FLAGGED AS ‘PERSON-IN-FACILITYPROVIDER’ AND AC11 HAS ALREADY BEEN ASKED FOR THIS USC PROVIDER), GO TO
AC12
12
Access to Care (AC) Section
Beta
AC10
Help Enabled
Variable Name
PROV.PARTPROV
Comment Enabled
Jump Back Enabled
Label
USUALLY SEE A PARTICULAR PROVIDER
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......}
(Do/Does) (PERSON) usually see a particular provider at (PROVIDER)?
YES
1
NO
2
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
PROGRAMMER NOTES:
NOTE: FOR QUESTIONS AC10 – AC20, THE CONTEXT HEADER WILL
DISPLAY THE PERSON-PROVIDER NAME IF THE USC PROVIDER BEING
ASKED ABOUT IS FLAGGED AS ‘PERSON-TYPE-PROVIDER’ OR ‘PERSON-INFACILITY-PROVIDER’. IF THE USC PROVIDER BEING ASKED ABOUT IS
FLAGGED AS ‘FACILITY-TYPE-PROVIDER’, THE CONTEXT HEADER WILL
DISPLAY THE FACILITY-PROVIDER NAME.
ROUTING INSTRUCTION:
IF AC11 WAS NOT ALREADY ASKED FOR THIS USC PROVIDER IN AN
EARLIER LOOP, CONTINUE WITH AC11
OTHERWISE, GO TO AC12
13
Access to Care (AC) Section
Beta
AC11
Help Enabled (AC11Help)
Variable Name
PROV.PLACETYP
Comment Enabled
Jump Back Enabled
Label
WHAT KIND OF PLACE IS/DOES PROV WORK AT?
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......}
ASK IF NOT OBVIOUS.
{Is (PROVIDER)/Does (PROVIDER) work at} a clinic in a hospital, a hospital
outpatient department, an emergency room at a hospital, or some other kind
of place?
HOSPITAL CLINIC OR OUTPATIENT
DEPARTMENT
1
{AC12}
HOSPITAL EMERGENCY ROOM
2
{AC12}
OTHER KIND OF PLACE
3
{AC12}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC12}
{AC12}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
DISPLAY INSTRUCTIONS:
DISPLAY ‘Is (PROVIDER)’ IF USC PROVIDER IS FLAGGED AS
‘FACILITY-TYPE-PROVIDER’. DISPLAY ‘Does (PROVIDER) work at’
IF USC PROVIDER IS FLAGGED AS ‘PERSON-IN-FACILITY-PROVIDER’.
14
Access to Care (AC) Section
Beta
AC12
Help Enabled
Variable Name
USCP.HOWGETTO
Comment Enabled
Jump Back Enabled
Label
Size
2
HOW USUALLY GET TO PROVIDER
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......}
How (do/does) (PERSON) usually get to (PROVIDER)?
DRIVE
1
{AC13}
IS DRIVEN
TAXI, BUS, TRAIN, OTHER PUBLIC
TRANSPORTATION
2
3
{AC13}
{AC13}
WALKS
4
{AC13}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
15
{AC13}
{AC13}
Access to Care (AC) Section
Beta
AC13
Help Enabled
Variable Name
USCP.GETTOTAK
Comment Enabled
Jump Back Enabled
Label
Size
2
HOW LONG TO GET TO PROVIDER
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER.......}
How long does it take (PERSON) to get to (PROVIDER)?
LESS THAN 15 MINUTES
1
{AC14}
15 TO 30 MINUTES
31 MINUTES TO 60 MINUTES (1 HOUR)
2
3
{AC14}
{AC14}
61 MINUTES TO 90 MINUTES
91 MINUTES TO 120 MINUTES (2
HOURS)
4
5
{AC14}
{AC14}
MORE THAN 120 MINUTES (2 HOURS)
6
{AC14}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
16
{AC14}
{AC14}
Access to Care (AC) Section
Beta
AC14
Help Enabled
Variable Name
USCP.GETTODIF
Comment Enabled
Jump Back Enabled
Label
HOW DIFFICULT TO GET TO PROVIDER
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER.......}
SHOW CARD AC-1.
How difficult is it for (PERSON) to get to (PROVIDER)?
Would you say it is ...
very difficult,
1
{BOX_03}
somewhat difficult,
2
{BOX_03}
not too difficult or
not at all difficult?
3
4
{BOX_03}
{BOX_03}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_03}
{BOX_03}
BOX_03
IF THIS USC PROVIDER IS FLAGGED AS ‘PERSON-TYPE-PROVIDER’ OR ‘PERSON-INFACILITY-PROVIDER’ AND AC15 WAS NOT ALREADY ASKED FOR THIS USC PROVIDER IN
AN EARLIER LOOP, CONTINUE WITH AC15
OTHERWISE, GO TO END_LP01
17
Access to Care (AC) Section
Beta
AC15
Help Enabled (MEDPROV)
Variable Name
PROV.MEDTYPE
Comment Enabled
Jump Back Enabled
Label
IS PROV A MD OR SOME OTHER TYPE MED PERS
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......}
Is (PROVIDER) a medical doctor?
YES
1
{AC17}
NO
2
{AC16}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC18}
{AC18}
HELP AVAILABLE FOR DEFINITION OF MEDICAL DOCTOR.
18
Access to Care (AC) Section
Beta
AC16
Help Enabled (AC16Help)
Variable Name
PROV.OTHTYPE
Comment Enabled
Jump Back Enabled
Label
WHAT OTH TYPE OF MED PERS IS PROV?
Size
3
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......}
Is (PROVIDER) a nurse, nurse practitioner, physician’s assistant, midwife, or
some other kind of person?
SELECT 'CHIROPRACTOR' IF CHIROPRACTOR VOLUNTEERED AS TYPE
OF MEDICAL PERSON.
NURSE
1
{AC18}
NURSE PRACTITIONER
PHYSICIAN'S ASSISTANT
2
3
{AC18}
{AC18}
MIDWIFE
4
{AC18}
CHIROPRACTOR
OTHER
5
91
{AC18}
{AC16OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC18}
{AC18}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
19
Access to Care (AC) Section
Beta
AC16OV
Help Enabled
Variable Name
PROV.MDTYPEOS
Comment Enabled
Jump Back Enabled
Label
TYPE OF MEDICAL PERSON: OTHER SPECIFY
Size
25
OTHER: _______________________
{AC18}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
20
{AC18}
{AC18}
Access to Care (AC) Section
Beta
AC17
Help Enabled
Variable Name
PROV.MDSPECLT
Comment Enabled
Jump Back Enabled
Label
Size
3
WHAT IS PROV'S SPECIALTY?
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......}
What is (PROVIDER)’s specialty?
GENERAL/FAMILY PRACTICE
1
{AC18}
INTERNAL MEDICINE
PEDIATRICS
2
3
{AC18}
{AC18}
OB/GYN
SURGERY
CHIROPRACTOR
4
5
6
{AC18}
{AC18}
{AC18}
OTHER
91
{AC17OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
21
{AC18}
{AC18}
Access to Care (AC) Section
Beta
AC17OV
Help Enabled
Variable Name
PROV.MDSPECOS
Comment Enabled
Jump Back Enabled
Label
Size
25
PROV'S SPECIALTY: OTHER SPECIFY
OTHER: _______________________
{AC18}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
22
{AC18}
{AC18}
Access to Care (AC) Section
Beta
AC18
Help Enabled
Variable Name
PROV.P_HSPLAT
Comment Enabled
Jump Back Enabled
Label
Size
2
IS PROVIDER HISPANIC OR LATINO
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER.......}
Is (PROVIDER) Hispanic or Latino?
YES
1
{AC19}
NO
2
{AC19}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
23
{AC19}
{AC19}
Access to Care (AC) Section
Beta
AC19
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
PROV.PRVWHITE
PROVIDER RACE WHITE
Label
Size
2
PROV.PRVBLACK
PROV.PRVASIAN
PROVIDER RACE BLACK
PROVIDER RACE ASIAN
2
2
PROV.PRVNATAM
PROV.PRVPACIS
PROVIDER RACE INDIAN/NATIVE AMER/ALASKAN
PROVIDER RACE PACIFIC ISLANDER
2
2
PROV.PRVOTHRC
PROVIDER RACE SOME OTHER RACE
2
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER.......}
SHOW CARD AC-2.
What is (PROVIDER)’s race?
CHECK ALL THAT APPLY.
WHITE
BLACK/AFRICAN AMERICAN
1
2
ASIAN
INDIAN/NATIVE AMERICAN/ALASKA
NATIVE
3
4
OTHER PACIFIC ISLANDER
5
SOME OTHER RACE
91
{AC19OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC20}
{AC20}
ROUTING INSTRUCTION:
IF CODED ‘91’ (SOME OTHER RACE) ALONE OR IN COMBINATION WITH
OTHER CODES, CONTINUE WITH AC19OV
OTHERWISE, GO TO AC20
24
Access to Care (AC) Section
Beta
AC19OV
Help Enabled
Variable Name
PROV.PRVRACOS
Comment Enabled
Jump Back Enabled
Label
AC19OV PROVIDER RACE OTHER SPECIFY
Size
25
OTHER RACE: _______________________
{AC20}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
25
{AC20}
{AC20}
Access to Care (AC) Section
Beta
AC20
Help Enabled
Variable Name
PROV.PRVGENDR
Comment Enabled
Jump Back Enabled
Label
Size
2
PROVIDER GENDER
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER.......}
Is (PROVIDER) male or female?
MALE
1
{END_LP01}
FEMALE
2
{END_LP01}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP01}
{END_LP01}
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_04
BOX_04
IF AT LEAST ONE PROVIDER FLAGGED AS ‘USC PROVIDER’ ON THE RU-MEDICALPROVIDERS-ROSTER, CONTINUE WITH LOOP_02
OTHERWISE, GO TO AC32A
26
Access to Care (AC) Section
Beta
LOOP_02
FOR EACH ELEMENT IN THE RU-MEDICAL-PROVIDERS-ROSTER, ASK AC21-END_LP02
LOOP DEFINITION: LOOP_02 COLLECTS DETAILED INFORMATION ON EACH UNIQUE
USUAL SOURCE OF CARE PROVIDER IDENTIFIED FOR THIS RU. THIS LOOP CYCLES ON
PROVIDERS WHO MEET THE FOLLOWING CONDITION:
- PROVIDER FLAGGED AS ‘USC PROVIDER’ DURING THE CURRENT ROUND FOR A CURRENT
RU MEMBER.
NOTE: IF THE USC PROVIDER BEING LOOPED ON IS FLAGGED AS ‘PERSON-TYPEPROVIDER’ OR ‘PERSON-IN-FACILITY-PROVIDER’ THE CONTEXT HEADER IN LOOP_02
WILL DISPLAY THE PERSON-PROVIDER NAME. IF THE USC PROVIDER BEING LOOPED
ON IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER’ THE CONTEXT HEADER IN LOOP_02
WILL DISPLAY THE FACILITY-PROVIDER NAME.
27
Access to Care (AC) Section
Beta
AC21
Help Enabled
Comment Enabled
Jump Back Enabled
{NAME OF MEDICAL CARE PROVIDER......}
The next few questions ask about the experience (READ NAME(S) BELOW)
(have/has) had with (PROVIDER). Please think about their overall
experiences when answering the following questions.
IF ONLY CHILDREN ARE DISPLAYED BELOW, USE THE PRONOUN
‘YOU’ OR THE PARENT’S NAME.
PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{AC22}
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for display.
Roster Behavior:
1. Select, add, delete, and edit disallowed
Roster Filter:
Display all persons on the RU-Members-Roster who identified
provider being asked about as person’s USC provider for the
current round.
28
Access to Care (AC) Section
Beta
AC22
Help Enabled (PREVENTHC)
Comment Enabled
Jump Back Enabled
Variable Name
USCP.MINORPRB
Label
GOTO USC FOR ROUTINE OR MINOR HLTH PROB?
Size
2
USCP.PREVENTV
USCP.REFERRAL
GOTO USC FOR PREVENTIVE HEALTH CARE?
GOTO USC FOR REFERRALS?
2
2
USCP.ONGOHPRB
GO TO USC FOR ON GOING HLTH PROB
2
{NAME OF MEDICAL CARE PROVIDER......}
Is (PROVIDER) the {person/place} (READ NAME(S) BELOW) would go to
for ...
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
a. New health problems?
YES
1
NO
2
Refused
Don't Know
b. Preventive health care, such as general
checkups, examinations, and
immunizations?
YES
RF
DK
1
NO
2
Refused
Don't Know
RF
DK
c. Referrals to other health professionals
when needed?
YES
1
NO
Refused
2
RF
Don't Know
DK
29
Access to Care (AC) Section
Beta
d. Ongoing health problems?
YES
NO
Refused
Don't Know
1
2
RF
DK
HELP AVAILABLE FOR DEFINITION OF PREVENTIVE HEALTH CARE AND
REFERRAL.
DISPLAY INSTRUCTIONS:
DISPLAY ‘person’ IF THE USC PROVIDER BEING LOOPED ON IS
FLAGGED AS ‘PERSON-TYPE-PROVIDER’ OR ‘PERSON-IN-FACILITYPROVIDER’. DISPLAY ‘place’ IF USC PROVIDER BEING LOOPED ON IS
FLAGGED AS ‘FACILITY-TYPE-PROVIDER’.
PROGRAMMER NOTES:
ALLOW ‘RF’ (REFUSED) AND ‘DK’ (DON’T KNOW) ON ALL FORM ITEMS.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for display.
Roster Behavior:
1. Select, add, delete, and edit disallowed
Roster Filter:
Display all persons on the RU-Members-Roster who identified
provider being asked about as person’s USC provider for the
current round.
30
Access to Care (AC) Section
Beta
AC23
Help Enabled
Variable Name
USCP.PHONEDIF
Comment Enabled
Jump Back Enabled
Label
HOW DIFF TO TALK TO PROV OVER THE PHONE?
Size
2
{NAME OF MEDICAL CARE PROVIDER......}
SHOW CARD AC-1.
How difficult is it to contact {a medical person at} (PROVIDER) during regular
business hours over the telephone about a health problem?
Would you say it is ...
very difficult,
1
somewhat difficult,
2
not too difficult, or
not at all difficult?
3
4
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
DISPLAY INSTRUCTIONS:
DISPLAY ‘a medical person at’ IF USC PROVIDER BEING LOOPED ON
IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER’. OTHERWISE, USE A NULL
DISPLAY.
ROUTING INSTRUCTION:
IF AC11 WAS CODED ‘2’ (HOSPITAL EMERGENCY ROOM) FOR THIS USC
PROVIDER, GO TO AC25
OTHERWISE, CONTINUE WITH AC24
31
Access to Care (AC) Section
Beta
AC24
Help Enabled
Variable Name
USCP.OFFHOURS
Comment Enabled
Jump Back Enabled
Label
DOES USC HAVE OFFICE HRS AT NIGHT/WKEND?
Size
2
{NAME OF MEDICAL CARE PROVIDER......}
Does (PROVIDER) have office hours at night or on weekends?
YES
1
{AC25}
NO
2
{AC25}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
32
{AC25}
{AC25}
Access to Care (AC) Section
Beta
AC25
Help Enabled
Variable Name
USCP.AFTHOURS
Comment Enabled
Jump Back Enabled
Label
HOW DIFF TO CONTACT AFTER HOURS
Size
2
{NAME OF MEDICAL CARE PROVIDER.......}
SHOW CARD AC-1.
How difficult is it to contact {a medical person at} (PROVIDER) after their
regular hours in case of urgent medical needs?
Would you say it is ...
very difficult,
1
{AC26}
somewhat difficult,
2
{AC26}
not too difficult, or
not at all difficult?
3
4
{AC26}
{AC26}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC26}
{AC26}
DISPLAY INSTRUCTIONS:
DISPLAY ‘a medical person at’ IF USC PROVIDER BEING LOOPED ON
IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER’. OTHERWISE, USE A NULL
DISPLAY.
33
Access to Care (AC) Section
Beta
AC26
Help Enabled
Variable Name
USCP.TREATMNT
Comment Enabled
Jump Back Enabled
Label
DOES USC PROV ASK ABOUT OTH TREATMENTS?
Size
2
{NAME OF MEDICAL CARE PROVIDER......}
Does {someone at} (PROVIDER) usually ask about prescription medications
and treatments other doctors may give them?
YES
NO
1
2
{AC27}
{AC27}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC27}
{AC27}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone at’ IF USC PROVIDER BEING LOOPED ON IS
FLAGGED AS ‘FACILITY-TYPE-PROVIDER’. OTHERWISE, USE A NULL
DISPLAY.
34
Access to Care (AC) Section
Beta
AC27
Help Enabled
Variable Name
USCP.SHOWRESP
Comment Enabled
Jump Back Enabled
Label
PROV SHOW RESPECT FOR OTHER TRTMNT
Size
2
{NAME OF MEDICAL CARE PROVIDER.......}
SHOW CARD AC-3.
Thinking about the types of medical, traditional and alternative treatments that
(READ NAME(S) BELOW) are happy with, how often does {a medical person
at} (PROVIDER) show respect for these treatments?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
Would you say…
never,
1
{AC28}
sometimes,
usually, or
2
3
{AC28}
{AC28}
always?
4
{AC28}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC28}
{AC28}
DISPLAY INSTRUCTIONS:
DISPLAY ‘a medical person at’ IF USC PROVIDER BEING LOOPED ON
IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER.’ OTHERWISE, USE A NULL
DISPLAY.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
35
Access to Care (AC) Section
Beta
Roster Definition:
This item displays RU-MEMBERS-ROSTER for display.
Roster Behavior:
1. Select, add, delete, and edit disallowed
Roster Filter:
Display all persons on the RU-Members-Roster who identified
provider being asked about as person’s USC provider for the
current round.
36
Access to Care (AC) Section
Beta
AC28
Help Enabled
Variable Name
USCP.HLPMKDEC
Comment Enabled
Jump Back Enabled
Label
Size
2
PROV ASK HLP TO MAKE DECISION
{NAME OF MEDICAL CARE PROVIDER.......}
SHOW CARD AC-3.
If there were a choice between treatments, how often would {a medical person
at} (PROVIDER) ask (READ NAME(S) BELOW) to help make the decision?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
Would you say…
never,
sometimes,
usually, or
always?
1
2
3
4
{AC30}
{AC30}
{AC30}
{AC30}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC30}
{AC30}
DISPLAY INSTRUCTIONS:
DISPLAY ‘a medical person at’ IF USC PROVIDER BEING LOOPED ON
IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER’. OTHERWISE, USE A NULL
DISPLAY.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
37
Access to Care (AC) Section
Beta
Roster Definition:
This item displays RU-MEMBERS-ROSTER for display.
Roster Behavior:
1. Select, add, delete, and edit disallowed
Roster Filter:
Display all persons on the RU-Members-Roster who identified
provider being asked about as person’s USC provider for the
current round.
38
Access to Care (AC) Section
Beta
AC30
Help Enabled
Variable Name
USCP.EXPLNOPT
Comment Enabled
Jump Back Enabled
Label
Size
2
PROVIDER EXPLAIN OPTIONS
{NAME OF MEDICAL CARE PROVIDER.......}
Does {a medical person at} (PROVIDER) present and explain all options to
(READ NAME(S) BELOW)?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
YES
1
{BOX_05}
NO
2
{BOX_05}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_05}
{BOX_05}
DISPLAY INSTRUCTIONS:
DISPLAY ‘a medical person at’ IF USC PROVIDER BEING LOOPED ON
IS FLAGGED AS ‘FACILITY-TYPE-PROVIDER.’ OTHERWISE, USE A NULL
DISPLAY.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for display.
Roster Behavior:
1. Select, add, delete, and edit disallowed
39
Access to Care (AC) Section
Beta
Roster Filter:
Display all persons on the RU-Members-Roster who identified
provider being asked about as person’s USC provider for the
current round.
BOX_05
IF AT LEAST ONE RU MEMBER WAS SELECTED AT AC02A (FLAGGED AS NOT
COMFORTABLE CONVERSING IN ENGLISH) AND PERSON IDENTIFIED THIS USC PROVIDER
AS THEIR USC PROVIDER (AC05 IS SET TO '1' OR AC06 IS SET TO '1'), CONTINUE
WITH AC31
OTHERWISE, GO TO END_LP02
40
Access to Care (AC) Section
Beta
AC31
Help Enabled
Variable Name
USCP.LANGPREF
Comment Enabled
Jump Back Enabled
Label
Size
2
PROVIDER SPEAK LANGUAGE
{NAME OF MEDICAL CARE PROVIDER.......}
Does {someone at} (PROVIDER) speak the language (READ NAME(S)
BELOW) prefer(s) or provide translator services for them?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
YES
1
{END_LP02}
NO
2
{END_LP02}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP02}
{END_LP02}
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone at’ IF USC PROVIDER BEING LOOPED ON IS
FLAGGED AS ‘FACILITY-TYPE-PROVIDER.’ OTHERWISE, USE A NULL
DISPLAY.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for display.
Roster Behavior:
1. Select, add, delete, and edit disallowed
41
Access to Care (AC) Section
Beta
Roster Filter:
Display all persons on the RU-Members-Roster who
- identified provider being asked about as person’s USC
provider for the current round
and
- were identified as not comfortable conversing in English
at AC02A
END_LP02
CYCLE ON NEXT PROVIDER IN THE RU-MEDICAL-PROVIDERS-ROSTER WHO MEETS THE
CONDITIONS STATED IN THE LOOP DEFINITION.
IF NO OTHER PROVIDERS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE
WITH AC32A
AC32A
Help Enabled
Variable Name
HOME.NEEDTRET
Comment Enabled
Jump Back Enabled
Label
Size
2
AC32A ANYONE NEED TREATMENT
When answering the next few questions, do not include dental care and
prescription medicines.
In the last 12 months, did anyone in the family or a doctor believe they needed
any medical care, tests, or treatment?
YES
NO
1
2
{AC32}
{AC40A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
42
{AC40A}
{AC40A}
Access to Care (AC) Section
Beta
AC32
Help Enabled
Variable Name
HOME.UNABTRET
Comment Enabled
Jump Back Enabled
Label
ANYONE UNABLE TO OBTAIN TREATMENT
Size
2
In the last 12 months, was anyone in the family unable to obtain medical
care, tests, or treatments they or a doctor believed necessary?
YES
NO
1
2
{AC36}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC36}
{AC36}
ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS ‘UNMET NEED FOR MEDICAL CARE’ AT AC33 BY CAPI
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_03
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE WITH AC33
43
Access to Care (AC) Section
Beta
AC33
Help Enabled
Variable Name
PRND.NOGTTRET
Comment Enabled
Jump Back Enabled
Label
PERSON UNABLE TO OBTAIN TREATMENT
Size
2
Who was that?
PROBE: Was anyone else in the family unable to get medical care, tests, or
treatments they or a doctor believed necessary?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
ROUTING INSTRUCTION:
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED,
GO TO AC36.
OTHERWISE, CONTINUE WITH LOOP_03.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
No filter; display all.
44
Access to Care (AC) Section
Beta
LOOP_03
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK AC34 – END_LP03
LOOP DEFINITION: LOOP_03 COLLECTS THE MAIN REASON AND THE PROBLEM WITH
THE UNMET NEED FOR MEDICAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET
THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR MEDICAL CARE (I.E., PERSON WAS SELECTED AT
AC33)
45
Access to Care (AC) Section
Beta
AC34
Help Enabled
Variable Name
PRND.RSNOTRET
Comment Enabled
Jump Back Enabled
Label
MAIN REASON UNABLE TO OBT TREATMNT
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason (PERSON) (were/was) unable
to get medical care, tests, or treatments (he/she) or a doctor believed
necessary?
COULDN'T AFFORD CARE
1
{AC35}
INSURANCE COMPANY WOULDN'T
APPROVE, COVER, OR PAY FOR CARE
2
{AC35}
DOCTOR REFUSED TO ACCEPT
FAMILY'S INSURANCE PLAN
PROBLEMS GETTING TO DOCTOR'S
OFFICE
3
{AC35}
4
{AC35}
DIFFERENT LANGUAGE
COULDN'T GET TIME OFF WORK
5
6
{AC35}
{AC35}
DIDN'T KNOW WHERE TO GO TO GET
CARE
WAS REFUSED SERVICES
COULDN'T GET CHILD CARE
7
{AC35}
8
9
{AC35}
{AC35}
DIDN'T HAVE TIME OR TOOK TOO LONG 10
OTHER
91
{AC35}
{AC35}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
46
{AC35}
{AC35}
Access to Care (AC) Section
Beta
AC35
Help Enabled
Variable Name
PRND.PRBNTTRT
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM TREATMNT NOT OBTAINED
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) did not get medical care, tests,
or treatments (he/she) or a doctor believed necessary?
Would you say ...
a big problem,
a small problem, or
1
2
{END_LP03}
{END_LP03}
not a problem?
3
{END_LP03}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP03}
{END_LP03}
END_LP03
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_03 AND CONTINUE
WITH AC36
47
Access to Care (AC) Section
Beta
AC36
Help Enabled
Variable Name
HOME.DELAYTRT
Comment Enabled
Jump Back Enabled
Label
ANYONE DELAYED IN RECEIVING TREATMENT
Size
2
In the last 12 months, was anyone in the family delayed in getting medical
care, tests, or treatments they or a doctor believed necessary?
YES
NO
1
2
{AC40A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC40A}
{AC40A}
ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS ‘DELAY IN RECEIVING MEDICAL CARE’ AT AC37 BY CAPI
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_04
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE WITH AC37
48
Access to Care (AC) Section
Beta
AC37
Help Enabled
Variable Name
PRND.DLAYTRET
Comment Enabled
Jump Back Enabled
Label
PERSON DELAY IN TREATMENT
Who was that?
PROBE: Was anyone else in the family delayed in getting medical care,
tests, or treatments they or a doctor believed necessary?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
ROUTING INSTRUCTION:
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED,
GO TO AC40A.
OTHERWISE, CONTINUE WITH LOOP_04.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
No filter; display all.
49
Size
2
Access to Care (AC) Section
Beta
LOOP_04
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK AC38 – END_LP04
LOOP DEFINITION: LOOP_04 COLLECTS THE MAIN REASON AND THE PROBLEM WITH
THE DELAY IN RECEIVING MEDICAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO
MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING MEDICAL CARE (I.E., PERSON WAS SELECTED
AT AC37)
50
Access to Care (AC) Section
Beta
AC38
Help Enabled
Variable Name
PRND.REASDLAY
Comment Enabled
Jump Back Enabled
Label
Size
2
MAIN REASON DELAY IN TREATMENT
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason (PERSON) (were/was)
delayed in getting medical care, tests, or treatments (he/she) or a doctor
believed necessary?
COULDN'T AFFORD CARE
1
{AC39}
INSURANCE COMPANY WOULDN'T
APPROVE, COVER, OR PAY FOR CARE
2
{AC39}
DOCTOR REFUSED TO ACCEPT
FAMILY'S INSURANCE PLAN
PROBLEMS GETTING TO DOCTOR'S
OFFICE
3
{AC39}
4
{AC39}
DIFFERENT LANGUAGE
COULDN'T GET TIME OFF WORK
5
6
{AC39}
{AC39}
DIDN'T KNOW WHERE TO GO TO GET
CARE
WAS REFUSED SERVICES
COULDN'T GET CHILD CARE
7
{AC39}
8
9
{AC39}
{AC39}
DIDN'T HAVE TIME OR TOOK TOO LONG 10
OTHER
91
{AC39}
{AC39}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
51
{AC39}
{AC39}
Access to Care (AC) Section
Beta
AC39
Help Enabled
Variable Name
PRND.PROBDLAY
Comment Enabled
Jump Back Enabled
Label
PROBLEM WITH DELAY OF TREATMENT
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) (were/was) delayed in getting
medical care, tests, or treatments (he/she) or a doctor believed necessary?
Would you say ...
a big problem,
a small problem, or
1
2
{END_LP04}
{END_LP04}
not a problem?
3
{END_LP04}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP04}
{END_LP04}
END_LP04
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_04 AND CONTINUE
WITH AC40A
52
Access to Care (AC) Section
Beta
AC40A
Help Enabled
Variable Name
HOME.NDDNTRET
Comment Enabled
Jump Back Enabled
Label
Size
2
ANYONE NEED DENTAL TREATMENT
In the last 12 months, did anyone in the family or a dentist believe they
needed any dental care, tests, or treatment?
YES
NO
1
2
{AC40}
{AC48A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
53
{AC48A}
{AC48A}
Access to Care (AC) Section
Beta
AC40
Help Enabled
Variable Name
HOME.UNABDNTR
Comment Enabled
Jump Back Enabled
Label
ANYONE UNABLE TO OBT DN TREATMENT
Size
2
In the last 12 months, was anyone in the family unable to obtain dental care,
tests, or treatments they or a dentist believed necessary?
YES
NO
1
2
{AC44}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC44}
{AC44}
ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS ‘UNMET NEED FOR DENTAL CARE’ AT AC41 BY CAPI
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_05
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE WITH AC41
54
Access to Care (AC) Section
Beta
AC41
Help Enabled
Variable Name
PRND.NOGTDNTR
Comment Enabled
Jump Back Enabled
Label
PERSON UNABLE TO OBT DN TRTMNT
Who was that?
PROBE: Was anyone else in the family unable to get dental care, tests, or
treatments they or a dentist believed necessary?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
ROUTING INSTRUCTION:
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED,
GO TO AC44.
OTHERWISE, CONTINUE WITH LOOP_05.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
No filter; display all.
55
Size
2
Access to Care (AC) Section
Beta
LOOP_05
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK AC42 – END_LP05
LOOP DEFINITION: LOOP_05 COLLECTS THE MAIN REASON AND THE PROBLEM WITH
THE UNMET NEED FOR DENTAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET
THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR DENTAL CARE (I.E., PERSON WAS SELECTED AT
AC41)
56
Access to Care (AC) Section
Beta
AC42
Help Enabled
Variable Name
PRND.RSNODNTR
Comment Enabled
Jump Back Enabled
Label
MAIN REASON UNABLE OBT DN TRTMNT
Size
2
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason (PERSON) (were/was) unable
to get dental care, tests, or treatments (he/she) or a dentist believed
necessary?
COULDN'T AFFORD CARE
1
{AC43}
INSURANCE COMPANY WOULDN'T
APPROVE, COVER, OR PAY FOR CARE
2
{AC43}
DOCTOR REFUSED TO ACCEPT
FAMILY'S INSURANCE PLAN
PROBLEMS GETTING TO DOCTOR'S
OFFICE
3
{AC43}
4
{AC43}
DIFFERENT LANGUAGE
COULDN'T GET TIME OFF WORK
5
6
{AC43}
{AC43}
DIDN'T KNOW WHERE TO GO TO GET
CARE
WAS REFUSED SERVICES
COULDN'T GET CHILD CARE
7
{AC43}
8
9
{AC43}
{AC43}
DIDN'T HAVE TIME OR TOOK TOO LONG 10
OTHER
91
{AC43}
{AC43}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
57
{AC43}
{AC43}
Access to Care (AC) Section
Beta
AC43
Help Enabled
Variable Name
PRND.PRBNODN
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM W/NOT OBT DN TRTMNT
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) did not get dental care, tests,
or treatments (he/she) or a dentist believed necessary?
Would you say ...
a big problem,
a small problem, or
1
2
{END_LP05}
{END_LP05}
not a problem?
3
{END_LP05}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP05}
{END_LP05}
END_LP05
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_05 AND CONTINUE
WITH AC44
58
Access to Care (AC) Section
Beta
AC44
Help Enabled
Variable Name
HOME.DELAYDN
Comment Enabled
Jump Back Enabled
Label
Size
2
ANYONE DELAYED IN DN TRTMNT
In the last 12 months, was anyone in the family delayed in getting dental
care, tests, or treatments they or a dentist believed necessary?
YES
NO
1
2
{AC48A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC48A}
{AC48A}
ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS ‘DELAY IN RECEIVING DENTAL CARE’ AT AC45 BY CAPI
IF CODE '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_06
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE WITH AC45
59
Access to Care (AC) Section
Beta
AC45
Help Enabled
Variable Name
PRND.DLAYDNTR
Comment Enabled
Jump Back Enabled
Label
PERSON DELAYED IN DN TRTMNT
Size
2
Who was that?
PROBE: Was anyone else in the family delayed in getting dental care, tests,
or treatments they or a dentist believed necessary?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
ROUTING INSTRUCTION:
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED,
GO TO AC48A.
OTHERWISE, CONTINUE WITH LOOP_06.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
No filter; display all.
60
Access to Care (AC) Section
Beta
LOOP_06
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK AC46 – END_LP06
LOOP DEFINITION: LOOP_06 COLLECTS THE MAIN REASON AND THE PROBLEM WITH
THE DELAY IN RECEIVING DENTAL CARE. THIS LOOP CYCLES ON RU MEMBERS WHO
MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING DENTAL CARE (I.E., PERSON WAS SELECTED
AT AC45)
61
Access to Care (AC) Section
Beta
AC46
Help Enabled
Variable Name
PRND.RSDNDLAY
Comment Enabled
Jump Back Enabled
Label
Size
2
MAIN REASON DELAY IN DN TRTMNT
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason (PERSON) (were/was)
delayed in getting dental care, tests, or treatments (he/she) or a dentist
believed necessary?
COULDN'T AFFORD CARE
1
{AC47}
INSURANCE COMPANY WOULDN'T
APPROVE, COVER, OR PAY FOR CARE
2
{AC47}
DOCTOR REFUSED TO ACCEPT
FAMILY'S INSURANCE PLAN
PROBLEMS GETTING TO DOCTOR'S
OFFICE
3
{AC47}
4
{AC47}
DIFFERENT LANGUAGE
COULDN'T GET TIME OFF WORK
5
6
{AC47}
{AC47}
DIDN'T KNOW WHERE TO GO TO GET
CARE
WAS REFUSED SERVICES
COULDN'T GET CHILD CARE
7
{AC47}
8
9
{AC47}
{AC47}
DIDN'T HAVE TIME OR TOOK TOO LONG 10
OTHER
91
{AC47}
{AC47}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
62
{AC47}
{AC47}
Access to Care (AC) Section
Beta
AC47
Help Enabled
Variable Name
PRND.PRBDNDLY
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM W/DELAY IN DN TRTMNT
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) (were/was) delayed in getting
dental care, tests, or treatments (he/she) or a dentist believed necessary?
Would you say ...
a big problem,
a small problem, or
1
2
{END_LP06}
{END_LP06}
not a problem?
3
{END_LP06}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP06}
{END_LP06}
END_LP06
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_06 AND CONTINUE
WITH AC48A
63
Access to Care (AC) Section
Beta
AC48A
Help Enabled
Variable Name
HOME.NEEDPM
Comment Enabled
Jump Back Enabled
Label
Size
2
ANYONE NEED PRESCRIPTION MEDS
In the last 12 months, did anyone in the family or a doctor believe they needed
prescription medicines?
YES
NO
1
2
{AC48}
{BOX_06}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
64
{BOX_06}
{BOX_06}
Access to Care (AC) Section
Beta
AC48
Help Enabled
Variable Name
HOME.UNABGTPM
Comment Enabled
Jump Back Enabled
Label
Size
2
ANYONE UNABLE TO OBTAIN PM
In the last 12 months, was anyone in the family unable to obtain
prescription medicines they or a doctor believed necessary?
YES
1
NO
2
{AC52}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{AC52}
{AC52}
ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS ‘UNMET NEED FOR PRESCRIPTION MEDICINES’ AT AC49 BY
CAPI AND GO TO LOOP_07
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE WITH AC49
65
Access to Care (AC) Section
Beta
AC49
Help Enabled
Variable Name
PRND.NOGTPM
Comment Enabled
Jump Back Enabled
Label
PERSON UNABLE TO OBT PM
Who was that?
PROBE: Was anyone else in the family unable to get prescription
medicines they or a doctor believed necessary?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
ROUTING INSTRUCTION:
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED,
GO TO AC52.
OTHERWISE, CONTINUE WITH LOOP_07.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
No filter; display all.
66
Size
2
Access to Care (AC) Section
Beta
LOOP_07
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK AC50 – END_LP07
LOOP DEFINITION: LOOP_07 COLLECTS THE MAIN REASON AND THE PROBLEM WITH
THE UNMET NEED FOR PRESCRIPTION MEDICINES. THIS LOOP CYCLES ON RU MEMBERS
WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD AN UNMET NEED FOR PRESCRIPTION MEDICINES (I.E., PERSON WAS
SELECTED AT AC49)
67
Access to Care (AC) Section
Beta
AC50
Help Enabled
Variable Name
PRND.RSNOGTPM
Comment Enabled
Jump Back Enabled
Label
Size
2
MAIN REASON UNABLE TO OBT PM
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason (PERSON) (were/was) unable
to get prescription medicines (he/she) or a doctor believed necessary?
COULDN'T AFFORD CARE
INSURANCE COMPANY WOULDN'T
APPROVE, COVER, OR PAY FOR CARE
1
2
{AC51}
{AC51}
DOCTOR REFUSED TO ACCEPT
FAMILY'S INSURANCE PLAN
PROBLEMS GETTING TO DOCTOR'S
OFFICE
DIFFERENT LANGUAGE
3
{AC51}
4
{AC51}
5
{AC51}
COULDN'T GET TIME OFF WORK
DIDN'T KNOW WHERE TO GO TO GET
CARE
6
7
{AC51}
{AC51}
WAS REFUSED SERVICES
8
{AC51}
COULDN'T GET CHILD CARE
9
DIDN'T HAVE TIME OR TOOK TOO LONG 10
{AC51}
{AC51}
OTHER
{AC51}
91
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
68
{AC51}
{AC51}
Access to Care (AC) Section
Beta
AC51
Help Enabled
Variable Name
PRND.PRBNOPM
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM W/NOT OBTAINING PM
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) did not get prescription
medicines (he/she) or a doctor believed necessary?
Would you say ...
a big problem,
a small problem, or
1
2
{END_LP07}
{END_LP07}
not a problem?
3
{END_LP07}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP07}
{END_LP07}
END_LP07
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_07 AND CONTINUE
WITH AC52
69
Access to Care (AC) Section
Beta
AC52
Help Enabled
Variable Name
HOME.DELAYPM
Comment Enabled
Jump Back Enabled
Label
Size
2
ANYONE DELAYED IN RECEIVING PM
In the last 12 months, was anyone in the family delayed in getting
prescription medicines they or a doctor believed necessary?
YES
1
NO
2
{BOX_06}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_06}
{BOX_06}
ROUTING INSTRUCTION:
IF CODED ‘1’ (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS ‘DELAY IN RECEIVING PRESCRIPTION MEDICINES’ AT AC53
BY CAPI AND GO TO LOOP_08
IF CODED ‘1’ (YES) AND A MULTI-PERSON RU, CONTINUE WITH AC53
70
Access to Care (AC) Section
Beta
AC53
Help Enabled
Variable Name
PRND.DLAYPM
Comment Enabled
Jump Back Enabled
Label
PERSON DELAY IN RECV'G PM
Who was that?
PROBE: Was anyone else in the family delayed in getting prescription
medicines they or a doctor believed necessary?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
ROUTING INSTRUCTION:
IF THE ONLY PERSON SELECTED IS DECEASED OR INSTITUTIONALIZED,
GO TO BOX_06.
OTHERWISE, CONTINUE WITH LOOP_08.
Roster Details
Title:
RU_Members_1
Col #
Header
Instructions
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
No filter; display all.
71
Size
2
Access to Care (AC) Section
Beta
LOOP_08
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK AC54 – END_LP08
LOOP DEFINITION: LOOP_08 COLLECTS THE MAIN REASON AND THE PROBLEM WITH
THE DELAY IN RECEIVING PRESCRIPTION MEDICINES. THIS LOOP CYCLES ON RU
MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS NOT INSTITUTIONALIZED
- PERSON HAD A DELAY IN RECEIVING PRESCRIPTION MEDICINES (I.E., PERSON WAS
SELECTED AT AC53)
72
Access to Care (AC) Section
Beta
AC54
Help Enabled
Variable Name
PRND.RSPMDLAY
Comment Enabled
Jump Back Enabled
Label
Size
2
MAIN REASON DELAY IN RECV'G PM
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-4.
Which of these best describes the main reason (PERSON) (were/was)
delayed in getting prescription medicines (he/she) or a doctor believed
necessary?
COULDN'T AFFORD CARE
1
{AC55}
INSURANCE COMPANY WOULDN'T
APPROVE, COVER, OR PAY FOR CARE
2
{AC55}
DOCTOR REFUSED TO ACCEPT
FAMILY'S INSURANCE PLAN
PROBLEMS GETTING TO DOCTOR'S
OFFICE
3
{AC55}
4
{AC55}
DIFFERENT LANGUAGE
COULDN'T GET TIME OFF WORK
5
6
{AC55}
{AC55}
DIDN'T KNOW WHERE TO GO TO GET
CARE
WAS REFUSED SERVICES
COULDN'T GET CHILD CARE
7
{AC55}
8
9
{AC55}
{AC55}
DIDN'T HAVE TIME OR TOOK TOO LONG 10
OTHER
91
{AC55}
{AC55}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
73
{AC55}
{AC55}
Access to Care (AC) Section
Beta
AC55
Help Enabled
Variable Name
PRND.PRBPMDLY
Comment Enabled
Jump Back Enabled
Label
Size
2
PROBLEM W/ DELAY IN RECV'G PM
{PERSON’S FIRST MIDDLE AND LAST NAME}
SHOW CARD AC-5.
How much of a problem was it that (PERSON) (were/was) delayed in getting
prescription medicines (he/she) or a doctor believed necessary?
Would you say …
a big problem,
a small problem, or
1
2
{END_LP08}
{END_LP08}
not a problem?
3
{END_LP08}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{END_LP08}
{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_06
BOX_06
GO TO NEXT QUESTIONNAIRE SECTION
74
| File Type | application/pdf |
| File Title | C:\Documents and Settings\POLACHEK_L\Local Settings\Temporary Internet Files\OLK8\AC (Beta).snp |
| Author | polachek_l |
| File Modified | 2006-02-20 |
| File Created | 2006-02-20 |