MEPS-HC Survey Instrument

20 - CP (BETA).pdf

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC through 2009)

MEPS-HC Survey Instrument

OMB: 0935-0118

Document [pdf]
Download: pdf | pdf
RU Information (RS) Section
Beta
NOTE: THIS SECTION DOES NOT REQUIRE DISPLAYS OF ANY PREVIOUSLY ENTERED
INFORMATION. IT CONSISTS ONLY OF QUESTIONS ASKED TO THE INTERVIEWER
AND INFORMATION RECORDED ON HARD COPY MATERIALS.
ALL INFORMATION IS SAVED BY ROUND.
SHEET WILL BE THE ENTIRE HISTORY.

THE INFORMATION USED FOR THE FACE

BOX_00
IF NOT ROUND 5, CONTINUE WITH RS01
OTHERWISE (I.E., IF ROUND 5) GO TO RS05

RS01

Help Enabled

Variable Name
INFO.SPECSTAT

Comment Enabled

Jump Back Enabled

Label

Size
2

ARE THERE SPECIAL INSTRUCTIONS?

REFER TO THE RU FACE SHEET AND RU FOLDER FOR INFORMATION
REQUIRED TO COMPLETE THIS SECTION.
BASED ON YOUR EXPERIENCE WITH THE RU AND YOUR REVIEW OF
THE RECORD OF CALLS, ARE THERE ANY {ADDITIONAL} SPECIAL
INSTRUCTIONS THAT SHOULD BE CARRIED OVER TO THE NEXT
ROUND THAT WOULD HELP WITH THE COMPLETION OF THE
INTERVIEW? INCLUDE SUCH THINGS AS BEST TIME TO CONTACT,
SPECIAL NEEDS OF THE RESPONDENT, OR OTHER CONSIDERATIONS.

YES

1

{RS02}

NO

2

{RS03}

DISPLAY INSTRUCTIONS:
IF ROUND > 1, DISPLAY THE WORD “ADDITIONAL”.
A NULL DISPLAY.

1

IF ROUND 1, USE

RU Information (RS) Section
Beta

RS02

Help Enabled

Comment Enabled

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Variable Name
INFO.SPECINS1

SPECIAL INSTRUCTIONS LINE 1

Label

Size
45

INFO.SPECINS2
INFO.SPECINS3

SPECIAL INSTRUCTIONS LINE 2
SPECIAL INSTRUCTIONS LINE 3

45
45

INFO.SPECINS4

SPECIAL INSTRUCTIONS LINE 4

45

ENTER SPECIAL INSTRUCTIONS:

TEXT: _______________________

{RS03}

PROGRAMMER NOTES:
ALLOW THE MAXIMUM NUMBER OF LINES AND CHARACTERS PER LINE THAT
THE SCREEN WILL PERMIT.

2

RU Information (RS) Section
Beta

RS03

Help Enabled

Variable Name
INFO.DIRSTAT

Comment Enabled

Jump Back Enabled

Label
ARE THERE SPECIAL LOCATING DIRECTIONS?

Size
2

BASED ON YOUR EXPERIENCE USING THE PREPRINTED ADDRESS
INFORMATION ON THE RU FOLDER AND FACE SHEET TO FIND THE
HOUSEHOLD, ARE THERE ANY {ADDITIONAL OR DIFFERENT}
LOCATING DIRECTIONS THAT SHOULD BE CARRIED OVER TO THE
NEXT ROUND? INCLUDE SUCH THINGS AS LANDMARKS, MILEAGE,
ROAD SIGNS AND SO FORTH.

YES

1

{RS04}

NO

2

{RS05}

DISPLAY INSTRUCTIONS:
IF ROUND > 1, DISPLAY “ADDITIONAL OR DIFFERENT”.
USE A NULL DISPLAY.

3

IF ROUND 1,

RU Information (RS) Section
Beta

RS04

Help Enabled

Comment Enabled

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Variable Name
INFO.CURDIR1

DIRECTIONS TO CURRENT RU LINE 1

Label

Size
45

INFO.CURDIR2
INFO.CURDIR3

DIRECTIONS TO CURRENT RU LINE 2
DIRECTIONS TO CURRENT RU LINE 3

45
45

INFO.CURDIR4

DIRECTIONS TO CURRENT RU LINE 4

45

ENTER DIRECTIONS THAT WILL HELP TO LOCATE THE RU IN THE NEXT
ROUND.

TEXT: _______________________

{RS05}

PROGRAMMER NOTES:
ALLOW THE MAXIMUM NUMBER OF LINESAND CHARACTERS PER LINE THAT
THE SCREEN WILL PERMIT.

4

RU Information (RS) Section
Beta

RS05

Help Enabled

Variable Name
INFO.RSPROB

Comment Enabled

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Label
ANY PROBLEMS W/ADMINISTRATION OF CAPI?

Size
2

OTHER THAN AUTHORIZATION FORM PROBLEMS REPORTED IN THE
CLOSING SECTION, IN GENERAL, DID YOU HAVE ANY PROBLEMS WITH
THE ADMINISTRATION OF THE QUESTIONNAIRE? IS THERE ANYTHING
IN THE CASE RECORDS THAT NEED
TO BE FIXED AT THE HOME OFFICE BEFORE THE NEXT ROUND?

YES

1

{RS06}

NO

2

{RS09}

5

RU Information (RS) Section
Beta

RS06

Help Enabled

Comment Enabled

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Variable Name
INFO.RSPROB1

PROBS W/ADMIN OF CAPI LINE 1

Label

Size
45

INFO.RSPROB2
INFO.RSPROB3

PROBS W/ADMIN OF CAPI LINE 2
PROBS W/ADMIN OF CAPI LINE 3

45
45

INFO.RSPROB4

PROBS W/ADMIN OF CAPI LINE 4

45

ENTER COMMENTS OR QUESTIONS OR DESCRIBE THE SITUATION:

TEXT: _______________________

{RS09}

PROGRAMMER NOTES:
ALLOW THE MAXIMUM NUMBER OF LINES AND CHARACTERS PER LINE THAT
THE SCREEN WILL PERMIT.
NOTE THAT INFORMATION COLLECTED AT THIS ITEM WILL NOT APPEAR
ON THE FACE SHEET.

6

RU Information (RS) Section
Beta

RS09

Help Enabled

Variable Name
INFO.OBSTAT

Comment Enabled

Jump Back Enabled

Label

Size
2

OBSERVATION STATUS

WAS THE INTERVIEW FOR THIS RU OBSERVED THIS ROUND?

YES
NO

1
2

ROUTING INSTRUCTION:
IF MESSAGE FROM DATA PREP, CONTINUE WITH RS10.
TO RS12.

OTHERWISE, GO

RS10

Help Enabled

Comment Enabled

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MESSAGE FROM DATA PREP:

PROGRAMMER NOTES:
THIS MESSAGE TEXT WILL DISPLAY THE SPECIAL INSTRUCTIONS (FROM
DATA PREP).
ALLOW THE MAXIMUM NUMBER OF LINES AND CHARACTERS THAT THE
SCREEN PERMITS.

7

RU Information (RS) Section
Beta

RS11

Help Enabled

Comment Enabled

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Variable Name
INFO.INTNOTE1

INTERVIEWER NOTE LINE 1

Label

Size
30

INFO.INTNOTE2
INFO.INTNOTE3

INTERVIEWER NOTE LINE 2
INTERVIEWER NOTE LINE 3

30
30

PLEASE PROVIDE ENOUGH INFORMATION TO CLARIFY THE SITUATION
AND/OR DESCRIBE THE ACTION TAKEN TO CORRECT THE SITUATION:

TEXT: _______________________
PROGRAMMER NOTES:
ALLOW THREE LINES OF 30 CHARACTERS PER LINE.
ROUTING INSTRUCTION:
IF ROUND 1, 3, OR 5, CONTINUE WITH RS12. OTHERWISE, GO TO
BOX_01.

BOX_01
END OF RU INFORMATION SCREEN (RS) SECTION.

8


File Typeapplication/pdf
File TitleC:\Documents and Settings\POLACHEK_L\Local Settings\Temporary Internet Files\OLK8\RS (Beta).snp
Authorpolachek_l
File Modified2006-02-20
File Created2006-02-20

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