Beta
Health Status (HE) Section
BOX_01
NOTE: THIS SECTION IS ASKED FOR ALL CURRENT RU MEMBERS AND
INSTITUTIONALIZED PERSONS. DO NOT ASK THIS SECTION FOR DECEASED PERSONS.
NOTE: QUESTIONS HE01 THROUGH HE06 ARE ASKED EVERY ROUND.
NOTE: THROUGHOUT THE HEALTH STATUS (HE) SECTION, AGE CATEGORIES ARE
REFERENCED WHEN A TRUE AGE WAS NOT OBTAINED. THE AGES FOR THESE AGE
CATEGORIES ARE AS FOLLOWS:
1 = LESS THAN 1 YEAR OLD
2 = 1-4
3 = 5-15
4 = 16-23
5 = 24-34
6 = 35-44
7 = 45-54
8 = 55-64
9 = 65 YEARS OLD OR OLDER
1
Beta
Health Status (HE) Section
HE01
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(IMPAIRMENT)
The next few questions are about difficulties people may have with everyday
activities such as getting around, bathing or taking medications. We are
interested in difficulties due to an impairment or a physical or mental health
problem.
{Also, please keep in mind that we are only interested in difficulties family
members may have had between (START DATE) and (END DATE).}
Does anyone in the family receive help or supervision using the telephone,
paying bills, taking medications, preparing light meals, doing laundry, or going
shopping?
Size
Variable Name
Label
HOME.FONEHLP
2
ANYONE GET HELP USING PHONE/PAYING BILLS
1
YES
2
NO
{HE04}
RF
Refused
{HE04}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE04}
HELP AVAILABLE FOR DEFINITION OF IMPAIRMENT AND
HELP/SUPERVISION.
DISPLAY INSTRUCTIONS:
DISPLAY '{Also, please keep in mind that we are only
interested in difficulties family members may have had between
(START DATE) and (END DATE).}' IF ROUND 5. OTHERWISE, USE
NULL DISPLAY.
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE PERSON RU, AUTOMATICALLY CODE
PERSON AS 'RECEIVES HELP' AT HE02 BY CAPI AND GO TO LOOP_01
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE02
2
Beta
Health Status (HE) Section
HE02
HELP OR SUPERVISION USING THE TELEPHONE, PAYING BILLS,
TAKING MEDICATIONS, PREPARING LIGHT MEALS, DOING LAUNDRY,
OR GOING SHOPPING.
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Does anyone else receive help or supervision doing these types of
activities?
Size
Variable Name
Label
PRND.WHOFONE
2
WHO GOT HELP USING PHONE/PAYING BILLS
PRND.IADLFLAG
2
LTC SUPPLEMENT FLAG: IADL SECTION
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_01}
PROGRAMMER NOTES:
FLAG ALL SELECTED PERSONS WHO ARE = OR > 13 YEARS OLD OR IN
AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: IADL SECTION.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
3
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Health Status (HE) Section
Display all RU members excluding deceased RU members.
LOOP_01
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK BOX_01A - END_LP01
LOOP DEFINITION: LOOP_01 DETERMINES IF PERSONS RECEIVE HELP OR
SUPERVISION WITH INSTRUMENTAL ACTIVITIES OF DAILY LIVING BECAUSE OF AN
IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM. THIS LOOP CYCLES ON RU
MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP WITH INSTRUMENTAL ACTIVITIES OF DAILY LIVING (I.E.,
PERSON SELECTED AT HE02)
BOX_01A
IF THE RU MEMBER BEING LOOPED ON IS < 13 YEARS OF AGE OR IN AGE CATEGORIES
1-3, CONTINUE WITH HE03
OTHERWISE, GO TO HE03A
4
Beta
Health Status (HE) Section
HE03
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(IMPAIRMENT)
(Do/Does) (PERSON) receive help or supervision using the telephone, paying
bills, taking medications, preparing light meals, doing laundry or going
shopping because of an impairment or a physical or mental health
problem?
Size
Variable Name
Label
PRND.PHONPROB
2
DID PERSON GET HELP FOR HEALTH REASONS
PRND.IADLFLAG
2
LTC SUPPLEMENT FLAG: IADL SECTION
1
YES
{HE03A}
2
NO
{END_LP01}
RF
Refused
{END_LP01}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{END_LP01}
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION AND
IMPAIRMENT.
PROGRAMMER NOTES:
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: IADL
SECTION.
5
Beta
Health Status (HE) Section
HE03A
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Do you expect that (PERSON) will need help or supervision with these
activities for at least three more months?
Size
Variable Name
Label
PRND.HLPACTIV
2
HELP OR SUPERVISION WITH ACTIVITIES
1
YES
{END_LP01}
2
NO
{END_LP01}
RF
Refused
{END_LP01}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{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 HE04
6
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Health Status (HE) Section
HE04
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(HE04Help)
Does anyone in the family receive help or supervision with personal care such
as bathing, dressing, or getting around the house?
Size
Variable Name
Label
HOME.PERSHLP
2
ANYONE GET HELP WITH PERSONAL CARE
1
YES
2
NO
{BOX_02}
RF
Refused
{BOX_02}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_02}
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION.
PROGRAMMER NOTES:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS 'RECEIVES HELP' AT HE05 BY CAPI.
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_02
IF CODED '1' (YES) AND MULTI-PERSON RU, CONTINUE WITH HE05
7
Beta
Health Status (HE) Section
HE05
HELP OR SUPERVISION WITH PERSONAL CARE SUCH AS BATHING,
DRESSING OR GETTING AROUND THE HOUSE.
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Does anyone else receive help or supervision with personal care?
Size
Variable Name
Label
PRND.WHOPERS
2
WHO GOT HELP WITH PERSONAL CARE
PRND.ADLFLAG
2
LTC SUPPLEMENT FLAG: ADL SECTION
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_02}
PROGRAMMER NOTES:
FLAG ALL SELECTED PERSONS WHO ARE = OR > 13 YEARS OLD OR IN
AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: ADL SECTION.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Display all RU members excluding deceased RU members.
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
8
Beta
Health Status (HE) Section
LOOP_02
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK BOX_01B - END_LP02
LOOP DEFINITION: LOOP_02 DETERMINES IF PERSONS RECEIVE HELP OR
SUPERVISION WITH PERSONAL CARE (I.E., ACTIVITIES OF DAILY LIVING) BECAUSE
OF AN IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM. THIS LOOP CYCLES
ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON RECEIVES HELP OR SUPERVISION WITH PERSONAL CARE (I.E., ACTIVITIES
OF DAILY LIVING, THAT IS, THE PERSON
IS SELECTED AT HE05)
- PERSON = OR > 13 YEARS OF AGE OR IN AGE CATEGORIES 4-9
BOX_01B
IF THE RU MEMBER BEING LOOPED ON IS < 13 YEARS OF AGE OR IN AGE CATEGORIES
1-3, CONTINUE WITH HE06
OTHERWISE, GO TO HE06A
9
Beta
Health Status (HE) Section
HE06
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(IMPAIRMENT)
(Do/Does) (PERSON) receive help or supervision with personal care such as
bathing, dressing or getting around the house because of an impairment or
a physical or mental health problem?
Size
Variable Name
Label
PRND.PERSPROB
2
DID PERSON GET HELP FOR HEALTH PROBLEMS
PRND.ADLFLAG
2
LTC SUPPLEMENT FLAG: ADL SECTION
1
YES
{HE06A}
2
NO
{END_LP02}
RF
Refused
{END_LP02}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{END_LP02}
HELP AVAILABLE FOR DEFINITION OF HELP/SUPERVISION AND
IMPAIRMENT.
PROGRAMMER NOTES:
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT: ADL
SECTION.
10
Beta
Health Status (HE) Section
HE06A
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Do you expect that (PERSON) will need help or supervision with personal care
for at least three more months?
Size
Variable Name
Label
PRND.HLPPCARE
2
HELP OR SUPERVISION WITH PERSONAL CARE
1
YES
{END_LP02}
2
NO
{END_LP02}
RF
Refused
{END_LP02}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{END_LP02}
END_LP02
CYCLE ON NEXT PERSON IN THE RU-MEMBERS-ROSTER WHO MEETS THE CONDITIONS
STATED IN THE LOOP DEFINITION
IF NO OTHER PERSONS MEET THE STATED CONDITIONS, END LOOP_02 AND CONTINUE
WITH BOX_02
BOX_02
IF ROUND 1 OR ROUND 3 OR ROUND 5, CONTINUE WITH HE07
IF ROUND 2 OR ROUND 4, GO TO HE26
11
Beta
Health Status (HE) Section
HE07
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(HE07Help)
Does anyone in the family use any aids such as a walker, grab bars in the
bathtub or any other special equipment for personal care or everyday
activities?
Size
Variable Name
Label
HOME.AIDSHLP
2
ANYONE GET HELP FROM AIDS/EQUIPMENT
1
YES
2
NO
{HE09}
RF
Refused
{HE09}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE09}
HELP AVAILABLE FOR EXAMPLES OF AIDS/SPECIAL EQUIPMENT.
PROGRAMMER NOTES:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS 'USES AIDS' AT HE08 BY CAPI.
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO HE09
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE08
12
Beta
Health Status (HE) Section
HE08
USE ANY AIDS SUCH AS A WALKER, GRAB BARS IN THE BATHTUB OR
ANY OTHER SPECIAL EQUIPMENT FOR PERSONAL CARE OR
EVERYDAY ACTIVITIES.
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Does anyone else use any aids for personal care or everyday
activities?
Size
Variable Name
Label
PRND.WHOAIDS
2
WHO GOT HELP FROM AIDS/EQUIPMENT
PRND.ASEFLAG
2
LTC SUPP. FLAG: AIDS/SPECIAL EQUIP. SECT
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{HE09}
PROGRAMMER NOTES:
FLAG ALL SELECTED PERSONS FOR THE LTC SUPPLEMENT: AIDS/SPECIAL
EQUIPMENT SECTION.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
13
Beta
Health Status (HE) Section
Display all RU members excluding deceased RU members.
HE09
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Does anyone in the family have difficulties walking, climbing stairs, grasping
objects, reaching overhead, lifting, bending or stooping, or standing for long
periods of time?
Size
Variable Name
Label
HOME.WALKHELP
2
ANYONE HAVE DIFFICULTY WALK/CLIMB/GRASP/
1
YES
2
NO
{HE19}
RF
Refused
{HE19}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE19}
PROGRAMMER NOTES:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS 'HAVING DIFFICULTY' AT HE10 BY CAPI.
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_03
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE10
14
Beta
Health Status (HE) Section
HE10
DIFFICULTIES WALKING, CLIMBING STAIRS, GRASPING OBJECTS,
REACHING OVERHEAD, LIFTING, BENDING OR STOOPING, OR
STANDING FOR LONG PERIODS OF TIME.
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Does anyone else have difficulties doing these types of activities?
Size
Variable Name
Label
PRND.WHOWALK
2
WHO HAD DIFFICULTY WALK/CLIMB/GRASP
PRND.FULIFLAG
2
LTC SUPP. FLAG: FUNCTIONAL LIMITATIONS
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_03}
PROGRAMMER NOTES:
FLAG ALL SELECTED PERSONS WHO ARE = OR > 13 YEARS OLD OR IN
AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: FUNCTIONAL
LIMITATIONS SECTION.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
15
Beta
Health Status (HE) Section
Display all RU members excluding deceased RU members.
LOOP_03
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE11 - END_LP03
LOOP DEFINITION: LOOP_03 COLLECTS INFORMATION ON THE LEVEL OF FUNCTIONAL
LIMITATION WITH VARIOUS PHYSICAL ACTIVITIES FOR PERSONS = OR > 13 YEARS OF
AGE. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS FUNCTIONAL LIMITATIONS (I.E., PERSON SELECTED AT HE10)
- PERSON = OR > 13 YEARS OF AGE OR IN AGE CATEGORIES 4-9
16
Beta
Health Status (HE) Section
HE11
SHOW CARD HE-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
{For these next questions, I would like you to think about the time when
(PERSON) entered the institution and what (PERSON) was able to do at that
time.}
Please look at this card and tell me how much difficulty (do/does) (PERSON)
have lifting something as heavy as 10 pounds, such as a full bag of groceries?
Would you say no difficulty, some difficulty, a lot of difficulty, or completely
unable to do it?
Size
Variable Name
Label
PRND.LIFTDIFF
2
HAVE DIFFICULTY LIFTING THINGS
1
NO DIFFICULTY
{HE12}
2
SOME DIFFICULTY
{HE12}
3
A LOT OF DIFFICULTY
{HE12}
4
COMPLETELY UNABLE TO DO IT
{HE12}
RF
Refused
{HE12}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE12}
DISPLAY INSTRUCTIONS:
DISPLAY ‘For these next questions, I would like you to think
about the time when (PERSON) entered the institution and what
(PERSON) was able to do at that time.}’ IF PERSON BEING ASKED
ABOUT CODED AS BEING INSTITUTIONALIZED AT END DATE. IF PERSON
BEING ASKED ABOUT IS A CURRENT RU MEMBER LIVING IN THE RU, USE
A NULL DISPLAY.
17
Beta
Health Status (HE) Section
HE12
SHOW CARD HE-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
How much difficulty (do/does) (PERSON) have walking up 10 steps without
resting?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or
completely unable to do it?
Size
Variable Name
Label
PRND.STEPDIFF
2
HAVE DIFFICULTY WALKING UP STEPS
IF RESPONDENT VOLUNTEERS THAT PERSON IS COMPLETELY
UNABLE TO WALK, SELECT 'COMPLETELY UNABLE TO WALK.'
1
NO DIFFICULTY
{HE13}
2
SOME DIFFICULTY
{HE13}
3
A LOT OF DIFFICULTY
{HE13}
4
COMPLETELY UNABLE TO DO IT
{HE13}
5
COMPLETELY UNABLE TO WALK
{HE17}
RF
Refused
{HE13}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE13}
PROGRAMMER NOTES:
IF CODED '5' (COMPLETELY UNABLE TO WALK), AUTOMATICALLY CODE
HE13, HE14, HE15, AND HE16 AS '4' (COMPLETELY UNABLE TO DO IT)
BY CAPI
18
Beta
Health Status (HE) Section
HE13
SHOW CARD HE-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
How much difficulty (do/does) (PERSON) have walking about 3 city blocks or
about a quarter of a mile?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or
completely unable to do it?
Size
Variable Name
Label
PRND.BLOKDIFF
2
HAVE DIFFICULTY WALKING CITY BLOCKS
1
NO DIFFICULTY
{HE14}
2
SOME DIFFICULTY
{HE14}
3
A LOT OF DIFFICULTY
{HE14}
4
COMPLETELY UNABLE TO DO IT
{HE15}
RF
Refused
{HE14}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE14}
PROGRAMMER NOTES:
IF CODED '4' (COMPLETELY UNABLE TO DO IT), AUTOMATICALLY CODE
HE14 AS '4' (COMPLETELY UNABLE TO DO IT) BY CAPI
19
Beta
Health Status (HE) Section
HE14
SHOW CARD HE-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
How much difficulty (do/does) (PERSON) have walking a mile?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or
completely unable to do it?
Size
Variable Name
Label
PRND.MILEDIFF
2
HAVE DIFFICULTY WALKING A MILE
1
NO DIFFICULTY
{HE15}
2
SOME DIFFICULTY
{HE15}
3
A LOT OF DIFFICULTY
{HE15}
4
COMPLETELY UNABLE TO DO IT
{HE15}
RF
Refused
{HE15}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE15}
20
Beta
Health Status (HE) Section
HE15
SHOW CARD HE-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
How much difficulty (do/does) (PERSON) have standing for about 20 minutes?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or
completely unable to do it?
Size
Variable Name
Label
PRND.STNDDIFF
2
HAVE DIFFICULTY STANDING 20 MINUTES
1
NO DIFFICULTY
{HE16}
2
SOME DIFFICULTY
{HE16}
3
A LOT OF DIFFICULTY
{HE16}
4
COMPLETELY UNABLE TO DO IT
{HE16}
RF
Refused
{HE16}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE16}
21
Beta
Health Status (HE) Section
HE16
SHOW CARD HE-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
How much difficulty (do/does) (PERSON) have bending down or stooping from
a standing position to pick up an object from the floor or tie a shoe?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or
completely unable to do it?
Size
Variable Name
Label
PRND.BENDDIFF
2
HAVE DIFFICULTY BENDING/STOOPING
1
NO DIFFICULTY
{HE17}
2
SOME DIFFICULTY
{HE17}
3
A LOT OF DIFFICULTY
{HE17}
4
COMPLETELY UNABLE TO DO IT
{HE17}
RF
Refused
{HE17}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE17}
22
Beta
Health Status (HE) Section
HE17
SHOW CARD HE-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
How much difficulty (do/does) (PERSON) have reaching up overhead, for
example to remove something from a shelf?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or
completely unable to do it?
Size
Variable Name
Label
PRND.RECHDIFF
2
HAVE DIFFICULTY REACHING OVERHEAD
1
NO DIFFICULTY
{HE18}
2
SOME DIFFICULTY
{HE18}
3
A LOT OF DIFFICULTY
{HE18}
4
COMPLETELY UNABLE TO DO IT
{HE18}
RF
Refused
{HE18}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE18}
23
Beta
Health Status (HE) Section
HE18
SHOW CARD HE-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
How much difficulty (do/does) (PERSON) have using fingers to grasp or
handle something such as picking up a glass from a table or using a pencil to
write?
PROBE: Would you say no difficulty, some difficulty, a lot of difficulty, or
completely unable to do it?
Size
Variable Name
Label
PRND.GRSPDIFF
2
HAVE DIFFICULTY GRASPING/PICKING UP
1
NO DIFFICULTY
{HE18A}
2
SOME DIFFICULTY
{HE18A}
3
A LOT OF DIFFICULTY
{HE18A}
4
COMPLETELY UNABLE TO DO IT
{HE18A}
RF
Refused
{HE18A}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE18A}
24
Beta
Health Status (HE) Section
HE18A
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(Are/Is) (PERSON) expected to have difficulty with any of these activities for at
least three more months?
Size
Variable Name
Label
PRND.DIFACTIV
2
DIFFICULTY WITH ANY OF THESE ACTIVITIES
1
YES
{END_LP03}
2
NO
{END_LP03}
RF
Refused
{END_LP03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{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 HE19
25
Beta
Health Status (HE) Section
HE19
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(HE19Help)
Is anyone in the family limited in any way in the ability to work at a job, do
housework, or go to school because of an impairment or a physical or
mental health problem?
Size
Variable Name
Label
HOME.WORKLIMT
2
ANYONE LIMITED IN ABILITY TO WORK
1
YES
2
NO
{HE22}
RF
Refused
{HE22}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE22}
HELP AVAILABLE FOR DEFINITION OF LIMITED ABILITY AND
IMPAIRMENT.
PROGRAMMER NOTES:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS 'LIMITED ABILITY' AT HE20 BY CAPI
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_04
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE20
26
Beta
Health Status (HE) Section
HE20
LIMITED ABILITY TO WORK AT A JOB, DO HOUSEWORK OR GO TO
SCHOOL BECAUSE OF AN IMPAIRMENT OR A PHYSICAL OR MENTAL
HEALTH PROBLEM.
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Is anyone else limited in the ability to work at a job, do housework,
or go to school because of an impairment or a physical or mental health
problem?
Size
Variable Name
Label
PRND.WHOWORKL
2
WHO IS LIMITED IN ABILITY TO WORK
PRND.WHSLFLAG
2
LTC SUPP FLAG: WORK/HOUSEWORK/SCHL LIMIT
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_04}
PROGRAMMER NOTES:
FLAG ALL SELECTED PERSONS WHO ARE = OR > 5 YEARS OLD OR IN AGE
CATEGORIES 3-9 FOR THE LTC SUPPLEMENT: WORK-HOUSEWORK-SCHOOL
LIMITATIONS SECTION.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
27
Beta
Health Status (HE) Section
Roster Filter:
Display all RU members excluding deceased RU members.
LOOP_04
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE20A - END_LP04
LOOP DEFINITION: LOOP_03 COLLECTS INFORMATION ON WORK/HOUSEWORK/SCHOOL
LIMITATIONS BECAUSE OF AN IMPAIRMENT OR PHYSICAL OR MENTAL HEALTH PROBLEM
FOR PERSONS = OR > 5 YEARS OF AGE. THIS LOOP CYCLES ON RU MEMBERS WHO
MEET THE FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON IS LIMITED IN ABILITY TO WORK AT A JOB, DO HOUSEWORK, OR GO TO
SCHOOL (I.E., PERSON SELECTED AT HE20)
- PERSON = OR > 5 YEARS OF AGE OR IN AGE CATEGORIES 3-9
28
Beta
Health Status (HE) Section
HE20A
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Which activities is (PERSON) limited in doing because of an impairment or a
physical or mental health problem - working at a job, doing housework, or
going to school?
Size
Variable Name
Label
PRND.LIMTWORK
2
PERSON HAS LIMITED ACTIVITIES-WORKING A
PRND.LIMTHSWK
2
PERSON HAS LIMITED ACTIVITIES-DOING HOUS
PRND.LIMTSCHL
2
PERSON HAS LIMITED ACTIVITIES-GOING TO S
CHECK ALL THAT APPLY.
1
WORKING AT A JOB
{HE21}
2
DOING HOUSEWORK
{HE21}
3
GOING TO SCHOOL
{HE21}
RF
Refused
{HE21}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE21}
29
Beta
Health Status (HE) Section
HE21
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
{At the time (PERSON) entered the institution, was/(Are/Is)} (PERSON)
completely unable to {work at a job}{,/ and} { do housework}{ and}{ go to
school}?
Size
Variable Name
Label
PRND.UNABLWRK
2
IS PERSON COMPLETELY UNABLE TO WORK
1
YES
{END_LP04}
2
NO
{END_LP04}
RF
Refused
{END_LP04}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{END_LP04}
DISPLAY INSTRUCTIONS:
DISPLAY ‘At the time (PERSON) entered the institution, was’
IF PERSON BEING ASKED ABOU CODED AS BEING INSTITUTIONALIZED AT
END DATE. DISPLAY ‘(Are/Is)’ IF PERSON BEING ASKED ABOUT IS A
CURRENT RU MEMBER LIVING IN THE RU.
DISPLAY ‘work at a job’ IF HE20A IS CODED ‘1’ (WORKING AT A
JOB), EITHER ALONE OR IN COMBINATION WITH OTHER CODES OR IF
HE20A IS CODED ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW). IF HE20A
IS NOT CODED ‘1’, ‘RF’, OR ‘DK’, USE A NULL DISPLAY.
DISPLAY ‘,’ IF HE20A IS CODED ‘1’, ‘2’, AND ‘3’ OR IF HE20A IS
CODED EITHER ‘RF’ OR ‘DK’. DISPLAY ‘ and’ IF HE20A IS CODED
‘1’ AND EITHER ‘2’ OR ‘3’. OTHERWISE, USE A NULL DISPLAY.
DISPLAY ‘ do housework’ IF HE20A IS CODED ‘2’ (DOING
HOUSEWORK), EITHER ALONE OR IN COMBINATION WITH OTHER CODES OR
IF HE20A IS CODED ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW). IF
HE20A IS NOT CODED ‘2’, ‘RF’, OR ‘DK’, USE A NULL DISPLAY.
DISPLAY ‘ and’ IF ONLY CODES ‘2’ AND ‘3’ ARE SELECTED AT HE20A
OR IF CODES ‘1’, ‘2’, AND ‘3’ ARE ALL SELECTED AT HE20A OR IF
CODED EITHER ‘RF’ OR ‘DK’ AT HE20A. OTHERWISE, USE A NULL
DISPLAY.
DISPLAY ‘ go to school’ IF HE20A IS CODED ‘3’ (GOING TO
SCHOOL), EITHER ALONE OR IN COMBINATION WITH OTHER CODES OR IF
HE20A IS CODED ‘RF’ (REFUSED) OR ‘DK’ (DON’T KNOW). IF HE20A
IS NOT CODED ‘3’, ‘RF’, OR ‘DK’, USE A NULL DISPLAY.
30
Beta
Health Status (HE) Section
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 HE22
HE22
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(HE22Help)
Besides the limitations we just talked about, is anyone in the family limited in
participating in social, recreational or family activities because of an
impairment or a physical or mental health problem?
Size
Variable Name
Label
HOME.SOCLLIMT
2
ANYONE LIMITED IN SOCIAL ACTIVITIES
1
YES
2
NO
{HE24}
RF
Refused
{HE24}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE24}
HELP AVAILABLE FOR DEFINITION OF LIMITED IN PARTICIPATING.
PROGRAMMER NOTES:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS 'LIMITED IN PARTICIPATION' AT HE23 BY CAPI
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO HE24
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE23
31
Beta
Health Status (HE) Section
HE23
LIMITED IN PARTICIPATION IN SOCIAL, RECREATIONAL OR FAMILY
ACTIVITIES BECAUSE OF AN IMPAIRMENT OR A PHYSICAL OR MENTAL
HEALTH PROBLEM.
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Is anyone else limited in participation in activities because of an
impairment or a physical or mental health problem?
Size
Variable Name
Label
PRND.WHOSOCLL
2
WHO IS LIMITED IN SOCIAL ACTIVITIES
PRND.SOLIFLAG
2
LTC SUPP FLAG: SOCIAL LIMITATIONS SECT
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{HE24}
PROGRAMMER NOTES:
FLAG ALL SELECTED PERSONS WHO ARE = OR > 5 YEARS OLD OR IN AGE
CATEGORIES 3-9 FOR THE LTC SUPPLEMENT: SOCIAL LIMITATIONS
SECTION.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
32
Beta
Health Status (HE) Section
Roster Filter:
Display all RU members excluding deceased RU members.
HE24
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Do any of the adults in the family…
YES
NO
REF
DK
HE24_01
Comment Enabled
Jump Back Enabled
Help Enabled
Experience confusion or
memory loss such that
it interferes with
daily activities?
YES
NO
REF
DK
Size
Variable Name
Label
HOME.MEMORY
2
ANYONE EXPERIENCE CONFUSION/MEMORY LOSS
33
Beta
Health Status (HE) Section
HE24_02
Comment Enabled
Jump Back Enabled
Help Enabled
Have problems making
decisions to the point
that it interferes
with daily activities?
YES
NO
REF
DK
Size
Variable Name
Label
HOME.DECISION
2
ANYONE HAVE PROBLEMS MAKING DECISIONS
34
Beta
Health Status (HE) Section
HE24_03
Comment Enabled
Jump Back Enabled
Help Enabled
Require supervision
for their own safety?
YES
NO
REF
DK
Size
Variable Name
Label
HOME.SUPVSAFE
2
ANYONE REQUIRE SUPERVISION FOR SAFETY
PROGRAMMER NOTES:
IF HE24_01, HE24_02, OR HE24_03 IS CODED '1' (YES) AND A
SINGLE-PERSON RU, AUTOMATICALLY CODE AS 'EXPERIENCES
CONFUSION' AT HE25 BY CAPI
ROUTING INSTRUCTION:
IF HE24_01, HE24_02, OR HE24_03 IS CODED '1' (YES) AND A
SINGLE-PERSON RU, GO TO BOX_10
IF HE24_01, HE24_02, AND HE24_03 ARE ALL CODED '2' (NO), 'RF'
(REFUSED), OR 'DK' (DON'T KNOW), GO TO BOX_10
OTHERWISE, CONTINUE WITH HE25
35
Beta
Health Status (HE) Section
HE25
{EXPERIENCE CONFUSION OR MEMORY LOSS SUCH THAT IT
INTERFERES WITH DAILY ACTIVITIES}{{/}HAVE PROBLEMS MAKING
DECISIONS TO THE POINT THAT IT INTERFERES WITH DAILY
ACTIVITIES}{{/}REQUIRE SUPERVISION FOR THEIR OWN SAFETY}
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Does anyone else {experience confusion or memory loss such that it
interferes with daily activities} {{or }have problems making decisions to the
point that it interferes with daily activities} {{or }require supervision for their own
safety}?
Size
Variable Name
Label
PRND.WHOMEMRY
2
WHO HAS PROB WITH MEMORY/DECISION/SAFETY
PRND.COLIFLAG
2
LTC SUPP FLAG: COGNITIVE LIMITATIONS SEC
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{BOX_10}
36
Beta
Health Status (HE) Section
DISPLAY INSTRUCTIONS:
DISPLAY 'EXPERIENCE CONFUSION OR MEMORY LOSS SUCH THAT IT
INTERFERES WITH DAILY ACTIVITIES' IF HE24_01 CODED '1' (YES).
DISPLAY '{/}HAVE PROBLEMS MAKING DECISIONS TO THE POINT THAT
IT INTERFERES WITH DAILY ACTIVITIES' IF HE24_02 CODED '1'
(YES). DISPLAY THE '/' ONLY IF HE24_01 IS ALSO CODED ‘1’
(YES).
DISPLAY '{/}REQUIRE SUPERVISION FOR THEIR OWN SAFETY' IF
HE24_03 IS CODED '1' (YES). DISPLAY THE '/' ONLY IF HE24_01
AND/OR HE24_02 ARE ALSO CODED ‘1’ (YES).
DISPLAY 'experience confusion or memory loss such that it
interferes with daily activities' IF HE24_01 CODED '1' (YES).
DISPLAY '{or }have problems making decisions to the point that
it interferes with daily activities' IF HE24_02 CODED '1'
(YES). DISPLAY THE 'or ' ONLY IF HE24_01 IS ALSO CODED ‘1’
(YES).
DISPLAY '{or }require supervision for their own safety' IF
HE24_03 IS CODED '1' (YES). DISPLAY 'or ' ONLY IF HE24_01
AND/OR HE24_02 ARE ALSO CODED ‘1’ (YES).
PROGRAMMER NOTES:
FLAG ALL SELECTED PERSONS WHO ARE = OR > 18 YEARS OLD OR IN
AGE CATEGORIES 4-9 FOR THE LTC SUPPLEMENT: COGNITIVE
LIMITATIONS SECTION.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Display all RU members excluding deceased RU members.
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
37
Beta
Health Status (HE) Section
HE26
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Does anyone in the family wear eyeglasses or contact lenses?
Size
Variable Name
Label
HOME.EYEGLASS
2
DOES ANYONE WEAR EYEGLASSES/CONTACTS?
1
YES
{HE27}
2
NO
{HE28}
RF
Refused
{HE28}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE28}
DISPLAY INSTRUCTIONS:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AT HE27 BY CAPI.
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO HE28
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE27
38
Beta
Health Status (HE) Section
HE27
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Does anyone else wear eyeglasses or contact lenses?
Size
Variable Name
Label
PRND.WHOGLASS
2
WHO WEARS EYEGLASSES/CONTACTS
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{HE28}
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Display all RU members excluding deceased RU members.
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
39
Beta
Health Status (HE) Section
HE28
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Does anyone in the family have any difficulty seeing {[with glasses or contacts,
if they use them]}?
Size
Variable Name
Label
HOME.DIFFSEE
2
DOES ANYONE HAVE DIFFICULTY SEEING?
1
YES
2
NO
{HE33}
RF
Refused
{HE33}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE33}
DISPLAY INSTRUCTIONS:
DISPLAY ‘ [with glasses or contacts, if they use them] ’ IF
HE26 IS CODED ‘1’ (YES). OTHERWISE, USE A NULL DISPLAY.
PROGRAMMER NOTES:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS 'VISION IMPAIRED' AT HE29 BY CAPI.
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_05
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE29
40
Beta
Health Status (HE) Section
HE29
DIFFICULTY SEEING {WITH GLASSES OR CONTACTS, IF THEY USE
THEM}.
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Does anyone else have any difficulty seeing {[with glasses or
contacts, if they use them]}?
Size
Variable Name
Label
PRND.WHOSEE
2
WHO HAS DIFFICULTY SEEING?
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_05}
DISPLAY INSTRUCTIONS:
DISPLAY ‘ [WITH GLASSES OR CONTACTS, IF THEY USE THEM]’ IF
HE26 IS CODED ‘1’ (YES). OTHERWISE, USE A NULL DISPLAY.
Display ‘ [with glasses or contacts, if they use them] ’ IF
HE26 IS CODED ‘1’ (YES). OTHERWISE, USE A NULL DISPLAY.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
41
Beta
Health Status (HE) Section
Display all RU members excluding deceased RU members.
LOOP_05
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE30 - END_LP05
LOOP DEFINITION: LOOP_05 COLLECTS VISION IMPAIRMENT DETAILS FOR PERSONS
HAVING DIFFICULTY SEEING. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE
FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY SEEING (I.E., PERSON SELECTED AT HE29)
HE30
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(HE30Help)
Can (PERSON) not see anything at all, that is, (are/is) (PERSON) blind?
Size
Variable Name
Label
PRND.ISBLIND
2
CAN PERSON NOT SEE ANYTHING-ARE THEY BLI
PRND.VISNFLAG
2
LTC SUPP FLAG: VISION SECTION
1
YES
{END_LP05}
2
NO
{HE31}
RF
Refused
{HE31}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE31}
HELP AVAILABLE FOR DEFINITION OF BLIND.
PROGRAMMER NOTES:
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT:
VISION SECTION.
42
Beta
Health Status (HE) Section
HE31
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
{With glasses or contacts, can/Can} (PERSON) see well enough to read
ordinary newspaper print, even if (PERSON) cannot read?
Size
Variable Name
Label
PRND.CANREAD
2
CAN PERSON SEE WELL ENOUGH TO READ
1
YES
{END_LP05}
2
NO
{HE32}
RF
Refused
{HE32}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE32}
DISPLAY INSTRUCTIONS:
DISPLAY ‘With glasses or contacts, can’ IF PERSON BEING ASKED
ABOUT WAS SELECTED AT HE27, OTHERWISE (PERSON NOT SELECTED AT
HE27), DISPLAY ‘Can’.
43
Beta
Health Status (HE) Section
HE32
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
{With glasses or contacts, can/Can} (PERSON) see well enough to recognize
familiar people if they are two or three feet away?
Size
Variable Name
Label
PRND.RECOGNIZ
2
CAN PERSON SEE TO RECOGNIZE FAMILIAR PEO
PRND.VISNFLAG
2
LTC SUPP FLAG: VISION SECTION
1
YES
{END_LP05}
2
NO
{END_LP05}
RF
Refused
{END_LP05}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{END_LP05}
DISPLAY INSTRUCTIONS:
DISPLAY ‘With glasses or contacts, can’ IF PERSON BEING ASKED
ABOUT WAS SELECTED AT HE27, OTHERWISE (PERSON NOT SELECTED AT
HE27), DISPLAY ‘Can’.
PROGRAMMER NOTES:
IF CODED '2' (NO), FLAG PERSON FOR THE LTC SUPPLEMENT: VISION
SECTION.
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 HE33
44
Beta
Health Status (HE) Section
HE33
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Does anyone in the family wear a hearing aid?
Size
Variable Name
Label
HOME.HEARAIDE
2
DOES ANYONE WEAR A HEARING AIDE?
1
YES
2
NO
{HE35}
RF
Refused
{HE35}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE35}
PROGRAMMER NOTES:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AT HE34 BY CAPI.
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO HE35
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE34
45
Beta
Health Status (HE) Section
HE34
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE:
Does anyone else wear a hearing aid?
Size
Variable Name
Label
PRND.WHOHRAID
2
WHO WEARS A HEARING AIDE
PRND.HEARFLAG
2
LTC SUPP FLAG: HEARING SECTION
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{HE35}
PROGRAMMER NOTES:
FLAG ALL SELECTED PERSONS FOR THE LTC SUPPLEMENT: HEARING
SECTION.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Display all RU members excluding deceased RU members.
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
46
Beta
Health Status (HE) Section
HE35
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Does anyone in the family have any difficulty hearing {[with a hearing aid, if
they use one}]?
Size
Variable Name
Label
HOME.DIFFHEAR
2
DOES ANYONE HAVE DIFFICULTY HEARING?
1
YES
2
NO
{BOX_10}
RF
Refused
{BOX_10}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_10}
DISPLAY INSTRUCTIONS:
DISPLAY ‘[with a hearing aid, if they use one]’ IF HE33 IS
CODED ‘1’ (YES). OTHERWISE, USE A NULL DISPLAY.
PROGRAMMER NOTES:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, AUTOMATICALLY CODE
PERSON AS 'HEARING IMPAIRED' AT HE36 BY CAPI.
ROUTING INSTRUCTION:
IF CODED '1' (YES) AND A SINGLE-PERSON RU, GO TO LOOP_06
IF CODED '1' (YES) AND A MULTI-PERSON RU, CONTINUE WITH HE36
47
Beta
Health Status (HE) Section
HE36
DIFFICULTY HEARING {WITH A HEARING AID, IF THEY USE ONE}.
{STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Who is that?
PROBE: Does anyone else have any difficulty hearing {[with a hearing aid, if
they use one]}?
Size
Variable Name
Label
PRND.WHOHEAR
2
WHO HAS DIFFICULTY HEARING
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
[First Name,[Middle Name],Last Name]
{LOOP_06}
DISPLAY INSTRUCTIONS:
DISPLAY ‘ WITH A HEARING AID, IF THEY USE ONE’ IF HE33 IS
CODED ‘1’ (YES). OTHERWISE USE A NULL DISPLAY.
DISPLAY ‘ [with a hearing aid, if they use one] ’ IF HE33 IS
CODED ‘1’ (YES). OTHERWISE, USE A NULL DISPLAY.
Title:
RU_Members_1
Roster Details
Col #
Header
Instructions
1
NAME
Display RU member's first, middle, and last names
PERS.FULLNAME
Roster Behavior:
1. Multiple select allowed.
2. Add, delete, and edit disallowed
Roster Filter:
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection.
48
Beta
Health Status (HE) Section
Display all RU members excluding deceased RU members.
LOOP_06
FOR EACH ELEMENT IN THE RU-MEMBERS-ROSTER, ASK HE37 - END_LP06
LOOP DEFINITION: LOOP_06 COLLECTS HEARING IMPAIRMENT DETAILS FOR PERSONS
HAVING DIFFICULTY HEARING. THIS LOOP CYCLES ON RU MEMBERS WHO MEET THE
FOLLOWING CONDITIONS:
- PERSON IS NOT DECEASED
- PERSON HAS DIFFICULTY HEARING (I.E., PERSON SELECTED AT HE36)
HE37
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(HE37Help)
Can (PERSON) not hear any speech at all, that is, (are/is) (PERSON) deaf?
Size
Variable Name
Label
PRND.ISDEAF
2
CAN PERSON NOT HEAR - ARE THEY DEAF?
PRND.HEARFLAG
2
LTC SUPP FLAG: HEARING SECTION
1
YES
{END_LP06}
2
NO
{HE38}
RF
Refused
{HE38}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE38}
HELP AVAILABLE FOR DEFINITION OF DEAF.
PROGRAMMER NOTES:
IF CODED '1' (YES), FLAG PERSON FOR THE LTC SUPPLEMENT:
HEARING SECTION
49
Beta
Health Status (HE) Section
HE38
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
{With a hearing aid, can/Can} (PERSON) hear most of the things people say?
Size
Variable Name
Label
PRND.HEARMOST
2
CAN PERSON HEAR MOST THINGS PEOPLE SAY
1
YES
{END_LP06}
2
NO
{HE39}
RF
Refused
{HE39}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{HE39}
DISPLAY INSTRUCTIONS:
DISPLAY ‘With a hearing aid, can’ IF PERSON BEING ASKED ABOUT
WAS SELECTED AT HE34. OTHERWISE (PERSON NOT SELECTED AT
HE34), DISPLAY ‘Can’.
50
Beta
Health Status (HE) Section
HE39
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} {END-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
{With a hearing aid, can/Can} (PERSON) hear some of the things people say?
Size
Variable Name
Label
PRND.HEARSOME
2
CAN PERSON HEAR SOME THINGS PEOPLE SAY
PRND.HEARFLAG
2
LTC SUPP FLAG: HEARING SECTION
1
YES
{END_LP06}
2
NO
{END_LP06}
RF
Refused
{END_LP06}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{END_LP06}
DISPLAY INSTRUCTIONS:
DISPLAY ‘With a hearing aid, can’ IF PERSON BEING ASKED ABOUT
WAS SELECTED AT HE34. OTHERWISE (PERSON NOT SELECTED AT
HE34), DISPLAY ‘Can’.
PROGRAMMER NOTES:
IF CODED '2' (NO), FLAG PERSON FOR THE LTC SUPPLEMENT:
HEARING SECTION.
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 BOX_10
BOX_10
GO TO NEXT QUESTIONNAIRE SECTION
51
| File Type | application/pdf |
| File Title | C:\Documents and Settings\POLACHEK_L\Local Settings\Temporary Internet Files\OLK8\HE (BETA).snp |
| Author | polachek_l |
| File Modified | 2006-02-20 |
| File Created | 2006-02-20 |