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pdfEvent Roster (EV) Section
Beta
BOX_01
IF COMING FROM WITHIN PERSON LOOP IN PROVIDER PROBES, CODE EV01
AUTOMATICALLY BY CAPI WITH THE CORRECT PERSON NAME AND GO TO EV02
OTHERWISE, CONTINUE WITH EV01
EV01
Help Enabled
Comment Enabled
Variable Name
EVNT.EV01BLSWVS
Jump Back Enabled
Label
Size
INTERVIEWER: SELECT CORRECT PERSON FOR THIS EVENT.
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
[First Name, [Middle Name], Last Name]
{EV02}
Roster Details
Title:
RU_MEMBERS_SelectOne
Col #
Header
Instructions
PERSON-TYPEPROVIDER
Display RU members’ first, middle, and last names
PERS.FULLNAME
1
Roster Definition:
This item displays RU-MEMBERS-ROSTER for selection of RUmembers.
Roster Behavior:
1. Select allowed. Interviewer may select one from the
listed members.
2. Multiple select disallowed.
3. Add, delete, and edit disallowed.
Roster Filter:
None, Display All.
1
Event Roster (EV) Section
Beta
EV02
Help Enabled (EV02Help)
Comment Enabled
Jump Back Enabled
Variable Name
EVNT.EVNTID
Label
EVNT ID KEY: PERSID + COUNTER(3) + CD
Size
12
EVNT.EVNTRURN
EVNT.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EVNT SEGMENT
2
5
EVNT.EVNTTYPE
EVENT TYPE
2
{PERSON'S FIRST MIDDLE AND LAST NAME}
INTERVIEWER: WHAT TYPE OF EVENT IS IT?
HOSPITAL STAY
HOSPITAL EMERGENCY ROOM
HS
ER
{BOX_02}
{BOX_02}
HOSPITAL OUTPATIENT DEPARTMENT
OP
{BOX_02}
MEDICAL PROVIDER VISIT
DENTAL CARE
MV
DN
{BOX_02}
{BOX_02}
HOME HEALTH
OTHER MEDICAL EXPENSES
HH
OM
{EV06}
INSTITUTIONAL/LONG TERM CARE
STAY
IC
{BOX_02}
HELP AVAILABLE FOR DEFINITION OF EVENT TYPES.
ROUTING INSTRUCTION:
IF ROUNDS 3 OR 5 AND EV02 IS CODED ‘OM’, GO TO EV02A
IF ROUNDS 1, 2, OR 4 AND EV02 IS CODED ‘OM’, GO TO EV03
BOX_02
ASK PROVIDER ROSTER (PV) SECTION FOR THIS EVENT
AT COMPLETION OF THE PV SECTION, GO TO BOX_03
2
Event Roster (EV) Section
Beta
EV02A
Help Enabled
Comment Enabled
Jump Back Enabled
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV}
INTERVIEWER: SELECT GROUP TYPE OF OTHER MEDICAL EXPENSE
(OM) EVENT YOU NEED TO ADD:
NOTE: ONLY ONE OM GROUP TYPE MAY BE ADDED AT THIS SCREEN
REGULAR (GLASSES OR CONTACTS,
INSULIN, OTHER DIABETIC SUPPLIES)
ADDITIONAL (E.G., AMBULANCE
SERVICES, ORTHOPEDIC ITEMS,
HEARING DEVICES, MEDICAL
EQUIPMENT, ETC.)
1
{EV03}
2
{EV03A}
PROGRAMMER NOTES:
THE WORD 'REGULAR' AND THE WORD 'ADDITIONAL' IN THE ANSWER
CATEGORIES SHOULD BE IN BOLD TEXT.
3
Event Roster (EV) Section
Beta
EV03
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
PERS.DIABSUPS
Label
DIABETIC SUPPLIES RECEIVED AT LEAST ONCE
Size
2
DRUG.DRUGID
PMED.DRUGLINK
DRUG ID KEY: PERSID + COUNTER(3)
LINKS PMED TO DRUGID
11
3
DRUG.DRUGNAME
DRUG.DRUGRURN
NAME OF MEDS AND PRESCRIPTIONS FILLED
ROUND STAMP: RU LETTER + ROUND NUMBER
30
2
PERS.INSULIN
DRUG.CREATEQ
INSULIN RECEIVED AT LEAST ONCE
QUESTION THAT CREATED DRUG SEGMENT
2
4
EVNT.EVNTID
EVNT ID KEY: PERSID + COUNTER(3) + CD
12
EVNT.EVNTRURN
EVNT.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EVNT SEGMENT
2
5
EVNT.EVNTTYPE
EVNT.OMTYPE
EVENT TYPE
OTHER MEDICAL EXPENSE TYPE
2
2
EVNT.PROVNUM
PROVIDER ID NUMBER
11
EVPV.EVPVID
EVPV.EVPVRURN
EVPV ID KEY: EVNTID + PROVID
ROUND STAMP: RU LETTER + ROUND NUMBER
23
2
EVPV.CREATEQ
QUESTION THAT CREATED EVPV SEGMENT
5
EVPV.EVNTTYPE
EVPV.EVPVTYPE
EVENT TYPE
PROVIDER TYPE RELATED TO EVENT
2
2
PMED.PMEDID
PMED.PMEDRURN
PMED ID KEY: PERSID + COUNTER(3) + CD
ROUND STAMP: RU LETTER + ROUND NUMBER
12
2
PMED.CREATEQ
QUESTION THAT CREATED PMED SEGMENT
4
PMED.PMEDNAME
RXLK.RXLKID
NAME OF MEDS AND PRESCRIPTIONS FILLED
RXLK ID KEY: EVENTID + PMEDID
30
24
RXLK.RXLKRURN
ROUND STAMP: RU LETTER + ROUND NUMBER
2
RXLK.CREATEQ
PRND.PGLASSES
QUESTION THAT CREATED RXLK RECORD
WHO BOUGHT/REPAIRED GLASSES/CONTACTS
4
2
PRND.PINSULIN
PRND.PDIABSUP
WHO OBTAINED INSULIN
WHO BOUGHT DIABETIC EQUIPMENT/SUPPLIES
2
2
PRND.EV03BLSWVS
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT} {END-DT}
IF KNOWN, SELECT CORRECT OME ITEM GROUP.
OTHERWISE ASK:
Did (PERSON) obtain glasses or contact lenses, insulin, or other diabetic
equipment or supplies since (START DATE)?
CHECK ALL THAT APPLY.
GLASSES OR CONTACT LENSES
1
{BOX_01A}
INSULIN
2
{BOX_01A}
4
Event Roster (EV) Section
Beta
OTHER DIABETIC EQUIPMENT OR
SUPPLIES
3
{BOX_01A}
PROGRAMMER NOTES:
IF CODED ‘2’ (INSULIN), ADD ‘INSULIN’ TO PERSON’S-PRESCRIBEDMEDICINES-ROSTER, CREATING NECESSARY RECORDS FOR INSULIN.
IF CODED ‘3’ (OTHER DIABETIC EQUIPMENT OR SUPPLIES), ADD
‘OTHER DIABETIC EQUIP/SUPPLIES’ TO PERSON’S-PRESCRIBEDMEDICINES-ROSTER, CREATING NECESSARY RECORDS FOR 'OTHER
DIABETIC EQUIP/SUPPLIES'.
5
Event Roster (EV) Section
Beta
EV03A
Help Enabled (OTHOMES)
Comment Enabled
Jump Back Enabled
Variable Name
EVNT.PROVNUM
PROVIDER ID NUMBER
Label
Size
11
PRND.EV03ABLSWVS
PRND.AMBULANC
AMBULANCE SERVICES
2
PRND.ORTHOPED
PRND.HEARDEV
ORTHOPEDIC ITEMS
HEARING DEVICES
2
2
PRND.PROSHES
PROSTHESES
2
PRND.BATHAIDS
PRND.MEDEQUIP
BATHROOM AIDS
MEDICAL EQUIPMENT
2
2
PRND.DISPSUPL
DISPOSABLE SUPPLIES
2
PRND.ALTRMODF
PRND.OMOTH
ALTERATIONS/MODIFICATIONS
OTHER
2
2
EVNT.EVNTID
EVNT.EVNTRURN
EVNT ID KEY: PERSID + COUNTER(3) + CD
ROUND STAMP: RU LETTER + ROUND NUMBER
12
2
EVNT.CREATEQ
QUESTION THAT CREATED EVNT SEGMENT
5
EVNT.EVNTTYPE
EVNT.OMTYPE
EVENT TYPE
OTHER MEDICAL EXPENSE TYPE
2
2
EVPV.EVPVID
EVPV ID KEY: EVNTID + PROVID
23
EVPV.EVPVRURN
EVPV.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EVPV SEGMENT
2
5
EVPV.EVNTTYPE
EVPV.EVPVTYPE
EVENT TYPE
PROVIDER TYPE RELATED TO EVENT
2
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {JAN 01} {DEC 31}
SHOW CARD PP-4A or PP-12
IF KNOWN, SELECT CORRECT ADDITIONAL OME ITEM GROUP.
OTHERWISE ASK:
Looking at this card, what type of other medical expenses did (PERSON)
obtain, purchase, or rent during the calendar year {year}?
CHECK ALL THAT APPLY.
AMBULANCE SERVICES
ORTHOPEDIC ITEMS
HEARING DEVICES
1
2
3
PROSTHESES
4
BATHROOM AIDS
MEDICAL EQUIPMENT
5
6
DISPOSABLE SUPPLIES
7
6
Event Roster (EV) Section
Beta
ALTERATIONS/MODIFICATIONS
8
OTHER
91
DISPLAY INSTRUCTIONS:
FOR SPECIFICATION ONLY, 'YEAR' IN PROGRAM IS HARD-CODED.
IF ROUND 3, DISPLAY FIRST YEAR OF PANEL FOR {YEAR}. IF ROUND
5, DISPLAY SECOND YEAR OF PANEL FOR {YEAR}.
ROUTING INSTRUCTION:
IF CODED '91' (OTHER) ALONE OR IN COMBINATION WITH ANY OTHER
CODES, CONTINUE WITH EV03AOV
OTHERWISE, GO TO BOX_06
EV03AOV
Help Enabled (OTHOMES)
Variable Name
EVNT.OMOTHOS
Comment Enabled
Jump Back Enabled
Label
Size
25
OMTYPE OTHER SPECIFY
ENTER OTHER _______________________
GROUPING OF
OTHER MEDICAL
EXPENSES:
{BOX_01A}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
BOX_03
IF EVENT TYPE IS HS OR IC, CONTINUE WITH EV04
OTHERWISE, GO TO EV05
7
{BOX_06}
{BOX_06}
Event Roster (EV) Section
Beta
EV04
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
EVNT.EVNTID
Label
EVNT ID KEY: PERSID + COUNTER(3) + CD
Size
12
EVNT.EVNTRURN
EVNT.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EVNT SEGMENT
2
5
EVNT.EVNTBEGM
EVNT.EVNTBEGD
EV04/EV05 EVENT BEGIN DATE - MONTH
EV04/EV05 EVENT BEGIN DATE - DAY
2
2
EVNT.EVNTBEGY
EV04/EV05 EVENT BEGIN DATE - YEAR
4
EVNT.EVNTENDM
EVNT.EVNTENDD
EVENT END DATE - MONTH
EVENT END DATE - DAY
2
2
EVNT.EVNTENDY
EVENT END DATE - YEAR
4
EVNT.PROVNUM
EVNT.DRFNAM
PROVIDER ID NUMBER
DOCTOR'S FIRST NAME
11
20
EVNT.LORPNAME
EVPV.EVNTBEGM
DOCTOR'S LAST NAME OR PROVIDER NAME
EVENT START DATE - MONTH
45
2
EVPV.EVNTBEGD
EVENT START DATE - DAY
2
EVPV.EVNTBEGY
EVPV.EVNTENDM
EVENT START DATE - YEAR
EVENT END DATE - MONTH
4
2
EVPV.EVNTENDD
EVENT END DATE - DAY
2
EVPV.EVNTENDY
EVPV.EVNTTYPE
EVENT END DATE - YEAR
EVENT TYPE
4
2
EVPV.EVPVTYPE
EVPV.PROVTYPE
PROVIDER TYPE RELATED TO EVENT
PROVIDER TYPE
2
2
EVPV.DRFNAM
DOCTOR'S FIRST NAME
20
EVPV.LORPNAME
DOCTOR'S LAST OR PROVIDER NAME
45
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EV} {STR-DT}{END-DT}
IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS PERSONPROVIDER PAIR WITH THE EVENT TYPE (EV).
IF DATES NOT KNOWN, ASK: When (were/was) (PERSON) admitted to
and discharged from (PROVIDER)? Please tell me the dates of all stays
between (START DATE) and (END DATE).
IF NECESSARY, PROBE: On what date did (PERSON) enter (PROVIDER)?
On what date did (PERSON) leave (PROVIDER)?
IF STILL IN (PROVIDER) {OR RELEASED IN 2009}, ENTER 95 IN MONTH
FOR DISCHARGE DATE.
PROBE: Any other stays?
[ENTER MM/DD/YY] [ENTER MM/DD/YY]
8
Event Roster (EV) Section
Beta
[ENTER MM/DD/YY] [ENTER MM/DD/YY]
[ENTER MM/DD/YY] [ENTER MM/DD/YY]
DISPLAY INSTRUCTIONS:
DISPLAY ‘OR RELEASED IN 2009’ IF ROUND 5.
NULL DISPLAY.
{BOX_06}
OTHERWISE, USE A
PROGRAMMER NOTES:
ALLOW 'RF' AND 'DK' FOR THE DAY AND YEAR BUT NOT FOR THE MONTH.
Roster Details
Title:
PERS_EVNT_Add_1
Col #
Header
Instructions
1
ADMIT DATE
Display Event Begin Date
EVNT.EVNTBEGM
EVNT.EVNTBEGD
EVNT.EVNTBEGY
2
DISCHARGE DATE
Display Event End Date
EVNT.EVNTENDM
EVNT.EVNTENDD
EVNT.EVNTENDY
Roster Definition:
This item displays the PERSON’S-MEDICAL-EVENTS-ROSTER for
adding begin and end dates.
Roster Behavior:
1. Select Disallowed.
2. Multiple add allowed. Interviewer should record the
event begin and end dates.
3. Limited delete allowed. Interviewer can delete an event
that was entered on the screen where delete is used.
That is, as long as the interviewer has not left the
screen, they should be able to delete an event entered
in error.
4. Limited edit allowed. Interviewer can edit an event that
was entered on the screen where edit is used. That is,
as long as the interviewer has not left the screen, they
should be able to edit an event.
Roster Filter:
Display no events on roster initially.
IC event types (EVNT.EVNTYPE) only.
9
This relates to HS and
Event Roster (EV) Section
Beta
EV05
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
EVPV.EVNTENDM
EVENT END DATE - MONTH
Label
EVPV.CREATEQ
EVPV.DRMNAM
QUESTION THAT CREATED EVPV SEGMENT
DOCTOR'S MIDDLE NAME
5
20
EVNT.EVNTENDD
EVNT.EVNTENDM
EVENT END DATE - DAY
EVENT END DATE - MONTH
2
2
EVNT.EVNTENDY
EVENT END DATE - YEAR
4
EVPV.EVNTENDY
EVPV.EVPVID
EVENT END DATE - YEAR
EVPV ID KEY: EVNTID + PROVID
4
23
EVPV.EVPVRURN
ROUND STAMP: RU LETTER + ROUND NUMBER
2
EVPV.EVNTENDD
EVNT.EVNTID
EVENT END DATE - DAY
EVNT ID KEY: PERSID + COUNTER(3) + CD
2
12
EVNT.EVNTRURN
EVNT.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED EVNT SEGMENT
2
5
EVNT.EVNTBEGM
EV04/EV05 EVENT BEGIN DATE - MONTH
2
EVNT.EVNTBEGD
EVNT.EVNTBEGY
EV04/EV05 EVENT BEGIN DATE - DAY
EV04/EV05 EVENT BEGIN DATE - YEAR
2
4
EVNT.PROVNUM
PROVIDER ID NUMBER
11
EVNT.DRFNAM
EVNT.LORPNAME
DOCTOR'S FIRST NAME
DOCTOR'S LAST NAME OR PROVIDER NAME
20
45
EVPV.EVNTBEGM
EVPV.EVNTBEGD
EVENT START DATE - MONTH
EVENT START DATE - DAY
2
2
EVPV.EVNTBEGY
EVENT START DATE - YEAR
4
EVPV.EVNTTYPE
EVPV.EVPVTYPE
EVENT TYPE
PROVIDER TYPE RELATED TO EVENT
2
2
EVPV.PROVTYPE
PROVIDER TYPE
2
EVPV.DRFNAM
EVPV.LORPNAME
DOCTOR'S FIRST NAME
DOCTOR'S LAST OR PROVIDER NAME
20
45
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EV} {STR-DT} {END-DT}
IF DATES KNOWN, ENTER ALL EVENT DATES FOR THIS PERSONPROVIDER PAIR WITH THE EVENT TYPE (EV).
IF DATES NOT KNOWN, ASK: When did (PERSON) visit (PROVIDER)?
Please tell me all the dates between (START DATE) and (END DATE).
PROBE: Any other dates?
[ENTER MONTH, DAY, YEAR-4]
[ENTER MONTH, DAY, YEAR-4]
[ENTER MONTH, DAY, YEAR-4]
10
Size
2
Event Roster (EV) Section
Beta
PROGRAMMER NOTES:
ALLOW 'RF' AND 'DK' FOR THE DAY AND YEAR BUT NOT FOR THE MONTH.
ROUTING INSTRUCTION:
GO TO BOX_06
Roster Details
Title:
PERS_EVNT_Add_2
Col #
Header
Instructions
EVENT DATE
Display Event Begin Date
EVNT.EVNTBEGM
EVNT.EVNTBEGD
EVNT.EVNTBEGY
1
Roster Definition:
This item displays the PERSON’S-MEDICAL-EVENTS-ROSTER for
adding event begin dates.
Roster Behavior:
This item can collect only those events that are the same
provider, person, and event type as the event being asked
about.
1. Select Disallowed.
2. Multiple add allowed. Interviewer should record the
event begin dates.
3. Limited delete allowed. Interviewer can delete an event
that was entered on the screen where delete is used. That
is, as long as the interviewer has not left the screen,
they should be able to delete an event entered in error.
4. Limited edit allowed. Interviewer can edit an event that
was entered on the screen where edit is used. That is,
as long as the interviewer has not left the screen, they
should be able to edit an event.
Roster Filter:
Display no events on roster initially.
11
Event Roster (EV) Section
Beta
EV06
Help Enabled (EV06Help)
Comment Enabled
Jump Back Enabled
Variable Name
PROV.PROVTYPE
PROVIDER TYPE
Label
Size
2
EVNT.PROVTYPE
EVNT.PROVNUM
PROVIDER TYPE
PROVIDER ID NUMBER
2
11
EVNT.LORPNAME
EVNT.HHTYPE
DOCTOR'S LAST NAME OR PROVIDER NAME
HOME HEALTH EVENT TYPE
45
2
PROV.PROVID
PROV ID KEY: RUNTID + COUNTER(3) + CD
11
PROV.PROVRURN
PROV.CREATEQ
ROUND STAMP: RU LETTER + ROUND NUMBER
QUESTION THAT CREATED PROV SEGMENT
2
5
PROV.HHTYPE
HOME HEALTH PROVIDER TYPE
2
PROV.DRFNAM
PROV.LORPNAME
DOCTOR'S FIRST NAME
DR'S LAST NAME OR PROVIDER NAME
20
45
PROV.PRVFLAG
PRND.MEALSERV
FLAGS VOLUNTEER/FRIEND/OTHER-REL HH CARE
VOLUNTEERED MEAL DELIVERY SERVICE
2
2
PROV.PVFACID
PERSON PROVIDER'S LINK TO FACILITY
4
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}{END-DT}
Thinking about the health care (PERSON) received at home, was the person
who provided the care a friend or neighbor, a relative, a volunteer, or some
type of provider who was paid? Please do not include health care received
from friends or relatives living here.
PROBE: Do you have a brochure, folder, binder of papers, telephone listing,
or anything which might help?
NOTE: SELECT ONLY ONE TYPE OF PROVIDER AT THIS TIME.
FRIEND/NEIGHBOR
1
{EV08}
RELATIVE
VOLUNTEER
2
3
{EV07}
{EV08}
OTHER-PAID
VOLUNTEERED: MEAL DELIVERY
SERVICE
4
5
{EV06A}
{BOX_06}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
PROGRAMMER NOTES:
IF CODED ‘5’ (VOLUNTEERED: MEAL DELIVERY SERVICE), DO NOT
CREATE AN EVENT RECORD.
12
Event Roster (EV) Section
Beta
EV06A
Help Enabled
Variable Name
EVNT.SELFAGEN
Comment Enabled
Jump Back Enabled
Label
DOES PROVIDER WORK FOR AGENCY OR SELF?
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}{END-DT}
Did this person work for a home health agency, hospital, or nursing home or
did they work for themselves?
PROBE: Do you have a brochure, folder, binder of papers, telephone listing,
or anything which might help?
WORKED FOR AGENCY, HOSPITAL, OR
NURSING HOME
1
{BOX_04}
WORKED FOR SELF
2
{BOX_04}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
13
{BOX_04}
{BOX_04}
Event Roster (EV) Section
Beta
EV07
Help Enabled
Variable Name
EVNT.HHRELTYP
Comment Enabled
Jump Back Enabled
Label
RELATIONSHIP OF REL PROVIDING HH CARE
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT}{END-DT}
What is the relationship of the relative who provided home care services to
(PERSON)?
IF MORE THAN ONE DAUGHTER/DAUGHTER-IN-LAW/SON/SON-IN-LAW,
CODE ONLY ONE AT THIS TIME AND TREAT EACH AS A SEPARATE
HOME HEALTH EVENT.
INCLUDE ALL OTHER TYPES OF RELATIVES AS ONE GROUP AND
CODE ‘OTHER-RELATIVE’ ONLY ONE TIME.
DAUGHTER
1
{BOX_04}
DAUGHTER-IN-LAW
2
{BOX_04}
SON
SON-IN-LAW
3
4
{BOX_04}
{BOX_04}
OTHER RELATIVE
5
{EV07OV1}
14
Event Roster (EV) Section
Beta
EV07OV1
Help Enabled (EV07OVHelp)
Comment Enabled
Variable Name
EVNT.EV07OV1BLSWVS
Jump Back Enabled
Label
Size
EVNT.HHMOTHER
EVNT.HHFATHER
MOTHER PROVIDED HH CARE SERVICES
FATHER PROVIDED HH CARE SERVICES
2
2
EVNT.HHSISTER
EVNT.HHBROTHR
SISTER PROVIDED HH CARE SERVICES
BROTHER PROVIDED HH CARE SERVICES
2
2
EVNT.HHGRANPA
GRANDFATHER PROVIDED HH CARE
2
EVNT.HHGRANCH
EVNT.HHAUNTUN
GRANDCHILD PROVIDED HH CARE
AUNT/UNCLE PROVIDED HH CARE
2
2
EVNT.HHNIENEP
NIECE/NEPHEW PROVIDED HH CARE
2
EVNT.HHCOUSIN
EVNT.HHOTHREL
COUSIN PROVIDED HH CARE
OTHER RELS WHO PROVIDED HH CARE?
2
2
CODE RELATIONSHIPS OF ALL DIFFERENT TYPES OF RELATIVES WHO
PROVIDED HOME CARE SERVICES SINCE (START DATE) TO (PERSON).
CHECK ALL THAT APPLY.
MOTHER
FATHER
1
2
SISTER
BROTHER
3
4
GRANDPARENT
5
GRANDCHILD
AUNT/UNCLE
6
7
NIECE/NEPHEW
COUSIN
8
9
OTHER
91
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY: CAPI DOES NOT ALLOW 'RF' OR
'DK' IN COMBINATION WITH ANY OTHER CODE.
15
Event Roster (EV) Section
Beta
ROUTING INSTRUCTION:
IF EV07OV1 IS CODED ‘91’ (OTHER) ALONE OR IN COMBINATION WITH
ANY OTHER CODES, CONTINUE WITH EV07OV2
OTHERWISE, GO TO EV08
EV07OV2
Help Enabled (EV07OVHelp)
Variable Name
EVNT.HHOTREOS
Comment Enabled
Jump Back Enabled
Label
SPECIFY OTH REL PROVIDED HH CARE
Size
25
ENTER OTHER: _______________________
{EV08}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
16
{EV08}
{EV08}
Event Roster (EV) Section
Beta
EV08
Help Enabled
Variable Name
EVNT.HHRELNUM
Comment Enabled
Jump Back Enabled
Label
NUM OF FRIEND/RELATIVES PROVIDED HH CARE
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {STR-DT} {END-DT}
How many different {friends or neighbors/volunteers/relatives, other than
daughters, daughters-in-law, sons, and sons-in-law} provided home care
services for (PERSON) since (START DATE)?
NUMBER: _______
{BOX_05}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
{BOX_05}
{BOX_05}
DISPLAY INSTRUCTIONS:
DISPLAY ‘friends or neighbors’ IF EV06 IS CODED ‘1’
(FRIEND/NEIGHBOR). DISPLAY ‘volunteers’ IF EV06 IS CODED ‘3’
(VOLUNTEER). DISPLAY ‘relatives, other than daughters,
daughters-in-law, sons, and sons-in-law’ IF EV07 IS CODED ‘5’
(OTHER-RELATIVE).
PROGRAMMER NOTES:
IF EV06 IS CODED ‘1' (FRIEND/NEIGHBOR):
- ADD ‘FRIEND/NEIGHBOR’ TO THE RU-MEDICAL-PROVIDERS-ROSTER,
PERSON-TYPE-PROVIDER NAME COLUMN. NO ADDRESS
INFORMATION IS NECESSARY.
- FLAG PROVIDER AS ‘INFORMAL’.
IF EV06 IS CODED ‘3’ (VOLUNTEER):
- ADD ‘VOLUNTEER’ TO THE RU-MEDICAL-PROVIDERS-ROSTER,
PERSON-TYPE-PROVIDER NAME COLUMN. NO ADDRESS
INFORMATION IS NECESSARY.
- FLAG PROVIDER AS ‘INFORMAL’.
IF EV07 IS CODED ‘5’ (OTHER RELATIVE):
- ADD ‘OTHER RELATIVE’ TO THE RU-MEDICAL-PROVIDERS-ROSTER,
PERSON-TYPE-PROVIDER NAME COLUMN. NO ADDRESS
INFORMATION IS NECESSARY.
- FLAG PROVIDER AS ‘INFORMAL’.
17
Event Roster (EV) Section
Beta
BOX_04
ASK PROVIDER ROSTER (PV) SECTION FOR THIS EVENT
AT COMPLETION OF THE PV SECTION, CONTINUE WITH BOX_05
BOX_05
IF EV06 IS CODED ‘1’ (FRIEND/NEIGHBOR) OR ‘3’ (VOLUNTEER) AND ROUND 1, GO
TO EV12.
IF EV06 IS CODED ‘1’ (FRIEND/NEIGHBOR) OR ‘3’ (VOLUNTEER) AND NOT ROUND 1,
GO TO EV13.
IF EV06 IS CODED ‘2’ (RELATIVE), FLAG PROVIDER
SECTION AS ‘INFORMAL’ AND GO TO EV13.
JUST COLLECTED IN PV
IF EV06A IS CODED ‘2’ (WORKED FOR SELF), ‘RF’(REFUSED), OR ‘DK’ (DON’T
KNOW), FLAG PROVIDER JUST COLLECTED IN PV SECTION AS ‘PAID INDEPENDENT’
AND GO TO EV10.
IF EV06A IS CODED ‘1’ (WORKED FOR AGENCY, HOSPITAL, OR NURSING HOME), FLAG
PROVIDER JUST COLLECTED IN PV SECTION AS ‘AGENCY’ AND CONTINUE WITH EV09.
18
Event Roster (EV) Section
Beta
EV09
Help Enabled
Variable Name
EVNT.HHPRVNUM
Comment Enabled
Jump Back Enabled
Label
HOW MANY PEOPLE PROVIDED HH CARE?
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EV} {STR-DT}{END-DT}
How many people from (PROVIDER) provided home care services for
(PERSON)?
NUMBER: _______
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
ROUTING INSTRUCTION:
IF ROUND 1, GO TO EV12
OTHERWISE, GO TO EV13
19
Event Roster (EV) Section
Beta
EV10
Help Enabled (EV10Help)
Variable Name
EVNT.HHPRTYPE
Comment Enabled
Jump Back Enabled
Label
Size
2
WHAT TYPE OF HH PROVIDER
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EV} {STR-DT}{END-DT}
Is (PROVIDER) a companion, a professional homemaker, a home health or
nurse’s aide, a health professional, or something else?
PROBE: Health professionals include people like nurses, social workers,
therapists of any type.
COMPANION
DOMESTIC WORKER/HOUSE CLEANER
1
2
HEALTH PROFESSIONAL
3
HOMEMAKER
HOME HEALTH AIDE
4
5
NURSE'S AIDE
PERSONAL CARE ATTENDANT
OTHER
6
7
91
{EV11}
{EV10OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
ROUTING INSTRUCTION:
IF EV10 NOT CODED ‘3’ (HEALTH PROFESSIONAL), OR ‘91’ (OTHER),
AND ROUND 1, GO TO EV12
OTHERWISE, GO TO EV13
20
Event Roster (EV) Section
Beta
EV10OV
Help Enabled (EV10Help)
Variable Name
EVNT.HHPROS
Comment Enabled
Jump Back Enabled
Label
Size
25
SPECIFY OTHER HH TYPE PROVIDER
ENTER OTHER: _______________________
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
ROUTING INSTRUCTION:
IF ROUND 1, GO TO EV12
OTHERWISE, GO TO EV13
21
Event Roster (EV) Section
Beta
EV11
Help Enabled (EV11Help)
Variable Name
EVNT.HHPROFTY
Comment Enabled
Jump Back Enabled
Label
WHAT TYPE OF HEALTH PRO IS PROVIDER?
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EV} {STR-DT}{END-DT}
What type of health professional is (PROVIDER)?
DIETITIAN/NUTRITIONIST
HOME HEALTH AIDE
1
2
HOSPICE WORKER
I.V./INFUSION THERAPIST
3
4
MEDICAL DOCTOR
5
NURSE/NURSE PRACTITIONER
NURSE'S AIDE
6
7
OCCUPATIONAL THERAPIST
PERSONAL CARE ATTENDANT
8
9
PHYSICAL THERAPIST
RESPIRATORY THERAPIST
10
11
SOCIAL WORKER
SPEECH THERAPIST
OTHER
12
13
91
{EV11OV}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
HELP AVAILABLE FOR DEFINITION OF ANSWER CATEGORIES.
ROUTING INSTRUCTION:
IF EV11 NOT CODED ‘91’ (OTHER), AND ROUND 1, GO TO EV12
IF EV11 NOT CODED '91' (OTHER), AND ROUNDS 2-5 GO TO EV13
22
Event Roster (EV) Section
Beta
EV11OV
Help Enabled (EV11Help)
Variable Name
EVNT.HHPROFOS
Comment Enabled
Jump Back Enabled
Label
SPECIFY OTHER TYPE OF HH PROFESSIONAL
Size
25
ENTER OTHER: _______________________
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
ROUTING INSTRUCTION:
IF ROUND 1, CONTINUE WITH EV12
OTHERWISE, GO TO EV13
23
Event Roster (EV) Section
Beta
EV12
Help Enabled
Variable Name
EVNT.HHPRVHLP
Comment Enabled
Jump Back Enabled
Label
DID PROV PROVIDE HH CARE BEFORE 1/1/96
Size
2
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EV} {STR-DT}{END-DT}
Did {someone from} (PROVIDER) ever provide home care services for
(PERSON) before January 1, 2007?
YES
1
{EV13}
NO
2
{EV13}
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
DISPLAY INSTRUCTIONS:
DISPLAY ‘someone from’ IF PROVIDER IS A FACILITY.
USE A NULL DISPLAY.
24
{EV13}
{EV13}
OTHERWISE,
Event Roster (EV) Section
Beta
EV13
Help Enabled
Comment Enabled
Jump Back Enabled
Variable Name
EVNT.EVNTID
Label
EVNT ID KEY: PERSID + COUNTER(3) + CD
Size
12
EVNT.DRFNAM
EVPV.DRFNAM
DOCTOR'S FIRST NAME
DOCTOR'S FIRST NAME
20
20
EVNT.EVNTBEGD
EVPV.EVNTBEGD
EV04/EV05 EVENT BEGIN DATE - DAY
EVENT START DATE - DAY
2
2
EVNT.EVNTBEGM
EV04/EV05 EVENT BEGIN DATE - MONTH
2
EVPV.EVNTBEGM
EVNT.CREATEQ
EVENT START DATE - MONTH
QUESTION THAT CREATED EVNT SEGMENT
2
5
EVPV.EVNTBEGY
EVENT START DATE - YEAR
4
EVPV.PROVTYPE
EVNT.EVNTRURN
PROVIDER TYPE
ROUND STAMP: RU LETTER + ROUND NUMBER
2
2
EVPV.EVNTTYPE
EVPV.EVPVTYPE
EVENT TYPE
PROVIDER TYPE RELATED TO EVENT
2
2
EVNT.LORPNAME
DOCTOR'S LAST NAME OR PROVIDER NAME
45
EVPV.LORPNAME
EVNT.PROCFLAG
DOCTOR'S LAST OR PROVIDER NAME
EVNT UTILIZATION PROCESS FLAG
45
2
EVNT.PROVNUM
PROVIDER ID NUMBER
11
EVNT.EVNTBEGY
EV04/EV05 EVENT BEGIN DATE - YEAR
4
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER......} {EV} {STR-DT}{END-DT}
{Last time we recorded that (PERSON) received home care services from
(PROVIDER) during some part of {PRV RD INTV MTH}. Did (PERSON)
continue to receive home care services from (PROVIDER) during the rest of
{PRV RD INTV MTH}?}
Did {someone from} (PROVIDER) provide home care services for (PERSON)
during the month of (MONTH)?
How about in (MONTH)?
YES
NO
1
2
----------------------------------------------------------------------------------------------------------------------------------
Refused
Don't Know
RF
DK
25
Event Roster (EV) Section
Beta
DISPLAY INSTRUCTIONS:
DISPLAY FIRST PARAGRAPH IF A HOME HEALTH EVENT FOR THE MONTH
OF THE PREVIOUS ROUND’S INTERVIEW FOR THIS PERSON-PROVIDER
PAIR WAS CREATED DURING THE PREVIOUS ROUND. (HOWEVER, IT
WOULD NOT HAVE BEEN ASKED ABOUT.) OTHERWISE, USE A NULL
DISPLAY.
DISPLAY THE MONTH OF THE PREVIOUS ROUND’S INTERVIEW DATE FOR
‘{PRV RD INTV MTH}’.
DISPLAY ‘someone from’ IF PROVIDER IS A FACILITY.
USE A NULL DISPLAY.
OTHERWISE,
PROGRAMMER NOTES:
EV13 SCREEN DISPLAY SPECIFICATIONS:
1. THE NUMBER AND NAMES OF THE MONTHS LISTED ARE DETERMINED
BY THE NUMBER OF MONTHS BETWEEN THE MONTH OF THE START
DATE AND THE MONTH OF THE END DATE FOR THIS PERSON. FOR
EXAMPLE, IF THE START DATE IS JANUARY 1 AND THE END DATE IS
APRIL 10 FOR THIS PERSON’S REFERENCE PERIOD, ‘JANUARY’,
'FEBRUARY', 'MARCH', AND ‘APRIL’ ARE DISPLAYED. THAT IS,
THE MONTHS ARE ALL THE MONTHS OF THE PERSON’S
REFERENCE PERIOD.
2. ‘RF’ (REFUSED) AND ‘DK’ (DON’T KNOW) ARE ALLOWED FOR
EV13_01, EV13_02, EV13_03, AND EV13_04. HOWEVER,
THEY WILL BE TREATED AS A ‘NO’ WHEN CREATING EVENTS.
3. THE MONTHS ARE DISPLAYED IN GRID FORMAT WITH
YES/NO/DK/RF RADIO BUTTONS.
4. EV13 HAS TO ACCOMMODATE AT LEAST 10 MONTHS.
5. A SEAM MONTH WILL BE ASKED ONLY ONE HOME HEALTH
UTILIZATION SECTION WHENEVER IT RECEIVES (OR
RECEIVED) A CODE OF ‘1’ (YES) IN EITHER THE CURRENT
ROUND OR THE PREVIOUS ROUND.
MESSAGE: IF CURRENT INTERVIEW MONTH IS CODED ‘1’ (YES),
DISPLAY THE FOLLOWING MESSAGE: ‘HOME HEALTH UTILIZATION SEC
FOR {INT MONTH} WILL NOT BE ASKED UNTIL NEXT ROUND.’
EACH MONTH CODED ‘1’ (YES) BECOMES A SEPARATE HOME HEALTH
EVENT FOR THIS PERSON-PROVIDER PAIR. HOWEVER, IF THE CURRENT
INTERVIEW MONTH IS CODED ‘1’ (YES), IT WILL NOT BE ASKED ABOUT
UNTIL THE NEXT ROUND. IF THE MONTH OF THE PREVIOUS ROUND’S
INTERVIEW DATE IS CODED ‘1’ (YES), IT IS ASKED ONE TIME. THAT
IS, IT IS NOT A SEPARATE EVENT FOR BOTH THE PREVIOUS ROUND AND
THIS ROUND, IT IS ONLY ONE EVENT.
Hard CHECK:
EDIT: ALL MONTHS DURING THE REFERENCE PERIOD CANNOT BE CODED ‘2’ (NO), ‘RF’
(REFUSED), OR ‘DK’ (DON’T KNOW). IF ALL ARE, WVS ERROR HANDLER WILL FORCE
THE INTERVIEWER TO RECTIFY THE DATA.
26
Event Roster (EV) Section
Beta
BOX_06
RETURN TO ORIGINAL QUESTIONNAIRE SECTION IN PP OR ED.
27
| File Type | application/pdf |
| File Title | C:\EV (BETA).snp |
| Author | miller_n |
| File Modified | 2005-08-10 |
| File Created | 2005-08-10 |