Beta
Emergency Room (ER) Section
ER01
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(MEDPROVHELP)
Did (PERSON) see a medical doctor during this particular visit?
Size
Variable Name
Label
EROM.SEEDOC
2
DID P SEE MEDICAL DOC DURING THIS VISIT
1
YES
{ER02}
2
NO
{ER02}
RF
Refused
{ER02}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{ER02}
HELP AVAILABLE FOR DEFINITION OF MEDICAL DOCTOR.
1
Beta
Emergency Room (ER) Section
ER02
SHOW CARD ER-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(ER02Help)
Please look at this card and tell me which category best describes the care
(PERSON) received during the visit to (PROVIDER) emergency room on
(VISIT DATE)?
Size
Variable Name
Label
EROM.VSTCTGRY
2
BEST CATEGORY FOR EROM CARE ON VISIT
1
DIAGNOSIS OR TREATMENT
{ER03}
2
EMERGENCY (E.G., ACCIDENT OR
INJURY)
{ER03}
3
PSYCHOTHERAPY OR MENTAL
HEALTH COUNSELING
{ER03}
4
FOLLOW-UP OR POST-OPERATIVE
VISIT
{ER03}
5
IMMUNIZATIONS OR SHOTS
{ER03}
6
PREGNANCY-RELATED (INCLUDING
PRENATAL CARE AND DELIVERY)
{ER03}
91
OTHER
{ER03}
RF
Refused
{ER03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{ER03}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
PROGRAMMER NOTES:
IF CODED ‘6’ (PREGNANCY-RELATED (INCLUDING PRENATAL CARE AND
DELIVERY) ), CHECK THAT PERSON IS FEMALE. IF NOT, DISPLAY
THE FOLLOWING MESSAGE: ‘CODE UNAVAILABLE FOR MALES. VERIFY
AND RE-ENTER.’
2
Beta
Emergency Room (ER) Section
ER03
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Was this visit related to any specific health condition or were any conditions
discovered during this visit?
Size
Variable Name
Label
EROM.VSTRELCN
2
WAS THIS VISIT RELATED TO SPEC HLTH COND
1
YES
{ER04}
2
NO
{ER05}
RF
Refused
{ER05}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{ER05}
3
Beta
Emergency Room (ER) Section
ER04
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
What conditions were discovered or led (PERSON) to make this visit?
PROBE: Any other condition?
IF CONDITION IS ALREADY LISTED, ASK: Is this the same (NAME OF
CONDITION) that we have already talked about before?
Size
Variable Name
Label
COND.CONDID
12
COND ID KEY: PERSID + COUNTER(3) + CD
COND.CONDRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
COND.CREATEQ
4
QUESTION THAT CREATED COND SEGMENT
COND.CONDNAM
30
NAME OF CONDITION
CLNK.CLNKID
24
CLNK ID KEY: CONDID + EVNTID
CLNK.CLNKRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
CLNK.CREATEQ
4
QUESTION THAT CREATED CLNK SEGMENT
CLNK.CLNKTYPE
2
TYPE OF EVENT CONDITION IS LINKED TO
CRND.CRNDID
13
CRND ID KEY: CONDID + ROUND NUMBER
CRND.CRNDRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
CRND.CREATEQ
2
CREATION STAMP
IF SAME EPISODE OF CONDITION, SELECT ENTRY ON ROSTER.
IF NEW EPISODE OF CONDITION, ADD TO ROSTER.
[Medical Condition]
{ER05}
[Medical Condition]
{ER05}
[Medical Condition]
{ER05}
PROGRAMMER NOTES:
DISPLAY 'ADD CONDITION' AS AN OPTION ON THIS SCREEN.
Title:
PERS_COND_1
Roster Details
4
Beta
Emergency Room (ER) Section
Col #
Header
Instructions
1
MEDICAL CONDITION Display name of medical condition
COND.CONDNAM
Roster Behavior:
1. Multiple Select allowed. Selection should NOT
impact the round flag of the condition.
2. Multiple Add allowed. Interviewer should record
the condition name.
3. Limited Delete allowed. Interviewer may delete a
condition added on this screen as long as CAPI has
not yet created the link between this condition and
the event. If the interviewer attempts to delete a
condition when delete is not allowed, display the
following message: “DELETE ALLOWED ONLY WHEN
CONDITION IS FIRST ENTERED.”
4. Limited Edit allowed. Interviewer may edit a condition
name newly added on this screen as long as CAPI has
not yet created the link between this condition and
the event. If the interviewer attempts to edit a condition
when edit is not allowed, display the following message:
“EDIT ALLOWED ONLY WHEN CONDITION IS FIRST
ENTERED.”
Roster Filter:
Display all conditions on person’s roster; no filter.
Roster Definition:
Display the PERSON-MEDICAL-CONDITIONS-ROSTER for the selection
and addition of one or many medical condition(s) associated
with this event.
5
Beta
Emergency Room (ER) Section
ER05
SHOW CARD ER-2.
{PERSON’S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(MEDSERVHELP)
Looking at this card, which of these services, if any, did (PERSON) have
during this visit?
Size
Variable Name
Label
EROM.THRTSWAB
2
EROM.ER05BLSWVS
EROM.LABTEST
2
HAVE LAB TESTS THIS VISIT
EROM.SONOGRAM
2
HAVE SONOGRAM/ULTRASOUND THIS VISIT
EROM.XRAYS
2
HAVE XRAYS THIS VISIT
EROM.MAMMOG
2
HAVE MAMMOGRAM THIS VISIT
EROM.MRI
2
HAVE MRI OR CATSCAN THIS VISIT
EROM.EKG
2
HAVE EKG OR ECG THIS VISIT
EROM.EEG
2
HAVE EEG THIS VISIT
EROM.RCVVAC
2
HAVE VACCINATION THIS VISIT
EROM.ANESTH
2
HAVE ANESTHESIA THIS VISIT
EROM.OTHSVCE
2
HAVE OTHER DIAG TEST THIS VISIT
CHECK ALL THAT APPLY.
1
LABORATORY TESTS
{ER06}
11
THROAT SWAB
{ER06}
2
SONOGRAM OR ULTRASOUND
{ER06}
3
X-RAYS
{ER06}
4
MAMMOGRAM
{ER06}
5
MRI OR CATSCAN
{ER06}
6
EKG OR ECG
{ER06}
7
EEG
{ER06}
8
VACCINATION
{ER06}
9
ANESTHESIA
{ER06}
10
OTHER DIAGNOSTIC TEST
{ER06}
95
NO SERVICES RECEIVED
{ER06}
RF
Refused
{ER06}
----------------------------------------------------------------------------------------------------------------------------------
6
Beta
Emergency Room (ER) Section
DK
Don't Know
{ER06}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
PROGRAMMER NOTES:
ALLOW CODE ‘4’ (MAMMOGRAM) ONLY IF PERSON IS FEMALE AND AGE IS
> 17 YEARS (OR AGE CATEGORIES 4 THROUGH 9).
ALLOW CODE '95' (NO SERVICES RECEIVED), 'RF' (REFUSED), 'DK'
(DON'T KNOW) AND ALONE ONLY; THESE RESPONSES MAY NOT BE
SELECTED WITH ANY OTHER RESPONSE.
NOTE: 'OTHER DIAGNOSTIC TESTS' AND 'NO SERVICES RECEIVED' ARE
NOT DISPLAYED ON SHOW CARD.
Hard CHECK:
EDIT: IF CODED ‘95’ (NO SERVICESS RECEIVED), NO OTHER SERVICE CATEGORIES
CAN BE CODED. IF INTERVIEWER SELECTS ANOTHER CODE WITH 'NO SERVICES',
DISPLAY THE FOLLOWING MESSAGE: ‘NO SERVICES RECEIVED CANNOT BE SELECTED
WITH OTHER OPTIONS. VERIFY AND RE-ENTER.'
ER06
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(SURGPROCHELP)
Was a surgical procedure performed on (PERSON) during this visit?
Size
Variable Name
Label
EROM.SURGPROC
2
HAVE SURGICAL PROCEDURE THIS VISIT
1
YES
{ER08}
2
NO
{ER08}
RF
Refused
{ER08}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{ER08}
HELP AVAILABLE FOR DEFINITION OF SURGICAL PROCEDURE.
7
Beta
Emergency Room (ER) Section
ER08
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(MEDPRESHELP)
During this visit, were any medicines prescribed for (PERSON)? Please
include only prescriptions which were filled.
Size
Variable Name
Label
EROM.MEDPRESC
2
HAVE MEDICINES PRESCRIBED THIS VISIT
1
YES
{ER09}
2
NO
{BOX_03}
RF
Refused
{BOX_03}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_03}
HELP AVAILABLE FOR DEFINITION OF PRESCRIBED MEDICINE.
8
Beta
Emergency Room (ER) Section
ER09
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
Please tell me the names of the prescriptions from this visit that were filled.
PROBE: Any other prescribed medicines from this visit that were filled?
Size
Variable Name
Label
PMED.PMEDID
12
PMED ID KEY: PERSID + COUNTER(3) + CD
PMED.PMEDRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
PMED.CREATEQ
4
QUESTION THAT CREATED PMED SEGMENT
PMED.PMEDNAME
30
NAME OF MEDS AND PRESCRIPTIONS FILLED
PMED.DRUGLINK
3
LINKS PMED TO DRUGID
PMED.STOREVAR
2
MATRIX TEMPORARY STORAGE VARIABLE
RXLK.RXLKID
24
RXLK ID KEY: EVENTID + PMEDID
RXLK.RXLKRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
RXLK.CREATEQ
4
QUESTION THAT CREATED RXLK RECORD
EVNT.EVNTID
12
EVNT ID KEY: PERSID + COUNTER(3) + CD
EVNT.EVNTRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
EVNT.CREATEQ
5
QUESTION THAT CREATED EVNT SEGMENT
EVNT.EVNTTYPE
2
EVENT TYPE
EVPV.EVPVID
23
EVPV ID KEY: EVNTID + PROVID
EVPV.EVPVRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
EVPV.CREATEQ
5
QUESTION THAT CREATED EVPV SEGMENT
EVPV.EVNTTYPE
2
EVENT TYPE
EVPV.EVPVTYPE
2
PROVIDER TYPE RELATED TO EVENT
DRUG.DRUGID
11
DRUG ID KEY: PERSID + COUNTER(3)
DRUG.DRUGRURN
2
ROUND STAMP: RU LETTER + ROUND NUMBER
DRUG.CREATEQ
4
QUESTION THAT CREATED DRUG SEGMENT
DRUG.DRUGNAME
30
NAME OF MEDS AND PRESCRIPTIONS FILLED
DRUG.STOREVAR
2
MATRIX TEMPORARY STORAGE VARIABLE
[Prescribed Medicine]
{BOX_03}
[Prescribed Medicine]
{BOX_03}
[Prescribed Medicine]
{BOX_03}
PROGRAMMER NOTES:
Display 'Add Medicine' as an option on this screen.
9
Beta
Emergency Room (ER) Section
Title:
PERSON'S_PRESCRIBED-MEDICINES_1
Roster Details
Col #
Header
Instructions
1
PRESCRIBED
MEDICINE
Display name of prescribed medicine
DRUG.DRUGNAME
Roster Behavior:
1. Multiple select allowed.
2. Multiple add allowed.
3. Limited delete allowed. Interviewer may delete a medicine
added on this screen as CAPI has not yet created the
link between this medicine and the event. If the
interviewer attempts to delete a medicine when delete
is not allowed (i.e., after the link is established),
display
the following error message: ‘DELETE ALLOWED ONLY
WHEN MEDICINE IS FIRST ENTERED.’
4. Limited edit allowed. Interviewer may edit a medicine
name on the screen as long as CAPI has not yet created
the link between this medicine and the event. If the
interviewer attempts to edit a medicine name when edit
is not allowed (i.e., after the link is established),
display
the following error message: 'EDIT ALLOWED ONLY WHEN
MEDICINE IS FIRST ENTERED.'
Roster Filter:
all medicines on person's roster; no filter.
Roster Definition:
This item displays the PERSON’S-PRESCRIPTION MEDICINES-ROSTER
for selection.
BOX_03
IF THE CHARGE/PAYMENT (CP) SECTION FOR THIS EMERGENCY ROOM EVENT IS NOT
COMPLETED, ASK THE CHARGE/PAYMENT (CP) SECTION.
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION.
10
| File Type | application/pdf |
| File Title | \\rk29\vol2905\MEPSWVS\SpecWriter\BETA\er (beta).snp |
| Author | miller_n |
| File Modified | 2005-12-21 |
| File Created | 2005-12-21 |