Beta
Dental Visit (DN) Section
DN03
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(DN03Help)
What type of dental care provider did (PERSON) see during this visit?
PROBE:
Any other type of dental care person?
Size
Variable Name
Label
DVIS.DENTPERSBLSWVS
8
DVIS.GENDENT
2
GENERAL DENTIST SEEN
DVIS.DENTHYG
2
DENTAL HYGIENIST SEEN
DVIS.DENTTECH
2
DENTAL TECHNICIAN SEEN
DVIS.DENTSURG
2
DENTAL SURGEON SEEN
DVIS.ORTHODNT
2
ORTHODONTIS SEEN
DVIS.ENDODENT
2
ENDODONTIST SEEN
DVIS.PERIODNT
2
PERIODONTIST SEEN
DVIS.DENTYPE
2
OTHER SPECIFY SEEN
CHECK ALL THAT APPLY.
1
GENERAL DENTIST
{DN04}
2
DENTAL HYGIENIST
{DN04}
3
DENTAL TECHNICIAN
{DN04}
4
DENTAL SURGEON
{DN04}
5
ORTHODONTIST
{DN04}
6
ENDODONTIST
{DN04}
7
PERIODONTIST
{DN04}
91
OTHER
{DN04}
RF
Refused
{DN04}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{DN04}
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
PROGRAMMER NOTES:
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES AUTOMATICALLY)
: CAPI DOES NOT ALLOW 'RF' OR 'DK' IN COMBINATION WITH ANY
OTHER CODE.
1
Beta
Dental Visit (DN) Section
DN04
SHOW CARD DN-1.
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(DENTPROC)
What did (PERSON) have done during this visit?
PROBE: What else was done?
Size
Variable Name
Label
DVIS.DENTALSVCS
DVIS.EXAMINE
2
GENERAL EXAM OR CONSULTATION
DVIS.CLENTETH
2
CLEANING,PROPHYLAXIS, OR POLISHING
DVIS.JUSTXRAY
2
X-RAYS, RADIOGRAPHS OR BITEWINGS
DVIS.FLUORIDE
2
FLUORIDE TREATMENT
DVIS.SEALANT
2
SEALANT APPLICATION
DVIS.FILLING
2
FILLINGS
DVIS.INLAY
2
INLAYS
DVIS.CROWNS
2
CROWNS OR CAPS
DVIS.ROOTCANL
2
ROOT CANAL
DVIS.GUMSURG
2
PERIODONTAL SCALING,ROOT PLANING OR GUM
DVIS.RECLVIS
2
PERIODONTAL RECALL VISIT
DVIS.EXTRACT
2
EXTRACTION, TOOTH PULLED
DVIS.IMPLANT
2
IMPLANTS
DVIS.ABSCESS
2
ABCESS OR INFECTION TREATMENT
DVIS.ORALSURG
2
ORAL SURGERY
DVIS.BRIDGES
2
BRIDGES
DVIS.DENTURES
2
DENTURES OR PARTIAL DENTURES
DVIS.REPAIR
2
REPAIR OF BRIDGES/DENTURES OR RELINING
DVIS.ORTHDONT
2
ORTHODONTIA, BRACES OR RETAINERS
DVIS.WHITEN
2
BONDING, WHITENING OR BLEACHING
DVIS.TMDTMJ
2
TREATMENT FOR TMD OR TMJ
DVIS.DENTSPEC
2
OTHER SPECIFY
CHECK ALL THAT APPLY.
1
GENERAL EXAM, CHECKUP, OR
CONSULTATION
2
CLEANING, PROPHYLAXIS, OR
POLISHING
3
X-RAYS, RADIOGRAPHS, OR
BITEWINGS
4
FLUORIDE TREATMENT
2
Beta
Dental Visit (DN) Section
5
SEALANT (PLASTIC COATINGS ON
BACK TEETH)
6
FILLINGS
7
INLAYS
8
CROWNS OR CAPS
9
ROOT CANAL
10
PERIODONTAL SCALING, ROOT
PLANING, OR GUM SURGERY
11
PERIODONTAL RECALL VISIT
(PERIODIC OR REGULAR)
12
EXTRACTION, TOOTH PULLED
13
IMPLANTS
14
ABSCESS OR INFECTION TREATMENT
15
OTHER ORAL SURGERY
16
FIXED BRIDGES
17
DENTURES OR REMOVABLE PARTIAL
DENTURES
18
RELINING OR REPAIR OF BRIDGES OR
DENTURES
19
ORTHODONTIA, BRACES, OR
RETAINERS
20
BOND, WHITEN, OR BLEACH
21
TREATMENT FOR TMD OR TMJ
91
OTHER
{DN04OV}
RF
Refused
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
HELP AVAILABLE FOR DEFINITIONS OF ANSWER CATEGORIES.
3
Beta
Dental Visit (DN) Section
PROGRAMMER NOTES:
HEADINGS AND CODE CATEGORIES WILL NOT FIT ON ONE SCREEN.
THEREFORE, HEADINGS WILL APPEAR ONLY ON THE HELP SCREEN AND
SHOW CARD DN-1. HEADINGS SHOULD BE ASSOCIATED WITH CODES AS
FOLLOWS:
*DIAGNOSTIC OR PREVENTATIVE = CODES 1-5
*RESTORATIVE OR ENDODONTIC = CODES 6-9
*PERIODONTIC (GUM TREATMENT) = CODES 10-11
*ORAL SURGERY = CODES 12-15
*PROSTHETICS = CODES 16-18
*ORTHODONTICS = CODE 19
*ADDITIONAL PROCEDURES = CODES 20-21 AND 91
FOR SPECIFICATIONS PURPOSES ONLY (CAPI HANDLES AUTOMATICALLY):
CAPI DOES NOT ALLOW 'RF' OR 'DK' IN COMBINATION WITH ANY OTHER
CODE.
ROUTING INSTRUCTION:
IF CODE ‘91’ (OTHER) ENTERED ALONE OR IN COMBINATION WITH ANY
OTHER CODE, CONTINUE WITH DN04OV.
OTHERWISE, GO TO DN05.
DN04OV
Comment Enabled
Jump Back Enabled
Help Enabled
(DENTPROC)
Size
Variable Name
Label
DVIS.DENTOTHR
25
DENTAL WORK DONE OTHER SPECIFY
{DN05}
_______________________
OTHER TYPE OF
DENTAL CARE:
RF
Refused
{DN05}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{DN05}
4
Beta
Dental Visit (DN) Section
DN05
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EVN-DT}
Comment Enabled
Jump Back Enabled
Help Enabled
(MEDPRES)
During this visit, were any medicines prescribed for (PERSON)? Please
include only prescriptions which were filled.
Size
Variable Name
Label
DVIS.DENTMED
2
RECEIVE MEDICINE INCLUDING FREE SAMPLES
1
YES
{DN06}
2
NO
{BOX_01}
RF
Refused
{BOX_01}
----------------------------------------------------------------------------------------------------------------------------------
DK
Don't Know
{BOX_01}
HELP AVAILABLE FOR DEFINITION OF PRESCRIBED MEDICINE.
5
Beta
Dental Visit (DN) Section
DN06
{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 prescriptions from this visit filled?
Size
Variable Name
Label
DRUG.DN06BLSWVS
DVIS.DN06BLSWVS
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
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
[Prescribed Medicine]
[Prescribed Medicine]
[Prescribed Medicine]
{BOX_01}
Title:
Person's-Prescribed-Medicines_1.
Roster Details
6
Beta
Dental Visit (DN) Section
Col #
Header
Instructions
1
Prescribed Medicine
Display PMED name
PMED.PMEDNAME
Roster Behavior:
1. Multiple Select and add allowed.
2. Limited Delete allowed. Interviewer may delete a
PMED added on this screen as long as CAPI has not
yet created the link between this PMED and the event.
If the interviewer attempts to delete a PMED name when
delete is not allowed, display the following message:
“DELETE ALLOWED ONLY WHEN MEDICINE IS FIRST
ENTERED.”
3. Limited Edit allowed. Interviewer may edit the name
of a PMED added on this screen as long as CAPI has
not yet created the link between this PMED and the
event. If the interviewer attempts to edit a PMED
name when editing is not allowed, display the following
message: “EDITING ALLOWED ONLY WHEN MEDICINE
IS FIRST ENTERED.”
Roster Filter:
NONE, DISPLAY ALL.
Roster Definition:
This item displays PERSON'S-PRESCRIBED-MEDICINES-ROSTER for
selection and addition of prescribed medicines.
BOX_01
IF THE CHARGE/PAYMENT MODULE HAS NOT BEEN ASKED FOR THE EVENT-PROVIDER
PAIR BEING ASKED ABOUT, GO TO THE CHARGE/PAYMENT (CP) SECTION.
OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION.
7
| File Type | application/pdf |
| File Title | C:\DN (BETA).snp |
| Author | miller_n |
| File Modified | 2005-08-10 |
| File Created | 2005-08-10 |