Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

END1

END1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

INTLANG

Field 2:

INTLANOS

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

10

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

WAS THIS INTERVIEW CONDUCTED MOSTLY IN ENGLISH,
SPANISH, OR SOME OTHER LANGUAGE?

Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

8:00:53 PM Monday, July 07, 2008

Page 1 of 6

END1
INTLANG

Field1:
Cheshire Name:

( END1005 )

MRES.INTLANG

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TIntclang
1
No
No

Number Label
2 English

FieldSize:
Min Value:
Max Value:
Mask:

Route
END2 - SAVECASE ( END1015 )

3

English text: ENGLISH
Spanish

END2 - SAVECASE ( END1015 )

91

English text: SPANISH
Other

END1 - INTLANOS ( END1010 )

English text: OTHER

8:00:58 PM Monday, July 07, 2008

Page 2 of 6

END1

Field2:
Cheshire Name:

INTLANOS

( END1010 )

MRES.INTLANOS

Item Text display:

Display (SPECIFY) in the same blue font used for
interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

String
TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
END2 - SAVECASE ( END1015 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

8:01:00 PM Monday, July 07, 2008

Page 3 of 6

END2

END2

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

SAVECASE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

20

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display case result code, MRES.MRESRSLT.
If MRES.MRESRSLT = 50, display "DECEASED".
Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

Someone from the home office may be calling to verify that I was

here to conduct this interview.

Int. Instr II:

THIS CASE IS CODED (CASE RESULT CODE) COMPLETE
(DECEASED).
PRESS ENTER TO RETURN TO THE IMS.

8:01:02 PM Monday, July 07, 2008

Page 4 of 6

END2
INPUT FIELDS / ROUTING

Field1:

SAVECASE

( END1015 )

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TContinueEMPTY
1
No
No

Number Label
1 Continue

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX END - (END1020 )

English text: CONTINUE
Attribute
Empty

Route
BOX END - (END1020 )

BACKGROUND VARIABLE ASSIGNMENTS
At this screen, set the case as a complete on MRES where MRES.MRESRND=current
round and MRES.MRESRESP=01. See detailed instructions below.
MRESRSLT

IF MRES.SPALIVE = 3/Deceased, set
MRES.MRESRSLT=50/CompleteDeceased.
Else set MRES.MRESRSLT = 40/Complete.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

8:01:05 PM Monday, July 07, 2008

Page 5 of 6

BOX END

BOX END

Page Order # :

30

BOX INSTRUCTIONS
( END1020 )

CASE IS COMPLETE. RETURN TO IMS .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

8:01:05 PM Monday, July 07, 2008

Page 6 of 6