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pdfDUINTRO
DUINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
DUINT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
20
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If this is not the SP's first community interview, display "Now would
be a good time to get out the planner that [you/(SP)] may have used
to record health care visits or other medical expenses."
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
The next questions are about any medical care [you/(SP)] may have
had between (REFERENCE DATE) and (today/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION). (Now would be a
good time to get out the planner that [you/(SP)] may have used to
record health care visits or other medical expenses.)
First we’ll talk about dental care.
12:44:33 PM Monday, November 03, 2008
Page 1 of 53
DUINTRO
Int. Instr II:
INPUT FIELDS / ROUTING
( DUQ1020 )
DUINT
Field1:
Cheshire Name:
TEMP
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
DU1 - DUPROBE ( DUQ1030 )
English text: CONTINUE
Attribute
Empty
Route
DU1 - DUPROBE ( DUQ1030 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
126
FirstCommunity
If this is SP's first community interview =
(MRES.INTTYPE=2/NewFromFacility or
MRES.INTTYPE=3/NewFromSupplement) on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
12:44:34 PM Monday, November 03, 2008
Page 2 of 53
DU1
DU1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DUPROBE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
30
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Dental providers include….]'" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD DU
Question Text:
Please look at this card. [Since (REFERENCE DATE)/Between
(REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] go to a dentist or any
other person for dental care? [Dental providers include dentists,
dental surgeons, endodontists, periodontists, and dental hygienists.]
Int. Instr II:
INPUT FIELDS / ROUTING
12:44:36 PM Monday, November 03, 2008
Page 3 of 53
DU1
DUPROBE
Field1:
Cheshire Name:
Item Text display:
( DUQ1030 )
HRND.DUPROBE
Do not display response option 3/IndicatedYesByDataprep.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
DU2 - PROVIDER_DU ( DUQ1040 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
BOX DU6 - (DUQ1335 )
DO NOT DISPLAY.
DATA EDITING ONLY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
BOX DU6 - (DUQ1335 )
Refusal
BOX DU6 - (DUQ1335 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:44:38 PM Monday, November 03, 2008
Page 4 of 53
DU2
DU2
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PROVIDER_DU
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Provider Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
40
Display as ' Add a Provider '
Display as ' Edit a Provider '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all Providers except for Providers where
PROV.PROVNUM=01 and 02, which are reserved for PM and OM
events.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
1
Provider Name
INSTRUCTIONS
Display PROV.PROVNAME.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Who did [you/(SP)] see?
Int. Instr II:
SELECT OR ADD ONLY ONE PROVIDER.
INPUT FIELDS / ROUTING
12:44:39 PM Monday, November 03, 2008
Page 5 of 53
DU2
Field1:
Cheshire Name:
PROVIDER_DU
( DUQ1040 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TProvPick4
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
4
Route
BOX DU1 - (DUQ1060 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on PROV:
PROV key = PROV.PROVBASE + PROV.PROVNUM
PROV.PROVNUM = Number of Provider selected at DU2.
If Provider added at Provider Roster, see PROVIDER ROSTER POP-UP specifications for
pop-up window programming instructions.
Variables populated in Provider Roster Pop-Up Window:
PROV.PROVNUM
PROV.PROVRNDC
PROV.PROVNAME
Provider number
Round number
Provider name
If Provider added, set provider type and specialty as instructed below:
PROVTYPE
PROV.PROVTYPE=1/Dental.
PROVSPEC
PROV.PROVSPEC=1/Dentist.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
Begin Loop 1: Probe for one provider, collect all event dates for this
provider.
12:44:40 PM Monday, November 03, 2008
Page 6 of 53
BOX DU1
BOX DU1
Page Order # :
50
BOX INSTRUCTIONS
( DUQ1060 )
IF (SP REPORTED RECEIVING HEALTH CARE SERVICES THROUGH V.A.
IN THE CURRENT ROUND OR ANY PREVIOUS ROUND) AND (IF THIS
PROVIDER IS ASSOCIATED WITH V.A. IS UNKNOWN), GO TO DU3 VAPLACE ( DUQ1070 ).
ELSE GO TO BOX DU2 - (DUQ1080 ).
ASSIGNMENTS
TECHNICAL NOTES
423
SPReceivedCaretThruV
A
SP reported receiving health care services through V.A.in
the current or any previous round =
There is an HRND where HRND.HRNDRND = current
round and HRND.VACOVER = 1/Yes.
HRND.VACOVER is set at BOX HI20 or collected at HI36.
127
ProviderVAUnknown
If Provider is associated with V.A. is unknown =
PROV.VAPLACE = empty.
DESIGN NOTES
12:44:40 PM Monday, November 03, 2008
Page 7 of 53
DU3
DU3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
VAPLACE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
60
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of provider, PROV.PROVNAME, currently being
asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Is (PROVIDER NAME) associated with a Department of Veterans
Affairs, or V.A., facility?
Int. Instr II:
INPUT FIELDS / ROUTING
12:44:41 PM Monday, November 03, 2008
Page 8 of 53
DU3
VAPLACE
Field1:
Cheshire Name:
( DUQ1070 )
PROV.VAPLACE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX DU2 - (DUQ1080 )
English text: YES
No
BOX DU2 - (DUQ1080 )
English text: NO
Attribute
Don't know
Route
BOX DU2 - (DUQ1080 )
Refusal
BOX DU2 - (DUQ1080 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:44:43 PM Monday, November 03, 2008
Page 9 of 53
BOX DU2
BOX DU2
12:44:43 PM Monday, November 03, 2008
Page Order # :
70
Page 10 of 53
BOX DU2
BOX INSTRUCTIONS
( DUQ1080 )
IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE
CURRENT ROUND) AND (IF THIS PROVIDER IS ASSOCIATED WITH A
MANAGED CARE PLAN IS UNKNOWN), GO TO DU4 - HMOASSOC (
DUQ1090 ).
ELSE IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING
THE CURRENT ROUND) AND (THIS PROVIDER IS NOT ASSOCIATED
WITH A MANAGED CARE PLAN), GO TO DU5 - HMOREFER ( DUQ1100 ).
ELSE GO TO DU6 - EVENT_DU ( DUQ1140 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
128
ProviderHMOUnknown
If Provider is associated with a Managed Care plan is
unknown =
PROV.HMOASSOC=empty.
130
ProviderNotHMO
Provider is not associated with a Managed Care plan =
PROV.HMOASSOC=2/No, DK, or RF.
129
ProviderAssocHMO
Provider is associated with a Managed Care plan =
PROV.HMOASSOC=1/Yes.
DESIGN NOTES
If the SP belongs to a managed care plan (HMO), we ask each provider
selected/added if the provider is associated with an HMO. This question,
which is asked throughout utilization and cost series, is only asked once
in the study for each provider. The response is never updated. (this
design may change in the future).
If the SP belongs to an HMO, and we have not asked this question for this
provider, HMOASSOC=empty, BOX DU2 is routed to DU4
HMOASSOC. If we have already asked this question about this provider,
and the provider responded to HMOASSOC=No, DK or RF, BOX DU2 is
routed to DU5, skipping DU4, to determine if the SP was referred to this
provider by their HMO.
If SP does not belong to an HMO or this provider already reported being
associated with the HMO, BOX DU2 routes directly to DU6, collect dental
visits, skipping DU4 and DU5.
12:44:43 PM Monday, November 03, 2008
Page 11 of 53
DU4
DU4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HMOASSOC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
80
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of provider, PROV.PROVNAME, currently being
asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
12:44:45 PM Monday, November 03, 2008
Page 12 of 53
DU4
Int. Instr I:
Is (PROVIDER NAME) associated with [your/(SP’s)] [READ
MANAGED CARE PLAN NAME(S) BELOW] plan?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
HMOASSOC
Field1:
Cheshire Name:
( DUQ1090 )
PROV.HMOASSOC
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
DU6 - EVENT_DU ( DUQ1140 )
English text: YES
No
DU5 - HMOREFER ( DUQ1100 )
English text: NO
Attribute
Don't know
Route
DU5 - HMOREFER ( DUQ1100 )
Refusal
DU5 - HMOREFER ( DUQ1100 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
12:44:47 PM Monday, November 03, 2008
Deleted plans that are not valid for displays or checks =
Page 13 of 53
DU4
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
12:44:47 PM Monday, November 03, 2008
Page 14 of 53
DU5
DU5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HMOREFER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
90
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of provider, PROV.PROVNAME, currently being
asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
12:44:49 PM Monday, November 03, 2008
Page 15 of 53
DU5
Int. Instr I:
[Were you/Was (SP)] referred to (PROVIDER NAME) by [READ
MANAGED CARE PLAN NAME(S) BELOW]?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
HMOREFER
Field1:
Cheshire Name:
( DUQ1100 )
EVNT.HMOREFER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
DU6 - EVENT_DU ( DUQ1140 )
English text: YES
No
DU5B - NOGOHMO ( DUQ1110 )
English text: NO
Attribute
Don't know
Route
DU6 - EVENT_DU ( DUQ1140 )
Refusal
DU6 - EVENT_DU ( DUQ1140 )
BACKGROUND VARIABLE ASSIGNMENTS
DU5 - HMOREFER is an EVENT level detail. The response to DU5 - HMOREFER needs
to be copied to EVNT.HMOREFER for each DU Event added at DU6.
SOFT EDIT CHECKS
HARD EDIT CHECKS
12:44:52 PM Monday, November 03, 2008
Page 16 of 53
DU5
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
12:44:52 PM Monday, November 03, 2008
Page 17 of 53
DU5B
DU5B
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NOGOHMO
Field 2:
NOGOHMOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
101
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
Int. Instr I:
12:44:54 PM Monday, November 03, 2008
Page 18 of 53
DU5B
Question Text:
What is the most important reason [you/(SP)] did not see a dental
provider associated with [READ MANAGED CARE PLAN NAME(S)
BELOW] or a dental provider that [READ MANAGED CARE PLAN
NAME(S) BELOW] would refer [you/(SP)] to?
Int. Instr II:
SCROLL DOWN TO SEE RESPONSE CATEGORIES.
INPUT FIELDS / ROUTING
12:44:59 PM Monday, November 03, 2008
Page 19 of 53
DU5B
NOGOHMO
Field1:
Cheshire Name:
Item Text display:
( DUQ1110 )
EVNT.NOGOHMO
Display responses in one column.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Tnogohmo
1
No
No
Number Label
1 PlanNotCoverService
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
DU6 - EVENT_DU ( DUQ1140 )
English text: PLAN DOES NOT COVER THE SERVICE SP WANTED
DifficultyDelayGettingService
DU6 - EVENT_DU ( DUQ1140 )
4
English text: DIFFICULTY OR DELAY IN GETTING SERVICES
SPProviderPreference
DU6 - EVENT_DU ( DUQ1140 )
English text: SP PROVIDER PREFERENCE
ServiceCoverdbyOtherInsurance
DU6 - EVENT_DU ( DUQ1140 )
5
English text: THIS SERVICE WAS COVERED BY OTHER INSURANCE SP HAS
NotinManagedCareTimeofEvent
DU6 - EVENT_DU ( DUQ1140 )
6
English text: NOT IN A MANAGED CARE PLAN AT TIME OF EVENT
NoChoiceMedEmergency
DU6 - EVENT_DU ( DUQ1140 )
3
91
English text: NO CHOICE - MEDICAL EMERGENCY OR OUT OF SERVICE AREA
Other
DU5B - NOGOHMOS ( DUQ1120 )
English text: OTHER
Attribute
Don't know
Route
DU6 - EVENT_DU ( DUQ1140 )
Refusal
DU6 - EVENT_DU ( DUQ1140 )
12:45:06 PM Monday, November 03, 2008
Page 20 of 53
DU5B
NOGOHMOS
Field2:
Cheshire Name:
( DUQ1120 )
EVNT.NOGOHMOS
Item Text display:
Display (SPECIFY) in 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
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
DU6 - EVENT_DU ( DUQ1140 )
BACKGROUND VARIABLE ASSIGNMENTS
DU5B - NOGOHMO and NOGOHMOS are EVENT level details. The response to DU5B
NOGOHMO and NOGOHMOS needs to be copied to EVNT.NOGOHMO and
EVNT.NOGOHMOS for each DU Event added at DU6.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
12:45:07 PM Monday, November 03, 2008
Page 21 of 53
DU5B
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
12:45:07 PM Monday, November 03, 2008
Page 22 of 53
DU6
DU6
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_DU
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date RV
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
120
Display as ' Add a Dental Visit '
Display as ' Edit a Visit '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of provider, PROV.PROVNAME, currently being
asked about.
Multi Field display:
Roster/Grid Instructions:
Display all Dental Events for this provider that have been added in
the current round where:
EVNT.EVNTDFLG ^= 1/Yes, and
EVNT.EVNTRNDC = current round, and
EVNT.EVNTTYPE = 'DU', and
EVNT.EVNTPROV=PROV.PROVNUM for the provider selected at
DU2.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
12:45:07 PM Monday, November 03, 2008
HEADER
INSTRUCTIONS
1
Event Date
Display EVENT DATE in "Mon DD YYYY"
format.
2
Repeat Visit
If VISTTYPE=2/RepeatVisit, display "RV".
Else do not display.
3
Times Per Month
If VISTTYPE=2/RepeatVisit, display
EVNT.RVTIMES.
Else do not display.
Page 23 of 53
DU6
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
When did [you/(SP)] see (PROVIDER NAME)? Please tell me all
the dates [since (REFERENCE DATE)/between (REFERENCE
DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION)].
Int. Instr II:
ENTER ALL DATES.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_DU
( DUQ1140 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
DU6_IN - NAVIGATOR ( DUQ1145 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of event selected at DU6.
For Event(s) added, see EVENT ROSTER BEGIN DATE RV POP-UP specifications for
pop-up window programming instructions.
Variables populated in Event Roster Begin Date RV:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
EVNT.VISTTYPE
Event number
Round
Visit Month
Visit Day
Visit Year
Type of Visit
12:45:08 PM Monday, November 03, 2008
Page 24 of 53
DU6
EVNT.RVTIMES
BASE.LASTEVNT
# of visits for Repeat Visit
Highest EVNT.EVNTNUM
For each event added at DU6, set Event type, Statement Event type, Event provider
number, and Event details collected at DU5 and DU5B. See detailed instructions below.
EVNTTYPE
EVNT.EVNTTYPE='DU'.
STEVTYPE
EVNT.STEVTYPE=3/DU.
EVNTPROV
EVNT.EVNTPROV=PROV.PROVNUM of provider
selected at DU2.
HMOREFER
EVNT.HMOREFER = Response to DU5 HMOREFER.
NOGOHMO
EVNT.NOGOHMO = Response to DU5B NOGOHMO.
NOGOHMOS
EVNT.NOGOHMOS = Response to DU5B NOGOHMOS.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
Edit #2
See date check logic in general specifications.
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date on this roster. If date of event added at DU6 does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added at DU6 to be a
duplicate of an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
Both EVNTTYPE=DU.
EVNTPROV matches.
EVBEGMM matches.
If EVBEGDD ^= empty, EVBEGDD matches.
Else If EVBEGDD = empty, both VISTTYPE=2/RepeatVisit.
EVBEGYY matches.
The date of the event added at DU6 should not match any other date
on roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE".
TECHNICAL NOTES
DESIGN NOTES
12:45:08 PM Monday, November 03, 2008
Page 25 of 53
DU6
Begin Loop 2: Collect all event dates for this provider, loop through details
for each event added at DU6.
DU allows you to select a provider more than once at DU2. If this provider
has already been selected and visits added at DU6 in an earlier loop, the
visits will be displayed at DU6 as protected rows.
12:45:08 PM Monday, November 03, 2008
Page 26 of 53
DU6_IN
DU6_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
125
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 events added at DU6.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
12:45:09 PM Monday, November 03, 2008
Page 27 of 53
DU6_IN
NAVIGATOR
Field1:
Cheshire Name:
( DUQ1145 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
DU7 - DVPROCDR ( DUQ1170 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
DU14 - DUMORE ( DUQ1330 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:45:10 PM Monday, November 03, 2008
Page 28 of 53
DU7
DU7
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
DVPROCDR
Field 2:
EVOSTEXT
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
130
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display date of event for the dental visit currently being asked about.
Question display:
Display date of event for the dental visit currently being asked about.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
DATE OF DENTAL VISIT: [VISIT ON EVENT DATE]
Int. Instr I:
Question Text:
For [your/(SP’s)] [VISIT ON EVENT DATE], what did [you/(SP)] have
done?
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
12:45:14 PM Monday, November 03, 2008
Page 29 of 53
DU7
12:45:21 PM Monday, November 03, 2008
Page 30 of 53
DU7
DVPROCDR
Field1:
Cheshire Name:
( DUQ1170 )
NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1/XraysTaken = EVNT.DVXRAYS
2/CleaningTeeth = EVNT.DVCLEAN
3/Examination = EVNT.DVEXAM
4/Fillings
= EVNT.DVFILLNG
5/Extractions
= EVNT.DVEXTRAC
6/RootCanals
= EVNT.DVRTCNAL
7/Crowns
= EVNT.DVCROWN
8/Bridges
= EVNT.DVBRIDGE
9/Orthodonita
= EVNT.DVORTHO
10/Periodontia = EVNT.DVPERIOD
11/Bonding
= EVNT.DVBONDNG
12/Surgery
= EVNT.DVSURG
91/Other
= EVNT.DVOTHER
Item Text display:
Do not display response option 12/Surgery.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TDVProcdr
12
No
No
Number Label
1 XraysTaken
2
English text: X-RAYS TAKEN
CleaningTeeth
4
English text: CLEANING TEETH
Examination
English text: EXAMINATION
Fillings
5
English text: FILLINGS
Extractions
3
6
7
English text: EXTRACTIONS
RootCanals
English text: ROOT CANALS
Crowns
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX DU3 - (DUQ1200 )
BOX DU3 - (DUQ1200 )
BOX DU3 - (DUQ1200 )
BOX DU3 - (DUQ1200 )
BOX DU3 - (DUQ1200 )
BOX DU3 - (DUQ1200 )
BOX DU3 - (DUQ1200 )
English text: CROWNS
12:45:31 PM Monday, November 03, 2008
Page 31 of 53
DU7
8
Bridges
BOX DU3 - (DUQ1200 )
9
English text: BRIDGES, DENTURES, PLATES, ETC. -- EITHER NEW ONES OR REPAIR WORK
Orthodontia
BOX DU3 - (DUQ1200 )
10
English text: ORTHODONTIA -- BITE ADJUSTMENT, BRACES, RETAINERS, ETC.
Periodontia
BOX DU3 - (DUQ1200 )
11
English text: PERIODONTIA -- E.G., TREATMENT OF GUM DISEASE
Bonding
BOX DU3 - (DUQ1200 )
12
English text: BONDING
Surgery
DO NOT DISPLAY.
DATA EDITING ONLY.
91
English text: DATA EDITING ONLY
Other
DU7 - EVOSTEXT ( DUQ1190 )
English text: OTHER
Attribute
Don't know
Route
BOX DU3 - (DUQ1200 )
Refusal
BOX DU3 - (DUQ1200 )
12:45:36 PM Monday, November 03, 2008
Page 32 of 53
DU7
( DUQ1190 )
EVOSTEXT
Field2:
Cheshire Name:
EVOS.EVOSTEXT
SQL FIELD = EVNT.EVOSTEXT
DATA TRANSFORMATION INSTRUCTIONS:
EVOS Key = EVOS.EVOSBASE + EVOS.EVOSEVNT +
EVOS.EVOSNUM.
If response to DU7 - DVPROCDR includes 91/Other, create a
new EVOS where:
EVOS.EVOSEVNT = EVNT.EVNTNUM
EVOS.EVOSNUM = next sequential EVOS.EVOSNUM for
this EVOS.EVNTEVNT.
EVOS.EVOSRNDC = current round.
EVOS.EVNTQUES = 'DU7'.
EVOS.EVOSTEXT = EVNT.EVOSTEXT.
Item Text display:
Display (SPECIFY) in 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
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
BOX DU3 - (DUQ1200 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
135
RepeatVisitEvent
12:45:37 PM Monday, November 03, 2008
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
Page 33 of 53
DU7
136
NumberRepeatVisits
Number of Repeat Visits =
EVNT.RVTIMES.
DESIGN NOTES
DU7 is called from BOX ST22A and BOX NS22A in ST and/or NS.
12:45:37 PM Monday, November 03, 2008
Page 34 of 53
BOX DU3
BOX DU3
Page Order # :
140
BOX INSTRUCTIONS
( DUQ1200 )
IF RESPONSE TO DU7 - DVPROCDR INCLUDES 1/XraysTaken or RF, GO
TO BOX DU3A - (DUQ1220 ).
ELSE GO TO DU8 - XRAYS ( DUQ1210 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
12:45:37 PM Monday, November 03, 2008
Page 35 of 53
DU8
DU8
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
XRAYS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
150
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display date of event for the dental visit currently being asked about.
Question display:
If event entered as a Repeat Visit, display "any of these visits".
Else display "this visit".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
DATE OF DENTAL VISIT: [VISIT ON EVENT DATE]
Int. Instr I:
Question Text:
Were X-rays taken on (any of these visits/this visit)?
Int. Instr II:
INPUT FIELDS / ROUTING
12:45:38 PM Monday, November 03, 2008
Page 36 of 53
DU8
( DUQ1210 )
XRAYS
Field1:
Cheshire Name:
EVNT.XRAYS
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX DU3A - (DUQ1220 )
English text: YES
No
BOX DU3A - (DUQ1220 )
English text: NO
Attribute
Don't know
Route
BOX DU3A - (DUQ1220 )
Refusal
BOX DU3A - (DUQ1220 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
12:45:41 PM Monday, November 03, 2008
Page 37 of 53
BOX DU3A
BOX DU3A
Page Order # :
160
BOX INSTRUCTIONS
( DUQ1220 )
IF ADMINISTERING ST, GO TO BOX ST23B - (STQ1700 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS23B - (NSQ1700 ).
ELSE GO TO DU9 - PRESMDCN ( DUQ1230 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
When DU is called from ST, or NS, we do not continue to probe for
medicines prescribed for these visits. If currently administering one of
these sections, return to BOX ST23B or BOX NS23B.
12:45:41 PM Monday, November 03, 2008
Page 38 of 53
DU9
DU9
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRESMDCN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
170
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display date of event for the dental visit currently being asked about.
Question display:
If event entered as a Repeat Visit, display "any of these visits".
Else display "this visit".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
DATE OF DENTAL VISIT: [VISIT ON EVENT DATE]
Int. Instr I:
Question Text:
Were any medicines prescribed for [you/(SP)] during (this visit/any of
these visits)?
Int. Instr II:
INPUT FIELDS / ROUTING
12:45:42 PM Monday, November 03, 2008
Page 39 of 53
DU9
PRESMDCN
Field1:
Cheshire Name:
( DUQ1230 )
EVNT.PRESMDCN
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
DU10 - PRESFILL ( DUQ1240 )
English text: YES
No
BOX DU4 - (DUQ1290 )
English text: NO
Attribute
Don't know
Route
BOX DU4 - (DUQ1290 )
Refusal
BOX DU4 - (DUQ1290 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
12:45:44 PM Monday, November 03, 2008
Page 40 of 53
DU10
DU10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRESFILL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
180
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Were any of the prescriptions filled?
Int. Instr II:
INPUT FIELDS / ROUTING
12:45:46 PM Monday, November 03, 2008
Page 41 of 53
DU10
PRESFILL
Field1:
Cheshire Name:
( DUQ1240 )
EVNT.PRESFILL
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX DU3B - (DUQ1250 )
English text: YES
No
BOX DU4 - (DUQ1290 )
English text: NO
Attribute
Don't know
Route
BOX DU4 - (DUQ1290 )
Refusal
BOX DU4 - (DUQ1290 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:45:48 PM Monday, November 03, 2008
Page 42 of 53
BOX DU3B
BOX DU3B
Page Order # :
190
BOX INSTRUCTIONS
( DUQ1250 )
IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN
ASKED IN THE CURRENT ROUND, GO TO DU10A - DUPMMEDS (
DUQ1260 ).
ELSE GO TO DU11 - MEDICINE_DU ( DUQ1270 ).
ASSIGNMENTS
TECHNICAL NOTES
131
PMBottleProbe
Prescription Medicine Bottle probe has been asked in the
current round =
GETPMMEDS=1/Yes.
DESIGN NOTES
Only probe for prescription medicine bottles once during the current
round.
Adding a new TEMP flag, GETPMMEDS. GETPMMEDS is set to 1/Yes
whenever the Prescription Bottle probe is asked during the current
round. This will get set anywhere in utilization or cost series.
12:45:48 PM Monday, November 03, 2008
Page 43 of 53
DU10A
DU10A
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
DUPMMEDS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(s)" in "bottle(s), container(s), or bag(s)" in
parenthesis.
If SP has a "current" Medicare Prescription Drug plan or there was a
Medicare Prescription Drug plan "current" at the time of the
previous round interview, then display "Also, please take out
[your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN NAME)
medicine statements....".
Else do not display.
MEDICARE PRESCRIPTION DRUG PLAN NAME =
Display the name of the "current" Medicare Prescription Drug plan.
If it does not exist, display the name of the Medicare Prescription
Drug plan "current" at the time of the previous round interview.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
12:45:49 PM Monday, November 03, 2008
Page 44 of 53
DU10A
Int. Instr I:
It would be helpful if I could look at any medicine bottle(s),
container(s), or bag(s) that you have so that I can spell the medicine
name correctly and enter the strength of the medicine. [Also, please
take out [your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN
NAME) medicine statements, which should have that same
information on them.]
Question Text:
[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that same
information for all of the medicines [you/(SP)] obtained since the last
interview, if you’d like to get those bottles, too.
Int. Instr II:
INPUT FIELDS / ROUTING
DUPMMEDS
Field1:
Cheshire Name:
( DUQ1260 )
TEMP
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
DU11 - MEDICINE_DU ( DUQ1270 )
English text: CONTINUE
Attribute
Empty
Route
DU11 - MEDICINE_DU ( DUQ1270 )
BACKGROUND VARIABLE ASSIGNMENTS
The question displayed at DU10A is repeated in other utilization sections. Only show this
probe for prescription medicine bottles once during the current round interview.
If DU10A - DUPMMEDS is asked, set flag as instructed below:
GETPMMEDS
Set GETPMMEDS=1/Yes.
SOFT EDIT CHECKS
12:45:51 PM Monday, November 03, 2008
Page 45 of 53
DU10A
HARD EDIT CHECKS
TECHNICAL NOTES
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
12:45:51 PM Monday, November 03, 2008
Page 46 of 53
DU11
DU11
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
MEDICINE_DU
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Prescription Medicine Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
210
Display as ' Add a Medicine '
Display as ' Edit a Medicine '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "CHECK STATEMENT OR MEDICINE BOTTLE FOR
SPELLING." in BOLD.
Display "INCLUDE STRENGTH WITH NAME." in BOLD.
Multi Field display:
Roster/Grid Instructions:
Display all Prescription Medicine events where:
EVNT.EVNTDFLG ^=1/Yes, and
EVNT.EVNTTYPE='PM'.
Display in alphabetical order.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine
Display prescription medicine name,
EVNT.PMEDNAME.
2
Strength
Display prescription medicine strength
text field, EVNT.PMSTRUNI.
Report display:
TEXT:
Context Header:
12:45:52 PM Monday, November 03, 2008
Page 47 of 53
DU11
Int. Instr I:
Question Text:
Please tell me the names of these medicines.
Int. Instr II:
ENTER ALL MEDICINES.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
MEDICINE_DU
( DUQ1270 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX DU4 - (DUQ1290 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected at DU11.
If Prescription Medicine added at Prescription Medicine Roster, see PRESCRIPTION
MEDICINE ROSTER POP-UP specifications for pop-up window programming instructions.
Variables populated at the Prescription Medicine Roster:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVNTTYPE
EVNT.PMEDNAME
EVNT.PMSTRUNI
EVNT.EVNTPROV
BASE.LASTEVNT
Event number
Round number
PM
Prescription Medicine name
Prescription Medicine strength text field
02
Highest EVNT.EVNTNUM
For all Prescription Medicines selected at DU11, create a current round PMRO. Note: a
current round PMRO may already exist for a Prescription Medicine event if it has already
been selected earlier in the interview.
12:45:53 PM Monday, November 03, 2008
Page 48 of 53
DU11
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND.
Create PMRO where PMRO.PMROEVNT = EVNT.EVNTNUM for prescription medicine
selected and PMRO.PMRORND = current round. Set additional PMRO variable as
instructed below.
All prescription medicines selected at DU11 should be linked to the Dental visit being asked
about. Prescription medicine events are linked to other events on XMED.
XMED key = XMED.XMEDBASE + XMED.XMEDEVNT + XMED.XMEDBAS2 +
XMED.XMEDEVT2.
For each medicine selected at DU11, create an XMED where XMEDEVNT =
EVNT.EVNTNUM of Dental visit being asked about and XMEDEVT2 = EVNT.EVNTNUM of
Prescription Medicine selected at DU11. XMEDBASE and XMEDBAS2 both equal the
Cheshire BASE.BASEID. Set additional XMED variables as specified below.
Set the following PMRO and XMED variables for each prescription medicine selected at
DU11:
PMROEVNT
PMRO.PMROEVNT = EVNT.EVNTNUM of
prescription medicine selected at DU11.
PMRORND
PMRO.PMRORND = current round.
PMROTYPE
PMRO.PMROTYPE = PM.
XMEDEVNT
XMED.XMEDEVNT = EVNT.EVNTNUM of dental
visit being asked about.
XMEDEVT2
XMED.XMEDEVT2 = EVNT.EVNTNUM of
prescription medicince selected at DU11.
XMEDRNDC
XMED.XMEDRNDC = current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:45:53 PM Monday, November 03, 2008
Page 49 of 53
BOX DU4
BOX DU4
Page Order # :
220
BOX INSTRUCTIONS
( DUQ1290 )
GO TO DU6_IN - NAVIGATOR ( DUQ1145 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
12:45:53 PM Monday, November 03, 2008
Page 50 of 53
DU14
DU14
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DUMORE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
260
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], did
[you/(SP)] have any other dental care visits to this or any other
provider?
Int. Instr II:
INPUT FIELDS / ROUTING
12:45:54 PM Monday, November 03, 2008
Page 51 of 53
DU14
DUMORE
Field1:
Cheshire Name:
( DUQ1330 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
DU2 - PROVIDER_DU ( DUQ1040 )
English text: YES
No
BOX DU6 - (DUQ1335 )
English text: NO
Attribute
Don't know
Route
BOX DU6 - (DUQ1335 )
Refusal
BOX DU6 - (DUQ1335 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
End Loop 1: DU14 - DUMORE probes for additional dental visits. Dental
visits can be for a new provider or a provider already selected and asked
about. If DUMORE=1/Yes, go to DU2 to select the next provider.
12:45:56 PM Monday, November 03, 2008
Page 52 of 53
BOX DU6
BOX DU6
Page Order # :
270
BOX INSTRUCTIONS
( DUQ1335 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
12:45:56 PM Monday, November 03, 2008
Page 53 of 53
| File Type | application/pdf |
| Author | hubbard_r |
| File Modified | 2010-04-02 |
| File Created | 0000-00-00 |