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

Medicare Current Beneficiary Survey (MCBS)

Attachment 4 Questionnaire Comprehensive Format Section by Section HF_05.01.0008

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

OMB: 0938-0568

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0568 can be found here:
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BOX HFBEG

BOX HFBEG

Page Order # :

10

BOX INSTRUCTIONS
( HFQ1010 )

GO TO HFA1 - GENHELTH ( HFQ1020 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

3:53:07 PM Monday, August 03, 2009

Page 1 of 760

HFA1

HFA1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

GENHELTH

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:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:

Now, I would like to ask you about [your/(SP's)] health.
In general, compared to other people [your/(SP's)] age, would you
say that (your/his/her) health is . . .

Int. Instr II:
INPUT FIELDS / ROUTING

3:53:10 PM Monday, August 03, 2009

Page 2 of 760

HFA1
GENHELTH

Field1:

( HFQ1020 )

HEST.GENHELTH

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
TGenhelth
1
No
No

Number Label
1 Excellent

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFA2 - COMPHLTH ( HFQ1030 )

2

English text: excellent,
VeryGood

HFA2 - COMPHLTH ( HFQ1030 )

3

English text: very good,
Good

HFA2 - COMPHLTH ( HFQ1030 )

4

English text: good,
Fair

HFA2 - COMPHLTH ( HFQ1030 )

5

English text: fair, or
Poor

HFA2 - COMPHLTH ( HFQ1030 )

English text: poor?
Attribute
Don't know

Route
HFA2 - COMPHLTH ( HFQ1030 )

Refusal

HFA2 - COMPHLTH ( HFQ1030 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

3:53:15 PM Monday, August 03, 2009

Page 3 of 760

HFA1
DESIGN NOTES

3:53:15 PM Monday, August 03, 2009

Page 4 of 760


HFA2

HFA2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

COMPHLTH

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:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Compared to one year ago, how would you rate [your/(SP's)] health

in general now?
Would you say [your/(SP's)] health is . . .

Int. Instr II:
INPUT FIELDS / ROUTING

3:53:18 PM Monday, August 03, 2009

Page 5 of 760

HFA2
COMPHLTH

Field1:

( HFQ1030 )

HEST.COMPHLTH

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
TComphlth
1
No
No

Number Label
1 MuchBetter

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFA3 - HELMTACT ( HFQ1040 )

2

English text: much better now than one year ago,
SomewhatBetter
HFA3 - HELMTACT ( HFQ1040 )

3

English text: somewhat better now than one year ago,
AboutTheSame
HFA3 - HELMTACT ( HFQ1040 )

4

English text: about the same,
SomewhatWorse

5

English text: somewhat worse now than one year ago, or
MuchWorse
HFA3 - HELMTACT ( HFQ1040 )

HFA3 - HELMTACT ( HFQ1040 )

English text: much worse now than one year ago?
Attribute
Don't know

Route
HFA3 - HELMTACT ( HFQ1040 )

Refusal

HFA3 - HELMTACT ( HFQ1040 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

3:53:23 PM Monday, August 03, 2009

Page 6 of 760

HFA2
DESIGN NOTES

3:53:23 PM Monday, August 03, 2009

Page 7 of 760


HFA3

HFA3

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HELMTACT

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

35

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "past month" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

How much of the time during the past month has [your/(SP's)] health
limited [your/(SP's)] social activities, like visiting with friends or close
relatives?
Would you say . . .

Int. Instr II:

INPUT FIELDS / ROUTING


3:53:25 PM Monday, August 03, 2009	

Page 8 of 760

HFA3
HELMTACT

Field1:

( HFQ1040 )

HEST.HELMTACT

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
THelmtact
1
No
No

Number Label
1 NoneOfTheTime

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFA1 - (HFQ1045 )

2

English text: none of the time,
SomeOfTheTime

BOX HFA1 - (HFQ1045 )

3

English text: some of the time,
MostOfTheTime

BOX HFA1 - (HFQ1045 )

4

English text: most of the time, or
AllOfTheTime

BOX HFA1 - (HFQ1045 )

English text: all of the time?
Attribute
Don't know

Route
BOX HFA1 - (HFQ1045 )

Refusal

BOX HFA1 - (HFQ1045 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:53:28 PM Monday, August 03, 2009

Page 9 of 760

BOX HFA1

BOX HFA1

Page Order # :

40

BOX INSTRUCTIONS
( HFQ1045 )	

IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO BOX HFF1 - (HFQ1290 ).
ELSE GO TO HFB1 - ECHELP ( HFQ1050 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

3:53:28 PM Monday, August 03, 2009	

Page 10 of 760

HFB1

HFB1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

ECHELP

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

50

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:

[Do you/Does (SP)] wear eyeglasses or contact lenses?


Int. Instr II:

INPUT FIELDS / ROUTING


3:53:30 PM Monday, August 03, 2009

Page 11 of 760

HFB1
ECHELP

Field1:

( HFQ1050 )

HEST.ECHELP

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
TEchelp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFB2 - ECTROUB ( HFQ1060 )

2

English text: YES
No

HFB2 - ECTROUB ( HFQ1060 )

3

English text: NO
Blind

HFB3 - EINTROUB ( HFQ1070 )

English text: SP IS BLIND
Attribute
Don't know

Route
HFB6 - EDOCEXAM ( HFQ1110 )

Refusal

HFB6 - EDOCEXAM ( HFQ1110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:53:33 PM Monday, August 03, 2009

Page 12 of 760

HFB2

HFB2

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

ECTROUB

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:	

If HFB1 - ECHELP = 1/Yes, display "while wearing glasses or
contact lenses".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

Which statement best describes [your/(SP's)] vision (while wearing
glasses or contact lenses): no trouble seeing, a little trouble, a lot of
trouble, or no usable vision?

Int. Instr II:

INPUT FIELDS / ROUTING


3:53:35 PM Monday, August 03, 2009	

Page 13 of 760

HFB2
ECTROUB

Field1:

( HFQ1060 )

HEST.ECTROUB

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
TTrouble
1
No
No

Number Label
1 NoTroubleSeeing

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFB6 - EDOCEXAM ( HFQ1110 )

2

English text: NO TROUBLE SEEING
LittleTroubleSeeing

HFB3 - EINTROUB ( HFQ1070 )

3

English text: A LITTLE TROUBLE SEEING
LotOfTroubleSeeing

HFB3 - EINTROUB ( HFQ1070 )

4

English text: A LOT OF TROUBLE SEEING
NoUsableVision

HFB3 - EINTROUB ( HFQ1070 )

English text: NO USABLE VISION
Attribute
Don't know

Route
HFB6 - EDOCEXAM ( HFQ1110 )

Refusal

HFB6 - EDOCEXAM ( HFQ1110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:53:38 PM Monday, August 03, 2009

Page 14 of 760

HFB3

HFB3

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

EINTROUB

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

70

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:	

Because of [your/(SP's)] difficulty seeing, how much trouble [do
you/does (SP)] have with prescription labels or medical
instructions? Would you say (you have/she has/he has) no trouble,
a little trouble, or a lot of trouble?

Int. Instr II:

INPUT FIELDS / ROUTING


3:53:40 PM Monday, August 03, 2009	

Page 15 of 760

HFB3
EINTROUB

Field1:

( HFQ1070 )

HEST.EINTROUB

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
TTroub
1
No
No

Number Label
1 NoTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFB4 - EMCTROUB ( HFQ1080 )

2

English text: NO TROUBLE
ALittleTrouble

HFB4 - EMCTROUB ( HFQ1080 )

3

English text: A LITTLE TROUBLE
ALotOfTrouble

HFB4 - EMCTROUB ( HFQ1080 )

English text: A LOT OF TROUBLE
Attribute
Don't know

Route
HFB4 - EMCTROUB ( HFQ1080 )

Refusal

HFB4 - EMCTROUB ( HFQ1080 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:53:43 PM Monday, August 03, 2009

Page 16 of 760

HFB4

HFB4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

EMCTROUB

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:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:

Because of [your/(SP's)] difficulty seeing, how much trouble [do
you/does (SP)] have finding out things (you need/he needs/she
needs) to know about Medicare? Would you say (you have/she
has/he has) no trouble, a little trouble, or a lot of trouble?

Int. Instr II:
INPUT FIELDS / ROUTING

3:53:45 PM Monday, August 03, 2009

Page 17 of 760

HFB4
EMCTROUB

Field1:

( HFQ1080 )

HEST.EMCTROUB

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
TTroub
1
No
No

Number Label
1 NoTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFB5 - EOBTROUB ( HFQ1090 )

2

English text: NO TROUBLE
ALittleTrouble

HFB5 - EOBTROUB ( HFQ1090 )

3

English text: A LITTLE TROUBLE
ALotOfTrouble

HFB5 - EOBTROUB ( HFQ1090 )

English text: A LOT OF TROUBLE
Attribute
Don't know

Route
HFB5 - EOBTROUB ( HFQ1090 )

Refusal

HFB5 - EOBTROUB ( HFQ1090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:53:48 PM Monday, August 03, 2009

Page 18 of 760

HFB5

HFB5

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

EOBTROUB

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:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

Because of [your/(SP's)] difficulty seeing, how much trouble [do
you/does (SP)] have obtaining medical care, such as finding care or
getting there when (you need/he needs/she needs) it? Would you
say (you have/she has/he has) no trouble, a little trouble, or a lot of
trouble?

Int. Instr II:

INPUT FIELDS / ROUTING


3:53:49 PM Monday, August 03, 2009	

Page 19 of 760

HFB5
EOBTROUB

Field1:

( HFQ1090 )

HEST.EOBTROUB

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
TTroub
1
No
No

Number Label
1 NoTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFB6 - EDOCEXAM ( HFQ1110 )

2

English text: NO TROUBLE
ALittleTrouble

HFB6 - EDOCEXAM ( HFQ1110 )

3

English text: A LITTLE TROUBLE
ALotOfTrouble

HFB6 - EDOCEXAM ( HFQ1110 )

English text: A LOT OF TROUBLE
Attribute
Don't know

Route
HFB6 - EDOCEXAM ( HFQ1110 )

Refusal

HFB6 - EDOCEXAM ( HFQ1110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:53:53 PM Monday, August 03, 2009

Page 20 of 760

HFB6

HFB6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EDOCEXAM

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

110

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:

[Have you/Has (SP)] had an eye examination by an eye doctor since

(LAST HF MONTH YEAR)?

Int. Instr II:

INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.

INPUT FIELDS / ROUTING

3:53:54 PM Monday, August 03, 2009

Page 21 of 760

HFB6
EDOCEXAM

Field1:

( HFQ1110 )

HEST.EDOCEXAM

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFB1 - (HFQ1150 )

English text: YES
No

HFB7 - EDOCLAST ( HFQ1130 )

English text: NO
Attribute
Don't know

Route
BOX HFB1 - (HFQ1150 )

Refusal

BOX HFB1 - (HFQ1150 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:53:57 PM Monday, August 03, 2009

Page 22 of 760

HFB7

HFB7

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

EDOCLAST

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

130

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:

How long has it been since [your/(SP's)] last eye examination by an

eye doctor?

Int. Instr II:
INPUT FIELDS / ROUTING

3:53:59 PM Monday, August 03, 2009

Page 23 of 760

HFB7
EDOCLAST

Field1:

( HFQ1130 )

HEST.EDOCLAST

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
TEdoclst
1
No
No

Number Label
1 NeverHadEyeExam

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFB1 - (HFQ1150 )

2

English text: NEVER HAD EYE EXAM BY EYE DOCTOR
OneYearToLessThan2Years
BOX HFB1 - (HFQ1150 )

3

English text: 1 YEAR TO LESS THAN 2 YEARS
TwoYearsToLessThan5Years
BOX HFB1 - (HFQ1150 )

4

English text: 2 YEARS TO LESS THAN 5 YEARS
FiveYearsOrMore
BOX HFB1 - (HFQ1150 )
English text: 5 YEARS OR MORE

Attribute
Don't know

Route
BOX HFB1 - (HFQ1150 )

Refusal

BOX HFB1 - (HFQ1150 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:54:02 PM Monday, August 03, 2009

Page 24 of 760

BOX HFB1

BOX HFB1

Page Order # :

155

BOX INSTRUCTIONS
( HFQ1150 )	

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFB10 - ECCATOP (
HFQ1160 ).
ELSE GO TO HFC1 - HCHELP ( HFQ1170 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

3:54:02 PM Monday, August 03, 2009	

Page 25 of 760

HFB10

HFB10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

ECCATOP

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

160

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:

[Have you/Has (SP)] ever had an operation for cataracts?


Int. Instr II:

INPUT FIELDS / ROUTING


3:54:04 PM Monday, August 03, 2009

Page 26 of 760

HFB10
ECCATOP

Field1:

( HFQ1160 )

HEST.ECCATOP

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFC1 - HCHELP ( HFQ1170 )

English text: YES
No

HFC1 - HCHELP ( HFQ1170 )

English text: NO
Attribute
Don't know

Route
HFC1 - HCHELP ( HFQ1170 )

Refusal

HFC1 - HCHELP ( HFQ1170 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:54:07 PM Monday, August 03, 2009

Page 27 of 760

HFC1

HFC1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HCHELP

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:

Question display:

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] use a hearing aid?


Int. Instr II:

INPUT FIELDS / ROUTING


3:54:08 PM Monday, August 03, 2009

Page 28 of 760

HFC1
HCHELP

Field1:

( HFQ1170 )

HEST.HCHELP

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
THchelp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFC2 - HCTROUB ( HFQ1180 )

2

English text: YES
No

HFC2 - HCTROUB ( HFQ1180 )

3

English text: NO
Deaf

HFC3 - HCKNOWMC ( HFQ1190 )

English text: SP IS DEAF
Attribute
Don't know

Route
HFD1A - FOODTRBL ( HFQ1205 )

Refusal

HFD1A - FOODTRBL ( HFQ1205 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:54:11 PM Monday, August 03, 2009

Page 29 of 760

HFC2

HFC2

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HCTROUB

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:	

If HFC1 - HCHELP = 1/Yes, display "with a hearing aid".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Which statement best describes [your/(SP's)] hearing (with a hearing

aid): no trouble hearing, a little trouble, a lot of trouble, or deaf?

Int. Instr II:
INPUT FIELDS / ROUTING

3:54:13 PM Monday, August 03, 2009	

Page 30 of 760

HFC2
HCTROUB

Field1:

( HFQ1180 )

HEST.HCTROUB

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
THctrble
1
No
No

Number Label
1 NoTroubleHearing

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFD1A - FOODTRBL ( HFQ1205 )

2

English text: NO TROUBLE HEARING
ALittleTroubleHearing

3

English text: A LITTLE TROUBLE HEARING
ALotOfTroubleHearing
HFC3 - HCKNOWMC ( HFQ1190 )

4

English text: A LOT OF TROUBLE HEARING
Deaf
HFC3 - HCKNOWMC ( HFQ1190 )

HFC3 - HCKNOWMC ( HFQ1190 )

English text: DEAF
Attribute
Don't know

Route
HFD1A - FOODTRBL ( HFQ1205 )

Refusal

HFD1A - FOODTRBL ( HFQ1205 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:54:17 PM Monday, August 03, 2009

Page 31 of 760

HFC3

HFC3

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HCKNOWMC

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

190

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If HFC1 - HCHELP = 3/SPIsDeaf or HFC2 - HCTROUB = 4/Deaf,
display "(you are/he is/she is) deaf".
Else display "of (your/his/her) difficulty hearing".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

How much trouble [do you/does (SP)] have finding out things (you
need/he needs/she needs) to know about Medicare because [of
(your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would
you say (you have/she has/he has) no trouble, a little trouble, or a lot
of trouble?

Int. Instr II:

3:54:18 PM Monday, August 03, 2009	

Page 32 of 760

HFC3
INPUT FIELDS / ROUTING
HCKNOWMC

Field1:

( HFQ1190 )

HEST.HCKNOWMC

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
TTroub
1
No
No

Number Label
1 NoTrouble
2
3

English text: NO TROUBLE
ALittleTrouble
English text: A LITTLE TROUBLE
ALotOfTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFC4 - HCCOMDOC ( HFQ1200 )
HFC4 - HCCOMDOC ( HFQ1200 )
HFC4 - HCCOMDOC ( HFQ1200 )

English text: A LOT OF TROUBLE
Attribute
Don't know

Route
HFC4 - HCCOMDOC ( HFQ1200 )

Refusal

HFC4 - HCCOMDOC ( HFQ1200 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:54:21 PM Monday, August 03, 2009

Page 33 of 760

HFC4

HFC4

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HCCOMDOC

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:	

If HFC1 - HCHELP = 3/Deaf or HFC2 - HCTROUB = 4/Deaf, display
"(you are/he is/she is) deaf".
Else display "of (your/his/her) difficulty hearing".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

How much trouble [do you/does (SP)] have communicating with
(your/his/her) doctor or other medical personnel because [of
(your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would
you say (you have/she has/he has) no trouble, a little trouble, or a lot
of trouble?

Int. Instr II:

3:54:23 PM Monday, August 03, 2009	

Page 34 of 760

HFC4
INPUT FIELDS / ROUTING
HCCOMDOC

Field1:

( HFQ1200 )

HEST.HCCOMDOC

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
TTroub
1
No
No

Number Label
1 NoTrouble
2
3

English text: NO TROUBLE
ALittleTrouble
English text: A LITTLE TROUBLE
ALotOfTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFD1A - FOODTRBL ( HFQ1205 )
HFD1A - FOODTRBL ( HFQ1205 )
HFD1A - FOODTRBL ( HFQ1205 )

English text: A LOT OF TROUBLE
Attribute
Don't know

Route
HFD1A - FOODTRBL ( HFQ1205 )

Refusal

HFD1A - FOODTRBL ( HFQ1205 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:54:26 PM Monday, August 03, 2009

Page 35 of 760

HFD1A

HFD1A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

FOODTRBL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

220

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

How much trouble [do you/does (SP)] have eating solid foods
because of problems with (your/his/her) mouth or teeth? Would you
say (you have/she has/he has) no trouble, a little trouble, or a lot of
trouble?

Int. Instr II:

INPUT FIELDS / ROUTING


3:54:27 PM Monday, August 03, 2009	

Page 36 of 760

HFD1A
FOODTRBL

Field1:

( HFQ1205 )

HEST.FOODTRBL

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
TTroub
1
No
No

Number Label
1 NoTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFE1 - HEIGHTFT ( HFQ1230 )

2

English text: NO TROUBLE
ALittleTrouble

HFE1 - HEIGHTFT ( HFQ1230 )

3

English text: A LITTLE TROUBLE
ALotOfTrouble

HFE1 - HEIGHTFT ( HFQ1230 )

English text: A LOT OF TROUBLE
Attribute
Don't know

Route
HFE1 - HEIGHTFT ( HFQ1230 )

Refusal

HFE1 - HEIGHTFT ( HFQ1230 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:54:30 PM Monday, August 03, 2009

Page 37 of 760

HFE1

HFE1

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

HEIGHTFT

Field 2:

HEIGHTIN

Field 3:

WEIGHT

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:

230

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Vertical Alignment

Display HFE1 - HEIGHTFT and HFE1 - HEIGHTIN input fields on 1st

line.

Display HFE1 - WEIGHT input field on 2nd line.


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

3:54:32 PM Monday, August 03, 2009

Page 38 of 760

HFE1
HEIGHTFT

Field1:

( HFQ1230 )

HEST.HEIGHTFT

Cheshire Name:
Item Text display:
Item Text:

How tall [are you/is (SP)]?

Label:
Label Position:

FEET:
Left

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

Integer
THeightft
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HFE1 - HEIGHTIN ( HFQ1240 )

Refusal

HFE1 - HEIGHTIN ( HFQ1240 )

3:54:36 PM Monday, August 03, 2009

FieldSize:
Min Value:
Max Value:
Mask:

3
7

Route
HFE1 - HEIGHTIN ( HFQ1240 )

Page 39 of 760

HFE1
HEIGHTIN

Field2:

( HFQ1240 )

HEST.HEIGHTIN

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

INCHES:
Left

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

Integer
THeightin
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HFE1 - WEIGHT ( HFQ1250 )

Refusal

HFE1 - WEIGHT ( HFQ1250 )

3:54:39 PM Monday, August 03, 2009

FieldSize:

Min Value:
Max Value:
Mask:


0

11


Route
HFE1 - WEIGHT ( HFQ1250 )

Page 40 of 760

HFE1
WEIGHT

Field3:

( HFQ1250 )

HEST.WEIGHT

Cheshire Name:
Item Text display:
Item Text:

How much [do you/does (SP)] weigh?

Label:
Label Position:

WEIGHT:
Left

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

Integer
TWeights
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
999

Route
HFFINTRO - PREVHLTHINTRO ( HFQ1260 )

Attribute
Don't know

Route
HFFINTRO - PREVHLTHINTRO ( HFQ1260 )

Refusal

HFFINTRO - PREVHLTHINTRO ( HFQ1260 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

Calculate Height based on HFE1 - HEIGHTFT and HFE1 
HEIGHTIN in inches.

HFE1 - HEIGHTFT and HFE1 - HEIGHTIN calculated height in

inches = 60 - 72.

If not true, display message "THE HEIGHT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

Edit #2:

HFE1 - WEIGHT = 80 - 280.

If not true, display message "THE WEIGHT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
3:54:41 PM Monday, August 03, 2009

Page 41 of 760

HFE1

3:54:41 PM Monday, August 03, 2009

Page 42 of 760


HFFINTRO

HFFINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PREVHLTHINTRO

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

250

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:

These next few questions are about preventive health care 

measures some people take.

Int. Instr II:
INPUT FIELDS / ROUTING

3:54:42 PM Monday, August 03, 2009

Page 43 of 760

HFFINTRO
PREVHLTHINTRO

Field1:

( HFQ1260 )

TEMP

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
HFF1 - BPTAKEN ( HFQ1270 )

English text: CONTINUE
Attribute
Empty

Route
HFF1 - BPTAKEN ( HFQ1270 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:54:44 PM Monday, August 03, 2009

Page 44 of 760

HFF1

HFF1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

BPTAKEN

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:

When was the most recent time [you/(SP)] had (your/his/her) blood

pressure taken by a doctor or other health professional?

Int. Instr II:
INPUT FIELDS / ROUTING

3:54:46 PM Monday, August 03, 2009

Page 45 of 760

HFF1
BPTAKEN

Field1:

( HFQ1270 )

HEST.BPTAKEN

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
TBptake
1
No
No

Number Label
1 LessThanSixMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF2 - BCTAKEN ( HFQ1280 )

2

English text: LESS THAN 6 MONTHS AGO
SixMonthsToOneYear

3

English text: 6 MONTHS TO LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears
HFF2 - BCTAKEN ( HFQ1280 )

4

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanFiveYears
HFF2 - BCTAKEN ( HFQ1280 )

5

English text: 2 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
HFF2 - BCTAKEN ( HFQ1280 )

6

English text: 5 OR MORE YEARS AGO
Never

HFF2 - BCTAKEN ( HFQ1280 )

HFF2 - BCTAKEN ( HFQ1280 )

English text: NEVER HAD BLOOD PRESSURE TAKEN
Attribute
Don't know

Route
HFF2 - BCTAKEN ( HFQ1280 )

Refusal

HFF2 - BCTAKEN ( HFQ1280 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

3:54:52 PM Monday, August 03, 2009

Page 46 of 760

HFF1
TECHNICAL NOTES

DESIGN NOTES

3:54:52 PM Monday, August 03, 2009

Page 47 of 760

HFF2

HFF2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

BCTAKEN

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

270

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:

When was the most recent time [you/(SP)] had (your/his/her) blood

cholesterol checked?

Int. Instr II:
INPUT FIELDS / ROUTING

3:54:54 PM Monday, August 03, 2009

Page 48 of 760

HFF2
BCTAKEN

Field1:

( HFQ1280 )

HEST.BCTAKEN

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
TBcTake
1
No
No

Number Label
1 LessThanSixMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF1 - (HFQ1290 )

2

English text: LESS THAN 6 MONTHS AGO
SixMonthsToLessThanOneYear

3

English text: 6 MONTHS TO LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears
BOX HFF1 - (HFQ1290 )

4

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanFiveYears
BOX HFF1 - (HFQ1290 )

5

English text: 2 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
BOX HFF1 - (HFQ1290 )

6

English text: 5 OR MORE YEARS AGO
Never

BOX HFF1 - (HFQ1290 )

BOX HFF1 - (HFQ1290 )

English text: NEVER HAD CHOLESTEROL CHECKED
Attribute
Don't know

Route
BOX HFF1 - (HFQ1290 )

Refusal

BOX HFF1 - (HFQ1290 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

3:54:59 PM Monday, August 03, 2009

Page 49 of 760

HFF2
TECHNICAL NOTES

DESIGN NOTES

3:54:59 PM Monday, August 03, 2009

Page 50 of 760

BOX HFF1

BOX HFF1

Page Order # :

280

BOX INSTRUCTIONS
( HFQ1290 )

IF SP IS FEMALE, GO TO HFF3 - MAMMOGRM ( HFQ1300 ).
ELSE GO TO BOX HFF3 - (HFQ1440 ).

ASSIGNMENTS

TECHNICAL NOTES
5

SPMale	

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale	

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

3:54:59 PM Monday, August 03, 2009	

Page 51 of 760

HFF3

HFF3

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

MAMMOGRM

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

290

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If SP is not in the Supplemental Sample, display "These next few
questions are about. . .".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

(These next few questions are about preventive health care
measures some people take). [Have you/Has (SP)] had a
mammogram or a breast X-ray since (LAST HF MONTH YEAR)?

Int. Instr II:

INPUT FIELDS / ROUTING


3:55:00 PM Monday, August 03, 2009	

Page 52 of 760

HFF3
MAMMOGRM

Field1:

( HFQ1300 )

HEST.MAMMOGRM

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF6 - PAPSMEAR ( HFQ1360 )

English text: YES
No

BOX HFF1A - (HFQ1315 )

English text: NO
Attribute
Don't know

Route
HFF6 - PAPSMEAR ( HFQ1360 )

Refusal

HFF6 - PAPSMEAR ( HFQ1360 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

3:55:02 PM Monday, August 03, 2009

Page 53 of 760

BOX HFF1A

BOX HFF1A

Page Order # :

310

BOX INSTRUCTIONS
( HFQ1315 )	

IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO HFF6 - PAPSMEAR ( HFQ1360 ).
ELSE GO TO HFF5 - MAMCODE ( HFQ1330 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

3:55:02 PM Monday, August 03, 2009	

Page 54 of 760

HFF5

HFF5

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

MAMCODE

Field 2:

MAMNOTHS

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:	

320

Roster Name:
Roster Type:

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:

Question Text:

What is the reason that [you have/(SP) has] not had a mammogram

since (LAST HF MONTH YEAR)?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

3:55:06 PM Monday, August 03, 2009	

Page 55 of 760

HFF5

3:55:15 PM Monday, August 03, 2009

Page 56 of 760


HFF5
MAMCODE

Field1:

( HFQ1330)

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.MAMNNEED
2=HEST.MAMNANUL
3=HEST.MAMNGET
4=HEST.MAMNRISK
5=HEST.MAMNPRES
6=HEST.MAMNREC
7=HEST.MAMNLIKE
8=HEST.MAMNLOCA
9=HEST.MAMNMISS
10=HEST.MAMNCOST
11 =HEST.MAMNFEAR
12=HEST.MAMNRADI
13=HEST.MAMNHEAR
14=HEST.MAMNAPPT
15= HESTMAMNMASC
16=HEST.MAMNILL
91=HEST.MAMNOTHR

Item Text display:
Item Text:
Label: 

Label Position: 

Field Type: 

Type Name: 

Answers Allowed: 

Drop Down List: 

Lookup File: 

Lookup File Name: 


Enumerated

THFF5CATA
17
No
No

Number Label
NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF6 - PAP SMEAR (HFQI360) 


English text: DIDN'T KNOW IT WAS NEEDEDINO NEEDINOTHING WRONG 

NotRecommendedEveryYear
HFF6 - PAP SMEAR (HFQI360) 


-----------------------------------------------------------------------------------------------------------------------------------------------------------

2

English text: NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT SCREENING 

SCHEDULE 

3 
 DidNotThinkPreventCancer
HFF6 - PAP SMEAR (HFQI360)

4

English text: DIDN'T THINK IT WOULD PREVENT BREAST CANCER/COULD GET BREAST
CANCERANYWAY/TEST IS USELESS
NotAtRisk
HFF6 - PAP SMEAR (HFQI360) 

---------------------------------------------------------------------------------------------------------------------------------------------

English text: NOT AT RISK FOR BREAST CANCER 

5 
 DrNotRecommended
HFF6 - PAP SMEAR (HFQI360)
English text: DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT

3:55:26 PM Monday, August 03, 2009

Page 57 of 760

HFF5

6

DrRecommendedAgainstIt

HFF6 - PAPSMEAR ( HFQ1360 )

7

English text: DOCTOR RECOMMENDED AGAINST GETTING IT
DontLikeMammogram
HFF6 - PAPSMEAR ( HFQ1360 )

8

English text: DON’T LIKE MAMMOGRAMS/PAIN, SORENESS, DISCOMFORT OR REACTIONS
Inconvenient
HFF6 - PAPSMEAR ( HFQ1360 )

9

English text: INCONVENIENT/UNABLE TO GET TO LOCATION/TRANSPORTATION
DIFFICULTY
Forgot
HFF6 - PAPSMEAR ( HFQ1360 )

11

English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT/PROCRASTINATED
CostOfMammogram
HFF6 - PAPSMEAR ( HFQ1360 )
English text: COST OF MAMMOGRAM/INSURANCE DOESN’T COVER COST/NOT WORTH
THE MONEY
AfraidOfResults
HFF6 - PAPSMEAR ( HFQ1360 )

12

English text: AFRAID OF RESULTS/DON’T WANT TO KNOW
CouldCauseCancer
HFF6 - PAPSMEAR ( HFQ1360 )

13

English text: MAMMOGRAM RADIATION COULD CAUSE CANCER/ILL EFFECTS
NeverHeardOfMammogram
HFF6 - PAPSMEAR ( HFQ1360 )

14

English text: NEVER HEARD OF MAMMOGRAM
AppointmentScheduled
HFF6 - PAPSMEAR ( HFQ1360 )

15

English text: APPOINTMENT SCHEDULED FOR FUTURE DATE
Mastectomy
HFF6 - PAPSMEAR ( HFQ1360 )

16

English text: MASTECTOMY/BREASTS REMOVED
TooIll
HFF6 - PAPSMEAR ( HFQ1360 )

91

English text: TOO ILL, PHYSICALLY/MENTALLY
Other
HFF5 - MAMNOTHS ( HFQ1350 )

10

English text: OTHER
Attribute
Don't know

Route
HFF6 - PAPSMEAR ( HFQ1360 )

Refusal

HFF6 - PAPSMEAR ( HFQ1360 )

3:55:34 PM Monday, August 03, 2009

Page 58 of 760

HFF5

Field2:

MAMNOTHS

( HFQ1350 )

HEST.MAMNOTHS

Cheshire Name:
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
HFF6 - PAPSMEAR ( HFQ1360 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:55:35 PM Monday, August 03, 2009

Page 59 of 760

HFF6

HFF6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PAPSMEAR

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

330

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:

[Have you/Has (SP)] had a Pap smear test since (LAST HF MONTH

YEAR)?

Int. Instr II:
INPUT FIELDS / ROUTING

3:55:36 PM Monday, August 03, 2009

Page 60 of 760

HFF6
PAPSMEAR

Field1:

( HFQ1360 )

HEST.PAPSMEAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF2 - (HFQ1420 )

English text: YES
No

BOX HFF1B - (HFQ1375 )

English text: NO
Attribute
Don't know

Route
BOX HFF2 - (HFQ1420 )

Refusal

BOX HFF2 - (HFQ1420 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:55:39 PM Monday, August 03, 2009

Page 61 of 760

BOX HFF1B

BOX HFF1B

Page Order # :

340

BOX INSTRUCTIONS
( HFQ1375 )	

IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO BOX HFF2 - (HFQ1420 ).
ELSE GO TO HFF8 - PAPCODE ( HFQ1390 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

3:55:39 PM Monday, August 03, 2009	

Page 62 of 760

HFF8

HFF8

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

PAPCODE

Field 2:

PAPNOTHS

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:	

360

Roster Name:
Roster Type:

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:

Question Text:

What is the reason that [you have/(SP) has] not had a Pap smear

test since (LAST HF MONTH YEAR)?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

3:55:43 PM Monday, August 03, 2009	

Page 63 of 760

HFF8

3:55:51 PM Monday, August 03, 2009

Page 64 of 760


HFF8
PAPCODE

Field1:

( HFQ1390)

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HESTPAPNNEED
2=HESTPAPNANUL
3= HESTPAPNGET
4=HESTPAPNRISK
5=HESTPAPNPRES
6= HESTPAPNREC
7= HESTPAPNLlKE
8=HESTPAPNLOCA
9=HESTPAPNMISS
10= HESTPAPNCOST
11=HESTPAPNFEAR
12=HESTPAPNHEAR
13=HESTPAPNAPPT
14=HESTPAPNHYST
15= HESTPAPNILL
91=HESTPAPNOTHR

Item Text display:
Item Text:
Label: 

Label Position: 

Field Type: 

Type Name: 

Answers Allowed: 

Drop Down List: 

Lookup File: 

Lookup File Name: 


Enumerated

THFF8CATA
16
No
No

Number Label
NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF2 - (HFQ1420 )

English text: DIDN'T KNOW IT WAS NEEDEDINO NEEDINOTHING WRONG
2

NotRecommended

BOX HFF2 - (HFQ1420 )

3

English text: NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT SCREENING
SCHEDULE
DidNotThinkPreventCancer
BOX HFF2 - (HFQ1420 )

4

English text: DIDN'T THINK IT WOULD PREVENT CANCER/COULD GET CANCER
ANYWAY/TEST IS USELESS
NotAtRisk
BOX HFF2 - (HFQ1420 )

5

English text: NOT AT RISK FOR CANCER
DrNotRecommended

BOX HFF2 - (HFQ1420 ) 


English text: DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT 


3:56:01 PM Monday, August 03, 2009

Page 65 of 760

HFF8

6

DrRecommendAgainstIt

BOX HFF2 - (HFQ1420 )

7

English text: DOCTOR RECOMMENDED AGAINST GETTING IT
DontLikePapSmear
BOX HFF2 - (HFQ1420 )

8

English text: DON’T LIKE PAP SMEAR/PAIN, SORENESS, DISCOMFORT OR REACTIONS
Inconvenient
BOX HFF2 - (HFQ1420 )

9

English text: INCONVENIENT/UNABLE TO GET TO LOCATION/TRANSPORTATION
DIFFICULTY
Forgot
BOX HFF2 - (HFQ1420 )

11

English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT/PROCRASTINATED
CostOfPapSmear
BOX HFF2 - (HFQ1420 )
English text: COST OF PAP SMEAR/INSURANCE DOESN’T COVER COST/NOT WORTH THE
MONEY
AfraidOfResults
BOX HFF2 - (HFQ1420 )

12

English text: AFRAID OF RESULTS/DON’T WANT TO KNOW
NeverHeardOfPapSmear
BOX HFF2 - (HFQ1420 )

13

English text: NEVER HEARD OF PAP SMEAR
AppointmentScheduled
BOX HFF2 - (HFQ1420 )

14

English text: APPOINTMENT SCHEDULED FOR FUTURE DATE
HadHysterectomy
BOX HFF2 - (HFQ1420 )

15

English text: HAD HYSTERECTOMY/NO UTERUS, OVARIES
TooIll
BOX HFF2 - (HFQ1420 )

91

English text: TOO ILL, PHYSICALLY/MENTALLY
Other
HFF8 - PAPNOTHS ( HFQ1410 )

10

English text: OTHER
Attribute
Don't know

Route
BOX HFF2 - (HFQ1420 )

Refusal

BOX HFF2 - (HFQ1420 )

3:56:09 PM Monday, August 03, 2009

Page 66 of 760

HFF8

Field2:

PAPNOTHS

( HFQ1410 )

HEST.PAPNOTHS

Cheshire Name:
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
BOX HFF2 - (HFQ1420 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:56:10 PM Monday, August 03, 2009

Page 67 of 760

BOX HFF2

BOX HFF2

Page Order # :

370

BOX INSTRUCTIONS
( HFQ1420 )	

IF SP IS IN THE SUPPLEMENTAL SAMPLE AND RESPONSE TO HHF8 –
PAPCODE DOES NOT INCLUDE 14/HadHysterectomy, GO TO HFF9 
HYSTEREC ( HFQ1430 ).
ELSE GO TO HFF15 - FLUSHOT ( HFQ1540 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

3:56:10 PM Monday, August 03, 2009	

Page 68 of 760

HFF9

HFF9

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYSTEREC

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

380

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:

[Have you/Has (SP)] ever had a hysterectomy?


Int. Instr II:

INPUT FIELDS / ROUTING


3:56:11 PM Monday, August 03, 2009

Page 69 of 760

HFF9
HYSTEREC

Field1:

( HFQ1430 )

HEST.HYSTEREC

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF15 - FLUSHOT ( HFQ1540 )

English text: YES
No

HFF15 - FLUSHOT ( HFQ1540 )

English text: NO
Attribute
Don't know

Route
HFF15 - FLUSHOT ( HFQ1540 )

Refusal

HFF15 - FLUSHOT ( HFQ1540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:56:13 PM Monday, August 03, 2009

Page 70 of 760

BOX HFF3

BOX HFF3

Page Order # :

390

BOX INSTRUCTIONS
( HFQ1440 )

IF SP HAS EVER REPORTED HAVING PROSTATE SURGERY IN A
PREVIOUS ROUND, GO TO HFF11 - DIGTEXAM ( HFQ1460 ).
ELSE GO TO HFF10 - PROSSURG ( HFQ1450 ).

ASSIGNMENTS

TECHNICAL NOTES
385

HFProstateSurg

SP has ever reported having prostate surgery in a
previous round =
There is a HEST where HEST.HESTRND < current round
and (HEST.PROSSURG = 1/Yes or HEST.PROSRMVD
= 1/Yes).

DESIGN NOTES

3:56:13 PM Monday, August 03, 2009

Page 71 of 760

HFF10

HFF10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PROSSURG

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

400

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "[Have you/Has (SP)] ever".
Else display "Since (LAST HF MONTH YEAR), [have you/has (SP)]".
If SP is the respondent, display "your".
Else display "his".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[Since (LAST HF MONTH YEAR), [have you/has (SP)/[Have you/has
(SP)] ever] had surgery on (your/his) prostate?
[EXPLAIN IF NECESSARY: Surgery on the prostate gland is
typically used as a treatment for prostate cancer or to correct urinary
problems. Surgery can include complete or partial removal of the

3:56:15 PM Monday, August 03, 2009

Page 72 of 760

HFF10
prostate.]
Int. Instr II:

INPUT FIELDS / ROUTING

PROSSURG

Field1:

( HFQ1450 )

HEST.PROSSURG

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF11 - DIGTEXAM ( HFQ1460 )

English text: YES
No

HFF11 - DIGTEXAM ( HFQ1460 )

English text: NO
Attribute
Don't know

Route
HFF11 - DIGTEXAM ( HFQ1460 )

Refusal

HFF11 - DIGTEXAM ( HFQ1460 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

3:56:18 PM Monday, August 03, 2009

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 73 of 760

HFF10
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

3:56:18 PM Monday, August 03, 2009

Page 74 of 760

HFF11

HFF11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIGTEXAM

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

410

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has ever reported having prostate surgery in the current round
or in a previous round, display "follow-up care sometimes
prescribed after prostate surgery."
Else display "preventive health care measures some people take."
If SP has not reported having prostate surgery in the current round
or any previous round, display "of the prostate".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

3:56:19 PM Monday, August 03, 2009	

These next few questions are about (preventive health care
measures some people take/follow-up care sometimes prescribed
after prostate surgery).

Page 75 of 760

HFF11
[Have you/Has (SP)] had a digital rectal examination (of the prostate)
since (LAST HF MONTH YEAR)?
[EXPLAIN IF NECESSARY: The exam may be used to detect
prostate cancer, to determine whether cancer has spread beyond
the prostate, and as part of follow-up care after prostate surgery.]
Int. Instr II:
INPUT FIELDS / ROUTING
DIGTEXAM

Field1:

( HFQ1460 )

HEST.DIGTEXAM

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF12 - BLOODTST ( HFQ1470 )

English text: YES
No

HFF12 - BLOODTST ( HFQ1470 )

English text: NO
Attribute
Don't know

Route
HFF12 - BLOODTST ( HFQ1470 )

Refusal

HFF12 - BLOODTST ( HFQ1470 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

3:56:22 PM Monday, August 03, 2009

Page 76 of 760

HFF11
TECHNICAL NOTES
387

HFProstateSurgCurrOr
Prev

If SP has ever reported having prostate surgery in the
current round or in a previous round =
(HEST.PROSSURG = /1Yes or HEST.PROSRMVD =
1/Yes ) on HEST where (HEST.HESTRND <= current
round).

DESIGN NOTES

3:56:22 PM Monday, August 03, 2009

Page 77 of 760

HFF12

HFF12

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

BLOODTST

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

420

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Display "PSA = PROSTATE-SPECIFIC ANTIGEN" in the same blue
font used for interviewer instructions.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[Have you/Has (SP)] had a blood test for detection of prostate
cancer, known as a PSA, since (LAST HF MONTH YEAR)?
PSA = PROSTATE-SPECIFIC ANTIGEN
[EXPLAIN IF NECESSARY: The test may be used to detect prostate
cancer, to determine whether cancer has spread beyond the
prostate, and as part of follow-up care after prostate surgery.]

Int. Instr II:
3:56:23 PM Monday, August 03, 2009	

Page 78 of 760

HFF12
INPUT FIELDS / ROUTING
BLOODTST

Field1:

( HFQ1470 )

HEST.BLOODTST

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF15 - FLUSHOT ( HFQ1540 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
HFF15 - FLUSHOT ( HFQ1540 )

Refusal

HFF15 - FLUSHOT ( HFQ1540 )

BOX HFF3B - (HFQ1485 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:56:25 PM Monday, August 03, 2009

Page 79 of 760

BOX HFF3B

BOX HFF3B

Page Order # :

430

BOX INSTRUCTIONS
( HFQ1485 )	

IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO HFF15 - FLUSHOT ( HFQ1540 ).
ELSE GO TO HFF14 - PRONCODE ( HFQ1500 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

3:56:25 PM Monday, August 03, 2009	

Page 80 of 760

HFF14

HFF14

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

PRONCODE

Field 2:

PRONOTHS

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:	

450

Roster Name:
Roster Type:

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:

Question Text:

What is the reason that [you have/(SP) has] not had a prostate blood

test or PSA since (LAST HF MONTH YEAR)?

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

3:56:29 PM Monday, August 03, 2009	

Page 81 of 760

HFF14

3:56:37 PM Monday, August 03, 2009

Page 82 of 760


HFF14
PRONCODE

Field1:

( HFQ1500 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.PRONNEED
2=HEST.PRONANUL
3=HEST.PRONGET
4=HEST.PRONRISK
5=HEST.PRONPRES
6=HEST.PRONREC
7=HEST.PRONLIKE
8=HEST.PRONLOCA
9=HEST.PRONMISS
10=HEST.PRONCOST
11=HEST.PRONFEAR
12=HEST.PRONHEAR
13=HEST.PRONAPPT
14=HEST.PRONPROS
91=HEST.PRONOTHR
Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
THFF14CATA
15
No
No

Number Label
1 NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF15 - FLUSHOT ( HFQ1540 )

3

English text: DIDN’T KNOW IT WAS NEEDED/NO NEED/NOTHING WRONG
NotRecommendedEveryYear
HFF15 - FLUSHOT ( HFQ1540 )
English text: NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT SCREENING
SCHEDULE
DidNotThinkPreventCancer
HFF15 - FLUSHOT ( HFQ1540 )

4

English text: DIDN’T THINK IT WOULD PREVENT CANCER/COULD GET CANCER
ANYWAY/TEST IS USELESS
NotAtRisk
HFF15 - FLUSHOT ( HFQ1540 )

5

English text: NOT AT RISK FOR CANCER
DrNotRecommended

6

English text: DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
DrRecommendedAgainstIt
HFF15 - FLUSHOT ( HFQ1540 )

2

HFF15 - FLUSHOT ( HFQ1540 )

English text: DOCTOR RECOMMENDED AGAINST GETTING IT
3:56:48 PM Monday, August 03, 2009

Page 83 of 760

HFF14

7

DontLikeBloodTests

HFF15 - FLUSHOT ( HFQ1540 )

8

English text: DON’T LIKE BLOOD TESTS/PAIN, SORENESS, DISCOMFORT OR REACTIONS
Inconvenient
HFF15 - FLUSHOT ( HFQ1540 )

9

English text: INCONVENIENT/UNABLE TO GET TO LOCATION/TRANSPORTATION
DIFFICULTY
Forgot
HFF15 - FLUSHOT ( HFQ1540 )

10

English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT/PROCRASTINATED
CostOfTest
HFF15 - FLUSHOT ( HFQ1540 )

11

English text: COST OF TEST/INSURANCE DOESN’T COVER COST/NOT WORTH THE
MONEY
AfraidOfResults
HFF15 - FLUSHOT ( HFQ1540 )

12

English text: AFRAID OF RESULTS/DON’T WANT TO KNOW
NeverHeardOfPsa
HFF15 - FLUSHOT ( HFQ1540 )

13

English text: NEVER HEARD OF PSA
AppointmentScheduled

14

English text: APPOINTMENT SCHEDULED FOR FUTURE DATE
Prostatectomy
HFF15 - FLUSHOT ( HFQ1540 )

91

English text: PROSTATECTOMY/PROSTATE REMOVED
Other
HFF14 - PRONOTHS ( HFQ1520 )

HFF15 - FLUSHOT ( HFQ1540 )

English text: OTHER
Attribute
Don't know

Route
HFF15 - FLUSHOT ( HFQ1540 )

Refusal

HFF15 - FLUSHOT ( HFQ1540 )

3:56:55 PM Monday, August 03, 2009

Page 84 of 760

HFF14

Field2:

PRONOTHS

( HFQ1520 )

HEST.PRONOTHS

Cheshire Name:
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
HFF15 - FLUSHOT ( HFQ1540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:56:56 PM Monday, August 03, 2009

Page 85 of 760

HFF15

HFF15

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

FLUSHOT

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

470

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:

On a different topic ...
Did [you/(SP)] have a flu shot for last winter?
[EXPLAIN IF NECESSARY: Did [you/(SP)] get a flu shot any time
during the period from September (PREVIOUS YEAR) through
December (PREVIOUS YEAR)?]

Int. Instr II:

3:56:57 PM Monday, August 03, 2009

Page 86 of 760

HFF15
INPUT FIELDS / ROUTING
FLUSHOT

Field1:

( HFQ1540 )

HEST.FLUSHOT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF18 - FLUSITE ( HFQ1600 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
BOX HFF5 - (HFQ1650 )

Refusal

BOX HFF5 - (HFQ1650 )

HFF17 - FLUCODE ( HFQ1560 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:56:59 PM Monday, August 03, 2009

Page 87 of 760

HFF17

HFF17

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

FLUCODE

Field 2:

FLUOTHOS

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:	

490

Roster Name:
Roster Type:

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:

Question Text:

Why didn't [you/(SP)] get a flu shot last winter?

[PROBE: Any other reason?]

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

3:57:03 PM Monday, August 03, 2009	

Page 88 of 760

HFF17

3:57:10 PM Monday, August 03, 2009

Page 89 of 760


HFF17
FLUCODE

Field1:

( HFQ1560 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.FLUNEED
2=HEST.FLUCAUSE
3=HEST.FLUSIDE
4=HEST.FLUPRVNT
5=HEST.FLURISK
6=HEST.FLUDOCNO
7=HEST.FLUAGNST
8=HEST.FLUREACT
9=HEST.FLULOCAT
10=HEST.FLUMISS
11=HEST.FLUCOST
12=HEST.FLUBEFOR
13=HEST.FLUVACC
91=HEST.FLUOTHER
Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
THFF17CATA
14
No
No

Number Label
1 NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF4 - (HFQ1590 )

2

English text: DIDN’T KNOW IT WAS NEEDED
ShotCauseFlu
BOX HFF4 - (HFQ1590 )

3

English text: SHOT COULD CAUSE FLU
SideEffects

4

English text: SHOT COULD HAVE SIDE EFFECTS OR CAUSE DISEASE
DidNotThinkPreventFlu
BOX HFF4 - (HFQ1590 )

5
6

BOX HFF4 - (HFQ1590 )

English text: DIDN’T THINK IT WOULD PREVENT THE FLU/COULD GET THE FLU
ANYWAY
FluNotSerious
BOX HFF4 - (HFQ1590 )
English text: FLU NOT SERIOUS/WOULD NOT GET FLU ANYWAY/NOT AT RISK
DrNotRecommended
BOX HFF4 - (HFQ1590 )
English text: DOCTOR DID NOT RECOMMEND THE SHOT

3:57:20 PM Monday, August 03, 2009

Page 90 of 760

HFF17

7

8

9

AllergicToShot

BOX HFF4 - (HFQ1590 )

English text: DOCTOR RECOMMENDED AGAINST GETTING SHOT/ALLERGIC TO
SHOT/MEDICAL REASONS
DontLikeShots
BOX HFF4 - (HFQ1590 )
English text: DON’T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT SORENESS OR
RASH/LOCAL REACTIONS
Inconvenient
BOX HFF4 - (HFQ1590 )

10

English text: INCONVENIENT TO GET SHOT/UNABLE TO GET TO LOCATION
Forgot
BOX HFF4 - (HFQ1590 )

11

English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT
CostOfShot
BOX HFF4 - (HFQ1590 )

12

English text: COST OF SHOT/NOT WORTH THE MONEY
HadShotBefore
BOX HFF4 - (HFQ1590 )

13

English text: HAD SHOT BEFORE/DIDN’T NEED IT AGAIN
VaccineUnavailable
BOX HFF4 - (HFQ1590 )

91

English text: VACCINE UNAVAILABLE/VACCINE SHORTAGE
Other
HFF17 - FLUOTHOS ( HFQ1580 )
English text: OTHER

Attribute
Don't know

Route
BOX HFF4 - (HFQ1590 )

Refusal

BOX HFF4 - (HFQ1590 )

Field2:

FLUOTHOS

( HFQ1580 )

HEST.FLUOTHOS

Cheshire Name:
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.]

3:57:27 PM Monday, August 03, 2009

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFF4 - (HFQ1590 )

Page 91 of 760

HFF17
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:57:27 PM Monday, August 03, 2009

Page 92 of 760

BOX HFF4

BOX HFF4

Page Order # :

500

BOX INSTRUCTIONS
( HFQ1590 )

IF RESPONSE TO HFF17 – FLUCODE DOES NOT INCLUDE
13/VaccineUnavailable, GO TO HFF21 - NOVACINE ( HFQ1640 ).
ELSE GO TO BOX HFF5 - (HFQ1650 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

3:57:27 PM Monday, August 03, 2009

Page 93 of 760

HFF18

HFF18

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

FLUSITE

Field 2:

FLUSITOS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

510

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "IF CLINIC ASK:" and "IF SOME OTHER PLACE, ASK:" in
same blue font used for interviewer instructions.

Multi Field display:

Vertical Alignment

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

Where did [you/(SP)] go for (your/his/her) most recent flu shot, was
that a managed care plan center or HMO, a clinic, a doctor’s office, a
hospital, a health fair, shopping mall, or some other place?
[IF CLINIC, ASK: Was it a hospital outpatient clinic, or some other
kind of clinic? IF SOME OTHER PLACE, ASK: Where was this?]

Int. Instr II:

3:57:32 PM Monday, August 03, 2009	

Page 94 of 760

HFF18
INPUT FIELDS / ROUTING

3:57:41 PM Monday, August 03, 2009

Page 95 of 760


HFF18
FLUSITE

Field1:

HEST.FLUSITE

Cheshire Name:
Item Text display:

( HFQ1600 )

Do not display response options 28/HealthDepartment and
29/PlaceofWork.

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

Enumerated
TFlusite
1
No
No

Number Label
1 DrsOfficeOrGroupPractice

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFF20 - VACSUPLY ( HFQ1630 )

2

English text: DOCTORS OFFICE OR GROUP PRACTICE
DoctorsClinic
HFF20 - VACSUPLY ( HFQ1630 )

3

English text: MEDICAL CLINIC
ManagedCarePlanCenter

4

English text: MANAGED CARE PLAN CENTER/HMO
NeighborhoodHealthCenter
HFF20 - VACSUPLY ( HFQ1630 )

5

English text: NEIGHBORHOOD/FAMILY HEALTH CENTER
FreestandingSurgicalCenter
HFF20 - VACSUPLY ( HFQ1630 )

6

English text: FREESTANDING SURGICAL CENTER
RuralHealthClinic
HFF20 - VACSUPLY ( HFQ1630 )

7

English text: RURAL HEALTH CLINIC
CompanyClinic

8
9
10
11
12

English text: COMPANY CLINIC
OtherClinic
English text: OTHER CLINIC
WalkInUrgentCenter
English text: WALK-IN URGENT CENTER
HospitalEmergencyRoom

HFF20 - VACSUPLY ( HFQ1630 )

HFF20 - VACSUPLY ( HFQ1630 )
HFF20 - VACSUPLY ( HFQ1630 )
HFF20 - VACSUPLY ( HFQ1630 )
HFF20 - VACSUPLY ( HFQ1630 )

English text: HOSPITAL EMERGENCY ROOM
HospitalOutpatientDept
HFF20 - VACSUPLY ( HFQ1630 )
English text: HOSPITAL OUTPATIENT DEPARTMENT/CLINIC
VaFacility
HFF20 - VACSUPLY ( HFQ1630 )
English text: VA FACILITY

3:57:56 PM Monday, August 03, 2009

Page 96 of 760

HFF18

13

HealthFair

HFF20 - VACSUPLY ( HFQ1630 )

14

English text: HEALTH FAIR
ShoppingMall

HFF20 - VACSUPLY ( HFQ1630 )

15

English text: SHOPPING MALL/OTHER STORE
SeniorCenter
HFF20 - VACSUPLY ( HFQ1630 )

16

English text: SENIOR CENTER
SpsHome

HFF20 - VACSUPLY ( HFQ1630 )

17

English text: AT HOME
Churchschool

HFF20 - VACSUPLY ( HFQ1630 )

18

English text: CHURCH/SCHOOL
Library1

HFF20 - VACSUPLY ( HFQ1630 )

28

English text: LIBRARY
HealthDepatment

29

English text: HEALTH DEPATMENT
PlaceOfWork

DATA EDITING ONLY. DO NOT DISPLAY.

DATA EDITING ONLY. DO NOT DISPLAY.
91

English text: PLACE OF WORK
Other

HFF18 - FLUSITOS ( HFQ1605 )

English text: OTHER
Attribute
Don't know

Route
HFF20 - VACSUPLY ( HFQ1630 )

Refusal

HFF20 - VACSUPLY ( HFQ1630 )

3:58:03 PM Monday, August 03, 2009

Page 97 of 760

HFF18

Field2:

FLUSITOS

( HFQ1605 )

HEST.FLUSITOS

Cheshire Name:
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
HFF20 - VACSUPLY ( HFQ1630 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:58:04 PM Monday, August 03, 2009

Page 98 of 760

HFF20

HFF20

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

VACSUPLY

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

530

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:

Did [you/(SP)] have any trouble getting a flu shot when (you/he/she)

wanted to because the vaccine was in short supply or unavailable?

Int. Instr II:
INPUT FIELDS / ROUTING

3:58:05 PM Monday, August 03, 2009

Page 99 of 760

HFF20
VACSUPLY

Field1:

( HFQ1630 )

HEST.VACSUPLY

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF5 - (HFQ1650 )

English text: YES
No

BOX HFF5 - (HFQ1650 )

English text: NO
Attribute
Don't know

Route
BOX HFF5 - (HFQ1650 )

Refusal

BOX HFF5 - (HFQ1650 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:58:08 PM Monday, August 03, 2009

Page 100 of 760

HFF21

HFF21

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

NOVACINE

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

540

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:

Was one reason that [you/(SP)] did not get a flu shot last winter

because the vaccine was in short supply or unavailable?

Int. Instr II:
INPUT FIELDS / ROUTING

3:58:09 PM Monday, August 03, 2009

Page 101 of 760

HFF21
NOVACINE

Field1:

( HFQ1640 )

HEST.NOVACINE

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF5 - (HFQ1650 )

English text: YES
No

BOX HFF5 - (HFQ1650 )

English text: NO
Attribute
Don't know

Route
BOX HFF5 - (HFQ1650 )

Refusal

BOX HFF5 - (HFQ1650 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:58:11 PM Monday, August 03, 2009

Page 102 of 760

BOX HFF5

BOX HFF5

550

Page Order # :

BOX INSTRUCTIONS
( HFQ1650 )	

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFF22 - PNEUSHOT (
HFQ1660 ).
ELSE IF SP HAS EVER REPORTED HAVING A PNEUMONIA SHOT IN A
PREVIOUS ROUND, GO TO BOX HFG1 - (HFQ1710 ).
ELSE GO TO HFF22 - PNEUSHOT ( HFQ1660 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

388

HFPneumoniaShot

SP has ever reported having a pneumonia shot in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.PNEUSHOT = 1/Yes.

DESIGN NOTES

3:58:11 PM Monday, August 03, 2009	

Page 103 of 760

HFF22

HFF22

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PNEUSHOT

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

560

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:

[Have you/Has (SP)] ever had a shot for pneumonia?


Int. Instr II:

INPUT FIELDS / ROUTING


3:58:13 PM Monday, August 03, 2009

Page 104 of 760

HFF22
PNEUSHOT

Field1:

( HFQ1660 )

HEST.PNEUSHOT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFG1 - (HFQ1710 )

English text: YES
No

BOX HFF5B - (HFQ1665 )

English text: NO
Attribute
Don't know

Route
BOX HFG1 - (HFQ1710 )

Refusal

BOX HFG1 - (HFQ1710 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:58:15 PM Monday, August 03, 2009

Page 105 of 760

BOX HFF5B

BOX HFF5B

Page Order # :

565

BOX INSTRUCTIONS
( HFQ1665 )	

IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO BOX HFG1 - (HFQ1710 ).
ELSE GO TO HFF23 - PNUCODE ( HFQ1680 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

3:58:15 PM Monday, August 03, 2009	

Page 106 of 760

HFF23

HFF23

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

PNUCODE

Field 2:

PNUOTHOS

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:	

570

Roster Name:
Roster Type:

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:

Question Text:

Why didn't [you/(SP)] ever have a shot for pneumonia?

[PROBE: Any other reason?]

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

3:58:18 PM Monday, August 03, 2009	

Page 107 of 760

HFF23

3:58:25 PM Monday, August 03, 2009

Page 108 of 760


HFF23
PNUCODE

Field1:

( HFQ1680 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.PNUNEED
2=HEST.PNUCAUSE
3=HEST.PNUSIDE
4=HEST.PNUPRVNT
5=HEST.PNURISK
6=HEST.PNUDOCNO
7=HEST.PNUAGNST
8=HEST.PNUREACT
9=HEST.PNULOCAT
10=HEST.PNUMISS
11=HEST.PNUCOST
91=HEST.PNUOTHER
Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
THFF23CATA
12
No
No

Number Label
1 NotNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFG1 - (HFQ1710 )

2

English text: DIDN'T KNOW IT WAS NEEDED
CouldCausePneumonia
BOX HFG1 - (HFQ1710 )

3

English text: SHOT COULD CAUSE PNEUMONIA
SideEffects
BOX HFG1 - (HFQ1710 )

4

English text: SHOT COULD HAVE SIDE EFFECTS OR CAUSE DISEASE
DidNotThinkPreventPneumonia
BOX HFG1 - (HFQ1710 )

5

English text: DIDN'T THINK IT WOULD PREVENT PNEUMONIA/COULD GET PNEUMONIA
ANYWAY
NotAtRisk
BOX HFG1 - (HFQ1710 )

6

English text: PNEUMONIA NOT SERIOUS/WOULD NOT GET PNEUMONIA ANYWAY/NOT
AT RISK
DrNotRecommended
BOX HFG1 - (HFQ1710 )
English text: DOCTOR DID NOT RECOMMEND THE SHOT

3:58:34 PM Monday, August 03, 2009

Page 109 of 760

HFF23

7

8

9

AllergicToShot	

BOX HFG1 - (HFQ1710 )

English text: DOCTOR RECOMMENDED AGAINST GETTING SHOT/ALLERGIC TO
SHOT/MEDICAL REASONS
DontLikeShots	
BOX HFG1 - (HFQ1710 )
English text: DON'T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT SORENESS OR
RASH/LOCAL REACTIONS
Inconvenient	
BOX HFG1 - (HFQ1710 )

10

English text: INCONVENIENT TO GET SHOT/UNABLE TO GET TO LOCATION
Forgot	
BOX HFG1 - (HFQ1710 )

11

English text: DIDN'T THINK ABOUT IT/FORGOT/MISSED IT
CostOfShot	
BOX HFG1 - (HFQ1710 )

91

English text: COST OF SHOT/NOT WORTH THE MONEY
Other	
HFF23 - PNUOTHOS ( HFQ1700 )
English text: OTHER

Attribute
Don't know

Route
BOX HFG1 - (HFQ1710 )

Refusal

BOX HFG1 - (HFQ1710 )

Field2:	
Cheshire Name:

PNUOTHOS

( HFQ1700 )

HEST.FLUOTHOS

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
BOX HFG1 - (HFQ1710 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
3:58:39 PM Monday, August 03, 2009	

Page 110 of 760

HFF23

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:58:39 PM Monday, August 03, 2009

Page 111 of 760

BOX HFG1

BOX HFG1

580

Page Order # :

BOX INSTRUCTIONS
( HFQ1710 )	

IF SP WAS ASKED IF HE/SHE NOW SMOKES CIGARETTES, CIGARS, OR
PIPE TOBACCO IN A PREVIOUS ROUND, GO TO HFG2 - SMOKNOW (
HFQ1740 ).
ELSE GO TO HFG1 - EVERSMOK ( HFQ1720 ).

ASSIGNMENTS

TECHNICAL NOTES
419

HFNowSmokesPrev

SP was asked if he/she now smokes cigarettes, cigars,
or pipe tobacco in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.SMOKNOW ^= empty.

DESIGN NOTES

3:58:39 PM Monday, August 03, 2009	

Page 112 of 760

HFG1

HFG1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EVERSMOK

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

590

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:

[Have you/Has (SP)] ever smoked cigarettes, cigars, or pipe

tobacco?

Int. Instr II:
INPUT FIELDS / ROUTING

3:58:41 PM Monday, August 03, 2009

Page 113 of 760

HFG1
EVERSMOK

Field1:

( HFQ1720 )

HEST.EVERSMOK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG2 - SMOKNOW ( HFQ1740 )

English text: YES
No

HFG7 - DRINKDAY ( HFQ1795 )

English text: NO
Attribute
Don't know

Route
HFG7 - DRINKDAY ( HFQ1795 )

Refusal

HFG7 - DRINKDAY ( HFQ1795 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:58:43 PM Monday, August 03, 2009

Page 114 of 760

HFG2

HFG2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

SMOKNOW

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

600

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:

[Do you/Does (SP)] smoke cigarettes, cigars, or pipe tobacco now?


Int. Instr II:

INPUT FIELDS / ROUTING

3:58:44 PM Monday, August 03, 2009

Page 115 of 760

HFG2
SMOKNOW

Field1:

HEST.SMOKNOW

Cheshire Name:
Item Text display:

( HFQ1740 )

Do not display response option 3/NoButOriginalllyYes.

Item Text:
Label:

Label Position:

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


Enumerated
TOchbp

1

No
No


Number Label
1 Yes

FieldSize:

Min Value:

Max Value:

Mask:


Route
HFG5 - HAVSMOKE ( HFQ1775 )

2

English text: YES
No

3

English text: NO
NoButOriginallyYes


HFG3 - DIDSMOKE ( HFQ1755 )

DO NOT DISPLAY.

DATA EDITING ONLY.

English text: NO, BUT ORIGINALLY YES
Attribute
Don't know

Route
HFG7 - DRINKDAY ( HFQ1795 )

Refusal

HFG7 - DRINKDAY ( HFQ1795 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:58:47 PM Monday, August 03, 2009

Page 116 of 760

HFG3

HFG3

Page Order # :

Design Screen Type:	

Numeric

Fields:	

Field 1:

DIDSMOKE

Field 2:

DIDSMOKE_LESSONE

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

640

Roster Name:
Roster Type:

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:

Question Text:

How many years did [you/(SP)] smoke?


Int. Instr II:

INPUT FIELDS / ROUTING


3:58:49 PM Monday, August 03, 2009	

Page 117 of 760

HFG3
DIDSMOKE

Field1:

( HFQ1755 )

HEST.DIDSMOKE

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF YEARS:
Left

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

Integer
TDidsmok
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:


Route
HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )

Attribute
Empty

Route
HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )

Don't know

HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )

Refusal

HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )

3:58:53 PM Monday, August 03, 2009

1

96


Page 118 of 760

HFG3
DIDSMOKE_LESSONE ( HFQ1758 )

Field2:

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.DIDSMOKE_LESSONE = 1/LessThanOneYear, set 

HEST.DIDSMOKE = 96.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated

TDidSmok96
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG4 - LASTSMOK ( HFQ1765 )

English text: LESS THAN ONE YEAR
Attribute
Empty

Route
HFG4 - LASTSMOK ( HFQ1765 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If DIDSMOKE ^= EMPTY then DIDSMOKE = 1-75, DK, RF.

If not true, display message "UNLIKELY NUMBER OF YEARS.

PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1

If DIDSMOKE ^= EMPTY then DIDSMOKE = 1-95, DK, RF.

If not true, display message "NUMBER OF YEARS MUST BE

BETWEEN 1 AND 95 OR LESS THAN ONE YEAR. PLEASE 

REENTER."

Edit #2

DIDSMOKE and DIDSMOKE_LESSONE cannot both be EMPTY.

If not true, display message "ENTRY REQUIRED. PLEASE ENTER


3:58:56 PM Monday, August 03, 2009

Page 119 of 760

HFG3
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
Edit #3
DIDSMOKE and DIDSMOKE_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES

DESIGN NOTES

3:58:56 PM Monday, August 03, 2009

Page 120 of 760

HFG4

HFG4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LASTSMOK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

650

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:

About how long has it been since [you/(SP)] last smoked regularly?


Int. Instr II:

INPUT FIELDS / ROUTING

3:58:58 PM Monday, August 03, 2009

Page 121 of 760

HFG4
LASTSMOK

Field1:

( HFQ1765 )

HEST.LASTSMOKE

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
TLastsmo
1
No
No

Number Label
1 WithTheLastMonth

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG7 - DRINKDAY ( HFQ1795 )

2

English text: WITHIN THE LAST MONTH
OneMonthToLessThan6MonthsAgo

3

English text: 1 MONTH TO LESS THAN 6 MONTHS AGO
SixMonthsToLessThan1YearAgo
HFG7 - DRINKDAY ( HFQ1795 )

4

English text: 6 MONTHS TO LESS THAN 1 YEAR AGO
OneYearToLessThan5YearsAgo
HFG7 - DRINKDAY ( HFQ1795 )

5

English text: 1 YEAR TO LESS THAN 5 YEARS AGO
FiveYearsToLessThan10YearsAgo
HFG7 - DRINKDAY ( HFQ1795 )

6

English text: 5 YEARS TO LESS THAN 10 YEARS AGO
TenOrMoreYearsAgo
HFG7 - DRINKDAY ( HFQ1795 )

HFG7 - DRINKDAY ( HFQ1795 )

English text: 10 OR MORE YEARS AGO
Attribute
Don't know

Route
HFG7 - DRINKDAY ( HFQ1795 )

Refusal

HFG7 - DRINKDAY ( HFQ1795 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
3:59:04 PM Monday, August 03, 2009

Page 122 of 760

HFG4

TECHNICAL NOTES

DESIGN NOTES

3:59:04 PM Monday, August 03, 2009

Page 123 of 760

HFG5

HFG5

Page Order # :

Design Screen Type:	

Numeric

Fields:	

Field 1:

HAVSMOKE

Field 2:

HAVSMOKE_LESSON

E


HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

660

Roster Name:
Roster Type:

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:

Question Text:

How many years [have you/has (SP)] smoked?


Int. Instr II:

INPUT FIELDS / ROUTING


3:59:06 PM Monday, August 03, 2009	

Page 124 of 760

HFG5
HAVSMOKE

Field1:

( HFQ1775 )

HEST.HAVSMOKE

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF YEARS:
Left

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

Integer
TDidsmok
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:


Route
HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )

Attribute
Empty

Route
HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )

Don't know

HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )

Refusal

HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )

3:59:10 PM Monday, August 03, 2009

1

96


Page 125 of 760

HFG5
HAVSMOKE_LESSON ( HFQ1778 )
E

Field2:

NONE


Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.HAVSMOKE_LESSONE = 1/LessThanOneYear, set 

HEST.HAVSMOKE = 96.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated

TDidSmok96
1
No
No

Number Label
1 LessThanOneYear
English text: LESS THAN ONE YEAR
Attribute
Empty

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG5A - DRQTSMOK ( HFQ1784 )

Route
HFG5A - DRQTSMOK ( HFQ1784 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If HAVSMOKE ^= EMPTY then HAVSMOKE = 1-75, DK, RF.

If not true, display message "UNLIKELY NUMBER OF YEARS.

PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1
If HAVSMOKE ^= EMPTY then HAVSMOKE = 1-95, DK, RF.
If not true, display message "NUMBER OF YEARS MUST BE
BETWEEN 1 AND 95 OR LESS THAN ONE YEAR, PLEASE
REENTER."
Edit #2
HAVSMOKE and HAVSMOKE_LESSONE cannot both be EMPTY.

3:59:12 PM Monday, August 03, 2009

Page 126 of 760

HFG5
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
Edit #3
HAVSMOKE and HAVSMOKE_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES

DESIGN NOTES

3:59:12 PM Monday, August 03, 2009

Page 127 of 760

HFG5A

HFG5A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DRQTSMOK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

665

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 (LAST HF MONTH YEAR), has a doctor or other health

professional advised [you/(SP)] to quit smoking?

Int. Instr II:
INPUT FIELDS / ROUTING

3:59:14 PM Monday, August 03, 2009

Page 128 of 760

HFG5A
DRQTSMOK

Field1:

( HFQ1784 )

HEST.DRQTSMOK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG6 - QUITSMOK ( HFQ1789 )

English text: YES
No

HFG6 - QUITSMOK ( HFQ1789 )

English text: NO
Attribute
Don't know

Route
HFG6 - QUITSMOK ( HFQ1789 )

Refusal

HFG6 - QUITSMOK ( HFQ1789 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:59:16 PM Monday, August 03, 2009

Page 129 of 760

HFG6

HFG6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

QUITSMOK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

670

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:	

During the past 12 months, [have you/has (SP)] stopped smoking for
one day or longer because (you were/he was/she was) trying to quit
smoking?

Int. Instr II:
INPUT FIELDS / ROUTING

3:59:17 PM Monday, August 03, 2009	

Page 130 of 760

HFG6
QUITSMOK

Field1:

( HFQ1789 )

HEST.QUITSMOK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG7 - DRINKDAY ( HFQ1795 )

English text: YES
No

HFG7 - DRINKDAY ( HFQ1795 )

English text: NO
Attribute
Don't know

Route
HFG7 - DRINKDAY ( HFQ1795 )

Refusal

HFG7 - DRINKDAY ( HFQ1795 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:59:20 PM Monday, August 03, 2009

Page 131 of 760

HFG7

HFG7

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DRINKDAY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

690

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:	

The next questions are about drinking alcoholic beverages. Included
are liquor such as whiskey or gin, mixed drinks, wine, beer, and any
other type of alcoholic beverage.
Please think about a typical month in the past year. On how many
days did [you/(SP)] drink any type of alcoholic beverage?

Int. Instr II:

ENTER "0" FOR "NEVER DRANK" OR "NONE".

INPUT FIELDS / ROUTING

3:59:21 PM Monday, August 03, 2009	

Page 132 of 760

HFG7
DRINKDAY

Field1:

( HFQ1795 )

HEST.DRINKDAY

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF DAYS:
Left

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

Integer
TDrinkda
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
BOX HFG2 - (HFQ1805 )

Refusal

BOX HFG2 - (HFQ1805 )

FieldSize:

Min Value:
Max Value:
Mask:


0

31


Route
BOX HFG2 - (HFQ1805 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:59:22 PM Monday, August 03, 2009

Page 133 of 760

BOX HFG2

BOX HFG2

Page Order # :

700

BOX INSTRUCTIONS
( HFQ1805 )	

IF HFG7 - DRINKDAY = 0, GO TO HFHINTRO - DIFINTRO ( HFQ1870 ).
ELSE GO TO HFG8 - DRINKSPD ( HFQ1815 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

3:59:22 PM Monday, August 03, 2009	

Page 134 of 760

HFG8

HFG8

Page Order # :

Design Screen Type:	

Numeric

Fields:	

Field 1:

DRINKSPD

Field 2:

DRINKSPD_LESSONE

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

710

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[Please…]" in brackets.
	

Multi Field display:

Vertical Alignment


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

[Please think about a typical month in the past year.] On those days
that [you/(SP)] drank alcohol, how many drinks did (you/he/she)
have?

Int. Instr II:

INPUT FIELDS / ROUTING


3:59:25 PM Monday, August 03, 2009	

Page 135 of 760

HFG8
DRINKSPD

Field1:

( HFQ1815 )

HEST.DRINKSPD

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF DRINKS:
Left

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

Integer
Tdrinksp
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:


Route
HFG8 - DRINKSPD_LESSONE ( HFQ1818 )

Attribute
Empty

Route
HFG8 - DRINKSPD_LESSONE ( HFQ1818 )

Don't know

HFG8 - DRINKSPD_LESSONE ( HFQ1818 )

Refusal

HFG8 - DRINKSPD_LESSONE ( HFQ1818 )

3:59:29 PM Monday, August 03, 2009

1

96


Page 136 of 760

HFG8
DRINKSPD_LESSONE ( HFQ1818 )

Field2:

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.DRINKSPD_LESSONE =

1/LessThanOneAlcoholDrinkPerDay, set HEST.DRINKSPD =

96.
Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TDrinksp96
1
No
No

Number Label
1 LessThanOne

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFG9 - FOURDRNK ( HFQ1825 )

English text: LESS THAN ONE
Attribute
Empty

Route
HFG9 - FOURDRNK ( HFQ1825 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If DRINKSPD ^= EMPTY then DRINKSPD = 1-12, DK, RF.

If not true, display message "UNLIKELY NUMBER OF DRINKS. 

PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1

If DRINKSPD ^= EMPTY then DRINKSPD = 1-50, DK, RF.

If not true, display message "NUMBER OF DRINKS MUST BE

BETWEEN 1 AND 50 OR LESS THAN ONE. PLEASE REENTER."

Edit #2

DRINKSPD and DRINKSPD_LESSONE cannot both be EMPTY.

If not true, display message "ENTRY REQUIRED. PLEASE ENTER


3:59:31 PM Monday, August 03, 2009

Page 137 of 760

HFG8
NUMBER OF DRINKS OR SELECT "LESS THAN ONE"."
Edit #3
DRINKSPD and DRINKSPD_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF DRINKS OR SELECT "LESS THAN ONE"."
TECHNICAL NOTES

DESIGN NOTES

3:59:31 PM Monday, August 03, 2009

Page 138 of 760

HFG9

HFG9

Page Order # :

Design Screen Type:	

Numeric

Fields:	

Field 1:

FOURDRNK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

720

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[Please…]" in brackets.
	

Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Please think about a typical month in the past year.] On how many

days did [you/(SP)] have 4 or more drinks in a single day?

Int. Instr II:

ENTER "0" FOR "NEVER" OR "NONE".

INPUT FIELDS / ROUTING

3:59:32 PM Monday, August 03, 2009	

Page 139 of 760

HFG9
FOURDRNK

Field1:

( HFQ1825 )

HEST.FOURDRNK

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF DAYS:
Left

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

Integer
TDrinkda
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HFHINTRO - DIFINTRO ( HFQ1870 )

Refusal

HFHINTRO - DIFINTRO ( HFQ1870 )

FieldSize:

Min Value:
Max Value:
Mask:


0

31


Route
HFHINTRO - DIFINTRO ( HFQ1870 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:59:34 PM Monday, August 03, 2009

Page 140 of 760

HFHINTRO

HFHINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

DIFINTRO

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

730

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:

Now, I'm going to ask about how difficult it is, on the average, for
[you/(SP)] to do certain kinds of activities. Please tell me for each
activity whether [you have/(SP) has] no difficulty at all, a little
difficulty, some difficulty, a lot of difficulty, or (is/are) not able to do it.

Int. Instr II:
INPUT FIELDS / ROUTING

3:59:35 PM Monday, August 03, 2009

Page 141 of 760

HFHINTRO
DIFINTRO

Field1:

( HFQ1870 )

TEMP

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
HFH1 - DIFSTOOP ( HFQ1880 )

English text: CONTINUE
Attribute
Empty

Route
HFH1 - DIFSTOOP ( HFQ1880 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

3:59:37 PM Monday, August 03, 2009

Page 142 of 760

HFH1

HFH1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFSTOOP

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

740

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:	

SHOW CARD HF1

Question Text:	

How much difficulty, if any, [do you/does (SP)] have stooping,
crouching, or kneeling? Would you say [you have/(SP) has] no
difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or
(is/are) not able to do it?

Int. Instr II:
INPUT FIELDS / ROUTING

3:59:39 PM Monday, August 03, 2009	

Page 143 of 760

HFH1
DIFSTOOP

Field1:

( HFQ1880 )

HEST.DIFSTOOP

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
TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH2 - DIFLIFT ( HFQ1890 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

HFH2 - DIFLIFT ( HFQ1890 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

HFH2 - DIFLIFT ( HFQ1890 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

HFH2 - DIFLIFT ( HFQ1890 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

HFH2 - DIFLIFT ( HFQ1890 )

English text: NOT ABLE TO DO IT
Attribute
Don't know

Route
HFH2 - DIFLIFT ( HFQ1890 )

Refusal

HFH2 - DIFLIFT ( HFQ1890 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

3:59:44 PM Monday, August 03, 2009

Page 144 of 760

HFH1
DESIGN NOTES

3:59:44 PM Monday, August 03, 2009

Page 145 of 760


HFH2

HFH2

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFLIFT

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

750

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:	

SHOW CARD HF1

Question Text:	

How much difficulty, if any, [do you/does (SP)] have lifting or carrying
objects as heavy as 10 pounds, like a sack of potatoes? Would you
say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or (is/are) not able to do it?

Int. Instr II:
INPUT FIELDS / ROUTING

3:59:46 PM Monday, August 03, 2009	

Page 146 of 760

HFH2
DIFLIFT

Field1:

( HFQ1890 )

HEST.DIFLIFT

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
TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH3 - DIFREACH ( HFQ1900 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

HFH3 - DIFREACH ( HFQ1900 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

HFH3 - DIFREACH ( HFQ1900 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

HFH3 - DIFREACH ( HFQ1900 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

HFH3 - DIFREACH ( HFQ1900 )

English text: NOT ABLE TO DO IT
Attribute
Don't know

Route
HFH3 - DIFREACH ( HFQ1900 )

Refusal

HFH3 - DIFREACH ( HFQ1900 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

3:59:50 PM Monday, August 03, 2009

Page 147 of 760

HFH2
DESIGN NOTES

3:59:50 PM Monday, August 03, 2009

Page 148 of 760


HFH3

HFH3

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFREACH

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

760

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:

SHOW CARD HF1

Question Text:

What about reaching or extending arms above shoulder level?

Int. Instr II:
INPUT FIELDS / ROUTING

3:59:52 PM Monday, August 03, 2009

Page 149 of 760

HFH3
DIFREACH

Field1:

( HFQ1900 )

HEST.DIFREACH

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
TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH4 - DIFWRITE ( HFQ1910 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

HFH4 - DIFWRITE ( HFQ1910 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

HFH4 - DIFWRITE ( HFQ1910 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

HFH4 - DIFWRITE ( HFQ1910 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

HFH4 - DIFWRITE ( HFQ1910 )

English text: NOT ABLE TO DO IT
Attribute
Don't know

Route
HFH4 - DIFWRITE ( HFQ1910 )

Refusal

HFH4 - DIFWRITE ( HFQ1910 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

3:59:57 PM Monday, August 03, 2009

Page 150 of 760

HFH3
DESIGN NOTES

3:59:57 PM Monday, August 03, 2009

Page 151 of 760


HFH4

HFH4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFWRITE

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

770

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:	

SHOW CARD HF1

Question Text:	

How much difficulty, if any, [do you/does (SP)] have either writing or
handling and grasping small objects? Would you say [you
have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a
lot of difficulty, or (is/are) not able to do it?

Int. Instr II:
INPUT FIELDS / ROUTING

3:59:59 PM Monday, August 03, 2009	

Page 152 of 760

HFH4
DIFWRITE

Field1:

( HFQ1910 )

HEST.DIFWRITE

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
TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH5 - DIFWALK ( HFQ1920 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

HFH5 - DIFWALK ( HFQ1920 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

HFH5 - DIFWALK ( HFQ1920 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

HFH5 - DIFWALK ( HFQ1920 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

HFH5 - DIFWALK ( HFQ1920 )

English text: NOT ABLE TO DO IT
Attribute
Don't know

Route
HFH5 - DIFWALK ( HFQ1920 )

Refusal

HFH5 - DIFWALK ( HFQ1920 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:00:03 PM Monday, August 03, 2009

Page 153 of 760

HFH4
DESIGN NOTES

4:00:03 PM Monday, August 03, 2009

Page 154 of 760


HFH5

HFH5

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIFWALK

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

780

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:

SHOW CARD HF1

Question Text:

What about walking a quarter of a mile - that is, about 2 or 3 blocks?

Int. Instr II:
INPUT FIELDS / ROUTING

4:00:05 PM Monday, August 03, 2009

Page 155 of 760

HFH5
DIFWALK

Field1:

( HFQ1920 )

HEST.DIFWALK

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
TDiffcult
1
No
No

Number Label
1 NoDifficultyAtAll

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH10INT - PHYSACTINTRO ( HFQ1935 )

2

English text: NO DIFFICULTY AT ALL
ALittleDifficulty

HFH10INT - PHYSACTINTRO ( HFQ1935 )

3

English text: A LITTLE DIFFICULTY
SomeDifficulty

HFH10INT - PHYSACTINTRO ( HFQ1935 )

4

English text: SOME DIFFICULTY
ALotOfDifficulty

HFH10INT - PHYSACTINTRO ( HFQ1935 )

5

English text: A LOT OF DIFFICULTY
NotAbleToDoIt

HFH10INT - PHYSACTINTRO ( HFQ1935 )

English text: NOT ABLE TO DO IT
Attribute
Don't know

Route
HFH10INT - PHYSACTINTRO ( HFQ1935 )

Refusal

HFH10INT - PHYSACTINTRO ( HFQ1935 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:00:10 PM Monday, August 03, 2009

Page 156 of 760

HFH5
DESIGN NOTES

4:00:10 PM Monday, August 03, 2009

Page 157 of 760


HFH10INT

HFH10INT

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PHYSACTINTRO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

850

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

We are interested in two types of physical activity - vigorous and
moderate. Vigorous activities cause large increases in breathing or
heart rate. Moderate activities cause small increases in breathing or
heart rate. First I will ask about the vigorous activities that [you
do/(SP) does].

Int. Instr II:

INPUT FIELDS / ROUTING


4:00:11 PM Monday, August 03, 2009	

Page 158 of 760

HFH10INT
PHYSACTINTRO

Field1:

( HFQ1935 )

TEMP

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
HFH10 - VIGUNIT ( HFQ1945 )

English text: CONTINUE
Attribute
Empty

Route
HFH10 - VIGUNIT ( HFQ1945 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:00:13 PM Monday, August 03, 2009

Page 159 of 760

HFH10

HFH10

Page Order # :

Design Screen Type:	

Quantity Unit

Fields:	

Field 1:

VIGUNIT

Field 2:

VIGNUM

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

860

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If respondent is SP, display "you do".
Else display "(SP) does".

Multi Field display:

Vertical Alignment

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

In a typical week, how much time [do you/does (SP)] spend doing
vigorous activities, such as team sports, running, aerobics, heavy
house or yard work, or anything else that causes large increases in
breathing or heart rate?

Int. Instr II:	

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO
NEAREST HOUR.

4:00:15 PM Monday, August 03, 2009	

Page 160 of 760

HFH10
INPUT FIELDS / ROUTING
VIGUNIT

Field1:

HEST.VIGUNIT

Cheshire Name:
Item Text display:

( HFQ1945 )

Display response options in the following order: 96, 1, 2, 3,
4.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TVigunit
1
No
No

Number Label
1 NumberOfMinutesPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH10 - VIGNUM ( HFQ1955 )

3

English text: NUMBER OF MINUTES PER DAY
NumberOfHoursPerDay
HFH10 - VIGNUM ( HFQ1955 )
English text: NUMBER OF HOURS PER DAY
NumberOfHoursPerWeek
HFH10 - VIGNUM ( HFQ1955 )

4

English text: NUMBER OF HOURS PER WEEK
NumberOfHoursPerMonth
HFH10 - VIGNUM ( HFQ1955 )

2

96

English text: NUMBER OF HOURS PER MONTH
None
HFH11 - MODUNIT ( HFQ1965 )
English text: NONE

Attribute
Don't know

Route
HFH11 - MODUNIT ( HFQ1965 )

Refusal

HFH11 - MODUNIT ( HFQ1965 )

4:00:20 PM Monday, August 03, 2009

Page 161 of 760

HFH10

Field2:

VIGNUM

( HFQ1955 )

HEST.VIGNUM

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER:
Left

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

Integer
Tvignum
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

3
1
999

Route
HFH11 - MODUNIT ( HFQ1965 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

If VIGUNIT = 1/NumberOfMinutesPerDay, then VIGNUM = 1-90. 

Else if VIGUNIT = 2/NumberOfHoursPerDay, then VIGNUM = 1-5.

Else if VIGUNIT = 3/NumberOfHoursPerWeeK, VIGNUM = 1-35.

Else if VIGUNIT = 4/NumberOfHoursPerMonth, VIGNUM = 1-150.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER SEEMS UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1:

If VIGUNIT = 1/NumberOfMinutesPerDay, then VIGNUM = 1-120. 

Else if VIGUNIT = 2/NumberOfHoursPerDay, then VIGNUM = 1-8.

Else if VIGUNIT = 3/NumberOfHoursPerWeeK, VIGNUM = 1-56.

Else if VIGUNIT = 4/NumberOfHoursPerMonth, VIGNUM = 1-224.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER IN NOT VALID. PLEASE REENTER."

TECHNICAL NOTES

DESIGN NOTES

4:00:21 PM Monday, August 03, 2009

Page 162 of 760

HFH11

HFH11

Page Order # :

Design Screen Type:	

Quantity Unit

Fields:	

Field 1:

MODUNIT

Field 2:

MODNUM

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

870

Roster Name:
Roster Type:

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:
Question Text:	

In a typical week, how much time [do you/does (SP)] spend doing
moderate activities, such as brisk walking, bicycling, gardening, golf,
swimming, or vacuuming?

Int. Instr II:	

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO
NEAREST HOUR.

INPUT FIELDS / ROUTING

4:00:23 PM Monday, August 03, 2009	

Page 163 of 760

HFH11
MODUNIT

Field1:

HEST.MODUNIT

Cheshire Name:
Item Text display:

( HFQ1965 )

Display response options in the following order: 96, 1, 2, 3,
4.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TVigunit
1
No
No

Number Label
1 NumberOfMinutesPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH11 - MODNUM ( HFQ1975 )

2

English text: NUMBER OF MINUTES PER DAY
NumberOfHoursPerDay
HFH11 - MODNUM ( HFQ1975 )

3

English text: NUMBER OF HOURS PER DAY
NumberOfHoursPerWeek
HFH11 - MODNUM ( HFQ1975 )

4

English text: NUMBER OF HOURS PER WEEK
NumberOfHoursPerMonth
HFH11 - MODNUM ( HFQ1975 )

96

English text: NUMBER OF HOURS PER MONTH
None
HFH12 - MUSUNIT ( HFQ1985 )
English text: NONE

Attribute
Don't know

Route
HFH12 - MUSUNIT ( HFQ1985 )

Refusal

HFH12 - MUSUNIT ( HFQ1985 )

4:00:29 PM Monday, August 03, 2009

Page 164 of 760

HFH11

Field2:

MODNUM

( HFQ1975 )

HEST.MODNUM

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER:
Left

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

Integer
Tvignum
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

3
1
999

Route
HFH12 - MUSUNIT ( HFQ1985 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

If MODUNIT = 1/NumberOfMinutesPerDay, then MODNUM = 1-90. 

Else if MODUNIT = 2/NumberOfHoursPerDay, then MODNUM = 1
5.

Else if MODUNIT = 3/NumberOfHoursPerWeeK, MODNUM = 1-35.

Else if MODUNIT = 4/NumberOfHoursPerMonth, MODNUM = 1
150.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER SEEMS UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1:

If MODUNIT = 1/NumberOfMinutesPerDay, then MODNUM = 1-120.

Else if MODUNIT = 2/NumberOfHoursPerDay, then MODNUM = 1
8.

Else if MODUNIT = 3/NumberOfHoursPerWeeK, MODNUM = 1-56.

Else if MODUNIT = 4/NumberOfHoursPerMonth, MODNUM = 1
224.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER IN NOT VALID. PLEASE REENTER."

TECHNICAL NOTES

DESIGN NOTES

4:00:29 PM Monday, August 03, 2009

Page 165 of 760

HFH12

HFH12

Page Order # :

Design Screen Type:	

Quantity Unit

Fields:	

Field 1:

MUSUNIT

Field 2:

MUSNUM

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

880

Roster Name:
Roster Type:

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:
Question Text:	

Now I’m going to ask you about activities [you/(SP)] may do to
increase (your/his/her) muscle strength or flexibility.
In a typical week, how much time [do you/does (SP)] spend doing
exercises to increase (your/his/her) muscle strength or flexibility,
such as lifting weights, push-ups, sit-ups, stretching, or yoga?

Int. Instr II:	

4:00:32 PM Monday, August 03, 2009	

IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO
NEAREST HOUR.

Page 166 of 760

HFH12
INPUT FIELDS / ROUTING
MUSUNIT

Field1:

HEST.MUSUNIT

Cheshire Name:
Item Text display:

( HFQ1985 )

Display response options in the following order: 96, 1, 2, 3,
4.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TVigunit
1
No
No

Number Label
1 NumberOfMinutesPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFH12 - MUSNUM ( HFQ1995 )

2

English text: NUMBER OF MINUTES PER DAY
NumberOfHoursPerDay
HFH12 - MUSNUM ( HFQ1995 )

3

English text: NUMBER OF HOURS PER DAY
NumberOfHoursPerWeek
HFH12 - MUSNUM ( HFQ1995 )

4

English text: NUMBER OF HOURS PER WEEK
NumberOfHoursPerMonth
HFH12 - MUSNUM ( HFQ1995 )

96

English text: NUMBER OF HOURS PER MONTH
None
HFJINTRO - MEDCONDINTRO ( HFQ2060 )
English text: NONE

Attribute
Don't know

Route
HFJINTRO - MEDCONDINTRO ( HFQ2060 )

Refusal

HFJINTRO - MEDCONDINTRO ( HFQ2060 )

4:00:37 PM Monday, August 03, 2009

Page 167 of 760

HFH12

Field2:

MUSNUM

( HFQ1995 )

HEST.MUSNUM

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER:
Left

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

Integer
Tvignum
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

3
1
999

Route
HFJINTRO - MEDCONDINTRO ( HFQ2060 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

If MUSUNIT = 1/NumberOfMinutesPerDay, then MUSNUM = 1-90. 

Else if MUSUNIT = 2/NumberOfHoursPerDay, then MUSNUM = 1-5.

Else if MUSUNIT = 3/NumberOfHoursPerWeeK, MUSNUM = 1-35.

Else if MUSUNIT = 4/NumberOfHoursPerMonth, MUSNUM = 1-150.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER SEEMS UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1:

If MUSUNIT = 1/NumberOfMinutesPerDay, then MUSNUM = 1-120. 

Else if MUSUNIT = 2/NumberOfHoursPerDay, then MUSNUM = 1-8.

Else if MUSUNIT = 3/NumberOfHoursPerWeeK, MUSNUM = 1-56.

Else if MUSUNIT = 4/NumberOfHoursPerMonth, MUSNUM = 1-224.

If not true, display message: "THE VALUE ENTERED FOR

NUMBER IN NOT VALID. PLEASE REENTER."

TECHNICAL NOTES

DESIGN NOTES

4:00:38 PM Monday, August 03, 2009

Page 168 of 760

HFJINTRO

HFJINTRO

Page Order # :

Design Screen Type:	

No Entry

Fields:	

Field 1:

MEDCONDINTRO

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

890

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

Next, I'm going to read a list of medical conditions. [Since (LAST HF
MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had any of these conditions?

Int. Instr II:

INPUT FIELDS / ROUTING


4:00:39 PM Monday, August 03, 2009	

Page 169 of 760

HFJINTRO
MEDCONDINTRO

Field1:

( HFQ2060 )

TEMP

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 HFJ1 - (HFQ2070 )

English text: CONTINUE
Attribute
Empty

Route
BOX HFJ1 - (HFQ2070 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:00:41 PM Monday, August 03, 2009

Page 170 of 760

BOX HFJ1

BOX HFJ1

Page Order # :

900

BOX INSTRUCTIONS
( HFQ2070 )	

IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN
A PREVIOUS ROUND, GO TO HFJ2 - OCHBP ( HFQ2110 ).
ELSE GO TO HFJ1 - OCARTERY ( HFQ2080 ).

ASSIGNMENTS

TECHNICAL NOTES
390

HFHardenArtery

SP has ever reported having hardening of the arteries in
a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCARTERY = 1/Yes.

DESIGN NOTES

4:00:41 PM Monday, August 03, 2009	

Page 171 of 760

HFJ1

HFJ1

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

OCARTERY

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

910

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...
hardening of the arteries or arteriosclerosis?

Int. Instr II:

INPUT FIELDS / ROUTING


4:00:42 PM Monday, August 03, 2009	

Page 172 of 760

HFJ1
( HFQ2080 )

OCARTERY

Field1:

HEST.OCARTERY

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ2 - OCHBP ( HFQ2110 )

English text: YES
No

HFJ2 - OCHBP ( HFQ2110 )

English text: NO
Attribute
Don't know

Route
HFJ2 - OCHBP ( HFQ2110 )

Refusal

HFJ2 - OCHBP ( HFQ2110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:00:45 PM Monday, August 03, 2009

Page 173 of 760

HFJ2

HFJ2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCHBP

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

930

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP reported having hypertension in the previous round then:
If SP is respondent, display "still have".
Else display "still has".
Else then:
If SP is respondent, display "have".
Else display "had".
If HJ1 - OCARTERY was asked in the current round, display first
line, "[Since...]", in brackets.
Else do not display first line in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:
4:00:46 PM Monday, August 03, 2009

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
Page 174 of 760

HFJ2
[you/(SP)] that (you/he/she) (still have/still has/have/had)...]
hypertension, sometimes called high blood pressure?
Int. Instr II:

INPUT FIELDS / ROUTING

OCHBP

Field1:

HEST.OCHBP

Cheshire Name:
Item Text display:

( HFQ2110 )

Do not display response option 3/NoButOriginallyYes.

Item Text:
Label:

Label Position:

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


Enumerated
TOchbp

1

No
No


Number Label
1 Yes

FieldSize:

Min Value:

Max Value:

Mask:


Route
BOX HFJ2 - (HFQ2140 )

2

English text: YES
No

3

English text: NO
NoButOriginallyYes

HFJ4 - OCMYOCAR ( HFQ2160 )

DO NOT DISPLAY. DATA EDITING ONLY.
English text: NO, BUT ORIGINALLY YES
Attribute
Don't know

Route
HFJ4 - OCMYOCAR ( HFQ2160 )

Refusal

HFJ4 - OCMYOCAR ( HFQ2160 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

4:00:49 PM Monday, August 03, 2009

Page 175 of 760

HFJ2
TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

391

HFHypertension	

SP reported having hypertension in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCHBP = 1/Yes.

DESIGN NOTES

4:00:49 PM Monday, August 03, 2009	

Page 176 of 760

BOX HFJ2

BOX HFJ2

Page Order # :

950

BOX INSTRUCTIONS
( HFQ2140 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ3 - YRHBP (
HFQ2150 ).
ELSE GO TO HFJ4 - OCMYOCAR ( HFQ2160 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:00:49 PM Monday, August 03, 2009

Page 177 of 760

HFJ3

HFJ3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRHBP

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

960

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that

(you/he/she) still had hypertension or high blood pressure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:00:51 PM Monday, August 03, 2009

Page 178 of 760

HFJ3
YRHBP

Field1:

( HFQ2150 )

HEST.YRHBP

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ4 - OCMYOCAR ( HFQ2160 )

English text: YES
No

HFJ4 - OCMYOCAR ( HFQ2160 )

English text: NO
Attribute
Don't know

Route
HFJ4 - OCMYOCAR ( HFQ2160 )

Refusal

HFJ4 - OCMYOCAR ( HFQ2160 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:00:53 PM Monday, August 03, 2009

Page 179 of 760

HFJ4

HFJ4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCMYOCAR

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

970

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
a myocardial infarction or heart attack?

Int. Instr II:

4:00:54 PM Monday, August 03, 2009

Page 180 of 760

HFJ4
INPUT FIELDS / ROUTING
OCMYOCAR

Field1:

( HFQ2160 )

HEST.OCMYOCAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ3 - (HFQ2190 )

English text: YES
No
English text: NO

HFJ6 - OCCHD ( HFQ2210 )

Attribute
Don't know

Route
HFJ6 - OCCHD ( HFQ2210 )

Refusal

HFJ6 - OCCHD ( HFQ2210 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:00:57 PM Monday, August 03, 2009

Page 181 of 760

BOX HFJ3

BOX HFJ3

Page Order # :

990

BOX INSTRUCTIONS
( HFQ2190 )	

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ5 - YRMYOCAR (
HFQ2200 ).
ELSE GO TO HFJ6 - OCCHD ( HFQ2210 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:00:57 PM Monday, August 03, 2009	

Page 182 of 760

HFJ5

HFJ5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRMYOCAR

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

1000

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that

(you/he/she) had a myocardial infarction or heart attack?

Int. Instr II:
INPUT FIELDS / ROUTING

4:00:58 PM Monday, August 03, 2009

Page 183 of 760

HFJ5
YRMYOCAR

Field1:

( HFQ2200 )

HEST.YRMYOCAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ6 - OCCHD ( HFQ2210 )

English text: YES
No

HFJ6 - OCCHD ( HFQ2210 )

English text: NO
Attribute
Don't know

Route
HFJ6 - OCCHD ( HFQ2210 )

Refusal

HFJ6 - OCCHD ( HFQ2210 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:01:00 PM Monday, August 03, 2009

Page 184 of 760

HFJ6

HFJ6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCHD

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

1010

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having angina pectoris or coronary heart
disease in a previous round, display "a new episode of". Display
"new" in BOLD
Else do not display.
Always display first line, "[Since..]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

4:01:02 PM Monday, August 03, 2009

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
Page 185 of 760

HFJ6
(a new episode of) angina pectoris or coronary heart disease?
Int. Instr II:

INPUT FIELDS / ROUTING

( HFQ2210 )

OCCHD

Field1:

HEST.OCCHD

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ4 - (HFQ2240 )

English text: YES
No

HFJ8 - OCCFAIL ( HFQ2260 )

English text: NO
Attribute
Don't know

Route
HFJ8 - OCCFAIL ( HFQ2260 )

Refusal

HFJ8 - OCCFAIL ( HFQ2260 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:01:04 PM Monday, August 03, 2009

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
Page 186 of 760

HFJ6
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

392

HFAngina

SP has ever reported having hardening angina pectoris
or coronary heart disease in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCHD = 1/Yes.

DESIGN NOTES

4:01:04 PM Monday, August 03, 2009

Page 187 of 760

BOX HFJ4

BOX HFJ4

Page Order # :

1030

BOX INSTRUCTIONS
( HFQ2240 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ7 - YRCHD (
HFQ2250 ).
ELSE GO TO HFJ8 - OCCFAIL ( HFQ2260 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:01:04 PM Monday, August 03, 2009

Page 188 of 760

HFJ7

HFJ7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRCHD

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

1040

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of angina pectoris or coronary heart
disease?

Int. Instr II:
INPUT FIELDS / ROUTING

4:01:06 PM Monday, August 03, 2009	

Page 189 of 760

HFJ7
YRCHD

Field1:

( HFQ2250 )

HEST.YRCHD

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ8 - OCCFAIL ( HFQ2260 )

English text: YES
No

HFJ8 - OCCFAIL ( HFQ2260 )

English text: NO
Attribute
Don't know

Route
HFJ8 - OCCFAIL ( HFQ2260 )

Refusal

HFJ8 - OCCFAIL ( HFQ2260 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:01:08 PM Monday, August 03, 2009

Page 190 of 760

HFJ8

HFJ8

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCFAIL

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

1050

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having congestive heart failure in a previous
round, display "a new episode of ". Display "new" in BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

4:01:09 PM Monday, August 03, 2009

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]

Page 191 of 760

HFJ8
(a new episode of) congestive heart failure?
Int. Instr II:

INPUT FIELDS / ROUTING

( HFQ2260 )

OCCFAIL

Field1:

HEST.OCCFAIL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ5 - (HFQ2280 )

English text: YES
No

HFJ10 - OCCVALVE ( HFQ2300 )

English text: NO
Attribute
Don't know

Route
HFJ10 - OCCVALVE ( HFQ2300 )

Refusal

HFJ10 - OCCVALVE ( HFQ2300 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:01:12 PM Monday, August 03, 2009

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 192 of 760

HFJ8
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

393

HFCongHeartFailure

SP has ever reported having congestive heart failure in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCFAIL = 1/Yes.

DESIGN NOTES

4:01:12 PM Monday, August 03, 2009

Page 193 of 760

BOX HFJ5

BOX HFJ5

Page Order # :

1060

BOX INSTRUCTIONS
( HFQ2280 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ9 - YRCFAIL (
HFQ2290 ).
ELSE GO TO HFJ10 - OCCVALVE ( HFQ2300 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:01:12 PM Monday, August 03, 2009

Page 194 of 760

HFJ9

HFJ9

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRCFAIL

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

1070

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that

(you/he/she) had an episode of congestive heart failure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:01:14 PM Monday, August 03, 2009

Page 195 of 760

HFJ9
YRCFAIL

Field1:

( HFQ2290 )

HEST.YRCFAIL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ10 - OCCVALVE ( HFQ2300 )

English text: YES
No

HFJ10 - OCCVALVE ( HFQ2300 )

English text: NO
Attribute
Don't know

Route
HFJ10 - OCCVALVE ( HFQ2300 )

Refusal

HFJ10 - OCCVALVE ( HFQ2300 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:01:16 PM Monday, August 03, 2009

Page 196 of 760

HFJ10

HFJ10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCVALVE

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

1080

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having problems with the valves of the heart
in a previous round, display "a new episode of". Display "new" in
BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

4:01:17 PM Monday, August 03, 2009

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
Page 197 of 760

HFJ10
(a new episode of) problems with the valves of the heart, such as
aortic stenosis?
Int. Instr II:

INPUT FIELDS / ROUTING

( HFQ2300 )

OCCVALVE

Field1:	
Cheshire Name:

HEST.OCCVALVE

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 HFJ6 - (HFQ2320 )

English text: YES
No	

HFJ12 - OCRHYTHM ( HFQ2340 )

English text: NO
Attribute
Don't know

Route
HFJ12 - OCRHYTHM ( HFQ2340 )

Refusal

HFJ12 - OCRHYTHM ( HFQ2340 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD	

4:01:20 PM Monday, August 03, 2009	

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
Page 198 of 760

HFJ10
where MRES.MRESRND = current round.
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

394

HFHeartValve

SP has ever reported having problems with the valves of
the heart in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCVALVE = 1/Yes.

DESIGN NOTES

4:01:20 PM Monday, August 03, 2009

Page 199 of 760

BOX HFJ6

BOX HFJ6

Page Order # :

1090

BOX INSTRUCTIONS
( HFQ2320 )

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ11 - YRVALVE (
HFQ2330 ).
ELSE GO TO HFJ12 - OCRHYTHM ( HFQ2340 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:01:20 PM Monday, August 03, 2009

Page 200 of 760

HFJ11

HFJ11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRVALVE

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

1100

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of problems with the valves of the
heart, such as aortic stenosis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:01:21 PM Monday, August 03, 2009	

Page 201 of 760

HFJ11
YRVALVE

Field1:

( HFQ2330 )

HEST.YRVALVE

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ12 - OCRHYTHM ( HFQ2340 )

English text: YES
No

HFJ12 - OCRHYTHM ( HFQ2340 )

English text: NO
Attribute
Don't know

Route
HFJ12 - OCRHYTHM ( HFQ2340 )

Refusal

HFJ12 - OCRHYTHM ( HFQ2340 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:01:24 PM Monday, August 03, 2009

Page 202 of 760

HFJ12

HFJ12

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCRHYTHM

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

1110

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having problems with the rhythm of the
heart in a previous round, display "a new episode of". Display
"new" in BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

4:01:25 PM Monday, August 03, 2009

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
Page 203 of 760

HFJ12
(a new episode of) problems with the rhythm of (your/his/her)
heartbeat, such as atrial fibrillation?
Int. Instr II:

INPUT FIELDS / ROUTING

OCRHYTHM

Field1:	
Cheshire Name:

( HFQ2340 )

HEST.OCRHYTHM

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 HFJ7 - (HFQ2360 )

English text: YES
No	

HFJ14 - OCOTHHRT ( HFQ2380 )

English text: NO
Attribute
Don't know

Route
HFJ14 - OCOTHHRT ( HFQ2380 )

Refusal

HFJ14 - OCOTHHRT ( HFQ2380 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD	

4:01:28 PM Monday, August 03, 2009	

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
Page 204 of 760

HFJ12
where MRES.MRESRND = current round.
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

395

HFHeartRhythm

SP has ever reported having problems with the rhythm of
the heart in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCRHYTHM = 1/Yes.

DESIGN NOTES

4:01:28 PM Monday, August 03, 2009

Page 205 of 760

BOX HFJ7

BOX HFJ7

Page Order # :

1120

BOX INSTRUCTIONS
( HFQ2360 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ13 - YRRHYTHM (
HFQ2370 ).
ELSE GO TO HFJ14 - OCOTHHRT ( HFQ2380 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:01:28 PM Monday, August 03, 2009	

Page 206 of 760

HFJ13

HFJ13

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRRHYTHM

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

1130

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of problems with the rhythm of
(your/his/her) heart, such as atrial fibrillation?

Int. Instr II:
INPUT FIELDS / ROUTING

4:01:29 PM Monday, August 03, 2009	

Page 207 of 760

HFJ13
YRRHYTHM

Field1:

( HFQ2370 )

HEST.YRRHYTHM

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ14 - OCOTHHRT ( HFQ2380 )

English text: YES
No

HFJ14 - OCOTHHRT ( HFQ2380 )

English text: NO
Attribute
Don't know

Route
HFJ14 - OCOTHHRT ( HFQ2380 )

Refusal

HFJ14 - OCOTHHRT ( HFQ2380 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:01:31 PM Monday, August 03, 2009

Page 208 of 760

HFJ14

HFJ14

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCOTHHRT

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

1140

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having any other heart condition in a
previous round, display "a new episode of". Display "new" in BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

4:01:33 PM Monday, August 03, 2009

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]

Page 209 of 760

HFJ14
(a new episode of) any other heart condition?
Int. Instr II:

INPUT FIELDS / ROUTING

( HFQ2380 )

OCOTHHRT

Field1:

HEST.OCOTHHRT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ8 - (HFQ2400 )

English text: YES
No

HFJ16 - OCSTROKE ( HFQ2440 )

English text: NO
Attribute
Don't know

Route
HFJ16 - OCSTROKE ( HFQ2440 )

Refusal

HFJ16 - OCSTROKE ( HFQ2440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

4:01:36 PM Monday, August 03, 2009

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 210 of 760

HFJ14
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

396

HFOtherHeart

SP has ever reported having any other heart condition in
a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCOTHHRT = 1/Yes.

DESIGN NOTES

4:01:36 PM Monday, August 03, 2009

Page 211 of 760

BOX HFJ8

BOX HFJ8

Page Order # :

1150

BOX INSTRUCTIONS
( HFQ2400 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ15 - YROTHHRT (
HFQ2410 ).
ELSE GO TO HFJ16 - OCSTROKE ( HFQ2440 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:01:36 PM Monday, August 03, 2009	

Page 212 of 760

HFJ15

HFJ15

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YROTHHRT

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

1160

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that

(you/he/she) had an episode of any other heart condition?

Int. Instr II:
INPUT FIELDS / ROUTING

4:01:37 PM Monday, August 03, 2009

Page 213 of 760

HFJ15
YROTHHRT

Field1:

( HFQ2410 )

HEST.YROTHHRT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ16 - OCSTROKE ( HFQ2440 )

English text: YES
No

HFJ16 - OCSTROKE ( HFQ2440 )

English text: NO
Attribute
Don't know

Route
HFJ16 - OCSTROKE ( HFQ2440 )

Refusal

HFJ16 - OCSTROKE ( HFQ2440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:01:39 PM Monday, August 03, 2009

Page 214 of 760

HFJ16

HFJ16

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCSTROKE

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

1190

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
a stroke, a brain hemorrhage, or a cerebrovascular accident?

Int. Instr II:

4:01:41 PM Monday, August 03, 2009

Page 215 of 760

HFJ16
INPUT FIELDS / ROUTING
OCSTROKE

Field1:

( HFQ2440 )

HEST.OCSTROKE

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ9 - (HFQ2460 )

English text: YES
No
English text: NO

HFJ17A - OCCHOLES ( HFQ2475 )

Attribute
Don't know

Route
HFJ17A - OCCHOLES ( HFQ2475 )

Refusal

HFJ17A - OCCHOLES ( HFQ2475 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:01:43 PM Monday, August 03, 2009

Page 216 of 760

BOX HFJ9

BOX HFJ9

Page Order # :

1200

BOX INSTRUCTIONS
( HFQ2460 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ17 - YRSTROKE (
HFQ2470 ).
ELSE GO TO HFJ17A - OCCHOLES ( HFQ2475 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:01:43 PM Monday, August 03, 2009	

Page 217 of 760

HFJ17

HFJ17

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRSTROKE

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

1210

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a stroke, a brain hemorrhage, or a cerebrovascular
accident?

Int. Instr II:
INPUT FIELDS / ROUTING

4:01:44 PM Monday, August 03, 2009	

Page 218 of 760

HFJ17
YRSTROKE

Field1:

( HFQ2470 )

HEST.YRSTROKE

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ17A - OCCHOLES ( HFQ2475 )

English text: YES
No

HFJ17A - OCCHOLES ( HFQ2475 )

English text: NO
Attribute
Don't know

Route
HFJ17A - OCCHOLES ( HFQ2475 )

Refusal

HFJ17A - OCCHOLES ( HFQ2475 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:01:46 PM Monday, August 03, 2009

Page 219 of 760

HFJ17A

HFJ17A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCHOLES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1215

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Has a doctor ever told [you/(SP)] that (you/he/she) had high

cholesterol?

Int. Instr II:
INPUT FIELDS / ROUTING

4:01:48 PM Monday, August 03, 2009

Page 220 of 760

HFJ17A
OCCHOLES

Field1:

( HFQ2475 )

HEST.OCCHOLES

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ17B - YRCHOLES ( HFQ2485 )

English text: YES
No

HFJ18 - OCCSKIN ( HFQ2490 )

English text: NO
Attribute
Don't know

Route
HFJ18 - OCCSKIN ( HFQ2490 )

Refusal

HFJ18 - OCCSKIN ( HFQ2490 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:01:50 PM Monday, August 03, 2009

Page 221 of 760

HFJ17B

HFJ17B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRCHOLES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1220

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that

(you/he/she) had high cholesterol?

Int. Instr II:
INPUT FIELDS / ROUTING

4:01:51 PM Monday, August 03, 2009

Page 222 of 760

HFJ17B
YRCHOLES

Field1:

( HFQ2485 )

HEST.YRCHOLES

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ18 - OCCSKIN ( HFQ2490 )

English text: YES
No

HFJ18 - OCCSKIN ( HFQ2490 )

English text: NO
Attribute
Don't know

Route
HFJ18 - OCCSKIN ( HFQ2490 )

Refusal

HFJ18 - OCCSKIN ( HFQ2490 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:01:54 PM Monday, August 03, 2009

Page 223 of 760

HFJ18

HFJ18

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCSKIN

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

1230

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has ever reported having skin cancer in a previous round,
display "I’ve recorded that [you/(SP)] previously..".
Else do not display.
If SP is in the Supplemental Sample, or SP skipped the previous

year interview, display "ever".

Else do not display.

If SP has ever reported having skin cancer in a previous round,

display "a new occurrence of". Display "new" in BOLD

Else do not display.

If SP has not ever reported having skin cancer in a previous round,

display first line of second sentence, "[Since...]", in brackets.

Else do not display in brackets.


Multi Field display:

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

TEXT:

4:01:55 PM Monday, August 03, 2009

Page 224 of 760

HFJ18
Context Header:
Int. Instr I:
[I've recorded that [you/(SP)] previously reported having had skin
cancer.]

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
(a new occurrence of) skin cancer?
Int. Instr II:

INPUT FIELDS / ROUTING

OCCSKIN

Field1:

( HFQ2490 )

HEST.OCCSKIN

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ10 - (HFQ2510 )

English text: YES
No

HFJ20 - OCCANCER ( HFQ2540 )

English text: NO
Attribute
Don't know

Route
HFJ20 - OCCANCER ( HFQ2540 )

Refusal

HFJ20 - OCCANCER ( HFQ2540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

4:01:58 PM Monday, August 03, 2009

Page 225 of 760

HFJ18
HARD EDIT CHECKS

TECHNICAL NOTES
398

HFSkinCancer

SP has ever reported having skin cancer in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCSKIN = 1/Yes.

9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:01:58 PM Monday, August 03, 2009

Page 226 of 760

BOX HFJ10

BOX HFJ10

Page Order # :

1240

BOX INSTRUCTIONS
( HFQ2510 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ19 - YRCSKIN (
HFQ2520 ).
ELSE GO TO HFJ20 - OCCANCER ( HFQ2540 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:01:58 PM Monday, August 03, 2009	

Page 227 of 760

HFJ19

HFJ19

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRCSKIN

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

1250

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that

(you/he/she) had an occurrence of skin cancer?

Int. Instr II:
INPUT FIELDS / ROUTING

4:01:59 PM Monday, August 03, 2009

Page 228 of 760

HFJ19
YRCSKIN

Field1:

( HFQ2520 )

HEST.YRCSKIN

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ20 - OCCANCER ( HFQ2540 )

English text: YES
No

HFJ20 - OCCANCER ( HFQ2540 )

English text: NO
Attribute
Don't know

Route
HFJ20 - OCCANCER ( HFQ2540 )

Refusal

HFJ20 - OCCANCER ( HFQ2540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:02:01 PM Monday, August 03, 2009

Page 229 of 760

HFJ20

HFJ20

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCCANCER

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

1270

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP has ever reported having had a tumor, growth or cancer in a
previous round, display "I’ve recorded that [you/(SP)] previously
reported...". Display "[READ RESPONSES BELOW]" in the same

blue font used for interviewer instructions.

Else do not display.

If SP is in the Supplemental Sample, or SP skipped the previous

year interview, display "ever".

Else do not display.

If SP has ever reported having had a tumor, growth or cancer in a

previous round, display "other".

Else do not display.

If SP has not ever reported having had a tumor, growth or cancer in

a previous round, display first line of second sentence, "[Since ...]",

in brackets.

Else do not display in brackets.

Display "other than skin cancer" in BOLD.


Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:

4:02:03 PM Monday, August 03, 2009

Page 230 of 760

HFJ20
Report display:	

Display report below Question Text.
Display English response text to all responses included in
HEST.OCCCODE during any round.
If the only response to HEST.OCCCODE = DK or RF, display
“Unknown”
Else for each response included in HEST.OCCCODE, display
response on a separate line in the report:
If HEST.OCCCODE includes 1/Lung, display “Lung”.
	
If HEST.OCCCODE includes 2/Colon, display “Colon, Rectum, or
	
Bowel”.
	
If HEST.OCCCODE includes 3/Breast, display “Breast”
	
If HEST.OCCCODE includes 4/Uterus, display “Uterus”.
	
If HEST.OCCCODE includes 5/Prostate, display “Prostate”.
	
If HEST.OCCCODE includes 6/Bladder, display “Bladder”.
	
If HEST.OCCCODE includes 7/Ovary, display “Ovary”.
	
If HEST.OCCCODE includes 8/Stomach, display “Stomach”.
	
If HEST.OCCCODE includes 9/Cervix, display “Cervix”.
	
If HEST.OCCCODE includes 10/Brain, display Brain”
	
If HEST.OCCCODE includes 11/Kidney, display “Kidney”
	
If HEST.OCCCODE includes 12/Throat, display “Throat”
	
If HEST.OCCCODE includes 13/Head, display “Head”
	
If HEST.OCCCODE includes 14/Back, display “Back”
	
If HEST.OCCCODE includes 15/FemalOrgansNotListed, display
“Female Organs Not Listed”
If HEST.OCCCODE includes 91/Other, display HEST.OCCOS text.

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[I've recorded that [you/(SP)] previously reported having had a
tumor, growth, or cancer of the [READ RESPONSES BELOW].]
[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
any (other) kind of cancer, malignancy, or tumor other than skin
cancer?

Int. Instr II:	

INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR
GROWTHS.

INPUT FIELDS / ROUTING

4:02:04 PM Monday, August 03, 2009	

Page 231 of 760

HFJ20
OCCANCER

Field1:

( HFQ2540 )

HEST.OCCANCER

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ11 - (HFQ2560 )

English text: YES
No

BOX HFJ13 - (HFQ2620 )

English text: NO
Attribute
Don't know

Route
BOX HFJ13 - (HFQ2620 )

Refusal

BOX HFJ13 - (HFQ2620 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

4:02:07 PM Monday, August 03, 2009

Page 232 of 760

HFJ20
412

HFTumorGrowth	

SP has ever reported having had a tumor, growth or
cancer in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCANCER = 1/Yes.

DESIGN NOTES

4:02:07 PM Monday, August 03, 2009	

Page 233 of 760

BOX HFJ11

BOX HFJ11

Page Order # :

1280

BOX INSTRUCTIONS
( HFQ2560 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ21 - YRCANCER (
HFQ2570 ).
ELSE GO TO HFJ22 - OCCCODE ( HFQ2575 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:02:07 PM Monday, August 03, 2009	

Page 234 of 760

HFJ21

HFJ21

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

YRCANCER

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

1290

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "other than skin cancer" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had any kind of cancer, malignancy, or tumor other
than skin cancer?

Int. Instr II:
INPUT FIELDS / ROUTING

4:02:08 PM Monday, August 03, 2009	

Page 235 of 760

HFJ21
YRCANCER

Field1:

( HFQ2570 )

HEST.YRCANCER

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ22 - OCCCODE ( HFQ2575 )

English text: YES
No

HFJ22 - OCCCODE ( HFQ2575 )

English text: NO
Attribute
Don't know

Route
HFJ22 - OCCCODE ( HFQ2575 )

Refusal

HFJ22 - OCCCODE ( HFQ2575 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:02:10 PM Monday, August 03, 2009

Page 236 of 760

HFJ22

HFJ22

Page Order # :

Design Screen Type:

Code All

Fields:

Field 1:

OCCCODE

Field 2:

OCCOS

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:

1300

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If HFJ21 - YRCANCER = 1/Yes, display "Since the first time a
doctor told [you/(SP)] that (you/he/she) had a cancer, malignancy,
or tumor, on".
Else display "On".

Multi Field display:

Vertical Alignment

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[Since the first time a doctor told [you/(SP)] that (you/he/she) had a
cancer, malignancy, or tumor, on/On] what part or parts of
[your/(SP's)] body was the cancer or tumor found?
[PROBE: Any other part?]

4:02:14 PM Monday, August 03, 2009	

Page 237 of 760

HFJ22
Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:02:22 PM Monday, August 03, 2009

Page 238 of 760

HFJ22
OCCCODE

Field1:

( HFQ2575 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.OCCLUNG
2=HEST.OCCCOLON
3=HEST.OCCBREST
4=HEST.OCCUTER
5=HEST.OCCPROST
6=HEST.OCCBLAD
7=HEST.OCCOVARY
8=HEST.OCCSTOM
9=HEST.OCCCERVX
10=HEST.OCCBRAIN
11=HEST.OCCKIDNY
12=HEST.OCCTHROA
13=HEST.OCCHEAD
14=HEST.OCCBACK
15=HEST.OCCFONEC
91=HEST.OCCOTHER
Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TOccCode
16
No
No

Number Label
1 Lung

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ13 - (HFQ2620 )

3

English text: LUNG
Colon
BOX HFJ13 - (HFQ2620 )
English text: COLON, RECTUM, OR BOWEL
Breast
BOX HFJ13 - (HFQ2620 )

4

English text: BREAST
Uterus

2

5
6

English text: UTERUS
Prostate
English text: PROSTATE
Bladder

BOX HFJ13 - (HFQ2620 )
BOX HFJ13 - (HFQ2620 )
BOX HFJ13 - (HFQ2620 )

English text: BLADDER

4:02:33 PM Monday, August 03, 2009

Page 239 of 760

HFJ22

7

Ovary

BOX HFJ13 - (HFQ2620 )

8

English text: OVARY
Stomach

BOX HFJ13 - (HFQ2620 )

9

English text: STOMACH
Cervix

BOX HFJ13 - (HFQ2620 )

10

English text: CERVIX
Brain

BOX HFJ13 - (HFQ2620 )

11

English text: BRAIN
Kidney

BOX HFJ13 - (HFQ2620 )

12

English text: KIDNEY
Throat

BOX HFJ13 - (HFQ2620 )

13

English text: THROAT
Head

BOX HFJ13 - (HFQ2620 )

14

English text: HEAD
Back

BOX HFJ13 - (HFQ2620 )

15

English text: BACK
FemaleOrgansNotListed

BOX HFJ13 - (HFQ2620 )

91

English text: FEMALE ORGANS NOT LISTED ABOVE
Other
HFJ22 - OCCOS ( HFQ2576 )
English text: OTHER

Attribute
Don't know

Route
BOX HFJ13 - (HFQ2620 )

Refusal

BOX HFJ13 - (HFQ2620 )

4:02:41 PM Monday, August 03, 2009

Page 240 of 760

HFJ22

Field2:

OCCOS

( HFQ2576 )

HEST.OCCOS

Cheshire Name:
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
BOX HFJ13 - (HFQ2620 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:02:41 PM Monday, August 03, 2009

Page 241 of 760

BOX HFJ13

BOX HFJ13

Page Order # :

1330

BOX INSTRUCTIONS
( HFQ2620 )	

IF SP HAS EVER REPORTED HAVING RHEUMATOID ARTHRITIS IN A
PREVIOUS ROUND, GO TO BOX HFJ14 - (HFQ2650 ).
ELSE GO TO HFJ24 - OCARTHRH ( HFQ2630 ).

ASSIGNMENTS

TECHNICAL NOTES
397

HFRheumArthritis

SP has ever reported having rheumatoid arthritis in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCARTHRH = 1/Yes.

DESIGN NOTES

4:02:41 PM Monday, August 03, 2009	

Page 242 of 760

HFJ24

HFJ24

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCARTHRH

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

1340

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
rheumatoid arthritis?

Int. Instr II:

4:02:43 PM Monday, August 03, 2009

Page 243 of 760

HFJ24
INPUT FIELDS / ROUTING
OCARTHRH

Field1:

( HFQ2630 )

HEST.OCARTHRH

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ14 - (HFQ2650 )

English text: YES
No
English text: NO

BOX HFJ14 - (HFQ2650 )

Attribute
Don't know

Route
BOX HFJ14 - (HFQ2650 )

Refusal

BOX HFJ14 - (HFQ2650 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:02:45 PM Monday, August 03, 2009

Page 244 of 760

BOX HFJ14

BOX HFJ14

Page Order # :

1350

BOX INSTRUCTIONS
( HFQ2650 )	

IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN
RHEUMATOID ARTHRITIS IN A PREVIOUS ROUND, GO TO BOX HFJ16A 
(HFQ2735 ).
ELSE GO TO HFJ25 - OCARTH ( HFQ2670 ).

ASSIGNMENTS

TECHNICAL NOTES
399

HFOtherArthritis

SP has ever reported having arthritis other than
rheumatoid arthritis in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCARTH = 1/Yes.

DESIGN NOTES

4:02:45 PM Monday, August 03, 2009	

Page 245 of 760

HFJ25

HFJ25

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCARTH

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

1370

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]

arthritis, other than rheumatoid arthritis? 

[EXPLAIN IF NECESSARY: This includes osteoarthritis.]


4:02:46 PM Monday, August 03, 2009

Page 246 of 760

HFJ25
Int. Instr II:
INPUT FIELDS / ROUTING
( HFQ2670 )

OCARTH

Field1:
Cheshire Name:

HEST.OCARTH

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 HFJ15 - (HFQ2690 )

English text: YES
No

BOX HFJ16 - (HFQ2720 )

English text: NO
Attribute
Don't know

Route
BOX HFJ16 - (HFQ2720 )

Refusal

BOX HFJ16 - (HFQ2720 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD	

4:02:49 PM Monday, August 03, 2009	

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 247 of 760

HFJ25
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:02:49 PM Monday, August 03, 2009

Page 248 of 760

BOX HFJ15

BOX HFJ15

Page Order # :

1380

BOX INSTRUCTIONS
( HFQ2690 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD (
HFQ2700 ).
ELSE GO TO BOX HFJ16A - (HFQ2735 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:02:49 PM Monday, August 03, 2009	

Page 249 of 760

HFJ26

HFJ26

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRARTHRD

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

1390

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had arthritis in any part of (your/his/her) body, other
than rheumatoid arthritis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:02:51 PM Monday, August 03, 2009	

Page 250 of 760

HFJ26
YRARTHRD

Field1:

( HFQ2700 )

HEST.YRARTHRD

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ16 - (HFQ2720 )

English text: YES
No

BOX HFJ16 - (HFQ2720 )

English text: NO
Attribute
Don't know

Route
BOX HFJ16 - (HFQ2720 )

Refusal

BOX HFJ16 - (HFQ2720 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:02:53 PM Monday, August 03, 2009

Page 251 of 760

BOX HFJ16

BOX HFJ16

Page Order # :

1410

BOX INSTRUCTIONS
( HFQ2720 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ28 - OCMENTAL (
HFQ2730 ).
ELSE GO TO BOX HFJ16A - (HFQ2735 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:02:53 PM Monday, August 03, 2009	

Page 252 of 760

HFJ28

HFJ28

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

OCMENTAL

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

1420

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display first line, "[Has a doctor...]", in brackets.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Has a doctor ever told [you/(SP)] that (you/he/she) had...]

an intellectual disability, sometimes called mental retardation?

Int. Instr II:
INPUT FIELDS / ROUTING

4:02:54 PM Monday, August 03, 2009	

Page 253 of 760

HFJ28
OCMENTAL

Field1:

( HFQ2730 )

HEST.OCMENTAL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ16A - (HFQ2735 )

English text: YES
No

BOX HFJ16A - (HFQ2735 )

English text: NO
Attribute
Don't know

Route
BOX HFJ16A - (HFQ2735 )

Refusal

BOX HFJ16A - (HFQ2735 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:02:56 PM Monday, August 03, 2009

Page 254 of 760

BOX HFJ16A

BOX HFJ16A

Page Order # :

1425

BOX INSTRUCTIONS
IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A
PREVIOUS ROUND, GO TO HFJ30AA - OCDEPRSS ( HFQ2775 ).

( HFQ2735 )

ELSE GO TO HFJ29A - OCALZMER ( HFQ2745 ).

ASSIGNMENTS

TECHNICAL NOTES
400

HFAlzheimers

SP has ever reported Alzheimer’s disease in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCALZMER = 1/Yes.

DESIGN NOTES

4:02:56 PM Monday, August 03, 2009

Page 255 of 760

HFJ29A

HFJ29A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCALZMER

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1430

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:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
Alzheimer's disease?

Int. Instr II:

4:02:58 PM Monday, August 03, 2009

Page 256 of 760

HFJ29A
INPUT FIELDS / ROUTING
OCALZMER

Field1:

( HFQ2745 )

HEST.OCALZMER

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ30AA - OCDEPRSS ( HFQ2775 )

English text: YES
No
English text: NO

BOX HFJ16B - (HFQ2755 )

Attribute
Don't know

Route
BOX HFJ16B - (HFQ2755 )

Refusal

BOX HFJ16B - (HFQ2755 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:03:00 PM Monday, August 03, 2009

Page 257 of 760

BOX HFJ16B

BOX HFJ16B

Page Order # :

1435

BOX INSTRUCTIONS
( HFQ2755 )

IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS
ROUND, GO TO HFJ30AA - OCDEPRSS ( HFQ2775 ).
ELSE GO TO HFJ29B - OCDEMENT ( HFQ2765 ).

ASSIGNMENTS

TECHNICAL NOTES
401

HFDementia

SP has ever reported having dementia in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCDEMENT = 1/Yes.

DESIGN NOTES

4:03:00 PM Monday, August 03, 2009

Page 258 of 760

HFJ29B

HFJ29B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCDEMENT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1440

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:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
any type of dementia other than Alzheimer's disease?

Int. Instr II:

4:03:01 PM Monday, August 03, 2009

Page 259 of 760

HFJ29B
INPUT FIELDS / ROUTING
OCDEMENT

Field1:

( HFQ2765 )

HEST.OCDEMENT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ30AA - OCDEPRSS ( HFQ2775 )

English text: YES
No
English text: NO

HFJ30AA - OCDEPRSS ( HFQ2775 )

Attribute
Don't know

Route
HFJ30AA - OCDEPRSS ( HFQ2775 )

Refusal

HFJ30AA - OCDEPRSS ( HFQ2775 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:03:04 PM Monday, August 03, 2009

Page 260 of 760

HFJ30AA

HFJ30AA

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCDEPRSS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1445

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:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
depression?

Int. Instr II:

4:03:05 PM Monday, August 03, 2009

Page 261 of 760

HFJ30AA
INPUT FIELDS / ROUTING
( HFQ2775 )

OCDEPRSS

Field1:

HEST.OCDEPRSS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ17A - (HFQ2785 )

English text: YES
No
English text: NO

HFJ30A - OCPSYCHO ( HFQ2805 )

Attribute
Don't know

Route
HFJ30A - OCPSYCHO ( HFQ2805 )

Refusal

HFJ30A - OCPSYCHO ( HFQ2805 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:03:07 PM Monday, August 03, 2009

Page 262 of 760

BOX HFJ17A

BOX HFJ17A

Page Order # :

1450

BOX INSTRUCTIONS
( HFQ2785 )	

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ30BB - YRDEPRSS
( HFQ2795 ).
ELSE GO TO HFJ30A - OCPSYCHO ( HFQ2805 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:03:07 PM Monday, August 03, 2009	

Page 263 of 760

HFJ30BB

HFJ30BB

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRDEPRSS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1455

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that

(you/he/she) had depression?

Int. Instr II:
INPUT FIELDS / ROUTING

4:03:09 PM Monday, August 03, 2009

Page 264 of 760

HFJ30BB
YRDEPRSS

Field1:

( HFQ2795 )

HEST.YRDEPRSS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ30A - OCPSYCHO ( HFQ2805 )

English text: YES
No

HFJ30A - OCPSYCHO ( HFQ2805 )

English text: NO
Attribute
Don't know

Route
HFJ30A - OCPSYCHO ( HFQ2805 )

Refusal

HFJ30A - OCPSYCHO ( HFQ2805 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:03:11 PM Monday, August 03, 2009

Page 265 of 760

HFJ30A

HFJ30A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCPSYCHO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1460

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:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
a mental or psychiatric disorder other than depression?

Int. Instr II:

4:03:12 PM Monday, August 03, 2009

Page 266 of 760

HFJ30A
INPUT FIELDS / ROUTING
OCPSYCHO

Field1:

( HFQ2805 )

HEST.OCPSYCHO

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ17B - (HFQ2810 )

English text: YES
No
English text: NO

BOX HFJ19 - (HFQ2820 )

Attribute
Don't know

Route
BOX HFJ19 - (HFQ2820 )

Refusal

BOX HFJ19 - (HFQ2820 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:03:14 PM Monday, August 03, 2009

Page 267 of 760

BOX HFJ17B

BOX HFJ17B

Page Order # :

1465

BOX INSTRUCTIONS
( HFQ2810 )	

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ31A - YRPSYCHO (
HFQ2815 ).
ELSE GO TO BOX HFJ19 - (HFQ2820 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:03:14 PM Monday, August 03, 2009	

Page 268 of 760

HFJ31A

HFJ31A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRPSYCHO

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1470

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a mental or psychiatric disorder other than
depression?

Int. Instr II:
INPUT FIELDS / ROUTING

4:03:16 PM Monday, August 03, 2009	

Page 269 of 760

HFJ31A
YRPSYCHO

Field1:

( HFQ2815 )

HEST.YRPSYCHO

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ19 - (HFQ2820 )

English text: YES
No

BOX HFJ19 - (HFQ2820 )

English text: NO
Attribute
Don't know

Route
BOX HFJ19 - (HFQ2820 )

Refusal

BOX HFJ19 - (HFQ2820 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:03:18 PM Monday, August 03, 2009

Page 270 of 760

BOX HFJ19

BOX HFJ19

Page Order # :

1490

BOX INSTRUCTIONS
( HFQ2820 )	

IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS
ROUND, GO TO HFJ33 - OCBRKHIP ( HFQ2860 ).
ELSE GO TO HFJ32 - OCOSTEOP ( HFQ2830 ).

ASSIGNMENTS

TECHNICAL NOTES
402

HFOsteoporosis

SP has ever reported having osteoporosis in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCOSTEOP = 1/Yes.

DESIGN NOTES

4:03:18 PM Monday, August 03, 2009	

Page 271 of 760

HFJ32

HFJ32

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCOSTEOP

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

1500

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
osteoporosis, sometimes called fragile or soft bones?

Int. Instr II:

4:03:19 PM Monday, August 03, 2009

Page 272 of 760

HFJ32
INPUT FIELDS / ROUTING
OCOSTEOP

Field1:	
Cheshire Name:

( HFQ2830 )

HEST.OCOSTEOP

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
HFJ33 - OCBRKHIP ( HFQ2860 )

English text: YES
No	
English text: NO

HFJ33 - OCBRKHIP ( HFQ2860 )

Attribute
Don't know

Route
HFJ33 - OCBRKHIP ( HFQ2860 )

Refusal

HFJ33 - OCBRKHIP ( HFQ2860 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD	

4:03:22 PM Monday, August 03, 2009	

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 273 of 760

HFJ32
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:03:22 PM Monday, August 03, 2009

Page 274 of 760

HFJ33

HFJ33

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCBRKHIP

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

1520

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
a broken hip?

Int. Instr II:

4:03:23 PM Monday, August 03, 2009

Page 275 of 760

HFJ33
INPUT FIELDS / ROUTING
( HFQ2860 )

OCBRKHIP

Field1:

HEST.OCBRKHIP

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ20 - (HFQ2880 )

English text: YES
No
English text: NO

BOX HFJ21 - (HFQ2900 )

Attribute
Don't know

Route
BOX HFJ21 - (HFQ2900 )

Refusal

BOX HFJ21 - (HFQ2900 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:03:26 PM Monday, August 03, 2009

Page 276 of 760

BOX HFJ20

BOX HFJ20

Page Order # :

1530

BOX INSTRUCTIONS
( HFQ2880 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ34 - YRBRKHIP (
HFQ2890 ).
ELSE GO TO BOX HFJ21 - (HFQ2900 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:03:26 PM Monday, August 03, 2009	

Page 277 of 760

HFJ34

HFJ34

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRBRKHIP

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

1540

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that

(you/he/she) had a broken hip?

Int. Instr II:
INPUT FIELDS / ROUTING

4:03:27 PM Monday, August 03, 2009

Page 278 of 760

HFJ34
YRBRKHIP

Field1:

( HFQ2890 )

HEST.YRBRKHIP

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ21 - (HFQ2900 )

English text: YES
No

BOX HFJ21 - (HFQ2900 )

English text: NO
Attribute
Don't know

Route
BOX HFJ21 - (HFQ2900 )

Refusal

BOX HFJ21 - (HFQ2900 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:03:29 PM Monday, August 03, 2009

Page 279 of 760

BOX HFJ21

BOX HFJ21

Page Order # :

1550

BOX INSTRUCTIONS
IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A
PREVIOUS ROUND, GO TO BOX HFJ22 - (HFQ2930 ).

( HFQ2900 )

ELSE GO TO HFJ35 - OCPARKIN ( HFQ2910 ).

ASSIGNMENTS

TECHNICAL NOTES
403

HFParkinsons

SP has ever reported having Parkinson’s disease in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCPARKIN = 1/Yes.

DESIGN NOTES

4:03:29 PM Monday, August 03, 2009

Page 280 of 760

HFJ35

HFJ35

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCPARKIN

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

1560

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
Parkinson's disease?

Int. Instr II:

4:03:31 PM Monday, August 03, 2009

Page 281 of 760

HFJ35
INPUT FIELDS / ROUTING
( HFQ2910 )

OCPARKIN

Field1:

HEST.OCPARKIN

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ22 - (HFQ2930 )

English text: YES
No
English text: NO

BOX HFJ22 - (HFQ2930 )

Attribute
Don't know

Route
BOX HFJ22 - (HFQ2930 )

Refusal

BOX HFJ22 - (HFQ2930 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES
4:03:33 PM Monday, August 03, 2009

Page 282 of 760

BOX HFJ22

BOX HFJ22

Page Order # :

1570

BOX INSTRUCTIONS
( HFQ2930 )	

IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD
IN A PREVIOUS ROUND, GO TO HFJ37 - OCPPARAL ( HFQ2970 ).
ELSE GO TO HFJ36 - OCEMPHYS ( HFQ2940 ).

ASSIGNMENTS

TECHNICAL NOTES
404

HFEmphysema

SP has ever reported having emphysema, asthma, or
COPD in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCEMPHYS = 1/Yes.

DESIGN NOTES

4:03:33 PM Monday, August 03, 2009	

Page 283 of 760

HFJ36

HFJ36

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCEMPHYS

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

1580

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Display "COPD = CHRONIC OBSTRUCTIVE PULMONARY
DISEASE" in the same blue font used for interviewer instructions.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told

[you/(SP)] that (you/he/she) had...]
emphysema, asthma, or COPD?

4:03:34 PM Monday, August 03, 2009

Page 284 of 760

HFJ36
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Int. Instr II:
INPUT FIELDS / ROUTING

OCEMPHYS

Field1:	
Cheshire Name:

( HFQ2940 )

HEST.OCEMPHYS

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
HFJ37 - OCPPARAL ( HFQ2970 )

English text: YES
No	

HFJ37 - OCPPARAL ( HFQ2970 )

English text: NO
Attribute
Don't know

Route
HFJ37 - OCPPARAL ( HFQ2970 )

Refusal

HFJ37 - OCPPARAL ( HFQ2970 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD	

4:03:37 PM Monday, August 03, 2009	

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

Page 285 of 760

HFJ36
386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

DESIGN NOTES

4:03:37 PM Monday, August 03, 2009

Page 286 of 760

HFJ37

HFJ37

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCPPARAL

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

1600

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
If SP has ever reported having complete or partial paralysis in a
previous round, display "IF SP IS OBVIOUSLY PARTIALLY OR
COMPLETELY PARALYZED, SELECT "YES" AND DO NOT ASK.
OTHERWISE, ASK:". Display in the same blue font used for
interviewer instructions.
Else do not display.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:

4:03:38 PM Monday, August 03, 2009

[IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY
PARALYZED, SELECT "YES" AND DO NOT ASK. OTHERWISE,
Page 287 of 760

HFJ37
ASK:]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]

Question Text:	

complete or partial paralysis?
Int. Instr II:

INPUT FIELDS / ROUTING

OCPPARAL

Field1:	
Cheshire Name:

( HFQ2970 )

HEST.OCPPARAL

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 HFJ23 - (HFQ3000 )

English text: YES
No	
English text: NO

Attribute
Don't know

Route
BOX HFJ24 - (HFQ3020 )

Refusal

BOX HFJ24 - (HFQ3020 )

BOX HFJ24 - (HFQ3020 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4:03:41 PM Monday, August 03, 2009	

Page 288 of 760

HFJ37
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

405

HFParalysis

SP has ever reported having complete or partial paralysis
in a previous round round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCPPARAL = 1/Yes.

DESIGN NOTES

4:03:41 PM Monday, August 03, 2009

Page 289 of 760

BOX HFJ23

BOX HFJ23

Page Order # :

1620

BOX INSTRUCTIONS
( HFQ3000 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ38 - YRPPARAL (
HFQ3010 ).
ELSE GO TO BOX HFJ24 - (HFQ3020 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:03:41 PM Monday, August 03, 2009	

Page 290 of 760

HFJ38

HFJ38

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

YRPPARAL

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

1630

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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that

(you/he/she) had complete or partial paralysis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:03:43 PM Monday, August 03, 2009

Page 291 of 760

HFJ38
YRPPARAL

Field1:

( HFQ3010 )

HEST.YRPPARAL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ24 - (HFQ3020 )

English text: YES
No

BOX HFJ24 - (HFQ3020 )

English text: NO
Attribute
Don't know

Route
BOX HFJ24 - (HFQ3020 )

Refusal

BOX HFJ24 - (HFQ3020 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:03:45 PM Monday, August 03, 2009

Page 292 of 760

BOX HFJ24

BOX HFJ24

Page Order # :

1640

BOX INSTRUCTIONS
( HFQ3020 )

IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN
A PREVIOUS ROUND, GO TO BOX HFJ25 - (HFQ3050 ).
ELSE GO TO HFJ39 - OCAMPUTE ( HFQ3030 ).

ASSIGNMENTS

TECHNICAL NOTES
406

HFAmpute

SP has ever reported an absence or loss of arm or leg in
a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCAMPUTE = 1/Yes.

DESIGN NOTES

4:03:45 PM Monday, August 03, 2009

Page 293 of 760

HFJ39

HFJ39

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

OCAMPUTE

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

1650

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Display "IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS,
SELECT "YES" AND DO NOT ASK. OTHERWISE, ASK:" in the
same blue font used for interviewer instructions.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:	

IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT
"YES" AND DO NOT ASK. OTHERWISE, ASK:

Question Text:	

What about absence or loss of an arm or a leg?

Int. Instr II:
INPUT FIELDS / ROUTING

4:03:46 PM Monday, August 03, 2009	

Page 294 of 760

HFJ39
OCAMPUTE

Field1:

( HFQ3030 )

HEST.OCAMPUTE

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ25 - (HFQ3050 )

English text: YES
No

BOX HFJ25 - (HFQ3050 )

English text: NO
Attribute
Don't know

Route
BOX HFJ25 - (HFQ3050 )

Refusal

BOX HFJ25 - (HFQ3050 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:03:48 PM Monday, August 03, 2009

Page 295 of 760

BOX HFJ25

BOX HFJ25

Page Order # :

1660

BOX INSTRUCTIONS
( HFQ3050 )

IF SP IS FEMALE, GO TO HFJ41A - OCBETES ( HFQ3081 ).
ELSE GO TO HFJ40 - HAVEPROS ( HFQ3060 ).

ASSIGNMENTS

TECHNICAL NOTES
5

SPMale	

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale	

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:03:48 PM Monday, August 03, 2009	

Page 296 of 760

HFJ40

HFJ40

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HAVEPROS

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

1670

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is in the Supplemental Sample, or SP skipped the previous

year interview, display "ever".

Else do not display.

Always display first line, "[Before [you/(SP)] had prostate surgery,

did a doctor ever tell/Since (LAST HF MONTH YEAR), has/Has]] a 

doctor (ever) told] [you/(SP)] that (you/he) had ...]", in brackets.

If SP has ever reported having prostate surgery in the current round

or in a previous round, display "Before [you/(SP)] had prostate 

surgery, did a doctor ever tell".

Else display "Since (LAST HF MONTH YEAR), has/Has]] a doctor

(ever) told".

If SP is the respondent, display "you".

Else display "he".

Always display "(BPH)" in parenthesis.


Multi Field display:

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

4:03:50 PM Monday, August 03, 2009

Page 297 of 760

HFJ40
TEXT:
Context Header:
Int. Instr I:
[[Before [you/(SP)] had prostate surgery, did a doctor ever tell/Since
(LAST HF MONTH YEAR), has/Has]] a doctor (ever) told ] [you/(SP)]
that (you/he) had...]

Question Text:

an enlarged prostate or benign prostatic hypertrophy (BPH)?
Int. Instr II:
INPUT FIELDS / ROUTING
HAVEPROS

Field1:

( HFQ3060 )

HEST.HAVEPROS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ26 - (HFQ3070 )

English text: YES
No

HFJ41A - OCBETES ( HFQ3081 )

English text: NO
Attribute
Don't know

Route
HFJ41A - OCBETES ( HFQ3081 )

Refusal

HFJ41A - OCBETES ( HFQ3081 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

4:03:53 PM Monday, August 03, 2009

Page 298 of 760

HFJ40
HARD EDIT CHECKS

TECHNICAL NOTES
9

SuppORD	

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

386

HFSkippedPrevYear	

SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).

4

Respondent	

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

387

HFProstateSurgCurrOr
Prev

If SP has ever reported having prostate surgery in the
current round or in a previous round =
(HEST.PROSSURG = /1Yes or HEST.PROSRMVD =
1/Yes ) on HEST where (HEST.HESTRND <= current
round).

DESIGN NOTES

4:03:53 PM Monday, August 03, 2009	

Page 299 of 760

BOX HFJ26

BOX HFJ26

Page Order # :

1680

BOX INSTRUCTIONS
( HFQ3070 )	

IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ41 - YRPROST (
HFQ3080 ).
ELSE GO TO HFJ41A - OCBETES ( HFQ3081 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:03:53 PM Monday, August 03, 2009	

Page 300 of 760

HFJ41

HFJ41

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

YRPROST

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

1690

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP is the respondent, display "you".
Else display "he".
Always display "(BPH)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he) had an enlarged prostate or benign prostatic hypertrophy
(BPH)?

Int. Instr II:

INPUT FIELDS / ROUTING


4:03:54 PM Monday, August 03, 2009	

Page 301 of 760

HFJ41
( HFQ3080 )

YRPROST

Field1:

HEST.YRPROST

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFJ41A - OCBETES ( HFQ3081 )

English text: YES
No

HFJ41A - OCBETES ( HFQ3081 )

English text: NO
Attribute
Don't know

Route
HFJ41A - OCBETES ( HFQ3081 )

Refusal

HFJ41A - OCBETES ( HFQ3081 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

4:03:57 PM Monday, August 03, 2009

Page 302 of 760

HFJ41
DESIGN NOTES

4:03:57 PM Monday, August 03, 2009

Page 303 of 760


HFJ41A

HFJ41A

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

OCBETES

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

1692

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:	

If SP is female, display "borderline diabetes, pre-diabetes, or
pregnancy-related diabetes".
Else display "borderline diabetes, or pre-diabetes".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

Has a doctor ever told [you/(SP)] that (you/he/she) had any type of
diabetes, including: sugar diabetes, high blood sugar, (borderline
diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
diabetes, or pre-diabetes)?

Int. Instr II:
INPUT FIELDS / ROUTING

4:03:58 PM Monday, August 03, 2009	

Page 304 of 760

HFJ41A
( HFQ3081 )

OCBETES

Field1:
Cheshire Name:

HEST.OCBETES

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
HFJ41B - OCDTYPE ( HFQ3083 )

English text: YES
No

BOX HFJ27 - (HFQ3090 )

English text: NO
Attribute
Don't know

Route
BOX HFJ27 - (HFQ3090 )

Refusal

BOX HFJ27 - (HFQ3090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
5

SPMale	

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale	

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:04:00 PM Monday, August 03, 2009	

Page 305 of 760

HFJ41B

HFJ41B

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

OCDTYPE

Field 2:

OCDTYPOS

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:	

1694

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:

SHOW CARD HF6

Question Text:

Looking at this card, please tell me which type of diabetes the doctor
said that [you have/(SP) has].

Int. Instr II:
INPUT FIELDS / ROUTING

4:04:03 PM Monday, August 03, 2009	

Page 306 of 760

HFJ41B
OCDTYPE

Field1:

HEST.OCDTYPE

Cheshire Name:
Item Text display:

( HFQ3083 )

If SP is male, do not display response option 5/Gestational.

Item Text:
Label:

Label Position:

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


Enumerated
TOCDType

1

No
No


Number Label
1 TypeOne

FieldSize:

Min Value:

Max Value:

Mask:


Route
HFJ41C - OCDVISIT ( HFQ3087 )

2

English text: TYPE 1 (“INSULIN-DEPENDENT”, “JUVENILE-ONSET”)
TypeTwo
HFJ41C - OCDVISIT ( HFQ3087 )

3

English text: TYPE 2 ("NON-INSULIN-DEPENDENT", "ADULT-ONSET")
Borderline
HFJ41C - OCDVISIT ( HFQ3087 )

4

English text: BORDERLINE
PreDiabetes

HFJ41C - OCDVISIT ( HFQ3087 )

5

English text: PRE-DIABETES
Gestational

HFJ41C - OCDVISIT ( HFQ3087 )

91

English text: GESTATIONAL (PREGNANCY-RELATED)
Other
HFJ41B - OCDTYPOS ( HFQ3085 )
English text: SOME OTHER TYPE

Attribute
Don't know

Route
HFJ41C - OCDVISIT ( HFQ3087 )

Refusal

HFJ41C - OCDVISIT ( HFQ3087 )

4:04:09 PM Monday, August 03, 2009

Page 307 of 760

HFJ41B
( HFQ3085 )

OCDTYPOS

Field2:
Cheshire Name:

HEST.OCDTYPOS

Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.


Item Text:

SOME OTHER TYPE (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
HFJ41C - OCDVISIT ( HFQ3087 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
5

SPMale	

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale	

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:04:09 PM Monday, August 03, 2009	

Page 308 of 760

HFJ41C

HFJ41C

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OCDVISIT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1698

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Were you/Was (SP)] told on two or more different visits that

(you/he/she) had diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:04:11 PM Monday, August 03, 2009

Page 309 of 760

HFJ41C
OCDVISIT

Field1:

( HFQ3087 )

HEST.OCDVISIT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ27 - (HFQ3090 )

English text: YES
No

BOX HFJ27 - (HFQ3090 )

English text: NO
Attribute
Don't know

Route
BOX HFJ27 - (HFQ3090 )

Refusal

BOX HFJ27 - (HFQ3090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:04:13 PM Monday, August 03, 2009

Page 310 of 760

BOX HFJ27

BOX HFJ27

4:04:13 PM Monday, August 03, 2009

Page Order # :

1700


Page 311 of 760


BOX HFJ27
BOX INSTRUCTIONS
( HFQ3090 )

IF SP IS IN THE SUPPLEMENTAL SAMPLE, AND SP'S AGE IS UNDER 65,
AND SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO
HFJ42 - EMCOND ( HFQ3100 ).
ELSE IF SP IS IN THE SUPPLEMENTAL SAMPLE, AND SP'S AGE IS
UNDER 65, AND SP REPORTED “NO” TO ALL HFJ CONDITIONS, GO TO
HFJ43 - EMCAUSEVB ( HFQ3110 ).
ELSE GO TO BOX HFP0 - 	(HFQ3175 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD	

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

103

SPAge	

SP's AGE is calculated based on SP's
ROST.HHDOBMM, ROST.HHDOBDD, ROST.HHDOBYY
and TODAY and is stored on ENUM.HHPAGE where
ENUM.ENUMRND = current round and
ENUM.ENUMROST = 01.

DESIGN NOTES
SP responded "YES" to at least one HFJ Condition =
IF HFJ1 – OCARTERY = 1/Yes, or
HFJ2 - OCHBP = 1/Yes, or
HFJ4 - OCMYOCAR = 1/Yes, or
HFJ6 - OCCHD = 1/Yes, or
HFJ8 - OCCFAIL = 1/Yes, or
HFJ10 - OCCVALVE = 1/Yes, or
HFJ 12- OCRHYTHM = 1/Yes, or
HFJ14 - OCOTHHRT = 1/Yes, or
HFJ16 - OCSTROKE = 1/Yes, or
HFJ18 - OCCSKIN = 1/Yes, or
HFJ20 - OCCANCER = 1/Yes, or
HFJ24 - OCARTHRH = 1/Yes, or
HFJ25 - OCARTH = 1/Yes, or
HFJ28 - OCMENTAL = 1/Yes, or
HFJ29A - OCALZMER = 1/Yes, or
HFJ29B - OCDEMENT = 1/Yes, or
HFJ30AA - OCDEPRSS = 1/Yes, or
HFJ30A - OCPSYCHO = 1/Yes, or
HFJ32 - OCOSTEOP = 1/Yes, or
HFJ33 - OCBRKHIP = 1/Yes, or
HFJ35 - OCPARKIN = 1/Yes, or
HFJ36 - OCEMPHYS = 1/Yes, or
HFJ37 - OCPPARAL = 1/Yes, or
HFJ39 - OCAMPUTE = 1/Yes, or
HFJ41A – OCBETES = 1/Yes.
SP responded "NO" to all HFJ Conditions =
IF (HFJ1 – OCARTERY =2/No, DK, OR RF), and
(HFJ2 - OCHBP =2/No, DK, OR RF), and
4:04:13 PM Monday, August 03, 2009	

Page 312 of 760

BOX HFJ27
(HFJ4 - OCMYOCAR =2/No, DK, OR RF), and
(HFJ6 - OCCHD =2/No, DK, OR RF), and
(HFJ8 - OCCFAIL =2/No, DK, OR RF), and
(HFJ10 - OCCVALVE =2/No, DK, OR RF), and
(HFJ 12- OCRHYTHM =2/No, DK, OR RF), and
(HFJ14 - OCOTHHRT =2/No, DK, OR RF), and
(HFJ16 - OCSTROKE =2/No, DK, OR RF), and
(HFJ18 - OCCSKIN =2/No, DK, OR RF), and
(HFJ20 - OCCANCER =2/No, DK, OR RF), and
(HFJ24 - OCARTHRH =2/No, DK, OR RF), and
(HFJ25 - OCARTH =2/No, DK, OR RF), and
(HFJ28 - OCMENTAL =2/No, DK, OR RF), and
(HFJ29A - OCALZMER =2/No, DK, OR RF), and
(HFJ29B - OCDEMENT =2/No, DK, OR RF), and
(HFJ30AA - OCDEPRSS =2/No, DK, OR RF), and
(HFJ30A - OCPSYCHO =2/No, DK, OR RF), and
(HFJ32 - OCOSTEOP =2/No, DK, OR RF), and
(HFJ33 - OCBRKHIP =2/No, DK, OR RF), and
(HFJ35 - OCPARKIN =2/No, DK, OR RF), and
(HFJ36 - OCEMPHYS =2/No, DK, OR RF), and
(HFJ37 - OCPPARAL =2/No, DK, OR RF), and
(HFJ39 - OCAMPUTE =2/No, DK, OR RF), and
(HFJ41A - OCBETES = 2/No, DK, OR RF)..

NOTE: We do not include a check for HFJ17A - OCCHOLES since High
Cholesterol cannot be a reason for why SP is eligible for Medicare.

4:04:13 PM Monday, August 03, 2009

Page 313 of 760

HFJ42

HFJ42

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

EMCOND

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

1710

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If SP Responded "YES" to only one HF condition, display "Was
this".
Else display "Were any of these".

Multi Field display:

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

Display report below Question text.
For each HFJ condition reported, display as a separate line in report:
IF HFJ1 – OCARTERY = 1/Yes, display “ARTERIES HARDENING”.
	
IF HFJ2 - OCHBP = 1/Yes, display “HYPERTENSION”.
	
IF HFJ4 - OCMYOCAR = 1/Yes, display “HEART ATTACK”. 

IF HFJ6 - OCCHD = 1/Yes, display “HEART DISEASE”.
	
IF HFJ8 - OCCFAIL = 1/Yes, display “CONGESTIVE HEART 

FAILURE”.
	
IF HFJ10 - OCCVALVE = 1/Yes, display “HEART VALVE
	
PROBLEM”.
	
IF HFJ 12- OCRHYTHM = 1/Yes, display “HEART RHYTHM
	
PROBLEM”.
	
IF HFJ14 - OCOTHHRT = 1/Yes, display “OTHER HEART 

PROBLEM”.
	
IF HFJ16 - OCSTROKE = 1/Yes, display “.STROKE OR
	

4:04:14 PM Monday, August 03, 2009	

Page 314 of 760

HFJ42
HEMORRHAGE”.
	
IF HFJ18 - OCCSKIN = 1/Yes, display “SKIN CANCER”.
	
IF HFJ20 - OCCANCER = 1/Yes, display “CANCER/TUMOR”.
	
IF HFJ24 - OCARTHRH = 1/Yes, display “RHEUMATOID
	
ARTHRITIS”.
	
IF HFJ25 - OCARTH = 1/Yes, display “OTHER ARTHRITIS”.
	
IF HFJ28 - OCMENTAL = 1/Yes, display “MENTAL RETARDATION”.
	
IF HFJ29A - OCALZMER = 1/Yes, display “ALZHEIMER'S”.
	
IF HFJ29B - OCDEMENT = 1/Yes, display “DEMENTIA”.
	
IF HFJ30AA - OCDEPRSS = 1/Yes, display “DEPRESSION”.
	
IF HFJ30A - OCPSYCHO = 1/Yes, display “MENTAL DISORDER”.
	
IF HFJ32 - OCOSTEOP = 1/Yes, display “OSTEOPOROSIS”.
	
IF HFJ33 - OCBRKHIP = 1/Yes, display “BROKEN HIP”.
	
IF HFJ35 - OCPARKIN = 1/Yes, display “PARKINSON'S”.
	
IF HFJ36 - OCEMPHYS = 1/Yes, display
“EMPHYSEMA/ASTHMA/COPD”.
	
IF HFJ37 - OCPPARAL = 1/Yes, display “PARALYSIS”.
	
IF HFJ39 - OCAMPUTE = 1/Yes, display “LOSS OF LIMB”.
	
IF HFJ41A – OCBETES = 1/Yes, display “DIABETES”.
	

TEXT:
Context Header:
Int. Instr I:
Question Text:	

You told me that [you have/(SP) has] had [READ CONDITIONS
LISTED BELOW]. (Was this/Were any of these) the original cause
of [your/(SP's)] becoming eligible for Medicare?

Int. Instr II:
INPUT FIELDS / ROUTING

4:04:17 PM Monday, August 03, 2009	

Page 315 of 760

HFJ42
EMCOND

Field1:

( HFQ3100 )

HEST.EMCOND

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFJ28 - (HFQ3160 )

English text: YES
No

HFJ43 - EMCAUSEVB ( HFQ3110 )

English text: NO
Attribute
Don't know

Route
BOX HFP0 - (HFQ3175 )

Refusal

BOX HFP0 - (HFQ3175 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
SP responded “YES” to only one HFJ Condition =
Only one of the following fields = 1/Yes:
HFJ1 – OCARTERY = 1/Yes, or
HFJ2 - OCHBP = 1/Yes, or

HFJ4 - OCMYOCAR = 1/Yes, or

HFJ6 - OCCHD = 1/Yes, or

4:04:20 PM Monday, August 03, 2009

Page 316 of 760

HFJ42
HFJ8 - OCCFAIL = 1/Yes, or
HFJ10 - OCCVALVE = 1/Yes, or
HFJ 12- OCRHYTHM = 1/Yes, or
HFJ14 - OCOTHHRT = 1/Yes, or
HFJ16 - OCSTROKE = 1/Yes, or
HFJ18 - OCCSKIN = 1/Yes, or
HFJ20 - OCCANCER = 1/Yes, or
HFJ24 - OCARTHRH = 1/Yes, or
HFJ25 - OCARTH = 1/Yes, or
HFJ28 - OCMENTAL = 1/Yes, or
HFJ29A - OCALZMER = 1/Yes, or
HFJ29B - OCDEMENT = 1/Yes, or
HFJ30AA - OCDEPRSS = 1/Yes, or
HFJ30A - OCPSYCHO = 1/Yes, or
HFJ32 - OCOSTEOP = 1/Yes, or
HFJ33 - OCBRKHIP = 1/Yes, or
HFJ35 - OCPARKIN = 1/Yes, or
HFJ36 - OCEMPHYS = 1/Yes, or
HFJ37 - OCPPARAL = 1/Yes, or
HFJ39 - OCAMPUTE = 1/Yes, or
HFJ41A – OCBETES = 1/Yes.
NOTE: We do not include a check for HFJ17A - OCCHOLES since High
Cholesterol cannot be a reason for why SP is eligible for Medicare.

4:04:20 PM Monday, August 03, 2009

Page 317 of 760

HFJ43

HFJ43

Page Order # :

Design Screen Type:

Verbatim Text

Fields:

Field 1:

EMCAUSEVB

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

1720

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:

What was the original cause of [your/(SP's)] becoming eligible for

Medicare?

Int. Instr II:

RECORD VERBATIM.

INPUT FIELDS / ROUTING

4:04:20 PM Monday, August 03, 2009

Page 318 of 760

HFJ43

Field1:

EMCAUSEVB

( HFQ3110 )

HEST.EMCAUSE1

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

Open
TOpen135
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

135

Route
BOX HFP0 - (HFQ3175 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:04:21 PM Monday, August 03, 2009

Page 319 of 760

BOX HFJ28

BOX HFJ28

Page Order # :

1730

BOX INSTRUCTIONS
( HFQ3160 )	

IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO BOX
HFP0 - (HFQ3175 ).
ELSE GO TO HFJ44 - EMCODE ( HFQ3165 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES
SP responded “YES” to only one HFJ Condition =
Only one of the following fields = 1/Yes:
HFJ1 – OCARTERY = 1/Yes, or
HFJ2 - OCHBP = 1/Yes, or
HFJ4 - OCMYOCAR = 1/Yes, or
HFJ6 - OCCHD = 1/Yes, or
HFJ8 - OCCFAIL = 1/Yes, or
HFJ10 - OCCVALVE = 1/Yes, or
HFJ 12- OCRHYTHM = 1/Yes, or
HFJ14 - OCOTHHRT = 1/Yes, or
HFJ16 - OCSTROKE = 1/Yes, or
HFJ18 - OCCSKIN = 1/Yes, or
HFJ20 - OCCANCER = 1/Yes, or
HFJ24 - OCARTHRH = 1/Yes, or
HFJ25 - OCARTH = 1/Yes, or
HFJ28 - OCMENTAL = 1/Yes, or
HFJ29A - OCALZMER = 1/Yes, or
HFJ29B - OCDEMENT = 1/Yes, or
HFJ30AA - OCDEPRSS = 1/Yes, or
HFJ30A - OCPSYCHO = 1/Yes, or
HFJ32 - OCOSTEOP = 1/Yes, or
HFJ33 - OCBRKHIP = 1/Yes, or
HFJ35 - OCPARKIN = 1/Yes, or
HFJ36 - OCEMPHYS = 1/Yes, or
HFJ37 - OCPPARAL = 1/Yes, or
HFJ39 - OCAMPUTE = 1/Yes, or
HFJ41A – OCBETES = 1/Yes.
NOTE: We do not include a check for HFJ17A - OCCHOLES since High
Cholesterol cannot be a reason for why SP is eligible for Medicare.

4:04:21 PM Monday, August 03, 2009	

Page 320 of 760

HFJ44

HFJ44

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

EMCODE

Field 2:

EMOS

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:	

1740

Roster Name:
Roster Type:

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:

Question Text:

Which of these conditions was the cause of [your/(SP's)] becoming

eligible for Medicare?
[PROBE: Any other condition?]

Int. Instr II:

CHECK UP TO 8 CONDITIONS.

INPUT FIELDS / ROUTING

4:04:26 PM Monday, August 03, 2009	

Page 321 of 760

HFJ44

4:04:36 PM Monday, August 03, 2009

Page 322 of 760


HFJ44

Field1:	
Cheshire Name:

EMCODE

( HFQ3165 )

NONE
REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=HEST.EMARTERY
2=HEST.EMHBP
3=HEST.EMMYOCAR
4=HEST.EMCHD
5=HEST.EMCFAIL
6=HEST.EMCVALVE
7=HEST.EMRHYTHM
8=HEST.EMOTHHRT
9=HEST.EMSTROKE
10=HEST.EMCSKIN
11=HEST.EMCANCER
12=HEST.EMARTHRH
13=HEST.EMARTH
14=HEST.EMMENTAL
15=HEST.EMALZMER
16=HEST.EMDEMENT
17=HEST.EMDEPRSS
18=HEST.EMPSYCHO
19=HEST.EMOSTEOP
20=HEST.EMBRKHIP
21=HEST.EMPARKIN
22=HEST.EMEMPHYS
23=HEST.EMPPARAL
24=HEST.EMAMPUTE
25=HEST.EMDIABTS
91=HEST.EMOTHOS

Item Text display:	

If response to HFJ CONDITION = 1/Yes, display condition
as a response option at HFJ44 - EMCODE.
Else do not display response option.
If HFJ1 - OCARTERY = 1/Yes, display HFJ44 – EMCODE
response option 1.
Else do not display.
IF HFJ2 - OCHBP = 1/Yes, display HFJ44 – EMCODE
response option 2.
Else do not display.
IF HFJ4 - OCMYOCAR = 1/Yes, display HFJ44 –
EMCODE response option 3.
Else do not display.
IF HFJ6 - OCCHD = 1/Yes, display HFJ44 – EMCODE
response option 4.
Else do not display.
IF HFJ8 - OCCFAIL = 1/Yes, display HFJ44 – EMCODE
response option 5.
Else do not display.
IF HFJ10 - OCCVALVE = 1/Yes, display HFJ44 –
EMCODE response option 6.

4:04:46 PM Monday, August 03, 2009	

Page 323 of 760

HFJ44
Else do not display.
IF HFJ 12- OCRHYTHM = 1/Yes, display HFJ44 –
EMCODE response option 7.
Else do not display.
IF HFJ14 - OCOTHHRT = 1/Yes, display HFJ44 –
EMCODE response option 8.
Else do not display.
IF HFJ16 - OCSTROKE = 1/Yes, display HFJ44 –
EMCODE response option 9.
Else do not display.
IF HFJ18 - OCCSKIN = 1/Yes, display HFJ44 – EMCODE
response option 10.
Else do not display.
IF HFJ20 - OCCANCER = 1/Yes, display HFJ44 –
EMCODE response option 11.
Else do not display.
IF HFJ24 - OCARTHRH = 1/Yes, display HFJ44 –
EMCODE response option 12.
Else do not display.
IF HFJ25 - OCARTH = 1/Yes, display HFJ44 – EMCODE
response option 13.
Else do not display.
IF HFJ28 - OCMENTAL = 1/Yes, display HFJ44 –
EMCODE response option 14.
Else do not display.
IF HFJ29A - OCALZMER = 1/Yes, display HFJ44 –
EMCODE response option 15.
Else do not display.
IF HFJ29B - OCDEMENT = 1/Yes, display HFJ44 –
EMCODE response option 16.
Else do not display.
IF HFJ30AA - OCDEPRSS = 1/Yes, display HFJ44 –
EMCODE response option 17.
Else do not display.
IF HFJ30A - OCPSYCHO = 1/Yes, display HFJ44 –
EMCODE response option 18.
Else do not display.
IF HFJ32 - OCOSTEOP = 1/Yes, display HFJ44 –
EMCODE response option 19.
Else do not display.
IF HFJ33 - OCBRKHIP = 1/Yes, display HFJ44 –
EMCODE response option 20.
Else do not display.
IF HFJ35 - OCPARKIN = 1/Yes, display HFJ44 –
EMCODE response option 21.
Else do not display.
4:04:55 PM Monday, August 03, 2009

Page 324 of 760

HFJ44
IF HFJ36 - OCEMPHYS = 1/Yes, display HFJ44 –
EMCODE response option 22.
Else do not display.
IF HFJ37 - OCPPARAL = 1/Yes, display HFJ44 –
EMCODE response option 23.
Else do not display.
IF HFJ39 - OCAMPUTE = 1/Yes, display HFJ44 –
EMCODE response option 24.
Else do not display.
IF HFJ41A – OCBETES = 1/Yes, display HFJ44 –
EMCODE response option 25.
Else do not display.
Always display HFJ – EMCODE response option 91.
Item Text:

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TEMCode
8
No
No

Number Label
1 AteriesHardening

3

English text: ARTERIES HARDENING
Hypertension
English text: HYPERTENSION
HeartAttack

4

English text: HEART ATTACK
HeartDisease

2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )

6

English text: HEART DISEASE
CongestiveHeartFailure
BOX HFP0 - (HFQ3175 )
CONGESTIVE
HEART
FAILURE
English text:
HeartValveProblem
BOX HFP0 - (HFQ3175 )

7

English text: HEART VALVE PROBLEM
HeartRhythmProblem

BOX HFP0 - (HFQ3175 )

8

English text: HEART RHYTHM PROBLEM
OtherHeartProblem

BOX HFP0 - (HFQ3175 )

9

English text: OTHER HEART PROBLEM
StrokeOrHemorrhage

BOX HFP0 - (HFQ3175 )

5

English text: STROKE OR HEMORRHAGE

4:05:09 PM Monday, August 03, 2009

Page 325 of 760

HFJ44

10

SkinCancer

BOX HFP0 - (HFQ3175 )

11

English text: SKIN CANCER
CancerTumor

BOX HFP0 - (HFQ3175 )

12

English text: CANCER/TUMOR
RheumatioidArthritis

BOX HFP0 - (HFQ3175 )

13

English text: RHEUMATOID ARTHRITIS
OtherArthritis

BOX HFP0 - (HFQ3175 )

14

English text: OTHER ARTHRITIS
MentalRetardation

BOX HFP0 - (HFQ3175 )

15

English text: MENTAL RETARDATION
Alzheimers

BOX HFP0 - (HFQ3175 )

16

English text: ALZHEIMER'S
Dementia

BOX HFP0 - (HFQ3175 )

17

English text: DEMENTIA
Depression

BOX HFP0 - (HFQ3175 )

18

English text: DEPRESSION
MentalDisorder

BOX HFP0 - (HFQ3175 )

19

English text: MENTAL DISORDER
Osteoporosis

BOX HFP0 - (HFQ3175 )

21

English text: OSTEOPOROSIS
BrokenHip
English text: BROKEN HIP
Parkinsons

BOX HFP0 - (HFQ3175 )

22

English text: PARKINSON'S
EmphysemaAsthmaCOPD

BOX HFP0 - (HFQ3175 )

20

24

English text: EMPHYSEMA/ASTHMA/COPD
Paralysis
English text: PARALYSIS
LossOfLimb

25

English text: LOSS OF LIMB
Diabetes

23

91

English text: DIABETES
Other
English text: OTHER

Attribute
Don't know

Route
BOX HFP0 - (HFQ3175 )

Refusal

BOX HFP0 - (HFQ3175 )

4:05:20 PM Monday, August 03, 2009

BOX HFP0 - (HFQ3175 )

BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
HFJ44 - EMOS ( HFQ3166 )

Page 326 of 760

HFJ44

Field2:

EMOS

( HFQ3166 )

HEST.EMOS

Cheshire Name:
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
BOX HFP0 - (HFQ3175 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1
If response to HFJ44 - EMCODE only includes 91/Other, display
message "PROBE WHETHER PREVIOUSLY ENTERED
CONDITION WAS CAUSE FOR ELIGIBILITY. REENTER OR
SELECT PREVIOUS PAGE TO CORRECT".
HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:05:21 PM Monday, August 03, 2009

Page 327 of 760

BOX HFP0

BOX HFP0

Page Order # :

1750

BOX INSTRUCTIONS
( HFQ3175 )

IF THIS IS ROUND 55, GO TO BOX HFR1 - (HFQ3363 ).
ELSE GO TO HFPINTRO - HLTHCAREINTRO ( HFQ3182 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:05:21 PM Monday, August 03, 2009

Page 328 of 760

HFPINTRO

HFPINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

HLTHCAREINTRO

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

1760

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:

Now I want to ask you about some things that [you/(SP)] may be
doing to maintain (your/his/her) health, either by getting tested for
health problems or by taking care of conditions that (you have/she
has/he has).

Int. Instr II:
INPUT FIELDS / ROUTING

4:05:22 PM Monday, August 03, 2009

Page 329 of 760

HFPINTRO
HLTHCAREINTRO

Field1:

( HFQ3182 )

TEMP

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 HFP1A - (HFQ3186 )

English text: CONTINUE
Attribute
Empty

Route
BOX HFP1A - (HFQ3186 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:05:24 PM Monday, August 03, 2009

Page 330 of 760

BOX HFP1A

BOX HFP1A

Page Order # :

1765

BOX INSTRUCTIONS
( HFQ3186 )	

IF (HFJ41A – OCBETES = 1/Yes) AND (HFJ41B - OCDTYPE = 1/TypeOne,
2/TypeTwo, 3/Borderline, 4/PreDiabetes, 91/Other, DK, or RF), GO TO HFP1 
DIAAGE ( HFQ3189 ).
ELSE GO TO HFP21 - DIAEVERT ( HFQ3342 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:05:24 PM Monday, August 03, 2009	

Page 331 of 760

HFP1

HFP1

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DIAAGE

Field 2:

DIAAGE_LESSONE

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1770

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:

If HFJ41B - OCDTYPE = 1/TypeOne, display "Type 1 diabetes".
Else if HFJ41B = 2/TypeTwo, display "Type 2 diabetes".
Else if HFJ41B = 3/Borderline, display "borderline diabetes".
Else if HFJ41B = 4/PreDiabetes, display "pre-diabetes".
Else display "diabetes".

Multi Field display:

Vertical Alignment
Display all input fields at one time.

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

I recorded that [you were/(SP) was] told by a doctor that (you
have/she has/he has) (Type 1 diabetes/Type 2 diabetes/borderline
diabetes/pre-diabetes/diabetes).
How old [were you/was (SP)] when (you were/he was/she was) first

4:05:26 PM Monday, August 03, 2009	

Page 332 of 760

HFP1
told that (you/he/she) had diabetes?
Int. Instr II:

INPUT FIELDS / ROUTING

DIAAGE

Field1:

( HFQ3189 )

HEST.DIAAGE

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

AGE:
Left

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

Integer
TDiaage
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Empty

Route
HFP1 - DIAAGE_LESSONE ( HFQ3192 )

Don't know

HFP1 - DIAAGE_LESSONE ( HFQ3192 )

Refusal

HFP1 - DIAAGE_LESSONE ( HFQ3192 )

4:05:30 PM Monday, August 03, 2009

FieldSize:
Min Value:
Max Value:
Mask:

1
997

Route
HFP1 - DIAAGE_LESSONE ( HFQ3192 )

Page 333 of 760

HFP1
DIAAGE_LESSONE

Field2:

( HFQ3192 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.DIAAGE_LESSONE = 1/LessThanOneYearOld, set 

HEST.DIAAGE = 996.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated

TDiage996
1
No
No

Number Label
1 LessThanOneYearOld

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFP2 - (HFQ3198 )

English text: LESS THAN ONE YEAR OLD
Attribute
Empty

Route
BOX HFP2 - (HFQ3198 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1:

HFP1 - DIAAGE and HFP1 - DIAAGE_LESSONE cannot both be

EMPTY.

If not true, display message "PLEASE ENTER AGE OR SELECT

"LESS THAN ONE YEAR OLD". ".

Edit #2:

HFP1 - DIAAGE and HFP1 - DIAAGE_LESSONE cannot both be

FILLED.

If not true, display message "PLEASE ENTER AGE OR SELECT

"LESS THAN ONE YEAR OLD". ".

Edit #3:

HFP1 - DIAAGE = 1 - 100, DK, RF, or EMPTY.

If not true, display message "INVALID RESPONSE. ENTRY NOT IN


4:05:32 PM Monday, August 03, 2009

Page 334 of 760

HFP1
RANGE. PLEASE REENTER.".
TECHNICAL NOTES

DESIGN NOTES

4:05:32 PM Monday, August 03, 2009

Page 335 of 760

BOX HFP2

BOX HFP2

Page Order # :

1775

BOX INSTRUCTIONS
( HFQ3198 )	

IF THE SP IS FEMALE AND (HFP1 – DIAAGE is >= 12 and is <= 45) OR
(HFP1 – DIAAGE = DK OR RF), GO TO HFP2 - DIAPRGNT ( HFQ3199 ).
ELSE GO TO HFP4 - DIAINSUL ( HFQ3202 ).

ASSIGNMENTS

TECHNICAL NOTES
5

SPMale	

SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.

6

SPFemale	

SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.

DESIGN NOTES

4:05:32 PM Monday, August 03, 2009	

Page 336 of 760

HFP2

HFP2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAPRGNT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1780

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Did [you/(SP)] have diabetes only during a pregnancy?


Int. Instr II:

INPUT FIELDS / ROUTING


4:05:34 PM Monday, August 03, 2009

Page 337 of 760

HFP2
DIAPRGNT

Field1:

( HFQ3199 )

HEST.DIAPRGNT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP21 - DIAEVERT ( HFQ3342 )

English text: YES
No

HFP4 - DIAINSUL ( HFQ3202 )

English text: NO
Attribute
Don't know

Route
HFP21 - DIAEVERT ( HFQ3342 )

Refusal

HFP21 - DIAEVERT ( HFQ3342 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:05:36 PM Monday, August 03, 2009

Page 338 of 760

HFP4

HFP4

Page Order # :

Design Screen Type:

List

Fields:

Field 1:

DIAINSUL

Field 2:

DIAMEDS

Field 3:

DIATEST

Field 6:

DIASORES

Field 8:

DIAPRESS

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1785

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Please tell me whether (you use/SP uses) any of the following ways

to manage (your/his/her) diabetes. [Do you/Does (SP)]…

Int. Instr II:

4:05:39 PM Monday, August 03, 2009

Page 339 of 760

HFP4
INPUT FIELDS / ROUTING
DIAINSUL

Field1:

( HFQ3202 )

HEST.DIAINSUL

Cheshire Name:
Item Text display:

Display "a." in front of LIST item text.

Item Text:

take insulin?

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
HFP4 - DIAMEDS ( HFQ3206 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
HFP4 - DIAMEDS ( HFQ3206 )

Refusal

HFP4 - DIAMEDS ( HFQ3206 )

4:05:44 PM Monday, August 03, 2009

HFP4 - DIAMEDS ( HFQ3206 )

Page 340 of 760

HFP4
DIAMEDS

Field2:

( HFQ3206 )

HEST.DIAMEDS

Cheshire Name:
Item Text display:

Display "b." in front of LIST item text.

Item Text:

take prescription diabetes pills or oral diabetes medicine?

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
HFP4 - DIATEST ( HFQ3209 )

English text: YES
No

HFP4 - DIATEST ( HFQ3209 )

English text: NO
Attribute
Don't know

Route
HFP4 - DIATEST ( HFQ3209 )

Refusal

HFP4 - DIATEST ( HFQ3209 )

4:05:49 PM Monday, August 03, 2009

Page 341 of 760

HFP4
DIATEST

Field3:

( HFQ3209 )

HEST.DIATEST

Cheshire Name:
Item Text display:

Display "c." in front of LIST item text.

Item Text:

test (your/his/her) blood for sugar or glucose?

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
HFP4 - DIASORES ( HFQ3219 )

English text: YES
No

HFP4 - DIASORES ( HFQ3219 )

English text: NO
Attribute
Don't know

Route
HFP4 - DIASORES ( HFQ3219 )

Refusal

HFP4 - DIASORES ( HFQ3219 )

4:05:55 PM Monday, August 03, 2009

Page 342 of 760

HFP4
DIASORES

Field6:

( HFQ3219 )

HEST.DIASORES

Cheshire Name:
Item Text display:

Display "f." in front of LIST item text.

Item Text:

check for sores or irritations on (your/his/her) feet?

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
HFP4 - DIAPRESS ( HFQ3226 )

English text: YES
No

HFP4 - DIAPRESS ( HFQ3226 )

English text: NO
Attribute
Don't know

Route
HFP4 - DIAPRESS ( HFQ3226 )

Refusal

HFP4 - DIAPRESS ( HFQ3226 )

4:06:00 PM Monday, August 03, 2009

Page 343 of 760

HFP4
DIAPRESS

Field8:

( HFQ3226 )

HEST.DIAPRESS

Cheshire Name:
Item Text display:

Display "h." in front of LIST item text.

Item Text:

measure (your/his/her) blood pressure at home?

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 HFP3 - (HFQ3229 )

English text: YES
No

BOX HFP3 - (HFQ3229 )

English text: NO
Attribute
Don't know

Route
BOX HFP3 - (HFQ3229 )

Refusal

BOX HFP3 - (HFQ3229 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:06:02 PM Monday, August 03, 2009

Page 344 of 760

BOX HFP3

BOX HFP3

Page Order # :

1790

BOX INSTRUCTIONS
( HFQ3229 )	

IF HFP4 - DIAINSUL = 1/Yes, GO TO HFP5 - INSUTAKE ( HFQ3232 ).
ELSE IF HFP4 - DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE ( HFQ3246 ).
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE ( HFQ3262 ).
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK ( HFQ3282
).
ELSE GO TO HFP10 - DIATENYR ( HFQ3299 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:06:02 PM Monday, August 03, 2009	

Page 345 of 760

HFP5

HFP5

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

INSUTAKE

Field 2:

INSUDAY

Field 3:

INSUWEEK

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1795

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:
Question Text:

How often [do you/does (SP)] take insulin?

Int. Instr II:
INPUT FIELDS / ROUTING

4:06:04 PM Monday, August 03, 2009

Page 346 of 760

HFP5
INSUTAKE

Field1:

( HFQ3232 )

HEST.INSUTAKE

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
TInsutak
1
No
No

Number Label
1 NumberPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP5 - INSUDAY ( HFQ3236 )

2

English text: NUMBER OF TIMES PER DAY
NumberPerWeek

3

English text: NUMBER OF TIMES PER WEEK
UseInsulinPump
BOX HFP4 - (HFQ3242 )

HFP5 - INSUWEEK ( HFQ3239 )

English text: USE INSULIN PUMP
Attribute
Don't know

Route
BOX HFP4 - (HFQ3242 )

Refusal

BOX HFP4 - (HFQ3242 )

4:06:09 PM Monday, August 03, 2009

Page 347 of 760

HFP5

Field2:

INSUDAY

( HFQ3236 )

HEST.INSUDAY

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF TIMES PER DAY:
Left

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

Integer
THFDay

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field3:

INSUWEEK

1
100

Route
BOX HFP4 - (HFQ3242 )
( HFQ3239 )

HEST.INSUWEEK

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:


NUMBER OF TIMES PER WEEK:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
THFWeek
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
BOX HFP4 - (HFQ3242 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:
4:06:11 PM Monday, August 03, 2009

Page 348 of 760

HFP5
HFP5 - INSUDAY = 1 - 10.

If not true, display message "NUMBER OF TIMES PER DAY

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #2:

HFP5 - INSUWEEK = 1 - 100.

If not true, display message "NUMBER OF TIMES PER WEEK

SEEMS UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:06:11 PM Monday, August 03, 2009

Page 349 of 760

BOX HFP4

BOX HFP4

Page Order # :

1800

BOX INSTRUCTIONS
( HFQ3242 )	

IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE ( HFQ3246 ).
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE ( HFQ3262 ).
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK ( HFQ3282
).
ELSE GO TO HFP10 - DIATENYR ( HFQ3299 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:06:11 PM Monday, August 03, 2009	

Page 350 of 760

HFP6

HFP6

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

MEDSTAKE

Field 2:

MEDDAY

Field 3:

MEDWEEK

Field 4:

MEDMONTH

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1805

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:

Question Text:

How often [do you/does (SP)] take prescription diabetes pills or oral

diabetes medicine?

Int. Instr II:
INPUT FIELDS / ROUTING
4:06:13 PM Monday, August 03, 2009

Page 351 of 760

HFP6
MEDSTAKE

Field1:

( HFQ3246 )

HEST.MEDSTAKE

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
TMedstak
1
No
No

Number Label
1 NumberPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP6 - MEDDAY ( HFQ3249 )

2

English text: NUMBER OF TIMES PER DAY
NumberPerWeek

3

English text: NUMBER OF TIMES PER WEEK
NumberPerMonth
HFP6 - MEDMONTH ( HFQ3256 )

HFP6 - MEDWEEK ( HFQ3252 )

English text: NUMBER OF TIMES PER MONTH
Attribute
Don't know

Route
BOX HFP5 - (HFQ3259 )

Refusal

BOX HFP5 - (HFQ3259 )

4:06:17 PM Monday, August 03, 2009

Page 352 of 760

HFP6

Field2:

MEDDAY

( HFQ3249 )

HEST.MEDDAY

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF TIMES PER DAY:
Left

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

Integer
THFDay

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field3:

MEDWEEK

1
100

Route
BOX HFP5 - (HFQ3259 )
( HFQ3252 )

HEST.MEDWEEK

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:


NUMBER OF TIMES PER WEEK:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
THFWeek
1
No
No

Number Label
1 [Continuous answer.]

4:06:20 PM Monday, August 03, 2009

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
BOX HFP5 - (HFQ3259 )

Page 353 of 760

HFP6

Field4:

MEDMONTH

( HFQ3256 )

HEST.MEDMONTH

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF TIMES PER MONTH:
Left

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

Integer
THFMonth
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
BOX HFP5 - (HFQ3259 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

HFP6 - MEDDAY = 1 - 10.

If not true, display message "NUMBER OF TIMES PER DAY

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #2:

HFP6 - MEDWEEK = 1 - 100.

If not true, display message "NUMBER OF TIMES PER WEEK

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #3:

HFP6 - MEDMONTH = 1 - 500.

If not true, display message "NUMBER OF TIMES PER MONTH

SEEMS UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:06:20 PM Monday, August 03, 2009

Page 354 of 760

BOX HFP5

BOX HFP5

Page Order # :

1810

BOX INSTRUCTIONS
( HFQ3259 )

IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE ( HFQ3262 ).
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK (
HFQ3282 ).
ELSE GO TO HFP10 - DIATENYR ( HFQ3299 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:06:20 PM Monday, August 03, 2009

Page 355 of 760

HFP7

HFP7

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

TESTTAKE

Field 2:

TESTDAY

Field 3:

TESTWEEK

Field 4:

TESTMNTH

Field 5:

TESTYEAR

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1815

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:

Question Text:

How often [do you/does (SP)] test (your/his/her) blood for sugar or

glucose?
[PROBE: Include times when it is tested by a family member or
friend, but do not include times when it is tested by a health

4:06:23 PM Monday, August 03, 2009

Page 356 of 760

HFP7
professional.]
Int. Instr II:

INPUT FIELDS / ROUTING

TESTTAKE

Field1:

( HFQ3262 )

HEST.TESTTAKE

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
TTesttak
1
No
No

Number Label
1 NumberPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP7 - TESTDAY ( HFQ3266 )

2

English text: NUMBER OF TIMES PER DAY
NumberPerWeek

3

English text: NUMBER OF TIMES PER WEEK
NumberPerMonth
HFP7 - TESTMNTH ( HFQ3272 )

4

English text: NUMBER OF TIMES PER MONTH
NumberPerYear
HFP7 - TESTYEAR ( HFQ3276 )

HFP7 - TESTWEEK ( HFQ3269 )

English text: NUMBER OF TIMES PER YEAR
Attribute
Don't know

Route
BOX HFP6 - (HFQ3279 )

Refusal

BOX HFP6 - (HFQ3279 )

4:06:27 PM Monday, August 03, 2009

Page 357 of 760

HFP7

Field2:

TESTDAY

( HFQ3266 )

HEST.TESTDAY

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF TIMES PER DAY:
Left

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

Integer
THFDay

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field3:

TESTWEEK

1
100

Route
BOX HFP6 - (HFQ3279 )
( HFQ3269 )

HEST.TESTWEEK

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:


NUMBER OF TIMES PER WEEK:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
THFWeek
1
No
No

Number Label
1 [Continuous answer.]

4:06:30 PM Monday, August 03, 2009

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
BOX HFP6 - (HFQ3279 )

Page 358 of 760

HFP7

Field4:

TESTMNTH

( HFQ3272 )

HEST.TESTMONTH

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF TIMES PER MONTH:
Left

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

Integer
THFMonth

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field5:

TESTYEAR

1
1000

Route
BOX HFP6 - (HFQ3279 )
( HFQ3276 )

HEST.TESTYEAR

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:


NUMBER OF TIMES PER YEAR:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
THFYear
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
10000

Route
BOX HFP6 - (HFQ3279 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:
4:06:32 PM Monday, August 03, 2009

Page 359 of 760

HFP7
HFP7 - TESTDAY = 1 - 10.

If not true, display message "NUMBER OF TIMES PER DAY

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #2:

HFP7 - TESTWEEK = 1 - 100.

If not true, display message "NUMBER OF TIMES PER WEEK

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #3:

HFP7 - TESTMNTH = 1 - 500.

If not true, display message "NUMBER OF TIMES PER MONTH

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #4:

HFP7 - TESTYEAR = 1 - 5000.

If not true, display message "NUMBER OF TIMES PER YEAR

SEEMS UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:06:32 PM Monday, August 03, 2009

Page 360 of 760

BOX HFP6

BOX HFP6

Page Order # :

1820

BOX INSTRUCTIONS
( HFQ3279 )	

IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK ( HFQ3282 ).
ELSE GO TO HFP10 - DIATENYR ( HFQ3299 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:06:32 PM Monday, August 03, 2009	

Page 361 of 760

HFP8

HFP8

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

SORECHEK

Field 2:

SOREDAY

Field 3:

SOREWEEK

Field 4:

SOREMNTH

Field 5:

SOREYEAR

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

1825

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:

Question Text:

How often [do you/does (SP)] check (your/his/her) feet for sores or

irritations?
[PROBE: Include times when they are checked by a family member
or friend, but do not include times when they are checked by a

4:06:34 PM Monday, August 03, 2009

Page 362 of 760

HFP8
health professional.]
Int. Instr II:

INPUT FIELDS / ROUTING

SORECHEK

Field1:

( HFQ3282 )

HEST.SORECHEK

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
TTesttak
1
No
No

Number Label
1 NumberPerDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP8 - SOREDAY ( HFQ3286 )

2

English text: NUMBER OF TIMES PER DAY
NumberPerWeek

3

English text: NUMBER OF TIMES PER WEEK
NumberPerMonth
HFP8 - SOREMNTH ( HFQ3292 )

4

English text: NUMBER OF TIMES PER MONTH
NumberPerYear
HFP8 - SOREYEAR ( HFQ3296 )

HFP8 - SOREWEEK ( HFQ3289 )

English text: NUMBER OF TIMES PER YEAR
Attribute
Don't know

Route
HFP10 - DIATENYR ( HFQ3299 )

Refusal

HFP10 - DIATENYR ( HFQ3299 )

4:06:39 PM Monday, August 03, 2009

Page 363 of 760

HFP8

Field2:

SOREDAY

( HFQ3286 )

HEST.SOREDAY

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF TIMES PER DAY:
Left

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

Integer
THFDay

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field3:

SOREWEEK

1
100

Route
HFP10 - DIATENYR ( HFQ3299 )
( HFQ3289 )

HEST.SOREWEEK

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:


NUMBER OF TIMES PER WEEK:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
THFWeek
1
No
No

Number Label
1 [Continuous answer.]

4:06:42 PM Monday, August 03, 2009

FieldSize:
Min Value:
Max Value:
Mask:

1
1000

Route
HFP10 - DIATENYR ( HFQ3299 )

Page 364 of 760

HFP8

Field4:

SOREMNTH

( HFQ3292 )

HEST.SOREMNTH

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF TIMES PER MONTH:
Left

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

Integer
THFMonth

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
Field5:

SOREYEAR

1
1000

Route
HFP10 - DIATENYR ( HFQ3299 )
( HFQ3296 )

HEST.SOREYEAR

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:


NUMBER OF TIMES PER YEAR:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
THFYear
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

1
10000

Route
HFP10 - DIATENYR ( HFQ3299 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:
4:06:44 PM Monday, August 03, 2009

Page 365 of 760

HFP8
HFP8 - SOREDAY = 1 - 10.

If not true, display message "NUMBER OF TIMES PER DAY

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #2:

HFP8 - SOREWEEK = 1 - 100.

If not true, display message "NUMBER OF TIMES PER WEEK

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #3:

HFP8 - SOREMNTH = 1 - 500.

If not true, display message "NUMBER OF TIMES PER MONTH

SEEMS UNLIKELY. PLEASE VERIFY.".

Edit #4:

HFP8 - SOREYEAR = 1 - 5000.

If not true, display message "NUMBER OF TIMES PER YEAR

SEEMS UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:06:44 PM Monday, August 03, 2009

Page 366 of 760

HFP10

HFP10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIATENYR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1830

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

In the past year has a doctor or other medical professional examined

(your/his/her) feet for sores or irritations?

Int. Instr II:
INPUT FIELDS / ROUTING

4:06:45 PM Monday, August 03, 2009

Page 367 of 760

HFP10
DIATENYR

Field1:

( HFQ3299 )

HEST.DIATENYR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP11 - DIADRSAW ( HFQ3302 )

English text: YES
No

HFP11 - DIADRSAW ( HFQ3302 )

English text: NO
Attribute
Don't know

Route
HFP11 - DIADRSAW ( HFQ3302 )

Refusal

HFP11 - DIADRSAW ( HFQ3302 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:06:47 PM Monday, August 03, 2009

Page 368 of 760

HFP11

HFP11

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DIADRSAW

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1835

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

About how many times in the past year [have you/has (SP)] seen a

doctor or other health professional for (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:06:48 PM Monday, August 03, 2009

Page 369 of 760

HFP11
DIADRSAW

Field1:

( HFQ3302 )

HEST.DIADRSAW

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF TIMES:
Left

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

Integer
TDiadrsaw
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HFP13 - DIAHEMOC ( HFQ3309 )

Refusal

HFP13 - DIAHEMOC ( HFQ3309 )

FieldSize:

Min Value:
Max Value:
Mask:


0

200


Route
HFP13 - DIAHEMOC ( HFQ3309 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

HFP11 - DIADRSAW = 1 - 100.

If not true, display message "NUMBER OF TIMES SEEMS

UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:06:50 PM Monday, August 03, 2009

Page 370 of 760

HFP13

HFP13

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

DIAHEMOC

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1845

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:

A test of hemoglobin "A one C" measures the average level of blood
sugar over the past three months. It is usually done in a doctor's
office. About how many times in the past year has a doctor or other
health professional checked [you/(SP)] for hemoglobin "A one C"?

Int. Instr II:
INPUT FIELDS / ROUTING

4:06:50 PM Monday, August 03, 2009

Page 371 of 760

HFP13
DIAHEMOC

Field1:

( HFQ3309 )

HEST.DIAHEMOC

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF TIMES:
Left

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

Integer
TDiahemo
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HFP14 - DIACTRLD ( HFQ3312 )

Refusal

HFP14 - DIACTRLD ( HFQ3312 )

FieldSize:

Min Value:
Max Value:
Mask:


0

200


Route
HFP14 - DIACTRLD ( HFQ3312 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1:

HFP13 - DIAHEMOC = 1 - 100.

If not true, display message "NUMBER OF TIMES SEEMS

UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:06:52 PM Monday, August 03, 2009

Page 372 of 760

HFP14

HFP14

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIACTRLD

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1850

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:	

SHOW CARD HF4

Question Text:	

Would you say that [your/(SP's)] blood sugar is well controlled all of
the time, most of the time, some of the time, a little of the time, or
none of the time? By "well controlled" we mean a recent hemoglobin
"A one C" result of 7.5 or less or an average fasting blood test of 140
or less.

Int. Instr II:

INPUT FIELDS / ROUTING


4:06:54 PM Monday, August 03, 2009	

Page 373 of 760

HFP14
DIACTRLD

Field1:

( HFQ3312 )

HEST.DIACTRLD

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
TDiactrl
1
No
No

Number Label
1 AllOfTheTime

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP14A - DIAFEET ( HFQ3316 )

2

English text: ALL OF THE TIME
MostOfTheTime

HFP14A - DIAFEET ( HFQ3316 )

3

English text: MOST OF THE TIME
SomeOfTheTime

HFP14A - DIAFEET ( HFQ3316 )

4

English text: SOME OF THE TIME
ALittleOfTheTime

HFP14A - DIAFEET ( HFQ3316 )

5

English text: A LITTLE OF THE TIME
NoneOfTheTime

HFP14A - DIAFEET ( HFQ3316 )

English text: NONE OF THE TIME
Attribute
Don't know

Route
HFP14A - DIAFEET ( HFQ3316 )

Refusal

HFP14A - DIAFEET ( HFQ3316 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:06:58 PM Monday, August 03, 2009

Page 374 of 760

HFP14
DESIGN NOTES

4:06:58 PM Monday, August 03, 2009

Page 375 of 760


HFP14A

HFP14A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAFEET

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1855

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] have any problems with (your/his/her) feet as a

result of (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:00 PM Monday, August 03, 2009

Page 376 of 760

HFP14A
DIAFEET

Field1:

( HFQ3316 )

HEST.DIAFEET

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP15 - DIAEYPRB ( HFQ3319 )

English text: YES
No

HFP15 - DIAEYPRB ( HFQ3319 )

English text: NO
Attribute
Don't know

Route
HFP15 - DIAEYPRB ( HFQ3319 )

Refusal

HFP15 - DIAEYPRB ( HFQ3319 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:02 PM Monday, August 03, 2009

Page 377 of 760

HFP15

HFP15

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAEYPRB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1860

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] have any problems with (your/his/her) eyes as a

result of (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:03 PM Monday, August 03, 2009

Page 378 of 760

HFP15
DIAEYPRB

Field1:

( HFQ3319 )

HEST.DIAEYPRB

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP16 - DIAKDPRB ( HFQ3322 )

English text: YES
No

HFP16 - DIAKDPRB ( HFQ3322 )

English text: NO
Attribute
Don't know

Route
HFP16 - DIAKDPRB ( HFQ3322 )

Refusal

HFP16 - DIAKDPRB ( HFQ3322 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:05 PM Monday, August 03, 2009

Page 379 of 760

HFP16

HFP16

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAKDPRB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1865

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] have any problems with (your/his/her) kidneys

as a result of (your/his/her) diabetes?
[EXPLAIN IF NECESSARY: This is tested by looking for protein in
the urine.]

Int. Instr II:

INPUT FIELDS / ROUTING


4:07:07 PM Monday, August 03, 2009

Page 380 of 760

HFP16
DIAKDPRB

Field1:

( HFQ3322 )

HEST.DIAKDPRB

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP17 - DIAMNGE ( HFQ3326 )

English text: YES
No

HFP17 - DIAMNGE ( HFQ3326 )

English text: NO
Attribute
Don't know

Route
HFP17 - DIAMNGE ( HFQ3326 )

Refusal

HFP17 - DIAMNGE ( HFQ3326 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:09 PM Monday, August 03, 2009

Page 381 of 760

HFP17

HFP17

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAMNGE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1870

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

[Have you/Has (SP)] ever participated in a diabetes selfmanagement course or class, or received special training on how
(you/he/she) can manage (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:10 PM Monday, August 03, 2009	

Page 382 of 760

HFP17
DIAMNGE

Field1:

( HFQ3326 )

HEST.DIAMNGE

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP18 - DIATRAIN ( HFQ3329 )

English text: YES
No

BOX HFP7 - (HFQ3332 )

English text: NO
Attribute
Don't know

Route
BOX HFP7 - (HFQ3332 )

Refusal

BOX HFP7 - (HFQ3332 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:13 PM Monday, August 03, 2009

Page 383 of 760

HFP18

HFP18

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIATRAIN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1875

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

When was the most recent time that [you/(SP)] participated in a
diabetes self-management course or class or received special
training on how (you/he/she) can manage (your/his/her) diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:15 PM Monday, August 03, 2009	

Page 384 of 760

HFP18
DIATRAIN

Field1:

( HFQ3329 )

HEST.DIATRAIN

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
TYearAgoDKRF
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFP7 - (HFQ3332 )

2

English text: LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanThreeYears
BOX HFP7 - (HFQ3332 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
ThreeYearsToLessThanFiveYears
BOX HFP7 - (HFQ3332 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
BOX HFP7 - (HFQ3332 )

BOX HFP7 - (HFQ3332 )

English text: 5 OR MORE YEARS AGO
Attribute
Don't know

Route
BOX HFP7 - (HFQ3332 )

Refusal

BOX HFP7 - (HFQ3332 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:07:21 PM Monday, August 03, 2009

Page 385 of 760

HFP18
DESIGN NOTES

4:07:21 PM Monday, August 03, 2009

Page 386 of 760


BOX HFP7

BOX HFP7

Page Order # :

1880

BOX INSTRUCTIONS
( HFQ3332 )	

IF THE SP IS THE RESPONDENT, GO TO HFP19 - DIAKNOW ( HFQ3336 ).
ELSE GO TO BOX HFS1 - (HFQ3410 ).

ASSIGNMENTS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

4:07:21 PM Monday, August 03, 2009	

Page 387 of 760

HFP19

HFP19

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIAKNOW

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1885

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

SHOW CARD HF3


Question Text:

How much do you think you know about managing your diabetes?

Do you know . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:23 PM Monday, August 03, 2009

Page 388 of 760

HFP19
DIAKNOW

Field1:

( HFQ3336 )

HEST.DIAKNOW

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
TDiaknow
1
No
No

Number Label
1 EverythingNeedToKnow

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP20 - DIASUPPS ( HFQ3339 )

2

English text: just about everything you need to know,
MostNeedToKnow
HFP20 - DIASUPPS ( HFQ3339 )

3

English text: most of what you need to know,
SomeNeedToKnow

HFP20 - DIASUPPS ( HFQ3339 )

4

English text: some of what you need to know,
AlittleNeedToKnow

HFP20 - DIASUPPS ( HFQ3339 )

5

English text: a little of what you need to know, or
NoneNeedToKnow
HFP20 - DIASUPPS ( HFQ3339 )
English text: almost none of what you need to know about managing your diabetes?

Attribute
Don't know

Route
HFP20 - DIASUPPS ( HFQ3339 )

Refusal

HFP20 - DIASUPPS ( HFQ3339 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:07:27 PM Monday, August 03, 2009

Page 389 of 760

HFP19
DESIGN NOTES

4:07:27 PM Monday, August 03, 2009

Page 390 of 760


HFP20

HFP20

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIASUPPS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1890

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

Before today, did you know that Medicare now helps pay the cost of
diabetic testing supplies and self-management education for people
with diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:29 PM Monday, August 03, 2009	

Page 391 of 760

HFP20
DIASUPPS

Field1:

( HFQ3339 )

HEST.DIASUPPS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFS1 - (HFQ3410 )

English text: YES
No

BOX HFS1 - (HFQ3410 )

English text: NO
Attribute
Don't know

Route
BOX HFS1 - (HFQ3410 )

Refusal

BOX HFS1 - (HFQ3410 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:31 PM Monday, August 03, 2009

Page 392 of 760

HFP21

HFP21

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DIAEVERT

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

1895

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:	

HFJ41A - OCBETES = 2/No, display first sentence.
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[I have recorded that [you have/(SP) has] never been told by a

doctor that (you have/she has/he has) diabetes.]
[Have you/Has (SP)] ever had a blood test to see if (you have/she
has/he has) diabetes?

Int. Instr II:

INPUT FIELDS / ROUTING


4:07:32 PM Monday, August 03, 2009	

Page 393 of 760

HFP21
DIAEVERT

Field1:

HEST.DIAEVERT

Cheshire Name:
Item Text display:

( HFQ3342 )

Do not display response option 3/SPHasDiabetes.

Item Text:
Label:

Label Position:

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

Enumerated
TDiaEvert

1
No
No

Number Label
1 Yes

FieldSize:

Min Value:
Max Value:
Mask:

Route
HFP22 - DIARECNT ( HFQ3346 )

2

English text: YES
No

3

English text: NO
SPHasDiabetes


BOX HFP8 - (HFQ3349 )

DO NOT DISPLAY.

DATA EDITING ONLY.

Attribute
Don't know

Route
BOX HFP8 - (HFQ3349 )

Refusal

BOX HFP8 - (HFQ3349 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:34 PM Monday, August 03, 2009

Page 394 of 760

HFP22

HFP22

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DIARECNT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1900

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

When was the most recent time [you were/(SP) was] tested for

diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:36 PM Monday, August 03, 2009

Page 395 of 760

HFP22
DIARECNT

Field1:

( HFQ3346 )

HEST.DIARECNT

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
TYearAgoDKRF
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP24 - DIARISK ( HFQ3356 )

2

English text: LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanThreeYears
HFP24 - DIARISK ( HFQ3356 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
ThreeYearsToLessThanFiveYears
HFP24 - DIARISK ( HFQ3356 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
HFP24 - DIARISK ( HFQ3356 )

HFP24 - DIARISK ( HFQ3356 )

English text: 5 OR MORE YEARS AGO
Attribute
Don't know

Route
HFP24 - DIARISK ( HFQ3356 )

Refusal

HFP24 - DIARISK ( HFQ3356 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:07:41 PM Monday, August 03, 2009

Page 396 of 760

HFP22
DESIGN NOTES

4:07:41 PM Monday, August 03, 2009

Page 397 of 760


BOX HFP8

BOX HFP8

Page Order # :

1905

BOX INSTRUCTIONS
( HFQ3349 )	

IF THE SP IS THE RESPONDENT, GO TO HFP23 - DIAAWARE ( HFQ3352
).
ELSE GO TO HFP24 - DIARISK ( HFQ3356 ).

ASSIGNMENTS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

4:07:41 PM Monday, August 03, 2009	

Page 398 of 760

HFP23

HFP23

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIAAWARE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1910

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Before today, were you aware that there is a blood test to determine

if a person has diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:42 PM Monday, August 03, 2009

Page 399 of 760

HFP23
DIAAWARE

Field1:

( HFQ3352 )

HEST.DIAAWARE

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP24 - DIARISK ( HFQ3356 )

English text: YES
No

HFP24 - DIARISK ( HFQ3356 )

English text: NO
Attribute
Don't know

Route
HFP24 - DIARISK ( HFQ3356 )

Refusal

HFP24 - DIARISK ( HFQ3356 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:44 PM Monday, August 03, 2009

Page 400 of 760

HFP24

HFP24

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIARISK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1915

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Has a doctor or other health professional ever told [you/(SP)] that

(you are/he is/she is) at high risk for diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:46 PM Monday, August 03, 2009

Page 401 of 760

HFP24
DIARISK

Field1:

( HFQ3356 )

HEST.DIARISK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFP25 - DIASIGNS ( HFQ3359 )

English text: YES
No

HFP25 - DIASIGNS ( HFQ3359 )

English text: NO
Attribute
Don't know

Route
HFP25 - DIASIGNS ( HFQ3359 )

Refusal

HFP25 - DIASIGNS ( HFQ3359 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:48 PM Monday, August 03, 2009

Page 402 of 760

HFP25

HFP25

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

DIASIGNS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1920

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

In the past year, [have you/has (SP)] received any information about

the signs, symptoms, or risk factors for diabetes?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:49 PM Monday, August 03, 2009

Page 403 of 760

HFP25
DIASIGNS

Field1:

( HFQ3359 )

HEST.DIASIGNS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFR1 - (HFQ3363 )

English text: YES
No

BOX HFR1 - (HFQ3363 )

English text: NO
Attribute
Don't know

Route
BOX HFR1 - (HFQ3363 )

Refusal

BOX HFR1 - (HFQ3363 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:52 PM Monday, August 03, 2009

Page 404 of 760

BOX HFR1

BOX HFR1

Page Order # :

1922

BOX INSTRUCTIONS
( HFQ3363 )	

IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER IS
UNKNOWN) AND (SP HAS NOT REPORTED HAVING COLON, RECTAL OR
BOWEL CANCER IN THE CURRENT ROUND OR IN A PREVIOUS ROUND),
GO TO HFR1 - COLHEAR ( HFQ3367 ).
ELSE GO TO BOX HFS0 - (HFQ3408 ).

ASSIGNMENTS

TECHNICAL NOTES
447

SPEverHrdColonCUnkn

SP has ever heard about colorectal or colon cancer is
unknown = There is no HEST wshere HEST.HESTRND
< current round and HEST.COLHEAR ^= EMPTY.

448

SPNotRepColonCCurPr
ev

SP has not reported having colon, rectal, or bowel cancer
in the current round or in a previous round = There is no
HEST where HEST.HESTRND <= current round and
HEST.OCCCODE includes 2/Colon.

DESIGN NOTES

4:07:52 PM Monday, August 03, 2009	

Page 405 of 760

HFR1

HFR1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLHEAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1924

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:

Now I'd like to talk about a different illness, colorectal or colon

cancer, a disease of the lower intestines.
Before today, had you ever heard of colorectal or colon cancer?

Int. Instr II:
INPUT FIELDS / ROUTING

4:07:53 PM Monday, August 03, 2009

Page 406 of 760

HFR1
COLHEAR

Field1:

( HFQ3367 )

HEST.COLHEAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR3 - COLHTEST ( HFQ3371 )

English text: YES
No

HFR3 - COLHTEST ( HFQ3371 )

English text: NO
Attribute
Don't know

Route
HFR3 - COLHTEST ( HFQ3371 )

Refusal

HFR3 - COLHTEST ( HFQ3371 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:55 PM Monday, August 03, 2009

Page 407 of 760

HFR3

HFR3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLHTEST

Enable Functions:

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Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1926

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:

The fecal occult blood test is a simple test for early signs of colon
cancer. It detects invisible traces of blood found in the stool. The
doctor or other health professional can give the patient a kit to
collect stool samples at the patient's home. The test is then sent to a
laboratory for the results to be determined.
Has a doctor or other health professional ever given [you/(SP)] a
home testing kit to test for blood in the stool?

Int. Instr II:

4:07:57 PM Monday, August 03, 2009

Page 408 of 760

HFR3
INPUT FIELDS / ROUTING
COLHTEST

Field1:

( HFQ3371 )

HEST.COLHTEST

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR5 - COLCARD ( HFQ3379 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
HFR4 - COLHKIT ( HFQ3375 )

Refusal

HFR4 - COLHKIT ( HFQ3375 )

HFR4 - COLHKIT ( HFQ3375 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:07:59 PM Monday, August 03, 2009

Page 409 of 760

HFR4

HFR4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLHKIT

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1928

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:

Have you ever heard of this home testing kit?


Int. Instr II:

INPUT FIELDS / ROUTING


4:08:00 PM Monday, August 03, 2009

Page 410 of 760

HFR4
COLHKIT

Field1:

( HFQ3375 )

HEST.COLHKIT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR8 - COLSCOPY ( HFQ3387 )

English text: YES
No

HFR8 - COLSCOPY ( HFQ3387 )

English text: NO
Attribute
Don't know

Route
HFR8 - COLSCOPY ( HFQ3387 )

Refusal

HFR8 - COLSCOPY ( HFQ3387 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:02 PM Monday, August 03, 2009

Page 411 of 760

HFR5

HFR5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLCARD

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

1930

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:

Did [you/(SP)] complete the samples and send the card in for

(your/his/her) most recent test?

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:04 PM Monday, August 03, 2009

Page 412 of 760

HFR5
COLCARD

Field1:

( HFQ3379 )

HEST.COLCARD

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR7 - COLRECNT ( HFQ3383 )

English text: YES
No

HFR7 - COLRECNT ( HFQ3383 )

English text: NO
Attribute
Don't know

Route
HFR7 - COLRECNT ( HFQ3383 )

Refusal

HFR7 - COLRECNT ( HFQ3383 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:06 PM Monday, August 03, 2009

Page 413 of 760

HFR7

HFR7

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

COLRECNT

Enable Functions:

HELP
COMMENTS
JUMPBACK

Yes
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
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No
No
No
No

Grid Functions:

Add Line
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No
No

1932

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:

When did [you/(SP)] have (your/his/her) most recent blood stool test

using a home testing kit?

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:08 PM Monday, August 03, 2009

Page 414 of 760

HFR7
COLRECNT

Field1:

( HFQ3383 )

HEST.COLRECNT

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
TYearago
1
No
No

Number Label
1 LessThan1YearAgo

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR8 - COLSCOPY ( HFQ3387 )

2

English text: LESS THAN 1 YEAR AGO
1YearToLessThan2YearsAgo

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
2YearsToLessThan3YearsAgo
HFR8 - COLSCOPY ( HFQ3387 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
3YearsToLessThan5YearsAgo
HFR8 - COLSCOPY ( HFQ3387 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
5OrMoreYearsAgo
HFR8 - COLSCOPY ( HFQ3387 )

HFR8 - COLSCOPY ( HFQ3387 )

English text: 5 OR MORE YEARS AGO
Attribute
Don't know

Route
HFR8 - COLSCOPY ( HFQ3387 )

Refusal

HFR8 - COLSCOPY ( HFQ3387 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:08:12 PM Monday, August 03, 2009

Page 415 of 760

HFR7
DESIGN NOTES

4:08:12 PM Monday, August 03, 2009

Page 416 of 760


HFR8

HFR8

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLSCOPY

Enable Functions:

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Yes
Yes
No

Roster Functions:

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No
No
No
No

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Add Line
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No
No

1934

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:	

Another test for early signs of colon cancer is performed in the
doctor's office. The doctor uses a flexible lighted tube to examine the
colon and rectum directly. This is called a sigmoidoscopy or
colonoscopy.
[Have you/Has (SP)] ever had this exam?

Int. Instr II:

INPUT FIELDS / ROUTING


4:08:14 PM Monday, August 03, 2009	

Page 417 of 760

HFR8
COLSCOPY

Field1:

( HFQ3387 )

HEST.COLSCOPY

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR9 - WHENSCOP ( HFQ3391 )

English text: YES
No

HFR10 - HEARSCOP ( HFQ3395 )

English text: NO
Attribute
Don't know

Route
HFR10 - HEARSCOP ( HFQ3395 )

Refusal

HFR10 - HEARSCOP ( HFQ3395 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:16 PM Monday, August 03, 2009

Page 418 of 760

HFR9

HFR9

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

WHENSCOP

Enable Functions:

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Yes
No

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No
No
No
No

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No
No

1936

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Context header display:

Question display:

Multi Field display:


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Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

When did [you/(SP)] have (your/his/her) most recent sigmoidoscopy

or colonoscopy?

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:18 PM Monday, August 03, 2009

Page 419 of 760

HFR9
WHENSCOP

Field1:

( HFQ3391 )

HEST.WHENSCOP

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
TYearago
1
No
No

Number Label
1 LessThan1YearAgo

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR13 - COLSCRNS ( HFQ3406 )

2

English text: LESS THAN 1 YEAR AGO
1YearToLessThan2YearsAgo

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
2YearsToLessThan3YearsAgo
HFR13 - COLSCRNS ( HFQ3406 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
3YearsToLessThan5YearsAgo
HFR13 - COLSCRNS ( HFQ3406 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
5OrMoreYearsAgo
HFR13 - COLSCRNS ( HFQ3406 )

HFR13 - COLSCRNS ( HFQ3406 )

English text: 5 OR MORE YEARS AGO
Attribute
Don't know

Route
HFR13 - COLSCRNS ( HFQ3406 )

Refusal

HFR13 - COLSCRNS ( HFQ3406 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:08:22 PM Monday, August 03, 2009

Page 420 of 760

HFR9
DESIGN NOTES

4:08:22 PM Monday, August 03, 2009

Page 421 of 760


HFR10

HFR10

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HEARSCOP

Enable Functions:

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No
Yes
No

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No
No
No
No

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No

1938

Roster Name:
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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:

Before today, had you ever heard of a sigmoidoscopy or 

colonoscopy?

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:24 PM Monday, August 03, 2009

Page 422 of 760

HFR10
HEARSCOP

Field1:

( HFQ3395 )

HEST.HEARSCOP

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR11 - COLDRREC ( HFQ3403 )

English text: YES
No

BOX HFR2 - (HFQ3399 )

English text: NO
Attribute
Don't know

Route
BOX HFR2 - (HFQ3399 )

Refusal

BOX HFR2 - (HFQ3399 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:26 PM Monday, August 03, 2009

Page 423 of 760

BOX HFR2

BOX HFR2

Page Order # :

1940

BOX INSTRUCTIONS
( HFQ3399 )	

IF HFR3 - COLHTEST = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13 
COLSCRNS ( HFQ3406 ).
ELSE GO TO BOX HFS0 - (HFQ3408 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:08:26 PM Monday, August 03, 2009	

Page 424 of 760

HFR11

HFR11

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLDRREC

Enable Functions:

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Yes
No

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No
No
No
No

Grid Functions:

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No
No

1942

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:

Has a doctor ever recommended that [you/(SP)] have this test?


Int. Instr II:

INPUT FIELDS / ROUTING

4:08:27 PM Monday, August 03, 2009

Page 425 of 760

HFR11
COLDRREC

Field1:

( HFQ3403 )

HEST.COLDRREC

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFR13 - COLSCRNS ( HFQ3406 )

English text: YES
No

HFR13 - COLSCRNS ( HFQ3406 )

English text: NO
Attribute
Don't know

Route
HFR13 - COLSCRNS ( HFQ3406 )

Refusal

HFR13 - COLSCRNS ( HFQ3406 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:29 PM Monday, August 03, 2009

Page 426 of 760

HFR13

HFR13

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

COLSCRNS

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Yes
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No

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No
No
No
No

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No
No

1944

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


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Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Before today, did you know that Medicare now helps pay the cost of

screening tests for colorectal cancer?

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:31 PM Monday, August 03, 2009

Page 427 of 760

HFR13
COLSCRNS

Field1:

( HFQ3406 )

HEST.COLSCRNS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFS0 - (HFQ3408 )

English text: YES
No

BOX HFS0 - (HFQ3408 )

English text: NO
Attribute
Don't know

Route
BOX HFS0 - (HFQ3408 )

Refusal

BOX HFS0 - (HFQ3408 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:33 PM Monday, August 03, 2009

Page 428 of 760

BOX HFS0

BOX HFS0

Page Order # :

1946

BOX INSTRUCTIONS
( HFQ3408 )

IF THIS IS ROUND 55, GO TO HFAC29 - HCTROUBL ( HFQ3490 ).
ELSE GO TO BOX HFS1 - (HFQ3410 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:08:33 PM Monday, August 03, 2009

Page 429 of 760

BOX HFS1

BOX HFS1

Page Order # :

1960

BOX INSTRUCTIONS
( HFQ3410 )	

IF SP HAS EVER REPORTED HAVING OSTEPOPORIS IN THE CURRENT
ROUND OR IN A PREVIOUS ROUND, GO TO HFS3 - OSTTEST ( HFQ3440
).
ELSE GO TO HFSINTRO - OSTINTRO ( HFQ3412 ).

ASSIGNMENTS

TECHNICAL NOTES
407

HFOsteoporosisCurrOr
Prev

SP has ever reported having osteoporosis in the current
round or in a previous round =
There is a HEST where HEST.HESTRND <= current
round and HEST.OCOSTEOP = 1/Yes.

DESIGN NOTES

4:08:33 PM Monday, August 03, 2009	

Page 430 of 760

HFSINTRO

HFSINTRO

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

OSTINTRO

Enable Functions:

HELP
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No
No
No

1965

Roster Name:
Roster Type:
Roster Functions:

Add Item
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No
No
No
No

Grid Functions:

Add Line
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No
No

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:	

Now I'd like to talk about a disease called osteoporosis, which can
be treated if found early. In osteoporosis, the bones lose their
calcium and become fragile and more easily broken.

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:34 PM Monday, August 03, 2009	

Page 431 of 760

HFSINTRO
OSTINTRO

Field1:

( HFQ3412 )

TEMP

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
HFS1 - OSTEVERT ( HFQ3420 )

English text: CONTINUE
Attribute
Empty

Route
HFS1 - OSTEVERT ( HFQ3420 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:36 PM Monday, August 03, 2009

Page 432 of 760

HFS1

HFS1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTEVERT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1970

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
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No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

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:

[Have you/Has (SP)] ever talked with (your/his/her) doctor or other

health professional about osteoporosis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:37 PM Monday, August 03, 2009

Page 433 of 760

HFS1
OSTEVERT

Field1:

( HFQ3420 )

HEST.OSTEVERT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS2 - OSTHRISK ( HFQ3430 )

English text: YES
No

HFS3 - OSTTEST ( HFQ3440 )

English text: NO
Attribute
Don't know

Route
HFS3 - OSTTEST ( HFQ3440 )

Refusal

HFS3 - OSTTEST ( HFQ3440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:39 PM Monday, August 03, 2009

Page 434 of 760

HFS2

HFS2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTHRISK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

1980

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Has a doctor or other health professional ever told [you/(SP)] that

(you are/he is/she is) at high risk for osteoporosis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:41 PM Monday, August 03, 2009

Page 435 of 760

HFS2
OSTHRISK

Field1:

( HFQ3430 )

HEST.OSTHRISK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS3 - OSTTEST ( HFQ3440 )

English text: YES
No

HFS3 - OSTTEST ( HFQ3440 )

English text: NO
Attribute
Don't know

Route
HFS3 - OSTTEST ( HFQ3440 )

Refusal

HFS3 - OSTTEST ( HFQ3440 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:43 PM Monday, August 03, 2009

Page 436 of 760

HFS3

HFS3

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

OSTTEST

Enable Functions:	

HELP
COMMENTS
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No
No
No

1990

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 "Mass" and "Density" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

There is a test to detect osteoporosis at an early stage, called Bone

Mass Measurement or Bone Density Measurement, or DEXA scan.
[Have you/Has (SP)] ever had a Bone Mass or Bone Density
Measurement test?

Int. Instr II:

INPUT FIELDS / ROUTING


4:08:44 PM Monday, August 03, 2009	

Page 437 of 760

HFS3
OSTTEST

Field1:

( HFQ3440 )

HEST.OSTTEST

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS5 - OSTRECNT ( HFQ3460 )

English text: YES
No

HFS4 - OSTHEAR ( HFQ3450 )

English text: NO
Attribute
Don't know

Route
HFS4 - OSTHEAR ( HFQ3450 )

Refusal

HFS4 - OSTHEAR ( HFQ3450 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:47 PM Monday, August 03, 2009

Page 438 of 760

HFS4

HFS4

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTHEAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2000

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Before today, had you ever heard of this test?


Int. Instr II:

INPUT FIELDS / ROUTING


4:08:48 PM Monday, August 03, 2009

Page 439 of 760

HFS4
OSTHEAR

Field1:

( HFQ3450 )

HEST.OSTHEAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS6 - OSTMASS ( HFQ3470 )

English text: YES
No

HFAC29 - HCTROUBL ( HFQ3490 )

English text: NO
Attribute
Don't know

Route
HFAC29 - HCTROUBL ( HFQ3490 )

Refusal

HFAC29 - HCTROUBL ( HFQ3490 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:08:50 PM Monday, August 03, 2009

Page 440 of 760

HFS5

HFS5

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

OSTRECNT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2010

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

When was the most recent time that [you/(SP)] had a Bone Mass or

Bone Density Measurement test?

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:52 PM Monday, August 03, 2009

Page 441 of 760

HFS5
OSTRECNT

Field1:

( HFQ3460 )

HEST.OSTRECNT

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
TYearAgoDKRF
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFS6 - OSTMASS ( HFQ3470 )

2

English text: LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears

3

English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanThreeYears
HFS6 - OSTMASS ( HFQ3470 )

4

English text: 2 YEARS TO LESS THAN 3 YEARS AGO
ThreeYearsToLessThanFiveYears
HFS6 - OSTMASS ( HFQ3470 )

5

English text: 3 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
HFS6 - OSTMASS ( HFQ3470 )

HFS6 - OSTMASS ( HFQ3470 )

English text: 5 OR MORE YEARS AGO
Attribute
Don't know

Route
HFS6 - OSTMASS ( HFQ3470 )

Refusal

HFS6 - OSTMASS ( HFQ3470 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:08:57 PM Monday, August 03, 2009

Page 442 of 760

HFS5
DESIGN NOTES

4:08:57 PM Monday, August 03, 2009

Page 443 of 760


HFS6

HFS6

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

OSTMASS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2020

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

Before today, did you know that Medicare would pay for Bone Mass
or Bone Density Measurement tests for Medicare beneficiaries who
are at risk for osteoporosis?

Int. Instr II:
INPUT FIELDS / ROUTING

4:08:58 PM Monday, August 03, 2009	

Page 444 of 760

HFS6
OSTMASS

Field1:

( HFQ3470 )

HEST.OSTMASS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC29 - HCTROUBL ( HFQ3490 )

English text: YES
No

HFAC29 - HCTROUBL ( HFQ3490 )

English text: NO
Attribute
Don't know

Route
HFAC29 - HCTROUBL ( HFQ3490 )

Refusal

HFAC29 - HCTROUBL ( HFQ3490 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:09:00 PM Monday, August 03, 2009

Page 445 of 760

HFAC29

HFAC29

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

HCTROUBL

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2050

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "past year" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Next, we are going to ask some questions about [your/(SP's)] health

care needs during the past year.
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any
trouble getting health care that (you/he/she) wanted or needed?

Int. Instr II:

INPUT FIELDS / ROUTING


4:09:01 PM Monday, August 03, 2009	

Page 446 of 760

HFAC29
HCTROUBL

Field1:

( HFQ3490 )

ACCS.HCTROUBL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30A - HCTCODE ( HFQ3510 )

English text: YES
No

BOX HFF8 - (HFQ3579 )

English text: NO
Attribute
Don't know

Route
BOX HFF8 - (HFQ3579 )

Refusal

BOX HFF8 - (HFQ3579 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:09:04 PM Monday, August 03, 2009

Page 447 of 760

HFAC30A

HFAC30A

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

HCTCODE

Field 2:

HCTOTHOS

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:	

2060

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:

Question Text:

Why was that?

[PROBE: Any other reason?]

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:09:08 PM Monday, August 03, 2009	

Page 448 of 760

HFAC30A

4:09:15 PM Monday, August 03, 2009

Page 449 of 760


HFAC30A
HCTCODE

Field1:

( HFQ3510 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=ACCS.HCTMONEY
2=ACCS.HCTHIGH
3=ACCS.HCTNOCOV
4=ACCS.HCTTRANS
5=ACCS.HCTHOMEH
6=ACCS.HCTNTREA
7=ACCS.HCTWAIT
8=ACCS.HCTACPMC
9=ACCS.HCTELIG
10=ACCS.HCTDELAY
11=ACCS.HCTSPECL
12=ACCS.HCTHMORF
13=ACCS.HCTHMOMD
14=ACCS.HCTHMOCV
91=ACCS.HCTOTHER
Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
THCTCode
15
No
No

Number Label
1 NoMoney

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF6 - (HFQ3537 )

2

English text: SP DOES NOT HAVE MONEY
CostTooHigh

BOX HFF6 - (HFQ3537 )

3

English text: COST IS TOO HIGH
ServiceNotCovered

BOX HFF6 - (HFQ3537 )

4

English text: SERVICES/SUPPLIES NOT COVERED
NeededTransportation
BOX HFF6 - (HFQ3537 )

5

English text: NEEDED TRANSPORTATION TO DOCTOR/HOSPITAL
DifficultyGettingHHCare
BOX HFF6 - (HFQ3537 )

6

English text: DIFFICULTY GETTING HOME HEALTH CARE
NoTreatmentAvailable
BOX HFF6 - (HFQ3537 )

7

English text: NO TREATMENT AVAILABLE/DOCTOR WON’T TREAT
WaitTooLong
BOX HFF6 - (HFQ3537 )
English text: WAIT TOO LONG/DOCTOR TOO BUSY

4:09:27 PM Monday, August 03, 2009

Page 450 of 760

HFAC30A

8

DrDoesNotAcceptMedicare

BOX HFF6 - (HFQ3537 )

9
10

English text: OWN DOCTOR DOESN’T ACCEPT MEDICARE/COULDN’T FIND DOCTOR WHO
ACCEPTS MEDICARE
NotEligible
BOX HFF6 - (HFQ3537 )
English text: NOT ELIGIBLE FOR PUBLIC COVERAGE
DifficultyGettingAppt
BOX HFF6 - (HFQ3537 )

11

English text: DIFFICULTY GETTING APPOINTMENT/ DELAYS BECAUSE SP ON MEDICARE
ReferredToSpecialist
BOX HFF6 - (HFQ3537 )

13

English text: DOCTOR REFERRED SP TO SPECIALIST OR OTHER DOCTOR
HMOReferralProcess
BOX HFF6 - (HFQ3537 )
English text: HMO REFERRAL PROCESS (DIFFICULTY GETTING)
HMODrNotGood
BOX HFF6 - (HFQ3537 )

14

English text: PROBLEMS WITH HMO DOCTORS NOT GOOD OR AVAILABLE
HMONotCoverService
BOX HFF6 - (HFQ3537 )

12

91

English text: HMO WOULD NOT COVER OR PROVIDE SERVICE
Other
HFAC30A - HCTOTHOS ( HFQ3530 )
English text: OTHER

Attribute
Don't know

Route
BOX HFF6 - (HFQ3537 )

Refusal

BOX HFF6 - (HFQ3537 )

Field2:

HCTOTHOS

( HFQ3530 )

ACCS.HCTOTHOS

Cheshire Name:
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.]

4:09:33 PM Monday, August 03, 2009

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFF6 - (HFQ3537 )

Page 451 of 760

HFAC30A
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:09:33 PM Monday, August 03, 2009

Page 452 of 760

BOX HFF6

BOX HFF6

Page Order # :

2070

BOX INSTRUCTIONS
( HFQ3537 )	

IF RESPONSE TO HFAC30A - HCTCODE INCLUDES
8/DrDoesNotAcceptMedicare OR 10/DifficultyGettingAppt, GO TO HFAC30D 
OFFEXPLN ( HFQ3565 ).
ELSE GO TO HFAC30B - CGETAPPT ( HFQ3544 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:09:33 PM Monday, August 03, 2009	

Page 453 of 760

HFAC30B

HFAC30B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

CGETAPPT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2080

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 (LAST HF MONTH YEAR), [have you/has (SP)] been told by a

doctor’s office that they cannot schedule an appointment with
[you/(SP)]?

Int. Instr II:
INPUT FIELDS / ROUTING

4:09:34 PM Monday, August 03, 2009

Page 454 of 760

HFAC30B
CGETAPPT

Field1:

( HFQ3544 )

ACCS.CGETAPPT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30C - CGETCODE ( HFQ3551 )

English text: YES
No

BOX HFF8 - (HFQ3579 )

English text: NO
Attribute
Don't know

Route
BOX HFF8 - (HFQ3579 )

Refusal

BOX HFF8 - (HFQ3579 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:09:37 PM Monday, August 03, 2009

Page 455 of 760

HFAC30C

HFAC30C

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

CGETCODE

Field 2:

CGETOTOS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

2090

Roster Name:
Roster Type:

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:

Question Text:

What were the reasons the doctor’s office offered as an explanation
	
for not scheduling an appointment with [you/(SP)]?
[PROBE: Any other reason?]

Int. Instr II:

CHECK ALL THAT APPLY

INPUT FIELDS / ROUTING

4:09:39 PM Monday, August 03, 2009	

Page 456 of 760

HFAC30C

4:09:45 PM Monday, August 03, 2009

Page 457 of 760


HFAC30C
CGETCODE

Field1:

( HFQ3551 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=ACCS.CGETINSR
2=ACCS.CGETFULL
3=ACCS.CGETNNEW
4=ACCS.CGETNNMP
5=ACCS.CGETHOUR
6=ACCS.CGETCAID
7=ACCS.CGETNAMC
8=ACCS.CGETNAMA
9=ACCS.CGETAPRV
91=ACCS.CGETOTHR
Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TCgetCod
10
No
No

Number Label
1 DocNotAcceptPlan

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFF7 - (HFQ3558 )

2

English text: DOCTOR DOES NOT ACCEPT INSURANCE PLAN
AllDocApptsFull
BOX HFF7 - (HFQ3558 )

3

English text: ALL OF DOCTORS APPOINTMENTS WERE FULL
DocNotAcceptNewPat
BOX HFF7 - (HFQ3558 )

4

English text: DOCTOR IS NOT ACCEPTING ANY NEW PATIENTS
DocNotAcceptNewMedicare
BOX HFF7 - (HFQ3558 )

5

English text: DOCTOR IS NOT ACCEPTING NEW MEDICARE PATIENTS
DocHoursConflicted
BOX HFF7 - (HFQ3558 )

6

English text: DOCTRS HOURS CONFLICTED WITH REQUIREMENTS OF SP
DocNotAcceptMCAD
BOX HFF7 - (HFQ3558 )

8

English text: DOCTOR DOES NOT ACCEPT MEDICAID
DocNotAcceptMCAR
BOX HFF7 - (HFQ3558 )
English text: DOCTOR DOES NOT ACCEPT MEDICARE AT ALL
DocNotAcceptAssign
BOX HFF7 - (HFQ3558 )

9

English text: DOCTOR DOES NOT ACCEPT MEDICARE ASSIGNMENT
DocAnotherProviderBetter
BOX HFF7 - (HFQ3558 )

7

English text: DOCTOR FELT ANOTHER PROVIDER WOULD BE BETTER FOR SP
4:09:55 PM Monday, August 03, 2009

Page 458 of 760

HFAC30C

91

Other

HFAC30C - CGETOTOS ( HFQ3555 )

English text: OTHER
Attribute
Don't know

Route
BOX HFF7 - (HFQ3558 )

Refusal

BOX HFF7 - (HFQ3558 )

Field2:

CGETOTOS

( HFQ3555 )

ACCS.CGETOTOS

Cheshire Name:
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
BOX HFF7 - (HFQ3558 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:09:57 PM Monday, August 03, 2009

Page 459 of 760

BOX HFF7

BOX HFF7

Page Order # :

2100

BOX INSTRUCTIONS
( HFQ3558 )	

IF RESPONSE TO HFAC30C - CGETCODE INCLUDES
4/DocNotAcceptNewMedicare OR 7/DocNotAcceptMCAR, GO TO HFAC30D 
OFFEXPLN ( HFQ3565 ).
ELSE GO TO BOX HFF8 - (HFQ3579 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:09:57 PM Monday, August 03, 2009	

Page 460 of 760

HFAC30D

HFAC30D

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 0:

OFFEXPLN

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2110

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:

If response to HFAC30a includes 10/DifficultyGettingAppt, display
"it is difficult for Medicare patients to get an appointment".
Else display "Medicare is not accepted".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Did the doctor’s office explain why (it is difficult for Medicare patients
	
to get an appointment/Medicare is not accepted) at that practice?

Int. Instr II:
INPUT FIELDS / ROUTING

4:09:59 PM Monday, August 03, 2009	

Page 461 of 760

HFAC30D
OFFEXPLN

Field0:

( HFQ3565 )

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30E - OFFEXVB ( HFQ3572 )

English text: YES
No

BOX HFF8 - (HFQ3579 )

English text: NO
Attribute
Don't know

Route
BOX HFF8 - (HFQ3579 )

Refusal

BOX HFF8 - (HFQ3579 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:10:01 PM Monday, August 03, 2009

Page 462 of 760

HFAC30E

HFAC30E

Page Order # :

Design Screen Type:

Verbatim Text

Fields:

Field 0:

OFFEXVB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2120

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

What was that explanation?


Int. Instr II:

INPUT FIELDS / ROUTING


4:10:01 PM Monday, August 03, 2009

Page 463 of 760

HFAC30E

Field0:

OFFEXVB

( HFQ3572 )

NONE

Cheshire Name:

REPLACES CHESHIRE VARIABLES:
ACCS.OFFEXVB1
ACCS.OFFEXVB2
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Open
TOpen90
1
No
No

Number Label
1

FieldSize:
Min Value:
Max Value:
Mask:

90

Route
BOX HFF8 - (HFQ3579 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:10:02 PM Monday, August 03, 2009

Page 464 of 760

BOX HFF8

BOX HFF8

Page Order # :

2122

BOX INSTRUCTIONS
( HFQ3579 )

IF RESPONDENT IS SP, GO TO HFAC30F - ABNFORM ( HFQ3586 ).
ELSE GO TO HFAC31 - HCDELAY ( HFQ3660 ).

ASSIGNMENTS

TECHNICAL NOTES
4

Respondent

On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.

DESIGN NOTES

4:10:02 PM Monday, August 03, 2009

Page 465 of 760

HFAC30F

HFAC30F

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

ABNFORM

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2124

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:

SHOW CARD HF7

Question Text:

In some situations your doctor or other health care provider may give
you a form called either an Advance Beneficiary Notice or notice of
noncoverage.
This form is used when the health care provider has some doubt that
a service will be covered by Medicare, and expects that you may
have to pay for the service. In such cases, you can make a choice.
You can choose to get or not get the service. If you sign the form,
you can get the service right away; and, usually, the provider will
collect payment from you.

4:10:03 PM Monday, August 03, 2009

Page 466 of 760

HFAC30F
You can still ask the provider to bill Medicare, in case the provider is
wrong and the service is covered. If the service is covered, then the
money you paid the provider is returned to you.
Since (LAST HF MONTH YEAR), has any doctor or other health care
provider given you a form like one shown on this card?
Int. Instr II:
INPUT FIELDS / ROUTING
ABNFORM

Field1:

( HFQ3586 )

ACCS.ABNFORM

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30G - ABNCODE ( HFQ3593 )

English text: YES
No

HFAC31 - HCDELAY ( HFQ3660 )

English text: NO
Attribute
Don't know

Route
HFAC31 - HCDELAY ( HFQ3660 )

Refusal

HFAC31 - HCDELAY ( HFQ3660 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

4:10:06 PM Monday, August 03, 2009

Page 467 of 760

HFAC30F
TECHNICAL NOTES

DESIGN NOTES

4:10:06 PM Monday, August 03, 2009

Page 468 of 760

HFAC30G

HFAC30G

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

ABNCODE

Field 2:

ABNOTHOS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

2126

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display "most recent" in bold.
Always display "(s)" in parentheses.

Multi Field display:

Vertical Alignment

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

Think about the most recent time you received an Advance
Beneficiary Notice, or "ABN". What items or services did the health
care provider expect would not be paid by Medicare?
[PROBE: What type(s) of health care items or services were
described on the ABN?]

4:10:10 PM Monday, August 03, 2009	

Page 469 of 760

HFAC30G
Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING

4:10:18 PM Monday, August 03, 2009

Page 470 of 760

HFAC30G
ABNCODE

Field1:

( HFQ3593 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=ACCS.ABNDOCT
2=ACCS.ABNHHOME
3=ACCS.ABNHOSPC
4=ACCS.ABNTHERA
5=ACCS.ABNIPCAR
6=ACCS.ABNOPCAR
7=ACCS.ABNNURSE
8=ACCS.ABNTESTS
9=ACCS.ABNEQUIP
10=ACCS.ABNVACC
11=ACCS.ABNEYE
12=ACCS.ABNPMED
13=ACCS.ABNSURG
14=ACCS.ABNCHECK
91=ACCS.ABNOTHER
Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TABNCod
15
No
No

Number Label
1 PhysicanServices

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30G1 - ABNREAD ( HFQ3600 )

2

English text: PHYSICIAN SERVICES
HomeHealthServices

HFAC30G1 - ABNREAD ( HFQ3600 )

3

English text: HOME HEALTH SERVICES
HospiceServices

HFAC30G1 - ABNREAD ( HFQ3600 )

4

English text: HOSPICE SERVICES
OccPhysTherapyServices

HFAC30G1 - ABNREAD ( HFQ3600 )

5

English text: OCCUPATIONAL AND/OR PHYSICAL THERAPY SERVICES
InpatientCare
HFAC30G1 - ABNREAD ( HFQ3600 )

6

English text: INPATIENT HOSPITAL CARE
OutpatientCare

7

English text: OUTPATIENT HOSPITAL CARE
SkilledNursingCare
HFAC30G1 - ABNREAD ( HFQ3600 )

HFAC30G1 - ABNREAD ( HFQ3600 )

English text: SKILLED NURSING CARE

4:10:29 PM Monday, August 03, 2009

Page 471 of 760

HFAC30G

8

LabTests

HFAC30G1 - ABNREAD ( HFQ3600 )

9

English text: LABORATORY TESTS
DurableMedEquip

HFAC30G1 - ABNREAD ( HFQ3600 )

10

English text: DURABLE MEDICAL EQUIPMENT
Vaccination
HFAC30G1 - ABNREAD ( HFQ3600 )

11

English text: VACCINATION
Eyeglasses

HFAC30G1 - ABNREAD ( HFQ3600 )

12

English text: EYEGLASSES/EYE SERVICES
PrescribedMeds

HFAC30G1 - ABNREAD ( HFQ3600 )

13

English text: PRESCRIBED MEDICINES ONLY
SurgicalServices
HFAC30G1 - ABNREAD ( HFQ3600 )

14

English text: ALL SURGICAL SERVICES
PreventiveTests

91

English text: PREVENTATIVE (NOT DIAGNOSTIC) TESTS
Other
HFAC30G - ABNOTHOS ( HFQ3597 )

HFAC30G1 - ABNREAD ( HFQ3600 )

English text: OTHER HEALTH CARE ITEM OR SERVICE
Attribute
Don't know

Route
HFAC30G1 - ABNREAD ( HFQ3600 )

Refusal

HFAC30G1 - ABNREAD ( HFQ3600 )

Field2:

ABNOTHOS

( HFQ3597 )

ACCS.ABNOTHOS

Cheshire Name:
Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.


Item Text:

OTHER HEALTH CARE ITEM OR SERVICE (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
HFAC30G1 - ABNREAD ( HFQ3600 )

BACKGROUND VARIABLE ASSIGNMENTS

4:10:36 PM Monday, August 03, 2009

Page 472 of 760

HFAC30G

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:10:36 PM Monday, August 03, 2009

Page 473 of 760

HFAC30G1

HFAC30G1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

ABNREAD

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2128

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Did you read the Advance Beneficiary Notice?


Int. Instr II:

INPUT FIELDS / ROUTING


4:10:37 PM Monday, August 03, 2009

Page 474 of 760

HFAC30G1
ABNREAD

Field1:

( HFQ3600 )

ACCS.ABNREAD

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30H - ABNUNDER ( HFQ3607 )

English text: YES
No

HFAC30I - ABNSIGN ( HFQ3614 )

English text: NO
Attribute
Don't know

Route
HFAC30I - ABNSIGN ( HFQ3614 )

Refusal

HFAC30I - ABNSIGN ( HFQ3614 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:10:39 PM Monday, August 03, 2009

Page 475 of 760

HFAC30H

HFAC30H

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

ABNUNDER

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2130

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

How much trouble did you have understanding the Advance

Beneficiary Notice for (the item or service/these items or services)?
Would you say you had no trouble, a little trouble, or a lot of trouble?

Int. Instr II:

INPUT FIELDS / ROUTING


4:10:41 PM Monday, August 03, 2009	

Page 476 of 760

HFAC30H
ABNUNDER

Field1:

( HFQ3607 )

ACCS.ABNUNDER

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
TTroub
1
No
No

Number Label
1 NoTrouble

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30I - ABNSIGN ( HFQ3614 )

2

English text: NO TROUBLE
ALittleTrouble

HFAC30I - ABNSIGN ( HFQ3614 )

3

English text: A LITTLE TROUBLE
ALotOfTrouble

HFAC30I - ABNSIGN ( HFQ3614 )

English text: A LOT OF TROUBLE
Attribute
Don't know

Route
HFAC30I - ABNSIGN ( HFQ3614 )

Refusal

HFAC30I - ABNSIGN ( HFQ3614 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:10:44 PM Monday, August 03, 2009

Page 477 of 760

HFAC30I

HFAC30I

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

ABNSIGN

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2134

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Always display "[Think…]" in brackets.
	
Display "most recent" in bold.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[Think about the most recent time you received an Advance

Beneficiary Notice.]
Did you sign the form?

Int. Instr II:

INPUT FIELDS / ROUTING


4:10:45 PM Monday, August 03, 2009	

Page 478 of 760

HFAC30I
ABNSIGN

Field1:

( HFQ3614 )

ACCS.ABNSIGN

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30K - ABNITEM ( HFQ3628 )

English text: YES
No

HFAC30J - ABNVB ( HFQ3621 )

English text: NO
Attribute
Don't know

Route
HFAC30K - ABNITEM ( HFQ3628 )

Refusal

HFAC30K - ABNITEM ( HFQ3628 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:10:47 PM Monday, August 03, 2009

Page 479 of 760

HFAC30J

HFAC30J

Page Order # :

Design Screen Type:

Verbatim Text

Fields:

Field 1:

ABNVB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2136

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:

Why didn’t you sign the form?
	

Int. Instr II:

INPUT FIELDS / ROUTING


4:10:48 PM Monday, August 03, 2009

Page 480 of 760

HFAC30J

Field1:

ABNVB

( HFQ3621 )

NONE

Cheshire Name:

REPLACES CHESHIRE VARIABLES:

ACCS.ABNVB1

ACCS.ABNVB2

ACCS.ABNVB3

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Open
TOpen135
1
No
No

Number Label
1

FieldSize:
Min Value:
Max Value:
Mask:

135

Route
HFAC30K - ABNITEM ( HFQ3628 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:10:48 PM Monday, August 03, 2009

Page 481 of 760

HFAC30K

HFAC30K

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

ABNITEM

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2138

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".

Multi Field display:

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

Display report below Question Text.
If current round ACCS.ABNCODE = DK or RF, display "Unknown".
Else for each response included in current round ACCS.ABNCODE,
display English response text on a separate line in the report:
If ACCS.ABNCODE includes 1/PhysicanServices, display "Physician
Services"
If ACCS.ABNCODE includes 2/HomeHealthServices, display "Home
Health Services"
If ACCS.ABNCODE includes 3/HospiceServices, display "Hospice
Services"
If ACCS.ABNCODE includes 4/OccPhysTherapyServices, display
"Occupational/Physical Therapy Services"
If ACCS.ABNCODE includes 5/InpatientCare, display "Inpatient
Hospital Care"
If ACCS.ABNCODE includes 6/OutpatientCare, display "Outpatient

4:10:50 PM Monday, August 03, 2009	

Page 482 of 760

HFAC30K
Hospital Care"

If ACCS.ABNCODE includes 7/SkilledNursingCare, display "Skilled

Nursing Care"

If ACCS.ABNCODE includes 8/LabTests, display "Laboratory Tests"

If ACCS.ABNCODE includes 9/DurableMedEquip, display "Durable

Medical Equipment"

If ACCS.ABNCODE includes 10/Vaccination, display "Vaccination"

If ACCS.ABNCODE includes 11/Eyeglasses, display

"Eyeglasses/Eye Services"

If ACCS.ABNCODE includes 12/PrescribedMeds, display

"Prescribed Medicines Only"

If ACCS.ABNCODE includes 13/SurgicalServices, display "All

Surgical Services"

If ACCS.ABNCODE includes 14/PreventiveTests, display

"Preventive Tests"

If ACCS.ABNCODE includes 91/Other, display ACCS.ABNOTHOS

text.


TEXT:
Context Header:
Int. Instr I:
Question Text:

You mentioned that you received an ABN for [READ HEALTH CARE
ITEMS AND SERVICES LISTED BELOW]. Did you choose to get
(the item or service/these items or services) even though the health
care provider expected Medicare would not pay?

Int. Instr II:
INPUT FIELDS / ROUTING

4:10:52 PM Monday, August 03, 2009

Page 483 of 760

HFAC30K
ABNITEM

Field1:

( HFQ3628 )

ACCS.ABNITEM

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30K1 - ABNBILL ( HFQ3635 )

English text: YES
No

HFAC31 - HCDELAY ( HFQ3660 )

English text: NO
Attribute
Don't know

Route
HFAC31 - HCDELAY ( HFQ3660 )

Refusal

HFAC31 - HCDELAY ( HFQ3660 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:10:55 PM Monday, August 03, 2009

Page 484 of 760

HFAC30K1

HFAC30K1

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

ABNBILL

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2140

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Did you ask that Medicare be billed for (the item or service/these

items or services)?

Int. Instr II:
INPUT FIELDS / ROUTING

4:10:56 PM Monday, August 03, 2009	

Page 485 of 760

HFAC30K1
ABNBILL

Field1:

( HFQ3635 )

ACCS.ABNBILL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30L - ABNDENY ( HFQ3642 )

English text: YES
No

HFAC30L - ABNDENY ( HFQ3642 )

English text: NO
Attribute
Don't know

Route
HFAC30L - ABNDENY ( HFQ3642 )

Refusal

HFAC30L - ABNDENY ( HFQ3642 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:10:58 PM Monday, August 03, 2009

Page 486 of 760

HFAC30L

HFAC30L

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

ABNDENY

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2144

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Did Medicare deny payment for (the item or service/these items or

services)?

Int. Instr II:
INPUT FIELDS / ROUTING

4:10:59 PM Monday, August 03, 2009	

Page 487 of 760

HFAC30L
ABNDENY

Field1:

( HFQ3642 )

ACCS.ABNDENY

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC30M - ABNPYCOD ( HFQ3649 )

English text: YES
No

HFAC30M - ABNPYCOD ( HFQ3649 )

English text: NO
Attribute
Don't know

Route
HFAC30M - ABNPYCOD ( HFQ3649 )

Refusal

HFAC30M - ABNPYCOD ( HFQ3649 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:02 PM Monday, August 03, 2009

Page 488 of 760

HFAC30M

HFAC30M

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

ABNPYCOD

Field 2:

ABNOTROS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

2146

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".

Multi Field display:

Vertical Alignment

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

What sources paid any part of the cost for (the item or service/these

items or services)?
[PROBE: Who else paid?]

Int. Instr II:

4:11:04 PM Monday, August 03, 2009	

CHECK ALL THAT APPLY.

Page 489 of 760

HFAC30M
INPUT FIELDS / ROUTING

4:11:10 PM Monday, August 03, 2009

Page 490 of 760


HFAC30M
ABNPYCOD

Field1:

( HFQ3649 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELDS:

1=ACCS.ABNMCAR

2=ACCS.ABNMCAID

3=ACCS.ABNPUBL

4=ACCS.ABNPRIV

5=ACCS.ABNTRIC

6=ACCS.ABNVA

7=ACCS.ABNFAML

91=ACCS.ABNOTHR

96=ACCS.ABNNOPAY

Item Text display:

Display response options in the following order: 96, 1, 2, 3,
4, 5, 6, 7, 91.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
TABNpycd
8
No
No

Number Label
1 MCARorMA

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFAC31 - HCDELAY ( HFQ3660 )

2

English text: MEDICARE OR MEDICARE ADVANTAGE PLAN
Medicaid
HFAC31 - HCDELAY ( HFQ3660 )

3

English text: MEDICAID
OtherPublic

4

English text: PUBLIC PLAN OTHER THAN MEDICAID
Private
HFAC31 - HCDELAY ( HFQ3660 )

5

English text: PRIVATE HEALTH INSURANCE
TRICARE
HFAC31 - HCDELAY ( HFQ3660 )

6

English text: TRICARE
VA

HFAC31 - HCDELAY ( HFQ3660 )

HFAC31 - HCDELAY ( HFQ3660 )

91

English text: V.A.
SPFamily
English text: SP/FAMILY
Other

96

English text: OTHER HEALTH CARE ITEM OR SERVICE
NoSource
HFAC31 - HCDELAY ( HFQ3660 )

7

HFAC31 - HCDELAY ( HFQ3660 )
HFAC30M - ABNOTROS ( HFQ3655 )

English text: NO SOURCE PAID/NOT PAID
4:11:19 PM Monday, August 03, 2009

Page 491 of 760

HFAC30M

Attribute
Don't know

Route
HFAC31 - HCDELAY ( HFQ3660 )

Refusal

HFAC31 - HCDELAY ( HFQ3660 )

Field2:

ABNOTROS

( HFQ3655 )

ACCS.ABNOTROS

Cheshire Name:
Item Text display:

Display "(SPECIFY)" in the same blue font used for

interviewer instructions.


Item Text:

OTHER HEALTH CARE ITEM OR SERVICE (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
HFAC31 - HCDELAY ( HFQ3660 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:20 PM Monday, August 03, 2009

Page 492 of 760

HFAC31

HFAC31

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HCDELAY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2148

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed
seeking medical care because (you were/he was/she was) worried
about the cost?

Int. Instr II:
INPUT FIELDS / ROUTING

4:11:22 PM Monday, August 03, 2009	

Page 493 of 760

HFAC31
HCDELAY

Field1:

( HFQ3660 )

ACCS.HCDELAY

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKINTRO - IADLINTRO ( HFQ3680 )

English text: YES
No

HFKINTRO - IADLINTRO ( HFQ3680 )

English text: NO
Attribute
Don't know

Route
HFKINTRO - IADLINTRO ( HFQ3680 )

Refusal

HFKINTRO - IADLINTRO ( HFQ3680 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:24 PM Monday, August 03, 2009

Page 494 of 760

HFKINTRO

HFKINTRO

Page Order # :

Design Screen Type:	

No Entry

Fields:	

Field 1:

IADLINTRO

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

2150

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "doing them by (yourself/himself/herself)" in BOLD.


Multi Field display:

Vertical Alignment


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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

Now I'm going to ask about some everyday activities and whether
[you have/(SP) has] any difficulty doing them by
(yourself/himself/herself).

Int. Instr II:
INPUT FIELDS / ROUTING

4:11:25 PM Monday, August 03, 2009	

Page 495 of 760

HFKINTRO
IADLINTRO

Field1:

( HFQ3680 )

TEMP

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
HFKA1 - PRBTELE ( HFQ3690 )

English text: CONTINUE
Attribute
Empty

Route
HFKA1 - PRBTELE ( HFQ3690 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:27 PM Monday, August 03, 2009

Page 496 of 760

HFKA1

HFKA1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

PRBTELE

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2155

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 "any" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
using the telephone?

Int. Instr II:
INPUT FIELDS / ROUTING

4:11:28 PM Monday, August 03, 2009	

Page 497 of 760

HFKA1
PRBTELE

Field1:

( HFQ3690 )

IADL.PRBTELE

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
TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKB1 - PRBLHWK ( HFQ3700 )

2

English text: YES
No

HFKB1 - PRBLHWK ( HFQ3700 )

3

English text: NO
DoesntDo

HFKA2 - DONTTELE ( HFQ3692 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFKB1 - PRBLHWK ( HFQ3700 )

Refusal

HFKB1 - PRBLHWK ( HFQ3700 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:31 PM Monday, August 03, 2009

Page 498 of 760

HFKA2

HFKA2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTTELE

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2160

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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that using the telephone is something that [you don't/(SP)

doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING


4:11:32 PM Monday, August 03, 2009	

Page 499 of 760

HFKA2
DONTTELE

Field1:

( HFQ3692 )

IADL.DONTTELE

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKB1 - PRBLHWK ( HFQ3700 )

English text: YES
No

HFKB1 - PRBLHWK ( HFQ3700 )

English text: NO
Attribute
Don't know

Route
HFKB1 - PRBLHWK ( HFQ3700 )

Refusal

HFKB1 - PRBLHWK ( HFQ3700 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:34 PM Monday, August 03, 2009

Page 500 of 760

HFKB1

HFKB1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

PRBLHWK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2165

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 "any" in BOLD.

Always display "(like washing...)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
doing light housework (like washing dishes, straightening up, or light
cleaning)?

Int. Instr II:

4:11:36 PM Monday, August 03, 2009	

Page 501 of 760

HFKB1
INPUT FIELDS / ROUTING
PRBLHWK

Field1:

( HFQ3700 )

IADL.PRBLHWK

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
TDontdo
1
No
No

Number Label
1 Yes
2
3

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKC1 - PRBHHWK ( HFQ3710 )

English text: YES
No
English text: NO
DoesntDo

HFKC1 - PRBHHWK ( HFQ3710 )
HFKB2 - DONTLHWK ( HFQ3702 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFKC1 - PRBHHWK ( HFQ3710 )

Refusal

HFKC1 - PRBHHWK ( HFQ3710 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:39 PM Monday, August 03, 2009

Page 502 of 760

HFKB2

HFKB2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTLHWK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2170

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 "health" and "physical" in BOLD.
Always display "(like washing...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[You said that doing light housework (like washing dishes,
straightening up, or light cleaning) is something that [you don't/(SP)
doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:
4:11:40 PM Monday, August 03, 2009	

Page 503 of 760

HFKB2
INPUT FIELDS / ROUTING
DONTLHWK

Field1:

( HFQ3702 )

IADL.DONTLHWK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKC1 - PRBHHWK ( HFQ3710 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
HFKC1 - PRBHHWK ( HFQ3710 )

Refusal

HFKC1 - PRBHHWK ( HFQ3710 )

HFKC1 - PRBHHWK ( HFQ3710 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:42 PM Monday, August 03, 2009

Page 504 of 760

HFKC1

HFKC1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

PRBHHWK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2175

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 "any" in BOLD.

Always display "(like scrubbing...)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
doing heavy housework (like scrubbing floors or washing windows)?

Int. Instr II:

INPUT FIELDS / ROUTING


4:11:44 PM Monday, August 03, 2009	

Page 505 of 760

HFKC1
PRBHHWK

Field1:

( HFQ3710 )

IADL.PRBHHWK

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
TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKD1 - PRBMEAL ( HFQ3720 )

2

English text: YES
No

HFKD1 - PRBMEAL ( HFQ3720 )

3

English text: NO
DoesntDo

HFKC2 - DONTHHWK ( HFQ3712 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFKD1 - PRBMEAL ( HFQ3720 )

Refusal

HFKD1 - PRBMEAL ( HFQ3720 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:47 PM Monday, August 03, 2009

Page 506 of 760

HFKC2

HFKC2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTHHWK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2180

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 "health" and "physical" in BOLD.
Always display "(like scrubbing...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that doing heavy housework (like scrubbing floors or

washing windows) is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

4:11:48 PM Monday, August 03, 2009	

Page 507 of 760

HFKC2
INPUT FIELDS / ROUTING
DONTHHWK

Field1:

( HFQ3712 )

IADL.DONTHHWK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKD1 - PRBMEAL ( HFQ3720 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
HFKD1 - PRBMEAL ( HFQ3720 )

Refusal

HFKD1 - PRBMEAL ( HFQ3720 )

HFKD1 - PRBMEAL ( HFQ3720 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:50 PM Monday, August 03, 2009

Page 508 of 760

HFKD1

HFKD1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

PRBMEAL

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2185

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 "any" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
preparing (your/his/her) own meals?

Int. Instr II:
INPUT FIELDS / ROUTING

4:11:52 PM Monday, August 03, 2009	

Page 509 of 760

HFKD1
PRBMEAL

Field1:

( HFQ3720 )

IADL.PRBMEAL

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
TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKE1 - PRBSHOP ( HFQ3730 )

2

English text: YES
No

HFKE1 - PRBSHOP ( HFQ3730 )

3

English text: NO
DoesntDo

HFKD2 - DONTMEAL ( HFQ3722 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFKE1 - PRBSHOP ( HFQ3730 )

Refusal

HFKE1 - PRBSHOP ( HFQ3730 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:54 PM Monday, August 03, 2009

Page 510 of 760

HFKD2

HFKD2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTMEAL

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2190

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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that preparing (your/his/her) own meals is something that 

[you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING


4:11:56 PM Monday, August 03, 2009	

Page 511 of 760

HFKD2
DONTMEAL

Field1:

( HFQ3722 )

IADL.DONTMEAL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKE1 - PRBSHOP ( HFQ3730 )

English text: YES
No

HFKE1 - PRBSHOP ( HFQ3730 )

English text: NO
Attribute
Don't know

Route
HFKE1 - PRBSHOP ( HFQ3730 )

Refusal

HFKE1 - PRBSHOP ( HFQ3730 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:11:58 PM Monday, August 03, 2009

Page 512 of 760

HFKE1

HFKE1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

PRBSHOP

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2195

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 "any" in BOLD.

Always display "(such as...)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
shopping for personal items (such as toilet items or medicines)?

Int. Instr II:

INPUT FIELDS / ROUTING


4:11:59 PM Monday, August 03, 2009	

Page 513 of 760

HFKE1
PRBSHOP

Field1:

( HFQ3730 )

IADL.PRBSHOP

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
TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKF1 - PRBBILS ( HFQ3740 )

2

English text: YES
No

HFKF1 - PRBBILS ( HFQ3740 )

3

English text: NO
DoesntDo

HFKE2 - DONTSHOP ( HFQ3732 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFKF1 - PRBBILS ( HFQ3740 )

Refusal

HFKF1 - PRBBILS ( HFQ3740 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:02 PM Monday, August 03, 2009

Page 514 of 760

HFKE2

HFKE2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTSHOP

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2200

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 "health" and "physical" in BOLD.
Always display "(such as...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that shopping for personal items (such as toilet items or

medicines) is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

4:12:03 PM Monday, August 03, 2009	

Page 515 of 760

HFKE2
INPUT FIELDS / ROUTING
DONTSHOP

Field1:

( HFQ3732 )

IADL.DONTSHOP

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKF1 - PRBBILS ( HFQ3740 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
HFKF1 - PRBBILS ( HFQ3740 )

Refusal

HFKF1 - PRBBILS ( HFQ3740 )

HFKF1 - PRBBILS ( HFQ3740 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:06 PM Monday, August 03, 2009

Page 516 of 760

HFKF1

HFKF1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

PRBBILS

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2205

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 "any" in BOLD.

Always display "(like keeping track...)" in parenthesis.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
managing money (like keeping track of expenses or paying bills)?

Int. Instr II:

INPUT FIELDS / ROUTING


4:12:07 PM Monday, August 03, 2009	

Page 517 of 760

HFKF1
PRBBILS

Field1:

( HFQ3740 )

IADL.PRBBILS

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
TDontdo
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFKA1 - (HFQ3810 )

2

English text: YES
No

BOX HFKA1 - (HFQ3810 )

3

English text: NO
DoesntDo

HFKF2 - DONTBILS ( HFQ3742 )

English text: DOESN'T DO
Attribute
Don't know

Route
BOX HFKA1 - (HFQ3810 )

Refusal

BOX HFKA1 - (HFQ3810 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:10 PM Monday, August 03, 2009

Page 518 of 760

HFKF2

HFKF2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTBILS

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2210

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 "health" and "physical" in BOLD.
Always display "(like keeping track...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that managing money (like keeping track of expenses or

paying bills) is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

4:12:11 PM Monday, August 03, 2009	

Page 519 of 760

HFKF2
INPUT FIELDS / ROUTING
DONTBILS

Field1:

( HFQ3742 )

IADL.DONTBILS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFKA1 - (HFQ3810 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
BOX HFKA1 - (HFQ3810 )

Refusal

BOX HFKA1 - (HFQ3810 )

BOX HFKA1 - (HFQ3810 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:13 PM Monday, August 03, 2009

Page 520 of 760

BOX HFKA1

BOX HFKA1

Page Order # :

2215

BOX INSTRUCTIONS
( HFQ3810 )	

IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO
HFKA3 - HELPTELE ( HFQ3820 ).
ELSE GO TO BOX HFKB1 - (HFQ3828 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:12:13 PM Monday, August 03, 2009	

Page 521 of 760

HFKA3

HFKA3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPTELE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2220

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:

If HFKA1 - PRBTELE = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[[You said that [your/(SP's)] health makes using the telephone
difficult./You said that using the telephone is something that [you
don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...

4:12:15 PM Monday, August 03, 2009

Page 522 of 760

HFKA3
using the telephone?
Int. Instr II:

INPUT FIELDS / ROUTING

HELPTELE

Field1:

( HFQ3820 )

IADL.HELPTELE

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKA4 - PERSON_HLPRTELE ( HFQ3822 )

English text: YES
No

BOX HFKB1 - (HFQ3828 )

English text: NO
Attribute
Don't know

Route
BOX HFKB1 - (HFQ3828 )

Refusal

BOX HFKB1 - (HFQ3828 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:17 PM Monday, August 03, 2009

Page 523 of 760

HFKA4

HFKA4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRTELE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2225

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:12:17 PM Monday, August 03, 2009	

Page 524 of 760

HFKA4
Question Text:

You mentioned that [you receive/(SP) receives] help with using the
telephone. Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:

PERSON_HLPRTELE

( HFQ3822 )

HLPR.HLPRTELE

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:

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


String
TPersPick30
1

No
No


Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:


30

Route
BOX HFKB1 - (HFQ3828 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

flags are set to a default value = 2/NotIndicated. See instructions below.

4:12:18 PM Monday, August 03, 2009

Page 525 of 760

HFKA4
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

Set HLPR.HLPRTELE = 1/Indicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL	

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS	

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS
4:12:18 PM Monday, August 03, 2009	

Page 526 of 760

HFKA4

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:18 PM Monday, August 03, 2009

Page 527 of 760

BOX HFKB1

BOX HFKB1

Page Order # :

2230

BOX INSTRUCTIONS
( HFQ3828 )	

IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO
HFKB3 - HELPLHWK ( HFQ3830 ).
ELSE GO TO BOX HFKC1 - (HFQ3838 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:12:18 PM Monday, August 03, 2009	

Page 528 of 760

HFKB3

HFKB3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPLHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2235

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:

If HFKB1 - PRBLHWK = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(like washing...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

4:12:20 PM Monday, August 03, 2009	

[[You said that [your/(SP's)] health makes doing light housework (like
washing dishes, straightening up, or light cleaning) difficult./You said
that doing light housework (like washing dishes, straightening up, or
light cleaning) is something that [you don't do/(SP) doesn't do].]]
Page 529 of 760

HFKB3
[Do you/Does (SP)] receive help from another person with...
doing light housework (like washing dishes, straightening up, or light
cleaning)?
Int. Instr II:

INPUT FIELDS / ROUTING

HELPLHWK

Field1:

( HFQ3830 )

IADL.HELPLHWK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKB4 - PERSON_HLPRLHWK ( HFQ3832 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
BOX HFKC1 - (HFQ3838 )

Refusal

BOX HFKC1 - (HFQ3838 )

BOX HFKC1 - (HFQ3838 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:12:23 PM Monday, August 03, 2009

Page 530 of 760

HFKB3

DESIGN NOTES

4:12:23 PM Monday, August 03, 2009

Page 531 of 760


HFKB4

HFKB4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRLHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
No
No

No


Grid Functions:

Add Line
Delete Line

No
No

2240

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Always display "(like washing...)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:12:23 PM Monday, August 03, 2009	

Page 532 of 760

HFKB4
Question Text:	

You mentioned that [you receive/(SP) receives] help with doing light
housework (like washing dishes, straightening up, or light cleaning).
Who gives that help?

Int. Instr II:	

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:	
Cheshire Name:

PERSON_HLPRLHWK ( HFQ3832 )

HLPR.HLPRLHWK

Item Text display:
Item Text:
Label:

Label Position:

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


String
TPersPick30
1

No
No


Number Label	
1 [Continuous answer.]	

FieldSize:
Min Value:

Max Value:

Mask:


30

Route
BOX HFKC1 - (HFQ3838 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:12:24 PM Monday, August 03, 2009	

Page 533 of 760

HFKB4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

Set HLPR.HLPRLHWK = 1/Indicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL	

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS	

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:12:24 PM Monday, August 03, 2009	

Page 534 of 760

HFKB4
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:24 PM Monday, August 03, 2009

Page 535 of 760

BOX HFKC1

BOX HFKC1

Page Order # :

2245

BOX INSTRUCTIONS
( HFQ3838 )	

IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO
HFKC3 - HELPHHWK ( HFQ3840 ).
ELSE GO TO BOX HFKD1 - (HFQ3848 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:12:24 PM Monday, August 03, 2009	

Page 536 of 760

HFKC3

HFKC3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPHHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2250

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:

If HFKC1 - PRBHHWK = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(like scrubbing...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

4:12:25 PM Monday, August 03, 2009	

[[You said that [your/(SP's)] health makes doing heavy housework
(like scrubbing floors or washing windows) difficult./You said that
heavy housework (like scrubbing floors or washing windows) is
something that [you don't do/(SP) doesn't do].]]
Page 537 of 760

HFKC3
[Do you/Does (SP)] receive help from another person with...
doing heavy housework (like scrubbing floors or washing windows)?
Int. Instr II:

INPUT FIELDS / ROUTING

HELPHHWK

Field1:

( HFQ3840 )

IADL.HELPHHWK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKC4 - PERSON_HLPRHHWK ( HFQ3842 )

English text: YES
No

BOX HFKD1 - (HFQ3848 )

English text: NO
Attribute
Don't know

Route
BOX HFKD1 - (HFQ3848 )

Refusal

BOX HFKD1 - (HFQ3848 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:12:28 PM Monday, August 03, 2009

Page 538 of 760

HFKC3
DESIGN NOTES

4:12:28 PM Monday, August 03, 2009

Page 539 of 760


HFKC4

HFKC4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRHHWK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2255

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Always display "(like scrubbing...)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:12:29 PM Monday, August 03, 2009	

Page 540 of 760

HFKC4
Question Text:	

You mentioned that [you receive/(SP) receives] help with doing
heavy housework (like scrubbing floors or washing windows). Who
gives that help?

Int. Instr II:	

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:	
Cheshire Name:

PERSON_HLPRHHWK ( HFQ3842 )

HLPR.HLPRHHWK

Item Text display:
Item Text:
Label:

Label Position:

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


String
TPersPick30
1

No
No


Number Label	
1 [Continuous answer.]	

FieldSize:
Min Value:

Max Value:

Mask:


30

Route
BOX HFKD1 - (HFQ3848 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:12:30 PM Monday, August 03, 2009	

Page 541 of 760

HFKC4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

Set HLPR.HLPRHHWK = 1/Indicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL	

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS	

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:12:30 PM Monday, August 03, 2009	

Page 542 of 760

HFKC4
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:30 PM Monday, August 03, 2009

Page 543 of 760

BOX HFKD1

BOX HFKD1

Page Order # :

2260

BOX INSTRUCTIONS
( HFQ3848 )	

IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO
HFKD3 - HELPMEAL ( HFQ3850 ).
ELSE GO TO BOX HFKE1 - (HFQ3858 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:12:30 PM Monday, August 03, 2009	

Page 544 of 760

HFKD3

HFKD3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPMEAL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2265

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:

If HFKD1 - PRBMEAL = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[[You said that [your/(SP's)] health makes preparing (your/his/her)
own meals difficult./You said that preparing (your/his/her) own meals
is something that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...

4:12:31 PM Monday, August 03, 2009

Page 545 of 760

HFKD3
preparing (your/his/her) own meals?
Int. Instr II:

INPUT FIELDS / ROUTING

HELPMEAL

Field1:

( HFQ3850 )

IADL.HELPMEAL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKD4 - PERSON_HLPRMEAL ( HFQ3852 )

English text: YES
No

BOX HFKE1 - (HFQ3858 )

English text: NO
Attribute
Don't know

Route
BOX HFKE1 - (HFQ3858 )

Refusal

BOX HFKE1 - (HFQ3858 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:33 PM Monday, August 03, 2009

Page 546 of 760

HFKD4

HFKD4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRMEAL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2270

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:12:34 PM Monday, August 03, 2009	

Page 547 of 760

HFKD4
Question Text:

You mentioned that [you receive/(SP) receives] help with preparing
(your/his/her) own meals. Who gives that help?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:

PERSON_HLPRMEAL

( HFQ3852 )

HLPR.HLPRMEAL

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:

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


String
TPersPick30
1

No
No


Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:


30

Route
BOX HFKE1 - (HFQ3858 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

flags are set to a default value = 2/NotIndicated. See instructions below.

4:12:35 PM Monday, August 03, 2009

Page 548 of 760

HFKD4
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

Set HLPR.HLPRMEAL = 1/Indicated.

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL	

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS	

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS
4:12:35 PM Monday, August 03, 2009	

Page 549 of 760

HFKD4

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:35 PM Monday, August 03, 2009

Page 550 of 760

BOX HFKE1

BOX HFKE1

Page Order # :

2275

BOX INSTRUCTIONS
( HFQ3858 )	

IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO
HFKE3 - HELPSHOP ( HFQ3860 ).
ELSE GO TO BOX HFKF1 - (HFQ3868 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:12:35 PM Monday, August 03, 2009	

Page 551 of 760

HFKE3

HFKE3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPSHOP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2280

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:

If HFKE1 - PRBSHOP = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(such as...)" in parenthesis.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

4:12:36 PM Monday, August 03, 2009

[[You said that [your/(SP's)] health makes shopping for personal

items (such as toilet items or medicines) difficult./You said that
shopping for personal items (such as toilet items or medicines) is
something that [you don't do/(SP) doesn't do].]]
Page 552 of 760

HFKE3
[Do you/Does (SP)] receive help from another person with...
shopping for personal items (such as toilet items or medicines)?
Int. Instr II:

INPUT FIELDS / ROUTING

HELPSHOP

Field1:

( HFQ3860 )

IADL.HELPSHOP

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKE4 - PERSON_HLPRSHOP ( HFQ3862 )

English text: YES
No

BOX HFKF1 - (HFQ3868 )

English text: NO
Attribute
Don't know

Route
BOX HFKF1 - (HFQ3868 )

Refusal

BOX HFKF1 - (HFQ3868 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:12:39 PM Monday, August 03, 2009

Page 553 of 760

HFKE3
DESIGN NOTES

4:12:39 PM Monday, August 03, 2009

Page 554 of 760


HFKE4

HFKE4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRSHOP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2285

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Always display "(such as...)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:12:39 PM Monday, August 03, 2009	

Page 555 of 760

HFKE4
Question Text:	

You mentioned that [you receive/(SP) receives] help with shopping
for personal items (such as toilet items or medicines). Who gives
that help?

Int. Instr II:	

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:	
Cheshire Name:

PERSON_HLPRSHOP

( HFQ3862 )

HLPR.HLPRSHOP

Item Text display:
Item Text:
Label:

Label Position:

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


String
TRostPick8
1

No
No


Number Label	
1 [Continuous answer.]	

FieldSize:
Min Value:

Max Value:

Mask:


8

Route
BOX HFKF1 - (HFQ3868 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:12:40 PM Monday, August 03, 2009	

Page 556 of 760

HFKE4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

Set HLPR.HLPRSHOP = 1/Indicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL	

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS	

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:12:40 PM Monday, August 03, 2009	

Page 557 of 760

HFKE4
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:40 PM Monday, August 03, 2009

Page 558 of 760

BOX HFKF1

BOX HFKF1

Page Order # :

2290

BOX INSTRUCTIONS
( HFQ3868 )

IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO
HFKF3 - HELPBILS ( HFQ3870 ).
ELSE GO TO HFLINTRO - ADLSINTRO ( HFQ3950 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:12:40 PM Monday, August 03, 2009

Page 559 of 760

HFKF3

HFKF3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPBILS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2295

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:

If HFKF1 - PRBBILS = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(like keeping track...)" in parenthesis.
Always display "[You said…]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

4:12:42 PM Monday, August 03, 2009	

[[You said that [your/(SP's)] health makes managing money (like
keeping track of expenses or paying bills) difficult./You said that
managing money (like keeping track of expenses or paying bills) is
something that [you don't do/(SP) doesn't do].]]
Page 560 of 760

HFKF3
[Do you/Does (SP)] receive help from another person with...
managing money (like keeping track of expenses or paying bills)?
Int. Instr II:

INPUT FIELDS / ROUTING

HELPBILS

Field1:

( HFQ3870 )

IADL.HELPBILS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFKF4 - PERSON_HLPRBILS ( HFQ3872 )

English text: YES
No

HFLINTRO - ADLSINTRO ( HFQ3950 )

English text: NO
Attribute
Don't know

Route
HFLINTRO - ADLSINTRO ( HFQ3950 )

Refusal

HFLINTRO - ADLSINTRO ( HFQ3950 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:12:45 PM Monday, August 03, 2009

Page 561 of 760

HFKF3
DESIGN NOTES

4:12:45 PM Monday, August 03, 2009

Page 562 of 760


HFKF4

HFKF4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRBILS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2300

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

Always display "(like keeping track...)" in parenthesis.

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:
Context Header:
Int. Instr I:
4:12:45 PM Monday, August 03, 2009	

Page 563 of 760

HFKF4
Question Text:	

You mentioned that [you receive/(SP) receives] help with managing
money (like keeping track of expenses or paying bills). Who gives
that help?

Int. Instr II:	

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:	
Cheshire Name:

PERSON_HLPRBILS

( HFQ3872 )

HLPR.HLPRBILS

Item Text display:
Item Text:
Label:

Label Position:

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


String
TPersPick30
1

No
No


Number Label	
1 [Continuous answer.]	

FieldSize:
Min Value:

Max Value:

Mask:


30

Route
HFLINTRO - ADLSINTRO ( HFQ3950 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.

If HLPR record does not exist where HLPR.HLPRRND = current round and

HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.

The very first time a HLPR record is created for a person in the current round, the HLPR

4:12:46 PM Monday, August 03, 2009	

Page 564 of 760

HFKF4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

Set HLPR.HLPRBILS = 1/Indicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

HLPRREL	

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS	

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

4:12:46 PM Monday, August 03, 2009	

Page 565 of 760

HFKF4
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:46 PM Monday, August 03, 2009

Page 566 of 760

HFLINTRO

HFLINTRO

Page Order # :

Design Screen Type:	

No Entry

Fields:	

Field 1:

ADLSINTRO

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

2305

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Display "by (yourself/himself/herself)" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:	

Now I'll ask about some other everyday activities. I'd like to know
whether [you have/(SP) has] any difficulty doing each one by
(yourself/himself/herself) and without special equipment.

Int. Instr II:
INPUT FIELDS / ROUTING

4:12:47 PM Monday, August 03, 2009	

Page 567 of 760

HFLINTRO
ADLSINTRO

Field1:

( HFQ3950 )

TEMP

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
HFLA1 - HPPDBATH ( HFQ3960 )

English text: CONTINUE
Attribute
Empty

Route
HFLA1 - HPPDBATH ( HFQ3960 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:49 PM Monday, August 03, 2009

Page 568 of 760

HFLA1

HFLA1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HPPDBATH

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2310

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 "any" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
bathing or showering?

Int. Instr II:
INPUT FIELDS / ROUTING

4:12:51 PM Monday, August 03, 2009	

Page 569 of 760

HFLA1
HPPDBATH

Field1:

( HFQ3960 )

ADLS.HPPDBATH

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
THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB1 - HPPDDRES ( HFQ3970 )

2

English text: YES
No

HFLB1 - HPPDDRES ( HFQ3970 )

3

English text: NO
DoesntDo

HFLA2 - DONTBATH ( HFQ3962 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLB1 - HPPDDRES ( HFQ3970 )

Refusal

HFLB1 - HPPDDRES ( HFQ3970 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:53 PM Monday, August 03, 2009

Page 570 of 760

HFLA2

HFLA2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTBATH

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2315

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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that bathing or showering is something that [you don't/(SP)

doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING


4:12:55 PM Monday, August 03, 2009	

Page 571 of 760

HFLA2
DONTBATH

Field1:

( HFQ3962 )

ADLS.DONTBATH

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB1 - HPPDDRES ( HFQ3970 )

English text: YES
No

HFLB1 - HPPDDRES ( HFQ3970 )

English text: NO
Attribute
Don't know

Route
HFLB1 - HPPDDRES ( HFQ3970 )

Refusal

HFLB1 - HPPDDRES ( HFQ3970 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:12:57 PM Monday, August 03, 2009

Page 572 of 760

HFLB1

HFLB1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HPPDDRES

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2320

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 "any" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
dressing?

Int. Instr II:
INPUT FIELDS / ROUTING

4:12:58 PM Monday, August 03, 2009	

Page 573 of 760

HFLB1
HPPDDRES

Field1:

( HFQ3970 )

ADLS.HPPDDRES

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
THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC1 - HPPDEAT ( HFQ3980 )

2

English text: YES
No

HFLC1 - HPPDEAT ( HFQ3980 )

3

English text: NO
DoesntDo

HFLB2 - DONTDRES ( HFQ3972 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLC1 - HPPDEAT ( HFQ3980 )

Refusal

HFLC1 - HPPDEAT ( HFQ3980 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:01 PM Monday, August 03, 2009

Page 574 of 760

HFLB2

HFLB2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTDRES

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2325

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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that dressing is something that [you don't/(SP) doesn't]

do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING


4:13:02 PM Monday, August 03, 2009	

Page 575 of 760

HFLB2
DONTDRES

Field1:

( HFQ3972 )

ADLS.DONTDRES

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC1 - HPPDEAT ( HFQ3980 )

English text: YES
No

HFLC1 - HPPDEAT ( HFQ3980 )

English text: NO
Attribute
Don't know

Route
HFLC1 - HPPDEAT ( HFQ3980 )

Refusal

HFLC1 - HPPDEAT ( HFQ3980 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:05 PM Monday, August 03, 2009

Page 576 of 760

HFLC1

HFLC1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HPPDEAT

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2330

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 "any" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
eating?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:06 PM Monday, August 03, 2009	

Page 577 of 760

HFLC1
HPPDEAT

Field1:

( HFQ3980 )

ADLS.HPPDEAT

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
THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD1 - HPPDCHAR ( HFQ3990 )

2

English text: YES
No

HFLD1 - HPPDCHAR ( HFQ3990 )

3

English text: NO
DoesntDo

HFLC2 - DONTEAT ( HFQ3982 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLD1 - HPPDCHAR ( HFQ3990 )

Refusal

HFLD1 - HPPDCHAR ( HFQ3990 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:09 PM Monday, August 03, 2009

Page 578 of 760

HFLC2

HFLC2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTEAT

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2335

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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that eating is something that [you don't/(SP) doesn't] do.]

Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING


4:13:10 PM Monday, August 03, 2009	

Page 579 of 760

HFLC2
DONTEAT

Field1:

( HFQ3982 )

ADLS.DONTEAT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD1 - HPPDCHAR ( HFQ3990 )

English text: YES
No

HFLD1 - HPPDCHAR ( HFQ3990 )

English text: NO
Attribute
Don't know

Route
HFLD1 - HPPDCHAR ( HFQ3990 )

Refusal

HFLD1 - HPPDCHAR ( HFQ3990 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:12 PM Monday, August 03, 2009

Page 580 of 760

HFLD1

HFLD1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HPPDCHAR

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2340

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 "any" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
getting in or out of bed or chairs?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:14 PM Monday, August 03, 2009	

Page 581 of 760

HFLD1
HPPDCHAR

Field1:

( HFQ3990 )

ADLS.HPPDCHAR

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
THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE1 - HPPDWALK ( HFQ4000 )

2

English text: YES
No

HFLE1 - HPPDWALK ( HFQ4000 )

3

English text: NO
DoesntDo

HFLD2 - DONTCHAR ( HFQ3992 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLE1 - HPPDWALK ( HFQ4000 )

Refusal

HFLE1 - HPPDWALK ( HFQ4000 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:17 PM Monday, August 03, 2009

Page 582 of 760

HFLD2

HFLD2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTCHAR

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2345

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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that getting in or out of bed or chairs is something that [you

don't/(SP) doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING


4:13:18 PM Monday, August 03, 2009	

Page 583 of 760

HFLD2
DONTCHAR

Field1:

( HFQ3992 )

ADLS.DONTCHAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE1 - HPPDWALK ( HFQ4000 )

English text: YES
No

HFLE1 - HPPDWALK ( HFQ4000 )

English text: NO
Attribute
Don't know

Route
HFLE1 - HPPDWALK ( HFQ4000 )

Refusal

HFLE1 - HPPDWALK ( HFQ4000 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:20 PM Monday, August 03, 2009

Page 584 of 760

HFLE1

HFLE1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HPPDWALK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2350

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 "any" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
walking?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:22 PM Monday, August 03, 2009	

Page 585 of 760

HFLE1
HPPDWALK

Field1:

( HFQ4000 )

ADLS.HPPDWALK

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
THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF1 - HPPDTOIL ( HFQ4010 )

2

English text: YES
No

HFLF1 - HPPDTOIL ( HFQ4010 )

3

English text: NO
DoesntDo

HFLE2 - DONTWALK ( HFQ4002 )

English text: DOESN'T DO
Attribute
Don't know

Route
HFLF1 - HPPDTOIL ( HFQ4010 )

Refusal

HFLF1 - HPPDTOIL ( HFQ4010 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:24 PM Monday, August 03, 2009

Page 586 of 760

HFLE2

HFLE2

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

DONTWALK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2355

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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that walking is something that [you don't/(SP) doesn't] do.]

Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING


4:13:26 PM Monday, August 03, 2009	

Page 587 of 760

HFLE2
DONTWALK

Field1:

( HFQ4002 )

ADLS.DONTWALK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF1 - HPPDTOIL ( HFQ4010 )

English text: YES
No

HFLF1 - HPPDTOIL ( HFQ4010 )

English text: NO
Attribute
Don't know

Route
HFLF1 - HPPDTOIL ( HFQ4010 )

Refusal

HFLF1 - HPPDTOIL ( HFQ4010 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:28 PM Monday, August 03, 2009

Page 588 of 760

HFLF1

HFLF1

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HPPDTOIL

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2360

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 "any" in BOLD.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Because of a health or physical problem, [do you/does (SP)] have

any difficulty...
using the toilet?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:30 PM Monday, August 03, 2009	

Page 589 of 760

HFLF1
HPPDTOIL

Field1:

( HFQ4010 )

ADLS.HPPDTOIL

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
THpp
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLA1 - (HFQ4080 )

2

English text: YES
No

BOX HFLA1 - (HFQ4080 )

3

English text: NO
DoesntDo

HFLF2 - DONTTOIL ( HFQ4012 )

English text: DOESN'T DO
Attribute
Don't know

Route
BOX HFLA1 - (HFQ4080 )

Refusal

BOX HFLA1 - (HFQ4080 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:32 PM Monday, August 03, 2009

Page 590 of 760

HFLF2

HFLF2

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

DONTTOIL

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2365

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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

[You said that using the toilet is something that [you don't/(SP)

doesn't] do.]
Is this because of a health or physical problem?

Int. Instr II:

INPUT FIELDS / ROUTING


4:13:34 PM Monday, August 03, 2009	

Page 591 of 760

HFLF2
DONTTOIL

Field1:

( HFQ4012 )

ADLS.DONTTOIL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLA1 - (HFQ4080 )

English text: YES
No

BOX HFLA1 - (HFQ4080 )

English text: NO
Attribute
Don't know

Route
BOX HFLA1 - (HFQ4080 )

Refusal

BOX HFLA1 - (HFQ4080 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:36 PM Monday, August 03, 2009

Page 592 of 760

BOX HFLA1

BOX HFLA1

Page Order # :

2370

BOX INSTRUCTIONS
( HFQ4080 )	

IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO
HFLA3 - HELPBATH ( HFQ4081 ).
ELSE GO TO BOX HFLB1 - (HFQ4090 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:13:36 PM Monday, August 03, 2009	

Page 593 of 760

HFLA3

HFLA3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2375

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:

If HFLA1 - HPPDBATH = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[[You said [your/(SP's)] health makes bathing or showering
difficult./You said that bathing or showering is something [you
don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with bathing or
showering?

4:13:37 PM Monday, August 03, 2009

Page 594 of 760

HFLA3
Int. Instr II:

INPUT FIELDS / ROUTING

HELPBATH

Field1:

( HFQ4081 )

ADLS.HELPBATH

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLA5 - EQIPBATH ( HFQ4083 )

English text: YES
No

HFLA4 - PCHKBATH ( HFQ4082 )

English text: NO
Attribute
Don't know

Route
HFLA4 - PCHKBATH ( HFQ4082 )

Refusal

HFLA4 - PCHKBATH ( HFQ4082 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:39 PM Monday, August 03, 2009

Page 595 of 760

HFLA4

HFLA4

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

PCHKBATH

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2380

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:

Always display "[That is, does...]" in brackets.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with bathing or showering?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING


4:13:41 PM Monday, August 03, 2009	

Page 596 of 760

HFLA4
PCHKBATH

Field1:

( HFQ4082 )

ADLS.PCHKBATH

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLA5 - EQIPBATH ( HFQ4083 )

English text: YES
No

HFLA5 - EQIPBATH ( HFQ4083 )

English text: NO
Attribute
Don't know

Route
HFLA5 - EQIPBATH ( HFQ4083 )

Refusal

HFLA5 - EQIPBATH ( HFQ4083 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:43 PM Monday, August 03, 2009

Page 597 of 760

HFLA5

HFLA5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2385

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] use special equipment or aids to help

(you/him/her) with bathing or showering?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:44 PM Monday, August 03, 2009

Page 598 of 760

HFLA5
EQIPBATH

Field1:

( HFQ4083 )

ADLS.EQIPBATH

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLA2 - (HFQ4085 )

English text: YES
No

BOX HFLA2 - (HFQ4085 )

English text: NO
Attribute
Don't know

Route
BOX HFLA2 - (HFQ4085 )

Refusal

BOX HFLA2 - (HFQ4085 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:46 PM Monday, August 03, 2009

Page 599 of 760

BOX HFLA2

BOX HFLA2

Page Order # :

2390

BOX INSTRUCTIONS
( HFQ4085 )	

IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH ( HFQ4086 ).
ELSE GO TO BOX HFLB1 - (HFQ4090 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:13:46 PM Monday, August 03, 2009	

Page 600 of 760

HFLA6

HFLA6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2395

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

How long [have you/has (SP)] needed help with bathing or

showering? Has it been . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:48 PM Monday, August 03, 2009

Page 601 of 760

HFLA6
LONGBATH

Field1:

( HFQ4086 )

ADLS.LONGBATH

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
THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLA7 - STILBATH ( HFQ4088 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLB1 - (HFQ4090 )

BOX HFLB1 - (HFQ4090 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLB1 - (HFQ4090 )

Refusal

BOX HFLB1 - (HFQ4090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:51 PM Monday, August 03, 2009

Page 602 of 760

HFLA7

HFLA7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2400

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Do you expect that [you/(SP)] will still need help with bathing or

showering three months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:13:52 PM Monday, August 03, 2009

Page 603 of 760

HFLA7
STILBATH

Field1:

( HFQ4088 )

ADLS.STILBATH

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLB1 - (HFQ4090 )

English text: YES
No

BOX HFLB1 - (HFQ4090 )

English text: NO
Attribute
Don't know

Route
BOX HFLB1 - (HFQ4090 )

Refusal

BOX HFLB1 - (HFQ4090 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:54 PM Monday, August 03, 2009

Page 604 of 760

BOX HFLB1

BOX HFLB1

Page Order # :

2405

BOX INSTRUCTIONS
( HFQ4090 )	

IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO
HFLB3 - HELPDRES ( HFQ4091 ).
ELSE GO TO BOX HFLC1 - (HFQ4100 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:13:54 PM Monday, August 03, 2009	

Page 605 of 760

HFLB3

HFLB3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2410

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:

If HFLB1 - HPPDDRES = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[[You said [your/(SP's)] health makes dressing difficult./You said that
dressing is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with dressing?

Int. Instr II:
4:13:55 PM Monday, August 03, 2009

Page 606 of 760

HFLB3
INPUT FIELDS / ROUTING
HELPDRES

Field1:

( HFQ4091 )

ADLS.HELPDRES

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB5 - EQIPDRES ( HFQ4093 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
HFLB4 - PCHKDRES ( HFQ4092 )

Refusal

HFLB4 - PCHKDRES ( HFQ4092 )

HFLB4 - PCHKDRES ( HFQ4092 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:13:58 PM Monday, August 03, 2009

Page 607 of 760

HFLB4

HFLB4

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

PCHKDRES

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2415

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:

Always display "[That is, does...]" in brackets.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with dressing?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING


4:13:59 PM Monday, August 03, 2009	

Page 608 of 760

HFLB4
PCHKDRES

Field1:

( HFQ4092 )

ADLS.PCHKDRES

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB5 - EQIPDRES ( HFQ4093 )

English text: YES
No

HFLB5 - EQIPDRES ( HFQ4093 )

English text: NO
Attribute
Don't know

Route
HFLB5 - EQIPDRES ( HFQ4093 )

Refusal

HFLB5 - EQIPDRES ( HFQ4093 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:01 PM Monday, August 03, 2009

Page 609 of 760

HFLB5

HFLB5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2420

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] use special equipment or aids to help

(you/him/her) with dressing?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:03 PM Monday, August 03, 2009

Page 610 of 760

HFLB5
EQIPDRES

Field1:

( HFQ4093 )

ADLS.EQIPDRES

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLB2 - (HFQ4095 )

English text: YES
No

BOX HFLB2 - (HFQ4095 )

English text: NO
Attribute
Don't know

Route
BOX HFLB2 - (HFQ4095 )

Refusal

BOX HFLB2 - (HFQ4095 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:05 PM Monday, August 03, 2009

Page 611 of 760

BOX HFLB2

BOX HFLB2

Page Order # :

2425

BOX INSTRUCTIONS
( HFQ4095 )	

IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES ( HFQ4096 ).
ELSE GO TO BOX HFLC1 - (HFQ4100 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:14:05 PM Monday, August 03, 2009	

Page 612 of 760

HFLB6

HFLB6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2430

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

How long [have you/has (SP)] needed help with dressing? Has it

been . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:06 PM Monday, August 03, 2009

Page 613 of 760

HFLB6
LONGDRES

Field1:

( HFQ4096 )

ADLS.LONGDRES

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
THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLB7 - STILDRES ( HFQ4098 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLC1 - (HFQ4100 )

BOX HFLC1 - (HFQ4100 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLC1 - (HFQ4100 )

Refusal

BOX HFLC1 - (HFQ4100 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:09 PM Monday, August 03, 2009

Page 614 of 760

HFLB7

HFLB7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2435

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Do you expect that [you/(SP)] will still need help with dressing three

months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:10 PM Monday, August 03, 2009

Page 615 of 760

HFLB7
STILDRES

Field1:

( HFQ4098 )

ADLS.STILDRES

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLC1 - (HFQ4100 )

English text: YES
No

BOX HFLC1 - (HFQ4100 )

English text: NO
Attribute
Don't know

Route
BOX HFLC1 - (HFQ4100 )

Refusal

BOX HFLC1 - (HFQ4100 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:13 PM Monday, August 03, 2009

Page 616 of 760

BOX HFLC1

BOX HFLC1

Page Order # :

2440

BOX INSTRUCTIONS
( HFQ4100 )	

IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO
HFLC3 - HELPEAT ( HFQ4101 ).
ELSE GO TO BOX HFLD1 - (HFQ4110 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:14:13 PM Monday, August 03, 2009	

Page 617 of 760

HFLC3

HFLC3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2445

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:

If HFLC1 - HPPDEAT = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[[You said [your/(SP's)] health makes eating difficult./You said that
eating is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with eating?

Int. Instr II:
4:14:14 PM Monday, August 03, 2009

Page 618 of 760

HFLC3
INPUT FIELDS / ROUTING
HELPEAT

Field1:

( HFQ4101 )

ADLS.HELPEAT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC5 - EQIPEAT ( HFQ4103 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
HFLC4 - PCHKEAT ( HFQ4102 )

Refusal

HFLC4 - PCHKEAT ( HFQ4102 )

HFLC4 - PCHKEAT ( HFQ4102 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:16 PM Monday, August 03, 2009

Page 619 of 760

HFLC4

HFLC4

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

PCHKEAT

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2450

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:

Always display "[That is, does...]" in brackets.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with eating?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING


4:14:17 PM Monday, August 03, 2009	

Page 620 of 760

HFLC4
PCHKEAT

Field1:

( HFQ4102 )

ADLS.PCHKEAT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC5 - EQIPEAT ( HFQ4103 )

English text: YES
No

HFLC5 - EQIPEAT ( HFQ4103 )

English text: NO
Attribute
Don't know

Route
HFLC5 - EQIPEAT ( HFQ4103 )

Refusal

HFLC5 - EQIPEAT ( HFQ4103 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:20 PM Monday, August 03, 2009

Page 621 of 760

HFLC5

HFLC5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2455

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] use special equipment or aids to help

(you/him/her) with eating?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:21 PM Monday, August 03, 2009

Page 622 of 760

HFLC5
EQIPEAT

Field1:

( HFQ4103 )

ADLS.EQIPEAT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLC2 - (HFQ4105 )

English text: YES
No

BOX HFLC2 - (HFQ4105 )

English text: NO
Attribute
Don't know

Route
BOX HFLC2 - (HFQ4105 )

Refusal

BOX HFLC2 - (HFQ4105 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:23 PM Monday, August 03, 2009

Page 623 of 760

BOX HFLC2

BOX HFLC2

Page Order # :

2460

BOX INSTRUCTIONS
( HFQ4105 )	

IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT ( HFQ4106 ).
ELSE GO TO BOX HFLD1 - (HFQ4110 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:14:23 PM Monday, August 03, 2009	

Page 624 of 760

HFLC6

HFLC6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2465

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:
Int. Instr I:
Question Text:

How long [have you/has (SP)] needed help with eating? Has it been .
..

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:25 PM Monday, August 03, 2009

Page 625 of 760

HFLC6
LONGEAT

Field1:

( HFQ4106 )

ADLS.LONGEAT

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
THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLC7 - STILEAT ( HFQ4108 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLD1 - (HFQ4110 )

BOX HFLD1 - (HFQ4110 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLD1 - (HFQ4110 )

Refusal

BOX HFLD1 - (HFQ4110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:27 PM Monday, August 03, 2009

Page 626 of 760

HFLC7

HFLC7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILEAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2470

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Do you expect that [you/(SP)] will still need help with eating three

months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:29 PM Monday, August 03, 2009

Page 627 of 760

HFLC7
STILEAT

Field1:

( HFQ4108 )

ADLS.STILEAT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLD1 - (HFQ4110 )

English text: YES
No

BOX HFLD1 - (HFQ4110 )

English text: NO
Attribute
Don't know

Route
BOX HFLD1 - (HFQ4110 )

Refusal

BOX HFLD1 - (HFQ4110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:31 PM Monday, August 03, 2009

Page 628 of 760

BOX HFLD1

BOX HFLD1

Page Order # :

2475

BOX INSTRUCTIONS
( HFQ4110 )	

IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO
HFLD3 - HELPCHAR ( HFQ4111 ).
ELSE GO TO BOX HFLE1 - (HFQ4120 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:14:31 PM Monday, August 03, 2009	

Page 629 of 760

HFLD3

HFLD3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2480

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:

If HFLD1 - HPPDCHAR = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[[You said [your/(SP's)] health makes getting in or out of bed or
chairs difficult./You said that getting in or out of bed or chairs is
something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with getting in
or out of bed or chairs?

4:14:32 PM Monday, August 03, 2009

Page 630 of 760

HFLD3
Int. Instr II:

INPUT FIELDS / ROUTING

HELPCHAR

Field1:

( HFQ4111 )

ADLS.HELPCHAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD5 - EQIPCHAR ( HFQ4113 )

English text: YES
No

HFLD4 - PCHKCHAR ( HFQ4112 )

English text: NO
Attribute
Don't know

Route
HFLD4 - PCHKCHAR ( HFQ4112 )

Refusal

HFLD4 - PCHKCHAR ( HFQ4112 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:34 PM Monday, August 03, 2009

Page 631 of 760

HFLD4

HFLD4

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

PCHKCHAR

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2485

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:

Always display "[That is, does...]" in brackets.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with getting in or out of bed or chairs?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING


4:14:36 PM Monday, August 03, 2009	

Page 632 of 760

HFLD4
PCHKCHAR

Field1:

( HFQ4112 )

ADLS.PCHKCHAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD5 - EQIPCHAR ( HFQ4113 )

English text: YES
No

HFLD5 - EQIPCHAR ( HFQ4113 )

English text: NO
Attribute
Don't know

Route
HFLD5 - EQIPCHAR ( HFQ4113 )

Refusal

HFLD5 - EQIPCHAR ( HFQ4113 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:38 PM Monday, August 03, 2009

Page 633 of 760

HFLD5

HFLD5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2490

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] use special equipment or aids to help

(you/him/her) with getting in or out of bed or chairs?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:39 PM Monday, August 03, 2009

Page 634 of 760

HFLD5
EQIPCHAR

Field1:

( HFQ4113 )

ADLS.EQIPCHAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLD2 - (HFQ4115 )

English text: YES
No

BOX HFLD2 - (HFQ4115 )

English text: NO
Attribute
Don't know

Route
BOX HFLD2 - (HFQ4115 )

Refusal

BOX HFLD2 - (HFQ4115 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:42 PM Monday, August 03, 2009

Page 635 of 760

BOX HFLD2

BOX HFLD2

Page Order # :

2495

BOX INSTRUCTIONS
( HFQ4115 )	

IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR ( HFQ4116 ).
ELSE GO TO BOX HFLE1 - (HFQ4120 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:14:42 PM Monday, August 03, 2009	

Page 636 of 760

HFLD6

HFLD6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2500

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

How long [have you/has (SP)] needed help with getting in or out of

bed or chairs? Has it been . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:43 PM Monday, August 03, 2009

Page 637 of 760

HFLD6
LONGCHAR

Field1:

( HFQ4116 )

ADLS.LONGCHAR

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
THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLD7 - STILCHAR ( HFQ4118 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLE1 - (HFQ4120 )

BOX HFLE1 - (HFQ4120 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLE1 - (HFQ4120 )

Refusal

BOX HFLE1 - (HFQ4120 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:46 PM Monday, August 03, 2009

Page 638 of 760

HFLD7

HFLD7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2505

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Do you expect that [you/(SP)] will still need help with getting in or out

of bed or chairs three months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:47 PM Monday, August 03, 2009

Page 639 of 760

HFLD7
STILCHAR

Field1:

( HFQ4118 )

ADLS.STILCHAR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLE1 - (HFQ4120 )

English text: YES
No

BOX HFLE1 - (HFQ4120 )

English text: NO
Attribute
Don't know

Route
BOX HFLE1 - (HFQ4120 )

Refusal

BOX HFLE1 - (HFQ4120 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:49 PM Monday, August 03, 2009

Page 640 of 760

BOX HFLE1

BOX HFLE1

Page Order # :

2510

BOX INSTRUCTIONS
( HFQ4120 )	

IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO
HFLE3 - HELPWALK ( HFQ4121 ).
ELSE GO TO BOX HFLF1 - (HFQ4130 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:14:49 PM Monday, August 03, 2009	

Page 641 of 760

HFLE3

HFLE3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2515

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:

If HFLE1 - HPPDWALK = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[[You said [your/(SP's)] health makes walking difficult./You said that
walking is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with walking?

Int. Instr II:
4:14:51 PM Monday, August 03, 2009

Page 642 of 760

HFLE3
INPUT FIELDS / ROUTING
HELPWALK

Field1:

( HFQ4121 )

ADLS.HELPWALK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE5 - EQIPWALK ( HFQ4123 )

English text: YES
No
English text: NO

Attribute
Don't know

Route
HFLE4 - PCHKWALK ( HFQ4122 )

Refusal

HFLE4 - PCHKWALK ( HFQ4122 )

HFLE4 - PCHKWALK ( HFQ4122 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:53 PM Monday, August 03, 2009

Page 643 of 760

HFLE4

HFLE4

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

PCHKWALK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2520

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:

Always display "[That is, does...]" in brackets.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with walking?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING


4:14:54 PM Monday, August 03, 2009	

Page 644 of 760

HFLE4
PCHKWALK

Field1:

( HFQ4122 )

ADLS.PCHKWALK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE5 - EQIPWALK ( HFQ4123 )

English text: YES
No

HFLE5 - EQIPWALK ( HFQ4123 )

English text: NO
Attribute
Don't know

Route
HFLE5 - EQIPWALK ( HFQ4123 )

Refusal

HFLE5 - EQIPWALK ( HFQ4123 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:14:56 PM Monday, August 03, 2009

Page 645 of 760

HFLE5

HFLE5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2525

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] use special equipment or aids to help

(you/him/her) with walking?

Int. Instr II:
INPUT FIELDS / ROUTING

4:14:58 PM Monday, August 03, 2009

Page 646 of 760

HFLE5
EQIPWALK

Field1:

( HFQ4123 )

ADLS.EQIPWALK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLE2 - (HFQ4125 )

English text: YES
No

BOX HFLE2 - (HFQ4125 )

English text: NO
Attribute
Don't know

Route
BOX HFLE2 - (HFQ4125 )

Refusal

BOX HFLE2 - (HFQ4125 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:00 PM Monday, August 03, 2009

Page 647 of 760

BOX HFLE2

BOX HFLE2

Page Order # :

2530

BOX INSTRUCTIONS
( HFQ4125 )	

IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK ( HFQ4126 ).
ELSE GO TO BOX HFLF1 - (HFQ4130 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:00 PM Monday, August 03, 2009	

Page 648 of 760

HFLE6

HFLE6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2535

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

How long [have you/has (SP)] needed help with walking? Has it

been . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:02 PM Monday, August 03, 2009

Page 649 of 760

HFLE6
LONGWALK

Field1:

( HFQ4126 )

ADLS.LONGWALK

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
THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLE7 - STILWALK ( HFQ4128 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLF1 - (HFQ4130 )

BOX HFLF1 - (HFQ4130 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLF1 - (HFQ4130 )

Refusal

BOX HFLF1 - (HFQ4130 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:04 PM Monday, August 03, 2009

Page 650 of 760

HFLE7

HFLE7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2540

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Do you expect that [you/(SP)] will still need help with walking three

months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:06 PM Monday, August 03, 2009

Page 651 of 760

HFLE7
STILWALK

Field1:

( HFQ4128 )

ADLS.STILWALK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLF1 - (HFQ4130 )

English text: YES
No

BOX HFLF1 - (HFQ4130 )

English text: NO
Attribute
Don't know

Route
BOX HFLF1 - (HFQ4130 )

Refusal

BOX HFLF1 - (HFQ4130 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:08 PM Monday, August 03, 2009

Page 652 of 760

BOX HFLF1

BOX HFLF1

Page Order # :

2545

BOX INSTRUCTIONS
( HFQ4130 )	

IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO
HFLF3 - HELPTOIL ( HFQ4131 ).
ELSE GO TO BOX HFLA3 - (HFQ4400 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:08 PM Monday, August 03, 2009	

Page 653 of 760

HFLF3

HFLF3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HELPTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2550

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:

If HFLF1 - HPPDTOIL = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

[[You said [your/(SP's)] health makes using the toilet difficult./You
said that using the toilet is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with using the
toilet?

4:15:09 PM Monday, August 03, 2009

Page 654 of 760

HFLF3
Int. Instr II:

INPUT FIELDS / ROUTING

HELPTOIL

Field1:

( HFQ4131 )

ADLS.HELPTOIL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF5 - EQIPTOIL ( HFQ4133 )

English text: YES
No

HFLF4 - PCHKTOIL ( HFQ4132 )

English text: NO
Attribute
Don't know

Route
HFLF4 - PCHKTOIL ( HFQ4132 )

Refusal

HFLF4 - PCHKTOIL ( HFQ4132 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:11 PM Monday, August 03, 2009

Page 655 of 760

HFLF4

HFLF4

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

PCHKTOIL

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
No
No

2555

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:

Always display "[That is, does...]" in brackets.


Multi Field display:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Does someone usually stay nearby just in case [you need/(SP)

needs] help with using the toilet?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]

Int. Instr II:

INPUT FIELDS / ROUTING


4:15:13 PM Monday, August 03, 2009	

Page 656 of 760

HFLF4
PCHKTOIL

Field1:

( HFQ4132 )

ADLS.PCHKTOIL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF5 - EQIPTOIL ( HFQ4133 )

English text: YES
No

HFLF5 - EQIPTOIL ( HFQ4133 )

English text: NO
Attribute
Don't know

Route
HFLF5 - EQIPTOIL ( HFQ4133 )

Refusal

HFLF5 - EQIPTOIL ( HFQ4133 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:15 PM Monday, August 03, 2009

Page 657 of 760

HFLF5

HFLF5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

EQIPTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2560

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

[Do you/Does (SP)] use special equipment or aids to help

(you/him/her) with using the toilet?

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:16 PM Monday, August 03, 2009

Page 658 of 760

HFLF5
EQIPTOIL

Field1:

( HFQ4133 )

ADLS.EQIPTOIL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLF2 - (HFQ4135 )

English text: YES
No

BOX HFLF2 - (HFQ4135 )

English text: NO
Attribute
Don't know

Route
BOX HFLF2 - (HFQ4135 )

Refusal

BOX HFLF2 - (HFQ4135 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:19 PM Monday, August 03, 2009

Page 659 of 760

BOX HFLF2

BOX HFLF2

Page Order # :

2565

BOX INSTRUCTIONS
( HFQ4135 )	

IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL ( HFQ4136 ).
ELSE GO TO BOX HFLA3 - (HFQ4400 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:19 PM Monday, August 03, 2009	

Page 660 of 760

HFLF6

HFLF6

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LONGTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2570

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

How long [have you/has (SP)] needed help with using the toilet? Has

it been . . .

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:20 PM Monday, August 03, 2009

Page 661 of 760

HFLF6
LONGTOIL

Field1:

( HFQ4136 )

ADLS.LONGTOIL

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
THwlong
1
No
No

Number Label
1 LessThanThreeMonths

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFLF7 - STILTOIL ( HFQ4138 )

2

English text: less than three months,
MoreThanThreeMonthsLessThanOneYear

3

English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLA3 - (HFQ4400 )

BOX HFLA3 - (HFQ4400 )

English text: one year or more?
Attribute
Don't know

Route
BOX HFLA3 - (HFQ4400 )

Refusal

BOX HFLA3 - (HFQ4400 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:23 PM Monday, August 03, 2009

Page 662 of 760

HFLF7

HFLF7

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

STILTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2575

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

Do you expect that [you/(SP)] will still need help with using the toilet

three months from now?

Int. Instr II:
INPUT FIELDS / ROUTING

4:15:24 PM Monday, August 03, 2009

Page 663 of 760

HFLF7
STILTOIL

Field1:

( HFQ4138 )

ADLS.STILTOIL

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFLA3 - (HFQ4400 )

English text: YES
No

BOX HFLA3 - (HFQ4400 )

English text: NO
Attribute
Don't know

Route
BOX HFLA3 - (HFQ4400 )

Refusal

BOX HFLA3 - (HFQ4400 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:26 PM Monday, August 03, 2009

Page 664 of 760

BOX HFLA3

BOX HFLA3

Page Order # :

2580

BOX INSTRUCTIONS
( HFQ4400 )

IF HFLA3 - HELPBATH = 1/Yes or HFLA4 – PCHKBATH = 1/Yes, GO
HFLA9 - PERSON_HLPRBATH ( HFQ4405 ).
ELSE GO TO BOX HFLB3 - (HFQ4410 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:26 PM Monday, August 03, 2009

Page 665 of 760

HFLA9

HFLA9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRBATH

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2585

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If HFLA3 - HELPBATH = 1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:

4:15:27 PM Monday, August 03, 2009	

Page 666 of 760

HFLA9
Context Header:
Int. Instr I:
Question Text:

You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with bathing and
showering. Who [gives that help/stays nearby in case [you
need/(SP) needs] help]?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:

PERSON_HLPRBATH

( HFQ4405 )

TEMP

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

String
TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFLB3 - (HFQ4410 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS


4:15:28 PM Monday, August 03, 2009

Page 667 of 760

HFLA9
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

Set HLPR.HLPRBATH = 1/Indicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

4:15:28 PM Monday, August 03, 2009	

Page 668 of 760

HFLA9
HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:28 PM Monday, August 03, 2009

Page 669 of 760

BOX HFLB3

BOX HFLB3

Page Order # :

2590

BOX INSTRUCTIONS
( HFQ4410 )	

IF HFLB3 - HELPDRES = 1/Yes or HFLB4 - PCHKDRES = 1/Yes, GO TO
HFLB9 - PERSON_HLPRDRES ( HFQ4415 ).
ELSE GO TO BOX HFLC3 - (HFQ4420 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:28 PM Monday, August 03, 2009	

Page 670 of 760

HFLB9

HFLB9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRDRES

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2595

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If HFLA3 - HELPDRES = 1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:

4:15:28 PM Monday, August 03, 2009	

Page 671 of 760

HFLB9
Context Header:
Int. Instr I:
Question Text:

You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with dressing. Who
[gives that help/stays nearby in case [you need/(SP) needs] help]?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:

PERSON_HLPRDRES

( HFQ4415 )

TEMP

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

String
TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFLC3 - (HFQ4420 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.


4:15:29 PM Monday, August 03, 2009

Page 672 of 760

HFLB9
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

Set HLPR.HLPRDRES = 1/Indicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

4:15:29 PM Monday, August 03, 2009	

Page 673 of 760

HFLB9
HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:29 PM Monday, August 03, 2009

Page 674 of 760

BOX HFLC3

BOX HFLC3

Page Order # :

2600

BOX INSTRUCTIONS
( HFQ4420 )

IF HFLC3 – HELPEAT = 1/Yes or HFLC4 – PCHKEAT = 1/Yes, GO TO
HFLC9 - PERSON_HLPREAT ( HFQ4425 ).
ELSE GO TO BOX HFLD3 - (HFQ4430 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:29 PM Monday, August 03, 2009

Page 675 of 760

HFLC9

HFLC9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPREAT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2605

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If HFLC3 - HELPEAT = 1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:

4:15:30 PM Monday, August 03, 2009	

Page 676 of 760

HFLC9
Context Header:
Int. Instr I:
Question Text:

You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with eating. Who [gives
that help/stays nearby in case [you need/(SP) needs] help]?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:

PERSON_HLPREAT

( HFQ4425 )

TEMP

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

String
TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFLD3 - (HFQ4430 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.


4:15:31 PM Monday, August 03, 2009

Page 677 of 760

HFLC9
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

Set HLPR.HLPREAT = 1/Indicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

4:15:31 PM Monday, August 03, 2009	

Page 678 of 760

HFLC9
HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:31 PM Monday, August 03, 2009

Page 679 of 760

BOX HFLD3

BOX HFLD3

Page Order # :

2610

BOX INSTRUCTIONS
( HFQ4430 )	

IF HFLD3 – HELPCHAR = 1/Yes or HFLD4 – PCHKCHAR = 1/Yes, GO TO
HFLD9 - PERSON_HLPRCHAR ( HFQ4435 ).
ELSE GO TO BOX HFLE3 - (HFQ4440 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:31 PM Monday, August 03, 2009	

Page 680 of 760

HFLD9

HFLD9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRCHAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2615

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If HFLD3 - HELPCHAR =1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:

4:15:31 PM Monday, August 03, 2009	

Page 681 of 760

HFLD9
Context Header:
Int. Instr I:
Question Text:

You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with getting in or out of
bed or chairs. Who [gives that help/stays nearby in case [you
need/(SP) needs] help]?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:

PERSON_HLPRCHAR ( HFQ4435 )

TEMP

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

String
TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFLE3 - (HFQ4440 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS


4:15:32 PM Monday, August 03, 2009

Page 682 of 760

HFLD9
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

Set HLPR.HLPRCHAR = 1/Indicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

4:15:32 PM Monday, August 03, 2009	

Page 683 of 760

HFLD9
HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:32 PM Monday, August 03, 2009

Page 684 of 760

BOX HFLE3

BOX HFLE3

Page Order # :

2620

BOX INSTRUCTIONS
( HFQ4440 )	

IF HFLE3 – HELPWALK = 1/Yes or HFLE4 – PCHKWALK = 1/Yes, GO TO
HFLE9 - PERSON_HLPRWALK ( HFQ4445 ).
ELSE GO TO BOX HFLF3 - (HFQ4450 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:32 PM Monday, August 03, 2009	

Page 685 of 760

HFLE9

HFLE9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRWALK

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2625

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If HFLE3 - HELPWALK = 1/Yes, display "[you receive/(SP)
receives] help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:

4:15:33 PM Monday, August 03, 2009	

Page 686 of 760

HFLE9
Context Header:
Int. Instr I:
Question Text:

You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with walking. Who
[gives that help/stays nearby in case [you need/(SP) needs] help]?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:

PERSON_HLPRWALK ( HFQ4445 )

TEMP

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

String
TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFLF3 - (HFQ4450 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS

Set reason for person added to roster. See instructions below.


4:15:34 PM Monday, August 03, 2009

Page 687 of 760

HFLE9
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

Set HLPR.HLPRWALK = 1/Indicated.

HLPRTOIL	

If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.

4:15:34 PM Monday, August 03, 2009	

Page 688 of 760

HFLE9
HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:34 PM Monday, August 03, 2009

Page 689 of 760

BOX HFLF3

BOX HFLF3

Page Order # :

2630

BOX INSTRUCTIONS
( HFQ4450 )	

IF HFLF3 – HELPTOIL = 1/Yes or HFLF4 – PCHKTOIL = 1/Yes, GO TO
HFLF9 - PERSON_HLPRTOIL ( HFQ4455 ).
ELSE GO TO BOX HFL4 - (HFQ4490 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:34 PM Monday, August 03, 2009	

Page 690 of 760

HFLF9

HFLF9

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

PERSON_HLPRTOIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

Roster Name:

Person 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

2635

Display as ' Add a Person '

Display as ' Edit a Person '


DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If HFLF3 - HELPTOIL = 1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".

Multi Field display:

Roster/Grid Instructions:	

Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.

Roster/Grid display:	

COL #

HEADER

INSTRUCTIONS

1

First Name	

Display ROST.ROSTFNAM.

2

Last Name	

Display ROST.ROSTLNAM.

3

Relationship to SP	

Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.

Report display:

TEXT:

4:15:34 PM Monday, August 03, 2009	

Page 691 of 760

HFLF9
Context Header:
Int. Instr I:
Question Text:

You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with using the toilet.
Who [gives that help/stays nearby in case [you need/(SP) needs]
help]?

Int. Instr II:

ENTER ALL HELPERS.

INPUT FIELDS / ROUTING

Field1:

PERSON_HLPRTOIL

( HFQ4455 )

TEMP

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

String
TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFL4 - (HFQ4490 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

If Person added, see PERSON ROSTER POP-UP specifications for pop-up window

programming instructions.

Variables populated in Person Roster:

ROST.ROSTNUM

ROST.ROSTRNDC

ROST.ROSTFNAM

ROST.ROSTLNAM

ROST.ROSTREL

ROST.ROSTREOS


4:15:35 PM Monday, August 03, 2009

Page 692 of 760

HFLF9
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS	

If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.

HLPRROST	

If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.

HLPRRND	

If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.

HLPRRESP	

If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.

HLPRTELE	

If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.

HLPRLHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.

HLPRHHWK	

If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.

HLPRMEAL	

If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..

HLPRSHOP	

If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.

HLPRBILS	

If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.

HLPRBATH	

If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.

HLPRDRES	

If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.

HLPREAT	

If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.

HLPRCHAR	

If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.

HLPRWALK	

If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.

HLPRTOIL	

Set HLPR.HLPRTOIL = 1/Indicated.

4:15:35 PM Monday, August 03, 2009	

Page 693 of 760

HFLF9
HLPRREL

Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.

HLPRREOS

Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:35 PM Monday, August 03, 2009

Page 694 of 760

BOX HFL4

BOX HFL4

Page Order # :

2640

BOX INSTRUCTIONS
( HFQ4490 )	

IF MORE THAN ONE PERSON SELECTED AT HFLA9, HFLB9, HFLC9,
HFLD9, HFLE9, AND/OR HFLF9, GO TO HFL10 - PERSON_HLPRMOST (
HFQ4500 ).
ELSE GO TO BOX HFM1 - (HFQ4505 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES
The design intent is to check each roster where helpers are identified and
if more than one person is identified as a helper, we route to HFL10 to
determine who helps the most.

4:15:35 PM Monday, August 03, 2009	

Page 695 of 760

HFL10

HFL10

Page Order # :

Design Screen Type:	

Roster

Fields:	

Field 1:

PERSON_HLPRMOST

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Person Roster

Roster Type:

Single Item Select

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2644

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:


Roster/Grid Instructions:	

Display all persons selected at HFLA9, HFLB9, HFLC9, HFLD9,
HFLE9 and HFLF9 rosters.
Display in order of entry.

Roster/Grid display:
Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:

Which of these persons gives [you/(SP)] the most help with these

things?

Int. Instr II:

SELECT ONLY ONE.

INPUT FIELDS / ROUTING

4:15:36 PM Monday, August 03, 2009	

Page 696 of 760

HFL10

Field1:
Cheshire Name:

PERSON_HLPRMOST ( HFQ4500 )

TEMP

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

String
TPersPick30
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
BOX HFM1 - (HFQ4505 )

BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:

HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +

HLPR.HLPRRESP

HLPR.HLPRROST = ROST.ROSTNUM of person selected.

HLPR.HLPRRND = current round.

HLRP.HLPRRESP = 01.

Set flag that person selected helps SP the most. See instructions below.

HLPRMOST	

Set HLPR.HLPRMOST = 1/Yes on HLPR where
HLPR.HLPRROST = ROST.ROSTNUM of person
selected and HLPR.HLPRRND = current round.

MOSTADLS	

Set current round ADLS.MOSTADLS =
ROST.ROSTNUM of person selected.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:36 PM Monday, August 03, 2009	

Page 697 of 760

BOX HFM1

BOX HFM1

Page Order # :

2647

BOX INSTRUCTIONS
( HFQ4505 )

IF THIS IS ROUND 55, GO TO HFM1 - FALLANY ( HFQ4510 ).
ELSE GO TO HFN1 - MEMLOSS ( HFQ4580 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:15:36 PM Monday, August 03, 2009

Page 698 of 760

HFM1

HFM1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

FALLANY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2650

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 (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?


Int. Instr II:

INPUT FIELDS / ROUTING

4:15:38 PM Monday, August 03, 2009

Page 699 of 760

HFM1
FALLANY

Field1:

( HFQ4510 )

HEST.FALLANY

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM2 - FALLTIME ( HFQ4515 )

English text: YES
No

HFN1 - MEMLOSS ( HFQ4580 )

English text: NO
Attribute
Don't know

Route
HFN1 - MEMLOSS ( HFQ4580 )

Refusal

HFN1 - MEMLOSS ( HFQ4580 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:40 PM Monday, August 03, 2009

Page 700 of 760

HFM2

HFM2

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

FALLTIME

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2653

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 (LAST HF MONTH YEAR), how many times [have you/has

(SP)] fallen down?

Int. Instr II:

ENTER "95" IF 95 OR MORE FALLS REPORTED.

INPUT FIELDS / ROUTING

4:15:41 PM Monday, August 03, 2009

Page 701 of 760

HFM2
FALLTIME

Field1:

( HFQ4515 )

HEST.FALLTIME

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:


NUMBER OF TIMES:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
TFalltm
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HFM3A - FALLHELP ( HFQ4520 )

Refusal

HFM3A - FALLHELP ( HFQ4520 )

FieldSize:

Min Value:
Max Value:
Mask:


1

95


Route
HFM3A - FALLHELP ( HFQ4520 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
HFM2 - FALLTIME = 1-25, DK, RF.

If not true, display "THE VALUE ENTERED FOR NUMBER OF

TIMES SEEMS UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:42 PM Monday, August 03, 2009

Page 702 of 760

HFM3A

HFM3A

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

FALLHELP

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2656

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

Thinking about the [most recent) time that [you/(SP)] fell, did
(you/he/she) hurt (yourself/himself/herself) badly enough to get
medical help?

Int. Instr II:

INPUT FIELDS / ROUTING


4:15:43 PM Monday, August 03, 2009	

Page 703 of 760

HFM3A
FALLHELP

Field1:

( HFQ4520 )

HEST.FALLHELP

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM3B - FALCODE ( HFQ4525 )

English text: YES
No

HFM3B - FALCODE ( HFQ4525 )

English text: NO
Attribute
Don't know

Route
HFM3B - FALCODE ( HFQ4525 )

Refusal

HFM3B - FALCODE ( HFQ4525 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:15:46 PM Monday, August 03, 2009

Page 704 of 760

HFM3B

HFM3B

Page Order # :

Design Screen Type:	

Code All

Fields:	

Field 1:

FALCODE

Field 2:

FALOTHOS

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

2659

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

What kind of injury did [you/(SP)] have in that (most recent) fall?

[PROBE: Anything else?]

Int. Instr II:

CHECK ALL THAT APPLY.

INPUT FIELDS / ROUTING
4:15:48 PM Monday, August 03, 2009	

Page 705 of 760

HFM3B

4:15:53 PM Monday, August 03, 2009

Page 706 of 760


HFM3B
FALCODE

Field1:

( HFQ4525 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.FALFRACT
2=HEST.FALSPRAN
3=HEST.FALBRUIS
4=HEST.FALCUT
5=HEST.FALCONC
6=HEST.FALDISLO
91=HEST.FALOTHER
96=HEST.FALNOINJ
Item Text display:

Display response options in the following order: 96, 1, 2, 3,
4, 5, 6, 91.

Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated
Tfalcode
7
No
No

Number Label
1 BrokenBone

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM3C - FALLIMIT ( HFQ4533 )

2

English text: BROKEN BONE/FRACTURE
SprainStrain

HFM3C - FALLIMIT ( HFQ4533 )

3

English text: SPRAIN/STRAIN
Bruise

HFM3C - FALLIMIT ( HFQ4533 )

4

English text: BRUISE
CutWound

HFM3C - FALLIMIT ( HFQ4533 )

5

English text: CUT/WOUND/LACERATION
Concussion

HFM3C - FALLIMIT ( HFQ4533 )

6

English text: CONCUSSION
Dislocation

HFM3C - FALLIMIT ( HFQ4533 )

91
96

English text: DISLOCATION
Other
English text: OTHER
NoInjury

HFM3B - FALOTHOS ( HFQ4530 )
HFM3C - FALLIMIT ( HFQ4533 )

English text: NO INJURY
Attribute
Don't know

Route
HFM3C - FALLIMIT ( HFQ4533 )

4:16:01 PM Monday, August 03, 2009

Page 707 of 760

HFM3B

Don't know
Refusal

HFM3C - FALLIMIT ( HFQ4533 )

Field2:

FALOTHOS

( HFQ4530 )

HEST.FALOTHOS

Cheshire Name:
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
HFM3C - FALLIMIT ( HFQ4533 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:03 PM Monday, August 03, 2009

Page 708 of 760

HFM3C

HFM3C

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

FALLIMIT

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2662

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

Did [your/(SP's)] (most recent) fall cause (you/him/her) to limit

(your/his/her) regular acivities?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:04 PM Monday, August 03, 2009	

Page 709 of 760

HFM3C
FALLIMIT

Field1:

( HFQ4533 )

HEST.FALLIMIT

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM3D - FALLBACK ( HFQ4535 )

English text: YES
No

HFM3E - FALLFEAR ( HFQ4540 )

English text: NO
Attribute
Don't know

Route
HFM3E - FALLFEAR ( HFQ4540 )

Refusal

HFM3E - FALLFEAR ( HFQ4540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:06 PM Monday, August 03, 2009

Page 710 of 760

HFM3D

HFM3D

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

FALLBACK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2665

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.

Multi Field display:

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

TEXT:
Context Header:

Int. Instr I:

Question Text:

How long did it take [you/(SP)] to get back to regular activities after

(your/his/her) (most recent) fall?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:08 PM Monday, August 03, 2009	

Page 711 of 760

HFM3D
FALLBACK

Field1:

( HFQ4535 )

HEST.FALLBACK

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
Tfalback
1
No
No

Number Label
1 LessThanOneWeek

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFM3E - FALLFEAR ( HFQ4540 )

2

English text: LESS THAN ONE WEEK
OneWeekOrMore

HFM3E - FALLFEAR ( HFQ4540 )

3

English text: ONE WEEK OR MORE
NeverResumed

HFM3E - FALLFEAR ( HFQ4540 )

English text: NEVER RESUMED REGULAR ACTIVITIES
Attribute
Don't know

Route
HFM3E - FALLFEAR ( HFQ4540 )

Refusal

HFM3E - FALLFEAR ( HFQ4540 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:10 PM Monday, August 03, 2009

Page 712 of 760

HFM3E

HFM3E

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

FALLFEAR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2668

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:	

How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6,
where 1 is "Not at all afraid of falling" and 6 is "Extremely afraid of
falling"?
NOT AT ALL AFRAID
1
2

3

4

EXTREMELY AFRAID
5
6

Int. Instr II:

4:16:11 PM Monday, August 03, 2009	

Page 713 of 760

HFM3E
INPUT FIELDS / ROUTING
FALLFEAR

Field1:

( HFQ4540 )

Cheshire Name:
Item Text display:
Item Text:
Label:

Label Position:


NUMBER:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Integer
Tfallfear
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HFN1 - MEMLOSS ( HFQ4580 )

Refusal

HFN1 - MEMLOSS ( HFQ4580 )

FieldSize:
Min Value:
Max Value:
Mask:

1
1
6

Route
HFN1 - MEMLOSS ( HFQ4580 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
The visual scale located in the question text is designed to provide the
interviewer with a conceptual example of the scale used in the question.
The end points (values 1 and 6) should be labeled with text above the
number and the numbers should be displayed on one line of text with the
digits appearing equidistant.

4:16:13 PM Monday, August 03, 2009

Page 714 of 760

HFN1

HFN1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

MEMLOSS

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

2674

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:

[Do you/Does (SP)] experience memory loss such that it interferes

with daily activities?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:14 PM Monday, August 03, 2009

Page 715 of 760

HFN1
MEMLOSS

Field1:

( HFQ4580 )

HEST.MEMLOSS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFN2 - PROBDECS ( HFQ4590 )

English text: YES
No

HFN2 - PROBDECS ( HFQ4590 )

English text: NO
Attribute
Don't know

Route
HFN2 - PROBDECS ( HFQ4590 )

Refusal

HFN2 - PROBDECS ( HFQ4590 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:16 PM Monday, August 03, 2009

Page 716 of 760

HFN2

HFN2

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PROBDECS

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

2678

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:

[Do you/Does (SP)] have problems making decisions to the point

that it interferes with daily activities?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:18 PM Monday, August 03, 2009

Page 717 of 760

HFN2
PROBDECS

Field1:

( HFQ4590 )

HEST.PROBDECS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFN3 - TROBCONC ( HFQ4600 )

English text: YES
No

HFN3 - TROBCONC ( HFQ4600 )

English text: NO
Attribute
Don't know

Route
HFN3 - TROBCONC ( HFQ4600 )

Refusal

HFN3 - TROBCONC ( HFQ4600 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:20 PM Monday, August 03, 2009

Page 718 of 760

HFN3

HFN3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

TROBCONC

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

2680

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:

[Do you/Does (SP)] have trouble concentrating or keeping

(your/his/her) mind on what (you are/he is/she is) doing?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:21 PM Monday, August 03, 2009

Page 719 of 760

HFN3
TROBCONC

Field1:

( HFQ4600 )

HEST.TROBCONC

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFN4 - TIMESAD ( HFQ4610 )

English text: YES
No

HFN4 - TIMESAD ( HFQ4610 )

English text: NO
Attribute
Don't know

Route
HFN4 - TIMESAD ( HFQ4610 )

Refusal

HFN4 - TIMESAD ( HFQ4610 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:23 PM Monday, August 03, 2009

Page 720 of 760

HFN4

HFN4

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

TIMESAD

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

2690

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:	

SHOW CARD HF4

Question Text:	

In the past 12 months, how much of the time did [you/(SP)] feel sad,
blue, or depressed? Would you say [you were/(SP) was] sad or
depressed all of the time, most of the time, some of the time, a little
of the time, or none of the time?

Int. Instr II:

INPUT FIELDS / ROUTING


4:16:25 PM Monday, August 03, 2009	

Page 721 of 760

HFN4
TIMESAD

Field1:

( HFQ4610 )

HEST.TIMESAD

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
TTimesad
1
No
No

Number Label
1 AllOfTheTime

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFN5 - LOSTINTR ( HFQ4620 )

2

English text: ALL OF THE TIME
MostOfTheTime

HFN5 - LOSTINTR ( HFQ4620 )

3

English text: MOST OF THE TIME
SomeOfTheTime

HFN5 - LOSTINTR ( HFQ4620 )

4

English text: SOME OF THE TIME
ALittleOfTheTime

HFN5 - LOSTINTR ( HFQ4620 )

5

English text: A LITTLE OF THE TIME
NoneOfTheTime

HFN5 - LOSTINTR ( HFQ4620 )

English text: NONE OF THE TIME
Attribute
Don't know

Route
HFN5 - LOSTINTR ( HFQ4620 )

Refusal

HFN5 - LOSTINTR ( HFQ4620 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

4:16:30 PM Monday, August 03, 2009

Page 722 of 760

HFN4
DESIGN NOTES

4:16:30 PM Monday, August 03, 2009

Page 723 of 760


HFN5

HFN5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

LOSTINTR

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

2700

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:	

In the past 12 months, [have you/has (SP)] had 2 weeks or more
when (you/he/she) lost interest or pleasure in things that
(you/he/she) usually cared about or enjoyed?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:31 PM Monday, August 03, 2009	

Page 724 of 760

HFN5
LOSTINTR

Field1:

( HFQ4620 )

HEST.LOSTINTR

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFQ1 - LOSTURIN ( HFQ4630 )

English text: YES
No

HFQ1 - LOSTURIN ( HFQ4630 )

English text: NO
Attribute
Don't know

Route
HFQ1 - LOSTURIN ( HFQ4630 )

Refusal

HFQ1 - LOSTURIN ( HFQ4630 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:33 PM Monday, August 03, 2009

Page 725 of 760

HFQ1

HFQ1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

LOSTURIN

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

2710

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:	

SHOW CARD HF2

Question Text:	

I'd like to ask about a health problem that is more common than
people think. Please look at this card and tell me how often, if at all,
since (LAST HF MONTH YEAR) [you have/(SP) has] lost urine
because (you/he/she) could not control (your/his/her) bladder.

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:36 PM Monday, August 03, 2009	

Page 726 of 760

HFQ1
LOSTURIN

Field1:

( HFQ4630 )

HEST.LOSTURIN

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
TLosturin
1
No
No

Number Label
1 MoreThanOnceWeek

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFT1 - (HFQ4645 )

2

English text: MORE THAN ONCE A WEEK
AboutOnceWeek

BOX HFT1 - (HFQ4645 )

3

English text: ABOUT ONCE A WEEK
TwoToThreeTimesMonth

BOX HFT1 - (HFQ4645 )

4

English text: 2-3 TIMES A MONTH
AboutOnceMonth

BOX HFT1 - (HFQ4645 )

5

English text: ABOUT ONCE A MONTH
EveryTwoToThreeMonths

BOX HFT1 - (HFQ4645 )

6

English text: EVERY 2-3 MONTHS
OnceOrTwiceYear

BOX HFT1 - (HFQ4645 )

7

English text: ONCE OR TWICE A YEAR
NotAtAll

BOX HFT1 - (HFQ4645 )

8

English text: NOT AT ALL
DialysisOrBladderBag

BOX HFT1 - (HFQ4645 )

English text: SP IS ON DIALYSIS OR CATHETERIZATION OR UROSTOMY OR BLADDER
BAG
Attribute
Don't know

Route
BOX HFT1 - (HFQ4645 )

Refusal

BOX HFT1 - (HFQ4645 )

BACKGROUND VARIABLE ASSIGNMENTS

4:16:42 PM Monday, August 03, 2009

Page 727 of 760

HFQ1
SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:42 PM Monday, August 03, 2009

Page 728 of 760

BOX HFT1

BOX HFT1

Page Order # :

2720

BOX INSTRUCTIONS
( HFQ4645 )

IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD ( HFQ4655 ).
ELSE GO TO BOX HFEND - (HFQ9000 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:16:42 PM Monday, August 03, 2009

Page 729 of 760

HFT1

HFT1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HYPETOLD

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2730

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:

We have recorded that [you were/(SP) was] told by a doctor that
(you had/he had/she had) hypertension, also called high blood
pressure.
[Were you/Was (SP)] told on two or more different medical visits that
(you/he/she) had high blood pressure or hypertension?
[EXPLAIN IF NECESSARY: We are interested in knowing whether
[your/(SP’s)] blood pressure was high for more than one reading.]

Int. Instr II:
4:16:43 PM Monday, August 03, 2009

Page 730 of 760

HFT1
INPUT FIELDS / ROUTING
HYPETOLD

Field1:

( HFQ4655 )

HEST.HYPETOLD

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
THypetol
1
No
No

Number Label
1 Yes
2
3

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT2 - HYPEAGE ( HFQ4665 )

English text: YES
No
English text: NO
NeverToldPriorEntryInError

HFT2 - HYPEAGE ( HFQ4665 )
BOX HFEND - (HFQ9000 )

English text: SP NEVER HAD HIGH BLOOD PRESSURE/PREVIOUS RESPONSE ENTERED IN
ERROR
Attribute
Don't know

Route
HFT2 - HYPEAGE ( HFQ4665 )

Refusal

HFT2 - HYPEAGE ( HFQ4665 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:46 PM Monday, August 03, 2009

Page 731 of 760

HFT2

HFT2

Page Order # :

Design Screen Type:	

Numeric

Fields:	

Field 1:

HYPEAGE

Field 2:

HYPEAGE_LESSONE

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

2735

Roster Name:
Roster Type:

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:

Question Text:

How old [were you/was (SP)] when (you were/he was/she was) first

told that (you/he/she) had high blood pressure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:48 PM Monday, August 03, 2009	

Page 732 of 760

HFT2
HYPEAGE

Field1:

( HFQ4665 )

HEST.HYPEAGE

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

AGE:
Left

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

Integer
THypeage
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:


Route
HFT2 - HYPEAGE_LESSONE ( HFQ4672 )

Attribute
Don't know

Route
HFT2 - HYPEAGE_LESSONE ( HFQ4672 )

Refusal

HFT2 - HYPEAGE_LESSONE ( HFQ4672 )

4:16:52 PM Monday, August 03, 2009

1

996


Page 733 of 760

HFT2
HYPEAGE_LESSONE

Field2:

( HFQ4672 )

NONE

Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.HYPEAGE_LESSONE = 1/LessThanOneYear, set 

HYPEAGE.DIDSMOKE = 996.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated

THypeage996
1
No
No

Number Label
1 LessThanOneYear

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT6D - HYPEHOME ( HFQ4675 )

English text: LESS THAN ONE YEAR OLD
Attribute
Empty

Route
HFT6D - HYPEHOME ( HFQ4675 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1

If HYPEAGE ^= EMPTY then HYPEAGE = 1-100, DK, RF.

If not true, display message "AGE MUST BE BETWEEN 1 AND 100

OR LESS THAN ONE YEAR OLD. PLEASE REENTER."

Edit #2

HYPEAGE and HYPEAGE_LESSONE cannot both be EMPTY.

If not true, display message "ENTRY REQUIRED. PLEASE ENTER

AGE OR SELECT "LESS THAN ONE YEAR OLD"."

Edit #3

HYPEAGE and HYPEAGE_LESSONE cannot both be FILLED.


4:16:54 PM Monday, August 03, 2009

Page 734 of 760

HFT2
If not true, display message "INVALID ENTRY. PLEASE ENTER
AGE OR SELECT "LESS THAN ONE YEAR OLD"."
TECHNICAL NOTES

DESIGN NOTES

4:16:54 PM Monday, August 03, 2009

Page 735 of 760

HFT6D

HFT6D

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYPEHOME

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2740

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:

Because of (your/his/her) high blood pressure, [are you/is (SP)] now

measuring (your/his/her) blood pressure at home?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:56 PM Monday, August 03, 2009

Page 736 of 760

HFT6D
HYPEHOME

Field1:

( HFQ4675 )

HEST.HYPEHOME

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT6G - HYPEMEDS ( HFQ4685 )

English text: YES
No

HFT6G - HYPEMEDS ( HFQ4685 )

English text: NO
Attribute
Don't know

Route
HFT6G - HYPEMEDS ( HFQ4685 )

Refusal

HFT6G - HYPEMEDS ( HFQ4685 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:16:58 PM Monday, August 03, 2009

Page 737 of 760

HFT6G

HFT6G

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYPEMEDS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2750

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:

Because of (your/his/her) high blood pressure, [are you/is (SP)] now

taking prescribed medicine for (your/his/her) high blood pressure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:16:59 PM Monday, August 03, 2009

Page 738 of 760

HFT6G
HYPEMEDS

Field1:

( HFQ4685 )

HEST.HYPEMEDS

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT6J - HYPEDRNK ( HFQ4695 )

English text: YES
No

HFT6J - HYPEDRNK ( HFQ4695 )

English text: NO
Attribute
Don't know

Route
HFT6J - HYPEDRNK ( HFQ4695 )

Refusal

HFT6J - HYPEDRNK ( HFQ4695 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:02 PM Monday, August 03, 2009

Page 739 of 760

HFT6J

HFT6J

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

HYPEDRNK

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2760

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

If HFG7 - DRINKDAY = 0, display "You mentioned…".
	
Else dispay "[Have you/Has (SP)] cut down".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

(You mentioned that in a typical month in the past year [you/(SP)] did
not drink alcohol. Is that because of (your/his/her) high blood
pressure?/[Have you/Has (SP)] cut down on drinking alcoholic
beverages because of (your/his/her) high blood pressure?)

Int. Instr II:

INPUT FIELDS / ROUTING


4:17:03 PM Monday, August 03, 2009	

Page 740 of 760

HFT6J
HYPEDRNK

Field1:

( HFQ4695 )

HEST.HYPEDRNK

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFT2 - (HFQ4705 )

English text: YES
No

BOX HFT2 - (HFQ4705 )

English text: NO
Attribute
Don't know

Route
BOX HFT2 - (HFQ4705 )

Refusal

BOX HFT2 - (HFQ4705 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:05 PM Monday, August 03, 2009

Page 741 of 760

BOX HFT2

BOX HFT2

Page Order # :

2770

BOX INSTRUCTIONS
( HFQ4705 )	

IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG ( HFQ4715 ).
ELSE GO TO HFT12A - HYPECTRL ( HFQ4749 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:17:05 PM Monday, August 03, 2009	

Page 742 of 760

HFT7

HFT7

Page Order # :

Design Screen Type:	

Numeric

Fields:	

Field 1:

HYPELONG

Field 2:

HYPELONG_LESSON

E


HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

Enable Functions:	

2780

Roster Name:
Roster Type:

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:

Question Text:

How long [have you/has (SP)] been treated with prescribed

medicines for (your/his/her) high blood pressure?

Int. Instr II:

INPUT FIELDS / ROUTING


4:17:07 PM Monday, August 03, 2009	

Page 743 of 760

HFT7
HYPELONG

Field1:

( HFQ4715 )

HEST.HYPELONG

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF YEARS:
Left

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

Integer
THypeyrs
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:


Route
HFT7 - HYPELONG_LESSONE ( HFQ4722 )

Attribute
Don't know

Route
HFT7 - HYPELONG_LESSONE ( HFQ4722 )

Refusal

HFT7 - HYPELONG_LESSONE ( HFQ4722 )

4:17:11 PM Monday, August 03, 2009

1

996


Page 744 of 760

HFT7
HYPELONG_LESSON
E

Field2:

( HFQ4722 )

NONE


Cheshire Name:

REPLACES THE FOLLOWING CHESHIRE FIELD=

If HEST.HYPELONG_LESSONE = 1/LessThanOneYear, set 

HEST.HYPELONG = 996.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:


Enumerated

THypelong996
1
No
No

Number Label
1 LessThanOneYear
English text: LESS THAN ONE YEAR
Attribute
Empty

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFT3 - (HFQ4725 )

Route
BOX HFT3 - (HFQ4725 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
Edit #1
If HYPELONG ^= EMPTY, then HYPELONG = 1-100, DK, RF.
If not true, display message "NUMBER OF YEARS MUST BE
BETWEEN 1 AND 100 OR LESS THAN ONE YEAR. PLEASE
REENTER."
Edit #2
HYPELONG and HYPELONG_LESSONE cannot both be EMPTY.
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
Edit #3

4:17:14 PM Monday, August 03, 2009

Page 745 of 760

HFT7
HYPELONG and HYPELONG_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES

DESIGN NOTES

4:17:14 PM Monday, August 03, 2009

Page 746 of 760

BOX HFT3

BOX HFT3

Page Order # :

2785

BOX INSTRUCTIONS
( HFQ4725 )	

IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFT8 - HYPEMANY (
HFQ4735 ).
ELSE GO TO HFT11A - HYPECOND ( HFQ4745 ).

ASSIGNMENTS

TECHNICAL NOTES
9

SuppORD

SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.

DESIGN NOTES

4:17:14 PM Monday, August 03, 2009	

Page 747 of 760

HFT8

HFT8

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

HYPEMANY

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

2790

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:


Roster/Grid Instructions:

Roster/Grid display:

Report display:


TEXT:

Context Header:

Int. Instr I:

Question Text:

How many different prescribed medicines [do you/does (SP)] take

for (your/his/her) high blood pressure?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:15 PM Monday, August 03, 2009

Page 748 of 760

HFT8
HYPEMANY

Field1:

( HFQ4735 )

HEST.HYPEMANY

Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:

NUMBER OF PRESCRIBED MEDICINES:
Left

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

Integer
THyperx
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
HFT11A - HYPECOND ( HFQ4745 )

Refusal

HFT11A - HYPECOND ( HFQ4745 )

FieldSize:
Min Value:
Max Value:
Mask:

1
30

Route
HFT11A - HYPECOND ( HFQ4745 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

HYPEMANY = 1 - 10, DK, RF.

If not true, display message "UNLIKELY RESPONSE. PLEASE

VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:16 PM Monday, August 03, 2009

Page 749 of 760

HFT11A

HFT11A

Page Order # :

Design Screen Type:	

Code 1

Fields:	

Field 1:

HYPECOND

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2800

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If (HFT8 - HYPEMANY = 1, DK, or RF) or (HFT8 was not asked),
display "medicine".
Else display "medicines".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:

How often [do you/does (SP)] have trouble with side effects from
(your/his/her) blood pressure (medicine/medicines)? Please tell me if
(you/he/she) always, sometimes, or never (have/has) trouble with
side effects.
[EXPLAIN IF NECESSARY: By "side effects", I mean that the
medicine causes any condition such as fatigue, headache, or
coughing.]

4:17:18 PM Monday, August 03, 2009	

Page 750 of 760

HFT11A
Int. Instr II:

INPUT FIELDS / ROUTING

HYPECOND

Field1:

( HFQ4745 )

HEST.HYPECOND

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
Talways
1
No
No

Number Label
1 Always

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT12A - HYPECTRL ( HFQ4749 )

2

English text: ALWAYS
Sometimes

HFT12A - HYPECTRL ( HFQ4749 )

3

English text: SOMETIMES
Never

HFT12A - HYPECTRL ( HFQ4749 )

English text: NEVER
Attribute
Don't know

Route
HFT12A - HYPECTRL ( HFQ4749 )

Refusal

HFT12A - HYPECTRL ( HFQ4749 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
4:17:20 PM Monday, August 03, 2009

Page 751 of 760

HFT12A

HFT12A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

HYPECTRL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2805

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:

Doctors often recommend changing your habits or lifestyle, such as
changing your diet, or getting regular exercise in order to control
blood pressure. How confident are you that [you/(SP)] can follow
these recommendation?
Would you say that you are very confident, confident, somewhat
confident, or not at all confident?

Int. Instr II:

4:17:22 PM Monday, August 03, 2009

Page 752 of 760

HFT12A
INPUT FIELDS / ROUTING
HYPECTRL

Field1:

( HFQ4749 )

HEST.HYPECTRL

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
TConfdnt
1
No
No

Number Label
1 VeryConfident

3

English text: VERY CONFIDENT
Confident
English text: CONFIDENT
SomewhatConfident

4

English text: SOMEWHAT CONFIDENT
NotAtAllConfident

2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFT4 - (HFQ4755 )
BOX HFT4 - (HFQ4755 )
BOX HFT4 - (HFQ4755 )
BOX HFT4 - (HFQ4755 )

English text: NOT AT ALL CONFIDENT
Attribute
Don't know

Route
BOX HFT4 - (HFQ4755 )

Refusal

BOX HFT4 - (HFQ4755 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
4:17:26 PM Monday, August 03, 2009

Page 753 of 760

HFT12A

4:17:26 PM Monday, August 03, 2009

Page 754 of 760


BOX HFT4

BOX HFT4

Page Order # :

2810

BOX INSTRUCTIONS
( HFQ4755 )	

IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY ( HFQ4765 ).
ELSE GO TO BOX HFEND - (HFQ9000 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:17:26 PM Monday, August 03, 2009	

Page 755 of 760

HFT13

HFT13

Page Order # :

Design Screen Type:	

Yes/No

Fields:	

Field 1:

HYPEPAY

Enable Functions:	

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:	

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:	

Add Line
Delete Line

No
No

2820

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:	

If (HFT8 - HYPEMANY = 1, DK, or RF) or (HFT8 was not asked),
display "medicine".
Else display "medicines".

Multi Field display:

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

TEXT:
Context Header:
Int. Instr I:
Question Text:	

[Do you/Does (SP)] have difficulty paying for the
(medicine/medicines) (your/his/her) doctor prescribes for
(your/his/her) high blood pressure?

Int. Instr II:

INPUT FIELDS / ROUTING


4:17:27 PM Monday, August 03, 2009	

Page 756 of 760

HFT13
HYPEPAY

Field1:

( HFQ4765 )

HEST.HYPEPAY

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
HFT14 - HYPESKIP ( HFQ4775 )

English text: YES
No

HFT14 - HYPESKIP ( HFQ4775 )

English text: NO
Attribute
Don't know

Route
HFT14 - HYPESKIP ( HFQ4775 )

Refusal

HFT14 - HYPESKIP ( HFQ4775 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:29 PM Monday, August 03, 2009

Page 757 of 760

HFT14

HFT14

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

HYPESKIP

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
No

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

2830

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:	

[Do you/Does (SP)] ever skip taking (your/his/her) medicine, take
less medicine than prescribed, or share medicine because of the
cost of the medicine?

Int. Instr II:
INPUT FIELDS / ROUTING

4:17:31 PM Monday, August 03, 2009	

Page 758 of 760

HFT14
HYPESKIP

Field1:

( HFQ4775 )

HEST.HYPESKIP

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
TYesNoDKRF
1
No
No

Number Label
1 Yes
2

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX HFEND - (HFQ9000 )

English text: YES
No

BOX HFEND - (HFQ9000 )

English text: NO
Attribute
Don't know

Route
BOX HFEND - (HFQ9000 )

Refusal

BOX HFEND - (HFQ9000 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

4:17:33 PM Monday, August 03, 2009

Page 759 of 760

BOX HFEND

BOX HFEND

Page Order # :

3000

BOX INSTRUCTIONS
( HFQ9000 )

GO TO NEXT SECTION .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

4:17:33 PM Monday, August 03, 2009

Page 760 of 760
File Type	application/pdf
Author	hubbard_r
File Modified	2010-04-05
File Created	0000-00-00