Download:
pdf |
pdfThe Centers for Medicare & Medicaid Services' Office of Research, Development, and Information (ORDI) strives to make information available to all.
Nevertheless, portions of our files including charts, tables, and graphics may be difficult to read using assistive technology.
In some cases due to size or complexity, we were not able to make files fully accessible using assistive technology. Persons with disabilities
experiencing problems accessing portions of any file should contact ORDI through e-mail at [email protected].
BOX PMS1
BOX PMS1
Page Order # :
10
BOX INSTRUCTIONS
( PMS1010 )
IF SP REPORTED PRESCRIPTION MEDICINE PURCHASES IN THE
PREVIOUS ROUND, GO TO PMSINTRA - PMSINTA ( PMS1020 ).
ELSE GO TO BOX PMS12 - (PMS1280 ).
ASSIGNMENTS
TECHNICAL NOTES
176
PMPrevRnd
SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.
DESIGN NOTES
12:35:27 PM Thursday, February 26, 2009
Page 1 of 76
PMSINTRA
PMSINTRA
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
PMSINTA
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:
During the last interview, we recorded the names of medicines that
[you/(SP)] had obtained between (SUMMARY REFERENCE DATE)
and (REFERENCE DATE).
[HAND PM SUMMARY PAGE TO RESPONDENT.]
You may want to refer to the medicine names to help you recall any
medicines that [you/(SP)] may have obtained since that time,
including any refills of these medicines.
Int. Instr II:
12:35:31 PM Thursday, February 26, 2009
Page 2 of 76
PMSINTRA
INPUT FIELDS / ROUTING
( PMS1020 )
PMSINTA
Field1:
Cheshire Name:
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
PMSINTRB - PMSUPDATE ( PMS1030 )
English text: CONTINUE
Attribute
Empty
Route
PMSINTRB - PMSUPDATE ( PMS1030 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
176
PMPrevRnd
SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.
DESIGN NOTES
12:35:35 PM Thursday, February 26, 2009
Page 3 of 76
PMSINTRB
PMSINTRB
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PMSUPDATE
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:
SUMMARY REFERENCE PERIOD: (SUMMARY REFERENCE
DATE) - (REFERENCE DATE)
Int. Instr I:
REFER TO SUMMARY PAGE FOR PRESCRIBED MEDICINES TO
REVIEW PREVIOUS ROUND UTILIZATION.
Question Text:
Int. Instr II:
CODE WITHOUT ASKING:
INPUT FIELDS / ROUTING
12:35:37 PM Thursday, February 26, 2009
Page 4 of 76
PMSINTRB
PMSUPDATE
Field1:
Cheshire Name:
( PMS1030 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TPMSUpdate
1
No
No
Number Label
1 NoChanges
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX PMS12 - (PMS1280 )
2
English text: NO CHANGES APPEAR TO BE NECESSARY
AddPM
PMS2 - MEDICINE_PMSADD ( PMS1040 )
3
English text: NEED TO ADD A MEDICINE NAME
CorrectPMName
PMS3 - MEDICINE_PMSEDIT ( PMS1060 )
4
English text: NEED TO CORRECT A MEDICINE NAME
DropMedicine
PMS4 - MEDICINE_PMSDELETE ( PMS1065 )
English text: NEED TO DROP A MEDICINE
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1
Note: The Soft edit should be displayed the first time "NEED TO
ADD A MEDICINE" is selected as verification that the medicine
being added is for the previous round.
PMSUPDATE = 1/NoChanges, 3/CorrectPMName or
4/DropMedicine.
If not true, display message, "VERIFY THAT THE SP PURCHASED
MEDICINE IN PREVIOUS ROUND."
Edit #2
Note: The Soft edit should be displayed the first time "NEED TO
DROP A MEDICINE" is selected as verification that the medicine
being deleted is from the previous round.
PMSUPDATE = 1/NoChanges, 2/AddPM or 3/CorrectPMName.
If not true, display message, "VERIFY THAT SP DID NOT
PURCHASE MEDICINE IN PREVIOUS ROUND."
12:35:42 PM Thursday, February 26, 2009
Page 5 of 76
PMSINTRB
HARD EDIT CHECKS
TECHNICAL NOTES
176
PMPrevRnd
SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.
180
PMCondition
Condition reported for the PM =
For this PM EVNT, there is an XCON where
(XCON.XCONEVNT=EVNT.EVNTNUM) and
(XCON.XCONCOND = COND.CONDNUM of condition
linked to PM EVNT).
Condition Name = COND.CONDTION.
DESIGN NOTES
12:35:42 PM Thursday, February 26, 2009
Page 6 of 76
PMS2
PMS2
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
MEDICINE_PMSADD
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Prescription Medicine Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
40
Display as ' Add a Medicine '
Display as ' Edit a Medicine '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all Prescription Medicine events where:
EVNT.EVNTDFLG ^=1/Yes, and
EVNT.EVNTTYPE='PM'.
Display in alphabetical order.
Display all prescription medicines that were reported in the previous
round that have number of purchases >0 or equal to DK or RF as
protected rows.
Display all remaining prescription medicines as active rows.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine Name
Display name of prescribed medicine,
EVNT.PMEDNAME.
2
Strength
Display prescription medicine strength
text field, EVNT.PMSTRUNI.
Report display:
TEXT:
12:35:43 PM Thursday, February 26, 2009
Page 7 of 76
PMS2
Context Header:
Int. Instr I:
Question Text:
What is the name of the medicine that needs to be added?
Int. Instr II:
ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
MEDICINE_PMSADD
( PMS1040 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick200
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
200
Route
PMS6A - GETNUM ( PMS1070 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected.
If Prescription Medicine added at Prescription Medicine Roster, see PRESCRIPTION
MEDICINE ROSTER POP-UP specifications for pop-up window programming instructions.
Variables populated at the Prescription Medicine Roster:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVNTTYPE
EVNT.PMEDNAME
EVNT.PMSTRUNI
EVNT.EVNTPROV
BASE.LASTEVNT
Event number
Round number
PM
Prescription Medicine name
Prescription Medicine strength text field
02
Highest EVNT.EVNTNUM
If Prescription Medicine added at PMS2, set EVNT.EVUTSFLG = 1/Yes to flag that PM
event was added in PMS section. See instruction below.
12:35:45 PM Thursday, February 26, 2009
Page 8 of 76
PMS2
For all Prescription Medicines selected, create a previous round PMRO. Note: a previous
round PMRO may already exist for a Prescription Medicine event if it has already been
selected earlier in the interview or if previous round PMRO.GETNUM = 0.
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND
PMRO.PMROEVNT = EVNT.EVNTNUM of PM event selected.
PMRO.PMRORND = previous round.
If Prescription Medicine selected that has it's previous round "PMRO DELETE" flag =1/Yes,
update flag = empty.
See additional instructions below.
PMROEVNT
PMRO.PMROEVNT = EVNT.EVNTNUM of
prescription medicine selected.
PMRORND
PMRO.PMRORND = previous round.
PMROTYPE
PMRO.PMROTYPE = PM.
PMRODFLG
If PMRO.PMRODFLG=1/Yes, update
PMRO.PMRODFLG=empty.
EVUTSFLG
If PM Event added at PMS2, set EVNT.EVUTSFLG =
1/Yes.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
176
PMPrevRnd
SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.
DESIGN NOTES
12:35:45 PM Thursday, February 26, 2009
Page 9 of 76
PMS3
PMS3
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
MEDICINE_PMSEDIT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Prescription Medicine Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
Yes
No
No
Add Line
Delete Line
No
No
Grid Functions:
60
Display as ' Edit a Medicine '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all prescription medicines that were reported in the previous
round that have number of purchases >0 or equal to DK or RF.
Display in alphabetical order.
SELECTION FROM THIS ROSTER IS NOT REQUIRED.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine Name
Display name of prescribed medicine,
EVNT.PMEDNAME
2
Strength
Display prescription medicine strength
text field, EVNT.PMSTRUNI.
Report display:
TEXT:
Context Header:
Int. Instr I:
EDIT ALL MEDICINES AT THIS ROSTER.
Question Text:
What is the name of the medicine that needs to be edited?
12:35:46 PM Thursday, February 26, 2009
Page 10 of 76
PMS3
Int. Instr II:
INPUT FIELDS / ROUTING
MEDICINE_PMSEDIT
Field1:
Cheshire Name:
( PMS1060 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
PMSINTRB - PMSUPDATE ( PMS1030 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
176
PMPrevRnd
SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.
DESIGN NOTES
The only purpose of PMS3 is to allow editing of prescribed medicine
names. We will not collect details for PMs selected at PMS3.
12:35:48 PM Thursday, February 26, 2009
Page 11 of 76
PMS4
PMS4
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
MEDICINE_PMSDELE
TE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Prescription Medicine Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
70
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all prescription medicines that were reported in the previous
round that have number of purchases >0 or equal to DK or RF.
Display in alphabetical order.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine Name
Display prescription medicine name,
EVNT.PMEDNAME.
2
Strength
Display prescription medicine strength
text field, EVNT.PMSTRUNI.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What is the name of the medicine that needs to be deleted?
12:35:49 PM Thursday, February 26, 2009
Page 12 of 76
PMS4
SELECT ALL MEDICINES FOR DELETION AT THIS ROSTER.
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
MEDICINE_PMSDELE
TE
( PMS1065 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
PMSINTRB - PMSUPDATE ( PMS1030 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected.
The purpose of PMS4 is to delete a specific round’s purchases of a medicine, not the entire
medicine. For each PM selected, set "PMRO DELETED" flag on the previous round
PMRO. See detailed instructions below.
However, if there are no other purchases reported for this PM in any other round, set the
“PM EVENT DELETED” flag on the PM EVNT record. Since not all PMROs linked to an
EVNT are sent out with the case, a flag is set on EVNT that indicates if there are PMROs
linked to the EVNT that are not with the case at this time. See detailed instructions below.
PMRODFLG
If PM selected, set PMRO.PMRODFLG=1/Yes on
previous round PMRO.
EVNTDFLG
If PM selected, and (there are no other PMROs
linked to this PM EVNT where PMRO.PMRODFLG =
empty) and (EVNT.PREVPMRO=empty), set
EVNT.EVNTDFLG=1/Yes.
SOFT EDIT CHECKS
HARD EDIT CHECKS
12:35:51 PM Thursday, February 26, 2009
Page 13 of 76
PMS4
TECHNICAL NOTES
176
PMPrevRnd
SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.
DESIGN NOTES
12:35:51 PM Thursday, February 26, 2009
Page 14 of 76
PMS6A
PMS6A
Page Order # :
Design Screen Type:
Grid
Fields:
Field 1:
GETNUM
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
80
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name and strength of medicine that is currently active in
grid.
Multi Field display:
Roster/Grid Instructions:
Display all PMs selected at PMS2 that do not already have previous
round PMRO.GETNUM > 0, DK or RF.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine Name
Display the name and strength of the
medicine, EVNT.PMEDNAME + ' ' +
EVNT.PMSTRUNI. Display only.
2
# Purchases
PMRO.GETNUM. Input column 1.
Report display:
TEXT:
Context Header:
Int. Instr I:
IF ALL MEDICINES ARE NOT LISTED, USE "PREVIOUS PAGE"
AND ADD THE MEDICINE TO THE ROSTER. REFER TO
STATEMENTS OR RECEIPTS, IF AVAILABLE.
12:35:55 PM Thursday, February 26, 2009
Page 15 of 76
PMS6A
How many times between (SUMMARY REFERENCE DATE) and
(REFERENCE DATE) did [you/(SP)] obtain (MEDICINE NAME)?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
GETNUM
Field1:
Cheshire Name:
Item Text display:
( PMS1070 )
PLRO.GETNUM
GRID COLUMN #2
If previous round PMRO.GETNUM = 0, display previous
round value. Allow "0" to be updated.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TGetnum
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX PMS3 - (PMS1075 )
Refusal
BOX PMS3 - (PMS1075 )
FieldSize:
Min Value:
Max Value:
Mask:
0
100
Route
BOX PMS3 - (PMS1075 )
BACKGROUND VARIABLE ASSIGNMENTS
For each PM where GETNUM is collected in PMS, set flag that PM collected in PMS. See
instructions below.
PMSUMFLG
If PMS6A - GETNUM ^= empty, set
PMRO.PMSUMFLG = 1/Yes on PMRO where
PMRO.PMRORND = previous round.
SOFT EDIT CHECKS
Edit #1
GETNUM = 1- 8, DK, RF.
If not true, display message: "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
12:35:58 PM Thursday, February 26, 2009
Page 16 of 76
PMS6A
TECHNICAL NOTES
194
PrevNumOfPurchases
The number of purchases for a PM in the previous round
=
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = previous round.)
Number of purchases = PMRO.GETNUM.
DESIGN NOTES
12:35:59 PM Thursday, February 26, 2009
Page 17 of 76
BOX PMS3
BOX PMS3
Page Order # :
90
BOX INSTRUCTIONS
( PMS1075 )
IF AT LEAST ONE PRESCRIPTION MEDICINE DISPLAYED AT PMS6A HAS
NUMBER OF PURCHASES > 0 OR EQUAL TO DK OR RF IN THE
PREVIOUS ROUND, GO TO PMS6A_IN - NAVIGATOR ( PMS1077 ).
ELSE GO TO PMSINTRB - PMSUPDATE ( PMS1030 ).
ASSIGNMENTS
TECHNICAL NOTES
194
PrevNumOfPurchases
The number of purchases for a PM in the previous round
=
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = previous round.)
Number of purchases = PMRO.GETNUM.
DESIGN NOTES
BOX PMS4 through BOX PMS11 only asks about PMs displayed at
PMS6A that have previous round PMRO.GETNUM > 0 or equal to DK,
RF. We do not collect PM details for PMs where number of purchases =
0.
If all PMs displayed at PMS6A have PMS6A - GETNUM = 0, BOX PMS3
is routed to PMSINTRB to probe for more updates. Else BOX PMS3 is
routed to Instance Navigator to collect PM details.
12:35:59 PM Thursday, February 26, 2009
Page 18 of 76
PMS6A_IN
PMS6A_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
95
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 all PM's displayed at PMS6A that have number of
purchases > 0, DK or RF.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
12:36:00 PM Thursday, February 26, 2009
Page 19 of 76
PMS6A_IN
NAVIGATOR
Field1:
Cheshire Name:
( PMS1077 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX PMS4 - (PMS1080 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
PMSINTRB - PMSUPDATE ( PMS1030 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
194
PrevNumOfPurchases
The number of purchases for a PM in the previous round
=
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = previous round.)
Number of purchases = PMRO.GETNUM.
DESIGN NOTES
12:36:03 PM Thursday, February 26, 2009
Page 20 of 76
BOX PMS4
BOX PMS4
Page Order # :
100
BOX INSTRUCTIONS
( PMS1080 )
IF SP USED V.A. FACILITIES IN THE PREVIOUS ROUND, GO TO PMS6A1
PMSATVA ( PMS1085 ).
ELSE GO TO BOX PMS6 - (PMS1095 ).
ASSIGNMENTS
TECHNICAL NOTES
195
SPUsedVAPrevRnd
SP used V.A. facilities in previous round =
HRND.VACOVER = 1/Yes on HRND where
HRND.HRNDRND = previous round.
DESIGN NOTES
BEGIN LOOP:
BOX PMS4 through BOX PMS11 ask previous round PM details for PMs
displayed at PMS6A that have number of purchases > 0, DK or RF.
12:36:03 PM Thursday, February 26, 2009
Page 21 of 76
PMS6A1
PMS6A1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PMSATVA
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:
Display name and strength of medicine currently being asked about.
If PMS6A - GETNUM = 1, display "this purchase".
Else display "any of these purchases".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did [you/(SP)] obtain (this purchase/any of these purchases) of
(MEDICINE NAME) through the Department of Veterans Affairs or
V.A.?
Int. Instr II:
INPUT FIELDS / ROUTING
12:36:06 PM Thursday, February 26, 2009
Page 22 of 76
PMS6A1
PMSATVA
Field1:
Cheshire Name:
( PMS1085 )
PMRO.PMSATVA
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 PMS6 - (PMS1095 )
English text: YES
No
BOX PMS6 - (PMS1095 )
English text: NO
Attribute
Don't know
Route
BOX PMS6 - (PMS1095 )
Refusal
BOX PMS6 - (PMS1095 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:36:10 PM Thursday, February 26, 2009
Page 23 of 76
BOX PMS6
BOX PMS6
Page Order # :
130
BOX INSTRUCTIONS
( PMS1095 )
IF SP COVERED BY A MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE PREVIOUS ROUND, GO
TO PMS6B - PMSATHMO ( PMS1100 ).
ELSE GO TO PMSINTB1 - PMSINTB ( PMS1110 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
364
PrivHMOAnytimePrevrn
d
SP covered by a Private Managed Care Plan anytime
during prev. round =
There is a PLAN where PLANTYPE = 4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
365
MHMOAnytimePrevrnd
SP covered by a Medicare Managed Care Plan anytime
during the previous round =
There is a PLAN where PLAN.PLANTYPE = 5/MHMO
and PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM
and PLRO.PLRORND =previous round and COVANYTM
= 1/Yes).
DESIGN NOTES
12:36:10 PM Thursday, February 26, 2009
Page 24 of 76
PMS6B
PMS6B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PMSATHMO
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
140
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name and strength of medicine currently being asked about.
If PMRO.GETNUM = 1, display "this purchase".
Else display "any of these purchases".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the previous round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS AS OF
(REFERENCE
DATE)"
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed
Care Plan".
12:36:13 PM Thursday, February 26, 2009
Page 25 of 76
PMS6B
TEXT:
Context Header:
Int. Instr I:
Did [you/(SP)] obtain (this purchase/any of these purchases) of
(MEDICINE NAME) at [READ MANAGED CARE PLAN NAME(S)
BELOW] or through a service or discount offered through [READ
MANAGED CARE PLAN NAME(S) BELOW]?
Question Text:
[PROBE: This could include obtaining the purchases at a plan
pharmacy; at a pharmacy that honors [your/(SP’s)] plan card; or
through a mail order service that the managed care plan referred
[you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
PMSATHMO
Field1:
Cheshire Name:
( PMS1100 )
PMRO.PMSATHMO
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
PMSINTB1 - PMSINTB ( PMS1110 )
English text: YES
No
PMSINTB1 - PMSINTB ( PMS1110 )
English text: NO
Attribute
Don't know
Route
PMSINTB1 - PMSINTB ( PMS1110 )
Refusal
PMSINTB1 - PMSINTB ( PMS1110 )
BACKGROUND VARIABLE ASSIGNMENTS
12:36:21 PM Thursday, February 26, 2009
Page 26 of 76
PMS6B
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
364
PrivHMOAnytimePrevrn
d
SP covered by a Private Managed Care Plan anytime
during prev. round =
There is a PLAN where PLANTYPE = 4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
365
MHMOAnytimePrevrnd
SP covered by a Medicare Managed Care Plan anytime
during the previous round =
There is a PLAN where PLAN.PLANTYPE = 5/MHMO
and PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM
and PLRO.PLRORND =previous round and COVANYTM
= 1/Yes).
DESIGN NOTES
12:36:21 PM Thursday, February 26, 2009
Page 27 of 76
PMSINTB1
PMSINTB1
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
PMSINTB
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:
Display name and strength of medicine currently being asked about.
Always display "[ASK R TO GET BOTTLES…] in brackets".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
[ASK R TO GET BOTTLES AND/OR STATEMENTS IF YOU HAVE
NOT ALREADY DONE SO.]
Question Text:
Now I need to ask you a few questions about the (MEDICINE NAME).
Int. Instr II:
INPUT FIELDS / ROUTING
12:36:25 PM Thursday, February 26, 2009
Page 28 of 76
PMSINTB1
PMSINTB
Field1:
Cheshire Name:
( PMS1110 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX PMS8 - (PMS1115 )
English text: CONTINUE
Attribute
Empty
Route
BOX PMS8 - (PMS1115 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:36:32 PM Thursday, February 26, 2009
Page 29 of 76
BOX PMS8
BOX PMS8
Page Order # :
170
BOX INSTRUCTIONS
( PMS1115 )
IF A CONDITION HAS ALREADY BEEN REPORTED FOR THE
PRESCRIPTION MEDICINE IN THE PREVIOUS ROUND, GO TO PMS8 PMBOTTLE ( PMS1125 ).
ELSE GO TO PMS7 - CONDITION_PMS ( PMS1120 ).
ASSIGNMENTS
TECHNICAL NOTES
180
PMCondition
Condition reported for the PM =
For this PM EVNT, there is an XCON where
(XCON.XCONEVNT=EVNT.EVNTNUM) and
(XCON.XCONCOND = COND.CONDNUM of condition
linked to PM EVNT).
Condition Name = COND.CONDTION.
DESIGN NOTES
12:36:33 PM Thursday, February 26, 2009
Page 30 of 76
PMS7
PMS7
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
CONDITION_PMS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Condition 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
180
Display as ' Add a Condition '
Display as ' Edit a Condition '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name and strength of medicine currently being asked about.
Multi Field display:
Roster/Grid Instructions:
Display all Conditions.
Display in alphabetical order.
Roster/Grid display:
COL #
1
HEADER
Condition
INSTRUCTIONS
Display condition name,
COND.CONDTION
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What condition was (MEDICINE NAME) for?
Int. Instr II:
SELECT OR ADD ALL CONDITIONS.
INPUT FIELDS / ROUTING
12:36:34 PM Thursday, February 26, 2009
Page 31 of 76
PMS7
Field1:
Cheshire Name:
CONDITION_PMS
( PMS1120 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TCondPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
PMS8 - PMBOTTLE ( PMS1125 )
BACKGROUND VARIABLE ASSIGNMENTS
If adding a new condition, see CONDITION ROSTER POP-UP specifications for pop-up
window programming instructions.
Variables populated at the Condition Roster:
COND.CONDNUM
COND.CONDRNDC
COND.CONDTION
All Conditions selected should be linked to the PM event being asked about. Link
Conditions to PM event on XCON.
XCON key = XCON.XCONBASE + XCON.XCONEVNT + XCON.XCONBAS2 +
XCON.XCONCOND.
For each condition selected, create an XCON where XCONEVNT= EVNT.EVNTNUM of
Prescription Medicine event and XCONCOND = COND.CONDNUM of Condition.
XCONBASE and XCONBAS2 both equal the Cheshire BASE.BASEID. Set additional
XCON variables as specified below.
XCONEVNT
XCON.XCONEVNT = EVNT.EVNTNUM of
prescription medicine being asked about.
XCONCOND
XCON.XCONCOND = COND.CONDNUM of
condition selected.
XCONRNDC
XCON.XCONRNDC = current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
12:36:35 PM Thursday, February 26, 2009
Page 32 of 76
PMS7
TECHNICAL NOTES
DESIGN NOTES
12:36:35 PM Thursday, February 26, 2009
Page 33 of 76
PMS8
PMS8
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PMBOTTLE
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:
Display name and strength of medicine currently being asked about.
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MEDICINE NAME: (MEDICINE NAME)
Int. Instr I:
CODE "YES" WITHOUT ASKING IF STATEMENT, RECEIPT,
BOTTLE OR BAG IS PRESENT.
Question Text:
Do you have the medicine bottle, container, or bag available?
Int. Instr II:
IF R DOES NOT HAVE BOTTLE, PROBE TO DETERMINE IF R
CAN ANSWER QUESTIONS ABOUT THE FORM, STRENGTH,
AND QUANTITY OF THE MEDICINE.
INPUT FIELDS / ROUTING
12:36:38 PM Thursday, February 26, 2009
Page 34 of 76
PMS8
PMBOTTLE
Field1:
Cheshire Name:
( PMS1125 )
PMRO.PMBOTTLE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TPmbottle
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
PMSINTRC - PMSINTC ( PMS1130 )
2
English text: YES
No
BOX PMS11 - (PMS1275 )
3
English text: NO
NoButRCanAnswerQuestions
PMS9 - PMFORM ( PMS1135 )
English text: NO BUT R CAN ANSWER QUESTIONS
Attribute
Don't know
Route
BOX PMS11 - (PMS1275 )
Refusal
BOX PMS11 - (PMS1275 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:36:43 PM Thursday, February 26, 2009
Page 35 of 76
PMSINTRC
PMSINTRC
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
PMSINTC
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
COMPLETE PMS9 -- PMS16 USING INFORMATION FROM
STATEMENT, RECEIPT, MEDICINE BOTTLE OR CONTAINER.
IF THERE IS MORE THAN ONE FOR THE SAME MEDICINE, USE
THE MOST RECENT CONTAINER.
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
12:36:45 PM Thursday, February 26, 2009
Page 36 of 76
PMSINTRC
PMSINTC
Field1:
Cheshire Name:
( PMS1130 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
PMS9 - PMFORM ( PMS1135 )
English text: CONTINUE
Attribute
Empty
Route
PMS9 - PMFORM ( PMS1135 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:36:52 PM Thursday, February 26, 2009
Page 37 of 76
PMS9
PMS9
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PMFORM
Field 2:
PMFORMOS
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:
210
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name and strength of medicine currently being asked about.
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MEDICINE NAME: (MEDICINE NAME)
Int. Instr I:
IN WHAT FORM WAS THE MEDICINE?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
12:36:57 PM Thursday, February 26, 2009
Page 38 of 76
PMS9
12:37:09 PM Thursday, February 26, 2009
Page 39 of 76
PMS9
PMFORM
Field1:
Cheshire Name:
( PMS1135 )
PMRO.PMFORM
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TPmform
1
No
No
Number Label
1 Pills
2
English text: PILLS (TABLETS, CAPSULES)
Liquid
FieldSize:
Min Value:
Max Value:
Mask:
Route
PMS10 - STRNUNIT96 ( PMS1144 )
PMS10 - STRNUNIT96 ( PMS1144 )
4
English text: LIQUID (TO BE TAKEN ORALLY)
Drops
PMS10 - STRNUNIT96 ( PMS1144 )
English text: DROPS (EYE/EAR/NOSE)
TopicalOintment
PMS10 - STRNUNIT96 ( PMS1144 )
5
English text: OINTMENT, CREAM, LOTION (TOPICAL OR INTERNAL)
Suppositories
PMS10 - STRNUNIT96 ( PMS1144 )
6
English text: SUPPOSITORIES
ArerosolSpray
7
English text: AEROSOL/SPRAY, INHALANT, SOLUTIONS, DISKUS
ShampooSoap
PMS10 - STRNUNIT96 ( PMS1144 )
8
English text: SHAMPOO, SOAP
Injection
PMS10 - STRNUNIT96 ( PMS1144 )
9
English text: INJECTION
IV
PMS10 - STRNUNIT96 ( PMS1144 )
10
English text: IV INJECTION
Patches
PMS10 - STRNUNIT96 ( PMS1144 )
11
English text: PATCHES
Gel
PMS10 - STRNUNIT96 ( PMS1144 )
12
English text: GEL OR JELLY (TOPICAL OR INTERNAL)
Powder
PMS10 - STRNUNIT96 ( PMS1144 )
91
English text: POWDER, GRANULES
Other
3
PMS10 - STRNUNIT96 ( PMS1144 )
PMS9 - PMFORMOS ( PMS1140 )
English text: OTHER
12:37:29 PM Thursday, February 26, 2009
Page 40 of 76
PMS9
Attribute
Don't know
Route
BOX PMS9 - (PMS1210 )
Field2:
Cheshire Name:
PMFORMOS
( PMS1140 )
PMRO.PMFORMOS
Item Text display:
Display (SPECIFY) in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
PMS10 - STRNUNIT96 ( PMS1144 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:37:31 PM Thursday, February 26, 2009
Page 41 of 76
PMS10
PMS10
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
STRNUNIT96
Field 2:
STRNUNIT
Field 3:
STRNUNOS
Field 4:
STRNNUM
Field 5:
STRNPER
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:
220
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name and strength of medicine currently being asked about.
Question display:
Refering to the previous round form, PMRO.PMFORM, for PM
currently being asked about:
If PMFORM = 1/Pill, display "EACH PILL".
Else if PMFORM = 5/Suppository, display "EACH SUPPOSITORY".
Else if PMFORM = 10/Patch, display "EACH PATCH".
Else then
Display "THE (MEDICINE FORM)".
If PMFORM = 91/Other, medicine form = Other Specify text,
PMRO.PMFORMOS.
Else medicine form = PMFORM response.
Multi Field display:
Vertical Alignment
Display fields in order specified.
When screen is first displayed, display 1st field, STRNUNIT96 and
2nd field, STRNUNIT, at one time.
Display remaining fields, STRNUNOS, STRNNUM, and STRNPER,
as specified on the route.
Roster/Grid Instructions:
12:37:40 PM Thursday, February 26, 2009
Page 42 of 76
PMS10
Roster/Grid display:
Report display:
TEXT:
Context Header:
MEDICINE NAME: (MEDICINE NAME)
Int. Instr I:
WHAT WAS THE STRENGTH OF [EACH PILL/EACH
PATCH/EACH SUPPOSITORY/THE (MEDICINE FORM)]?
IF COMPOUND/MORE THAN ONE MEDICINE COMBINED: CHECK
BOX BELOW AND THEN ENTER THE STRENGTH OF THE 1ST
MEDICINE IN COMPOUND.
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
STRNUNIT96
Field1:
Cheshire Name:
( PMS1144 )
NONE
REPLACES THE FOLLOWING CHESHIRE VALUE:
If STRNUNIT96 = 1/Compound, set PMRO.STRNUNIT =
96/Compound.
Item Text display:
Item Text:
Label:
Label Position:
COMPOUND/MORE THAN ONE MEDICINE COMBINED
Right
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TStrnUnit96
1
No
No
Number Label
1 Compound
FieldSize:
Min Value:
Max Value:
Mask:
Route
PMS10 - STRNUNIT ( PMS1145 )
English text: COMPOUND/MORE THAN ONE MEDICINE COMBINED
Attribute
Empty
Route
PMS10 - STRNUNIT ( PMS1145 )
12:37:52 PM Thursday, February 26, 2009
Page 43 of 76
PMS10
STRNUNIT
Field2:
Cheshire Name:
Item Text display:
( PMS1145 )
PMRO.STRNUNIT
Do not display response option 96/Compound.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TStrnunit
1
No
No
Number Label
1 Micrograms
2
English text: MICROGRAMS (mcg, mc)
Milligrams
FieldSize:
Min Value:
Max Value:
Mask:
Route
PMS10 - STRNNUM ( PMS1155 )
PMS10 - STRNNUM ( PMS1155 )
4
English text: MILLIGRAMS (mg)
Grains
English text: GRAINS (gr)
Milliequivalents
5
English text: MILLIEQUIVALENTS (meq)
Grams
PMS10 - STRNNUM ( PMS1155 )
6
English text: GRAMS (g, gm)
Percent
PMS10 - STRNPER ( PMS1160 )
7
English text: PERCENT (%)
InternationalUnits
PMS10 - STRNNUM ( PMS1155 )
8
English text: INTERNATIONAL UNITS (IU)
Units
PMS10 - STRNNUM ( PMS1155 )
91
English text: UNITS (U)
Other
PMS10 - STRNUNOS ( PMS1152 )
96
English text: OTHER
Compound
3
PMS10 - STRNNUM ( PMS1155 )
PMS10 - STRNNUM ( PMS1155 )
DO NOT DISPLAY.
English text: COMPOUND/MORE THAN ONE MEDICINE COMBINED
Attribute
Don't know
Route
BOX PMS8A - (PMS1168 )
12:38:05 PM Thursday, February 26, 2009
Page 44 of 76
PMS10
STRNUNOS
Field3:
Cheshire Name:
( PMS1152 )
PMRO.STRNUNOS
Item Text display:
Display (SPECIFY) in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
STRNNUM
Field4:
Cheshire Name:
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
PMS10 - STRNNUM ( PMS1155 )
( PMS1155 )
PMRO.STRNNUM
Item Text display:
Item Text:
Label:
Label Position:
NUMBER:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TNumunit
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
FieldSize:
Min Value:
Max Value:
Mask:
0.001
9999999
Route
BOX PMS8A - (PMS1168 )
Route
BOX PMS8A - (PMS1168 )
12:38:15 PM Thursday, February 26, 2009
Page 45 of 76
PMS10
STRNPER
Field5:
Cheshire Name:
( PMS1160 )
PMRO.STRNPER
Item Text display:
Item Text:
Label:
Label Position:
PERCENT:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TStrnper
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
FieldSize:
Min Value:
Max Value:
Mask:
0.001
100
Percent
Route
BOX PMS8A - (PMS1168 )
Route
BOX PMS8A - (PMS1168 )
BACKGROUND VARIABLE ASSIGNMENTS
COMPFLAG
If PMS10 - STRNUNIT96 = 1/Compound, set
PMRO.COMPFLAG=1/Indicated.
SOFT EDIT CHECKS
If STRNUNIT = 1/Micrograms, and PMFORM=6/Aerosol Spray, then
STRNNUM =.001-150, DK.
Else if STRNUNIT =1/Micrograms, then STRNNUM= .001-50, DK.
Else if STRNUNIT = 2/Milligrams, then STRNNUM = .005-800, DK.
Else if STRNUNIT = 3/Grains, then STRNNUM = .001-10, DK.
Else if STRNUNIT = 4/Milliequivalents, then STRNNUM = .01-100,
DK.
Else if STRNUNIT = 5/Grams, then STRNNUM = .01-30, DK.
Else if STRNUNIT = 6/Percent, then STRNPER = .001-5, DK.
Else if STRNUNIT = 7/International Units, then STRNNUM = .1
50,000, DK.
Else if STRNUNIT = 8/Units, then STRNNUM = 1-1,500, DK.
Else if STRNUNIT = 91/Other, then STRNNUM = .001-1,000, DK.
If not true, display message "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1
If STRNUNIT = 4/Milliequivalents, then STRNNUM = .01-9,999,999,
DK.
Else if STRNUNIT = 5/Grams, then STRNNUM = .01-9,999,999, DK.
If not true, display message "INVALID RESPONSE. ENTRY NOT IN
RANGE. PLEASE REENTER”.
12:38:19 PM Thursday, February 26, 2009
Page 46 of 76
PMS10
TECHNICAL NOTES
197
PrevRndForm
The previous round form for the prescription medicine =
PMRO.PMFORM on PMRO where (PMRO.PMROEVNT
= this EVNT.EVNTNUM and PMRO.PMRORND =
previous round). Other Specify Form =
PMRO.PMFORMOS.
DESIGN NOTES
12:38:19 PM Thursday, February 26, 2009
Page 47 of 76
BOX PMS8A
BOX PMS8A
Page Order # :
221
BOX INSTRUCTIONS
( PMS1168 )
IF PMS10 - STRNUNIT96 = 1/Compound, GO TO PMS10B - STRNUNI2 (
PMS1190 ).
ELSE GO TO BOX PMS9 - (PMS1210 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
12:38:19 PM Thursday, February 26, 2009
Page 48 of 76
PMS10B
PMS10B
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
STRNUNI2
Field 2:
STRNUNO2
Field 3:
STRNNUM2
Field 4:
STRNPER2
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:
224
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name and strength of medicine currently being asked about.
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MEDICINE NAME: (MEDICINE NAME)
2ND MEDICINE IN COMPOUND
Int. Instr I:
WHAT WAS THE STRENGTH OF THE 2ND MEDICINE IN THE
COMPOUND?
Question Text:
Int. Instr II:
12:38:24 PM Thursday, February 26, 2009
Page 49 of 76
PMS10B
INPUT FIELDS / ROUTING
STRNUNI2
Field1:
Cheshire Name:
Item Text display:
( PMS1190 )
PMRO.STRNUNI2
Do not display response option 96/Compound.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TStrnunit
1
No
No
Number Label
1 Micrograms
3
English text: MICROGRAMS (mcg, mc)
Milligrams
English text: MILLIGRAMS (mg)
Grains
4
English text: GRAINS (gr)
Milliequivalents
2
6
English text: MILLIEQUIVALENTS (meq)
Grams
English text: GRAMS (g, gm)
Percent
7
English text: PERCENT (%)
InternationalUnits
5
91
English text: INTERNATIONAL UNITS (IU)
Units
English text: UNITS (U)
Other
96
English text: OTHER
Compound
8
FieldSize:
Min Value:
Max Value:
Mask:
Route
PMS10B - STRNNUM2 ( PMS1195 )
PMS10B - STRNNUM2 ( PMS1195 )
PMS10B - STRNNUM2 ( PMS1195 )
PMS10B - STRNNUM2 ( PMS1195 )
PMS10B - STRNNUM2 ( PMS1195 )
PMS10B - STRNPER2 ( PMS1200 )
PMS10B - STRNNUM2 ( PMS1195 )
PMS10B - STRNNUM2 ( PMS1195 )
PMS10B - STRNUNO2 ( PMS1192 )
DO NOT DISPLAY.
English text: COMPOUND/MORE THAN ONE MEDICINE COMBINED
Attribute
Don't know
Route
BOX PMS9 - (PMS1210 )
12:38:37 PM Thursday, February 26, 2009
Page 50 of 76
PMS10B
STRNUNO2
Field2:
Cheshire Name:
( PMS1192 )
PLRO.STRNUNO2
Item Text display:
Display (SPECIFY) in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
STRNNUM2
Field3:
Cheshire Name:
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
PM10B - STRNNUM2 ( PMQ1422 )
( PMS1195 )
PMRO.STRNNUM2
Item Text display:
Item Text:
Label:
Label Position:
NUMBER:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TNumunit
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
FieldSize:
Min Value:
Max Value:
Mask:
0.001
9999999
Route
BOX PMS9 - (PMS1210 )
Route
BOX PMS9 - (PMS1210 )
12:38:46 PM Thursday, February 26, 2009
Page 51 of 76
PMS10B
STRNPER2
Field4:
Cheshire Name:
( PMS1200 )
PMRO.STRNPER2
Item Text display:
Item Text:
Label:
Label Position:
PERCENT:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TStrnper
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
FieldSize:
Min Value:
Max Value:
Mask:
0.001
100
Percent
Route
BOX PMS9 - (PMS1210 )
Route
BOX PMS9 - (PMS1210 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
If STRNUNI2 = 1/Micrograms, and PMFORM=6/Aerosol Spray, then
STRNNUM2 =.001-150, DK.
Else if STRNUNI2 =1/Micrograms, then STRNNUM2= .001-50, DK.
Else if STRNUNI2 = 2/Milligrams, then STRNNUM2 = .005-800, DK.
Else if STRNUNI2 = 3/Grains, then STRNNUM2 = .001-10, DK.
Else if STRNUNI2 = 4/Milliequivalents, then STRNNUM2 = .01-100,
DK.
Else if STRNUNI2 = 5/Grams, then STRNNUM2 = .01-30, DK.
Else if STRNUNI2 = 6/Percent, then STRNPER2 = .001-5, DK.
Else if STRNUNI2 = 7/International Units, then STRNNUM2 = .1
50,000, DK.
Else if STRNUNI2 = 8/Units, then STRNNUM2 = 1-1,500, DK.
Else if STRNUNI2 = 91/Other, then STRNNUM2 = .001-1,000, DK.
If not true, display message "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1
If STRNUNI2 = 4/Milliequivalents, then STRNNUM2 = .01-9,999,999,
DK.
Else if STRNUNI2 = 5/Grams, then STRNNUM2 = .01-9,999,999, DK.
If not true, display message "INVALID RESPONSE. ENTRY NOT IN
RANGE. PLEASE REENTER”.
12:38:50 PM Thursday, February 26, 2009
Page 52 of 76
PMS10B
TECHNICAL NOTES
DESIGN NOTES
12:38:50 PM Thursday, February 26, 2009
Page 53 of 76
BOX PMS9
BOX PMS9
Page Order # :
230
BOX INSTRUCTIONS
( PMS1210 )
IF THE PRESCRIPTION MEDICINE FORM IS PILLS, SUPPOSITORIES OR
PATCHES IN THE PREVIOUS ROUND, GO TO PMS11 - TABNUM (
PMS1215 ).
ELSE GO TO PMS16 - AMTUNIT ( PMS1260 ).
ASSIGNMENTS
TECHNICAL NOTES
187
PillsSuppPatches
PM form is stored on PMRO where PMRO.PMRORND =
round # checking and PMRO.PMROEVNT =
EVNT.EVNTNUM of PM being asked about:
Pills: PMRO.PMFORM = 1/Pills
Suppositories: PMRO.PMFORM = 5/Suppositories.
Patches: PMRO.PMFORM=10/Patches.
197
PrevRndForm
The previous round form for the prescription medicine =
PMRO.PMFORM on PMRO where (PMRO.PMROEVNT
= this EVNT.EVNTNUM and PMRO.PMRORND =
previous round). Other Specify Form =
PMRO.PMFORMOS.
DESIGN NOTES
12:38:50 PM Thursday, February 26, 2009
Page 54 of 76
PMS11
PMS11
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
TABNUM
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
240
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name and strength of medicine currently being asked about.
Question display:
Refering to the previous round form, PMRO.PMFORM, for PM
currently being asked about:
If PMFORM = 1/Pill, display " PILLS".
Else if PMFORM = 5/Suppository, display "SUPPOSITORIES".
Else if PMFORM = 10/Patch, display "PATCHES".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MEDICINE NAME: (MEDICINE NAME)
Int. Instr I:
HOW MANY (PILLS/SUPPOSITORIES/PATCHES) WERE IN THE
CONTAINER WHEN IT WAS OBTAINED?
Question Text:
Int. Instr II:
12:38:52 PM Thursday, February 26, 2009
Page 55 of 76
PMS11
INPUT FIELDS / ROUTING
( PMS1215 )
TABNUM
Field1:
Cheshire Name:
PMRO.TABNUM
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
TTabnum
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
1
999
Route
BOX PMS10 - (PMS1220 )
Route
BOX PMS10 - (PMS1220 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
TABNUM = 1-270, DK.
If not true, display message, “THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
197
PrevRndForm
The previous round form for the prescription medicine =
PMRO.PMFORM on PMRO where (PMRO.PMROEVNT
= this EVNT.EVNTNUM and PMRO.PMRORND =
previous round). Other Specify Form =
PMRO.PMFORMOS.
DESIGN NOTES
12:38:55 PM Thursday, February 26, 2009
Page 56 of 76
BOX PMS10
BOX PMS10
Page Order # :
250
BOX INSTRUCTIONS
( PMS1220 )
IF PRESCRIPTION MEDICINE FORM IS PILLS OR SUPPOSITORIES IN
THE PREVIOUS ROUND AND PMS11 - TABNUM=DK, GO TO PMS12
TABSADAY ( PMS1225 ).
ELSE GO TO BOX PMS11 - (PMS1275 ).
ASSIGNMENTS
TECHNICAL NOTES
187
PillsSuppPatches
PM form is stored on PMRO where PMRO.PMRORND =
round # checking and PMRO.PMROEVNT =
EVNT.EVNTNUM of PM being asked about:
Pills: PMRO.PMFORM = 1/Pills
Suppositories: PMRO.PMFORM = 5/Suppositories.
Patches: PMRO.PMFORM=10/Patches.
197
PrevRndForm
The previous round form for the prescription medicine =
PMRO.PMFORM on PMRO where (PMRO.PMROEVNT
= this EVNT.EVNTNUM and PMRO.PMRORND =
previous round). Other Specify Form =
PMRO.PMFORMOS.
DESIGN NOTES
12:38:55 PM Thursday, February 26, 2009
Page 57 of 76
PMS12
PMS12
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
TABSADAY
Field 2:
TABSADAY95
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:
260
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name and strength of medicine currently being asked about.
Question display:
Refering to the previous round form, PMRO.PMFORM, for PM
currently being asked about:
If PMFORM = 1/Pill, display "PILLS".
Else if PMFORM = 5/Suppository, display "SUPPOSITORIES".
Multi Field display:
Vertical Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MEDICINE NAME: (MEDICINE NAME)
Int. Instr I:
HOW MANY (PILLS/SUPPOSITORIES) WERE TO BE TAKEN IN A
DAY?
Question Text:
Int. Instr II:
12:39:00 PM Thursday, February 26, 2009
Page 58 of 76
PMS12
INPUT FIELDS / ROUTING
TABSADAY
Field1:
Cheshire Name:
( PMS1225 )
PMRO.TABSADAY
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
TTabsaday
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
Route
PMS12 - TABSADAY95 ( PMS1230 )
Don't know
PMS12 - TABSADAY95 ( PMS1230 )
12:39:08 PM Thursday, February 26, 2009
FieldSize:
Min Value:
Max Value:
Mask:
1
96
Route
PMS12 - TABSADAY95 ( PMS1230 )
Page 59 of 76
PMS12
TABSADAY95
Field2:
Cheshire Name:
( PMS1230 )
NONE
REPLACES THE FOLLOWING CHESHIRE VALUE:
If TABSADAY95=1/LessThanWhole, set
PMRO.TABSADAY=95.
Else if TABSADAY95=2/TakeAsNeeded, set
PMRO.TABSADAY=96.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTabs9596
1
No
No
Number Label
1 LessThanWhole
2
English text: LESS THAN WHOLE
TakeAsNeeded
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX PMS10A - (PMS1232 )
BOX PMS10A - (PMS1232 )
English text: TAKE AS NEEDED
Attribute
Empty
Route
BOX PMS10A - (PMS1232 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
TABSADAY = 1-8, DK.
If not true, display message, “THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1
TABSADAY and TABSADAY95 cannot both be EMPTY.
If not true, display message, "ENTRY REQUIRED. PLEASE ENTER
THE CORRECT DOSAGE."
Edit #2
TABSADAY and TABSADAY95 cannot both be FILLED.
If not true, display message, "INVALID ENTRY. PLEASE ENTER
THE NUMBER OF (PILLS/SUPPOSITORIES) OR SELECT
12:39:14 PM Thursday, February 26, 2009
Page 60 of 76
PMS12
RESPONSE."
If PMFORM = 1/Pill, display "PILLS".
Else if PMFORM = 5/Suppository, display "SUPPOSITORIES".
Edit #3
TABSADAY = 1-12, DK.
If not true, display message, "INVALID RESPONSE. ENTRY NOT
IN RANGE. PLEASE REENTER”.
TECHNICAL NOTES
197
PrevRndForm
The previous round form for the prescription medicine =
PMRO.PMFORM on PMRO where (PMRO.PMROEVNT
= this EVNT.EVNTNUM and PMRO.PMRORND =
previous round). Other Specify Form =
PMRO.PMFORMOS.
DESIGN NOTES
12:39:14 PM Thursday, February 26, 2009
Page 61 of 76
BOX PMS10A
BOX PMS10A
Page Order # :
265
BOX INSTRUCTIONS
( PMS1232 )
IF PMS12 - TABSADAY = DK, GO TO BOX PMS11 - (PMS1275 ).
ELSE IF PMS12 - TABSADAY95 = 2/TakeAsNeeded, GO TO PMS13 TABTAKE ( PMS1235 ).
ELSE GO TO PMS14 - TAKEUNIT ( PMS1245 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
12:39:14 PM Thursday, February 26, 2009
Page 62 of 76
PMS13
PMS13
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
TABTAKE
Field 2:
TABTAKE96
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:
270
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name and strength of medicine currently being asked about.
Question display:
Refering to the previous round form, PMRO.PMFORM, for PM
currently being asked about:
If PMFORM = 1/Pill, display "pills".
Else if PMFORM = 5/Suppository, display "suppositories".
If SP is deceased or institutionalized, display "did".
Else if SP is the respondent, display "do".
Else if Proxy is the respondent, display "does".
Display "usually" in BOLD.
Multi Field display:
Vertical Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
12:39:18 PM Thursday, February 26, 2009
MEDICINE NAME: (MEDICINE NAME)
Page 63 of 76
PMS13
Int. Instr I:
How many (pills/suppositories) did [you/(SP)] usually take in a day?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
TABTAKE
Field1:
Cheshire Name:
( PMS1235 )
PMRO.TABTAKE
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
TTabtake
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
Route
PMS13 - TABTAKE96 ( PMS1240 )
Don't know
PMS13 - TABTAKE96 ( PMS1240 )
12:39:27 PM Thursday, February 26, 2009
FieldSize:
Min Value:
Max Value:
Mask:
1
96
Route
PMS13 - TABTAKE96 ( PMS1240 )
Page 64 of 76
PMS13
TABTAKE96
Field2:
Cheshire Name:
( PMS1240 )
NONE
REPLACES THE FOLLOWING CHESHIRE VALUE:
If TABTAKE96=1/DontTakeEveryDay, set
PMRO.TABTAKE=96.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTabTake96
1
No
No
Number Label
1 DontTakeEveryDay
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX PMS10B - (PMS1242 )
English text: DON'T TAKE EVERY DAY
Attribute
Empty
Route
BOX PMS10B - (PMS1242 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
TABTAKE = 1-15, DK.
If not true, display message, “THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
Edit#1
TABTAKE and TABTAKE96 cannot both be EMPTY.
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
THE CORRECT DOSAGE.”.
Edit#2
TABTAKE and TABTAKE96 cannot both be FILLED.
If not true, display message, "INVALID ENTRY. PLEASE ENTER
THE NUMBER OF (PILLS/SUPPOSITORIES) OR SELECT
RESPONSE."
If PMFORM = 1/Pill, display "PILLS".
Else if PMFORM = 5/Suppository, display "SUPPOSITORIES".
12:39:31 PM Thursday, February 26, 2009
Page 65 of 76
PMS13
Edit #3
TABTAKE = 1-30, DK.
If not true, display message, "INVALID RESPONSE. ENTRY NOT
IN RANGE. PLEASE REENTER”
TECHNICAL NOTES
181
PrevRndForm
Previous round form for PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT= EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM form = PMRO.PMFORM, PMRO.PMFORMOS.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
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
12:39:31 PM Thursday, February 26, 2009
Page 66 of 76
BOX PMS10B
BOX PMS10B
Page Order # :
275
BOX INSTRUCTIONS
( PMS1242 )
IF PMS13 - TABTAKE96 = 1/DontTakeEveryDay, GO TO BOX PMS11
(PMS1275 ).
ELSE GO TO PMS14 - TAKEUNIT ( PMS1245 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
12:39:31 PM Thursday, February 26, 2009
Page 67 of 76
PMS14
PMS14
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
TAKEUNIT
Field 2:
TAKENUM
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:
280
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name and strength of medicine currently being asked about.
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MEDICINE NAME: (MEDICINE NAME)
Int. Instr I:
HOW MANY DAYS OR WEEKS WAS THE MEDICINE TO BE
TAKEN?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
12:39:35 PM Thursday, February 26, 2009
Page 68 of 76
PMS14
TAKEUNIT
Field1:
Cheshire Name:
( PMS1245 )
PMRO.TAKEUNIT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTakeunit
1
No
No
Number Label
1 Days
FieldSize:
Min Value:
Max Value:
Mask:
Route
PMS14 - TAKENUM ( PMS1250 )
2
English text: DAYS
Weeks
PMS14 - TAKENUM ( PMS1250 )
3
English text: WEEKS
TakeUntilGone
BOX PMS11 - (PMS1275 )
4
English text: TAKE UNTIL GONE
TakeAsNeeded
BOX PMS11 - (PMS1275 )
5
English text: TAKE AS NEEDED
TakeEveryDay
BOX PMS11 - (PMS1275 )
English text: TAKE EVERY DAY
Attribute
Don't know
Route
BOX PMS11 - (PMS1275 )
12:39:49 PM Thursday, February 26, 2009
Page 69 of 76
PMS14
Field2:
Cheshire Name:
TAKENUM
( PMS1250 )
PMRO.TAKENUM
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
TTakenum
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
99
Route
BOX PMS11 - (PMS1275 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
If TAKEUNIT = 1/Days, then TAKENUM = 1-30.
Else if TAKEUNIT =1/Weeks, then TAKENUM= 1-4.
If not true, display message "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:39:51 PM Thursday, February 26, 2009
Page 70 of 76
PMS16
PMS16
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
AMTUNIT
Field 2:
AMTUNOS
Field 3:
AMTNUM
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:
290
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name and strength of medicine currently being asked about.
Question display:
Always display "[PLEASE ENTER…]" in brackets.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
MEDICINE NAME: (MEDICINE NAME)
Int. Instr I:
HOW MUCH MEDICINE WAS IN THE CONTAINER WHEN IT WAS
OBTAINED?
Question Text:
Int. Instr II:
[PLEASE ENTER THE AMOUNT IN THE CONTAINER, NOT THE
STRENGTH OF THE MEDICINE.]
INPUT FIELDS / ROUTING
12:39:56 PM Thursday, February 26, 2009
Page 71 of 76
PMS16
AMTUNIT
Field1:
Cheshire Name:
( PMS1260 )
PMRO.AMTUNIT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAmtunit
1
No
No
Number Label
1 Ounces
FieldSize:
Min Value:
Max Value:
Mask:
Route
PMS16 - AMTNUM ( PMS1265 )
2
English text: OUNCES (oz)
Grams
PMS16 - AMTNUM ( PMS1265 )
3
English text: GRAMS (g, gm)
Milliliters
PMS16 - AMTNUM ( PMS1265 )
4
English text: MILLILITERS (ml, cc)
Milliequivalents
PMS16 - AMTNUM ( PMS1265 )
5
English text: MILLIEQUIVALENTS (meq)
Milligrams
PMS16 - AMTNUM ( PMS1265 )
6
English text: MILLIGRAMS (mg)
Micrograms
PMS16 - AMTNUM ( PMS1265 )
7
English text: MICROGRAMS (mcg)
Puffs
PMS16 - AMTNUM ( PMS1265 )
English text: PUFFS, DOSES, BLISTERS
Other
PMS16 - AMTUNOS ( PMS1262 )
91
English text: OTHER
Attribute
Don't know
Route
BOX PMS11 - (PMS1275 )
12:40:11 PM Thursday, February 26, 2009
Page 72 of 76
PMS16
AMTUNOS
Field2:
Cheshire Name:
( PMS1262 )
PLRO.AMTUNOS
Item Text display:
Display (SPECIFY) in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
AMTNUM
Field3:
Cheshire Name:
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
PMS16 - AMTNUM ( PMS1265 )
( PMS1265 )
PMRO.AMTNUM
Item Text display:
Item Text:
Label:
Label Position:
NUMBER:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Real
TNumunit
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
FieldSize:
Min Value:
Max Value:
Mask:
0.001
9999999
Route
BOX PMS11 - (PMS1275 )
Route
BOX PMS11 - (PMS1275 )
BACKGROUND VARIABLE ASSIGNMENTS
12:40:17 PM Thursday, February 26, 2009
Page 73 of 76
PMS16
SOFT EDIT CHECKS
Edit #1
If AMTUNIT= 1/Ounces, then AMTNUM =.01-16, DK.
Else if AMTUNIT =2/Grams, then AMTNUM= .01-60, DK.
Else if AMTUNIT = 3/Milliliters, then AMTNUM = .01-480, DK.
Else if AMTUNIT = 4/Milliequivalents, then AMTNUM = .01-100, DK.
Else if AMTUNIT = 5/Milligrams, then AMTNUM = .005- 800, DK.
Else if AMTUNIT = 6/Micrograms, then AMTNUM = .001- 50, DK.
Else if AMTUNIT = 91/Other, then AMTNUM = .01-1,000, DK.
If not true, display message "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1
If AMTUNIT= 1/Ounces, then AMTNUM =.01-9,999,999, DK.
Else if AMTUNIT =2/Grams, then AMTNUM = .01-9,999,999, DK.
Else if AMTUNIT = 3/Milliliters, then AMTNUM = .01-9,999,999, DK.
Else if AMTUNIT = 4/Milliequivalents, then AMTNUM = .01
9,999,999, DK
If not true, display message "INVALID RESPONSE. ENTRY NOT IN
RANGE. PLEASE REENTER."
TECHNICAL NOTES
DESIGN NOTES
12:40:17 PM Thursday, February 26, 2009
Page 74 of 76
BOX PMS11
BOX PMS11
Page Order # :
300
BOX INSTRUCTIONS
( PMS1275 )
GO TO PMS6A_IN - NAVIGATOR ( PMS1077 ).
ASSIGNMENTS
TECHNICAL NOTES
194
PrevNumOfPurchases
The number of purchases for a PM in the previous round
=
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = previous round.)
Number of purchases = PMRO.GETNUM.
DESIGN NOTES
12:40:17 PM Thursday, February 26, 2009
Page 75 of 76
BOX PMS12
BOX PMS12
Page Order # :
310
BOX INSTRUCTIONS
( PMS1280 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
12:40:17 PM Thursday, February 26, 2009
Page 76 of 76
| File Type | application/pdf |
| File Modified | 2010-04-06 |
| File Created | 0000-00-00 |