Download:
pdf |
pdfUS1
US1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PLACEPAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
20
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is a Proxy, display "goes".
Else display "go".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Is there a particular medical person or a clinic [you/(SP)] usually
(go/goes) to when (you are/he is/she is) sick or for advice about
(your/his/her) health?
Int. Instr II:
INPUT FIELDS / ROUTING
11:18:28 AM Monday, August 03, 2009
Page 1 of 90
US1
( USQ1020 )
PLACEPAR
Field1:
ACCS.PLACEPAR
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
US2 - PLACEKND ( USQ1030 )
English text: YES
No
US39 - NUSNOTSK ( USQ1750 )
English text: NO
Attribute
Don't know
Route
BOX US4 - (USQ1850 )
Refusal
BOX US4 - (USQ1850 )
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'.
11:18:31 AM Monday, August 03, 2009
Page 2 of 90
US1
DESIGN NOTES
11:18:31 AM Monday, August 03, 2009
Page 3 of 90
US2
US2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PLACEKND
Field 2:
PLACEOS
HELP
COMMENTS
JUMPBACK
Yes
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:
30
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:
What kind of place [do you/does (SP)] usually go to when (you
are/he is/she is) sick or for advice about (your/his/her) health -- is
that a managed care plan center or HMO, a clinic, a doctor's office, a
hospital, or some other place?
IF CLINIC, ASK: Is it a hospital outpatient clinic, or some other kind
of clinic?
IF SOME OTHER PLACE, ASK: Where is this?
11:18:35 AM Monday, August 03, 2009
Page 4 of 90
US2
Int. Instr II:
INPUT FIELDS / ROUTING
11:18:42 AM Monday, August 03, 2009
Page 5 of 90
US2
PLACEKND
Field1:
( USQ1030 )
ACCS.PLACEKND
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
TPlaceKnd3
1
No
No
Number Label
1 DoctorsOffice
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX USB - (USQ1050 )
English text: DOCTOR'S OFFICE OR GROUP PRACTICE
MedicalClinic
BOX USB - (USQ1050 )
4
English text: MEDICAL CLINIC
HMO
US3A - CLNAME ( USQ1080 )
English text: MANAGED CARE PLAN CENTER/HMO
FamilyHealthCenter
US3A - CLNAME ( USQ1080 )
5
English text: NEIGHBORHOOD/FAMILY HEALTH CENTER
SurgicalCenter
US3A - CLNAME ( USQ1080 )
6
English text: FREESTANDING SURGICAL CENTER
RuralHealthClinic
US3A - CLNAME ( USQ1080 )
7
English text: RURAL HEALTH CLINIC
CompanyClinic
US3A - CLNAME ( USQ1080 )
8
English text: COMPANY CLINIC
OtherClinic
US3A - CLNAME ( USQ1080 )
9
English text: OTHER CLINIC
UrgentCenter
US3A - CLNAME ( USQ1080 )
10
English text: WALK-IN URGENT CENTER
AtHome
US5A - MDNAME ( USQ1120 )
11
English text: DOCTOR COMES TO SP'S HOME
EmergencyRoom
US3A - CLNAME ( USQ1080 )
12
English text: HOSPITAL EMERGENCY ROOM
OutpatientDept
US3A - CLNAME ( USQ1080 )
13
English text: HOSPITAL OUTPATIENT DEPARTMENT/CLINIC
VaFacility
US3A - CLNAME ( USQ1080 )
3
English text: VA FACILITY
11:18:56 AM Monday, August 03, 2009
Page 6 of 90
US2
14
MentalHealthCtr
US3A - CLNAME ( USQ1080 )
91
English text: DATA EDITING ONLY CODE
Other
US2 - PLACEOS ( USQ1040 )
English text: OTHER
Attribute
Don't know
Route
US3A - CLNAME ( USQ1080 )
Refusal
US3A - CLNAME ( USQ1080 )
Field2:
PLACEOS
( USQ1040 )
ACCS.PLACEOS
Cheshire Name:
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
US3A - CLNAME ( USQ1080 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:18:58 AM Monday, August 03, 2009
Page 7 of 90
BOX USB
BOX USB
Page Order # :
40
BOX INSTRUCTIONS
( USQ1050 )
IF SP WAS COVERED BY A MANAGED CARE PLAN ANYTIME DURING
THE CURRENT ROUND, GO TO US2A - PLACEMCP ( USQ1060 ).
ELSE IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME (
USQ1120 ).
ELSE GO TO US3A - CLNAME ( USQ1080 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
DESIGN NOTES
11:18:58 AM Monday, August 03, 2009
Page 8 of 90
US2A
US2A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PLACEMCP
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
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:
If US2 - PLACEKND=1/DoctorsOffice, display "doctor".
Else display "medical clinic".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
11:19:00 AM Monday, August 03, 2009
Page 9 of 90
US2A
Int. Instr I:
Is this (doctor/medical clinic) associated with (your/his/her) [READ
MANAGED CARE PLAN NAME(S) BELOW] plan?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
( USQ1060 )
PLACEMCP
Field1:
ACCS.PLACEMCP
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 USC - (USQ1070 )
English text: YES
No
BOX USC - (USQ1070 )
English text: NO
Attribute
Don't know
Route
BOX USC - (USQ1070 )
Refusal
BOX USC - (USQ1070 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
11:19:02 AM Monday, August 03, 2009
Deleted plans that are not valid for displays or checks =
Page 10 of 90
US2A
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan
(Medicare Advantage plan) during the current round =
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
11:19:03 AM Monday, August 03, 2009
Page 11 of 90
BOX USC
BOX USC
Page Order # :
60
BOX INSTRUCTIONS
( USQ1070 )
IF US2 - PLACEKND = 1/DoctorsOffice, GO TO US5A - MDNAME (
USQ1120 ).
ELSE GO TO US3A - CLNAME ( USQ1080 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
11:19:03 AM Monday, August 03, 2009
Page 12 of 90
US3A
US3A
Page Order # :
Design Screen Type:
Text
Fields:
Field 1:
CLNAME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
70
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 US2 - PLACEKND=DK or RF, display "place".
Else if US2 - PLACEKND=3/HMO, display "HMO".
Else if US2 - PLACEKND=91/Other, display US2 Other specify
response, US2 - PLACEOS.
Else display US2 - PLACEKND response.
If proxy interview, display "goes to".
Else display "go to".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What is the complete name of the [place/HMO/(US2 RESPONSE)]
that [you/(SP)] (go to/goes to)?
Int. Instr II:
11:19:03 AM Monday, August 03, 2009
Page 13 of 90
US3A
INPUT FIELDS / ROUTING
( USQ1080 )
CLNAME
Field1:
ACCS.CLNAME
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NAME OF USUAL SOURCE OF CARE
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TName30
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
US4 - USUALDOC ( USQ1100 )
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'.
DESIGN NOTES
11:19:04 AM Monday, August 03, 2009
Page 14 of 90
US4
US4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
USUALDOC
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:
If proxy interview, display "usually sees".
Else display "usually see".
If US2 - PLACEKND=DK or RF, display "place".
Else if US2 - PLACEKND=3/HMO, display "HMO".
Else if US2 - PLACEKND=91/Other, display US2 Other specify
response, US2 - PLACEOS.
Else display US2 - PLACEKND response.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Is there a particular doctor [you/(SP)] (usually see/usually sees] at
this [place/HMO/(US2 RESPONSE)] ?
Int. Instr II:
11:19:05 AM Monday, August 03, 2009
Page 15 of 90
US4
INPUT FIELDS / ROUTING
( USQ1100 )
USUALDOC
Field1:
ACCS.USUALDOC
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
US5A - MDNAME ( USQ1120 )
English text: YES
No
English text: NO
BOX US1 - (USQ1150 )
Attribute
Don't know
Route
US7 - USHOUSCL ( USQ1160 )
Refusal
US7 - USHOUSCL ( USQ1160 )
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) =
11:19:08 AM Monday, August 03, 2009
Page 16 of 90
US4
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
11:19:08 AM Monday, August 03, 2009
Page 17 of 90
US5A
US5A
Page Order # :
Design Screen Type:
Text
Fields:
Field 1:
MDNAME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
90
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 is the complete name of that doctor?
Int. Instr II:
INPUT FIELDS / ROUTING
11:19:08 AM Monday, August 03, 2009
Page 18 of 90
US5A
Field1:
MDNAME
( USQ1120 )
ACCS.MDNAME
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NAME OF USUAL SOURCE OF CARE
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TName30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
US6A - MDSPEC ( USQ1130 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:19:09 AM Monday, August 03, 2009
Page 19 of 90
US6A
US6A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MDSPEC
Field 2:
MDSPECOS
HELP
COMMENTS
JUMPBACK
Yes
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:
100
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display US5A - MDNAME provider name.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What is (US5A PROVIDER NAME'S) specialty?
Int. Instr II:
INPUT FIELDS / ROUTING
11:19:14 AM Monday, August 03, 2009
Page 20 of 90
US6A
11:19:24 AM Monday, August 03, 2009
Page 21 of 90
US6A
MDSPEC
Field1:
ACCS.MDSPEC
Cheshire Name:
Item Text display:
( USQ1130 )
Do not display response option 6/ERPhysician.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TSpeclty
1
No
No
Number Label
1 Allergy
2
English text: ALLERGY/IMMUNOLOGY
Anesthesiology
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX US1 - (USQ1150 )
BOX US1 - (USQ1150 )
5
English text: ANESTHESIOLOGY
Cardiology
English text: CARDIOLOGY (HEART)
Dermatology
6
English text: DERMATOLOGY (SKIN)
ERPhysician
7
DO NOT DISPLAY.
English text: EMERGENCY ROOM PHYSICIAN
Endocrinology
BOX US1 - (USQ1150 )
8
English text: ENDOCRINOLOGY/ METABOLISM (DIABETES, THYROID)
FamilyPractice
BOX US1 - (USQ1150 )
3
BOX US1 - (USQ1150 )
BOX US1 - (USQ1150 )
10
English text: FAMILY PRACTICE
Gastroenterology
English text: GASTROENTEROLOGY
GenPractice
BOX US1 - (USQ1150 )
11
English text: GENERAL PRACTICE
GenSurgery
BOX US1 - (USQ1150 )
9
12
13
English text: GENERAL SURGERY
Geriatrics
English text: GERIATRICS (ELDERLY)
Gynecology
BOX US1 - (USQ1150 )
BOX US1 - (USQ1150 )
BOX US1 - (USQ1150 )
English text: GYNECOLOGY - OBSTETRICS
11:19:39 AM Monday, August 03, 2009
Page 22 of 90
US6A
14
Hematology
BOX US1 - (USQ1150 )
15
English text: HEMATOLOGY (BLOOD)
HospitalResidence
BOX US1 - (USQ1150 )
16
English text: HOSPITAL RESIDENCE
InternalMed
BOX US1 - (USQ1150 )
17
English text: INTERNAL MEDICINE (INTERNIST)
Nephrology
BOX US1 - (USQ1150 )
18
English text: NEPHROLOGY (KIDNEYS)
Neurology
BOX US1 - (USQ1150 )
19
English text: NEUROLOGY
NuclearMed
BOX US1 - (USQ1150 )
20
English text: NUCLEAR MEDICINE
Oncology
BOX US1 - (USQ1150 )
21
English text: ONCOLOGY (TUMORS, CANCER)
Ophthalmology
BOX US1 - (USQ1150 )
22
English text: OPHTHALMOLOGY (EYES)
Orthopedics
BOX US1 - (USQ1150 )
24
English text: ORTHOPEDICS
Osteopathy
BOX US1 - (USQ1150 )
26
English text: OSTEOPATHY (DO)
EarNoseThroat
BOX US1 - (USQ1150 )
English text: OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT)
Pathology
BOX US1 - (USQ1150 )
27
English text: PATHOLOGY
PhysMed
25
29
English text: PHYS MED/REHAB
PlasticSurgery
English text: PLASTIC SURGERY
Proctology
30
English text: PROCTOLOGY
Psychiatry
28
BOX US1 - (USQ1150 )
BOX US1 - (USQ1150 )
BOX US1 - (USQ1150 )
BOX US1 - (USQ1150 )
32
English text: PSYCHIATRY/PSYCHIATRIST
Pulmonary
English text: PULMONARY (LUNGS)
Radiology
33
English text: RADIOLOGY
Rheumatology
34
English text: RHEUMATOLOGY (ARTHRITIS)
ThoracicSurgery
BOX US1 - (USQ1150 )
35
English text: THORACIC SURGERY (CHEST)
Urology
BOX US1 - (USQ1150 )
31
BOX US1 - (USQ1150 )
BOX US1 - (USQ1150 )
BOX US1 - (USQ1150 )
English text: UROLOGY
11:19:59 AM Monday, August 03, 2009
Page 23 of 90
US6A
91
Other
US6A - MDSPECOS ( USQ1140 )
English text: OTHER DR SPECIALTY
Attribute
Don't know
Route
BOX US1 - (USQ1150 )
Refusal
BOX US1 - (USQ1150 )
Field2:
MDSPECOS
( USQ1140 )
ACCS.MDSPECOS
Cheshire Name:
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
OTHER DR SPECIALTY (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 US1 - (USQ1150 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:20:01 AM Monday, August 03, 2009
Page 24 of 90
BOX US1
BOX US1
Page Order # :
110
BOX INSTRUCTIONS
( USQ1150 )
IF US2 - PLACEKND = 10/AtHome, GO TO US15 - USHOWLNG ( USQ1350
).
ELSE GO TO US7 - USHOUSCL ( USQ1160 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
11:20:01 AM Monday, August 03, 2009
Page 25 of 90
US7
US7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
USHOUSCL
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
120
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (US2 - PLACEKND=1/DoctorsOffice) or (US4
USUALDOC=1/Yes),
Display "(US5A PROVIDER NAME)".
Display US5A - MDNAME provider name.
Else
Display "a doctor from (US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does [(US5A PROVIDER NAME)/a doctor from (US3A PROVIDER
NAME)] make house calls?
Int. Instr II:
11:20:02 AM Monday, August 03, 2009
Page 26 of 90
US7
INPUT FIELDS / ROUTING
( USQ1160 )
USHOUSCL
Field1:
ACCS.USHOUSCL
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
US8 - GETUSHOW ( USQ1170 )
English text: YES
No
English text: NO
US8 - GETUSHOW ( USQ1170 )
Attribute
Don't know
Route
US8 - GETUSHOW ( USQ1170 )
Refusal
US8 - GETUSHOW ( USQ1170 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
109
ProviderName
Provider Roster is stored on PROV.
Provider Name = PROV.PROVNAME.
DESIGN NOTES
11:20:04 AM Monday, August 03, 2009
Page 27 of 90
US8
US8
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
GETUSHOW
Field 2:
GETUSOS
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
130
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (US2 - PLACEKND=1/DoctorsOffice) or (US4
USUALDOC=1/Yes),
Display "(US5A PROVIDER NAME)'S office".
Display US5A - MDNAME provider name.
Else
Display "(US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
11:20:07 AM Monday, August 03, 2009
How [do you/does (SP)] usually get to [(US5A PROVIDER NAME)'S
office/(US3A PROVIDER NAME)]?
Page 28 of 90
US8
[EXPLAIN IF NECESSARY: [Do you/Does (SP)] get there by
walking, driving, being driven by someone else, by ambulance or
other special vehicle for disabled people, by taxi, other public
transportation, or some other way?]
Int. Instr II:
INPUT FIELDS / ROUTING
11:20:12 AM Monday, August 03, 2009
Page 29 of 90
US8
GETUSHOW
Field1:
ACCS.GETUSHOW
Cheshire Name:
Item Text display:
( USQ1170 )
Do not display option 8/SeniorCitizenVan.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TGetdrhow
1
No
No
Number Label
1 Walking
2
English text: WALKING
Driving
FieldSize:
Min Value:
Max Value:
Mask:
Route
US9 - GETUSUNT ( USQ1190 )
US9 - GETUSUNT ( USQ1190 )
4
English text: DRIVING
BeingDriven
English text: BEING DRIVEN
Ambulance
5
English text: AMBULANCE OR OTHER SPECIAL VEHICLE
Taxi
US9 - GETUSUNT ( USQ1190 )
6
English text: TAXI
OtherPublicTrans
7
English text: OTHER PUBLIC TRANSPORTATION
DrComesToHome
US15 - USHOWLNG ( USQ1350 )
3
8
91
US9 - GETUSUNT ( USQ1190 )
US9 - GETUSUNT ( USQ1190 )
US9 - GETUSUNT ( USQ1190 )
English text: DR. USUALLY COMES TO HOME
SeniorCitizenVan
DO NOT DISPLAY.
English text: DATA EDITING ONLY.
Other
US8 - GETUSOS ( USQ1180 )
English text: SOME OTHER WAY
Attribute
Don't know
Route
US15 - USHOWLNG ( USQ1350 )
Refusal
US15 - USHOWLNG ( USQ1350 )
11:20:20 AM Monday, August 03, 2009
Page 30 of 90
US8
( USQ1180 )
GETUSOS
Field2:
ACCS.GETUSOS
Cheshire Name:
Item Text display:
Display "(SPECIFY)" in same blue font used for interviewer
instructions.
Item Text:
SOME OTHER WAY (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
US9 - GETUSUNT ( USQ1190 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
109
ProviderName
Provider Roster is stored on PROV.
Provider Name = PROV.PROVNAME.
DESIGN NOTES
11:20:20 AM Monday, August 03, 2009
Page 31 of 90
US9
US9
Page Order # :
Design Screen Type:
Quantity Unit Hybrid
Fields:
Field 1:
GETUSUNT
Field 2:
GETUSHRS
Field 3:
GETUSMIN
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:
140
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:
About how long does it usually take for [you/(SP)] to get there?
Int. Instr II:
INPUT FIELDS / ROUTING
11:20:22 AM Monday, August 03, 2009
Page 32 of 90
US9
GETUSUNT
Field1:
( USQ1190 )
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
TAcsunta
1
No
No
Number Label
1 HoursOnly
FieldSize:
Min Value:
Max Value:
Mask:
Route
US9 - GETUSHRS ( USQ1200 )
2
English text: HOURS ONLY
MinutesOnly
US9 - GETUSMIN ( USQ1210 )
3
English text: MINUTES ONLY
HoursAndMinutes
US9 - GETUSHRS ( USQ1200 )
English text: HOURS AND MINUTES
Attribute
Don't know
Route
US10 - ACCOMPUS ( USQ1220 )
Refusal
US10 - ACCOMPUS ( USQ1220 )
11:20:25 AM Monday, August 03, 2009
Page 33 of 90
US9
Field2:
GETUSHRS
( USQ1200 )
ACCS.GETUSHRS
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
HOURS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccshrs1
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
72
Route
If US9 GETUSUNT=3/HoursAndMinutes go to
US9 - GETUSMIN.
Else go to US10 - ACCOMPUS.
Field3:
GETUSMIN
( USQ1210 )
ACCS.GETUSMIN
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
MINUTES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccsmin
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
59
Route
US10 - ACCOMPUS ( USQ1220 )
BACKGROUND VARIABLE ASSIGNMENTS
11:20:26 AM Monday, August 03, 2009
Page 34 of 90
US9
SOFT EDIT CHECKS
Edit #1:
If GETUSUNT = 1/HoursOnly or 3/HoursAndMinutes, GETUSHRS =
1-16.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF HOURS SEEMS UNLIKELY. PLEASE VERIFY."
Edit #2:
If GETUSUNT = 2/MinutesOnly or 3/HoursAndMinutes, GETUSMIN
= 5-59.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF MINUTES SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:20:26 AM Monday, August 03, 2009
Page 35 of 90
US10
US10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ACCOMPUS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
150
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
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)] usually have someone accompany (you/him/her)
there?
Int. Instr II:
INPUT FIELDS / ROUTING
11:20:28 AM Monday, August 03, 2009
Page 36 of 90
US10
ACCOMPUS
Field1:
( USQ1220 )
ACCS.ACCOMPUS
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
US11 - PERSON_USUALGO ( USQ1240 )
English text: YES
No
US15 - USHOWLNG ( USQ1350 )
English text: NO
Attribute
Don't know
Route
US15 - USHOWLNG ( USQ1350 )
Refusal
US15 - USHOWLNG ( USQ1350 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:20:30 AM Monday, August 03, 2009
Page 37 of 90
US11
US11
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_USUALGO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
PersonRoster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
Yes
Grid Functions:
Add Line
Delete Line
No
No
160
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 for SP. Do not
display SP, ROST.ROSTNUM='01'. If proxy interview, display proxy
on the first line. Display remaining persons 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:
11:20:30 AM Monday, August 03, 2009
Page 38 of 90
US11
Question Text:
Who usually goes with [you/(SP)]?
Int. Instr II:
SELECT OR ADD ONLY ONE PERSON.
INPUT FIELDS / ROUTING
Field1:
PERSON_USUALGO
( USQ1240 )
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
US11A1 - PERSWITH ( USQ1270 )
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.
11:20:31 AM Monday, August 03, 2009
Page 39 of 90
US11
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. See instructions below.
ROSTREAS
If new person added to person roster, set
ROST.ROSTREAS=9/AccompanierToSp.
HLPRTELE
If creating new HLPR, set
HLPR.HLPRTELE=2/NotIndicated.
HLPRLHWK
If creating new HLPR, set
HLPR.HLPRLHWK=2/NotIndicated.
HLPRHHWK
If creating new HLPR, set
HLPR.HLPRHHWK=2/NotIndicated.
HLPRMEAL
If creating new HLPR, set
HLPR.HLPRMEAL=2/NotIndicated.
HLPRSHOP
If creating new HLPR, set
HLPR.HLPRSHOP=2/NotIndicated.
HLPRBILS
If creating new HLPR, set
HLPR.HLPRBILS=2/NotIndicated.
HLPRBATH
If creating new HLPR, set
HLPR.HLPRBATH=2/NotIndicated.
HLPRDRES
If creating new HLPR, set
HLPR.HLPRDRES=2/NotIndicated.
HLPREAT
If creating new HLPR, set
HLPR.HLPREAT=2/NotIndicated.
HLPRCHAR
If creating new HLPR, set
HLPR.HLPRCHAR=2/NotIndicated.
HLPRWALK
If creating new HLPR, set
HLPR.HLPRWALK=2/NotIndicated.
HLPRTOIL
If creating new HLPR, set
HLPR.HLPRTOIL=2/NotIndicated.
HLPRREL
HLPR.HLPRREL=ROST.ROSTREL.
HLPRREOS
HLPR.HLPRREOS=ROST.ROSTREOS.
HLPRUSGO
HLPR.HLPRUSGO=1/Yes.
USHLPRGO
ACCS.USHLPRGO=ROST.ROSTNUM of person
selected at US11.
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'.
11:20:31 AM Monday, August 03, 2009
Page 40 of 90
US11
113
PersonName
The Person Roster is stored on ROST.
The persons' name = ROST.ROSTFNAM +
ROST.ROSTLNAM.
The person's relationship to SP = ROST.ROSTREL,
ROST.ROSTREOS.
110
PersonHelper
Person identified as a Helper to SP =
For this ROST, there is a HLPR where
(HLPR.HLPRROST = ROST.ROSTNUM and
HLPR.HLPRRND=current round ).
DESIGN NOTES
11:20:31 AM Monday, August 03, 2009
Page 41 of 90
US11A1
US11A1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PERSWITH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
170
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 person selected at US11 is proxy, display "are you".
Else display "is that person".
If proxy interview, display "sees".
Else display "see".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How often (are you/is that person) with [you/(SP)] while [you/(SP)]
(see/sees) the doctor or other medical person? Would you say
always, sometimes, or never?
Int. Instr II:
11:20:33 AM Monday, August 03, 2009
Page 42 of 90
US11A1
INPUT FIELDS / ROUTING
( USQ1270 )
PERSWITH
Field1:
ACCS.PERSWITH
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
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 Always
2
3
Route
US11AA - ACCREAS ( USQ1280 )
English text: ALWAYS
Sometimes
English text: SOMETIMES
Never
US11AA - ACCREAS ( USQ1280 )
US11AA - ACCREAS ( USQ1280 )
English text: NEVER
Attribute
Don't know
Route
US11AA - ACCREAS ( USQ1280 )
Refusal
US11AA - ACCREAS ( USQ1280 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
7
PersonIsProxy
11:20:36 AM Monday, August 03, 2009
Person selected from Person roster is proxy =
For this ROST, MRES.RROSTNUM = ROST.ROSTNUM
on MRES where MRES.MRESRND = current round.
Page 43 of 90
US11A1
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
11:20:36 AM Monday, August 03, 2009
Page 44 of 90
US11AA
US11AA
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
ACCREAS
Field 2:
ACCOTHOS
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:
180
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If proxy interview and person selected at US11 is proxy, display
"you accompany (SP)".
Else if proxy interview and person selected at US11 is not the proxy,
display "this person accompanies (SP)".
Else display "this person accompanies you".
If proxy interview and person selected at US11 is proxy, display "do
you".
Else display "does this person".
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
11:20:39 AM Monday, August 03, 2009
What are the reasons [you accompany (SP)/this person
Page 45 of 90
US11AA
accompanies you/this person accompanies (SP)] there? What (do
you/does this person) do?
[PROBE: Any other reason?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
11:20:45 AM Monday, August 03, 2009
Page 46 of 90
US11AA
ACCREAS
Field1:
(USQ1280 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1fT akesNotes=ACCS. ACCWRITE
2/G ivesl nfo=ACCS. ACCEXPDR
3/Explainslnstructions=ACCS.ACCEXPSP
4/AsksQuestions=ACCS.ACCASKQS
5fTranslatesLanguage=ACCS.ACCTRANS
6/SchedulesAppointments=ACCS.ACCAPPTS
7/Nothing=ACCS.ACCMORAL
8fTransportation=ACCS.ACCDRIVE
9/NeedsPhysicaIAssist=ACCS.ACCHELP
91/0ther=ACCS.ACCOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Tknpartd
9
No
No
Number Label
TakesNotes
FieldSize:
Min Value:
Max Value:
Mask:
Route
US15 - USHOWLNG (USQ1350)
2
English text: WRITES DOWN WHAT DOCTOR SAYSfRECORDS INSTRUCTIONSrr AKES
NOTESfREMEMBERS
US15 - USHOWLNG (USQ1350)
GivesInfo
3
English text: GIVES INFORMATIONfEXPLAINS SF'S MEDICAL CONDITION OR NEEDS TO
THE DOCTOR
ExplainsInstructions
US15 - USHOWLNG (USQ1350)
4
English text: EXPLAINS DOCTOR'S INSTRUCTIONS TO SP
AsksQuestions
US15 - USHOWLNG (USQ1350)
English text: ASKS QUESTIONS
11 :20:53 AM Monday, August 03, 2009
Page 47 of 90
US11AA
5
TranslatesLanguage
US15 - USHOWLNG ( USQ1350 )
6
English text: TRANSLATES LANGUAGE
SchedulesAppointments
US15 - USHOWLNG ( USQ1350 )
7
English text: SCHEDULES APPOINTMENTS
Nothing
US15 - USHOWLNG ( USQ1350 )
8
English text: NOTHING/KEEPS SP COMPANY/SITS WITH SP/MORAL SUPPORT
Transportation
US15 - USHOWLNG ( USQ1350 )
9
English text: TRANSPORTATION
NeedsPhysicalAssist
91
US15 - USHOWLNG ( USQ1350 )
English text: SP NEEDS PHYSICAL ASSISTANCE
Other
US11AA - ACCOTHOS ( USQ1300 )
If response(s) to ACCREAS includes 91/Other, go
to US11AA - ACCOTHOS.
Else go to US15.
English text: OTHER
Attribute
Don't know
Route
US15 - USHOWLNG ( USQ1350 )
Refusal
US15 - USHOWLNG ( USQ1350 )
Field2:
ACCOTHOS
( USQ1300 )
ACCS.ACCOTHOS
Cheshire Name:
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
US15 - USHOWLNG ( USQ1350 )
BACKGROUND VARIABLE ASSIGNMENTS
11:20:58 AM Monday, August 03, 2009
Page 48 of 90
US11AA
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'.
7
PersonIsProxy
Person selected from Person roster is proxy =
For this ROST, MRES.RROSTNUM = ROST.ROSTNUM
on MRES where MRES.MRESRND = current round.
DESIGN NOTES
11:20:58 AM Monday, August 03, 2009
Page 49 of 90
US15
US15
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
USHOWLNG
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
230
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4
USUALDOC=1/Yes),
Display "seeing (US5A PROVIDER NAME)".
Display US5A - MDNAME provider name.
Else
Display "going to (US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD US1
Question Text:
How long [have you/has (SP)] been [seeing (US5A PROVIDER
NAME)/going to (US3A PROVIDER NAME)]?
Int. Instr II:
11:21:00 AM Monday, August 03, 2009
Page 50 of 90
US15
INPUT FIELDS / ROUTING
USHOWLNG
Field1:
( USQ1350 )
ACCS.USHOWLNG
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
TUshowlng
1
No
No
Number Label
1 Lt1Year
FieldSize:
Min Value:
Max Value:
Mask:
Route
US17 - PREVMEDC ( USQ1370 )
3
English text: LESS THAN 1 YEAR
OneLt3Years
BOX US2A - (USQ1605 )
English text: 1 YEAR TO LESS THAN 3 YEARS
ThreeLt5Years
BOX US2A - (USQ1605 )
4
English text: 3 YEARS TO LESS THAN 5 YEARS
FiveLt10Years
BOX US2A - (USQ1605 )
2
5
English text: 5 YEARS TO LESS THAN 10 YEARS
TenOrMore
BOX US2A - (USQ1605 )
English text: 10 YEARS OR MORE
Attribute
Don't know
Route
BOX US2A - (USQ1605 )
Refusal
BOX US2A - (USQ1605 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
11:21:05 AM Monday, August 03, 2009
Page 51 of 90
US15
109
ProviderName
Provider Roster is stored on PROV.
Provider Name = PROV.PROVNAME.
DESIGN NOTES
11:21:05 AM Monday, August 03, 2009
Page 52 of 90
US17
US17
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PREVMEDC
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:
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4
USUALDOC=1/Yes),
Display "seeing (US5A PROVIDER NAME)".
Display US5A - MDNAME provider name.
Else
Display "going to (US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Before [you/(SP)] started [seeing (US5A PROVIDER NAME)/going to
(US3A PROVIDER NAME)], had [you/(SP)] usually been going to
some other place or seeing some other doctor for medical care?
Int. Instr II:
11:21:06 AM Monday, August 03, 2009
Page 53 of 90
US17
INPUT FIELDS / ROUTING
PREVMEDC
Field1:
( USQ1370 )
ACCS.PREVMEDC
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 US2A - (USQ1605 )
English text: YES
No
English text: NO
BOX US2A - (USQ1605 )
Attribute
Don't know
Route
BOX US2A - (USQ1605 )
Refusal
BOX US2A - (USQ1605 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
109
ProviderName
Provider Roster is stored on PROV.
Provider Name = PROV.PROVNAME.
DESIGN NOTES
11:21:08 AM Monday, August 03, 2009
Page 54 of 90
BOX US2A
BOX US2A
Page Order # :
375
BOX INSTRUCTIONS
( USQ1605 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO US27 - USCKEVRY (
USQ1610 ).
ELSE GO TO BOX US4 - (USQ1850 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
11:21:08 AM Monday, August 03, 2009
Page 55 of 90
US27
US27
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
USCKEVRY
Field 2:
USCOMPET
Field 3:
USUNHIST
Field 4:
USUNWRNG
Field 5:
USHURRY
HELP
COMMENTS
JUMPBACK
Yes
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:
380
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4
USUALDOC=1/Yes),
Display "(US5A PROVIDER NAME)".
Display US5A - MDNAME provider name.
Else
Display "(US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
If proxy interview, display "receives".
Else display "receive".
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
11:21:11 AM Monday, August 03, 2009
Page 56 of 90
US27
Context Header:
Int. Instr I:
SHOW CARD US2
Question Text:
Now I am going to read some statements people have made about
their health care. Think about the care [you/(SP)] (receive/receives)
from (US5A PROVIDER NAME/US3A PROVIDER NAME). For each
statement, please tell me whether you strongly agree, agree,
disagree, or strongly disagree.
Int. Instr II:
INPUT FIELDS / ROUTING
11:21:16 AM Monday, August 03, 2009
Page 57 of 90
US27
USCKEVRY
Field1:
ACCS.USCKEVRY
Cheshire Name:
Item Text display:
( USQ1610 )
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display "[Your/(SP's)] doctor is".
Else
Display "The doctors at (US3A PROVIDER NAME)
are".
Display US3A - CLNAME provider name.
Display "a." in front of List item text.
[[Your/(SP’s)] doctor is/The doctors at (US3A PROVIDER
NAME) are] very careful to check everything when examining
(you/him/her).
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
3
English text: STRONGLY AGREE
Agree
English text: AGREE
Disagree
4
English text: DISAGREE
StronglyDisagree
2
5
English text: STRONGLY DISAGREE
NotApplicable
English text: NOT APPLICABLE
Attribute
Don't know
Route
US27 - USCOMPET ( USQ1620 )
Refusal
US27 - USCOMPET ( USQ1620 )
11:21:24 AM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
Route
US27 - USCOMPET ( USQ1620 )
US27 - USCOMPET ( USQ1620 )
US27 - USCOMPET ( USQ1620 )
US27 - USCOMPET ( USQ1620 )
US27 - USCOMPET ( USQ1620 )
Page 58 of 90
US27
USCOMPET
Field2:
ACCS.USCOMPET
Cheshire Name:
Item Text display:
( USQ1620 )
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display “[Your/(SP’s)] doctor is”.
Else
Display “The doctors at (US3A PROVIDER NAME) are”.
Display US3A - CLNAME provider name.
Display "b." in front of List item text.
[[Your/(SP’s)] doctor is/The doctors at (US3A PROVIDER
NAME) are] competent and well-trained.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
2
English text: STRONGLY AGREE
Agree
4
English text: AGREE
Disagree
English text: DISAGREE
StronglyDisagree
5
English text: STRONGLY DISAGREE
NotApplicable
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
US27 - USUNHIST ( USQ1630 )
US27 - USUNHIST ( USQ1630 )
US27 - USUNHIST ( USQ1630 )
US27 - USUNHIST ( USQ1630 )
US27 - USUNHIST ( USQ1630 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
US27 - USUNHIST ( USQ1630 )
Refusal
US27 - USUNHIST ( USQ1630 )
11:21:31 AM Monday, August 03, 2009
Page 59 of 90
US27
USUNHIST
Field3:
ACCS.USUNHIST
Cheshire Name:
Item Text display:
( USQ1630 )
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display “[Your/(SP’s)] doctor has”.
Else
Display “The doctors at (US3A PROVIDER NAME)
have”.
Display US3A - CLNAME provider name.
Display "c." in front of List item text.
[[Your/(SP’s)] doctor has/The doctors at (US3A PROVIDER
NAME) have] a good understanding of (your/his/her) medical
history.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
3
English text: STRONGLY AGREE
Agree
English text: AGREE
Disagree
4
English text: DISAGREE
StronglyDisagree
2
5
English text: STRONGLY DISAGREE
NotApplicable
English text: NOT APPLICABLE
Attribute
Don't know
Route
US27 - USUNWRNG ( USQ1640 )
Refusal
US27 - USUNWRNG ( USQ1640 )
11:21:39 AM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
Route
US27 - USUNWRNG ( USQ1640 )
US27 - USUNWRNG ( USQ1640 )
US27 - USUNWRNG ( USQ1640 )
US27 - USUNWRNG ( USQ1640 )
US27 - USUNWRNG ( USQ1640 )
Page 60 of 90
US27
USUNWRNG
Field4:
ACCS.USUNWRNG
Cheshire Name:
Item Text display:
( USQ1640 )
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display “[Your/(SP’s)] doctor has”.
Else
Display “The doctors at (US3A PROVIDER NAME)
have”.
Display US3A - CLNAME provider name.
Display "d." in front of List item text.
[[Your/(SP’s)] doctor has/The doctors at (US3A PROVIDER
NAME) have] a complete understanding of the things that are
wrong with (you/him/her).
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
3
English text: STRONGLY AGREE
Agree
English text: AGREE
Disagree
4
English text: DISAGREE
StronglyDisagree
2
5
English text: STRONGLY DISAGREE
NotApplicable
English text: NOT APPLICABLE
Attribute
Don't know
Route
US27 - USHURRY ( USQ1650 )
Refusal
US27 - USHURRY ( USQ1650 )
11:21:46 AM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
Route
US27 - USHURRY ( USQ1650 )
US27 - USHURRY ( USQ1650 )
US27 - USHURRY ( USQ1650 )
US27 - USHURRY ( USQ1650 )
US27 - USHURRY ( USQ1650 )
Page 61 of 90
US27
USHURRY
Field5:
ACCS.USHURRY
Cheshire Name:
Item Text display:
( USQ1650 )
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display “[Your/(SP’s)] doctor”.
Else
Display "The doctors at (US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes), display “seems”.
Else displau "seem".
Display "e." in front of List item text.
[[Your/(SP’s)] doctor/The doctors at (US3A PROVIDER
NAME)] often (seem/seems) to be in a hurry.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
FieldSize:
Min Value:
Max Value:
Mask:
Route
US32 - USEXPPRB ( USQ1660 )
2
English text: STRONGLY AGREE
Agree
US32 - USEXPPRB ( USQ1660 )
3
English text: AGREE
Disagree
US32 - USEXPPRB ( USQ1660 )
4
English text: DISAGREE
StronglyDisagree
US32 - USEXPPRB ( USQ1660 )
5
English text: STRONGLY DISAGREE
NotApplicable
US32 - USEXPPRB ( USQ1660 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
US32 - USEXPPRB ( USQ1660 )
Refusal
US32 - USEXPPRB ( USQ1660 )
BACKGROUND VARIABLE ASSIGNMENTS
11:21:51 AM Monday, August 03, 2009
Page 62 of 90
US27
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
109
ProviderName
Provider Roster is stored on PROV.
Provider Name = PROV.PROVNAME.
DESIGN NOTES
11:21:51 AM Monday, August 03, 2009
Page 63 of 90
US32
US32
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
USEXPPRB
Field 2:
USDISCUS
Field 3:
USFAVOR
Field 4:
USTELALL
Field 5:
USANSQUX
HELP
COMMENTS
JUMPBACK
Yes
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:
390
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4
USUALDOC=1/Yes),
Display "(US5A PROVIDER NAME)".
Display US5A - MDNAME provider name.
Else
Display "(US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
Always display brackets around question text.
If proxy interview, display "receives".
Else display "receive".
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
11:21:53 AM Monday, August 03, 2009
Page 64 of 90
US32
TEXT:
Context Header:
Int. Instr I:
SHOW CARD US2
Question Text:
[Think about the care [you/(SP)] (receive/receives) from (US5A
PROVIDER NAME/US3A PROVIDER NAME).]
Int. Instr II:
INPUT FIELDS / ROUTING
11:21:57 AM Monday, August 03, 2009
Page 65 of 90
US32
USEXPPRB
Field1:
ACCS.USEXPPRB
Cheshire Name:
Item Text display:
( USQ1660 )
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display “[Your/(SP’s)] doctor”.
Else
Display “The doctors at (US3A PROVIDER NAME)”.
Display US3A - CLNAME provider name.
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes), display “does”.
Else display “do”.
Display "a." in front of List item text.
[[Your/(SP’s)] doctor/The doctors at (US3A PROVIDER
NAME)] often (does/do) not explain (your/his/her) medical
problems to (you/him/her).
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
FieldSize:
Min Value:
Max Value:
Mask:
Route
US32 - USDISCUS ( USQ1670 )
2
English text: STRONGLY AGREE
Agree
US32 - USDISCUS ( USQ1670 )
3
English text: AGREE
Disagree
US32 - USDISCUS ( USQ1670 )
4
5
English text: DISAGREE
StronglyDisagree
English text: STRONGLY DISAGREE
NotApplicable
US32 - USDISCUS ( USQ1670 )
US32 - USDISCUS ( USQ1670 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
US32 - USDISCUS ( USQ1670 )
Refusal
US32 - USDISCUS ( USQ1670 )
11:22:01 AM Monday, August 03, 2009
Page 66 of 90
US32
USDISCUS
Field2:
ACCS.USDISCUS
Cheshire Name:
Item Text display:
( USQ1670 )
If proxy interview display "has".
Else display "have".
Display "b." in front of List item text.
[You/(SP)] often (have/has) health problems that should be
discussed but are not.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
FieldSize:
Min Value:
Max Value:
Mask:
Route
US32 - USFAVOR ( USQ1680 )
2
English text: STRONGLY AGREE
Agree
US32 - USFAVOR ( USQ1680 )
3
English text: AGREE
Disagree
US32 - USFAVOR ( USQ1680 )
4
English text: DISAGREE
StronglyDisagree
US32 - USFAVOR ( USQ1680 )
5
English text: STRONGLY DISAGREE
NotApplicable
US32 - USFAVOR ( USQ1680 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
US32 - USFAVOR ( USQ1680 )
Refusal
US32 - USFAVOR ( USQ1680 )
11:22:09 AM Monday, August 03, 2009
Page 67 of 90
US32
USFAVOR
Field3:
ACCS.USFAVOR
Cheshire Name:
Item Text display:
( USQ1680 )
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display "[Your/(SP’s)] doctor often acts".
Else
Display "The doctors at (US3A PROVIDER NAME)
often act".
Display US3A - CLNAME provider name.
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display "(he/she) was".
Always display "(he/she)" in parenthesis.
Else display "they were".
Display "c." in front of List item text.
[[Your/(SP’s)] doctor often acts/The doctors at (US3A
PROVIDER NAME) often act] as though [(he/she) was/they
were] doing [you/(SP)] a favor by talking to (you/him/her).
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
2
English text: STRONGLY AGREE
Agree
4
English text: AGREE
Disagree
English text: DISAGREE
StronglyDisagree
5
English text: STRONGLY DISAGREE
NotApplicable
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
US32 - USTELALL ( USQ1690 )
US32 - USTELALL ( USQ1690 )
US32 - USTELALL ( USQ1690 )
US32 - USTELALL ( USQ1690 )
US32 - USTELALL ( USQ1690 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
US32 - USTELALL ( USQ1690 )
11:22:15 AM Monday, August 03, 2009
Page 68 of 90
US32
Refusal
US32 - USTELALL ( USQ1690 )
11:22:20 AM Monday, August 03, 2009
Page 69 of 90
US32
USTELALL
Field4:
ACCS.USTELALL
Cheshire Name:
Item Text display:
( USQ1690 )
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display "[Your/(SP's)] doctor tells".
Else
Display "The doctors at (US3A PROVIDER NAME)
tell".
Display US3A - CLNAME provider name.
If proxy interview and SP is male, display "he wants".
Else if proxy interview and SP is female, display "she
wants".
Else display "you want".
Display "d." in front of List item text.
[[Your/(SP’s)] doctor tells/The doctors at (US3A PROVIDER
NAME) tell] (you/him/her) all (you want/he wants/she wants)
to know about (your/his/her) condition and treatment.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
FieldSize:
Min Value:
Max Value:
Mask:
Route
US32 - USANSQUX ( USQ1700 )
2
English text: STRONGLY AGREE
Agree
US32 - USANSQUX ( USQ1700 )
3
English text: AGREE
Disagree
US32 - USANSQUX ( USQ1700 )
4
English text: DISAGREE
StronglyDisagree
US32 - USANSQUX ( USQ1700 )
5
English text: STRONGLY DISAGREE
NotApplicable
US32 - USANSQUX ( USQ1700 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
US32 - USANSQUX ( USQ1700 )
Refusal
US32 - USANSQUX ( USQ1700 )
11:22:24 AM Monday, August 03, 2009
Page 70 of 90
US32
USANSQUX
Field5:
ACCS.USANSQUX
Cheshire Name:
Item Text display:
( USQ1700 )
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or
(US4 - USUALDOC=1/Yes),
Display “[Your/(SP’s)] doctor answers”.
Else
Display “The doctors at (US3A PROVIDER NAME)
answer”.
Display US3A - CLNAME provider name.
Display "e." in front of List item text.
[[Your/(SP’s)] doctor answers/The doctors at (US3A
PROVIDER NAME) answer] all (your/his/her) questions.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
FieldSize:
Min Value:
Max Value:
Mask:
Route
US37 - USCONFID ( USQ1710 )
2
English text: STRONGLY AGREE
Agree
US37 - USCONFID ( USQ1710 )
3
English text: AGREE
Disagree
US37 - USCONFID ( USQ1710 )
4
English text: DISAGREE
StronglyDisagree
US37 - USCONFID ( USQ1710 )
5
English text: STRONGLY DISAGREE
NotApplicable
US37 - USCONFID ( USQ1710 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
US37 - USCONFID ( USQ1710 )
Refusal
US37 - USCONFID ( USQ1710 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
11:22:29 AM Monday, August 03, 2009
Page 71 of 90
US32
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'.
109
ProviderName
Provider Roster is stored on PROV.
Provider Name = PROV.PROVNAME.
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
11:22:29 AM Monday, August 03, 2009
Page 72 of 90
US37
US37
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
USCONFID
Field 2:
USDEPEND
HELP
COMMENTS
JUMPBACK
Yes
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:
400
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (US2 - PLACEKND=1/DoctorsOffice or 10/AtHome) or (US4
USUALDOC=1/Yes),
Display "(US5A PROVIDER NAME)".
Display US5A - MDNAME provider name.
Else
Display "(US3A PROVIDER NAME)".
Display US3A - CLNAME provider name.
Always display brackets around question text.
If proxy interview, display "receives".
Else display "receive".
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
11:22:31 AM Monday, August 03, 2009
Page 73 of 90
US37
Int. Instr I:
SHOW CARD US2
Question Text:
[Think about the care [you/(SP)] (receive/receives) from (US5A
PROVIDER NAME/US3A PROVIDER NAME).]
Int. Instr II:
INPUT FIELDS / ROUTING
11:22:36 AM Monday, August 03, 2009
Page 74 of 90
US37
USCONFID
Field1:
ACCS.USCONFID
Cheshire Name:
Item Text display:
( USQ1710 )
If (US2 - PLACEKND^=1/DoctorsOffice and US2
PLACEKND ^= 10/AtHome) and (US4 USUALDOC^=1/Yes),
Display “the doctors at (US3A PROVIDER NAME)”.
Display US3A - CLNAME provider name.
Else if SP interview, display “your doctor”.
Else if proxy interview and SP is male, display “his doctor”.
Else display “her doctor”.
Display "a." in front of List item text.
[You have/(SP) has] great confidence in [(your/his/her)
doctor/the doctors at (US3A PROVIDER NAME)].
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
3
English text: STRONGLY AGREE
Agree
English text: AGREE
Disagree
4
English text: DISAGREE
StronglyDisagree
2
5
English text: STRONGLY DISAGREE
NotApplicable
English text: NOT APPLICABLE
Attribute
Don't know
Route
US37 - USDEPEND ( USQ1720 )
Refusal
US37 - USDEPEND ( USQ1720 )
11:22:43 AM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
Route
US37 - USDEPEND ( USQ1720 )
US37 - USDEPEND ( USQ1720 )
US37 - USDEPEND ( USQ1720 )
US37 - USDEPEND ( USQ1720 )
US37 - USDEPEND ( USQ1720 )
Page 75 of 90
US37
USDEPEND
Field2:
ACCS.USDEPEND
Cheshire Name:
Item Text display:
( USQ1720 )
If (US2 - PLACEKND^=1/DoctorsOffice and US2
PLACEKND ^= 10/AtHome) and (US4 USUALDOC^=1/Yes),
Display “the doctors at (US3A PROVIDER NAME)”.
Display US3A - CLNAME provider name.
Else if SP interview, display “your doctor”.
Else if proxy interview and SP is male, display “his doctor”.
Else display “her doctor”.
If proxy interview, display "(SP) depends".
Else display "You depend".
Display "b." in front of List item text.
[You/(SP)] (depend/depends) on [(your/his/her) doctor/the
doctors at (US3A PROVIDER NAME)] in order to feel better
both physically and emotionally.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAgree
1
No
No
Number Label
1 StronglyAgree
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX US4 - (USQ1850 )
2
English text: STRONGLY AGREE
Agree
BOX US4 - (USQ1850 )
3
English text: AGREE
Disagree
BOX US4 - (USQ1850 )
4
English text: DISAGREE
StronglyDisagree
BOX US4 - (USQ1850 )
5
English text: STRONGLY DISAGREE
NotApplicable
BOX US4 - (USQ1850 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
BOX US4 - (USQ1850 )
Refusal
BOX US4 - (USQ1850 )
11:22:48 AM Monday, August 03, 2009
Page 76 of 90
US37
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'.
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'.
109
ProviderName
Provider Roster is stored on PROV.
Provider Name = PROV.PROVNAME.
DESIGN NOTES
11:22:48 AM Monday, August 03, 2009
Page 77 of 90
US39
US39
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
NUSNOTSK
Field 2:
NUSMOVIN
Field 3:
NUSAVAIL
HELP
COMMENTS
JUMPBACK
Yes
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:
430
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "not" in the first sentence in BOLD.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
I am going to read some reasons that people have given for not
having a usual source of health care. For each one, please tell me
whether or not it is a reason [you do/(SP) does] not have a usual
place for health care.
Int. Instr II:
11:22:51 AM Monday, August 03, 2009
Page 78 of 90
US39
INPUT FIELDS / ROUTING
NUSNOTSK
Field1:
ACCS.NUSNOTSK
Cheshire Name:
Item Text display:
( USQ1750 )
Always display "[Is that a reason…]" in brackets.
Display "a." in front of List item text.
There is no reason to have a usual source of health care
because [you/(SP)] seldom or never gets sick. [Is that a
reason [you do/(SP) does] not have a usual source of health
care?]
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
US39 - NUSMOVIN ( USQ1760 )
English text: YES
No
US39 - NUSMOVIN ( USQ1760 )
English text: NO
Attribute
Don't know
Route
US39 - NUSMOVIN ( USQ1760 )
Refusal
US39 - NUSMOVIN ( USQ1760 )
11:22:56 AM Monday, August 03, 2009
Page 79 of 90
US39
NUSMOVIN
Field2:
ACCS.NUSMOVIN
Cheshire Name:
Item Text display:
( USQ1760 )
Always display "[Is that a reason…]" in brackets.
Display "b." in front of List item text.
[You/(SP)] recently moved into the area. [Is that a reason
[you do/(SP) does] not have a usual source of health care?]
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
US39 - NUSAVAIL ( USQ1770 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
US39 - NUSAVAIL ( USQ1770 )
Refusal
US39 - NUSAVAIL ( USQ1770 )
11:23:01 AM Monday, August 03, 2009
US39 - NUSAVAIL ( USQ1770 )
Page 80 of 90
US39
NUSAVAIL
Field3:
ACCS.NUSAVAIL
Cheshire Name:
Item Text display:
( USQ1770 )
Always display "[Is that a reason…]" in brackets.
Display "c." in front of List item text.
[Your/(SP’s)] usual source of health care in this area is no
longer available. [Is that a reason [you do/(SP) does] not
have a usual source of health care?]
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
US42 - USWHYNAV ( USQ1780 )
English text: YES
No
US43 - NUSDIFFP ( USQ1820 )
English text: NO
Attribute
Don't know
Route
US43 - NUSDIFFP ( USQ1820 )
Refusal
US43 - NUSDIFFP ( USQ1820 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:23:04 AM Monday, August 03, 2009
Page 81 of 90
US42
US42
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
USWHYNAV
Field 2:
USWHYNO1
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:
440
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 is [your/(SP’s)] usual source of health care no longer available?
Int. Instr II:
INPUT FIELDS / ROUTING
11:23:06 AM Monday, August 03, 2009
Page 82 of 90
US42
USWHYNAV
Field1:
( USQ1780 )
ACCS.USWHYNAV
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
TUswhynav
1
No
No
Number Label
1 PrevDrRetired
FieldSize:
Min Value:
Max Value:
Mask:
Route
US43 - NUSDIFFP ( USQ1820 )
2
English text: PREVIOUS DOCTOR RETIRED
PrevDrDied
US43 - NUSDIFFP ( USQ1820 )
3
English text: PREVIOUS DOCTOR DIED
PrevDrMoved
US43 - NUSDIFFP ( USQ1820 )
4
English text: PREVIOUS DOCTOR MOVED
SpMoved
US43 - NUSDIFFP ( USQ1820 )
5
English text: SP MOVED
PrevDrTooFar
US43 - NUSDIFFP ( USQ1820 )
91
English text: PREVIOUS DR/PLACE TOO FAR AWAY
Other
US42 - USWHYNO1 ( USQ1790 )
English text: OTHER
Attribute
Don't know
Route
US43 - NUSDIFFP ( USQ1820 )
Refusal
US43 - NUSDIFFP ( USQ1820 )
11:23:12 AM Monday, August 03, 2009
Page 83 of 90
US42
Field2:
USWHYNO1
( USQ1790 )
ACCS.USWHYNO1
Cheshire Name:
REPLACES CHESHIRE VARIABLES:
ACCS.USWHYNO1
ACCS.USWHYNO2
ACCS.USWHYNO3
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:
Open
TOpen270
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
US43 - NUSDIFFP ( USQ1820 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:23:13 AM Monday, August 03, 2009
Page 84 of 90
US43
US43
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
NUSDIFFP
Field 2:
NUSTOOFR
Field 3:
NUSTOOEX
HELP
COMMENTS
JUMPBACK
Yes
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:
Display "not" in the first sentence in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Thinking about other possible reasons that people have for not
having a usual source of health, please tell me if this statement
applies to [you/(SP)]:
Int. Instr II:
INPUT FIELDS / ROUTING
11:23:16 AM Monday, August 03, 2009
Page 85 of 90
US43
NUSDIFFP
Field1:
ACCS.NUSDIFFP
Cheshire Name:
Item Text display:
( USQ1820 )
If proxy interview, display "(SP) likes".
Else display "You like".
Always display "[Is that a reason…]" in brackets.
Display "a." in front of List item text.
[You like/(SP) likes] to go to different places for different
health care needs. [Is that a reason [you do/(SP) does] not
have a usual source of health care?]
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
US43 - NUSTOOFR ( USQ1830 )
English text: YES
No
US43 - NUSTOOFR ( USQ1830 )
English text: NO
Attribute
Don't know
Route
US43 - NUSTOOFR ( USQ1830 )
Refusal
US43 - NUSTOOFR ( USQ1830 )
11:23:21 AM Monday, August 03, 2009
Page 86 of 90
US43
NUSTOOFR
Field2:
ACCS.NUSTOOFR
Cheshire Name:
Item Text display:
( USQ1830 )
Always display "[Is that a reason…]" in brackets.
Display "b." in front of List item text.
The places where [you/(SP)] can receive health care are too
far away. [Is that a reason [you do/(SP) does] not have a
usual source of health care?]
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
US43 - NUSTOOEX ( USQ1840 )
English text: YES
No
US43 - NUSTOOEX ( USQ1840 )
English text: NO
Attribute
Don't know
Route
US43 - NUSTOOEX ( USQ1840 )
Refusal
US43 - NUSTOOEX ( USQ1840 )
11:23:27 AM Monday, August 03, 2009
Page 87 of 90
US43
( USQ1840 )
NUSTOOEX
Field3:
ACCS.NUSTOOEX
Cheshire Name:
Item Text display:
Always display "[Is that a reason…]" in brackets.
Display "c." in front of List item text.
The cost of health care is too expensive. [Is that a reason
[you do/(SP) does] not have a usual source of health care?]
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 US4 - (USQ1850 )
English text: YES
No
English text: NO
BOX US4 - (USQ1850 )
Attribute
Don't know
Route
BOX US4 - (USQ1850 )
Refusal
BOX US4 - (USQ1850 )
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) =
11:23:29 AM Monday, August 03, 2009
Page 88 of 90
US43
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
11:23:29 AM Monday, August 03, 2009
Page 89 of 90
BOX US4
BOX US4
Page Order # :
460
BOX INSTRUCTIONS
( USQ1850 )
GO TO NEXT SECTION. .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
11:23:29 AM Monday, August 03, 2009
Page 90 of 90
| File Type | application/pdf |
| Author | hubbard_r |
| File Modified | 2010-04-05 |
| File Created | 0000-00-00 |