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SC1
SC1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCQUALTY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
20
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (SP is in the supplemental sample) or (SP did not receive the SC
section in the previous year), display "over the past year".
Else display "since (SURVEY REFERENCE MONTH AND YEAR)"
Display "past year" in BOLD.
Display Survey Reference month and year from current round
MRES.SRPBDAT in "Month YYYY" format.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
We’re interested in how you feel about the health care [you
have/(SP) has] received [over the past year/
since (SURVEY REFERENCE MONTH AND YEAR)] from doctors
and hospitals. Please tell me how satisfied you have been with the
2:49:58 PM Monday, August 03, 2009
Page 1 of 128
SC1
following:
The overall quality of the health care [you have /(SP) has] received
[over the past year/since (SURVEY REFERENCE DATE)].
Int. Instr II:
INPUT FIELDS / ROUTING
MCQUALTY
Field1:
( SCQ1005 )
ACCS.MCQUALTY
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC2 - MCAVAIL ( SCQ1010 )
2
English text: VERY SATISFIED
Satisfied
SC2 - MCAVAIL ( SCQ1010 )
3
English text: SATISFIED
Dissatisfied
SC2 - MCAVAIL ( SCQ1010 )
4
English text: DISSATISFIED
VeryDissatisfied
SC2 - MCAVAIL ( SCQ1010 )
5
English text: VERY DISSATISFIED
NotApplicable
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC2 - MCAVAIL ( SCQ1010 )
Refusal
SC2 - MCAVAIL ( SCQ1010 )
SC2 - MCAVAIL ( SCQ1010 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
2:50:03 PM Monday, August 03, 2009
Page 2 of 128
SC1
HARD EDIT CHECKS
TECHNICAL NOTES
249
NoFallSupps
SP did not receive the SC section in the previous year =
BASE.HSRNDSKP = 1/Yes.
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
2:50:03 PM Monday, August 03, 2009
Page 3 of 128
SC2
SC2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCAVAIL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
30
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The availability of health care at night and on weekends.
Int. Instr II:
INPUT FIELDS / ROUTING
2:50:04 PM Monday, August 03, 2009
Page 4 of 128
SC2
MCAVAIL
Field1:
( SCQ1010 )
ACCS.MCAVAIL
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC3 - MCEASE ( SCQ1015 )
2
English text: VERY SATISFIED
Satisfied
SC3 - MCEASE ( SCQ1015 )
3
English text: SATISFIED
Dissatisfied
SC3 - MCEASE ( SCQ1015 )
4
English text: DISSATISFIED
VeryDissatisfied
SC3 - MCEASE ( SCQ1015 )
5
English text: VERY DISSATISFIED
NotApplicable
SC3 - MCEASE ( SCQ1015 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC3 - MCEASE ( SCQ1015 )
Refusal
SC3 - MCEASE ( SCQ1015 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:50:09 PM Monday, August 03, 2009
Page 5 of 128
SC2
DESIGN NOTES
2:50:09 PM Monday, August 03, 2009
Page 6 of 128
SC3
SC3
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCEASE
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
40
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is SP, display "live".
Else display "lives".
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The ease and convenience of getting to a doctor from where
[you/(SP)] (live/lives).
Int. Instr II:
2:50:11 PM Monday, August 03, 2009
Page 7 of 128
SC3
INPUT FIELDS / ROUTING
MCEASE
Field1:
( SCQ1015 )
ACCS.MCEASE
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
3
English text: VERY SATISFIED
Satisfied
English text: SATISFIED
Dissatisfied
4
English text: DISSATISFIED
VeryDissatisfied
2
5
English text: VERY DISSATISFIED
NotApplicable
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC4 - MCCOSTS ( SCQ1020 )
Refusal
SC4 - MCCOSTS ( SCQ1020 )
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC4 - MCCOSTS ( SCQ1020 )
SC4 - MCCOSTS ( SCQ1020 )
SC4 - MCCOSTS ( SCQ1020 )
SC4 - MCCOSTS ( SCQ1020 )
SC4 - MCCOSTS ( SCQ1020 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:50:15 PM Monday, August 03, 2009
Page 8 of 128
SC3
DESIGN NOTES
2:50:15 PM Monday, August 03, 2009
Page 9 of 128
SC4
SC4
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCCOSTS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
50
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The out-of-pocket costs [you/(SP)] paid for health care.
Int. Instr II:
INPUT FIELDS / ROUTING
2:50:17 PM Monday, August 03, 2009
Page 10 of 128
SC4
MCCOSTS
Field1:
( SCQ1020 )
ACCS.MCCOSTS
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC5 - MCINFO ( SCQ1025 )
2
English text: VERY SATISFIED
Satisfied
SC5 - MCINFO ( SCQ1025 )
3
English text: SATISFIED
Dissatisfied
SC5 - MCINFO ( SCQ1025 )
4
English text: DISSATISFIED
VeryDissatisfied
SC5 - MCINFO ( SCQ1025 )
5
English text: VERY DISSATISFIED
NotApplicable
SC5 - MCINFO ( SCQ1025 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC5 - MCINFO ( SCQ1025 )
Refusal
SC5 - MCINFO ( SCQ1025 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:50:22 PM Monday, August 03, 2009
Page 11 of 128
SC4
DESIGN NOTES
2:50:22 PM Monday, August 03, 2009
Page 12 of 128
SC5
SC5
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCINFO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
60
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is SP, display "you".
Else display "you or (SP)".
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The information given to [you/you or (SP)] about what was wrong
with [you/(SP)].
Int. Instr II:
2:50:24 PM Monday, August 03, 2009
Page 13 of 128
SC5
INPUT FIELDS / ROUTING
MCINFO
Field1:
( SCQ1025 )
ACCS.MCINFO
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
3
English text: VERY SATISFIED
Satisfied
English text: SATISFIED
Dissatisfied
4
English text: DISSATISFIED
VeryDissatisfied
2
5
English text: VERY DISSATISFIED
NotApplicable
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC6 - MCFOLUP ( SCQ1030 )
Refusal
SC6 - MCFOLUP ( SCQ1030 )
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC6 - MCFOLUP ( SCQ1030 )
SC6 - MCFOLUP ( SCQ1030 )
SC6 - MCFOLUP ( SCQ1030 )
SC6 - MCFOLUP ( SCQ1030 )
SC6 - MCFOLUP ( SCQ1030 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:50:28 PM Monday, August 03, 2009
Page 14 of 128
SC5
DESIGN NOTES
2:50:28 PM Monday, August 03, 2009
Page 15 of 128
SC6
SC6
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCFOLUP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
70
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The follow-up care [you/(SP)] received after an initial treatment or
operation.
Int. Instr II:
INPUT FIELDS / ROUTING
2:50:30 PM Monday, August 03, 2009
Page 16 of 128
SC6
MCFOLUP
Field1:
( SCQ1030 )
ACCS.MCFOLUP
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC7 - MCCONCRN ( SCQ1035 )
2
English text: VERY SATISFIED
Satisfied
SC7 - MCCONCRN ( SCQ1035 )
3
English text: SATISFIED
Dissatisfied
SC7 - MCCONCRN ( SCQ1035 )
4
English text: DISSATISFIED
VeryDissatisfied
SC7 - MCCONCRN ( SCQ1035 )
5
English text: VERY DISSATISFIED
NotApplicable
SC7 - MCCONCRN ( SCQ1035 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC7 - MCCONCRN ( SCQ1035 )
Refusal
SC7 - MCCONCRN ( SCQ1035 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:50:35 PM Monday, August 03, 2009
Page 17 of 128
SC6
DESIGN NOTES
2:50:35 PM Monday, August 03, 2009
Page 18 of 128
SC7
SC7
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCCONCRN
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:
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The concern of doctors for [your/(SP’s)] overall health rather than
just for an isolated symptom or disease.
Int. Instr II:
INPUT FIELDS / ROUTING
2:50:37 PM Monday, August 03, 2009
Page 19 of 128
SC7
MCCONCRN
Field1:
( SCQ1035 )
ACCS.MCCONCRN
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8 - MCSAMLOC ( SCQ1040 )
2
English text: VERY SATISFIED
Satisfied
SC8 - MCSAMLOC ( SCQ1040 )
3
English text: SATISFIED
Dissatisfied
SC8 - MCSAMLOC ( SCQ1040 )
4
English text: DISSATISFIED
VeryDissatisfied
SC8 - MCSAMLOC ( SCQ1040 )
5
English text: VERY DISSATISFIED
NotApplicable
SC8 - MCSAMLOC ( SCQ1040 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC8 - MCSAMLOC ( SCQ1040 )
Refusal
SC8 - MCSAMLOC ( SCQ1040 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:50:41 PM Monday, August 03, 2009
Page 20 of 128
SC7
DESIGN NOTES
2:50:41 PM Monday, August 03, 2009
Page 21 of 128
SC8
SC8
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCSAMLOC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
90
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
Getting all [your/(SP’s)] health care needs taken care of at the same
location.
Int. Instr II:
INPUT FIELDS / ROUTING
2:50:43 PM Monday, August 03, 2009
Page 22 of 128
SC8
MCSAMLOC
Field1:
( SCQ1040 )
ACCS.MCSAMLOC
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8A - MCSPECAR ( SCQ1045 )
2
English text: VERY SATISFIED
Satisfied
SC8A - MCSPECAR ( SCQ1045 )
3
English text: SATISFIED
Dissatisfied
SC8A - MCSPECAR ( SCQ1045 )
4
English text: DISSATISFIED
VeryDissatisfied
SC8A - MCSPECAR ( SCQ1045 )
5
English text: VERY DISSATISFIED
NotApplicable
SC8A - MCSPECAR ( SCQ1045 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC8A - MCSPECAR ( SCQ1045 )
Refusal
SC8A - MCSPECAR ( SCQ1045 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:50:48 PM Monday, August 03, 2009
Page 23 of 128
SC8
DESIGN NOTES
2:50:48 PM Monday, August 03, 2009
Page 24 of 128
SC8A
SC8A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCSPECAR
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
100
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is SP, display "feel".
Else display "feels".
If respondent is SP, display "need".
Else display "needs".
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The availability of care by specialists when [you/(SP)] (feel/feels)
(you/he/she) (need/needs) it.
2:50:50 PM Monday, August 03, 2009
Page 25 of 128
SC8A
Int. Instr II:
INPUT FIELDS / ROUTING
MCSPECAR
Field1:
( SCQ1045 )
ACCS.MCSPECAR
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8B - MCTELANS ( SCQ1050 )
2
English text: VERY SATISFIED
Satisfied
SC8B - MCTELANS ( SCQ1050 )
3
English text: SATISFIED
Dissatisfied
SC8B - MCTELANS ( SCQ1050 )
4
5
English text: DISSATISFIED
VeryDissatisfied
English text: VERY DISSATISFIED
NotApplicable
SC8B - MCTELANS ( SCQ1050 )
SC8B - MCTELANS ( SCQ1050 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC8B - MCTELANS ( SCQ1050 )
Refusal
SC8B - MCTELANS ( SCQ1050 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
2:50:54 PM Monday, August 03, 2009
Page 26 of 128
SC8A
TECHNICAL NOTES
DESIGN NOTES
2:50:54 PM Monday, August 03, 2009
Page 27 of 128
SC8B
SC8B
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCTELANS
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:
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The ease of obtaining answers to questions over the telephone
about [your/(SP’s)] treatment or prescriptions.
Int. Instr II:
INPUT FIELDS / ROUTING
2:50:56 PM Monday, August 03, 2009
Page 28 of 128
SC8B
MCTELANS
Field1:
( SCQ1050 )
ACCS.MCTELANS
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8C - MCAMTPAY ( SCQ1051 )
2
English text: VERY SATISFIED
Satisfied
SC8C - MCAMTPAY ( SCQ1051 )
3
English text: SATISFIED
Dissatisfied
SC8C - MCAMTPAY ( SCQ1051 )
4
English text: DISSATISFIED
VeryDissatisfied
SC8C - MCAMTPAY ( SCQ1051 )
5
English text: VERY DISSATISFIED
NotApplicable
SC8C - MCAMTPAY ( SCQ1051 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC8C - MCAMTPAY ( SCQ1051 )
Refusal
SC8C - MCAMTPAY ( SCQ1051 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:51:01 PM Monday, August 03, 2009
Page 29 of 128
SC8B
DESIGN NOTES
2:51:01 PM Monday, August 03, 2009
Page 30 of 128
SC8C
SC8C
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCAMTPAY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
112
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The amount [you have/(SP) has] to pay for [your/(SP's)] prescribed
medicines.
Int. Instr II:
INPUT FIELDS / ROUTING
2:51:03 PM Monday, August 03, 2009
Page 31 of 128
SC8C
MCAMTPAY
Field1:
( SCQ1051 )
ACCS.MCAMTPAY
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX SC1A - (SCQ1052 )
2
English text: VERY SATISFIED
Satisfied
BOX SC1A - (SCQ1052 )
3
English text: SATISFIED
Dissatisfied
BOX SC1A - (SCQ1052 )
4
English text: DISSATISFIED
VeryDissatisfied
BOX SC1A - (SCQ1052 )
5
English text: VERY DISSATISFIED
NotApplicable
BOX SC1A - (SCQ1052 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
BOX SC1A - (SCQ1052 )
Refusal
BOX SC1A - (SCQ1052 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:51:07 PM Monday, August 03, 2009
Page 32 of 128
SC8C
DESIGN NOTES
2:51:07 PM Monday, August 03, 2009
Page 33 of 128
BOX SC1A
BOX SC1A
Page Order # :
114
BOX INSTRUCTIONS
( SCQ1052 )
IF (SP HAD PRESCRIPTION DRUG COVERAGE ANYTIME IN THE
CURRENT ROUND) OR (SP IS COVERED BY A MEDICARE
PRESCRIPTION DRUG PLAN ANYTIME IN THE CURRENT ROUND), GO
TO SC8D - MCDRGLST ( SCQ1053 ).
ELSE GO TO SC9 - MDISSFY ( SCQ1084 ).
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.
417
PMDrugCoverageCurrR
nd
SP had PM drug coverage current round =
There is a PLAN & PLRO where
(PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round & (MCDRXCOV=1/Yes
or TRIRXCOV=1/Yes or PUBRXCOV=1/Yes or
PRVRXCOV=1/Yes or MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
351
MPDPAnytimeCurrRnd
SP covered by an MPDP plan anytime during current
round =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
2:51:07 PM Monday, August 03, 2009
Page 34 of 128
SC8D
SC8D
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCDRGLST
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
116
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
[Your/(SP's)] prescription drug plan's formulary or the list of drugs
covered by the plan.
[EXPLAIN IF NECESSARY: By prescription drug plan, we mean any
health insurance plan that provides drug coverage.]
Int. Instr II:
2:51:09 PM Monday, August 03, 2009
Page 35 of 128
SC8D
INPUT FIELDS / ROUTING
MCDRGLST
Field1:
( SCQ1053 )
ACCS.MCDRGLST
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
3
English text: VERY SATISFIED
Satisfied
English text: SATISFIED
Dissatisfied
4
English text: DISSATISFIED
VeryDissatisfied
2
5
English text: VERY DISSATISFIED
NotApplicable
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC8E - MCFNDPCY ( SCQ1054 )
Refusal
SC8E - MCFNDPCY ( SCQ1054 )
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8E - MCFNDPCY ( SCQ1054 )
SC8E - MCFNDPCY ( SCQ1054 )
SC8E - MCFNDPCY ( SCQ1054 )
SC8E - MCFNDPCY ( SCQ1054 )
SC8E - MCFNDPCY ( SCQ1054 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:51:14 PM Monday, August 03, 2009
Page 36 of 128
SC8D
DESIGN NOTES
2:51:14 PM Monday, August 03, 2009
Page 37 of 128
SC8E
SC8E
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCFNDPCY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
118
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Please tell me…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1
Question Text:
[Please tell me how satisfied you have been with . . .]
The ease of finding a pharmacy which accepts your prescription
drug plan.
[EXPLAIN IF NECESSARY: By prescription drug plan, we mean any
health insurance plan that provides drug coverage.]
Int. Instr II:
2:51:16 PM Monday, August 03, 2009
Page 38 of 128
SC8E
INPUT FIELDS / ROUTING
MCFNDPCY
Field1:
( SCQ1054 )
ACCS.MCFNDPCY
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
TSatisfy
1
No
No
Number Label
1 VerySatisfied
3
English text: VERY SATISFIED
Satisfied
English text: SATISFIED
Dissatisfied
4
English text: DISSATISFIED
VeryDissatisfied
2
5
English text: VERY DISSATISFIED
NotApplicable
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC8F - MCRECPLN ( SCQ1055 )
Refusal
SC8F - MCRECPLN ( SCQ1055 )
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8F - MCRECPLN ( SCQ1055 )
SC8F - MCRECPLN ( SCQ1055 )
SC8F - MCRECPLN ( SCQ1055 )
SC8F - MCRECPLN ( SCQ1055 )
SC8F - MCRECPLN ( SCQ1055 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
2:51:20 PM Monday, August 03, 2009
Page 39 of 128
SC8E
DESIGN NOTES
2:51:20 PM Monday, August 03, 2009
Page 40 of 128
SC8F
SC8F
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MCRECPLN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
119
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:
Would [you/(SP)] recommend (your/his/her) prescription drug plan to
other people like (you/him/her)?
[EXPLAIN IF NECESSARY: By prescription drug plan, we mean any
health insurance plan that provides your drug coverage.]
Int. Instr II:
INPUT FIELDS / ROUTING
2:51:22 PM Monday, August 03, 2009
Page 41 of 128
SC8F
MCRECPLN
Field1:
( SCQ1055 )
ACCS.MCRECPLN
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
TYesnona3
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8G - DHEVHEAR ( SCQ1057 )
2
English text: YES
No
SC8G - DHEVHEAR ( SCQ1057 )
3
English text: NO
NotApplicable
SC8G - DHEVHEAR ( SCQ1057 )
English text: NOT APPLICABLE
Attribute
Don't know
Route
SC8G - DHEVHEAR ( SCQ1057 )
Refusal
SC8G - DHEVHEAR ( SCQ1057 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:51:25 PM Monday, August 03, 2009
Page 42 of 128
SC8G
SC8G
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DHEVHEAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
130
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has a "current" Medicare Prescription Drug plan, display "[You
receive/(SP) receives] (your/his/her) prescription drug coverage
through a Medicare Prescription Drug plan".
Else if SP has a "current" Medicare Advantage plan, display "[You
receive/(SP) receives] (your/his/her) prescription drug coverage
through a Medicare Advantage plan".
Else display "Some Medicare beneficiaries receive their prescription
drug coverage through Medicare Prescription Drug plans, also
called "Medicare Part D" plans."
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
2:51:26 PM Monday, August 03, 2009
[Some Medicare beneficiaries receive their prescription drug
coverage through Medicare Prescription Drug plans, also called
"Medicare Part D" plans./[You receive/(SP) receives] (your/his/her)
Page 43 of 128
SC8G
prescription drug coverage through a (Medicare Prescription Drug
plan/Medicare Advantage plan).] And, in most Medicare drug plans
there is a coverage gap, sometimes called a “doughnut hole”. I have
a picture to help explain this term.
SHOW CARD SC1A
Coverage is divided into four phases in most Medicare drug plans.
Depending on the plan, in the first phase, the beneficiary may pay a
deductible. In the second phase, the beneficiary pays a portion of
the total cost of each prescription and the drug plan pays a portion of
the cost. In the third phase, there is a gap in coverage, when most
people must pay 100 percent of their drug costs out of their own
pockets. This phase is commonly known as the coverage gap, or
“doughnut hole”. After paying a certain amount of out-of-pocket
costs, the fourth phase of coverage begins. In the fourth phase, the
beneficiary pays a small percentage of the total cost of each
prescription and the drug plan pays the remaining amount.
Before today, have you heard about the coverage gap or “doughnut
hole” that is part of most Medicare drug plans?
Int. Instr II:
INPUT FIELDS / ROUTING
2:51:28 PM Monday, August 03, 2009
Page 44 of 128
SC8G
( SCQ1057 )
DHEVHEAR
Field1:
ACCS.DHEVHEAR
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 SC1AA - (SCQ1058 )
English text: YES
No
BOX SC1AA - (SCQ1058 )
English text: NO
Attribute
Don't know
Route
BOX SC1AA - (SCQ1058 )
Refusal
BOX SC1AA - (SCQ1058 )
BACKGROUND VARIABLE ASSIGNMENTS
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.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
2:51:31 PM Monday, August 03, 2009
Page 45 of 128
SC8G
344
MHMOCurrWithRx
SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
2:51:31 PM Monday, August 03, 2009
Page 46 of 128
BOX SC1AA
BOX SC1AA
Page Order # :
132
BOX INSTRUCTIONS
( SCQ1058 )
IF (SP HAS A "CURRENT" MEDICARE PRESCRIPTION DRUG PLAN) OR
(SP HAS A "CURRENT" MEDICARE ADVANTAGE PLAN THAT HAS RX
COVERAGE), GO TO SC8H - DHAUTOEN ( SCQ1060 ).
ELSE GO TO SC9 - MDISSFY ( SCQ1084 ).
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.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
344
MHMOCurrWithRx
SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
2:51:31 PM Monday, August 03, 2009
Page 47 of 128
SC8H
SC8H
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DHAUTOEN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
134
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:
As you may know, there are Federal and state programs that help
beneficiaries pay for the costs associated with a Medicare drug plan
and the purchase of prescription drugs. The help provided is
referred to as a “low-income subsidy” or “extra help”. Beneficiaries
who qualify for these programs receive help paying for the Medicare
drug plan’s monthly premium, help paying any yearly deductible,
help paying coinsurance and copayments for prescription drugs, and
have no coverage gap.
[Are you/Is (SP)] receiving this type of help to pay for (your/his/her)
Medicare prescription drug coverage?]
2:51:33 PM Monday, August 03, 2009
Page 48 of 128
SC8H
Int. Instr II:
INPUT FIELDS / ROUTING
DHAUTOEN
Field1:
( SCQ1060 )
ACCS.DHAUTOEN
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
SC9 - MDISSFY ( SCQ1084 )
English text: YES
No
SC8I - DHPLAN ( SCQ1062 )
English text: NO
Attribute
Don't know
Route
SC9 - MDISSFY ( SCQ1084 )
Refusal
SC9 - MDISSFY ( SCQ1084 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:51:35 PM Monday, August 03, 2009
Page 49 of 128
SC8I
SC8I
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DHPLAN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
136
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has a "current" Medicare Prescription Drug plan, display
"(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)".
Else display "(CURRENT MEDICARE ADVANTAGE PLAN)".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1A
Question Text:
Does [your/(SP's)] [(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT MEDICARE ADVANTAGE PLAN)] plan have a
coverage gap, or “doughnut hole”?
[EXPLAIN IF NECESSARY: The coverage gap, or "doughnut hole",
is a phase in coverage when (your/his/her) plan will either stop
paying for all prescription drugs or it will offer only limited coverage.]
Int. Instr II:
2:51:36 PM Monday, August 03, 2009
Page 50 of 128
SC8I
INPUT FIELDS / ROUTING
( SCQ1062 )
DHPLAN
Field1:
ACCS.DHPLAN
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
SC8J - DHSTOPPY ( SCQ1064 )
English text: YES
No
English text: NO
SC9 - MDISSFY ( SCQ1084 )
Attribute
Don't know
Route
SC9 - MDISSFY ( SCQ1084 )
Refusal
SC9 - MDISSFY ( SCQ1084 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
2:51:39 PM Monday, August 03, 2009
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.
Page 51 of 128
SC8I
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
344
MHMOCurrWithRx
SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
2:51:39 PM Monday, August 03, 2009
Page 52 of 128
SC8J
SC8J
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DHSTOPPY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
138
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has a "current" Medicare Prescription Drug plan, display
"(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)".
Else display "(CURRENT MEDICARE ADVANTAGE PLAN)".
If respondent is SP, display "you reach".
Else display "(SP) reaches".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
2:51:41 PM Monday, August 03, 2009
For the next several questions, it would be helpful if I could look at
[your/(SP)'s] [(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT MEDICARE ADVANTAGE PLAN)] medicine
statements. The statements often contain the information required
by these questions.
Page 53 of 128
SC8J
First, once [you reach/(SP) reaches] the coverage gap, does
(your/his/her) [(CURRENT MEDICARE PRESCRIPTION DRUG
PLAN)/(CURRENT MEDICARE ADVANTAGE PLAN)] plan stop
paying for all prescription drugs or does (your/his/her) plan offer
some type of coverage for prescription drug costs?
REFER TO THE MOST RECENT MEDICARE PRESCRIPTION
DRUG PLAN STATEMENT TO HELP THE RESPONDENT VERIFY
THIS INFORMATION.
Int. Instr II:
INPUT FIELDS / ROUTING
DHSTOPPY
Field1:
( SCQ1064 )
ACCS.DHSTOPPY
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
TDHStopPy
1
No
No
Number Label
1 PlanStopsPayingForDrugs
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8L - DHTHISYR ( SCQ1068 )
English text: PLAN STOPS PAYING FOR ALL DRUGS
PlanOffersSomeCoverage
SC8K - DHCOVER ( SCQ1066 )
English text: PLAN OFFERS SOME COVERAGE
Attribute
Don't know
Route
SC8L - DHTHISYR ( SCQ1068 )
Refusal
SC8L - DHTHISYR ( SCQ1068 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
2:51:44 PM Monday, August 03, 2009
Page 54 of 128
SC8J
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.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
344
MHMOCurrWithRx
SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
2:51:44 PM Monday, August 03, 2009
Page 55 of 128
SC8K
SC8K
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DHCOVER
Field 2:
DHCOVROS
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
140
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has a "current" Medicare Prescription Drug plan, display
"(CURRENT MEDICARE PRESCRIPTION DRUG PLAN)".
Else display "(CURRENT MEDICARE ADVANTAGE PLAN)".
If respondent is SP, display "you reach".
Else display "(SP) reaches".
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
2:51:46 PM Monday, August 03, 2009
What type of coverage does [your/(SP's)] [(CURRENT MEDICARE
PRESCRIPTION DRUG PLAN)/(CURRENT MEDICARE
ADVANTAGE PLAN)] plan offer once [you reach/(SP) reaches] the
start of the coverage gap?
Page 56 of 128
SC8K
Does it cover generic drugs only, brand-name and generic drugs, or
does it provide some other type of coverage?
REFER TO THE MOST RECENT MEDICARE PRESCRIPTION
DRUG PLAN STATEMENT TO HELP THE RESPONDENT VERIFY
THIS INFORMATION.
Int. Instr II:
INPUT FIELDS / ROUTING
DHCOVER
Field1:
( SCQ1066 )
ACCS.DHCOVER
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
TDHCover
1
No
No
Number Label
1 GenericsOnly
2
91
English text: GENERICS ONLY
GenericsAndBrand
English text: GENERICS AND BRANDS
Other
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8L - DHTHISYR ( SCQ1068 )
SC8L - DHTHISYR ( SCQ1068 )
SC8K - DHCOVROS ( SCQ1067 )
English text: OTHER
Attribute
Don't know
Route
SC8L - DHTHISYR ( SCQ1068 )
Refusal
SC8L - DHTHISYR ( SCQ1068 )
2:51:50 PM Monday, August 03, 2009
Page 57 of 128
SC8K
DHCOVROS
Field2:
( SCQ1067 )
ACCS.DHCOVROS
Cheshire Name:
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
SC8L - DHTHISYR ( SCQ1068 )
BACKGROUND VARIABLE ASSIGNMENTS
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.
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
344
MHMOCurrWithRx
SP has "current" Medicare Managed care plan (Medicare
Advantage plan) with RX coverage=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVCURNT=1/Yes & MHMORX=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
2:51:51 PM Monday, August 03, 2009
Page 58 of 128
SC8L
SC8L
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DHTHISYR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
142
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1A
Question Text:
[Have you/Has (SP)] reached the start of the coverage gap during
[CURRENT YEAR]?
[EXPLAIN IF NECESSARY: If [you have/(SP) has] reached the start
of the coverage gap, it means (you have/he has/she has) reached a
phase in coverage when (your/his/her) plan will either stop paying for
all prescription drugs or it will offer only limited coverage.]
Int. Instr II:
2:51:52 PM Monday, August 03, 2009
REFER TO THE MOST RECENT MEDICARE PRESCRIPTION
DRUG PLAN STATEMENT TO HELP THE RESPONDENT VERIFY
THIS INFORMATION.
Page 59 of 128
SC8L
INPUT FIELDS / ROUTING
DHTHISYR
Field1:
( SCQ1068 )
ACCS.DHTHISYR
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
SC8M - DHSTART ( SCQ1070 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
SC9 - MDISSFY ( SCQ1084 )
Refusal
SC9 - MDISSFY ( SCQ1084 )
SC9 - MDISSFY ( SCQ1084 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:51:54 PM Monday, August 03, 2009
Page 60 of 128
SC8M
SC8M
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DHSTART
Field 2:
DHSTAROS
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
144
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 "first" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How did [you/(SP)] fist find out that (you/he/she) reached the start of
the coverage gap?
Int. Instr II:
INPUT FIELDS / ROUTING
2:51:57 PM Monday, August 03, 2009
Page 61 of 128
SC8M
DHSTART
Field1:
( SCQ1070 )
ACCS.DHSTART
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
TDHStart
1
No
No
Number Label
1 SPOrSomeoneKeptTrack
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC8N - DHEND ( SCQ1072 )
2
English text: SP OR SOMEONE FOR THE SP KEPT TRACK OF TOTAL MEDICINE SPENDING
InfoProvidedByPartD
SC8N - DHEND ( SCQ1072 )
3
English text: INFORMATION PROVIDED BY THE PART D PLAN
InfoProvidedByPharmacy
SC8N - DHEND ( SCQ1072 )
91
English text: INFORMATION PROVIDED BY THE PHARMACY
Other
SC8M - DHSTAROS ( SCQ1071 )
English text: OTHER
Attribute
Don't know
Route
SC8N - DHEND ( SCQ1072 )
Refusal
SC8N - DHEND ( SCQ1072 )
2:52:02 PM Monday, August 03, 2009
Page 62 of 128
SC8M
Field2:
DHSTAROS
( SCQ1071 )
ACCS.DHSTAROS
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
SC8N - DHEND ( SCQ1072 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:52:02 PM Monday, August 03, 2009
Page 63 of 128
SC8N
SC8N
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DHEND
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
146
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 respondent is SP, display "you pay".
Else display "(he/she) pays".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC1A
Question Text:
[Have you/Has (SP)] reached the end of the coverage gap during
[CURRENT YEAR]?
[EXPLAIN IF NECESSARY: If [you have/(SP) has] reached the end
of the coverage gap, it means (you have/he has/she has) reached a
phase in coverage when [you pay/(he/she) pays] a small percentage
of the total cost of each prescription and (your/his/her) drug plan
pays the remaining amoung.]
Int. Instr II:
2:52:04 PM Monday, August 03, 2009
REFER TO THE MOST RECENT MEDICARE PRESCRIPTION
Page 64 of 128
SC8N
DRUG PLAN STATEMENT TO HELP THE RESPONDENT VERIFY
THIS INFORMATION.
INPUT FIELDS / ROUTING
DHEND
Field1:
( SCQ1072 )
ACCS.DHEND
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
SC8O - DHWORRY ( SCQ1074 )
English text: YES
No
SC8O - DHWORRY ( SCQ1074 )
English text: NO
Attribute
Don't know
Route
SC9 - MDISSFY ( SCQ1084 )
Refusal
SC9 - MDISSFY ( SCQ1084 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:52:06 PM Monday, August 03, 2009
Page 65 of 128
SC8O
SC8O
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DHWORRY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
148
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 SC8N-DHEND = 2/No:
If SP is respondent, display "are".
Else display "is".
Else then:
If SP is respondent, display "were".
Else display "was".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
For [CURRENT YEAR], how worried (are/is/were/was) [you/(SP)]
about (your/his/her) ability to pay for (your/his/her) medicines during
the coverage gap?
Would you say that [you/(SP)] (are/is/were/was) very worried,
somewhat worried, or not at all worried?
2:52:07 PM Monday, August 03, 2009
Page 66 of 128
SC8O
Int. Instr II:
INPUT FIELDS / ROUTING
DHWORRY
Field1:
( SCQ1074 )
ACCS.DHWORRY
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
TDHWorry
1
No
No
Number Label
1 VeryWorried
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC9 - MDISSFY ( SCQ1084 )
2
English text: VERY WORRIED
SomewhatWorried
SC9 - MDISSFY ( SCQ1084 )
3
English text: SOMEWHAT WORRIED
NotWorried
SC9 - MDISSFY ( SCQ1084 )
English text: NOT AT ALL WORRIED
Attribute
Don't know
Route
SC9 - MDISSFY ( SCQ1084 )
Refusal
SC9 - MDISSFY ( SCQ1084 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:52:11 PM Monday, August 03, 2009
Page 67 of 128
SC8O
2:52:11 PM Monday, August 03, 2009
Page 68 of 128
SC9
SC9
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 1:
MDISSFY
Field 2:
MCDISVB
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:
160
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is SP, display "receive".
Else display "receives".
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Please think about all of the health care services [you/(SP)]
(receive/receives), including services provided by doctors, hospitals
and pharmacies.
What things, if anything, about the health care services [you/(SP)]
(receive/receives) are you dissatisfied with?
Int. Instr II:
2:52:13 PM Monday, August 03, 2009
Page 69 of 128
SC9
INPUT FIELDS / ROUTING
MDISSFY
Field1:
( SCQ1084 )
ACCS.MCDISSFY
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
TMcdissfy
1
No
No
Number Label
1 NotDissatisfiedWithAnything
91
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC10A - MCWORRY ( SCQ1087 )
English text: RESPONDENT IS NOT DISSATISFIED WITH ANYTHING
WhatDissatisfiedWithrecVerbatim
SC9 - MCDISVB ( SCQ1085 )
RESPONDENT
IS
DISSATISFIED
(RECORD VERBATIM BELOW)
English text:
Attribute
Don't know
Route
SC10A - MCWORRY ( SCQ1087 )
Refusal
SC10A - MCWORRY ( SCQ1087 )
2:52:16 PM Monday, August 03, 2009
Page 70 of 128
SC9
Field2:
MCDISVB
( SCQ1085 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
ACCS.MCDISVB1
ACCS.MCDISVB2
ACCS.MCDISVB3
Item Text display:
Item Text:
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
SC10A - MCWORRY ( SCQ1087 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:52:17 PM Monday, August 03, 2009
Page 71 of 128
SC10A
SC10A
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
MCWORRY
Field 2:
MCAVOID
Field 3:
MCSICK
Field 4:
MCDRSOON
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:
170
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:
Please tell me whether each of the following statements is true or
false.
Int. Instr II:
INPUT FIELDS / ROUTING
2:52:20 PM Monday, August 03, 2009
Page 72 of 128
SC10A
MCWORRY
Field1:
ACCS.MCWORRY
Cheshire Name:
Item Text display:
( SCQ1087 )
Display "a." before the question text.
If respondent is SP display "worry".
Else display "worries".
Always display "[Is this statement…]" in brackets.
[You/(SP)] (worry/worries) about (your/his/her) health more
than other people (your/his/her) age.
[Is this statement true or false?]
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTrufalse
1
No
No
Number Label
1 Tru
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC10A - MCAVOID ( SCQ1088 )
English text: TRUE
Fals
SC10A - MCAVOID ( SCQ1088 )
English text: FALSE
Attribute
Don't know
Route
SC10A - MCAVOID ( SCQ1088 )
Refusal
SC10A - MCAVOID ( SCQ1088 )
2:52:25 PM Monday, August 03, 2009
Page 73 of 128
SC10A
MCAVOID
Field2:
( SCQ1088 )
ACCS.MCAVOID
Cheshire Name:
Item Text display:
Display "b." before the question text.
Item Text:
[You/(SP)] will do just about anything to avoid going to the
doctor.
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTrufalse
1
No
No
Number Label
1 Tru
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC10A - MCSICK ( SCQ1089 )
English text: TRUE
Fals
SC10A - MCSICK ( SCQ1089 )
English text: FALSE
Attribute
Don't know
Route
SC10A - MCSICK ( SCQ1089 )
Refusal
SC10A - MCSICK ( SCQ1089 )
2:52:31 PM Monday, August 03, 2009
Page 74 of 128
SC10A
MCSICK
Field3:
ACCS.MCSICK
Cheshire Name:
Item Text display:
( SCQ1089 )
Display "c." before the question text.
If respondent is SP display "are" and "try".
Else display "is" and "tries".
When [you/(SP)] (are/is) sick, (you/he/she) (try/tries) to keep
it to (yourself/himself/herself).
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTrufalse
1
No
No
Number Label
1 Tru
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC10A - MCDRSOON ( SCQ1090 )
English text: TRUE
Fals
SC10A - MCDRSOON ( SCQ1090 )
English text: FALSE
Attribute
Don't know
Route
SC10A - MCDRSOON ( SCQ1090 )
Refusal
SC10A - MCDRSOON ( SCQ1090 )
2:52:36 PM Monday, August 03, 2009
Page 75 of 128
SC10A
MCDRSOON
Field4:
ACCS.MCDRSOON
Cheshire Name:
Item Text display:
( SCQ1090 )
Display "d." before the question text.
If respondent is SP display "go" and "start".
Else display "goes" and "starts".
Usually, [you/(SP)] (go/goes) to the doctor as soon as
(you/he/she) (start/starts) to feel bad.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TTrufalse
1
No
No
Number Label
1 Tru
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC11 - MCDRNSEE ( SCQ1095 )
English text: TRUE
Fals
SC11 - MCDRNSEE ( SCQ1095 )
English text: FALSE
Attribute
Don't know
Route
SC11 - MCDRNSEE ( SCQ1095 )
Refusal
SC11 - MCDRNSEE ( SCQ1095 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:52:39 PM Monday, August 03, 2009
Page 76 of 128
SC11
SC11
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MCDRNSEE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
180
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
During (CURRENT YEAR), did [you/(SP)] have any health problem
or condition about which you think (you/he/she) should have seen a
doctor or other medical person, but did not?
Int. Instr II:
INPUT FIELDS / ROUTING
2:52:40 PM Monday, August 03, 2009
Page 77 of 128
SC11
MCDRNSEE
Field1:
( SCQ1095 )
ACCS.MCDRNSEE
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
SC12AA - TEMPCOND1 ( SCQ1100 )
English text: YES
No
SC15 - PMNOTGET ( SCQ1135 )
English text: NO
Attribute
Don't know
Route
SC15 - PMNOTGET ( SCQ1135 )
Refusal
SC15 - PMNOTGET ( SCQ1135 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:52:42 PM Monday, August 03, 2009
Page 78 of 128
SC12AA
SC12AA
Page Order # :
Design Screen Type:
Text
Fields:
Field 1:
TEMPCOND1
Field 2:
TEMPCOND2
Field 3:
TEMPCOND3
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:
190
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Display all input fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What was the health problem or condition?
Int. Instr II:
ENTER ALL CONDITIONS.
INPUT FIELDS / ROUTING
2:52:44 PM Monday, August 03, 2009
Page 79 of 128
SC12AA
TEMPCOND1
Field1:
( SCQ1100 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
CONDITION 1:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TCondtion
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
TEMPCOND2
Field2:
30
Route
SC12AA - TEMPCOND2 ( SCQ1105 )
( SCQ1105 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
CONDITION 2:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TConditionEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
SC12AA - TEMPCOND3 ( SCQ1108 )
Route
SC12A - MCDRATMP ( SCQ1110 )
2:52:48 PM Monday, August 03, 2009
Page 80 of 128
SC12AA
TEMPCOND3
Field3:
( SCQ1108 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
CONDITION 3:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TConditionEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
SC12A - MCDRATMP ( SCQ1110 )
Route
SC12A - MCDRATMP ( SCQ1110 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:52:50 PM Monday, August 03, 2009
Page 81 of 128
SC12A
SC12A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MCDRATMP
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:
Display SC12AA - TEMPCOND1 response.
If SC12AA - TEMPCOND2 ^= empty, display SC12AA TEMPCOND2 response.
Else do not display.
If SC12AA - TEMPCOND3 ^= empty, display SC12AA TEMPCOND3 response.
Else do not display.
Always display "(s)" in the probe in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
2:52:51 PM Monday, August 03, 2009
Did [you/(SP)] attempt to see a doctor about this [READ
Page 82 of 128
SC12A
CONDITION(S) BELOW]?
(CONDITION 1 FROM SC12AA)
(CONDITION 2 FROM SC12AA)
(CONDITION 3 FROM SC12AA)
[PROBE: By "attempt" I mean, did [you/(SP)] contact a doctor’s
office or other medical place in order to set an appointment or talk to
someone about the condition(s)?]
Int. Instr II:
INPUT FIELDS / ROUTING
MCDRATMP
Field1:
( SCQ1110 )
ACCS.MCDRATMP
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
SC13A - SCRCODES ( SCQ1120 )
English text: YES
No
SC13A - SCRCODES ( SCQ1120 )
English text: NO
Attribute
Don't know
Route
SC13A - SCRCODES ( SCQ1120 )
Refusal
SC13A - SCRCODES ( SCQ1120 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
2:52:54 PM Monday, August 03, 2009
Page 83 of 128
SC12A
TECHNICAL NOTES
DESIGN NOTES
2:52:54 PM Monday, August 03, 2009
Page 84 of 128
SC13A
SC13A
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
SCRCODES
Field 2:
SCROTOS
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
225
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display SC12AA - TEMPCOND1 response.
If SC12AA - TEMPCOND2 ^= empty, display SC12AA TEMPCOND2 response.
Else do not display.
If SC12AA - TEMPCOND3 ^= empty, display SC12AA TEMPCOND3 response.
Else do not display.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC2
Question Text:
This card lists some reasons people have given for not seeing a
2:52:56 PM Monday, August 03, 2009
Page 85 of 128
SC13A
doctor or other medical person about a health problem or condition.
Which of these reasons explains why [you/(SP)] did not see a doctor
about the [READ CONDITION(S) BELOW]?
(CONDITION 1 FROM SC12AA)
(CONDITION 2 FROM SC12AA)
(CONDITION 3 FROM SC12AA)
[PROBE: Any other reason?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
2:53:01 PM Monday, August 03, 2009
Page 86 of 128
SC13A
SCRCODES
Field1:
( SCQ1120 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=ACCS.SCRNSERS
2=ACCS.SCRCOST
3=ACCS.SCRTROUB
4=ACCS.SCRSCHED
5=ACCS.SCRDRCDM
6=ACCS.SCRFEAR
7=ACCS.SCRNACCP
91=ACCS.SCROTHR
Item Text display:
For response option 91/Other, display "OTHER" as the
English Response Text.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TSCRMAIN
12
No
No
Number Label
1 ProbNotSerious
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX SC1B - (SCQ1125 )
2
English text: DIDN'T THINK THE PROBLEM WAS SERIOUS
CostTooMuch
BOX SC1B - (SCQ1125 )
3
English text: THOUGHT IT WOULD COST TOO MUCH
TroubleFinding
BOX SC1B - (SCQ1125 )
4
English text: TROUBLE FINDING/GETTING TO DOCTOR
Schedule
BOX SC1B - (SCQ1125 )
5
English text: TIME/SCHEDULE OR PERSONAL CONFLICTS
DrNotDoMuch
BOX SC1B - (SCQ1125 )
6
English text: THOUGHT DOCTOR COULDN'T DO MUCH ABOUT PROBLEM
AfraidToKnow
BOX SC1B - (SCQ1125 )
7
91
English text: WAS AFRAID OF FINDING OUT WHAT WAS WRONG
DrNoAcceptIns
BOX SC1B - (SCQ1125 )
English text: DOCTOR WOULD NOT ACCEPT MY INSURANCE
Other
SC13A - SCROTOS ( SCQ1122 )
English text: (OTHER/SC13A - SCROTOS OTHER SPECIFY TEXT)
Attribute
Don't know
Route
SC15 - PMNOTGET ( SCQ1135 )
2:53:10 PM Monday, August 03, 2009
Page 87 of 128
SC13A
Don't know
Refusal
SC15 - PMNOTGET ( SCQ1135 )
Field2:
SCROTOS
( SCQ1122 )
ACCS.SCROTOS
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
BOX SC1B - (SCQ1125 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:53:11 PM Monday, August 03, 2009
Page 88 of 128
BOX SC1B
BOX SC1B
Page Order # :
230
BOX INSTRUCTIONS
( SCQ1125 )
IF SC13A - SCRCODES INCLUDES MORE THAN ONE RESPONSE, GO TO
SC14A - SCRMAIN ( SCQ1130 ).
ELSE GO TO SC15 - PMNOTGET ( SCQ1135 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
2:53:11 PM Monday, August 03, 2009
Page 89 of 128
SC14A
SC14A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
SCRMAIN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
245
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 SC12AA - TEMPCOND2 = empty and SC12AA - TEMPCOND3 =
empty, display "this condition".
Else display "these conditions".
Display SC12AA - TEMPCOND1 response.
If SC12AA - TEMPCOND2 ^= empty, display SC12AA TEMPCOND2 response.
Else do not display.
If SC12AA - TEMPCOND3 ^= empty, display SC12AA TEMPCOND3 response.
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
2:53:13 PM Monday, August 03, 2009
Page 90 of 128
SC14A
Int. Instr I:
Question Text:
Which of these was the main reason [you/(SP)] did not see a doctor
about (this condition/these conditions) during (CURRENT YEAR)?
[READ REASONS BELOW IF NECESSARY.]
(CONDITION 1 FROM SC12AA)
(CONDITION 2 FROM SC12AA)
(CONDITION 3 FROM SC12AA)
Int. Instr II:
INPUT FIELDS / ROUTING
2:53:18 PM Monday, August 03, 2009
Page 91 of 128
SC14A
SCRMAIN
Field1:
ACCS.SCRMAIN
Cheshire Name:
Item Text display:
( SCQ1130 )
The response options for MCRMAIN will be displayed
based on the response to SC13A - SCRCODES. If
corresponding response included at SC13A, display same
response option at SC14A. Else do not display response
option. See detailed instructions below.
If SC13A - SCRCODES includes 1/ProbNotSerious,
display SCRMAIN response option 1/ProbNotSerious.
If SC13A - SCRCODES includes 2/CostTooMuch, display
SCRMAIN response option 2/CostTooMuch.
If SC13A - SCRCODES includes 3/TroubleFinding, display
SCRMAIN response option 3/TroubleFinding.
If SC13A - SCRCODES includes 4/Schedule, display
SCRMAIN response option 4/Schedule.
If SC13A - SCRCODES includes 5/DrNotDoMuch, display
SCRMAIN response option 5/DrNotDoMuch.
If SC13A - SCRCODES includes 6/AfraidToKnow, display
SCRMAIN response option 6/AfraidToKnow.
If SC13A - SCRCODES includes 7/DrNoAcceptIns, display
SCRMAIN response option 7/DrNoAcceptIns.
If SC13A - SCRCODES includes 91/Other, display
SCRMAIN response option 91/Other. Display SC13A SCROTOS Other Specify Response text as the English
response text (not "OTHER").
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TSCRMAIN
1
No
No
Number Label
1 ProbNotSerious
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC15 - PMNOTGET ( SCQ1135 )
2
English text: DIDN'T THINK THE PROBLEM WAS SERIOUS
CostTooMuch
SC15 - PMNOTGET ( SCQ1135 )
3
English text: THOUGHT IT WOULD COST TOO MUCH
TroubleFinding
SC15 - PMNOTGET ( SCQ1135 )
4
English text: TROUBLE FINDING/GETTING TO DOCTOR
Schedule
SC15 - PMNOTGET ( SCQ1135 )
5
English text: TIME/SCHEDULE OR PERSONAL CONFLICTS
DrNotDoMuch
SC15 - PMNOTGET ( SCQ1135 )
English text: THOUGHT DOCTOR COULDN'T DO MUCH ABOUT PROBLEM
2:53:26 PM Monday, August 03, 2009
Page 92 of 128
SC14A
6
AfraidToKnow
SC15 - PMNOTGET ( SCQ1135 )
7
English text: WAS AFRAID OF FINDING OUT WHAT WAS WRONG
DrNoAcceptIns
SC15 - PMNOTGET ( SCQ1135 )
91
English text: DOCTOR WOULD NOT ACCEPT MY INSURANCE
Other
SC15 - PMNOTGET ( SCQ1135 )
English text: (OTHER/SC13A - SCROTOS OTHER SPECIFY TEXT)
Attribute
Don't know
Route
SC15 - PMNOTGET ( SCQ1135 )
Refusal
SC15 - PMNOTGET ( SCQ1135 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:53:28 PM Monday, August 03, 2009
Page 93 of 128
SC15
SC15
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PMNOTGET
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
250
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
During (CURRENT YEAR), were any medicines prescribed for
[you/(SP)] that (you/he/she) did not get? Please include refills of
earlier prescriptions as well as prescriptions that were written or
phoned in by a doctor.
Int. Instr II:
INPUT FIELDS / ROUTING
2:53:30 PM Monday, August 03, 2009
Page 94 of 128
SC15
PMNOTGET
Field1:
( SCQ1135 )
ACCS.PMNOTGET
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
SC16 - TEMPMED1 ( SCQ1140 )
English text: YES
No
SC20 - GENERRX ( SCQ1190 )
English text: NO
Attribute
Don't know
Route
SC20 - GENERRX ( SCQ1190 )
Refusal
SC20 - GENERRX ( SCQ1190 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:53:32 PM Monday, August 03, 2009
Page 95 of 128
SC16
SC16
Page Order # :
Design Screen Type:
Text
Fields:
Field 1:
TEMPMED1
Field 2:
TEMPMED2
Field 3:
TEMPMED3
Field 4:
TEMPMED4
Field 5:
TEMPMED5
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:
Question display:
Multi Field display:
Vertical Alignment
Display all input fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What were the names of those medicines?
Int. Instr II:
ENTER ALL MEDICINES.
2:53:33 PM Monday, August 03, 2009
Page 96 of 128
SC16
INPUT FIELDS / ROUTING
TEMPMED1
Field1:
( SCQ1140 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
MEDICINE 1:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
Tmedicine
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
TEMPMED2
Field2:
30
Route
SC16 - TEMPMED2 ( SCQ1145 )
( SCQ1145 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
MEDICINE 2:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TMedicineEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
SC16 - TEMPMED3 ( SCQ1150 )
Route
SC17INTR - SCINT2 ( SCQ1165 )
2:53:37 PM Monday, August 03, 2009
Page 97 of 128
SC16
TEMPMED3
Field3:
( SCQ1150 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
MEDICINE 3:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TMedicineEmpty
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
30
Route
SC16 - TEMPMED4 ( SCQ1155 )
Route
SC17INTR - SCINT2 ( SCQ1165 )
TEMPMED4
Field4:
( SCQ1155 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
MEDICINE 4:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TMedicineEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
SC16 - TEMPMED5 ( SCQ1160 )
Route
SC17INTR - SCINT2 ( SCQ1165 )
2:53:41 PM Monday, August 03, 2009
Page 98 of 128
SC16
TEMPMED5
Field5:
( SCQ1160 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
MEDICINE 5:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TMedicineEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
SC17INTR - SCINT2 ( SCQ1165 )
Route
SC17INTR - SCINT2 ( SCQ1165 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:53:42 PM Monday, August 03, 2009
Page 99 of 128
SC17INTR
SC17INTR
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
SCINT2
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
270
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC3
Question Text:
This card lists some reasons people have given for not having
prescriptions filled or refilled.
Int. Instr II:
INPUT FIELDS / ROUTING
2:53:43 PM Monday, August 03, 2009
Page 100 of 128
SC17INTR
SCINT2
Field1:
( SCQ1165 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC17A - SCPMCODS ( SCQ1170 )
English text: CONTINUE
Attribute
Empty
Route
SC17A - SCPMCODS ( SCQ1170 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:53:45 PM Monday, August 03, 2009
Page 101 of 128
SC17A
SC17A
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
SCPMCODS
Field 2:
SCPMOTOS
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
285
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display SC16 - TEMPMED1 response.
If SC16 - TEMPMED2 ^= empty, display SC16 - TEMPMED2
response.
Else do not display.
If SC16 - TEMPMED3 ^= empty, display SC16 - TEMPMED3
response.
Else do not display.
If SC16 - TEMPMED4 ^= empty, display SC16 - TEMPMED4
response.
Else do not display.
If SC16 - TEMPMED5 ^= empty, display SC16 - TEMPMED5
response.
Else do not display.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
2:53:48 PM Monday, August 03, 2009
Page 102 of 128
SC17A
TEXT:
Context Header:
Int. Instr I:
Question Text:
Which of these reasons explains why [you/(SP)] did not obtain the
[READ MEDICINE(S) BELOW]?
[MEDICINE 1 FROM SC16]
[MEDICINE 2 FROM SC16]
[MEDICINE 3 FROM SC16]
[MEDICINE 4 FROM SC16]
[MEDICINE 5 FROM SC16]
[PROBE: Any other reason?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
2:53:54 PM Monday, August 03, 2009
Page 103 of 128
SC17A
SCPMCODS
Field1:
( SCQ1170 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=ACCS.SCPMCOST
2=ACCS.SCNOHELP
3=ACCS.SCPMREAC
4=ACCS.SCPMNLKE
5=ACCS.SCPMNCND
6=ACCS.SCPMNOCV
7=ACCS.SCPMTROB
8=ACCS.SCPMSMPL
9=ACCS.SCPMSUBS
91=ACCS.SCPMOTHR
Item Text display:
For response option 91/Other, display "OTHER" as the
English Response Text.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Tscpmmain
12
No
No
FieldSize:
Min Value:
Max Value:
Mask:
Number Label
1 CostTooMuch
2
Route
BOX SC2 - (SCQ1175 )
THOUGHT
IT
WOULD
COST
TOO
MUCH
English text:
MedNotHelpCondition
BOX SC2 - (SCQ1175 )
3
English text: DIDN'T THINK MEDICINE WOULD HELP CONDITION
AfraidOfReactions
BOX SC2 - (SCQ1175 )
4
English text: WAS AFRAID OF MEDICINE REATIONS/CONTRAINDICATIONS
DontLikeToTakeMed
BOX SC2 - (SCQ1175 )
5
English text: DON'T LIKE TO TAKE MEDICINE
MedNotNecessary
BOX SC2 - (SCQ1175 )
6
English text: DIDN'T THINK MEDICINE WAS NECESSARY
NotCovered
BOX SC2 - (SCQ1175 )
7
English text: NOT COVERED BY INSURANCE/NOT ON PLAN FORMULARY
TroubleObtaining
BOX SC2 - (SCQ1175 )
8
English text: TROUBLE OBTAINING MEDICINE
ObtainedSamples
BOX SC2 - (SCQ1175 )
English text: OBTAINED/USED SAMPLES
2:54:03 PM Monday, August 03, 2009
Page 104 of 128
SC17A
9
91
UsedSubtitute
BOX SC2 - (SCQ1175 )
English text: USED ANOTHER MEDICINE AS A SUBSTITUTION
Other
SC17A - SCPMOTOS ( SCQ1172 )
English text: (OTHER/SC17A - SCPMOTOS OTHER SPECIFY TEXT)
Attribute
Don't know
Route
SC20 - GENERRX ( SCQ1190 )
Refusal
SC20 - GENERRX ( SCQ1190 )
Field2:
SCPMOTOS
( SCQ1172 )
ACCS.SCPMOTOS
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
BOX SC2 - (SCQ1175 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:54:06 PM Monday, August 03, 2009
Page 105 of 128
BOX SC2
BOX SC2
Page Order # :
290
BOX INSTRUCTIONS
( SCQ1175 )
IF SC17A - SCPMCODS INCLUDES MORE THAN ONE RESPONSE, GO TO
SC18A - SCPMMAIN ( SCQ1180 ).
ELSE GO TO SC20 - GENERRX ( SCQ1190 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
2:54:06 PM Monday, August 03, 2009
Page 106 of 128
SC18A
SC18A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
SCPMMAIN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
305
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SC16 - TEMPMED2 = empty and SC16 - TEMPMED3 = empty
and SC16 - TEMPMED4 = empty and SC16 - TEMPMED5 = empty,
display "this medicine".
Else display "these medicines".
Display SC16 - TEMPMED1 response.
If SC16 - TEMPMED2 ^= empty, display SC16 - TEMPMED2
response.
Else do not display.
If SC16 - TEMPMED3 ^= empty, display SC16 - TEMPMED3
response.
Else do not display.
If SC16 - TEMPMED4 ^= empty, display SC16 - TEMPMED4
response.
Else do not display.
If SC16 - TEMPMED5 ^= empty, display SC16 - TEMPMED5
response.
Else do not display.
Multi Field display:
Roster/Grid Instructions:
2:54:09 PM Monday, August 03, 2009
Page 107 of 128
SC18A
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Which of these was the main reason [you/(SP)] did not obtain (this
medicine/these medicines) during (CURRENT YEAR)?
[READ REASONS BELOW IF NECESSARY.]
[MEDICINE 1 FROM SC16]
[MEDICINE 2 FROM SC16]
[MEDICINE 3 FROM SC16]
[MEDICINE 4 FROM SC16]
[MEDICINE 5 FROM SC16]
Int. Instr II:
INPUT FIELDS / ROUTING
2:54:14 PM Monday, August 03, 2009
Page 108 of 128
SC18A
SCPMMAIN
Field1:
ACCS.SCPMMAIN
Cheshire Name:
Item Text display:
( SCQ1180 )
The response options for SCPMMAIN will be displayed
based on the response to SC17A - SCPMCODS. If
corresponding response included at SC17A, display same
response option at SC18A. Else do not display response
option. See detailed instructions below.
If SC17A - SCPMCODS includes 1/CostTooMuch, display
SCPMMAIN response option 1/CostTooMuch.
If SC17A - SCPMCODS includes 2/MedNotHelpCondition,
display SCPMMAIN response option
2/MedNotHelpCondition.
If SC17A - SCPMCODS includes 3/AfraidOfReactions,
display SCPMMAIN response option 3/AfraidOfReactions.
If SC17A - SCPMCODS includes 4/DontLikeToTakeMe
display SCPMMAIN response option 4/DontLikeToTakeMe.
If SC17A - SCPMCODS includes 5/MedNotNecessary,
display SCPMMAIN response option 5/MedNotNecessary.
If SC17A - SCPMCODS includes 6/NotCovered, display
SCPMMAIN response option 6/NotCovered.
If SC17A - SCPMCODS includes 7/TroubleObtaining,
display SCPMMAIN response option 7/TroubleObtaining.
If SC17A - SCPMCODS includes 8/ObtainedSamples,
display SCPMMAIN response option 8/ObtainedSamples.
If SC17A - SCPMCODS includes 9/UsedSubstitute, display
SCPMMAIN response option 9/UsedSubstitute.
If SC17A - SCPMCODS includes 91/OtherReason, display
SCPMMAIN response option 91/Other. Display SC17A SCPMOTOS Other Specify Text as the English Response
Text (instead of "OTHER").
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Tscpmmain
1
No
No
Number Label
1 CostTooMuch
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC20 - GENERRX ( SCQ1190 )
2
English text: THOUGHT IT WOULD COST TOO MUCH
MedNotHelpCondition
SC20 - GENERRX ( SCQ1190 )
3
English text: DIDN'T THINK MEDICINE WOULD HELP CONDITION
AfraidOfReactions
SC20 - GENERRX ( SCQ1190 )
English text: WAS AFRAID OF MEDICINE REATIONS/CONTRAINDICATIONS
2:54:22 PM Monday, August 03, 2009
Page 109 of 128
SC18A
4
DontLikeToTakeMed
5
English text: DON'T LIKE TO TAKE MEDICINE
MedNotNecessary
SC20 - GENERRX ( SCQ1190 )
6
English text: DIDN'T THINK MEDICINE WAS NECESSARY
NotCovered
SC20 - GENERRX ( SCQ1190 )
7
English text: NOT COVERED BY INSURANCE/NOT ON PLAN FORMULARY
TroubleObtaining
SC20 - GENERRX ( SCQ1190 )
8
English text: TROUBLE OBTAINING MEDICINE
ObtainedSamples
SC20 - GENERRX ( SCQ1190 )
9
English text: OBTAINED/USED SAMPLES
UsedSubtitute
91
SC20 - GENERRX ( SCQ1190 )
SC20 - GENERRX ( SCQ1190 )
English text: USED ANOTHER MEDICINE AS A SUBSTITUTION
Other
SC20 - GENERRX ( SCQ1190 )
English text: (OTHER/SC17A - SCPMOTOS OTHER SPECIFY TEXT)
Attribute
Don't know
Route
SC20 - GENERRX ( SCQ1190 )
Refusal
SC20 - GENERRX ( SCQ1190 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:54:26 PM Monday, August 03, 2009
Page 110 of 128
SC20
SC20
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
GENERRX
Field 2:
MAILRX
Field 3:
DOSESRX
Field 4:
SKIPRX
Field 5:
DELAYRX
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:
307
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:
SHOW CARD SC4
Question Text:
Please tell me how often during (CURRENT YEAR) [you have /(SP)
has] done any of the following things. [Have you/has (SP)] often,
sometimes, or never…
Int. Instr II:
2:54:29 PM Monday, August 03, 2009
Page 111 of 128
SC20
INPUT FIELDS / ROUTING
GENERRX
Field1:
( SCQ1190 )
ACCS.GENERRX
Cheshire Name:
Item Text display:
Display "a. " before the Item text.
Item Text:
asked for generics instead of brand name drugs?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC20 - MAILRX ( SCQ1195 )
2
English text: OFTEN
Sometimes
SC20 - MAILRX ( SCQ1195 )
3
English text: SOMETIMES
Never
SC20 - MAILRX ( SCQ1195 )
English text: NEVER
Attribute
Don't know
Route
SC20 - MAILRX ( SCQ1195 )
Refusal
SC20 - MAILRX ( SCQ1195 )
2:54:36 PM Monday, August 03, 2009
Page 112 of 128
SC20
MAILRX
Field2:
( SCQ1195 )
ACCS.MAILRX
Cheshire Name:
Item Text display:
Display "b. " before the Item text.
Item Text:
purchased prescription drugs through the mail or on the
Internet?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC20 - DOSESRX ( SCQ1200 )
2
English text: OFTEN
Sometimes
SC20 - DOSESRX ( SCQ1200 )
3
English text: SOMETIMES
Never
SC20 - DOSESRX ( SCQ1200 )
English text: NEVER
Attribute
Don't know
Route
SC20 - DOSESRX ( SCQ1200 )
Refusal
SC20 - DOSESRX ( SCQ1200 )
2:54:42 PM Monday, August 03, 2009
Page 113 of 128
SC20
DOSESRX
Field3:
( SCQ1200 )
ACCS.DOSESRX
Cheshire Name:
Item Text display:
Display "c. " before the Item text.
Item Text:
taken smaller doses than prescribed of a medicine to make
the medicine last longer?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC20 - SKIPRX ( SCQ1205 )
2
English text: OFTEN
Sometimes
SC20 - SKIPRX ( SCQ1205 )
3
English text: SOMETIMES
Never
SC20 - SKIPRX ( SCQ1205 )
English text: NEVER
Attribute
Don't know
Route
SC20 - SKIPRX ( SCQ1205 )
Refusal
SC20 - SKIPRX ( SCQ1205 )
2:54:48 PM Monday, August 03, 2009
Page 114 of 128
SC20
SKIPRX
Field4:
( SCQ1205 )
ACCS.SKIPRX
Cheshire Name:
Item Text display:
Display "d. " before the Item text.
Item Text:
skipped doses to make the medicine last longer?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC20 - DELAYRX ( SCQ1207 )
English text: OFTEN
Sometimes
English text: SOMETIMES
Never
English text: NEVER
Attribute
Don't know
Route
SC20 - DELAYRX ( SCQ1207 )
Refusal
SC20 - DELAYRX ( SCQ1207 )
2:54:55 PM Monday, August 03, 2009
SC20 - DELAYRX ( SCQ1207 )
SC20 - DELAYRX ( SCQ1207 )
Page 115 of 128
SC20
DELAYRX
Field5:
( SCQ1207 )
ACCS.DELAYRX
Cheshire Name:
Item Text display:
Display "e. " before the Item text.
Item Text:
delayed getting a prescription filled because the medicine
cost too much?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC21 - SAMPLERX ( SCQ1210 )
2
English text: OFTEN
Sometimes
SC21 - SAMPLERX ( SCQ1210 )
3
English text: SOMETIMES
Never
SC21 - SAMPLERX ( SCQ1210 )
English text: NEVER
Attribute
Don't know
Route
SC21 - SAMPLERX ( SCQ1210 )
Refusal
SC21 - SAMPLERX ( SCQ1210 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:54:57 PM Monday, August 03, 2009
Page 116 of 128
SC21
SC21
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
SAMPLERX
Field 2:
COMPARRX
Field 3:
NOFILLRX
Field 4:
NONUSRX
Field 5:
SPENTLRX
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
308
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:
SHOW CARD SC4
Question Text:
Please tell me how often during (CURRENT YEAR) [you have /(SP)
has] done any of the following things. [Have you/has (SP)] often,
sometimes, or never…
Int. Instr II:
2:55:00 PM Monday, August 03, 2009
Page 117 of 128
SC21
INPUT FIELDS / ROUTING
SAMPLERX
Field1:
( SCQ1210 )
ACCS.SAMPLERX
Cheshire Name:
Item Text display:
Display "f. " before the Item text.
Item Text:
asked for or received free samples from (your/his/her) doctor
or health provider?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC21 - COMPARRX ( SCQ1215 )
2
English text: OFTEN
Sometimes
SC21 - COMPARRX ( SCQ1215 )
3
English text: SOMETIMES
Never
SC21 - COMPARRX ( SCQ1215 )
English text: NEVER
Attribute
Don't know
Route
SC21 - COMPARRX ( SCQ1215 )
Refusal
SC21 - COMPARRX ( SCQ1215 )
2:55:07 PM Monday, August 03, 2009
Page 118 of 128
SC21
COMPARRX
Field2:
( SCQ1215 )
ACCS.COMPARRX
Cheshire Name:
Item Text display:
Display "g. " before the Item text.
Item Text:
compared prices or shopped around for the best price?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC21 - NOFILLRX ( SCQ1217 )
English text: OFTEN
Sometimes
English text: SOMETIMES
Never
English text: NEVER
Attribute
Don't know
Route
SC21 - NOFILLRX ( SCQ1217 )
Refusal
SC21 - NOFILLRX ( SCQ1217 )
2:55:13 PM Monday, August 03, 2009
SC21 - NOFILLRX ( SCQ1217 )
SC21 - NOFILLRX ( SCQ1217 )
Page 119 of 128
SC21
NOFILLRX
Field3:
( SCQ1217 )
ACCS.NOFILLRX
Cheshire Name:
Item Text display:
Display "h. " before the Item text.
Item Text:
decided not to fill a prescription because it cost too much?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC21 - NONUSRX ( SCQ1220 )
English text: OFTEN
Sometimes
English text: SOMETIMES
Never
English text: NEVER
Attribute
Don't know
Route
SC21 - NONUSRX ( SCQ1220 )
Refusal
SC21 - NONUSRX ( SCQ1220 )
2:55:20 PM Monday, August 03, 2009
SC21 - NONUSRX ( SCQ1220 )
SC21 - NONUSRX ( SCQ1220 )
Page 120 of 128
SC21
NONUSRX
Field4:
( SCQ1220 )
ACCS.NONUSRX
Cheshire Name:
Item Text display:
Display "i. " before the Item text.
Item Text:
purchased prescription drugs from outside of the United
States?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC21 - SPENTLRX ( SCQ1225 )
2
English text: OFTEN
Sometimes
SC21 - SPENTLRX ( SCQ1225 )
3
English text: SOMETIMES
Never
SC21 - SPENTLRX ( SCQ1225 )
English text: NEVER
Attribute
Don't know
Route
SC21 - SPENTLRX ( SCQ1225 )
Refusal
SC21 - SPENTLRX ( SCQ1225 )
2:55:26 PM Monday, August 03, 2009
Page 121 of 128
SC21
SPENTLRX
Field5:
( SCQ1225 )
ACCS.SPENTLRX
Cheshire Name:
Item Text display:
Display "j. " before the Item text.
Item Text:
spent less money on food, heat, or other basic needs so that
(you/he/she) would have money for medicine?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC22 - BORROWRX ( SCQ1230 )
2
English text: OFTEN
Sometimes
SC22 - BORROWRX ( SCQ1230 )
3
English text: SOMETIMES
Never
SC22 - BORROWRX ( SCQ1230 )
English text: NEVER
Attribute
Don't know
Route
SC22 - BORROWRX ( SCQ1230 )
Refusal
SC22 - BORROWRX ( SCQ1230 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:55:29 PM Monday, August 03, 2009
Page 122 of 128
SC22
SC22
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
BORROWRX
Field 2:
CHAINRX
Field 3:
STOPRX
Field 4:
CREDRX
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
309
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD SC4
Question Text:
Please tell me how often during (CURRENT YEAR) [you have /(SP)
has] done any of the following things. [Have you/has (SP)] often,
sometimes, or never…
Int. Instr II:
2:55:32 PM Monday, August 03, 2009
Page 123 of 128
SC22
INPUT FIELDS / ROUTING
BORROWRX
Field1:
( SCQ1230 )
ACCS.BORROWRX
Cheshire Name:
Item Text display:
Display "k. " before the Item text.
Item Text:
borrowed money to pay for prescription drugs?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC22 - CHAINRX ( SCQ1235 )
English text: OFTEN
Sometimes
English text: SOMETIMES
Never
SC22 - CHAINRX ( SCQ1235 )
SC22 - CHAINRX ( SCQ1235 )
English text: NEVER
Attribute
Don't know
Route
SC22 - CHAINRX ( SCQ1235 )
Refusal
SC22 - CHAINRX ( SCQ1235 )
2:55:38 PM Monday, August 03, 2009
Page 124 of 128
SC22
CHAINRX
Field2:
( SCQ1235 )
ACCS.CHAINRX
Cheshire Name:
Item Text display:
Display "l. " before the Item text.
Item Text:
purchased prescription drugs from a large retail chain, like
Wal-Mart or Target, because of its discount plan?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC22 - STOPRX ( SCQ1240 )
2
English text: OFTEN
Sometimes
SC22 - STOPRX ( SCQ1240 )
3
English text: SOMETIMES
Never
SC22 - STOPRX ( SCQ1240 )
English text: NEVER
Attribute
Don't know
Route
SC22 - STOPRX ( SCQ1240 )
Refusal
SC22 - STOPRX ( SCQ1240 )
2:55:45 PM Monday, August 03, 2009
Page 125 of 128
SC22
STOPRX
Field3:
( SCQ1240 )
ACCS.STOPRX
Cheshire Name:
Item Text display:
Display "m. " before the Item text.
Item Text:
talked with (your/his/her) doctor about stopping a medicine to
save money or substituting a medicine with one that is less
expensive?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
SC22 - CREDRX ( SCQ1245 )
English text: OFTEN
Sometimes
English text: SOMETIMES
Never
SC22 - CREDRX ( SCQ1245 )
SC22 - CREDRX ( SCQ1245 )
English text: NEVER
Attribute
Don't know
Route
SC22 - CREDRX ( SCQ1245 )
Refusal
SC22 - CREDRX ( SCQ1245 )
2:55:51 PM Monday, August 03, 2009
Page 126 of 128
SC22
CREDRX
Field4:
( SCQ1245 )
ACCS.CREDRX
Cheshire Name:
Item Text display:
Display "n. " before the Item text.
Item Text:
used a credit card so that (you/he/she) could pay for
prescription drugs over time?
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THowOften
1
No
No
Number Label
1 Often
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX SCEND - (SCQ1280 )
2
English text: OFTEN
Sometimes
BOX SCEND - (SCQ1280 )
3
English text: SOMETIMES
Never
BOX SCEND - (SCQ1280 )
English text: NEVER
Attribute
Don't know
Route
BOX SCEND - (SCQ1280 )
Refusal
BOX SCEND - (SCQ1280 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
2:55:54 PM Monday, August 03, 2009
Page 127 of 128
BOX SCEND
BOX SCEND
Page Order # :
320
BOX INSTRUCTIONS
( SCQ1280 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
2:55:54 PM Monday, August 03, 2009
Page 128 of 128
| File Type | application/pdf |
| Author | hubbard_r |
| File Modified | 2010-04-06 |
| File Created | 0000-00-00 |