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pdfMP1
MP1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPPRMDOC
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 reported utilization during the current round, display "Besides
what you have already mentioned, [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]".
Else display "[Since (REFERENCE DATE)/Between(REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]".
If SP is alive and not institutionalized, display "seen".
Else display "see".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
11:06:23 AM Friday, March 06, 2009
(Besides what you have already mentioned), [(Since/since
(REFERENCE DATE)/(Between/between) (REFERENCE DATE)
Page 1 of 91
MP1
and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION), [have
you/has (SP)/did (SP)] (seen/see) any medical doctors?
INCLUDE ANY VISITS FOR TESTS/X-RAYS.
SEE REFERENCE CARD FOR TYPES OF MEDICAL DOCTORS, IF
NECESSARY.
Int. Instr II:
INPUT FIELDS / ROUTING
MPPRMDOC
Field1:
Cheshire Name:
Item Text display:
( MPQ1020 )
HRND.MPPRMDOC
Do not display response option 3/IndicatedYesByDataprep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
MP18 - MPPRPRAC ( MPQ1650 )
DO NOT DISPLAY.
DATA EDITING ONLY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
MP18 - MPPRPRAC ( MPQ1650 )
Refusal
MP18 - MPPRPRAC ( MPQ1650 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
11:06:26 AM Friday, March 06, 2009
Page 2 of 91
MP1
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
168
MPUtilizationCheck
SP reported utilization during the current round [up to MP
section] =
DU1-DUPROBE, ER1-ERPROBE, IP1-IPPROBE, OP1
OPPROBE, IU-IUPROBE, HH1-HHPRPROF, HH18
HHPRFRND, MP1-MPPRMDOC, MP18-MPPRPRAC,
MP26-MPPRMENT, MP34-MPPRTHER, or MP42
MPPRPERS=1/Yes.
DESIGN NOTES
11:06:26 AM Friday, March 06, 2009
Page 3 of 91
MP2
MP2
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PROVIDER_MP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Provider Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
30
Display as ' Add a Provider '
Display as ' Edit a Provider '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all Providers except for Providers where
PROV.PROVNUM=01 and 02, which are reserved for PM and OM
events.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
1
Provider Name
INSTRUCTIONS
Display PROV.PROVNAME.
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Who did [you/(SP)] see?
Int. Instr II:
SELECT OR ADD ONLY ONE PROVIDER.
INPUT FIELDS / ROUTING
11:06:27 AM Friday, March 06, 2009
Page 4 of 91
MP2
PROVIDER_MP
Field1:
( MPQ1030 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
String
TProvPick4
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
4
Route
BOX MP1B - (MPQ1034 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on PROV:
PROV key = PROV.PROVBASE + PROV.PROVNUM
PROV.PROVNUM = Number of Provider selected at MP2.
If Provider added at Provider Roster, see PROVIDER ROSTER POP-UP specifications for
pop-up window programming instructions.
Variables populated in Provider Roster Pop-Up Window:
PROV.PROVNUM
PROV.PROVRNDC
PROV.PROVNAME
Provider number
Round number
Provider name
If Provider added, set provider type based on which probe the Provider was entered, MP1,
MP18, MP26, MP23, MP42, or MP50. See detailed instructions below.
If Provider added from MP1 probe, set provider specialty as specified below.
PROVTYPE
MP1:
MP18:
MP26:
MP34:
MP42:
MP50:
PROVTYPE=8/MedicalDoctor.
PROVTYPE=9/HealthPractitioner.
PROVTYPE=10/MentalHealthPractitioner.
PROVTYPE=11/Therapist.
PROVTYPE=12/OtherMedicalPerson.
PROVTYPE=13/OtherMedicalPlace.
PROVSPEC
If Provider entered from MP1 probe, set
PROV.PROVSPEC=2/MedicalDoctor.
SOFT EDIT CHECKS
HARD EDIT CHECKS
11:06:28 AM Friday, March 06, 2009
Page 5 of 91
MP2
TECHNICAL NOTES
DESIGN NOTES
Begin Loop 1: Probe for one provider, collect all event dates for this
provider.
11:06:28 AM Friday, March 06, 2009
Page 6 of 91
BOX MP1B
BOX MP1B
Page Order # :
32
BOX INSTRUCTIONS
( MPQ1034 )
IF (PROVIDER IS A MEDICAL PLACE) OR (PROVIDER SPECIALTY HAS
ALREADY BEEN COLLECTED), GO TO BOX MP1 - (MPQ1060 ).
ELSE GO TO MP2A - PROVSPEC ( MPQ1036 ).
ASSIGNMENTS
TECHNICAL NOTES
169
ProviderMedicalPlace
Provider is a Medical Place =
Provider selected following MP50 Probe, MPPRPLAC =
1/Yes.
170
ProviderSpecCollected
Provider Specialty has already been collected =
PROV.PROVSPEC ^= EMPTY.
Provider Specialty has not been collected =
PROV.PROVSPEC = EMPTY.
DESIGN NOTES
Provider Specialty is asked at MP2A for Providers entered from MP18,
MP26, MP34, MP42 probes.
Provider Specialty was already set to "Medical Doctor" for Providers
entered from MP1 probe.
Providers entered from MP50 probe do not get Provider Specialty since
the probe is for Medical Places, not Medical Persons.
11:06:28 AM Friday, March 06, 2009
Page 7 of 91
MP2A
MP2A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PROVSPEC
Field 2:
PROVSPOS
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
34
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 Provider entered following MP18 probe, display "health
practitioner".
Else if Provider entered from MP26 probe, display "mental health
professional".
Else if Provider entered from MP34 probe, display "therapist".
Else if Provider entered from MP42 probe, display "medical person".
Display name of medical provider, PROV.PROVNAME, currently
being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
11:06:33 AM Friday, March 06, 2009
What kind of (health practitioner/mental health
Page 8 of 91
MP2A
professional/therapist/medical person) is (PROVIDER NAME)?
Int. Instr II:
INPUT FIELDS / ROUTING
11:06:43 AM Friday, March 06, 2009
Page 9 of 91
MP2A
PROVSPEC
Field1:
Cheshire Name:
( MPQ1036 )
PROV.PROVSPEC
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProvspec
1
No
No
Number Label
1 Dentist
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX MP1 - (MPQ1060 )
English text: DENTIST/DENTAL PROVIDER
BOX MP1 - (MPQ1060 )
MedicalDoctor
4
English text: MEDICAL DOCTOR
Audiologist
English text: AUDIOLOGIST
Chiropractor
5
English text: CHIROPRACTOR
ClinicalSocialWorker
BOX MP1 - (MPQ1060 )
6
English text: CLINICAL SOCIAL WORKER
Dietitian
BOX MP1 - (MPQ1060 )
7
English text: DIETITIAN-NUTRITIONIST
HearingTherapist
BOX MP1 - (MPQ1060 )
8
English text: HEARING THERAPIST
HomeHealthAide
BOX MP1 - (MPQ1060 )
9
English text: HOME HEALTH/HEALTH AIDE
Homemaker
BOX MP1 - (MPQ1060 )
3
BOX MP1 - (MPQ1060 )
BOX MP1 - (MPQ1060 )
10
English text: HOMEMAKER
HospiceWorker
BOX MP1 - (MPQ1060 )
11
English text: HOSPICE WORKER
IvTherapist
BOX MP1 - (MPQ1060 )
12
English text: I.V. THERAPIST
Nurse
BOX MP1 - (MPQ1060 )
13
English text: NURSE (RN)
NursePractitioner
BOX MP1 - (MPQ1060 )
English text: NURSE PRACTITIONER
11:07:00 AM Friday, March 06, 2009
Page 10 of 91
MP2A
14
NursesAide
BOX MP1 - (MPQ1060 )
15
English text: NURSE'S AIDE
OccupationalTherapist
BOX MP1 - (MPQ1060 )
16
English text: OCCUPATIONAL THERAPIST (OT)
Optometrist
BOX MP1 - (MPQ1060 )
17
English text: OPTOMETRIST (OD)
Osteopath
BOX MP1 - (MPQ1060 )
18
English text: OSTEOPATH (DO)
Paramedic
BOX MP1 - (MPQ1060 )
19
English text: PARAMEDIC
PhysicalTherapist
BOX MP1 - (MPQ1060 )
20
English text: PHYSICAL THERAPIST (PT)
PhysiciansAssistant
BOX MP1 - (MPQ1060 )
21
English text: PHYSICIAN'S ASSISTANT
Podiatrist
BOX MP1 - (MPQ1060 )
22
English text: PODIATRIST (FOOT DOCTOR)
Psychologist
BOX MP1 - (MPQ1060 )
23
English text: PSYCHOLOGIST
RespiratoryTherapist
BOX MP1 - (MPQ1060 )
25
English text: RESPIRATORY THERAPIST
SocialWorker
English text: SOCIAL/CASE WORKER
SpeechTherapist
BOX MP1 - (MPQ1060 )
26
English text: SPEECH THERAPIST
MentalHealth
BOX MP1 - (MPQ1060 )
24
BOX MP1 - (MPQ1060 )
28
English text: THERAPIST (MENTAL HEALTH)
XrayTechnician
BOX MP1 - (MPQ1060 )
English text: X-RAY TECHNICIAN
LicensedPracticalNurse
BOX MP1 - (MPQ1060 )
29
English text: LICENSED PRACTICAL NURSE (LPN)
Acupuncturist
BOX MP1 - (MPQ1060 )
27
31
English text: ACUPUNCTURIST
Homeopath
English text: HOMEOPATH
MassageTherapist
32
English text: MASSAGE THERAPIST
Naturopath
BOX MP1 - (MPQ1060 )
33
English text: NATUROPATH
LicensedCounselor
BOX MP1 - (MPQ1060 )
34
English text: LICENSED PROFESSIONAL COUNSELOR [LPC]
LabTechnician
BOX MP1 - (MPQ1060 )
30
BOX MP1 - (MPQ1060 )
BOX MP1 - (MPQ1060 )
English text: LAB TECHNICIAN
11:07:20 AM Friday, March 06, 2009
Page 11 of 91
MP2A
91
Other
MP2A - PROVSPOS ( MPQ1037 )
English text: OTHER MEDICAL PROVIDER SPECIALTY
Attribute
Don't know
Route
BOX MP1 - (MPQ1060 )
Refusal
BOX MP1 - (MPQ1060 )
Field2:
Cheshire Name:
PROVSPOS
( MPQ1037 )
PROV.PROVSPOS
Item Text display:
Display "(SPECIFY)" is same blue font used for interviewer
instructions.
Item Text:
OTHER MEDICAL PROVIDER (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 MP1 - (MPQ1060 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:07:22 AM Friday, March 06, 2009
Page 12 of 91
BOX MP1
BOX MP1
Page Order # :
40
BOX INSTRUCTIONS
( MPQ1060 )
IF (SP REPORTED RECEIVING HEALTH CARE SERVICES THROUGH V.A.
IN THE CURRENT ROUND OR ANY PREVIOUS ROUND) AND (IF THIS
PROVIDER IS ASSOCIATED WITH V.A. IS UNKNOWN), GO TO MP3
VAPLACE ( MPQ1070 ).
ELSE GO TO BOX MP2 - (MPQ1080 ).
ASSIGNMENTS
TECHNICAL NOTES
423
SPReceivedCaretThruV
A
SP reported receiving health care services through V.A.in
the current or any previous round =
There is an HRND where HRND.HRNDRND = current
round and HRND.VACOVER = 1/Yes.
HRND.VACOVER is set at BOX HI20 or collected at HI36.
127
ProviderVAUnknown
If Provider is associated with V.A. is unknown =
PROV.VAPLACE = empty.
DESIGN NOTES
11:07:22 AM Friday, March 06, 2009
Page 13 of 91
MP3
MP3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
VAPLACE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
50
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of medical provider, PROV.PROVNAME, currently
being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Is (PROVIDER NAME) associated with a Department of Veterans
Affairs, or V.A., facility?
Int. Instr II:
INPUT FIELDS / ROUTING
11:07:24 AM Friday, March 06, 2009
Page 14 of 91
MP3
VAPLACE
Field1:
Cheshire Name:
( MPQ1070 )
PROV.VAPLACE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX MP2 - (MPQ1080 )
English text: YES
No
BOX MP2 - (MPQ1080 )
English text: NO
Attribute
Don't know
Route
BOX MP2 - (MPQ1080 )
Refusal
BOX MP2 - (MPQ1080 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:07:26 AM Friday, March 06, 2009
Page 15 of 91
BOX MP2
BOX MP2
11:07:26 AM Friday, March 06, 2009
Page Order # :
60
Page 16 of 91
BOX MP2
BOX INSTRUCTIONS
( MPQ1080 )
IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE
CURRENT ROUND) AND (IF THIS PROVIDER IS ASSOCIATED WITH A
MANAGED CARE PLAN IS UNKNOWN), GO TO MP4 - HMOASSOC (
MPQ1090 ).
ELSE IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING
THE CURRENT ROUND) AND (THIS PROVIDER IS NOT ASSOCIATED
WITH A MANAGED CARE PLAN), GO TO MP5 - HMOREFER ( MPQ1100 ).
ELSE GO TO MP6 - EVENT_MP ( MPQ1140 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
128
ProviderHMOUnknown
If Provider is associated with a Managed Care plan is
unknown =
PROV.HMOASSOC=empty.
130
ProviderNotHMO
Provider is not associated with a Managed Care plan =
PROV.HMOASSOC=2/No, DK, or RF.
129
ProviderAssocHMO
Provider is associated with a Managed Care plan =
PROV.HMOASSOC=1/Yes.
DESIGN NOTES
If the SP belongs to a managed care plan (HMO), we ask each provider
selected/added if the provider is associated with an HMO. This question,
which is asked throughout utilization and cost series, is only asked once
in the study for each provider. The response is never updated. (this
design may change in the future).
If the SP belongs to an HMO, and we have not asked this question for this
provider, HMOASSOC=empty, you are to HMOASSOC. If we have
already asked this question about this provider, and the provider
responded to HMOASSOC=No, DK or RF, you are routed to
HMOREFER, skipping HMOASSOC, to determine if the SP was referred
to this provider by their HMO.
If SP does not belong to an HMO or this provider already reported being
associated with the HMO, you are routed directly to the event roster.
11:07:26 AM Friday, March 06, 2009
Page 17 of 91
MP4
MP4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HMOASSOC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
70
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of medical provider, PROV.PROVNAME, currently
being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
11:07:27 AM Friday, March 06, 2009
Page 18 of 91
MP4
Int. Instr I:
Is (PROVIDER NAME) associated with [your/(SP’s)] [READ
MANAGED CARE PLAN NAME(S) BELOW] plan?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
HMOASSOC
Field1:
Cheshire Name:
( MPQ1090 )
PROV.HMOASSOC
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP6 - EVENT_MP ( MPQ1140 )
English text: YES
No
MP5 - HMOREFER ( MPQ1100 )
English text: NO
Attribute
Don't know
Route
MP5 - HMOREFER ( MPQ1100 )
Refusal
MP5 - HMOREFER ( MPQ1100 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
11:07:30 AM Friday, March 06, 2009
Deleted plans that are not valid for displays or checks =
Page 19 of 91
MP4
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
11:07:30 AM Friday, March 06, 2009
Page 20 of 91
MP5
MP5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HMOREFER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
80
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of medical provider, PROV.PROVNAME, currently
being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
11:07:32 AM Friday, March 06, 2009
Page 21 of 91
MP5
Int. Instr I:
[Were you/Was (SP)] referred to (PROVIDER NAME) by [READ
MANAGED CARE PLAN NAME(S) BELOW]?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
HMOREFER
Field1:
Cheshire Name:
( MPQ1100 )
EVNT.HMOREFER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP6 - EVENT_MP ( MPQ1140 )
English text: YES
No
MP5B - NOGOHMO ( MPQ1110 )
English text: NO
Attribute
Don't know
Route
MP6 - EVENT_MP ( MPQ1140 )
Refusal
MP6 - EVENT_MP ( MPQ1140 )
BACKGROUND VARIABLE ASSIGNMENTS
MP5 - HMOREFER is an EVENT level detail. The response to MP5 - HMOREFER needs
to be copied to EVNT.HMOREFER for each MP Event added at MP6.
SOFT EDIT CHECKS
HARD EDIT CHECKS
11:07:35 AM Friday, March 06, 2009
Page 22 of 91
MP5
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
11:07:35 AM Friday, March 06, 2009
Page 23 of 91
MP5B
MP5B
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NOGOHMO
Field 2:
NOGOHMOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
100
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
11:07:37 AM Friday, March 06, 2009
Page 24 of 91
MP5B
Int. Instr I:
Question Text:
What is the most important reason [you/(SP)] did not see a doctor
associated with [READ MANAGED CARE PLAN NAME(S) BELOW]
or a doctor that [READ MANAGED CARE PLAN NAME(S) BELOW]
would refer [you/(SP)] to?
Int. Instr II:
SCROLL DOWN TO SEE RESPONSE CATEGORIES.
INPUT FIELDS / ROUTING
11:07:43 AM Friday, March 06, 2009
Page 25 of 91
MP5B
NOGOHMO
Field1:
Cheshire Name:
Item Text display:
( MPQ1110 )
EVNT.NOGOHMO
Display respnonses in one column.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Tnogohmo
1
No
No
Number Label
1 PlanNotCoverService
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP6 - EVENT_MP ( MPQ1140 )
English text: PLAN DOES NOT COVER THE SERVICE SP WANTED
DifficultyDelayGettingService
MP6 - EVENT_MP ( MPQ1140 )
4
English text: DIFFICULTY OR DELAY IN GETTING SERVICES
SPProviderPreference
MP6 - EVENT_MP ( MPQ1140 )
English text: SP PROVIDER PREFERENCE
ServiceCoverdbyOtherInsurance
MP6 - EVENT_MP ( MPQ1140 )
5
English text: THIS SERVICE WAS COVERED BY OTHER INSURANCE SP HAS
NotinManagedCareTimeofEvent
MP6 - EVENT_MP ( MPQ1140 )
6
English text: NOT IN A MANAGED CARE PLAN AT TIME OF EVENT
NoChoiceMedEmergency
MP6 - EVENT_MP ( MPQ1140 )
3
91
English text: NO CHOICE - MEDICAL EMERGENCY OR OUT OF SERVICE AREA
Other
MP5B - NOGOHMOS ( MPQ1120 )
English text: OTHER
Attribute
Don't know
Route
MP6 - EVENT_MP ( MPQ1140 )
Refusal
MP6 - EVENT_MP ( MPQ1140 )
11:07:49 AM Friday, March 06, 2009
Page 26 of 91
MP5B
NOGOHMOS
Field2:
Cheshire Name:
( MPQ1120 )
EVNT.NOGOHMOS
Item Text display:
Display "(SPECIFY)" is 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
MP6 - EVENT_MP ( MPQ1140 )
BACKGROUND VARIABLE ASSIGNMENTS
MP5B - NOGOHMO and NOGOHMOS are EVENT level details. The response to MP5B
NOGOHMO and NOGOHMOS needs to be copied to EVNT.NOGOHMO and
EVNT.NOGOHMOS for each MP Event added at MP6.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
11:07:50 AM Friday, March 06, 2009
Page 27 of 91
MP5B
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
11:07:50 AM Friday, March 06, 2009
Page 28 of 91
MP6
MP6
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_MP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date RV
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
110
Display as ' Add Medical Provider Visit '
Display as ' Edit a Visit '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of medical provider, PROV.PROVNAME, currently
being asked about.
Multi Field display:
Roster/Grid Instructions:
Display all Medical Provider Events for this provider that have been
added in the current round where:
EVNT.EVNTDFLG ^= 1/Yes, and
EVNT.EVNTRNDC = current round, and
EVNT.EVNTTYPE = 'MP', and
EVNT.EVNTPROV=PROV.PROVNUM for the provider selected at
MP2.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
11:07:51 AM Friday, March 06, 2009
COL #
HEADER
INSTRUCTIONS
1
Event Date
Display EVENT DATE in "Mon DD YYYY"
format.
2
Repeat Visit
If VISTTYPE=2/RepeatVisit, display "RV".
Else do not display.
3
Times Per Month
If VISTTYPE=2/RepeatVisit, display
EVNT.RVTIMES.
Else do not display.
Page 29 of 91
MP6
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
When did [you/(SP)] see (PROVIDER NAME)? Please tell me all
the dates [since (REFERENCE DATE)/between (REFERENCE
DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION)].
Int. Instr II:
ENTER ALL DATES.
INPUT FIELDS / ROUTING
EVENT_MP
Field1:
( MPQ1140 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
String
TEvntPick135
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
MP6_IN - NAVIGATOR ( MPQ1145 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of event selected at MP6.
For Event(s) added, see EVENT ROSTER BEGIN DATE RV POP-UP specifications for
pop-up window programming instructions.
Variables populated in Event Roster Begin Date RV:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
EVNT.VISTTYPE
Event number
Round
Visit Month
Visit Day
Visit Year
Type of Visit
11:07:52 AM Friday, March 06, 2009
Page 30 of 91
MP6
EVNT.RVTIMES
BASE.LASTEVNT
# of visits for Repeat Visit
Highest EVNT.EVNTNUM
For each event added at MP6, set Event type, Statement Event type, Event provider
number, MP type and Event details collected at MP5 and MP5B. Set MP type for Event
based on MP probe where Provider was entered. See detailed instructions below.
EVNTTYPE
EVNT.EVNTTYPE = 'MP'.
STEVTYPE
EVNT.STEVTYPE = 10/MP.
EVNTPROV
EVNT.EVNTPROV=PROV.PROVNUM of Provider
selected at MP2.
HMOREFER
EVNT.HMOREFER = Response to MP5
HMOREFER.
NOGOHMO
EVNT.NOGOHMO = Response to MP5B NOGOHMO.
NOGOHMOS
EVNT.NOGOHMOS = Response to MP5B NOGOHMOS.
MPTYPE
Set EVNT.MPTYPE based on probe:
MP1: MPTYPE=1/MedicalDoctor
MP18: MPTYPE=2/HealthPractitioner
MP26: MPTYPE=3/MentalHealthPractitioner
MP34: MPTYPE=4/Therapist
MP42: MPTYPE=5/OtherMedicalPerson
MP50: MPTYPE=6/OtherMedicalPlace
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (today/DATE OF DEATH/DATE
OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
See date check logic in general specifications.
Edit #2:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing MP event date for the provider selected at MP2. If date of
event added at MP6 does not have missing data, EVBEGMM,
EVBEGDD, EVBEGYY ^= DK and EVBEGMM, EVBEGDD,
EVBEGYY ^= RF, then check this date against other MP event dates
for duplicate dates.
The following must be true for the event added at MP6 to be a
duplicate of an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
Both EVNTTYPE='MP'.
EVNTPROV matches.
EVBEGMM matches.
If EVBEGDD ^= empty, EVBEGDD matches.
Else If EVBEGDD = empty, both VISTTYPE=2/RepeatVisit.
EVBEGYY matches.
11:07:52 AM Friday, March 06, 2009
Page 31 of 91
MP6
The date of the event added at MP6 should not match any MP event
date for the provider selected at MP2.
If not true, display message "INVALID DATE. THIS DATE
MATCHES AN EXISTING MEDICAL PROVIDER VISIT TO
(PROVIDER NAME).
Display instructions: Display name of medical provider,
PROV.PROVNAME, currently being asked about.
TECHNICAL NOTES
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
Begin Loop 2: Collect all event dates for this provider, loop through details
for each event added at MP6.
MP allows you to select a provider more than once at MP2. If this provider
has already been selected and visits added at MP6 in an earlier loop, the
visits will be displayed at MP6 as protected rows.
11:07:52 AM Friday, March 06, 2009
Page 32 of 91
MP6_IN
MP6_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
115
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display events added at MP6.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
11:07:53 AM Friday, March 06, 2009
Page 33 of 91
MP6_IN
NAVIGATOR
Field1:
Cheshire Name:
( MPQ1145 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX MP2AA - (MPQ1190 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX MP6AA - (MPQ1395 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:07:54 AM Friday, March 06, 2009
Page 34 of 91
BOX MP2AA
BOX MP2AA
Page Order # :
120
BOX INSTRUCTIONS
( MPQ1190 )
FOR FIRST/NEXT EVENT ENTERED AT MP6, IF (PROVIDER SPECIALTY
IS A MEDICAL DOCTOR) AND ((EVENT DATE OVERLAPS AN EXISTING IP
EVENT) OR (EVENT DATE MATCHES AN EXISTING ER OR OP EVENT),
GO TO MP6B - MPSDVIS ( MPQ1200 ).
ELSE GO TO BOX MP2C - (MPQ1220 ).
ASSIGNMENTS
TECHNICAL NOTES
171
ProviderMedicalDoctor
Provider Specialty is a Medical Doctor =
PROV.PROVSPEC=2/MedicalDoctor
350
OverlapERIPOPStay
Event date overlaps an existing IP stay or Event date
matches an existing ER or OP event date =
See general specifications for detailed date logic check.
DESIGN NOTES
11:07:54 AM Friday, March 06, 2009
Page 35 of 91
MP6B
MP6B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPSDVIS
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:
Display name of medical provider, PROV.PROVNAME, currently
being asked about.
Display date of event for the Medical Provider visit being asked
about.
Question display:
EVENT MONTH = Display Month of the Medical Provider visit being
asked about.
Display name of medical provider, PROV.PROVNAME, currently
being asked about.
Display "in" in the second sentence in BOLD.
If event overlaps or matches more than one existing ER, IP, or OP
event, display "any of these places".
Else display "the [READ EVENT LISTED BELOW]".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below question text.
Display ER, IP, and OP events that overlap or match the MP visit
date being asked about.
11:07:56 AM Friday, March 06, 2009
Page 36 of 91
MP6B
Report Header: OVERLAPPING EVENT DATES
Column 1, header = "EVENT TYPE".
Column 1, display =
If EVNT.EVNTTYPE = 2/ER, display "Emergency Room".
Else if EVNT.EVNTTYPE = 5/IP, display "Hospital as an Inpatient".
Else if EVNT.EVNTTYPE = 9/OP, display "Outpatient Department".
Column 2, header = "EVENT DATE".
Column 2, display EVENT BEGIN DATE
Column 3, header = "EVENT END DATE".
Column 3, display EVENT END DATE
TEXT:
Context Header:
PROVIDER: (PROVIDER NAME)
EVENT: (EVENT DATE)
Int. Instr I:
Question Text:
We have recorded that in (EVENT MONTH) [you were/(SP) was]
also in [READ EVENT(S) LISTED BELOW]. Was this visit with
(PROVIDER NAME) a visit while [you were/(SP) was] in [the [READ
EVENT LISTED BELOW]/any of these places]?
Int. Instr II:
INPUT FIELDS / ROUTING
11:07:58 AM Friday, March 06, 2009
Page 37 of 91
MP6B
( MPQ1200 )
MPSDVIS
Field1:
Cheshire Name:
EVNT.MPSDVIS
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 MP2B - (MPQ1210 )
English text: YES
No
BOX MP2C - (MPQ1220 )
English text: NO
Attribute
Don't know
Route
BOX MP2C - (MPQ1220 )
Refusal
BOX MP2C - (MPQ1220 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
350
OverlapERIPOPStay
Event date overlaps an existing IP stay or Event date
matches an existing ER or OP event date =
See general specifications for detailed date logic check.
DESIGN NOTES
11:08:01 AM Friday, March 06, 2009
Page 38 of 91
BOX MP2B
BOX MP2B
Page Order # :
140
BOX INSTRUCTIONS
( MPQ1210 )
UPDATE EVENT TYPE TO SEPARATELY BILLING DOCTOR AND GO TO
BOX MP6 - (MPQ1390 ).
ASSIGNMENTS
EVNTTYPE
EVNT.EVNTTYPE = 'SD'.
STEVTYPE
EVNT.STEVTYPE = 2/SD.
TECHNICAL NOTES
DESIGN NOTES
11:08:01 AM Friday, March 06, 2009
Page 39 of 91
BOX MP2C
BOX MP2C
Page Order # :
150
BOX INSTRUCTIONS
( MPQ1220 )
IF PROVIDER SPECIALTY = Dentist, Medical Doctor, Optometrist, Osteopath,
Paramedic, PhysicianAssistant, Podiatrist, Other, DK or RF, GO TO MP7 ANYOPERS ( MPQ1230 ).
ELSE GO TO MP10 - SPECCOND ( MPQ1270 ).
ASSIGNMENTS
TECHNICAL NOTES
382
ProvSpecCheck
Provider Specialty listed in BOX MP2C =
PROV.PROVSPEC =1/Dentist, 2/MedicalDoctor,
16/Optometrist, 17/Osteopath, 18/Paramedic,
20/PhysicianAssistant, 21/Podiatrist, 91/Other, DK or RF.
If PROV.PROVSPEC is collected at MP2A if not already
reported.
DESIGN NOTES
BOX MP2C is called from BOX ST23A and BOX NS23A when a Medical
Provider visit is added in ST or NS.
11:08:01 AM Friday, March 06, 2009
Page 40 of 91
MP7
MP7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ANYOPERS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
160
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display date of event for the Medical Provider visit being asked
about.
If event entered as a Repeat Visit then display "any of the".
Else display "the".
If MP7 is being asked for the first time in the current round
interview, display, "[Operations include surgery..]". Always display
this sentence in brackets.
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
11:08:02 AM Friday, March 06, 2009
Were any operations performed on [you/(SP)] during (any of the/the)
[VISIT ON EVENT DATE]?
Page 41 of 91
MP7
[Operations include surgery and other surgical procedures like
setting bones, stitching or removing growths, or any cutting of the
skin.]
Int. Instr II:
INPUT FIELDS / ROUTING
( MPQ1230 )
ANYOPERS
Field1:
Cheshire Name:
EVNT.ANYOPERS
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
MP11 - CONDITION_MP ( MPQ1280 )
English text: YES
No
MP10 - SPECCOND ( MPQ1270 )
English text: NO
Attribute
Don't know
Route
MP10 - SPECCOND ( MPQ1270 )
Refusal
MP10 - SPECCOND ( MPQ1270 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
136
NumberRepeatVisits
11:08:05 AM Friday, March 06, 2009
Number of Repeat Visits =
Page 42 of 91
MP7
EVNT.RVTIMES.
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
11:08:05 AM Friday, March 06, 2009
Page 43 of 91
MP10
MP10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
SPECCOND
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:
Display date of event for the Medical Provider visit currently being
asked about.
Question display:
If event entered as a Repeat Visit, display "Were any of these visits".
Else display "Was this visit".
Display name of medical provider, PROV.PROVNAME, currently
being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
DATE OF MEDICAL VISIT: [VISIT ON EVENT DATE]
Int. Instr I:
Question Text:
(Was this visit/Were any of these visits) to (PROVIDER NAME) for
any specific condition?
Int. Instr II:
11:08:06 AM Friday, March 06, 2009
Page 44 of 91
MP10
INPUT FIELDS / ROUTING
SPECCOND
Field1:
Cheshire Name:
( MPQ1270 )
EVNT.SPECCOND
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
MP11 - CONDITION_MP ( MPQ1280 )
English text: YES
No
English text: NO
BOX MP2D - (MPQ1290 )
Attribute
Don't know
Route
BOX MP2D - (MPQ1290 )
Refusal
BOX MP2D - (MPQ1290 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
11:08:09 AM Friday, March 06, 2009
Page 45 of 91
MP11
MP11
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
CONDITION_MP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Condition Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
210
Display as ' Add a Condition '
Display as ' Edit a Condition '
DISPLAY INSTRUCTIONS:
Context header display:
Display date of event for the Medical Provider visit currently being
asked about.
Question display:
If MP7 = 1\Yes, then display, then display "What condition required
the surgery]".
Else display "What was the condition".
Multi Field display:
Roster/Grid Instructions:
Display all Conditions.
Display in alphabetical order.
Roster/Grid display:
Report display:
TEXT:
Context Header:
DATE OF MEDICAL VISIT: [VISIT ON EVENT DATE]
Int. Instr I:
Question Text:
(What condition required the surgery/What was the condition)?
Int. Instr II:
SELECT OR ADD ALL CONDITIONS.
INPUT FIELDS / ROUTING
11:08:09 AM Friday, March 06, 2009
Page 46 of 91
MP11
Field1:
Cheshire Name:
CONDITION_MP
( MPQ1280 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TCondPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX MP2D - (MPQ1290 )
BACKGROUND VARIABLE ASSIGNMENTS
Conditions will be collected on COND:
COND key = COND.CONDBASE + COND.CONDNUM
COND.CONDNUM = Number of condition selected at MP11.
If adding a new condition, see CONDITION ROSTER POP-UP specifications for pop-up
window programming instructions.
Variables populated at the Condition Roster:
COND.CONDNUM
COND.CONDRNDC
COND.CONDTION
All Conditions selected at MP11 should be linked to the Medical Provider visit being asked
about. Link Conditions to MP visit on XCON.
XCON key = XCON.XCONBASE + XCON.XCONEVNT + XCON.XCONBAS2 +
XCON.XCONCOND.
For each condition selected at MP11, create an XCON where XCONEVNT=
EVNT.EVNTNUM of Medical Provider visit and XCONCOND = COND.CONDNUM of
Condition. XCONBASE and XCONBAS2 both equal the Cheshire BASE.BASEID. Set
additional XCON variables as specified below.
XCONEVNT
XCON.XCONEVNT = EVNT.EVNTNUM of Medical
Provider visit being asked about.
XCONCOND
XCON.XCONCOND = COND.CONDNUM of
condition selected at MP11.
XCONRNDC
XCON.XCONRNDC = current round.
SOFT EDIT CHECKS
11:08:10 AM Friday, March 06, 2009
Page 47 of 91
MP11
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:08:10 AM Friday, March 06, 2009
Page 48 of 91
BOX MP2D
BOX MP2D
Page Order # :
220
BOX INSTRUCTIONS
( MPQ1290 )
IF CURRENTLY ADMINISTERING ST, GO TO BOX ST23B - (STQ1700 ).
ELSE IF CURRENTLY ADMINISTERING NS, GO TO BOX NS23B (NSQ1700 ).
ELSE GO TO MP12 - PRESMDCN ( MPQ1300 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If currently administering ST or NS, return to BOX ST23B or BOX NS23B.
11:08:10 AM Friday, March 06, 2009
Page 49 of 91
MP12
MP12
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRESMDCN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
230
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display date of event for the Medical Provider visit currently being
asked about.
Question display:
If event entered as a Repeat Visit, display "any of these visits".
Else display "this visit".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
DATE OF MEDICAL VISIT: [VISIT ON EVENT DATE]
Int. Instr I:
Question Text:
During (this visit/any of these visits) to (PROVIDER NAME), were
any medicines prescribed for [you/(SP)]?
Int. Instr II:
INPUT FIELDS / ROUTING
11:08:11 AM Friday, March 06, 2009
Page 50 of 91
MP12
PRESMDCN
Field1:
Cheshire Name:
( MPQ1300 )
EVNT.PRESMDCN
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP13 - PRESFILL ( MPQ1310 )
English text: YES
No
BOX MP6 - (MPQ1390 )
English text: NO
Attribute
Don't know
Route
BOX MP6 - (MPQ1390 )
Refusal
BOX MP6 - (MPQ1390 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
135
RepeatVisitEvent
If Event entered as a Repeat Visit =
EVNT.VISTTYPE=2/RepeatVisit.
DESIGN NOTES
11:08:14 AM Friday, March 06, 2009
Page 51 of 91
MP13
MP13
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRESFILL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
240
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Were any of the prescriptions filled?
Int. Instr II:
INPUT FIELDS / ROUTING
11:08:15 AM Friday, March 06, 2009
Page 52 of 91
MP13
PRESFILL
Field1:
Cheshire Name:
( MPQ1310 )
EVNT.PRESFILL
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX MP3A - (MPQ1320 )
English text: YES
No
BOX MP6 - (MPQ1390 )
English text: NO
Attribute
Don't know
Route
BOX MP6 - (MPQ1390 )
Refusal
BOX MP6 - (MPQ1390 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:08:17 AM Friday, March 06, 2009
Page 53 of 91
BOX MP3A
BOX MP3A
Page Order # :
250
BOX INSTRUCTIONS
( MPQ1320 )
IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN
ASKED IN THE CURRENT ROUND, GO TO MP13A - MPPMMEDS (
MPQ1330 ).
ELSE GO TO MP14 - MEDICINE_MP ( MPQ1340 ).
ASSIGNMENTS
TECHNICAL NOTES
131
PMBottleProbe
Prescription Medicine Bottle probe has been asked in the
current round =
GETPMMEDS=1/Yes.
DESIGN NOTES
11:08:17 AM Friday, March 06, 2009
Page 54 of 91
MP13A
MP13A
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
MPPMMEDS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
260
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(s)" in "bottle(s), container(s), or bag(s)" in
parenthesis.
If SP has a "current" Medicare Prescription Drug plan or there was a
Medicare Prescription Drug plan "current" at the time of the
previous round interview, then display "Also, please take out
[your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN NAME)
medicine statements....".
Else do not display.
MEDICARE PRESCRIPTION DRUG PLAN NAME =
Display the name of the "current" Medicare Prescription Drug plan.
If it does not exist, display the name of the Medicare Prescription
Drug plan "current" at the time of the previous round interview.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
11:08:18 AM Friday, March 06, 2009
Page 55 of 91
MP13A
Int. Instr I:
It would be helpful if I could look at any medicine bottle(s),
container(s), or bag(s) that you have so that I can spell the medicine
name correctly and enter the strength of the medicine. [Also, please
take out [your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN
NAME) medicine statements, which should have that same
information on them.]
Question Text:
[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that same
information for all of the medicines [you/(SP)] obtained since the last
interview, if you’d like to get those bottles, too.
Int. Instr II:
INPUT FIELDS / ROUTING
MPPMMEDS
Field1:
Cheshire Name:
( MPQ1330 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP14 - MEDICINE_MP ( MPQ1340 )
English text: CONTINUE
Attribute
Empty
Route
MP14 - MEDICINE_MP ( MPQ1340 )
BACKGROUND VARIABLE ASSIGNMENTS
The question displayed at MP13A is repeated in other utilization sections. Only show this
probe for prescription medicine bottles once during the current round interview.
If MP13A - MPPMMEDS is asked, set flag as instructed below:
GETPMMEDS
Set GETPMMEDS = 1/Yes.
SOFT EDIT CHECKS
11:08:21 AM Friday, March 06, 2009
Page 56 of 91
MP13A
HARD EDIT CHECKS
TECHNICAL NOTES
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
11:08:21 AM Friday, March 06, 2009
Page 57 of 91
MP14
MP14
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
MEDICINE_MP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Prescription Medicine Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
270
Display as ' Add a Medicine '
Display as ' Edit a Medicine '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "CHECK STATEMENT OR MEDICINE BOTTLE FOR
SPELLING." in BOLD.
Display "INCLUDE STRENGTH WITH NAME." in BOLD.
Multi Field display:
Roster/Grid Instructions:
Display all Prescription Medicine events where:
EVNT.EVNTDFLG ^=1/Yes, and
EVNT.EVNTTYPE='PM'.
Display in alphabetical order.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine
Display prescription medicine name,
EVNT.PMEDNAME.
2
Strength
Display prescription medicine strength
text field, EVNT.PMSTRUNI.
Report display:
TEXT:
Context Header:
11:08:21 AM Friday, March 06, 2009
Page 58 of 91
MP14
Int. Instr I:
Question Text:
Please tell me the names of these medicines.
Int. Instr II:
ENTER ALL MEDICINE NAMES.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.
INPUT FIELDS / ROUTING
MEDICINE_MP
Field1:
( MPQ1340 )
TEMP
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
String
TEvntPick135
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX MP6 - (MPQ1390 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected at MP14.
If Prescription Medicine added at Prescription Medicine Roster, see PRESCRIPTION
MEDICINE ROSTER POP-UP specifications for pop-up window programming instructions.
Variables populated at the Prescription Medicine Roster:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVNTTYPE
EVNT.PMEDNAME
EVNT.PMSTRUNI
EVNT.EVNTPROV
BASE.LASTEVNT
Event number
Round number
PM
Prescription Medicine name
Prescription Medicine strength text field
02
Highest EVNT.EVNTNUM
For all Prescription Medicines selected at MP14, create a current round PMRO. Note: a
current round PMRO may already exist for a Prescription Medicine event if it has already
been selected earlier in the interview.
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND.
11:08:22 AM Friday, March 06, 2009
Page 59 of 91
MP14
Create PMRO where PMRO.PMROEVNT = EVNT.EVNTNUM for prescription medicine
selected and PMRO.PMRORND = current round. Set additional PMRO variable as
instructed below.
All prescription medicines selected at MP14 should be linked to the Medical Provider visit
being asked about. Prescription medicine events are linked to other events on XMED.
XMED key = XMED.XMEDBASE + XMED.XMEDEVNT + XMED.XMEDBAS2 +
XMED.XMEDEVT2.
For each medicine selected at MP14, create an XMED where XMEDEVNT =
EVNT.EVNTNUM of Medical Provider visit being asked about and XMEDEVT2 =
EVNT.EVNTNUM of Prescription Medicine selected at MP14. XMEDBASE and
XMEDBAS2 both equal the Cheshire BASE.BASEID. Set additional XMED variables as
specified below.
Set the following PMRO and XMED variables for each prescription medicine selected at
MP14:
PMROEVNT
PMRO.PMROEVNT = EVNT.EVNTNUM of
prescription medicine selected at MP14.
PMRORND
PMRO.PMRORND = current round.
PMROTYPE
PMRO.PMROTYPE = 'PM'.
XMEDEVNT
XMED.XMEDEVNT = EVNT.EVNTNUM of Medical
Provider visit being asked about.
XMEDEVT2
XMED.XMEDEVT2 = EVNT.EVNTNUM of
prescription medicine selected at MP14.
XMEDRNDC
XMED.XMEDRNDC = current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:08:22 AM Friday, March 06, 2009
Page 60 of 91
BOX MP6
BOX MP6
Page Order # :
320
BOX INSTRUCTIONS
( MPQ1390 )
GO TO MP6_IN - NAVIGATOR ( MPQ1145 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
NOTE ON ELSE CONDITION:
Once all items at MP6_IN Instance Navigator screen are DONE, routing
will return to MP6_IN until Interviewer selects CONTINUE INTERVIEW.
When MP6_IN CONTINUE INTERVIEW is selected, BOX MP6 specifies
routing to the next item.
11:08:22 AM Friday, March 06, 2009
Page 61 of 91
BOX MP6AA
BOX MP6AA
Page Order # :
325
BOX INSTRUCTIONS
( MPQ1395 )
IF MEDICAL PROVIDER VISIT WAS REPORTED FOLLOWING MP1
PROBE, GO TO MP17 - MDOCMORE ( MPQ1400 ).
ELSE IF MEDICAL PROVIDER VISIT WAS REPORTED FOLLOWING MP18
PROBE, GO TO MP25 - PRACMORE ( MPQ1810 ).
ELSE IF MEDICAL PROVIDER VISIT WAS REPORTED FOLLOWING MP26
PROBE, GO TO MP33 - MENTMORE ( MPQ1980 ).
ELSE IF MEDICAL PROVIDER VISIT WAS REPORTED FOLLOWING MP34
PROBE, GO TO MP41 - THERMORE ( MPQ2150 ).
ELSE IF MEDICAL PROVIDER VISIT WAS REPORTED FOLLOWING MP42
PROBE, GO TO MP49 - PERSMORE ( MPQ2320 ).
ELSE IF MEDICAL PROVIDER VISIT WAS REPORTED FOLLOWING MP50
PROBE, GO TO MP56 - MPPRMORE ( MPQ2470 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
11:08:22 AM Friday, March 06, 2009
Page 62 of 91
MP17
MP17
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MDOCMORE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
330
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "other" in "any other visits" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], did
[you/(SP)] have any other visits to this doctor or any other medical
doctor?
Int. Instr II:
INPUT FIELDS / ROUTING
11:08:24 AM Friday, March 06, 2009
Page 63 of 91
MP17
MDOCMORE
Field1:
Cheshire Name:
( MPQ1400 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
English text: YES
No
BOX MP6A - (MPQ1410 )
English text: NO
Attribute
Don't know
Route
BOX MP6A - (MPQ1410 )
Refusal
BOX MP6A - (MPQ1410 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
End loop 1: Probes for additional Medical Provider visits. MP visits can be
for a new provider or a provider already selected and asked about. If
MDOCMORE=1/Yes, go to MP2 to select the next provider.
11:08:26 AM Friday, March 06, 2009
Page 64 of 91
BOX MP6A
BOX MP6A
Page Order # :
340
BOX INSTRUCTIONS
( MPQ1410 )
IF FALL ROUND AND (SP IS ALIVE AND NOT INSTITUTIONALIZED) AND
(SP REPORTED A MEDICAL PROVIDER VISIT AT MP6 AND MP6B MPSDVIS ^= 1/Yes AND PROVIDER'S SPECIALTY IS A MEDICAL
DOCTOR), GO TO AC20 - MDSPCLTY ( ACQ1430 ).
ELSE GO TO MP18 - MPPRPRAC ( MPQ1650 ).
ASSIGNMENTS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
171
ProviderMedicalDoctor
Provider Specialty is a Medical Doctor =
PROV.PROVSPEC=2/MedicalDoctor
98
FallRound
If the remainder of (Current round divided by 3) = 1, then
it is a Fall round.
DESIGN NOTES
If Fall round, call AC section if MP visit added in current round.
11:08:26 AM Friday, March 06, 2009
Page 65 of 91
MP18
MP18
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPPRPRAC
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
460
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP reported utilization during the current round, display "Besides
what you have already mentioned, [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]".
Else display "[Since (REFERENCE DATE)/Between(REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]".
If SP is alive and not institutionalized, display "seen".
Else display "see".
Always display "[Health practitioners…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
11:08:27 AM Friday, March 06, 2009
SHOW CARD MP1
Page 66 of 91
MP18
Question Text:
(Besides what you have already mentioned), [(Since/since
(REFERENCE DATE)/(Between/between) (REFERENCE DATE)
and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION), [have
you/has (SP)/did (SP)] (seen/see) a health practitioner like any of the
ones listed on this card? [Health practitioners include acupuncturist,
audiologist, optometrist, chiropractor, podiatrist (foot doctor),
homeopath, naturopath, or any other kind of health provider who is
not a medical doctor.]
Int. Instr II:
INCLUDE ANY VISITS FOR TESTS/X-RAYS.
INPUT FIELDS / ROUTING
MPPRPRAC
Field1:
Cheshire Name:
Item Text display:
( MPQ1650 )
HRND.MPPRPRAC
Do not display response option 3/IndicatedYesByDataprep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
MP26 - MPPRMENT ( MPQ1820 )
DO NOT DISPLAY.
DATA EDITING ONLY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
MP26 - MPPRMENT ( MPQ1820 )
Refusal
MP26 - MPPRMENT ( MPQ1820 )
BACKGROUND VARIABLE ASSIGNMENTS
11:08:31 AM Friday, March 06, 2009
Page 67 of 91
MP18
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
168
MPUtilizationCheck
SP reported utilization during the current round [up to MP
section] =
DU1-DUPROBE, ER1-ERPROBE, IP1-IPPROBE, OP1
OPPROBE, IU-IUPROBE, HH1-HHPRPROF, HH18
HHPRFRND, MP1-MPPRMDOC, MP18-MPPRPRAC,
MP26-MPPRMENT, MP34-MPPRTHER, or MP42
MPPRPERS=1/Yes.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
11:08:31 AM Friday, March 06, 2009
Page 68 of 91
MP25
MP25
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRACMORE
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
580
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "other" in "any other visits" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], did
[you/(SP)] have any other visits to this practitioner or any other
health practitioner?
Int. Instr II:
INPUT FIELDS / ROUTING
11:08:32 AM Friday, March 06, 2009
Page 69 of 91
MP25
PRACMORE
Field1:
Cheshire Name:
( MPQ1810 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
English text: YES
No
MP26 - MPPRMENT ( MPQ1820 )
English text: NO
Attribute
Don't know
Route
MP26 - MPPRMENT ( MPQ1820 )
Refusal
MP26 - MPPRMENT ( MPQ1820 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:08:35 AM Friday, March 06, 2009
Page 70 of 91
MP26
MP26
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPPRMENT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
590
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP reported utilization during the current round, display "Besides
what you have already mentioned, [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]".
Else display "[Since (REFERENCE DATE)/Between(REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]".
If SP is alive and not institutionalized, display "seen".
Else display "see".
Always display "[Mental health….]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
11:08:36 AM Friday, March 06, 2009
SHOW CARD MP2
Page 71 of 91
MP26
(Besides what you have already mentioned), [(Since/since
(REFERENCE DATE)/(Between/between) (REFERENCE DATE)
and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION), [have
you/has (SP)/did (SP)] (seen/see) a mental health professional like
any of the ones listed on this card? [Mental health professional
includes psychiatrist, psychologist, clinical social worker, and
licensed professional counselor.]
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
MPPRMENT
Field1:
Cheshire Name:
Item Text display:
( MPQ1820 )
HRND.MPPRMENT
Do not display response option 3/IndicatedYesByDataprep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
MP34 - MPPRTHER ( MPQ1990 )
DO NOT DISPLAY.
DATA EDITING ONLY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
MP34 - MPPRTHER ( MPQ1990 )
Refusal
MP34 - MPPRTHER ( MPQ1990 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
11:08:40 AM Friday, March 06, 2009
Page 72 of 91
MP26
HARD EDIT CHECKS
TECHNICAL NOTES
168
MPUtilizationCheck
SP reported utilization during the current round [up to MP
section] =
DU1-DUPROBE, ER1-ERPROBE, IP1-IPPROBE, OP1
OPPROBE, IU-IUPROBE, HH1-HHPRPROF, HH18
HHPRFRND, MP1-MPPRMDOC, MP18-MPPRPRAC,
MP26-MPPRMENT, MP34-MPPRTHER, or MP42
MPPRPERS=1/Yes.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
11:08:40 AM Friday, March 06, 2009
Page 73 of 91
MP33
MP33
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MENTMORE
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
710
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "other" in "any other visits" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], did
[you/(SP)] have any other visits to this professional or any other
mental health professional?
Int. Instr II:
INPUT FIELDS / ROUTING
11:08:41 AM Friday, March 06, 2009
Page 74 of 91
MP33
MENTMORE
Field1:
Cheshire Name:
( MPQ1980 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
English text: YES
No
MP34 - MPPRTHER ( MPQ1990 )
English text: NO
Attribute
Don't know
Route
MP34 - MPPRTHER ( MPQ1990 )
Refusal
MP34 - MPPRTHER ( MPQ1990 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:08:44 AM Friday, March 06, 2009
Page 75 of 91
MP34
MP34
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPPRTHER
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
720
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP reported utilization during the current round, display "Besides
what you have already mentioned, [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]".
Else display "[Since (REFERENCE DATE)/Between(REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]".
If SP is alive and not institutionalized, display "seen".
Else display "see".
Always display "[Therapists include….]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
11:08:45 AM Friday, March 06, 2009
SHOW CARD MP3
Page 76 of 91
MP34
(Besides what you have already mentioned), [(Since/since
(REFERENCE DATE)/(Between/between) (REFERENCE DATE)
and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION), [have
you/has (SP)/did (SP)] (seen/see) a therapist like any of the ones
listed on this card? [Therapist includes physical therapist, speech
therapist, intravenous (IV) therapist, massage therapist,
occupational therapist, and respiratory therapist.]
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
MPPRTHER
Field1:
Cheshire Name:
Item Text display:
( MPQ1990 )
HRND.MPPRTHER
Do not display response option 3/IndicatedYesByDataprep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
MP42 - MPPRPERS ( MPQ2160 )
DO NOT DISPLAY.
DATA EDITING ONLY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
MP42 - MPPRPERS ( MPQ2160 )
Refusal
MP42 - MPPRPERS ( MPQ2160 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
11:08:49 AM Friday, March 06, 2009
Page 77 of 91
MP34
HARD EDIT CHECKS
TECHNICAL NOTES
168
MPUtilizationCheck
SP reported utilization during the current round [up to MP
section] =
DU1-DUPROBE, ER1-ERPROBE, IP1-IPPROBE, OP1
OPPROBE, IU-IUPROBE, HH1-HHPRPROF, HH18
HHPRFRND, MP1-MPPRMDOC, MP18-MPPRPRAC,
MP26-MPPRMENT, MP34-MPPRTHER, or MP42
MPPRPERS=1/Yes.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
11:08:49 AM Friday, March 06, 2009
Page 78 of 91
MP41
MP41
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
THERMORE
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
840
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "other" in "any other visits" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], did
[you/(SP)] have any other visits to this therapist or any other
therapist?
Int. Instr II:
INPUT FIELDS / ROUTING
11:08:50 AM Friday, March 06, 2009
Page 79 of 91
MP41
THERMORE
Field1:
Cheshire Name:
( MPQ2150 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
English text: YES
No
MP42 - MPPRPERS ( MPQ2160 )
English text: NO
Attribute
Don't know
Route
MP42 - MPPRPERS ( MPQ2160 )
Refusal
MP42 - MPPRPERS ( MPQ2160 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:08:52 AM Friday, March 06, 2009
Page 80 of 91
MP42
MP42
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPPRPERS
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
850
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP reported utilization during the current round, display "Besides
what you have already mentioned, [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]".
Else display "[Since (REFERENCE DATE)/Between(REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]".
If SP is alive and not institutionalized, display "seen".
Else display "see".
Always display "[Other medical persons….]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
11:08:54 AM Friday, March 06, 2009
SHOW CARD MP4
Page 81 of 91
MP42
Question Text:
(Besides what you have already mentioned), [(Since/since
(REFERENCE DATE)/(Between/between) (REFERENCE DATE)
and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION), [have
you/has (SP)/did (SP)] (seen/see) any other medical persons like the
ones listed on this card? [Other medical persons include nurse,
nurse practitioner, paramedic, and physician’s assistant.]
Int. Instr II:
INCLUDE ANY VISITS FOR TESTS/X-RAYS. DO NOT INCLUDE
PARAMEDIC IF ONLY AMBULANCE SERVICES WERE
PROVIDED.
INPUT FIELDS / ROUTING
MPPRPERS
Field1:
Cheshire Name:
Item Text display:
( MPQ2160 )
HRND.MPPRPERS
Do not display response option 3/IndicatedYesByDataprep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
MP50 - MPPRPLAC ( MPQ2330 )
DO NOT DISPLAY.
DATA EDITING ONLY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
MP50 - MPPRPLAC ( MPQ2330 )
Refusal
MP50 - MPPRPLAC ( MPQ2330 )
BACKGROUND VARIABLE ASSIGNMENTS
11:08:57 AM Friday, March 06, 2009
Page 82 of 91
MP42
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
168
MPUtilizationCheck
SP reported utilization during the current round [up to MP
section] =
DU1-DUPROBE, ER1-ERPROBE, IP1-IPPROBE, OP1
OPPROBE, IU-IUPROBE, HH1-HHPRPROF, HH18
HHPRFRND, MP1-MPPRMDOC, MP18-MPPRPRAC,
MP26-MPPRMENT, MP34-MPPRTHER, or MP42
MPPRPERS=1/Yes.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
11:08:57 AM Friday, March 06, 2009
Page 83 of 91
MP49
MP49
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PERSMORE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
970
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "other" in "any other visits" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], did
[you/(SP)] have any other visits to this person or any other medical
person?
Int. Instr II:
INPUT FIELDS / ROUTING
11:08:59 AM Friday, March 06, 2009
Page 84 of 91
MP49
PERSMORE
Field1:
Cheshire Name:
( MPQ2320 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
English text: YES
No
MP50 - MPPRPLAC ( MPQ2330 )
English text: NO
Attribute
Don't know
Route
MP50 - MPPRPLAC ( MPQ2330 )
Refusal
MP50 - MPPRPLAC ( MPQ2330 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:09:01 AM Friday, March 06, 2009
Page 85 of 91
MP50
MP50
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPPRPLAC
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
980
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP reported utilization during the current round, display "Besides
what you have already mentioned, [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]".
Else display "[Since (REFERENCE DATE)/Between(REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]".
If SP is alive and not institutionalized, display "visited".
Else display "visit".
Always display "[Other types of….]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
11:09:02 AM Friday, March 06, 2009
SHOW CARD MP5
Page 86 of 91
MP50
(Besides what you have already mentioned), [(Since/since
(REFERENCE DATE)/(Between/between) (REFERENCE DATE)
and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION), [have
you/has (SP)/did (SP)] (visited/visit) any other types of medical
places like the ones listed on this card? [Other types of medical
places include health clinic, neighborhood health center, rural health
clinic, infirmary, mental health clinic, urgent care center, or any other
place.]
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
MPPRPLAC
Field1:
Cheshire Name:
Item Text display:
( MPQ2330 )
HRND.MPPRPLAC
Do not display response option 3/IndicatedYesByDataprep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
BOX MP22 - (MPQ2475 )
DO NOT DISPLAY.
DATA EDITING ONLY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
BOX MP22 - (MPQ2475 )
Refusal
BOX MP22 - (MPQ2475 )
BACKGROUND VARIABLE ASSIGNMENTS
11:09:06 AM Friday, March 06, 2009
Page 87 of 91
MP50
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
168
MPUtilizationCheck
SP reported utilization during the current round [up to MP
section] =
DU1-DUPROBE, ER1-ERPROBE, IP1-IPPROBE, OP1
OPPROBE, IU-IUPROBE, HH1-HHPRPROF, HH18
HHPRFRND, MP1-MPPRMDOC, MP18-MPPRPRAC,
MP26-MPPRMENT, MP34-MPPRTHER, or MP42
MPPRPERS=1/Yes.
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
11:09:06 AM Friday, March 06, 2009
Page 88 of 91
MP56
MP56
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MPPRMORE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1080
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "other" in "any other visits" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], did
[you/(SP)] have any other visits to this place or any other type of
medical place?
Int. Instr II:
INPUT FIELDS / ROUTING
11:09:07 AM Friday, March 06, 2009
Page 89 of 91
MP56
MPPRMORE
Field1:
Cheshire Name:
( MPQ2470 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
MP2 - PROVIDER_MP ( MPQ1030 )
English text: YES
No
BOX MP22 - (MPQ2475 )
English text: NO
Attribute
Don't know
Route
BOX MP22 - (MPQ2475 )
Refusal
BOX MP22 - (MPQ2475 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
11:09:10 AM Friday, March 06, 2009
Page 90 of 91
BOX MP22
BOX MP22
Page Order # :
1090
BOX INSTRUCTIONS
( MPQ2475 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
11:09:10 AM Friday, March 06, 2009
Page 91 of 91
| File Type | application/pdf |
| Author | hubbard_r |
| File Modified | 2010-04-05 |
| File Created | 0000-00-00 |