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

Person Roster Pop Up Window
Item #:

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

PER1005

ROST.ROSTFNAM

String

TRostlnam

1

No
No

Number Label
1 [Continuous answer.]

9:06:44 AM Thursday, December 20, 2007

FieldSize:
Min Value:

Max Value:
Mask:

25

Route
PersonRoster - ROSTLNAM ( PER1010 )

Page 1 of 5

Person Roster Pop Up Window
Item #:

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

PER1010

ROST.ROSTLNAM

String

TRostlnam

1

No
No

Number Label
1 [Continuous answer.]

9:06:45 AM Thursday, December 20, 2007

FieldSize:
Min Value:

Max Value:
Mask:

25

Route
PersonRoster - ROSTREL ( PER1015 )

Page 2 of 5

Person Roster Pop Up Window
Item #:

ROSTREL
Cheshire Name:

PER1015

ROST.ROSTREL

Do not display option 1/SamplePerson.

Display response categories in the following order: 2, 52, 5,

4, 10, 7, 51, 12, 11, 55, 54, 8, 13, 14, 53, 50, 6, 3, 9.

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

Enumerated
TRelaship

1

No
No

Number Label
1 SamplePerson

FieldSize:

Min Value:

Max Value:

Mask:

Route
Exit.

2

English text: SAMPLE PERSON
Spouse

3

English text: SPOUSE
Son

4

English text: SON
Daughter

Exit.

Exit.

Exit.
5

English text: DAUGHTER
Brother
Exit.

6

English text: BROTHER
Sister

7

English text: SISTER
Father

Exit.

Exit.
8

English text: FATHER
Mother
Exit.

9

English text: MOTHER
SonLaw
Exit.

10

English text: SON-IN-LAW
DaughterLaw
Exit.
English text: DAUGHTER-IN-LAW

9:06:54 AM Thursday, December 20, 2007

Page 3 of 5

Person Roster Pop Up Window
11

Grandson

12

English text: GRANDSON
Granddaughter

Exit.

Exit.
13

English text: GRANDDAUGHTER
Nephew
Exit.

14

English text: NEPHEW
Niece

50

English text: NIECE
Partner

51

English text: PARTNER/ROOMMATE
Friendneighbor

Exit.

Exit.

Exit.
52

English text: FRIEND/NEIGHBOR
Boarder
Exit.

53

English text: BOARDER
NurseAide

54

English text: NURSE/NURSE'S AIDE
LegalOfficer

55

English text: LEGAL/FINANCIAL OFFICER
Guardian

Exit.

Exit.

Exit.
91

English text: GUARDIAN
OtherRelative

PersonRoster - ROSTREOS ( PER1020 )

92

English text: OTHER RELATIVE
OtherNonRelative

PersonRoster - ROSTREOS ( PER1020 )

English text: OTHER NON-RELATIVE
Attribute
Don't know

Route
Exit.

Refusal
Exit.

9:07:02 AM Thursday, December 20, 2007

Page 4 of 5

Person Roster Pop Up Window
Item #:

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

PER1020

ROST.ROSTREOS

String

TOthrspec

1

No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:
Mask:

30

Route
Exit.

9:07:02 AM Thursday, December 20, 2007

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