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

Statement Event Roster Pop-Up
Item #:

STEVTYPE
Cheshire Name:

STA1005

EVNT.STEVTYPE

Do not display response option 8/HP and 9/HF.

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

Enumerated
TStevtype
1
No
No

Number Label
1 SL

FieldSize:
Min Value:
Max Value:
Mask:

Route
STEvent - VISTTYPE ( STA1010 )

2

English text: Separately Billing Lab (SL)
SD

STEvent - VISTTYPE ( STA1010 )

3

English text: Separately Billing Doctor (SD)
DU

STEvent - VISTTYPE ( STA1010 )

4

English text: Dental (DU)
ER

STEvent - VISTTYPE ( STA1010 )

5

English text: Hospital Emergency Room (ER)
IP

STEvent - VISTTYPE ( STA1010 )

6

English text: Hospital Inpatient Stay (IP)
OP

STEvent - VISTTYPE ( STA1010 )

7

English text: Hospital Outpatient visit (OP)
IU

STEvent - VISTTYPE ( STA1010 )

8

English text: Institutional Stay (IU)
HP
DO NOT DISPLAY.

9

English text: Home Health Professional (HP)
HF
DO NOT DISPLAY.

10

English text: Other Home Health Provider (HF)
MP
STEvent - VISTTYPE ( STA1010 )
English text: All other visits to Medical Provider (MP)

10:00:08 AM Thursday, December 20, 2007

Page 1 of 9

Statement Event Roster Pop-Up
Item #:

VISTTYPE
Cheshire Name:

STA1010

EVNT.VISTTYPE
If Field 1 - STEVTYPE = 1/SL, 2/SD, 3/DU, 6/OP, or 10/MP,

allow entry.

Else disallow entry.

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TVisitType
1
No
No

Number Label
1 SingleVisit
2

English text: SINGLE VISIT
RepeatVisit

FieldSize:
Min Value:
Max Value:
Mask:

Route
STEvent - EVBEGMM ( STA1015 )
STEvent - EVBEGMM ( STA1015 )

English text: REPEAT VISIT

10:00:11 AM Thursday, December 20, 2007

Page 2 of 9

Statement Event Roster Pop-Up
Item #:

EVBEGMM
Cheshire Name:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

STA1015

EVNT.EVBEGMM
Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
STEvent - EVBEGDD ( STA1020 )

Refusal

STEvent - EVBEGDD ( STA1020 )

10:00:13 AM Thursday, December 20, 2007

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
STEvent - EVBEGDD ( STA1020 )

Page 3 of 9

Statement Event Roster Pop-Up
Item #:

EVBEGDD
Cheshire Name:

STA1020

EVNT.EVBEGDD

If Field 2 - VISTTYPE = 1/SingleVisit, allow entry.

Else disallow entry.

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
STEvent - EVBEGYY ( STA1025 )

Refusal

STEvent - EVBEGYY ( STA1025 )

10:00:15 AM Thursday, December 20, 2007

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
STEvent - EVBEGYY ( STA1025 )

Page 4 of 9

Statement Event Roster Pop-Up
Item #:

EVBEGYY
Cheshire Name:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

STA1025

EVNT.EVBEGYY
Integer
TYearDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
STEvent - RVTIMES ( STA1030 )

Refusal

STEvent - RVTIMES ( STA1030 )

10:00:17 AM Thursday, December 20, 2007

FieldSize:
Min Value:
Max Value:
Mask:

0
99

Route
STEvent - RVTIMES ( STA1030 )

Page 5 of 9

Statement Event Roster Pop-Up
Item #:

RVTIMES
Cheshire Name:

STA1030

EVNT.RVTIMES

If Field 2 - VISTTYPE = 2/RepeatVisit, allow entry.

Else disallow entry.

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
TRvtimes
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
STEvent - EVENDMM ( STA1035 )

Refusal

STEvent - EVENDMM ( STA1035 )

10:00:19 AM Thursday, December 20, 2007

FieldSize:

Min Value:
Max Value:
Mask:

1

90

Route
STEvent - EVENDMM ( STA1035 )

Page 6 of 9

Statement Event Roster Pop-Up
Item #:

EVENDMM
Cheshire Name:

STA1035

EVNT.EVENDMM

If Field 1 - STEVTYPE = 5/IP or 7/IU, allow entry.

Else disallow entry.

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
TMonthInt
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
STEvent - EVENDDD ( STA1040 )

Refusal

STEvent - EVENDDD ( STA1040 )

10:00:21 AM Thursday, December 20, 2007

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
STEvent - EVENDDD ( STA1040 )

Page 7 of 9

Statement Event Roster Pop-Up
Item #:

EVENDDD
Cheshire Name:

STA1040

EVNT.EVENDDD

If Field 1 - STEVTYPE = 5/IP or 7/IU, allow entry.

Else disallow entry.

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
TDayDKRF
1
No
No

Number Label
1 [Continuous answer.]
Attribute
Don't know

Route
STEvent - EVENDYY ( STA1045 )

Refusal

STEvent - EVENDYY ( STA1045 )

10:00:23 AM Thursday, December 20, 2007

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
STEvent - EVENDYY ( STA1045 )

Page 8 of 9

Statement Event Roster Pop-Up
Item #:

EVENDYY
Cheshire Name:

STA1045

EVNT.EVENDYY

If Field 1 - STEVTYPE = 5/IP or 7/IU, allow entry.

Else disallow entry.

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
TYearDKRF
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:

0

99

Route
Exit Pop-Up Window.

Attribute
Don't know

Route
Exit Pop-Up Window.

Refusal
Exit Pop-Up Window.

10:00:23 AM Thursday, December 20, 2007

Page 9 of 9