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

Statement Event Edit Roster Pop-Up
Item #:

STEVTYPE
Cheshire Name:

STB1005

EVNT.STEVTYPE

Display previously collected response.

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

Disallow updates.

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
STEventEdit - VISTTYPE ( STB1010 )

2

English text: Separately Billing Lab (SL)
SD

STEventEdit - VISTTYPE ( STB1010 )

3

English text: Separately Billing Doctor (SD)
DU

STEventEdit - VISTTYPE ( STB1010 )

4

English text: Dental (DU)
ER

STEventEdit - VISTTYPE ( STB1010 )

5

English text: Hospital Emergency Room (ER)
IP

STEventEdit - VISTTYPE ( STB1010 )

6

English text: Hospital Inpatient Stay (IP)
OP

STEventEdit - VISTTYPE ( STB1010 )

7

English text: Hospital Outpatient visit (OP)
IU

STEventEdit - VISTTYPE ( STB1010 )

8

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

9

10

English text: Home Health Professional (HP)
HF
DO NOT DISPLAY.
Other
Home
Health
Provider
(HF)
English text:
MP
STEventEdit - VISTTYPE ( STB1010 )
English text: All other visits to Medical Provider (MP)

10:02:56 AM Thursday, December 20, 2007

Page 1 of 9

Statement Event Edit Roster Pop-Up
Item #:

VISTTYPE
Cheshire Name:

STB1010

EVNT.VISTTYPE

Display previously collected response.

Disallow updates.

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
STEventEdit - EVBEGMM ( STB1015 )
STEventEdit - EVBEGMM ( STB1015 )

English text: REPEAT VISIT

10:02:59 AM Thursday, December 20, 2007

Page 2 of 9

Statement Event Edit Roster Pop-Up
Item #:

EVBEGMM
Cheshire Name:

STB1015

EVNT.EVBEGMM

Display previously collected response.

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
STEventEdit - EVBEGDD ( STB1020 )

Refusal

STEventEdit - EVBEGDD ( STB1020 )

10:03:01 AM Thursday, December 20, 2007

FieldSize:
Min Value:
Max Value:
Mask:

2

01

12

Route
STEventEdit - EVBEGDD ( STB1020 )

Page 3 of 9

Statement Event Edit Roster Pop-Up
Item #:

EVBEGDD
Cheshire Name:

STB1020

EVNT.EVBEGDD

Display previously collected response.

If EVNT.VISTTYPE ^= 2/RepeatVisit, allow updates to field.

Else disallow updates.

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
STEventEdit - EVBEGYY ( STB1025 )

Refusal

STEventEdit - EVBEGYY ( STB1025 )

10:03:03 AM Thursday, December 20, 2007

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
STEventEdit - EVBEGYY ( STB1025 )

Page 4 of 9

Statement Event Edit Roster Pop-Up
Item #:

EVBEGYY
Cheshire Name:

STB1025

EVNT.EVBEGYY

Display previously collected response.

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

Integer
TYearDKRF

1

No
No

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

Route
STEventEdit - RVTIMES ( STB1030 )

Refusal

STEventEdit - RVTIMES ( STB1030 )

10:03:05 AM Thursday, December 20, 2007

FieldSize:

Min Value:
Max Value:
Mask:

0

99

Route
STEventEdit - RVTIMES ( STB1030 )

Page 5 of 9

Statement Event Edit Roster Pop-Up
Item #:

RVTIMES
Cheshire Name:

STB1030

EVNT.RVTIMES

Display previously collected response.

If EVNT.VISTTYPE = 2/RepeatVisit, allow updates to field.

Else disallow updates.

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
STEventEdit - EVENDMM ( STB1035 )

Refusal

STEventEdit - EVENDMM ( STB1035 )

10:03:07 AM Thursday, December 20, 2007

FieldSize:

Min Value:
Max Value:
Mask:

1

90

Route
STEventEdit - EVENDMM ( STB1035 )

Page 6 of 9

Statement Event Edit Roster Pop-Up
Item #:

EVENDMM
Cheshire Name:

STB1035

EVNT.EVENDMM

Display previously collected response.

If EVNT.STEVTYPE = 5/IP or 7/IU, allow updates to field.

Else disallow updates.

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
STEventEdit - EVENDDD ( STB1040 )

Refusal

STEventEdit - EVENDDD ( STB1040 )

10:03:09 AM Thursday, December 20, 2007

FieldSize:
Min Value:
Max Value:
Mask:

2
01
12

Route
STEventEdit - EVENDDD ( STB1040 )

Page 7 of 9

Statement Event Edit Roster Pop-Up
Item #:

EVENDDD
Cheshire Name:

STB1040

EVNT.EVENDDD

Display previously collected response.

If EVNT.STEVTYPE = 5/IP or 7/IU, allow updates to field.

Else disallow updates.

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
STEventEdit - EVENDYY ( STB1045 )

Refusal

STEventEdit - EVENDYY ( STB1045 )

10:03:11 AM Thursday, December 20, 2007

FieldSize:
Min Value:
Max Value:
Mask:

2
1
31

Route
STEventEdit - EVENDYY ( STB1045 )

Page 8 of 9

Statement Event Edit Roster Pop-Up
Item #:

EVENDYY
Cheshire Name:

STB1045

EVNT.EVENDYY

Display previously collected response.

If EVNT.STEVTYPE = 5/IP or 7/IU, allow updates to field.

Else disallow updates.

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.

10:03:12 AM Thursday, December 20, 2007

Page 9 of 9