MEPS-HC Core Interview

MEPS FAMES P12R5/P13R3/P14R1 Other Medical Expenses (OM) Section

December 8, 2008

Other Medical Expenses (OM) Section

BOX_01A

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| IF ROUND 3, CONTINUE WITH BOX_01B |

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| OTHERWISE, GO TO BOX_01 |

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BOX_01B

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| IF OM ITEM TYPE IS GLASSES/CONTACT LENSES, |

| CONTINUE WITH OM01A |

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| OTHERWISE, GO TO BOX_01 |

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OM01A

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{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}{END-DT}

Of the times (PERSON) obtained glasses or contact lenses since

(START DATE), how many were during {YEAR}?

[Enter Number of Times]................ {OM01B}

REF.................................... -7 {OM01B}

DK..................................... -8 {OM01B}

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| (FOR SPECIFICATIONS ONLY; CAPI HANDLES |

| AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS FIRST |

| CALENDAR YEAR OF PANEL. |

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OM01B

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{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}{END-DT}

Of the times (PERSON) obtained glasses or contact lenses since

(START DATE), how many were during {YEAR}?

[Enter Number of Times]................

REF.................................... -7

DK..................................... -8

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| (FOR SPECIFICATIONS ONLY; CAPI HANDLES |

| AUTOMATICALLY): ‘YEAR’ IN QUESTION TEXT IS SECOND |

| CALENDAR YEAR OF PANEL. |

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| IF THE CHARGE/PAYMENT (CP) SECTION HAS NOT BEEN |

| ASKED FOR THE EVENT BEING ASKED ABOUT, GO TO THE |

| CP SECTION. |

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| OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION. |

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BOX_01

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| IF THE OM ITEM TYPE IS INSULIN OR OTHER DIABETIC |

| EQUIPMENT OR SUPPLIES, GO TO OM02 |

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| OTHERWISE, CONTINUE WITH OM01 |

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OM01

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{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}{END-DT}

NOTE:

NO UTILIZATION SECTION IS REQUIRED FOR {GLASSES OR CONTACT

LENSES/Ambulance Services/Orthopedic Items/Hearing Devices/

Prostheses/Bathroom Aids/Medical Equipment/Disposable Supplies/

Alterations or Modifications/{text from other specify}}.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

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| DISPLAY ‘GLASSES OR CONTACT LENSES’ IF EVENT TYPE |

| IS OM AND ITEM TYPE IS CODED ‘1’ (GLASSES OR |

| CONTACT LENSES.) DISPLAY ‘AMbulance Services’ |

| IF EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘4’ |

| (AMBULANCE SERVICES). DISPLAY ‘Orthopedic Items’ |

| IF EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘5’ |

| (ORTHOPEDIC ITEMS). DISPLAY ‘Hearing Devices’ |

| IF EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘6’ |

| (HEARING DEVICES). DISPLAY ‘Prostheses’ IF EVENT |

| TYPE IS OM AND ITEM TYPE IS CODED ‘7’ |

| (PROSTHESES). DISPLAY ‘BATHROOM Aids’ IF EVENT |

| TYPE IS OM AND ITEM TYPE IS CODED ‘8’ (BATHROOM |

| AIDS). DISPLAY ‘Medical Equipment’ IF EVENT TYPE |

| IS OM AND ITEM TYPE IS CODED ‘9’ (MEDICAL |

| EQUIPMENT). DISPLAY ‘Disposable Supplies’ IS |

| EVENT TYPE IS OM AND ITEM TYPE IS CODED ‘10’ |

| (DISPOSABLE SUPPLIES). DISPLAY ‘Alterations or |

| Modifications’ IF EVENT TYPE IS OM AND ITEM TYPE |

| IS CODED ‘11’ (ALTERATIONS/MODIFICATIONS). FOR |

| ‘text from other specify’, DISPLAY THE TEXT |

| ENTERED IN THE OTHER SPECIFY FIELD FOR OM EVENTS |

| WHEN OM ITEM TYPE IS CODED ‘91’ (OTHER). |

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| IF THE CHARGE/PAYMENT (CP) SECTION HAS NOT BEEN |

| ASKED FOR THE EVENT BEING ASKED ABOUT, GO TO THE |

| CP SECTION |

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| OTHERWISE, GO TO THE EVENT DRIVER (ED) SECTION |

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OM02

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{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}{END-DT}

NOTE:

{INSULIN/OTHER DIABETIC EQUIPMENT OR SUPPLIES} WILL BE PROCESSED

LIKE A PRESCRIBED MEDICINE.

AT THIS TIME, NO UTILIZATION OR CHARGE/PAYMENT SECTION WILL BE

ASKED.

PRESCRIBED MEDICINE QUESTIONS AND CHARGE/PAYMENT DATA WILL BE

COLLECTED LATER.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

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| DISPLAY ‘INSULIN’ IF OM ITEM TYPE BEING ASKED |

| ABOUT IS INSULIN. DISPLAY ‘OTHER DIABETIC |

| EQUIPMENT OR SUPPLIES’ IF OM TYPE BEING ASKED |

| ABOUT IS OTHER DIABETIC EQUIPMENT OR SUPPLIES. |

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| FLAG THE OM CHARGE/PAYMENT (CP) SECTION AS |

| ‘PROCESSED’. INSULIN AND OTHER DIABETIC EQUIPMENT|

| AND SUPPLIES WILL BE PROCESSED THROUGH CP AS |

| PRESCRIBED MEDICINES. |

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| GO TO BOX_02 |

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BOX_02

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| GO TO THE EVENT DRIVER (ED) SECTION |

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