MEPS-HC Core Interview

Medical Expenditure Panel Survey Household Component and Medical Provider Component (MEPS-HC and MEPS-MPC through 2009)

Attachment 58 -- HC Provider Directory Section

MEPS-HC Core Interview

OMB: 0935-0118

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0935-0118 can be found here:

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MEPS FAMES P12R5/P13R3/P14R1 Provider Directory (PD) Section

December 8, 2008

Provider Directory (PD) Section

----------------------------------------------------

| NOTE: THERE ARE THREE BASIC TYPES OF PROVIDERS: |

| 1. PERSON-TYPE-PROVIDERS |

| 2. PERSON-IN-FACILITY-PROVIDERS |

| 3. FACILITY PROVIDERS |

| THE PROVIDER DIRECTORY (PD) SECTION DEALS |

| ONLY WITH THE FIRST AND THIRD TYPES. THE |

| SECOND TYPE (PERSON-IN-FACILITY-PROVIDERS) |

| SHOULD BE TREATED AS A FACILITY FOR THE |

| PURPOSES OF THE PD SECTION. THAT IS, THE |

| PERSON'S NAME IS NOT DISPLAYED OR SEARCHED |

| ON, BUT RATHER THE FACILITY WITH WHICH |

| S/HE IS ASSOCIATED WILL BE DISPLAYED AND |

| SEARCHED ON. THEREFORE, IF THERE IS MORE |

| THAN ONE PERSON-IN-FACILITY-PROVIDER |

| ASSOCIATED WITH THE SAME FACILITY, THE |

| PROVIDER LOOP WILL BE CYCLED ON ONCE FOR |

| THAT FACILITY. |

----------------------------------------------------

BOX_00

======

----------------------------------------------------

| CONTEXT HEADER DISPLAY INSTRUCTIONS: |

| DISPLAY PROV.LORPNAME, PROV.PVSTRT1 |

----------------------------------------------------

PD01AA

======

ENTER PROVIDER DIRECTORY REGION TO SEARCH

PROVIDER DIRECTORY 1 ................... 1 {LOOP_01}

PROVIDER DIRECTORY 2 ................... 2 {LOOP_01}

PROVIDER DIRECTORY 3 ................... 3 {LOOP_01}

PROVIDER DIRECTORY 4 ................... 4 {LOOP_01}

LOOP_01

=======

-----------------------------------------------------

| FOR EACH ELEMENT IN RU-MEDICAL-PROVIDERS-ROSTER, |

| ASK PD01A - END_LP01 |

-----------------------------------------------------

| LOOP DEFINITION: LOOP_01 COLLECTS VA AFFILIATION |

| AND ADDRESS INFORMATION FOR PROVIDERS. THIS LOOP |

| CYCLES ON PROVIDERS THAT MEET THE FOLLOWING |

| CONDITIONS: |

| - CREATED THIS ROUND |

-----------------------------------------------------

| NOTE THAT, STARTING IN PANEL 12 ROUND 3, THE LOOP |

| DEFINITION AND CRITERIA WERE AS FOLLOWS. STARTING |

| IN PANEL 13, THIS DEFINITION AND CRITERIA WILL BE |

| IMPLEMENTED IN ALL ROUNDS. |

| |

| LOOP DEFINITION: LOOP_01 COLLECTS VA AFFILIATION |

| AND ADDRESS INFORMATION FOR PROVIDERS. THIS LOOP |

| CYCLES ON PROVIDERS THAT MEET THE FOLLOWING |

| CONDITIONS: |

| - CREATED THIS ROUND AND LINKED TO A KEY RU MEMBER |

| OR |

| - CREATED IN A PREVIOUS ROUND AND NOW LINKED TO A |

| KEY RU MEMBER (AND HAS NOT BEEN THROUGH THE PD |

| SECTION PREVIOUSLY) |

| |

| AND |

| - ASSOCIATED WITH AN HS, ER, OP, OR IC EVENT |

| OR |

| - ASSOCIATED WITH AN MV EVENT |

| OR |

| - ASSOCIATED WITH AN HH EVENT AND FLAGGED AS |

| ‘AGENCY’ |

-----------------------------------------------------

PD01A

=====

PROVIDER: {NAME OF MEDICAL CARE PROVIDER......}

{Is the clinic or place where (PROVIDER) was seen a

facility of the Veteran’s Administration?/ Is

(PROVIDER) a facility of the Veteran’s Administration?}

YES .................................... 1 {BOX_01A}

NO ..................................... 2 {BOX_01A}

REF ................................... -7 {BOX_01A}

DK .................................... -8 {BOX_01A}

-----------------------------------------------------

| DISPLAY NAME OF PROVIDER BEING LOOPED ON FOR |

| ‘NAME OF MEDICAL CARE PROVIDER.’ |

-----------------------------------------------------

| IF PERSON PROVIDER DISPLAY ‘Is the clinic or place |

| where (PROVIDER) was seen a facility of the |

| Veteran’s Administration?’ |

| |

| IF FACILITY PROVIDER DISPLAY ‘Is (PROVIDER) a |

| facility of the Veteran’s Administration?’ |

-----------------------------------------------------

BOX_01A

=======

----------------------------------------------------

| IF PROVIDER IS: |

| - ASSOCIATED WITH AN HS, ER, OP, OR IC EVENT |

| OR |

| - ASSOCIATED WITH AN MV EVENT AND MV03 IS CODED |

| ‘1’ (YES-TALKED TO A MEDICAL DOCTOR) OR MV03 |

| IS CODED ‘2’ (NO), ‘-7’ (REFUSED) OR ‘-8’ |

| (DON’T KNOW) AND MV06 IS CODED ‘1’ (YES-MEDICAL|

DOCTORS WORK AT LOCATION) |

| OR |

| - ASSOCIATED WITH A HH EVENT AND FLAGGED AS |

| ‘AGENCY’, |

| CONTINUE WITH BOX_03 |

----------------------------------------------------

| OTHERWISE, GO TO END_LP01 |

----------------------------------------------------

BOX_01

======

OMITTED.

BOX_02

======

OMITTED.

PD01

====

OMITTED.

PD02

====

OMITTED.

BOX_03

======

----------------------------------------------------

| IF LOOPING ON PROVIDER ASSOCIATED ONLY WITH AN MV |

| EVENT AND RU IS NOT SELECTED FOR THE MEDICAL |

| PROVIDER COMPONENT (MPC), GO TO END_LP01 |

----------------------------------------------------

| OTHERWISE, CONTINUE WITH BOX_04 |

----------------------------------------------------

BOX_04

======

-----------------------------------------------------

| IF FIRST TIME THROUGH LOOP_01, CONTINUE WITH PD03 |

----------------------------------------------------

| OTHERWISE, GO TO PD05A IF PERSON-PROVIDER OR PD05B|

| IF FACILITY-PROVIDER |

----------------------------------------------------

PD03

====

Now I would like to make sure I have complete information

for the medical providers you mentioned. I will use a

directory to look up the names, addresses, and telephone

numbers of the sources of medical care you mentioned.

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------

| IF PROVIDER TYPE IS PERSON GO TO PD05A |

----------------------------------------------------

| OTHERWISE GO TO PD05B |

----------------------------------------------------

PD04

====

OMITTED.

PD05A

=====

PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}

STREET ADDRESS: {STREET ADDRESS FROM PV}

CURRENT STATE CODE: {STATE ABBREVIATION FOR RESPONDENT}

STATE: [_____] [CHANGE STATE FOR SEARCH]

SELECT A SEARCH STRATEGY:

_ SEARCH ON PROVIDER NAME SHOWN ABOVE

_ SEARCH ON CORE STREET NAME

_ SEARCH ON TELEPHONE NUMBER

----------------------------------------------------

| ITEM DETAILS |

| PROVID: ...... {Display PROVID} |

| TITLE: ....... {Display Provider Title} |

| FIRST NAME: .. {Display Provider First Name} |

| LAST NAME: ... {Display Provider Last Name} |

| ADDRESSS: .... {Display Provider Street Address} |

| .... {Display Provider City, State, Zip}|

| PHONE: ....... {Display Provider Telephone Number}|

| SPECIALTY: ... {Display Provider Specialty} |

----------------------------------------------------

{SEARCH CRITERIA 1}

{SEARCH CRITERIA 2}

[SEARCH]

THE NUMBER OF POTENTIAL MATCHES FOUND: {NUMBER OF MATCHES}

|-----------------|------------------|----------------|---------------|

|-----------------|------------------|----------------|---------------|

|-----------------|------------- ----|----------------|---------------|

|-----------------|------------- ----|----------------|---------------|

{DON’T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES}

----------------------------------------------------

| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |

| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |

| BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER |

| FROM PV’. |

----------------------------------------------------

| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |

| THE PROVIDER ROSTER FROM SECTION PV FOR THE |

| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM |

| PV’. |

----------------------------------------------------

| DISPLAY ‘FIRST NAME’ FOR SEARCH CRITERIA 1 AND |

| ‘LAST NAME’ FOR SEARCH CRITERIA 2 IF ‘SEARCH ON |

| PROVIDER NAME SHOWN ABOVE’ SELECTED. |

----------------------------------------------------

| DISPLAY ‘STREET LIKE’ FOR SEARCH CRITERIA 1 IF |

| ‘SEARCH ON CORE STREET NAME’ SELECTED. DISPLAY NO |

| SEARCH CRITERIA 2. |

----------------------------------------------------

| DISPLAY ‘PHONE NUMBER’ FOR SEARCH CRITERIA 1 IF |

| ‘SEARCH ON TELEPHONE NUMBER’ SELECTED. DISPLAY NO |

| SEARCH CRITERIA 2. |

----------------------------------------------------

| DISPLAY TWO-CHARACTER STATE ABBREVIATION |

| ASSOCIATED WITH THIS RU’S ADDRESS FOR ‘STATE |

| ABBREVIATION FOR RESPONDENT’. |

----------------------------------------------------

| A LIST OF PROVIDERS IS DISPLAYED ON THE BOTTOM |

| HALF OF THE SCREEN AFTER SEARCH CRITERIA ENTERED |

| AND ‘SEARCH’ BUTTON SELECTED. |

----------------------------------------------------

| AN ‘ITEM DETAILS’ BOX WILL APPEAR AFTER A PROVIDER|

| HAS BEEN SELECTED FROM THE LIST OF PROVIDERS. |

----------------------------------------------------

| SEARCHES CAN BE CONDUCTED MULTIPLE TIMES FROM THIS|

| SCREEN WITHOUT MOVING FORWARD IN THE INSTRUMENT. |

----------------------------------------------------

| YOU CAN ONLY PROCEED AFTER A PROVIDER OR ‘DON’T |

| SEARCH ANYMORE/NONE OF THE ABOVE MATCHES’ HAS BEEN|

| SELECTED. |

----------------------------------------------------

| IF A PROVIDER IS SELECTED, PROCEED TO PD14 |

----------------------------------------------------

| IF ‘DON’T SEARCH ANYMORE/NONE OF THE ABOVE |

| MATCHES’ HAS BEEN SELECTED, PROCEED TO PD18 |

----------------------------------------------------

PD05B

=====

PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}

STREET ADDRESS: {STREET ADDRESS FOR RESPONDENT}

STATE: {STATE ABBREVIATION FOR RESPONDENT}

STATE: [_____] [CHANGE STATE FOR SEARCH]

SELECT A SEARCH STRATEGY:

_ SEARCH ON PROVIDER NAME SHOWN ABOVE

_ SEARCH ON CORE STREET NAME

_ SEARCH ON TELEPHONE NUMBER

_ SEARCH ON PROVIDER NAME AND STREET

----------------------------------------------------

| ITEM DETAILS |

| PROVID: ...... {Display PROVID} |

| PROVIDER: .... {Display Provider Name} |

| ADDRESSS: .... {Display Provider Street Address} |

| .... {Display Provider City, State, Zip}|

| PHONE: ....... {Display Provider Telephone Number}|

----------------------------------------------------

{SEARCH CRITERIA 1}

{SEARCH CRITERIA 2}

[SEARCH]

THE NUMBER OF POTENTIAL MATCHES FOUND: {NUMBER OF MATCHES}

|-----------------|------------------|----------------|---------------|

|-----------------|------------------|----------------|---------------|

|-----------------|------------- ----|----------------|---------------|

|-----------------|------------- ----|----------------|---------------|

{DON’T SEARCH ANYMORE/NONE OF THE ABOVE MATCHES}

----------------------------------------------------

| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |

| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |

| BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER |

| FROM PV’. |

----------------------------------------------------

| DISPLAY TWO-CHARACTER STATE ABBREVIATION |

| ASSOCIATED WITH THIS RU’S ADDRESS FOR ‘STATE |

| ABBREVIATION FOR RESPONDENT’. |

----------------------------------------------------

| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |

| THE PROVIDER ROSTER FROM SECTION PV FOR THE |

| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM |

| PV’. |

----------------------------------------------------

| DISPLAY ‘PROVIDER LIKE’ FOR SEARCH CRITERIA 1 IF |

| ‘SEARCH ON PROVIDER NAME SHOWN ABOVE’ SELECTED. |

| DISPLAY NO SEARCH CRITERIA 2. |

----------------------------------------------------

| DISPLAY ‘STREET LIKE’ FOR SEARCH CRITERIA 1 IF |

| ‘SEARCH ON CORE STREET NAME’ SELECTED. DISPLAY NO |

| SEARCH CRITERIA 2. |

----------------------------------------------------

| DISPLAY ‘PHONE NUMBER’ FOR SEARCH CRITERIA 1 IF |

| ‘SEARCH ON TELEPHONE NUMBER’ SELECTED. DISPLAY NO |

| SEARCH CRITERIA 2. |

----------------------------------------------------

| DISPLAY ‘PROVIDER LIKE’ FOR SEARCH CRITERIA 1 AND |

| ‘STREET LIKE’ FOR SEARCH CRITERIA 2 IF ‘SEARCH ON |

| PROVIDER NAME AND STREET SHOWN ABOVE’ SELECTED. |

----------------------------------------------------

| A LIST OF PROVIDERS IS DISPLAYED ON THE BOTTOM |

| HALF OF THE SCREEN AFTER SEARCH CRITERIA ENTERED |

| AND ‘SEARCH’ BUTTON SELECTED. |

----------------------------------------------------

| AN ‘ITEM DETAILS’ BOX WILL APPEAR AFTER A PROVIDER|

| HAS BEEN SELECTED FROM THE LIST OF PROVIDERS. |

----------------------------------------------------

| SEARCHES CAN BE CONDUCTED MULTIPLE TIMES FROM THIS|

| SCREEN WITHOUT MOVING FORWARD IN THE INSTRUMENT. |

----------------------------------------------------

| YOU CAN ONLY PROCEED AFTER A PROVIDER OR ‘DON’T |

| SEARCH ANYMORE/NONE OF THE ABOVE MATCHES’ HAS BEEN|

| SELECTED. |

----------------------------------------------------

| IF A PROVIDER IS SELECTED, PROCEED TO PD14 |

----------------------------------------------------

| IF ‘DON’T SEARCH ANYMORE/NONE OF THE ABOVE |

| MATCHES’ HAS BEEN SELECTED, PROCEED TO PD18 |

----------------------------------------------------

LOOP_02

=======

OMITTED.

PD05

====

OMITTED.

PD06

====

OMITTED.

PD07

====

OMITTED.

PD08

====

OMITTED.

PD09

====

OMITTED.

PD10

====

OMITTED.

PD11

====

OMITTED.

BOX_05

======

OMITTED.

PD12

====

OMITTED.

PD13

====

OMITTED.

PD14

====

YOU HAVE CHOSEN THE FOLLOWING PROVIDER:

{NAME OF PROVIDER SELECTED AT PD05A/B}

{ADDRESS OF PROVIDER SELECTED AT PD05A/B}

YOUR ORIGINAL INPUT PROVIDER:

{NAME OF MEDICAL CARE PROVIDER FROM PV}

{STREET ADDRESS FROM PV}

YOUR OPTIONS:

ACCEPT PROVIDER AS SHOWN ............... 1 {END_LP01}

ACCEPT PROVIDER BUT MAKE CHANGES ....... 2 {PD15}

WRONG PROVIDER, GO BACK TO PREVIOUS

SCREEN ............................... 3

DON’T SEARCH ANYMORE ................... 4 {PD18}

----------------------------------------------------

| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |

| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |

| BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER |

| FROM PV’. IF PERSON-TYPE-PROVIDER, DISPLAY |

| PERSON NAME. IF FACILITY-PROVIDER, DISPLAY |

| FACILITY NAME. |

----------------------------------------------------

| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |

| THE PROVIDER ROSTER FROM SECTION PV FOR THE |

| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM |

| PV’. |

----------------------------------------------------

| DISPLAY FULL INFORMATION (I.E., NAME, ADDRESS, |

| CITY, STATE, ZIP, TELEPHONE, AND SPECIALTY) FOR |

| PROVIDER SELECTED IN PD05A OR PD05B FOR ‘NAME OF |

| PROVIDER SELECTED AT PD05A/PD05B’. |

----------------------------------------------------

| IF CODED ‘1’ (ACCEPT PROVIDER AS SHOWN) OR ‘2’ |

| (ACCEPT PROVIDER BUT MAKE CHANGES), STORE THIS |

| PROVIDER DIRECTORY ID. |

----------------------------------------------------

| NOTE: INFORMATION OBTAINED FROM THE PROVIDER |

| DIRECTORY SEARCH IS NOT USED TO REPLACE DATA |

| REPORTED BY THE RESPONDENT DURING THE INTERVIEW |

| OR INCORPORATED INTO PROVIDER ROSTER DISPLAYS. |

----------------------------------------------------

| IF CODED ‘3’ (WRONG PROVIDER, GO BACK TO PREVIOUS |

| SCREEN), CAPI AUTOMATICALLY RETURNS TO PD05A OR |

| PD05B. |

----------------------------------------------------

PD15

====

PROVIDER NAME: {NAME OF PROVIDER SELECTED AT PD05A/B}

PROVIDER ADDRESS: {ADDRESS OF PROVIDER SELECTED AT PD05A/B}

PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}

STREET ADDRESS: {STREET ADDRESS FROM PV}

MAKE CORRECTIONS TO ADDRESS BELOW.

USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH

NEED CORRECTION.

{Display Prov Name from ProvDir}

NAME: [______________________________]

{Display Prov Street Address from ProvDir}

1ST_STR_ ADDRESS: [______________________________]

{Display Prov City from ProvDir}

CITY: [______________________________]

{Display Prov State from ProvDir}

STATE: [______________________________]

{Display Prov Zip Code from ProvDir}

ZIP CODE: [______________________________]

{Display Prov Telephone from ProvDir}

TELEPHONE: [______________________________]

PRESS ENTER OR SELECT NEXT PAGE TO CONTINUE.

----------------------------------------------------

| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |

| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |

| BEING LOOPED ON FOR ‘NAME OF MEDICAL PROVIDER |

| FROM PV’. IF PERSON-TYPE-PROVIDER, DISPLAY |

| PERSON NAME. IF FACILITY-PROVIDER, DISPLAY |

| FACILITY NAME. |

----------------------------------------------------

| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |

| THE PROVIDER ROSTER FROM SECTION PV FOR THE |

| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS FROM |

| PV’. |

----------------------------------------------------

| DISPLAY NAME, ADDRESS, CITY, STATE, ZIP, AND |

| TELEPHONE FOR PROVIDER SELECTED IN PD05A OR PD05B |

| ‘NAME OF PROVIDER SELECTED AT PD05A/B’. |

----------------------------------------------------

| ENTRY FIELD SPECIFICATIONS: |

| |

| - FOR NAME, IF PERSON-TYPE-PROVIDER, DISPLAY |

| TITLE, FIRST NAME, AND LAST NAME FIELDS. |

| |

| - ELSE, DISPLAY FACILITY NAME FIELD. |

----------------------------------------------------

| FLAG THIS RECORD AS ‘UPDATED. NEEDS HOME OFFICE |

| REVIEW.’ |

----------------------------------------------------

| CONTINUE WITH PD16 |

----------------------------------------------------

PD16

====

PROVIDER NAME: {NAME OF PROVIDER SELECTED AT PD05A/B}

PROVIDER ADDRESS: {ADDRESS OF PROVIDER SELECTED AT PD05A/B}

PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}

STREET ADDRESS: {STREET ADDRESS FROM PV}

DO YOU WANT TO MAKE ANY NOTES ABOUT THIS PROVIDER?

YES .................................... 1 {PD16OV}

NO ..................................... 2 {END_LP01}

----------------------------------------------------

| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |

| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |

| BEING LOOPED ON FOR ‘NAME OF MEDICAL CARE |

| PROVIDER’. IF PERSON-TYPE-PROVIDER, DISPLAY |

| PERSON NAME. IF FACILITY-PROVIDER, DISPLAY |

| FACILITY NAME. |

----------------------------------------------------

| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |

| THE PROVIDER ROSTER FROM SECTION PV FOR THE |

| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS’. |

----------------------------------------------------

| DISPLAY NAME, ADDRESS, CITY, STATE, ZIP, AND |

| TELEPHONE FOR PROVIDER SELECTED IN PD05A OR PD05B |

| ‘NAME OF PROVIDER SELECTED AT PD05A/B’. |

----------------------------------------------------

PD16OV

======

PROVIDER NAME: {NAME OF PROVIDER SELECTED AT PD05A/B}

PROVIDER ADDRESS: {ADDRESS OF PROVIDER SELECTED AT PD05A/B}

PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}

STREET ADDRESS: {STREET ADDRESS FROM PV}

[ENTER TEXT].........................{END_LP01}

----------------------------------------------------

| ALLOW MULTIPLE LINES FOR ENTRY. |

----------------------------------------------------

PD17

====

OMITTED.

PD18

====

ENTER COMPLETE PROVIDER NAME, ADDRESS, AND TELEPHONE.

USE TAB TO MOVE THROUGH FIELDS. RETYPE ANY FIELDS WHICH

NEED CORRECTION.

IF NEEDED, TYPE THREE Xs (XXX) TO DELETE 2ND STREET ADDRESS.

{Provider Name from PV}

NAME: [______________________________]

{1ST_STR_Provider Address from PV}

1ST_STR_ADDRESS: [______________________________]

{2ND_STR_Provider Address from PV}

2ND_STR_ADDRESS: [______________________________]

CITY: [______________________________]

STATE: [______________________________]

ZIP CODE: [______________________________]

PHONE: [______________________________]

SPECIALTY: [______________________________]

USE HELP TO VIEW LIST OF STATE ABBREVIATIONS.

----------------------------------------------------

| IF STREET ADDRESS LINES ARE CODED REFUSED OR DON’T|

| KNOW (-7 OR -8) IN PROVIDER ROSTER (PV) SECTION, |

| DISPLAY BLANK LINES FOR THESE FIELDS. |

----------------------------------------------------

| DISPLAY THE name and address as recorded on the |

| provider roster from section pv for the provider |

| BEING LOOPED ON FOR ‘PROVIDER NAME FROM PV’. IF |

| PERSON-TYPE-PROVIDER, DISPLAY PERSON NAME. IF |

| FACILITY-PROVIDER, DISPLAY FACILITY NAME. |

----------------------------------------------------

| ENTRY FIELD SPECIFICATIONS: |

| |

| - FOR NAME, IF PERSON-TYPE-PROVIDER, DISPLAY |

| TITLE, FIRST NAME, AND LAST NAME FIELDS. |

| |

| - ELSE, DISPLAY FACILITY NAME FIELD. |

| |

| - DISPLAY THE NAME (IN APPROPRIATE FIRST & LAST |

| NAME OR FACILITY FIELDS) AS RECORDED ON THE |

| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER|

| BEING LOOPED ON IN THE ENTRY FIELD FOR THE |

| INTERVIEWER TO EITHER ACCEPT OR EDIT. |

| |

| - DISPLAY THE ADDRESS (IN APPROPRIATE FIRST AND |

| SECOND STREET FIELDS) AS RECORDED ON THE |

| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER|

| BEING LOOPED ON IN THE ENTRY FIELD FOR THE |

| INTERVIEWER TO EITHER ACCEPT OR EDIT. |

----------------------------------------------------

| FLAG THIS RECORD AS ‘NEW NAME/ADDRESS INFORMATION.|

| NEEDS HOME OFFICE REVIEW.’ |

----------------------------------------------------

| REFUSED AND DON’T KNOW ALLOWED IN ALL FIELDS, |

| EXCEPT THE ‘NAME’ AND ‘STATE’ FIELDS. |

----------------------------------------------------

| CONTINUE WITH PD19 |

----------------------------------------------------

PD19

====

PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}

STREET ADDRESS: {STREET ADDRESS FROM PV}

DO YOU WANT TO MAKE ANY NOTES ABOUT THIS PROVIDER?

YES .................................... 1 {PD19OV}

NO ..................................... 2 {END_LP01}

----------------------------------------------------

| DISPLAY NAME OF PROVIDER AS RECORDED ON THE |

| PROVIDER ROSTER FROM SECTION PV FOR THE PROVIDER |

| BEING LOOPED ON FOR ‘NAME OF MEDICAL CARE |

| PROVIDER’. IF PERSON-TYPE PROVIDER, DISPLAY |

| PERSON NAME. IF FACILITY-PROVIDER, DISPLAY |

| FACILITY NAME. |

----------------------------------------------------

| DISPLAY THE FIRST STREET ADDRESS AS RECORDED ON |

| THE PROVIDER ROSTER FROM SECTION PV FOR THE |

| PROVIDER BEING LOOPED ON FOR ‘STREET ADDRESS’. |

----------------------------------------------------

PD19OV

======

PROVIDER NAME: {NAME OF MEDICAL CARE PROVIDER FROM PV}

STREET ADDRESS: {STREET ADDRESS FROM PV}

[ENTER TEXT].................... {END_LP01}

----------------------------------------------------

| ALLOW MULTIPLE LINES FOR ENTRY. |

----------------------------------------------------

END_LP02

========

OMITTED.

END_LP01

========

----------------------------------------------------

| CYCLE ON NEXT PROVIDER THAT MEETS THE CONDITIONS |

| STATED IN THE LOOP DEFINITION. |

----------------------------------------------------

| IF NO OTHER PROVIDER MEETS THE STATED CONDITIONS, |

| END LOOP_01 AND CONTINUE WITH BOX_06 |

----------------------------------------------------

BOX_06

======

----------------------------------------------------

| GO TO NEXT QUESTIONNAIRE SECTION. |

----------------------------------------------------

32-19

File Type	application/msword
File Title	MEPS Provider Directory - P12R5/P13R3/P14R1
Subject	PD Section Item Specifications
Author	Agency for Healthcare Research and Quality
Last Modified By	wcarroll
File Modified	2009-07-10
File Created	2009-07-10