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pdfBOX AC1AA
BOX AC1AA
Page Order # :
10
BOX INSTRUCTIONS
( ACQ1010 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO ACINTRO - ACINT (
ACQ1030 ).
ELSE IF (SP HAD AN ER VISIT IN THE CURRENT ROUND OR ANY OF THE
2 PREVIOUS ROUNDS) AND (AC6A NOT ALREADY ASKED), GO TO
AC6A - EWAITHRS ( ACQ1130 ).
ELSE GO TO BOX AC1C - (ACQ1170 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
26
SPHadERVisit
SP had ER visit in current round or 2 previous rounds =
There is an EVNT where (EVNT.EVNTTYPE=ER and
EVNT.EVNTDFLG^=1/Yes and EVNT.EVNTRNDC >=
current round - 2).
31
AC6AAsked
AC6A already asked =
ACCS.EWAITUNT ^= EMPTY on ACCS where
ACCS.ACCSRND = current round.
DESIGN NOTES
The AC section collects Access to Care information based on the SP's
Emergency Room, Outpatient and Medical Provider visits.
The AC section is asked in its entirety for Supplement sample following
the DM section.
The Continuing sample receives a subset of AC questions based on ER,
OP, and MP utilization in the current round. If the SP reports a current
round ER visit, we ask AC6A while administering ER. If the SP reports a
current round OP visit, we ask AC9-AC16A while administering OP. If the
SP reports a current round MP visit, we ask AC20-AC28A1 while
administering MP. Once MP is complete, the AC section is administered
to the continuing sample. The SP will receive ER, OP, MP related
questions in AC based on whether or not the SP reported an ER, OP or
MP visit during the past year. The AC questions will only be asked once,
therefore if the SP has already received a subset of the AC questions in
ER, OP, and/or MP, these questions will be skipped while administering
AC.
6:29:13 PM Monday, July 07, 2008
Page 1 of 85
ACINTRO
ACINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
ACINT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
30
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
The next questions are about health care services [you/(SP)] may
have used since (REFERENCE DATE).
Int. Instr II:
INPUT FIELDS / ROUTING
6:29:15 PM Monday, July 07, 2008
Page 2 of 85
ACINTRO
ACINT
Field1:
Cheshire Name:
( ACQ1030 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC1 - ERVISIT ( ACQ1040 )
English text: CONTINUE
Attribute
Empty
Route
AC1 - ERVISIT ( ACQ1040 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:29:19 PM Monday, July 07, 2008
Page 3 of 85
AC1
AC1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ERVISIT
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
40
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Since (REFERENCE DATE), did [you/(SP)] go to a hospital
emergency room?
Int. Instr II:
INPUT FIELDS / ROUTING
6:29:21 PM Monday, July 07, 2008
Page 4 of 85
AC1
ERVISIT
Field1:
Cheshire Name:
( ACQ1040 )
ACCS.ERVISIT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC6A - EWAITHRS ( ACQ1130 )
English text: YES
No
AC8 - OPDVISIT ( ACQ1180 )
English text: NO
Attribute
Don't know
Route
AC8 - OPDVISIT ( ACQ1180 )
Refusal
AC8 - OPDVISIT ( ACQ1180 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:29:25 PM Monday, July 07, 2008
Page 5 of 85
AC6A
AC6A
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
EWAITUNT
Field 2:
EWAITHRS
Field 3:
EWAITMIN
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
90
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "most recent" in the first sentence in BOLD.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Think about the most recent time [you/(SP)] went to the hospital
emergency room. How long did [you/(SP)] have to wait during
(your/his/her) visit before (you/he/she) saw a doctor or some other
medical person? Please include the time spent in the waiting room
and exam room.
Int. Instr II:
6:29:28 PM Monday, July 07, 2008
Page 6 of 85
AC6A
INPUT FIELDS / ROUTING
Field1:
EWAITUNT
Cheshire Name:
( ACQ1120 )
ACCS.EWAITUNT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAcsuntb
1
No
No
Number Label
0 DidNotHaveToWait
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX AC1B - (ACQ1150 )
1
English text: DID NOT HAVE TO WAIT
HoursOnly
AC6A - EWAITHRS ( ACQ1130 )
2
English text: HOURS ONLY
MinutesOnly
AC6A - EWAITMIN ( ACQ1140 )
3
English text: MINUTES ONLY
HoursAndMinutes
AC6A - EWAITHRS ( ACQ1130 )
English text: HOURS AND MINUTES
Attribute
Don't know
Route
BOX AC1B - (ACQ1150 )
Refusal
BOX AC1B - (ACQ1150 )
6:29:34 PM Monday, July 07, 2008
Page 7 of 85
AC6A
Field2:
Cheshire Name:
EWAITHRS
( ACQ1130 )
ACCS.EWAITHRS
Item Text display:
Item Text:
Label:
Label Position:
HOURS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccshrs1
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
72
Route
If AC6A - EWAITUNT = 3/HoursAndMinutes, go
to AC6A - EWAITMIN.
Else go to BOX AC1B.
Field3:
Cheshire Name:
EWAITMIN
( ACQ1140 )
ACCS.EWAITMIN
Item Text display:
Item Text:
Label:
Label Position:
MINUTES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccsmin
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
59
Route
BOX AC1B - (ACQ1150 )
BACKGROUND VARIABLE ASSIGNMENTS
6:29:36 PM Monday, July 07, 2008
Page 8 of 85
AC6A
SOFT EDIT CHECKS
Edit #1:
If EWAITUNT = 1/HoursOnly or 3/HoursAndMinutes, EWAITHRS =
1-16.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF HOURS SEEMS UNLIKELY. PLEASE VERIFY."
Edit #2:
If EWAITUNT = 2/MinutesOnly or 3/HoursAndMinutes, EWAITMIN =
5 - 59.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF MINUTES SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:29:36 PM Monday, July 07, 2008
Page 9 of 85
BOX AC1B
BOX AC1B
Page Order # :
100
BOX INSTRUCTIONS
( ACQ1150 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO AC7 - ERADMT (
ACQ1160 ).
ELSE GO TO BOX AC1C - (ACQ1170 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
6:29:36 PM Monday, July 07, 2008
Page 10 of 85
AC7
AC7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ERADMT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
110
Roster Name:
Roster Type:
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Were you/Was (SP)] admitted to the hospital from the emergency
room?
Int. Instr II:
INPUT FIELDS / ROUTING
6:29:38 PM Monday, July 07, 2008
Page 11 of 85
AC7
ERADMT
Field1:
Cheshire Name:
( ACQ1160 )
ACCS.ERADMT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX AC1C - (ACQ1170 )
English text: YES
No
BOX AC1C - (ACQ1170 )
English text: NO
Attribute
Don't know
Route
BOX AC1C - (ACQ1170 )
Refusal
BOX AC1C - (ACQ1170 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:29:42 PM Monday, July 07, 2008
Page 12 of 85
BOX AC1C
BOX AC1C
Page Order # :
120
BOX INSTRUCTIONS
( ACQ1170 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO AC8 - OPDVISIT (
ACQ1180 ).
ELSE IF AC6A ASKED WHILE ADMINISTERING ER, GO TO BOX ER6 (ERQ1365 ).
ELSE IF (SP HAD AN OP VISIT IN THE CURRENT ROUND OR ANY OF
THE 2 PREVIOUS ROUNDS) AND (AC9-AC16A NOT ALREADY ASKED),
GO TO AC9 - OPDREAS ( ACQ1190 ).
ELSE GO TO BOX AC1E - (ACQ1380 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
27
SPHadOPVisit
SP had OP visit in current round or 2 previous rounds =
There is an EVNT where (EVNT.EVNTTYPE=OP and
EVNT.EVNTDFLG^=1/Yes and EVNT.EVNTRNDC >=
current round - 2).
32
AC9AC16AAsked
AC9-AC16A already asked =
ACCS.OPDREAS ^= EMPTY on ACCS where
ACCS.ACCSRND = current round.
DESIGN NOTES
Included in this box is logic that handles exiting AC when being called
from ER. When administering ER, if the SP reports a current round ER
visit, the ER section calls AC6A. When complete, return to ER.
6:29:42 PM Monday, July 07, 2008
Page 13 of 85
AC8
AC8
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OPDVISIT
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
130
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Since (REFERENCE DATE), did [you/(SP)] go to a hospital clinic or
outpatient department?
Int. Instr II:
DO NOT INCLUDE HOSPITAL INPATIENT STAYS.
INPUT FIELDS / ROUTING
6:29:44 PM Monday, July 07, 2008
Page 14 of 85
AC8
OPDVISIT
Field1:
Cheshire Name:
( ACQ1180 )
ACCS.OPDVISIT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC9 - OPDREAS ( ACQ1190 )
English text: YES
No
AC17 - NHRESEVR ( ACQ1390 )
English text: NO
Attribute
Don't know
Route
AC17 - NHRESEVR ( ACQ1390 )
Refusal
AC17 - NHRESEVR ( ACQ1390 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:29:48 PM Monday, July 07, 2008
Page 15 of 85
AC9
AC9
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
OPDREAS
Field 2:
OPDOTHOS
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
140
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
DESIGN NOTE: The first sentence is designed to be the
introductory statement for continuing sample SPs when
administering AC. If SP skipped AC6A, then AC9 will be the SP's
first question in AC. The SP does not receive this introductory
statement when AC9 is called from OP.
If SP is in the continuing sample and AC9 is the SP's first question
asked while administering AC, display "I have a few more . . ." .
Else do not display.
Display "in the past" in the first sentence in BOLD.
Display "most recent" in the second sentence in BOLD.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
6:29:53 PM Monday, July 07, 2008
Page 16 of 85
AC9
Int. Instr I:
Question Text:
[I have a few more questions about visits that [you/(SP)] had in the
past.]
Think about the most recent time [you/(SP)] went to a hospital clinic
or outpatient department. What was the reason [you/(SP)] went to
the hospital clinic or outpatient department?
[PROBE: Any other reason?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
6:30:01 PM Monday, July 07, 2008
Page 17 of 85
AC9
OPDREAS
Field1:
Cheshire Name:
( ACQ1190 )
NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1/MedCondNamed=ACCS.OPDMCOND
2/Tests=ACCS.OPDTESTS
3/Followup=ACCS.OPDFOLUP
4/Checkup=ACCS.OPDCHKUP
5/Referral=ACCS.OPDRFRL
6/Surgery=ACCS.OPDSURGY
7/PreventiveShot=ACCS.OPDPSHOT
8/TreatmentShot=ACCS.OPDTSHOT
9/RefillPM=ACCS.OPDPMED
91/Other=ACCS.OPDOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Treason
10
No
No
Number Label
1 MedCondNamed
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX AC1D - (ACQ1220 )
2
English text: MEDICAL CONDITION NAMED
Tests
BOX AC1D - (ACQ1220 )
3
English text: TESTS
Followup
BOX AC1D - (ACQ1220 )
4
English text: FOLLOW-UP
Checkup
BOX AC1D - (ACQ1220 )
5
English text: CHECKUP
Referral
BOX AC1D - (ACQ1220 )
English text: REFERRAL
6:30:13 PM Monday, July 07, 2008
Page 18 of 85
AC9
6
Surgery
BOX AC1D - (ACQ1220 )
7
English text: SURGERY
PreventiveShot
BOX AC1D - (ACQ1220 )
8
English text: PREVENTIVE SHOT
TreatmentShot
BOX AC1D - (ACQ1220 )
9
English text: TREATMENT SHOT
RefillPM
BOX AC1D - (ACQ1220 )
91
English text: TO GET OR REFILL PRESCRIPTION
Other
AC9 - OPDOTHOS ( ACQ1210 )
English text: OTHER
Attribute
Don't know
Route
BOX AC1D - (ACQ1220 )
Refusal
BOX AC1D - (ACQ1220 )
Field2:
Cheshire Name:
OPDOTHOS
( ACQ1210 )
ACCS.OPDOTHOS
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX AC1D - (ACQ1220 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:30:21 PM Monday, July 07, 2008
Page 19 of 85
AC9
TECHNICAL NOTES
30
ContinuingSample
Continuing Sample SP =
MRES.INTTYPE ^=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
6:30:21 PM Monday, July 07, 2008
Page 20 of 85
BOX AC1D
BOX AC1D
Page Order # :
150
BOX INSTRUCTIONS
( ACQ1220 )
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) AND (RESPONSE TO AC9 OPDREAS INCLUDES 1/MedCondNamed OR 6/Surgery), GO TO AC12 OPDAPPT ( ACQ1260 ).
ELSE IF (SP IS IN THE SUPPLEMENTAL SAMPLE) AND (RESPONSE TO
AC9 - OPDREAS DOES NOT INCLUDE 1/MedCondNamed AND DOES NOT
INCLUDE 6/Surgery), GO TO AC10 - OPDSCOND ( ACQ1230 ).
ELSE GO TO AC12 - OPDAPPT ( ACQ1260 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
6:30:21 PM Monday, July 07, 2008
Page 21 of 85
AC10
AC10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OPDSCOND
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
160
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Was that for a specific condition?
Int. Instr II:
INPUT FIELDS / ROUTING
6:30:24 PM Monday, July 07, 2008
Page 22 of 85
AC10
OPDSCOND
Field1:
Cheshire Name:
( ACQ1230 )
ACCS.OPDSCOND
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC12 - OPDAPPT ( ACQ1260 )
English text: YES
No
AC12 - OPDAPPT ( ACQ1260 )
English text: NO
Attribute
Don't know
Route
AC12 - OPDAPPT ( ACQ1260 )
Refusal
AC12 - OPDAPPT ( ACQ1260 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:30:27 PM Monday, July 07, 2008
Page 23 of 85
AC12
AC12
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
OPDAPPT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
180
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did [you/(SP)] have an appointment for this visit to the hospital clinic
or outpatient department, or did (you/he/she) just walk in?
Int. Instr II:
INPUT FIELDS / ROUTING
6:30:30 PM Monday, July 07, 2008
Page 24 of 85
AC12
OPDAPPT
Field1:
Cheshire Name:
( ACQ1260 )
ACCS.OPDAPPT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TApptwalk
1
No
No
Number Label
1 Appointment
2
English text: APPOINTMENT
WalkedIn
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC13 - OPDDRTEL ( ACQ1270 )
AC16A - OWAITHRS ( ACQ1360 )
English text: WALKED IN
Attribute
Don't know
Route
AC16A - OWAITHRS ( ACQ1360 )
Refusal
AC16A - OWAITHRS ( ACQ1360 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:30:34 PM Monday, July 07, 2008
Page 25 of 85
AC13
AC13
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
OPDDRTEL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
190
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did someone at the hospital clinic or outpatient department tell
[you/(SP)] when to come back during an
earlier visit, or did [you/(SP)] call for an appointment?
Int. Instr II:
INPUT FIELDS / ROUTING
6:30:36 PM Monday, July 07, 2008
Page 26 of 85
AC13
OPDDRTEL
Field1:
( ACQ1270 )
ACCS.OPDDRTEL
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TApptback
1
No
No
Number Label
1 ToldToComeBack
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC16A - OWAITHRS ( ACQ1360 )
English text: TOLD TO COME BACK DURING EARLIER VISIT
CalledForAnAppointment
AC14 - OPDAWUNT ( ACQ1280 )
English text: CALLED FOR AN APPOINTMENT
Attribute
Don't know
Route
AC16A - OWAITHRS ( ACQ1360 )
Refusal
AC16A - OWAITHRS ( ACQ1360 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:30:40 PM Monday, July 07, 2008
Page 27 of 85
AC14
AC14
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
OPDAWUNT
Field 2:
OPDAWDAY
Field 3:
OPDAWWKS
Field 4:
OPDAWMOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How long did [you/(SP)] have to wait for the appointment -- about
how many days, weeks, or months?
Int. Instr II:
INPUT FIELDS / ROUTING
6:30:43 PM Monday, July 07, 2008
Page 28 of 85
AC14
OPDAWUNT
Field1:
Cheshire Name:
( ACQ1280 )
ACCS.OPDAWUNT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAcsuntc
1
No
No
Number Label
0 NoWait
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC16A - OWAITHRS ( ACQ1360 )
1
English text: DID NOT HAVE TO WAIT
Days
AC14 - OPDAWDAY ( ACQ1290 )
2
English text: DAYS
Weeks
AC14 - OPDAWWKS ( ACQ1300 )
3
English text: WEEKS
Months
AC14 - OPDAWMOS ( ACQ1310 )
English text: MONTHS
Attribute
Don't know
Route
AC16A - OWAITHRS ( ACQ1360 )
Refusal
AC16A - OWAITHRS ( ACQ1360 )
6:30:51 PM Monday, July 07, 2008
Page 29 of 85
AC14
Field2:
Cheshire Name:
OPDAWDAY
( ACQ1290 )
ACCS.OPDAWDAY
Item Text display:
Item Text:
Label:
Label Position:
DAYS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccsday
1
No
No
Number Label
1 [Continuous answer.]
Field3:
Cheshire Name:
OPDAWWKS
FieldSize:
Min Value:
Max Value:
Mask:
1
180
Route
AC16A - OWAITHRS ( ACQ1360 )
( ACQ1300 )
ACCS.OPDAWWKS
Item Text display:
Item Text:
Label:
Label Position:
WEEKS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccswk
1
No
No
Number Label
1 [Continuous answer.]
6:30:56 PM Monday, July 07, 2008
FieldSize:
Min Value:
Max Value:
Mask:
1
30
Route
AC16A - OWAITHRS ( ACQ1360 )
Page 30 of 85
AC14
Field4:
Cheshire Name:
OPDAWMOS
( ACQ1310 )
ACCS.OPDAWMOS
Item Text display:
Item Text:
Label:
Label Position:
MONTHS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccsmos
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
6
Route
AC16A - OWAITHRS ( ACQ1360 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
If OPDAWUNT = 1/Days, OPDAWDAY = 1-90.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF DAYS SEEMS UNLIKELY. PLEASE VERIFY."
Edit #2:
If OPDAWUNT = 2/Weeks, OPDAWWKS = 1-14.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF WEEKS SEEMS UNLIKELY. PLEASE VERIFY."
Edit #3:
If OPDAWUNT = 3/Months, OPDAWMOS = 1-3.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF MONTHS SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:30:58 PM Monday, July 07, 2008
Page 31 of 85
AC16A
AC16A
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
OWAITUNT
Field 2:
OWAITHRS
Field 3:
OWAITMIN
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
220
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display first sentence, "[Think about...]" in brackets.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Think about the most recent time [you/(SP)] went to a hospital clinic
or outpatient department.]
How long did [you/(SP)] have to wait during (your/his/her) most
recent visit before (you/he/she) saw a doctor or some other medical
person? Please include the time spent in the waiting room and
exam room.
6:31:01 PM Monday, July 07, 2008
Page 32 of 85
AC16A
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
OWAITUNT
Cheshire Name:
( ACQ1350 )
ACCS.OWAITUNT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAcsuntb
1
No
No
Number Label
0 DidNotHaveToWait
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX AC1E - (ACQ1380 )
1
English text: DID NOT HAVE TO WAIT
HoursOnly
AC16A - OWAITHRS ( ACQ1360 )
2
English text: HOURS ONLY
MinutesOnly
AC16A - OWAITMIN ( ACQ1370 )
3
English text: MINUTES ONLY
HoursAndMinutes
AC16A - OWAITHRS ( ACQ1360 )
English text: HOURS AND MINUTES
Attribute
Don't know
Route
BOX AC1E - (ACQ1380 )
Refusal
BOX AC1E - (ACQ1380 )
6:31:07 PM Monday, July 07, 2008
Page 33 of 85
AC16A
Field2:
Cheshire Name:
OWAITHRS
( ACQ1360 )
ACCS.OWAITHRS
Item Text display:
Item Text:
Label:
Label Position:
HOURS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccshrs1
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
72
Route
If AC16A - OWAITUNT = 3/HoursAndMinutes,
go to AC16A - OWAITMIN.
Else go to BOX AC1E.
Field3:
Cheshire Name:
OWAITMIN
( ACQ1370 )
ACCS.OWAITMIN
Item Text display:
Item Text:
Label:
Label Position:
MINUTES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccsmin
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
59
Route
BOX AC1E - (ACQ1380 )
BACKGROUND VARIABLE ASSIGNMENTS
6:31:09 PM Monday, July 07, 2008
Page 34 of 85
AC16A
SOFT EDIT CHECKS
Edit #1:
If OWAITUNT = 1/HoursOnly or 3/HoursAndMinutes, OWAITHRS =
1-16.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER FO HOURS SEEMS UNLIKELY. PLEASE VERIFY."
Edit #2:
If OWAITUNT = 2/MinutesOnly or 3/HoursAndMinutes, OWAITMIN
= 5 - 59.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF MINUTES SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:31:09 PM Monday, July 07, 2008
Page 35 of 85
BOX AC1E
BOX AC1E
Page Order # :
230
BOX INSTRUCTIONS
( ACQ1380 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO AC17 - NHRESEVR (
ACQ1390 ).
ELSE IF AC9-AC16A ASKED WHILE ADMINISTERING OP, GO TO BOX
OP7 - (OPQ1505 ).
ELSE IF (SP HAD AN MP VISIT IN THE CURRENT ROUND OR ANY OF
THE 2 PREVIOUS ROUNDS) AND (AC20-AC28A1 NOT ALREADY ASKED),
GO TO AC20 - MDSPCLTY ( ACQ1430 ).
ELSE GO TO BOX AC1G - (ACQ1700 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
28
SPHadMPVisit
SP had MP visit current round or 2 prev.rounds =
There is an EVNT where ((EVNTRNDC>=(current
round - 2)) & EVNTTYPE=MP & EVNTDFLG^=1/Yes &
MPIPSTAY ^=1/Yes & ((MPTYPE = 1/MedicalDoctor) or
(PROV.PROVSPEC=2/MedicalDoctor on PROV where
PROVNUM=EVNTNUM))).
33
AC20AC28A1Asked
AC20-AC28A1 already asked =
ACCS.MDSPCLTY ^= EMPTY on ACCS where
ACCS.ACCSRND = current round.
DESIGN NOTES
Included in this box is logic that handles exiting AC when being called
from OP. When administering OP, if the SP reports a current round OP
visit, the OP section calls AC9-AC16A. When complete, return to OP.
6:31:09 PM Monday, July 07, 2008
Page 36 of 85
AC17
AC17
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
NHRESEVR
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
240
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Have you/Has (SP)] ever been a resident or patient in a nursing
home or similar place?
Int. Instr II:
INPUT FIELDS / ROUTING
6:31:11 PM Monday, July 07, 2008
Page 37 of 85
AC17
NHRESEVR
Field1:
Cheshire Name:
( ACQ1390 )
ACCS.NHRESEVR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC18 - NHLRESMM ( ACQ1400 )
English text: YES
No
AC19 - MDVISIT ( ACQ1420 )
English text: NO
Attribute
Don't know
Route
AC19 - MDVISIT ( ACQ1420 )
Refusal
AC19 - MDVISIT ( ACQ1420 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:31:15 PM Monday, July 07, 2008
Page 38 of 85
AC18
AC18
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
NHLRESMM
Field 2:
NHLRESYY
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
250
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display the word "last" in BOLD.
Multi Field display:
Horizontal Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
When [were you/was (SP)] last a resident or patient in a nursing
home or similar place?
Int. Instr II:
INPUT FIELDS / ROUTING
6:31:18 PM Monday, July 07, 2008
Page 39 of 85
AC18
NHLRESMM
Field1:
Cheshire Name:
( ACQ1400 )
ACCS.NHLRESMM
Item Text display:
Item Text:
Label:
Label Position:
MM
Under
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
AC18 - NHLRESYY ( ACQ1410 )
Refusal
AC18 - NHLRESYY ( ACQ1410 )
6:31:25 PM Monday, July 07, 2008
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
AC18 - NHLRESYY ( ACQ1410 )
Page 40 of 85
AC18
( ACQ1410 )
NHLRESYY
Field2:
Cheshire Name:
ACCS.NHLRESYY
Item Text display:
Item Text:
Label:
Label Position:
YY
Under
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TYearDKRF
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
0
99
Route
AC19 - MDVISIT ( ACQ1420 )
Attribute
Don't know
Route
AC19 - MDVISIT ( ACQ1420 )
Refusal
AC19 - MDVISIT ( ACQ1420 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
In order to check date, set date of last residency to equal
ACCS.NHLRESMM/ '01'/ACCS.NHLRESYY.
Date of last residency is on or between SP's date of birth,
ROST.HHDOBMM/ ROST.HHDOBDD/ROST.HHDOBYY, and
today's date.
If not true, display message "INVALID ENTRY. PLEASE
REENTER."
TECHNICAL NOTES
101
SPDateofBirth
SP's Date of Birth is stored on ROST where
ROST.ROSTNUM='01'.
Month: ROST.HHDOBMM
Day: ROST.HHDOBDD
Year: ROST.HHDOBYY
DESIGN NOTES
6:31:28 PM Monday, July 07, 2008
Page 41 of 85
AC19
AC19
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MDVISIT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
260
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Next, I want to ask about [your/(SP)’s] visits to doctors since
(REFERENCE DATE). [Have you/Has (SP)] seen a medical doctor
since (REFERENCE DATE)? Please do not include a doctor seen
at home, at an emergency room or outpatient department, or while
an inpatient at a hospital.
Int. Instr II:
INPUT FIELDS / ROUTING
6:31:30 PM Monday, July 07, 2008
Page 42 of 85
AC19
MDVISIT
Field1:
Cheshire Name:
( ACQ1420 )
ACCS.MDVISIT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC20 - MDSPCLTY ( ACQ1430 )
English text: YES
No
BOX AC1G - (ACQ1700 )
English text: NO
Attribute
Don't know
Route
BOX AC1G - (ACQ1700 )
Refusal
BOX AC1G - (ACQ1700 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:31:34 PM Monday, July 07, 2008
Page 43 of 85
AC20
AC20
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MDSPCLTY
Field 2:
MDSPCLOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
270
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
DESIGN NOTE: The first sentence is designed to be the
introductory statement for continuing sample SPs when
administering AC. If SP skipped AC6A and AC9-AC16A, then
AC20 will be the SP's first question in AC. The SP does not receive
this introductory statement when AC20 is called from MP.
If SP is in the continuing sample and AC20 is the SP's first question
asked while administering AC, display "I have a few more . . ." .
Else do not display.
Display "in the past" in the first sentence in BOLD.
Display "most recent" in the second sentence in BOLD.
Display "other than at home" in the second sentence in BOLD.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
6:31:41 PM Monday, July 07, 2008
Page 44 of 85
AC20
TEXT:
Context Header:
Int. Instr I:
Question Text:
[I have a few more questions about visits that [you/(SP)] had in the
past.]
Think about the most recent time [you/(SP)] saw a medical doctor
somewhere other than at home or at a hospital. What was the
doctor’s specialty?
Int. Instr II:
INPUT FIELDS / ROUTING
6:31:53 PM Monday, July 07, 2008
Page 45 of 85
AC20
MDSPCLTY
Field1:
Cheshire Name:
( ACQ1430 )
ACCS.MDSPCLTY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMdspclty
1
No
No
Number Label
1 Allergy
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC21 - MDREAS ( ACQ1450 )
2
English text: ALLERGY/IMMUNOLOGY
Anesthesiology
AC21 - MDREAS ( ACQ1450 )
3
English text: ANESTHESIOLOGY
Cardiology
AC21 - MDREAS ( ACQ1450 )
5
English text: CARDIOLOGY (HEART)
Dermatology
AC21 - MDREAS ( ACQ1450 )
7
English text: DERMATOLOGY (SKIN)
Endocrinology
AC21 - MDREAS ( ACQ1450 )
8
English text: ENDOCRINOLOGY/METABOLISM (DIABETES,THYROID)
FamilyPractice
AC21 - MDREAS ( ACQ1450 )
9
English text: FAMILY PRACTICE
Gastroenterology
AC21 - MDREAS ( ACQ1450 )
10
English text: GASTROENTEROLOGY
GeneralPractice
AC21 - MDREAS ( ACQ1450 )
11
English text: GENERAL PRACTICE
GeneralSurgery
AC21 - MDREAS ( ACQ1450 )
12
English text: GENERAL SURGERY
Geriatrics
AC21 - MDREAS ( ACQ1450 )
13
English text: GERIATRICS (ELDERLY)
Gynecology
AC21 - MDREAS ( ACQ1450 )
14
English text: GYNECOLOGY - OBSTETRICS
Hematology
AC21 - MDREAS ( ACQ1450 )
15
English text: HEMATOLOGY (BLOOD)
Hospital
AC21 - MDREAS ( ACQ1450 )
English text: HOSPITAL RESIDENCE
6:32:16 PM Monday, July 07, 2008
Page 46 of 85
AC20
16
InternalMed
AC21 - MDREAS ( ACQ1450 )
17
English text: INTERNAL MEDICINE (INTERNIST)
Nephrology
AC21 - MDREAS ( ACQ1450 )
18
English text: NEPHROLOGY (KIDNEYS)
Neurology
AC21 - MDREAS ( ACQ1450 )
19
English text: NEUROLOGY
NuclearMed
AC21 - MDREAS ( ACQ1450 )
20
English text: NUCLEAR MEDICINE
Oncology
AC21 - MDREAS ( ACQ1450 )
21
English text: ONCOLOGY (TUMORS, CANCER)
Ophthalmology
AC21 - MDREAS ( ACQ1450 )
22
English text: OPHTHALMOLOGY (EYES)
Orthopedics
AC21 - MDREAS ( ACQ1450 )
24
English text: ORTHOPEDICS
Osteopathy
AC21 - MDREAS ( ACQ1450 )
25
English text: OSTEOPATHY (DO)
Otorhinolaryngology
AC21 - MDREAS ( ACQ1450 )
26
English text: OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT)
Pathology
AC21 - MDREAS ( ACQ1450 )
27
English text: PATHOLOGY
PhysMed
AC21 - MDREAS ( ACQ1450 )
28
English text: PHYS MED/REHAB
PlasticSurgery
AC21 - MDREAS ( ACQ1450 )
29
English text: PLASTIC SURGERY
Proctology
AC21 - MDREAS ( ACQ1450 )
30
English text: PROCTOLOGY
Psychiatry
AC21 - MDREAS ( ACQ1450 )
31
English text: PSYCHIATRY/PSYCHIATRIST
Pulmonary
AC21 - MDREAS ( ACQ1450 )
32
English text: PULMONARY (LUNGS)
Radiology
AC21 - MDREAS ( ACQ1450 )
33
English text: RADIOLOGY
Rheumatology
AC21 - MDREAS ( ACQ1450 )
34
English text: RHEUMATOLOGY (ARTHRITIS)
ThoracicSurgery
AC21 - MDREAS ( ACQ1450 )
35
English text: THORACIC SURGERY (CHEST)
Urology
AC21 - MDREAS ( ACQ1450 )
91
English text: UROLOGY
OtherSpecialty
AC20 - MDSPCLOS ( ACQ1440 )
English text: OTHER DR SPECIALTY
Attribute
Don't know
Route
AC21 - MDREAS ( ACQ1450 )
6:32:40 PM Monday, July 07, 2008
Page 47 of 85
AC20
Refusal
AC21 - MDREAS ( ACQ1450 )
Field2:
( ACQ1440 )
MDSPCLOS
Cheshire Name:
ACCS.MDSPCLOS
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
OTHER DR SPECIALTY (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
AC21 - MDREAS ( ACQ1450 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
30
ContinuingSample
Continuing Sample SP =
MRES.INTTYPE ^=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
6:32:42 PM Monday, July 07, 2008
Page 48 of 85
AC21
AC21
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
MDREAS
Field 2:
MDOTHOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
280
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What was the reason [you/(SP)] saw the doctor?
[PROBE: Any other reason?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
6:32:47 PM Monday, July 07, 2008
Page 49 of 85
AC21
6:32:55 PM Monday, July 07, 2008
Page 50 of 85
AC21
MDREAS
Field1:
Cheshire Name:
( ACQ1450 )
NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1/MedCondNamed=ACCS.MDMCOND
2/Tests=ACCS.MDTESTS
3/Followup=ACCS.MDFOLUP
4/Checkup=ACCS.MDCHKUP
5/Referral=ACCS.MDRFRL
6/Surgery=ACCS.MDSURGY
7/PreventiveShot=ACCS.MDPSHOT
8/TreatmentShot=ACCS.MDTSHOT
9/RefillPM=ACCS.MDPMED
91/Other=ACCS.MDOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Treason
10
No
No
Number Label
1 MedCondNamed
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX AC1F - (ACQ1480 )
2
English text: MEDICAL CONDITION NAMED
Tests
BOX AC1F - (ACQ1480 )
3
English text: TESTS
Followup
BOX AC1F - (ACQ1480 )
4
English text: FOLLOW-UP
Checkup
BOX AC1F - (ACQ1480 )
5
English text: CHECKUP
Referral
BOX AC1F - (ACQ1480 )
English text: REFERRAL
6:33:07 PM Monday, July 07, 2008
Page 51 of 85
AC21
6
Surgery
BOX AC1F - (ACQ1480 )
7
English text: SURGERY
PreventiveShot
BOX AC1F - (ACQ1480 )
8
English text: PREVENTIVE SHOT
TreatmentShot
BOX AC1F - (ACQ1480 )
9
English text: TREATMENT SHOT
RefillPM
BOX AC1F - (ACQ1480 )
91
English text: TO GET OR REFILL PRESCRIPTION
Other
AC21 - MDOTHOS ( ACQ1470 )
English text: OTHER
Attribute
Don't know
Route
BOX AC1F - (ACQ1480 )
Refusal
BOX AC1F - (ACQ1480 )
Field2:
Cheshire Name:
MDOTHOS
( ACQ1470 )
ACCS.MDOTHOS
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX AC1F - (ACQ1480 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:33:15 PM Monday, July 07, 2008
Page 52 of 85
AC21
TECHNICAL NOTES
DESIGN NOTES
6:33:15 PM Monday, July 07, 2008
Page 53 of 85
BOX AC1F
BOX AC1F
Page Order # :
290
BOX INSTRUCTIONS
( ACQ1480 )
IF (SP IS IN THE SUPPLEMENTAL SAMPLE) AND (RESPONSE TO AC21MDREAS INCLUDES 1/MedCondNamed OR 6/Surgery), GO TO AC24 MDAPPT ( ACQ1520 ).
ELSE IF (SP IS IN THE SUPPLEMENTAL SAMPLE) AND (RESPONSE TO
AC21- MDREAS DOES NOT INCLUDE 1/MedCondNamed AND DOES NOT
INCLUDE 6/Surgery), GO TO AC22 - MDSCOND ( ACQ1490 ).
ELSE GO TO AC24 - MDAPPT ( ACQ1520 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
6:33:15 PM Monday, July 07, 2008
Page 54 of 85
AC22
AC22
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MDSCOND
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
300
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Was that for a specific condition?
Int. Instr II:
INPUT FIELDS / ROUTING
6:33:17 PM Monday, July 07, 2008
Page 55 of 85
AC22
MDSCOND
Field1:
Cheshire Name:
( ACQ1490 )
ACCS.MDSCOND
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC24 - MDAPPT ( ACQ1520 )
English text: YES
No
AC24 - MDAPPT ( ACQ1520 )
English text: NO
Attribute
Don't know
Route
AC24 - MDAPPT ( ACQ1520 )
Refusal
AC24 - MDAPPT ( ACQ1520 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:33:21 PM Monday, July 07, 2008
Page 56 of 85
AC24
AC24
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MDAPPT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
320
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did [you/(SP)] have an appointment for this visit with the doctor, or
did (you/he/she) just walk in?
Int. Instr II:
INPUT FIELDS / ROUTING
6:33:24 PM Monday, July 07, 2008
Page 57 of 85
AC24
MDAPPT
Field1:
Cheshire Name:
( ACQ1520 )
ACCS.MDAPPT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TApptwalk
1
No
No
Number Label
1 Appointment
2
English text: APPOINTMENT
WalkedIn
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC25 - MDDRTEL ( ACQ1530 )
AC28A1 - MWAITHRS ( ACQ1620 )
English text: WALKED IN
Attribute
Don't know
Route
AC28A1 - MWAITHRS ( ACQ1620 )
Refusal
AC28A1 - MWAITHRS ( ACQ1620 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:33:27 PM Monday, July 07, 2008
Page 58 of 85
AC25
AC25
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MDDRTEL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
330
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did someone in the doctor’s office tell [you/(SP)] when to come back
during an earlier visit, or did [you/(SP)] call for an appointment?
Int. Instr II:
INPUT FIELDS / ROUTING
6:33:30 PM Monday, July 07, 2008
Page 59 of 85
AC25
MDDRTEL
Field1:
( ACQ1530 )
ACCS.MDDRTEL
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TApptback
1
No
No
Number Label
1 ToldToComeBack
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC28A1 - MWAITHRS ( ACQ1620 )
English text: TOLD TO COME BACK DURING EARLIER VISIT
CalledForAnAppointment
AC26 - MDAWUNT ( ACQ1540 )
English text: CALLED FOR AN APPOINTMENT
Attribute
Don't know
Route
AC28A1 - MWAITHRS ( ACQ1620 )
Refusal
AC28A1 - MWAITHRS ( ACQ1620 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:33:33 PM Monday, July 07, 2008
Page 60 of 85
AC26
AC26
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
MDAWUNT
Field 2:
MDAWDAY
Field 3:
MDAWWKS
Field 4:
MDAWMOS
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
340
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How long did [you/(SP)] have to wait for the appointment with the
medical doctor -- about how many days, weeks, or months?
Int. Instr II:
INPUT FIELDS / ROUTING
6:33:37 PM Monday, July 07, 2008
Page 61 of 85
AC26
MDAWUNT
Field1:
Cheshire Name:
( ACQ1540 )
ACCS.MDAWUNT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAcsuntc
1
No
No
Number Label
0 NoWait
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC28A1 - MWAITHRS ( ACQ1620 )
1
English text: DID NOT HAVE TO WAIT
Days
AC26 - MDAWDAY ( ACQ1550 )
2
English text: DAYS
Weeks
AC26 - MDAWWKS ( ACQ1560 )
3
English text: WEEKS
Months
AC26 - MDAWMOS ( ACQ1570 )
English text: MONTHS
Attribute
Don't know
Route
AC28A1 - MWAITHRS ( ACQ1620 )
Refusal
AC28A1 - MWAITHRS ( ACQ1620 )
6:33:45 PM Monday, July 07, 2008
Page 62 of 85
AC26
Field2:
Cheshire Name:
MDAWDAY
( ACQ1550 )
ACCS.MDAWDAY
Item Text display:
Item Text:
Label:
Label Position:
DAYS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccsday
1
No
No
Number Label
1 [Continuous answer.]
Field3:
Cheshire Name:
MDAWWKS
FieldSize:
Min Value:
Max Value:
Mask:
1
180
Route
AC28A1 - MWAITHRS ( ACQ1620 )
( ACQ1560 )
ACCS.MDAWWKS
Item Text display:
Item Text:
Label:
Label Position:
WEEKS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccswk
1
No
No
Number Label
1 [Continuous answer.]
6:33:50 PM Monday, July 07, 2008
FieldSize:
Min Value:
Max Value:
Mask:
1
30
Route
AC28A1 - MWAITHRS ( ACQ1620 )
Page 63 of 85
AC26
Field4:
Cheshire Name:
MDAWMOS
( ACQ1570 )
ACCS.MDAWMOS
Item Text display:
Item Text:
Label:
Label Position:
MONTHS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccsmos
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
6
Route
AC28A1 - MWAITHRS ( ACQ1620 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
If MDAWUNT = 1/Days, MDAWDAY = 1-90.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF DAYS SEEMS UNLIKELY. PLEASE VERIFY."
Edit #2:
If MDAWUNT = 2/Weeks, MDAWWKS = 1-14.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF WEEKS SEEMS UNLIKELY. PLEASE VERIFY."
Edit #3:
If MDAWUNT = 3/Months, MDAWMOS = 1-3.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF MONTHS SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:33:51 PM Monday, July 07, 2008
Page 64 of 85
AC28A1
AC28A1
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
MWAITUNT
Field 2:
MWAITHRS
Field 3:
MWAITMIN
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
360
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display first sentence "[Think about...]" in brackets.
Display "most recent" in first sentence in BOLD.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
6:33:54 PM Monday, July 07, 2008
[Think about the most recent time [you/(SP)] saw a medical doctor
somewhere other than at home or at a hospital.] How long did
[you/(SP)] have to wait during (your/his/her) most recent visit before
(you/he/she) saw a doctor or some other medical person? Please
include the time spent in the waiting room and exam room.
Page 65 of 85
AC28A1
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MWAITUNT
Cheshire Name:
( ACQ1610 )
ACCS.MWAITUNT
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAcsuntb
1
No
No
Number Label
0 DidNotHaveToWait
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX AC1G - (ACQ1700 )
1
English text: DID NOT HAVE TO WAIT
HoursOnly
AC28A1 - MWAITHRS ( ACQ1620 )
2
English text: HOURS ONLY
MinutesOnly
AC28A1 - MWAITMIN ( ACQ1630 )
3
English text: MINUTES ONLY
HoursAndMinutes
AC28A1 - MWAITHRS ( ACQ1620 )
English text: HOURS AND MINUTES
Attribute
Don't know
Route
BOX AC1G - (ACQ1700 )
Refusal
BOX AC1G - (ACQ1700 )
6:34:00 PM Monday, July 07, 2008
Page 66 of 85
AC28A1
Field2:
Cheshire Name:
MWAITHRS
( ACQ1620 )
ACCS.MWAITHRS
Item Text display:
Item Text:
Label:
Label Position:
HOURS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccshrs1
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
72
Route
If AC28A1 - MWAITUNT = 3/HoursAndMinutes,
go to AC28A1 - MWAITMIN.
Else go to BOX AC1G.
Field3:
Cheshire Name:
MWAITMIN
( ACQ1630 )
ACCS.MWAITMIN
Item Text display:
Item Text:
Label:
Label Position:
MINUTES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TAccsmin
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
59
Route
BOX AC1G - (ACQ1700 )
BACKGROUND VARIABLE ASSIGNMENTS
6:34:02 PM Monday, July 07, 2008
Page 67 of 85
AC28A1
SOFT EDIT CHECKS
Edit #1:
If MWAITUNT = 1/HoursOnly or 3/HoursAndMinutes, MWAITHRS =
1-16.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF HOURS SEEMS UNLIKELY. PLEASE VERIFY."
Edit #2:
If MWAITUNT = 2/MinutesOnly or 3/HoursAndMinutes, MWAITMIN
= 5 - 59.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER OF MINUTES SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:34:02 PM Monday, July 07, 2008
Page 68 of 85
BOX AC1G
BOX AC1G
Page Order # :
410
BOX INSTRUCTIONS
( ACQ1700 )
IF AC20-AC28A1 ASKED WHILE ADMINISTERING MP, GO TO MP18 MPPRPRAC ( MPQ1650 ).
ELSE IF SP HAS A CURRENT MEDICARE MANAGED CARE PLAN, GO TO
AC33 - MHREFDIF ( ACQ1710 ).
ELSE GO TO BOX AC3 - (ACQ1790 ).
ASSIGNMENTS
TECHNICAL NOTES
52
DeletedPlans
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
65
MHMOCurrent
SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
Included in this box is logic that handles exiting AC when being called
from MP. When administering MP, if the SP reports a current round MP
visit, the MP section calls AC20-AC28A1. When complete, return to MP,
6:34:03 PM Monday, July 07, 2008
Page 69 of 85
AC33
AC33
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MHREFDIF
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
420
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of SP's current Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
The following questions are about health care that [you/(SP)]
received through (CURRENT MEDICARE MANAGED CARE PLAN
NAME).
While a member of (CURRENT MEDICARE MANAGED CARE
PLAN NAME), [have you/has (SP)] had difficulty in obtaining
referrals for the services of a specialist or other medical person
within (CURRENT MEDICARE MANAGED CARE PLAN NAME) that
[you/(SP)] thought were necessary?
6:34:05 PM Monday, July 07, 2008
Page 70 of 85
AC33
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
( ACQ1710 )
MHREFDIF
Cheshire Name:
ACCS.MHREFDIF
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMhrefdif
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 Yes
Route
AC34A - MHSPCLTY ( ACQ1730 )
2
English text: YES
No
AC36 - MHREFPAY ( ACQ1780 )
3
English text: NO
NaHaventTriedToObtainReferral
AC36 - MHREFPAY ( ACQ1780 )
English text: N/A, HAVEN'T TRIED TO OBTAIN REFERRAL
Attribute
Don't know
Route
AC36 - MHREFPAY ( ACQ1780 )
Refusal
AC36 - MHREFPAY ( ACQ1780 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
6:34:11 PM Monday, July 07, 2008
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
Page 71 of 85
AC33
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
65
MHMOCurrent
SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:34:11 PM Monday, July 07, 2008
Page 72 of 85
AC34A
AC34A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MHSPCLTY
Field 2:
MHSPCLOS
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
440
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What kind of specialist or medical person was this?
Int. Instr II:
INPUT FIELDS / ROUTING
6:34:18 PM Monday, July 07, 2008
Page 73 of 85
AC34A
6:34:32 PM Monday, July 07, 2008
Page 74 of 85
AC34A
MHSPCLTY
Field1:
Cheshire Name:
( ACQ1730 )
ACCS.MHSPCLTY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMhspclty
1
No
No
Number Label
1 Allergy
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC35 - MHDIFCLT ( ACQ1750 )
3
English text: ALLERGY/IMMUNOLOGY
Cardiology
AC35 - MHDIFCLT ( ACQ1750 )
5
English text: CARDIOLOGY (HEART)
Dermatology
AC35 - MHDIFCLT ( ACQ1750 )
7
English text: DERMATOLOGY (SKIN)
Endocrinology
AC35 - MHDIFCLT ( ACQ1750 )
9
English text: ENDOCRINOLOGY/METABOLISM (DIABETES,THYROID)
Gastroenterology
AC35 - MHDIFCLT ( ACQ1750 )
11
English text: GASTROENTEROLOGY
GeneralSurgery
AC35 - MHDIFCLT ( ACQ1750 )
12
English text: GENERAL SURGERY
Geriatrics
AC35 - MHDIFCLT ( ACQ1750 )
13
English text: GERIATRICS (ELDERLY)
Gynecology
AC35 - MHDIFCLT ( ACQ1750 )
14
English text: GYNECOLOGY - OBSTETRICS
Hematology
AC35 - MHDIFCLT ( ACQ1750 )
16
English text: HEMATOLOGY (BLOOD)
InternalMed
17
English text: INTERNAL MEDICINE (INTERNIST)
Nephrology
AC35 - MHDIFCLT ( ACQ1750 )
18
English text: NEPHROLOGY (KIDNEYS)
Neurology
AC35 - MHDIFCLT ( ACQ1750 )
20
English text: NEUROLOGY
Oncology
AC35 - MHDIFCLT ( ACQ1750 )
AC35 - MHDIFCLT ( ACQ1750 )
English text: ONCOLOGY (TUMORS, CANCER)
6:34:56 PM Monday, July 07, 2008
Page 75 of 85
AC34A
21
Ophthalmology
AC35 - MHDIFCLT ( ACQ1750 )
22
English text: OPHTHALMOLOGY (EYES)
Orthopedics
AC35 - MHDIFCLT ( ACQ1750 )
24
English text: ORTHOPEDICS
Osteopathy
AC35 - MHDIFCLT ( ACQ1750 )
25
English text: OSTEOPATHY (DO)
Otorhinolaryngology
AC35 - MHDIFCLT ( ACQ1750 )
26
English text: OTORHINOLARYNGOLOGY (EAR, NOSE, THROAT)
Pathology
AC35 - MHDIFCLT ( ACQ1750 )
27
English text: PATHOLOGY
PhysMed
AC35 - MHDIFCLT ( ACQ1750 )
28
English text: PHYS MED/REHAB
PlasticSurgery
AC35 - MHDIFCLT ( ACQ1750 )
29
English text: PLASTIC SURGERY
Proctology
AC35 - MHDIFCLT ( ACQ1750 )
30
English text: PROCTOLOGY
Psychiatry
AC35 - MHDIFCLT ( ACQ1750 )
31
English text: PSYCHIATRY/PSYCHIATRIST
Pulmonary
AC35 - MHDIFCLT ( ACQ1750 )
33
English text: PULMONARY (LUNGS)
Rheumatology
AC35 - MHDIFCLT ( ACQ1750 )
35
English text: RHEUMATOLOGY (ARTHRITIS)
Urology
AC35 - MHDIFCLT ( ACQ1750 )
36
English text: UROLOGY
Audiologist
AC35 - MHDIFCLT ( ACQ1750 )
37
English text: AUDIOLOGIST
Chiropractor
AC35 - MHDIFCLT ( ACQ1750 )
38
English text: CHIROPRACTOR
Dentist
AC35 - MHDIFCLT ( ACQ1750 )
39
English text: DENTIST
Optometrist
AC35 - MHDIFCLT ( ACQ1750 )
40
English text: OPTOMETRIST
PhysicalTherapist
AC35 - MHDIFCLT ( ACQ1750 )
41
English text: PHYSICAL THERAPIST
Psychologist
AC35 - MHDIFCLT ( ACQ1750 )
91
English text: PSYCHOLOGIST
Other
AC34A - MHSPCLOS ( ACQ1740 )
English text: OTHER DR SPECIALTY
Attribute
Don't know
Route
AC35 - MHDIFCLT ( ACQ1750 )
6:35:19 PM Monday, July 07, 2008
Page 76 of 85
AC34A
Refusal
AC35 - MHDIFCLT ( ACQ1750 )
Field2:
Cheshire Name:
MHSPCLOS
( ACQ1740 )
ACCS.MHSPCLOS
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
AC35 - MHDIFCLT ( ACQ1750 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:35:22 PM Monday, July 07, 2008
Page 77 of 85
AC35
AC35
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
MHDIFCLT
Field 2:
MHOTHOS
HELP
COMMENTS
JUMPBACK
Yes
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
450
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What kind of difficulty did [you/(SP)] have?
[PROBE: Any other difficulty?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
6:35:25 PM Monday, July 07, 2008
Page 78 of 85
AC35
6:35:32 PM Monday, July 07, 2008
Page 79 of 85
AC35
MHDIFCLT
Field1:
Cheshire Name:
( ACQ1750 )
NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1/NoAuthorize=ACCS.MHNOAUTH
2/WaitLongAppt=ACCS.MHWAITLG
3/LocateNotConven=ACCS.MHNOCONV
4/NoReferral=ACCS.MHNOREFR
5/DidNotLikeProv=ACCS.MHNOLIKE
6/HoursNotConven=ACCS.MHBADHRS
91/Other=ACCS.MHOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMHDifclt
7
No
No
Number Label
1 NoAuthorize
FieldSize:
Min Value:
Max Value:
Mask:
Route
AC36 - MHREFPAY ( ACQ1780 )
2
English text: PLAN WOULDN’T AUTHORIZE SERVICE
WaitLongAppt
AC36 - MHREFPAY ( ACQ1780 )
3
English text: THE WAIT FOR APPOINTMENT WAS TOO LONG
LocateNotConven
AC36 - MHREFPAY ( ACQ1780 )
4
English text: PROVIDER’S LOCATION WAS NOT CONVENIENT
NoReferral
AC36 - MHREFPAY ( ACQ1780 )
5
English text: DOCTOR/PLAN WOULDN'T GIVE SP REFERRAL TO SEE PROVIDER SP
WANTED TO SEE
DidNotLikeProv
AC36 - MHREFPAY ( ACQ1780 )
6
English text: SP DIDN'T LIKE/NOT CONFIDENT IN PROVIDER PLAN REFERRED SP TO
HoursNotConven
AC36 - MHREFPAY ( ACQ1780 )
91
English text: PROVIDER’S OFFICE HOURS WERE NOT CONVENIENT
Other
AC35 - MHOTHOS ( ACQ1770 )
English text: OTHER
6:35:43 PM Monday, July 07, 2008
Page 80 of 85
AC35
Attribute
Don't know
Route
AC36 - MHREFPAY ( ACQ1780 )
Refusal
AC36 - MHREFPAY ( ACQ1780 )
Field2:
Cheshire Name:
MHOTHOS
( ACQ1770 )
ACCS.MHOTHOS
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
AC36 - MHREFPAY ( ACQ1780 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:35:45 PM Monday, July 07, 2008
Page 81 of 85
AC36
AC36
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
MHREFPAY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
460
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of SP's current Medicare Managed Care Plan,
PLAN.PLNAME.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Has (CURRENT MEDICARE MANAGED CARE PLAN NAME) ever
refused to pay for emergency treatment that [you/(SP)] felt was
necessary?
Int. Instr II:
INPUT FIELDS / ROUTING
6:35:48 PM Monday, July 07, 2008
Page 82 of 85
AC36
( ACQ1780 )
MHREFPAY
Field1:
Cheshire Name:
ACCS.MHREFPAY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TMhrefpay
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 Yes
Route
BOX AC3 - (ACQ1790 )
2
English text: YES
No
BOX AC3 - (ACQ1790 )
3
English text: NO
NaHaventNeededEmergencyTreatment
BOX AC3 - (ACQ1790 )
English text: N/A, HAVEN'T NEEDED EMERGENCY TREATMENT
Attribute
Don't know
Route
BOX AC3 - (ACQ1790 )
Refusal
BOX AC3 - (ACQ1790 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
6:35:53 PM Monday, July 07, 2008
Deleted plans that are not valid for displays or checks =
Any PLAN where (PLAN.PLANDFLG=1/Yes or
PLAN.MHMODFLG=1/Yes or PLAN.PLANHIDE=1/Yes or
PLAN.LOSEPLFG ^=EMPTY) is a deleted PLAN.
Page 83 of 85
AC36
65
MHMOCurrent
SP has a current Medicare Managed Care plan =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:35:54 PM Monday, July 07, 2008
Page 84 of 85
BOX AC3
BOX AC3
Page Order # :
470
BOX INSTRUCTIONS
( ACQ1790 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:35:54 PM Monday, July 07, 2008
Page 85 of 85
| File Type | application/pdf |
| File Title | rptMCBSSpecs_Main |
| Author | Sweeney_l |
| File Modified | 2010-03-30 |
| File Created | 2008-07-07 |