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pdfER1
ER1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ERPROBE
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
20
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is deceased or institutionalized, display "did (SP) go".
Else if proxy interview, display "has (SP) gone".
Else display "have you gone".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (REFERENCE DATE)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], [have you
gone/has (SP) gone/did (SP) go] to a hospital emergency room for
medical care?
Int. Instr II:
INPUT FIELDS / ROUTING
12:46:58 PM Monday, November 03, 2008
Page 1 of 48
ER1
ERPROBE
Field1:
Cheshire Name:
Item Text display:
( ERQ1020 )
HRND.ERPROBE
Do not display response option 3/IndicatedYesByDataprep.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
ER2 - PROVIDER_ER ( ERQ1030 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
BOX ER6 - (ERQ1365 )
DO NOT DISPLAY.
DATA EDITING ONLY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
BOX ER6 - (ERQ1365 )
Refusal
BOX ER6 - (ERQ1365 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:47:00 PM Monday, November 03, 2008
Page 2 of 48
ER2
ER2
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PROVIDER_ER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Provider Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
30
Display as ' Add a Provider '
Display as ' Edit a Provider '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(to which hospital)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all Providers except for Providers where
PROV.PROVNUM=01 and 02, which are reserved for PM and OM
events.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
1
Provider Name
INSTRUCTIONS
Display PROV.PROVNAME
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Where did [you/(SP)] go (to which hospital)?
Int. Instr II:
SELECT OR ADD ONLY ONE HOSPITAL.
INPUT FIELDS / ROUTING
12:47:01 PM Monday, November 03, 2008
Page 3 of 48
ER2
Field1:
Cheshire Name:
PROVIDER_ER
( ERQ1030 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TProvPick4
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
4
Route
BOX ER1 - (ERQ1040 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on PROV:
PROV key = PROV.PROVBASE + PROV.PROVNUM
PROV.PROVNUM = Number of Provider selected at ER2.
If Provider added at Provider Roster, see PROVIDER ROSTER POP-UP specifications for
pop-up window programming instructions.
Variables populated in Provider Roster Pop-Up Window:
PROV.PROVNUM
PROV.PROVRNDC
PROV.PROVNAME
Provider number
Round number
Provider name
If Provider added, set provider type as instructed below:
PROVTYPE
PROV.PROVTYPE=2/EmergencyRoom.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
Begin Loop 1: Probe for one provider, collect all event dates for this
provider.
12:47:01 PM Monday, November 03, 2008
Page 4 of 48
BOX ER1
BOX ER1
Page Order # :
40
BOX INSTRUCTIONS
( ERQ1040 )
IF (SP REPORTED RECEIVING HEALTH CARE SERVICES THROUGH V.A.
IN THE CURRENT ROUND OR ANY PREVIOUS ROUND) AND (IF THIS
PROVIDER IS ASSOCIATED WITH V.A. IS UNKNOWN), GO TO ER3
VAPLACE ( ERQ1050 ).
ELSE GO TO BOX ER1B - (ERQ1060 ).
ASSIGNMENTS
TECHNICAL NOTES
423
SPReceivedCaretThruV
A
SP reported receiving health care services through V.A.in
the current or any previous round =
There is an HRND where HRND.HRNDRND = current
round and HRND.VACOVER = 1/Yes.
HRND.VACOVER is set at BOX HI20 or collected at HI36.
127
ProviderVAUnknown
If Provider is associated with V.A. is unknown =
PROV.VAPLACE = empty.
DESIGN NOTES
12:47:01 PM Monday, November 03, 2008
Page 5 of 48
ER3
ER3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
VAPLACE
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
50
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of hospital, PROV.PROVNAME, currently being
asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Is (PROVIDER NAME) a Department of Veterans Affairs, or V.A.,
facility?
Int. Instr II:
INPUT FIELDS / ROUTING
12:47:03 PM Monday, November 03, 2008
Page 6 of 48
ER3
VAPLACE
Field1:
Cheshire Name:
( ERQ1050 )
PROV.VAPLACE
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 ER1B - (ERQ1060 )
English text: YES
No
BOX ER1B - (ERQ1060 )
English text: NO
Attribute
Don't know
Route
BOX ER1B - (ERQ1060 )
Refusal
BOX ER1B - (ERQ1060 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:47:05 PM Monday, November 03, 2008
Page 7 of 48
BOX ER1B
BOX ER1B
12:47:05 PM Monday, November 03, 2008
Page Order # :
60
Page 8 of 48
BOX ER1B
BOX INSTRUCTIONS
( ERQ1060 )
IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING THE
CURRENT ROUND) AND (IF THIS PROVIDER IS ASSOCIATED WITH A
MANAGED CARE PLAN IS UNKNOWN), GO TO ER3A - HMOASSOC (
ERQ1070 ).
ELSE IF (SP COVERED BY A MANAGED CARE PLAN ANYTIME DURING
THE CURRENT ROUND) AND (THIS PROVIDER IS NOT ASSOCIATED
WITH A MANAGED CARE PLAN), GO TO ER3B - HMOREFER ( ERQ1080 ).
ELSE GO TO ER4 - EVENT_ER ( ERQ1120 ).
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.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
128
ProviderHMOUnknown
If Provider is associated with a Managed Care plan is
unknown =
PROV.HMOASSOC=empty.
130
ProviderNotHMO
Provider is not associated with a Managed Care plan =
PROV.HMOASSOC=2/No, DK, or RF.
129
ProviderAssocHMO
Provider is associated with a Managed Care plan =
PROV.HMOASSOC=1/Yes.
DESIGN NOTES
If the SP belongs to a managed care plan (HMO), we ask each provider
selected/added if the provider is associated with an HMO. This question,
which is asked throughout utilization and cost series, is only asked once
in the study for each provider. The response is never updated. (this
design may change in the future).
If the SP belongs to an HMO, and we have not asked this question for this
provider, HMOASSOC=empty, BOX ER1B is routed to ER3A
HMOASSOC. If we have already asked this question about this provider,
and the provider responded to HMOASSOC=No, DK or RF, BOX ER1B is
routed to ER3B, skipping ER3A, to determine if the SP was referred to
this provider by their HMO.
If SP does not belong to an HMO or this provider already reported being
associated with the HMO, BOX ER1B routes directly to ER4, collect
emergency room visits, skipping ER3A and ER3B.
12:47:05 PM Monday, November 03, 2008
Page 9 of 48
ER3A
ER3A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HMOASSOC
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
70
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of hospital, PROV.PROVNAME, currently being
asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
12:47:06 PM Monday, November 03, 2008
Page 10 of 48
ER3A
Int. Instr I:
Is (PROVIDER NAME) associated with [your/(SP’s)] [READ
MANAGED CARE PLAN NAME(S) BELOW] plan?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
HMOASSOC
Field1:
Cheshire Name:
( ERQ1070 )
PROV.HMOASSOC
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
ER4 - EVENT_ER ( ERQ1120 )
English text: YES
No
ER3B - HMOREFER ( ERQ1080 )
English text: NO
Attribute
Don't know
Route
ER3B - HMOREFER ( ERQ1080 )
Refusal
ER3B - HMOREFER ( ERQ1080 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
52
DeletedPlans
12:47:09 PM Monday, November 03, 2008
Deleted plans that are not valid for displays or checks =
Page 11 of 48
ER3A
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.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
12:47:09 PM Monday, November 03, 2008
Page 12 of 48
ER3B
ER3B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HMOREFER
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
80
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of hospital, PROV.PROVNAME, currently being
asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all managed care plans SP was covered by anytime during
the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display= If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
12:47:10 PM Monday, November 03, 2008
Page 13 of 48
ER3B
Int. Instr I:
[Were you/Was (SP)] referred to (PROVIDER NAME) by [READ
MANAGED CARE PLAN NAME(S) BELOW]?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
HMOREFER
Field1:
Cheshire Name:
( ERQ1080 )
EVNT.HMOREFER
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
ER4 - EVENT_ER ( ERQ1120 )
English text: YES
No
ER3D - NOGOHMO ( ERQ1090 )
English text: NO
Attribute
Don't know
Route
ER4 - EVENT_ER ( ERQ1120 )
Refusal
ER4 - EVENT_ER ( ERQ1120 )
BACKGROUND VARIABLE ASSIGNMENTS
ER3B - HMOREFER is an EVENT level detail. The response to ER3B - HMOREFER
needs to be copied to EVNT.HMOREFER for each ER Event added at ER4.
SOFT EDIT CHECKS
HARD EDIT CHECKS
12:47:13 PM Monday, November 03, 2008
Page 14 of 48
ER3B
TECHNICAL NOTES
DESIGN NOTES
12:47:13 PM Monday, November 03, 2008
Page 15 of 48
ER3D
ER3D
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
NOGOHMO
Field 2:
NOGOHMOS
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:
91
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Medicaid Managed Care plans, and Private Managed Care plans. If
there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = If Medicaid Managed Care Plan, display
"Medicaid Managed Care Plan".
Else display health insurance plan name "(PLAN NAME) Managed
Care Plan".
TEXT:
Context Header:
Int. Instr I:
12:47:16 PM Monday, November 03, 2008
Page 16 of 48
ER3D
Question Text:
What is the most important reason [you/(SP)] did not go to an
emergency room associated with [READ MANAGED CARE PLAN
NAME(S) BELOW] or an emergency room that [READ MANAGED
CARE PLAN NAME(S) BELOW] would refer [you/(SP)] to?
Int. Instr II:
SCROLL DOWN TO SEE RESPONSE CATEGORIES.
INPUT FIELDS / ROUTING
12:47:21 PM Monday, November 03, 2008
Page 17 of 48
ER3D
NOGOHMO
Field1:
Cheshire Name:
Item Text display:
( ERQ1090 )
EVNT.NOGOHMO
Display responses in one column.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Tnogohmo
1
No
No
Number Label
1 PlanNotCoverService
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
ER4 - EVENT_ER ( ERQ1120 )
English text: PLAN DOES NOT COVER THE SERVICE SP WANTED
DifficultyDelayGettingService
ER4 - EVENT_ER ( ERQ1120 )
4
English text: DIFFICULTY OR DELAY IN GETTING SERVICES
SPProviderPreference
ER4 - EVENT_ER ( ERQ1120 )
English text: SP PROVIDER PREFERENCE
ServiceCoverdbyOtherInsurance
ER4 - EVENT_ER ( ERQ1120 )
5
English text: THIS SERVICE WAS COVERED BY OTHER INSURANCE SP HAS
NotinManagedCareTimeofEvent
ER4 - EVENT_ER ( ERQ1120 )
6
English text: NOT IN A MANAGED CARE PLAN AT TIME OF EVENT
NoChoiceMedEmergency
ER4 - EVENT_ER ( ERQ1120 )
3
91
English text: NO CHOICE - MEDICAL EMERGENCY OR OUT OF SERVICE AREA
Other
ER3D - NOGOHMOS ( ERQ1100 )
English text: OTHER
Attribute
Don't know
Route
ER4 - EVENT_ER ( ERQ1120 )
Refusal
ER4 - EVENT_ER ( ERQ1120 )
12:47:27 PM Monday, November 03, 2008
Page 18 of 48
ER3D
NOGOHMOS
Field2:
Cheshire Name:
( ERQ1100 )
EVNT.NOGOHMOS
Item Text display:
Display (SPECIFY) in 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
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
ER4 - EVENT_ER ( ERQ1120 )
BACKGROUND VARIABLE ASSIGNMENTS
ER3D - NOGOHMO and NOGOHMOS are EVENT level details. The response to ER3D NOGOHMO and NOGOHMOS needs to be copied to EVNT.NOGOHMO and
EVNT.NOGOHMOS for each ER Event added at ER4.
SOFT EDIT CHECKS
HARD EDIT CHECKS
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.
2
ManagedCarePlan
SP covered by a Managed Care Plan anytime during
current round =
There is a PLRO.PLROPLAN=PLAN.PLANUM &
PLRO.PLRORND=current round &
((PLRO.PPRVHMO=1/Yes) or (PLAN.PLANTYPE =
5/MHMO & PLRO.COVANYTM=1/Yes) or
(PLRO.MCAIDHMO=1/Yes)). See T.N. 52.
12:47:28 PM Monday, November 03, 2008
Page 19 of 48
ER3D
107
PlanIsMCaidHMO
SP is covered by a Medicaid Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=2/Medicaid &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.MCAIDHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
111
PlanIsMCareHMO
SP is covered by a Medicare Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=5/MHMO &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
112
PlanIsPrivateHMO
SP is covered by a Private Managed Care Plan during
the current round =
There is a PLAN where PLAN.PLANTYPE=4/PrivatePlan
& PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes).
Exclude Deleted Plans. See T.N. 52.
106
HIPlanName
Health Insurance Plan Roster is stored on PLAN.
Plan name = PLAN.PLNAME.
DESIGN NOTES
12:47:28 PM Monday, November 03, 2008
Page 20 of 48
ER4
ER4
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_ER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
110
Display as ' Add an Emergency Room visit '
Display as ' Edit a Visit '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of hospital, PROV.PROVNAME, currently being
asked about.
Multi Field display:
Roster/Grid Instructions:
Display all Emergency Room visits for this provider that have been
added in the current round where:
EVNT.EVNTDFLG ^= 1/Yes, and
EVNT.EVNTRNDC=current round, and
EVNT.EVNTTYPE = 'ER', and
EVNT.EVNTPROV = PROV.PROVNUM for the provider selected at
ER2.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
1
HEADER
Event Date
INSTRUCTIONS
Display EVENT DATE in "Mon DD YYYY"
format.
Report display:
TEXT:
Context Header:
12:47:29 PM Monday, November 03, 2008
Page 21 of 48
ER4
Int. Instr I:
When did [you/(SP)] go to the emergency room at (PROVIDER
NAME)?
Question Text:
Please tell me all the dates [since (REFERENCE DATE)/between
(REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)].
ENTER ALL DATES.
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_ER
( ERQ1120 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
ER4_IN - NAVIGATOR ( ERQ1125 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of event selected at ER4.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Visit Month
Visit Day
Visit Year
Highest EVNT.EVNTNUM.
For each event added at ER4, set Event type, Statement Event type, Event provider
number, and Event details collected at ER3B and ER3D. See detailed instructions below.
12:47:30 PM Monday, November 03, 2008
Page 22 of 48
ER4
EVNTTYPE
EVNT.EVNTTYPE='ER'.
STEVTYPE
EVNT.STEVTYPE=4/ER.
EVNTPROV
EVNT.EVNTPROV=PROV.PROVNUM of provider
selected at ER2.
HMOREFER
EVNT.HMOREFER = Repsonse to ER3B -
HMOREFER.
NOGOHMO
EVNT.NOGOHMO = Response to ER3D -
NOGOHMO.
NOGOHMOS
EVNT.NOGOHMOS = Response to ER3D NOGOHMOS.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION). If not true, display
message "INVALID DATE. DATE MUST BE ON OR BETWEEN
(REFERENCE DATE) AND (TODAY/DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)".
See general specifications for date check logic.
Edit #2:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing ER event date for the provider selected at ER2.
If date of event added at ER4 does not have missing data,
EVBEGMM, EVBEGDD, EVBEGYY ^= DK and EVBEGMM,
EVBEGDD, EVBEGYY ^= RF, then check this date against other ER
events for duplicate dates.
The following must be true for the event added at ER4 to be a
duplicate of an existing ER event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
Both EVNTTYPE=ER.
EVNTPROV matches.
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
The date of the event added at ER4 should not match any other ER
event date for the provider selected at ER2.
If not true, display message, "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE".
TECHNICAL NOTES
DESIGN NOTES
Begin Loop 2: Collect all event dates for this provider, loop through details
for each event added at ER4.
ER allows you to select a provider more than once at ER2. If this provider
12:47:30 PM Monday, November 03, 2008
Page 23 of 48
ER4
has already been selected and visits added at ER4 in an earlier loop, the
visits will be displayed at ER4 as protected rows.
12:47:30 PM Monday, November 03, 2008
Page 24 of 48
ER4_IN
ER4_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
115
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 events added at ER4.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
12:47:30 PM Monday, November 03, 2008
Page 25 of 48
ER4_IN
NAVIGATOR
Field1:
Cheshire Name:
( ERQ1125 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
ER5 - CONDTION_ER ( ERQ1160 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
ER10 - ERMORE ( ERQ1270 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:47:32 PM Monday, November 03, 2008
Page 26 of 48
ER5
ER5
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
CONDTION_ER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Condition Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
130
Display as ' Add a Condition '
Display as ' Edit a Condition '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display date of emergency room visit currently being asked about.
Multi Field display:
Roster/Grid Instructions:
Display all Conditions.
Display in alphabetical order.
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
For what condition did [you/(SP)] go to the emergency room on
[EVENT DATE]?
Int. Instr II:
SELECT OR ADD ALL CONDITIONS.
INPUT FIELDS / ROUTING
12:47:33 PM Monday, November 03, 2008
Page 27 of 48
ER5
Field1:
Cheshire Name:
CONDTION_ER
( ERQ1160 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TCondPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX ER2A - (ERQ1170 )
BACKGROUND VARIABLE ASSIGNMENTS
Conditions will be collected on COND:
COND key = COND.CONDBASE + COND.CONDNUM
COND.CONDNUM = Number of condition selected at ER5.
If adding a new condition, see CONDITION ROSTER POP-UP specifications for pop-up
window programming instructions.
Variables populated at the Condition Roster:
COND.CONDNUM
COND.CONDRNDC
COND.CONDTION
All Conditions selected at ER5 should be linked to the Emergency Room visit being asked
about. Link Conditions to ER visit on XCON.
XCON key = XCON.XCONBASE + XCON.XCONEVNT + XCON.XCONBAS2 +
XCON.XCONCOND.
For each condition selected at ER5, create an XCON where XCONEVNT=
EVNT.EVNTNUM of Emergency Room visit and XCONCOND = COND.CONDNUM of
Condition. XCONBASE and XCONBAS2 both equal the Cheshire BASE.BASEID. Set
additional XCON variables as specified below.
XCONEVNT
XCON.XCONEVNT = EVNT.EVNTNUM of
Emergency Room visit being asked about.
XCONCOND
XCON.XCONCOND = COND.CONDNUM of
Condition selected at ER5.
XCONRNDC
XCON.XCONRNDC = current round.
SOFT EDIT CHECKS
12:47:33 PM Monday, November 03, 2008
Page 28 of 48
ER5
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
Called by Box ST22A and Box NS22A if ER visit added in ST and/or NS.
12:47:33 PM Monday, November 03, 2008
Page 29 of 48
BOX ER2A
BOX ER2A
Page Order # :
140
BOX INSTRUCTIONS
( ERQ1170 )
IF CURRENTLY ADMINISTERING ST, GO TO BOX ST23B - (STQ1700 ).
ELSE IF CURRENTLY ADMINISTERING NS, GO TO BOX NS23B (NSQ1700 ).
ELSE GO TO ER6 - ERADMIT ( ERQ1180 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If currently administering ST or NS, return to Box ST23B or Box NS23B.
12:47:33 PM Monday, November 03, 2008
Page 30 of 48
ER6
ER6
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ERADMIT
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
150
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display date of emergency room visit currently being asked about.
Question display:
Display name of hospital, PROV.PROVNAME, currently being
asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
DATE OF ER VISIT: [VISIT ON EVENT DATE]
Int. Instr I:
Question Text:
[Were you/Was (SP)] admitted to (PROVIDER NAME) from the
emergency room?
Int. Instr II:
INPUT FIELDS / ROUTING
12:47:35 PM Monday, November 03, 2008
Page 31 of 48
ER6
ERADMIT
Field1:
Cheshire Name:
( ERQ1180 )
EVNT.ERADMIT
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 ER4 - (ERQ1260 )
English text: YES
No
ER7 - PRESMDCN ( ERQ1200 )
English text: NO
Attribute
Don't know
Route
ER7 - PRESMDCN ( ERQ1200 )
Refusal
ER7 - PRESMDCN ( ERQ1200 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:47:37 PM Monday, November 03, 2008
Page 32 of 48
ER7
ER7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRESMDCN
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
170
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display date of emergency room visit currently being asked about.
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
DATE OF ER VISIT: [VISIT ON EVENT DATE]
Int. Instr I:
Question Text:
During [your/(SP’s)] visit to the emergency room, were any
medicines prescribed for [you/(SP)]?
Int. Instr II:
INPUT FIELDS / ROUTING
12:47:38 PM Monday, November 03, 2008
Page 33 of 48
ER7
PRESMDCN
Field1:
Cheshire Name:
( ERQ1200 )
EVNT.PRESMDCN
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
ER8 - PRESFILL ( ERQ1210 )
English text: YES
No
BOX ER4 - (ERQ1260 )
English text: NO
Attribute
Don't know
Route
BOX ER4 - (ERQ1260 )
Refusal
BOX ER4 - (ERQ1260 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:47:40 PM Monday, November 03, 2008
Page 34 of 48
ER8
ER8
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PRESFILL
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:
Were any of the prescriptions filled?
Int. Instr II:
INPUT FIELDS / ROUTING
12:47:42 PM Monday, November 03, 2008
Page 35 of 48
ER8
PRESFILL
Field1:
Cheshire Name:
( ERQ1210 )
EVNT.PRESFILL
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 ER3A - (ERQ1220 )
English text: YES
No
BOX ER4 - (ERQ1260 )
English text: NO
Attribute
Don't know
Route
BOX ER4 - (ERQ1260 )
Refusal
BOX ER4 - (ERQ1260 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:47:44 PM Monday, November 03, 2008
Page 36 of 48
BOX ER3A
BOX ER3A
Page Order # :
190
BOX INSTRUCTIONS
( ERQ1220 )
IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN
ASKED IN THE CURRENT ROUND, GO TO ER8A - ERPMMEDS ( ERQ1230
).
ELSE GO TO ER9 - MEDICINE_ER ( ERQ1240 ).
ASSIGNMENTS
TECHNICAL NOTES
131
PMBottleProbe
Prescription Medicine Bottle probe has been asked in the
current round =
GETPMMEDS=1/Yes.
DESIGN NOTES
Only probe for prescription medicine bottles once during the current
round.
Adding a new TEMP flag, GETPMMEDS. GETPMMEDS is set to 1/Yes
whenever the Prescription Bottle probe is asked during the current
round. This will get set anywhere in utilization or cost series.
12:47:44 PM Monday, November 03, 2008
Page 37 of 48
ER8A
ER8A
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
ERPMMEDS
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
200
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(s)" in "bottle(s), container(s), or bag(s)" in
parenthesis.
If SP has a "current" Medicare Prescription Drug plan or there was a
Medicare Prescription Drug plan "current" at the time of the
previous round interview, then display "Also, please take out
[your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN NAME)
medicine statements....".
Else do not display.
MEDICARE PRESCRIPTION DRUG PLAN NAME =
Display the name of the "current" Medicare Prescription Drug plan.
If it does not exist, display the name of the Medicare Prescription
Drug plan "current" at the time of the previous round interview.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
12:47:45 PM Monday, November 03, 2008
Page 38 of 48
ER8A
Int. Instr I:
It would be helpful if I could look at any medicine bottle(s),
container(s), or bag(s) that you have so that I can spell the medicine
name correctly and enter the strength of the medicine. [Also, please
take out [your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN
NAME) medicine statements, which should have that same
information on them.]
Question Text:
[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that same
information for all of the medicines [you/(SP)] obtained since the last
interview, if you’d like to get those bottles, too.
Int. Instr II:
INPUT FIELDS / ROUTING
ERPMMEDS
Field1:
( ERQ1230 )
TEMP
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
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
ER9 - MEDICINE_ER ( ERQ1240 )
English text: CONTINUE
Attribute
Empty
Route
ER9 - MEDICINE_ER ( ERQ1240 )
BACKGROUND VARIABLE ASSIGNMENTS
The question displayed at ER8A is repeated in other utilization sections. Only show this
probe for prescription medicine bottles once during the current round interview.
If ER8A - ERPMMEDS is asked, set flag as instructed below:
GETPMMEDS
Set GETPMMEDS=1/Yes
SOFT EDIT CHECKS
12:47:47 PM Monday, November 03, 2008
Page 39 of 48
ER8A
HARD EDIT CHECKS
TECHNICAL NOTES
342
MPDPCurrent
SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
343
MPDPCurrPrevRnd
Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
12:47:47 PM Monday, November 03, 2008
Page 40 of 48
ER9
ER9
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
MEDICINE_ER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Prescription Medicine Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
210
Display as ' Add a Medicine '
Display as ' Edit a Medicine '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "CHECK STATEMENT OR MEDICINE BOTTLE FOR
SPELLING." in BOLD.
Display "INCLUDE STRENGTH WITH NAME." in BOLD.
Multi Field display:
Roster/Grid Instructions:
Display all prescription medicines where:
EVNT.EVNTDFLG ^= 1, and
EVNT.EVNTTYPE='PM' .
Display in alphabetical order.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Medicine
Display prescription medicine name,
EVNT.PMEDNAME.
2
Strength
Display prescription medicine strength
text field, EVNT.PMSTRUNI.
Report display:
TEXT:
Context Header:
12:47:48 PM Monday, November 03, 2008
Page 41 of 48
ER9
Int. Instr I:
Question Text:
Please tell me the names of these medicines.
Int. Instr II:
ENTER ALL MEDICINES.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
MEDICINE_ER
( ERQ1240 )
EVNT.PMEDNAME
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX ER4 - (ERQ1260 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected at ER9.
If Prescription Medicine added at Prescription Medicine Roster, see PRESCRIPTION
MEDICINE ROSTER POP-UP specifications for pop-up window programming instructions.
Variables populated at the Prescription Medicine Roster:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVNTTYPE
EVNT.PMEDNAME
EVNT.PMSTRUNI
EVNT.EVNTPROV
BASE.LASTEVNT
Event number
Round number
PM
Prescription Medicine name
Prescription Medicine strength text field
02
Highest EVNT.EVNTNUM
For all Prescription Medicines selected at ER9, create a current round PMRO. Note: a
current round PMRO may already exist for a Prescription Medicine event if it has already
been selected earlier in the interview.
12:47:49 PM Monday, November 03, 2008
Page 42 of 48
ER9
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND.
Create PMRO where PMRO.PMROEVNT = EVNT.EVNTNUM for prescription medicine
selected and PMRO.PMRORND = current round. Set additional PMRO variable as
instructed below.
All prescription medicines selected at ER9 should be linked to the Emergency Room visit
being asked about. Prescription medicine events are linked to other events on XMED.
XMED key = XMED.XMEDBASE + XMED.XMEDEVNT + XMED.XMEDBAS2 +
XMED.XMEDEVT2.
For each medicine selected at ER9, create an XMED where XMEDEVNT =
EVNT.EVNTNUM of Emergency
Room visit being asked about and XMEDEVT2 = EVNT.EVNTNUM of Prescription
Medicine selected at ER9. XMEDBASE and XMEDBAS2 both equal the Cheshire
BASE.BASEID. Set additional XMED variables as specified below.
Set the following PMRO and XMED variables for each prescription medicine selected at
ER9:
PMROEVNT
PMRO.PMROEVNT = EVNT.EVNTNUM of
prescription medicine selected at ER9.
PMRORND
PMRO.PMRORND = current round.
PMROTYPE
PMRO.PMROTYPE = PM.
XMEDEVNT
XMED.XMEDEVNT = EVNT.EVNTNUM of
Emergency Room visit being asked about.
XMEDEVT2
XMED.XMEDEVT2 = EVNT.EVNTNUM of
prescription medicine selected at ER9.
XMEDRNDC
XMED.XMEDRNDC = current round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
12:47:49 PM Monday, November 03, 2008
Page 43 of 48
BOX ER4
BOX ER4
Page Order # :
220
BOX INSTRUCTIONS
( ERQ1260 )
GO TO ER4_IN - NAVIGATOR ( ERQ1125 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
12:47:49 PM Monday, November 03, 2008
Page 44 of 48
ER10
ER10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ERMORE
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
230
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)/Between (REFERENCE DATE) and
(DATE OF DEATH/DATE OF INSTITUTIONALIZATION)], did
[you/(SP)] have any other visits to the emergency room at this or any
other hospital?
Int. Instr II:
INPUT FIELDS / ROUTING
12:47:50 PM Monday, November 03, 2008
Page 45 of 48
ER10
ERMORE
Field1:
Cheshire Name:
( ERQ1270 )
TEMP
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
ER2 - PROVIDER_ER ( ERQ1030 )
English text: YES
No
BOX ER5 - (ERQ1280 )
English text: NO
Attribute
Don't know
Route
BOX ER5 - (ERQ1280 )
Refusal
BOX ER5 - (ERQ1280 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
End Loop 1: ER10 - ERMORE probes for additional Emergency Room
visits. Emergency Room visits can be for a new provider or a provider
already selected and asked about. If ERMORE=1/Yes, go to ER2 to select
the next provider.
12:47:52 PM Monday, November 03, 2008
Page 46 of 48
BOX ER5
BOX ER5
Page Order # :
240
BOX INSTRUCTIONS
( ERQ1280 )
IF FALL ROUND AND ((SP REPORTED AN EMERGENCY ROOM VISIT AT
ER2) AND (SP IS ALIVE AND NOT INSTITUTIONALIZED)), GO TO AC6A EWAITHRS ( ACQ1130 ).
ELSE GO TO BOX ER6 - (ERQ1365 ).
ASSIGNMENTS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
98
FallRound
If the remainder of (Current round divided by 3) = 1, then
it is a Fall round.
DESIGN NOTES
12:47:52 PM Monday, November 03, 2008
Page 47 of 48
BOX ER6
BOX ER6
Page Order # :
290
BOX INSTRUCTIONS
( ERQ1365 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
12:47:52 PM Monday, November 03, 2008
Page 48 of 48
| File Type | application/pdf |
| Author | hubbard_r |
| File Modified | 2010-04-02 |
| File Created | 0000-00-00 |