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pdfBOX HFBEG
BOX HFBEG
Page Order # :
10
BOX INSTRUCTIONS
( HFQ1010 )
GO TO HFA1 - GENHELTH ( HFQ1020 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:53:07 PM Monday, August 03, 2009
Page 1 of 760
HFA1
HFA1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
GENHELTH
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Now, I would like to ask you about [your/(SP's)] health.
In general, compared to other people [your/(SP's)] age, would you
say that (your/his/her) health is . . .
Int. Instr II:
INPUT FIELDS / ROUTING
3:53:10 PM Monday, August 03, 2009
Page 2 of 760
HFA1
GENHELTH
Field1:
( HFQ1020 )
HEST.GENHELTH
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
TGenhelth
1
No
No
Number Label
1 Excellent
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFA2 - COMPHLTH ( HFQ1030 )
2
English text: excellent,
VeryGood
HFA2 - COMPHLTH ( HFQ1030 )
3
English text: very good,
Good
HFA2 - COMPHLTH ( HFQ1030 )
4
English text: good,
Fair
HFA2 - COMPHLTH ( HFQ1030 )
5
English text: fair, or
Poor
HFA2 - COMPHLTH ( HFQ1030 )
English text: poor?
Attribute
Don't know
Route
HFA2 - COMPHLTH ( HFQ1030 )
Refusal
HFA2 - COMPHLTH ( HFQ1030 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
3:53:15 PM Monday, August 03, 2009
Page 3 of 760
HFA1
DESIGN NOTES
3:53:15 PM Monday, August 03, 2009
Page 4 of 760
HFA2
HFA2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
COMPHLTH
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:
Compared to one year ago, how would you rate [your/(SP's)] health
in general now?
Would you say [your/(SP's)] health is . . .
Int. Instr II:
INPUT FIELDS / ROUTING
3:53:18 PM Monday, August 03, 2009
Page 5 of 760
HFA2
COMPHLTH
Field1:
( HFQ1030 )
HEST.COMPHLTH
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
TComphlth
1
No
No
Number Label
1 MuchBetter
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFA3 - HELMTACT ( HFQ1040 )
2
English text: much better now than one year ago,
SomewhatBetter
HFA3 - HELMTACT ( HFQ1040 )
3
English text: somewhat better now than one year ago,
AboutTheSame
HFA3 - HELMTACT ( HFQ1040 )
4
English text: about the same,
SomewhatWorse
5
English text: somewhat worse now than one year ago, or
MuchWorse
HFA3 - HELMTACT ( HFQ1040 )
HFA3 - HELMTACT ( HFQ1040 )
English text: much worse now than one year ago?
Attribute
Don't know
Route
HFA3 - HELMTACT ( HFQ1040 )
Refusal
HFA3 - HELMTACT ( HFQ1040 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
3:53:23 PM Monday, August 03, 2009
Page 6 of 760
HFA2
DESIGN NOTES
3:53:23 PM Monday, August 03, 2009
Page 7 of 760
HFA3
HFA3
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HELMTACT
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
35
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "past month" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How much of the time during the past month has [your/(SP's)] health
limited [your/(SP's)] social activities, like visiting with friends or close
relatives?
Would you say . . .
Int. Instr II:
INPUT FIELDS / ROUTING
3:53:25 PM Monday, August 03, 2009
Page 8 of 760
HFA3
HELMTACT
Field1:
( HFQ1040 )
HEST.HELMTACT
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
THelmtact
1
No
No
Number Label
1 NoneOfTheTime
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFA1 - (HFQ1045 )
2
English text: none of the time,
SomeOfTheTime
BOX HFA1 - (HFQ1045 )
3
English text: some of the time,
MostOfTheTime
BOX HFA1 - (HFQ1045 )
4
English text: most of the time, or
AllOfTheTime
BOX HFA1 - (HFQ1045 )
English text: all of the time?
Attribute
Don't know
Route
BOX HFA1 - (HFQ1045 )
Refusal
BOX HFA1 - (HFQ1045 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:53:28 PM Monday, August 03, 2009
Page 9 of 760
BOX HFA1
BOX HFA1
Page Order # :
40
BOX INSTRUCTIONS
( HFQ1045 )
IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO BOX HFF1 - (HFQ1290 ).
ELSE GO TO HFB1 - ECHELP ( HFQ1050 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
3:53:28 PM Monday, August 03, 2009
Page 10 of 760
HFB1
HFB1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ECHELP
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Do you/Does (SP)] wear eyeglasses or contact lenses?
Int. Instr II:
INPUT FIELDS / ROUTING
3:53:30 PM Monday, August 03, 2009
Page 11 of 760
HFB1
ECHELP
Field1:
( HFQ1050 )
HEST.ECHELP
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
TEchelp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFB2 - ECTROUB ( HFQ1060 )
2
English text: YES
No
HFB2 - ECTROUB ( HFQ1060 )
3
English text: NO
Blind
HFB3 - EINTROUB ( HFQ1070 )
English text: SP IS BLIND
Attribute
Don't know
Route
HFB6 - EDOCEXAM ( HFQ1110 )
Refusal
HFB6 - EDOCEXAM ( HFQ1110 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:53:33 PM Monday, August 03, 2009
Page 12 of 760
HFB2
HFB2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
ECTROUB
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
60
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If HFB1 - ECHELP = 1/Yes, display "while wearing glasses or
contact lenses".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Which statement best describes [your/(SP's)] vision (while wearing
glasses or contact lenses): no trouble seeing, a little trouble, a lot of
trouble, or no usable vision?
Int. Instr II:
INPUT FIELDS / ROUTING
3:53:35 PM Monday, August 03, 2009
Page 13 of 760
HFB2
ECTROUB
Field1:
( HFQ1060 )
HEST.ECTROUB
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
TTrouble
1
No
No
Number Label
1 NoTroubleSeeing
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFB6 - EDOCEXAM ( HFQ1110 )
2
English text: NO TROUBLE SEEING
LittleTroubleSeeing
HFB3 - EINTROUB ( HFQ1070 )
3
English text: A LITTLE TROUBLE SEEING
LotOfTroubleSeeing
HFB3 - EINTROUB ( HFQ1070 )
4
English text: A LOT OF TROUBLE SEEING
NoUsableVision
HFB3 - EINTROUB ( HFQ1070 )
English text: NO USABLE VISION
Attribute
Don't know
Route
HFB6 - EDOCEXAM ( HFQ1110 )
Refusal
HFB6 - EDOCEXAM ( HFQ1110 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:53:38 PM Monday, August 03, 2009
Page 14 of 760
HFB3
HFB3
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
EINTROUB
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of [your/(SP's)] difficulty seeing, how much trouble [do
you/does (SP)] have with prescription labels or medical
instructions? Would you say (you have/she has/he has) no trouble,
a little trouble, or a lot of trouble?
Int. Instr II:
INPUT FIELDS / ROUTING
3:53:40 PM Monday, August 03, 2009
Page 15 of 760
HFB3
EINTROUB
Field1:
( HFQ1070 )
HEST.EINTROUB
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
TTroub
1
No
No
Number Label
1 NoTrouble
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFB4 - EMCTROUB ( HFQ1080 )
2
English text: NO TROUBLE
ALittleTrouble
HFB4 - EMCTROUB ( HFQ1080 )
3
English text: A LITTLE TROUBLE
ALotOfTrouble
HFB4 - EMCTROUB ( HFQ1080 )
English text: A LOT OF TROUBLE
Attribute
Don't know
Route
HFB4 - EMCTROUB ( HFQ1080 )
Refusal
HFB4 - EMCTROUB ( HFQ1080 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:53:43 PM Monday, August 03, 2009
Page 16 of 760
HFB4
HFB4
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
EMCTROUB
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of [your/(SP's)] difficulty seeing, how much trouble [do
you/does (SP)] have finding out things (you need/he needs/she
needs) to know about Medicare? Would you say (you have/she
has/he has) no trouble, a little trouble, or a lot of trouble?
Int. Instr II:
INPUT FIELDS / ROUTING
3:53:45 PM Monday, August 03, 2009
Page 17 of 760
HFB4
EMCTROUB
Field1:
( HFQ1080 )
HEST.EMCTROUB
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
TTroub
1
No
No
Number Label
1 NoTrouble
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFB5 - EOBTROUB ( HFQ1090 )
2
English text: NO TROUBLE
ALittleTrouble
HFB5 - EOBTROUB ( HFQ1090 )
3
English text: A LITTLE TROUBLE
ALotOfTrouble
HFB5 - EOBTROUB ( HFQ1090 )
English text: A LOT OF TROUBLE
Attribute
Don't know
Route
HFB5 - EOBTROUB ( HFQ1090 )
Refusal
HFB5 - EOBTROUB ( HFQ1090 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:53:48 PM Monday, August 03, 2009
Page 18 of 760
HFB5
HFB5
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
EOBTROUB
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
90
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:
Because of [your/(SP's)] difficulty seeing, how much trouble [do
you/does (SP)] have obtaining medical care, such as finding care or
getting there when (you need/he needs/she needs) it? Would you
say (you have/she has/he has) no trouble, a little trouble, or a lot of
trouble?
Int. Instr II:
INPUT FIELDS / ROUTING
3:53:49 PM Monday, August 03, 2009
Page 19 of 760
HFB5
EOBTROUB
Field1:
( HFQ1090 )
HEST.EOBTROUB
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
TTroub
1
No
No
Number Label
1 NoTrouble
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFB6 - EDOCEXAM ( HFQ1110 )
2
English text: NO TROUBLE
ALittleTrouble
HFB6 - EDOCEXAM ( HFQ1110 )
3
English text: A LITTLE TROUBLE
ALotOfTrouble
HFB6 - EDOCEXAM ( HFQ1110 )
English text: A LOT OF TROUBLE
Attribute
Don't know
Route
HFB6 - EDOCEXAM ( HFQ1110 )
Refusal
HFB6 - EDOCEXAM ( HFQ1110 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:53:53 PM Monday, August 03, 2009
Page 20 of 760
HFB6
HFB6
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EDOCEXAM
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
110
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)] had an eye examination by an eye doctor since
(LAST HF MONTH YEAR)?
Int. Instr II:
INCLUDE OPHTHALMOLOGISTS AND OPTOMETRISTS.
INPUT FIELDS / ROUTING
3:53:54 PM Monday, August 03, 2009
Page 21 of 760
HFB6
EDOCEXAM
Field1:
( HFQ1110 )
HEST.EDOCEXAM
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFB1 - (HFQ1150 )
English text: YES
No
HFB7 - EDOCLAST ( HFQ1130 )
English text: NO
Attribute
Don't know
Route
BOX HFB1 - (HFQ1150 )
Refusal
BOX HFB1 - (HFQ1150 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:53:57 PM Monday, August 03, 2009
Page 22 of 760
HFB7
HFB7
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
EDOCLAST
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
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:
How long has it been since [your/(SP's)] last eye examination by an
eye doctor?
Int. Instr II:
INPUT FIELDS / ROUTING
3:53:59 PM Monday, August 03, 2009
Page 23 of 760
HFB7
EDOCLAST
Field1:
( HFQ1130 )
HEST.EDOCLAST
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
TEdoclst
1
No
No
Number Label
1 NeverHadEyeExam
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFB1 - (HFQ1150 )
2
English text: NEVER HAD EYE EXAM BY EYE DOCTOR
OneYearToLessThan2Years
BOX HFB1 - (HFQ1150 )
3
English text: 1 YEAR TO LESS THAN 2 YEARS
TwoYearsToLessThan5Years
BOX HFB1 - (HFQ1150 )
4
English text: 2 YEARS TO LESS THAN 5 YEARS
FiveYearsOrMore
BOX HFB1 - (HFQ1150 )
English text: 5 YEARS OR MORE
Attribute
Don't know
Route
BOX HFB1 - (HFQ1150 )
Refusal
BOX HFB1 - (HFQ1150 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:54:02 PM Monday, August 03, 2009
Page 24 of 760
BOX HFB1
BOX HFB1
Page Order # :
155
BOX INSTRUCTIONS
( HFQ1150 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFB10 - ECCATOP (
HFQ1160 ).
ELSE GO TO HFC1 - HCHELP ( HFQ1170 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
3:54:02 PM Monday, August 03, 2009
Page 25 of 760
HFB10
HFB10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ECCATOP
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:
[Have you/Has (SP)] ever had an operation for cataracts?
Int. Instr II:
INPUT FIELDS / ROUTING
3:54:04 PM Monday, August 03, 2009
Page 26 of 760
HFB10
ECCATOP
Field1:
( HFQ1160 )
HEST.ECCATOP
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFC1 - HCHELP ( HFQ1170 )
English text: YES
No
HFC1 - HCHELP ( HFQ1170 )
English text: NO
Attribute
Don't know
Route
HFC1 - HCHELP ( HFQ1170 )
Refusal
HFC1 - HCHELP ( HFQ1170 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:54:07 PM Monday, August 03, 2009
Page 27 of 760
HFC1
HFC1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HCHELP
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:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Do you/Does (SP)] use a hearing aid?
Int. Instr II:
INPUT FIELDS / ROUTING
3:54:08 PM Monday, August 03, 2009
Page 28 of 760
HFC1
HCHELP
Field1:
( HFQ1170 )
HEST.HCHELP
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
THchelp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFC2 - HCTROUB ( HFQ1180 )
2
English text: YES
No
HFC2 - HCTROUB ( HFQ1180 )
3
English text: NO
Deaf
HFC3 - HCKNOWMC ( HFQ1190 )
English text: SP IS DEAF
Attribute
Don't know
Route
HFD1A - FOODTRBL ( HFQ1205 )
Refusal
HFD1A - FOODTRBL ( HFQ1205 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:54:11 PM Monday, August 03, 2009
Page 29 of 760
HFC2
HFC2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HCTROUB
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:
If HFC1 - HCHELP = 1/Yes, display "with a hearing aid".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Which statement best describes [your/(SP's)] hearing (with a hearing
aid): no trouble hearing, a little trouble, a lot of trouble, or deaf?
Int. Instr II:
INPUT FIELDS / ROUTING
3:54:13 PM Monday, August 03, 2009
Page 30 of 760
HFC2
HCTROUB
Field1:
( HFQ1180 )
HEST.HCTROUB
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
THctrble
1
No
No
Number Label
1 NoTroubleHearing
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFD1A - FOODTRBL ( HFQ1205 )
2
English text: NO TROUBLE HEARING
ALittleTroubleHearing
3
English text: A LITTLE TROUBLE HEARING
ALotOfTroubleHearing
HFC3 - HCKNOWMC ( HFQ1190 )
4
English text: A LOT OF TROUBLE HEARING
Deaf
HFC3 - HCKNOWMC ( HFQ1190 )
HFC3 - HCKNOWMC ( HFQ1190 )
English text: DEAF
Attribute
Don't know
Route
HFD1A - FOODTRBL ( HFQ1205 )
Refusal
HFD1A - FOODTRBL ( HFQ1205 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:54:17 PM Monday, August 03, 2009
Page 31 of 760
HFC3
HFC3
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HCKNOWMC
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:
If HFC1 - HCHELP = 3/SPIsDeaf or HFC2 - HCTROUB = 4/Deaf,
display "(you are/he is/she is) deaf".
Else display "of (your/his/her) difficulty hearing".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How much trouble [do you/does (SP)] have finding out things (you
need/he needs/she needs) to know about Medicare because [of
(your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would
you say (you have/she has/he has) no trouble, a little trouble, or a lot
of trouble?
Int. Instr II:
3:54:18 PM Monday, August 03, 2009
Page 32 of 760
HFC3
INPUT FIELDS / ROUTING
HCKNOWMC
Field1:
( HFQ1190 )
HEST.HCKNOWMC
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
TTroub
1
No
No
Number Label
1 NoTrouble
2
3
English text: NO TROUBLE
ALittleTrouble
English text: A LITTLE TROUBLE
ALotOfTrouble
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFC4 - HCCOMDOC ( HFQ1200 )
HFC4 - HCCOMDOC ( HFQ1200 )
HFC4 - HCCOMDOC ( HFQ1200 )
English text: A LOT OF TROUBLE
Attribute
Don't know
Route
HFC4 - HCCOMDOC ( HFQ1200 )
Refusal
HFC4 - HCCOMDOC ( HFQ1200 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:54:21 PM Monday, August 03, 2009
Page 33 of 760
HFC4
HFC4
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HCCOMDOC
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:
If HFC1 - HCHELP = 3/Deaf or HFC2 - HCTROUB = 4/Deaf, display
"(you are/he is/she is) deaf".
Else display "of (your/his/her) difficulty hearing".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How much trouble [do you/does (SP)] have communicating with
(your/his/her) doctor or other medical personnel because [of
(your/his/her) difficulty hearing/(you are/he is/she is) deaf]? Would
you say (you have/she has/he has) no trouble, a little trouble, or a lot
of trouble?
Int. Instr II:
3:54:23 PM Monday, August 03, 2009
Page 34 of 760
HFC4
INPUT FIELDS / ROUTING
HCCOMDOC
Field1:
( HFQ1200 )
HEST.HCCOMDOC
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
TTroub
1
No
No
Number Label
1 NoTrouble
2
3
English text: NO TROUBLE
ALittleTrouble
English text: A LITTLE TROUBLE
ALotOfTrouble
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFD1A - FOODTRBL ( HFQ1205 )
HFD1A - FOODTRBL ( HFQ1205 )
HFD1A - FOODTRBL ( HFQ1205 )
English text: A LOT OF TROUBLE
Attribute
Don't know
Route
HFD1A - FOODTRBL ( HFQ1205 )
Refusal
HFD1A - FOODTRBL ( HFQ1205 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:54:26 PM Monday, August 03, 2009
Page 35 of 760
HFD1A
HFD1A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
FOODTRBL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
220
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:
How much trouble [do you/does (SP)] have eating solid foods
because of problems with (your/his/her) mouth or teeth? Would you
say (you have/she has/he has) no trouble, a little trouble, or a lot of
trouble?
Int. Instr II:
INPUT FIELDS / ROUTING
3:54:27 PM Monday, August 03, 2009
Page 36 of 760
HFD1A
FOODTRBL
Field1:
( HFQ1205 )
HEST.FOODTRBL
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
TTroub
1
No
No
Number Label
1 NoTrouble
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFE1 - HEIGHTFT ( HFQ1230 )
2
English text: NO TROUBLE
ALittleTrouble
HFE1 - HEIGHTFT ( HFQ1230 )
3
English text: A LITTLE TROUBLE
ALotOfTrouble
HFE1 - HEIGHTFT ( HFQ1230 )
English text: A LOT OF TROUBLE
Attribute
Don't know
Route
HFE1 - HEIGHTFT ( HFQ1230 )
Refusal
HFE1 - HEIGHTFT ( HFQ1230 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:54:30 PM Monday, August 03, 2009
Page 37 of 760
HFE1
HFE1
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
HEIGHTFT
Field 2:
HEIGHTIN
Field 3:
WEIGHT
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:
230
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Display HFE1 - HEIGHTFT and HFE1 - HEIGHTIN input fields on 1st
line.
Display HFE1 - WEIGHT input field on 2nd line.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
3:54:32 PM Monday, August 03, 2009
Page 38 of 760
HFE1
HEIGHTFT
Field1:
( HFQ1230 )
HEST.HEIGHTFT
Cheshire Name:
Item Text display:
Item Text:
How tall [are you/is (SP)]?
Label:
Label Position:
FEET:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THeightft
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HFE1 - HEIGHTIN ( HFQ1240 )
Refusal
HFE1 - HEIGHTIN ( HFQ1240 )
3:54:36 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
3
7
Route
HFE1 - HEIGHTIN ( HFQ1240 )
Page 39 of 760
HFE1
HEIGHTIN
Field2:
( HFQ1240 )
HEST.HEIGHTIN
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
INCHES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THeightin
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HFE1 - WEIGHT ( HFQ1250 )
Refusal
HFE1 - WEIGHT ( HFQ1250 )
3:54:39 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
0
11
Route
HFE1 - WEIGHT ( HFQ1250 )
Page 40 of 760
HFE1
WEIGHT
Field3:
( HFQ1250 )
HEST.WEIGHT
Cheshire Name:
Item Text display:
Item Text:
How much [do you/does (SP)] weigh?
Label:
Label Position:
WEIGHT:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TWeights
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
999
Route
HFFINTRO - PREVHLTHINTRO ( HFQ1260 )
Attribute
Don't know
Route
HFFINTRO - PREVHLTHINTRO ( HFQ1260 )
Refusal
HFFINTRO - PREVHLTHINTRO ( HFQ1260 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
Calculate Height based on HFE1 - HEIGHTFT and HFE1
HEIGHTIN in inches.
HFE1 - HEIGHTFT and HFE1 - HEIGHTIN calculated height in
inches = 60 - 72.
If not true, display message "THE HEIGHT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
Edit #2:
HFE1 - WEIGHT = 80 - 280.
If not true, display message "THE WEIGHT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:54:41 PM Monday, August 03, 2009
Page 41 of 760
HFE1
3:54:41 PM Monday, August 03, 2009
Page 42 of 760
HFFINTRO
HFFINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
PREVHLTHINTRO
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
250
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:
These next few questions are about preventive health care
measures some people take.
Int. Instr II:
INPUT FIELDS / ROUTING
3:54:42 PM Monday, August 03, 2009
Page 43 of 760
HFFINTRO
PREVHLTHINTRO
Field1:
( HFQ1260 )
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
HFF1 - BPTAKEN ( HFQ1270 )
English text: CONTINUE
Attribute
Empty
Route
HFF1 - BPTAKEN ( HFQ1270 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:54:44 PM Monday, August 03, 2009
Page 44 of 760
HFF1
HFF1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
BPTAKEN
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:
When was the most recent time [you/(SP)] had (your/his/her) blood
pressure taken by a doctor or other health professional?
Int. Instr II:
INPUT FIELDS / ROUTING
3:54:46 PM Monday, August 03, 2009
Page 45 of 760
HFF1
BPTAKEN
Field1:
( HFQ1270 )
HEST.BPTAKEN
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
TBptake
1
No
No
Number Label
1 LessThanSixMonths
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF2 - BCTAKEN ( HFQ1280 )
2
English text: LESS THAN 6 MONTHS AGO
SixMonthsToOneYear
3
English text: 6 MONTHS TO LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears
HFF2 - BCTAKEN ( HFQ1280 )
4
English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanFiveYears
HFF2 - BCTAKEN ( HFQ1280 )
5
English text: 2 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
HFF2 - BCTAKEN ( HFQ1280 )
6
English text: 5 OR MORE YEARS AGO
Never
HFF2 - BCTAKEN ( HFQ1280 )
HFF2 - BCTAKEN ( HFQ1280 )
English text: NEVER HAD BLOOD PRESSURE TAKEN
Attribute
Don't know
Route
HFF2 - BCTAKEN ( HFQ1280 )
Refusal
HFF2 - BCTAKEN ( HFQ1280 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
3:54:52 PM Monday, August 03, 2009
Page 46 of 760
HFF1
TECHNICAL NOTES
DESIGN NOTES
3:54:52 PM Monday, August 03, 2009
Page 47 of 760
HFF2
HFF2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
BCTAKEN
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
270
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:
When was the most recent time [you/(SP)] had (your/his/her) blood
cholesterol checked?
Int. Instr II:
INPUT FIELDS / ROUTING
3:54:54 PM Monday, August 03, 2009
Page 48 of 760
HFF2
BCTAKEN
Field1:
( HFQ1280 )
HEST.BCTAKEN
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
TBcTake
1
No
No
Number Label
1 LessThanSixMonths
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFF1 - (HFQ1290 )
2
English text: LESS THAN 6 MONTHS AGO
SixMonthsToLessThanOneYear
3
English text: 6 MONTHS TO LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears
BOX HFF1 - (HFQ1290 )
4
English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanFiveYears
BOX HFF1 - (HFQ1290 )
5
English text: 2 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
BOX HFF1 - (HFQ1290 )
6
English text: 5 OR MORE YEARS AGO
Never
BOX HFF1 - (HFQ1290 )
BOX HFF1 - (HFQ1290 )
English text: NEVER HAD CHOLESTEROL CHECKED
Attribute
Don't know
Route
BOX HFF1 - (HFQ1290 )
Refusal
BOX HFF1 - (HFQ1290 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
3:54:59 PM Monday, August 03, 2009
Page 49 of 760
HFF2
TECHNICAL NOTES
DESIGN NOTES
3:54:59 PM Monday, August 03, 2009
Page 50 of 760
BOX HFF1
BOX HFF1
Page Order # :
280
BOX INSTRUCTIONS
( HFQ1290 )
IF SP IS FEMALE, GO TO HFF3 - MAMMOGRM ( HFQ1300 ).
ELSE GO TO BOX HFF3 - (HFQ1440 ).
ASSIGNMENTS
TECHNICAL NOTES
5
SPMale
SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.
6
SPFemale
SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.
DESIGN NOTES
3:54:59 PM Monday, August 03, 2009
Page 51 of 760
HFF3
HFF3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MAMMOGRM
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
290
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is not in the Supplemental Sample, display "These next few
questions are about. . .".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
(These next few questions are about preventive health care
measures some people take). [Have you/Has (SP)] had a
mammogram or a breast X-ray since (LAST HF MONTH YEAR)?
Int. Instr II:
INPUT FIELDS / ROUTING
3:55:00 PM Monday, August 03, 2009
Page 52 of 760
HFF3
MAMMOGRM
Field1:
( HFQ1300 )
HEST.MAMMOGRM
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF6 - PAPSMEAR ( HFQ1360 )
English text: YES
No
BOX HFF1A - (HFQ1315 )
English text: NO
Attribute
Don't know
Route
HFF6 - PAPSMEAR ( HFQ1360 )
Refusal
HFF6 - PAPSMEAR ( HFQ1360 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
3:55:02 PM Monday, August 03, 2009
Page 53 of 760
BOX HFF1A
BOX HFF1A
Page Order # :
310
BOX INSTRUCTIONS
( HFQ1315 )
IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO HFF6 - PAPSMEAR ( HFQ1360 ).
ELSE GO TO HFF5 - MAMCODE ( HFQ1330 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
3:55:02 PM Monday, August 03, 2009
Page 54 of 760
HFF5
HFF5
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
MAMCODE
Field 2:
MAMNOTHS
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:
320
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 is the reason that [you have/(SP) has] not had a mammogram
since (LAST HF MONTH YEAR)?
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
3:55:06 PM Monday, August 03, 2009
Page 55 of 760
HFF5
3:55:15 PM Monday, August 03, 2009
Page 56 of 760
HFF5
MAMCODE
Field1:
( HFQ1330)
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.MAMNNEED
2=HEST.MAMNANUL
3=HEST.MAMNGET
4=HEST.MAMNRISK
5=HEST.MAMNPRES
6=HEST.MAMNREC
7=HEST.MAMNLIKE
8=HEST.MAMNLOCA
9=HEST.MAMNMISS
10=HEST.MAMNCOST
11 =HEST.MAMNFEAR
12=HEST.MAMNRADI
13=HEST.MAMNHEAR
14=HEST.MAMNAPPT
15= HESTMAMNMASC
16=HEST.MAMNILL
91=HEST.MAMNOTHR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THFF5CATA
17
No
No
Number Label
NotNeeded
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF6 - PAP SMEAR (HFQI360)
English text: DIDN'T KNOW IT WAS NEEDEDINO NEEDINOTHING WRONG
NotRecommendedEveryYear
HFF6 - PAP SMEAR (HFQI360)
-----------------------------------------------------------------------------------------------------------------------------------------------------------
2
English text: NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT SCREENING
SCHEDULE
3
DidNotThinkPreventCancer
HFF6 - PAP SMEAR (HFQI360)
4
English text: DIDN'T THINK IT WOULD PREVENT BREAST CANCER/COULD GET BREAST
CANCERANYWAY/TEST IS USELESS
NotAtRisk
HFF6 - PAP SMEAR (HFQI360)
---------------------------------------------------------------------------------------------------------------------------------------------
English text: NOT AT RISK FOR BREAST CANCER
5
DrNotRecommended
HFF6 - PAP SMEAR (HFQI360)
English text: DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
3:55:26 PM Monday, August 03, 2009
Page 57 of 760
HFF5
6
DrRecommendedAgainstIt
HFF6 - PAPSMEAR ( HFQ1360 )
7
English text: DOCTOR RECOMMENDED AGAINST GETTING IT
DontLikeMammogram
HFF6 - PAPSMEAR ( HFQ1360 )
8
English text: DON’T LIKE MAMMOGRAMS/PAIN, SORENESS, DISCOMFORT OR REACTIONS
Inconvenient
HFF6 - PAPSMEAR ( HFQ1360 )
9
English text: INCONVENIENT/UNABLE TO GET TO LOCATION/TRANSPORTATION
DIFFICULTY
Forgot
HFF6 - PAPSMEAR ( HFQ1360 )
11
English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT/PROCRASTINATED
CostOfMammogram
HFF6 - PAPSMEAR ( HFQ1360 )
English text: COST OF MAMMOGRAM/INSURANCE DOESN’T COVER COST/NOT WORTH
THE MONEY
AfraidOfResults
HFF6 - PAPSMEAR ( HFQ1360 )
12
English text: AFRAID OF RESULTS/DON’T WANT TO KNOW
CouldCauseCancer
HFF6 - PAPSMEAR ( HFQ1360 )
13
English text: MAMMOGRAM RADIATION COULD CAUSE CANCER/ILL EFFECTS
NeverHeardOfMammogram
HFF6 - PAPSMEAR ( HFQ1360 )
14
English text: NEVER HEARD OF MAMMOGRAM
AppointmentScheduled
HFF6 - PAPSMEAR ( HFQ1360 )
15
English text: APPOINTMENT SCHEDULED FOR FUTURE DATE
Mastectomy
HFF6 - PAPSMEAR ( HFQ1360 )
16
English text: MASTECTOMY/BREASTS REMOVED
TooIll
HFF6 - PAPSMEAR ( HFQ1360 )
91
English text: TOO ILL, PHYSICALLY/MENTALLY
Other
HFF5 - MAMNOTHS ( HFQ1350 )
10
English text: OTHER
Attribute
Don't know
Route
HFF6 - PAPSMEAR ( HFQ1360 )
Refusal
HFF6 - PAPSMEAR ( HFQ1360 )
3:55:34 PM Monday, August 03, 2009
Page 58 of 760
HFF5
Field2:
MAMNOTHS
( HFQ1350 )
HEST.MAMNOTHS
Cheshire Name:
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
HFF6 - PAPSMEAR ( HFQ1360 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:55:35 PM Monday, August 03, 2009
Page 59 of 760
HFF6
HFF6
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PAPSMEAR
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:
[Have you/Has (SP)] had a Pap smear test since (LAST HF MONTH
YEAR)?
Int. Instr II:
INPUT FIELDS / ROUTING
3:55:36 PM Monday, August 03, 2009
Page 60 of 760
HFF6
PAPSMEAR
Field1:
( HFQ1360 )
HEST.PAPSMEAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFF2 - (HFQ1420 )
English text: YES
No
BOX HFF1B - (HFQ1375 )
English text: NO
Attribute
Don't know
Route
BOX HFF2 - (HFQ1420 )
Refusal
BOX HFF2 - (HFQ1420 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:55:39 PM Monday, August 03, 2009
Page 61 of 760
BOX HFF1B
BOX HFF1B
Page Order # :
340
BOX INSTRUCTIONS
( HFQ1375 )
IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO BOX HFF2 - (HFQ1420 ).
ELSE GO TO HFF8 - PAPCODE ( HFQ1390 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
3:55:39 PM Monday, August 03, 2009
Page 62 of 760
HFF8
HFF8
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
PAPCODE
Field 2:
PAPNOTHS
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:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What is the reason that [you have/(SP) has] not had a Pap smear
test since (LAST HF MONTH YEAR)?
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
3:55:43 PM Monday, August 03, 2009
Page 63 of 760
HFF8
3:55:51 PM Monday, August 03, 2009
Page 64 of 760
HFF8
PAPCODE
Field1:
( HFQ1390)
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HESTPAPNNEED
2=HESTPAPNANUL
3= HESTPAPNGET
4=HESTPAPNRISK
5=HESTPAPNPRES
6= HESTPAPNREC
7= HESTPAPNLlKE
8=HESTPAPNLOCA
9=HESTPAPNMISS
10= HESTPAPNCOST
11=HESTPAPNFEAR
12=HESTPAPNHEAR
13=HESTPAPNAPPT
14=HESTPAPNHYST
15= HESTPAPNILL
91=HESTPAPNOTHR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THFF8CATA
16
No
No
Number Label
NotNeeded
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFF2 - (HFQ1420 )
English text: DIDN'T KNOW IT WAS NEEDEDINO NEEDINOTHING WRONG
2
NotRecommended
BOX HFF2 - (HFQ1420 )
3
English text: NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT SCREENING
SCHEDULE
DidNotThinkPreventCancer
BOX HFF2 - (HFQ1420 )
4
English text: DIDN'T THINK IT WOULD PREVENT CANCER/COULD GET CANCER
ANYWAY/TEST IS USELESS
NotAtRisk
BOX HFF2 - (HFQ1420 )
5
English text: NOT AT RISK FOR CANCER
DrNotRecommended
BOX HFF2 - (HFQ1420 )
English text: DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
3:56:01 PM Monday, August 03, 2009
Page 65 of 760
HFF8
6
DrRecommendAgainstIt
BOX HFF2 - (HFQ1420 )
7
English text: DOCTOR RECOMMENDED AGAINST GETTING IT
DontLikePapSmear
BOX HFF2 - (HFQ1420 )
8
English text: DON’T LIKE PAP SMEAR/PAIN, SORENESS, DISCOMFORT OR REACTIONS
Inconvenient
BOX HFF2 - (HFQ1420 )
9
English text: INCONVENIENT/UNABLE TO GET TO LOCATION/TRANSPORTATION
DIFFICULTY
Forgot
BOX HFF2 - (HFQ1420 )
11
English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT/PROCRASTINATED
CostOfPapSmear
BOX HFF2 - (HFQ1420 )
English text: COST OF PAP SMEAR/INSURANCE DOESN’T COVER COST/NOT WORTH THE
MONEY
AfraidOfResults
BOX HFF2 - (HFQ1420 )
12
English text: AFRAID OF RESULTS/DON’T WANT TO KNOW
NeverHeardOfPapSmear
BOX HFF2 - (HFQ1420 )
13
English text: NEVER HEARD OF PAP SMEAR
AppointmentScheduled
BOX HFF2 - (HFQ1420 )
14
English text: APPOINTMENT SCHEDULED FOR FUTURE DATE
HadHysterectomy
BOX HFF2 - (HFQ1420 )
15
English text: HAD HYSTERECTOMY/NO UTERUS, OVARIES
TooIll
BOX HFF2 - (HFQ1420 )
91
English text: TOO ILL, PHYSICALLY/MENTALLY
Other
HFF8 - PAPNOTHS ( HFQ1410 )
10
English text: OTHER
Attribute
Don't know
Route
BOX HFF2 - (HFQ1420 )
Refusal
BOX HFF2 - (HFQ1420 )
3:56:09 PM Monday, August 03, 2009
Page 66 of 760
HFF8
Field2:
PAPNOTHS
( HFQ1410 )
HEST.PAPNOTHS
Cheshire Name:
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 HFF2 - (HFQ1420 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:56:10 PM Monday, August 03, 2009
Page 67 of 760
BOX HFF2
BOX HFF2
Page Order # :
370
BOX INSTRUCTIONS
( HFQ1420 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE AND RESPONSE TO HHF8 –
PAPCODE DOES NOT INCLUDE 14/HadHysterectomy, GO TO HFF9
HYSTEREC ( HFQ1430 ).
ELSE GO TO HFF15 - FLUSHOT ( HFQ1540 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
3:56:10 PM Monday, August 03, 2009
Page 68 of 760
HFF9
HFF9
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HYSTEREC
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
380
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 had a hysterectomy?
Int. Instr II:
INPUT FIELDS / ROUTING
3:56:11 PM Monday, August 03, 2009
Page 69 of 760
HFF9
HYSTEREC
Field1:
( HFQ1430 )
HEST.HYSTEREC
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF15 - FLUSHOT ( HFQ1540 )
English text: YES
No
HFF15 - FLUSHOT ( HFQ1540 )
English text: NO
Attribute
Don't know
Route
HFF15 - FLUSHOT ( HFQ1540 )
Refusal
HFF15 - FLUSHOT ( HFQ1540 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:56:13 PM Monday, August 03, 2009
Page 70 of 760
BOX HFF3
BOX HFF3
Page Order # :
390
BOX INSTRUCTIONS
( HFQ1440 )
IF SP HAS EVER REPORTED HAVING PROSTATE SURGERY IN A
PREVIOUS ROUND, GO TO HFF11 - DIGTEXAM ( HFQ1460 ).
ELSE GO TO HFF10 - PROSSURG ( HFQ1450 ).
ASSIGNMENTS
TECHNICAL NOTES
385
HFProstateSurg
SP has ever reported having prostate surgery in a
previous round =
There is a HEST where HEST.HESTRND < current round
and (HEST.PROSSURG = 1/Yes or HEST.PROSRMVD
= 1/Yes).
DESIGN NOTES
3:56:13 PM Monday, August 03, 2009
Page 71 of 760
HFF10
HFF10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PROSSURG
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
400
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "[Have you/Has (SP)] ever".
Else display "Since (LAST HF MONTH YEAR), [have you/has (SP)]".
If SP is the respondent, display "your".
Else display "his".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (LAST HF MONTH YEAR), [have you/has (SP)/[Have you/has
(SP)] ever] had surgery on (your/his) prostate?
[EXPLAIN IF NECESSARY: Surgery on the prostate gland is
typically used as a treatment for prostate cancer or to correct urinary
problems. Surgery can include complete or partial removal of the
3:56:15 PM Monday, August 03, 2009
Page 72 of 760
HFF10
prostate.]
Int. Instr II:
INPUT FIELDS / ROUTING
PROSSURG
Field1:
( HFQ1450 )
HEST.PROSSURG
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF11 - DIGTEXAM ( HFQ1460 )
English text: YES
No
HFF11 - DIGTEXAM ( HFQ1460 )
English text: NO
Attribute
Don't know
Route
HFF11 - DIGTEXAM ( HFQ1460 )
Refusal
HFF11 - DIGTEXAM ( HFQ1460 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
3:56:18 PM Monday, August 03, 2009
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
Page 73 of 760
HFF10
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
3:56:18 PM Monday, August 03, 2009
Page 74 of 760
HFF11
HFF11
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIGTEXAM
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
410
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has ever reported having prostate surgery in the current round
or in a previous round, display "follow-up care sometimes
prescribed after prostate surgery."
Else display "preventive health care measures some people take."
If SP has not reported having prostate surgery in the current round
or any previous round, display "of the prostate".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
3:56:19 PM Monday, August 03, 2009
These next few questions are about (preventive health care
measures some people take/follow-up care sometimes prescribed
after prostate surgery).
Page 75 of 760
HFF11
[Have you/Has (SP)] had a digital rectal examination (of the prostate)
since (LAST HF MONTH YEAR)?
[EXPLAIN IF NECESSARY: The exam may be used to detect
prostate cancer, to determine whether cancer has spread beyond
the prostate, and as part of follow-up care after prostate surgery.]
Int. Instr II:
INPUT FIELDS / ROUTING
DIGTEXAM
Field1:
( HFQ1460 )
HEST.DIGTEXAM
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF12 - BLOODTST ( HFQ1470 )
English text: YES
No
HFF12 - BLOODTST ( HFQ1470 )
English text: NO
Attribute
Don't know
Route
HFF12 - BLOODTST ( HFQ1470 )
Refusal
HFF12 - BLOODTST ( HFQ1470 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
3:56:22 PM Monday, August 03, 2009
Page 76 of 760
HFF11
TECHNICAL NOTES
387
HFProstateSurgCurrOr
Prev
If SP has ever reported having prostate surgery in the
current round or in a previous round =
(HEST.PROSSURG = /1Yes or HEST.PROSRMVD =
1/Yes ) on HEST where (HEST.HESTRND <= current
round).
DESIGN NOTES
3:56:22 PM Monday, August 03, 2009
Page 77 of 760
HFF12
HFF12
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
BLOODTST
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
420
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "PSA = PROSTATE-SPECIFIC ANTIGEN" in the same blue
font used for interviewer instructions.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Have you/Has (SP)] had a blood test for detection of prostate
cancer, known as a PSA, since (LAST HF MONTH YEAR)?
PSA = PROSTATE-SPECIFIC ANTIGEN
[EXPLAIN IF NECESSARY: The test may be used to detect prostate
cancer, to determine whether cancer has spread beyond the
prostate, and as part of follow-up care after prostate surgery.]
Int. Instr II:
3:56:23 PM Monday, August 03, 2009
Page 78 of 760
HFF12
INPUT FIELDS / ROUTING
BLOODTST
Field1:
( HFQ1470 )
HEST.BLOODTST
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF15 - FLUSHOT ( HFQ1540 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
HFF15 - FLUSHOT ( HFQ1540 )
Refusal
HFF15 - FLUSHOT ( HFQ1540 )
BOX HFF3B - (HFQ1485 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:56:25 PM Monday, August 03, 2009
Page 79 of 760
BOX HFF3B
BOX HFF3B
Page Order # :
430
BOX INSTRUCTIONS
( HFQ1485 )
IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO HFF15 - FLUSHOT ( HFQ1540 ).
ELSE GO TO HFF14 - PRONCODE ( HFQ1500 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
3:56:25 PM Monday, August 03, 2009
Page 80 of 760
HFF14
HFF14
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
PRONCODE
Field 2:
PRONOTHS
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:
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 is the reason that [you have/(SP) has] not had a prostate blood
test or PSA since (LAST HF MONTH YEAR)?
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
3:56:29 PM Monday, August 03, 2009
Page 81 of 760
HFF14
3:56:37 PM Monday, August 03, 2009
Page 82 of 760
HFF14
PRONCODE
Field1:
( HFQ1500 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.PRONNEED
2=HEST.PRONANUL
3=HEST.PRONGET
4=HEST.PRONRISK
5=HEST.PRONPRES
6=HEST.PRONREC
7=HEST.PRONLIKE
8=HEST.PRONLOCA
9=HEST.PRONMISS
10=HEST.PRONCOST
11=HEST.PRONFEAR
12=HEST.PRONHEAR
13=HEST.PRONAPPT
14=HEST.PRONPROS
91=HEST.PRONOTHR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THFF14CATA
15
No
No
Number Label
1 NotNeeded
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF15 - FLUSHOT ( HFQ1540 )
3
English text: DIDN’T KNOW IT WAS NEEDED/NO NEED/NOTHING WRONG
NotRecommendedEveryYear
HFF15 - FLUSHOT ( HFQ1540 )
English text: NOT RECOMMENDED EVERY YEAR/ON A DIFFERENT SCREENING
SCHEDULE
DidNotThinkPreventCancer
HFF15 - FLUSHOT ( HFQ1540 )
4
English text: DIDN’T THINK IT WOULD PREVENT CANCER/COULD GET CANCER
ANYWAY/TEST IS USELESS
NotAtRisk
HFF15 - FLUSHOT ( HFQ1540 )
5
English text: NOT AT RISK FOR CANCER
DrNotRecommended
6
English text: DOCTOR DID NOT PRESCRIBE OR RECOMMEND IT
DrRecommendedAgainstIt
HFF15 - FLUSHOT ( HFQ1540 )
2
HFF15 - FLUSHOT ( HFQ1540 )
English text: DOCTOR RECOMMENDED AGAINST GETTING IT
3:56:48 PM Monday, August 03, 2009
Page 83 of 760
HFF14
7
DontLikeBloodTests
HFF15 - FLUSHOT ( HFQ1540 )
8
English text: DON’T LIKE BLOOD TESTS/PAIN, SORENESS, DISCOMFORT OR REACTIONS
Inconvenient
HFF15 - FLUSHOT ( HFQ1540 )
9
English text: INCONVENIENT/UNABLE TO GET TO LOCATION/TRANSPORTATION
DIFFICULTY
Forgot
HFF15 - FLUSHOT ( HFQ1540 )
10
English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT/PROCRASTINATED
CostOfTest
HFF15 - FLUSHOT ( HFQ1540 )
11
English text: COST OF TEST/INSURANCE DOESN’T COVER COST/NOT WORTH THE
MONEY
AfraidOfResults
HFF15 - FLUSHOT ( HFQ1540 )
12
English text: AFRAID OF RESULTS/DON’T WANT TO KNOW
NeverHeardOfPsa
HFF15 - FLUSHOT ( HFQ1540 )
13
English text: NEVER HEARD OF PSA
AppointmentScheduled
14
English text: APPOINTMENT SCHEDULED FOR FUTURE DATE
Prostatectomy
HFF15 - FLUSHOT ( HFQ1540 )
91
English text: PROSTATECTOMY/PROSTATE REMOVED
Other
HFF14 - PRONOTHS ( HFQ1520 )
HFF15 - FLUSHOT ( HFQ1540 )
English text: OTHER
Attribute
Don't know
Route
HFF15 - FLUSHOT ( HFQ1540 )
Refusal
HFF15 - FLUSHOT ( HFQ1540 )
3:56:55 PM Monday, August 03, 2009
Page 84 of 760
HFF14
Field2:
PRONOTHS
( HFQ1520 )
HEST.PRONOTHS
Cheshire Name:
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
HFF15 - FLUSHOT ( HFQ1540 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:56:56 PM Monday, August 03, 2009
Page 85 of 760
HFF15
HFF15
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
FLUSHOT
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
470
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:
On a different topic ...
Did [you/(SP)] have a flu shot for last winter?
[EXPLAIN IF NECESSARY: Did [you/(SP)] get a flu shot any time
during the period from September (PREVIOUS YEAR) through
December (PREVIOUS YEAR)?]
Int. Instr II:
3:56:57 PM Monday, August 03, 2009
Page 86 of 760
HFF15
INPUT FIELDS / ROUTING
FLUSHOT
Field1:
( HFQ1540 )
HEST.FLUSHOT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF18 - FLUSITE ( HFQ1600 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
BOX HFF5 - (HFQ1650 )
Refusal
BOX HFF5 - (HFQ1650 )
HFF17 - FLUCODE ( HFQ1560 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:56:59 PM Monday, August 03, 2009
Page 87 of 760
HFF17
HFF17
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
FLUCODE
Field 2:
FLUOTHOS
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:
490
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:
Why didn't [you/(SP)] get a flu shot last winter?
[PROBE: Any other reason?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
3:57:03 PM Monday, August 03, 2009
Page 88 of 760
HFF17
3:57:10 PM Monday, August 03, 2009
Page 89 of 760
HFF17
FLUCODE
Field1:
( HFQ1560 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.FLUNEED
2=HEST.FLUCAUSE
3=HEST.FLUSIDE
4=HEST.FLUPRVNT
5=HEST.FLURISK
6=HEST.FLUDOCNO
7=HEST.FLUAGNST
8=HEST.FLUREACT
9=HEST.FLULOCAT
10=HEST.FLUMISS
11=HEST.FLUCOST
12=HEST.FLUBEFOR
13=HEST.FLUVACC
91=HEST.FLUOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THFF17CATA
14
No
No
Number Label
1 NotNeeded
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFF4 - (HFQ1590 )
2
English text: DIDN’T KNOW IT WAS NEEDED
ShotCauseFlu
BOX HFF4 - (HFQ1590 )
3
English text: SHOT COULD CAUSE FLU
SideEffects
4
English text: SHOT COULD HAVE SIDE EFFECTS OR CAUSE DISEASE
DidNotThinkPreventFlu
BOX HFF4 - (HFQ1590 )
5
6
BOX HFF4 - (HFQ1590 )
English text: DIDN’T THINK IT WOULD PREVENT THE FLU/COULD GET THE FLU
ANYWAY
FluNotSerious
BOX HFF4 - (HFQ1590 )
English text: FLU NOT SERIOUS/WOULD NOT GET FLU ANYWAY/NOT AT RISK
DrNotRecommended
BOX HFF4 - (HFQ1590 )
English text: DOCTOR DID NOT RECOMMEND THE SHOT
3:57:20 PM Monday, August 03, 2009
Page 90 of 760
HFF17
7
8
9
AllergicToShot
BOX HFF4 - (HFQ1590 )
English text: DOCTOR RECOMMENDED AGAINST GETTING SHOT/ALLERGIC TO
SHOT/MEDICAL REASONS
DontLikeShots
BOX HFF4 - (HFQ1590 )
English text: DON’T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT SORENESS OR
RASH/LOCAL REACTIONS
Inconvenient
BOX HFF4 - (HFQ1590 )
10
English text: INCONVENIENT TO GET SHOT/UNABLE TO GET TO LOCATION
Forgot
BOX HFF4 - (HFQ1590 )
11
English text: DIDN’T THINK ABOUT IT/FORGOT/MISSED IT
CostOfShot
BOX HFF4 - (HFQ1590 )
12
English text: COST OF SHOT/NOT WORTH THE MONEY
HadShotBefore
BOX HFF4 - (HFQ1590 )
13
English text: HAD SHOT BEFORE/DIDN’T NEED IT AGAIN
VaccineUnavailable
BOX HFF4 - (HFQ1590 )
91
English text: VACCINE UNAVAILABLE/VACCINE SHORTAGE
Other
HFF17 - FLUOTHOS ( HFQ1580 )
English text: OTHER
Attribute
Don't know
Route
BOX HFF4 - (HFQ1590 )
Refusal
BOX HFF4 - (HFQ1590 )
Field2:
FLUOTHOS
( HFQ1580 )
HEST.FLUOTHOS
Cheshire Name:
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.]
3:57:27 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFF4 - (HFQ1590 )
Page 91 of 760
HFF17
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:57:27 PM Monday, August 03, 2009
Page 92 of 760
BOX HFF4
BOX HFF4
Page Order # :
500
BOX INSTRUCTIONS
( HFQ1590 )
IF RESPONSE TO HFF17 – FLUCODE DOES NOT INCLUDE
13/VaccineUnavailable, GO TO HFF21 - NOVACINE ( HFQ1640 ).
ELSE GO TO BOX HFF5 - (HFQ1650 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:57:27 PM Monday, August 03, 2009
Page 93 of 760
HFF18
HFF18
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
FLUSITE
Field 2:
FLUSITOS
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
510
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "IF CLINIC ASK:" and "IF SOME OTHER PLACE, ASK:" in
same blue font used for interviewer instructions.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Where did [you/(SP)] go for (your/his/her) most recent flu shot, was
that a managed care plan center or HMO, a clinic, a doctor’s office, a
hospital, a health fair, shopping mall, or some other place?
[IF CLINIC, ASK: Was it a hospital outpatient clinic, or some other
kind of clinic? IF SOME OTHER PLACE, ASK: Where was this?]
Int. Instr II:
3:57:32 PM Monday, August 03, 2009
Page 94 of 760
HFF18
INPUT FIELDS / ROUTING
3:57:41 PM Monday, August 03, 2009
Page 95 of 760
HFF18
FLUSITE
Field1:
HEST.FLUSITE
Cheshire Name:
Item Text display:
( HFQ1600 )
Do not display response options 28/HealthDepartment and
29/PlaceofWork.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TFlusite
1
No
No
Number Label
1 DrsOfficeOrGroupPractice
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFF20 - VACSUPLY ( HFQ1630 )
2
English text: DOCTORS OFFICE OR GROUP PRACTICE
DoctorsClinic
HFF20 - VACSUPLY ( HFQ1630 )
3
English text: MEDICAL CLINIC
ManagedCarePlanCenter
4
English text: MANAGED CARE PLAN CENTER/HMO
NeighborhoodHealthCenter
HFF20 - VACSUPLY ( HFQ1630 )
5
English text: NEIGHBORHOOD/FAMILY HEALTH CENTER
FreestandingSurgicalCenter
HFF20 - VACSUPLY ( HFQ1630 )
6
English text: FREESTANDING SURGICAL CENTER
RuralHealthClinic
HFF20 - VACSUPLY ( HFQ1630 )
7
English text: RURAL HEALTH CLINIC
CompanyClinic
8
9
10
11
12
English text: COMPANY CLINIC
OtherClinic
English text: OTHER CLINIC
WalkInUrgentCenter
English text: WALK-IN URGENT CENTER
HospitalEmergencyRoom
HFF20 - VACSUPLY ( HFQ1630 )
HFF20 - VACSUPLY ( HFQ1630 )
HFF20 - VACSUPLY ( HFQ1630 )
HFF20 - VACSUPLY ( HFQ1630 )
HFF20 - VACSUPLY ( HFQ1630 )
English text: HOSPITAL EMERGENCY ROOM
HospitalOutpatientDept
HFF20 - VACSUPLY ( HFQ1630 )
English text: HOSPITAL OUTPATIENT DEPARTMENT/CLINIC
VaFacility
HFF20 - VACSUPLY ( HFQ1630 )
English text: VA FACILITY
3:57:56 PM Monday, August 03, 2009
Page 96 of 760
HFF18
13
HealthFair
HFF20 - VACSUPLY ( HFQ1630 )
14
English text: HEALTH FAIR
ShoppingMall
HFF20 - VACSUPLY ( HFQ1630 )
15
English text: SHOPPING MALL/OTHER STORE
SeniorCenter
HFF20 - VACSUPLY ( HFQ1630 )
16
English text: SENIOR CENTER
SpsHome
HFF20 - VACSUPLY ( HFQ1630 )
17
English text: AT HOME
Churchschool
HFF20 - VACSUPLY ( HFQ1630 )
18
English text: CHURCH/SCHOOL
Library1
HFF20 - VACSUPLY ( HFQ1630 )
28
English text: LIBRARY
HealthDepatment
29
English text: HEALTH DEPATMENT
PlaceOfWork
DATA EDITING ONLY. DO NOT DISPLAY.
DATA EDITING ONLY. DO NOT DISPLAY.
91
English text: PLACE OF WORK
Other
HFF18 - FLUSITOS ( HFQ1605 )
English text: OTHER
Attribute
Don't know
Route
HFF20 - VACSUPLY ( HFQ1630 )
Refusal
HFF20 - VACSUPLY ( HFQ1630 )
3:58:03 PM Monday, August 03, 2009
Page 97 of 760
HFF18
Field2:
FLUSITOS
( HFQ1605 )
HEST.FLUSITOS
Cheshire Name:
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
HFF20 - VACSUPLY ( HFQ1630 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:58:04 PM Monday, August 03, 2009
Page 98 of 760
HFF20
HFF20
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
VACSUPLY
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
530
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 any trouble getting a flu shot when (you/he/she)
wanted to because the vaccine was in short supply or unavailable?
Int. Instr II:
INPUT FIELDS / ROUTING
3:58:05 PM Monday, August 03, 2009
Page 99 of 760
HFF20
VACSUPLY
Field1:
( HFQ1630 )
HEST.VACSUPLY
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFF5 - (HFQ1650 )
English text: YES
No
BOX HFF5 - (HFQ1650 )
English text: NO
Attribute
Don't know
Route
BOX HFF5 - (HFQ1650 )
Refusal
BOX HFF5 - (HFQ1650 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:58:08 PM Monday, August 03, 2009
Page 100 of 760
HFF21
HFF21
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
NOVACINE
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
540
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 one reason that [you/(SP)] did not get a flu shot last winter
because the vaccine was in short supply or unavailable?
Int. Instr II:
INPUT FIELDS / ROUTING
3:58:09 PM Monday, August 03, 2009
Page 101 of 760
HFF21
NOVACINE
Field1:
( HFQ1640 )
HEST.NOVACINE
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFF5 - (HFQ1650 )
English text: YES
No
BOX HFF5 - (HFQ1650 )
English text: NO
Attribute
Don't know
Route
BOX HFF5 - (HFQ1650 )
Refusal
BOX HFF5 - (HFQ1650 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:58:11 PM Monday, August 03, 2009
Page 102 of 760
BOX HFF5
BOX HFF5
550
Page Order # :
BOX INSTRUCTIONS
( HFQ1650 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFF22 - PNEUSHOT (
HFQ1660 ).
ELSE IF SP HAS EVER REPORTED HAVING A PNEUMONIA SHOT IN A
PREVIOUS ROUND, GO TO BOX HFG1 - (HFQ1710 ).
ELSE GO TO HFF22 - PNEUSHOT ( HFQ1660 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
388
HFPneumoniaShot
SP has ever reported having a pneumonia shot in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.PNEUSHOT = 1/Yes.
DESIGN NOTES
3:58:11 PM Monday, August 03, 2009
Page 103 of 760
HFF22
HFF22
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PNEUSHOT
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
560
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 had a shot for pneumonia?
Int. Instr II:
INPUT FIELDS / ROUTING
3:58:13 PM Monday, August 03, 2009
Page 104 of 760
HFF22
PNEUSHOT
Field1:
( HFQ1660 )
HEST.PNEUSHOT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFG1 - (HFQ1710 )
English text: YES
No
BOX HFF5B - (HFQ1665 )
English text: NO
Attribute
Don't know
Route
BOX HFG1 - (HFQ1710 )
Refusal
BOX HFG1 - (HFQ1710 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:58:15 PM Monday, August 03, 2009
Page 105 of 760
BOX HFF5B
BOX HFF5B
Page Order # :
565
BOX INSTRUCTIONS
( HFQ1665 )
IF THIS IS ROUND 55 AND SP IS NOT IN THE SUPPLEMENTAL SAMPLE
GO TO BOX HFG1 - (HFQ1710 ).
ELSE GO TO HFF23 - PNUCODE ( HFQ1680 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
3:58:15 PM Monday, August 03, 2009
Page 106 of 760
HFF23
HFF23
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
PNUCODE
Field 2:
PNUOTHOS
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:
570
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:
Why didn't [you/(SP)] ever have a shot for pneumonia?
[PROBE: Any other reason?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
3:58:18 PM Monday, August 03, 2009
Page 107 of 760
HFF23
3:58:25 PM Monday, August 03, 2009
Page 108 of 760
HFF23
PNUCODE
Field1:
( HFQ1680 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.PNUNEED
2=HEST.PNUCAUSE
3=HEST.PNUSIDE
4=HEST.PNUPRVNT
5=HEST.PNURISK
6=HEST.PNUDOCNO
7=HEST.PNUAGNST
8=HEST.PNUREACT
9=HEST.PNULOCAT
10=HEST.PNUMISS
11=HEST.PNUCOST
91=HEST.PNUOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THFF23CATA
12
No
No
Number Label
1 NotNeeded
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFG1 - (HFQ1710 )
2
English text: DIDN'T KNOW IT WAS NEEDED
CouldCausePneumonia
BOX HFG1 - (HFQ1710 )
3
English text: SHOT COULD CAUSE PNEUMONIA
SideEffects
BOX HFG1 - (HFQ1710 )
4
English text: SHOT COULD HAVE SIDE EFFECTS OR CAUSE DISEASE
DidNotThinkPreventPneumonia
BOX HFG1 - (HFQ1710 )
5
English text: DIDN'T THINK IT WOULD PREVENT PNEUMONIA/COULD GET PNEUMONIA
ANYWAY
NotAtRisk
BOX HFG1 - (HFQ1710 )
6
English text: PNEUMONIA NOT SERIOUS/WOULD NOT GET PNEUMONIA ANYWAY/NOT
AT RISK
DrNotRecommended
BOX HFG1 - (HFQ1710 )
English text: DOCTOR DID NOT RECOMMEND THE SHOT
3:58:34 PM Monday, August 03, 2009
Page 109 of 760
HFF23
7
8
9
AllergicToShot
BOX HFG1 - (HFQ1710 )
English text: DOCTOR RECOMMENDED AGAINST GETTING SHOT/ALLERGIC TO
SHOT/MEDICAL REASONS
DontLikeShots
BOX HFG1 - (HFQ1710 )
English text: DON'T LIKE SHOTS OR NEEDLES/CONCERNS ABOUT SORENESS OR
RASH/LOCAL REACTIONS
Inconvenient
BOX HFG1 - (HFQ1710 )
10
English text: INCONVENIENT TO GET SHOT/UNABLE TO GET TO LOCATION
Forgot
BOX HFG1 - (HFQ1710 )
11
English text: DIDN'T THINK ABOUT IT/FORGOT/MISSED IT
CostOfShot
BOX HFG1 - (HFQ1710 )
91
English text: COST OF SHOT/NOT WORTH THE MONEY
Other
HFF23 - PNUOTHOS ( HFQ1700 )
English text: OTHER
Attribute
Don't know
Route
BOX HFG1 - (HFQ1710 )
Refusal
BOX HFG1 - (HFQ1710 )
Field2:
Cheshire Name:
PNUOTHOS
( HFQ1700 )
HEST.FLUOTHOS
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 HFG1 - (HFQ1710 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
3:58:39 PM Monday, August 03, 2009
Page 110 of 760
HFF23
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:58:39 PM Monday, August 03, 2009
Page 111 of 760
BOX HFG1
BOX HFG1
580
Page Order # :
BOX INSTRUCTIONS
( HFQ1710 )
IF SP WAS ASKED IF HE/SHE NOW SMOKES CIGARETTES, CIGARS, OR
PIPE TOBACCO IN A PREVIOUS ROUND, GO TO HFG2 - SMOKNOW (
HFQ1740 ).
ELSE GO TO HFG1 - EVERSMOK ( HFQ1720 ).
ASSIGNMENTS
TECHNICAL NOTES
419
HFNowSmokesPrev
SP was asked if he/she now smokes cigarettes, cigars,
or pipe tobacco in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.SMOKNOW ^= empty.
DESIGN NOTES
3:58:39 PM Monday, August 03, 2009
Page 112 of 760
HFG1
HFG1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EVERSMOK
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
590
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 smoked cigarettes, cigars, or pipe
tobacco?
Int. Instr II:
INPUT FIELDS / ROUTING
3:58:41 PM Monday, August 03, 2009
Page 113 of 760
HFG1
EVERSMOK
Field1:
( HFQ1720 )
HEST.EVERSMOK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG2 - SMOKNOW ( HFQ1740 )
English text: YES
No
HFG7 - DRINKDAY ( HFQ1795 )
English text: NO
Attribute
Don't know
Route
HFG7 - DRINKDAY ( HFQ1795 )
Refusal
HFG7 - DRINKDAY ( HFQ1795 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:58:43 PM Monday, August 03, 2009
Page 114 of 760
HFG2
HFG2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
SMOKNOW
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
600
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:
[Do you/Does (SP)] smoke cigarettes, cigars, or pipe tobacco now?
Int. Instr II:
INPUT FIELDS / ROUTING
3:58:44 PM Monday, August 03, 2009
Page 115 of 760
HFG2
SMOKNOW
Field1:
HEST.SMOKNOW
Cheshire Name:
Item Text display:
( HFQ1740 )
Do not display response option 3/NoButOriginalllyYes.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TOchbp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG5 - HAVSMOKE ( HFQ1775 )
2
English text: YES
No
3
English text: NO
NoButOriginallyYes
HFG3 - DIDSMOKE ( HFQ1755 )
DO NOT DISPLAY.
DATA EDITING ONLY.
English text: NO, BUT ORIGINALLY YES
Attribute
Don't know
Route
HFG7 - DRINKDAY ( HFQ1795 )
Refusal
HFG7 - DRINKDAY ( HFQ1795 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:58:47 PM Monday, August 03, 2009
Page 116 of 760
HFG3
HFG3
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
DIDSMOKE
Field 2:
DIDSMOKE_LESSONE
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
640
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 many years did [you/(SP)] smoke?
Int. Instr II:
INPUT FIELDS / ROUTING
3:58:49 PM Monday, August 03, 2009
Page 117 of 760
HFG3
DIDSMOKE
Field1:
( HFQ1755 )
HEST.DIDSMOKE
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF YEARS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDidsmok
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )
Attribute
Empty
Route
HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )
Don't know
HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )
Refusal
HFG3 - DIDSMOKE_LESSONE ( HFQ1758 )
3:58:53 PM Monday, August 03, 2009
1
96
Page 118 of 760
HFG3
DIDSMOKE_LESSONE ( HFQ1758 )
Field2:
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELD=
If HEST.DIDSMOKE_LESSONE = 1/LessThanOneYear, set
HEST.DIDSMOKE = 96.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TDidSmok96
1
No
No
Number Label
1 LessThanOneYear
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG4 - LASTSMOK ( HFQ1765 )
English text: LESS THAN ONE YEAR
Attribute
Empty
Route
HFG4 - LASTSMOK ( HFQ1765 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1
If DIDSMOKE ^= EMPTY then DIDSMOKE = 1-75, DK, RF.
If not true, display message "UNLIKELY NUMBER OF YEARS.
PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1
If DIDSMOKE ^= EMPTY then DIDSMOKE = 1-95, DK, RF.
If not true, display message "NUMBER OF YEARS MUST BE
BETWEEN 1 AND 95 OR LESS THAN ONE YEAR. PLEASE
REENTER."
Edit #2
DIDSMOKE and DIDSMOKE_LESSONE cannot both be EMPTY.
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
3:58:56 PM Monday, August 03, 2009
Page 119 of 760
HFG3
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
Edit #3
DIDSMOKE and DIDSMOKE_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES
DESIGN NOTES
3:58:56 PM Monday, August 03, 2009
Page 120 of 760
HFG4
HFG4
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
LASTSMOK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
650
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:
About how long has it been since [you/(SP)] last smoked regularly?
Int. Instr II:
INPUT FIELDS / ROUTING
3:58:58 PM Monday, August 03, 2009
Page 121 of 760
HFG4
LASTSMOK
Field1:
( HFQ1765 )
HEST.LASTSMOKE
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
TLastsmo
1
No
No
Number Label
1 WithTheLastMonth
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG7 - DRINKDAY ( HFQ1795 )
2
English text: WITHIN THE LAST MONTH
OneMonthToLessThan6MonthsAgo
3
English text: 1 MONTH TO LESS THAN 6 MONTHS AGO
SixMonthsToLessThan1YearAgo
HFG7 - DRINKDAY ( HFQ1795 )
4
English text: 6 MONTHS TO LESS THAN 1 YEAR AGO
OneYearToLessThan5YearsAgo
HFG7 - DRINKDAY ( HFQ1795 )
5
English text: 1 YEAR TO LESS THAN 5 YEARS AGO
FiveYearsToLessThan10YearsAgo
HFG7 - DRINKDAY ( HFQ1795 )
6
English text: 5 YEARS TO LESS THAN 10 YEARS AGO
TenOrMoreYearsAgo
HFG7 - DRINKDAY ( HFQ1795 )
HFG7 - DRINKDAY ( HFQ1795 )
English text: 10 OR MORE YEARS AGO
Attribute
Don't know
Route
HFG7 - DRINKDAY ( HFQ1795 )
Refusal
HFG7 - DRINKDAY ( HFQ1795 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
3:59:04 PM Monday, August 03, 2009
Page 122 of 760
HFG4
TECHNICAL NOTES
DESIGN NOTES
3:59:04 PM Monday, August 03, 2009
Page 123 of 760
HFG5
HFG5
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
HAVSMOKE
Field 2:
HAVSMOKE_LESSON
E
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
660
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 many years [have you/has (SP)] smoked?
Int. Instr II:
INPUT FIELDS / ROUTING
3:59:06 PM Monday, August 03, 2009
Page 124 of 760
HFG5
HAVSMOKE
Field1:
( HFQ1775 )
HEST.HAVSMOKE
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF YEARS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDidsmok
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )
Attribute
Empty
Route
HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )
Don't know
HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )
Refusal
HFG5 - HAVSMOKE_LESSONE ( HFQ1778 )
3:59:10 PM Monday, August 03, 2009
1
96
Page 125 of 760
HFG5
HAVSMOKE_LESSON ( HFQ1778 )
E
Field2:
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELD=
If HEST.HAVSMOKE_LESSONE = 1/LessThanOneYear, set
HEST.HAVSMOKE = 96.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TDidSmok96
1
No
No
Number Label
1 LessThanOneYear
English text: LESS THAN ONE YEAR
Attribute
Empty
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG5A - DRQTSMOK ( HFQ1784 )
Route
HFG5A - DRQTSMOK ( HFQ1784 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1
If HAVSMOKE ^= EMPTY then HAVSMOKE = 1-75, DK, RF.
If not true, display message "UNLIKELY NUMBER OF YEARS.
PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1
If HAVSMOKE ^= EMPTY then HAVSMOKE = 1-95, DK, RF.
If not true, display message "NUMBER OF YEARS MUST BE
BETWEEN 1 AND 95 OR LESS THAN ONE YEAR, PLEASE
REENTER."
Edit #2
HAVSMOKE and HAVSMOKE_LESSONE cannot both be EMPTY.
3:59:12 PM Monday, August 03, 2009
Page 126 of 760
HFG5
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
Edit #3
HAVSMOKE and HAVSMOKE_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES
DESIGN NOTES
3:59:12 PM Monday, August 03, 2009
Page 127 of 760
HFG5A
HFG5A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DRQTSMOK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
665
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 (LAST HF MONTH YEAR), has a doctor or other health
professional advised [you/(SP)] to quit smoking?
Int. Instr II:
INPUT FIELDS / ROUTING
3:59:14 PM Monday, August 03, 2009
Page 128 of 760
HFG5A
DRQTSMOK
Field1:
( HFQ1784 )
HEST.DRQTSMOK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG6 - QUITSMOK ( HFQ1789 )
English text: YES
No
HFG6 - QUITSMOK ( HFQ1789 )
English text: NO
Attribute
Don't know
Route
HFG6 - QUITSMOK ( HFQ1789 )
Refusal
HFG6 - QUITSMOK ( HFQ1789 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:59:16 PM Monday, August 03, 2009
Page 129 of 760
HFG6
HFG6
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
QUITSMOK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
670
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:
During the past 12 months, [have you/has (SP)] stopped smoking for
one day or longer because (you were/he was/she was) trying to quit
smoking?
Int. Instr II:
INPUT FIELDS / ROUTING
3:59:17 PM Monday, August 03, 2009
Page 130 of 760
HFG6
QUITSMOK
Field1:
( HFQ1789 )
HEST.QUITSMOK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG7 - DRINKDAY ( HFQ1795 )
English text: YES
No
HFG7 - DRINKDAY ( HFQ1795 )
English text: NO
Attribute
Don't know
Route
HFG7 - DRINKDAY ( HFQ1795 )
Refusal
HFG7 - DRINKDAY ( HFQ1795 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:59:20 PM Monday, August 03, 2009
Page 131 of 760
HFG7
HFG7
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
DRINKDAY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
690
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 drinking alcoholic beverages. Included
are liquor such as whiskey or gin, mixed drinks, wine, beer, and any
other type of alcoholic beverage.
Please think about a typical month in the past year. On how many
days did [you/(SP)] drink any type of alcoholic beverage?
Int. Instr II:
ENTER "0" FOR "NEVER DRANK" OR "NONE".
INPUT FIELDS / ROUTING
3:59:21 PM Monday, August 03, 2009
Page 132 of 760
HFG7
DRINKDAY
Field1:
( HFQ1795 )
HEST.DRINKDAY
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF DAYS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDrinkda
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
BOX HFG2 - (HFQ1805 )
Refusal
BOX HFG2 - (HFQ1805 )
FieldSize:
Min Value:
Max Value:
Mask:
0
31
Route
BOX HFG2 - (HFQ1805 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:59:22 PM Monday, August 03, 2009
Page 133 of 760
BOX HFG2
BOX HFG2
Page Order # :
700
BOX INSTRUCTIONS
( HFQ1805 )
IF HFG7 - DRINKDAY = 0, GO TO HFHINTRO - DIFINTRO ( HFQ1870 ).
ELSE GO TO HFG8 - DRINKSPD ( HFQ1815 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
3:59:22 PM Monday, August 03, 2009
Page 134 of 760
HFG8
HFG8
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
DRINKSPD
Field 2:
DRINKSPD_LESSONE
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
710
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Please…]" in brackets.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Please think about a typical month in the past year.] On those days
that [you/(SP)] drank alcohol, how many drinks did (you/he/she)
have?
Int. Instr II:
INPUT FIELDS / ROUTING
3:59:25 PM Monday, August 03, 2009
Page 135 of 760
HFG8
DRINKSPD
Field1:
( HFQ1815 )
HEST.DRINKSPD
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF DRINKS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
Tdrinksp
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG8 - DRINKSPD_LESSONE ( HFQ1818 )
Attribute
Empty
Route
HFG8 - DRINKSPD_LESSONE ( HFQ1818 )
Don't know
HFG8 - DRINKSPD_LESSONE ( HFQ1818 )
Refusal
HFG8 - DRINKSPD_LESSONE ( HFQ1818 )
3:59:29 PM Monday, August 03, 2009
1
96
Page 136 of 760
HFG8
DRINKSPD_LESSONE ( HFQ1818 )
Field2:
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELD=
If HEST.DRINKSPD_LESSONE =
1/LessThanOneAlcoholDrinkPerDay, set HEST.DRINKSPD =
96.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TDrinksp96
1
No
No
Number Label
1 LessThanOne
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFG9 - FOURDRNK ( HFQ1825 )
English text: LESS THAN ONE
Attribute
Empty
Route
HFG9 - FOURDRNK ( HFQ1825 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1
If DRINKSPD ^= EMPTY then DRINKSPD = 1-12, DK, RF.
If not true, display message "UNLIKELY NUMBER OF DRINKS.
PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1
If DRINKSPD ^= EMPTY then DRINKSPD = 1-50, DK, RF.
If not true, display message "NUMBER OF DRINKS MUST BE
BETWEEN 1 AND 50 OR LESS THAN ONE. PLEASE REENTER."
Edit #2
DRINKSPD and DRINKSPD_LESSONE cannot both be EMPTY.
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
3:59:31 PM Monday, August 03, 2009
Page 137 of 760
HFG8
NUMBER OF DRINKS OR SELECT "LESS THAN ONE"."
Edit #3
DRINKSPD and DRINKSPD_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF DRINKS OR SELECT "LESS THAN ONE"."
TECHNICAL NOTES
DESIGN NOTES
3:59:31 PM Monday, August 03, 2009
Page 138 of 760
HFG9
HFG9
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
FOURDRNK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
720
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Please…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Please think about a typical month in the past year.] On how many
days did [you/(SP)] have 4 or more drinks in a single day?
Int. Instr II:
ENTER "0" FOR "NEVER" OR "NONE".
INPUT FIELDS / ROUTING
3:59:32 PM Monday, August 03, 2009
Page 139 of 760
HFG9
FOURDRNK
Field1:
( HFQ1825 )
HEST.FOURDRNK
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF DAYS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDrinkda
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HFHINTRO - DIFINTRO ( HFQ1870 )
Refusal
HFHINTRO - DIFINTRO ( HFQ1870 )
FieldSize:
Min Value:
Max Value:
Mask:
0
31
Route
HFHINTRO - DIFINTRO ( HFQ1870 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:59:34 PM Monday, August 03, 2009
Page 140 of 760
HFHINTRO
HFHINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
DIFINTRO
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
730
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:
Now, I'm going to ask about how difficult it is, on the average, for
[you/(SP)] to do certain kinds of activities. Please tell me for each
activity whether [you have/(SP) has] no difficulty at all, a little
difficulty, some difficulty, a lot of difficulty, or (is/are) not able to do it.
Int. Instr II:
INPUT FIELDS / ROUTING
3:59:35 PM Monday, August 03, 2009
Page 141 of 760
HFHINTRO
DIFINTRO
Field1:
( HFQ1870 )
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
HFH1 - DIFSTOOP ( HFQ1880 )
English text: CONTINUE
Attribute
Empty
Route
HFH1 - DIFSTOOP ( HFQ1880 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
3:59:37 PM Monday, August 03, 2009
Page 142 of 760
HFH1
HFH1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DIFSTOOP
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
740
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:
SHOW CARD HF1
Question Text:
How much difficulty, if any, [do you/does (SP)] have stooping,
crouching, or kneeling? Would you say [you have/(SP) has] no
difficulty at all, a little difficulty, some difficulty, a lot of difficulty, or
(is/are) not able to do it?
Int. Instr II:
INPUT FIELDS / ROUTING
3:59:39 PM Monday, August 03, 2009
Page 143 of 760
HFH1
DIFSTOOP
Field1:
( HFQ1880 )
HEST.DIFSTOOP
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
TDiffcult
1
No
No
Number Label
1 NoDifficultyAtAll
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFH2 - DIFLIFT ( HFQ1890 )
2
English text: NO DIFFICULTY AT ALL
ALittleDifficulty
HFH2 - DIFLIFT ( HFQ1890 )
3
English text: A LITTLE DIFFICULTY
SomeDifficulty
HFH2 - DIFLIFT ( HFQ1890 )
4
English text: SOME DIFFICULTY
ALotOfDifficulty
HFH2 - DIFLIFT ( HFQ1890 )
5
English text: A LOT OF DIFFICULTY
NotAbleToDoIt
HFH2 - DIFLIFT ( HFQ1890 )
English text: NOT ABLE TO DO IT
Attribute
Don't know
Route
HFH2 - DIFLIFT ( HFQ1890 )
Refusal
HFH2 - DIFLIFT ( HFQ1890 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
3:59:44 PM Monday, August 03, 2009
Page 144 of 760
HFH1
DESIGN NOTES
3:59:44 PM Monday, August 03, 2009
Page 145 of 760
HFH2
HFH2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DIFLIFT
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
750
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:
SHOW CARD HF1
Question Text:
How much difficulty, if any, [do you/does (SP)] have lifting or carrying
objects as heavy as 10 pounds, like a sack of potatoes? Would you
say [you have/(SP) has] no difficulty at all, a little difficulty, some
difficulty, a lot of difficulty, or (is/are) not able to do it?
Int. Instr II:
INPUT FIELDS / ROUTING
3:59:46 PM Monday, August 03, 2009
Page 146 of 760
HFH2
DIFLIFT
Field1:
( HFQ1890 )
HEST.DIFLIFT
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
TDiffcult
1
No
No
Number Label
1 NoDifficultyAtAll
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFH3 - DIFREACH ( HFQ1900 )
2
English text: NO DIFFICULTY AT ALL
ALittleDifficulty
HFH3 - DIFREACH ( HFQ1900 )
3
English text: A LITTLE DIFFICULTY
SomeDifficulty
HFH3 - DIFREACH ( HFQ1900 )
4
English text: SOME DIFFICULTY
ALotOfDifficulty
HFH3 - DIFREACH ( HFQ1900 )
5
English text: A LOT OF DIFFICULTY
NotAbleToDoIt
HFH3 - DIFREACH ( HFQ1900 )
English text: NOT ABLE TO DO IT
Attribute
Don't know
Route
HFH3 - DIFREACH ( HFQ1900 )
Refusal
HFH3 - DIFREACH ( HFQ1900 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
3:59:50 PM Monday, August 03, 2009
Page 147 of 760
HFH2
DESIGN NOTES
3:59:50 PM Monday, August 03, 2009
Page 148 of 760
HFH3
HFH3
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DIFREACH
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
760
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:
SHOW CARD HF1
Question Text:
What about reaching or extending arms above shoulder level?
Int. Instr II:
INPUT FIELDS / ROUTING
3:59:52 PM Monday, August 03, 2009
Page 149 of 760
HFH3
DIFREACH
Field1:
( HFQ1900 )
HEST.DIFREACH
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
TDiffcult
1
No
No
Number Label
1 NoDifficultyAtAll
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFH4 - DIFWRITE ( HFQ1910 )
2
English text: NO DIFFICULTY AT ALL
ALittleDifficulty
HFH4 - DIFWRITE ( HFQ1910 )
3
English text: A LITTLE DIFFICULTY
SomeDifficulty
HFH4 - DIFWRITE ( HFQ1910 )
4
English text: SOME DIFFICULTY
ALotOfDifficulty
HFH4 - DIFWRITE ( HFQ1910 )
5
English text: A LOT OF DIFFICULTY
NotAbleToDoIt
HFH4 - DIFWRITE ( HFQ1910 )
English text: NOT ABLE TO DO IT
Attribute
Don't know
Route
HFH4 - DIFWRITE ( HFQ1910 )
Refusal
HFH4 - DIFWRITE ( HFQ1910 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
3:59:57 PM Monday, August 03, 2009
Page 150 of 760
HFH3
DESIGN NOTES
3:59:57 PM Monday, August 03, 2009
Page 151 of 760
HFH4
HFH4
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DIFWRITE
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
770
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:
SHOW CARD HF1
Question Text:
How much difficulty, if any, [do you/does (SP)] have either writing or
handling and grasping small objects? Would you say [you
have/(SP) has] no difficulty at all, a little difficulty, some difficulty, a
lot of difficulty, or (is/are) not able to do it?
Int. Instr II:
INPUT FIELDS / ROUTING
3:59:59 PM Monday, August 03, 2009
Page 152 of 760
HFH4
DIFWRITE
Field1:
( HFQ1910 )
HEST.DIFWRITE
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
TDiffcult
1
No
No
Number Label
1 NoDifficultyAtAll
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFH5 - DIFWALK ( HFQ1920 )
2
English text: NO DIFFICULTY AT ALL
ALittleDifficulty
HFH5 - DIFWALK ( HFQ1920 )
3
English text: A LITTLE DIFFICULTY
SomeDifficulty
HFH5 - DIFWALK ( HFQ1920 )
4
English text: SOME DIFFICULTY
ALotOfDifficulty
HFH5 - DIFWALK ( HFQ1920 )
5
English text: A LOT OF DIFFICULTY
NotAbleToDoIt
HFH5 - DIFWALK ( HFQ1920 )
English text: NOT ABLE TO DO IT
Attribute
Don't know
Route
HFH5 - DIFWALK ( HFQ1920 )
Refusal
HFH5 - DIFWALK ( HFQ1920 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:00:03 PM Monday, August 03, 2009
Page 153 of 760
HFH4
DESIGN NOTES
4:00:03 PM Monday, August 03, 2009
Page 154 of 760
HFH5
HFH5
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DIFWALK
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
780
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:
SHOW CARD HF1
Question Text:
What about walking a quarter of a mile - that is, about 2 or 3 blocks?
Int. Instr II:
INPUT FIELDS / ROUTING
4:00:05 PM Monday, August 03, 2009
Page 155 of 760
HFH5
DIFWALK
Field1:
( HFQ1920 )
HEST.DIFWALK
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
TDiffcult
1
No
No
Number Label
1 NoDifficultyAtAll
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFH10INT - PHYSACTINTRO ( HFQ1935 )
2
English text: NO DIFFICULTY AT ALL
ALittleDifficulty
HFH10INT - PHYSACTINTRO ( HFQ1935 )
3
English text: A LITTLE DIFFICULTY
SomeDifficulty
HFH10INT - PHYSACTINTRO ( HFQ1935 )
4
English text: SOME DIFFICULTY
ALotOfDifficulty
HFH10INT - PHYSACTINTRO ( HFQ1935 )
5
English text: A LOT OF DIFFICULTY
NotAbleToDoIt
HFH10INT - PHYSACTINTRO ( HFQ1935 )
English text: NOT ABLE TO DO IT
Attribute
Don't know
Route
HFH10INT - PHYSACTINTRO ( HFQ1935 )
Refusal
HFH10INT - PHYSACTINTRO ( HFQ1935 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:00:10 PM Monday, August 03, 2009
Page 156 of 760
HFH5
DESIGN NOTES
4:00:10 PM Monday, August 03, 2009
Page 157 of 760
HFH10INT
HFH10INT
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
PHYSACTINTRO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
850
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:
We are interested in two types of physical activity - vigorous and
moderate. Vigorous activities cause large increases in breathing or
heart rate. Moderate activities cause small increases in breathing or
heart rate. First I will ask about the vigorous activities that [you
do/(SP) does].
Int. Instr II:
INPUT FIELDS / ROUTING
4:00:11 PM Monday, August 03, 2009
Page 158 of 760
HFH10INT
PHYSACTINTRO
Field1:
( HFQ1935 )
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
HFH10 - VIGUNIT ( HFQ1945 )
English text: CONTINUE
Attribute
Empty
Route
HFH10 - VIGUNIT ( HFQ1945 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:00:13 PM Monday, August 03, 2009
Page 159 of 760
HFH10
HFH10
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
VIGUNIT
Field 2:
VIGNUM
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
860
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If respondent is SP, display "you do".
Else display "(SP) does".
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
In a typical week, how much time [do you/does (SP)] spend doing
vigorous activities, such as team sports, running, aerobics, heavy
house or yard work, or anything else that causes large increases in
breathing or heart rate?
Int. Instr II:
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO
NEAREST HOUR.
4:00:15 PM Monday, August 03, 2009
Page 160 of 760
HFH10
INPUT FIELDS / ROUTING
VIGUNIT
Field1:
HEST.VIGUNIT
Cheshire Name:
Item Text display:
( HFQ1945 )
Display response options in the following order: 96, 1, 2, 3,
4.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TVigunit
1
No
No
Number Label
1 NumberOfMinutesPerDay
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFH10 - VIGNUM ( HFQ1955 )
3
English text: NUMBER OF MINUTES PER DAY
NumberOfHoursPerDay
HFH10 - VIGNUM ( HFQ1955 )
English text: NUMBER OF HOURS PER DAY
NumberOfHoursPerWeek
HFH10 - VIGNUM ( HFQ1955 )
4
English text: NUMBER OF HOURS PER WEEK
NumberOfHoursPerMonth
HFH10 - VIGNUM ( HFQ1955 )
2
96
English text: NUMBER OF HOURS PER MONTH
None
HFH11 - MODUNIT ( HFQ1965 )
English text: NONE
Attribute
Don't know
Route
HFH11 - MODUNIT ( HFQ1965 )
Refusal
HFH11 - MODUNIT ( HFQ1965 )
4:00:20 PM Monday, August 03, 2009
Page 161 of 760
HFH10
Field2:
VIGNUM
( HFQ1955 )
HEST.VIGNUM
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
Tvignum
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
3
1
999
Route
HFH11 - MODUNIT ( HFQ1965 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
If VIGUNIT = 1/NumberOfMinutesPerDay, then VIGNUM = 1-90.
Else if VIGUNIT = 2/NumberOfHoursPerDay, then VIGNUM = 1-5.
Else if VIGUNIT = 3/NumberOfHoursPerWeeK, VIGNUM = 1-35.
Else if VIGUNIT = 4/NumberOfHoursPerMonth, VIGNUM = 1-150.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1:
If VIGUNIT = 1/NumberOfMinutesPerDay, then VIGNUM = 1-120.
Else if VIGUNIT = 2/NumberOfHoursPerDay, then VIGNUM = 1-8.
Else if VIGUNIT = 3/NumberOfHoursPerWeeK, VIGNUM = 1-56.
Else if VIGUNIT = 4/NumberOfHoursPerMonth, VIGNUM = 1-224.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER IN NOT VALID. PLEASE REENTER."
TECHNICAL NOTES
DESIGN NOTES
4:00:21 PM Monday, August 03, 2009
Page 162 of 760
HFH11
HFH11
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
MODUNIT
Field 2:
MODNUM
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
870
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:
In a typical week, how much time [do you/does (SP)] spend doing
moderate activities, such as brisk walking, bicycling, gardening, golf,
swimming, or vacuuming?
Int. Instr II:
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO
NEAREST HOUR.
INPUT FIELDS / ROUTING
4:00:23 PM Monday, August 03, 2009
Page 163 of 760
HFH11
MODUNIT
Field1:
HEST.MODUNIT
Cheshire Name:
Item Text display:
( HFQ1965 )
Display response options in the following order: 96, 1, 2, 3,
4.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TVigunit
1
No
No
Number Label
1 NumberOfMinutesPerDay
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFH11 - MODNUM ( HFQ1975 )
2
English text: NUMBER OF MINUTES PER DAY
NumberOfHoursPerDay
HFH11 - MODNUM ( HFQ1975 )
3
English text: NUMBER OF HOURS PER DAY
NumberOfHoursPerWeek
HFH11 - MODNUM ( HFQ1975 )
4
English text: NUMBER OF HOURS PER WEEK
NumberOfHoursPerMonth
HFH11 - MODNUM ( HFQ1975 )
96
English text: NUMBER OF HOURS PER MONTH
None
HFH12 - MUSUNIT ( HFQ1985 )
English text: NONE
Attribute
Don't know
Route
HFH12 - MUSUNIT ( HFQ1985 )
Refusal
HFH12 - MUSUNIT ( HFQ1985 )
4:00:29 PM Monday, August 03, 2009
Page 164 of 760
HFH11
Field2:
MODNUM
( HFQ1975 )
HEST.MODNUM
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
Tvignum
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
3
1
999
Route
HFH12 - MUSUNIT ( HFQ1985 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
If MODUNIT = 1/NumberOfMinutesPerDay, then MODNUM = 1-90.
Else if MODUNIT = 2/NumberOfHoursPerDay, then MODNUM = 1
5.
Else if MODUNIT = 3/NumberOfHoursPerWeeK, MODNUM = 1-35.
Else if MODUNIT = 4/NumberOfHoursPerMonth, MODNUM = 1
150.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1:
If MODUNIT = 1/NumberOfMinutesPerDay, then MODNUM = 1-120.
Else if MODUNIT = 2/NumberOfHoursPerDay, then MODNUM = 1
8.
Else if MODUNIT = 3/NumberOfHoursPerWeeK, MODNUM = 1-56.
Else if MODUNIT = 4/NumberOfHoursPerMonth, MODNUM = 1
224.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER IN NOT VALID. PLEASE REENTER."
TECHNICAL NOTES
DESIGN NOTES
4:00:29 PM Monday, August 03, 2009
Page 165 of 760
HFH12
HFH12
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
MUSUNIT
Field 2:
MUSNUM
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
880
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:
Now I’m going to ask you about activities [you/(SP)] may do to
increase (your/his/her) muscle strength or flexibility.
In a typical week, how much time [do you/does (SP)] spend doing
exercises to increase (your/his/her) muscle strength or flexibility,
such as lifting weights, push-ups, sit-ups, stretching, or yoga?
Int. Instr II:
4:00:32 PM Monday, August 03, 2009
IF TIME REPORTED IN BOTH MINUTES AND HOURS, ROUND TO
NEAREST HOUR.
Page 166 of 760
HFH12
INPUT FIELDS / ROUTING
MUSUNIT
Field1:
HEST.MUSUNIT
Cheshire Name:
Item Text display:
( HFQ1985 )
Display response options in the following order: 96, 1, 2, 3,
4.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TVigunit
1
No
No
Number Label
1 NumberOfMinutesPerDay
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFH12 - MUSNUM ( HFQ1995 )
2
English text: NUMBER OF MINUTES PER DAY
NumberOfHoursPerDay
HFH12 - MUSNUM ( HFQ1995 )
3
English text: NUMBER OF HOURS PER DAY
NumberOfHoursPerWeek
HFH12 - MUSNUM ( HFQ1995 )
4
English text: NUMBER OF HOURS PER WEEK
NumberOfHoursPerMonth
HFH12 - MUSNUM ( HFQ1995 )
96
English text: NUMBER OF HOURS PER MONTH
None
HFJINTRO - MEDCONDINTRO ( HFQ2060 )
English text: NONE
Attribute
Don't know
Route
HFJINTRO - MEDCONDINTRO ( HFQ2060 )
Refusal
HFJINTRO - MEDCONDINTRO ( HFQ2060 )
4:00:37 PM Monday, August 03, 2009
Page 167 of 760
HFH12
Field2:
MUSNUM
( HFQ1995 )
HEST.MUSNUM
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
Tvignum
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
3
1
999
Route
HFJINTRO - MEDCONDINTRO ( HFQ2060 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
If MUSUNIT = 1/NumberOfMinutesPerDay, then MUSNUM = 1-90.
Else if MUSUNIT = 2/NumberOfHoursPerDay, then MUSNUM = 1-5.
Else if MUSUNIT = 3/NumberOfHoursPerWeeK, MUSNUM = 1-35.
Else if MUSUNIT = 4/NumberOfHoursPerMonth, MUSNUM = 1-150.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
Edit #1:
If MUSUNIT = 1/NumberOfMinutesPerDay, then MUSNUM = 1-120.
Else if MUSUNIT = 2/NumberOfHoursPerDay, then MUSNUM = 1-8.
Else if MUSUNIT = 3/NumberOfHoursPerWeeK, MUSNUM = 1-56.
Else if MUSUNIT = 4/NumberOfHoursPerMonth, MUSNUM = 1-224.
If not true, display message: "THE VALUE ENTERED FOR
NUMBER IN NOT VALID. PLEASE REENTER."
TECHNICAL NOTES
DESIGN NOTES
4:00:38 PM Monday, August 03, 2009
Page 168 of 760
HFJINTRO
HFJINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
MEDCONDINTRO
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
890
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Next, I'm going to read a list of medical conditions. [Since (LAST HF
MONTH YEAR) has/Has] a doctor (ever) told [you/(SP)] that
(you/he/she) had any of these conditions?
Int. Instr II:
INPUT FIELDS / ROUTING
4:00:39 PM Monday, August 03, 2009
Page 169 of 760
HFJINTRO
MEDCONDINTRO
Field1:
( HFQ2060 )
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
BOX HFJ1 - (HFQ2070 )
English text: CONTINUE
Attribute
Empty
Route
BOX HFJ1 - (HFQ2070 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:00:41 PM Monday, August 03, 2009
Page 170 of 760
BOX HFJ1
BOX HFJ1
Page Order # :
900
BOX INSTRUCTIONS
( HFQ2070 )
IF SP HAS EVER REPORTED HAVING HARDENING OF THE ARTERIES IN
A PREVIOUS ROUND, GO TO HFJ2 - OCHBP ( HFQ2110 ).
ELSE GO TO HFJ1 - OCARTERY ( HFQ2080 ).
ASSIGNMENTS
TECHNICAL NOTES
390
HFHardenArtery
SP has ever reported having hardening of the arteries in
a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCARTERY = 1/Yes.
DESIGN NOTES
4:00:41 PM Monday, August 03, 2009
Page 171 of 760
HFJ1
HFJ1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCARTERY
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
910
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...
hardening of the arteries or arteriosclerosis?
Int. Instr II:
INPUT FIELDS / ROUTING
4:00:42 PM Monday, August 03, 2009
Page 172 of 760
HFJ1
( HFQ2080 )
OCARTERY
Field1:
HEST.OCARTERY
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ2 - OCHBP ( HFQ2110 )
English text: YES
No
HFJ2 - OCHBP ( HFQ2110 )
English text: NO
Attribute
Don't know
Route
HFJ2 - OCHBP ( HFQ2110 )
Refusal
HFJ2 - OCHBP ( HFQ2110 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:00:45 PM Monday, August 03, 2009
Page 173 of 760
HFJ2
HFJ2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCHBP
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
930
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP reported having hypertension in the previous round then:
If SP is respondent, display "still have".
Else display "still has".
Else then:
If SP is respondent, display "have".
Else display "had".
If HJ1 - OCARTERY was asked in the current round, display first
line, "[Since...]", in brackets.
Else do not display first line in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:00:46 PM Monday, August 03, 2009
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
Page 174 of 760
HFJ2
[you/(SP)] that (you/he/she) (still have/still has/have/had)...]
hypertension, sometimes called high blood pressure?
Int. Instr II:
INPUT FIELDS / ROUTING
OCHBP
Field1:
HEST.OCHBP
Cheshire Name:
Item Text display:
( HFQ2110 )
Do not display response option 3/NoButOriginallyYes.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TOchbp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ2 - (HFQ2140 )
2
English text: YES
No
3
English text: NO
NoButOriginallyYes
HFJ4 - OCMYOCAR ( HFQ2160 )
DO NOT DISPLAY. DATA EDITING ONLY.
English text: NO, BUT ORIGINALLY YES
Attribute
Don't know
Route
HFJ4 - OCMYOCAR ( HFQ2160 )
Refusal
HFJ4 - OCMYOCAR ( HFQ2160 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
4:00:49 PM Monday, August 03, 2009
Page 175 of 760
HFJ2
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
391
HFHypertension
SP reported having hypertension in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCHBP = 1/Yes.
DESIGN NOTES
4:00:49 PM Monday, August 03, 2009
Page 176 of 760
BOX HFJ2
BOX HFJ2
Page Order # :
950
BOX INSTRUCTIONS
( HFQ2140 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ3 - YRHBP (
HFQ2150 ).
ELSE GO TO HFJ4 - OCMYOCAR ( HFQ2160 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:00:49 PM Monday, August 03, 2009
Page 177 of 760
HFJ3
HFJ3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRHBP
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
960
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) still had hypertension or high blood pressure?
Int. Instr II:
INPUT FIELDS / ROUTING
4:00:51 PM Monday, August 03, 2009
Page 178 of 760
HFJ3
YRHBP
Field1:
( HFQ2150 )
HEST.YRHBP
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ4 - OCMYOCAR ( HFQ2160 )
English text: YES
No
HFJ4 - OCMYOCAR ( HFQ2160 )
English text: NO
Attribute
Don't know
Route
HFJ4 - OCMYOCAR ( HFQ2160 )
Refusal
HFJ4 - OCMYOCAR ( HFQ2160 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:00:53 PM Monday, August 03, 2009
Page 179 of 760
HFJ4
HFJ4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCMYOCAR
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
970
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
a myocardial infarction or heart attack?
Int. Instr II:
4:00:54 PM Monday, August 03, 2009
Page 180 of 760
HFJ4
INPUT FIELDS / ROUTING
OCMYOCAR
Field1:
( HFQ2160 )
HEST.OCMYOCAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ3 - (HFQ2190 )
English text: YES
No
English text: NO
HFJ6 - OCCHD ( HFQ2210 )
Attribute
Don't know
Route
HFJ6 - OCCHD ( HFQ2210 )
Refusal
HFJ6 - OCCHD ( HFQ2210 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:00:57 PM Monday, August 03, 2009
Page 181 of 760
BOX HFJ3
BOX HFJ3
Page Order # :
990
BOX INSTRUCTIONS
( HFQ2190 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ5 - YRMYOCAR (
HFQ2200 ).
ELSE GO TO HFJ6 - OCCHD ( HFQ2210 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:00:57 PM Monday, August 03, 2009
Page 182 of 760
HFJ5
HFJ5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRMYOCAR
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
1000
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a myocardial infarction or heart attack?
Int. Instr II:
INPUT FIELDS / ROUTING
4:00:58 PM Monday, August 03, 2009
Page 183 of 760
HFJ5
YRMYOCAR
Field1:
( HFQ2200 )
HEST.YRMYOCAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ6 - OCCHD ( HFQ2210 )
English text: YES
No
HFJ6 - OCCHD ( HFQ2210 )
English text: NO
Attribute
Don't know
Route
HFJ6 - OCCHD ( HFQ2210 )
Refusal
HFJ6 - OCCHD ( HFQ2210 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:01:00 PM Monday, August 03, 2009
Page 184 of 760
HFJ6
HFJ6
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCCHD
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
1010
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having angina pectoris or coronary heart
disease in a previous round, display "a new episode of". Display
"new" in BOLD
Else do not display.
Always display first line, "[Since..]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:01:02 PM Monday, August 03, 2009
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Page 185 of 760
HFJ6
(a new episode of) angina pectoris or coronary heart disease?
Int. Instr II:
INPUT FIELDS / ROUTING
( HFQ2210 )
OCCHD
Field1:
HEST.OCCHD
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ4 - (HFQ2240 )
English text: YES
No
HFJ8 - OCCFAIL ( HFQ2260 )
English text: NO
Attribute
Don't know
Route
HFJ8 - OCCFAIL ( HFQ2260 )
Refusal
HFJ8 - OCCFAIL ( HFQ2260 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
4:01:04 PM Monday, August 03, 2009
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
Page 186 of 760
HFJ6
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
392
HFAngina
SP has ever reported having hardening angina pectoris
or coronary heart disease in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCHD = 1/Yes.
DESIGN NOTES
4:01:04 PM Monday, August 03, 2009
Page 187 of 760
BOX HFJ4
BOX HFJ4
Page Order # :
1030
BOX INSTRUCTIONS
( HFQ2240 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ7 - YRCHD (
HFQ2250 ).
ELSE GO TO HFJ8 - OCCFAIL ( HFQ2260 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:01:04 PM Monday, August 03, 2009
Page 188 of 760
HFJ7
HFJ7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRCHD
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
1040
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of angina pectoris or coronary heart
disease?
Int. Instr II:
INPUT FIELDS / ROUTING
4:01:06 PM Monday, August 03, 2009
Page 189 of 760
HFJ7
YRCHD
Field1:
( HFQ2250 )
HEST.YRCHD
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ8 - OCCFAIL ( HFQ2260 )
English text: YES
No
HFJ8 - OCCFAIL ( HFQ2260 )
English text: NO
Attribute
Don't know
Route
HFJ8 - OCCFAIL ( HFQ2260 )
Refusal
HFJ8 - OCCFAIL ( HFQ2260 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:01:08 PM Monday, August 03, 2009
Page 190 of 760
HFJ8
HFJ8
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCCFAIL
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
1050
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having congestive heart failure in a previous
round, display "a new episode of ". Display "new" in BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:01:09 PM Monday, August 03, 2009
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Page 191 of 760
HFJ8
(a new episode of) congestive heart failure?
Int. Instr II:
INPUT FIELDS / ROUTING
( HFQ2260 )
OCCFAIL
Field1:
HEST.OCCFAIL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ5 - (HFQ2280 )
English text: YES
No
HFJ10 - OCCVALVE ( HFQ2300 )
English text: NO
Attribute
Don't know
Route
HFJ10 - OCCVALVE ( HFQ2300 )
Refusal
HFJ10 - OCCVALVE ( HFQ2300 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
4:01:12 PM Monday, August 03, 2009
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
Page 192 of 760
HFJ8
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
393
HFCongHeartFailure
SP has ever reported having congestive heart failure in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCFAIL = 1/Yes.
DESIGN NOTES
4:01:12 PM Monday, August 03, 2009
Page 193 of 760
BOX HFJ5
BOX HFJ5
Page Order # :
1060
BOX INSTRUCTIONS
( HFQ2280 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ9 - YRCFAIL (
HFQ2290 ).
ELSE GO TO HFJ10 - OCCVALVE ( HFQ2300 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:01:12 PM Monday, August 03, 2009
Page 194 of 760
HFJ9
HFJ9
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRCFAIL
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
1070
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of congestive heart failure?
Int. Instr II:
INPUT FIELDS / ROUTING
4:01:14 PM Monday, August 03, 2009
Page 195 of 760
HFJ9
YRCFAIL
Field1:
( HFQ2290 )
HEST.YRCFAIL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ10 - OCCVALVE ( HFQ2300 )
English text: YES
No
HFJ10 - OCCVALVE ( HFQ2300 )
English text: NO
Attribute
Don't know
Route
HFJ10 - OCCVALVE ( HFQ2300 )
Refusal
HFJ10 - OCCVALVE ( HFQ2300 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:01:16 PM Monday, August 03, 2009
Page 196 of 760
HFJ10
HFJ10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCCVALVE
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
1080
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having problems with the valves of the heart
in a previous round, display "a new episode of". Display "new" in
BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:01:17 PM Monday, August 03, 2009
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Page 197 of 760
HFJ10
(a new episode of) problems with the valves of the heart, such as
aortic stenosis?
Int. Instr II:
INPUT FIELDS / ROUTING
( HFQ2300 )
OCCVALVE
Field1:
Cheshire Name:
HEST.OCCVALVE
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 HFJ6 - (HFQ2320 )
English text: YES
No
HFJ12 - OCRHYTHM ( HFQ2340 )
English text: NO
Attribute
Don't know
Route
HFJ12 - OCRHYTHM ( HFQ2340 )
Refusal
HFJ12 - OCRHYTHM ( HFQ2340 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
4:01:20 PM Monday, August 03, 2009
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
Page 198 of 760
HFJ10
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
394
HFHeartValve
SP has ever reported having problems with the valves of
the heart in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCVALVE = 1/Yes.
DESIGN NOTES
4:01:20 PM Monday, August 03, 2009
Page 199 of 760
BOX HFJ6
BOX HFJ6
Page Order # :
1090
BOX INSTRUCTIONS
( HFQ2320 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ11 - YRVALVE (
HFQ2330 ).
ELSE GO TO HFJ12 - OCRHYTHM ( HFQ2340 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:01:20 PM Monday, August 03, 2009
Page 200 of 760
HFJ11
HFJ11
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRVALVE
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
1100
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of problems with the valves of the
heart, such as aortic stenosis?
Int. Instr II:
INPUT FIELDS / ROUTING
4:01:21 PM Monday, August 03, 2009
Page 201 of 760
HFJ11
YRVALVE
Field1:
( HFQ2330 )
HEST.YRVALVE
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ12 - OCRHYTHM ( HFQ2340 )
English text: YES
No
HFJ12 - OCRHYTHM ( HFQ2340 )
English text: NO
Attribute
Don't know
Route
HFJ12 - OCRHYTHM ( HFQ2340 )
Refusal
HFJ12 - OCRHYTHM ( HFQ2340 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:01:24 PM Monday, August 03, 2009
Page 202 of 760
HFJ12
HFJ12
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCRHYTHM
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
1110
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having problems with the rhythm of the
heart in a previous round, display "a new episode of". Display
"new" in BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:01:25 PM Monday, August 03, 2009
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Page 203 of 760
HFJ12
(a new episode of) problems with the rhythm of (your/his/her)
heartbeat, such as atrial fibrillation?
Int. Instr II:
INPUT FIELDS / ROUTING
OCRHYTHM
Field1:
Cheshire Name:
( HFQ2340 )
HEST.OCRHYTHM
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 HFJ7 - (HFQ2360 )
English text: YES
No
HFJ14 - OCOTHHRT ( HFQ2380 )
English text: NO
Attribute
Don't know
Route
HFJ14 - OCOTHHRT ( HFQ2380 )
Refusal
HFJ14 - OCOTHHRT ( HFQ2380 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
4:01:28 PM Monday, August 03, 2009
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
Page 204 of 760
HFJ12
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
395
HFHeartRhythm
SP has ever reported having problems with the rhythm of
the heart in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCRHYTHM = 1/Yes.
DESIGN NOTES
4:01:28 PM Monday, August 03, 2009
Page 205 of 760
BOX HFJ7
BOX HFJ7
Page Order # :
1120
BOX INSTRUCTIONS
( HFQ2360 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ13 - YRRHYTHM (
HFQ2370 ).
ELSE GO TO HFJ14 - OCOTHHRT ( HFQ2380 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:01:28 PM Monday, August 03, 2009
Page 206 of 760
HFJ13
HFJ13
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRRHYTHM
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
1130
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of problems with the rhythm of
(your/his/her) heart, such as atrial fibrillation?
Int. Instr II:
INPUT FIELDS / ROUTING
4:01:29 PM Monday, August 03, 2009
Page 207 of 760
HFJ13
YRRHYTHM
Field1:
( HFQ2370 )
HEST.YRRHYTHM
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ14 - OCOTHHRT ( HFQ2380 )
English text: YES
No
HFJ14 - OCOTHHRT ( HFQ2380 )
English text: NO
Attribute
Don't know
Route
HFJ14 - OCOTHHRT ( HFQ2380 )
Refusal
HFJ14 - OCOTHHRT ( HFQ2380 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:01:31 PM Monday, August 03, 2009
Page 208 of 760
HFJ14
HFJ14
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCOTHHRT
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
1140
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having any other heart condition in a
previous round, display "a new episode of". Display "new" in BOLD
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:01:33 PM Monday, August 03, 2009
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Page 209 of 760
HFJ14
(a new episode of) any other heart condition?
Int. Instr II:
INPUT FIELDS / ROUTING
( HFQ2380 )
OCOTHHRT
Field1:
HEST.OCOTHHRT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ8 - (HFQ2400 )
English text: YES
No
HFJ16 - OCSTROKE ( HFQ2440 )
English text: NO
Attribute
Don't know
Route
HFJ16 - OCSTROKE ( HFQ2440 )
Refusal
HFJ16 - OCSTROKE ( HFQ2440 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
4:01:36 PM Monday, August 03, 2009
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
Page 210 of 760
HFJ14
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
396
HFOtherHeart
SP has ever reported having any other heart condition in
a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCOTHHRT = 1/Yes.
DESIGN NOTES
4:01:36 PM Monday, August 03, 2009
Page 211 of 760
BOX HFJ8
BOX HFJ8
Page Order # :
1150
BOX INSTRUCTIONS
( HFQ2400 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ15 - YROTHHRT (
HFQ2410 ).
ELSE GO TO HFJ16 - OCSTROKE ( HFQ2440 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:01:36 PM Monday, August 03, 2009
Page 212 of 760
HFJ15
HFJ15
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YROTHHRT
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
1160
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an episode of any other heart condition?
Int. Instr II:
INPUT FIELDS / ROUTING
4:01:37 PM Monday, August 03, 2009
Page 213 of 760
HFJ15
YROTHHRT
Field1:
( HFQ2410 )
HEST.YROTHHRT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ16 - OCSTROKE ( HFQ2440 )
English text: YES
No
HFJ16 - OCSTROKE ( HFQ2440 )
English text: NO
Attribute
Don't know
Route
HFJ16 - OCSTROKE ( HFQ2440 )
Refusal
HFJ16 - OCSTROKE ( HFQ2440 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:01:39 PM Monday, August 03, 2009
Page 214 of 760
HFJ16
HFJ16
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCSTROKE
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
1190
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
a stroke, a brain hemorrhage, or a cerebrovascular accident?
Int. Instr II:
4:01:41 PM Monday, August 03, 2009
Page 215 of 760
HFJ16
INPUT FIELDS / ROUTING
OCSTROKE
Field1:
( HFQ2440 )
HEST.OCSTROKE
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ9 - (HFQ2460 )
English text: YES
No
English text: NO
HFJ17A - OCCHOLES ( HFQ2475 )
Attribute
Don't know
Route
HFJ17A - OCCHOLES ( HFQ2475 )
Refusal
HFJ17A - OCCHOLES ( HFQ2475 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:01:43 PM Monday, August 03, 2009
Page 216 of 760
BOX HFJ9
BOX HFJ9
Page Order # :
1200
BOX INSTRUCTIONS
( HFQ2460 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ17 - YRSTROKE (
HFQ2470 ).
ELSE GO TO HFJ17A - OCCHOLES ( HFQ2475 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:01:43 PM Monday, August 03, 2009
Page 217 of 760
HFJ17
HFJ17
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRSTROKE
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
1210
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a stroke, a brain hemorrhage, or a cerebrovascular
accident?
Int. Instr II:
INPUT FIELDS / ROUTING
4:01:44 PM Monday, August 03, 2009
Page 218 of 760
HFJ17
YRSTROKE
Field1:
( HFQ2470 )
HEST.YRSTROKE
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ17A - OCCHOLES ( HFQ2475 )
English text: YES
No
HFJ17A - OCCHOLES ( HFQ2475 )
English text: NO
Attribute
Don't know
Route
HFJ17A - OCCHOLES ( HFQ2475 )
Refusal
HFJ17A - OCCHOLES ( HFQ2475 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:01:46 PM Monday, August 03, 2009
Page 219 of 760
HFJ17A
HFJ17A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCCHOLES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1215
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:
Has a doctor ever told [you/(SP)] that (you/he/she) had high
cholesterol?
Int. Instr II:
INPUT FIELDS / ROUTING
4:01:48 PM Monday, August 03, 2009
Page 220 of 760
HFJ17A
OCCHOLES
Field1:
( HFQ2475 )
HEST.OCCHOLES
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ17B - YRCHOLES ( HFQ2485 )
English text: YES
No
HFJ18 - OCCSKIN ( HFQ2490 )
English text: NO
Attribute
Don't know
Route
HFJ18 - OCCSKIN ( HFQ2490 )
Refusal
HFJ18 - OCCSKIN ( HFQ2490 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:01:50 PM Monday, August 03, 2009
Page 221 of 760
HFJ17B
HFJ17B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRCHOLES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1220
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:
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had high cholesterol?
Int. Instr II:
INPUT FIELDS / ROUTING
4:01:51 PM Monday, August 03, 2009
Page 222 of 760
HFJ17B
YRCHOLES
Field1:
( HFQ2485 )
HEST.YRCHOLES
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ18 - OCCSKIN ( HFQ2490 )
English text: YES
No
HFJ18 - OCCSKIN ( HFQ2490 )
English text: NO
Attribute
Don't know
Route
HFJ18 - OCCSKIN ( HFQ2490 )
Refusal
HFJ18 - OCCSKIN ( HFQ2490 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:01:54 PM Monday, August 03, 2009
Page 223 of 760
HFJ18
HFJ18
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCCSKIN
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
1230
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has ever reported having skin cancer in a previous round,
display "I’ve recorded that [you/(SP)] previously..".
Else do not display.
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having skin cancer in a previous round,
display "a new occurrence of". Display "new" in BOLD
Else do not display.
If SP has not ever reported having skin cancer in a previous round,
display first line of second sentence, "[Since...]", in brackets.
Else do not display in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
4:01:55 PM Monday, August 03, 2009
Page 224 of 760
HFJ18
Context Header:
Int. Instr I:
[I've recorded that [you/(SP)] previously reported having had skin
cancer.]
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
(a new occurrence of) skin cancer?
Int. Instr II:
INPUT FIELDS / ROUTING
OCCSKIN
Field1:
( HFQ2490 )
HEST.OCCSKIN
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ10 - (HFQ2510 )
English text: YES
No
HFJ20 - OCCANCER ( HFQ2540 )
English text: NO
Attribute
Don't know
Route
HFJ20 - OCCANCER ( HFQ2540 )
Refusal
HFJ20 - OCCANCER ( HFQ2540 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
4:01:58 PM Monday, August 03, 2009
Page 225 of 760
HFJ18
HARD EDIT CHECKS
TECHNICAL NOTES
398
HFSkinCancer
SP has ever reported having skin cancer in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCSKIN = 1/Yes.
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:01:58 PM Monday, August 03, 2009
Page 226 of 760
BOX HFJ10
BOX HFJ10
Page Order # :
1240
BOX INSTRUCTIONS
( HFQ2510 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ19 - YRCSKIN (
HFQ2520 ).
ELSE GO TO HFJ20 - OCCANCER ( HFQ2540 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:01:58 PM Monday, August 03, 2009
Page 227 of 760
HFJ19
HFJ19
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRCSKIN
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
1250
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had an occurrence of skin cancer?
Int. Instr II:
INPUT FIELDS / ROUTING
4:01:59 PM Monday, August 03, 2009
Page 228 of 760
HFJ19
YRCSKIN
Field1:
( HFQ2520 )
HEST.YRCSKIN
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ20 - OCCANCER ( HFQ2540 )
English text: YES
No
HFJ20 - OCCANCER ( HFQ2540 )
English text: NO
Attribute
Don't know
Route
HFJ20 - OCCANCER ( HFQ2540 )
Refusal
HFJ20 - OCCANCER ( HFQ2540 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:02:01 PM Monday, August 03, 2009
Page 229 of 760
HFJ20
HFJ20
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCCANCER
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
1270
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP has ever reported having had a tumor, growth or cancer in a
previous round, display "I’ve recorded that [you/(SP)] previously
reported...". Display "[READ RESPONSES BELOW]" in the same
blue font used for interviewer instructions.
Else do not display.
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
If SP has ever reported having had a tumor, growth or cancer in a
previous round, display "other".
Else do not display.
If SP has not ever reported having had a tumor, growth or cancer in
a previous round, display first line of second sentence, "[Since ...]",
in brackets.
Else do not display in brackets.
Display "other than skin cancer" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
4:02:03 PM Monday, August 03, 2009
Page 230 of 760
HFJ20
Report display:
Display report below Question Text.
Display English response text to all responses included in
HEST.OCCCODE during any round.
If the only response to HEST.OCCCODE = DK or RF, display
“Unknown”
Else for each response included in HEST.OCCCODE, display
response on a separate line in the report:
If HEST.OCCCODE includes 1/Lung, display “Lung”.
If HEST.OCCCODE includes 2/Colon, display “Colon, Rectum, or
Bowel”.
If HEST.OCCCODE includes 3/Breast, display “Breast”
If HEST.OCCCODE includes 4/Uterus, display “Uterus”.
If HEST.OCCCODE includes 5/Prostate, display “Prostate”.
If HEST.OCCCODE includes 6/Bladder, display “Bladder”.
If HEST.OCCCODE includes 7/Ovary, display “Ovary”.
If HEST.OCCCODE includes 8/Stomach, display “Stomach”.
If HEST.OCCCODE includes 9/Cervix, display “Cervix”.
If HEST.OCCCODE includes 10/Brain, display Brain”
If HEST.OCCCODE includes 11/Kidney, display “Kidney”
If HEST.OCCCODE includes 12/Throat, display “Throat”
If HEST.OCCCODE includes 13/Head, display “Head”
If HEST.OCCCODE includes 14/Back, display “Back”
If HEST.OCCCODE includes 15/FemalOrgansNotListed, display
“Female Organs Not Listed”
If HEST.OCCCODE includes 91/Other, display HEST.OCCOS text.
TEXT:
Context Header:
Int. Instr I:
Question Text:
[I've recorded that [you/(SP)] previously reported having had a
tumor, growth, or cancer of the [READ RESPONSES BELOW].]
[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
any (other) kind of cancer, malignancy, or tumor other than skin
cancer?
Int. Instr II:
INCLUDE BENIGN OR NON-MALIGNANT TUMORS OR
GROWTHS.
INPUT FIELDS / ROUTING
4:02:04 PM Monday, August 03, 2009
Page 231 of 760
HFJ20
OCCANCER
Field1:
( HFQ2540 )
HEST.OCCANCER
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ11 - (HFQ2560 )
English text: YES
No
BOX HFJ13 - (HFQ2620 )
English text: NO
Attribute
Don't know
Route
BOX HFJ13 - (HFQ2620 )
Refusal
BOX HFJ13 - (HFQ2620 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
4:02:07 PM Monday, August 03, 2009
Page 232 of 760
HFJ20
412
HFTumorGrowth
SP has ever reported having had a tumor, growth or
cancer in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCCANCER = 1/Yes.
DESIGN NOTES
4:02:07 PM Monday, August 03, 2009
Page 233 of 760
BOX HFJ11
BOX HFJ11
Page Order # :
1280
BOX INSTRUCTIONS
( HFQ2560 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ21 - YRCANCER (
HFQ2570 ).
ELSE GO TO HFJ22 - OCCCODE ( HFQ2575 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:02:07 PM Monday, August 03, 2009
Page 234 of 760
HFJ21
HFJ21
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRCANCER
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
1290
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "other than skin cancer" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had any kind of cancer, malignancy, or tumor other
than skin cancer?
Int. Instr II:
INPUT FIELDS / ROUTING
4:02:08 PM Monday, August 03, 2009
Page 235 of 760
HFJ21
YRCANCER
Field1:
( HFQ2570 )
HEST.YRCANCER
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ22 - OCCCODE ( HFQ2575 )
English text: YES
No
HFJ22 - OCCCODE ( HFQ2575 )
English text: NO
Attribute
Don't know
Route
HFJ22 - OCCCODE ( HFQ2575 )
Refusal
HFJ22 - OCCCODE ( HFQ2575 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:02:10 PM Monday, August 03, 2009
Page 236 of 760
HFJ22
HFJ22
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
OCCCODE
Field 2:
OCCOS
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:
1300
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If HFJ21 - YRCANCER = 1/Yes, display "Since the first time a
doctor told [you/(SP)] that (you/he/she) had a cancer, malignancy,
or tumor, on".
Else display "On".
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Since the first time a doctor told [you/(SP)] that (you/he/she) had a
cancer, malignancy, or tumor, on/On] what part or parts of
[your/(SP's)] body was the cancer or tumor found?
[PROBE: Any other part?]
4:02:14 PM Monday, August 03, 2009
Page 237 of 760
HFJ22
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
4:02:22 PM Monday, August 03, 2009
Page 238 of 760
HFJ22
OCCCODE
Field1:
( HFQ2575 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.OCCLUNG
2=HEST.OCCCOLON
3=HEST.OCCBREST
4=HEST.OCCUTER
5=HEST.OCCPROST
6=HEST.OCCBLAD
7=HEST.OCCOVARY
8=HEST.OCCSTOM
9=HEST.OCCCERVX
10=HEST.OCCBRAIN
11=HEST.OCCKIDNY
12=HEST.OCCTHROA
13=HEST.OCCHEAD
14=HEST.OCCBACK
15=HEST.OCCFONEC
91=HEST.OCCOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TOccCode
16
No
No
Number Label
1 Lung
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ13 - (HFQ2620 )
3
English text: LUNG
Colon
BOX HFJ13 - (HFQ2620 )
English text: COLON, RECTUM, OR BOWEL
Breast
BOX HFJ13 - (HFQ2620 )
4
English text: BREAST
Uterus
2
5
6
English text: UTERUS
Prostate
English text: PROSTATE
Bladder
BOX HFJ13 - (HFQ2620 )
BOX HFJ13 - (HFQ2620 )
BOX HFJ13 - (HFQ2620 )
English text: BLADDER
4:02:33 PM Monday, August 03, 2009
Page 239 of 760
HFJ22
7
Ovary
BOX HFJ13 - (HFQ2620 )
8
English text: OVARY
Stomach
BOX HFJ13 - (HFQ2620 )
9
English text: STOMACH
Cervix
BOX HFJ13 - (HFQ2620 )
10
English text: CERVIX
Brain
BOX HFJ13 - (HFQ2620 )
11
English text: BRAIN
Kidney
BOX HFJ13 - (HFQ2620 )
12
English text: KIDNEY
Throat
BOX HFJ13 - (HFQ2620 )
13
English text: THROAT
Head
BOX HFJ13 - (HFQ2620 )
14
English text: HEAD
Back
BOX HFJ13 - (HFQ2620 )
15
English text: BACK
FemaleOrgansNotListed
BOX HFJ13 - (HFQ2620 )
91
English text: FEMALE ORGANS NOT LISTED ABOVE
Other
HFJ22 - OCCOS ( HFQ2576 )
English text: OTHER
Attribute
Don't know
Route
BOX HFJ13 - (HFQ2620 )
Refusal
BOX HFJ13 - (HFQ2620 )
4:02:41 PM Monday, August 03, 2009
Page 240 of 760
HFJ22
Field2:
OCCOS
( HFQ2576 )
HEST.OCCOS
Cheshire Name:
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 HFJ13 - (HFQ2620 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:02:41 PM Monday, August 03, 2009
Page 241 of 760
BOX HFJ13
BOX HFJ13
Page Order # :
1330
BOX INSTRUCTIONS
( HFQ2620 )
IF SP HAS EVER REPORTED HAVING RHEUMATOID ARTHRITIS IN A
PREVIOUS ROUND, GO TO BOX HFJ14 - (HFQ2650 ).
ELSE GO TO HFJ24 - OCARTHRH ( HFQ2630 ).
ASSIGNMENTS
TECHNICAL NOTES
397
HFRheumArthritis
SP has ever reported having rheumatoid arthritis in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCARTHRH = 1/Yes.
DESIGN NOTES
4:02:41 PM Monday, August 03, 2009
Page 242 of 760
HFJ24
HFJ24
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCARTHRH
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
1340
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
rheumatoid arthritis?
Int. Instr II:
4:02:43 PM Monday, August 03, 2009
Page 243 of 760
HFJ24
INPUT FIELDS / ROUTING
OCARTHRH
Field1:
( HFQ2630 )
HEST.OCARTHRH
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ14 - (HFQ2650 )
English text: YES
No
English text: NO
BOX HFJ14 - (HFQ2650 )
Attribute
Don't know
Route
BOX HFJ14 - (HFQ2650 )
Refusal
BOX HFJ14 - (HFQ2650 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:02:45 PM Monday, August 03, 2009
Page 244 of 760
BOX HFJ14
BOX HFJ14
Page Order # :
1350
BOX INSTRUCTIONS
( HFQ2650 )
IF SP HAS EVER REPORTED HAVING ARTHRITIS OTHER THAN
RHEUMATOID ARTHRITIS IN A PREVIOUS ROUND, GO TO BOX HFJ16A
(HFQ2735 ).
ELSE GO TO HFJ25 - OCARTH ( HFQ2670 ).
ASSIGNMENTS
TECHNICAL NOTES
399
HFOtherArthritis
SP has ever reported having arthritis other than
rheumatoid arthritis in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCARTH = 1/Yes.
DESIGN NOTES
4:02:45 PM Monday, August 03, 2009
Page 245 of 760
HFJ25
HFJ25
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCARTH
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
1370
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
arthritis, other than rheumatoid arthritis?
[EXPLAIN IF NECESSARY: This includes osteoarthritis.]
4:02:46 PM Monday, August 03, 2009
Page 246 of 760
HFJ25
Int. Instr II:
INPUT FIELDS / ROUTING
( HFQ2670 )
OCARTH
Field1:
Cheshire Name:
HEST.OCARTH
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 HFJ15 - (HFQ2690 )
English text: YES
No
BOX HFJ16 - (HFQ2720 )
English text: NO
Attribute
Don't know
Route
BOX HFJ16 - (HFQ2720 )
Refusal
BOX HFJ16 - (HFQ2720 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
4:02:49 PM Monday, August 03, 2009
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
Page 247 of 760
HFJ25
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:02:49 PM Monday, August 03, 2009
Page 248 of 760
BOX HFJ15
BOX HFJ15
Page Order # :
1380
BOX INSTRUCTIONS
( HFQ2690 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ26 - YRARTHRD (
HFQ2700 ).
ELSE GO TO BOX HFJ16A - (HFQ2735 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:02:49 PM Monday, August 03, 2009
Page 249 of 760
HFJ26
HFJ26
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRARTHRD
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
1390
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had arthritis in any part of (your/his/her) body, other
than rheumatoid arthritis?
Int. Instr II:
INPUT FIELDS / ROUTING
4:02:51 PM Monday, August 03, 2009
Page 250 of 760
HFJ26
YRARTHRD
Field1:
( HFQ2700 )
HEST.YRARTHRD
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ16 - (HFQ2720 )
English text: YES
No
BOX HFJ16 - (HFQ2720 )
English text: NO
Attribute
Don't know
Route
BOX HFJ16 - (HFQ2720 )
Refusal
BOX HFJ16 - (HFQ2720 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:02:53 PM Monday, August 03, 2009
Page 251 of 760
BOX HFJ16
BOX HFJ16
Page Order # :
1410
BOX INSTRUCTIONS
( HFQ2720 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ28 - OCMENTAL (
HFQ2730 ).
ELSE GO TO BOX HFJ16A - (HFQ2735 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:02:53 PM Monday, August 03, 2009
Page 252 of 760
HFJ28
HFJ28
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCMENTAL
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
1420
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display first line, "[Has a doctor...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Has a doctor ever told [you/(SP)] that (you/he/she) had...]
an intellectual disability, sometimes called mental retardation?
Int. Instr II:
INPUT FIELDS / ROUTING
4:02:54 PM Monday, August 03, 2009
Page 253 of 760
HFJ28
OCMENTAL
Field1:
( HFQ2730 )
HEST.OCMENTAL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ16A - (HFQ2735 )
English text: YES
No
BOX HFJ16A - (HFQ2735 )
English text: NO
Attribute
Don't know
Route
BOX HFJ16A - (HFQ2735 )
Refusal
BOX HFJ16A - (HFQ2735 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:02:56 PM Monday, August 03, 2009
Page 254 of 760
BOX HFJ16A
BOX HFJ16A
Page Order # :
1425
BOX INSTRUCTIONS
IF SP HAS EVER REPORTED HAVING ALZHEIMER’S DISEASE IN A
PREVIOUS ROUND, GO TO HFJ30AA - OCDEPRSS ( HFQ2775 ).
( HFQ2735 )
ELSE GO TO HFJ29A - OCALZMER ( HFQ2745 ).
ASSIGNMENTS
TECHNICAL NOTES
400
HFAlzheimers
SP has ever reported Alzheimer’s disease in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCALZMER = 1/Yes.
DESIGN NOTES
4:02:56 PM Monday, August 03, 2009
Page 255 of 760
HFJ29A
HFJ29A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCALZMER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1430
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:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Alzheimer's disease?
Int. Instr II:
4:02:58 PM Monday, August 03, 2009
Page 256 of 760
HFJ29A
INPUT FIELDS / ROUTING
OCALZMER
Field1:
( HFQ2745 )
HEST.OCALZMER
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ30AA - OCDEPRSS ( HFQ2775 )
English text: YES
No
English text: NO
BOX HFJ16B - (HFQ2755 )
Attribute
Don't know
Route
BOX HFJ16B - (HFQ2755 )
Refusal
BOX HFJ16B - (HFQ2755 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:03:00 PM Monday, August 03, 2009
Page 257 of 760
BOX HFJ16B
BOX HFJ16B
Page Order # :
1435
BOX INSTRUCTIONS
( HFQ2755 )
IF SP HAS EVER REPORTED HAVING DEMENTIA IN A PREVIOUS
ROUND, GO TO HFJ30AA - OCDEPRSS ( HFQ2775 ).
ELSE GO TO HFJ29B - OCDEMENT ( HFQ2765 ).
ASSIGNMENTS
TECHNICAL NOTES
401
HFDementia
SP has ever reported having dementia in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCDEMENT = 1/Yes.
DESIGN NOTES
4:03:00 PM Monday, August 03, 2009
Page 258 of 760
HFJ29B
HFJ29B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCDEMENT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1440
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:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
any type of dementia other than Alzheimer's disease?
Int. Instr II:
4:03:01 PM Monday, August 03, 2009
Page 259 of 760
HFJ29B
INPUT FIELDS / ROUTING
OCDEMENT
Field1:
( HFQ2765 )
HEST.OCDEMENT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ30AA - OCDEPRSS ( HFQ2775 )
English text: YES
No
English text: NO
HFJ30AA - OCDEPRSS ( HFQ2775 )
Attribute
Don't know
Route
HFJ30AA - OCDEPRSS ( HFQ2775 )
Refusal
HFJ30AA - OCDEPRSS ( HFQ2775 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:03:04 PM Monday, August 03, 2009
Page 260 of 760
HFJ30AA
HFJ30AA
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCDEPRSS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1445
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:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
depression?
Int. Instr II:
4:03:05 PM Monday, August 03, 2009
Page 261 of 760
HFJ30AA
INPUT FIELDS / ROUTING
( HFQ2775 )
OCDEPRSS
Field1:
HEST.OCDEPRSS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ17A - (HFQ2785 )
English text: YES
No
English text: NO
HFJ30A - OCPSYCHO ( HFQ2805 )
Attribute
Don't know
Route
HFJ30A - OCPSYCHO ( HFQ2805 )
Refusal
HFJ30A - OCPSYCHO ( HFQ2805 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:03:07 PM Monday, August 03, 2009
Page 262 of 760
BOX HFJ17A
BOX HFJ17A
Page Order # :
1450
BOX INSTRUCTIONS
( HFQ2785 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ30BB - YRDEPRSS
( HFQ2795 ).
ELSE GO TO HFJ30A - OCPSYCHO ( HFQ2805 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:03:07 PM Monday, August 03, 2009
Page 263 of 760
HFJ30BB
HFJ30BB
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRDEPRSS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1455
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:
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had depression?
Int. Instr II:
INPUT FIELDS / ROUTING
4:03:09 PM Monday, August 03, 2009
Page 264 of 760
HFJ30BB
YRDEPRSS
Field1:
( HFQ2795 )
HEST.YRDEPRSS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ30A - OCPSYCHO ( HFQ2805 )
English text: YES
No
HFJ30A - OCPSYCHO ( HFQ2805 )
English text: NO
Attribute
Don't know
Route
HFJ30A - OCPSYCHO ( HFQ2805 )
Refusal
HFJ30A - OCPSYCHO ( HFQ2805 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:03:11 PM Monday, August 03, 2009
Page 265 of 760
HFJ30A
HFJ30A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCPSYCHO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1460
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:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
a mental or psychiatric disorder other than depression?
Int. Instr II:
4:03:12 PM Monday, August 03, 2009
Page 266 of 760
HFJ30A
INPUT FIELDS / ROUTING
OCPSYCHO
Field1:
( HFQ2805 )
HEST.OCPSYCHO
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ17B - (HFQ2810 )
English text: YES
No
English text: NO
BOX HFJ19 - (HFQ2820 )
Attribute
Don't know
Route
BOX HFJ19 - (HFQ2820 )
Refusal
BOX HFJ19 - (HFQ2820 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:03:14 PM Monday, August 03, 2009
Page 267 of 760
BOX HFJ17B
BOX HFJ17B
Page Order # :
1465
BOX INSTRUCTIONS
( HFQ2810 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFJ31A - YRPSYCHO (
HFQ2815 ).
ELSE GO TO BOX HFJ19 - (HFQ2820 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:03:14 PM Monday, August 03, 2009
Page 268 of 760
HFJ31A
HFJ31A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRPSYCHO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1470
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:
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a mental or psychiatric disorder other than
depression?
Int. Instr II:
INPUT FIELDS / ROUTING
4:03:16 PM Monday, August 03, 2009
Page 269 of 760
HFJ31A
YRPSYCHO
Field1:
( HFQ2815 )
HEST.YRPSYCHO
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ19 - (HFQ2820 )
English text: YES
No
BOX HFJ19 - (HFQ2820 )
English text: NO
Attribute
Don't know
Route
BOX HFJ19 - (HFQ2820 )
Refusal
BOX HFJ19 - (HFQ2820 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:03:18 PM Monday, August 03, 2009
Page 270 of 760
BOX HFJ19
BOX HFJ19
Page Order # :
1490
BOX INSTRUCTIONS
( HFQ2820 )
IF SP HAS EVER REPORTED HAVING OSTEOPOROSIS IN A PREVIOUS
ROUND, GO TO HFJ33 - OCBRKHIP ( HFQ2860 ).
ELSE GO TO HFJ32 - OCOSTEOP ( HFQ2830 ).
ASSIGNMENTS
TECHNICAL NOTES
402
HFOsteoporosis
SP has ever reported having osteoporosis in a previous
round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCOSTEOP = 1/Yes.
DESIGN NOTES
4:03:18 PM Monday, August 03, 2009
Page 271 of 760
HFJ32
HFJ32
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCOSTEOP
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
1500
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
osteoporosis, sometimes called fragile or soft bones?
Int. Instr II:
4:03:19 PM Monday, August 03, 2009
Page 272 of 760
HFJ32
INPUT FIELDS / ROUTING
OCOSTEOP
Field1:
Cheshire Name:
( HFQ2830 )
HEST.OCOSTEOP
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
HFJ33 - OCBRKHIP ( HFQ2860 )
English text: YES
No
English text: NO
HFJ33 - OCBRKHIP ( HFQ2860 )
Attribute
Don't know
Route
HFJ33 - OCBRKHIP ( HFQ2860 )
Refusal
HFJ33 - OCBRKHIP ( HFQ2860 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
4:03:22 PM Monday, August 03, 2009
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
Page 273 of 760
HFJ32
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:03:22 PM Monday, August 03, 2009
Page 274 of 760
HFJ33
HFJ33
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCBRKHIP
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
1520
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
a broken hip?
Int. Instr II:
4:03:23 PM Monday, August 03, 2009
Page 275 of 760
HFJ33
INPUT FIELDS / ROUTING
( HFQ2860 )
OCBRKHIP
Field1:
HEST.OCBRKHIP
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ20 - (HFQ2880 )
English text: YES
No
English text: NO
BOX HFJ21 - (HFQ2900 )
Attribute
Don't know
Route
BOX HFJ21 - (HFQ2900 )
Refusal
BOX HFJ21 - (HFQ2900 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:03:26 PM Monday, August 03, 2009
Page 276 of 760
BOX HFJ20
BOX HFJ20
Page Order # :
1530
BOX INSTRUCTIONS
( HFQ2880 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ34 - YRBRKHIP (
HFQ2890 ).
ELSE GO TO BOX HFJ21 - (HFQ2900 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:03:26 PM Monday, August 03, 2009
Page 277 of 760
HFJ34
HFJ34
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRBRKHIP
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
1540
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had a broken hip?
Int. Instr II:
INPUT FIELDS / ROUTING
4:03:27 PM Monday, August 03, 2009
Page 278 of 760
HFJ34
YRBRKHIP
Field1:
( HFQ2890 )
HEST.YRBRKHIP
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ21 - (HFQ2900 )
English text: YES
No
BOX HFJ21 - (HFQ2900 )
English text: NO
Attribute
Don't know
Route
BOX HFJ21 - (HFQ2900 )
Refusal
BOX HFJ21 - (HFQ2900 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:03:29 PM Monday, August 03, 2009
Page 279 of 760
BOX HFJ21
BOX HFJ21
Page Order # :
1550
BOX INSTRUCTIONS
IF SP HAS EVER REPORTED HAVING PARKINSON’S DISEASE IN A
PREVIOUS ROUND, GO TO BOX HFJ22 - (HFQ2930 ).
( HFQ2900 )
ELSE GO TO HFJ35 - OCPARKIN ( HFQ2910 ).
ASSIGNMENTS
TECHNICAL NOTES
403
HFParkinsons
SP has ever reported having Parkinson’s disease in a
previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCPARKIN = 1/Yes.
DESIGN NOTES
4:03:29 PM Monday, August 03, 2009
Page 280 of 760
HFJ35
HFJ35
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCPARKIN
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
1560
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Parkinson's disease?
Int. Instr II:
4:03:31 PM Monday, August 03, 2009
Page 281 of 760
HFJ35
INPUT FIELDS / ROUTING
( HFQ2910 )
OCPARKIN
Field1:
HEST.OCPARKIN
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ22 - (HFQ2930 )
English text: YES
No
English text: NO
BOX HFJ22 - (HFQ2930 )
Attribute
Don't know
Route
BOX HFJ22 - (HFQ2930 )
Refusal
BOX HFJ22 - (HFQ2930 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:03:33 PM Monday, August 03, 2009
Page 282 of 760
BOX HFJ22
BOX HFJ22
Page Order # :
1570
BOX INSTRUCTIONS
( HFQ2930 )
IF SP HAS EVER REPORTED HAVING EMPHYSEMA, ASTHMA OR COPD
IN A PREVIOUS ROUND, GO TO HFJ37 - OCPPARAL ( HFQ2970 ).
ELSE GO TO HFJ36 - OCEMPHYS ( HFQ2940 ).
ASSIGNMENTS
TECHNICAL NOTES
404
HFEmphysema
SP has ever reported having emphysema, asthma, or
COPD in a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCEMPHYS = 1/Yes.
DESIGN NOTES
4:03:33 PM Monday, August 03, 2009
Page 283 of 760
HFJ36
HFJ36
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCEMPHYS
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
1580
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
Display "COPD = CHRONIC OBSTRUCTIVE PULMONARY
DISEASE" in the same blue font used for interviewer instructions.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
emphysema, asthma, or COPD?
4:03:34 PM Monday, August 03, 2009
Page 284 of 760
HFJ36
COPD=CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Int. Instr II:
INPUT FIELDS / ROUTING
OCEMPHYS
Field1:
Cheshire Name:
( HFQ2940 )
HEST.OCEMPHYS
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
HFJ37 - OCPPARAL ( HFQ2970 )
English text: YES
No
HFJ37 - OCPPARAL ( HFQ2970 )
English text: NO
Attribute
Don't know
Route
HFJ37 - OCPPARAL ( HFQ2970 )
Refusal
HFJ37 - OCPPARAL ( HFQ2970 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
4:03:37 PM Monday, August 03, 2009
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
Page 285 of 760
HFJ36
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
DESIGN NOTES
4:03:37 PM Monday, August 03, 2009
Page 286 of 760
HFJ37
HFJ37
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCPPARAL
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
1600
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Since...]", in brackets.
If SP has ever reported having complete or partial paralysis in a
previous round, display "IF SP IS OBVIOUSLY PARTIALLY OR
COMPLETELY PARALYZED, SELECT "YES" AND DO NOT ASK.
OTHERWISE, ASK:". Display in the same blue font used for
interviewer instructions.
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
4:03:38 PM Monday, August 03, 2009
[IF SP IS OBVIOUSLY PARTIALLY OR COMPLETELY
PARALYZED, SELECT "YES" AND DO NOT ASK. OTHERWISE,
Page 287 of 760
HFJ37
ASK:]
[[Since (LAST HF MONTH YEAR) has/Has] a doctor (ever) told
[you/(SP)] that (you/he/she) had...]
Question Text:
complete or partial paralysis?
Int. Instr II:
INPUT FIELDS / ROUTING
OCPPARAL
Field1:
Cheshire Name:
( HFQ2970 )
HEST.OCPPARAL
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 HFJ23 - (HFQ3000 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
BOX HFJ24 - (HFQ3020 )
Refusal
BOX HFJ24 - (HFQ3020 )
BOX HFJ24 - (HFQ3020 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:03:41 PM Monday, August 03, 2009
Page 288 of 760
HFJ37
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
405
HFParalysis
SP has ever reported having complete or partial paralysis
in a previous round round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCPPARAL = 1/Yes.
DESIGN NOTES
4:03:41 PM Monday, August 03, 2009
Page 289 of 760
BOX HFJ23
BOX HFJ23
Page Order # :
1620
BOX INSTRUCTIONS
( HFQ3000 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ38 - YRPPARAL (
HFQ3010 ).
ELSE GO TO BOX HFJ24 - (HFQ3020 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:03:41 PM Monday, August 03, 2009
Page 290 of 760
HFJ38
HFJ38
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRPPARAL
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
1630
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 (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he/she) had complete or partial paralysis?
Int. Instr II:
INPUT FIELDS / ROUTING
4:03:43 PM Monday, August 03, 2009
Page 291 of 760
HFJ38
YRPPARAL
Field1:
( HFQ3010 )
HEST.YRPPARAL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ24 - (HFQ3020 )
English text: YES
No
BOX HFJ24 - (HFQ3020 )
English text: NO
Attribute
Don't know
Route
BOX HFJ24 - (HFQ3020 )
Refusal
BOX HFJ24 - (HFQ3020 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:03:45 PM Monday, August 03, 2009
Page 292 of 760
BOX HFJ24
BOX HFJ24
Page Order # :
1640
BOX INSTRUCTIONS
( HFQ3020 )
IF SP HAS EVER REPORTED AN ABSENCE OR LOSS OF ARM OR LEG IN
A PREVIOUS ROUND, GO TO BOX HFJ25 - (HFQ3050 ).
ELSE GO TO HFJ39 - OCAMPUTE ( HFQ3030 ).
ASSIGNMENTS
TECHNICAL NOTES
406
HFAmpute
SP has ever reported an absence or loss of arm or leg in
a previous round =
There is a HEST where HEST.HESTRND < current round
and HEST.OCAMPUTE = 1/Yes.
DESIGN NOTES
4:03:45 PM Monday, August 03, 2009
Page 293 of 760
HFJ39
HFJ39
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCAMPUTE
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
1650
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS,
SELECT "YES" AND DO NOT ASK. OTHERWISE, ASK:" in the
same blue font used for interviewer instructions.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
IF SP IS OBVIOUSLY MISSING ONE OR MORE LIMBS, SELECT
"YES" AND DO NOT ASK. OTHERWISE, ASK:
Question Text:
What about absence or loss of an arm or a leg?
Int. Instr II:
INPUT FIELDS / ROUTING
4:03:46 PM Monday, August 03, 2009
Page 294 of 760
HFJ39
OCAMPUTE
Field1:
( HFQ3030 )
HEST.OCAMPUTE
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ25 - (HFQ3050 )
English text: YES
No
BOX HFJ25 - (HFQ3050 )
English text: NO
Attribute
Don't know
Route
BOX HFJ25 - (HFQ3050 )
Refusal
BOX HFJ25 - (HFQ3050 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:03:48 PM Monday, August 03, 2009
Page 295 of 760
BOX HFJ25
BOX HFJ25
Page Order # :
1660
BOX INSTRUCTIONS
( HFQ3050 )
IF SP IS FEMALE, GO TO HFJ41A - OCBETES ( HFQ3081 ).
ELSE GO TO HFJ40 - HAVEPROS ( HFQ3060 ).
ASSIGNMENTS
TECHNICAL NOTES
5
SPMale
SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.
6
SPFemale
SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.
DESIGN NOTES
4:03:48 PM Monday, August 03, 2009
Page 296 of 760
HFJ40
HFJ40
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HAVEPROS
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
1670
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is in the Supplemental Sample, or SP skipped the previous
year interview, display "ever".
Else do not display.
Always display first line, "[Before [you/(SP)] had prostate surgery,
did a doctor ever tell/Since (LAST HF MONTH YEAR), has/Has]] a
doctor (ever) told] [you/(SP)] that (you/he) had ...]", in brackets.
If SP has ever reported having prostate surgery in the current round
or in a previous round, display "Before [you/(SP)] had prostate
surgery, did a doctor ever tell".
Else display "Since (LAST HF MONTH YEAR), has/Has]] a doctor
(ever) told".
If SP is the respondent, display "you".
Else display "he".
Always display "(BPH)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
4:03:50 PM Monday, August 03, 2009
Page 297 of 760
HFJ40
TEXT:
Context Header:
Int. Instr I:
[[Before [you/(SP)] had prostate surgery, did a doctor ever tell/Since
(LAST HF MONTH YEAR), has/Has]] a doctor (ever) told ] [you/(SP)]
that (you/he) had...]
Question Text:
an enlarged prostate or benign prostatic hypertrophy (BPH)?
Int. Instr II:
INPUT FIELDS / ROUTING
HAVEPROS
Field1:
( HFQ3060 )
HEST.HAVEPROS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ26 - (HFQ3070 )
English text: YES
No
HFJ41A - OCBETES ( HFQ3081 )
English text: NO
Attribute
Don't know
Route
HFJ41A - OCBETES ( HFQ3081 )
Refusal
HFJ41A - OCBETES ( HFQ3081 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
4:03:53 PM Monday, August 03, 2009
Page 298 of 760
HFJ40
HARD EDIT CHECKS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
386
HFSkippedPrevYear
SP skipped the previous year interview =
There is no HEST where HEST.HESTRND = (current
round - 3).
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
387
HFProstateSurgCurrOr
Prev
If SP has ever reported having prostate surgery in the
current round or in a previous round =
(HEST.PROSSURG = /1Yes or HEST.PROSRMVD =
1/Yes ) on HEST where (HEST.HESTRND <= current
round).
DESIGN NOTES
4:03:53 PM Monday, August 03, 2009
Page 299 of 760
BOX HFJ26
BOX HFJ26
Page Order # :
1680
BOX INSTRUCTIONS
( HFQ3070 )
IF SP IS IN THE SUPPLMENTAL SAMPLE, GO TO HFJ41 - YRPROST (
HFQ3080 ).
ELSE GO TO HFJ41A - OCBETES ( HFQ3081 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:03:53 PM Monday, August 03, 2009
Page 300 of 760
HFJ41
HFJ41
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
YRPROST
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
1690
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is the respondent, display "you".
Else display "he".
Always display "(BPH)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Since (LAST HF MONTH YEAR), did a doctor tell [you/(SP)] that
(you/he) had an enlarged prostate or benign prostatic hypertrophy
(BPH)?
Int. Instr II:
INPUT FIELDS / ROUTING
4:03:54 PM Monday, August 03, 2009
Page 301 of 760
HFJ41
( HFQ3080 )
YRPROST
Field1:
HEST.YRPROST
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ41A - OCBETES ( HFQ3081 )
English text: YES
No
HFJ41A - OCBETES ( HFQ3081 )
English text: NO
Attribute
Don't know
Route
HFJ41A - OCBETES ( HFQ3081 )
Refusal
HFJ41A - OCBETES ( HFQ3081 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
4:03:57 PM Monday, August 03, 2009
Page 302 of 760
HFJ41
DESIGN NOTES
4:03:57 PM Monday, August 03, 2009
Page 303 of 760
HFJ41A
HFJ41A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCBETES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1692
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:
If SP is female, display "borderline diabetes, pre-diabetes, or
pregnancy-related diabetes".
Else display "borderline diabetes, or pre-diabetes".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Has a doctor ever told [you/(SP)] that (you/he/she) had any type of
diabetes, including: sugar diabetes, high blood sugar, (borderline
diabetes, pre-diabetes, or pregnancy-related diabetes/borderline
diabetes, or pre-diabetes)?
Int. Instr II:
INPUT FIELDS / ROUTING
4:03:58 PM Monday, August 03, 2009
Page 304 of 760
HFJ41A
( HFQ3081 )
OCBETES
Field1:
Cheshire Name:
HEST.OCBETES
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
HFJ41B - OCDTYPE ( HFQ3083 )
English text: YES
No
BOX HFJ27 - (HFQ3090 )
English text: NO
Attribute
Don't know
Route
BOX HFJ27 - (HFQ3090 )
Refusal
BOX HFJ27 - (HFQ3090 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
5
SPMale
SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.
6
SPFemale
SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.
DESIGN NOTES
4:04:00 PM Monday, August 03, 2009
Page 305 of 760
HFJ41B
HFJ41B
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
OCDTYPE
Field 2:
OCDTYPOS
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
1694
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:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
SHOW CARD HF6
Question Text:
Looking at this card, please tell me which type of diabetes the doctor
said that [you have/(SP) has].
Int. Instr II:
INPUT FIELDS / ROUTING
4:04:03 PM Monday, August 03, 2009
Page 306 of 760
HFJ41B
OCDTYPE
Field1:
HEST.OCDTYPE
Cheshire Name:
Item Text display:
( HFQ3083 )
If SP is male, do not display response option 5/Gestational.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TOCDType
1
No
No
Number Label
1 TypeOne
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFJ41C - OCDVISIT ( HFQ3087 )
2
English text: TYPE 1 (“INSULIN-DEPENDENT”, “JUVENILE-ONSET”)
TypeTwo
HFJ41C - OCDVISIT ( HFQ3087 )
3
English text: TYPE 2 ("NON-INSULIN-DEPENDENT", "ADULT-ONSET")
Borderline
HFJ41C - OCDVISIT ( HFQ3087 )
4
English text: BORDERLINE
PreDiabetes
HFJ41C - OCDVISIT ( HFQ3087 )
5
English text: PRE-DIABETES
Gestational
HFJ41C - OCDVISIT ( HFQ3087 )
91
English text: GESTATIONAL (PREGNANCY-RELATED)
Other
HFJ41B - OCDTYPOS ( HFQ3085 )
English text: SOME OTHER TYPE
Attribute
Don't know
Route
HFJ41C - OCDVISIT ( HFQ3087 )
Refusal
HFJ41C - OCDVISIT ( HFQ3087 )
4:04:09 PM Monday, August 03, 2009
Page 307 of 760
HFJ41B
( HFQ3085 )
OCDTYPOS
Field2:
Cheshire Name:
HEST.OCDTYPOS
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
SOME OTHER TYPE (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
HFJ41C - OCDVISIT ( HFQ3087 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
5
SPMale
SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.
6
SPFemale
SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.
DESIGN NOTES
4:04:09 PM Monday, August 03, 2009
Page 308 of 760
HFJ41C
HFJ41C
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OCDVISIT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1698
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)] told on two or more different visits that
(you/he/she) had diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:04:11 PM Monday, August 03, 2009
Page 309 of 760
HFJ41C
OCDVISIT
Field1:
( HFQ3087 )
HEST.OCDVISIT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ27 - (HFQ3090 )
English text: YES
No
BOX HFJ27 - (HFQ3090 )
English text: NO
Attribute
Don't know
Route
BOX HFJ27 - (HFQ3090 )
Refusal
BOX HFJ27 - (HFQ3090 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:04:13 PM Monday, August 03, 2009
Page 310 of 760
BOX HFJ27
BOX HFJ27
4:04:13 PM Monday, August 03, 2009
Page Order # :
1700
Page 311 of 760
BOX HFJ27
BOX INSTRUCTIONS
( HFQ3090 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, AND SP'S AGE IS UNDER 65,
AND SP REPORTED “YES” TO AT LEAST ONE HFJ CONDITION, GO TO
HFJ42 - EMCOND ( HFQ3100 ).
ELSE IF SP IS IN THE SUPPLEMENTAL SAMPLE, AND SP'S AGE IS
UNDER 65, AND SP REPORTED “NO” TO ALL HFJ CONDITIONS, GO TO
HFJ43 - EMCAUSEVB ( HFQ3110 ).
ELSE GO TO BOX HFP0 - (HFQ3175 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
103
SPAge
SP's AGE is calculated based on SP's
ROST.HHDOBMM, ROST.HHDOBDD, ROST.HHDOBYY
and TODAY and is stored on ENUM.HHPAGE where
ENUM.ENUMRND = current round and
ENUM.ENUMROST = 01.
DESIGN NOTES
SP responded "YES" to at least one HFJ Condition =
IF HFJ1 – OCARTERY = 1/Yes, or
HFJ2 - OCHBP = 1/Yes, or
HFJ4 - OCMYOCAR = 1/Yes, or
HFJ6 - OCCHD = 1/Yes, or
HFJ8 - OCCFAIL = 1/Yes, or
HFJ10 - OCCVALVE = 1/Yes, or
HFJ 12- OCRHYTHM = 1/Yes, or
HFJ14 - OCOTHHRT = 1/Yes, or
HFJ16 - OCSTROKE = 1/Yes, or
HFJ18 - OCCSKIN = 1/Yes, or
HFJ20 - OCCANCER = 1/Yes, or
HFJ24 - OCARTHRH = 1/Yes, or
HFJ25 - OCARTH = 1/Yes, or
HFJ28 - OCMENTAL = 1/Yes, or
HFJ29A - OCALZMER = 1/Yes, or
HFJ29B - OCDEMENT = 1/Yes, or
HFJ30AA - OCDEPRSS = 1/Yes, or
HFJ30A - OCPSYCHO = 1/Yes, or
HFJ32 - OCOSTEOP = 1/Yes, or
HFJ33 - OCBRKHIP = 1/Yes, or
HFJ35 - OCPARKIN = 1/Yes, or
HFJ36 - OCEMPHYS = 1/Yes, or
HFJ37 - OCPPARAL = 1/Yes, or
HFJ39 - OCAMPUTE = 1/Yes, or
HFJ41A – OCBETES = 1/Yes.
SP responded "NO" to all HFJ Conditions =
IF (HFJ1 – OCARTERY =2/No, DK, OR RF), and
(HFJ2 - OCHBP =2/No, DK, OR RF), and
4:04:13 PM Monday, August 03, 2009
Page 312 of 760
BOX HFJ27
(HFJ4 - OCMYOCAR =2/No, DK, OR RF), and
(HFJ6 - OCCHD =2/No, DK, OR RF), and
(HFJ8 - OCCFAIL =2/No, DK, OR RF), and
(HFJ10 - OCCVALVE =2/No, DK, OR RF), and
(HFJ 12- OCRHYTHM =2/No, DK, OR RF), and
(HFJ14 - OCOTHHRT =2/No, DK, OR RF), and
(HFJ16 - OCSTROKE =2/No, DK, OR RF), and
(HFJ18 - OCCSKIN =2/No, DK, OR RF), and
(HFJ20 - OCCANCER =2/No, DK, OR RF), and
(HFJ24 - OCARTHRH =2/No, DK, OR RF), and
(HFJ25 - OCARTH =2/No, DK, OR RF), and
(HFJ28 - OCMENTAL =2/No, DK, OR RF), and
(HFJ29A - OCALZMER =2/No, DK, OR RF), and
(HFJ29B - OCDEMENT =2/No, DK, OR RF), and
(HFJ30AA - OCDEPRSS =2/No, DK, OR RF), and
(HFJ30A - OCPSYCHO =2/No, DK, OR RF), and
(HFJ32 - OCOSTEOP =2/No, DK, OR RF), and
(HFJ33 - OCBRKHIP =2/No, DK, OR RF), and
(HFJ35 - OCPARKIN =2/No, DK, OR RF), and
(HFJ36 - OCEMPHYS =2/No, DK, OR RF), and
(HFJ37 - OCPPARAL =2/No, DK, OR RF), and
(HFJ39 - OCAMPUTE =2/No, DK, OR RF), and
(HFJ41A - OCBETES = 2/No, DK, OR RF)..
NOTE: We do not include a check for HFJ17A - OCCHOLES since High
Cholesterol cannot be a reason for why SP is eligible for Medicare.
4:04:13 PM Monday, August 03, 2009
Page 313 of 760
HFJ42
HFJ42
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EMCOND
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
1710
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP Responded "YES" to only one HF condition, display "Was
this".
Else display "Were any of these".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below Question text.
For each HFJ condition reported, display as a separate line in report:
IF HFJ1 – OCARTERY = 1/Yes, display “ARTERIES HARDENING”.
IF HFJ2 - OCHBP = 1/Yes, display “HYPERTENSION”.
IF HFJ4 - OCMYOCAR = 1/Yes, display “HEART ATTACK”.
IF HFJ6 - OCCHD = 1/Yes, display “HEART DISEASE”.
IF HFJ8 - OCCFAIL = 1/Yes, display “CONGESTIVE HEART
FAILURE”.
IF HFJ10 - OCCVALVE = 1/Yes, display “HEART VALVE
PROBLEM”.
IF HFJ 12- OCRHYTHM = 1/Yes, display “HEART RHYTHM
PROBLEM”.
IF HFJ14 - OCOTHHRT = 1/Yes, display “OTHER HEART
PROBLEM”.
IF HFJ16 - OCSTROKE = 1/Yes, display “.STROKE OR
4:04:14 PM Monday, August 03, 2009
Page 314 of 760
HFJ42
HEMORRHAGE”.
IF HFJ18 - OCCSKIN = 1/Yes, display “SKIN CANCER”.
IF HFJ20 - OCCANCER = 1/Yes, display “CANCER/TUMOR”.
IF HFJ24 - OCARTHRH = 1/Yes, display “RHEUMATOID
ARTHRITIS”.
IF HFJ25 - OCARTH = 1/Yes, display “OTHER ARTHRITIS”.
IF HFJ28 - OCMENTAL = 1/Yes, display “MENTAL RETARDATION”.
IF HFJ29A - OCALZMER = 1/Yes, display “ALZHEIMER'S”.
IF HFJ29B - OCDEMENT = 1/Yes, display “DEMENTIA”.
IF HFJ30AA - OCDEPRSS = 1/Yes, display “DEPRESSION”.
IF HFJ30A - OCPSYCHO = 1/Yes, display “MENTAL DISORDER”.
IF HFJ32 - OCOSTEOP = 1/Yes, display “OSTEOPOROSIS”.
IF HFJ33 - OCBRKHIP = 1/Yes, display “BROKEN HIP”.
IF HFJ35 - OCPARKIN = 1/Yes, display “PARKINSON'S”.
IF HFJ36 - OCEMPHYS = 1/Yes, display
“EMPHYSEMA/ASTHMA/COPD”.
IF HFJ37 - OCPPARAL = 1/Yes, display “PARALYSIS”.
IF HFJ39 - OCAMPUTE = 1/Yes, display “LOSS OF LIMB”.
IF HFJ41A – OCBETES = 1/Yes, display “DIABETES”.
TEXT:
Context Header:
Int. Instr I:
Question Text:
You told me that [you have/(SP) has] had [READ CONDITIONS
LISTED BELOW]. (Was this/Were any of these) the original cause
of [your/(SP's)] becoming eligible for Medicare?
Int. Instr II:
INPUT FIELDS / ROUTING
4:04:17 PM Monday, August 03, 2009
Page 315 of 760
HFJ42
EMCOND
Field1:
( HFQ3100 )
HEST.EMCOND
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFJ28 - (HFQ3160 )
English text: YES
No
HFJ43 - EMCAUSEVB ( HFQ3110 )
English text: NO
Attribute
Don't know
Route
BOX HFP0 - (HFQ3175 )
Refusal
BOX HFP0 - (HFQ3175 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
SP responded “YES” to only one HFJ Condition =
Only one of the following fields = 1/Yes:
HFJ1 – OCARTERY = 1/Yes, or
HFJ2 - OCHBP = 1/Yes, or
HFJ4 - OCMYOCAR = 1/Yes, or
HFJ6 - OCCHD = 1/Yes, or
4:04:20 PM Monday, August 03, 2009
Page 316 of 760
HFJ42
HFJ8 - OCCFAIL = 1/Yes, or
HFJ10 - OCCVALVE = 1/Yes, or
HFJ 12- OCRHYTHM = 1/Yes, or
HFJ14 - OCOTHHRT = 1/Yes, or
HFJ16 - OCSTROKE = 1/Yes, or
HFJ18 - OCCSKIN = 1/Yes, or
HFJ20 - OCCANCER = 1/Yes, or
HFJ24 - OCARTHRH = 1/Yes, or
HFJ25 - OCARTH = 1/Yes, or
HFJ28 - OCMENTAL = 1/Yes, or
HFJ29A - OCALZMER = 1/Yes, or
HFJ29B - OCDEMENT = 1/Yes, or
HFJ30AA - OCDEPRSS = 1/Yes, or
HFJ30A - OCPSYCHO = 1/Yes, or
HFJ32 - OCOSTEOP = 1/Yes, or
HFJ33 - OCBRKHIP = 1/Yes, or
HFJ35 - OCPARKIN = 1/Yes, or
HFJ36 - OCEMPHYS = 1/Yes, or
HFJ37 - OCPPARAL = 1/Yes, or
HFJ39 - OCAMPUTE = 1/Yes, or
HFJ41A – OCBETES = 1/Yes.
NOTE: We do not include a check for HFJ17A - OCCHOLES since High
Cholesterol cannot be a reason for why SP is eligible for Medicare.
4:04:20 PM Monday, August 03, 2009
Page 317 of 760
HFJ43
HFJ43
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 1:
EMCAUSEVB
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
1720
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:
What was the original cause of [your/(SP's)] becoming eligible for
Medicare?
Int. Instr II:
RECORD VERBATIM.
INPUT FIELDS / ROUTING
4:04:20 PM Monday, August 03, 2009
Page 318 of 760
HFJ43
Field1:
EMCAUSEVB
( HFQ3110 )
HEST.EMCAUSE1
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Open
TOpen135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX HFP0 - (HFQ3175 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:04:21 PM Monday, August 03, 2009
Page 319 of 760
BOX HFJ28
BOX HFJ28
Page Order # :
1730
BOX INSTRUCTIONS
( HFQ3160 )
IF SP RESPONDED “YES” TO ONLY ONE HFJ CONDITION, GO TO BOX
HFP0 - (HFQ3175 ).
ELSE GO TO HFJ44 - EMCODE ( HFQ3165 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
SP responded “YES” to only one HFJ Condition =
Only one of the following fields = 1/Yes:
HFJ1 – OCARTERY = 1/Yes, or
HFJ2 - OCHBP = 1/Yes, or
HFJ4 - OCMYOCAR = 1/Yes, or
HFJ6 - OCCHD = 1/Yes, or
HFJ8 - OCCFAIL = 1/Yes, or
HFJ10 - OCCVALVE = 1/Yes, or
HFJ 12- OCRHYTHM = 1/Yes, or
HFJ14 - OCOTHHRT = 1/Yes, or
HFJ16 - OCSTROKE = 1/Yes, or
HFJ18 - OCCSKIN = 1/Yes, or
HFJ20 - OCCANCER = 1/Yes, or
HFJ24 - OCARTHRH = 1/Yes, or
HFJ25 - OCARTH = 1/Yes, or
HFJ28 - OCMENTAL = 1/Yes, or
HFJ29A - OCALZMER = 1/Yes, or
HFJ29B - OCDEMENT = 1/Yes, or
HFJ30AA - OCDEPRSS = 1/Yes, or
HFJ30A - OCPSYCHO = 1/Yes, or
HFJ32 - OCOSTEOP = 1/Yes, or
HFJ33 - OCBRKHIP = 1/Yes, or
HFJ35 - OCPARKIN = 1/Yes, or
HFJ36 - OCEMPHYS = 1/Yes, or
HFJ37 - OCPPARAL = 1/Yes, or
HFJ39 - OCAMPUTE = 1/Yes, or
HFJ41A – OCBETES = 1/Yes.
NOTE: We do not include a check for HFJ17A - OCCHOLES since High
Cholesterol cannot be a reason for why SP is eligible for Medicare.
4:04:21 PM Monday, August 03, 2009
Page 320 of 760
HFJ44
HFJ44
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
EMCODE
Field 2:
EMOS
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:
1740
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:
Which of these conditions was the cause of [your/(SP's)] becoming
eligible for Medicare?
[PROBE: Any other condition?]
Int. Instr II:
CHECK UP TO 8 CONDITIONS.
INPUT FIELDS / ROUTING
4:04:26 PM Monday, August 03, 2009
Page 321 of 760
HFJ44
4:04:36 PM Monday, August 03, 2009
Page 322 of 760
HFJ44
Field1:
Cheshire Name:
EMCODE
( HFQ3165 )
NONE
REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=HEST.EMARTERY
2=HEST.EMHBP
3=HEST.EMMYOCAR
4=HEST.EMCHD
5=HEST.EMCFAIL
6=HEST.EMCVALVE
7=HEST.EMRHYTHM
8=HEST.EMOTHHRT
9=HEST.EMSTROKE
10=HEST.EMCSKIN
11=HEST.EMCANCER
12=HEST.EMARTHRH
13=HEST.EMARTH
14=HEST.EMMENTAL
15=HEST.EMALZMER
16=HEST.EMDEMENT
17=HEST.EMDEPRSS
18=HEST.EMPSYCHO
19=HEST.EMOSTEOP
20=HEST.EMBRKHIP
21=HEST.EMPARKIN
22=HEST.EMEMPHYS
23=HEST.EMPPARAL
24=HEST.EMAMPUTE
25=HEST.EMDIABTS
91=HEST.EMOTHOS
Item Text display:
If response to HFJ CONDITION = 1/Yes, display condition
as a response option at HFJ44 - EMCODE.
Else do not display response option.
If HFJ1 - OCARTERY = 1/Yes, display HFJ44 – EMCODE
response option 1.
Else do not display.
IF HFJ2 - OCHBP = 1/Yes, display HFJ44 – EMCODE
response option 2.
Else do not display.
IF HFJ4 - OCMYOCAR = 1/Yes, display HFJ44 –
EMCODE response option 3.
Else do not display.
IF HFJ6 - OCCHD = 1/Yes, display HFJ44 – EMCODE
response option 4.
Else do not display.
IF HFJ8 - OCCFAIL = 1/Yes, display HFJ44 – EMCODE
response option 5.
Else do not display.
IF HFJ10 - OCCVALVE = 1/Yes, display HFJ44 –
EMCODE response option 6.
4:04:46 PM Monday, August 03, 2009
Page 323 of 760
HFJ44
Else do not display.
IF HFJ 12- OCRHYTHM = 1/Yes, display HFJ44 –
EMCODE response option 7.
Else do not display.
IF HFJ14 - OCOTHHRT = 1/Yes, display HFJ44 –
EMCODE response option 8.
Else do not display.
IF HFJ16 - OCSTROKE = 1/Yes, display HFJ44 –
EMCODE response option 9.
Else do not display.
IF HFJ18 - OCCSKIN = 1/Yes, display HFJ44 – EMCODE
response option 10.
Else do not display.
IF HFJ20 - OCCANCER = 1/Yes, display HFJ44 –
EMCODE response option 11.
Else do not display.
IF HFJ24 - OCARTHRH = 1/Yes, display HFJ44 –
EMCODE response option 12.
Else do not display.
IF HFJ25 - OCARTH = 1/Yes, display HFJ44 – EMCODE
response option 13.
Else do not display.
IF HFJ28 - OCMENTAL = 1/Yes, display HFJ44 –
EMCODE response option 14.
Else do not display.
IF HFJ29A - OCALZMER = 1/Yes, display HFJ44 –
EMCODE response option 15.
Else do not display.
IF HFJ29B - OCDEMENT = 1/Yes, display HFJ44 –
EMCODE response option 16.
Else do not display.
IF HFJ30AA - OCDEPRSS = 1/Yes, display HFJ44 –
EMCODE response option 17.
Else do not display.
IF HFJ30A - OCPSYCHO = 1/Yes, display HFJ44 –
EMCODE response option 18.
Else do not display.
IF HFJ32 - OCOSTEOP = 1/Yes, display HFJ44 –
EMCODE response option 19.
Else do not display.
IF HFJ33 - OCBRKHIP = 1/Yes, display HFJ44 –
EMCODE response option 20.
Else do not display.
IF HFJ35 - OCPARKIN = 1/Yes, display HFJ44 –
EMCODE response option 21.
Else do not display.
4:04:55 PM Monday, August 03, 2009
Page 324 of 760
HFJ44
IF HFJ36 - OCEMPHYS = 1/Yes, display HFJ44 –
EMCODE response option 22.
Else do not display.
IF HFJ37 - OCPPARAL = 1/Yes, display HFJ44 –
EMCODE response option 23.
Else do not display.
IF HFJ39 - OCAMPUTE = 1/Yes, display HFJ44 –
EMCODE response option 24.
Else do not display.
IF HFJ41A – OCBETES = 1/Yes, display HFJ44 –
EMCODE response option 25.
Else do not display.
Always display HFJ – EMCODE response option 91.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TEMCode
8
No
No
Number Label
1 AteriesHardening
3
English text: ARTERIES HARDENING
Hypertension
English text: HYPERTENSION
HeartAttack
4
English text: HEART ATTACK
HeartDisease
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
6
English text: HEART DISEASE
CongestiveHeartFailure
BOX HFP0 - (HFQ3175 )
CONGESTIVE
HEART
FAILURE
English text:
HeartValveProblem
BOX HFP0 - (HFQ3175 )
7
English text: HEART VALVE PROBLEM
HeartRhythmProblem
BOX HFP0 - (HFQ3175 )
8
English text: HEART RHYTHM PROBLEM
OtherHeartProblem
BOX HFP0 - (HFQ3175 )
9
English text: OTHER HEART PROBLEM
StrokeOrHemorrhage
BOX HFP0 - (HFQ3175 )
5
English text: STROKE OR HEMORRHAGE
4:05:09 PM Monday, August 03, 2009
Page 325 of 760
HFJ44
10
SkinCancer
BOX HFP0 - (HFQ3175 )
11
English text: SKIN CANCER
CancerTumor
BOX HFP0 - (HFQ3175 )
12
English text: CANCER/TUMOR
RheumatioidArthritis
BOX HFP0 - (HFQ3175 )
13
English text: RHEUMATOID ARTHRITIS
OtherArthritis
BOX HFP0 - (HFQ3175 )
14
English text: OTHER ARTHRITIS
MentalRetardation
BOX HFP0 - (HFQ3175 )
15
English text: MENTAL RETARDATION
Alzheimers
BOX HFP0 - (HFQ3175 )
16
English text: ALZHEIMER'S
Dementia
BOX HFP0 - (HFQ3175 )
17
English text: DEMENTIA
Depression
BOX HFP0 - (HFQ3175 )
18
English text: DEPRESSION
MentalDisorder
BOX HFP0 - (HFQ3175 )
19
English text: MENTAL DISORDER
Osteoporosis
BOX HFP0 - (HFQ3175 )
21
English text: OSTEOPOROSIS
BrokenHip
English text: BROKEN HIP
Parkinsons
BOX HFP0 - (HFQ3175 )
22
English text: PARKINSON'S
EmphysemaAsthmaCOPD
BOX HFP0 - (HFQ3175 )
20
24
English text: EMPHYSEMA/ASTHMA/COPD
Paralysis
English text: PARALYSIS
LossOfLimb
25
English text: LOSS OF LIMB
Diabetes
23
91
English text: DIABETES
Other
English text: OTHER
Attribute
Don't know
Route
BOX HFP0 - (HFQ3175 )
Refusal
BOX HFP0 - (HFQ3175 )
4:05:20 PM Monday, August 03, 2009
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
BOX HFP0 - (HFQ3175 )
HFJ44 - EMOS ( HFQ3166 )
Page 326 of 760
HFJ44
Field2:
EMOS
( HFQ3166 )
HEST.EMOS
Cheshire Name:
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 HFP0 - (HFQ3175 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1
If response to HFJ44 - EMCODE only includes 91/Other, display
message "PROBE WHETHER PREVIOUSLY ENTERED
CONDITION WAS CAUSE FOR ELIGIBILITY. REENTER OR
SELECT PREVIOUS PAGE TO CORRECT".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:05:21 PM Monday, August 03, 2009
Page 327 of 760
BOX HFP0
BOX HFP0
Page Order # :
1750
BOX INSTRUCTIONS
( HFQ3175 )
IF THIS IS ROUND 55, GO TO BOX HFR1 - (HFQ3363 ).
ELSE GO TO HFPINTRO - HLTHCAREINTRO ( HFQ3182 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:05:21 PM Monday, August 03, 2009
Page 328 of 760
HFPINTRO
HFPINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
HLTHCAREINTRO
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
1760
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:
Now I want to ask you about some things that [you/(SP)] may be
doing to maintain (your/his/her) health, either by getting tested for
health problems or by taking care of conditions that (you have/she
has/he has).
Int. Instr II:
INPUT FIELDS / ROUTING
4:05:22 PM Monday, August 03, 2009
Page 329 of 760
HFPINTRO
HLTHCAREINTRO
Field1:
( HFQ3182 )
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
BOX HFP1A - (HFQ3186 )
English text: CONTINUE
Attribute
Empty
Route
BOX HFP1A - (HFQ3186 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:05:24 PM Monday, August 03, 2009
Page 330 of 760
BOX HFP1A
BOX HFP1A
Page Order # :
1765
BOX INSTRUCTIONS
( HFQ3186 )
IF (HFJ41A – OCBETES = 1/Yes) AND (HFJ41B - OCDTYPE = 1/TypeOne,
2/TypeTwo, 3/Borderline, 4/PreDiabetes, 91/Other, DK, or RF), GO TO HFP1
DIAAGE ( HFQ3189 ).
ELSE GO TO HFP21 - DIAEVERT ( HFQ3342 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:05:24 PM Monday, August 03, 2009
Page 331 of 760
HFP1
HFP1
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
DIAAGE
Field 2:
DIAAGE_LESSONE
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
1770
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:
If HFJ41B - OCDTYPE = 1/TypeOne, display "Type 1 diabetes".
Else if HFJ41B = 2/TypeTwo, display "Type 2 diabetes".
Else if HFJ41B = 3/Borderline, display "borderline diabetes".
Else if HFJ41B = 4/PreDiabetes, display "pre-diabetes".
Else display "diabetes".
Multi Field display:
Vertical Alignment
Display all input fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
I recorded that [you were/(SP) was] told by a doctor that (you
have/she has/he has) (Type 1 diabetes/Type 2 diabetes/borderline
diabetes/pre-diabetes/diabetes).
How old [were you/was (SP)] when (you were/he was/she was) first
4:05:26 PM Monday, August 03, 2009
Page 332 of 760
HFP1
told that (you/he/she) had diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
DIAAGE
Field1:
( HFQ3189 )
HEST.DIAAGE
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
AGE:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDiaage
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
Route
HFP1 - DIAAGE_LESSONE ( HFQ3192 )
Don't know
HFP1 - DIAAGE_LESSONE ( HFQ3192 )
Refusal
HFP1 - DIAAGE_LESSONE ( HFQ3192 )
4:05:30 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
1
997
Route
HFP1 - DIAAGE_LESSONE ( HFQ3192 )
Page 333 of 760
HFP1
DIAAGE_LESSONE
Field2:
( HFQ3192 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELD=
If HEST.DIAAGE_LESSONE = 1/LessThanOneYearOld, set
HEST.DIAAGE = 996.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TDiage996
1
No
No
Number Label
1 LessThanOneYearOld
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFP2 - (HFQ3198 )
English text: LESS THAN ONE YEAR OLD
Attribute
Empty
Route
BOX HFP2 - (HFQ3198 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1:
HFP1 - DIAAGE and HFP1 - DIAAGE_LESSONE cannot both be
EMPTY.
If not true, display message "PLEASE ENTER AGE OR SELECT
"LESS THAN ONE YEAR OLD". ".
Edit #2:
HFP1 - DIAAGE and HFP1 - DIAAGE_LESSONE cannot both be
FILLED.
If not true, display message "PLEASE ENTER AGE OR SELECT
"LESS THAN ONE YEAR OLD". ".
Edit #3:
HFP1 - DIAAGE = 1 - 100, DK, RF, or EMPTY.
If not true, display message "INVALID RESPONSE. ENTRY NOT IN
4:05:32 PM Monday, August 03, 2009
Page 334 of 760
HFP1
RANGE. PLEASE REENTER.".
TECHNICAL NOTES
DESIGN NOTES
4:05:32 PM Monday, August 03, 2009
Page 335 of 760
BOX HFP2
BOX HFP2
Page Order # :
1775
BOX INSTRUCTIONS
( HFQ3198 )
IF THE SP IS FEMALE AND (HFP1 – DIAAGE is >= 12 and is <= 45) OR
(HFP1 – DIAAGE = DK OR RF), GO TO HFP2 - DIAPRGNT ( HFQ3199 ).
ELSE GO TO HFP4 - DIAINSUL ( HFQ3202 ).
ASSIGNMENTS
TECHNICAL NOTES
5
SPMale
SP is male =
ROST.ROSTSEX=1/Male on ROST where
ROST.ROSTNUM='01'.
6
SPFemale
SP is female =
ROST.ROSTSEX=2/Female on ROST where
ROST.ROSTNUM='01'.
DESIGN NOTES
4:05:32 PM Monday, August 03, 2009
Page 336 of 760
HFP2
HFP2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIAPRGNT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1780
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:
Did [you/(SP)] have diabetes only during a pregnancy?
Int. Instr II:
INPUT FIELDS / ROUTING
4:05:34 PM Monday, August 03, 2009
Page 337 of 760
HFP2
DIAPRGNT
Field1:
( HFQ3199 )
HEST.DIAPRGNT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP21 - DIAEVERT ( HFQ3342 )
English text: YES
No
HFP4 - DIAINSUL ( HFQ3202 )
English text: NO
Attribute
Don't know
Route
HFP21 - DIAEVERT ( HFQ3342 )
Refusal
HFP21 - DIAEVERT ( HFQ3342 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:05:36 PM Monday, August 03, 2009
Page 338 of 760
HFP4
HFP4
Page Order # :
Design Screen Type:
List
Fields:
Field 1:
DIAINSUL
Field 2:
DIAMEDS
Field 3:
DIATEST
Field 6:
DIASORES
Field 8:
DIAPRESS
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
1785
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:
Please tell me whether (you use/SP uses) any of the following ways
to manage (your/his/her) diabetes. [Do you/Does (SP)]…
Int. Instr II:
4:05:39 PM Monday, August 03, 2009
Page 339 of 760
HFP4
INPUT FIELDS / ROUTING
DIAINSUL
Field1:
( HFQ3202 )
HEST.DIAINSUL
Cheshire Name:
Item Text display:
Display "a." in front of LIST item text.
Item Text:
take insulin?
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
HFP4 - DIAMEDS ( HFQ3206 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
HFP4 - DIAMEDS ( HFQ3206 )
Refusal
HFP4 - DIAMEDS ( HFQ3206 )
4:05:44 PM Monday, August 03, 2009
HFP4 - DIAMEDS ( HFQ3206 )
Page 340 of 760
HFP4
DIAMEDS
Field2:
( HFQ3206 )
HEST.DIAMEDS
Cheshire Name:
Item Text display:
Display "b." in front of LIST item text.
Item Text:
take prescription diabetes pills or oral diabetes medicine?
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
HFP4 - DIATEST ( HFQ3209 )
English text: YES
No
HFP4 - DIATEST ( HFQ3209 )
English text: NO
Attribute
Don't know
Route
HFP4 - DIATEST ( HFQ3209 )
Refusal
HFP4 - DIATEST ( HFQ3209 )
4:05:49 PM Monday, August 03, 2009
Page 341 of 760
HFP4
DIATEST
Field3:
( HFQ3209 )
HEST.DIATEST
Cheshire Name:
Item Text display:
Display "c." in front of LIST item text.
Item Text:
test (your/his/her) blood for sugar or glucose?
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
HFP4 - DIASORES ( HFQ3219 )
English text: YES
No
HFP4 - DIASORES ( HFQ3219 )
English text: NO
Attribute
Don't know
Route
HFP4 - DIASORES ( HFQ3219 )
Refusal
HFP4 - DIASORES ( HFQ3219 )
4:05:55 PM Monday, August 03, 2009
Page 342 of 760
HFP4
DIASORES
Field6:
( HFQ3219 )
HEST.DIASORES
Cheshire Name:
Item Text display:
Display "f." in front of LIST item text.
Item Text:
check for sores or irritations on (your/his/her) feet?
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
HFP4 - DIAPRESS ( HFQ3226 )
English text: YES
No
HFP4 - DIAPRESS ( HFQ3226 )
English text: NO
Attribute
Don't know
Route
HFP4 - DIAPRESS ( HFQ3226 )
Refusal
HFP4 - DIAPRESS ( HFQ3226 )
4:06:00 PM Monday, August 03, 2009
Page 343 of 760
HFP4
DIAPRESS
Field8:
( HFQ3226 )
HEST.DIAPRESS
Cheshire Name:
Item Text display:
Display "h." in front of LIST item text.
Item Text:
measure (your/his/her) blood pressure at home?
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 HFP3 - (HFQ3229 )
English text: YES
No
BOX HFP3 - (HFQ3229 )
English text: NO
Attribute
Don't know
Route
BOX HFP3 - (HFQ3229 )
Refusal
BOX HFP3 - (HFQ3229 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:06:02 PM Monday, August 03, 2009
Page 344 of 760
BOX HFP3
BOX HFP3
Page Order # :
1790
BOX INSTRUCTIONS
( HFQ3229 )
IF HFP4 - DIAINSUL = 1/Yes, GO TO HFP5 - INSUTAKE ( HFQ3232 ).
ELSE IF HFP4 - DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE ( HFQ3246 ).
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE ( HFQ3262 ).
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK ( HFQ3282
).
ELSE GO TO HFP10 - DIATENYR ( HFQ3299 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:06:02 PM Monday, August 03, 2009
Page 345 of 760
HFP5
HFP5
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
INSUTAKE
Field 2:
INSUDAY
Field 3:
INSUWEEK
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
1795
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:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How often [do you/does (SP)] take insulin?
Int. Instr II:
INPUT FIELDS / ROUTING
4:06:04 PM Monday, August 03, 2009
Page 346 of 760
HFP5
INSUTAKE
Field1:
( HFQ3232 )
HEST.INSUTAKE
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
TInsutak
1
No
No
Number Label
1 NumberPerDay
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP5 - INSUDAY ( HFQ3236 )
2
English text: NUMBER OF TIMES PER DAY
NumberPerWeek
3
English text: NUMBER OF TIMES PER WEEK
UseInsulinPump
BOX HFP4 - (HFQ3242 )
HFP5 - INSUWEEK ( HFQ3239 )
English text: USE INSULIN PUMP
Attribute
Don't know
Route
BOX HFP4 - (HFQ3242 )
Refusal
BOX HFP4 - (HFQ3242 )
4:06:09 PM Monday, August 03, 2009
Page 347 of 760
HFP5
Field2:
INSUDAY
( HFQ3236 )
HEST.INSUDAY
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER DAY:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFDay
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
Field3:
INSUWEEK
1
100
Route
BOX HFP4 - (HFQ3242 )
( HFQ3239 )
HEST.INSUWEEK
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER WEEK:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFWeek
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
1000
Route
BOX HFP4 - (HFQ3242 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
4:06:11 PM Monday, August 03, 2009
Page 348 of 760
HFP5
HFP5 - INSUDAY = 1 - 10.
If not true, display message "NUMBER OF TIMES PER DAY
SEEMS UNLIKELY. PLEASE VERIFY.".
Edit #2:
HFP5 - INSUWEEK = 1 - 100.
If not true, display message "NUMBER OF TIMES PER WEEK
SEEMS UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:06:11 PM Monday, August 03, 2009
Page 349 of 760
BOX HFP4
BOX HFP4
Page Order # :
1800
BOX INSTRUCTIONS
( HFQ3242 )
IF HFP4 – DIAMEDS = 1/Yes, GO TO HFP6 - MEDSTAKE ( HFQ3246 ).
ELSE IF HFP4 - DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE ( HFQ3262 ).
ELSE IF HFP4 - DIASORES = 1/Yes, GO TO HFP8 - SORECHEK ( HFQ3282
).
ELSE GO TO HFP10 - DIATENYR ( HFQ3299 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:06:11 PM Monday, August 03, 2009
Page 350 of 760
HFP6
HFP6
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
MEDSTAKE
Field 2:
MEDDAY
Field 3:
MEDWEEK
Field 4:
MEDMONTH
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
1805
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:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How often [do you/does (SP)] take prescription diabetes pills or oral
diabetes medicine?
Int. Instr II:
INPUT FIELDS / ROUTING
4:06:13 PM Monday, August 03, 2009
Page 351 of 760
HFP6
MEDSTAKE
Field1:
( HFQ3246 )
HEST.MEDSTAKE
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
TMedstak
1
No
No
Number Label
1 NumberPerDay
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP6 - MEDDAY ( HFQ3249 )
2
English text: NUMBER OF TIMES PER DAY
NumberPerWeek
3
English text: NUMBER OF TIMES PER WEEK
NumberPerMonth
HFP6 - MEDMONTH ( HFQ3256 )
HFP6 - MEDWEEK ( HFQ3252 )
English text: NUMBER OF TIMES PER MONTH
Attribute
Don't know
Route
BOX HFP5 - (HFQ3259 )
Refusal
BOX HFP5 - (HFQ3259 )
4:06:17 PM Monday, August 03, 2009
Page 352 of 760
HFP6
Field2:
MEDDAY
( HFQ3249 )
HEST.MEDDAY
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER DAY:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFDay
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
Field3:
MEDWEEK
1
100
Route
BOX HFP5 - (HFQ3259 )
( HFQ3252 )
HEST.MEDWEEK
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER WEEK:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFWeek
1
No
No
Number Label
1 [Continuous answer.]
4:06:20 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
1
1000
Route
BOX HFP5 - (HFQ3259 )
Page 353 of 760
HFP6
Field4:
MEDMONTH
( HFQ3256 )
HEST.MEDMONTH
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER MONTH:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFMonth
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
1000
Route
BOX HFP5 - (HFQ3259 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
HFP6 - MEDDAY = 1 - 10.
If not true, display message "NUMBER OF TIMES PER DAY
SEEMS UNLIKELY. PLEASE VERIFY.".
Edit #2:
HFP6 - MEDWEEK = 1 - 100.
If not true, display message "NUMBER OF TIMES PER WEEK
SEEMS UNLIKELY. PLEASE VERIFY.".
Edit #3:
HFP6 - MEDMONTH = 1 - 500.
If not true, display message "NUMBER OF TIMES PER MONTH
SEEMS UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:06:20 PM Monday, August 03, 2009
Page 354 of 760
BOX HFP5
BOX HFP5
Page Order # :
1810
BOX INSTRUCTIONS
( HFQ3259 )
IF HFP4 – DIATEST = 1/Yes, GO TO HFP7 - TESTTAKE ( HFQ3262 ).
ELSE IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK (
HFQ3282 ).
ELSE GO TO HFP10 - DIATENYR ( HFQ3299 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:06:20 PM Monday, August 03, 2009
Page 355 of 760
HFP7
HFP7
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
TESTTAKE
Field 2:
TESTDAY
Field 3:
TESTWEEK
Field 4:
TESTMNTH
Field 5:
TESTYEAR
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
1815
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:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How often [do you/does (SP)] test (your/his/her) blood for sugar or
glucose?
[PROBE: Include times when it is tested by a family member or
friend, but do not include times when it is tested by a health
4:06:23 PM Monday, August 03, 2009
Page 356 of 760
HFP7
professional.]
Int. Instr II:
INPUT FIELDS / ROUTING
TESTTAKE
Field1:
( HFQ3262 )
HEST.TESTTAKE
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
TTesttak
1
No
No
Number Label
1 NumberPerDay
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP7 - TESTDAY ( HFQ3266 )
2
English text: NUMBER OF TIMES PER DAY
NumberPerWeek
3
English text: NUMBER OF TIMES PER WEEK
NumberPerMonth
HFP7 - TESTMNTH ( HFQ3272 )
4
English text: NUMBER OF TIMES PER MONTH
NumberPerYear
HFP7 - TESTYEAR ( HFQ3276 )
HFP7 - TESTWEEK ( HFQ3269 )
English text: NUMBER OF TIMES PER YEAR
Attribute
Don't know
Route
BOX HFP6 - (HFQ3279 )
Refusal
BOX HFP6 - (HFQ3279 )
4:06:27 PM Monday, August 03, 2009
Page 357 of 760
HFP7
Field2:
TESTDAY
( HFQ3266 )
HEST.TESTDAY
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER DAY:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFDay
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
Field3:
TESTWEEK
1
100
Route
BOX HFP6 - (HFQ3279 )
( HFQ3269 )
HEST.TESTWEEK
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER WEEK:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFWeek
1
No
No
Number Label
1 [Continuous answer.]
4:06:30 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
1
1000
Route
BOX HFP6 - (HFQ3279 )
Page 358 of 760
HFP7
Field4:
TESTMNTH
( HFQ3272 )
HEST.TESTMONTH
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER MONTH:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFMonth
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
Field5:
TESTYEAR
1
1000
Route
BOX HFP6 - (HFQ3279 )
( HFQ3276 )
HEST.TESTYEAR
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER YEAR:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFYear
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
10000
Route
BOX HFP6 - (HFQ3279 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
4:06:32 PM Monday, August 03, 2009
Page 359 of 760
HFP7
HFP7 - TESTDAY = 1 - 10.
If not true, display message "NUMBER OF TIMES PER DAY
SEEMS UNLIKELY. PLEASE VERIFY.".
Edit #2:
HFP7 - TESTWEEK = 1 - 100.
If not true, display message "NUMBER OF TIMES PER WEEK
SEEMS UNLIKELY. PLEASE VERIFY.".
Edit #3:
HFP7 - TESTMNTH = 1 - 500.
If not true, display message "NUMBER OF TIMES PER MONTH
SEEMS UNLIKELY. PLEASE VERIFY.".
Edit #4:
HFP7 - TESTYEAR = 1 - 5000.
If not true, display message "NUMBER OF TIMES PER YEAR
SEEMS UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:06:32 PM Monday, August 03, 2009
Page 360 of 760
BOX HFP6
BOX HFP6
Page Order # :
1820
BOX INSTRUCTIONS
( HFQ3279 )
IF HFP4 – DIASORES = 1/Yes, GO TO HFP8 - SORECHEK ( HFQ3282 ).
ELSE GO TO HFP10 - DIATENYR ( HFQ3299 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:06:32 PM Monday, August 03, 2009
Page 361 of 760
HFP8
HFP8
Page Order # :
Design Screen Type:
Quantity Unit
Fields:
Field 1:
SORECHEK
Field 2:
SOREDAY
Field 3:
SOREWEEK
Field 4:
SOREMNTH
Field 5:
SOREYEAR
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
1825
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:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How often [do you/does (SP)] check (your/his/her) feet for sores or
irritations?
[PROBE: Include times when they are checked by a family member
or friend, but do not include times when they are checked by a
4:06:34 PM Monday, August 03, 2009
Page 362 of 760
HFP8
health professional.]
Int. Instr II:
INPUT FIELDS / ROUTING
SORECHEK
Field1:
( HFQ3282 )
HEST.SORECHEK
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
TTesttak
1
No
No
Number Label
1 NumberPerDay
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP8 - SOREDAY ( HFQ3286 )
2
English text: NUMBER OF TIMES PER DAY
NumberPerWeek
3
English text: NUMBER OF TIMES PER WEEK
NumberPerMonth
HFP8 - SOREMNTH ( HFQ3292 )
4
English text: NUMBER OF TIMES PER MONTH
NumberPerYear
HFP8 - SOREYEAR ( HFQ3296 )
HFP8 - SOREWEEK ( HFQ3289 )
English text: NUMBER OF TIMES PER YEAR
Attribute
Don't know
Route
HFP10 - DIATENYR ( HFQ3299 )
Refusal
HFP10 - DIATENYR ( HFQ3299 )
4:06:39 PM Monday, August 03, 2009
Page 363 of 760
HFP8
Field2:
SOREDAY
( HFQ3286 )
HEST.SOREDAY
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER DAY:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFDay
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
Field3:
SOREWEEK
1
100
Route
HFP10 - DIATENYR ( HFQ3299 )
( HFQ3289 )
HEST.SOREWEEK
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER WEEK:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFWeek
1
No
No
Number Label
1 [Continuous answer.]
4:06:42 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
1
1000
Route
HFP10 - DIATENYR ( HFQ3299 )
Page 364 of 760
HFP8
Field4:
SOREMNTH
( HFQ3292 )
HEST.SOREMNTH
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER MONTH:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFMonth
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
Field5:
SOREYEAR
1
1000
Route
HFP10 - DIATENYR ( HFQ3299 )
( HFQ3296 )
HEST.SOREYEAR
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES PER YEAR:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THFYear
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
1
10000
Route
HFP10 - DIATENYR ( HFQ3299 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
4:06:44 PM Monday, August 03, 2009
Page 365 of 760
HFP8
HFP8 - SOREDAY = 1 - 10.
If not true, display message "NUMBER OF TIMES PER DAY
SEEMS UNLIKELY. PLEASE VERIFY.".
Edit #2:
HFP8 - SOREWEEK = 1 - 100.
If not true, display message "NUMBER OF TIMES PER WEEK
SEEMS UNLIKELY. PLEASE VERIFY.".
Edit #3:
HFP8 - SOREMNTH = 1 - 500.
If not true, display message "NUMBER OF TIMES PER MONTH
SEEMS UNLIKELY. PLEASE VERIFY.".
Edit #4:
HFP8 - SOREYEAR = 1 - 5000.
If not true, display message "NUMBER OF TIMES PER YEAR
SEEMS UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:06:44 PM Monday, August 03, 2009
Page 366 of 760
HFP10
HFP10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIATENYR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1830
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:
In the past year has a doctor or other medical professional examined
(your/his/her) feet for sores or irritations?
Int. Instr II:
INPUT FIELDS / ROUTING
4:06:45 PM Monday, August 03, 2009
Page 367 of 760
HFP10
DIATENYR
Field1:
( HFQ3299 )
HEST.DIATENYR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP11 - DIADRSAW ( HFQ3302 )
English text: YES
No
HFP11 - DIADRSAW ( HFQ3302 )
English text: NO
Attribute
Don't know
Route
HFP11 - DIADRSAW ( HFQ3302 )
Refusal
HFP11 - DIADRSAW ( HFQ3302 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:06:47 PM Monday, August 03, 2009
Page 368 of 760
HFP11
HFP11
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
DIADRSAW
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1835
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:
About how many times in the past year [have you/has (SP)] seen a
doctor or other health professional for (your/his/her) diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:06:48 PM Monday, August 03, 2009
Page 369 of 760
HFP11
DIADRSAW
Field1:
( HFQ3302 )
HEST.DIADRSAW
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDiadrsaw
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HFP13 - DIAHEMOC ( HFQ3309 )
Refusal
HFP13 - DIAHEMOC ( HFQ3309 )
FieldSize:
Min Value:
Max Value:
Mask:
0
200
Route
HFP13 - DIAHEMOC ( HFQ3309 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
HFP11 - DIADRSAW = 1 - 100.
If not true, display message "NUMBER OF TIMES SEEMS
UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:06:50 PM Monday, August 03, 2009
Page 370 of 760
HFP13
HFP13
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
DIAHEMOC
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1845
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:
A test of hemoglobin "A one C" measures the average level of blood
sugar over the past three months. It is usually done in a doctor's
office. About how many times in the past year has a doctor or other
health professional checked [you/(SP)] for hemoglobin "A one C"?
Int. Instr II:
INPUT FIELDS / ROUTING
4:06:50 PM Monday, August 03, 2009
Page 371 of 760
HFP13
DIAHEMOC
Field1:
( HFQ3309 )
HEST.DIAHEMOC
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDiahemo
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HFP14 - DIACTRLD ( HFQ3312 )
Refusal
HFP14 - DIACTRLD ( HFQ3312 )
FieldSize:
Min Value:
Max Value:
Mask:
0
200
Route
HFP14 - DIACTRLD ( HFQ3312 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1:
HFP13 - DIAHEMOC = 1 - 100.
If not true, display message "NUMBER OF TIMES SEEMS
UNLIKELY. PLEASE VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:06:52 PM Monday, August 03, 2009
Page 372 of 760
HFP14
HFP14
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DIACTRLD
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1850
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:
SHOW CARD HF4
Question Text:
Would you say that [your/(SP's)] blood sugar is well controlled all of
the time, most of the time, some of the time, a little of the time, or
none of the time? By "well controlled" we mean a recent hemoglobin
"A one C" result of 7.5 or less or an average fasting blood test of 140
or less.
Int. Instr II:
INPUT FIELDS / ROUTING
4:06:54 PM Monday, August 03, 2009
Page 373 of 760
HFP14
DIACTRLD
Field1:
( HFQ3312 )
HEST.DIACTRLD
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
TDiactrl
1
No
No
Number Label
1 AllOfTheTime
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP14A - DIAFEET ( HFQ3316 )
2
English text: ALL OF THE TIME
MostOfTheTime
HFP14A - DIAFEET ( HFQ3316 )
3
English text: MOST OF THE TIME
SomeOfTheTime
HFP14A - DIAFEET ( HFQ3316 )
4
English text: SOME OF THE TIME
ALittleOfTheTime
HFP14A - DIAFEET ( HFQ3316 )
5
English text: A LITTLE OF THE TIME
NoneOfTheTime
HFP14A - DIAFEET ( HFQ3316 )
English text: NONE OF THE TIME
Attribute
Don't know
Route
HFP14A - DIAFEET ( HFQ3316 )
Refusal
HFP14A - DIAFEET ( HFQ3316 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:06:58 PM Monday, August 03, 2009
Page 374 of 760
HFP14
DESIGN NOTES
4:06:58 PM Monday, August 03, 2009
Page 375 of 760
HFP14A
HFP14A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIAFEET
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1855
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:
[Do you/Does (SP)] have any problems with (your/his/her) feet as a
result of (your/his/her) diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:00 PM Monday, August 03, 2009
Page 376 of 760
HFP14A
DIAFEET
Field1:
( HFQ3316 )
HEST.DIAFEET
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP15 - DIAEYPRB ( HFQ3319 )
English text: YES
No
HFP15 - DIAEYPRB ( HFQ3319 )
English text: NO
Attribute
Don't know
Route
HFP15 - DIAEYPRB ( HFQ3319 )
Refusal
HFP15 - DIAEYPRB ( HFQ3319 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:02 PM Monday, August 03, 2009
Page 377 of 760
HFP15
HFP15
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIAEYPRB
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1860
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:
[Do you/Does (SP)] have any problems with (your/his/her) eyes as a
result of (your/his/her) diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:03 PM Monday, August 03, 2009
Page 378 of 760
HFP15
DIAEYPRB
Field1:
( HFQ3319 )
HEST.DIAEYPRB
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP16 - DIAKDPRB ( HFQ3322 )
English text: YES
No
HFP16 - DIAKDPRB ( HFQ3322 )
English text: NO
Attribute
Don't know
Route
HFP16 - DIAKDPRB ( HFQ3322 )
Refusal
HFP16 - DIAKDPRB ( HFQ3322 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:05 PM Monday, August 03, 2009
Page 379 of 760
HFP16
HFP16
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIAKDPRB
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1865
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:
[Do you/Does (SP)] have any problems with (your/his/her) kidneys
as a result of (your/his/her) diabetes?
[EXPLAIN IF NECESSARY: This is tested by looking for protein in
the urine.]
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:07 PM Monday, August 03, 2009
Page 380 of 760
HFP16
DIAKDPRB
Field1:
( HFQ3322 )
HEST.DIAKDPRB
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP17 - DIAMNGE ( HFQ3326 )
English text: YES
No
HFP17 - DIAMNGE ( HFQ3326 )
English text: NO
Attribute
Don't know
Route
HFP17 - DIAMNGE ( HFQ3326 )
Refusal
HFP17 - DIAMNGE ( HFQ3326 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:09 PM Monday, August 03, 2009
Page 381 of 760
HFP17
HFP17
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIAMNGE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1870
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:
[Have you/Has (SP)] ever participated in a diabetes selfmanagement course or class, or received special training on how
(you/he/she) can manage (your/his/her) diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:10 PM Monday, August 03, 2009
Page 382 of 760
HFP17
DIAMNGE
Field1:
( HFQ3326 )
HEST.DIAMNGE
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP18 - DIATRAIN ( HFQ3329 )
English text: YES
No
BOX HFP7 - (HFQ3332 )
English text: NO
Attribute
Don't know
Route
BOX HFP7 - (HFQ3332 )
Refusal
BOX HFP7 - (HFQ3332 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:13 PM Monday, August 03, 2009
Page 383 of 760
HFP18
HFP18
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DIATRAIN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1875
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:
When was the most recent time that [you/(SP)] participated in a
diabetes self-management course or class or received special
training on how (you/he/she) can manage (your/his/her) diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:15 PM Monday, August 03, 2009
Page 384 of 760
HFP18
DIATRAIN
Field1:
( HFQ3329 )
HEST.DIATRAIN
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
TYearAgoDKRF
1
No
No
Number Label
1 LessThanOneYear
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFP7 - (HFQ3332 )
2
English text: LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears
3
English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanThreeYears
BOX HFP7 - (HFQ3332 )
4
English text: 2 YEARS TO LESS THAN 3 YEARS AGO
ThreeYearsToLessThanFiveYears
BOX HFP7 - (HFQ3332 )
5
English text: 3 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
BOX HFP7 - (HFQ3332 )
BOX HFP7 - (HFQ3332 )
English text: 5 OR MORE YEARS AGO
Attribute
Don't know
Route
BOX HFP7 - (HFQ3332 )
Refusal
BOX HFP7 - (HFQ3332 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:07:21 PM Monday, August 03, 2009
Page 385 of 760
HFP18
DESIGN NOTES
4:07:21 PM Monday, August 03, 2009
Page 386 of 760
BOX HFP7
BOX HFP7
Page Order # :
1880
BOX INSTRUCTIONS
( HFQ3332 )
IF THE SP IS THE RESPONDENT, GO TO HFP19 - DIAKNOW ( HFQ3336 ).
ELSE GO TO BOX HFS1 - (HFQ3410 ).
ASSIGNMENTS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
4:07:21 PM Monday, August 03, 2009
Page 387 of 760
HFP19
HFP19
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DIAKNOW
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1885
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:
SHOW CARD HF3
Question Text:
How much do you think you know about managing your diabetes?
Do you know . . .
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:23 PM Monday, August 03, 2009
Page 388 of 760
HFP19
DIAKNOW
Field1:
( HFQ3336 )
HEST.DIAKNOW
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
TDiaknow
1
No
No
Number Label
1 EverythingNeedToKnow
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP20 - DIASUPPS ( HFQ3339 )
2
English text: just about everything you need to know,
MostNeedToKnow
HFP20 - DIASUPPS ( HFQ3339 )
3
English text: most of what you need to know,
SomeNeedToKnow
HFP20 - DIASUPPS ( HFQ3339 )
4
English text: some of what you need to know,
AlittleNeedToKnow
HFP20 - DIASUPPS ( HFQ3339 )
5
English text: a little of what you need to know, or
NoneNeedToKnow
HFP20 - DIASUPPS ( HFQ3339 )
English text: almost none of what you need to know about managing your diabetes?
Attribute
Don't know
Route
HFP20 - DIASUPPS ( HFQ3339 )
Refusal
HFP20 - DIASUPPS ( HFQ3339 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:07:27 PM Monday, August 03, 2009
Page 389 of 760
HFP19
DESIGN NOTES
4:07:27 PM Monday, August 03, 2009
Page 390 of 760
HFP20
HFP20
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIASUPPS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1890
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:
Before today, did you know that Medicare now helps pay the cost of
diabetic testing supplies and self-management education for people
with diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:29 PM Monday, August 03, 2009
Page 391 of 760
HFP20
DIASUPPS
Field1:
( HFQ3339 )
HEST.DIASUPPS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFS1 - (HFQ3410 )
English text: YES
No
BOX HFS1 - (HFQ3410 )
English text: NO
Attribute
Don't know
Route
BOX HFS1 - (HFQ3410 )
Refusal
BOX HFS1 - (HFQ3410 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:31 PM Monday, August 03, 2009
Page 392 of 760
HFP21
HFP21
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIAEVERT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1895
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:
HFJ41A - OCBETES = 2/No, display first sentence.
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[I have recorded that [you have/(SP) has] never been told by a
doctor that (you have/she has/he has) diabetes.]
[Have you/Has (SP)] ever had a blood test to see if (you have/she
has/he has) diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:32 PM Monday, August 03, 2009
Page 393 of 760
HFP21
DIAEVERT
Field1:
HEST.DIAEVERT
Cheshire Name:
Item Text display:
( HFQ3342 )
Do not display response option 3/SPHasDiabetes.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TDiaEvert
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP22 - DIARECNT ( HFQ3346 )
2
English text: YES
No
3
English text: NO
SPHasDiabetes
BOX HFP8 - (HFQ3349 )
DO NOT DISPLAY.
DATA EDITING ONLY.
Attribute
Don't know
Route
BOX HFP8 - (HFQ3349 )
Refusal
BOX HFP8 - (HFQ3349 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:34 PM Monday, August 03, 2009
Page 394 of 760
HFP22
HFP22
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DIARECNT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1900
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:
When was the most recent time [you were/(SP) was] tested for
diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:36 PM Monday, August 03, 2009
Page 395 of 760
HFP22
DIARECNT
Field1:
( HFQ3346 )
HEST.DIARECNT
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
TYearAgoDKRF
1
No
No
Number Label
1 LessThanOneYear
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP24 - DIARISK ( HFQ3356 )
2
English text: LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears
3
English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanThreeYears
HFP24 - DIARISK ( HFQ3356 )
4
English text: 2 YEARS TO LESS THAN 3 YEARS AGO
ThreeYearsToLessThanFiveYears
HFP24 - DIARISK ( HFQ3356 )
5
English text: 3 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
HFP24 - DIARISK ( HFQ3356 )
HFP24 - DIARISK ( HFQ3356 )
English text: 5 OR MORE YEARS AGO
Attribute
Don't know
Route
HFP24 - DIARISK ( HFQ3356 )
Refusal
HFP24 - DIARISK ( HFQ3356 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:07:41 PM Monday, August 03, 2009
Page 396 of 760
HFP22
DESIGN NOTES
4:07:41 PM Monday, August 03, 2009
Page 397 of 760
BOX HFP8
BOX HFP8
Page Order # :
1905
BOX INSTRUCTIONS
( HFQ3349 )
IF THE SP IS THE RESPONDENT, GO TO HFP23 - DIAAWARE ( HFQ3352
).
ELSE GO TO HFP24 - DIARISK ( HFQ3356 ).
ASSIGNMENTS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
4:07:41 PM Monday, August 03, 2009
Page 398 of 760
HFP23
HFP23
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIAAWARE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1910
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:
Before today, were you aware that there is a blood test to determine
if a person has diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:42 PM Monday, August 03, 2009
Page 399 of 760
HFP23
DIAAWARE
Field1:
( HFQ3352 )
HEST.DIAAWARE
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP24 - DIARISK ( HFQ3356 )
English text: YES
No
HFP24 - DIARISK ( HFQ3356 )
English text: NO
Attribute
Don't know
Route
HFP24 - DIARISK ( HFQ3356 )
Refusal
HFP24 - DIARISK ( HFQ3356 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:44 PM Monday, August 03, 2009
Page 400 of 760
HFP24
HFP24
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIARISK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1915
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:
Has a doctor or other health professional ever told [you/(SP)] that
(you are/he is/she is) at high risk for diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:46 PM Monday, August 03, 2009
Page 401 of 760
HFP24
DIARISK
Field1:
( HFQ3356 )
HEST.DIARISK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFP25 - DIASIGNS ( HFQ3359 )
English text: YES
No
HFP25 - DIASIGNS ( HFQ3359 )
English text: NO
Attribute
Don't know
Route
HFP25 - DIASIGNS ( HFQ3359 )
Refusal
HFP25 - DIASIGNS ( HFQ3359 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:48 PM Monday, August 03, 2009
Page 402 of 760
HFP25
HFP25
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DIASIGNS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1920
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:
In the past year, [have you/has (SP)] received any information about
the signs, symptoms, or risk factors for diabetes?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:49 PM Monday, August 03, 2009
Page 403 of 760
HFP25
DIASIGNS
Field1:
( HFQ3359 )
HEST.DIASIGNS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFR1 - (HFQ3363 )
English text: YES
No
BOX HFR1 - (HFQ3363 )
English text: NO
Attribute
Don't know
Route
BOX HFR1 - (HFQ3363 )
Refusal
BOX HFR1 - (HFQ3363 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:52 PM Monday, August 03, 2009
Page 404 of 760
BOX HFR1
BOX HFR1
Page Order # :
1922
BOX INSTRUCTIONS
( HFQ3363 )
IF (SP HAS EVER HEARD ABOUT COLORECTAL OR COLON CANCER IS
UNKNOWN) AND (SP HAS NOT REPORTED HAVING COLON, RECTAL OR
BOWEL CANCER IN THE CURRENT ROUND OR IN A PREVIOUS ROUND),
GO TO HFR1 - COLHEAR ( HFQ3367 ).
ELSE GO TO BOX HFS0 - (HFQ3408 ).
ASSIGNMENTS
TECHNICAL NOTES
447
SPEverHrdColonCUnkn
SP has ever heard about colorectal or colon cancer is
unknown = There is no HEST wshere HEST.HESTRND
< current round and HEST.COLHEAR ^= EMPTY.
448
SPNotRepColonCCurPr
ev
SP has not reported having colon, rectal, or bowel cancer
in the current round or in a previous round = There is no
HEST where HEST.HESTRND <= current round and
HEST.OCCCODE includes 2/Colon.
DESIGN NOTES
4:07:52 PM Monday, August 03, 2009
Page 405 of 760
HFR1
HFR1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COLHEAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1924
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:
Now I'd like to talk about a different illness, colorectal or colon
cancer, a disease of the lower intestines.
Before today, had you ever heard of colorectal or colon cancer?
Int. Instr II:
INPUT FIELDS / ROUTING
4:07:53 PM Monday, August 03, 2009
Page 406 of 760
HFR1
COLHEAR
Field1:
( HFQ3367 )
HEST.COLHEAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFR3 - COLHTEST ( HFQ3371 )
English text: YES
No
HFR3 - COLHTEST ( HFQ3371 )
English text: NO
Attribute
Don't know
Route
HFR3 - COLHTEST ( HFQ3371 )
Refusal
HFR3 - COLHTEST ( HFQ3371 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:55 PM Monday, August 03, 2009
Page 407 of 760
HFR3
HFR3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COLHTEST
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1926
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 fecal occult blood test is a simple test for early signs of colon
cancer. It detects invisible traces of blood found in the stool. The
doctor or other health professional can give the patient a kit to
collect stool samples at the patient's home. The test is then sent to a
laboratory for the results to be determined.
Has a doctor or other health professional ever given [you/(SP)] a
home testing kit to test for blood in the stool?
Int. Instr II:
4:07:57 PM Monday, August 03, 2009
Page 408 of 760
HFR3
INPUT FIELDS / ROUTING
COLHTEST
Field1:
( HFQ3371 )
HEST.COLHTEST
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFR5 - COLCARD ( HFQ3379 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
HFR4 - COLHKIT ( HFQ3375 )
Refusal
HFR4 - COLHKIT ( HFQ3375 )
HFR4 - COLHKIT ( HFQ3375 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:07:59 PM Monday, August 03, 2009
Page 409 of 760
HFR4
HFR4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COLHKIT
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1928
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 ever heard of this home testing kit?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:00 PM Monday, August 03, 2009
Page 410 of 760
HFR4
COLHKIT
Field1:
( HFQ3375 )
HEST.COLHKIT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFR8 - COLSCOPY ( HFQ3387 )
English text: YES
No
HFR8 - COLSCOPY ( HFQ3387 )
English text: NO
Attribute
Don't know
Route
HFR8 - COLSCOPY ( HFQ3387 )
Refusal
HFR8 - COLSCOPY ( HFQ3387 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:02 PM Monday, August 03, 2009
Page 411 of 760
HFR5
HFR5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COLCARD
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1930
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)] complete the samples and send the card in for
(your/his/her) most recent test?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:04 PM Monday, August 03, 2009
Page 412 of 760
HFR5
COLCARD
Field1:
( HFQ3379 )
HEST.COLCARD
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFR7 - COLRECNT ( HFQ3383 )
English text: YES
No
HFR7 - COLRECNT ( HFQ3383 )
English text: NO
Attribute
Don't know
Route
HFR7 - COLRECNT ( HFQ3383 )
Refusal
HFR7 - COLRECNT ( HFQ3383 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:06 PM Monday, August 03, 2009
Page 413 of 760
HFR7
HFR7
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
COLRECNT
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1932
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:
When did [you/(SP)] have (your/his/her) most recent blood stool test
using a home testing kit?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:08 PM Monday, August 03, 2009
Page 414 of 760
HFR7
COLRECNT
Field1:
( HFQ3383 )
HEST.COLRECNT
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
TYearago
1
No
No
Number Label
1 LessThan1YearAgo
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFR8 - COLSCOPY ( HFQ3387 )
2
English text: LESS THAN 1 YEAR AGO
1YearToLessThan2YearsAgo
3
English text: 1 YEAR TO LESS THAN 2 YEARS AGO
2YearsToLessThan3YearsAgo
HFR8 - COLSCOPY ( HFQ3387 )
4
English text: 2 YEARS TO LESS THAN 3 YEARS AGO
3YearsToLessThan5YearsAgo
HFR8 - COLSCOPY ( HFQ3387 )
5
English text: 3 YEARS TO LESS THAN 5 YEARS AGO
5OrMoreYearsAgo
HFR8 - COLSCOPY ( HFQ3387 )
HFR8 - COLSCOPY ( HFQ3387 )
English text: 5 OR MORE YEARS AGO
Attribute
Don't know
Route
HFR8 - COLSCOPY ( HFQ3387 )
Refusal
HFR8 - COLSCOPY ( HFQ3387 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:08:12 PM Monday, August 03, 2009
Page 415 of 760
HFR7
DESIGN NOTES
4:08:12 PM Monday, August 03, 2009
Page 416 of 760
HFR8
HFR8
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COLSCOPY
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1934
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:
Another test for early signs of colon cancer is performed in the
doctor's office. The doctor uses a flexible lighted tube to examine the
colon and rectum directly. This is called a sigmoidoscopy or
colonoscopy.
[Have you/Has (SP)] ever had this exam?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:14 PM Monday, August 03, 2009
Page 417 of 760
HFR8
COLSCOPY
Field1:
( HFQ3387 )
HEST.COLSCOPY
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFR9 - WHENSCOP ( HFQ3391 )
English text: YES
No
HFR10 - HEARSCOP ( HFQ3395 )
English text: NO
Attribute
Don't know
Route
HFR10 - HEARSCOP ( HFQ3395 )
Refusal
HFR10 - HEARSCOP ( HFQ3395 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:16 PM Monday, August 03, 2009
Page 418 of 760
HFR9
HFR9
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
WHENSCOP
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
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Edit Item
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No
No
No
No
Grid Functions:
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No
No
1936
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:
When did [you/(SP)] have (your/his/her) most recent sigmoidoscopy
or colonoscopy?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:18 PM Monday, August 03, 2009
Page 419 of 760
HFR9
WHENSCOP
Field1:
( HFQ3391 )
HEST.WHENSCOP
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
TYearago
1
No
No
Number Label
1 LessThan1YearAgo
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFR13 - COLSCRNS ( HFQ3406 )
2
English text: LESS THAN 1 YEAR AGO
1YearToLessThan2YearsAgo
3
English text: 1 YEAR TO LESS THAN 2 YEARS AGO
2YearsToLessThan3YearsAgo
HFR13 - COLSCRNS ( HFQ3406 )
4
English text: 2 YEARS TO LESS THAN 3 YEARS AGO
3YearsToLessThan5YearsAgo
HFR13 - COLSCRNS ( HFQ3406 )
5
English text: 3 YEARS TO LESS THAN 5 YEARS AGO
5OrMoreYearsAgo
HFR13 - COLSCRNS ( HFQ3406 )
HFR13 - COLSCRNS ( HFQ3406 )
English text: 5 OR MORE YEARS AGO
Attribute
Don't know
Route
HFR13 - COLSCRNS ( HFQ3406 )
Refusal
HFR13 - COLSCRNS ( HFQ3406 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:08:22 PM Monday, August 03, 2009
Page 420 of 760
HFR9
DESIGN NOTES
4:08:22 PM Monday, August 03, 2009
Page 421 of 760
HFR10
HFR10
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HEARSCOP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1938
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:
Before today, had you ever heard of a sigmoidoscopy or
colonoscopy?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:24 PM Monday, August 03, 2009
Page 422 of 760
HFR10
HEARSCOP
Field1:
( HFQ3395 )
HEST.HEARSCOP
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFR11 - COLDRREC ( HFQ3403 )
English text: YES
No
BOX HFR2 - (HFQ3399 )
English text: NO
Attribute
Don't know
Route
BOX HFR2 - (HFQ3399 )
Refusal
BOX HFR2 - (HFQ3399 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:26 PM Monday, August 03, 2009
Page 423 of 760
BOX HFR2
BOX HFR2
Page Order # :
1940
BOX INSTRUCTIONS
( HFQ3399 )
IF HFR3 - COLHTEST = 1/Yes or HFR4 - COLHKIT = 1/Yes, GO TO HFR13
COLSCRNS ( HFQ3406 ).
ELSE GO TO BOX HFS0 - (HFQ3408 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:08:26 PM Monday, August 03, 2009
Page 424 of 760
HFR11
HFR11
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COLDRREC
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1942
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:
Has a doctor ever recommended that [you/(SP)] have this test?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:27 PM Monday, August 03, 2009
Page 425 of 760
HFR11
COLDRREC
Field1:
( HFQ3403 )
HEST.COLDRREC
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFR13 - COLSCRNS ( HFQ3406 )
English text: YES
No
HFR13 - COLSCRNS ( HFQ3406 )
English text: NO
Attribute
Don't know
Route
HFR13 - COLSCRNS ( HFQ3406 )
Refusal
HFR13 - COLSCRNS ( HFQ3406 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:29 PM Monday, August 03, 2009
Page 426 of 760
HFR13
HFR13
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
COLSCRNS
Enable Functions:
HELP
COMMENTS
JUMPBACK
Yes
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
1944
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:
Before today, did you know that Medicare now helps pay the cost of
screening tests for colorectal cancer?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:31 PM Monday, August 03, 2009
Page 427 of 760
HFR13
COLSCRNS
Field1:
( HFQ3406 )
HEST.COLSCRNS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFS0 - (HFQ3408 )
English text: YES
No
BOX HFS0 - (HFQ3408 )
English text: NO
Attribute
Don't know
Route
BOX HFS0 - (HFQ3408 )
Refusal
BOX HFS0 - (HFQ3408 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:33 PM Monday, August 03, 2009
Page 428 of 760
BOX HFS0
BOX HFS0
Page Order # :
1946
BOX INSTRUCTIONS
( HFQ3408 )
IF THIS IS ROUND 55, GO TO HFAC29 - HCTROUBL ( HFQ3490 ).
ELSE GO TO BOX HFS1 - (HFQ3410 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:08:33 PM Monday, August 03, 2009
Page 429 of 760
BOX HFS1
BOX HFS1
Page Order # :
1960
BOX INSTRUCTIONS
( HFQ3410 )
IF SP HAS EVER REPORTED HAVING OSTEPOPORIS IN THE CURRENT
ROUND OR IN A PREVIOUS ROUND, GO TO HFS3 - OSTTEST ( HFQ3440
).
ELSE GO TO HFSINTRO - OSTINTRO ( HFQ3412 ).
ASSIGNMENTS
TECHNICAL NOTES
407
HFOsteoporosisCurrOr
Prev
SP has ever reported having osteoporosis in the current
round or in a previous round =
There is a HEST where HEST.HESTRND <= current
round and HEST.OCOSTEOP = 1/Yes.
DESIGN NOTES
4:08:33 PM Monday, August 03, 2009
Page 430 of 760
HFSINTRO
HFSINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
OSTINTRO
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1965
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:
Now I'd like to talk about a disease called osteoporosis, which can
be treated if found early. In osteoporosis, the bones lose their
calcium and become fragile and more easily broken.
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:34 PM Monday, August 03, 2009
Page 431 of 760
HFSINTRO
OSTINTRO
Field1:
( HFQ3412 )
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
HFS1 - OSTEVERT ( HFQ3420 )
English text: CONTINUE
Attribute
Empty
Route
HFS1 - OSTEVERT ( HFQ3420 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:36 PM Monday, August 03, 2009
Page 432 of 760
HFS1
HFS1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OSTEVERT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1970
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:
[Have you/Has (SP)] ever talked with (your/his/her) doctor or other
health professional about osteoporosis?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:37 PM Monday, August 03, 2009
Page 433 of 760
HFS1
OSTEVERT
Field1:
( HFQ3420 )
HEST.OSTEVERT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFS2 - OSTHRISK ( HFQ3430 )
English text: YES
No
HFS3 - OSTTEST ( HFQ3440 )
English text: NO
Attribute
Don't know
Route
HFS3 - OSTTEST ( HFQ3440 )
Refusal
HFS3 - OSTTEST ( HFQ3440 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:39 PM Monday, August 03, 2009
Page 434 of 760
HFS2
HFS2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OSTHRISK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1980
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:
Has a doctor or other health professional ever told [you/(SP)] that
(you are/he is/she is) at high risk for osteoporosis?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:41 PM Monday, August 03, 2009
Page 435 of 760
HFS2
OSTHRISK
Field1:
( HFQ3430 )
HEST.OSTHRISK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFS3 - OSTTEST ( HFQ3440 )
English text: YES
No
HFS3 - OSTTEST ( HFQ3440 )
English text: NO
Attribute
Don't know
Route
HFS3 - OSTTEST ( HFQ3440 )
Refusal
HFS3 - OSTTEST ( HFQ3440 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:43 PM Monday, August 03, 2009
Page 436 of 760
HFS3
HFS3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OSTTEST
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1990
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 "Mass" and "Density" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
There is a test to detect osteoporosis at an early stage, called Bone
Mass Measurement or Bone Density Measurement, or DEXA scan.
[Have you/Has (SP)] ever had a Bone Mass or Bone Density
Measurement test?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:44 PM Monday, August 03, 2009
Page 437 of 760
HFS3
OSTTEST
Field1:
( HFQ3440 )
HEST.OSTTEST
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFS5 - OSTRECNT ( HFQ3460 )
English text: YES
No
HFS4 - OSTHEAR ( HFQ3450 )
English text: NO
Attribute
Don't know
Route
HFS4 - OSTHEAR ( HFQ3450 )
Refusal
HFS4 - OSTHEAR ( HFQ3450 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:47 PM Monday, August 03, 2009
Page 438 of 760
HFS4
HFS4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OSTHEAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2000
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:
Before today, had you ever heard of this test?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:48 PM Monday, August 03, 2009
Page 439 of 760
HFS4
OSTHEAR
Field1:
( HFQ3450 )
HEST.OSTHEAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFS6 - OSTMASS ( HFQ3470 )
English text: YES
No
HFAC29 - HCTROUBL ( HFQ3490 )
English text: NO
Attribute
Don't know
Route
HFAC29 - HCTROUBL ( HFQ3490 )
Refusal
HFAC29 - HCTROUBL ( HFQ3490 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:08:50 PM Monday, August 03, 2009
Page 440 of 760
HFS5
HFS5
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
OSTRECNT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2010
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:
When was the most recent time that [you/(SP)] had a Bone Mass or
Bone Density Measurement test?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:52 PM Monday, August 03, 2009
Page 441 of 760
HFS5
OSTRECNT
Field1:
( HFQ3460 )
HEST.OSTRECNT
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
TYearAgoDKRF
1
No
No
Number Label
1 LessThanOneYear
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFS6 - OSTMASS ( HFQ3470 )
2
English text: LESS THAN 1 YEAR AGO
OneYearToLessThanTwoYears
3
English text: 1 YEAR TO LESS THAN 2 YEARS AGO
TwoYearsToLessThanThreeYears
HFS6 - OSTMASS ( HFQ3470 )
4
English text: 2 YEARS TO LESS THAN 3 YEARS AGO
ThreeYearsToLessThanFiveYears
HFS6 - OSTMASS ( HFQ3470 )
5
English text: 3 YEARS TO LESS THAN 5 YEARS AGO
FiveOrMoreYears
HFS6 - OSTMASS ( HFQ3470 )
HFS6 - OSTMASS ( HFQ3470 )
English text: 5 OR MORE YEARS AGO
Attribute
Don't know
Route
HFS6 - OSTMASS ( HFQ3470 )
Refusal
HFS6 - OSTMASS ( HFQ3470 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:08:57 PM Monday, August 03, 2009
Page 442 of 760
HFS5
DESIGN NOTES
4:08:57 PM Monday, August 03, 2009
Page 443 of 760
HFS6
HFS6
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OSTMASS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2020
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:
Before today, did you know that Medicare would pay for Bone Mass
or Bone Density Measurement tests for Medicare beneficiaries who
are at risk for osteoporosis?
Int. Instr II:
INPUT FIELDS / ROUTING
4:08:58 PM Monday, August 03, 2009
Page 444 of 760
HFS6
OSTMASS
Field1:
( HFQ3470 )
HEST.OSTMASS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC29 - HCTROUBL ( HFQ3490 )
English text: YES
No
HFAC29 - HCTROUBL ( HFQ3490 )
English text: NO
Attribute
Don't know
Route
HFAC29 - HCTROUBL ( HFQ3490 )
Refusal
HFAC29 - HCTROUBL ( HFQ3490 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:00 PM Monday, August 03, 2009
Page 445 of 760
HFAC29
HFAC29
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HCTROUBL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2050
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "past year" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Next, we are going to ask some questions about [your/(SP's)] health
care needs during the past year.
Since (LAST HF MONTH YEAR), [have you/has (SP)] had any
trouble getting health care that (you/he/she) wanted or needed?
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:01 PM Monday, August 03, 2009
Page 446 of 760
HFAC29
HCTROUBL
Field1:
( HFQ3490 )
ACCS.HCTROUBL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30A - HCTCODE ( HFQ3510 )
English text: YES
No
BOX HFF8 - (HFQ3579 )
English text: NO
Attribute
Don't know
Route
BOX HFF8 - (HFQ3579 )
Refusal
BOX HFF8 - (HFQ3579 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:04 PM Monday, August 03, 2009
Page 447 of 760
HFAC30A
HFAC30A
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
HCTCODE
Field 2:
HCTOTHOS
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
2060
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:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Why was that?
[PROBE: Any other reason?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
4:09:08 PM Monday, August 03, 2009
Page 448 of 760
HFAC30A
4:09:15 PM Monday, August 03, 2009
Page 449 of 760
HFAC30A
HCTCODE
Field1:
( HFQ3510 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=ACCS.HCTMONEY
2=ACCS.HCTHIGH
3=ACCS.HCTNOCOV
4=ACCS.HCTTRANS
5=ACCS.HCTHOMEH
6=ACCS.HCTNTREA
7=ACCS.HCTWAIT
8=ACCS.HCTACPMC
9=ACCS.HCTELIG
10=ACCS.HCTDELAY
11=ACCS.HCTSPECL
12=ACCS.HCTHMORF
13=ACCS.HCTHMOMD
14=ACCS.HCTHMOCV
91=ACCS.HCTOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THCTCode
15
No
No
Number Label
1 NoMoney
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFF6 - (HFQ3537 )
2
English text: SP DOES NOT HAVE MONEY
CostTooHigh
BOX HFF6 - (HFQ3537 )
3
English text: COST IS TOO HIGH
ServiceNotCovered
BOX HFF6 - (HFQ3537 )
4
English text: SERVICES/SUPPLIES NOT COVERED
NeededTransportation
BOX HFF6 - (HFQ3537 )
5
English text: NEEDED TRANSPORTATION TO DOCTOR/HOSPITAL
DifficultyGettingHHCare
BOX HFF6 - (HFQ3537 )
6
English text: DIFFICULTY GETTING HOME HEALTH CARE
NoTreatmentAvailable
BOX HFF6 - (HFQ3537 )
7
English text: NO TREATMENT AVAILABLE/DOCTOR WON’T TREAT
WaitTooLong
BOX HFF6 - (HFQ3537 )
English text: WAIT TOO LONG/DOCTOR TOO BUSY
4:09:27 PM Monday, August 03, 2009
Page 450 of 760
HFAC30A
8
DrDoesNotAcceptMedicare
BOX HFF6 - (HFQ3537 )
9
10
English text: OWN DOCTOR DOESN’T ACCEPT MEDICARE/COULDN’T FIND DOCTOR WHO
ACCEPTS MEDICARE
NotEligible
BOX HFF6 - (HFQ3537 )
English text: NOT ELIGIBLE FOR PUBLIC COVERAGE
DifficultyGettingAppt
BOX HFF6 - (HFQ3537 )
11
English text: DIFFICULTY GETTING APPOINTMENT/ DELAYS BECAUSE SP ON MEDICARE
ReferredToSpecialist
BOX HFF6 - (HFQ3537 )
13
English text: DOCTOR REFERRED SP TO SPECIALIST OR OTHER DOCTOR
HMOReferralProcess
BOX HFF6 - (HFQ3537 )
English text: HMO REFERRAL PROCESS (DIFFICULTY GETTING)
HMODrNotGood
BOX HFF6 - (HFQ3537 )
14
English text: PROBLEMS WITH HMO DOCTORS NOT GOOD OR AVAILABLE
HMONotCoverService
BOX HFF6 - (HFQ3537 )
12
91
English text: HMO WOULD NOT COVER OR PROVIDE SERVICE
Other
HFAC30A - HCTOTHOS ( HFQ3530 )
English text: OTHER
Attribute
Don't know
Route
BOX HFF6 - (HFQ3537 )
Refusal
BOX HFF6 - (HFQ3537 )
Field2:
HCTOTHOS
( HFQ3530 )
ACCS.HCTOTHOS
Cheshire Name:
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.]
4:09:33 PM Monday, August 03, 2009
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFF6 - (HFQ3537 )
Page 451 of 760
HFAC30A
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:33 PM Monday, August 03, 2009
Page 452 of 760
BOX HFF6
BOX HFF6
Page Order # :
2070
BOX INSTRUCTIONS
( HFQ3537 )
IF RESPONSE TO HFAC30A - HCTCODE INCLUDES
8/DrDoesNotAcceptMedicare OR 10/DifficultyGettingAppt, GO TO HFAC30D
OFFEXPLN ( HFQ3565 ).
ELSE GO TO HFAC30B - CGETAPPT ( HFQ3544 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:09:33 PM Monday, August 03, 2009
Page 453 of 760
HFAC30B
HFAC30B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
CGETAPPT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2080
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 (LAST HF MONTH YEAR), [have you/has (SP)] been told by a
doctor’s office that they cannot schedule an appointment with
[you/(SP)]?
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:34 PM Monday, August 03, 2009
Page 454 of 760
HFAC30B
CGETAPPT
Field1:
( HFQ3544 )
ACCS.CGETAPPT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30C - CGETCODE ( HFQ3551 )
English text: YES
No
BOX HFF8 - (HFQ3579 )
English text: NO
Attribute
Don't know
Route
BOX HFF8 - (HFQ3579 )
Refusal
BOX HFF8 - (HFQ3579 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:37 PM Monday, August 03, 2009
Page 455 of 760
HFAC30C
HFAC30C
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
CGETCODE
Field 2:
CGETOTOS
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2090
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 were the reasons the doctor’s office offered as an explanation
for not scheduling an appointment with [you/(SP)]?
[PROBE: Any other reason?]
Int. Instr II:
CHECK ALL THAT APPLY
INPUT FIELDS / ROUTING
4:09:39 PM Monday, August 03, 2009
Page 456 of 760
HFAC30C
4:09:45 PM Monday, August 03, 2009
Page 457 of 760
HFAC30C
CGETCODE
Field1:
( HFQ3551 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=ACCS.CGETINSR
2=ACCS.CGETFULL
3=ACCS.CGETNNEW
4=ACCS.CGETNNMP
5=ACCS.CGETHOUR
6=ACCS.CGETCAID
7=ACCS.CGETNAMC
8=ACCS.CGETNAMA
9=ACCS.CGETAPRV
91=ACCS.CGETOTHR
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TCgetCod
10
No
No
Number Label
1 DocNotAcceptPlan
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFF7 - (HFQ3558 )
2
English text: DOCTOR DOES NOT ACCEPT INSURANCE PLAN
AllDocApptsFull
BOX HFF7 - (HFQ3558 )
3
English text: ALL OF DOCTORS APPOINTMENTS WERE FULL
DocNotAcceptNewPat
BOX HFF7 - (HFQ3558 )
4
English text: DOCTOR IS NOT ACCEPTING ANY NEW PATIENTS
DocNotAcceptNewMedicare
BOX HFF7 - (HFQ3558 )
5
English text: DOCTOR IS NOT ACCEPTING NEW MEDICARE PATIENTS
DocHoursConflicted
BOX HFF7 - (HFQ3558 )
6
English text: DOCTRS HOURS CONFLICTED WITH REQUIREMENTS OF SP
DocNotAcceptMCAD
BOX HFF7 - (HFQ3558 )
8
English text: DOCTOR DOES NOT ACCEPT MEDICAID
DocNotAcceptMCAR
BOX HFF7 - (HFQ3558 )
English text: DOCTOR DOES NOT ACCEPT MEDICARE AT ALL
DocNotAcceptAssign
BOX HFF7 - (HFQ3558 )
9
English text: DOCTOR DOES NOT ACCEPT MEDICARE ASSIGNMENT
DocAnotherProviderBetter
BOX HFF7 - (HFQ3558 )
7
English text: DOCTOR FELT ANOTHER PROVIDER WOULD BE BETTER FOR SP
4:09:55 PM Monday, August 03, 2009
Page 458 of 760
HFAC30C
91
Other
HFAC30C - CGETOTOS ( HFQ3555 )
English text: OTHER
Attribute
Don't know
Route
BOX HFF7 - (HFQ3558 )
Refusal
BOX HFF7 - (HFQ3558 )
Field2:
CGETOTOS
( HFQ3555 )
ACCS.CGETOTOS
Cheshire Name:
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 HFF7 - (HFQ3558 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:09:57 PM Monday, August 03, 2009
Page 459 of 760
BOX HFF7
BOX HFF7
Page Order # :
2100
BOX INSTRUCTIONS
( HFQ3558 )
IF RESPONSE TO HFAC30C - CGETCODE INCLUDES
4/DocNotAcceptNewMedicare OR 7/DocNotAcceptMCAR, GO TO HFAC30D
OFFEXPLN ( HFQ3565 ).
ELSE GO TO BOX HFF8 - (HFQ3579 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:09:57 PM Monday, August 03, 2009
Page 460 of 760
HFAC30D
HFAC30D
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 0:
OFFEXPLN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2110
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:
If response to HFAC30a includes 10/DifficultyGettingAppt, display
"it is difficult for Medicare patients to get an appointment".
Else display "Medicare is not accepted".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did the doctor’s office explain why (it is difficult for Medicare patients
to get an appointment/Medicare is not accepted) at that practice?
Int. Instr II:
INPUT FIELDS / ROUTING
4:09:59 PM Monday, August 03, 2009
Page 461 of 760
HFAC30D
OFFEXPLN
Field0:
( HFQ3565 )
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30E - OFFEXVB ( HFQ3572 )
English text: YES
No
BOX HFF8 - (HFQ3579 )
English text: NO
Attribute
Don't know
Route
BOX HFF8 - (HFQ3579 )
Refusal
BOX HFF8 - (HFQ3579 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:10:01 PM Monday, August 03, 2009
Page 462 of 760
HFAC30E
HFAC30E
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 0:
OFFEXVB
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2120
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:
What was that explanation?
Int. Instr II:
INPUT FIELDS / ROUTING
4:10:01 PM Monday, August 03, 2009
Page 463 of 760
HFAC30E
Field0:
OFFEXVB
( HFQ3572 )
NONE
Cheshire Name:
REPLACES CHESHIRE VARIABLES:
ACCS.OFFEXVB1
ACCS.OFFEXVB2
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Open
TOpen90
1
No
No
Number Label
1
FieldSize:
Min Value:
Max Value:
Mask:
90
Route
BOX HFF8 - (HFQ3579 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:10:02 PM Monday, August 03, 2009
Page 464 of 760
BOX HFF8
BOX HFF8
Page Order # :
2122
BOX INSTRUCTIONS
( HFQ3579 )
IF RESPONDENT IS SP, GO TO HFAC30F - ABNFORM ( HFQ3586 ).
ELSE GO TO HFAC31 - HCDELAY ( HFQ3660 ).
ASSIGNMENTS
TECHNICAL NOTES
4
Respondent
On MRES where MRES.MRESRND = current round:
A Proxy interview (respondent is a proxy) =
MRES.SPPROXY=2/Proxy.
MRES.RROSTNUM=ROST.ROSTNUM of respondent.
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
4:10:02 PM Monday, August 03, 2009
Page 465 of 760
HFAC30F
HFAC30F
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ABNFORM
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2124
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:
SHOW CARD HF7
Question Text:
In some situations your doctor or other health care provider may give
you a form called either an Advance Beneficiary Notice or notice of
noncoverage.
This form is used when the health care provider has some doubt that
a service will be covered by Medicare, and expects that you may
have to pay for the service. In such cases, you can make a choice.
You can choose to get or not get the service. If you sign the form,
you can get the service right away; and, usually, the provider will
collect payment from you.
4:10:03 PM Monday, August 03, 2009
Page 466 of 760
HFAC30F
You can still ask the provider to bill Medicare, in case the provider is
wrong and the service is covered. If the service is covered, then the
money you paid the provider is returned to you.
Since (LAST HF MONTH YEAR), has any doctor or other health care
provider given you a form like one shown on this card?
Int. Instr II:
INPUT FIELDS / ROUTING
ABNFORM
Field1:
( HFQ3586 )
ACCS.ABNFORM
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30G - ABNCODE ( HFQ3593 )
English text: YES
No
HFAC31 - HCDELAY ( HFQ3660 )
English text: NO
Attribute
Don't know
Route
HFAC31 - HCDELAY ( HFQ3660 )
Refusal
HFAC31 - HCDELAY ( HFQ3660 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
4:10:06 PM Monday, August 03, 2009
Page 467 of 760
HFAC30F
TECHNICAL NOTES
DESIGN NOTES
4:10:06 PM Monday, August 03, 2009
Page 468 of 760
HFAC30G
HFAC30G
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
ABNCODE
Field 2:
ABNOTHOS
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2126
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "most recent" in bold.
Always display "(s)" in parentheses.
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 received an Advance
Beneficiary Notice, or "ABN". What items or services did the health
care provider expect would not be paid by Medicare?
[PROBE: What type(s) of health care items or services were
described on the ABN?]
4:10:10 PM Monday, August 03, 2009
Page 469 of 760
HFAC30G
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
4:10:18 PM Monday, August 03, 2009
Page 470 of 760
HFAC30G
ABNCODE
Field1:
( HFQ3593 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=ACCS.ABNDOCT
2=ACCS.ABNHHOME
3=ACCS.ABNHOSPC
4=ACCS.ABNTHERA
5=ACCS.ABNIPCAR
6=ACCS.ABNOPCAR
7=ACCS.ABNNURSE
8=ACCS.ABNTESTS
9=ACCS.ABNEQUIP
10=ACCS.ABNVACC
11=ACCS.ABNEYE
12=ACCS.ABNPMED
13=ACCS.ABNSURG
14=ACCS.ABNCHECK
91=ACCS.ABNOTHER
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TABNCod
15
No
No
Number Label
1 PhysicanServices
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30G1 - ABNREAD ( HFQ3600 )
2
English text: PHYSICIAN SERVICES
HomeHealthServices
HFAC30G1 - ABNREAD ( HFQ3600 )
3
English text: HOME HEALTH SERVICES
HospiceServices
HFAC30G1 - ABNREAD ( HFQ3600 )
4
English text: HOSPICE SERVICES
OccPhysTherapyServices
HFAC30G1 - ABNREAD ( HFQ3600 )
5
English text: OCCUPATIONAL AND/OR PHYSICAL THERAPY SERVICES
InpatientCare
HFAC30G1 - ABNREAD ( HFQ3600 )
6
English text: INPATIENT HOSPITAL CARE
OutpatientCare
7
English text: OUTPATIENT HOSPITAL CARE
SkilledNursingCare
HFAC30G1 - ABNREAD ( HFQ3600 )
HFAC30G1 - ABNREAD ( HFQ3600 )
English text: SKILLED NURSING CARE
4:10:29 PM Monday, August 03, 2009
Page 471 of 760
HFAC30G
8
LabTests
HFAC30G1 - ABNREAD ( HFQ3600 )
9
English text: LABORATORY TESTS
DurableMedEquip
HFAC30G1 - ABNREAD ( HFQ3600 )
10
English text: DURABLE MEDICAL EQUIPMENT
Vaccination
HFAC30G1 - ABNREAD ( HFQ3600 )
11
English text: VACCINATION
Eyeglasses
HFAC30G1 - ABNREAD ( HFQ3600 )
12
English text: EYEGLASSES/EYE SERVICES
PrescribedMeds
HFAC30G1 - ABNREAD ( HFQ3600 )
13
English text: PRESCRIBED MEDICINES ONLY
SurgicalServices
HFAC30G1 - ABNREAD ( HFQ3600 )
14
English text: ALL SURGICAL SERVICES
PreventiveTests
91
English text: PREVENTATIVE (NOT DIAGNOSTIC) TESTS
Other
HFAC30G - ABNOTHOS ( HFQ3597 )
HFAC30G1 - ABNREAD ( HFQ3600 )
English text: OTHER HEALTH CARE ITEM OR SERVICE
Attribute
Don't know
Route
HFAC30G1 - ABNREAD ( HFQ3600 )
Refusal
HFAC30G1 - ABNREAD ( HFQ3600 )
Field2:
ABNOTHOS
( HFQ3597 )
ACCS.ABNOTHOS
Cheshire Name:
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
OTHER HEALTH CARE ITEM OR SERVICE (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
HFAC30G1 - ABNREAD ( HFQ3600 )
BACKGROUND VARIABLE ASSIGNMENTS
4:10:36 PM Monday, August 03, 2009
Page 472 of 760
HFAC30G
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:10:36 PM Monday, August 03, 2009
Page 473 of 760
HFAC30G1
HFAC30G1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ABNREAD
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2128
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:
Did you read the Advance Beneficiary Notice?
Int. Instr II:
INPUT FIELDS / ROUTING
4:10:37 PM Monday, August 03, 2009
Page 474 of 760
HFAC30G1
ABNREAD
Field1:
( HFQ3600 )
ACCS.ABNREAD
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30H - ABNUNDER ( HFQ3607 )
English text: YES
No
HFAC30I - ABNSIGN ( HFQ3614 )
English text: NO
Attribute
Don't know
Route
HFAC30I - ABNSIGN ( HFQ3614 )
Refusal
HFAC30I - ABNSIGN ( HFQ3614 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:10:39 PM Monday, August 03, 2009
Page 475 of 760
HFAC30H
HFAC30H
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
ABNUNDER
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2130
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How much trouble did you have understanding the Advance
Beneficiary Notice for (the item or service/these items or services)?
Would you say you had no trouble, a little trouble, or a lot of trouble?
Int. Instr II:
INPUT FIELDS / ROUTING
4:10:41 PM Monday, August 03, 2009
Page 476 of 760
HFAC30H
ABNUNDER
Field1:
( HFQ3607 )
ACCS.ABNUNDER
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
TTroub
1
No
No
Number Label
1 NoTrouble
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30I - ABNSIGN ( HFQ3614 )
2
English text: NO TROUBLE
ALittleTrouble
HFAC30I - ABNSIGN ( HFQ3614 )
3
English text: A LITTLE TROUBLE
ALotOfTrouble
HFAC30I - ABNSIGN ( HFQ3614 )
English text: A LOT OF TROUBLE
Attribute
Don't know
Route
HFAC30I - ABNSIGN ( HFQ3614 )
Refusal
HFAC30I - ABNSIGN ( HFQ3614 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:10:44 PM Monday, August 03, 2009
Page 477 of 760
HFAC30I
HFAC30I
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ABNSIGN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2134
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Think…]" in brackets.
Display "most recent" in bold.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Think about the most recent time you received an Advance
Beneficiary Notice.]
Did you sign the form?
Int. Instr II:
INPUT FIELDS / ROUTING
4:10:45 PM Monday, August 03, 2009
Page 478 of 760
HFAC30I
ABNSIGN
Field1:
( HFQ3614 )
ACCS.ABNSIGN
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30K - ABNITEM ( HFQ3628 )
English text: YES
No
HFAC30J - ABNVB ( HFQ3621 )
English text: NO
Attribute
Don't know
Route
HFAC30K - ABNITEM ( HFQ3628 )
Refusal
HFAC30K - ABNITEM ( HFQ3628 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:10:47 PM Monday, August 03, 2009
Page 479 of 760
HFAC30J
HFAC30J
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 1:
ABNVB
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2136
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:
Why didn’t you sign the form?
Int. Instr II:
INPUT FIELDS / ROUTING
4:10:48 PM Monday, August 03, 2009
Page 480 of 760
HFAC30J
Field1:
ABNVB
( HFQ3621 )
NONE
Cheshire Name:
REPLACES CHESHIRE VARIABLES:
ACCS.ABNVB1
ACCS.ABNVB2
ACCS.ABNVB3
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Open
TOpen135
1
No
No
Number Label
1
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
HFAC30K - ABNITEM ( HFQ3628 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:10:48 PM Monday, August 03, 2009
Page 481 of 760
HFAC30K
HFAC30K
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ABNITEM
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2138
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below Question Text.
If current round ACCS.ABNCODE = DK or RF, display "Unknown".
Else for each response included in current round ACCS.ABNCODE,
display English response text on a separate line in the report:
If ACCS.ABNCODE includes 1/PhysicanServices, display "Physician
Services"
If ACCS.ABNCODE includes 2/HomeHealthServices, display "Home
Health Services"
If ACCS.ABNCODE includes 3/HospiceServices, display "Hospice
Services"
If ACCS.ABNCODE includes 4/OccPhysTherapyServices, display
"Occupational/Physical Therapy Services"
If ACCS.ABNCODE includes 5/InpatientCare, display "Inpatient
Hospital Care"
If ACCS.ABNCODE includes 6/OutpatientCare, display "Outpatient
4:10:50 PM Monday, August 03, 2009
Page 482 of 760
HFAC30K
Hospital Care"
If ACCS.ABNCODE includes 7/SkilledNursingCare, display "Skilled
Nursing Care"
If ACCS.ABNCODE includes 8/LabTests, display "Laboratory Tests"
If ACCS.ABNCODE includes 9/DurableMedEquip, display "Durable
Medical Equipment"
If ACCS.ABNCODE includes 10/Vaccination, display "Vaccination"
If ACCS.ABNCODE includes 11/Eyeglasses, display
"Eyeglasses/Eye Services"
If ACCS.ABNCODE includes 12/PrescribedMeds, display
"Prescribed Medicines Only"
If ACCS.ABNCODE includes 13/SurgicalServices, display "All
Surgical Services"
If ACCS.ABNCODE includes 14/PreventiveTests, display
"Preventive Tests"
If ACCS.ABNCODE includes 91/Other, display ACCS.ABNOTHOS
text.
TEXT:
Context Header:
Int. Instr I:
Question Text:
You mentioned that you received an ABN for [READ HEALTH CARE
ITEMS AND SERVICES LISTED BELOW]. Did you choose to get
(the item or service/these items or services) even though the health
care provider expected Medicare would not pay?
Int. Instr II:
INPUT FIELDS / ROUTING
4:10:52 PM Monday, August 03, 2009
Page 483 of 760
HFAC30K
ABNITEM
Field1:
( HFQ3628 )
ACCS.ABNITEM
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30K1 - ABNBILL ( HFQ3635 )
English text: YES
No
HFAC31 - HCDELAY ( HFQ3660 )
English text: NO
Attribute
Don't know
Route
HFAC31 - HCDELAY ( HFQ3660 )
Refusal
HFAC31 - HCDELAY ( HFQ3660 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:10:55 PM Monday, August 03, 2009
Page 484 of 760
HFAC30K1
HFAC30K1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ABNBILL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2140
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did you ask that Medicare be billed for (the item or service/these
items or services)?
Int. Instr II:
INPUT FIELDS / ROUTING
4:10:56 PM Monday, August 03, 2009
Page 485 of 760
HFAC30K1
ABNBILL
Field1:
( HFQ3635 )
ACCS.ABNBILL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30L - ABNDENY ( HFQ3642 )
English text: YES
No
HFAC30L - ABNDENY ( HFQ3642 )
English text: NO
Attribute
Don't know
Route
HFAC30L - ABNDENY ( HFQ3642 )
Refusal
HFAC30L - ABNDENY ( HFQ3642 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:10:58 PM Monday, August 03, 2009
Page 486 of 760
HFAC30L
HFAC30L
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
ABNDENY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2144
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did Medicare deny payment for (the item or service/these items or
services)?
Int. Instr II:
INPUT FIELDS / ROUTING
4:10:59 PM Monday, August 03, 2009
Page 487 of 760
HFAC30L
ABNDENY
Field1:
( HFQ3642 )
ACCS.ABNDENY
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC30M - ABNPYCOD ( HFQ3649 )
English text: YES
No
HFAC30M - ABNPYCOD ( HFQ3649 )
English text: NO
Attribute
Don't know
Route
HFAC30M - ABNPYCOD ( HFQ3649 )
Refusal
HFAC30M - ABNPYCOD ( HFQ3649 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:02 PM Monday, August 03, 2009
Page 488 of 760
HFAC30M
HFAC30M
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
ABNPYCOD
Field 2:
ABNOTROS
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2146
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If more than one response selected at HFAC30G - ABNCODE,
display "these items or services".
Else display "the item or service".
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What sources paid any part of the cost for (the item or service/these
items or services)?
[PROBE: Who else paid?]
Int. Instr II:
4:11:04 PM Monday, August 03, 2009
CHECK ALL THAT APPLY.
Page 489 of 760
HFAC30M
INPUT FIELDS / ROUTING
4:11:10 PM Monday, August 03, 2009
Page 490 of 760
HFAC30M
ABNPYCOD
Field1:
( HFQ3649 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELDS:
1=ACCS.ABNMCAR
2=ACCS.ABNMCAID
3=ACCS.ABNPUBL
4=ACCS.ABNPRIV
5=ACCS.ABNTRIC
6=ACCS.ABNVA
7=ACCS.ABNFAML
91=ACCS.ABNOTHR
96=ACCS.ABNNOPAY
Item Text display:
Display response options in the following order: 96, 1, 2, 3,
4, 5, 6, 7, 91.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TABNpycd
8
No
No
Number Label
1 MCARorMA
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFAC31 - HCDELAY ( HFQ3660 )
2
English text: MEDICARE OR MEDICARE ADVANTAGE PLAN
Medicaid
HFAC31 - HCDELAY ( HFQ3660 )
3
English text: MEDICAID
OtherPublic
4
English text: PUBLIC PLAN OTHER THAN MEDICAID
Private
HFAC31 - HCDELAY ( HFQ3660 )
5
English text: PRIVATE HEALTH INSURANCE
TRICARE
HFAC31 - HCDELAY ( HFQ3660 )
6
English text: TRICARE
VA
HFAC31 - HCDELAY ( HFQ3660 )
HFAC31 - HCDELAY ( HFQ3660 )
91
English text: V.A.
SPFamily
English text: SP/FAMILY
Other
96
English text: OTHER HEALTH CARE ITEM OR SERVICE
NoSource
HFAC31 - HCDELAY ( HFQ3660 )
7
HFAC31 - HCDELAY ( HFQ3660 )
HFAC30M - ABNOTROS ( HFQ3655 )
English text: NO SOURCE PAID/NOT PAID
4:11:19 PM Monday, August 03, 2009
Page 491 of 760
HFAC30M
Attribute
Don't know
Route
HFAC31 - HCDELAY ( HFQ3660 )
Refusal
HFAC31 - HCDELAY ( HFQ3660 )
Field2:
ABNOTROS
( HFQ3655 )
ACCS.ABNOTROS
Cheshire Name:
Item Text display:
Display "(SPECIFY)" in the same blue font used for
interviewer instructions.
Item Text:
OTHER HEALTH CARE ITEM OR SERVICE (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
HFAC31 - HCDELAY ( HFQ3660 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:20 PM Monday, August 03, 2009
Page 492 of 760
HFAC31
HFAC31
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HCDELAY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2148
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:
Since (LAST HF MONTH YEAR), [have you/has (SP)] delayed
seeking medical care because (you were/he was/she was) worried
about the cost?
Int. Instr II:
INPUT FIELDS / ROUTING
4:11:22 PM Monday, August 03, 2009
Page 493 of 760
HFAC31
HCDELAY
Field1:
( HFQ3660 )
ACCS.HCDELAY
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKINTRO - IADLINTRO ( HFQ3680 )
English text: YES
No
HFKINTRO - IADLINTRO ( HFQ3680 )
English text: NO
Attribute
Don't know
Route
HFKINTRO - IADLINTRO ( HFQ3680 )
Refusal
HFKINTRO - IADLINTRO ( HFQ3680 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:24 PM Monday, August 03, 2009
Page 494 of 760
HFKINTRO
HFKINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
IADLINTRO
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
2150
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "doing them by (yourself/himself/herself)" in BOLD.
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Now I'm going to ask about some everyday activities and whether
[you have/(SP) has] any difficulty doing them by
(yourself/himself/herself).
Int. Instr II:
INPUT FIELDS / ROUTING
4:11:25 PM Monday, August 03, 2009
Page 495 of 760
HFKINTRO
IADLINTRO
Field1:
( HFQ3680 )
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
HFKA1 - PRBTELE ( HFQ3690 )
English text: CONTINUE
Attribute
Empty
Route
HFKA1 - PRBTELE ( HFQ3690 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:27 PM Monday, August 03, 2009
Page 496 of 760
HFKA1
HFKA1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PRBTELE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2155
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 "any" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
using the telephone?
Int. Instr II:
INPUT FIELDS / ROUTING
4:11:28 PM Monday, August 03, 2009
Page 497 of 760
HFKA1
PRBTELE
Field1:
( HFQ3690 )
IADL.PRBTELE
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
TDontdo
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKB1 - PRBLHWK ( HFQ3700 )
2
English text: YES
No
HFKB1 - PRBLHWK ( HFQ3700 )
3
English text: NO
DoesntDo
HFKA2 - DONTTELE ( HFQ3692 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFKB1 - PRBLHWK ( HFQ3700 )
Refusal
HFKB1 - PRBLHWK ( HFQ3700 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:31 PM Monday, August 03, 2009
Page 498 of 760
HFKA2
HFKA2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTTELE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2160
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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that using the telephone is something that [you don't/(SP)
doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
INPUT FIELDS / ROUTING
4:11:32 PM Monday, August 03, 2009
Page 499 of 760
HFKA2
DONTTELE
Field1:
( HFQ3692 )
IADL.DONTTELE
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKB1 - PRBLHWK ( HFQ3700 )
English text: YES
No
HFKB1 - PRBLHWK ( HFQ3700 )
English text: NO
Attribute
Don't know
Route
HFKB1 - PRBLHWK ( HFQ3700 )
Refusal
HFKB1 - PRBLHWK ( HFQ3700 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:34 PM Monday, August 03, 2009
Page 500 of 760
HFKB1
HFKB1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PRBLHWK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2165
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 "any" in BOLD.
Always display "(like washing...)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
doing light housework (like washing dishes, straightening up, or light
cleaning)?
Int. Instr II:
4:11:36 PM Monday, August 03, 2009
Page 501 of 760
HFKB1
INPUT FIELDS / ROUTING
PRBLHWK
Field1:
( HFQ3700 )
IADL.PRBLHWK
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
TDontdo
1
No
No
Number Label
1 Yes
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKC1 - PRBHHWK ( HFQ3710 )
English text: YES
No
English text: NO
DoesntDo
HFKC1 - PRBHHWK ( HFQ3710 )
HFKB2 - DONTLHWK ( HFQ3702 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFKC1 - PRBHHWK ( HFQ3710 )
Refusal
HFKC1 - PRBHHWK ( HFQ3710 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:39 PM Monday, August 03, 2009
Page 502 of 760
HFKB2
HFKB2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTLHWK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2170
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 "health" and "physical" in BOLD.
Always display "(like washing...)" in parenthesis.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that doing light housework (like washing dishes,
straightening up, or light cleaning) is something that [you don't/(SP)
doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
4:11:40 PM Monday, August 03, 2009
Page 503 of 760
HFKB2
INPUT FIELDS / ROUTING
DONTLHWK
Field1:
( HFQ3702 )
IADL.DONTLHWK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKC1 - PRBHHWK ( HFQ3710 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
HFKC1 - PRBHHWK ( HFQ3710 )
Refusal
HFKC1 - PRBHHWK ( HFQ3710 )
HFKC1 - PRBHHWK ( HFQ3710 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:42 PM Monday, August 03, 2009
Page 504 of 760
HFKC1
HFKC1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PRBHHWK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2175
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 "any" in BOLD.
Always display "(like scrubbing...)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
doing heavy housework (like scrubbing floors or washing windows)?
Int. Instr II:
INPUT FIELDS / ROUTING
4:11:44 PM Monday, August 03, 2009
Page 505 of 760
HFKC1
PRBHHWK
Field1:
( HFQ3710 )
IADL.PRBHHWK
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
TDontdo
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKD1 - PRBMEAL ( HFQ3720 )
2
English text: YES
No
HFKD1 - PRBMEAL ( HFQ3720 )
3
English text: NO
DoesntDo
HFKC2 - DONTHHWK ( HFQ3712 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFKD1 - PRBMEAL ( HFQ3720 )
Refusal
HFKD1 - PRBMEAL ( HFQ3720 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:47 PM Monday, August 03, 2009
Page 506 of 760
HFKC2
HFKC2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTHHWK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2180
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 "health" and "physical" in BOLD.
Always display "(like scrubbing...)" in parenthesis.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that doing heavy housework (like scrubbing floors or
washing windows) is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
4:11:48 PM Monday, August 03, 2009
Page 507 of 760
HFKC2
INPUT FIELDS / ROUTING
DONTHHWK
Field1:
( HFQ3712 )
IADL.DONTHHWK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKD1 - PRBMEAL ( HFQ3720 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
HFKD1 - PRBMEAL ( HFQ3720 )
Refusal
HFKD1 - PRBMEAL ( HFQ3720 )
HFKD1 - PRBMEAL ( HFQ3720 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:50 PM Monday, August 03, 2009
Page 508 of 760
HFKD1
HFKD1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PRBMEAL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2185
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 "any" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
preparing (your/his/her) own meals?
Int. Instr II:
INPUT FIELDS / ROUTING
4:11:52 PM Monday, August 03, 2009
Page 509 of 760
HFKD1
PRBMEAL
Field1:
( HFQ3720 )
IADL.PRBMEAL
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
TDontdo
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKE1 - PRBSHOP ( HFQ3730 )
2
English text: YES
No
HFKE1 - PRBSHOP ( HFQ3730 )
3
English text: NO
DoesntDo
HFKD2 - DONTMEAL ( HFQ3722 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFKE1 - PRBSHOP ( HFQ3730 )
Refusal
HFKE1 - PRBSHOP ( HFQ3730 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:54 PM Monday, August 03, 2009
Page 510 of 760
HFKD2
HFKD2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTMEAL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2190
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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that preparing (your/his/her) own meals is something that
[you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
INPUT FIELDS / ROUTING
4:11:56 PM Monday, August 03, 2009
Page 511 of 760
HFKD2
DONTMEAL
Field1:
( HFQ3722 )
IADL.DONTMEAL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKE1 - PRBSHOP ( HFQ3730 )
English text: YES
No
HFKE1 - PRBSHOP ( HFQ3730 )
English text: NO
Attribute
Don't know
Route
HFKE1 - PRBSHOP ( HFQ3730 )
Refusal
HFKE1 - PRBSHOP ( HFQ3730 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:11:58 PM Monday, August 03, 2009
Page 512 of 760
HFKE1
HFKE1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PRBSHOP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2195
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 "any" in BOLD.
Always display "(such as...)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
shopping for personal items (such as toilet items or medicines)?
Int. Instr II:
INPUT FIELDS / ROUTING
4:11:59 PM Monday, August 03, 2009
Page 513 of 760
HFKE1
PRBSHOP
Field1:
( HFQ3730 )
IADL.PRBSHOP
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
TDontdo
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKF1 - PRBBILS ( HFQ3740 )
2
English text: YES
No
HFKF1 - PRBBILS ( HFQ3740 )
3
English text: NO
DoesntDo
HFKE2 - DONTSHOP ( HFQ3732 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFKF1 - PRBBILS ( HFQ3740 )
Refusal
HFKF1 - PRBBILS ( HFQ3740 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:02 PM Monday, August 03, 2009
Page 514 of 760
HFKE2
HFKE2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTSHOP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2200
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 "health" and "physical" in BOLD.
Always display "(such as...)" in parenthesis.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that shopping for personal items (such as toilet items or
medicines) is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
4:12:03 PM Monday, August 03, 2009
Page 515 of 760
HFKE2
INPUT FIELDS / ROUTING
DONTSHOP
Field1:
( HFQ3732 )
IADL.DONTSHOP
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKF1 - PRBBILS ( HFQ3740 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
HFKF1 - PRBBILS ( HFQ3740 )
Refusal
HFKF1 - PRBBILS ( HFQ3740 )
HFKF1 - PRBBILS ( HFQ3740 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:06 PM Monday, August 03, 2009
Page 516 of 760
HFKF1
HFKF1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
PRBBILS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2205
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 "any" in BOLD.
Always display "(like keeping track...)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
managing money (like keeping track of expenses or paying bills)?
Int. Instr II:
INPUT FIELDS / ROUTING
4:12:07 PM Monday, August 03, 2009
Page 517 of 760
HFKF1
PRBBILS
Field1:
( HFQ3740 )
IADL.PRBBILS
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
TDontdo
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFKA1 - (HFQ3810 )
2
English text: YES
No
BOX HFKA1 - (HFQ3810 )
3
English text: NO
DoesntDo
HFKF2 - DONTBILS ( HFQ3742 )
English text: DOESN'T DO
Attribute
Don't know
Route
BOX HFKA1 - (HFQ3810 )
Refusal
BOX HFKA1 - (HFQ3810 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:10 PM Monday, August 03, 2009
Page 518 of 760
HFKF2
HFKF2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTBILS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2210
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 "health" and "physical" in BOLD.
Always display "(like keeping track...)" in parenthesis.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that managing money (like keeping track of expenses or
paying bills) is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
4:12:11 PM Monday, August 03, 2009
Page 519 of 760
HFKF2
INPUT FIELDS / ROUTING
DONTBILS
Field1:
( HFQ3742 )
IADL.DONTBILS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFKA1 - (HFQ3810 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
BOX HFKA1 - (HFQ3810 )
Refusal
BOX HFKA1 - (HFQ3810 )
BOX HFKA1 - (HFQ3810 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:13 PM Monday, August 03, 2009
Page 520 of 760
BOX HFKA1
BOX HFKA1
Page Order # :
2215
BOX INSTRUCTIONS
( HFQ3810 )
IF HFKA1 - PRBTELE = 1/Yes OR HFKA2 – DONTTELE = 1/Yes, GO TO
HFKA3 - HELPTELE ( HFQ3820 ).
ELSE GO TO BOX HFKB1 - (HFQ3828 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:12:13 PM Monday, August 03, 2009
Page 521 of 760
HFKA3
HFKA3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPTELE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2220
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:
If HFKA1 - PRBTELE = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[You said that [your/(SP's)] health makes using the telephone
difficult./You said that using the telephone is something that [you
don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
4:12:15 PM Monday, August 03, 2009
Page 522 of 760
HFKA3
using the telephone?
Int. Instr II:
INPUT FIELDS / ROUTING
HELPTELE
Field1:
( HFQ3820 )
IADL.HELPTELE
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKA4 - PERSON_HLPRTELE ( HFQ3822 )
English text: YES
No
BOX HFKB1 - (HFQ3828 )
English text: NO
Attribute
Don't know
Route
BOX HFKB1 - (HFQ3828 )
Refusal
BOX HFKB1 - (HFQ3828 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:17 PM Monday, August 03, 2009
Page 523 of 760
HFKA4
HFKA4
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRTELE
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2225
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
Context Header:
Int. Instr I:
4:12:17 PM Monday, August 03, 2009
Page 524 of 760
HFKA4
Question Text:
You mentioned that [you receive/(SP) receives] help with using the
telephone. Who gives that help?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
PERSON_HLPRTELE
( HFQ3822 )
HLPR.HLPRTELE
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFKB1 - (HFQ3828 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
4:12:18 PM Monday, August 03, 2009
Page 525 of 760
HFKA4
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
Set HLPR.HLPRTELE = 1/Indicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
SOFT EDIT CHECKS
4:12:18 PM Monday, August 03, 2009
Page 526 of 760
HFKA4
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:18 PM Monday, August 03, 2009
Page 527 of 760
BOX HFKB1
BOX HFKB1
Page Order # :
2230
BOX INSTRUCTIONS
( HFQ3828 )
IF HFKB1 - PRBLHWK = 1/Yes or HFKB2 - DONTLHWK = 1/Yes, GO TO
HFKB3 - HELPLHWK ( HFQ3830 ).
ELSE GO TO BOX HFKC1 - (HFQ3838 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:12:18 PM Monday, August 03, 2009
Page 528 of 760
HFKB3
HFKB3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPLHWK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2235
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:
If HFKB1 - PRBLHWK = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(like washing...)" in parenthesis.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:12:20 PM Monday, August 03, 2009
[[You said that [your/(SP's)] health makes doing light housework (like
washing dishes, straightening up, or light cleaning) difficult./You said
that doing light housework (like washing dishes, straightening up, or
light cleaning) is something that [you don't do/(SP) doesn't do].]]
Page 529 of 760
HFKB3
[Do you/Does (SP)] receive help from another person with...
doing light housework (like washing dishes, straightening up, or light
cleaning)?
Int. Instr II:
INPUT FIELDS / ROUTING
HELPLHWK
Field1:
( HFQ3830 )
IADL.HELPLHWK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKB4 - PERSON_HLPRLHWK ( HFQ3832 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
BOX HFKC1 - (HFQ3838 )
Refusal
BOX HFKC1 - (HFQ3838 )
BOX HFKC1 - (HFQ3838 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:12:23 PM Monday, August 03, 2009
Page 530 of 760
HFKB3
DESIGN NOTES
4:12:23 PM Monday, August 03, 2009
Page 531 of 760
HFKB4
HFKB4
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRLHWK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person Roster
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2240
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(like washing...)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
Context Header:
Int. Instr I:
4:12:23 PM Monday, August 03, 2009
Page 532 of 760
HFKB4
Question Text:
You mentioned that [you receive/(SP) receives] help with doing light
housework (like washing dishes, straightening up, or light cleaning).
Who gives that help?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PERSON_HLPRLHWK ( HFQ3832 )
HLPR.HLPRLHWK
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFKC1 - (HFQ3838 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
4:12:24 PM Monday, August 03, 2009
Page 533 of 760
HFKB4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
Set HLPR.HLPRLHWK = 1/Indicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
4:12:24 PM Monday, August 03, 2009
Page 534 of 760
HFKB4
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:24 PM Monday, August 03, 2009
Page 535 of 760
BOX HFKC1
BOX HFKC1
Page Order # :
2245
BOX INSTRUCTIONS
( HFQ3838 )
IF HFKC1 - PRBHHWK = 1/Yes or HFKC2 - DONTHHWK = 1/Yes, GO TO
HFKC3 - HELPHHWK ( HFQ3840 ).
ELSE GO TO BOX HFKD1 - (HFQ3848 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:12:24 PM Monday, August 03, 2009
Page 536 of 760
HFKC3
HFKC3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPHHWK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2250
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:
If HFKC1 - PRBHHWK = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(like scrubbing...)" in parenthesis.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:12:25 PM Monday, August 03, 2009
[[You said that [your/(SP's)] health makes doing heavy housework
(like scrubbing floors or washing windows) difficult./You said that
heavy housework (like scrubbing floors or washing windows) is
something that [you don't do/(SP) doesn't do].]]
Page 537 of 760
HFKC3
[Do you/Does (SP)] receive help from another person with...
doing heavy housework (like scrubbing floors or washing windows)?
Int. Instr II:
INPUT FIELDS / ROUTING
HELPHHWK
Field1:
( HFQ3840 )
IADL.HELPHHWK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKC4 - PERSON_HLPRHHWK ( HFQ3842 )
English text: YES
No
BOX HFKD1 - (HFQ3848 )
English text: NO
Attribute
Don't know
Route
BOX HFKD1 - (HFQ3848 )
Refusal
BOX HFKD1 - (HFQ3848 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:12:28 PM Monday, August 03, 2009
Page 538 of 760
HFKC3
DESIGN NOTES
4:12:28 PM Monday, August 03, 2009
Page 539 of 760
HFKC4
HFKC4
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRHHWK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2255
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(like scrubbing...)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
Context Header:
Int. Instr I:
4:12:29 PM Monday, August 03, 2009
Page 540 of 760
HFKC4
Question Text:
You mentioned that [you receive/(SP) receives] help with doing
heavy housework (like scrubbing floors or washing windows). Who
gives that help?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PERSON_HLPRHHWK ( HFQ3842 )
HLPR.HLPRHHWK
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFKD1 - (HFQ3848 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
4:12:30 PM Monday, August 03, 2009
Page 541 of 760
HFKC4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
Set HLPR.HLPRHHWK = 1/Indicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
4:12:30 PM Monday, August 03, 2009
Page 542 of 760
HFKC4
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:30 PM Monday, August 03, 2009
Page 543 of 760
BOX HFKD1
BOX HFKD1
Page Order # :
2260
BOX INSTRUCTIONS
( HFQ3848 )
IF HFKD1 – PRBMEAL = 1/Yes or HFKD2 – DONTMEAL = 1/Yes, GO TO
HFKD3 - HELPMEAL ( HFQ3850 ).
ELSE GO TO BOX HFKE1 - (HFQ3858 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:12:30 PM Monday, August 03, 2009
Page 544 of 760
HFKD3
HFKD3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPMEAL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2265
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:
If HFKD1 - PRBMEAL = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[You said that [your/(SP's)] health makes preparing (your/his/her)
own meals difficult./You said that preparing (your/his/her) own meals
is something that [you don't do/(SP) doesn't do].]]
[Do you/Does (SP)] receive help from another person with...
4:12:31 PM Monday, August 03, 2009
Page 545 of 760
HFKD3
preparing (your/his/her) own meals?
Int. Instr II:
INPUT FIELDS / ROUTING
HELPMEAL
Field1:
( HFQ3850 )
IADL.HELPMEAL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKD4 - PERSON_HLPRMEAL ( HFQ3852 )
English text: YES
No
BOX HFKE1 - (HFQ3858 )
English text: NO
Attribute
Don't know
Route
BOX HFKE1 - (HFQ3858 )
Refusal
BOX HFKE1 - (HFQ3858 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:33 PM Monday, August 03, 2009
Page 546 of 760
HFKD4
HFKD4
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRMEAL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2270
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
Context Header:
Int. Instr I:
4:12:34 PM Monday, August 03, 2009
Page 547 of 760
HFKD4
Question Text:
You mentioned that [you receive/(SP) receives] help with preparing
(your/his/her) own meals. Who gives that help?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
PERSON_HLPRMEAL
( HFQ3852 )
HLPR.HLPRMEAL
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFKE1 - (HFQ3858 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
4:12:35 PM Monday, August 03, 2009
Page 548 of 760
HFKD4
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
Set HLPR.HLPRMEAL = 1/Indicated.
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
SOFT EDIT CHECKS
4:12:35 PM Monday, August 03, 2009
Page 549 of 760
HFKD4
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:35 PM Monday, August 03, 2009
Page 550 of 760
BOX HFKE1
BOX HFKE1
Page Order # :
2275
BOX INSTRUCTIONS
( HFQ3858 )
IF HFKE1 – PRBSHOP = 1/Yes or HFKE2 – DONTSHOP = 1/Yes, GO TO
HFKE3 - HELPSHOP ( HFQ3860 ).
ELSE GO TO BOX HFKF1 - (HFQ3868 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:12:35 PM Monday, August 03, 2009
Page 551 of 760
HFKE3
HFKE3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPSHOP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2280
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:
If HFKE1 - PRBSHOP = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(such as...)" in parenthesis.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:12:36 PM Monday, August 03, 2009
[[You said that [your/(SP's)] health makes shopping for personal
items (such as toilet items or medicines) difficult./You said that
shopping for personal items (such as toilet items or medicines) is
something that [you don't do/(SP) doesn't do].]]
Page 552 of 760
HFKE3
[Do you/Does (SP)] receive help from another person with...
shopping for personal items (such as toilet items or medicines)?
Int. Instr II:
INPUT FIELDS / ROUTING
HELPSHOP
Field1:
( HFQ3860 )
IADL.HELPSHOP
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKE4 - PERSON_HLPRSHOP ( HFQ3862 )
English text: YES
No
BOX HFKF1 - (HFQ3868 )
English text: NO
Attribute
Don't know
Route
BOX HFKF1 - (HFQ3868 )
Refusal
BOX HFKF1 - (HFQ3868 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:12:39 PM Monday, August 03, 2009
Page 553 of 760
HFKE3
DESIGN NOTES
4:12:39 PM Monday, August 03, 2009
Page 554 of 760
HFKE4
HFKE4
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRSHOP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2285
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(such as...)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
Context Header:
Int. Instr I:
4:12:39 PM Monday, August 03, 2009
Page 555 of 760
HFKE4
Question Text:
You mentioned that [you receive/(SP) receives] help with shopping
for personal items (such as toilet items or medicines). Who gives
that help?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PERSON_HLPRSHOP
( HFQ3862 )
HLPR.HLPRSHOP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TRostPick8
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
8
Route
BOX HFKF1 - (HFQ3868 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
4:12:40 PM Monday, August 03, 2009
Page 556 of 760
HFKE4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
Set HLPR.HLPRSHOP = 1/Indicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
4:12:40 PM Monday, August 03, 2009
Page 557 of 760
HFKE4
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:40 PM Monday, August 03, 2009
Page 558 of 760
BOX HFKF1
BOX HFKF1
Page Order # :
2290
BOX INSTRUCTIONS
( HFQ3868 )
IF HFKF1- PRBBILS = 1/Yes or HFKF2 – DONTBILS = 1/Yes, GO TO
HFKF3 - HELPBILS ( HFQ3870 ).
ELSE GO TO HFLINTRO - ADLSINTRO ( HFQ3950 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:12:40 PM Monday, August 03, 2009
Page 559 of 760
HFKF3
HFKF3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPBILS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2295
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:
If HFKF1 - PRBBILS = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "(like keeping track...)" in parenthesis.
Always display "[You said…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
4:12:42 PM Monday, August 03, 2009
[[You said that [your/(SP's)] health makes managing money (like
keeping track of expenses or paying bills) difficult./You said that
managing money (like keeping track of expenses or paying bills) is
something that [you don't do/(SP) doesn't do].]]
Page 560 of 760
HFKF3
[Do you/Does (SP)] receive help from another person with...
managing money (like keeping track of expenses or paying bills)?
Int. Instr II:
INPUT FIELDS / ROUTING
HELPBILS
Field1:
( HFQ3870 )
IADL.HELPBILS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFKF4 - PERSON_HLPRBILS ( HFQ3872 )
English text: YES
No
HFLINTRO - ADLSINTRO ( HFQ3950 )
English text: NO
Attribute
Don't know
Route
HFLINTRO - ADLSINTRO ( HFQ3950 )
Refusal
HFLINTRO - ADLSINTRO ( HFQ3950 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:12:45 PM Monday, August 03, 2009
Page 561 of 760
HFKF3
DESIGN NOTES
4:12:45 PM Monday, August 03, 2009
Page 562 of 760
HFKF4
HFKF4
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRBILS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2300
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(like keeping track...)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
Context Header:
Int. Instr I:
4:12:45 PM Monday, August 03, 2009
Page 563 of 760
HFKF4
Question Text:
You mentioned that [you receive/(SP) receives] help with managing
money (like keeping track of expenses or paying bills). Who gives
that help?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
PERSON_HLPRBILS
( HFQ3872 )
HLPR.HLPRBILS
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
HFLINTRO - ADLSINTRO ( HFQ3950 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
4:12:46 PM Monday, August 03, 2009
Page 564 of 760
HFKF4
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
Set HLPR.HLPRBILS = 1/Indicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
4:12:46 PM Monday, August 03, 2009
Page 565 of 760
HFKF4
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:46 PM Monday, August 03, 2009
Page 566 of 760
HFLINTRO
HFLINTRO
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
ADLSINTRO
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
2305
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display "by (yourself/himself/herself)" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Now I'll ask about some other everyday activities. I'd like to know
whether [you have/(SP) has] any difficulty doing each one by
(yourself/himself/herself) and without special equipment.
Int. Instr II:
INPUT FIELDS / ROUTING
4:12:47 PM Monday, August 03, 2009
Page 567 of 760
HFLINTRO
ADLSINTRO
Field1:
( HFQ3950 )
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
HFLA1 - HPPDBATH ( HFQ3960 )
English text: CONTINUE
Attribute
Empty
Route
HFLA1 - HPPDBATH ( HFQ3960 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:49 PM Monday, August 03, 2009
Page 568 of 760
HFLA1
HFLA1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HPPDBATH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2310
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 "any" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
bathing or showering?
Int. Instr II:
INPUT FIELDS / ROUTING
4:12:51 PM Monday, August 03, 2009
Page 569 of 760
HFLA1
HPPDBATH
Field1:
( HFQ3960 )
ADLS.HPPDBATH
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
THpp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLB1 - HPPDDRES ( HFQ3970 )
2
English text: YES
No
HFLB1 - HPPDDRES ( HFQ3970 )
3
English text: NO
DoesntDo
HFLA2 - DONTBATH ( HFQ3962 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFLB1 - HPPDDRES ( HFQ3970 )
Refusal
HFLB1 - HPPDDRES ( HFQ3970 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:53 PM Monday, August 03, 2009
Page 570 of 760
HFLA2
HFLA2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTBATH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2315
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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that bathing or showering is something that [you don't/(SP)
doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
INPUT FIELDS / ROUTING
4:12:55 PM Monday, August 03, 2009
Page 571 of 760
HFLA2
DONTBATH
Field1:
( HFQ3962 )
ADLS.DONTBATH
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLB1 - HPPDDRES ( HFQ3970 )
English text: YES
No
HFLB1 - HPPDDRES ( HFQ3970 )
English text: NO
Attribute
Don't know
Route
HFLB1 - HPPDDRES ( HFQ3970 )
Refusal
HFLB1 - HPPDDRES ( HFQ3970 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:12:57 PM Monday, August 03, 2009
Page 572 of 760
HFLB1
HFLB1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HPPDDRES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2320
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 "any" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
dressing?
Int. Instr II:
INPUT FIELDS / ROUTING
4:12:58 PM Monday, August 03, 2009
Page 573 of 760
HFLB1
HPPDDRES
Field1:
( HFQ3970 )
ADLS.HPPDDRES
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
THpp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLC1 - HPPDEAT ( HFQ3980 )
2
English text: YES
No
HFLC1 - HPPDEAT ( HFQ3980 )
3
English text: NO
DoesntDo
HFLB2 - DONTDRES ( HFQ3972 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFLC1 - HPPDEAT ( HFQ3980 )
Refusal
HFLC1 - HPPDEAT ( HFQ3980 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:01 PM Monday, August 03, 2009
Page 574 of 760
HFLB2
HFLB2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTDRES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2325
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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that dressing is something that [you don't/(SP) doesn't]
do.]
Is this because of a health or physical problem?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:02 PM Monday, August 03, 2009
Page 575 of 760
HFLB2
DONTDRES
Field1:
( HFQ3972 )
ADLS.DONTDRES
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLC1 - HPPDEAT ( HFQ3980 )
English text: YES
No
HFLC1 - HPPDEAT ( HFQ3980 )
English text: NO
Attribute
Don't know
Route
HFLC1 - HPPDEAT ( HFQ3980 )
Refusal
HFLC1 - HPPDEAT ( HFQ3980 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:05 PM Monday, August 03, 2009
Page 576 of 760
HFLC1
HFLC1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HPPDEAT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2330
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 "any" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
eating?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:06 PM Monday, August 03, 2009
Page 577 of 760
HFLC1
HPPDEAT
Field1:
( HFQ3980 )
ADLS.HPPDEAT
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
THpp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLD1 - HPPDCHAR ( HFQ3990 )
2
English text: YES
No
HFLD1 - HPPDCHAR ( HFQ3990 )
3
English text: NO
DoesntDo
HFLC2 - DONTEAT ( HFQ3982 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFLD1 - HPPDCHAR ( HFQ3990 )
Refusal
HFLD1 - HPPDCHAR ( HFQ3990 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:09 PM Monday, August 03, 2009
Page 578 of 760
HFLC2
HFLC2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTEAT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2335
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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that eating is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:10 PM Monday, August 03, 2009
Page 579 of 760
HFLC2
DONTEAT
Field1:
( HFQ3982 )
ADLS.DONTEAT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLD1 - HPPDCHAR ( HFQ3990 )
English text: YES
No
HFLD1 - HPPDCHAR ( HFQ3990 )
English text: NO
Attribute
Don't know
Route
HFLD1 - HPPDCHAR ( HFQ3990 )
Refusal
HFLD1 - HPPDCHAR ( HFQ3990 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:12 PM Monday, August 03, 2009
Page 580 of 760
HFLD1
HFLD1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HPPDCHAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2340
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 "any" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
getting in or out of bed or chairs?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:14 PM Monday, August 03, 2009
Page 581 of 760
HFLD1
HPPDCHAR
Field1:
( HFQ3990 )
ADLS.HPPDCHAR
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
THpp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLE1 - HPPDWALK ( HFQ4000 )
2
English text: YES
No
HFLE1 - HPPDWALK ( HFQ4000 )
3
English text: NO
DoesntDo
HFLD2 - DONTCHAR ( HFQ3992 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFLE1 - HPPDWALK ( HFQ4000 )
Refusal
HFLE1 - HPPDWALK ( HFQ4000 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:17 PM Monday, August 03, 2009
Page 582 of 760
HFLD2
HFLD2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTCHAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2345
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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that getting in or out of bed or chairs is something that [you
don't/(SP) doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:18 PM Monday, August 03, 2009
Page 583 of 760
HFLD2
DONTCHAR
Field1:
( HFQ3992 )
ADLS.DONTCHAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLE1 - HPPDWALK ( HFQ4000 )
English text: YES
No
HFLE1 - HPPDWALK ( HFQ4000 )
English text: NO
Attribute
Don't know
Route
HFLE1 - HPPDWALK ( HFQ4000 )
Refusal
HFLE1 - HPPDWALK ( HFQ4000 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:20 PM Monday, August 03, 2009
Page 584 of 760
HFLE1
HFLE1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HPPDWALK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2350
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 "any" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
walking?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:22 PM Monday, August 03, 2009
Page 585 of 760
HFLE1
HPPDWALK
Field1:
( HFQ4000 )
ADLS.HPPDWALK
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
THpp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLF1 - HPPDTOIL ( HFQ4010 )
2
English text: YES
No
HFLF1 - HPPDTOIL ( HFQ4010 )
3
English text: NO
DoesntDo
HFLE2 - DONTWALK ( HFQ4002 )
English text: DOESN'T DO
Attribute
Don't know
Route
HFLF1 - HPPDTOIL ( HFQ4010 )
Refusal
HFLF1 - HPPDTOIL ( HFQ4010 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:24 PM Monday, August 03, 2009
Page 586 of 760
HFLE2
HFLE2
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
DONTWALK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2355
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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that walking is something that [you don't/(SP) doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:26 PM Monday, August 03, 2009
Page 587 of 760
HFLE2
DONTWALK
Field1:
( HFQ4002 )
ADLS.DONTWALK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLF1 - HPPDTOIL ( HFQ4010 )
English text: YES
No
HFLF1 - HPPDTOIL ( HFQ4010 )
English text: NO
Attribute
Don't know
Route
HFLF1 - HPPDTOIL ( HFQ4010 )
Refusal
HFLF1 - HPPDTOIL ( HFQ4010 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:28 PM Monday, August 03, 2009
Page 588 of 760
HFLF1
HFLF1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HPPDTOIL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2360
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 "any" in BOLD.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Because of a health or physical problem, [do you/does (SP)] have
any difficulty...
using the toilet?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:30 PM Monday, August 03, 2009
Page 589 of 760
HFLF1
HPPDTOIL
Field1:
( HFQ4010 )
ADLS.HPPDTOIL
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
THpp
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLA1 - (HFQ4080 )
2
English text: YES
No
BOX HFLA1 - (HFQ4080 )
3
English text: NO
DoesntDo
HFLF2 - DONTTOIL ( HFQ4012 )
English text: DOESN'T DO
Attribute
Don't know
Route
BOX HFLA1 - (HFQ4080 )
Refusal
BOX HFLA1 - (HFQ4080 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:32 PM Monday, August 03, 2009
Page 590 of 760
HFLF2
HFLF2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
DONTTOIL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2365
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 "health" and "physical" in BOLD.
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[You said that using the toilet is something that [you don't/(SP)
doesn't] do.]
Is this because of a health or physical problem?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:34 PM Monday, August 03, 2009
Page 591 of 760
HFLF2
DONTTOIL
Field1:
( HFQ4012 )
ADLS.DONTTOIL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLA1 - (HFQ4080 )
English text: YES
No
BOX HFLA1 - (HFQ4080 )
English text: NO
Attribute
Don't know
Route
BOX HFLA1 - (HFQ4080 )
Refusal
BOX HFLA1 - (HFQ4080 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:36 PM Monday, August 03, 2009
Page 592 of 760
BOX HFLA1
BOX HFLA1
Page Order # :
2370
BOX INSTRUCTIONS
( HFQ4080 )
IF HFLA1 – HPPDBATH = 1/Yes OR HFLA2 - DONTBATH = 1/Yes, GO TO
HFLA3 - HELPBATH ( HFQ4081 ).
ELSE GO TO BOX HFLB1 - (HFQ4090 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:13:36 PM Monday, August 03, 2009
Page 593 of 760
HFLA3
HFLA3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPBATH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2375
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:
If HFLA1 - HPPDBATH = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[You said [your/(SP's)] health makes bathing or showering
difficult./You said that bathing or showering is something [you
don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with bathing or
showering?
4:13:37 PM Monday, August 03, 2009
Page 594 of 760
HFLA3
Int. Instr II:
INPUT FIELDS / ROUTING
HELPBATH
Field1:
( HFQ4081 )
ADLS.HELPBATH
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLA5 - EQIPBATH ( HFQ4083 )
English text: YES
No
HFLA4 - PCHKBATH ( HFQ4082 )
English text: NO
Attribute
Don't know
Route
HFLA4 - PCHKBATH ( HFQ4082 )
Refusal
HFLA4 - PCHKBATH ( HFQ4082 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:39 PM Monday, August 03, 2009
Page 595 of 760
HFLA4
HFLA4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PCHKBATH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2380
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:
Always display "[That is, does...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does someone usually stay nearby just in case [you need/(SP)
needs] help with bathing or showering?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:41 PM Monday, August 03, 2009
Page 596 of 760
HFLA4
PCHKBATH
Field1:
( HFQ4082 )
ADLS.PCHKBATH
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLA5 - EQIPBATH ( HFQ4083 )
English text: YES
No
HFLA5 - EQIPBATH ( HFQ4083 )
English text: NO
Attribute
Don't know
Route
HFLA5 - EQIPBATH ( HFQ4083 )
Refusal
HFLA5 - EQIPBATH ( HFQ4083 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:43 PM Monday, August 03, 2009
Page 597 of 760
HFLA5
HFLA5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EQIPBATH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2385
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:
[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with bathing or showering?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:44 PM Monday, August 03, 2009
Page 598 of 760
HFLA5
EQIPBATH
Field1:
( HFQ4083 )
ADLS.EQIPBATH
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLA2 - (HFQ4085 )
English text: YES
No
BOX HFLA2 - (HFQ4085 )
English text: NO
Attribute
Don't know
Route
BOX HFLA2 - (HFQ4085 )
Refusal
BOX HFLA2 - (HFQ4085 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:46 PM Monday, August 03, 2009
Page 599 of 760
BOX HFLA2
BOX HFLA2
Page Order # :
2390
BOX INSTRUCTIONS
( HFQ4085 )
IF HFLA3 – HELPBATH = 1/Yes, GO TO HFLA6 - LONGBATH ( HFQ4086 ).
ELSE GO TO BOX HFLB1 - (HFQ4090 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:13:46 PM Monday, August 03, 2009
Page 600 of 760
HFLA6
HFLA6
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
LONGBATH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2395
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:
How long [have you/has (SP)] needed help with bathing or
showering? Has it been . . .
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:48 PM Monday, August 03, 2009
Page 601 of 760
HFLA6
LONGBATH
Field1:
( HFQ4086 )
ADLS.LONGBATH
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
THwlong
1
No
No
Number Label
1 LessThanThreeMonths
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLA7 - STILBATH ( HFQ4088 )
2
English text: less than three months,
MoreThanThreeMonthsLessThanOneYear
3
English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLB1 - (HFQ4090 )
BOX HFLB1 - (HFQ4090 )
English text: one year or more?
Attribute
Don't know
Route
BOX HFLB1 - (HFQ4090 )
Refusal
BOX HFLB1 - (HFQ4090 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:51 PM Monday, August 03, 2009
Page 602 of 760
HFLA7
HFLA7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
STILBATH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2400
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:
Do you expect that [you/(SP)] will still need help with bathing or
showering three months from now?
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:52 PM Monday, August 03, 2009
Page 603 of 760
HFLA7
STILBATH
Field1:
( HFQ4088 )
ADLS.STILBATH
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLB1 - (HFQ4090 )
English text: YES
No
BOX HFLB1 - (HFQ4090 )
English text: NO
Attribute
Don't know
Route
BOX HFLB1 - (HFQ4090 )
Refusal
BOX HFLB1 - (HFQ4090 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:54 PM Monday, August 03, 2009
Page 604 of 760
BOX HFLB1
BOX HFLB1
Page Order # :
2405
BOX INSTRUCTIONS
( HFQ4090 )
IF HFLB1 - HPPDDRES = 1/Yes OR HFLB2 – DONTDRES = 1/Yes, GO TO
HFLB3 - HELPDRES ( HFQ4091 ).
ELSE GO TO BOX HFLC1 - (HFQ4100 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:13:54 PM Monday, August 03, 2009
Page 605 of 760
HFLB3
HFLB3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPDRES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2410
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:
If HFLB1 - HPPDDRES = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[You said [your/(SP's)] health makes dressing difficult./You said that
dressing is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with dressing?
Int. Instr II:
4:13:55 PM Monday, August 03, 2009
Page 606 of 760
HFLB3
INPUT FIELDS / ROUTING
HELPDRES
Field1:
( HFQ4091 )
ADLS.HELPDRES
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLB5 - EQIPDRES ( HFQ4093 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
HFLB4 - PCHKDRES ( HFQ4092 )
Refusal
HFLB4 - PCHKDRES ( HFQ4092 )
HFLB4 - PCHKDRES ( HFQ4092 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:13:58 PM Monday, August 03, 2009
Page 607 of 760
HFLB4
HFLB4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PCHKDRES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2415
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:
Always display "[That is, does...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does someone usually stay nearby just in case [you need/(SP)
needs] help with dressing?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:13:59 PM Monday, August 03, 2009
Page 608 of 760
HFLB4
PCHKDRES
Field1:
( HFQ4092 )
ADLS.PCHKDRES
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLB5 - EQIPDRES ( HFQ4093 )
English text: YES
No
HFLB5 - EQIPDRES ( HFQ4093 )
English text: NO
Attribute
Don't know
Route
HFLB5 - EQIPDRES ( HFQ4093 )
Refusal
HFLB5 - EQIPDRES ( HFQ4093 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:01 PM Monday, August 03, 2009
Page 609 of 760
HFLB5
HFLB5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EQIPDRES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2420
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:
[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with dressing?
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:03 PM Monday, August 03, 2009
Page 610 of 760
HFLB5
EQIPDRES
Field1:
( HFQ4093 )
ADLS.EQIPDRES
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLB2 - (HFQ4095 )
English text: YES
No
BOX HFLB2 - (HFQ4095 )
English text: NO
Attribute
Don't know
Route
BOX HFLB2 - (HFQ4095 )
Refusal
BOX HFLB2 - (HFQ4095 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:05 PM Monday, August 03, 2009
Page 611 of 760
BOX HFLB2
BOX HFLB2
Page Order # :
2425
BOX INSTRUCTIONS
( HFQ4095 )
IF HFLB3 – HELPDRES = 1/Yes, GO TO HFLB6 - LONGDRES ( HFQ4096 ).
ELSE GO TO BOX HFLC1 - (HFQ4100 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:14:05 PM Monday, August 03, 2009
Page 612 of 760
HFLB6
HFLB6
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
LONGDRES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2430
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:
How long [have you/has (SP)] needed help with dressing? Has it
been . . .
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:06 PM Monday, August 03, 2009
Page 613 of 760
HFLB6
LONGDRES
Field1:
( HFQ4096 )
ADLS.LONGDRES
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
THwlong
1
No
No
Number Label
1 LessThanThreeMonths
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLB7 - STILDRES ( HFQ4098 )
2
English text: less than three months,
MoreThanThreeMonthsLessThanOneYear
3
English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLC1 - (HFQ4100 )
BOX HFLC1 - (HFQ4100 )
English text: one year or more?
Attribute
Don't know
Route
BOX HFLC1 - (HFQ4100 )
Refusal
BOX HFLC1 - (HFQ4100 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:09 PM Monday, August 03, 2009
Page 614 of 760
HFLB7
HFLB7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
STILDRES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2435
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:
Do you expect that [you/(SP)] will still need help with dressing three
months from now?
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:10 PM Monday, August 03, 2009
Page 615 of 760
HFLB7
STILDRES
Field1:
( HFQ4098 )
ADLS.STILDRES
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLC1 - (HFQ4100 )
English text: YES
No
BOX HFLC1 - (HFQ4100 )
English text: NO
Attribute
Don't know
Route
BOX HFLC1 - (HFQ4100 )
Refusal
BOX HFLC1 - (HFQ4100 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:13 PM Monday, August 03, 2009
Page 616 of 760
BOX HFLC1
BOX HFLC1
Page Order # :
2440
BOX INSTRUCTIONS
( HFQ4100 )
IF HFLC1 - HPPDEAT = 1/Yes OR HFLC2 – DONTEAT = 1/Yes, GO TO
HFLC3 - HELPEAT ( HFQ4101 ).
ELSE GO TO BOX HFLD1 - (HFQ4110 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:14:13 PM Monday, August 03, 2009
Page 617 of 760
HFLC3
HFLC3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPEAT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2445
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:
If HFLC1 - HPPDEAT = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[You said [your/(SP's)] health makes eating difficult./You said that
eating is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with eating?
Int. Instr II:
4:14:14 PM Monday, August 03, 2009
Page 618 of 760
HFLC3
INPUT FIELDS / ROUTING
HELPEAT
Field1:
( HFQ4101 )
ADLS.HELPEAT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLC5 - EQIPEAT ( HFQ4103 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
HFLC4 - PCHKEAT ( HFQ4102 )
Refusal
HFLC4 - PCHKEAT ( HFQ4102 )
HFLC4 - PCHKEAT ( HFQ4102 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:16 PM Monday, August 03, 2009
Page 619 of 760
HFLC4
HFLC4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PCHKEAT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2450
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:
Always display "[That is, does...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does someone usually stay nearby just in case [you need/(SP)
needs] help with eating?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:17 PM Monday, August 03, 2009
Page 620 of 760
HFLC4
PCHKEAT
Field1:
( HFQ4102 )
ADLS.PCHKEAT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLC5 - EQIPEAT ( HFQ4103 )
English text: YES
No
HFLC5 - EQIPEAT ( HFQ4103 )
English text: NO
Attribute
Don't know
Route
HFLC5 - EQIPEAT ( HFQ4103 )
Refusal
HFLC5 - EQIPEAT ( HFQ4103 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:20 PM Monday, August 03, 2009
Page 621 of 760
HFLC5
HFLC5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EQIPEAT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2455
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:
[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with eating?
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:21 PM Monday, August 03, 2009
Page 622 of 760
HFLC5
EQIPEAT
Field1:
( HFQ4103 )
ADLS.EQIPEAT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLC2 - (HFQ4105 )
English text: YES
No
BOX HFLC2 - (HFQ4105 )
English text: NO
Attribute
Don't know
Route
BOX HFLC2 - (HFQ4105 )
Refusal
BOX HFLC2 - (HFQ4105 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:23 PM Monday, August 03, 2009
Page 623 of 760
BOX HFLC2
BOX HFLC2
Page Order # :
2460
BOX INSTRUCTIONS
( HFQ4105 )
IF HFLC3 - HELPEAT = 1/Yes, GO TO HFLC6 - LONGEAT ( HFQ4106 ).
ELSE GO TO BOX HFLD1 - (HFQ4110 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:14:23 PM Monday, August 03, 2009
Page 624 of 760
HFLC6
HFLC6
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
LONGEAT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2465
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:
How long [have you/has (SP)] needed help with eating? Has it been .
..
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:25 PM Monday, August 03, 2009
Page 625 of 760
HFLC6
LONGEAT
Field1:
( HFQ4106 )
ADLS.LONGEAT
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
THwlong
1
No
No
Number Label
1 LessThanThreeMonths
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLC7 - STILEAT ( HFQ4108 )
2
English text: less than three months,
MoreThanThreeMonthsLessThanOneYear
3
English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLD1 - (HFQ4110 )
BOX HFLD1 - (HFQ4110 )
English text: one year or more?
Attribute
Don't know
Route
BOX HFLD1 - (HFQ4110 )
Refusal
BOX HFLD1 - (HFQ4110 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:27 PM Monday, August 03, 2009
Page 626 of 760
HFLC7
HFLC7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
STILEAT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2470
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:
Do you expect that [you/(SP)] will still need help with eating three
months from now?
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:29 PM Monday, August 03, 2009
Page 627 of 760
HFLC7
STILEAT
Field1:
( HFQ4108 )
ADLS.STILEAT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLD1 - (HFQ4110 )
English text: YES
No
BOX HFLD1 - (HFQ4110 )
English text: NO
Attribute
Don't know
Route
BOX HFLD1 - (HFQ4110 )
Refusal
BOX HFLD1 - (HFQ4110 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:31 PM Monday, August 03, 2009
Page 628 of 760
BOX HFLD1
BOX HFLD1
Page Order # :
2475
BOX INSTRUCTIONS
( HFQ4110 )
IF HFLD1 – HPPDCHAR = 1/Yes OR HFLD2 - DONTCHAR = 1/Yes, GO TO
HFLD3 - HELPCHAR ( HFQ4111 ).
ELSE GO TO BOX HFLE1 - (HFQ4120 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:14:31 PM Monday, August 03, 2009
Page 629 of 760
HFLD3
HFLD3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPCHAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2480
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:
If HFLD1 - HPPDCHAR = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[You said [your/(SP's)] health makes getting in or out of bed or
chairs difficult./You said that getting in or out of bed or chairs is
something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with getting in
or out of bed or chairs?
4:14:32 PM Monday, August 03, 2009
Page 630 of 760
HFLD3
Int. Instr II:
INPUT FIELDS / ROUTING
HELPCHAR
Field1:
( HFQ4111 )
ADLS.HELPCHAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLD5 - EQIPCHAR ( HFQ4113 )
English text: YES
No
HFLD4 - PCHKCHAR ( HFQ4112 )
English text: NO
Attribute
Don't know
Route
HFLD4 - PCHKCHAR ( HFQ4112 )
Refusal
HFLD4 - PCHKCHAR ( HFQ4112 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:34 PM Monday, August 03, 2009
Page 631 of 760
HFLD4
HFLD4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PCHKCHAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2485
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:
Always display "[That is, does...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does someone usually stay nearby just in case [you need/(SP)
needs] help with getting in or out of bed or chairs?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:36 PM Monday, August 03, 2009
Page 632 of 760
HFLD4
PCHKCHAR
Field1:
( HFQ4112 )
ADLS.PCHKCHAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLD5 - EQIPCHAR ( HFQ4113 )
English text: YES
No
HFLD5 - EQIPCHAR ( HFQ4113 )
English text: NO
Attribute
Don't know
Route
HFLD5 - EQIPCHAR ( HFQ4113 )
Refusal
HFLD5 - EQIPCHAR ( HFQ4113 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:38 PM Monday, August 03, 2009
Page 633 of 760
HFLD5
HFLD5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EQIPCHAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2490
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:
[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with getting in or out of bed or chairs?
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:39 PM Monday, August 03, 2009
Page 634 of 760
HFLD5
EQIPCHAR
Field1:
( HFQ4113 )
ADLS.EQIPCHAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLD2 - (HFQ4115 )
English text: YES
No
BOX HFLD2 - (HFQ4115 )
English text: NO
Attribute
Don't know
Route
BOX HFLD2 - (HFQ4115 )
Refusal
BOX HFLD2 - (HFQ4115 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:42 PM Monday, August 03, 2009
Page 635 of 760
BOX HFLD2
BOX HFLD2
Page Order # :
2495
BOX INSTRUCTIONS
( HFQ4115 )
IF HFLD3 – HELPCHAR = 1/Yes, GO TO HFLD6 - LONGCHAR ( HFQ4116 ).
ELSE GO TO BOX HFLE1 - (HFQ4120 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:14:42 PM Monday, August 03, 2009
Page 636 of 760
HFLD6
HFLD6
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
LONGCHAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2500
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:
How long [have you/has (SP)] needed help with getting in or out of
bed or chairs? Has it been . . .
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:43 PM Monday, August 03, 2009
Page 637 of 760
HFLD6
LONGCHAR
Field1:
( HFQ4116 )
ADLS.LONGCHAR
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
THwlong
1
No
No
Number Label
1 LessThanThreeMonths
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLD7 - STILCHAR ( HFQ4118 )
2
English text: less than three months,
MoreThanThreeMonthsLessThanOneYear
3
English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLE1 - (HFQ4120 )
BOX HFLE1 - (HFQ4120 )
English text: one year or more?
Attribute
Don't know
Route
BOX HFLE1 - (HFQ4120 )
Refusal
BOX HFLE1 - (HFQ4120 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:46 PM Monday, August 03, 2009
Page 638 of 760
HFLD7
HFLD7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
STILCHAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2505
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:
Do you expect that [you/(SP)] will still need help with getting in or out
of bed or chairs three months from now?
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:47 PM Monday, August 03, 2009
Page 639 of 760
HFLD7
STILCHAR
Field1:
( HFQ4118 )
ADLS.STILCHAR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLE1 - (HFQ4120 )
English text: YES
No
BOX HFLE1 - (HFQ4120 )
English text: NO
Attribute
Don't know
Route
BOX HFLE1 - (HFQ4120 )
Refusal
BOX HFLE1 - (HFQ4120 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:49 PM Monday, August 03, 2009
Page 640 of 760
BOX HFLE1
BOX HFLE1
Page Order # :
2510
BOX INSTRUCTIONS
( HFQ4120 )
IF HFLE1- HPPDWALK = 1/Yes OR HFLE2 – DONTWALK = 1/Yes, GO TO
HFLE3 - HELPWALK ( HFQ4121 ).
ELSE GO TO BOX HFLF1 - (HFQ4130 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:14:49 PM Monday, August 03, 2009
Page 641 of 760
HFLE3
HFLE3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPWALK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2515
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:
If HFLE1 - HPPDWALK = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[You said [your/(SP's)] health makes walking difficult./You said that
walking is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with walking?
Int. Instr II:
4:14:51 PM Monday, August 03, 2009
Page 642 of 760
HFLE3
INPUT FIELDS / ROUTING
HELPWALK
Field1:
( HFQ4121 )
ADLS.HELPWALK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLE5 - EQIPWALK ( HFQ4123 )
English text: YES
No
English text: NO
Attribute
Don't know
Route
HFLE4 - PCHKWALK ( HFQ4122 )
Refusal
HFLE4 - PCHKWALK ( HFQ4122 )
HFLE4 - PCHKWALK ( HFQ4122 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:53 PM Monday, August 03, 2009
Page 643 of 760
HFLE4
HFLE4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PCHKWALK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2520
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:
Always display "[That is, does...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does someone usually stay nearby just in case [you need/(SP)
needs] help with walking?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:54 PM Monday, August 03, 2009
Page 644 of 760
HFLE4
PCHKWALK
Field1:
( HFQ4122 )
ADLS.PCHKWALK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLE5 - EQIPWALK ( HFQ4123 )
English text: YES
No
HFLE5 - EQIPWALK ( HFQ4123 )
English text: NO
Attribute
Don't know
Route
HFLE5 - EQIPWALK ( HFQ4123 )
Refusal
HFLE5 - EQIPWALK ( HFQ4123 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:14:56 PM Monday, August 03, 2009
Page 645 of 760
HFLE5
HFLE5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EQIPWALK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2525
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:
[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with walking?
Int. Instr II:
INPUT FIELDS / ROUTING
4:14:58 PM Monday, August 03, 2009
Page 646 of 760
HFLE5
EQIPWALK
Field1:
( HFQ4123 )
ADLS.EQIPWALK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLE2 - (HFQ4125 )
English text: YES
No
BOX HFLE2 - (HFQ4125 )
English text: NO
Attribute
Don't know
Route
BOX HFLE2 - (HFQ4125 )
Refusal
BOX HFLE2 - (HFQ4125 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:00 PM Monday, August 03, 2009
Page 647 of 760
BOX HFLE2
BOX HFLE2
Page Order # :
2530
BOX INSTRUCTIONS
( HFQ4125 )
IF HFLE3 - HELPWALK = 1/Yes, GO TO HFLE6 - LONGWALK ( HFQ4126 ).
ELSE GO TO BOX HFLF1 - (HFQ4130 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:00 PM Monday, August 03, 2009
Page 648 of 760
HFLE6
HFLE6
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
LONGWALK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2535
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:
How long [have you/has (SP)] needed help with walking? Has it
been . . .
Int. Instr II:
INPUT FIELDS / ROUTING
4:15:02 PM Monday, August 03, 2009
Page 649 of 760
HFLE6
LONGWALK
Field1:
( HFQ4126 )
ADLS.LONGWALK
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
THwlong
1
No
No
Number Label
1 LessThanThreeMonths
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLE7 - STILWALK ( HFQ4128 )
2
English text: less than three months,
MoreThanThreeMonthsLessThanOneYear
3
English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLF1 - (HFQ4130 )
BOX HFLF1 - (HFQ4130 )
English text: one year or more?
Attribute
Don't know
Route
BOX HFLF1 - (HFQ4130 )
Refusal
BOX HFLF1 - (HFQ4130 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:04 PM Monday, August 03, 2009
Page 650 of 760
HFLE7
HFLE7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
STILWALK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2540
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:
Do you expect that [you/(SP)] will still need help with walking three
months from now?
Int. Instr II:
INPUT FIELDS / ROUTING
4:15:06 PM Monday, August 03, 2009
Page 651 of 760
HFLE7
STILWALK
Field1:
( HFQ4128 )
ADLS.STILWALK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLF1 - (HFQ4130 )
English text: YES
No
BOX HFLF1 - (HFQ4130 )
English text: NO
Attribute
Don't know
Route
BOX HFLF1 - (HFQ4130 )
Refusal
BOX HFLF1 - (HFQ4130 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:08 PM Monday, August 03, 2009
Page 652 of 760
BOX HFLF1
BOX HFLF1
Page Order # :
2545
BOX INSTRUCTIONS
( HFQ4130 )
IF HFLF1 – HPPDTOIL = 1/Yes OR HFLF2 – DONTTOIL = 1/Yes, GO TO
HFLF3 - HELPTOIL ( HFQ4131 ).
ELSE GO TO BOX HFLA3 - (HFQ4400 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:08 PM Monday, August 03, 2009
Page 653 of 760
HFLF3
HFLF3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HELPTOIL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2550
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:
If HFLF1 - HPPDTOIL = 1/Yes, display "You said that [your/(SP's)]
health makes ...difficult".
Else display "You said that ...is something that [you don't do/(SP)
doesn't do]".
Always display "[You said...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[[You said [your/(SP's)] health makes using the toilet difficult./You
said that using the toilet is something [you don't/(SP) doesn't] do.]]
[Do you/Does (SP)] receive help from another person with using the
toilet?
4:15:09 PM Monday, August 03, 2009
Page 654 of 760
HFLF3
Int. Instr II:
INPUT FIELDS / ROUTING
HELPTOIL
Field1:
( HFQ4131 )
ADLS.HELPTOIL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLF5 - EQIPTOIL ( HFQ4133 )
English text: YES
No
HFLF4 - PCHKTOIL ( HFQ4132 )
English text: NO
Attribute
Don't know
Route
HFLF4 - PCHKTOIL ( HFQ4132 )
Refusal
HFLF4 - PCHKTOIL ( HFQ4132 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:11 PM Monday, August 03, 2009
Page 655 of 760
HFLF4
HFLF4
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PCHKTOIL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2555
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:
Always display "[That is, does...]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Does someone usually stay nearby just in case [you need/(SP)
needs] help with using the toilet?
[That is, does someone usually stay or come into the room to check
on (you/him/her)?]
Int. Instr II:
INPUT FIELDS / ROUTING
4:15:13 PM Monday, August 03, 2009
Page 656 of 760
HFLF4
PCHKTOIL
Field1:
( HFQ4132 )
ADLS.PCHKTOIL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLF5 - EQIPTOIL ( HFQ4133 )
English text: YES
No
HFLF5 - EQIPTOIL ( HFQ4133 )
English text: NO
Attribute
Don't know
Route
HFLF5 - EQIPTOIL ( HFQ4133 )
Refusal
HFLF5 - EQIPTOIL ( HFQ4133 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:15 PM Monday, August 03, 2009
Page 657 of 760
HFLF5
HFLF5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
EQIPTOIL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2560
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:
[Do you/Does (SP)] use special equipment or aids to help
(you/him/her) with using the toilet?
Int. Instr II:
INPUT FIELDS / ROUTING
4:15:16 PM Monday, August 03, 2009
Page 658 of 760
HFLF5
EQIPTOIL
Field1:
( HFQ4133 )
ADLS.EQIPTOIL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLF2 - (HFQ4135 )
English text: YES
No
BOX HFLF2 - (HFQ4135 )
English text: NO
Attribute
Don't know
Route
BOX HFLF2 - (HFQ4135 )
Refusal
BOX HFLF2 - (HFQ4135 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:19 PM Monday, August 03, 2009
Page 659 of 760
BOX HFLF2
BOX HFLF2
Page Order # :
2565
BOX INSTRUCTIONS
( HFQ4135 )
IF HFLF3 - HELPTOIL = 1/Yes, GO TO HFLF6 - LONGTOIL ( HFQ4136 ).
ELSE GO TO BOX HFLA3 - (HFQ4400 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:19 PM Monday, August 03, 2009
Page 660 of 760
HFLF6
HFLF6
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
LONGTOIL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2570
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:
How long [have you/has (SP)] needed help with using the toilet? Has
it been . . .
Int. Instr II:
INPUT FIELDS / ROUTING
4:15:20 PM Monday, August 03, 2009
Page 661 of 760
HFLF6
LONGTOIL
Field1:
( HFQ4136 )
ADLS.LONGTOIL
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
THwlong
1
No
No
Number Label
1 LessThanThreeMonths
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFLF7 - STILTOIL ( HFQ4138 )
2
English text: less than three months,
MoreThanThreeMonthsLessThanOneYear
3
English text: three months or more but less than one year, or
MoreThanOneYear
BOX HFLA3 - (HFQ4400 )
BOX HFLA3 - (HFQ4400 )
English text: one year or more?
Attribute
Don't know
Route
BOX HFLA3 - (HFQ4400 )
Refusal
BOX HFLA3 - (HFQ4400 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:23 PM Monday, August 03, 2009
Page 662 of 760
HFLF7
HFLF7
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
STILTOIL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2575
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:
Do you expect that [you/(SP)] will still need help with using the toilet
three months from now?
Int. Instr II:
INPUT FIELDS / ROUTING
4:15:24 PM Monday, August 03, 2009
Page 663 of 760
HFLF7
STILTOIL
Field1:
( HFQ4138 )
ADLS.STILTOIL
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFLA3 - (HFQ4400 )
English text: YES
No
BOX HFLA3 - (HFQ4400 )
English text: NO
Attribute
Don't know
Route
BOX HFLA3 - (HFQ4400 )
Refusal
BOX HFLA3 - (HFQ4400 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:26 PM Monday, August 03, 2009
Page 664 of 760
BOX HFLA3
BOX HFLA3
Page Order # :
2580
BOX INSTRUCTIONS
( HFQ4400 )
IF HFLA3 - HELPBATH = 1/Yes or HFLA4 – PCHKBATH = 1/Yes, GO
HFLA9 - PERSON_HLPRBATH ( HFQ4405 ).
ELSE GO TO BOX HFLB3 - (HFQ4410 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:26 PM Monday, August 03, 2009
Page 665 of 760
HFLA9
HFLA9
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRBATH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2585
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If HFLA3 - HELPBATH = 1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
4:15:27 PM Monday, August 03, 2009
Page 666 of 760
HFLA9
Context Header:
Int. Instr I:
Question Text:
You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with bathing and
showering. Who [gives that help/stays nearby in case [you
need/(SP) needs] help]?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
PERSON_HLPRBATH
( HFQ4405 )
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:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFLB3 - (HFQ4410 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
4:15:28 PM Monday, August 03, 2009
Page 667 of 760
HFLA9
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
Set HLPR.HLPRBATH = 1/Indicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
4:15:28 PM Monday, August 03, 2009
Page 668 of 760
HFLA9
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:28 PM Monday, August 03, 2009
Page 669 of 760
BOX HFLB3
BOX HFLB3
Page Order # :
2590
BOX INSTRUCTIONS
( HFQ4410 )
IF HFLB3 - HELPDRES = 1/Yes or HFLB4 - PCHKDRES = 1/Yes, GO TO
HFLB9 - PERSON_HLPRDRES ( HFQ4415 ).
ELSE GO TO BOX HFLC3 - (HFQ4420 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:28 PM Monday, August 03, 2009
Page 670 of 760
HFLB9
HFLB9
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRDRES
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2595
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If HFLA3 - HELPDRES = 1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
4:15:28 PM Monday, August 03, 2009
Page 671 of 760
HFLB9
Context Header:
Int. Instr I:
Question Text:
You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with dressing. Who
[gives that help/stays nearby in case [you need/(SP) needs] help]?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
PERSON_HLPRDRES
( HFQ4415 )
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:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFLC3 - (HFQ4420 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Set reason for person added to roster. See instructions below.
4:15:29 PM Monday, August 03, 2009
Page 672 of 760
HFLB9
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
Set HLPR.HLPRDRES = 1/Indicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
4:15:29 PM Monday, August 03, 2009
Page 673 of 760
HFLB9
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:29 PM Monday, August 03, 2009
Page 674 of 760
BOX HFLC3
BOX HFLC3
Page Order # :
2600
BOX INSTRUCTIONS
( HFQ4420 )
IF HFLC3 – HELPEAT = 1/Yes or HFLC4 – PCHKEAT = 1/Yes, GO TO
HFLC9 - PERSON_HLPREAT ( HFQ4425 ).
ELSE GO TO BOX HFLD3 - (HFQ4430 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:29 PM Monday, August 03, 2009
Page 675 of 760
HFLC9
HFLC9
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPREAT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2605
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If HFLC3 - HELPEAT = 1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
4:15:30 PM Monday, August 03, 2009
Page 676 of 760
HFLC9
Context Header:
Int. Instr I:
Question Text:
You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with eating. Who [gives
that help/stays nearby in case [you need/(SP) needs] help]?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
PERSON_HLPREAT
( HFQ4425 )
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:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFLD3 - (HFQ4430 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Set reason for person added to roster. See instructions below.
4:15:31 PM Monday, August 03, 2009
Page 677 of 760
HFLC9
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
Set HLPR.HLPREAT = 1/Indicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
4:15:31 PM Monday, August 03, 2009
Page 678 of 760
HFLC9
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:31 PM Monday, August 03, 2009
Page 679 of 760
BOX HFLD3
BOX HFLD3
Page Order # :
2610
BOX INSTRUCTIONS
( HFQ4430 )
IF HFLD3 – HELPCHAR = 1/Yes or HFLD4 – PCHKCHAR = 1/Yes, GO TO
HFLD9 - PERSON_HLPRCHAR ( HFQ4435 ).
ELSE GO TO BOX HFLE3 - (HFQ4440 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:31 PM Monday, August 03, 2009
Page 680 of 760
HFLD9
HFLD9
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRCHAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2615
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If HFLD3 - HELPCHAR =1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
4:15:31 PM Monday, August 03, 2009
Page 681 of 760
HFLD9
Context Header:
Int. Instr I:
Question Text:
You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with getting in or out of
bed or chairs. Who [gives that help/stays nearby in case [you
need/(SP) needs] help]?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
PERSON_HLPRCHAR ( HFQ4435 )
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:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFLE3 - (HFQ4440 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
4:15:32 PM Monday, August 03, 2009
Page 682 of 760
HFLD9
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
Set HLPR.HLPRCHAR = 1/Indicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
4:15:32 PM Monday, August 03, 2009
Page 683 of 760
HFLD9
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:32 PM Monday, August 03, 2009
Page 684 of 760
BOX HFLE3
BOX HFLE3
Page Order # :
2620
BOX INSTRUCTIONS
( HFQ4440 )
IF HFLE3 – HELPWALK = 1/Yes or HFLE4 – PCHKWALK = 1/Yes, GO TO
HFLE9 - PERSON_HLPRWALK ( HFQ4445 ).
ELSE GO TO BOX HFLF3 - (HFQ4450 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:32 PM Monday, August 03, 2009
Page 685 of 760
HFLE9
HFLE9
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRWALK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2625
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If HFLE3 - HELPWALK = 1/Yes, display "[you receive/(SP)
receives] help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
4:15:33 PM Monday, August 03, 2009
Page 686 of 760
HFLE9
Context Header:
Int. Instr I:
Question Text:
You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with walking. Who
[gives that help/stays nearby in case [you need/(SP) needs] help]?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
PERSON_HLPRWALK ( HFQ4445 )
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:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFLF3 - (HFQ4450 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
Set reason for person added to roster. See instructions below.
4:15:34 PM Monday, August 03, 2009
Page 687 of 760
HFLE9
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
Set HLPR.HLPRWALK = 1/Indicated.
HLPRTOIL
If creating a new HLPR for person selected, and
HLPR.HLPRTOIL = empty, set default
HLPR.HLPRTOIL = 2/NotIndicated.
4:15:34 PM Monday, August 03, 2009
Page 688 of 760
HFLE9
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:34 PM Monday, August 03, 2009
Page 689 of 760
BOX HFLF3
BOX HFLF3
Page Order # :
2630
BOX INSTRUCTIONS
( HFQ4450 )
IF HFLF3 – HELPTOIL = 1/Yes or HFLF4 – PCHKTOIL = 1/Yes, GO TO
HFLF9 - PERSON_HLPRTOIL ( HFQ4455 ).
ELSE GO TO BOX HFL4 - (HFQ4490 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:34 PM Monday, August 03, 2009
Page 690 of 760
HFLF9
HFLF9
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRTOIL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
Roster Name:
Person 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
2635
Display as ' Add a Person '
Display as ' Edit a Person '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If HFLF3 - HELPTOIL = 1/Yes, display "[you receive/(SP) receives]
help" and "gives that help".
Else display "someone stays nearby in case [you need/(SP) needs]
help" and "stays nearby in case [you need/(SP) needs] help".
Multi Field display:
Roster/Grid Instructions:
Display all persons from Person Roster, except SP.
Do not display SP, ROST.ROSTNUM = '01'.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
First Name
Display ROST.ROSTFNAM.
2
Last Name
Display ROST.ROSTLNAM.
3
Relationship to SP
Display relationship:
If ROST.ROSTREL=91/OtherRelative or
92/OtherNon-Relative, display
ROST.ROSTREOS.
Else display ROST.ROSTREL
relationship.
Report display:
TEXT:
4:15:34 PM Monday, August 03, 2009
Page 691 of 760
HFLF9
Context Header:
Int. Instr I:
Question Text:
You mentioned that [[you receive/(SP) receives] help/someone stays
nearby in case [you need/(SP) needs] help] with using the toilet.
Who [gives that help/stays nearby in case [you need/(SP) needs]
help]?
Int. Instr II:
ENTER ALL HELPERS.
INPUT FIELDS / ROUTING
Field1:
PERSON_HLPRTOIL
( HFQ4455 )
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:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFL4 - (HFQ4490 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
If Person added, see PERSON ROSTER POP-UP specifications for pop-up window
programming instructions.
Variables populated in Person Roster:
ROST.ROSTNUM
ROST.ROSTRNDC
ROST.ROSTFNAM
ROST.ROSTLNAM
ROST.ROSTREL
ROST.ROSTREOS
4:15:35 PM Monday, August 03, 2009
Page 692 of 760
HFLF9
Set reason for person added to roster. See instructions below.
If HLPR record does not exist where HLPR.HLPRRND = current round and
HLPR.HLPRROST = ROST.ROSTNUM of person selected, create a current round HLPR.
The very first time a HLPR record is created for a person in the current round, the HLPR
flags are set to a default value = 2/NotIndicated. See instructions below.
Always update this person's relatsionship on HLPR with this person's most current
ROST.ROSTREL and ROST.ROSTREOS. See instructions below.
Set flag that this person was selected as this type of helper.
ROSTREAS
If person added to person roster, set
ROST.ROSTREAS =4/AdlIadlHelper.
HLPRROST
If creating a new HLPR for person selected, set
HLPR.HLPRROST = this person's ROST.ROSTNUM.
HLPRRND
If creating a new HLPR for person selected, set
HLPR.HLPRRND = current round.
HLPRRESP
If creating a new HLPR for person selected, set
HLPR.HLPRRESP = '01'.
HLPRTELE
If creating a new HLPR for person selected, and
HLPR.HLPRTELE = empty, set default
HLPR.HLPRTELE = 2/NotIndicated.
HLPRLHWK
If creating a new HLPR for person selected, and
HLPR.HLPRLHWK = empty, set default
HLPR.HLPRLHWK = 2/NotIndicated.
HLPRHHWK
If creating a new HLPR for person selected, and
HLPR.HLPRHHWK = empty, set default
HLPR.HLPRHHWK = 2/NotIndicated.
HLPRMEAL
If creating a new HLPR for person selected, and
HLPR.HLPRMEAL = empty, set default
HLPR.HLPRMEAL = 2/NotIndicated..
HLPRSHOP
If creating a new HLPR for person selected, and
HLPR.HLPRSHOP = empty, set default
HLPR.HLPRSHOP = 2/NotIndicated.
HLPRBILS
If creating a new HLPR for person selected, and
HLPR.HLPRBILS = empty, set default
HLPR.HLPRBILS = 2/NotIndicated.
HLPRBATH
If creating a new HLPR for person selected, and
HLPR.HLPRBATH = empty, set default
HLPR.HLPRBATH = 2/NotIndicated.
HLPRDRES
If creating a new HLPR for person selected, and
HLPR.HLPRDRES = empty, set default
HLPR.HLPRDRES = 2/NotIndicated.
HLPREAT
If creating a new HLPR for person selected, and
HLPR.HLPREAT = empty, set default
HLPR.HLPREAT = 2/NotIndicated.
HLPRCHAR
If creating a new HLPR for person selected, and
HLPR.HLPRCHAR = empty, set default
HLPR.HLPRCHAR = 2/NotIndicated.
HLPRWALK
If creating a new HLPR for person selected, and
HLPR.HLPRWALK = empty, set default
HLPR.HLPRWALK = 2/NotIndicated.
HLPRTOIL
Set HLPR.HLPRTOIL = 1/Indicated.
4:15:35 PM Monday, August 03, 2009
Page 693 of 760
HFLF9
HLPRREL
Always update HLPR.HLPRREL = this person's
current ROST.ROSTREL.
HLPRREOS
Always update HLPR.HLPRREOS = this person's
current ROST.ROSTREOS.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:35 PM Monday, August 03, 2009
Page 694 of 760
BOX HFL4
BOX HFL4
Page Order # :
2640
BOX INSTRUCTIONS
( HFQ4490 )
IF MORE THAN ONE PERSON SELECTED AT HFLA9, HFLB9, HFLC9,
HFLD9, HFLE9, AND/OR HFLF9, GO TO HFL10 - PERSON_HLPRMOST (
HFQ4500 ).
ELSE GO TO BOX HFM1 - (HFQ4505 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
The design intent is to check each roster where helpers are identified and
if more than one person is identified as a helper, we route to HFL10 to
determine who helps the most.
4:15:35 PM Monday, August 03, 2009
Page 695 of 760
HFL10
HFL10
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
PERSON_HLPRMOST
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Person Roster
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2644
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all persons selected at HFLA9, HFLB9, HFLC9, HFLD9,
HFLE9 and HFLF9 rosters.
Display in order of entry.
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Which of these persons gives [you/(SP)] the most help with these
things?
Int. Instr II:
SELECT ONLY ONE.
INPUT FIELDS / ROUTING
4:15:36 PM Monday, August 03, 2009
Page 696 of 760
HFL10
Field1:
Cheshire Name:
PERSON_HLPRMOST ( HFQ4500 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TPersPick30
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
BOX HFM1 - (HFQ4505 )
BACKGROUND VARIABLE ASSIGNMENTS
Set fields on HLPR:
HLPR Key = HLPR.HLPRBASE + HLPR.HLPRROST + HLPR.HLPRRND +
HLPR.HLPRRESP
HLPR.HLPRROST = ROST.ROSTNUM of person selected.
HLPR.HLPRRND = current round.
HLRP.HLPRRESP = 01.
Set flag that person selected helps SP the most. See instructions below.
HLPRMOST
Set HLPR.HLPRMOST = 1/Yes on HLPR where
HLPR.HLPRROST = ROST.ROSTNUM of person
selected and HLPR.HLPRRND = current round.
MOSTADLS
Set current round ADLS.MOSTADLS =
ROST.ROSTNUM of person selected.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:36 PM Monday, August 03, 2009
Page 697 of 760
BOX HFM1
BOX HFM1
Page Order # :
2647
BOX INSTRUCTIONS
( HFQ4505 )
IF THIS IS ROUND 55, GO TO HFM1 - FALLANY ( HFQ4510 ).
ELSE GO TO HFN1 - MEMLOSS ( HFQ4580 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:15:36 PM Monday, August 03, 2009
Page 698 of 760
HFM1
HFM1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
FALLANY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2650
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 (LAST HF MONTH YEAR), [have you/has (SP)] fallen down?
Int. Instr II:
INPUT FIELDS / ROUTING
4:15:38 PM Monday, August 03, 2009
Page 699 of 760
HFM1
FALLANY
Field1:
( HFQ4510 )
HEST.FALLANY
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFM2 - FALLTIME ( HFQ4515 )
English text: YES
No
HFN1 - MEMLOSS ( HFQ4580 )
English text: NO
Attribute
Don't know
Route
HFN1 - MEMLOSS ( HFQ4580 )
Refusal
HFN1 - MEMLOSS ( HFQ4580 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:40 PM Monday, August 03, 2009
Page 700 of 760
HFM2
HFM2
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
FALLTIME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2653
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 (LAST HF MONTH YEAR), how many times [have you/has
(SP)] fallen down?
Int. Instr II:
ENTER "95" IF 95 OR MORE FALLS REPORTED.
INPUT FIELDS / ROUTING
4:15:41 PM Monday, August 03, 2009
Page 701 of 760
HFM2
FALLTIME
Field1:
( HFQ4515 )
HEST.FALLTIME
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF TIMES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TFalltm
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HFM3A - FALLHELP ( HFQ4520 )
Refusal
HFM3A - FALLHELP ( HFQ4520 )
FieldSize:
Min Value:
Max Value:
Mask:
1
95
Route
HFM3A - FALLHELP ( HFQ4520 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HFM2 - FALLTIME = 1-25, DK, RF.
If not true, display "THE VALUE ENTERED FOR NUMBER OF
TIMES SEEMS UNLIKELY. PLEASE VERIFY."
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:42 PM Monday, August 03, 2009
Page 702 of 760
HFM3A
HFM3A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
FALLHELP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2656
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Thinking about the [most recent) time that [you/(SP)] fell, did
(you/he/she) hurt (yourself/himself/herself) badly enough to get
medical help?
Int. Instr II:
INPUT FIELDS / ROUTING
4:15:43 PM Monday, August 03, 2009
Page 703 of 760
HFM3A
FALLHELP
Field1:
( HFQ4520 )
HEST.FALLHELP
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFM3B - FALCODE ( HFQ4525 )
English text: YES
No
HFM3B - FALCODE ( HFQ4525 )
English text: NO
Attribute
Don't know
Route
HFM3B - FALCODE ( HFQ4525 )
Refusal
HFM3B - FALCODE ( HFQ4525 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:15:46 PM Monday, August 03, 2009
Page 704 of 760
HFM3B
HFM3B
Page Order # :
Design Screen Type:
Code All
Fields:
Field 1:
FALCODE
Field 2:
FALOTHOS
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2659
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What kind of injury did [you/(SP)] have in that (most recent) fall?
[PROBE: Anything else?]
Int. Instr II:
CHECK ALL THAT APPLY.
INPUT FIELDS / ROUTING
4:15:48 PM Monday, August 03, 2009
Page 705 of 760
HFM3B
4:15:53 PM Monday, August 03, 2009
Page 706 of 760
HFM3B
FALCODE
Field1:
( HFQ4525 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
1=HEST.FALFRACT
2=HEST.FALSPRAN
3=HEST.FALBRUIS
4=HEST.FALCUT
5=HEST.FALCONC
6=HEST.FALDISLO
91=HEST.FALOTHER
96=HEST.FALNOINJ
Item Text display:
Display response options in the following order: 96, 1, 2, 3,
4, 5, 6, 91.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
Tfalcode
7
No
No
Number Label
1 BrokenBone
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFM3C - FALLIMIT ( HFQ4533 )
2
English text: BROKEN BONE/FRACTURE
SprainStrain
HFM3C - FALLIMIT ( HFQ4533 )
3
English text: SPRAIN/STRAIN
Bruise
HFM3C - FALLIMIT ( HFQ4533 )
4
English text: BRUISE
CutWound
HFM3C - FALLIMIT ( HFQ4533 )
5
English text: CUT/WOUND/LACERATION
Concussion
HFM3C - FALLIMIT ( HFQ4533 )
6
English text: CONCUSSION
Dislocation
HFM3C - FALLIMIT ( HFQ4533 )
91
96
English text: DISLOCATION
Other
English text: OTHER
NoInjury
HFM3B - FALOTHOS ( HFQ4530 )
HFM3C - FALLIMIT ( HFQ4533 )
English text: NO INJURY
Attribute
Don't know
Route
HFM3C - FALLIMIT ( HFQ4533 )
4:16:01 PM Monday, August 03, 2009
Page 707 of 760
HFM3B
Don't know
Refusal
HFM3C - FALLIMIT ( HFQ4533 )
Field2:
FALOTHOS
( HFQ4530 )
HEST.FALOTHOS
Cheshire Name:
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
HFM3C - FALLIMIT ( HFQ4533 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:03 PM Monday, August 03, 2009
Page 708 of 760
HFM3C
HFM3C
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
FALLIMIT
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2662
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did [your/(SP's)] (most recent) fall cause (you/him/her) to limit
(your/his/her) regular acivities?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:04 PM Monday, August 03, 2009
Page 709 of 760
HFM3C
FALLIMIT
Field1:
( HFQ4533 )
HEST.FALLIMIT
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFM3D - FALLBACK ( HFQ4535 )
English text: YES
No
HFM3E - FALLFEAR ( HFQ4540 )
English text: NO
Attribute
Don't know
Route
HFM3E - FALLFEAR ( HFQ4540 )
Refusal
HFM3E - FALLFEAR ( HFQ4540 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:06 PM Monday, August 03, 2009
Page 710 of 760
HFM3D
HFM3D
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
FALLBACK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2665
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (HFM2 - FALLTIME > 1) or (HFM2 - FALLTIME = DK or RF),
display "most recent".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How long did it take [you/(SP)] to get back to regular activities after
(your/his/her) (most recent) fall?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:08 PM Monday, August 03, 2009
Page 711 of 760
HFM3D
FALLBACK
Field1:
( HFQ4535 )
HEST.FALLBACK
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
Tfalback
1
No
No
Number Label
1 LessThanOneWeek
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFM3E - FALLFEAR ( HFQ4540 )
2
English text: LESS THAN ONE WEEK
OneWeekOrMore
HFM3E - FALLFEAR ( HFQ4540 )
3
English text: ONE WEEK OR MORE
NeverResumed
HFM3E - FALLFEAR ( HFQ4540 )
English text: NEVER RESUMED REGULAR ACTIVITIES
Attribute
Don't know
Route
HFM3E - FALLFEAR ( HFQ4540 )
Refusal
HFM3E - FALLFEAR ( HFQ4540 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:10 PM Monday, August 03, 2009
Page 712 of 760
HFM3E
HFM3E
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
FALLFEAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2668
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:
How would you rate [your/(SP's)] fear of falling on a scale of 1 to 6,
where 1 is "Not at all afraid of falling" and 6 is "Extremely afraid of
falling"?
NOT AT ALL AFRAID
1
2
3
4
EXTREMELY AFRAID
5
6
Int. Instr II:
4:16:11 PM Monday, August 03, 2009
Page 713 of 760
HFM3E
INPUT FIELDS / ROUTING
FALLFEAR
Field1:
( HFQ4540 )
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
Tfallfear
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HFN1 - MEMLOSS ( HFQ4580 )
Refusal
HFN1 - MEMLOSS ( HFQ4580 )
FieldSize:
Min Value:
Max Value:
Mask:
1
1
6
Route
HFN1 - MEMLOSS ( HFQ4580 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
The visual scale located in the question text is designed to provide the
interviewer with a conceptual example of the scale used in the question.
The end points (values 1 and 6) should be labeled with text above the
number and the numbers should be displayed on one line of text with the
digits appearing equidistant.
4:16:13 PM Monday, August 03, 2009
Page 714 of 760
HFN1
HFN1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MEMLOSS
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
2674
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:
[Do you/Does (SP)] experience memory loss such that it interferes
with daily activities?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:14 PM Monday, August 03, 2009
Page 715 of 760
HFN1
MEMLOSS
Field1:
( HFQ4580 )
HEST.MEMLOSS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFN2 - PROBDECS ( HFQ4590 )
English text: YES
No
HFN2 - PROBDECS ( HFQ4590 )
English text: NO
Attribute
Don't know
Route
HFN2 - PROBDECS ( HFQ4590 )
Refusal
HFN2 - PROBDECS ( HFQ4590 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:16 PM Monday, August 03, 2009
Page 716 of 760
HFN2
HFN2
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
PROBDECS
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
2678
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:
[Do you/Does (SP)] have problems making decisions to the point
that it interferes with daily activities?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:18 PM Monday, August 03, 2009
Page 717 of 760
HFN2
PROBDECS
Field1:
( HFQ4590 )
HEST.PROBDECS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFN3 - TROBCONC ( HFQ4600 )
English text: YES
No
HFN3 - TROBCONC ( HFQ4600 )
English text: NO
Attribute
Don't know
Route
HFN3 - TROBCONC ( HFQ4600 )
Refusal
HFN3 - TROBCONC ( HFQ4600 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:20 PM Monday, August 03, 2009
Page 718 of 760
HFN3
HFN3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
TROBCONC
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
2680
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:
[Do you/Does (SP)] have trouble concentrating or keeping
(your/his/her) mind on what (you are/he is/she is) doing?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:21 PM Monday, August 03, 2009
Page 719 of 760
HFN3
TROBCONC
Field1:
( HFQ4600 )
HEST.TROBCONC
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFN4 - TIMESAD ( HFQ4610 )
English text: YES
No
HFN4 - TIMESAD ( HFQ4610 )
English text: NO
Attribute
Don't know
Route
HFN4 - TIMESAD ( HFQ4610 )
Refusal
HFN4 - TIMESAD ( HFQ4610 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:23 PM Monday, August 03, 2009
Page 720 of 760
HFN4
HFN4
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
TIMESAD
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
2690
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:
SHOW CARD HF4
Question Text:
In the past 12 months, how much of the time did [you/(SP)] feel sad,
blue, or depressed? Would you say [you were/(SP) was] sad or
depressed all of the time, most of the time, some of the time, a little
of the time, or none of the time?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:25 PM Monday, August 03, 2009
Page 721 of 760
HFN4
TIMESAD
Field1:
( HFQ4610 )
HEST.TIMESAD
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
TTimesad
1
No
No
Number Label
1 AllOfTheTime
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFN5 - LOSTINTR ( HFQ4620 )
2
English text: ALL OF THE TIME
MostOfTheTime
HFN5 - LOSTINTR ( HFQ4620 )
3
English text: MOST OF THE TIME
SomeOfTheTime
HFN5 - LOSTINTR ( HFQ4620 )
4
English text: SOME OF THE TIME
ALittleOfTheTime
HFN5 - LOSTINTR ( HFQ4620 )
5
English text: A LITTLE OF THE TIME
NoneOfTheTime
HFN5 - LOSTINTR ( HFQ4620 )
English text: NONE OF THE TIME
Attribute
Don't know
Route
HFN5 - LOSTINTR ( HFQ4620 )
Refusal
HFN5 - LOSTINTR ( HFQ4620 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
4:16:30 PM Monday, August 03, 2009
Page 722 of 760
HFN4
DESIGN NOTES
4:16:30 PM Monday, August 03, 2009
Page 723 of 760
HFN5
HFN5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
LOSTINTR
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
2700
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:
In the past 12 months, [have you/has (SP)] had 2 weeks or more
when (you/he/she) lost interest or pleasure in things that
(you/he/she) usually cared about or enjoyed?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:31 PM Monday, August 03, 2009
Page 724 of 760
HFN5
LOSTINTR
Field1:
( HFQ4620 )
HEST.LOSTINTR
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFQ1 - LOSTURIN ( HFQ4630 )
English text: YES
No
HFQ1 - LOSTURIN ( HFQ4630 )
English text: NO
Attribute
Don't know
Route
HFQ1 - LOSTURIN ( HFQ4630 )
Refusal
HFQ1 - LOSTURIN ( HFQ4630 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:33 PM Monday, August 03, 2009
Page 725 of 760
HFQ1
HFQ1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
LOSTURIN
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
2710
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:
SHOW CARD HF2
Question Text:
I'd like to ask about a health problem that is more common than
people think. Please look at this card and tell me how often, if at all,
since (LAST HF MONTH YEAR) [you have/(SP) has] lost urine
because (you/he/she) could not control (your/his/her) bladder.
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:36 PM Monday, August 03, 2009
Page 726 of 760
HFQ1
LOSTURIN
Field1:
( HFQ4630 )
HEST.LOSTURIN
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
TLosturin
1
No
No
Number Label
1 MoreThanOnceWeek
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFT1 - (HFQ4645 )
2
English text: MORE THAN ONCE A WEEK
AboutOnceWeek
BOX HFT1 - (HFQ4645 )
3
English text: ABOUT ONCE A WEEK
TwoToThreeTimesMonth
BOX HFT1 - (HFQ4645 )
4
English text: 2-3 TIMES A MONTH
AboutOnceMonth
BOX HFT1 - (HFQ4645 )
5
English text: ABOUT ONCE A MONTH
EveryTwoToThreeMonths
BOX HFT1 - (HFQ4645 )
6
English text: EVERY 2-3 MONTHS
OnceOrTwiceYear
BOX HFT1 - (HFQ4645 )
7
English text: ONCE OR TWICE A YEAR
NotAtAll
BOX HFT1 - (HFQ4645 )
8
English text: NOT AT ALL
DialysisOrBladderBag
BOX HFT1 - (HFQ4645 )
English text: SP IS ON DIALYSIS OR CATHETERIZATION OR UROSTOMY OR BLADDER
BAG
Attribute
Don't know
Route
BOX HFT1 - (HFQ4645 )
Refusal
BOX HFT1 - (HFQ4645 )
BACKGROUND VARIABLE ASSIGNMENTS
4:16:42 PM Monday, August 03, 2009
Page 727 of 760
HFQ1
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:42 PM Monday, August 03, 2009
Page 728 of 760
BOX HFT1
BOX HFT1
Page Order # :
2720
BOX INSTRUCTIONS
( HFQ4645 )
IF HFJ2 - OCHBP = 1/Yes, GO TO HFT1 - HYPETOLD ( HFQ4655 ).
ELSE GO TO BOX HFEND - (HFQ9000 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:16:42 PM Monday, August 03, 2009
Page 729 of 760
HFT1
HFT1
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HYPETOLD
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2730
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:
We have recorded that [you were/(SP) was] told by a doctor that
(you had/he had/she had) hypertension, also called high blood
pressure.
[Were you/Was (SP)] told on two or more different medical visits that
(you/he/she) had high blood pressure or hypertension?
[EXPLAIN IF NECESSARY: We are interested in knowing whether
[your/(SP’s)] blood pressure was high for more than one reading.]
Int. Instr II:
4:16:43 PM Monday, August 03, 2009
Page 730 of 760
HFT1
INPUT FIELDS / ROUTING
HYPETOLD
Field1:
( HFQ4655 )
HEST.HYPETOLD
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
THypetol
1
No
No
Number Label
1 Yes
2
3
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFT2 - HYPEAGE ( HFQ4665 )
English text: YES
No
English text: NO
NeverToldPriorEntryInError
HFT2 - HYPEAGE ( HFQ4665 )
BOX HFEND - (HFQ9000 )
English text: SP NEVER HAD HIGH BLOOD PRESSURE/PREVIOUS RESPONSE ENTERED IN
ERROR
Attribute
Don't know
Route
HFT2 - HYPEAGE ( HFQ4665 )
Refusal
HFT2 - HYPEAGE ( HFQ4665 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:46 PM Monday, August 03, 2009
Page 731 of 760
HFT2
HFT2
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
HYPEAGE
Field 2:
HYPEAGE_LESSONE
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2735
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 old [were you/was (SP)] when (you were/he was/she was) first
told that (you/he/she) had high blood pressure?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:48 PM Monday, August 03, 2009
Page 732 of 760
HFT2
HYPEAGE
Field1:
( HFQ4665 )
HEST.HYPEAGE
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
AGE:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THypeage
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFT2 - HYPEAGE_LESSONE ( HFQ4672 )
Attribute
Don't know
Route
HFT2 - HYPEAGE_LESSONE ( HFQ4672 )
Refusal
HFT2 - HYPEAGE_LESSONE ( HFQ4672 )
4:16:52 PM Monday, August 03, 2009
1
996
Page 733 of 760
HFT2
HYPEAGE_LESSONE
Field2:
( HFQ4672 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELD=
If HEST.HYPEAGE_LESSONE = 1/LessThanOneYear, set
HYPEAGE.DIDSMOKE = 996.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THypeage996
1
No
No
Number Label
1 LessThanOneYear
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFT6D - HYPEHOME ( HFQ4675 )
English text: LESS THAN ONE YEAR OLD
Attribute
Empty
Route
HFT6D - HYPEHOME ( HFQ4675 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If HYPEAGE ^= EMPTY then HYPEAGE = 1-100, DK, RF.
If not true, display message "AGE MUST BE BETWEEN 1 AND 100
OR LESS THAN ONE YEAR OLD. PLEASE REENTER."
Edit #2
HYPEAGE and HYPEAGE_LESSONE cannot both be EMPTY.
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
AGE OR SELECT "LESS THAN ONE YEAR OLD"."
Edit #3
HYPEAGE and HYPEAGE_LESSONE cannot both be FILLED.
4:16:54 PM Monday, August 03, 2009
Page 734 of 760
HFT2
If not true, display message "INVALID ENTRY. PLEASE ENTER
AGE OR SELECT "LESS THAN ONE YEAR OLD"."
TECHNICAL NOTES
DESIGN NOTES
4:16:54 PM Monday, August 03, 2009
Page 735 of 760
HFT6D
HFT6D
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HYPEHOME
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2740
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:
Because of (your/his/her) high blood pressure, [are you/is (SP)] now
measuring (your/his/her) blood pressure at home?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:56 PM Monday, August 03, 2009
Page 736 of 760
HFT6D
HYPEHOME
Field1:
( HFQ4675 )
HEST.HYPEHOME
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFT6G - HYPEMEDS ( HFQ4685 )
English text: YES
No
HFT6G - HYPEMEDS ( HFQ4685 )
English text: NO
Attribute
Don't know
Route
HFT6G - HYPEMEDS ( HFQ4685 )
Refusal
HFT6G - HYPEMEDS ( HFQ4685 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:16:58 PM Monday, August 03, 2009
Page 737 of 760
HFT6G
HFT6G
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HYPEMEDS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2750
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:
Because of (your/his/her) high blood pressure, [are you/is (SP)] now
taking prescribed medicine for (your/his/her) high blood pressure?
Int. Instr II:
INPUT FIELDS / ROUTING
4:16:59 PM Monday, August 03, 2009
Page 738 of 760
HFT6G
HYPEMEDS
Field1:
( HFQ4685 )
HEST.HYPEMEDS
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFT6J - HYPEDRNK ( HFQ4695 )
English text: YES
No
HFT6J - HYPEDRNK ( HFQ4695 )
English text: NO
Attribute
Don't know
Route
HFT6J - HYPEDRNK ( HFQ4695 )
Refusal
HFT6J - HYPEDRNK ( HFQ4695 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:17:02 PM Monday, August 03, 2009
Page 739 of 760
HFT6J
HFT6J
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HYPEDRNK
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2760
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If HFG7 - DRINKDAY = 0, display "You mentioned…".
Else dispay "[Have you/Has (SP)] cut down".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
(You mentioned that in a typical month in the past year [you/(SP)] did
not drink alcohol. Is that because of (your/his/her) high blood
pressure?/[Have you/Has (SP)] cut down on drinking alcoholic
beverages because of (your/his/her) high blood pressure?)
Int. Instr II:
INPUT FIELDS / ROUTING
4:17:03 PM Monday, August 03, 2009
Page 740 of 760
HFT6J
HYPEDRNK
Field1:
( HFQ4695 )
HEST.HYPEDRNK
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFT2 - (HFQ4705 )
English text: YES
No
BOX HFT2 - (HFQ4705 )
English text: NO
Attribute
Don't know
Route
BOX HFT2 - (HFQ4705 )
Refusal
BOX HFT2 - (HFQ4705 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:17:05 PM Monday, August 03, 2009
Page 741 of 760
BOX HFT2
BOX HFT2
Page Order # :
2770
BOX INSTRUCTIONS
( HFQ4705 )
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT7 - HYPELONG ( HFQ4715 ).
ELSE GO TO HFT12A - HYPECTRL ( HFQ4749 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:17:05 PM Monday, August 03, 2009
Page 742 of 760
HFT7
HFT7
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
HYPELONG
Field 2:
HYPELONG_LESSON
E
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
2780
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 [have you/has (SP)] been treated with prescribed
medicines for (your/his/her) high blood pressure?
Int. Instr II:
INPUT FIELDS / ROUTING
4:17:07 PM Monday, August 03, 2009
Page 743 of 760
HFT7
HYPELONG
Field1:
( HFQ4715 )
HEST.HYPELONG
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF YEARS:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THypeyrs
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFT7 - HYPELONG_LESSONE ( HFQ4722 )
Attribute
Don't know
Route
HFT7 - HYPELONG_LESSONE ( HFQ4722 )
Refusal
HFT7 - HYPELONG_LESSONE ( HFQ4722 )
4:17:11 PM Monday, August 03, 2009
1
996
Page 744 of 760
HFT7
HYPELONG_LESSON
E
Field2:
( HFQ4722 )
NONE
Cheshire Name:
REPLACES THE FOLLOWING CHESHIRE FIELD=
If HEST.HYPELONG_LESSONE = 1/LessThanOneYear, set
HEST.HYPELONG = 996.
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
THypelong996
1
No
No
Number Label
1 LessThanOneYear
English text: LESS THAN ONE YEAR
Attribute
Empty
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFT3 - (HFQ4725 )
Route
BOX HFT3 - (HFQ4725 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If HYPELONG ^= EMPTY, then HYPELONG = 1-100, DK, RF.
If not true, display message "NUMBER OF YEARS MUST BE
BETWEEN 1 AND 100 OR LESS THAN ONE YEAR. PLEASE
REENTER."
Edit #2
HYPELONG and HYPELONG_LESSONE cannot both be EMPTY.
If not true, display message "ENTRY REQUIRED. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
Edit #3
4:17:14 PM Monday, August 03, 2009
Page 745 of 760
HFT7
HYPELONG and HYPELONG_LESSONE cannot both be FILLED.
If not true, display message "INVALID ENTRY. PLEASE ENTER
NUMBER OF YEARS OR SELECT "LESS THAN ONE YEAR"."
TECHNICAL NOTES
DESIGN NOTES
4:17:14 PM Monday, August 03, 2009
Page 746 of 760
BOX HFT3
BOX HFT3
Page Order # :
2785
BOX INSTRUCTIONS
( HFQ4725 )
IF SP IS IN THE SUPPLEMENTAL SAMPLE, GO TO HFT8 - HYPEMANY (
HFQ4735 ).
ELSE GO TO HFT11A - HYPECOND ( HFQ4745 ).
ASSIGNMENTS
TECHNICAL NOTES
9
SuppORD
SP is in the Supplemental Sample =
MRES.INTTYPE=3/NewFromSupplement on MRES
where MRES.MRESRND = current round.
DESIGN NOTES
4:17:14 PM Monday, August 03, 2009
Page 747 of 760
HFT8
HFT8
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
HYPEMANY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
2790
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:
How many different prescribed medicines [do you/does (SP)] take
for (your/his/her) high blood pressure?
Int. Instr II:
INPUT FIELDS / ROUTING
4:17:15 PM Monday, August 03, 2009
Page 748 of 760
HFT8
HYPEMANY
Field1:
( HFQ4735 )
HEST.HYPEMANY
Cheshire Name:
Item Text display:
Item Text:
Label:
Label Position:
NUMBER OF PRESCRIBED MEDICINES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
THyperx
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Don't know
Route
HFT11A - HYPECOND ( HFQ4745 )
Refusal
HFT11A - HYPECOND ( HFQ4745 )
FieldSize:
Min Value:
Max Value:
Mask:
1
30
Route
HFT11A - HYPECOND ( HFQ4745 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
Edit #1
HYPEMANY = 1 - 10, DK, RF.
If not true, display message "UNLIKELY RESPONSE. PLEASE
VERIFY.".
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:17:16 PM Monday, August 03, 2009
Page 749 of 760
HFT11A
HFT11A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HYPECOND
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2800
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (HFT8 - HYPEMANY = 1, DK, or RF) or (HFT8 was not asked),
display "medicine".
Else display "medicines".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
How often [do you/does (SP)] have trouble with side effects from
(your/his/her) blood pressure (medicine/medicines)? Please tell me if
(you/he/she) always, sometimes, or never (have/has) trouble with
side effects.
[EXPLAIN IF NECESSARY: By "side effects", I mean that the
medicine causes any condition such as fatigue, headache, or
coughing.]
4:17:18 PM Monday, August 03, 2009
Page 750 of 760
HFT11A
Int. Instr II:
INPUT FIELDS / ROUTING
HYPECOND
Field1:
( HFQ4745 )
HEST.HYPECOND
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
Talways
1
No
No
Number Label
1 Always
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFT12A - HYPECTRL ( HFQ4749 )
2
English text: ALWAYS
Sometimes
HFT12A - HYPECTRL ( HFQ4749 )
3
English text: SOMETIMES
Never
HFT12A - HYPECTRL ( HFQ4749 )
English text: NEVER
Attribute
Don't know
Route
HFT12A - HYPECTRL ( HFQ4749 )
Refusal
HFT12A - HYPECTRL ( HFQ4749 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:17:20 PM Monday, August 03, 2009
Page 751 of 760
HFT12A
HFT12A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
HYPECTRL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2805
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:
Doctors often recommend changing your habits or lifestyle, such as
changing your diet, or getting regular exercise in order to control
blood pressure. How confident are you that [you/(SP)] can follow
these recommendation?
Would you say that you are very confident, confident, somewhat
confident, or not at all confident?
Int. Instr II:
4:17:22 PM Monday, August 03, 2009
Page 752 of 760
HFT12A
INPUT FIELDS / ROUTING
HYPECTRL
Field1:
( HFQ4749 )
HEST.HYPECTRL
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
TConfdnt
1
No
No
Number Label
1 VeryConfident
3
English text: VERY CONFIDENT
Confident
English text: CONFIDENT
SomewhatConfident
4
English text: SOMEWHAT CONFIDENT
NotAtAllConfident
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFT4 - (HFQ4755 )
BOX HFT4 - (HFQ4755 )
BOX HFT4 - (HFQ4755 )
BOX HFT4 - (HFQ4755 )
English text: NOT AT ALL CONFIDENT
Attribute
Don't know
Route
BOX HFT4 - (HFQ4755 )
Refusal
BOX HFT4 - (HFQ4755 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:17:26 PM Monday, August 03, 2009
Page 753 of 760
HFT12A
4:17:26 PM Monday, August 03, 2009
Page 754 of 760
BOX HFT4
BOX HFT4
Page Order # :
2810
BOX INSTRUCTIONS
( HFQ4755 )
IF HFT6G - HYPEMEDS = 1/Yes, GO TO HFT13 - HYPEPAY ( HFQ4765 ).
ELSE GO TO BOX HFEND - (HFQ9000 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:17:26 PM Monday, August 03, 2009
Page 755 of 760
HFT13
HFT13
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HYPEPAY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2820
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If (HFT8 - HYPEMANY = 1, DK, or RF) or (HFT8 was not asked),
display "medicine".
Else display "medicines".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
[Do you/Does (SP)] have difficulty paying for the
(medicine/medicines) (your/his/her) doctor prescribes for
(your/his/her) high blood pressure?
Int. Instr II:
INPUT FIELDS / ROUTING
4:17:27 PM Monday, August 03, 2009
Page 756 of 760
HFT13
HYPEPAY
Field1:
( HFQ4765 )
HEST.HYPEPAY
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
HFT14 - HYPESKIP ( HFQ4775 )
English text: YES
No
HFT14 - HYPESKIP ( HFQ4775 )
English text: NO
Attribute
Don't know
Route
HFT14 - HYPESKIP ( HFQ4775 )
Refusal
HFT14 - HYPESKIP ( HFQ4775 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:17:29 PM Monday, August 03, 2009
Page 757 of 760
HFT14
HFT14
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
HYPESKIP
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
No
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
2830
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:
[Do you/Does (SP)] ever skip taking (your/his/her) medicine, take
less medicine than prescribed, or share medicine because of the
cost of the medicine?
Int. Instr II:
INPUT FIELDS / ROUTING
4:17:31 PM Monday, August 03, 2009
Page 758 of 760
HFT14
HYPESKIP
Field1:
( HFQ4775 )
HEST.HYPESKIP
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
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX HFEND - (HFQ9000 )
English text: YES
No
BOX HFEND - (HFQ9000 )
English text: NO
Attribute
Don't know
Route
BOX HFEND - (HFQ9000 )
Refusal
BOX HFEND - (HFQ9000 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
4:17:33 PM Monday, August 03, 2009
Page 759 of 760
BOX HFEND
BOX HFEND
Page Order # :
3000
BOX INSTRUCTIONS
( HFQ9000 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
4:17:33 PM Monday, August 03, 2009
Page 760 of 760
| File Type | application/pdf |
| Author | hubbard_r |
| File Modified | 2010-04-05 |
| File Created | 0000-00-00 |