Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

MCBS R55 GENERAL SPECFICATIONS FOR BLAISE/WVS

Version 07.01.0001

GLOBAL DISPLAY FILLS

TYPE
Respondent

GLOBAL DISPLAY NOTATION
You/(SP)

Respondent

you/(SP)

Respondent

Were you/Was (SP)

Respondent

were you/was (SP)

Respondent

Your/(SP's)

Respondent

your/(SP's)

Respondent

You are/(SP) is

Respondent

you are/(SP) is

Respondent

You have/(SP) has

Respondent

you have/(SP) has

Respondent

yourself/(SP)

Respondent

you were/(SP) was

Respondent

Have you/Has (SP)

Respondent

have you/has (SP)

Respondent

have you/has (SP)/has (SP)

Respondent

Have you/Has (SP)/Had (SP)

Respondent

have you/has (SP)/had (SP)

DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If MRES.SPPROXY = 1/SP, display "You".
Else display "(SP's name)".
If MRES.SPPROXY = 1/SP, display "you".
Else display "(SP's name)".
If MRES.SPPROXY = 1/SP, display "Were you".
Else display "Was (SP's name)".
If MRES.SPPROXY = 1/SP, display "were you".
Else display "was (SP's name)".
If MRES.SPPROXY = 1/SP, display "Your.
Else display "(SP's name)'s".
If MRES.SPPROXY = 1/SP, display "your.
Else display "(SP's name)'s".
If MRES.SPPROXY = 1/SP, display "You are".
Else display "(SP's name) is".
If MRES.SPPROXY = 1/SP, display "you are".
Else display "(SP's name) is".
If MRES.SPPROXY = 1/SP, display "You have".
Else display "(SP's name) has".
If MRES.SPPROXY = 1/SP, display "you have".
Else display "(SP's name) has".
If MRES.SPPROXY = 1/SP, display "yourself".
Else display "(SP's name)".
If MRES.SPPROXY = 1/SP, display "you were".
Else display "(SP's name) was".
If MRES.SPPROXY = 1/SP, display "Have you".
Else display "Has (SP's name)".
If MRES.SPPROXY = 1/SP, display "have you".
Else display "has (SP's name)".
If MRES.SPPROXY = 1/SP, display "have you".
Else display "has (SP's name)".
If MRES.SPPROXY = 1/SP, display "Have you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "Had (SP's name)".
Else display "Has (SP's name)".

DESCRIPTION

If MRES.SPPROXY = 1/SP, display "have you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "had (SP's name)".
Else display "has (SP's name)".

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MCBS R55 GENERAL SPECFICATIONS FOR BLAISE/WVS

Version 07.01.0001

GLOBAL DISPLAY FILLS
DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If MRES.SPPROXY = 1/SP, display "have you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "was (SP's name)".
Else display "has (SP's name)".

TYPE
Respondent

GLOBAL DISPLAY NOTATION
have you/has (SP)/was (SP)

Respondent

Are you/Is (SP)

If MRES.SPPROXY = 1/SP, display "Are you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "Was (SP's name)".
Else display "Is (SP's name)".

Respondent

are you/is (SP)

If MRES.SPPROXY = 1/SP, display "are you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "was (SP's name)".
Else display "is (SP's name)".

Respondent

is/are

If MRES.SPPROXY = 1/SP, display "are".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "was".
Else display "is".

Respondent

Do you/Does (SP)

If MRES.SPPROXY = 1/SP, display "Do you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "Did (SP's name)".
Else display "Does (SP's name)".

Respondent

Do you/Does (SP)/Did (SP)

If MRES.SPPROXY = 1/SP, display "Do you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "Did (SP's name)".
Else display "Does (SP's name)".

Respondent

do you/does (SP)

If MRES.SPPROXY = 1/SP, display "do you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "did (SP's name)".
Else display "does (SP's name)".

Respondent

do you/does (SP)/did (SP)

If MRES.SPPROXY = 1/SP, display "do you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "did (SP's name)".
Else display "does (SP's name)".

Respondent

you need/(SP) needs

If MRES.SPPROXY = 1/SP, display "you need".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "(SP's name) needed".
Else display "(SP's name) needs".

Respondent

don't you/doesn't (SP)

If MRES.SPPROXY = 1/SP, display "don't you".
Else if MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "didn't (SP's name)".
Else display "doesn't (SP's name)".

Respondent

haven’t you/hasn’t (SP)

Respondent

If MRES.SPPROXY = 1/SP, display "haven't you".
Else "hasn't (SP's name)".
you & your spouse/(SP) & (his/her) If MRES.SPPROXY = 1/SP, display "you and your spouse".
spouse
Else if SP is male, display "(SP's name) and his spouse".
Else if SP is female, display "(SP's name) and her spouse".

Respondent

you have/she has/he has

DESCRIPTION

If MRES.SPPROXY = 1/SP, display "you have".
Else if SP is male, display "he has".
Else if SP is female, display "she has".

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MCBS R55 GENERAL SPECFICATIONS FOR BLAISE/WVS

Version 07.01.0001

GLOBAL DISPLAY FILLS
DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If MRES.SPPROXY = 1/SP, display "you have".
Else if SP is male, display "he has".
Else if SP is female, display "she has".

TYPE
Respondent

GLOBAL DISPLAY NOTATION
she has/he has

Respondent

were you/was he/was she

If MRES.SPPROXY = 1/SP, display "were you".
Else if SP is male, display "was he".
Else if SP is female, display "was she".

Respondent

was he/was she

If MRES.SPPROXY = 1/SP, display "were you".
Else if SP is male, display "was he".
Else if SP is female, display "was she".

Respondent

you/him/her

If MRES.SPPROXY = 1/SP, display "you".
Else if SP is male, display "him".
Else if SP is female, display "her".

Respondent

him/her

If MRES.SPPROXY = 1/SP, display "you".
Else if SP is male, display "him".
Else if SP is female, display "her".

Respondent

you were/he was/she was

If MRES.SPPROXY = 1/SP, display "you were".
Else if SP is male, display "he was".
Else if SP is female, display "she was".

Respondent

he was/she was

If MRES.SPPROXY = 1/SP, display "you were".
Else if SP is male, display "he was".
Else if SP is female, display "she was".

Respondent

you're/he's/she's

If MRES.SPPROXY = 1/SP, display "you're".
Else if SP is male, display "he's".
Else if SP is female, display "she's".

Respondent

he's/she's

If MRES.SPPROXY = 1/SP, display "you're".
Else if SP is male, display "he's".
Else if SP is female, display "she's".

Respondent

You/He/She

If MRES.SPPROXY = 1/SP, display "You".
Else if SP is male, display "He".
Else if SP is female, display "She".

Respondent

He/She

If MRES.SPPROXY = 1/SP, display "You".
Else if SP is male, display "He".
Else if SP is female, display "She".

Respondent

you/he/she

If MRES.SPPROXY = 1/SP, display "you".
Else if SP is male, display "he".
Else if SP is female, display "she".

DESCRIPTION

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MCBS R55 GENERAL SPECFICATIONS FOR BLAISE/WVS

Version 07.01.0001

GLOBAL DISPLAY FILLS
DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If MRES.SPPROXY = 1/SP, display "you".
Else if SP is male, display "he".
Else if SP is female, display "she".

TYPE
Respondent

GLOBAL DISPLAY NOTATION
he/she

Respondent

your/his/her

If MRES.SPPROXY = 1/SP, display "your".
Else if SP is male, display "his".
Else if SP is female, display "her".

Respondent

his/her

If MRES.SPPROXY = 1/SP, display "your".
Else if SP is male, display "his".
Else if SP is female, display "her".

Respondent

yourself/himself/herself

If MRES.SPPROXY = 1/SP, display "yourself".
Else if SP is male, display "himself".
Else if SP is female, display "herself".

Respondent

himself/herself

If MRES.SPPROXY = 1/SP, display "yourself".
Else if SP is male, display "himself".
Else if SP is female, display "herself".

Respondent

you are/he is/she is

If MRES.SPPROXY = 1/SP, display "you are".
Else if SP is male and (MRES.SPALIVE = 1/Alive or EMPTY), display "he is".
Else if SP is female and (MRES.SPALIVE = 1/Alive or EMPTY), display "she is".
Else if SP is male and MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "he was".
Else if SP is female and MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "she was".

Respondent

he is/she is

If MRES.SPPROXY = 1/SP, display "you are".
Else if SP is male and (MRES.SPALIVE = 1/Alive or EMPTY), display "he is".
Else if SP is female and (MRES.SPALIVE = 1/Alive or EMPTY), display "she is".
Else if SP is male and MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "he was".
Else if SP is female and MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "she was".

Respondent

Do you/Does (he/she)

If MRES.SPPROXY = 1/SP, display "Do you".
Else if SP is male and (MRES.SPALIVE = 1/Alive or EMPTY), display "Does he".
Else if SP is female and (MRES.SPALIVE = 1/Alive or EMPTY), display "Does she".
Else if SP is male and MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "Did he".
Else if SP is female and MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "Did she".

Respondent

do you/does (he/she)

If MRES.SPPROXY = 1/SP, display "do you".
Else if SP is male and (MRES.SPALIVE = 1/Alive or EMPTY), display "does he".
Else if SP is female and (MRES.SPALIVE = 1/Alive or EMPTY), display "does she".
Else if SP is male and MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "did he".
Else if SP is female and MRES.SPALIVE = 3/Deceased or 2/AliveAndInstitute, display "did she".

Respondent

you need/she needs/he needs

If MRES.SPPROXY = 1/SP, display "you need".
Else if SP is male, display "he needs".
Else if SP is female, display "she needs".

DESCRIPTION

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MCBS R55 GENERAL SPECFICATIONS FOR BLAISE/WVS

Version 07.01.0001

GLOBAL DISPLAY FILLS

TYPE
Respondent

GLOBAL DISPLAY NOTATION
you receive/(SP) receives

Respondent

you use/(SP) uses

Respondent

you don't/(SP) doesn't

Respondent

you use/she uses/he uses

DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If MRES.SPPROXY = 1/SP, display "you receive".
Else display "(SP name) receives".
If MRES.SPPROXY = 1/SP, display "you use".
Else display "(SP name) uses".
If MRES.SPPROXY = 1/SP, display "you don't".
Else display "(SP name) doesn't".
If MRES.SPPROXY = 1/SP, display "you use".
Else if SP is male, display "he uses".
Else if SP is female, display "she uses".

DESCRIPTION

Reference Date TODAY

Display today's date in "Month DD, YYYY" format.

The date of the current interview.

Reference Date REFERENCE DATE

Display MRES.MREFDATE in "Month DD, YYYY" format.

Typically, set to the date of the previous round interview.
However, depending on INTTYPE, this value may be set based on
a Facility discharge date, or other date. New Sample cases
REFERENCE date is January 1st of the year they entered the
sample.

Reference Date SUMMARY REFERENCE DATE

Display MRES.SUMMBDAT in "Month DD, YYYY" format.

Typically, set to the REFERENCE DATE for the previous round
community interview. Used to mark the begin date for reviewing
previous round collected data in the current round summary
sections. However, depending on INTTYPE, this value may be
set based on a Facility discharge date, or other date.

Reference Date SURVEY REFERENCE DATE

Display MRES.SRPBDAT in "Month DD, YYYY" format.

Typically,set to the REFERENCE DATE for 2 rounds previous
community interview. Used to mark the begin date for collecting
COST data (we usually collect data from the past year) as well as
data collected in supplement sections (ex: ACCESS to CARE).
However, depending on INTTYPE, this value may be set based on
a Facility discharge date, or other date. New Sample cases
SURVEY REFERENCE DATE is January 1st of the year they
entered the sample.

Reference Date DATE OF DEATH

Display MRES.SPDODMM / MRES.SPDODDD / MRES.SPDODYY in "Month DD, YYYY" format.

Date recorded in IN as the SP's date of death.

Reference Date DATE OF
Display MRES.SPINSTMM / MRES.SPINSTDD / MRES.SPINSTYY in "Month DD, YYYY" format.
INSTITUTIONALIZATION
Reference Date CHARGE BUNDLE REFERENCE if COST.COSTRNDC = (current round - 1), display "(MRES.SUMMBDAT) TO (MRES.MREFDATE)".
PERIOD
Else if COST.COSTRNDC = (current round - 2), display "(MRES.SRPBDAT) TO (MRES.SUMBDAT)".
Display dates in "Month DD, YYYY" format.

Date recorded in IN as the date SP was admitted to an institution.
Display the reference period for the round when COST first
generated.

Reference Date CURRENT YEAR

Display current year in "YYYY" format.

Display the current year as 4-digit year.

Reference Date PREVIOUS YEAR

Display (current year - 1) in "YYYY" format.

Display (current year - 1) as 4-digit year.

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GLOBAL DISPLAY FILLS

TYPE
GLOBAL DISPLAY NOTATION
Reference Date since (REFERENCE
DATE)/between (REFERENCE
DATE) and (DATE OF
DEATH/DATE OF
INSTITUTIONALIZATION)

DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If MRES.SPALIVE = 3/Deceased, display "between (REFERENCE DATE) and (DATE OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute, display "between (REFERENCE DATE) and (DATE OF
INSTITUTIONALIZATION)"
Else display "since (REFERENCE DATE)".

Reference Date Since (REFERENCE
DATE)/Between (REFERENCE
DATE) and (DATE OF
DEATH/DATE OF
INSTITUTIONALIZATION)

If MRES.SPALIVE = 3/Deceased, display "Between (REFERENCE DATE) and (DATE OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute, display "Between (REFERENCE DATE) and (DATE OF
INSTITUTIONALIZATION)".
Else display "Since (REFERENCE DATE)".

Reference Date (today/DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)

If MRES.SPALIVE = 3/Deceasedd, display "(DATE OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute, display "(DATE OF INSTITUTIONALIZATION)".
Else display "today".

Reference Date (DATE OF DEATH/DATE OF
INSTITUTION)
Reference Date (TODAY/DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)

If MRES.SPALIVE = 3/Deceased, display "(DATE OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute, display "(DATE OF INSTITUTIONALIZATION)".
If MRES.SPALIVE = 3/Deceased, display "(DATE OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute, display "(DATE OF INSTITUTIONALIZATION)".
Else display "(TODAY)".

Reference Date (REFERENCE PERIOD END
DATE)

If MRES.SPALIVE = 3/Deceased, display "(DATE OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute, display "(DATE OF INSTITUTIONALIZATION)".
Else display "(TODAY)".

Reference Date since (REFERENCE
DATE/SURVEY REFERENCE
DATE)/between (REFERENCE
DATE/SURVEY REFERENCE
DATE) and (DATE OF
DEATH/DATE OF
INSTITUTIONALIZATION)

If MRES.SPALIVE = 3/Deceased and administering OM from ST or NS, display "between (SURVEY REFERENCE
DATE) and (DATE OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute and administering OM from ST or NS, display "between (SURVEY
REFERENCE DATE) and (DATE OF INSTITUTIONALIZATION)"
Else if (MRES.SPALIVE = 1/Alive or EMPTY) and administering OM from ST or NS, display "since (SURVEY
REFERENCE DATE)".
Else If MRES.SPALIVE = 3/Deceased and administering OM, display "between (REFERENCE DATE) and (DATE
OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute and administering OM, display "between (REFERENCE DATE) and
(DATE OF INSTITUTIONALIZATION)"
Else if (MRES.SPALIVE = 1/Alive or EMPTY) and administering OM, display "since (REFERENCE DATE)".

DESCRIPTION

Since OM events added in the COST series are added in the OM
section, the reference period display is different if administering
OM from ST or NS (SURVEY REFERENCE DATE), or if
administering OM (REFERENCE DATE).

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MCBS R55 GENERAL SPECFICATIONS FOR BLAISE/WVS

Version 07.01.0001

GLOBAL DISPLAY FILLS

TYPE
GLOBAL DISPLAY NOTATION
Reference Date Since (REFERENCE
DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE
DATE/SURVEY REFERENCE
DATE) and (DATE OF
DEATH/DATE OF
INSTITUTIONALIZATION)

DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If MRES.SPALIVE = 3/Deceased and administering OM from ST or NS, display "Between (SURVEY REFERENCE
DATE) and (DATE OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute and administering OM from ST or NS, display "Between (SURVEY
REFERENCE DATE) and (DATE OF INSTITUTIONALIZATION)"
Else if (MRES.SPALIVE = 1/Alive or EMPTY) and administering OM from ST or NS, display "Since (SURVEY
REFERENCE DATE)".
Else If MRES.SPALIVE = 3/Deceased and administering OM, display "Between (REFERENCE DATE) and (DATE
OF DEATH)".
Else if MRES.SPALIVE = 2/AliveAndInstitute and administering OM, display "Between (REFERENCE DATE) and
(DATE OF INSTITUTIONALIZATION)"
Else if (MRES.SPALIVE = 1/Alive or EMPTY) and administering OM, display "Since (REFERENCE DATE)".

Reference Date LAST HF MONTH YEAR

If Supplemental Sample or SP skipped the previous year interview, display today’s month and previous year,
(current year - 1), in “Month YYYY” format.
Else display month and year from current round MRES.SRPBDAT in "Month YYYY" format.

Reference Date SURVEY REFERENCE MONTH
AND YEAR
Enumeration
HOUSEHOLD MEMBER NAME

Display MRES.SRPBDAT in "Month YYYY" format.

DESCRIPTION
Since OM events added in the COST series are added in the OM
section, the reference period display is different if administering
OM from ST or NS (SURVEY REFERENCE DATE), or if
administering OM (REFERENCE DATE).

ENUM.ENUMFNAM / ENUM.ENUMLNAM

Health Insurance PLAN COVERAGE START DATE Display PLAN.COVBEGMM / PLRO.COVBEGDD / PLRO.COVBEGYY in "Month DD, YYYY" format.
Health Insurance PLAN COVERAGE STOP DATE

Display PLAN.COVENDMM / PLRO.COVENDDD / PLRO.COVENDYY in "Month DD, YYYY" format.

Health Insurance PREVIOUS ROUND PLAN
STATUS

If plan is being added to the roster, display "BEING ADDED".
Else if previous round PLRO has (PLRO.COVTIME=1/WholeTime or PLRO.COVNOW=1/Yes or
PLRO.COVCURNT=1/Yes), display "CURRENT".
Else if previous round PLRO has PLRO.COVNOW=DK, display "DK".
Else if previous round PLRO has PLRO.COVNOW=RF, display "REUSED".
Else display "STOPPED".
ALWAYS DISPLAY MEDICARE PLAN AS "CURRENT".

Display status of plan at the time of the previous round interview.
Should be reevaluated each time the Plan Roster is displayed (the
plan status may be updated during the current round).

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GLOBAL DISPLAY FILLS

TYPE
GLOBAL DISPLAY NOTATION
Health Insurance CURRENT ROUND PLAN
STATUS

Health Insurance CMS MEDICARE MANAGED
CARE PLAN NAME

DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If plan is being added to the roster, display "BEING ADDED".
Else if current round PLRO has (PLRO.COVTIME=1/WholeTime or PLRO.COVNOW=1/Yes or
PLRO.COVCURNT=1/Yes), display "CURRENT".
Else if current round PLRO has PLRO.COVNOW=DK, display "DK".
Else if current round PLRO has PLRO.COVNOW=RF, display "REUSED".
Else if current round PLRO has (PLRO.COVNOW = 2/No or PLRO.COVCURNT=2/No), display "STOPPED".
Else if there is no current round PLRO for this PLAN, and there is a previous round PLRO that has
(PLRO.COVTIME=1/WholeTime or PLRO.COVNOW=1/Yes or PLRO.COVCURNT=1/Yes), display "CURRENT".
Else display "STOPPED".
ALWAYS DISPLAY MEDICARE PLAN AS "CURRENT".

DESCRIPTION
Display status of plan at the time of the current round interview.
Should be reevaluated each time the Plan Roster is displayed (the
plan status may updated during the current round).
Design Intent: To display the status of the plan in the current
round. However, the status of the plan in the current round may
not be known if the plan has not been asked about in the current
round. If the plan has not been asked about in the current round
and was current at the time of the previous round interview, the
plan status will be "CURRENT" until the plan status has been
reviewed/updated in the current round.

Display the name of Medicare Managed Care plan that was loaded from CMS, PLAN.PLNAME on PLAN where
PLAN.PLANTYPE=5/MHMO and PLAN.MHMOLRND = current round.

or
CMS MEDICARE ADVANTAGE
PLAN NAME
Health Insurance CURRENT MEDICARE
MANAGED CARE PLAN NAME

Display name of Medicare Managed Care plan that is "current" in the current round, PLAN.PLNAME.

or
CURRENT MEDICARE
ADVANTAGE PLAN NAME
or
CURRENT MEDICARE
ADVANTAGE PLAN

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Version 07.01.0001

GLOBAL DISPLAY FILLS

TYPE
GLOBAL DISPLAY NOTATION
Health Insurance PREVIOUS ROUND CURRENT
MEDICARE MANAGED CARE
PLAN NAME

DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
Display name of Medicare Managed Care plan that was "current" at the time of the previous round interview,
PLAN.PLNAME.

DESCRIPTION

or
PREVIOUS ROUND CURRENT
MEDICARE ADVANTAGE PLAN
NAME
Alternate:
MEDICARE MANAGED CARE
PLAN CURRENT AT THE TIME
OF THE PREVIOUS ROUND.
Health Insurance MEDICARE MANAGED CARE
PLAN NAME

Display name of Medicare Managed Care plan currently being asked about, PLAN.PLNAME.

or
MEDICARE ADVANTAGE PLAN
Health Insurance MEDICARE PRESCRIPTION
DRUG PLAN NAME
Health Insurance CURRENT MEDICARE
PRESCRIPTION DRUG PLAN
Health Insurance MEDICARE PRESCRIPTION
DRUG PLAN CURRENT LAST
ROUND

Display name of Medicare Prescription Drug plan currently being asked about, PLAN.PLNAME.

Health Insurance PUBLIC PLAN NAME

Display name of Public plan currently being asked about, PLAN.PLNAME.

Health Insurance PRIVATE PLAN NAME

Display name of Private plan currently being asked about, PLAN.PLNAME.

DM

Display name of Medicare Prescription Drug plan that is "current" in the current round, PLAN.PLNAME.
Display name of Medicare Prescription Drug plan that was "current" at the time of the previous round interview,
PLAN.PLNAME.

DISCOUNT MEMBERSHIP NAME Display name of DM currently being asked about, DMEM.DMNAMEX.

Events

EVENT DATE

Events

EVENT BEGIN DATE

Events

ADMISSION DATE

If (EVNT.EVNTTYPE = 'OM' and EVNT.OMSTATUS = 1/AlterationNotComplete), display "ONGOING".
Else display EVNT.EVBEGMM, EVNT.EVBEGDD, EVNT.EVBEGYY in "Month DD, YYYY" format.
If (EVNT.EVNTTYPE = 'OM' and EVNT.OMSTATUS = 1/AlterationNotComplete), display "ONGOING".
Else display EVNT.EVBEGMM, EVNT.EVBEGDD, EVNT.EVBEGYY in "Month DD, YYYY" format.
Display EVNT.EVBEGMM, EVNT.EVBEGDD, EVNT.EVBEGYY in "Month DD, YYYY" format.

Events

RENTAL START DATE

Display EVNT.EVBEGMM, EVNT.EVBEGDD, EVNT.EVBEGYY in "Month DD, YYYY" format.

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DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If (EVNT.EVNTTYPE = 'OM' and EVNT.RENTPROB = 2/Rent and EVNT.RENTSTIL = 1/Yes), display “RR”.
Else If (EVNT.EVNTTYPE = 'OM' and EVNT.RENTPROB = 2/Rent and EVNT.RENT2BUY =
2/PurchasedRentToBuy), display "OW”.
Else if EVNT.EVNTTYPE = 'IP' and EVNT.IPSTATUS = 1/StillInHospital, display "(STILL IN HOSPITAL)".
Else display EVNT.EVENDMM, EVNT.EVENDDD, EVNT.EVENDYY in "Month DD, YYYY" format.

TYPE
Events

GLOBAL DISPLAY NOTATION
EVENT END DATE

Events

DISCHARGE DATE

Events

RENTAL STOP DATE

Events

EVENT BEGIN TO END DATE

Display "(EVENT DATE) TO (EVENT END DATE)". See logic above for displaying dates.

Events

EVENT MONTH

Display EVNT.EVBEGMM in "Month" format.

Events

EVENT MONTH, YEAR

Display EVNT.EVBEGMM and EVNT.EVBEGYY in "Month, YYYY" format.

Events

PROVIDER NAME

PROV.PROVNAME

Events

HOSPTIAL NAME

PROV.PROVNAME

Events

FACILITY NAME

PROV.PROVNAME

Events

OME ITEM TYPE

If EVNT.STOMTYPE = 91/Other, display EVOS.EVOSTEXT on EVOS where EVOS.EVOSEVNT = this
EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response text.

Events

NUMBER OF VISITS

EVNT.RVTIMES

Events

NUMBER OF REPEAT VISITS

EVNT.RVTIMES

Events

NUMBER OF SERVICES

EVNT.RVTIMES

Events

NUMBER OF PURCHASES

PMRO.GETNUM

Events

VISIT ON EVENT DATE

"If Repeat visit event and # of visits = DK or RF, display "visits in (EVENT MONTH, YEAR)".
Else if Repeat visit, display "(NUMBER OF VISITS) visits in (EVENT MONTH, YEAR)".
Else display "visit on (EVENT DATE)".

Events

MEDICINE NAME

Display the name of the medicine concatenated with strength text field collected in PM roster pop-up window:
EVNT.PMEDNAME + ' ' + EVNT.PMSTRUNI.
If there is an EVNT linked to charge bundle (there is an XCEV where XCEV.XCEVEVNT = this EVNT.EVNTNUM
and XCEV.XCEVCOST = COST.COSTNUM for this charge bundle and XCEV.DELLINK ^=1/Yes) and
(EVNT.EVNTPROV ^= 01 or 02), display in context headers: "PROVIDER: (PROVIDER NAME)" for first
PROV.PROVNAME linked to charge bundle.
Else do not display in context headers.

Events in COST PROVIDER NAME
*NEED TO COME UP WITH A
NEW NOTATION FOR
DISPLAYING THE "1ST"
PROVIDER LINKED TO A
CHARGE BUNDLE FOR ST.
Events in COST EVENT

DESCRIPTION

If EVNT.EVNTTYPE = 'IP' and EVNT.IPSTATUS = 1/StillInHospital, display "(STILL IN HOSPITAL)".
Else display EVNT.EVENDMM, EVNT.EVENDDD, EVNT.EVENDYY in "Month DD, YYYY" format.
If (EVNT.EVNTTYPE = 'OM' and EVNT.RENTPROB = 2/Rent and EVNT.RENTSTIL = 1/Yes), display “RR”.
Else If (EVNT.EVNTTYPE = 'OM' and EVNT.RENTPROB = 2/Rent and EVNT.RENT2BUY =
2/PurchasedRentToBuy), display "OW”.
Else display EVNT.EVENDMM, EVNT.EVENDDD, EVNT.EVENDYY in "Month DD, YYYY" format.

See EVENT DISPLAY IN COST for event display specifications.

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TYPE
GLOBAL DISPLAY NOTATION
Events in COST CHARGE BUNDLE EVENT

DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
Events linked to this charge bundle =
There is an EVNT and an XCEV where XCEV.XCEVEVNT = EVNT.EVNTNUM and XCEV.XCEVCOST =
COST.COSTNUM and XCEV.DELLINK ^= 1/Yes.

DESCRIPTION

If displaying more than one CHARGE BUNDLE EVENT in the Context Header, and COST.ORIGNSEV ^= empty,the
default is to display Event where EVNT.EVNTNUM = COST.ORIGNSEV on 1st line, followed by any other Event
linked to Charge Bundle on second line.
See EVENT DISPLAY IN COST for event display specifications.
Events in COST ORIGINAL CHARGE BUNDLE
EVENT

EVNT.EVNTNUM = COST.ORIGNSEV.
Only applicable to COSTs generated in NS section.
See EVENT DISPLAY IN COST for event display specifications.

Events in COST LINKED CHARGE BUNDLE
EVENT

Event linked to charge bundle that is not the ORIGINAL CHARGE BUNDLE EVENT =
There is an EVNT where (EVNT.EVNTNUM ^= COST.ORIGNSEV) and an XCEV where (XCEV.XCEVEVNT =
EVNT.EVNTNUM and XCEV.XCEVCOST = COST.COSTNUM and XCEV.DELLINK ^= 1/Yes).
See EVENT DISPLAY IN COST for event display specifications.

Events in COST etc.

If more than 2 events are linked to the charge bundle, display "ETC." after 2nd event.
Else do not display.

Follows (CHARGE BUNDLE
EVENT) or (LINKED CHARGE
BUNDLE EVENT).
Events in COST NUMBER OF VISITS COVERED
BY CHARGE
Events in COST NUMBER OF SERVICES
COVERED BY CHARGE
Events in COST NUMBER OF MONTHS
COVERED BY CHARGE
Events in COST NUMBER OF PURCHASES
COVERED BY CHARGE
COST
COST START DATE

XCEV.RVLINKS
XCEV.RVLINKS
XCEV.MONTHCOV
XCEV.NUMLINKS
Display COST.COSTBEGM / COST.COSTBEGD / COST.COSTBEGY in "Month DD, YYYY" format.

COST

COST STOP DATE

Display COST.COSTENDM / COST.COSTENDD / COST.COSTENDY in "Month DD, YYYY" format.

COST

MPDP SERVICE START DATE

Display COST.PDPBEGMM / COST.PDPBEGDD / COST.PDPBEGYY in "Month DD, YYYY" format.

COST

MPDP SERVICE STOP DATE

Display COST.PDPENDMM / COST.PDPENDDD / COST.PDPENDYY in "Month DD, YYYY" format.

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GLOBAL DISPLAY FILLS
DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
If COST.STATTYPE = 8/MPDPBenefit, display "MEDICARE PRESCRIPTION DRUG CLAIMS FROM (MPDP
SERVICE START DATE) TO (MPDP SERVICE STOP DATE)".
Else If COST.STATTYPE = 2/Insurance, display “INSURANCE CLAIM CONTROL NUMBER: (CLAIM CONTROL
NUMBER)”.
Else if COST.STATTYPE = 4/Tricare or 6/TricareAndInsurance, display “TRICARE CLAIM CONTROL NUMBER:
(CLAIM CONTROL NUMBER)”.
Else display “MSN CLAIM CONTROL NUMBER: (CLAIM CONTROL NUMBER)”

TYPE
COST

GLOBAL DISPLAY NOTATION
ST CLAIM HEADER

COST

TYPE OF STATEMENT

If COST.STATTYPE = 8/MPDPBenefit, display "MEDICARE PRESCRIPTION DRUG BENEFIT STATEMENT'.
Else if COST.STATTYPE = 2/Insurance, display “INSURANCE STATEMENT”.
Else if COST.STATTYPE = 4/Tricare or 6/TricareAndInsurance, display “TRICARE STATEMENT”.
Else display “MEDICARE SUMMARY NOTICE (MSN)”. Always display "(MSN)".

COST

CLAIM CONTROL NUMBER

If COST.STATTYPE = 1/Medicare, 3/MedicareAndInsurance, 5/MedicareAndTricare or
7/MedicareAndTricareAndInsurance and COSA.MSNCLNUM ^= DK on COSA where COSA.COSACOST=this
COST.COSTNUM, display this COSA.MSNCLNUM.
Else if COST. STATTYPE = 2/Insurance and COST.INSCLNUM ^= DK, display COST.INSCLNUM.
Else if COST.STATTYPE = 4/Tricare or 6/TricareAndInsurance and COST.TRICLNUM^= DK, display
COST.TRICLNUM.
Else display “NOT KNOWN”.

COST

MSN/INSURANCE/TRICARE:

If COST.STATTYPE = 2/Insurance, display “INSURANCE”.
Else if COST.STATTYPE = 4/Tricare or 6/TricareAndInsurance, display “TRICARE”.
Else display “MSN”

COST

MEDICARE SUMMARY NOTICE
(MSN)/INSURANCE
STATEMENT/TRICARE
STATEMENT

If COST.STATTYPE = 2/Insurance, display “INSURANCE STATEMENT”.
Else if COST.STATTYPE = 4/Tricare or 6/TricareAndInsurance, display “TRICARE STATEMENT”.
Else display “MEDICARE SUMMARY NOTICE (MSN)”. Always display "(MSN)".

DESCRIPTION

ALT:
(INSURANCE
STATEMENT/TRICARE
STATEMENT)
COST

MSN CLAIM CONTROL NUMBER If COSA.MSNCLNUM = DK on COSA where COSA.COSACOST=this COST.COSTNUM, display “NOT KNOWN”.
Else display COSA.MSNCLNUM.

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GLOBAL DISPLAY FILLS

TYPE
COST

GLOBAL DISPLAY NOTATION
INSURANCE CLAIM CONTROL
NUMBER

DISPLAY INSTRUCTIONS
All references to MRES refer to current round MRES, where MRES.MRESRND = current round.
IF COST.INSCLNUM = DK, display “NOT KNOWN”.
Else display COST.INSCLNUM.

COST

TRICARE CLAIM CONTROL
NUMBER

IF COST.TRICLNUM = DK, display “NOT KNOWN”.
Else display COST.TRICLNUM.

COST

TOTAL CHARGE

If CORO.TOTALCHG/COST.TOTALAMT = DK , RF or empty, display “NOT KNOWN”
Else display total charge, COST.TOTALAMT/CORO.TOTALCHG.

COST

AMOUNT REMAINING

IF COST.AREMAING = DK or EMPTY, display “NOT KNOWN”
Else display COST.AREMAING

COST

TOTAL CHARGE AMOUNT

COST.TOTALAMT/CORO.TOTALCHG

COST

COST.MCAPPAMT

COST

MEDICARE APPROVED
AMOUNT
MEDICARE PAYMENT

COST

MAY BE BILLED

COST.MAYBBILL

COST

DAYS USED

COST.DAYSUSED

COST

NON COVERED CHARGES

COST.NONCOVRD

COST

COINSURANCE:

COST.COINSUR

COST

AMOUNT PER VISIT

Divide COST.TOTALAMT/CORO.TOTALCHG by XCEV.NUMLINKS.
Display calculated amount.

COST

SOURCE OF PAYMENT

TSOP.TSOPTEXT

DESCRIPTION

COST.MCPAYAMT

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EVENT DISPLAY IN COST
DISPLAY FILL INSTRUCTIONS BASED ON
EVNT.EVNTTYPE

If Repeat Visit event, EVNT.VISTTYPE = 2/RepeatVisit, display “(NUMBER OF VISITS) visit(s)
to (PROVIDER NAME) during the month of (EVENT MONTH)”.
Else display “dental visit to (PROVIDER NAME) on (EVENT DATE)”.

(CHARGE BUNDLE EVENT)
(ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT)
If Repeat Visit event, EVNT.VISTTYPE = 2/RepeatVisit, display “(NUMBER OF VISITS
COVERED BY CHARGE) visit(s) to (PROVIDER NAME) during the month of (EVENT MONTH)”.
Else display “dental visit to (PROVIDER NAME) on (EVENT DATE)”.

Display NUMBER OF VISITS: EVNT.RVTIMES.
Always display "(s)" in parenthesis.

Display NUMBER OF VISITS COVERED BY CHARGE: XCEV.RVLINKS.
Always display "(s)" in parenthesis.

EMERGENCY ROOM / ER

“visit to the ER at (PROVIDER NAME) on (EVENT DATE)”

“visit to the ER at (PROVIDER NAME) on (EVENT DATE)”

INPATIENT HOSPITAL STAY / IP

“stay at (PROVIDER NAME) from (EVENT BEGIN DATE) to (EVENT END DATE)”

“stay at (PROVIDER NAME) from (EVENT BEGIN DATE) to (EVENT END DATE)”

DENTAL / DU

(EVENT)

INSTITUTIONAL UTILIZATION / IU

"stay at (PROVIDER NAME) from (EVENT BEGIN DATE) to (EVENT END DATE)"

"stay at (PROVIDER NAME) from (EVENT BEGIN DATE) to (EVENT END DATE)"

OUTPATIENT HOSPITAL VISIT / OP

If Repeat Visit event, EVNT.VISTTYPE = 2/RepeatVisit, display “(NUMBER OF VISITS) visit(s)
to the OPD at (PROVIDER NAME) during the month of (EVENT MONTH)”.
Else display “visit to the OPD at (PROVIDER NAME) on (EVENT DATE)”.

If Repeat Visit event, EVNT.VISTTYPE = 2/RepeatVisit, display “(NUMBER OF VISITS
COVERED BY CHARGE) visit(s) to the OPD at (PROVIDER NAME) during the month of
(EVENT MONTH)”.
Else display “visit to the OPD at (PROVIDER NAME) on (EVENT DATE)”.

Display NUMBER OF VISITS: EVNT.RVTIMES.
Always display "(s)" in parenthesis.

HOME HEALTH / HH

If PROV.SUBPROV ^= empty on PROV where PROV.PROVNUM = EVNT.EVNTPROV, display If PROV.SUBPROV ^= empty on PROV where PROV.PROVNUM = EVNT.EVNTPROV, display
"visit(s) from someone from (PROVIDER NAME).
"visit(s) from someone from (PROVIDER NAME).
Else display "visit(s) from (PROVIDER NAME)".
Else display "visit(s) from (PROVIDER NAME)".
Always display "(s)" in parenthesis.

MEDICAL PROVIDER VISIT / MP

Display NUMBER OF VISITS COVERED BY CHARGE: XCEV.RVLINKS.
Always display "(s)" in parenthesis.

Always display "(s)" in parenthesis.

If Repeat Visit event, EVNT.VISTTYPE = 2/RepeatVisit, display (NUMBER OF VISITS) visit(s) to If Repeat Visit event, EVNT.VISTTYPE = 2/RepeatVisit, display (NUMBER OF VISITS
(PROVIDER NAME) during the month of (EVENT MONTH)”.
COVERED BY CHARGE) visit(s) to (PROVIDER NAME) during the month of (EVENT MONTH)”.
Else display “visit to (PROVIDER NAME) on (EVENT DATE)”.
Else display “visit to (PROVIDER NAME) on (EVENT DATE)”.
Display NUMBER OF VISITS: EVNT.RVTIMES.
Always display "(s)" in parenthesis.

Display NUMBER OF VISITS COVERED BY CHARGE: XCEV.RVLINKS.
Always display "(s)" in parenthesis.

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EVENT DISPLAY IN COST
DISPLAY FILL INSTRUCTIONS BASED ON
EVNT.EVNTTYPE
OTHER MEDICAL EXPENSES / OM

(EVENT)

(CHARGE BUNDLE EVENT)
(ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT)

OME ITEM TYPE =
If EVNT.STOMTYPE = 91/Other, display EVOS.EVOSTEXT on EVOS where EVOS.EVOSEVNT
= this EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response text.

OME ITEM TYPE =
If EVNT.STOMTYPE = 91/Other, display EVOS.EVOSTEXT on EVOS where EVOS.EVOSEVNT
= this EVNT.EVNTNUM.
Else display EVNT.STOMTYPE response text.

If (EVNT.RENTPROB = 2/Rent and EVNT.RENTSTIL = 1/Yes), display “(OME ITEM TYPE)
rented from (EVENT BEGIN DATE) to RR”.
Else If (EVNT.RENTPROB = 2/Rent and EVNT.RENT2BUY =
2/PurchasedRentToBuy), display “(OME ITEM TYPE) rented from (EVENT BEGIN DATE) to
OW”.
Else If (EVNT.RENTPROB = 2/Rent and EVNT.RENTSTIL = 2/No, DK, or RF) and
(EVNT.RENT2BUY ^=2/PurchasedRentTo Buy), display “(OME ITEM TYPE) rented from
(EVENT BEGIN DATE) to (EVENT END DATE)”.
Else if EVNT.OMETYPE = 7/Alteration and EVNT.OMSTATUS = 1/AlterationNotComplete,
display "(OME ITEM TYPE) completed on ONGOING".
Else if EVNT.OMETYPE = 7/Alteration and EVNT.OMSTATUS = 2/AlterationComplete, display
"(OME ITEM TYPE) completed on (EVENT DATE)".
Else if EVNT.OMETYPE = 10/Other & EVNT.OTHRTYPE = 5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages, display “(NUMBER OF PURCHASES) times [you/(SP)]
obtained (OME ITEM TYPE)".
Else display "(OME ITEM TYPE) obtained on (EVENT DATE)".

If (EVNT.RENTPROB = 2/Rent and EVNT.RENTSTIL = 1/Yes), display “(OME ITEM TYPE)
rented from (EVENT BEGIN DATE) to RR”.
Else If (EVNT.RENTPROB = 2/Rent and EVNT.RENT2BUY =
2/PurchasedRentToBuy), display “(OME ITEM TYPE) rented from (EVENT BEGIN DATE) to
OW”.
Else If (EVNT.RENTPROB = 2/Rent and EVNT.RENTSTIL = 2/No, DK, or RF) and
(EVNT.RENT2BUY ^=2/PurchasedRentTo Buy), display “(OME ITEM TYPE) rented from
(EVENT BEGIN DATE) to (EVENT END DATE)”.
Else if EVNT.OMETYPE = 7/Alteration and EVNT.OMSTATUS = 1/AlterationNotComplete,
display "(OME ITEM TYPE) completed on ONGOING".
Else if EVNT.OMETYPE = 7/Alteration and EVNT.OMSTATUS = 2/AlterationComplete, display
"(OME ITEM TYPE) completed on (EVENT DATE)".
Else if EVNT.OMETYPE = 10/Other & EVNT.OTHRTYPE = 5/OstomySupplies,
6/IncontinenceSupplies, or 7/Bandages, display “(NUMBER OF PURCHASES COVERED BY
CHARGE) times [you/(SP)] obtained (OME ITEM TYPE)".
Else display "(OME ITEM TYPE) obtained on (EVENT DATE)".

Display NUMBER OF PURCHASES:
PMRO.GETNUM on which PMRO where PMRO.PMROEVNT = this EVNT.EVNTNUM and
PMRO.PMRORND = current round.

Display NUMBER OF PURCHASES COVERED BY CHARGE,
XCEV.NUMLINKS.

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EVENT DISPLAY IN COST
DISPLAY FILL INSTRUCTIONS BASED ON
EVNT.EVNTTYPE
PRESCRIPTION MEDICINE / PM

(EVENT)

Display “(NUMBER OF PURCHASES/NUMBER OF PURCHASES COVERED BY CHARGE)
times [you/(SP)] obtained (MEDICINE NAME)”.

(CHARGE BUNDLE EVENT)
(ORIGINAL CHARGE BUNDLE EVENT)
(LINKED CHARGE BUNDLE EVENT)
Display “(NUMBER OF PURCHASES/NUMBER OF PURCHASES COVERED BY CHARGE)
times [you/(SP)] obtained (MEDICINE NAME)”.

Display NUMBER OF PURCHASES:

Display NUMBER OF PURCHASES COVERED BY CHARGE: XCEV.NUMLINKS.

If there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and PMRO.PMRORND =
current round and PMRO.GETNUM > 0 and PMRO.GETNUM ^= DK and PMRO.GETNUM ^=
RF) AND
if there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and PMRO.PMRORND =
previous round and PMRO.GETNUM > 0 and PMRO.GETNUM ^= DK and PMRO.GETNUM ^=
RF and PMRO.PMSUMFLG = 1.Yes and PMRO.PMRODFLG ^= 1/Yes)
then display:
(PMRO.GETNUM on PMRO where PMRO.PMRORND = previous round) +
(PMRO.GETNUM on PMRO where PMRO.PMRORND = current round).
Else If there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and PMRO.PMRORND
= current round and PMRO.GETNUM > 0 and PMRO.GETNUM ^= DK and PMRO.GETNUM ^=
RF), display:
(PMRO.GETNUM on PMRO where PMRO.PMRORND = current round).
Else if there is a PMRO where (PMRO.PMROEVNT = EVNT.EVNTNUM and PMRO.PMRORND
= previous round and PMRO.GETNUM > 0 and PMRO.GETNUM ^= DK and PMRO.GETNUM
^= RF and PMRO.PMSUMFLG = 1.Yes and PMRO.PMRODFLG ^= 1/Yes)
then display:
(PMRO.GETNUM on PMRO where PMRO.PMRORND = previous round).

SEPARATELY BILLING LAB / SL

If Repeat Visit event, EVNT.VISTTYPE = 2/RepeatVisit, display “(NUMBER OF SERVICES) lab
service(s) provided by (PROVIDER NAME) during the month of (EVENT MONTH)”.
Else display “lab services from (PROVIDER NAME) on (EVENT DATE)”.
Display NUMBER OF SERVICES: EVNT.RVTIMES.
Always display "(s)" in parenthesis.

SEPARATELY BILLING DOCTOR / SD

"services from (PROVIDER NAME) on (EVENT DATE)"

If Repeat Visit event, EVNT.VISTTYPE = 2/RepeatVisit, display “(NUMBER OF SERVICES
COVERED BY CHARGE) lab service(s) provided by (PROVIDER NAME) during the month of
(EVENT MONTH)”.
Else display “lab services from (PROVIDER NAME) on (EVENT DATE)”.
Display NUMBER OF SERVICES COVERED BY CHARGE: XCEV.RVLINKS.
Always display "(s)" in parenthesis.
"services from (PROVIDER NAME) on (EVENT DATE)"

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Nested fills in IA that are specified in General Specification global display fills:
(SP)
(SP’s)
(his/her)
Nested Fills in IA that are part of IA global display fills:
(wife/husband)

If (SP is married and SP's Spouse is Respondent) and SP is male, display “husband”.
Else if (SP is married and SP's Spouse is Respondent) and SP is female, display “wife”.
Else if SP is male, display “wife”.
Else if SP is female, display “husband”.

(wife’s/husband’s)

If (SP is married and SP's Spouse is Respondent) and SP is male, display “husband’s”.
Else if (SP is married and SP's Spouse is Respondent) and SP is female, display “wife’s”.
Else if SP is male, display “wife’s”.
Else if SP is female, display “husband’s”.

Remaining IA global display fills:
[you/(SP)/you and your (wife/husband)/(SP) and (his/her) (wife/husband)]

If (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “you and your (wife/husband)”.
Else if Proxy is respondent and SP is married, display “(SP) and (his/her) (wife/husband)”.
Else if SP is respondent, display “you”.
Else display “(SP)”.

[your/(SP’s)/you and your (wife’s/husband’s)/(SP) and (his/her) (wife’s/husband’s)]

If (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “you and your (wife’s/husband’s)”.
Else if Proxy is respondent and SP is married, display “(SP) and (his/her) (wife’s/husband’s)”.
Else if SP is respondent, display “your”.
Else display “(SP’s)”.

[you and your (wife/husband)/(SP) and (his/her) (wife/husband)]

If (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “you and your (wife/husband)”.
Else if Proxy is respondent and SP is married, display “(SP) and (his/her) (wife/husband)”.
NOTE: This display fill is only applicable if SP is married. Otherwise, sentence is not displayed. EX: See IAINTRO1 and
IAINTRO4.

[you/(SP)/you or your (wife/husband)/(SP) or (his/her) (wife/husband)]

If (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “you or your (wife/husband)”.
Else if Proxy is respondent and SP is married, display “(SP) or (his/her) (wife/husband)”.
Else if SP is respondent, display “you”.
Else display “(SP)”.

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IA GLOBAL DISPLAYS
Nested fills in IA that are specified in General Specification global display fills:
[you/he/she/he or his wife/she or her husband/you or your (wife/husband)]

If (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “you or your (wife/husband)”.
Else if Proxy is respondent and SP is married and SP is male, display “he or his wife”
Else if Proxy is respondent and SP is married and SP is female, display “she or her husband”
Else if SP is respondent, display “you”
Else if Proxy is respondent and SP is male, display “he”.
Else if Proxy is respondent and SP is female, display “she”.

[your/(SP’s)/their]

If (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “your”.
Else if Proxy is respondent and SP is married, display “their”.
Else display “(SP’s)”.

(your/his/her/their)

If (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “your”.
Else if Proxy is respondent and SP is married, display “their”.
Else if Proxy is respondent and SP is male, display “his”.
Else if Proxy is respondent and SP is female, display “her”.

(you/he/she/they)

If (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “you”.
Else if Proxy is respondent and SP is married, display “they”.
Else if Proxy is respondent and SP is male, display “he”.
Else if Proxy is respondent and SP is female, display “she”.

(Do/Did/Does)

If SP is deceased, display “Did”.
Else if (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “Do”.
Else display “Does”.

(do/did/does)

If SP is deceased, display “did”.
Else if (SP is respondent) or (SP is married and SP's Spouse is Respondent), display “do”..
Else display “does”.

(live/lives/lived)

If SP is deceased, display “lived”.
Else if Proxy is respondent and SP is not married, display “lives”.
Else display “live”.

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Version 07.01.0001

MCBS R55 GENERAL SPECFICATIONS FOR BLAISE/WVS
ADDRESS and PHONE displays
DESCRIPTION
SP's Home Address
Proxy's Home Address
First Contact's Home Address
Second Contact's Home Address
Future Proxy's Home Address

DISPLAY FILL SPECIFCATION
STREET ADDRESS LINE 1

DISPLAY VARIABLES
ADDR STADDR1

DETAILS
1st line in street address

STREET ADDRESS LINE 2

ADDR STADDR2

2nd line in street address (not required)

CITY

ADDR CITY

City

STATE

ADDR STATE

State

ZIPCODE

ADDR ZIPCODE

Zipcode

PRIMARY PHONE NUMBER
FUTURE PROXY PRIMARY PHONE NUMBER

ADDR PHONAREA
PHONEXCH
PHONLOCL

Area code
Exchange
Local #

SECONDARY PHONE NUMBER
FUTURE PROXY SECONDARY PHONE NUMBER

ADDR PHONAR2
PHONEX2
PHONLO2

Area code
Exchange
Local #

HRND CONTNUM1

ROST.ROSTNUM of First Contact

SP/Proxy:
Display CURRENT ROUND Address information.
A current round ADDR is always created. Previous ADDR fields are copied to
the current round ADDR if they exist. The current round ADDR is then
verified/updated.
First and Second ContactL
Display CURRENT ROUND Address information.
A current round ADDR is always created if Contact is the same as the previous
round. Previous ADDR fields are copied to the current round ADDR if they exist.
The current round ADDR is then verified/updated.
Future Proxy:
We do not display previously collected address for Future Proxy.
We only collect a new ADDR if it does not exist for the Future Proxy. We do not
verify the Future Proxy's address if has already been collected.

First Contact Information

FIRST CONTACT NAME FROM PREVIOUS ROUND

Display PREVIOUS ROUND contact information. If same contact in current
round, copy HRND fields to the current round HRND.

Name of Contact stored on ROST where
ROST.ROSTNUM = previous HRND.CONTNUM1.
HRND PHONNAM1
PHONN1OS
HRND PHO2NAM1
PHO2N1OS

Name First Contact's primary phone number listed.
Name First Contact's secondary phone number listed.

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Version 07.01.0001

MCBS R55 GENERAL SPECFICATIONS FOR BLAISE/WVS
ADDRESS and PHONE displays
DESCRIPTION
Second Contact Information

DISPLAY FILL SPECIFCATION
SECOND CONTACT NAME FROM PREVIOUS
ROUND

Display PREVIOUS ROUND contact information. If same contact in current
round, copy HRND fields to the current round HRND.

DISPLAY VARIABLES
HRND CONTNUM2

DETAILS
ROST.ROSTNUM of Second Contact
Name of Contact stored on ROST where
ROST.ROSTNUM = previous HRND.CONTNUM2.

Future Proxy information

FUTURE PROXY NAME

Display CURRENT ROUND future proxy information. We do not verify Future
Proxy information from previous round. We probe for a future proxy every round.

HRND PHONNAM2
PHONN2OS
HRND PHO2NAM2
PHO2N2OS

Name Second Contact's primary phone number listed.

HRND FUTRPROX

ROST.ROSTNUM of Future Proxy

Name Second Contact's secondary phone number
listed.

Name of Future proxy stored on ROST where
ROST.ROSTNUM = HRND.FUTRPROX
PROXNAM1
PROXN1OS
PROXNAM2
PROXN2OS
Best phone number for arranging next PREVIOUS BEST PHONE NUMBER FOR NEXT
interviewe.
INTERVIEW

SP's mailing address

MAILING ADDRESS LINE 1

Display THE MOST RECENT best phone number prior to the current round. If
phone number is the same, copy best phone fields to current round HRND.

Display address on HOME. Verify/update address.

Name Future Proxy's primary phone number listed.
Name Future Proxy's secondary phone number listed.

HRND INTNAREA
INTNEXCH
INTNLOCL

Area code
Exchange
Local #

HRND PHONWHER
PHONWHOS

Where is best phone number located.
Can answer SP/Proxy's Home, SP/Proxy's office,
Neighbors, Friends, Relatives, or Other. If Neighbors,
Friends, Relatives, we collect person's name in Person
Roster and name phone is listed.

HRND PHONROST

ROST.ROSTNUM of person where best phone is
located.
(PHONWHER = Neighbors, Friends or Relatives).

HRND INTNNAME
INTNAMOS

Name best phone is under.
(PHONWHER = Neighbors, Friends or Relatives).

HOME MSTADDR1

1st line in street address

MAILING ADDRESS LINE 2

HOME MSTADDR2

2nd line in street address (not required)

MAILING CITY

HOME MCITY

City

MAILING STATE

HOME MSTATE

State

MAILING ZIPCODE

HOME MZIPCODE

Zipcode

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Version 07.01.0001

MCBS R55 GENERAL SPECFICATIONS FOR BLAISE/WVS
ADDRESS and PHONE displays
DESCRIPTION
SP's vacation home address

DISPLAY FILL SPECIFCATION
VACATION HOME ADDRESS LINE 1

DISPLAY VARIABLES
HRND VSTADDR1

DETAILS
1st line in street address

VACATION HOME ADDRESS LINE 2

HRND VSTADDR2

2nd line in street address (not required)

VACATION HOME CITY

HRND VCITY

City

VACATION HOME STATE

HRND VSTATE

State

VACATION HOME ZIPCODE

HRND VZIPCODE

Zipcode

VACATION HOME PHONE NUMBER

HRND VPHONARE
VPHONEXC
VPHONLOC

Area code
Exchange
Local #

DisplayTHE MOST RECENT vacation home address prior to the current round.
If address is the same, copy address fields to current round HRND. Otherwise
collect new address.

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