Download:
pdf |
pdfOM1
OM1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPREYEG
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:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
Question Text:
Next I’m going to ask you about other medical expenses that
[you/(SP)] may have had between (REFERENCE DATE/SURVEY
REFERENCE DATE) and (today/(DATE OF DEATH/DATE OF
INSTITUTIONALIZATION).
[Since (REFERENCE DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] buy, replace, or pay for
repairs of eyeglasses or contact lenses?
6:19:35 PM Wednesday, March 27, 2013
Page 1 of 341
OM1
Int. Instr II:
INPUT FIELDS / ROUTING
OMPREYEG
Field1:
Cheshire Name:
Item Text display:
( OMQ1020 )
HRND.OMPREYEG
Do not display response option 3/IndicatedYesByDataPrep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM2 - EVENT_OMEYEG ( OMQ1030 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
OM3 - OMPRHEAR ( OMQ1100 )
DO NOT DISPLAY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
OM3 - OMPRHEAR ( OMQ1100 )
Refusal
OM3 - OMPRHEAR ( OMQ1100 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
6:19:36 PM Wednesday, March 27, 2013
Page 2 of 341
OM1
DESIGN NOTES
6:19:36 PM Wednesday, March 27, 2013
Page 3 of 341
OM2
OM2
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMEYEG
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
30
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all eyeglasses or contacts that have been reported in the
current round where:
EVNT.EVNTDFLG^=1/Yes, and
EVNT.EVNTRNDC = current round, and
EVNT.EVNTTYPE = 'OM', and
EVNT.OMETYPE = 1/EyeGlasses.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Purchase or
Repair Date
Display EVENT DATE in "Mon DD YYYY"
format.
2
OME Type
Display OM Type, EVNT.OMETYPE.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
6:19:37 PM Wednesday, March 27, 2013
Page 4 of 341
OM2
Int. Instr I:
SELECT OR ADD ALL DATES AT THIS ROSTER.
Question Text:
When did [you/(SP)] buy or repair glasses or contact lenses?
Please tell me all the dates [since (REFERENCE DATE/SURVEY
REFERENCE DATE)/between (REFERENCE DATE/SURVEY
REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)].
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_OMEYEG
( OMQ1030 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX OM1AA - (OMQ1080 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
6:19:37 PM Wednesday, March 27, 2013
Page 5 of 341
OM2
OMETYPE
EVNT.OMETYPE = 1/EyeGlasses.
STOMTYPE
EVNT.STOMTYPE = 1/EyeGlasses.
EVNTPROV
EVNT.EVNTPROV = 01.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
6:19:37 PM Wednesday, March 27, 2013
Page 6 of 341
OM2
Called from ST36 and NS36 if OM needs to be added to charge bundle in
ST and/or NS.
6:19:37 PM Wednesday, March 27, 2013
Page 7 of 341
BOX OM1AA
BOX OM1AA
Page Order # :
40
BOX INSTRUCTIONS
( OMQ1080 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM2_IN - NAVIGATOR ( OMQ1085 ).
ELSE GO TO BOX OM1AA2 - (OMQ1098 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:19:37 PM Wednesday, March 27, 2013
Page 8 of 341
OM2_IN
OM2_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
45
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 OM's added at OM2.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:19:38 PM Wednesday, March 27, 2013
Page 9 of 341
OM2_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ1085 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM2A - OMSATHMO ( OMQ1090 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX OM1AA2 - (OMQ1098 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:19:38 PM Wednesday, March 27, 2013
Page 10 of 341
OM2A
OM2A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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:
Display the event date for the OM event currently being asked about.
Question display:
Display the event date for the OM event currently being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
EVENT DATE: (EVENT DATE)
Int. Instr I:
Question Text:
On (EVENT DATE), did [you/(SP)] buy or repair the glasses or
6:19:39 PM Wednesday, March 27, 2013
Page 11 of 341
OM2A
contact lenses at [READ MANAGED CARE PLAN NAME(S)
BELOW] or through a service or discount offered through [READ
MANAGED CARE PLAN NAME(S) BELOW]?
[PROBE: This could include buying or repairing the glasses or
lenses at a plan center; at an optician, optometrist or other place
that honors [your/(SP’s)] plan card; or through a place or service that
the plan referred [you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
OMSATHMO
Cheshire Name:
( OMQ1090 )
EVNT.OMSATHMO
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 OM1AA1 - (OMQ1095 )
English text: YES
No
BOX OM1AA1 - (OMQ1095 )
English text: NO
Attribute
Route
Don't know
BOX OM1AA1 - (OMQ1095 )
Refusal
BOX OM1AA1 - (OMQ1095 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:19:40 PM Wednesday, March 27, 2013
Page 12 of 341
OM2A
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:19:40 PM Wednesday, March 27, 2013
Page 13 of 341
BOX OM1AA1
BOX OM1AA1
Page Order # :
55
BOX INSTRUCTIONS
( OMQ1095 )
GO TO OM2_IN - NAVIGATOR ( OMQ1085 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:19:40 PM Wednesday, March 27, 2013
Page 14 of 341
BOX OM1AA2
BOX OM1AA2
Page Order # :
58
BOX INSTRUCTIONS
( OMQ1098 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO OM3 - OMPRHEAR ( OMQ1100 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:19:40 PM Wednesday, March 27, 2013
Page 15 of 341
OM3
OM3
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPRHEAR
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
Question Text:
[Since (REFERENCE DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] buy, replace, or pay for
repairs of a hearing aid, amplifier for a telephone, or similar device to
help [you/(SP)] hear or speak?
Int. Instr II:
6:19:41 PM Wednesday, March 27, 2013
Page 16 of 341
OM3
INPUT FIELDS / ROUTING
OMPRHEAR
Field1:
Cheshire Name:
Item Text display:
( OMQ1100 )
HRND.OMPRHEAR
Do not display response option 3/IndicatedYesByDataPrep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM4 - EVENT_OMHEAR ( OMQ1110 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
BOX OMA1 - (OMQ1170 )
DO NOT DISPLAY.
English text: INDICATED YES BY DATAPREP
Attribute
Route
Don't know
BOX OMA1 - (OMQ1170 )
Refusal
BOX OMA1 - (OMQ1170 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:19:42 PM Wednesday, March 27, 2013
Page 17 of 341
OM4
OM4
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMHEAR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
70
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all Hearing Devices that have been reported in the current
round where:
EVNT.EVNTDFLG^=1/Yes, and
EVNT.EVNTRNDC = current round, and
EVNT.EVNTTYPE = 'OM', and
EVNT.OMETYPE = 2/Hearing.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Purchase or
Repair Date
Display EVENT DATE in "Mon DD YYYY"
format.
2
OME Type
Display OM Type, EVNT.OMETYPE.
Report display:
TEXT:
Context Header:
6:19:43 PM Wednesday, March 27, 2013
Page 18 of 341
OM4
Int. Instr I:
SELECT OR ADD ALL DATES AT THIS ROSTER.
Question Text:
When did [you/(SP)] buy or repair a hearing or speech device?
Please tell me the dates of each purchase or repair [since
(REFERENCE DATE/SURVEY REFERENCE DATE)/between
(REFERENCE DATE/SURVEY REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)].
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_OMHEAR
( OMQ1110 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX OM1BB - (OMQ1150 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
6:19:43 PM Wednesday, March 27, 2013
Page 19 of 341
OM4
OMETYPE
EVNT.OMETYPE = 2/Hearing.
STOMTYPE
EVNT.STOMTYPE = 2/Hearing.
EVNTPROV
EVNT.EVNTPROV = 01.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
6:19:43 PM Wednesday, March 27, 2013
Page 20 of 341
OM4
Called from ST36 and NS36 if OM needs to be added to charge bundle in
ST and/or NS.
6:19:43 PM Wednesday, March 27, 2013
Page 21 of 341
BOX OM1BB
BOX OM1BB
80
Page Order # :
BOX INSTRUCTIONS
( OMQ1150 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM4_IN - NAVIGATOR ( OMQ1155 ).
ELSE GO TO BOX OM1BB2 - (OMQ1168 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:19:43 PM Wednesday, March 27, 2013
Page 22 of 341
OM4_IN
OM4_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
85
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 OM's added at OM4.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:19:44 PM Wednesday, March 27, 2013
Page 23 of 341
OM4_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ1155 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM4A - OMSATHMO ( OMQ1160 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX OM1BB2 - (OMQ1168 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:19:44 PM Wednesday, March 27, 2013
Page 24 of 341
OM4A
OM4A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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:
Display the event date for the OM event currently being asked about.
Question display:
Display the event date for the OM event currently being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
EVENT DATE: (EVENT DATE)
Int. Instr I:
Question Text:
On (EVENT DATE), did [you/(SP)] buy or repair the hearing or
6:19:45 PM Wednesday, March 27, 2013
Page 25 of 341
OM4A
speech device at [READ MANAGED CARE PLAN NAME(S)
BELOW] or through a service or discount offered through [READ
MANAGED CARE PLAN NAME(S) BELOW]?
[PROBE: This could include buying or repairing the hearing or
speech device at a plan center; from an audiologist, speech
pathologist, or other provider that honors [your/(SP’s)] plan card; or
through a place or service that the plan referred [you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
OMSATHMO
Cheshire Name:
( OMQ1160 )
EVNT.OMSATHMO
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 OM1BB1 - (OMQ1165 )
English text: YES
No
BOX OM1BB1 - (OMQ1165 )
English text: NO
Attribute
Route
Don't know
BOX OM1BB1 - (OMQ1165 )
Refusal
BOX OM1BB1 - (OMQ1165 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:19:46 PM Wednesday, March 27, 2013
Page 26 of 341
OM4A
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:19:46 PM Wednesday, March 27, 2013
Page 27 of 341
BOX OM1BB1
BOX OM1BB1
Page Order # :
95
BOX INSTRUCTIONS
( OMQ1165 )
GO TO OM4_IN - NAVIGATOR ( OMQ1155 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:19:46 PM Wednesday, March 27, 2013
Page 28 of 341
BOX OM1BB2
BOX OM1BB2
Page Order # :
98
BOX INSTRUCTIONS
( OMQ1168 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO BOX OMA1 - (OMQ1170 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:19:46 PM Wednesday, March 27, 2013
Page 29 of 341
BOX OMA1
BOX OMA1
Page Order # :
100
BOX INSTRUCTIONS
( OMQ1170 )
IF SP WAS STILL RENTING AT LEAST ONE ORTHOPEDIC ITEM AT THE
TIME OF THE PREVIOUS ROUND INTERVIEW, GO TO OMS5INTR
ORTHINTRO ( OMQ1175 ).
ELSE GO TO OM5 - OMPRORTH ( OMQ1210 ).
ASSIGNMENTS
TECHNICAL NOTES
199
StillRentOrthItem
SP still renting an orthopedic item at the time of the
previous round interview =
There is an EVNT where EVNT.EVNTTYPE ='OM' and
EVNT.OMETYPE=3/Orthopedic and EVNT.RENTSTIL =
1/Yes and EVNT.RENTRECR = previous round and
EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:19:47 PM Wednesday, March 27, 2013
Page 30 of 341
OMS5INTR
OMS5INTR
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
ORTHINTRO
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
105
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:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
The next questions are about orthopedic items [you were/(SP) was]
renting as of (REFERENCE DATE).
Int. Instr II:
INPUT FIELDS / ROUTING
6:19:47 PM Wednesday, March 27, 2013
Page 31 of 341
OMS5INTR
Field1:
ORTHINTRO
Cheshire Name:
( OMQ1175 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS5_IN - NAVIGATOR ( OMQ1176 )
English text: CONTINUE
Attribute
Route
Empty
OMS5_IN - NAVIGATOR ( OMQ1176 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:19:48 PM Wednesday, March 27, 2013
Page 32 of 341
OMS5_IN
OMS5_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
106
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 all Orthopedic Items that the SP was renting at the time of
the previous round interview.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:19:49 PM Wednesday, March 27, 2013
Page 33 of 341
OMS5_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ1176 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS5 - RENTSTIL ( OMQ1180 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
OM5 - OMPRORTH ( OMQ1210 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
199
StillRentOrthItem
SP still renting an orthopedic item at the time of the
previous round interview =
There is an EVNT where EVNT.EVNTTYPE ='OM' and
EVNT.OMETYPE=3/Orthopedic and EVNT.RENTSTIL =
1/Yes and EVNT.RENTRECR = previous round and
EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:19:49 PM Wednesday, March 27, 2013
Page 34 of 341
OMS5
OMS5
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENTSTIL
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:
Display the name of the Orthopic item currently being asked about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT. See technical note.
Else display EVNT.ORTHTYPE response.
Question display:
Display the name of the Orthopic item currently being asked about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT. See technical note.
Else display EVNT.ORTHTYPE response.
If EVNT.ORTHTYPE= 4/Crutches then:
If SP is alive and not institutionalized, display "are".
Else display "were"
Else EVNT.ORTHTYPE ^= 4/Crutches then:
If SP is alive and not institutionalized, display "is".
Else display "was"
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
6:19:50 PM Wednesday, March 27, 2013
Page 35 of 341
OMS5
TEXT:
OM ITEM: (ORTHOPEDIC ITEM)
Context Header:
Int. Instr I:
At the time of the last interview, [you were/(SP) was] renting
(ORTHOPEDIC ITEM). As of (today/DATE OF DEATH/DATE OF
INSTITUTIONALIZATION), (was/were/is/are) the (ORTHOPEDIC
ITEM) being rented?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
RENTSTIL
Cheshire Name:
Item Text display:
( OMQ1180 )
EVNT.RENTSTIL
Display previous response to EVNT.RENTSTIL and allow
field to be updated.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentstil
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1EE - (OMQ1520 )
2
English text: YES
No
OM7C - EVENDMM ( OMQ1420 )
3
English text: NO
EnteredInError
BOX OM4 - (OMQ1540 )
English text: EVENT ENTERED IN ERROR
Attribute
Don't know
Route
BOX OM4 - (OMQ1540 )
Refusal
BOX OM4 - (OMQ1540 )
BACKGROUND VARIABLE ASSIGNMENTS
RENTRECR
If OMS5 - RENTSTIL = 1/Yes, set
EVNT.RENTRECR = current round.
6:19:51 PM Wednesday, March 27, 2013
Page 36 of 341
OMS5
RENTENDR
If OMS5 - RENTSTIL ^= 1/Yes, set
EVNT.RENTENDR = current round.
EVENDMM
If OMS5 - RENTSTIL = DK, set EVNT.EVENDMM =
DK.
Else if OMS5 - RENTSTIL = RF, set
EVNT.EVENDMM = RF.
EVENDDD
If OMS5 - RENTSTIL = DK, set EVNT.EVENDDD =
DK.
Else if OMS5 - RENTSTIL = RF, set
EVNT.EVENDDD = RF.
EVENDYY
If OMS5 - RENTSTIL = DK, set EVNT.EVENDYY =
DK.
Else if OMS5 - RENTSTIL = RF, set
EVNT.EVENDYY = RF.
EVNTDFLG
If OMS5 - RENTSTIL = 3/EnteredInError, set
EVNT.EVNTDFLG = 1/Yes.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
217
EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in
SQL and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
DESIGN NOTES
6:19:51 PM Wednesday, March 27, 2013
Page 37 of 341
OM5
OM5
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPRORTH
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
120
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If OMS5 was asked, display "Other than what we already talked
about, [since (REFERENCE DATE/SURVEY REFERENCE
DATE)/between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]" and "(other)".
Else display "[Since (REFERENCE DATE/SURVEY
REFERENCE)/Between (REFERENCE DATE/SURVEY
REFERENCE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]" and do not display "(other)"."
Always display "[Orthopedic items include…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
SHOW CARD OM1
6:19:52 PM Wednesday, March 27, 2013
Page 38 of 341
OM5
(Other than what we already talked about,) [(Since/since)
(REFERENCE DATE/SURVEY REFERENCE
DATE)/(Between/between) (REFERENCE DATE/SURVEY
REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] buy, repair or rent (other)
orthopedic items, such as any of those listed on this card?
Question Text:
[Orthopedic items include crutches, canes, wheelchairs, walkers,
corrective shoes or inserts, support stockings, and braces or
supports.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
OMPRORTH
Cheshire Name:
Item Text display:
( OMQ1210 )
HRND.OMPRORTH
Do not display response option 3/IndicatedYesByDataPrep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM6 - ORTHTYPE ( OMQ1220 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
OM9 - OMPRDIAB ( OMQ1560 )
DO NOT DISPLAY,
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
OM9 - OMPRDIAB ( OMQ1560 )
Refusal
OM9 - OMPRDIAB ( OMQ1560 )
BACKGROUND VARIABLE ASSIGNMENTS
6:19:54 PM Wednesday, March 27, 2013
Page 39 of 341
OM5
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:19:54 PM Wednesday, March 27, 2013
Page 40 of 341
OM6
OM6
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
ORTHTYPE
Field 2:
EVOSTEXT
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:
130
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What was the item?
Int. Instr II:
INPUT FIELDS / ROUTING
6:19:55 PM Wednesday, March 27, 2013
Page 41 of 341
OM6
Field1:
ORTHTYPE
Cheshire Name:
( OMQ1220 )
EVNT.ORTHTYPE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TOrthtype
1
No
No
Number Label
1 Braces
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM7 - EVENT_OMORTH ( OMQ1280 )
2
English text: BRACES/SUPPORTS
Cane
OM7 - EVENT_OMORTH ( OMQ1280 )
3
English text: CANE
Shoes
OM7 - EVENT_OMORTH ( OMQ1280 )
4
English text: CORRECTIVE SHOES/INSERTS
Crutches
OM6A - RENTPROB ( OMQ1250 )
5
English text: CRUTCHES
Walker
OM6A - RENTPROB ( OMQ1250 )
6
English text: WALKER
Wheelchair
OM6A - RENTPROB ( OMQ1250 )
7
English text: WHEELCHAIR/CART
Stockings
OM7 - EVENT_OMORTH ( OMQ1280 )
English text: STOCKINGS
Other
OM6 - EVOSTEXT ( OMQ1230 )
91
English text: OTHER
6:19:57 PM Wednesday, March 27, 2013
Page 42 of 341
OM6
Field2:
( OMQ1230 )
EVOSTEXT
Cheshire Name:
EVOS.EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in SQL
and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
Item Text display:
Display (SPECIFY) in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
FieldSize:
Min Value:
Max Value:
Mask:
1
No
No
Number Label
1 [Continuous answer.]
30
Route
OM6A - RENTPROB ( OMQ1250 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
217
EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in
SQL and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
DESIGN NOTES
Called from ST36 and NS36 if OM needs to be added to charge bundle in
ST and/or NS.
OM6 - ORTHTYPE and OM6 - EVOSTEXT are EVENT level detail.
6:19:57 PM Wednesday, March 27, 2013
Page 43 of 341
OM6
The response to OM6 - ORTHTYPE needs to be copied to
EVNT.ORTHTYPE for each Event selected at OM7 or OM7A.
The response to OM6 - EVOSTEXT needs to be copied to
EVNT.EVOSTEXT for each Event selected at OM7 or OM7A.
6:19:57 PM Wednesday, March 27, 2013
Page 44 of 341
OM6A
OM6A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENTPROB
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
140
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If OM6-ORTHTYPE= 91/Other, display other specify text, OM6
EVOSTEXT.
Else display OM6-ORTHTYPE response.
Question display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If OM6-ORTHTYPE= 91/Other, display other specify text, OM6
EVOSTEXT.
Else display OM6-ORTHTYPE response.
If OM6-ORTHTYPE=1/Braces/Supports, 3/Shoes, or 7/Stockings,
display "them".
Else display "it".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
6:19:58 PM Wednesday, March 27, 2013
Page 45 of 341
OM6A
TEXT:
OM ITEM: (ORTHOPEDIC ITEM)
Context Header:
Int. Instr I:
Did [you/(SP)] buy or repair the (ORTHOPEDIC ITEM), or did
[you/(SP)] rent (it/them)?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
RENTPROB
Field1:
Cheshire Name:
Item Text display:
( OMQ1250 )
EVNT.RENTPROB
Do not display response option 3/BoughtAndRented
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentprob
1
No
No
Number Label
1 Buy
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM7 - EVENT_OMORTH ( OMQ1280 )
2
English text: BUY/REPAIR
Rent
3
English text: RENT
BoughtAndRented
OM7A - EVENT_OMORTHRENT ( OMQ1340 )
DO NOT DISPLAY.
BOUGHT/REPAIRED
EQUIPMENT
AND RENTED EQUIPMENT
English text:
Attribute
Route
Don't know
OM7 - EVENT_OMORTH ( OMQ1280 )
Refusal
OM7 - EVENT_OMORTH ( OMQ1280 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
6:20:00 PM Wednesday, March 27, 2013
Page 46 of 341
OM6A
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
OM6A - RENTPROB is an EVENT level detail.
The response to OM6A - RENTPROB needs to be copied to
EVNT.RENTPROB for each Event added at OM7 or OM7A.
6:20:00 PM Wednesday, March 27, 2013
Page 47 of 341
OM7
OM7
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMORTH
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
170
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If OM6-ORTHTYPE= 91/Other, display other specify text, OM6
EVOSTEXT.
Else display OM6-ORTHTYPE response.
Question display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If OM6-ORTHTYPE= 91/Other, display other specify text, OM6
EVOSTEXT.
Else display OM6-ORTHTYPE response.
If OM6-ORTHTYPE^=7/Stockings, display "or repair".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Display all orthopedic items that have been reported in the current
round where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round), and
EVNT.EVNTTYPE = 'OM', and
EVNT.OMETYPE = 3/Orthopedic.
6:20:00 PM Wednesday, March 27, 2013
Page 48 of 341
OM7
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Purchase or
Repair/Rental
Display EVENT DATE in "Mon DD YYYY"
format.
2
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
3
Rentals
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
4
Status
If EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
5
OME Type
If EVNT.ORTHTYPE= 91/Other, display
other specify text, EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Report display:
TEXT:
Context Header:
OM ITEM: (ORTHOPEDIC ITEM)
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
SELECT OR ADD ALL DATES AT THIS ROSTER.
Question Text:
When did [you/(SP)] buy (or repair) the (ORTHOPEDIC ITEM)?
Please tell me all the dates [since (REFERENCE DATE/SURVEY
REFERENCE DATE)/between (REFERENCE DATE/SURVEY
REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)].
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:01 PM Wednesday, March 27, 2013
Page 49 of 341
OM7
Field1:
Cheshire Name:
EVENT_OMORTH
( OMQ1280 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX OM1CC - (OMQ1310 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 3/Orthopedic.
ORTHTYPE
EVNT.ORTHTYPE = OM6 - ORTHTYPE response.
STOMTYPE
If ORTHTYPE =
1/Braces, STOMTYPE=21/Braces.
2/Cane, STOMTYPE=22/Cane.
3/Shoes, STOMTYPE=23/Shoes.
4/Crutches, STOMTYPE=24/Crutches.
5/Walker, STOMTYPE=25/Walker.
6/Wheelchair, STOMTYPE=26/Wh...
7/Stockings, STOMTYPE=27/St..
91/Other, STOMTYPE=91.
6:20:01 PM Wednesday, March 27, 2013
Page 50 of 341
OM7
EVNTPROV
EVNT.EVNTPROV = 01.
RENTPROB
If ORTHTYPE = 4/Crutches, 5/Walker, 6/Wheelchair
or 91/Other, set EVNT.RENTPROB = OM6A
RENTPROB response.
EVOSTEXT
If OM6 - ORTHTYPE = 91/Other, set
EVNT.EVOSTEXT = OM6 - EVOSTEXT.
EVNTQUES
If OM6 - ORTHTYPE = 91/Other, set
EVNT.EVNTQUES = 'OM6'.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
ORTHTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
RENTPROB matches, OR
1st Event RENTPROB = 1/Buy and 2nd Event RENTPROB = DK
or RF, OR
1st Event RENTPROB = DK or RF and 2nd Event RENTPROB =
1/Buy.
6:20:01 PM Wednesday, March 27, 2013
Page 51 of 341
OM7
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
217
EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in
SQL and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
DESIGN NOTES
6:20:01 PM Wednesday, March 27, 2013
Page 52 of 341
BOX OM1CC
BOX OM1CC
Page Order # :
180
BOX INSTRUCTIONS
( OMQ1310 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM7_IN - NAVIGATOR ( OMQ1315 ).
ELSE GO TO BOX OM1EE1 - (OMQ1538 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:01 PM Wednesday, March 27, 2013
Page 53 of 341
OM7_IN
OM7_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
185
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 OM's added at OM7.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:02 PM Wednesday, March 27, 2013
Page 54 of 341
OM7_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ1315 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM7AA - OMSATHMO ( OMQ1320 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX OM1EE1 - (OMQ1538 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:02 PM Wednesday, March 27, 2013
Page 55 of 341
OM7AA
OM7AA
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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:
Display the event date for the OM event currently being asked about.
Display name of the orthopedic item currently being asked about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Question display:
Display the event date for the OM event currently being asked about.
Display name of the orthopedic item currently being asked about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
If EVNT.ORTHTYPE^=7/Stockings, display "or repair".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
6:20:03 PM Wednesday, March 27, 2013
Page 56 of 341
OM7AA
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
EVENT DATE: (EVENT DATE)
OM ITEM: (ORTHOPEDIC ITEM)
Int. Instr I:
Question Text:
On (EVENT DATE), did [you/(SP)] buy (or repair) the
(ORTHOPEDIC ITEM) at [READ MANAGED CARE PLAN NAME(S)
BELOW] or through a service or discount offered through [READ
MANAGED CARE PLAN NAME(S) BELOW]?
[PROBE: This could include buying or repairing the (ORTHOPEDIC
ITEM) at a plan center; at a place or store that honors [your/(SP's)]
plan card; or through a place or store that the plan referred
[you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:04 PM Wednesday, March 27, 2013
Page 57 of 341
OM7AA
Field1:
OMSATHMO
Cheshire Name:
( OMQ1320 )
EVNT.OMSATHMO
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 OM2A - (OMQ1330 )
English text: YES
No
BOX OM2A - (OMQ1330 )
English text: NO
Attribute
Route
Don't know
BOX OM2A - (OMQ1330 )
Refusal
BOX OM2A - (OMQ1330 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
46
SPHadMHMO
6:20:05 PM Wednesday, March 27, 2013
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
Page 58 of 341
OM7AA
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:06 PM Wednesday, March 27, 2013
Page 59 of 341
BOX OM2A
BOX OM2A
Page Order # :
200
BOX INSTRUCTIONS
( OMQ1330 )
GO TO OM7_IN - NAVIGATOR ( OMQ1315 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:20:06 PM Wednesday, March 27, 2013
Page 60 of 341
OM7A
OM7A
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMORTHREN
T
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
210
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If OM6-ORTHTYPE= 91/Other, display other specify text, OM6
EVOSTEXT.
Else display OM6-ORTHTYPE response.
Question display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If OM6-ORTHTYPE= 91/Other, display other specify text, OM6
EVOSTEXT.
Else display OM6-ORTHTYPE response.
Multi Field display:
Roster/Grid Instructions:
Display all orthopedic items that have been reported in the current
round where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round), and
EVNT.EVNTTYPE = 'OM', and
EVNT.OMETYPE = 3/Orthopedic.
Display all loaded events as protected rows.
6:20:06 PM Wednesday, March 27, 2013
Page 61 of 341
OM7A
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Purchase or
Repair/Rental
Display EVENT DATE in "Mon DD YYYY"
format.
2
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
3
Rentals
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
4
Status
If EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
5
OME Type
If EVNT.ORTHTYPE= 91/Other, display
other specify text, EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
OM ITEM= (ORTHOPEDIC ITEM)
Int. Instr I:
ENTER ONLY ONE DATE AT THIS ROSTER.
Question Text:
Please tell me the first date [since (REFERENCE DATE/SURVEY
REFERENCE DATE)/between (REFERENCE DATE/SURVEY
REFERENCE DATE) AND (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION] that [you/(SP)] rented the (ORTHOPEDIC
ITEM).
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:06 PM Wednesday, March 27, 2013
Page 62 of 341
OM7A
Field1:
Cheshire Name:
EVENT_OMORTHREN ( OMQ1340 )
T
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
OM7B - RENTSTIL ( OMQ1370 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 3/Orthopedic.
ORTHTYPE
EVNT.ORTHTYPE = OM6 - ORTHTYPE response.
STOMTYPE
If ORTHTYPE =
4/Crutches, STOMTYPE=24/Crutches.
5/Walker, STOMTYPE=25/Walker.
6/Wheelchair, STOMTYPE=26/Wheelchair
91/Other, STOMTYPE=91/Other.
EVNTPROV
EVNT.EVNTPROV = 01.
RENTPROB
EVNT.RENTPROB = OM6A - RENTPROB response.
6:20:07 PM Wednesday, March 27, 2013
Page 63 of 341
OM7A
EVOSTEXT
If OM6 - ORTHTYPE = 91/Other, set
EVNT.EVOSTEXT = OM6 - EVOSTEXT.
EVNTQUES
If OM6 - ORTHTYPE = 91/Other, set
EVNT.EVNTQUES = 'OM6'.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
ORTHTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
RENTPROB matches, OR
1st Event RENTPROB = 1/Buy and 2nd Event RENTPROB = DK
or RF, OR
1st Event RENTPROB = DK or RF and 2nd Event RENTPROB =
1/Buy.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
6:20:07 PM Wednesday, March 27, 2013
Page 64 of 341
OM7A
TECHNICAL NOTES
217
EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in
SQL and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
DESIGN NOTES
6:20:07 PM Wednesday, March 27, 2013
Page 65 of 341
OM7B
OM7B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
RENTSTIL
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
220
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Question display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
OM ITEM= (ORTHOPEDIC ITEM)
6:20:08 PM Wednesday, March 27, 2013
Page 66 of 341
OM7B
Int. Instr I:
[Are you/Is (SP)/Was (SP)] still renting the (ORTHOPEDIC ITEM)?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
RENTSTIL
Cheshire Name:
Item Text display:
( OMQ1370 )
EVNT.RENTSTIL
Do not display response option 3/EnteredInError.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentstil
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1EE - (OMQ1520 )
2
English text: YES
No
3
English text: NO
EnteredInError
OM7C - EVENDMM ( OMQ1420 )
DO NOT DISPLAY.
English text: EVENT ENTERED IN ERROR
Attribute
Route
Don't know
BOX OM1EE1 - (OMQ1538 )
Refusal
BOX OM1EE1 - (OMQ1538 )
BACKGROUND VARIABLE ASSIGNMENTS
RENTRECR
If OM7B - RENTSTIL = 1/Yes, set
EVNT.RENTRECR = current round.
RENTENDR
If OM7B - RENTSTIL ^= 1/Yes, set
EVNT.RENTENDR = current round.
6:20:09 PM Wednesday, March 27, 2013
Page 67 of 341
OM7B
EVENDMM
If OM7B - RENTSTIL = DK, set EVNT.EVENDMM =
DK.
Else if OM7B - RENTSTIL = RF, set
EVNT.EVENDMM = RF.
EVENDDD
If OM7B - RENTSTIL = DK, set EVNT.EVENDDD =
DK.
Else if OM7B - RENTSTIL = RF, set
EVNT.EVENDDD = RF.
EVENDYY
If OM7B - RENTSTIL = DK, set EVNT.EVENDYY =
DK.
Else if OM7B - RENTSTIL = RF, set
EVNT.EVENDYY = RF.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:09 PM Wednesday, March 27, 2013
Page 68 of 341
OM7C
OM7C
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
EVENDMM
Field 2:
EVENDDD
Field 3:
EVENDYY
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
No
No
No
No
Grid Functions:
Add Line
Delete Line
No
No
Enable Functions:
250
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Question display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
If EVNT.ORTHTYPE= 4/Crutches, display "were".
Else display "was".
Multi Field display:
Horizontal Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
6:20:10 PM Wednesday, March 27, 2013
Page 69 of 341
OM7C
TEXT:
OM ITEM= (ORTHOPEDIC ITEM)
Context Header:
Int. Instr I:
What was the last date the (ORTHOPEDIC ITEM) (were/was)
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
EVENDMM
Field1:
Cheshire Name:
( OMQ1420 )
EVNT.EVENDMM
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
OM7C - EVENDDD ( OMQ1430 )
Refusal
OM7C - EVENDDD ( OMQ1430 )
6:20:13 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
OM7C - EVENDDD ( OMQ1430 )
Page 70 of 341
OM7C
Field2:
EVENDDD
Cheshire Name:
( OMQ1430 )
EVNT.EVENDDD
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
OM7C - EVENDYY ( OMQ1440 )
Refusal
OM7C - EVENDYY ( OMQ1440 )
6:20:15 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
OM7C - EVENDYY ( OMQ1440 )
Page 71 of 341
OM7C
Field3:
EVENDYY
Cheshire Name:
( OMQ1440 )
EVNT.EVENDYY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TYear2DKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
BOX OM3A - (OMQ1450 )
Refusal
BOX OM3A - (OMQ1450 )
FieldSize:
Min Value:
Max Value:
Mask:
2
00
99
Route
BOX OM3A - (OMQ1450 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Rental end date, EVENDMM/EVENDDD/EVENDYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVENDMM, EVENDDD, EVENDYY.
Edit #2
Rental end date, EVENDMM/EVENDDD/EVENDYY, must be on or
after the date the item was rented,
EVBEGMM/EVBEGDD/EVBEGYY.
If not true, display message, "INVALID DATE. DATE MUST BE ON
6:20:16 PM Wednesday, March 27, 2013
Page 72 of 341
OM7C
OR AFTER (EVENT DATE). PLEASE REENTER."
INVOLVES EVENDMM, EVENDDD, EVENDYY.
TECHNICAL NOTES
DESIGN NOTES
6:20:16 PM Wednesday, March 27, 2013
Page 73 of 341
BOX OM3A
BOX OM3A
Page Order # :
260
BOX INSTRUCTIONS
( OMQ1450 )
IF SP IS NOT DECEASED, GO TO OM7CC - RENT2BUY ( OMQ1460 ).
ELSE GO TO BOX OM1EE - (OMQ1520 ).
ASSIGNMENTS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
6:20:16 PM Wednesday, March 27, 2013
Page 74 of 341
OM7CC
OM7CC
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENT2BUY
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:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Question display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
If SP is the respondent, display "have".
Else display "has".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
6:20:17 PM Wednesday, March 27, 2013
Page 75 of 341
OM7CC
OM ITEM= (ORTHOPEDIC ITEM)
Context Header:
Int. Instr I:
You said [you/(SP)] stopped renting the (ORTHOPEDIC ITEM). Is
this because (you/he/she) no longer (have/has) that item or because
(you/he/she) (have/has) purchased it through a rent-to-buy option?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
RENT2BUY
Field1:
Cheshire Name:
( OMQ1460 )
EVNT.RENT2BUY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRen2buy
1
No
No
Number Label
1 NoLongerHave
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1EE - (OMQ1520 )
2
English text: NO LONGER HAVE THE ITEM
PurchasedRentToBuy
3
English text: PURCHASED THROUGH RENT-TO-BUY
Other
OM7CCVB - REN2BVB ( OMQ1470 )
BOX OM1EE - (OMQ1520 )
English text: OTHER
Attribute
Route
Don't know
BOX OM1EE - (OMQ1520 )
Refusal
BOX OM1EE - (OMQ1520 )
BACKGROUND VARIABLE ASSIGNMENTS
RBUYCOST
If OM7CC - RENT2BUY = 2/PurchasedRentToBuy or
3/Other, set EVNT.RBUYCOST=1/StillCollectCost.
SOFT EDIT CHECKS
6:20:18 PM Wednesday, March 27, 2013
Page 76 of 341
OM7CC
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'.
DESIGN NOTES
6:20:18 PM Wednesday, March 27, 2013
Page 77 of 341
OM7CCVB
OM7CCVB
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 1:
REN2BVB
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
280
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Display name of the orthopedic item that is currently being asked
about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
BRIEFLY EXPLAIN WHY SP STOPPED RENTING THE
(ORTHOPEDIC ITEM).
Question Text:
Int. Instr II:
6:20:19 PM Wednesday, March 27, 2013
RECORD VERBATIM.
Page 78 of 341
OM7CCVB
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
REN2BVB
( OMQ1470 )
NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
EVNT.REN2BVB1
EVNT.REN2BVB2
EVNT.REN2BVB3
EVNT.REN2BVB4
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Open
TOpen180
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
180
Route
BOX OM1EE - (OMQ1520 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:19 PM Wednesday, March 27, 2013
Page 79 of 341
BOX OM1EE
BOX OM1EE
Page Order # :
300
BOX INSTRUCTIONS
( OMQ1520 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM7D - OMSATHMO ( OMQ1530 ).
ELSE GO TO BOX OM1EE1 - (OMQ1538 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:19 PM Wednesday, March 27, 2013
Page 80 of 341
OM7D
OM7D
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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
310
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the orthopedic item currently being asked about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Question display:
Display name of the orthopedic item currently being asked about.
Orthopedic Item =
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
6:20:20 PM Wednesday, March 27, 2013
Page 81 of 341
OM7D
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
OM ITEM= (ORTHOPEDIC ITEM)
Int. Instr I:
Question Text:
Did [you/(SP)] rent the (ORTHOPEDIC ITEM) at [READ MANAGED
CARE PLAN NAME(S) BELOW] or through a service or discount
offered through [READ MANAGED CARE PLAN NAME(S) BELOW]?
[PROBE: This could include renting the (ORTHOPEDIC ITEM) at a
plan center; at a place or store that honors [your/(SP’s)] plan card; or
through a place or service that the plan referred [you/(SP]] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:21 PM Wednesday, March 27, 2013
Page 82 of 341
OM7D
Field1:
OMSATHMO
Cheshire Name:
Item Text display:
( OMQ1530 )
EVNT.OMSATHMO
EVNT.OMSATHMO may already be filled from the previous
round. Do not display previous round response. Current
round response to OMSATHMO will overwrite
EVNT.OMSATHMO.
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 OM1EE1 - (OMQ1538 )
English text: YES
No
BOX OM1EE1 - (OMQ1538 )
English text: NO
Attribute
Don't know
Route
BOX OM1EE1 - (OMQ1538 )
Refusal
BOX OM1EE1 - (OMQ1538 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
46
SPHadMHMO
6:20:22 PM Wednesday, March 27, 2013
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
Page 83 of 341
OM7D
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:22 PM Wednesday, March 27, 2013
Page 84 of 341
BOX OM1EE1
BOX OM1EE1
Page Order # :
315
BOX INSTRUCTIONS
( OMQ1538 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO BOX OM4 - (OMQ1540 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:20:22 PM Wednesday, March 27, 2013
Page 85 of 341
BOX OM4
BOX OM4
Page Order # :
320
BOX INSTRUCTIONS
( OMQ1540 )
IF ASKING ABOUT A RENTAL ITEM FROM THE PREVIOUS ROUND, GO
TO OMS5_IN - NAVIGATOR ( OMQ1176 ).
ELSE GO TO OM8 - MOREORTH ( OMQ1550 ).
ASSIGNMENTS
TECHNICAL NOTES
199
StillRentOrthItem
SP still renting an orthopedic item at the time of the
previous round interview =
There is an EVNT where EVNT.EVNTTYPE ='OM' and
EVNT.OMETYPE=3/Orthopedic and EVNT.RENTSTIL =
1/Yes and EVNT.RENTRECR = previous round and
EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:20:22 PM Wednesday, March 27, 2013
Page 86 of 341
OM8
OM8
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MOREORTH
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:
If more than one orthopedic item reported in the current round,
display "s".
Else do not display.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below question text.
Display all orthopedic items that have been reported in the current
round where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round), and
EVNT.EVNTTYPE = 'OM', and
EVNT.OMETYPE = 3/Orthopedic.
If a specific orthopedic item was reported more than once, only
display the item once in report:
If EVNT.ORTHTYPE ^= 91/Other and EVNT.ORTHTYPE matches
EVNT.ORTHTYPE on another EVNT already being displayed in
report, do not display.
Column 1, display = Display name of orthopedic item.
6:20:23 PM Wednesday, March 27, 2013
Page 87 of 341
OM8
If EVNT.ORTHTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.ORTHTYPE response.
TEXT:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Context Header:
Int. Instr I:
In addition to the orthopedic item(s) you just told me about, did
[you/(SP)] buy, repair, or rent any other orthopedic items [since
(REFERENCE DATE/SURVEY REFERENCE DATE)/between
(REFERENCE DATE/SURVEY REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)].?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MOREORTH
Cheshire Name:
( OMQ1550 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM6 - ORTHTYPE ( OMQ1220 )
English text: YES
No
OM9 - OMPRDIAB ( OMQ1560 )
English text: NO
Attribute
Route
Don't know
OM9 - OMPRDIAB ( OMQ1560 )
Refusal
OM9 - OMPRDIAB ( OMQ1560 )
BACKGROUND VARIABLE ASSIGNMENTS
6:20:25 PM Wednesday, March 27, 2013
Page 88 of 341
OM8
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:25 PM Wednesday, March 27, 2013
Page 89 of 341
OM9
OM9
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPRDIAB
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
340
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "[Diabetic…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
SHOW CARD OM2
Question Text:
[Since (REFERENCE DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] buy diabetic equipment or
supplies, such as those listed on this card?
[Diabetic equipment or supplies include syringes, test paper, test
strips, and blood monitoring kits.]
Int. Instr II:
6:20:25 PM Wednesday, March 27, 2013
Page 90 of 341
OM9
INPUT FIELDS / ROUTING
OMPRDIAB
Field1:
Cheshire Name:
Item Text display:
( OMQ1560 )
HRND.OMPRDIAB
Do not display response option 3/IndicatedYesByDataPrep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM10 - EVENT_OMDIAB ( OMQ1570 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
OM11 - OMPRAMBL ( OMQ1630 )
DO NOT DISPLAY.
English text: INDICATED YES BY DATAPREP
Attribute
Route
Don't know
OM11 - OMPRAMBL ( OMQ1630 )
Refusal
OM11 - OMPRAMBL ( OMQ1630 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:26 PM Wednesday, March 27, 2013
Page 91 of 341
OM10
OM10
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMDIAB
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
350
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all Diabetic equipment/supplies that have been reported in
the current round where:
EVNT.EVNTDFLG^=1/Yes, and
EVNT.EVNTRNDC = current round, and
EVNT.EVNTTYPE = 'OM', and
EVNT.OMETYPE = 4/Diabetic.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Purchase or
Repair Date
Display EVENT DATE in "Mon DD YYYY"
format.
2
OME Type
Display OM Type, EVNT.OMETYPE.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
6:20:27 PM Wednesday, March 27, 2013
Page 92 of 341
OM10
Int. Instr I:
SELECT OR ADD ALL DATES AT THIS ROSTER.
Question Text:
When did [you/(SP)] buy diabetic equipment or supplies? Please tell
me all the dates [since (REFERENCE DATE/SURVEY REFERENCE
DATE)/between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION)].
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_OMDIAB
( OMQ1570 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX OM1FF - (OMQ1610 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 4/Diabetic.
6:20:27 PM Wednesday, March 27, 2013
Page 93 of 341
OM10
STOMTYPE
EVNT.STOMTYPE = 4/Diabetic.
EVNTPROV
EVNT.EVNTPROV = 01.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
Called from ST36 and NS36 if OM needs to be added to charge bundle in
6:20:28 PM Wednesday, March 27, 2013
Page 94 of 341
OM10
ST and/or NS.
6:20:28 PM Wednesday, March 27, 2013
Page 95 of 341
BOX OM1FF
BOX OM1FF
Page Order # :
360
BOX INSTRUCTIONS
( OMQ1610 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM10_IN - NAVIGATOR ( OMQ1615 ).
ELSE GO TO BOX OM1FF2 - (OMQ1628 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:28 PM Wednesday, March 27, 2013
Page 96 of 341
OM10_IN
OM10_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
365
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 OM's added at OM10.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:28 PM Wednesday, March 27, 2013
Page 97 of 341
OM10_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ1615 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM10A - OMSATHMO ( OMQ1620 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX OM1FF2 - (OMQ1628 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:29 PM Wednesday, March 27, 2013
Page 98 of 341
OM10A
OM10A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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
370
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the event date for the OM event currently being asked about.
Question display:
Display the event date for the OM event currently being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
EVENT DATE: (EVENT DATE)
Int. Instr I:
Question Text:
On (EVENT DATE), did [you/(SP)] buy the diabetic equipment or
6:20:29 PM Wednesday, March 27, 2013
Page 99 of 341
OM10A
supplies at [READ MANAGED CARE PLAN NAME(S) BELOW] or
through a service or discount offered through [READ MANAGED
CARE PLAN NAME(S) BELOW]?
[PROBE: This could include buying the diabetic equipment or
supplies at a plan center; at a place or store that honors [your/(SP’s)]
plan card; or through a place or store that the plan referred
[you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
OMSATHMO
Cheshire Name:
( OMQ1620 )
EVNT.OMSATHMO
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 OM1FF1 - (OMQ1625 )
English text: YES
No
BOX OM1FF1 - (OMQ1625 )
English text: NO
Attribute
Route
Don't know
BOX OM1FF1 - (OMQ1625 )
Refusal
BOX OM1FF1 - (OMQ1625 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:20:31 PM Wednesday, March 27, 2013
Page 100 of 341
OM10A
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:31 PM Wednesday, March 27, 2013
Page 101 of 341
BOX OM1FF1
BOX OM1FF1
Page Order # :
375
BOX INSTRUCTIONS
( OMQ1625 )
GO TO OM10_IN - NAVIGATOR ( OMQ1615 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:20:31 PM Wednesday, March 27, 2013
Page 102 of 341
BOX OM1FF2
BOX OM1FF2
Page Order # :
378
BOX INSTRUCTIONS
( OMQ1628 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO OM11 - OMPRAMBL ( OMQ1630 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:20:31 PM Wednesday, March 27, 2013
Page 103 of 341
OM11
OM11
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPRAMBL
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:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
Question Text:
[Since (REFERENCE DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] use any ambulance or
rescue squad service?
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:32 PM Wednesday, March 27, 2013
Page 104 of 341
OM11
Field1:
OMPRAMBL
Cheshire Name:
Item Text display:
( OMQ1630 )
HRND.OMPRAMBL
Do not display response option 3/IndicatedYesByDataPrep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM12 - EVENT_OMAMBL ( OMQ1640 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
OM13 - OMPRPROS ( OMQ1700 )
DO NOT DISPLAY.
English text: INDICATED YES BY DATAPREP
Attribute
Route
Don't know
OM13 - OMPRPROS ( OMQ1700 )
Refusal
OM13 - OMPRPROS ( OMQ1700 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:33 PM Wednesday, March 27, 2013
Page 105 of 341
OM12
OM12
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMAMBL
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
390
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all Ambulances that have been reported in the current round
where:
EVNT.EVNTDFLG^=1/Yes, and
EVNT.EVNTRNDC = current round, and
EVNT.EVNTTYPE = 'OM', and
EVNT.OMETYPE = 5/Ambulance.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Purchase or
Repair Date
Display EVENT DATE in "Mon DD YYYY"
format.
2
OME Type
Display OM Type, EVNT.OMETYPE.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
6:20:33 PM Wednesday, March 27, 2013
Page 106 of 341
OM12
Int. Instr I:
SELECT OR ADD ALL DATES AT THIS ROSTER.
Question Text:
When did [you/(SP)] use an ambulance? Please tell me all the
dates [since (REFERENCE DATE/SURVEY REFERENCE
DATE)/between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION)].
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_OMAMBL
( OMQ1640 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX OM1GG - (OMQ1680 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 5/Ambulance.
6:20:34 PM Wednesday, March 27, 2013
Page 107 of 341
OM12
STOMTYPE
EVNT.STOMTYPE = 5/Ambulance.
EVNTPROV
EVNT.EVNTPROV = 01.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
Called from ST36 and NS36 if OM needs to be added to charge bundle in
6:20:34 PM Wednesday, March 27, 2013
Page 108 of 341
OM12
ST and/or NS.
6:20:34 PM Wednesday, March 27, 2013
Page 109 of 341
BOX OM1GG
BOX OM1GG
Page Order # :
400
BOX INSTRUCTIONS
( OMQ1680 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM12_IN - NAVIGATOR ( OMQ1685 ).
ELSE GO TO BOX OM1GG2 - (OMQ1698 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:34 PM Wednesday, March 27, 2013
Page 110 of 341
OM12_IN
OM12_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
405
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 OM's added at OM12.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:34 PM Wednesday, March 27, 2013
Page 111 of 341
OM12_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ1685 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM12A - OMSATHMO ( OMQ1690 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX OM1GG2 - (OMQ1698 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:35 PM Wednesday, March 27, 2013
Page 112 of 341
OM12A
OM12A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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:
Display the event date for the OM event currently being asked about.
Question display:
Display the event date for the OM event currently being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
EVENT DATE: (EVENT DATE)
Int. Instr I:
Question Text:
Was the ambulance on (EVENT DATE) provided by or approved by
6:20:36 PM Wednesday, March 27, 2013
Page 113 of 341
OM12A
[READ MANAGED CARE PLAN NAME(S) BELOW]?
[PROBE: This could mean that the ambulance was sent by the plan,
or that [you/(SP)] or someone for [you/(SP)] contacted the plan for
them to authorize or approve the use of the ambulance. This
approval could have come after the use of the ambulance.]
Int. Instr II:
INPUT FIELDS / ROUTING
OMSATHMO
Field1:
Cheshire Name:
( OMQ1690 )
EVNT.OMSATHMO
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 OM1GG1 - (OMQ1695 )
English text: YES
No
BOX OM1GG1 - (OMQ1695 )
English text: NO
Attribute
Don't know
Route
BOX OM1GG1 - (OMQ1695 )
Refusal
BOX OM1GG1 - (OMQ1695 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:20:37 PM Wednesday, March 27, 2013
Page 114 of 341
OM12A
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:37 PM Wednesday, March 27, 2013
Page 115 of 341
BOX OM1GG1
BOX OM1GG1
Page Order # :
415
BOX INSTRUCTIONS
( OMQ1695 )
GO TO OM12_IN - NAVIGATOR ( OMQ1685 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:20:37 PM Wednesday, March 27, 2013
Page 116 of 341
BOX OM1GG2
BOX OM1GG2
Page Order # :
418
BOX INSTRUCTIONS
( OMQ1698 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO OM13 - OMPRPROS ( OMQ1700 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:20:37 PM Wednesday, March 27, 2013
Page 117 of 341
OM13
OM13
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPRPROS
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:
Always display "[Prostheses include…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
SHOW CARD OM3
Question Text:
[Since (REFERENCE DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] buy or pay for repairs of
any prostheses, such as those on the card?
[Prostheses include artificial leg or arm, mastectomy prosthesis, and
artificial or glass eye.]
Int. Instr II:
6:20:38 PM Wednesday, March 27, 2013
Page 118 of 341
OM13
INPUT FIELDS / ROUTING
OMPRPROS
Field1:
Cheshire Name:
Item Text display:
( OMQ1700 )
HRND.OMPRPROS
Do not display response option 3/IndicatedYesByDataPrep.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM14 - EVENT_OMPROS ( OMQ1710 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
BOX OMA4 - (OMQ1780 )
DO NOT DISPLAY.
English text: INDICATED YES BY DATAPREP
Attribute
Route
Don't know
BOX OMA4 - (OMQ1780 )
Refusal
BOX OMA4 - (OMQ1780 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:39 PM Wednesday, March 27, 2013
Page 119 of 341
OM14
OM14
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMPROS
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
430
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all Prothesis that have been reported in the current round
where:
EVNT.EVNTDFLG^=1/Yes, and
EVNT.EVNTRNDC = current round, and
EVNT.EVNTTYPE = 'OM', and
EVNT.OMETYPE = 6/Prothesis.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Purchase or
Repair Date
Display EVENT DATE in "Mon DD YYYY"
format.
2
OME Type
Display OM Type, EVNT.OMETYPE.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
6:20:39 PM Wednesday, March 27, 2013
Page 120 of 341
OM14
Int. Instr I:
SELECT OR ADD ALL DATES AT THIS ROSTER.
Question Text:
When did [you/(SP)] buy or repair the prosthesis? Please tell me all
the dates [since (REFERENCE DATE/SURVEY REFERENCE
DATE)/between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION)].
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_OMPROS
( OMQ1710 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX OM1HH - (OMQ1750 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 6/Prothesis.
6:20:40 PM Wednesday, March 27, 2013
Page 121 of 341
OM14
STOMTYPE
EVNT.STOMTYPE = 6/Prothesis.
EVNTPROV
EVNT.EVNTPROV = 01.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
Called from ST36 and NS36 if OM needs to be added to charge bundle in
6:20:40 PM Wednesday, March 27, 2013
Page 122 of 341
OM14
ST and/or NS.
6:20:40 PM Wednesday, March 27, 2013
Page 123 of 341
BOX OM1HH
BOX OM1HH
Page Order # :
440
BOX INSTRUCTIONS
( OMQ1750 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM14_IN - NAVIGATOR ( OMQ1755 ).
ELSE GO TO BOX OM1HH2 - (OMQ1768 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:40 PM Wednesday, March 27, 2013
Page 124 of 341
OM14_IN
OM14_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
445
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 OM's added at OM14.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:40 PM Wednesday, March 27, 2013
Page 125 of 341
OM14_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ1755 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM14A - OMSATHMO ( OMQ1760 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX OM1HH2 - (OMQ1768 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:41 PM Wednesday, March 27, 2013
Page 126 of 341
OM14A
OM14A
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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
450
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the event date for the OM event currently being asked about.
Question display:
Display the event date for the OM event currently being asked about.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
EVENT DATE: (EVENT DATE)
Int. Instr I:
Question Text:
On (EVENT DATE), did [you/(SP)] buy or repair the prosthesis at
6:20:42 PM Wednesday, March 27, 2013
Page 127 of 341
OM14A
[READ MANAGED CARE PLAN NAME(S) BELOW] or through a
service or discount offered through [READ MANAGED CARE PLAN
NAME(S) BELOW]?
[PROBE: This could include buying or repairing the prosthesis at a
plan center; at a place or store that honors [your/(SP’s)] plan card; or
through a place or service that the plan referred [you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
OMSATHMO
Field1:
Cheshire Name:
( OMQ1760 )
EVNT.OMSATHMO
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 OM1HH1 - (OMQ1765 )
English text: YES
No
BOX OM1HH1 - (OMQ1765 )
English text: NO
Attribute
Route
Don't know
BOX OM1HH1 - (OMQ1765 )
Refusal
BOX OM1HH1 - (OMQ1765 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:20:43 PM Wednesday, March 27, 2013
Page 128 of 341
OM14A
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:43 PM Wednesday, March 27, 2013
Page 129 of 341
BOX OM1HH1
BOX OM1HH1
Page Order # :
455
BOX INSTRUCTIONS
( OMQ1765 )
GO TO OM14_IN - NAVIGATOR ( OMQ1755 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:20:43 PM Wednesday, March 27, 2013
Page 130 of 341
BOX OM1HH2
BOX OM1HH2
Page Order # :
460
BOX INSTRUCTIONS
( OMQ1768 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO BOX OMA4 - (OMQ1780 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:20:43 PM Wednesday, March 27, 2013
Page 131 of 341
BOX OMA4
BOX OMA4
470
Page Order # :
BOX INSTRUCTIONS
( OMQ1780 )
IF SP WAS STILL RENTING OXYGEN-RELATED EQUIPMENT AT THE TIME
OF THE PREVIOUS ROUND INTERVIEW, GO TO OMS19INTR
OXGNINTRO ( OMQ1785 ).
ELSE GO TO OM19 - OMPROXGN ( OMQ1820 ).
ASSIGNMENTS
TECHNICAL NOTES
200
StillRentOxgnItem
SP still renting oxygen related equipment at the time of
the previous round interview =
There is an EVNT where EVNT.EVNTTYPE ='OM' and
EVNT.OMETYPE=8/Oxygen and EVNT.RENTSTIL =
1/Yes and EVNT.RENTRECR = previous round and
EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:20:43 PM Wednesday, March 27, 2013
Page 132 of 341
OMS19INTR
OMS19INTR
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
OXGNINTRO
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
475
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:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
The next questions are about oxygen-related equipment [you
were/(SP) was] renting as of (REFERENCE DATE).
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:44 PM Wednesday, March 27, 2013
Page 133 of 341
OMS19INTR
Field1:
OXGNINTRO
Cheshire Name:
( OMQ1785 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS19_IN - NAVIGATOR ( OMQ1786 )
English text: CONTINUE
Attribute
Route
Empty
OMS19_IN - NAVIGATOR ( OMQ1786 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:45 PM Wednesday, March 27, 2013
Page 134 of 341
OMS19_IN
OMS19_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
476
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 all Oxygen related Items that the SP was renting at the time
of the previous round interview.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:45 PM Wednesday, March 27, 2013
Page 135 of 341
OMS19_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ1786 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS19 - RENTSTIL ( OMQ1790 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
OM19 - OMPROXGN ( OMQ1820 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
200
StillRentOxgnItem
SP still renting oxygen related equipment at the time of
the previous round interview =
There is an EVNT where EVNT.EVNTTYPE ='OM' and
EVNT.OMETYPE=8/Oxygen and EVNT.RENTSTIL =
1/Yes and EVNT.RENTRECR = previous round and
EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:20:46 PM Wednesday, March 27, 2013
Page 136 of 341
OMS19
OMS19
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENTSTIL
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
480
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is alive and not institutionalized, display "is".
Else display "was".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
At the time of the last interview, [you were/(SP) was] renting oxygenrelated equipment. As of [today/(DATE OF DEATH)/(DATE OF
INSTITUTIONALIZATION)] (is/was) the oxygen-related equipment
being rented?
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:47 PM Wednesday, March 27, 2013
Page 137 of 341
OMS19
Field1:
RENTSTIL
Cheshire Name:
Item Text display:
( OMQ1790 )
EVNT.RENTSTIL
Display previous response to EVNT.RENTSTIL and allow
field to be updated.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentstil
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1KK - (OMQ2130 )
2
English text: YES
No
OM20C - EVENDMM ( OMQ2030 )
3
English text: NO
EnteredInError
BOX OM9 - (OMQ2150 )
English text: EVENT ENTERED IN ERROR
Attribute
Route
Don't know
BOX OM9 - (OMQ2150 )
Refusal
BOX OM9 - (OMQ2150 )
BACKGROUND VARIABLE ASSIGNMENTS
RENTRECR
If OMS19 - RENTSTIL = 1/Yes, set
EVNT.RENTRECR = current round.
RENTENDR
If OMS19 - RENTSTIL ^= 1/Yes, set
EVNT.RENTENDR = current round.
EVENDMM
If OMS19 - RENTSTIL = DK, set EVNT.EVENDMM =
DK.
Else if OMS19 - RENTSTIL = RF, set
EVNT.EVENDMM = RF.
EVENDDD
If OMS19 - RENTSTIL = DK, set EVNT.EVENDDD =
DK.
Else if OMS19 - RENTSTIL = RF, set
EVNT.EVENDDD = RF.
6:20:48 PM Wednesday, March 27, 2013
Page 138 of 341
OMS19
EVENDYY
If OMS19 - RENTSTIL = DK, set EVNT.EVENDYY =
DK.
Else if OMS19 - RENTSTIL = RF, set
EVNT.EVENDYY = RF.
EVNTDFLG
If OMS19 - RENTSTIL = 3/EnteredInError, set
EVNT.EVNTDFLG = 1/Yes.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
6:20:48 PM Wednesday, March 27, 2013
Page 139 of 341
OM19
OM19
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPROXGN
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
490
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If OMS19 was asked, display "Other than what we already talked
about, [since (REFERENCE DATE/SURVEY REFERENCE
DATE)/between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]" and "other".
Else display "[Since (REFERENCE DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]" and do not display "(other)".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
Question Text:
(Other than what we already talked about,) [(Since/since)
(REFERENCE DATE/SURVEY REFERENCE
6:20:49 PM Wednesday, March 27, 2013
Page 140 of 341
OM19
DATE)/(Between/between) (REFERENCE DATE/SURVEY
REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] have any (other)
expenses for oxygen or supplies or oxygen-related equipment?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
OMPROXGN
Cheshire Name:
Item Text display:
( OMQ1820 )
HRND.OMPROXGN
Do not display response option 3/IndicatedYesByDataPrep.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM19A - OXGNTYPE ( OMQ1830 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
BOX OMA11 - (OMQ2190 )
DO NOT DISPLAY.
English text: INDICATED YES BY DATAPREP
Attribute
Route
Don't know
BOX OMA11 - (OMQ2190 )
Refusal
BOX OMA11 - (OMQ2190 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:20:50 PM Wednesday, March 27, 2013
Page 141 of 341
OM19
TECHNICAL NOTES
DESIGN NOTES
Called from ST36 and NS36 if OM needs to be added to charge bundle in
ST and/or NS.
6:20:50 PM Wednesday, March 27, 2013
Page 142 of 341
OM19A
OM19A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
OXGNTYPE
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
500
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 that?
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:51 PM Wednesday, March 27, 2013
Page 143 of 341
OM19A
Field1:
OXGNTYPE
Cheshire Name:
( OMQ1830 )
EVNT.OXGNTYPE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TOxgntype
1
No
No
Number Label
1 Supplies
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM20 - EVENT_OMOXGN ( OMQ1880 )
English text: OXYGEN/SUPPLIES
Equipment
OM19B - RENTPROB ( OMQ1850 )
English text: OXYGEN-RELATED EQUIPMENT
BACKGROUND VARIABLE ASSIGNMENTS
Oxygen Type is collected at OM19A or set in the background at BOX OM11 prior to
entering the event dates into the roster. The value of Oxygen Type will need to be copied
to the events entered into the roster. Therefore, a temporary variable, LASTOXGNTYPE
will hold the most recent value entered/set for OXGNTYPE.
LASTOXGNTYPE
LASTOXGNTYPE = OM19A - OXGNTYPE.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:51 PM Wednesday, March 27, 2013
Page 144 of 341
OM19B
OM19B
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENTPROB
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
510
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)] buy or repair the oxygen-related equipment, or did
[you/(SP)] rent it?
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:52 PM Wednesday, March 27, 2013
Page 145 of 341
OM19B
Field1:
RENTPROB
Cheshire Name:
( OMQ1850 )
EVNT.RENTPROB
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentprob
1
No
No
Number Label
1 Buy
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM20 - EVENT_OMOXGN ( OMQ1880 )
2
English text: BUY/REPAIR
Rent
OM20A - EVENT_OMOXGNRENT ( OMQ1950 )
3
English text: RENT
BoughtAndRented
OM20 - EVENT_OMOXGN ( OMQ1880 )
English text: BOUGHT/REPAIRED EQUIPMENT AND RENTED EQUIPMENT
Attribute
Don't know
Route
OM20 - EVENT_OMOXGN ( OMQ1880 )
Refusal
OM20 - EVENT_OMOXGN ( OMQ1880 )
BACKGROUND VARIABLE ASSIGNMENTS
OM19B - RENTPROB is an EVENT level detail.
The response to OM19B - RENTPROB needs to be copied to EVNT.RENTPROB for each
Event selected at OM20 or OM20A.
If OM19B - RENTPROB = 3/BoughtAndRented, we will first probe for all the purchase dates
at OM20, setting RENTPROB=1/Buy and then we will probe for the rental date at OM20A,
setting RENTPROB=2/Rent.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
6:20:54 PM Wednesday, March 27, 2013
Page 146 of 341
OM19B
DESIGN NOTES
6:20:54 PM Wednesday, March 27, 2013
Page 147 of 341
OM20
OM20
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMOXGN
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
540
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If LASTOXGNTYPE = 1/Supplies, display "oxygen or supplies".
Else display "oxygen-related equipment".
Multi Field display:
Roster/Grid Instructions:
Display all oxygen items that have been added in the current round
where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round), and
EVNT.EVNTTYPE = OM, and
EVNT.OMETYPE = 8/Oxygen.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
1
Purchase or
Repair/Rental
6:20:54 PM Wednesday, March 27, 2013
INSTRUCTIONS
Display EVENT DATE in "Mon DD YYYY"
format.
Page 148 of 341
OM20
2
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
3
Rentals
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
4
Status
If EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
5
OME Type
Display EVNT.OXGNTYPE.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
SELECT OR ADD ALL DATES AT THIS ROSTER.
Question Text:
When did (you/(SP)] purchase the [(oxygen or supplies)/(oxygen
related equipment)]? Please tell me the dates of each purchase
[since (REFERENCE DATE/SURVEY REFERENCE DATE)/between
(REFERENCE DATE/SURVEY REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)].
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:54 PM Wednesday, March 27, 2013
Page 149 of 341
OM20
Field1:
Cheshire Name:
EVENT_OMOXGN
( OMQ1880 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX OM1II - (OMQ1920 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 8/Oxygen.
OXGNTYPE
EVNT.OXGNTYPE = LASTOXGNTYPE.
STOMTYPE
If OXGNTYPE =
1/Supplies, STOMTYPE=51/OxygenSupplies.
2/Equipment, STOMTYPE=52/OxygenEquipment.
EVNTPROV
EVNT.EVNTPROV = 01.
6:20:55 PM Wednesday, March 27, 2013
Page 150 of 341
OM20
RENTPROB
If LASTOXGNTYPE = 2/Equipment then set
RENTPROB:
If OM19B - RENTPROB = 3/BoughtAndRented, set
RENTPROB = 1/Buy.
Else set EVNT.RENTPROB = OM19B - RENTPROB
response.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
OXGNTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
RENTPROB matches, OR
1st Event RENTPROB = 1/Buy and 2nd Event RENTPROB = DK
or RF, OR
1st Event RENTPROB = DK or RF and 2nd Event RENTPROB =
1/Buy.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
6:20:55 PM Wednesday, March 27, 2013
Page 151 of 341
OM20
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
6:20:55 PM Wednesday, March 27, 2013
Page 152 of 341
BOX OM1II
BOX OM1II
Page Order # :
550
BOX INSTRUCTIONS
( OMQ1920 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM20_IN - NAVIGATOR ( OMQ1925 ).
ELSE GO TO BOX OM7 - (OMQ1945 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:55 PM Wednesday, March 27, 2013
Page 153 of 341
OM20_IN
OM20_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
555
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 OM's added at OM20.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:55 PM Wednesday, March 27, 2013
Page 154 of 341
OM20_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ1925 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM20AA - OMSATHMO ( OMQ1930 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX OM7 - (OMQ1945 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:20:56 PM Wednesday, March 27, 2013
Page 155 of 341
OM20AA
OM20AA
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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:
Display the event date for the OM event currently being asked about.
Display the name of the Oxygen Item currently being asked about.
Display the name of the Oxygen Item currently being asked about.
Oxygen Item =
If LASTOXGNTYPE = 1/Supplies, display "OXYGEN OR SUPPLIES".
Else display "OXYGEN-RELATED EQUIPMENT".
Question display:
Display the event date for the OM event currently being asked about.
Display the name of the Oxygen Item currently being asked about.
Oxygen Item =
If LASTOXGNTYPE = 1/Supplies, display "oxygen or supplies".
Else display "oxygen-related equipment".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
6:20:57 PM Wednesday, March 27, 2013
Page 156 of 341
OM20AA
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
EVENT DATE: (EVENT DATE)
ITEM: (OXYGEN ITEM)
Int. Instr I:
Question Text:
On (EVENT DATE), did [you/(SP)] buy or repair the (OXYGEN ITEM)
at [READ MANAGED CARE PLAN NAME(S) BELOW] or through a
service or discount offered through [READ MANAGED CARE PLAN
NAME(S) BELOW]?
[PROBE: This could include buying or repairing the (OXYGEN
ITEM) at a plan center; at a place or store that honors [your/(SP’s)]
plan card; or through a place or store that the plan referred
[you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
6:20:58 PM Wednesday, March 27, 2013
Page 157 of 341
OM20AA
Field1:
OMSATHMO
Cheshire Name:
( OMQ1930 )
EVNT.OMSATHMO
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 OM1II1 - (OMQ1940 )
English text: YES
No
BOX OM1II1 - (OMQ1940 )
English text: NO
Attribute
Route
Don't know
BOX OM1II1 - (OMQ1940 )
Refusal
BOX OM1II1 - (OMQ1940 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
46
SPHadMHMO
6:20:59 PM Wednesday, March 27, 2013
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
Page 158 of 341
OM20AA
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:20:59 PM Wednesday, March 27, 2013
Page 159 of 341
BOX OM1II1
BOX OM1II1
Page Order # :
572
BOX INSTRUCTIONS
( OMQ1940 )
GO TO OM20_IN - NAVIGATOR ( OMQ1925 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:20:59 PM Wednesday, March 27, 2013
Page 160 of 341
BOX OM7
BOX OM7
Page Order # :
575
BOX INSTRUCTIONS
( OMQ1945 )
IF OM19B - RENTPROB = 3/BoughtAndRented, GO TO OM20A
EVENT_OMOXGNRENT ( OMQ1950 ).
ELSE GO TO BOX OM1KK1 - (OMQ2148 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:20:59 PM Wednesday, March 27, 2013
Page 161 of 341
OM20A
OM20A
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMOXGNREN
T
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
580
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all oxygen items that have been added in the current round
where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round), and
EVNT.EVNTTYPE = OM, and
EVNT.OMETYPE = 8/Oxygen.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
1
Purchase or
Repair/Rental
6:21:00 PM Wednesday, March 27, 2013
INSTRUCTIONS
Display EVENT DATE in "Mon DD YYYY"
format.
Page 162 of 341
OM20A
2
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
3
Rentals
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
4
Status
If EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
5
OME Type
Display EVNT.OXGNTYPE.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
SELECT OR ADD ONLY ONE DATE AT THIS ROSTER.
Question Text:
Please tell me the first date [since (REFERENCE DATE/SURVEY
REFERENCE DATE)/between (REFERENCE DATE/SURVEY
REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)] that [you/(SP)] rented the oxygen-related
equipment.
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:00 PM Wednesday, March 27, 2013
Page 163 of 341
OM20A
Field1:
Cheshire Name:
EVENT_OMOXGNREN ( OMQ1950 )
T
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
OM20B - RENTSTIL ( OMQ1980 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 8/Oxygen.
OXGNTYPE
EVNT.OXGNTYPE = 2/Equipment.
STOMTYPE
STOMTYPE = 52/OxygenEquipment.
EVNTPROV
EVNT.EVNTPROV = 01.
RENTPROB
If OM19B - RENTPROB = 3/BoughtAndRented, set
RENTPROB = 2/Rent.
Else set EVNT.RENTPROB = OM19B - RENTPROB
response.
6:21:01 PM Wednesday, March 27, 2013
Page 164 of 341
OM20A
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
OXGNTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
RENTPROB matches, OR
1st Event RENTPROB = 1/Buy and 2nd Event RENTPROB = DK
or RF, OR
1st Event RENTPROB = DK or RF and 2nd Event RENTPROB =
1/Buy.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
6:21:01 PM Wednesday, March 27, 2013
Page 165 of 341
OM20A
DESIGN NOTES
6:21:01 PM Wednesday, March 27, 2013
Page 166 of 341
OM20B
OM20B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
RENTSTIL
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:
[Are you/Is (SP)/Was (SP)] still renting the oxygen-related
equipment?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:01 PM Wednesday, March 27, 2013
Page 167 of 341
OM20B
Field1:
RENTSTIL
Cheshire Name:
Item Text display:
( OMQ1980 )
EVNT.RENTSTIL
Do not display response option 3/EnteredInError.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentstil
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1KK - (OMQ2130 )
2
English text: YES
No
3
English text: NO
EnteredInError
OM20C - EVENDMM ( OMQ2030 )
DO NOT DISPLAY.
English text: EVENT ENTERED IN ERROR
Attribute
Route
Don't know
BOX OM1KK1 - (OMQ2148 )
Refusal
BOX OM1KK1 - (OMQ2148 )
BACKGROUND VARIABLE ASSIGNMENTS
RENTRECR
If OM20B - RENTSTIL = 1/Yes, set
EVNT.RENTRECR = current round.
RENTENDR
If OM20B - RENTSTIL ^= 1/Yes, set
EVNT.RENTENDR = current round.
EVENDMM
If OM20B - RENTSTIL = DK, set EVNT.EVENDMM =
DK.
Else if OM20B - RENTSTIL = RF, set
EVNT.EVENDMM = RF.
EVENDDD
If OM20B - RENTSTIL = DK, set EVNT.EVENDDD =
DK.
Else if OM20B - RENTSTIL = RF, set
EVNT.EVENDDD = RF.
6:21:03 PM Wednesday, March 27, 2013
Page 168 of 341
OM20B
EVENDYY
If OM20B - RENTSTIL = DK, set EVNT.EVENDYY =
DK.
Else if OM20B - RENTSTIL = RF, set
EVNT.EVENDYY = RF.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:21:03 PM Wednesday, March 27, 2013
Page 169 of 341
OM20C
OM20C
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
EVENDMM
Field 2:
EVENDDD
Field 3:
EVENDYY
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:
620
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Horizontal Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What was the last date the equipment was rented?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:04 PM Wednesday, March 27, 2013
Page 170 of 341
OM20C
Field1:
EVENDMM
Cheshire Name:
( OMQ2030 )
EVNT.EVENDMM
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
OM20C - EVENDDD ( OMQ2040 )
Refusal
OM20C - EVENDDD ( OMQ2040 )
6:21:06 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
OM20C - EVENDDD ( OMQ2040 )
Page 171 of 341
OM20C
Field2:
EVENDDD
Cheshire Name:
( OMQ2040 )
EVNT.EVENDDD
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
OM20C - EVENDYY ( OMQ2050 )
Refusal
OM20C - EVENDYY ( OMQ2050 )
6:21:09 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
OM20C - EVENDYY ( OMQ2050 )
Page 172 of 341
OM20C
Field3:
EVENDYY
Cheshire Name:
( OMQ2050 )
EVNT.EVENDYY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TYear2DKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
BOX OM8A - (OMQ2060 )
Refusal
BOX OM8A - (OMQ2060 )
FieldSize:
Min Value:
Max Value:
Mask:
2
00
99
Route
BOX OM8A - (OMQ2060 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Rental end date, EVENDMM/EVENDDD/EVENDYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVENDMM, EVENDDD, EVENDYY.
Edit #2
Rental end date, EVENDMM/EVENDDD/EVENDYY, must be on or
after the date the item was rented,
EVBEGMM/EVBEGDD/EVBEGYY.
If not true, display message, "INVALID DATE. DATE MUST BE ON
OR AFTER (EVENT DATE). PLEASE REENTER."
6:21:10 PM Wednesday, March 27, 2013
Page 173 of 341
OM20C
INVOLVES EVENDMM, EVENDDD, EVENDYY.
TECHNICAL NOTES
DESIGN NOTES
6:21:10 PM Wednesday, March 27, 2013
Page 174 of 341
BOX OM8A
BOX OM8A
Page Order # :
630
BOX INSTRUCTIONS
( OMQ2060 )
IF SP IS NOT DECEASED, GO TO OM20CC - RENT2BUY ( OMQ2070 ).
ELSE GO TO BOX OM1KK - (OMQ2130 ).
ASSIGNMENTS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
6:21:10 PM Wednesday, March 27, 2013
Page 175 of 341
OM20CC
OM20CC
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENT2BUY
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
640
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is the respondent, display "have".
Else display "has".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
You said [you/(SP)] stopped renting the oxygen-related equipment.
Is this because (you/he/she) no longer (have/has) the equipment or
because (you/he/she) (have/has) purchased it through a rent-to-buy
option?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:10 PM Wednesday, March 27, 2013
Page 176 of 341
OM20CC
Field1:
( OMQ2070 )
RENT2BUY
Cheshire Name:
EVNT.RENT2BUY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRen2buy
1
No
No
Number Label
1 NoLongerHave
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1KK - (OMQ2130 )
2
English text: NO LONGER HAVE THE ITEM
PurchasedRentToBuy
3
English text: PURCHASED THROUGH RENT-TO-BUY
Other
OM20CCVB - REN2BVB ( OMQ2080 )
BOX OM1KK - (OMQ2130 )
English text: OTHER
Attribute
Don't know
Route
BOX OM1KK - (OMQ2130 )
Refusal
BOX OM1KK - (OMQ2130 )
BACKGROUND VARIABLE ASSIGNMENTS
RBUYCOST
If OM20CC - RENT2BUY = 2/PurchasedRentToBuy
or 3/Other, set EVNT.RBUYCOST=1/StillCollectCost.
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.
6:21:12 PM Wednesday, March 27, 2013
Page 177 of 341
OM20CC
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
6:21:12 PM Wednesday, March 27, 2013
Page 178 of 341
OM20CCVB
OM20CCVB
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 1:
REN2BVB
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
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:
BRIEFLY EXPLAIN WHY SP STOPPED RENTING THE OXYGEN
RELATED EQUIPMENT.
Question Text:
Int. Instr II:
RECORD VERBATIM.
INPUT FIELDS / ROUTING
6:21:12 PM Wednesday, March 27, 2013
Page 179 of 341
OM20CCVB
Field1:
Cheshire Name:
REN2BVB
( OMQ2080 )
NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
EVNT.REN2BVB1
EVNT.REN2BVB2
EVNT.REN2BVB3
EVNT.REN2BVB4
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Open
TOpen180
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
180
Route
BOX OM1KK - (OMQ2130 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:21:13 PM Wednesday, March 27, 2013
Page 180 of 341
BOX OM1KK
BOX OM1KK
Page Order # :
670
BOX INSTRUCTIONS
( OMQ2130 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM20D1 - OMSATHMO ( OMQ2140 ).
ELSE GO TO BOX OM1KK1 - (OMQ2148 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:21:13 PM Wednesday, March 27, 2013
Page 181 of 341
OM20D1
OM20D1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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
680
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did [you/(SP)] rent the oxygen equipment at [READ MANAGED
6:21:13 PM Wednesday, March 27, 2013
Page 182 of 341
OM20D1
CARE PLAN NAME(S) BELOW] or through a service or discount
offered through [READ MANAGED CARE PLAN NAME(S) BELOW]?
[PROBE: This could include renting the oxygen equipment at a plan
center; at a place or store that honors [your/(SP’s)] plan card; or
through a place or service that the plan referred [you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
OMSATHMO
Field1:
Cheshire Name:
Item Text display:
( OMQ2140 )
EVNT.OMSATHMO
EVNT.OMSATHMO may already be filled from the previous
round. Do not display previous round response. Current
round response to OMSATHMO will overwrite
EVNT.OMSATHMO.
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 OM1KK1 - (OMQ2148 )
English text: YES
No
BOX OM1KK1 - (OMQ2148 )
English text: NO
Attribute
Route
Don't know
BOX OM1KK1 - (OMQ2148 )
Refusal
BOX OM1KK1 - (OMQ2148 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:21:15 PM Wednesday, March 27, 2013
Page 183 of 341
OM20D1
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:21:15 PM Wednesday, March 27, 2013
Page 184 of 341
BOX OM1KK1
BOX OM1KK1
Page Order # :
685
BOX INSTRUCTIONS
( OMQ2148 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO BOX OM9 - (OMQ2150 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:21:15 PM Wednesday, March 27, 2013
Page 185 of 341
BOX OM9
BOX OM9
690
Page Order # :
BOX INSTRUCTIONS
( OMQ2150 )
IF ASKING ABOUT A RENTAL ITEM FROM THE PREVIOUS ROUND, GO
TO OMS19_IN - NAVIGATOR ( OMQ1786 ).
ELSE GO TO BOX OM10 - (OMQ2160 ).
ASSIGNMENTS
TECHNICAL NOTES
200
StillRentOxgnItem
SP still renting oxygen related equipment at the time of
the previous round interview =
There is an EVNT where EVNT.EVNTTYPE ='OM' and
EVNT.OMETYPE=8/Oxygen and EVNT.RENTSTIL =
1/Yes and EVNT.RENTRECR = previous round and
EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:21:15 PM Wednesday, March 27, 2013
Page 186 of 341
BOX OM10
BOX OM10
Page Order # :
700
BOX INSTRUCTIONS
( OMQ2160 )
IF OM20D HAS NOT BEEN ASKED, GO TO OM20D - MOREOXGN (
OMQ2170 ).
ELSE GO TO BOX OMA11 - (OMQ2190 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:21:15 PM Wednesday, March 27, 2013
Page 187 of 341
OM20D
OM20D
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MOREOXGN
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
710
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If LASTOXGNTYPE = 1/Supplies, display "oxygen or supplies" and
"have any expenses for oxygen-related equipment".
Else display "oxygen-related equipment" and "buy oxygen or
supplies".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
In addition to the [(oxygen or supplies)/(oxygen-related equipment)]
that you just told me about, did [you/(SP)] [(buy oxygen or
supplies)/(have any expenses for oxygen-related equipment)]?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:16 PM Wednesday, March 27, 2013
Page 188 of 341
OM20D
Field1:
MOREOXGN
Cheshire Name:
( OMQ2170 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM11 - (OMQ2180 )
English text: YES
No
BOX OMA11 - (OMQ2190 )
English text: NO
Attribute
Route
Don't know
BOX OMA11 - (OMQ2190 )
Refusal
BOX OMA11 - (OMQ2190 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:21:17 PM Wednesday, March 27, 2013
Page 189 of 341
BOX OM11
BOX OM11
Page Order # :
720
BOX INSTRUCTIONS
( OMQ2180 )
IF OM19A - OXYGTYPE = 1/Supplies, SET NEXT OXYGEN TYPE TO
EQUIPMENT AND GO TO OM19B - RENTPROB ( OMQ1850 ).
ELSE SET NEXT OXYGEN TYPE TO SUPPLIES AND GO TO OM20 EVENT_OMOXGN ( OMQ1880 ).
ASSIGNMENTS
LASTOXGNTYPE
If OM19A - OXGNTYPE = 1/Supplies, set
LASTOXGNTYPE = 2/Equipment.
Else if OM19A - OXGNTYPE = 2/Equipment, set
LASTOXGNTYPE = 1/Supplies.
TECHNICAL NOTES
DESIGN NOTES
6:21:17 PM Wednesday, March 27, 2013
Page 190 of 341
BOX OMA11
BOX OMA11
730
Page Order # :
BOX INSTRUCTIONS
( OMQ2190 )
IF SP WAS RENTING AT LEAST ONE KIDNEY DIALYSIS EQUIPMENT AT
THE TIME OF THE PREVIOUS ROUND INTERVIEW, GO TO OMS21INTR
KDNYINTRO ( OMQ2195 ).
ELSE GO TO OM21 - OMPRKDNY ( OMQ2230 ).
ASSIGNMENTS
TECHNICAL NOTES
201
StillRentKdnyItem
SP still renting kidney dialysis equipment at the time of
the previous round interview =
There is an EVNT where EVNT.EVNTTYPE ='OM' and
EVNT.OMETYPE=9/Kidney and EVNT.RENTSTIL =
1/Yes and EVNT.RENTRECR = previous round and
EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:21:17 PM Wednesday, March 27, 2013
Page 191 of 341
OMS21INTR
OMS21INTR
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
KDNYINTRO
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
735
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:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
The next questions are about kidney dialysis equipment [you
were/(SP) was] renting as of (REFERENCE DATE).
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:17 PM Wednesday, March 27, 2013
Page 192 of 341
OMS21INTR
Field1:
KDNYINTRO
Cheshire Name:
( OMQ2195 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS21_IN - NAVIGATOR ( OMQ2196 )
English text: CONTINUE
Attribute
Route
Empty
OMS21_IN - NAVIGATOR ( OMQ2196 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:21:18 PM Wednesday, March 27, 2013
Page 193 of 341
OMS21_IN
OMS21_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
736
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 all Kidney Dialysis Items that the SP was renting at the time
of the previous round interview.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:19 PM Wednesday, March 27, 2013
Page 194 of 341
OMS21_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ2196 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS21 - RENTSTIL ( OMQ2200 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
OM21 - OMPRKDNY ( OMQ2230 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
201
StillRentKdnyItem
SP still renting kidney dialysis equipment at the time of
the previous round interview =
There is an EVNT where EVNT.EVNTTYPE ='OM' and
EVNT.OMETYPE=9/Kidney and EVNT.RENTSTIL =
1/Yes and EVNT.RENTRECR = previous round and
EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:21:19 PM Wednesday, March 27, 2013
Page 195 of 341
OMS21
OMS21
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENTSTIL
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:
Is SP is alive and not institutionalized display "is".
Else display "was".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
At the time of the last interview, [you were/(SP) was] renting
equipment for kidney dialysis. As of (today/DATE OF DEATH/DATE
OF INSTITUTIONALIZATION), (is/was) the equipment being rented?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:20 PM Wednesday, March 27, 2013
Page 196 of 341
OMS21
Field1:
RENTSTIL
Cheshire Name:
Item Text display:
( OMQ2200 )
EVNT.RENTSTIL
Display previous response to EVNT.RENTSTIL and allow
field to be updated.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentstil
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1NN - (OMQ2540 )
2
English text: YES
No
OM22C - EVENDMM ( OMQ2440 )
3
English text: NO
EnteredInError
BOX OM16 - (OMQ2560 )
English text: EVENT ENTERED IN ERROR
Attribute
Route
Don't know
BOX OM16 - (OMQ2560 )
Refusal
BOX OM16 - (OMQ2560 )
BACKGROUND VARIABLE ASSIGNMENTS
RENTRECR
If OMS21 - RENTSTIL = 1/Yes, set
EVNT.RENTRECR = current round.
RENTENDR
If OMS21 - RENTSTIL ^= 1/Yes, set
EVNT.RENTENDR = current round.
EVENDMM
If OMS21 - RENTSTIL = DK, set EVNT.EVENDMM =
DK.
Else if OMS21 - RENTSTIL = RF, set
EVNT.EVENDMM = RF.
EVENDDD
If OMS21 - RENTSTIL = DK, set EVNT.EVENDDD =
DK.
Else if OMS21 - RENTSTIL = RF, set
EVNT.EVENDDD = RF.
6:21:21 PM Wednesday, March 27, 2013
Page 197 of 341
OMS21
EVENDYY
If OMS21 - RENTSTIL = DK, set EVNT.EVENDYY =
DK.
Else if OMS21 - RENTSTIL = RF, set
EVNT.EVENDYY = RF.
EVNTDFLG
If OMS21 - RENTSTIL = 3/EnteredInError, set
EVNT.EVNTDFLG = 1/Yes.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
6:21:21 PM Wednesday, March 27, 2013
Page 198 of 341
OM21
OM21
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPRKDNY
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:
If OMS21 was asked, display "Other than what we already talked
about, [since (REFERENCE DATE/SURVEY REFERENCE
DATE)/between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]" and "other".
Else display "[Since (REFERENCE DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]" and do not display "(other)".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
Question Text:
(Other than what we already talked about), [(Since/since)
(REFERENCE DATE/SURVEY REFERENCE
6:21:22 PM Wednesday, March 27, 2013
Page 199 of 341
OM21
DATE)/(Between/between) (REFERENCE DATE/SURVEY
REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] buy any (other) kidney
dialysis supplies or buy, rent, or repair any related equipment?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
OMPRKDNY
Cheshire Name:
Item Text display:
( OMQ2230 )
HRND.OMPRKDNY
Do not display response option 3/IndicatedYesByDataPrep.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM21A - KDNYTYPE ( OMQ2240 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
BOX OMA18 - (OMQ2600 )
DO NOT DISPLAY.
English text: INDICATED YES BY DATAPREP
Attribute
Route
Don't know
BOX OMA18 - (OMQ2600 )
Refusal
BOX OMA18 - (OMQ2600 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:21:24 PM Wednesday, March 27, 2013
Page 200 of 341
OM21
TECHNICAL NOTES
DESIGN NOTES
6:21:24 PM Wednesday, March 27, 2013
Page 201 of 341
OM21A
OM21A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
KDNYTYPE
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:
Question Text:
What was that?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:24 PM Wednesday, March 27, 2013
Page 202 of 341
OM21A
Field1:
KDNYTYPE
Cheshire Name:
( OMQ2240 )
EVNT.KDNYTYPE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TKdnytype
1
No
No
Number Label
1 Supplies
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM22 - EVENT_OMKDNY ( OMQ2290 )
English text: KIDNEY DIALYSIS SUPPLIES
Equipment
OM21B - RENTPROB ( OMQ2260 )
English text: KIDNEY DIALYSIS EQUIPMENT
BACKGROUND VARIABLE ASSIGNMENTS
Kidney Dialysis Type is collected at OM21A or set in the background at BOX OM18 prior to
entering the event dates into the roster. The value of Kidney Dialysis Type will need to be
copied to the events entered into the roster. Therefore, a temporary variable,
LASTKDNYTYPE will hold the most recent value entered/set for KDNYTYPE.
LASTKDNYTYPE
LASTKDNYTYPE = OM21A - KDNYTYPE.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
Called from ST36 and NS36 if OM needs to be added to charge bundle in
ST and/or NS.
6:21:25 PM Wednesday, March 27, 2013
Page 203 of 341
OM21B
OM21B
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENTPROB
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:
Question Text:
Did [you/(SP)] buy or repair the dialysis equipment, or did [you/(SP)]
rent it?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:25 PM Wednesday, March 27, 2013
Page 204 of 341
OM21B
Field1:
RENTPROB
Cheshire Name:
Item Text display:
( OMQ2260 )
EVNT.RENTPROB
Do not display response option 3/BoughtAndRented.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentprob
1
No
No
Number Label
1 Buy
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM22 - EVENT_OMKDNY ( OMQ2290 )
2
English text: BUY/REPAIR
Rent
3
English text: RENT
BoughtAndRented
OM22A - EVENT_OMKDNYRENT ( OMQ2360 )
DO NOT DISPLAY.
English text: BOUGHT/REPAIRED EQUIPMENT AND RENTED EQUIPMENT
Attribute
Route
Don't know
OM22 - EVENT_OMKDNY ( OMQ2290 )
Refusal
OM22 - EVENT_OMKDNY ( OMQ2290 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
OM21B - RENTPROB is an EVENT level detail.
The response to OM21B - RENTPROB needs to be copied to
6:21:27 PM Wednesday, March 27, 2013
Page 205 of 341
OM21B
EVNT.RENTPROB for each Event selected at OM22 or OM22A.
6:21:27 PM Wednesday, March 27, 2013
Page 206 of 341
OM22
OM22
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMKDNY
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
800
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If LASTKDNYTYPE = 1/Supplies, display "purchase the kidney
dialysis supplies".
Else display "buy or repair kidney dialysis equipment".
Multi Field display:
Roster/Grid Instructions:
Display all kidney dialysis items that have been added in the current
round where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round), and
EVNT.EVNTTYPE = OM, and
EVNT.OMETYPE = 9/Kidney.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
1
Purchase or
Repair/Rental
6:21:27 PM Wednesday, March 27, 2013
INSTRUCTIONS
Display EVENT DATE in "Mon DD YYYY"
format.
Page 207 of 341
OM22
2
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
3
Rentals
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
4
Status
If EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
5
OME Type
Display EVNT.KDNYTYPE.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
SELECT OR ADD ALL DATES AT THIS ROSTER.
Question Text:
When did [you/(SP)] (purchase the kidney dialysis supplies)/(buy or
repair kidney dialysis equipment)? Please tell me all the dates
[since (REFERENCE DATE/SURVEY REFERENCE DATE)/between
(REFERENCE DATE/SURVEY REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)].
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:28 PM Wednesday, March 27, 2013
Page 208 of 341
OM22
Field1:
Cheshire Name:
EVENT_OMKDNY
( OMQ2290 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX OM1LL - (OMQ2330 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 9/Kidney.
KDNYTYPE
EVNT.KDNYTYPE = LASTKDNYTYPE.
STOMTYPE
If KDNYTYPE =
1/Supplies, STOMTYPE = 61/KidneySupplies.
2/Equipment, STOMTYPE = 62/KidneyEquipment.
EVNTPROV
EVNT.EVNTPROV = 01.
RENTPROB
If LASTKDNYTYPE = 2/Equipment, set RENTPROB
= OM21B - RENTPROB response.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
6:21:28 PM Wednesday, March 27, 2013
Page 209 of 341
OM22
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
KDNYTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
RENTPROB matches, OR
1st Event RENTPROB = 1/Buy and 2nd Event RENTPROB = DK
or RF, OR
1st Event RENTPROB = DK or RF and 2nd Event RENTPROB =
1/Buy.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
6:21:28 PM Wednesday, March 27, 2013
Page 210 of 341
BOX OM1LL
BOX OM1LL
Page Order # :
810
BOX INSTRUCTIONS
( OMQ2330 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM22_IN - NAVIGATOR ( OMQ2335 ).
ELSE GO TO BOX OM1NN1 - (OMQ2558 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:21:28 PM Wednesday, March 27, 2013
Page 211 of 341
OM22_IN
OM22_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
815
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 OM's added at OM22.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:29 PM Wednesday, March 27, 2013
Page 212 of 341
OM22_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ2335 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM22AA - OMSATHMO ( OMQ2340 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX OM1NN1 - (OMQ2558 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:21:29 PM Wednesday, March 27, 2013
Page 213 of 341
OM22AA
OM22AA
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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
820
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the event date for the OM event currently being asked about.
Display the name of the Kidney Item currently being asked about.
Kidney Item:
If KDNYTYPE = 1/Supplies, display "KIDNEY DIALYSIS
SUPPLIES".
Else display "KIDNEY DIALYSIS EQUIPMENT".
Question display:
Display the event date for the OM event currently being asked about.
Display the name of the Kidney Item currently being asked about.
Kidney Item:
If KDNYTYPE = 1/Supplies, display "kidney dialysis supplies".
Else display "kidney dialysis equipment".
Always display "(or repair)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
6:21:30 PM Wednesday, March 27, 2013
Page 214 of 341
OM22AA
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
EVENT DATE: (EVENT DATE)
OM ITEM: (KIDNEY ITEM)
Int. Instr I:
Question Text:
On (EVENT DATE), did [you/(SP)] buy (or repair) the (KIDNEY
ITEM) at [READ MANAGED CARE PLAN NAME(S) BELOW] or
through a service or discount offered through [READ MANAGED
CARE PLAN NAME(S) BELOW]?
[PROBE: This could include buying (or repairing) the (KIDNEY
ITEM) at a plan center; at a place or store that honors [your/(SP’s)]
plan card; or through a place or store that the plan referred
[you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:31 PM Wednesday, March 27, 2013
Page 215 of 341
OM22AA
Field1:
OMSATHMO
Cheshire Name:
( OMQ2340 )
EVNT.OMSATHMO
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 OM14 - (OMQ2350 )
English text: YES
No
BOX OM14 - (OMQ2350 )
English text: NO
Attribute
Route
Don't know
BOX OM14 - (OMQ2350 )
Refusal
BOX OM14 - (OMQ2350 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
46
SPHadMHMO
6:21:33 PM Wednesday, March 27, 2013
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
Page 216 of 341
OM22AA
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:21:33 PM Wednesday, March 27, 2013
Page 217 of 341
BOX OM14
BOX OM14
Page Order # :
830
BOX INSTRUCTIONS
( OMQ2350 )
GO TO OM22_IN - NAVIGATOR ( OMQ2335 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:21:33 PM Wednesday, March 27, 2013
Page 218 of 341
OM22A
OM22A
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMKDNYREN
T
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
840
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Display all kidney dialysis items that have been added in the current
round where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round), and
EVNT.EVNTTYPE = OM, and
EVNT.OMETYPE = 9/Kidney.
Display all loaded events as protected rows.
Display in order of entry.
Roster/Grid display:
COL #
HEADER
1
Purchase or
Repair/Rental
6:21:33 PM Wednesday, March 27, 2013
INSTRUCTIONS
Display EVENT DATE in "Mon DD YYYY"
format.
Page 219 of 341
OM22A
2
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
3
Rentals
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
4
Status
If EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
5
OME Type
Display EVNT.KDNYTYPE.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
SELECT OR ADD ONLY ONE DATE AT THIS ROSTER.
Question Text:
Please tell me the first date [since (REFERENCE DATE/SURVEY
REFERENCE DATE)/between (REFERENCE DATE/SURVEY
REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)] that [you/(SP)] rented the kidney dialysis
equipment.
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:34 PM Wednesday, March 27, 2013
Page 220 of 341
OM22A
Field1:
Cheshire Name:
EVENT_OMKDNYREN ( OMQ2360 )
T
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
OM22B - RENTSTIL ( OMQ2390 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 9/Kidney.
KDNYTYPE
EVNT.KDNYTYPE = 2/Equipment.
STOMTYPE
STOMTYPE = 62/KidneyEquipment.
EVNTPROV
EVNT.EVNTPROV = 01.
RENTPROB
RENTPROB = OM21B - RENTPROB response.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
6:21:34 PM Wednesday, March 27, 2013
Page 221 of 341
OM22A
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
KDNYTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
RENTPROB matches, OR
1st Event RENTPROB = 1/Buy and 2nd Event RENTPROB = DK
or RF, OR
1st Event RENTPROB = DK or RF and 2nd Event RENTPROB =
1/Buy.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
6:21:34 PM Wednesday, March 27, 2013
Page 222 of 341
OM22B
OM22B
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
RENTSTIL
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
850
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:
[Are you/Is (SP)/Was (SP)] still renting the kidney dialysis
equipment?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:35 PM Wednesday, March 27, 2013
Page 223 of 341
OM22B
Field1:
RENTSTIL
Cheshire Name:
Item Text display:
( OMQ2390 )
EVNT.RENTSTIL
Do not display response option 3/EnteredInError
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentstil
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1NN - (OMQ2540 )
2
English text: YES
No
3
English text: NO
EnteredInError
OM22C - EVENDYY ( OMQ2460 )
DO NOT DISPLAY.
English text: EVENT ENTERED IN ERROR
Attribute
Route
Don't know
BOX OM1NN1 - (OMQ2558 )
Refusal
BOX OM1NN1 - (OMQ2558 )
BACKGROUND VARIABLE ASSIGNMENTS
RENTRECR
If OM22B - RENTSTIL = 1/Yes, set
EVNT.RENTRECR = current round.
RENTENDR
If OM22B - RENTSTIL ^= 1/Yes, set
EVNT.RENTENDR = current round.
EVENDMM
If OM22B - RENTSTIL = DK, set EVNT.EVENDMM =
DK.
Else if OM22B - RENTSTIL = RF, set
EVNT.EVENDMM = RF.
EVENDDD
If OM22B - RENTSTIL = DK, set EVNT.EVENDDD =
DK.
Else if OM22B - RENTSTIL = RF, set
EVNT.EVENDDD = RF.
6:21:36 PM Wednesday, March 27, 2013
Page 224 of 341
OM22B
EVENDYY
If OM22B - RENTSTIL = DK, set EVNT.EVENDYY =
DK.
Else if OM22B - RENTSTIL = RF, set
EVNT.EVENDYY = RF.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:21:37 PM Wednesday, March 27, 2013
Page 225 of 341
OM22C
OM22C
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
EVENDMM
Field 2:
EVENDDD
Field 3:
EVENDYY
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:
880
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Horizontal Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What was the last date the equipment was rented?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:38 PM Wednesday, March 27, 2013
Page 226 of 341
OM22C
Field1:
EVENDMM
Cheshire Name:
( OMQ2440 )
EVNT.EVENDMM
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
OM22C - EVENDDD ( OMQ2450 )
Refusal
OM22C - EVENDDD ( OMQ2450 )
6:21:40 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
OM22C - EVENDDD ( OMQ2450 )
Page 227 of 341
OM22C
Field2:
EVENDDD
Cheshire Name:
( OMQ2450 )
EVNT.EVENDDD
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
OM22C - EVENDYY ( OMQ2460 )
Refusal
OM22C - EVENDYY ( OMQ2460 )
6:21:42 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
OM22C - EVENDYY ( OMQ2460 )
Page 228 of 341
OM22C
Field3:
EVENDYY
Cheshire Name:
( OMQ2460 )
EVNT.EVENDYY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TYear2DKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
BOX OM15A - (OMQ2470 )
Refusal
BOX OM15A - (OMQ2470 )
FieldSize:
Min Value:
Max Value:
Mask:
2
00
99
Route
BOX OM15A - (OMQ2470 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Rental end date, EVENDMM/EVENDDD/EVENDYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVENDMM, EVENDDD, EVENDYY.
Edit #2
Rental end date, EVENDMM/EVENDDD/EVENDYY, must be on or
after the date the item was rented,
EVBEGMM/EVBEGDD/EVBEGYY.
If not true, display message, "INVALID DATE. DATE MUST BE ON
OR AFTER (EVENT DATE). PLEASE REENTER."
6:21:43 PM Wednesday, March 27, 2013
Page 229 of 341
OM22C
INVOLVES EVENDMM, EVENDDD, EVENDYY.
TECHNICAL NOTES
DESIGN NOTES
6:21:43 PM Wednesday, March 27, 2013
Page 230 of 341
BOX OM15A
BOX OM15A
Page Order # :
890
BOX INSTRUCTIONS
( OMQ2470 )
IF SP IS NOT DECEASED, GO TO OM22CC - RENT2BUY ( OMQ2480 ).
ELSE GO TO BOX OM1NN - (OMQ2540 ).
ASSIGNMENTS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
6:21:43 PM Wednesday, March 27, 2013
Page 231 of 341
OM22CC
OM22CC
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENT2BUY
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
900
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
If SP is the respondent, display "have".
Else display "has".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
You said [you/(SP)] stopped renting the dialysis equipment. Is this
because (you/he/she) no longer (have/has) the equipment or
because (you/he/she) (have/has) purchased it through a rent-to-buy
option?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:44 PM Wednesday, March 27, 2013
Page 232 of 341
OM22CC
Field1:
( OMQ2480 )
RENT2BUY
Cheshire Name:
EVNT.RENT2BUY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRen2buy
1
No
No
Number Label
1 NoLongerHave
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1NN - (OMQ2540 )
2
English text: NO LONGER HAVE THE ITEM
PurchasedRentToBuy
3
English text: PURCHASED THROUGH RENT-TO-BUY
Other
OM22CCVB - REN2BVB ( OMQ2490 )
BOX OM1NN - (OMQ2540 )
English text: OTHER
Attribute
Don't know
Route
BOX OM1NN - (OMQ2540 )
Refusal
BOX OM1NN - (OMQ2540 )
BACKGROUND VARIABLE ASSIGNMENTS
RBUYCOST
If OM22CC - RENT2BUY = 2/PurchasedRentToBuy
or 3/Other, set EVNT.RBUYCOST=1/StillCollectCost.
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.
6:21:45 PM Wednesday, March 27, 2013
Page 233 of 341
OM22CC
An SP interview (respondent is the SP) =
MRES.SPPROXY=1/SP.
MRES.RROSTNUM='01'.
DESIGN NOTES
6:21:46 PM Wednesday, March 27, 2013
Page 234 of 341
OM22CCVB
OM22CCVB
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 1:
REN2BVB
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
BRIEFLY EXPLAIN WHY SP STOPPED RENTING THE DIALYSIS
EQUIPMENT.
Question Text:
Int. Instr II:
RECORD VERBATIM.
INPUT FIELDS / ROUTING
6:21:46 PM Wednesday, March 27, 2013
Page 235 of 341
OM22CCVB
Field1:
Cheshire Name:
REN2BVB
( OMQ2490 )
NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
EVNT.REN2BVB1
EVNT.REN2BVB2
EVNT.REN2BVB3
EVNT.REN2BVB4
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Open
TOpen180
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
180
Route
BOX OM1NN - (OMQ2540 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:21:46 PM Wednesday, March 27, 2013
Page 236 of 341
BOX OM1NN
BOX OM1NN
Page Order # :
930
BOX INSTRUCTIONS
( OMQ2540 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM22D1 - OMSATHMO ( OMQ2550 ).
ELSE GO TO BOX OM1NN1 - (OMQ2558 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:21:46 PM Wednesday, March 27, 2013
Page 237 of 341
OM22D1
OM22D1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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
940
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
Int. Instr I:
Question Text:
Did [you/(SP)] rent the kidney dialysis equipment at [READ
6:21:47 PM Wednesday, March 27, 2013
Page 238 of 341
OM22D1
MANAGED CARE PLAN NAME(S) BELOW] or through a service or
discount offered through [READ MANAGED CARE PLAN NAME(S)
BELOW]?
[PROBE: This could include renting the kidney dialysis equipment at
a plan center; at a place or store that honors [your/(SP’s)] plan card;
or through a place or service that the plan referred [you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
OMSATHMO
Field1:
Cheshire Name:
Item Text display:
( OMQ2550 )
EVNT.OMSATHMO
EVNT.OMSATHMO may already be filled from the previous
round. Do not display previous round response. Current
round response to OMSATHMO will overwrite
EVNT.OMSATHMO.
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 OM1NN1 - (OMQ2558 )
English text: YES
No
BOX OM1NN1 - (OMQ2558 )
English text: NO
Attribute
Route
Don't know
BOX OM1NN1 - (OMQ2558 )
Refusal
BOX OM1NN1 - (OMQ2558 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
6:21:48 PM Wednesday, March 27, 2013
Page 239 of 341
OM22D1
HARD EDIT CHECKS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:21:48 PM Wednesday, March 27, 2013
Page 240 of 341
BOX OM1NN1
BOX OM1NN1
Page Order # :
945
BOX INSTRUCTIONS
( OMQ2558 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO BOX OM16 - (OMQ2560 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:21:48 PM Wednesday, March 27, 2013
Page 241 of 341
BOX OM16
BOX OM16
Page Order # :
950
BOX INSTRUCTIONS
( OMQ2560 )
IF ASKING ABOUT A RENTAL ITEM FROM THE PREVIOUS ROUND, GO
TO OMS21_IN - NAVIGATOR ( OMQ2196 ).
ELSE GO TO BOX OM17 - (OMQ2570 ).
ASSIGNMENTS
TECHNICAL NOTES
201
StillRentKdnyItem
SP still renting kidney dialysis equipment at the time of
the previous round interview =
There is an EVNT where EVNT.EVNTTYPE ='OM' and
EVNT.OMETYPE=9/Kidney and EVNT.RENTSTIL =
1/Yes and EVNT.RENTRECR = previous round and
EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:21:49 PM Wednesday, March 27, 2013
Page 242 of 341
BOX OM17
BOX OM17
Page Order # :
960
BOX INSTRUCTIONS
( OMQ2570 )
IF OM22D HAS NOT BEEN ASKED, GO TO OM22D - MOREKDNY (
OMQ2580 ).
ELSE GO TO BOX OMA18 - (OMQ2600 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:21:49 PM Wednesday, March 27, 2013
Page 243 of 341
OM22D
OM22D
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MOREKDNY
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:
Display the name of the Kidney Item currently being asked about.
Kidney Item:
If KDNYTYPE = 1/Supplies, display "KIDNEY DIALYSIS
SUPPLIES".
Else display "KIDNEY DIALYSIS EQUIPMENT".
Question display:
If LASTKDNYTYPE = 1/Supplies, display "kidney dialysis supplies".
Else display "kidney dialysis equipment".
If LASTKDNYTYPE = 1/Supplies, display "obtain any kidney dialysis
equipment".
Else display "buy any kidney dialysis supplies".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
OM ITEM: (KIDNEY ITEM)
Int. Instr I:
Question Text:
In addition to the [(kidney dialysis supplies)/(kidney dialysis
6:21:49 PM Wednesday, March 27, 2013
Page 244 of 341
OM22D
equipment)] that you just told me about, did [you/(SP)] [(obtain any
kidney dialysis equipment)/(buy any kidney dialysis supplies)]?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
MOREKDNY
Cheshire Name:
( OMQ2580 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM18 - (OMQ2590 )
English text: YES
No
BOX OMA18 - (OMQ2600 )
English text: NO
Attribute
Route
Don't know
BOX OMA18 - (OMQ2600 )
Refusal
BOX OMA18 - (OMQ2600 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:21:50 PM Wednesday, March 27, 2013
Page 245 of 341
BOX OM18
BOX OM18
Page Order # :
980
BOX INSTRUCTIONS
( OMQ2590 )
IF OM21A - KDNYTYPE = 1/Supplies, SET NEXT KIDNEY TYPE TO
EQUIPMENT AND GO TO OM21B - RENTPROB ( OMQ2260 ).
ELSE SET NEXT KIDNEY TYPE TO SUPPLIES AND GO TO OM22
EVENT_OMKDNY ( OMQ2290 ).
ASSIGNMENTS
LASTKDNYTYPE
If OM21A - KDNYTYPE = 1/Supplies, set
LASTKDNYTYPE = 2/Equipment.
Else if OM21A - KDNYTYPE = 2/Equipment, set
LASTKDNYTYPE = 1/Supplies.
TECHNICAL NOTES
DESIGN NOTES
6:21:50 PM Wednesday, March 27, 2013
Page 246 of 341
BOX OMA18
BOX OMA18
Page Order # :
990
BOX INSTRUCTIONS
( OMQ2600 )
IF SP WAS STILL RENTING AT LEAST ONE OTHER MEDICAL EQUIPMENT
AT THE TIME OF THE PREVIOUS ROUND INTERVIEW, GO TO
OMS23INTR - OTHRINTRO ( OMQ2605 ).
ELSE GO TO OM23 - OMPROTHR ( OMQ2640 ).
ASSIGNMENTS
TECHNICAL NOTES
202
StillRentOthrItem
SP still renting an other medical equipment at the time of
the previous round interview =
There is an EVNT where EVNTTYPE ='OM' and
OMETYPE=10/OtherMedicalExpense and
EVNT.RENTSTIL = 1/Yes and EVNT.RENTRECR =
previous round and EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:21:50 PM Wednesday, March 27, 2013
Page 247 of 341
OMS23INTR
OMS23INTR
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
OTHRINTRO
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
995
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:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
The next questions are about other medical equipment [you
were/(SP) was] renting as of (REFERENCE DATE).
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:51 PM Wednesday, March 27, 2013
Page 248 of 341
OMS23INTR
Field1:
OTHRINTRO
Cheshire Name:
( OMQ2605 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS23_IN - NAVIGATOR ( OMQ2606 )
English text: CONTINUE
Attribute
Route
Empty
OMS23_IN - NAVIGATOR ( OMQ2606 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:21:52 PM Wednesday, March 27, 2013
Page 249 of 341
OMS23_IN
OMS23_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
996
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 all Other Medical Expense Items that the SP was renting at
the time of the previous round interview.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:52 PM Wednesday, March 27, 2013
Page 250 of 341
OMS23_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ2606 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS23 - RENTSTIL ( OMQ2610 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
OM23 - OMPROTHR ( OMQ2640 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
202
StillRentOthrItem
SP still renting an other medical equipment at the time of
the previous round interview =
There is an EVNT where EVNTTYPE ='OM' and
OMETYPE=10/OtherMedicalExpense and
EVNT.RENTSTIL = 1/Yes and EVNT.RENTRECR =
previous round and EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:21:53 PM Wednesday, March 27, 2013
Page 251 of 341
OMS23
OMS23
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENTSTIL
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:
Display the name of the Other Medical Expense Item currently being
asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT. See technical note.
Else display EVNT.OTHRTYPE response.
Question display:
Display the name of the Other Medical Expense Item currently being
asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT. See technical note.
Else display EVNT.OTHRTYPE response.
If SP is alive and not institutionalized, display "is".
Else display "was".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
6:21:54 PM Wednesday, March 27, 2013
Page 252 of 341
OMS23
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
Context Header:
Int. Instr I:
At the time of the last interview, [you were/(SP) was] renting (OTHER
MEDICAL EXPENSE ITEM). As of (today/DATE OF DEATH/DATE
OF INSTITUTIONALIZATION), (is/was) the (OTHER MEDICAL
EXPENSE ITEM) being rented?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
RENTSTIL
Field1:
Cheshire Name:
Item Text display:
( OMQ2610 )
EVNT.RENTSTIL
Display previous response to EVNT.RENTSTIL and allow
field to be updated.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentstil
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1QQ - (OMQ2980 )
2
English text: YES
No
OM26B - EVENDMM ( OMQ2880 )
3
English text: NO
EnteredInError
BOX OM23 - (OMQ3000 )
English text: EVENT ENTERED IN ERROR
Attribute
Route
Don't know
BOX OM23 - (OMQ3000 )
Refusal
BOX OM23 - (OMQ3000 )
BACKGROUND VARIABLE ASSIGNMENTS
RENTRECR
If OMS23 - RENTSTIL = 1/Yes, set
EVNT.RENTRECR = current round.
6:21:55 PM Wednesday, March 27, 2013
Page 253 of 341
OMS23
RENTENDR
If OMS23 - RENTSTIL ^= 1/Yes, set
EVNT.RENTENDR = current round.
EVENDMM
If OMS23 - RENTSTIL = DK, set EVNT.EVENDMM =
DK.
Else if OMS23 - RENTSTIL = RF, set
EVNT.EVENDMM = RF.
EVENDDD
If OMS23 - RENTSTIL = DK, set EVNT.EVENDDD =
DK.
Else if OMS23 - RENTSTIL = RF, set
EVNT.EVENDDD = RF.
EVENDYY
If OMS23 - RENTSTIL = DK, set EVNT.EVENDYY =
DK.
Else if OMS23 - RENTSTIL = RF, set
EVNT.EVENDYY = RF.
EVNTDFLG
If OMS23 - RENTSTIL = 3/EnteredInError, set
EVNT.EVNTDFLG = 1/Yes.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
217
EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in
SQL and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
DESIGN NOTES
6:21:55 PM Wednesday, March 27, 2013
Page 254 of 341
OM23
OM23
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPROTHR
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:
Always display "[Other medical…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
SHOW CARD OM4
Question Text:
[Since (REFERENCE DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] buy, rent, or repair any
other medical equipment or buy any other medical supplies besides
what we have talked about?
[Other medical equipment and supplies include portable commodes
or raised toilet seats, portable tub seats, special chairs or cushions,
hospital beds, ostomy supplies, incontenence supplies such as
6:21:56 PM Wednesday, March 27, 2013
Page 255 of 341
OM23
Depends, Serenity or other brands of disposable undergarments,
pads or briefs, bandages, dressings, tape supplies, pulmonary
equipment such as a Nebulizer or CPAP, and blood pressure
equipment such as cuffs or monitors, etc.]
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
OMPROTHR
Cheshire Name:
Item Text display:
( OMQ2640 )
HRND.OMPROTHR
Do not display response option 3/IndicatedYesByDataPrep
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM24 - OTHRTYPE ( OMQ2650 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
BOX OM24 - (OMQ3019 )
DO NOT DISPLAY.
English text: INDICATED YES BY DATAPREP
Attribute
Route
Don't know
BOX OM24 - (OMQ3019 )
Refusal
BOX OM24 - (OMQ3019 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:21:57 PM Wednesday, March 27, 2013
Page 256 of 341
OM23
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
6:21:57 PM Wednesday, March 27, 2013
Page 257 of 341
OM24
OM24
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
OTHRTYPE
Field 2:
EVOSTEXT
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:
1020
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 kind of equipment was the item?
Int. Instr II:
INPUT FIELDS / ROUTING
6:21:58 PM Wednesday, March 27, 2013
Page 258 of 341
OM24
Field1:
OTHRTYPE
Cheshire Name:
( OMQ2650 )
EVNT.OTHRTYPE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TOthrtype
1
No
No
Number Label
1 Toilet
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM24A - RENTPROB ( OMQ2690 )
2
English text: PORTABLE COMMODE OR RAISED TOILET SEAT
Tub
OM24A - RENTPROB ( OMQ2690 )
3
English text: PORTABLE TUB SEAT
Chair
4
English text: SPECIAL CHAIR/CUSHION/MATTRESS
Bed
OM24A - RENTPROB ( OMQ2690 )
5
English text: HOSPITAL BED/BED SIDES
OstomySupplies
BOX OM18B - (OMQ2700 )
6
English text: OSTOMY SUPPLIES
IncontinenceSupplies
BOX OM18B - (OMQ2700 )
7
English text: INCONTINENCE SUPPLIES (I.E. DEPENDS, SERENITY DISPOSABLE DIAPERS
OR PADS)
Bandages
BOX OM18B - (OMQ2700 )
8
English text: BANDAGES, DRESSINGS, TAPE SUPPLIES
PulmonaryEquipment
OM24A - RENTPROB ( OMQ2690 )
9
English text: PULMONARY EQUIPMENT
BloodPressureEquipment
91
OM24A - RENTPROB ( OMQ2690 )
OM26 - EVENT_OMOTHR ( OMQ2740 )
English text: BLOOD PRESSURE EQUIPMENT
Other
OM24 - EVOSTEXT ( OMQ2660 )
English text: OTHER
6:22:01 PM Wednesday, March 27, 2013
Page 259 of 341
OM24
Field2:
Cheshire Name:
EVOSTEXT
( OMQ2660 )
EVOS.EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in SQL
and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
Item Text display:
Display (SPECIFY) in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
OM24A - RENTPROB ( OMQ2690 )
BACKGROUND VARIABLE ASSIGNMENTS
THE FOLLOWING INSTRUCTIONS APPLY ONLY TO OM24 - OTHRTYPE =
5/OstomySupplies, 6/IncontinenceSupplies, or 7/Bandages:
When Ostomy Supplies, Incontinence Supplies or Bandages is selected as the Other
Medical Expense Type, only one EVNT record is generated per type across all rounds. A
current round PMRO linked to this EVNT is created each round the SP reports this OM type
in order to collect round specific event details.
If OM24 - OTHRTYPE = 5/OstomySupplies, 6/IncontinenceSupplies, or 7/Bandages, then
create and fill the following fields as instructed below:
First search for an existing EVNT that matches OM24 - OTHRTYPE.
An existing EVNT is an EVNT where:
EVNT.OMETYPE =10/OtherMedicalExpense, and
EVNT.OTHRTYPE matches OM24 - OTHRTYPE, and EVNT.EVNTDFLG ^=1/Yes
If no matching EVNT exists, create a new EVNT.
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM.
BASE.LASTEVNT holds the highest EVNT.EVNTNUM prior to fielding cases. Not all
EVNT records are fielded. The first time an EVNT record is generated in the field,
BASE.LASTEVNT should be >= to the highest EVNT.EVNTNUM fielded. The new
EVNT.EVNTNUM should be calculated based on BASE.LASTEVNT + 001. Each time an
6:22:02 PM Wednesday, March 27, 2013
Page 260 of 341
OM24
EVNT record is generated in the field, BASE.LASTEVNT will be updated to match the
highest EVNT.EVNTNUM in the field. Therefore, each time an EVNT record is generated in
the field, the new EVNT.EVNTNUM should be calculated based on BASE.LASTEVNT +
001. See detailed instructions below.
Set additional EVNT fields as instructed below.
Regardless if matching EVNT exists, create a current round PMRO where
PMRO.PMROEVNT = EVNT.EVNTNUM and PMRO.PMRORND = current round. NOTE:
PMRO may already exist. Set additional PMRO fields as instructed below.
EVNTNUM
Set new EVNT.EVNTNUM = BASE.LASTEVNT +
001. This assumes that BASE.LASTEVNT is
incremented each time an EVNT record is generated
in the field.
LASTEVNT
If creating a new EVNT, once new EVNT record is
generated, set BASE.LASTEVNT = new
EVNT.EVNTNUM.
EVNTRNDC
If creating a new EVNT, set EVNT.EVNTRNDC =
current round.
EVNTTYPE
If creating a new EVNT, set EVNT.EVNTYPE = 'OM'.
OMETYPE
If creating a new EVNT, set EVNT.OMETYPE =
10/OtherMedicalExpense.
OTHRTYPE
If creating a new EVNT, set EVNT.OTHRTYPE =
OM24 - OTHRTYPE response.
STOMTYPE
If creating a new EVNT, if OM24 - OTHRTYPE =
5/OstomySupplies, STOMTYPE =
45/OstomySupplies.
6/IncontinenceSupplies, STOMTYPE =
46/IncontinenceSupplies.
7/Bandages, STOMTYPE = 47/Bandages.
EVNTPROV
EVNT.EVNTPROV = 01.
PMROEVNT
PMRO.PMROEVNT = this EVNT.EVNTNUM.
PMRORND
PMRO.PMRORND = current round.
PMROTYPE
PMRO.PMROTYPE = 'OM'.
EVCHGFLG
If creating a new event and currently administering
ST or NS, set EVNT.EVCHGFLG = 1/Yes.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
217
EVOSTEXT
6:22:02 PM Wednesday, March 27, 2013
EVOSTEXT and EVNTQUES are stored on tblEVNT in
SQL and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
Page 261 of 341
OM24
DESIGN NOTES
Called from ST36 and NS36 if OM needs to be added to charge bundle in
ST and/or NS.
OM24 - OTHRTYPE and OM24 - EVOSTEXT are EVENT level detail.
The response to OM24 - OTHRTYPE needs to be copied to
EVNT.OTHRTYPE for each Event selected at OM26 or OM26A.
The response to OM24 - EVOSTEXT needs to be copied to
EVNT.EVOSTEXT for each Event selected at OM26 or OM26A.
6:22:02 PM Wednesday, March 27, 2013
Page 262 of 341
OM24A
OM24A
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENTPROB
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
1030
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If OM24-OTHRTYPE=91/Other, display other specify text, OM24
EVOSTEXT.
Else display OM24-OTHRTYPE response.
Question display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If OM24-OTHRTYPE=91/Other, display other specify text, OM24
EVOSTEXT.
Else display OM24-OTHRTYPE response.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
6:22:02 PM Wednesday, March 27, 2013
Page 263 of 341
OM24A
Int. Instr I:
Did [you/(SP)] buy or repair the (OTHER MEDICAL EXPENSE
ITEM), or did [you/(SP)] rent it?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
RENTPROB
Cheshire Name:
Item Text display:
( OMQ2690 )
EVNT.RENTPROB
Do not display response option 3/BoughtAndRented
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentprob
1
No
No
Number Label
1 Buy
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM26 - EVENT_OMOTHR ( OMQ2740 )
2
English text: BUY/REPAIR
Rent
3
English text: RENT
BoughtAndRented
OM26A - EVENT_OMOTHRRENT ( OMQ2810 )
DO NOT DISPLAY.
English text: BOUGHT/REPAIRED EQUIPMENT AND RENTED EQUIPMENT
Attribute
Route
Don't know
OM26 - EVENT_OMOTHR ( OMQ2740 )
Refusal
OM26 - EVENT_OMOTHR ( OMQ2740 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
6:22:04 PM Wednesday, March 27, 2013
Page 264 of 341
OM24A
TECHNICAL NOTES
DESIGN NOTES
OM24A - RENTPROB is an EVENT level detail.
The response to OM24A - RENTPROB needs to be copied to
EVNT.RENTPROB for each Event selected at OM26 or OM26A.
6:22:04 PM Wednesday, March 27, 2013
Page 265 of 341
BOX OM18B
BOX OM18B
Page Order # :
1050
BOX INSTRUCTIONS
( OMQ2700 )
IF NOT ADMINISTERING ST AND NOT ADMINISTERING NS, GO TO OM25
GETNUM ( OMQ2720 ).
ELSE GO TO BOX OM1QQ1 - (OMQ2998 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, we do not collect GETNUM in OM. When
returning to ST/NS, we will collect # of purchases covered by charge
bundle, XCEV.NUMLINKS, and then copy this value to PMRO.GETNUM.
6:22:04 PM Wednesday, March 27, 2013
Page 266 of 341
OM25
OM25
Page Order # :
Design Screen Type:
Numeric
Fields:
Field 1:
GETNUM
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
1060
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item = Display OM24-OTHRTYPE response.
Question display:
If the SP has reported the Other Medical Expense entered at OM24,
EVNT.OTHRTYPE, more than once in the current round, display
interviewer instruction 1.
Else do not display.
If SP is alive and not institutionalized, display "[have you/has (SP)]
bought or obtained".
Else display "did (SP) buy or obtain".
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item = Display OM24-OTHRTYPE response.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
6:22:05 PM Wednesday, March 27, 2013
Page 267 of 341
OM25
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
Int. Instr I:
THIS ITEM AND NUMBER OF PURCHASES HAS BEEN ENTERED
ALREADY FOR THIS ROUND. PLEASE CORRECT THE NUMBER
OF TIMES TO BE THE TOTAL NUMBER OF TIMES PURCHASED
SINCE (REFERENCE DATE).
Question Text:
How many times [since (REFERENCE DATE)/between
(REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)] [[have you/has (SP)] bought or
obtained/did (SP) buy or obtain] (OTHER MEDICAL EXPENSE
ITEM)?
Int. Instr II:
INPUT FIELDS / ROUTING
GETNUM
Field1:
Cheshire Name:
Item Text display:
( OMQ2720 )
PMRO.GETNUM
PMRO.GETNUM may already be filled. If so, display this
value in the input field and allow the field to be updated.
Item Text:
Label:
Label Position:
NUMBER OF PURCHASES:
Left
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TGetnum
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
BOX OM1QQ1 - (OMQ2998 )
Refusal
BOX OM1QQ1 - (OMQ2998 )
FieldSize:
Min Value:
Max Value:
Mask:
0
100
Route
BOX OM1QQ1 - (OMQ2998 )
BACKGROUND VARIABLE ASSIGNMENTS
OM25 - GETNUM is stored on the current round PMRO where PMRO.PMROEVNT = this
EVNT.EVNTNUM and PMRO.PMRORND = current round.
SOFT EDIT CHECKS
6:22:06 PM Wednesday, March 27, 2013
Page 268 of 341
OM25
GETNUM = 1-60, DK or RF;
If not true, display message: "THE AMOUNT ENTERED SEEMS
UNLIKELY. PLEASE VERIFY AND REENTER."
HARD EDIT CHECKS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
6:22:06 PM Wednesday, March 27, 2013
Page 269 of 341
OM26
OM26
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMOTHR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Multiple Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
1070
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If OM24-OTHRTYPE=91/Other, display other specify text, OM24
EVOSTEXT.
Else display OM24-OTHRTYPE response.
Question display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If OM24-OTHRTYPE=91/Other, display other specify text, OM24
EVOSTEXT.
Else display OM24-OTHRTYPE response.
Multi Field display:
Roster/Grid Instructions:
Display all other medical expense items that have been reported in
the current round where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round), and
EVNT.EVNTTYPE = OM, and
EVNT.OMETYPE = 10/OtherMedicalExpense.
Display all loaded events as protected rows.
Display in order of entry.
6:22:06 PM Wednesday, March 27, 2013
Page 270 of 341
OM26
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Purchase or
Repair/Rental
If (EVNT.OTHRTYPE ^=
5/OstomySupplies and
EVNT.OTHRTYPE ^=
6/IncontinenceSupplies and
EVNT.OTHRTYPE ^= 7/Bandages),
display EVENT DATE in "Mon DD YYYY"
format.
Else do not display.
2
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
3
Purchases
IF PMRO.GETNUM > 0,DK, or RF,
display number of purchases,
PMRO.GETNUM, on PMRO where
PMRO.PMROEVNT = this
EVNT.EVNTNUM and PMRO.PMRORND
= current round.
Else do not display.
4
Rentals
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
5
Status
If EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
6
OME Type
If EVNT.OTHRTYPE=91/Other, display
other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
Int. Instr I:
SELECT OR ADD ALL DATES AT THIS ROSTER.
Question Text:
When did [you/(SP)] buy or repair the (OTHER MEDICAL EXPENSE
ITEM)? Please tell me all the dates [since (REFERENCE
DATE/SURVEY REFERENCE DATE)/between (REFERENCE
DATE/SURVEY REFERENCE DATE) and (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)]
Int. Instr II:
6:22:07 PM Wednesday, March 27, 2013
Page 271 of 341
OM26
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_OMOTHR
( OMQ2740 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
BOX OM1OO - (OMQ2780 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 10/OtherMedicalExpense.
OTHRTYPE
EVNT.ORTHTYPE = OM24 - OTHRTYPE response.
6:22:07 PM Wednesday, March 27, 2013
Page 272 of 341
OM26
STOMTYPE
If OTHRTYPE =
1/Toilet, STOMTYPE=41/Toilet.
2/Tub, STOMTYPE=42/Tub.
3/Chair, STOMTYPE=43/Chair.
4/Bed, STOMTYPE=44/Bed.
8/PulmonaryEquipment,
STOMTYPE=48/PulmonaryEquipment.
9/BloodPressureEquipment, STOMTYPE=49/Bl...
91/Other, STOMTYPE=91/Other.
EVNTPROV
EVNT.EVNTPROV = 01.
RENTPROB
If OTHRTYPE=1/Toilet, 2/Tub, 3/Chair, 4/Bed,
8/PulmonaryEquipment, or 91/Other, set
EVNT.RENTPROB = OM24A response.
EVOSTEXT
If OM24 - OTHRTYPE= 91/Other, set
EVNT.EVOSTEXT = OM24 - EVOSTEXT other
specify text.
EVNTQUES
If OM24 - OTHRTYPE = 91/Other, set
EVNT.EVNTQUES = 'OM24'.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
6:22:07 PM Wednesday, March 27, 2013
Page 273 of 341
OM26
OTHRTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
RENTPROB matches, OR
1st Event RENTPROB = 1/Buy and 2nd Event RENTPROB = DK
or RF, OR
1st Event RENTPROB = DK or RF and 2nd Event RENTPROB =
1/Buy.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
6:22:07 PM Wednesday, March 27, 2013
Page 274 of 341
BOX OM1OO
BOX OM1OO
Page Order # :
1080
BOX INSTRUCTIONS
( OMQ2780 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM26_IN - NAVIGATOR ( OMQ2785 ).
ELSE GO TO BOX OM1QQ1 - (OMQ2998 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:22:07 PM Wednesday, March 27, 2013
Page 275 of 341
OM26_IN
OM26_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1085
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 OM's added at OM26.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:22:08 PM Wednesday, March 27, 2013
Page 276 of 341
OM26_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ2785 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM26AA - OMSATHMO ( OMQ2790 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX OM1QQ1 - (OMQ2998 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:22:08 PM Wednesday, March 27, 2013
Page 277 of 341
OM26AA
OM26AA
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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
1090
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display the event date for the OM event currently being asked about.
Display name of the other medical expense item currently being
asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Question display:
Display the event date for the OM event currently being asked about.
Display name of the other medical expense item currently being
asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
6:22:09 PM Wednesday, March 27, 2013
Page 278 of 341
OM26AA
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
DATE: (DATE ON OM26)
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
Int. Instr I:
Question Text:
On (EVENT DATE), did [you/(SP)] buy or repair the (OTHER
MEDICAL EXPENSE ITEM) at [READ MANAGED CARE PLAN
NAME(S) BELOW] or through a service or discount offered through
[READ MANAGED CARE PLAN NAME(S) BELOW]?
[PROBE: This could include buying or repairing the (OTHER
MEDICAL EXPENSE ITEM) at a plan center; at a place or store that
honors [your/(SP’s)] plan card; or through a place or store that the
plan referred [you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
6:22:10 PM Wednesday, March 27, 2013
Page 279 of 341
OM26AA
Field1:
OMSATHMO
Cheshire Name:
( OMQ2790 )
EVNT.OMSATHMO
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 OM21 - (OMQ2800 )
English text: YES
No
BOX OM21 - (OMQ2800 )
English text: NO
Attribute
Route
Don't know
BOX OM21 - (OMQ2800 )
Refusal
BOX OM21 - (OMQ2800 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
46
SPHadMHMO
6:22:11 PM Wednesday, March 27, 2013
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
Page 280 of 341
OM26AA
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:22:11 PM Wednesday, March 27, 2013
Page 281 of 341
BOX OM21
BOX OM21
Page Order # :
1100
BOX INSTRUCTIONS
( OMQ2800 )
GO TO OM26_IN - NAVIGATOR ( OMQ2785 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:22:12 PM Wednesday, March 27, 2013
Page 282 of 341
OM26A
OM26A
Page Order # :
Design Screen Type:
Roster
Fields:
Field 1:
EVENT_OMOTHRREN
T
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
Yes
Yes
Roster Name:
Event Roster Begin Date
Roster Type:
Single Item Select
Roster Functions:
Add Item
Edit Item
Delete Item
Search Item
Yes
Yes
No
No
Grid Functions:
Add Line
Delete Line
No
No
1110
Display as ' Add a Date '
Display as ' Edit a Date '
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Question display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Multi Field display:
Roster/Grid Instructions:
Display all other medical expense items that have been reported in
the current round where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round), and
EVNT.EVNTTYPE = OM, and
EVNT.OMETYPE = 10/OtherMedicalExpense.
Display all loaded events as protected rows.
6:22:12 PM Wednesday, March 27, 2013
Page 283 of 341
OM26A
Display in order of entry.
Roster/Grid display:
COL #
HEADER
INSTRUCTIONS
1
Purchase or
Repair/Rental
If (EVNT.OTHRTYPE ^=
5/OstomySupplies and
EVNT.OTHRTYPE ^=
6/IncontinenceSupplies and
EVNT.OTHRTYPE ^= 7/Bandages),
display EVENT DATE in "Mon DD YYYY"
format.
Else do not display.
2
Rental Stop Date
If EVNT.RENTPROB = 2/Rent and
(EVNT.RENTSTIL = 2/No, DK, or RF)
and ((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
EVENT END DATE in "Mon DD YYYY"
format.
Else do not display.
3
Purchases
IF PMRO.GETNUM > 0, DK, or RF,
display number of purchases,
PMRO.GETNUM, on PMRO where
PMRO.PMROEVNT = this
EVNT.EVNTNUM and PMRO.PMRORND
= current round.
Else do not display.
4
Rentals
If EVNT.RENTPROB=2/Rent and
((EVNT.RENT2BUY ^=
2/PurchasedRentToBuy) or
(EVNT.RENT2BUY = EMPTY)), display
"R".
Else do not display.
5
Status
If EVNT.RENTSTIL = 1/Yes, display "RR".
Else if EVNT.RENT2BUY =
2/PurchasedRentToBuy, display "OW".
Else do not display.
6
OME Type
If EVNT.OTHRTYPE=91/Other, display
other specify text, EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
Int. Instr I:
ADD ONLY ONE DATE AT THIS ROSTER.
Question Text:
Please tell me the first date [since (REFERENCE DATE/SURVEY
REFERENCE DATE)/between (REFERENCE DATE/SURVEY
REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)] that [you/(SP)] rented the (OTHER
MEDICAL EXPENSE ITEM)
Int. Instr II:
6:22:12 PM Wednesday, March 27, 2013
Page 284 of 341
OM26A
INPUT FIELDS / ROUTING
Field1:
Cheshire Name:
EVENT_OMOTHRREN ( OMQ2810 )
T
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TEvntPick135
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
135
Route
OM26A1 - RENTSTIL ( OMQ2840 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTTYPE
EVNT.EVNTTYPE = OM.
OMETYPE
EVNT.OMETYPE = 10/OtherMedicalExpense.
OTHRTYPE
EVNT.ORTHTYPE = OM24 - OTHRTYPE response.
6:22:13 PM Wednesday, March 27, 2013
Page 285 of 341
OM26A
STOMTYPE
If OTHRTYPE =
1/Toilet, STOMTYPE=41/Toilet.
2/Tub, STOMTYPE=42/Tub.
3/Chair, STOMTYPE=43/Chair.
4/Bed, STOMTYPE=44/Bed.
8/PulmonaryEquipment,
STOMTYPE=48/PulmonaryEquipment.
91/Other, STOMTYPE=91/Other.
EVNTPROV
EVNT.EVNTPROV = 01.
RENTPROB
EVNT.RENTPROB = OM24A response.
EVOSTEXT
If OM24 - OTHRTYPE= 91/Other, set
EVNT.EVOSTEXT = OM24 - EVOSTEXT other
specify text.
EVNTQUES
If OM24 - OTHRTYPE = 91/Other, set
EVNT.EVNTQUES = 'OM24'.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #2
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing date entered on this roster. If date of event added does not
have missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
Both EVNTRNDC=current round.
OMETYPE matches.
OTHRTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF and
EVBEGMM matches.
6:22:13 PM Wednesday, March 27, 2013
Page 286 of 341
OM26A
EVBEGDD matches.
EVBEGYY matches.
RENTPROB matches, OR
1st Event RENTPROB = 1/Buy and 2nd Event RENTPROB = DK
or RF, OR
1st Event RENTPROB = DK or RF and 2nd Event RENTPROB =
1/Buy.
The date of the event added should not match any other date on
roster.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
6:22:13 PM Wednesday, March 27, 2013
Page 287 of 341
OM26A1
OM26A1
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
RENTSTIL
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
1120
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Question display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
6:22:14 PM Wednesday, March 27, 2013
Page 288 of 341
OM26A1
Int. Instr I:
[Are you/Is (SP)] still renting the (OTHER MEDICAL EXPENSE
ITEM)?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
RENTSTIL
Cheshire Name:
Item Text display:
( OMQ2840 )
EVNT.RENTSTIL
Do not display response option 3/EnteredInError.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRentstil
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1QQ - (OMQ2980 )
2
English text: YES
No
3
English text: NO
EnteredInError
OM26B - EVENDMM ( OMQ2880 )
DO NOT DISPLAY.
English text: EVENT ENTERED IN ERROR
Attribute
Route
Don't know
BOX OM1QQ1 - (OMQ2998 )
Refusal
BOX OM1QQ1 - (OMQ2998 )
BACKGROUND VARIABLE ASSIGNMENTS
RENTRECR
If OM26A1 - RENTSTIL = 1/Yes, set
EVNT.RENTRECR = current round.
RENTENDR
If OM26A1 - RENTSTIL ^= 1/Yes, set
EVNT.RENTENDR = current round.
6:22:15 PM Wednesday, March 27, 2013
Page 289 of 341
OM26A1
EVENDMM
If OM26A1 - RENTSTIL = DK, set EVNT.EVENDMM
= DK.
Else if OM26A1 - RENTSTIL = RF, set
EVNT.EVENDMM = RF.
EVENDDD
If OM26A1 - RENTSTIL = DK, set EVNT.EVENDDD
= DK.
Else if OM26A1 - RENTSTIL = RF, set
EVNT.EVENDDD = RF.
EVENDYY
If OM26A1 - RENTSTIL = DK, set EVNT.EVENDYY
= DK.
Else if OM26A1 - RENTSTIL = RF, set
EVNT.EVENDYY = RF.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:22:15 PM Wednesday, March 27, 2013
Page 290 of 341
OM26B
OM26B
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
EVENDMM
Field 2:
EVENDDD
Field 3:
EVENDYY
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:
1150
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Question display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Multi Field display:
Horizontal Alignment
Display all fields at one time.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
6:22:16 PM Wednesday, March 27, 2013
Page 291 of 341
OM26B
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
Context Header:
Int. Instr I:
What was the last date [you/(SP)] rented the (OTHER MEDICAL
EXPENSE ITEM)?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
EVENDMM
Field1:
Cheshire Name:
( OMQ2880 )
EVNT.EVENDMM
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthInt
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
OM26B - EVENDDD ( OMQ2890 )
Refusal
OM26B - EVENDDD ( OMQ2890 )
6:22:19 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
OM26B - EVENDDD ( OMQ2890 )
Page 292 of 341
OM26B
Field2:
EVENDDD
Cheshire Name:
( OMQ2890 )
EVNT.EVENDDD
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
OM26B - EVENDYY ( OMQ2900 )
Refusal
OM26B - EVENDYY ( OMQ2900 )
6:22:21 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
OM26B - EVENDYY ( OMQ2900 )
Page 293 of 341
OM26B
Field3:
EVENDYY
Cheshire Name:
( OMQ2900 )
EVNT.EVENDYY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TYear2DKRF
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Don't know
BOX OM22A - (OMQ2910 )
Refusal
BOX OM22A - (OMQ2910 )
FieldSize:
Min Value:
Max Value:
Mask:
2
00
99
Route
BOX OM22A - (OMQ2910 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #1:
Rental end date, EVENDMM/EVENDDD/EVENDYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVENDMM, EVENDDD, EVENDYY.
Edit #2
Rental end date, EVENDMM/EVENDDD/EVENDYY, must be on or
after the date the item was rented,
EVBEGMM/EVBEGDD/EVBEGYY.
If not true, display message, "INVALID DATE. DATE MUST BE ON
6:22:22 PM Wednesday, March 27, 2013
Page 294 of 341
OM26B
OR AFTER (EVENT DATE). PLEASE REENTER."
INVOLVES EVENDMM, EVENDDD, EVENDYY.
TECHNICAL NOTES
DESIGN NOTES
6:22:22 PM Wednesday, March 27, 2013
Page 295 of 341
BOX OM22A
BOX OM22A
Page Order # :
1160
BOX INSTRUCTIONS
( OMQ2910 )
IF SP IS NOT DECEASED, GO TO OM26BB - RENT2BUY ( OMQ2920 ).
ELSE GO TO BOX OM1QQ - (OMQ2980 ).
ASSIGNMENTS
TECHNICAL NOTES
59
SPStatus
SP is Alive and not institutionalized =
MRES.SPALIVE=1/Alive or empty
SP is Alive =
MRES.SPALIVE=1/Alive, 2/AliveAndInstitute, or EMPTY
SP is Institutionalized =
MRES.SPALIVE=2/AliveAndInstitute
SP is Deceased =
MRES.SPALIVE=3/Deceased.
DESIGN NOTES
6:22:22 PM Wednesday, March 27, 2013
Page 296 of 341
OM26BB
OM26BB
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
RENT2BUY
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
1170
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Question display:
Display name of the other medical expense item that is currently
being asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
If SP is the respondent, display "have".
Else display "has".
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
6:22:23 PM Wednesday, March 27, 2013
Page 297 of 341
OM26BB
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
Context Header:
Int. Instr I:
You said [you/(SP)] stopped renting the (OTHER MEDICAL
EXPENSE ITEM). Is this because (you/he/she) no longer (have/has)
the item or because (you/he/she) (have/has) purchased it through a
rent-to-buy option?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
RENT2BUY
Field1:
Cheshire Name:
( OMQ2920 )
EVNT.RENT2BUY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TRen2buy
1
No
No
Number Label
1 NoLongerHave
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM1QQ - (OMQ2980 )
2
English text: NO LONGER HAVE THE ITEM
PurchasedRentToBuy
3
English text: PURCHASED THROUGH RENT-TO-BUY
Other
OM26BBVB - REN2BVB ( OMQ2930 )
BOX OM1QQ - (OMQ2980 )
English text: OTHER
Attribute
Route
Don't know
BOX OM1QQ - (OMQ2980 )
Refusal
BOX OM1QQ - (OMQ2980 )
BACKGROUND VARIABLE ASSIGNMENTS
RBUYCOST
If OM26BB - RENT2BUY = 2/PurchasedRentToBuy
or 3/Other, set EVNT.RBUYCOST=1/StillCollectCost.
SOFT EDIT CHECKS
6:22:24 PM Wednesday, March 27, 2013
Page 298 of 341
OM26BB
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'.
DESIGN NOTES
6:22:24 PM Wednesday, March 27, 2013
Page 299 of 341
OM26BBVB
OM26BBVB
Page Order # :
Design Screen Type:
Verbatim Text
Fields:
Field 1:
REN2BVB
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
1180
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:
BRIEFLY EXPLAIN WHY SP STOPPED RENTING THE (OTHER
MEDICAL EXPENSE ITEM).
Question Text:
Int. Instr II:
RECORD VERBATIM.
INPUT FIELDS / ROUTING
6:22:25 PM Wednesday, March 27, 2013
Page 300 of 341
OM26BBVB
Field1:
Cheshire Name:
REN2BVB
( OMQ2930 )
NONE
REPLACES THE FOLLOWING CHESHIRE VARIABLES:
EVNT.REN2BVB1
EVNT.REN2BVB2
EVNT.REN2BVB3
EVNT.REN2BVB4
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Open
TOpen180
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
180
Route
BOX OM1QQ - (OMQ2980 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:22:25 PM Wednesday, March 27, 2013
Page 301 of 341
BOX OM1QQ
BOX OM1QQ
Page Order # :
1200
BOX INSTRUCTIONS
( OMQ2980 )
IF SP COVERED BY AN MEDICARE MANAGED CARE PLAN OR PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO TO
OM26C - OMSATHMO ( OMQ2990 ).
ELSE GO TO BOX OM1QQ1 - (OMQ2998 ).
ASSIGNMENTS
TECHNICAL NOTES
46
SPHadMHMO
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:22:25 PM Wednesday, March 27, 2013
Page 302 of 341
OM26C
OM26C
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMSATHMO
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:
Display name of the other medical expense item currently being
asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Question display:
Display name of the other medical expense item currently being
asked about.
Other Medical Expense Item =
If EVNT.OTHRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display all Medicare managed care plans and Private managed care
plans SP was covered by anytime during the current round.
Display managed care plan name(s) below question text.
Display plans in the following order: Medicare Managed Care plans,
Private Managed Care plans.
If there is more than one plan for any specific plan type, display in
order of entry.
6:22:26 PM Wednesday, March 27, 2013
Page 303 of 341
OM26C
Column 1, header = "MANAGED CARE PLANS".
Column 1, display = Health insurance plan name "(PLAN NAME)
Managed Care Plan".
TEXT:
Context Header:
OM ITEM: (OTHER MEDICAL EXPENSE ITEM)
Int. Instr I:
Question Text:
Did [you/(SP)] rent the (OTHER MEDICAL EXPENSE ITEM) at
[READ MANAGED CARE PLAN NAME(S) BELOW] or through a
service or discount offered through [READ MANAGED CARE PLAN
NAME(S) BELOW]?
[PROBE: This could include renting the (OTHER MEDICAL
EXPENSE ITEM) at a plan center; at a place or store that honors
[your/(SP’s)] plan card; or through a place or service that the plan
referred [you/(SP)] to.]
Int. Instr II:
INPUT FIELDS / ROUTING
6:22:27 PM Wednesday, March 27, 2013
Page 304 of 341
OM26C
Field1:
OMSATHMO
Cheshire Name:
Item Text display:
( OMQ2990 )
EVNT.OMSATHMO
EVNT.OMSATHMO may already be filled from the previous
round. Do not display previous round response. Current
round response to OMSATHMO will overwrite
EVNT.OMSATHMO.
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 OM1QQ1 - (OMQ2998 )
English text: YES
No
BOX OM1QQ1 - (OMQ2998 )
English text: NO
Attribute
Don't know
Route
BOX OM1QQ1 - (OMQ2998 )
Refusal
BOX OM1QQ1 - (OMQ2998 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
46
SPHadMHMO
6:22:28 PM Wednesday, March 27, 2013
SP was covered by Medicare Managed Care plan
(Medicare Advantage plan) anytime during current round
=
There is a PLAN where PLANTYPE=5/MHMO & PLRO
where (PLROPLAN=PLANNUM & PLRORND=current
round & COVANYTM=1/Yes).
Exclude Deleted Plans. See T.N. 52.
Page 305 of 341
OM26C
362
PrivHMOAnytime
SP covered by Private Managed Care Plan anytime
during current round =
There is a PLAN where PLANTYPE=4/PrivatePlan &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.PPRVHMO=1/Yes)).
Exclude Deleted Plans. See T.N. 52.
DESIGN NOTES
6:22:28 PM Wednesday, March 27, 2013
Page 306 of 341
BOX OM1QQ1
BOX OM1QQ1
Page Order # :
1215
BOX INSTRUCTIONS
( OMQ2998 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO BOX OM23 - (OMQ3000 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:22:28 PM Wednesday, March 27, 2013
Page 307 of 341
BOX OM23
BOX OM23
Page Order # :
1220
BOX INSTRUCTIONS
( OMQ3000 )
IF ASKING ABOUT A RENTAL ITEM FROM THE PREVIOUS ROUND, GO
TO OMS23_IN - NAVIGATOR ( OMQ2606 ).
ELSE GO TO OM27 - MOREOTHR ( OMQ3010 ).
ASSIGNMENTS
TECHNICAL NOTES
202
StillRentOthrItem
SP still renting an other medical equipment at the time of
the previous round interview =
There is an EVNT where EVNTTYPE ='OM' and
OMETYPE=10/OtherMedicalExpense and
EVNT.RENTSTIL = 1/Yes and EVNT.RENTRECR =
previous round and EVNT.EVNTDFLG ^= 1/Yes.
DESIGN NOTES
6:22:28 PM Wednesday, March 27, 2013
Page 308 of 341
OM27
OM27
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MOREOTHR
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:
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below question text.
Display all other medical expense items that have been reported in
the current round where:
EVNT.EVNTDFLG^=1/Yes, and
EVNT.EVNTTYPE = OM, and
EVNT.OMETYPE = 10/OtherMedicalExpense, and
(EVNT.EVNTRNDC = current round or EVNT.RENTRECR = current
round) or (EVNT.EVNTRNDC ^= current round and
EVNT.OTHRTYPE = 5/OstomySupplies, 6/IncontinenceSupplies, or
7/Bandages and there is a current round PMRO where
(PMRO.PMROEVNT=this EVNT.EVNTNUM and
PMRO.PMRORND=current round)).
If a specific other medical expense item was reported more than
once, only display the item once in report:
If EVNT.OTHRTYPE ^= 91/Other and EVNT.OTHRYPE matches
EVNT.OTHRTYPE on another EVNT already being displayed in
report, do not display.
6:22:29 PM Wednesday, March 27, 2013
Page 309 of 341
OM27
Column 1, display = Display name of other medical expense item.
If EVNT.OTHRTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
Else display EVNT.OTHRTYPE response.
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
Question Text:
In addition to the medical equipment you just told me about, did
[you/(SP)] buy, rent, or repair any other medical equipment [since
(REFERENCE DATE/SURVEY REFERENCE DATE)/between
(REFERENCE DATE/SURVEY REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]?
Int. Instr II:
INPUT FIELDS / ROUTING
6:22:30 PM Wednesday, March 27, 2013
Page 310 of 341
OM27
Field1:
MOREOTHR
Cheshire Name:
( OMQ3010 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM24 - OTHRTYPE ( OMQ2650 )
English text: YES
No
BOX OM24 - (OMQ3019 )
English text: NO
Attribute
Route
Don't know
BOX OM24 - (OMQ3019 )
Refusal
BOX OM24 - (OMQ3019 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:22:31 PM Wednesday, March 27, 2013
Page 311 of 341
BOX OM24
BOX OM24
Page Order # :
1240
BOX INSTRUCTIONS
( OMQ3019 )
IF SP HAD AT LEAST ONE ALTERATION THAT WAS NOT COMPLETE AT
THE TIME OF THE PREVIOUS ROUND INTERVIEW, GO TO OMS28INTR
ALTRINTRO ( OMQ3020 ).
ELSE GO TO OM28 - OMPRALTR ( OMQ3030 ).
ASSIGNMENTS
TECHNICAL NOTES
203
AlterationNotComplete
SP reported an alteration that was not complete at the
time of the previous round interview =
There is an EVNT where EVNTTYPE = 'OM' and
EVNT.OMETYPE = 7/Alteration and EVNT.OMSTATUS =
1/AlterationNotComplete and EVNT.EVNTDFLG ^=1/Yes.
DESIGN NOTES
6:22:31 PM Wednesday, March 27, 2013
Page 312 of 341
OMS28INTR
OMS28INTR
Page Order # :
Design Screen Type:
No Entry
Fields:
Field 1:
ALTRINTRO
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
1243
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:
REFERENCE DATE: (REFERENCE DATE)
Int. Instr I:
Question Text:
The next questions are about an alteration [you were/(SP) was]
making as of (REFERENCE DATE).
Int. Instr II:
INPUT FIELDS / ROUTING
6:22:32 PM Wednesday, March 27, 2013
Page 313 of 341
OMS28INTR
Field1:
ALTRINTRO
Cheshire Name:
( OMQ3020 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TContinueEMPTY
1
No
No
Number Label
1 Continue
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS28_IN - NAVIGATOR ( OMQ3021 )
English text: CONTINUE
Attribute
Route
Empty
OMS28_IN - NAVIGATOR ( OMQ3021 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:22:33 PM Wednesday, March 27, 2013
Page 314 of 341
OMS28_IN
OMS28_IN
Page Order # :
Design Screen Type:
Instance Navigator
Fields:
Field 1:
NAVIGATOR
Enable Functions:
HELP
COMMENTS
JUMPBACK
No
No
No
1244
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 all Alterations that were not complete at the time of the
previous round interview.
Invoke NO TRAVEL I/N.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
6:22:33 PM Wednesday, March 27, 2013
Page 315 of 341
OMS28_IN
Field1:
NAVIGATOR
Cheshire Name:
( OMQ3021 )
N/A
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TInstanceNavigator
1
No
No
Number Label
1 SelectItemInList
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OMS28 - EVBEGMM ( OMQ3022 )
English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
OM28 - OMPRALTR ( OMQ3030 )
English text: CONTINUE INTERVIEW SELECTED
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
203
AlterationNotComplete
SP reported an alteration that was not complete at the
time of the previous round interview =
There is an EVNT where EVNTTYPE = 'OM' and
EVNT.OMETYPE = 7/Alteration and EVNT.OMSTATUS =
1/AlterationNotComplete and EVNT.EVNTDFLG ^=1/Yes.
DESIGN NOTES
6:22:34 PM Wednesday, March 27, 2013
Page 316 of 341
OMS28
OMS28
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
EVBEGMM
Field 2:
EVBEGDD
Field 3:
EVBEGYY
Field 4:
OMNOTDONE
HELP
COMMENTS
JUMPBACK
No
No
No
Enable Functions:
1245
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:
Display the name of the Alteration currently being asked about.
Alteration =
If EVNT.ALTRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT. See technical note.
Else display EVNT.ALTRTYPE response.
Question display:
Display the name of the Alteration currently being asked about.
Alteration =
If EVNT.ALTRTYPE=91/Other, display other specify text,
EVNT.EVOSTEXT. See technical note.
Else display EVNT.ALTRTYPE response.
Multi Field display:
Vertical Alignment
Display all fields at one time.
Display date input fields, EVENDMM, EVENDDD, EVENDYY, on 1st
line.
Display radio button for "ALTERATION NOT YET COMPLETED",
OMS28 - OMNOTDONE, on 2nd line.
Roster/Grid Instructions:
Roster/Grid display:
6:22:35 PM Wednesday, March 27, 2013
Page 317 of 341
OMS28
Report display:
TEXT:
ALTERATION: (ALTERATION)
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Context Header:
Int. Instr I:
Last time [you/(SP)] had started to make an alteration
(ALTERATION) that was not completed as of (REFERENCE
DATE/SURVEY REFERENCE DATE).
Question Text:
On what date [since (REFERENCE DATE/SURVEY REFERENCE
DATE)/between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION)]
was this alteration completed?
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
EVBEGMM
Cheshire Name:
( OMQ3022 )
EVNT.EVBEGMM
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthIntEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Empty
Route
OMS28 - EVBEGDD ( OMQ3023 )
Don't know
OMS28 - EVBEGDD ( OMQ3023 )
Refusal
OMS28 - EVBEGDD ( OMQ3023 )
6:22:37 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
OMS28 - EVBEGDD ( OMQ3023 )
Page 318 of 341
OMS28
Field2:
EVBEGDD
Cheshire Name:
( OMQ3023 )
EVNT.EVBEGDD
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRFEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Empty
OMS28 - EVBEGYY ( OMQ3024 )
Don't know
OMS28 - EVBEGYY ( OMQ3024 )
Refusal
OMS28 - EVBEGYY ( OMQ3024 )
6:22:39 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
OMS28 - EVBEGYY ( OMQ3024 )
Page 319 of 341
OMS28
Field3:
EVBEGYY
Cheshire Name:
( OMQ3024 )
EVNT.EVBEGYY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TYear2DKRFEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Empty
OMS28 - OMNOTDONE ( OMQ3025 )
Don't know
OMS28 - OMNOTDONE ( OMQ3025 )
Refusal
OMS28 - OMNOTDONE ( OMQ3025 )
6:22:41 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
00
99
Route
OMS28 - OMNOTDONE ( OMQ3025 )
Page 320 of 341
OMS28
Field4:
OMNOTDONE
Cheshire Name:
( OMQ3025 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TOMNotDone
1
No
No
Number Label
1 AlterationNotComplete
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM25 - (OMQ3026 )
English text: ALTERATION NOT YET COMPLETED
Attribute
Route
Empty
BOX OM25 - (OMQ3026 )
BACKGROUND VARIABLE ASSIGNMENTS
Set status of Alteration as instructed below.
OMSTATUS
If date entered, set EVNT.OMSTATUS =
2/AlterationComplete.
EV95FLG
If date entered, set EVNT.EV95FLG = previous
round.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
Date of event, EVENDMM,/EVENDDD/EVENDYY, and
OMNOTDONE cannot both be EMPTY.
If not true, display message "PLEASE ENTER DATE OR SELECT
"ALTERATION NOT YET COMPLETED"."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY, OMNOTDONE.
Edit # 2
Date of event, EVENDMM,/EVENDDD/EVENDYY, and
OMNOTDONE cannot both be filled.
If not true, display message "PLEASE ENTER DATE OR SELECT
"ALTERATION NOT YET COMPLETED"."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY, OMNOTDONE.
6:22:43 PM Wednesday, March 27, 2013
Page 321 of 341
OMS28
Edit #3
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #4
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing alteration date. If date of event is entered and does not have
missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
OMETYPE matches.
ALTRTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF, EMPTY and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
The date of the event should not match any other Alteration event
date.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
217
EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in
SQL and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
DESIGN NOTES
6:22:43 PM Wednesday, March 27, 2013
Page 322 of 341
BOX OM25
BOX OM25
Page Order # :
1247
BOX INSTRUCTIONS
( OMQ3026 )
GO TO OMS28_IN - NAVIGATOR ( OMQ3021 ).
ASSIGNMENTS
TECHNICAL NOTES
203
AlterationNotComplete
SP reported an alteration that was not complete at the
time of the previous round interview =
There is an EVNT where EVNTTYPE = 'OM' and
EVNT.OMETYPE = 7/Alteration and EVNT.OMSTATUS =
1/AlterationNotComplete and EVNT.EVNTDFLG ^=1/Yes.
DESIGN NOTES
6:22:43 PM Wednesday, March 27, 2013
Page 323 of 341
OM28
OM28
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
OMPRALTR
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:
Always display "[Alterations include…]" in brackets.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
SHOW CARD OM5
Question Text:
[Since (REFERENCE DATE/SURVEY REFERENCE
DATE)/Between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)], did [you/(SP)] make any alterations or
modify the inside or outside of (your/his/her) home or car because of
some illness or injury? This card lists some examples.
[Alterations include ramps, handrails, elevator or incline chair, tub
seats, tub handrails, and any car alterations.]
6:22:43 PM Wednesday, March 27, 2013
Page 324 of 341
OM28
Int. Instr II:
INPUT FIELDS / ROUTING
OMPRALTR
Field1:
Cheshire Name:
Item Text display:
( OMQ3030 )
HRND.OMPRALTR
Do not display response option
3/IndicatedYesByDataEditing.
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TProbe
1
No
No
Number Label
1 Yes
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM29 - ALTRTYPE ( OMQ3040 )
2
English text: YES
No
3
English text: NO
IndicatedYesByDataPrep
BOX OM26 - (OMQ3105 )
DO NOT DISPLAY.
English text: INDICATED YES BY DATAPREP
Attribute
Don't know
Route
BOX OM26 - (OMQ3105 )
Refusal
BOX OM26 - (OMQ3105 )
BACKGROUND VARIABLE ASSIGNMENTS
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
6:22:45 PM Wednesday, March 27, 2013
Page 325 of 341
OM28
DESIGN NOTES
6:22:45 PM Wednesday, March 27, 2013
Page 326 of 341
OM29
OM29
Page Order # :
Design Screen Type:
Code 1
Fields:
Field 1:
ALTRTYPE
Field 2:
EVOSTEXT
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:
1260
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
Int. Instr I:
Question Text:
What was the alteration?
Int. Instr II:
INPUT FIELDS / ROUTING
6:22:46 PM Wednesday, March 27, 2013
Page 327 of 341
OM29
Field1:
ALTRTYPE
Cheshire Name:
( OMQ3040 )
EVNT.ALTRTYPE
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TAltrtype
1
No
No
Number Label
1 Elevator
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM30 - EVBEGMM ( OMQ3070 )
2
English text: ELEVATOR OR INCLINE CHAIR
HandrailsNotTub
OM30 - EVBEGMM ( OMQ3070 )
3
English text: HANDRAILS (OTHER THAN TUB)
Ramps
OM30 - EVBEGMM ( OMQ3070 )
4
English text: RAMPS
TubHandrails
OM30 - EVBEGMM ( OMQ3070 )
5
English text: TUB HANDRAILS
TubSeat
OM30 - EVBEGMM ( OMQ3070 )
6
English text: TUB SEAT
CarAlteration
OM30 - EVBEGMM ( OMQ3070 )
English text: ANY CAR ALTERATION
Other
OM29 - EVOSTEXT ( OMQ3050 )
91
English text: OTHER
6:22:48 PM Wednesday, March 27, 2013
Page 328 of 341
OM29
Field2:
Cheshire Name:
EVOSTEXT
( OMQ3050 )
EVOS.EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in SQL
and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
Item Text display:
Display (SPECIFY) in same blue font used for interviewer
instructions.
Item Text:
OTHER (SPECIFY)
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
String
TOthrspec
1
No
No
Number Label
1 [Continuous answer.]
FieldSize:
Min Value:
Max Value:
Mask:
30
Route
OM30 - EVBEGMM ( OMQ3070 )
BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of OM event selected.
For Event(s) added, see EVENT ROSTER BEGIN DATE POP-UP specifications for pop-up
window programming instructions.
Variables populated in Event Roster Begin Date:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVBEGMM
EVNT.EVBEGDD
EVNT.EVBEGYY
BASE.LASTEVNT
Event number
Round
Event Month
Event Day
Event Year
Highest EVNT.EVNTNUM.
For each event added, set additional EVNT fields as instructed below.
EVNTNUM
Set new EVNT.EVNTNUM = BASE.LASTEVNT +
001. This assumes that BASE.LASTEVNT is
incremented each time an EVNT record is generated
in the field.
LASTEVNT
Once new EVNT record is generated, set
BASE.LASTEVNT = new EVNT.EVNTNUM.
6:22:48 PM Wednesday, March 27, 2013
Page 329 of 341
OM29
EVNTRNDC
EVNT.EVNTRNDC = current round.
EVNTTYPE
EVNT.EVNTYPE = 'OM'.
OMETYPE
EVNT.OMETYPE = 7/Alteration.
ALTRTYPE
EVNT.ALTRTYPE = OM29 - ALTRTYPE response.
STOMTYPE
If ALTRTYPE =
1/Elevator, STOMTYPE = 31/Elevator.
2/HandrailsNotTub,
STOMTYPE=32/HandrailsNotTub.
3/Ramps, STOMTYPE=33/Ramps.
4/TubHandrails, STOMTYPE=34/TubH...
5/TubSeat, STOMTYPE=35/TubS..
6/CarAlteration, STOMTYPE=36/Ca..
91/Other, STOMTYPE=91.
EVNTPROV
EVNT.EVNTPROV = 01.
EVNTQUES
If OM29 - ALTRTYPE = 91/Other, set
EVNT.EVNTQUES = 'OM29'.
EVOSTEXT
If OM29 - ALTRTYPE = 91/Other, set
EVNT.EVOSTEXT = OM29 - EVOSTEXT other
specify text.
EVCHGFLG
If currently administering ST or NS, set
EVNT.EVCHGFLG = 1/Yes.
EVORPFLG
If currently administering ST or NS, and if OM Event
date added is outside the Survey Reference Period,
set EVNT.EVORPFLG = 1/ORP. See General
Specifications for setting this ORP flag.
EVCHGLOC
If adding an EVNT and if currently administering ST,
set EVNT.EVCHGLOC = 'ST';
Else if adding an EVNT and currently administering
NS, set EVNT.EVCHGLOC = 'NS'.
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
217
EVOSTEXT
EVOSTEXT and EVNTQUES are stored on tblEVNT in
SQL and then transformed to EVOS in Cheshire:
EVOS.EVOSNUM = unique sequential #
EVOS.EVOSRNDC = current round
EVOS.EVOSTEXT = EVNT.EVOSTEXT
EVOS.EVNTQUES = EVNT.EVNTQUES
DESIGN NOTES
Called from ST36 and NS36 if OM needs to be added to charge bundle in
ST and/or NS.
6:22:49 PM Wednesday, March 27, 2013
Page 330 of 341
OM30
OM30
Page Order # :
Design Screen Type:
Date
Fields:
Field 1:
EVBEGMM
Field 2:
EVBEGDD
Field 3:
EVBEGYY
Field 4:
OMNOTDONE
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:
1270
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Multi Field display:
Vertical Alignment
Display all fields at one time.
Display date input fields, EVENDMM, EVENDDD, EVENDYY, on 1st
line.
Display radio button for "ALTERATION NOT YET COMPLETED",
OMNOTDONE, on 2nd line.
Roster/Grid Instructions:
Roster/Grid display:
Report display:
TEXT:
Context Header:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Int. Instr I:
6:22:50 PM Wednesday, March 27, 2013
Page 331 of 341
OM30
On what date [since (REFERENCE DATE/SURVEY REFERENCE
DATE)/between (REFERENCE DATE/SURVEY REFERENCE
DATE) and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION)]
was this alteration completed?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
Field1:
EVBEGMM
Cheshire Name:
( OMQ3070 )
EVNT.EVBEGMM
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TMonthIntEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Empty
OM30 - EVBEGDD ( OMQ3080 )
Don't know
OM30 - EVBEGDD ( OMQ3080 )
Refusal
OM30 - EVBEGDD ( OMQ3080 )
6:22:52 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
01
12
Route
OM30 - EVBEGDD ( OMQ3080 )
Page 332 of 341
OM30
Field2:
EVBEGDD
Cheshire Name:
( OMQ3080 )
EVNT.EVBEGDD
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TDayDKRFEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Empty
OM30 - EVBEGYY ( OMQ3090 )
Don't know
OM30 - EVBEGYY ( OMQ3090 )
Refusal
OM30 - EVBEGYY ( OMQ3090 )
6:22:54 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
1
31
Route
OM30 - EVBEGYY ( OMQ3090 )
Page 333 of 341
OM30
Field3:
EVBEGYY
Cheshire Name:
( OMQ3090 )
EVNT.EVBEGYY
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Integer
TYear2DKRFEmpty
1
No
No
Number Label
1 [Continuous answer.]
Attribute
Route
Empty
OM30 - OMNOTDONE ( OMQ3092 )
Don't know
OM30 - OMNOTDONE ( OMQ3092 )
Refusal
OM30 - OMNOTDONE ( OMQ3092 )
6:22:57 PM Wednesday, March 27, 2013
FieldSize:
Min Value:
Max Value:
Mask:
2
00
99
Route
OM30 - OMNOTDONE ( OMQ3092 )
Page 334 of 341
OM30
Field4:
OMNOTDONE
Cheshire Name:
( OMQ3092 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TOMNotDone
1
No
No
Number Label
1 AlterationNotComplete
FieldSize:
Min Value:
Max Value:
Mask:
Route
BOX OM25A - (OMQ3098 )
English text: ALTERATION NOT YET COMPLETED
Attribute
Route
Empty
BOX OM25A - (OMQ3098 )
BACKGROUND VARIABLE ASSIGNMENTS
Set status of Alteration as instructed below.
OMSTATUS
If OM30 - OMNOTDONE = 1/AlterationNotComplete,
set EVNT.OMSTATUS = 1/AlterationNotComplete.
Else if date entered, set EVNT.OMSTATUS =
2/AlterationComplete.
SOFT EDIT CHECKS
HARD EDIT CHECKS
Edit #1
Date of event, EVENDMM,/EVENDDD/EVENDYY, and
OMNOTDONE cannot both be EMPTY.
If not true, display message "PLEASE ENTER DATE OR SELECT
"ALTERATION NOT YET COMPLETED"."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY, OMNOTDONE.
Edit # 2
Date of event, EVENDMM/EVENDDD/EVENDYY, and
OMNOTDONE cannot both be filled.
If not true, display message "PLEASE ENTER DATE OR SELECT
"ALTERATION NOT YET COMPLETED"."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY, OMNOTDONE.
6:22:58 PM Wednesday, March 27, 2013
Page 335 of 341
OM30
Edit #3
If administering OM section in the current round utilization series (i.e.
OM not being asked from ST or NS), then execute Edit #3:
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, must be on or
between (REFERENCE DATE) and (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION).
If not true, display message "INVALID DATE. DATE MUST BE ON
OR BETWEEN (REFERENCE DATE) AND (TODAY/DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)".
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
Edit #4
Date of event, EVBEGMM/EVBEGDD/EVBEGYY, cannot match an
existing alteration date. If date of event is entered and does not have
missing data, EVBEGMM, EVBEGDD, EVBEGYY ^= DK and
EVBEGMM, EVBEGDD, EVBEGYY ^= RF, then check this date
against other event dates for duplicate dates.
The following must be true for the event added to be a duplicate of
an existing event:
Both EVNTDFLG ^= 1/Yes.
OMETYPE matches.
ALTRTYPE matches.
EVBEGMM, EVBEGDD, and EVBEGYY ^= DK, RF, EMPTY and
EVBEGMM matches.
EVBEGDD matches.
EVBEGYY matches.
The date of the event should not match any other Alteration event
date.
If not true, display message "THIS DATE HAS ALREADY BEEN
ENTERED. PLEASE VERIFY YOUR RESPONSE AND REENTER."
INVOLVES EVBEGMM, EVBEGDD, EVBEGYY.
TECHNICAL NOTES
DESIGN NOTES
When OM Alterations are added in ST or NS and ST routes to OM30, once
a date is entered at OM30, the program first displays a NO ENTRY screen
before returning to ST/NS. The screen reads "PRESS ENTER TO
CONTINUE".
6:22:58 PM Wednesday, March 27, 2013
Page 336 of 341
BOX OM25A
BOX OM25A
Page Order # :
1275
BOX INSTRUCTIONS
( OMQ3098 )
IF ADMINISTERING ST, GO TO BOX ST36 - (STQ1810 ).
ELSE IF ADMINISTERING NS, GO TO BOX NS36 - (NSQ1810 ).
ELSE GO TO OM31 - MOREALTR ( OMQ3100 ).
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
If administering ST or NS, return to BOX ST36 or BOX NS36.
6:22:58 PM Wednesday, March 27, 2013
Page 337 of 341
OM31
OM31
Page Order # :
Design Screen Type:
Yes/No
Fields:
Field 1:
MOREALTR
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
1280
Roster Name:
Roster Type:
DISPLAY INSTRUCTIONS:
Context header display:
Question display:
Always display "(s)" in parenthesis.
Multi Field display:
Roster/Grid Instructions:
Roster/Grid display:
Report display:
Display report below question text.
Display all alterations that have been reported in the current round
where:
EVNT.EVNTDFLG^=1/Yes, and
(EVNT.EVNTRNDC = current round or EVNT.OMSTATUS =
1/AlterationNotComplete), and
EVNT.EVNTTYPE = OM, and
EVNT.OMETYPE = 7/Alteration.
If a specific Alteration item was reported more than once, only
display the item once in report:
If EVNT.ALTRTYPE ^= 91/Other and EVNT.ALTRTYPE matches
EVNT.ALTRTYPE on another EVNT already being displayed in
report, do not display.
Column 1, display = Display name of alteration.
If EVNT.ALTRTYPE= 91/Other, display other specify text,
EVNT.EVOSTEXT.
6:22:58 PM Wednesday, March 27, 2013
Page 338 of 341
OM31
Else display EVNT.ALTRTYPE response.
TEXT:
REFERENCE DATE: (REFERENCE DATE/SURVEY REFERENCE
DATE)
Context Header:
Int. Instr I:
In addition to the alteration(s) you just told me about, did [you/(SP)]
make any other alterations because of some illness or injury [since
(REFERENCE DATE/SURVEY REFERENCE DATE)/between
(REFERENCE DATE/SURVEY REFERENCE DATE) and (DATE OF
DEATH/DATE OF INSTITUTIONALIZATION)]?
Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING
MOREALTR
Field1:
Cheshire Name:
( OMQ3100 )
TEMP
Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:
Enumerated
TYesNoDKRF
1
No
No
Number Label
1 Yes
2
FieldSize:
Min Value:
Max Value:
Mask:
Route
OM29 - ALTRTYPE ( OMQ3040 )
English text: YES
No
BOX OM26 - (OMQ3105 )
English text: NO
Attribute
Don't know
Route
BOX OM26 - (OMQ3105 )
Refusal
BOX OM26 - (OMQ3105 )
BACKGROUND VARIABLE ASSIGNMENTS
6:23:00 PM Wednesday, March 27, 2013
Page 339 of 341
OM31
SOFT EDIT CHECKS
HARD EDIT CHECKS
TECHNICAL NOTES
DESIGN NOTES
6:23:00 PM Wednesday, March 27, 2013
Page 340 of 341
BOX OM26
BOX OM26
Page Order # :
1290
BOX INSTRUCTIONS
( OMQ3105 )
GO TO NEXT SECTION .
ASSIGNMENTS
TECHNICAL NOTES
DESIGN NOTES
6:23:00 PM Wednesday, March 27, 2013
Page 341 of 341
| File Type | application/pdf |
| File Title | OM_09.01.0000.pdf |
| Subject | OM_09.01.0000.pdf |
| Author | CMS |
| File Modified | 2013-07-01 |
| File Created | 2013-03-27 |