CMS-P0015A English Section by Section

PMINTROA

PMINTROA

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PMINTA

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

10

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP reported PM purchases in the previous round, display 1st
sentence "Now let’s talk …."
Else do not display.
If SP reported PM's in the current round utilization, display 2nd

sentence "While talking about medical visits..."

Else do not display.

If (SP did not report PM purchases in the previous round) and (SP

did not report PM's in the current round utilization), display 3rd

sentence "Now I’d like to talk about..."

Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

If SP reported PM's in the current round utilization, display the
following report.
Display report below question text.

Column 1, header = Medicine Name

Column, 1, display = Display the name and strength of the medicine,

EVNT.PMEDNAME + ' ' + EVNT.PMSTRUNI.

11:34:58 AM Tuesday, May 21, 2013

Page 1 of 139

PMINTROA
TEXT:
REFERENCE DATE: (REFERENCE DATE)

Context Header:
Int. Instr I:

[Now let’s talk about prescribed medicines [you have/(SP) has]
obtained since (REFERENCE DATE).]

Question Text:

(While talking about medical visits, you mentioned some
medicine(s): [READ MEDICINE NAME(S) BELOW.])
(Now I’d like to talk about prescribed medicines.)
Int. Instr II:
INPUT FIELDS / ROUTING
PMINTA

Field1:
Cheshire Name:

( PMQ1010 )

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
PM1 - PMFILLED ( PMQ1020 )

English text: CONTINUE
Attribute

Route

Empty

PM1 - PMFILLED ( PMQ1020 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

11:34:59 AM Tuesday, May 21, 2013

Page 2 of 139

PMINTROA

TECHNICAL NOTES
176

PMPrevRnd

SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.

177

PMCurrentUtilization

SP reported PMs in the current round utilization =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round & PMRO.PMROTYPE
= 'PM' and PMRO.PMRODFLG ^= 1/Yes).
Medicine Name = EVNT.PMEDNAME.

DESIGN NOTES

11:34:59 AM Tuesday, May 21, 2013

Page 3 of 139

PM1

PM1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PMFILLED

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

20

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If only one PM reported during the current round utilization, display

"Besides that medicine, ".

Else if more than one PM reported during the current round

utilization, display "Besides those medicines, "

Else do not display.

If one or more PM's reported during the current round utilization,

display "[since (REFERENCE DATE)/between (REFERENCE

DATE) and (DATE OF DEATH/DATE OF

INSTITUTIONALIZATION)]".

Else display "[Since (REFERENCE DATE)/Between (REFERENCE

DATE) and (DATE OF DEATH/DATE OF

INSTITUTIONALIZATION)]".

If one or more PM's reported during the current round utilization,

display "other".

Else do not display.

If SP is the respondent, display "have you had".

Else if SP is alive and not institutionalized, display "has (SP) had".

Else display "did (SP) have".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
11:35:00 AM Tuesday, May 21, 2013

Page 4 of 139

PM1
Report display:

TEXT:
REFERENCE DATE: (REFERENCE DATE)

Context Header:
Int. Instr I:

[Besides that medicine, /Besides those medicines, ] [(Since/since)
(REFERENCE DATE)/(Between/between) (REFERENCE DATE)
and (DATE OF DEATH/DATE OF INSTITUTIONALIZATION)] [have
you had/has (SP) had/did (SP) have] any (other) prescriptions filled?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING
PMFILLED

Field1:
Cheshire Name:
Item Text display:

( PMQ1020 )

HRND.PMFILLED

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
BOX PMA1 - (PMQ1030 )

2

English text: YES
No

3

English text: NO
IndicatedYesByDataPrep

PM3 - PMREFILL ( PMQ1070 )

DO NOT DISPLAY.
DATA EDITING ONLY.
English text: INDICATED YES BY DATAPREP
Attribute

Route

Don't know

PM3 - PMREFILL ( PMQ1070 )

Refusal

PM3 - PMREFILL ( PMQ1070 )

11:35:01 AM Tuesday, May 21, 2013

Page 5 of 139

PM1
BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
177

PMCurrentUtilization

SP reported PMs in the current round utilization =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round & PMRO.PMROTYPE
= 'PM' and PMRO.PMRODFLG ^= 1/Yes).
Medicine Name = EVNT.PMEDNAME.

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

11:35:01 AM Tuesday, May 21, 2013

Page 6 of 139

BOX PMA1

BOX PMA1

Page Order # :

30

BOX INSTRUCTIONS
( PMQ1030 )

IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN
ASKED IN THE CURRENT ROUND, GO TO PM1A - PM1PMMEDS (
PMQ1040 ).
ELSE GO TO PM2 - MEDICINE_PM1 ( PMQ1050 ).

ASSIGNMENTS

TECHNICAL NOTES
131

PMBottleProbe

Prescription Medicine Bottle probe has been asked in the
current round =
GETPMMEDS=1/Yes.

DESIGN NOTES
Only probe for prescription medicine bottles once during the current
round.
Adding a new TEMP flag, GETPMMEDS. GETPMMEDS is set to 1/Yes
whenever the Prescription Bottle probe is asked during the current
round. This will get set anywhere in utilization or cost series.

11:35:01 AM Tuesday, May 21, 2013

Page 7 of 139

PM1A

PM1A

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PM1PMMEDS

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

40

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

If SP has a "current" Medicare Prescription Drug plan or there was
a Medicare Prescription Drug plan "current" at the time of the
previous round interview, then display "MPDP: (MEDICARE
PRESCRIPTION DRUG PLAN NAME)".
Else do not display.
MEDICARE PRESCRIPTION DRUG PLAN NAME:

Display the name of the "current" Medicare Prescription Drug plan.

If it does not exist, display the name of the Medicare Prescription

Drug plan "current" at the time of the previous round interview.

Question display:

Always display "(s)" in "bottle(s), container(s), or bag(s)" in
parenthesis.
If SP has a "current" Medicare Prescription Drug plan or there was

a Medicare Prescription Drug plan "current" at the time of the

previous round interview, then display "Also, please take out

[your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN NAME)

medicine statements....".

Else do not display.

MEDICARE PRESCRIPTION DRUG PLAN NAME =

Display the name of the "current" Medicare Prescription Drug plan.

If it does not exist, display the name of the Medicare Prescription

Drug plan "current" at the time of the previous round interview.

Multi Field display:

Roster/Grid Instructions:
11:35:02 AM Tuesday, May 21, 2013

Page 8 of 139

PM1A
Roster/Grid display:
Report display:

TEXT:
[MPDP: (MEDICARE PRESCRIPTION DRUG PLAN NAME)]

Context Header:
Int. Instr I:

It would be helpful if I could look at any medicine bottle(s),
container(s), or bag(s) that you have so that I can spell the medicine
name correctly and enter the strength of the medicine. [Also, please
take out [your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN
NAME) medicine statements, which should have that same
information on them.]

Question Text:

[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that same
information for all of the medicines [you/(SP)] obtained since the last
interview, if you’d like to get those bottles, too.
Int. Instr II:
INPUT FIELDS / ROUTING
PM1PMMEDS

Field1:
Cheshire Name:

( PMQ1040 )

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
PM2 - MEDICINE_PM1 ( PMQ1050 )

English text: CONTINUE
Attribute

Route

Empty

PM2 - MEDICINE_PM1 ( PMQ1050 )

BACKGROUND VARIABLE ASSIGNMENTS
The question displayed at PM1A is repeated in other utilization sections. Only show this
11:35:03 AM Tuesday, May 21, 2013

Page 9 of 139

PM1A
probe for prescription medicine bottles once during the current round interview.

If PM1A is asked, set flag as instructed below:

GETPMMEDS

Set GETPMMEDS=1/Yes.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.

Exclude plans stopped in HIS. See T.N. 476.

476

HISStoppedPlans

Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.

DESIGN NOTES

11:35:03 AM Tuesday, May 21, 2013

Page 10 of 139

PM2

PM2

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

MEDICINE_PM1

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Prescription Medicine Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

50

Display as ' Add a Medicine '
Display as ' Edit a Medicine '

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Display all Prescription Medicine events where:
EVNT.EVNTDFLG ^=1/Yes, and
EVNT.EVNTTYPE='PM'.
Display in alphabetical order.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

Medicine

Display prescription medicine name,
EVNT.PMEDNAME.

2

Strength

Display prescription medicine strength
text field, EVNT.PMSTRUNI.

Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:
11:35:03 AM Tuesday, May 21, 2013

What is the name of the medicine?

Page 11 of 139

PM2
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.

Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

MEDICINE_PM1

( PMQ1050 )

TEMP

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

String

TEvntPick200

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

200

Route
PM3 - PMREFILL ( PMQ1070 )

BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected.
If Prescription Medicine added at Prescription Medicine Roster, see PRESCRIPTION
MEDICINE ROSTER POP-UP specifications for pop-up window programming instructions.
Variables populated at the Prescription Medicine Roster:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVNTTYPE
EVNT.PMEDNAME
EVNT.PMSTRUNI
EVNT.EVNTPROV
BASE.LASTEVNT

Event number
Round number
PM
Prescription Medicine name
Prescription Medicine strength text field
02
Highest EVNT.EVNTNUM

For all Prescription Medicines selected, create a current round PMRO. Note: a current
round PMRO may already exist for a Prescription Medicine event if it has already been
selected earlier in the interview.
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND.
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND
11:35:03 AM Tuesday, May 21, 2013

Page 12 of 139

PM2
PMRO.PMROEVNT = EVNT.EVNTNUM of PM event selected.
PMRO.PMRORND = current round.
Set variables as specified below.
PMROEVNT

PMRO.PMROEVNT = EVNT.EVNTNUM of
prescription medicine selected.

PMRORND

PMRO.PMRORND = current round.

PMROTYPE

PMRO.PMROTYPE = PM.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

11:35:03 AM Tuesday, May 21, 2013

Page 13 of 139

PM3

PM3

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PMREFILL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

60

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP reported one or more PM's in the current round utilization,
display "In addition to what you've told be about, did".
Else display "Did".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

REFERENCE DATE: (REFERENCE DATE)

Int. Instr I:
Question Text:

People sometimes forget to mention refills of earlier prescriptions.
(In addition to what you’ve told me about, did/Did) [you/(SP)] have
any prescriptions refilled [since (REFERENCE DATE)/between
(REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)]?

Int. Instr II:

11:35:04 AM Tuesday, May 21, 2013

Page 14 of 139

PM3
INPUT FIELDS / ROUTING
( PMQ1070 )

PMREFILL

Field1:
Cheshire Name:

HRND.PMREFILL

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 PMA2 - (PMQ1080 )

English text: YES
No

PM5 - PMDRPHON ( PMQ1110 )

English text: NO
Attribute
Don't know

Route
PM5 - PMDRPHON ( PMQ1110 )

Refusal

PM5 - PMDRPHON ( PMQ1110 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
177

PMCurrentUtilization

SP reported PMs in the current round utilization =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round & PMRO.PMROTYPE
= 'PM' and PMRO.PMRODFLG ^= 1/Yes).
Medicine Name = EVNT.PMEDNAME.

DESIGN NOTES

11:35:05 AM Tuesday, May 21, 2013

Page 15 of 139

BOX PMA2

BOX PMA2

70

Page Order # :

BOX INSTRUCTIONS
( PMQ1080 )

IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN
ASKED IN THE CURRENT ROUND, GO TO PM3A - PM2PMMEDS (
PMQ1090 ).
ELSE GO TO PM4 - MEDICINE_PM2 ( PMQ1100 ).

ASSIGNMENTS

TECHNICAL NOTES
131

PMBottleProbe

Prescription Medicine Bottle probe has been asked in the
current round =
GETPMMEDS=1/Yes.

DESIGN NOTES
Only probe for prescription medicine bottles once during the current
round.
Adding a new TEMP flag, GETPMMEDS. GETPMMEDS is set to 1/Yes
whenever the Prescription Bottle probe is asked during the current
round. This will get set anywhere in utilization or cost series.

11:35:05 AM Tuesday, May 21, 2013

Page 16 of 139

PM3A

PM3A

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PM2PMMEDS

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

80

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

If SP has a "current" Medicare Prescription Drug plan or there was
a Medicare Prescription Drug plan "current" at the time of the
previous round interview, then display "MPDP: (MEDICARE
PRESCRIPTION DRUG PLAN NAME)".
Else do not display.
MEDICARE PRESCRIPTION DRUG PLAN NAME =

Display the name of the "current" Medicare Prescription Drug plan.

If it does not exist, display the name of the Medicare Prescription

Drug plan "current" at the time of the previous round interview.

Question display:

Always display "(s)" in "bottle(s), container(s), or bag(s)" in
parenthesis.
If SP has a "current" Medicare Prescription Drug plan or there was

a Medicare Prescription Drug plan "current" at the time of the

previous round interview, then display "Also, please take out

[your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN NAME)

medicine statements....".

Else do not display.

MEDICARE PRESCRIPTION DRUG PLAN NAME =

Display the name of the "current" Medicare Prescription Drug plan.

If it does not exist, display the name of the Medicare Prescription

Drug plan "current" at the time of the previous round interview.

Multi Field display:

Roster/Grid Instructions:
11:35:06 AM Tuesday, May 21, 2013

Page 17 of 139

PM3A
Roster/Grid display:
Report display:

TEXT:
[MPDP: (MEDICARE PRESCRIPTION DRUG PLAN NAME)]

Context Header:
Int. Instr I:

It would be helpful if I could look at any medicine bottle(s),
container(s), or bag(s) that you have so that I can spell the medicine
name correctly and enter the strength of the medicine. [Also, please
take out [your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN
NAME) medicine statements, which should have that same
information on them.]

Question Text:

[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that same
information for all of the medicines [you/(SP)] obtained since the last
interview, if you’d like to get those bottles, too.
Int. Instr II:
INPUT FIELDS / ROUTING
PM2PMMEDS

Field1:
Cheshire Name:

( PMQ1090 )

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
PM4 - MEDICINE_PM2 ( PMQ1100 )

English text: CONTINUE
Attribute

Route

Empty

PM4 - MEDICINE_PM2 ( PMQ1100 )

BACKGROUND VARIABLE ASSIGNMENTS
The question displayed at PM1A is repeated in other utilization sections. Only show this
11:35:07 AM Tuesday, May 21, 2013

Page 18 of 139

PM3A
probe for prescription medicine bottles once during the current round interview.

If PM3A is asked, set flag as instructed below:

GETPMMEDS

Set GETPMMEDS=1/Yes.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.

Exclude plans stopped in HIS. See T.N. 476.

476

HISStoppedPlans

Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.

DESIGN NOTES

11:35:07 AM Tuesday, May 21, 2013

Page 19 of 139

PM4

PM4

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

MEDICINE_PM2

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Prescription Medicine Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

90

Display as ' Add a Medicine '
Display as ' Edit a Medicine '

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Display all Prescription Medicine events where:
EVNT.EVNTDFLG ^=1/Yes, and
EVNT.EVNTTYPE='PM'.
Display in alphabetical order.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

Medicine

Display prescription medicine name,
EVNT.PMEDNAME.

2

Strength

Display prescription medicine strength
text field, EVNT.PMSTRUNI.

Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:
11:35:07 AM Tuesday, May 21, 2013

What is the name of the medicine?

Page 20 of 139

PM4
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.

Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

MEDICINE_PM2

( PMQ1100 )

TEMP

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

String

TEvntPick200

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

200

Route
PM5 - PMDRPHON ( PMQ1110 )

BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected.
If Prescription Medicine added at Prescription Medicine Roster, see PRESCRIPTION
MEDICINE ROSTER POP-UP specifications for pop-up window programming instructions.
Variables populated at the Prescription Medicine Roster:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVNTTYPE
EVNT.PMEDNAME
EVNT.PMSTRUNI
EVNT.EVNTPROV
BASE.LASTEVNT

Event number
Round number
PM
Prescription Medicine name
Prescription Medicine strength text field
02
Highest EVNT.EVNTNUM

For all Prescription Medicines selected, create a current round PMRO. Note: a current
round PMRO may already exist for a Prescription Medicine event if it has already been
selected earlier in the interview.
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND.
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND
11:35:08 AM Tuesday, May 21, 2013

Page 21 of 139

PM4
PMRO.PMROEVNT = EVNT.EVNTNUM of PM event selected.
PMRO.PMRORND = current round.
Set variables as specified below.
PMROEVNT

PMRO.PMROEVNT = EVNT.EVNTNUM of
prescription medicine selected.

PMRORND

PMRO.PMRORND = current round.

PMROTYPE

PMRO.PMROTYPE = PM.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

11:35:08 AM Tuesday, May 21, 2013

Page 22 of 139

PM5

PM5

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PMDRPHON

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

100

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP reported one or more PM's in the current round utilization,
display "In addition to what you've told be about, did".
Else display "Did".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

REFERENCE DATE: (REFERENCE DATE)

Int. Instr I:
Question Text:

People sometimes forget to mention prescriptions that were phoned
in by a doctor. (In addition to what you’ve told me about, did/Did)
[you/(SP)] get any medicine prescribed by a doctor in a telephone
call to a drugstore or pharmacy [since (REFERENCE
DATE)/between (REFERENCE DATE) and (DATE OF DEATH/DATE
OF INSTITUTIONALIZATION)]?

Int. Instr II:

11:35:08 AM Tuesday, May 21, 2013

Page 23 of 139

PM5
INPUT FIELDS / ROUTING
PMDRPHON

Field1:
Cheshire Name:

( PMQ1110 )

HRND.PMDRPHON

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 PMA3 - (PMQ1120 )

English text: YES
No

BOX PM1 - (PMQ1150 )

English text: NO
Attribute
Don't know

Route
BOX PM1 - (PMQ1150 )

Refusal

BOX PM1 - (PMQ1150 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
177

PMCurrentUtilization

SP reported PMs in the current round utilization =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round & PMRO.PMROTYPE
= 'PM' and PMRO.PMRODFLG ^= 1/Yes).
Medicine Name = EVNT.PMEDNAME.

DESIGN NOTES

11:35:09 AM Tuesday, May 21, 2013

Page 24 of 139

BOX PMA3

BOX PMA3

Page Order # :

110

BOX INSTRUCTIONS
( PMQ1120 )

IF THE PROBE FOR PRESCRIPTION MEDICINE BOTTLES HAS NOT BEEN
ASKED IN THE CURRENT ROUND, GO TO PM5A - PM3PMMEDS (
PMQ1130 ).
ELSE GO TO PM6 - MEDICINE_PM3 ( PMQ1140 ).

ASSIGNMENTS

TECHNICAL NOTES
131

PMBottleProbe

Prescription Medicine Bottle probe has been asked in the
current round =
GETPMMEDS=1/Yes.

DESIGN NOTES
Only probe for prescription medicine bottles once during the current
round.
Adding a new TEMP flag, GETPMMEDS. GETPMMEDS is set to 1/Yes
whenever the Prescription Bottle probe is asked during the current
round. This will get set anywhere in utilization or cost series.

11:35:09 AM Tuesday, May 21, 2013

Page 25 of 139

PM5A

PM5A

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PM3PMMEDS

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:
If SP has a "current" Medicare Prescription Drug plan or there was

a Medicare Prescription Drug plan "current" at the time of the

previous round interview, then display "MPDP: (MEDICARE

PRESCRIPTION DRUG PLAN NAME)".

Else do not display.

MEDICARE PRESCRIPTION DRUG PLAN NAME =

Display the name of the "current" Medicare Prescription Drug plan.

If it does not exist, display the name of the Medicare Prescription

Drug plan "current" at the time of the previous round interview.

Question display:

Always display "(s)" in "bottle(s), container(s), or bag(s)" in
parenthesis.
If SP has a "current" Medicare Prescription Drug plan or there was

a Medicare Prescription Drug plan "current" at the time of the

previous round interview, then display "Also, please take out

[your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN NAME)

medicine statements....".

Else do not display.

MEDICARE PRESCRIPTION DRUG PLAN NAME =

Display the name of the "current" Medicare Prescription Drug plan.

If it does not exist, display the name of the Medicare Prescription

Drug plan "current" at the time of the previous round interview.

Multi Field display:

11:35:10 AM Tuesday, May 21, 2013

Page 26 of 139

PM5A
Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
[MPDP: (MEDICARE PRESCRIPTION DRUG PLAN NAME)]

Context Header:
Int. Instr I:

It would be helpful if I could look at any medicine bottle(s),
container(s), or bag(s) that you have so that I can spell the medicine
name correctly and enter the strength of the medicine. [Also, please
take out [your/(SP's)] (MEDICARE PRESCRIPTION DRUG PLAN
NAME) medicine statements, which should have that same
information on them.]

Question Text:

[IF RESPONDENT HAS BOTTLE, ASK:] I’ll need that same
information for all of the medicines [you/(SP)] obtained since the last
interview, if you’d like to get those bottles, too.
Int. Instr II:
INPUT FIELDS / ROUTING
PM3PMMEDS

Field1:
Cheshire Name:

( PMQ1130 )

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
PM6 - MEDICINE_PM3 ( PMQ1140 )

English text: CONTINUE
Attribute

Route

Empty

PM6 - MEDICINE_PM3 ( PMQ1140 )

11:35:11 AM Tuesday, May 21, 2013

Page 27 of 139

PM5A
BACKGROUND VARIABLE ASSIGNMENTS
The question displayed at PM1A is repeated in other utilization sections. Only show this
probe for prescription medicine bottles once during the current round interview.
If PM5A is asked, set flag as instructed below:
GETPMMEDS

Set GETPMMEDS=1/Yes.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
342

MPDPCurrent

SP has a "current" Medicare Prescription Drug plan =
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLRO.PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=current round &
PLRO.COVCURNT=1/Yes).
Exclude Deleted Plans. See T.N. 52.

343

MPDPCurrPrevRnd

Medicare Prescription Drug plan "current" at time of
previous round interview=
There is a PLAN where PLAN.PLANTYPE=7/MPDP &
PLRO where (PLROPLAN=PLAN.PLANNUM &
PLRO.PLRORND=previous round &
PLRO.COVCURNT=1/Yes). Exclude Deleted Plans. See
T.N. 52.

Exclude plans stopped in HIS. See T.N. 476.

476

HISStoppedPlans

Plans stopped in HIS that are not valid for displays or
checks =
Any PLAN where PLAN.PLANSFLG=1/Yes is a PLAN
stopped in HIS.

DESIGN NOTES

11:35:11 AM Tuesday, May 21, 2013

Page 28 of 139

PM6

PM6

Page Order # :

Design Screen Type:

Roster

Fields:

Field 1:

MEDICINE_PM3

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Name:

Prescription Medicine Roster

Roster Type:

Multiple Item Select

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

Yes
Yes
No
No

Grid Functions:

Add Line
Delete Line

No
No

125

Display as ' Add a Medicine '
Display as ' Edit a Medicine '

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Roster/Grid Instructions:

Display all Prescription Medicine events where:
EVNT.EVNTDFLG ^=1/Yes, and
EVNT.EVNTTYPE='PM'.
Display in alphabetical order.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

Medicine

Display prescription medicine name,
EVNT.PMEDNAME.

2

Strength

Display prescription medicine strength
text field, EVNT.PMSTRUNI.

Report display:

TEXT:
Context Header:

Int. Instr I:

Question Text:
11:35:11 AM Tuesday, May 21, 2013

What is the name of the medicine?

Page 29 of 139

PM6
SELECT OR ADD ALL MEDICINES AT THIS ROSTER.
CHECK STATEMENT OR MEDICINE BOTTLE FOR SPELLING.
INCLUDE STRENGTH WITH NAME.

Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

MEDICINE_PM3

( PMQ1140 )

TEMP

Cheshire Name:
Item Text display:

Item Text:

Label:

Label Position:

String

TEvntPick200

Field Type:
Type Name:
Answers Allowed:

Drop Down List:
Lookup File:
Lookup File Name:

1
No

No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:

Max Value:

Mask:

200

Route
BOX PM1 - (PMQ1150 )

BACKGROUND VARIABLE ASSIGNMENTS
Roster details will be collected on EVNT:
EVNT key = EVNT.EVNTBASE + EVNT.EVNTNUM
EVNT.EVNTNUM = Number of PM event selected.
If Prescription Medicine added at Prescription Medicine Roster, see PRESCRIPTION
MEDICINE ROSTER POP-UP specifications for pop-up window programming instructions.
Variables populated at the Prescription Medicine Roster:
EVNT.EVNTNUM
EVNT.EVNTRNDC
EVNT.EVNTTYPE
EVNT.PMEDNAME
EVNT.PMSTRUNI
EVNT.EVNTPROV
BASE.LASTEVNT

Event number
Round number
PM
Prescription Medicine name
Prescription Medicine strength text field
02
Highest EVNT.EVNTNUM

For all Prescription Medicines selected, create a current round PMRO. Note: a current
round PMRO may already exist for a Prescription Medicine event if it has already been
selected earlier in the interview.
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND.
PMRO key = PMRO.PMROBASE + PMRO.PMROEVNT + PMRO.PMRORND
11:35:12 AM Tuesday, May 21, 2013

Page 30 of 139

PM6
PMRO.PMROEVNT = EVNT.EVNTNUM of PM event selected.
PMRO.PMRORND = current round.
PM6 can be asked more than once if response to PM17=1/Yes, there are more PM's to
enter. If at PM6, a medicine is selected that was previously displayed at PM6A and
GETNUM was set to 0, we will reset GETNUM=empty so that the medicine will be
displayed again at PM6A. See additional instructions below.
PMROEVNT

PMRO.PMROEVNT = EVNT.EVNTNUM of
prescription medicine selected.

PMRORND

PMRO.PMRORND = current round.

PMROTYPE

PMRO.PMROTYPE = PM.

GETNUM

If PMRO.GETNUM = 0, set PMRO.GETNUM =
empty.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES
Begin Loop 1: PM6A is the first question in the 1st, larger loop in PM. It is
asked the first time through PM and is also asked each time PM17=1/Yes,
the probe for more medicines.

11:35:12 AM Tuesday, May 21, 2013

Page 31 of 139

BOX PM1

BOX PM1

Page Order # :

130

BOX INSTRUCTIONS
( PMQ1150 )

IF SP REPORTED AT LEAST ONE PRESCRIPTION MEDICINE IN THE
CURRENT ROUND UTILIZATION THAT DOES NOT HAVE NUMBER OF
PURCHASES ENTERED, GO TO PM6A - GETNUM ( PMQ1160 ).
ELSE GO TO PM17 - PMMORE ( PMQ1560 ).

ASSIGNMENTS

TECHNICAL NOTES
190

NeedNumOfPurchases

PM reported in the current round utilization that does not
have number of purchases entered =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = current round & PMRO.GETNUM =
empty & PMRO.PMRODFLG ^= 1/Yes).

DESIGN NOTES
BOX PM1 checks for any PM's reported during the current round
utilization sections, including PMs selected at PM2, PM4 and PM6. The
PM's entered in utilization sections, PM2, and PM4 do not have number of
purchases entered. However, because PM6 could be asked more than
once in PM and we do not prohibit PM's from being selected more than
once at PM6, BOX PM1 excludes any PM that has been selected in an
earlier loop and GETNUM has already been asked.

11:35:12 AM Tuesday, May 21, 2013

Page 32 of 139

PM6A

PM6A

Page Order # :

Design Screen Type:

Grid

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

135

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

Display name and strength of medicine that is currently active in
grid.

Multi Field display:

Roster/Grid Instructions:

Display all PM's reported during the current round utilization that do
not have number of purchases collected.
Display in order of entry.

Roster/Grid display:

COL #

HEADER

INSTRUCTIONS

1

Medicine Name

Display the name and strength of the
medicine, EVNT.PMEDNAME + ' ' +
EVNT.PMSTRUNI. Display only.

2

# Purchases

PMRO.GETNUM. Input column 1.

Report display:

TEXT:
Context Header:

REFERENCE DATE: (REFERENCE DATE)

Int. Instr I:

IF ALL MEDICINES ARE NOT LISTED, USE "PREVIOUS PAGE"
AND ADD THE MEDICINE TO THE ROSTER. REFER TO
STATEMENTS OR RECEIPTS, IF AVAILABLE.

11:35:12 AM Tuesday, May 21, 2013

Page 33 of 139

PM6A
How many times [since (REFERENCE DATE)/between
(REFERENCE DATE) and (DATE OF DEATH/DATE OF
INSTITUTIONALIZATION)] did [(you/(SP)] obtain (MEDICINE
NAME)]]?

Question Text:

Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

( PMQ1160 )

GETNUM

Cheshire Name:
Item Text display:

PMRO.GETNUM

GRID COLUMN #2

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer

TGetnum

FieldSize:

Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

0
100

Route
BOX PM1A - (PMQ1170 )

Attribute

Route

Don't know

BOX PM1A - (PMQ1170 )

Refusal

BOX PM1A - (PMQ1170 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

GETNUM = 1- 8, DK or RF.

If not true, display message: "THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY.".

HARD EDIT CHECKS

TECHNICAL NOTES
190

NeedNumOfPurchases

11:35:13 AM Tuesday, May 21, 2013

PM reported in the current round utilization that does not
have number of purchases entered =
Page 34 of 139

PM6A
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = current round & PMRO.GETNUM =
empty & PMRO.PMRODFLG ^= 1/Yes).
DESIGN NOTES

11:35:13 AM Tuesday, May 21, 2013

Page 35 of 139

BOX PM1A

BOX PM1A

Page Order # :

140

BOX INSTRUCTIONS
( PMQ1170 )

IF AT LEAST ONE PRESCRIPTION MEDICINE DISPLAYED AT PM6A HAS
NUMBER OF PURCHASES > 0 OR EQUAL TO DK OR RF, GO TO BOX
PM1AB - (PMQ1171 ).
ELSE GO TO PM17 - PMMORE ( PMQ1560 ).

ASSIGNMENTS

TECHNICAL NOTES
182

NumberOfPurchases

The number of purchases for PM or OM =
For the OM or PM EVNT, there is PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Number of purchases = PMRO.GETNUM.

DESIGN NOTES
We do not collect PM details for PMs where number of purchases = 0. If
all PMs selected at the PM roster and displayed at PM6A have PM6A ­
GETNUM = 0, BOX PM1A is routed to PM17, a probe for more PMs.

11:35:13 AM Tuesday, May 21, 2013

Page 36 of 139

BOX PM1AB

BOX PM1AB

Page Order # :

145

BOX INSTRUCTIONS
( PMQ1171 )

IF THIS IS ROUND 67 AND PM6AB - RXNOFILL HAS NOT BEEN ASKED IN
THE CURRENT ROUND, GO TO PM6AB - RXNOFILL ( PMQ1175 ).
ELSE GO TO PM6A_IN - NAVIGATOR ( PMQ1183 ).

ASSIGNMENTS

TECHNICAL NOTES
450

PM6ABNotAsked

PM6AB - RXNOFILL not asked in the current round =
HRND.RXNOFILL = NULL on HRND where
HRND.HRNDRND = current round.

DESIGN NOTES

11:35:13 AM Tuesday, May 21, 2013

Page 37 of 139

PM6AB

PM6AB

Page Order # :

Design Screen Type:

List

Fields:

Field 1:

RXNOFILL

Field 2:

RXDELAY

Field 3:

RXSKIP

Field 4:

RXDOSE

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

150

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

Display all PM's displayed at PM6A that have number of purchases

> 0, DK or RF.

Display report below question text.

Column 1, column header= MEDICINES REPORTED FOR

CURRENT REFERENCE PERIOD

Column 1, display = Display the name and strength of the medicine,

EVNT.PMEDNAME + ' ' + EVNT.PMSTRUNI.

TEXT:
Context Header:

11:35:15 AM Tuesday, May 21, 2013

Page 38 of 139

PM6AB
Int. Instr I:

SHOW CARD PM1

Question Text:

Please think about the medicines you have obtained since
(REFERENCE DATE), including [READ MEDICINE NAME(S)
BELOW.] Since (REFERENCE DATE), how often did [you/(SP)] do
any of the following things for these medicines. Did [you/(SP)] often,
sometimes, or never…

Int. Instr II:

INPUT FIELDS / ROUTING

RXNOFILL

Field1:
Cheshire Name:

( PMQ1175 )

HRND.RXNOFILL

Item Text display:

Display "a." in front of Item Text.

Item Text:

decide not to fill or refill a prescription because the medicine

cost too much?

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

TRXOFTEN
1
No
No

Number Label
1 Often

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM6AB - RXDELAY ( PMQ1176 )

2

English text: OFTEN
Sometimes

PM6AB - RXDELAY ( PMQ1176 )

3

English text: SOMETIMES
Never

PM6AB - RXDELAY ( PMQ1176 )

English text: NEVER
Attribute

Route

Don't know

PM6AB - RXDELAY ( PMQ1176 )

Refusal

PM6AB - RXDELAY ( PMQ1176 )

11:35:17 AM Tuesday, May 21, 2013

Page 39 of 139

PM6AB

Field2:

RXDELAY

Cheshire Name:

( PMQ1176 )

HRND.RXDELAY

Item Text display:

Display "b." in front of Item Text.

Item Text:

delay getting a prescription filled or refilled because the

medicine cost too much?

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

TRXOFTEN
1
No
No

Number Label
1 Often

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM6AB - RXSKIP ( PMQ1177 )

2

English text: OFTEN
Sometimes

PM6AB - RXSKIP ( PMQ1177 )

3

English text: SOMETIMES
Never

PM6AB - RXSKIP ( PMQ1177 )

English text: NEVER
Attribute

Route

Don't know

PM6AB - RXSKIP ( PMQ1177 )

Refusal

PM6AB - RXSKIP ( PMQ1177 )

11:35:20 AM Tuesday, May 21, 2013

Page 40 of 139

PM6AB

Field3:

RXSKIP

Cheshire Name:

( PMQ1177 )

HRND.RXSKIP

Item Text display:

Display "c." in front of Item Text.

Item Text:

skip doses to make the medicine last longer?

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TRXOFTEN
1
No
No

Number Label
1 Often

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM6AB - RXDOSE ( PMQ1178 )

2

English text: OFTEN
Sometimes

PM6AB - RXDOSE ( PMQ1178 )

3

English text: SOMETIMES
Never

PM6AB - RXDOSE ( PMQ1178 )

English text: NEVER
Attribute
Don't know

Route
PM6AB - RXDOSE ( PMQ1178 )

Refusal

PM6AB - RXDOSE ( PMQ1178 )

11:35:22 AM Tuesday, May 21, 2013

Page 41 of 139

PM6AB

Field4:

RXDOSE

Cheshire Name:

( PMQ1178 )

HRND.RXDOSE

Item Text display:

Display "d." in front of Item Text.

Item Text:

take smaller doses to make the medicine last longer?

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TRXOFTEN
1
No
No

Number Label
1 Often

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM6A_IN - NAVIGATOR ( PMQ1183 )

2

English text: OFTEN
Sometimes

PM6A_IN - NAVIGATOR ( PMQ1183 )

3

English text: SOMETIMES
Never

PM6A_IN - NAVIGATOR ( PMQ1183 )

English text: NEVER
Attribute
Don't know

Route
PM6A_IN - NAVIGATOR ( PMQ1183 )

Refusal

PM6A_IN - NAVIGATOR ( PMQ1183 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

11:35:23 AM Tuesday, May 21, 2013

Page 42 of 139

PM6A_IN

PM6A_IN

Page Order # :

Design Screen Type:

Instance Navigator

Fields:

Field 1:

NAVIGATOR

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

155

Roster Name:
Roster Type:
Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If administering PM, display all PM's displayed at PM6A that have
number of purchases > 0, DK or RF.
If administering ST, display all PM's added at ST41 that have
number of purchases > 0, DK or RF.
If administering NS, display all PM's added at NS41 that have
number of purchases > 0, DK or RF.
Invoke NO TRAVEL I/N.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
Int. Instr I:
Question Text:

11:35:24 AM Tuesday, May 21, 2013

Page 43 of 139

PM6A_IN
Int. Instr II:

INPUT FIELDS / ROUTING

NAVIGATOR

Field1:
Cheshire Name:

( PMQ1183 )

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
BOX PM1A-1 - (PMQ1184 )

English text: ITEM SELECTED IN INSTANCE NAVIGATOR
SelectContinueInterview
BOX PM3A - (PMQ1559 )
English text: CONTINUE INTERVIEW SELECTED

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
182

NumberOfPurchases

The number of purchases for PM or OM =
For the OM or PM EVNT, there is PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Number of purchases = PMRO.GETNUM.

DESIGN NOTES

11:35:24 AM Tuesday, May 21, 2013

Page 44 of 139

BOX PM1A-1

BOX PM1A-1

Page Order # :

160

BOX INSTRUCTIONS
( PMQ1184 )

IF (SP REPORTED RECEIVING HEALTH CARE SERVICES THROUGH V.A.
IN THE CURRENT ROUND OR ANY PREVIOUS ROUND), GO TO PM6A1 ­
PMSATVA ( PMQ1185 ).
ELSE GO TO BOX PM1AA - (PMQ1190 ).

ASSIGNMENTS

TECHNICAL NOTES
423

SPReceivedCaretThruV
A

SP reported receiving health care services through V.A.in
the current or any previous round =
There is an HRND where HRND.HRNDRND = current
round and HRND.VACOVER = 1/Yes.
HRND.VACOVER is set at BOX HI20 or collected at HI36.

182

NumberOfPurchases

The number of purchases for PM or OM =
For the OM or PM EVNT, there is PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Number of purchases = PMRO.GETNUM.

DESIGN NOTES

11:35:24 AM Tuesday, May 21, 2013

Page 45 of 139

PM6A1

PM6A1

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PMSATVA

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

170

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.

Question display:

Display name and strength of medicine that is currently being asked
about.
If PMRO.GETNUM = 1, display "this purchase".
Else display "any of these purchases".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)

Int. Instr I:
Question Text:

Did [you/(SP)] obtain (this purchase/any of these purchases) of
(MEDICINE NAME) through the Department of Veterans Affairs or
V.A.?

Int. Instr II:

11:35:25 AM Tuesday, May 21, 2013

Page 46 of 139

PM6A1
INPUT FIELDS / ROUTING
( PMQ1185 )

PMSATVA

Field1:
Cheshire Name:

PMRO.PMSATVA

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 PM1AA - (PMQ1190 )

English text: YES
No

BOX PM1AA - (PMQ1190 )

English text: NO
Attribute
Don't know

Route
BOX PM1AA - (PMQ1190 )

Refusal

BOX PM1AA - (PMQ1190 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
182

NumberOfPurchases

The number of purchases for PM or OM =
For the OM or PM EVNT, there is PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Number of purchases = PMRO.GETNUM.

DESIGN NOTES

11:35:26 AM Tuesday, May 21, 2013

Page 47 of 139

BOX PM1AA

BOX PM1AA

Page Order # :

180

BOX INSTRUCTIONS
( PMQ1190 )

IF SP COVERED BY A MEDICARE MANAGED CARE PLAN OR A PRIVATE
MANAGED CARE PLAN ANYTIME DURING THE CURRENT ROUND, GO
TO PM6B - PMSATHMO ( PMQ1200 ).
ELSE GO TO PMINTROB - PMINTB ( PMQ1210 ).

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

11:35:26 AM Tuesday, May 21, 2013

Page 48 of 139

PM6B

PM6B

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PMSATHMO

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 name and strength of medicine that is currently being asked
about.

Question display:

Display name and strength of medicine that is currently being asked
about.
If PMRO.GETNUM = 1, display "this purchase".
Else display "any of these purchases".

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:
11:35:26 AM Tuesday, May 21, 2013

Page 49 of 139

PM6B
MEDICINE NAME: (MEDICINE NAME)

Context Header:
Int. Instr I:

Did [you/(SP)] obtain (this purchase/any of these purchases) of
(MEDICINE NAME) at [READ MANAGED CARE PLAN NAME(S)
BELOW] or through a service or discount offered through [READ
MANAGED CARE PLAN NAME(S) BELOW]?

Question Text:

[PROBE: This could include obtaining the purchases at a plan
pharmacy; at a pharmacy that honors [your/(SP’s)] plan card; or
through a mail order service that the managed care plan referred
[you/(SP)] to.]
Int. Instr II:

INPUT FIELDS / ROUTING

PMSATHMO

Field1:
Cheshire Name:

( PMQ1200 )

PMRO.PMSATHMO

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
PMINTROB - PMINTB ( PMQ1210 )

English text: YES
No

PMINTROB - PMINTB ( PMQ1210 )

English text: NO
Attribute
Don't know

Route
PMINTROB - PMINTB ( PMQ1210 )

Refusal

PMINTROB - PMINTB ( PMQ1210 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
11:35:28 AM Tuesday, May 21, 2013

Page 50 of 139

PM6B

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.

182

NumberOfPurchases

The number of purchases for PM or OM =
For the OM or PM EVNT, there is PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Number of purchases = PMRO.GETNUM.

DESIGN NOTES

11:35:28 AM Tuesday, May 21, 2013

Page 51 of 139

PMINTROB

PMINTROB

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PMINTB

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

200

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.

Question display:

Always display "[ASK R TO GET BOTTLES…]" in brackets.
Display name and strength of medicine that is currently being asked
about.
If SP was covered by a Medicare managed care plan or a private
managed care plan anytime during the current round, display
"more".
Else do not display.
If SP was not covered by a Medicare managed care plan and was
not covered by a private managed care plan anytime during the
current round, display "Now".
Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:

11:35:29 AM Tuesday, May 21, 2013

Page 52 of 139

PMINTROB
Context Header:

MEDICINE NAME: (MEDICINE NAME)

Int. Instr I:

[ASK R TO GET BOTTLES AND/OR STATEMENTS IF YOU HAVE
NOT ALREADY DONE SO.]

Question Text:

(Now) I need to ask you a few (more) questions about the
(MEDICINE NAME).

Int. Instr II:
INPUT FIELDS / ROUTING
( PMQ1210 )

PMINTB

Field1:
Cheshire Name:

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
BOX PM1B - (PMQ1220 )

English text: CONTINUE
Attribute
Empty

Route
BOX PM1B - (PMQ1220 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
46

SPHadMHMO

11:35:30 AM Tuesday, May 21, 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
Page 53 of 139

PMINTROB
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
Begin Loop 4:

PMINTROB is the first question in the larger PM detail loop.

DISALLOW PREVIOUS PAGE

11:35:30 AM Tuesday, May 21, 2013

Page 54 of 139

BOX PM1B

BOX PM1B

Page Order # :

210

BOX INSTRUCTIONS
( PMQ1220 )

GO TO PM8 - PMBOTTLE ( PMQ1240 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

11:35:30 AM Tuesday, May 21, 2013

Page 55 of 139

PM8

PM8

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PMBOTTLE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

230

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.

Question display:
Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)

Int. Instr I:

CODE “YES” WITHOUT ASKING IF STATEMENT, RECEIPT,
BOTTLE OR BAG IS PRESENT.

Question Text:

Do you have the medicine bottle, container, or bag available?

Int. Instr II:

IF R DOES NOT HAVE BOTTLE, PROBE TO DETERMINE IF R
CAN ANSWER QUESTIONS ABOUT THE FORM, STRENGTH,
AND QUANTITY OF THE MEDICINE.

INPUT FIELDS / ROUTING

11:35:30 AM Tuesday, May 21, 2013

Page 56 of 139

PM8

Field1:

PMBOTTLE

Cheshire Name:

( PMQ1240 )

PMRO.PMBOTTLE

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated

TPmbottle
1
No
No

Number Label
1 Yes

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX PM1B-1 - (PMQ1250 )

2

English text: YES
No

BOX PM2 - (PMQ1550 )

3

English text: NO
NoButRCanAnswerQuestions

BOX PM1B-1 - (PMQ1250 )

English text: NO BUT R CAN ANSWER QUESTIONS
Attribute
Don't know

Route
BOX PM2 - (PMQ1550 )

Refusal

BOX PM2 - (PMQ1550 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

11:35:31 AM Tuesday, May 21, 2013

Page 57 of 139

BOX PM1B-1

BOX PM1B-1

11:35:31 AM Tuesday, May 21, 2013

Page Order # :

240

Page 58 of 139

BOX PM1B-1
BOX INSTRUCTIONS
( PMQ1250 )

IF (SP REPORTED THE PRESCRIPTION MEDICINE IN THE PREVIOUS
ROUND AND THE PREVIOUS ROUND FORM WAS ASKED AND DID NOT
EQUAL DK) AND (SP REPORTED THE PRESCRIPTION MEDICINE IN THE
PREVIOUS ROUND AND THE PREVIOUS ROUND STRENGTH WAS
ASKED AND DID NOT EQUAL DK) AND ((SP REPORTED THE
PRESCRIPTION MEDICINE IN THE PREVIOUS ROUND AND THE
PREVIOUS ROUND NUMBER WAS ASKED AND DID NOT EQUAL DK) OR
(SP REPORTED THE PRESCRIPTION MEDICINE IN THE PREVIOUS
ROUND AND THE PREVIOUS ROUND AMOUNT WAS ASKED AND DID
NOT EQUAL DK)), GO TO PM8AA - SAMEFSAM ( PMQ1255 ).
IF SP REPORTED THE PRESCRIPTION MEDICINE IN THE PREVIOUS
ROUND AND THE PREVIOUS ROUND FORM WAS ASKED AND DID NOT
EQUAL DK, GO TO PM8A - SAMEFORM ( PMQ1260 ).
ELSE GO TO BOX PM1B-2A - (PMQ1280 ).

ASSIGNMENTS

TECHNICAL NOTES
176

PMPrevRnd

SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.

181

PrevRndForm

Previous round form for PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT= EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM form = PMRO.PMFORM, PMRO.PMFORMOS.

193

FormEqualDK

Previous round PM Form was asked and did not equal
DK =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = previous round & PMRO.PMFORM
^= EMPTY & PMRO.PMFORM ^= DK).

183

PrevRndStrength

Previous round strength for PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round).
Strength =STRNUNIT, STRNUNOS, STRNNUM,
STRNPER
If compound, 2nd strength= STRNUNI2, STRNUNO2,
STRNNUM2, STRNPER2.

11:35:31 AM Tuesday, May 21, 2013

Page 59 of 139

BOX PM1B-1
184

StrengthEqualDK

Previous round PM Strength was asked and did not equal
DK =
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round & PMRO.STRNUNIT
^= EMPTY & (STRNUNIT, STRNUNI2, STRNNUM,
STRNUM2, STRNPER, & STRNPER2 ^= DK)).

187

PillsSuppPatches

PM form is stored on PMRO where PMRO.PMRORND =
round # checking and PMRO.PMROEVNT =
EVNT.EVNTNUM of PM being asked about:
Pills: PMRO.PMFORM = 1/Pills
Suppositories: PMRO.PMFORM = 5/Suppositories.
Patches: PMRO.PMFORM=10/Patches.

188

PrevRndAmount

The previous round amount for the PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM amount = PMRO.AMTUNIT, PMRO.AMTUNOS,
PMRO.AMTNUM.

189

AmountEqualDK

Previous round PM Amount was asked and did not equal
DK =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = previous round & PMRO.AMTUNIT
^= EMPTY & (PMRO.AMTUNIT ^= DK &
PMRO.AMTNUM ^= DK)).

472

PrevRndNumber

The previous round amount for the PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM number = PMRO.TABNUM.

473

NumberEqualDK

Previous round PM Amount was asked and did not equal
DK =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = previous round & PMRO.TABNUM
^= EMPTY or DK).

DESIGN NOTES

11:35:31 AM Tuesday, May 21, 2013

Page 60 of 139

PM8AA

PM8AA

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

SAMEFSAM

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

245

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.
MEDICINE FORM:
If previous round PMRO.PMFORM = 91/Other, display other specify
text, PMRO.PMFORMOS for medicine currently being asked about.
Else display PMRO.PMFORM response.
STRENGTH MEDICINE FORM:

If previous round PMRO.PMFORM = 1/Pill, display "PILL" for

medicine currently being asked about.

Else if previous round PMRO.PMFORM = 5/Suppository, display

"SUPPOSITORY".

Else if previous round PMRO.PMFORM = 10/Patch, display

"PATCH".

Else then

If previous round PMRO.PMFORM = 91/Other, medicine form =
Other Specify text, PMRO.PMFORMOS.
Else display PMRO.PMFORM response.
Referring to the previous round strength, PMRO.STRNUNIT &

PMRO.STRNUNI2, for PM currently being asked about:

STRENGTH 1:

If previous round PMRO.STRNUNIT=91/Other, display

PMRO.STRNNUM + other specify text response,

PMRO.STRNUNOS.

Else if previous round PMRO.STRNUNIT = 6/Percent, display

PMRO.STRNPER + PMRO.STRNUNIT response.

Else display PMRO.STRNNUM + PMRO.STRNUNIT response.

STRENGTH 2:

11:35:32 AM Tuesday, May 21, 2013

Page 61 of 139

PM8AA
If prescription medicine entered as a compound in the previous
round, PMRO.COMPFLAG=1/Indicated, then,
If previous round PMRO.STRNUNI2=91/Other, display
PMRO.STRNNUM2 + other specify text response,
PMRO.STRNUNO2.
Else if previous round PMRO.STRNUNI2 = 6/Percent, display
PMRO.STRNPER2 + PMRO.STRNUNI2 response.
Else display PMRO.STRNNUM2 + PMRO.STRNUNI2 response.
Else do not display.
PREVIOUS ROUND MEDICINE AMOUNT:

Referring to the previous round amount, PMRO.AMTUNIT, for PM

currently being asked about:

If previous round PMRO.AMTUNIT=91/Other, display other specify

text response, PMRO.AMTNUM + PMRO.AMTUNOS.

Else display PMRO.AMTNUM + PMRO.AMTUNIT response.

PREVIOUS ROUND MEDICNE NUMBER:

Display PMRO.TABNUM

Question display:

MEDICINE NAME:

Display name and strength of medicine that is currently being asked

about.

MEDICINE FORM:

If previous round PMRO.PMFORM = 91/Other, display other specify

text, PMRO.PMFORMOS for medicine currently being asked about.

Else display PMRO.PMFORM response.

Display form in lower case letters.

STRENGTH MEDICINE FORM:

If previous round PMRO.PMFORM = 1/Pill, display "each pill" for

medicine currently being asked about.

Else if previous round PMRO.PMFORM = 5/Suppository, display

"each suppository".

Else if previous round PMRO.PMFORM = 10/Patch, display "each

patch".

Else then

Display "the (MEDICINE FORM)".
If previous round PMRO.PMFORM = 91/Other, medicine form =
Other Specify text, PMRO.PMFORMOS.
Else display PMRO.PMFORM response.
Referring to the previous round strength, PMRO.STRNUNIT &

PMRO.STRNUNI2, for PM currently being asked about:

STRENGTH 1:

If previous round PMRO.STRNUNIT=91/Other, display

PMRO.STRNNUM + other specify text response,

PMRO.STRNUNOS.

Else if previous round PMRO.STRNUNIT = 6/Percent, display

PMRO.STRNPER + PMRO.STRNUNIT response.

Else display PMRO.STRNNUM + PMRO.STRNUNIT response.

STRENGTH 2:

If prescription medicine entered as a compound in the previous

round, PMRO.COMPFLAG=1/Indicated, then,

If previous round PMRO.STRNUNI2=91/Other, display
PMRO.STRNNUM2 + other specify text response,

11:35:33 AM Tuesday, May 21, 2013

Page 62 of 139

PM8AA
PMRO.STRNUNO2.
Else if previous round PMRO.STRNUNI2 = 6/Percent, display
PMRO.STRNPER2 + PMRO.STRNUNI2 response.
Else display PMRO.STRNNUM2 + PMRO.STRNUNI2 response.
Else do not display.
If SP reported the prescription medicine in the previous round and
the previous round amount was asked, display "The amount of the
(MEDICINE FORM) in the container when it was obtained was
(PREVIOUS ROUND MEDICINE AMOUNT)."
Else if SP reported the prescription medicine in the previous round
and the previous round medicine number was asked, display “The
number of (MEDICINE FORM) in the container when it was
obtained was (PREVIOUS ROUND MEDICINE NUMBER).".
PREVIOUS ROUND MEDICINE AMOUNT:
Referring to the previous round amount, PMRO.AMTUNIT, for PM
currently being asked about:
If previous round PMRO.AMTUNIT=91/Other, display other specify
text response, PMRO.AMTNUM + PMRO.AMTUNOS.
Else display PMRO.AMTNUM + PMRO.AMTUNIT response.
PREVIOUS ROUND MEDICNE NUMBER:
Display PMRO.TABNUM
Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME) STRENGTH: (STRENGTH
1) (STRENGTH 2)
FORM: (MEDICINE FORM)
AMOUNT (PREVIOUS ROUND MEDIINE AMOUNT) (PREVIOUS
ROUND NUMBER)

Int. Instr I:

CODE "YES" WITHOUT ASKING IF STATEMENT, RECEIPT,
BOTTLE OR BAG IS PRESENT AND FORM, STRENGTH AND
AMOUNT ARE THE SAME AS IN THE PREVIOUS INTERVIEW.

Question Text:

At the time of the last interview, [you/(SP)] purchased (MEDICINE
NAME) in the form of (MEDICINE FORM).
The strength of [each pill/each suppository/each patch/the
(STRENGTH MEDICINE FORM)] was [READ STRENGTH BELOW].
(STRENGTH 1)
(STRENGTH 2)
[The amount of the (MEDICINE FORM) in the container when it was
obtained was (PREVIOUS ROUND MEDICINE AMOUNT)./The
number of (MEDICINE FORM) in the container when it was obtained
was (PREVIOUS ROUND NUMBER).]

11:35:34 AM Tuesday, May 21, 2013

Page 63 of 139

PM8AA
Is this medicine in the same strength, form and amount?
CODE "NO" UNLESS STRENGTH, FORM AND AMOUNT
EXACTLY MATCH PREVIOUS ROUND.

Int. Instr II:

INPUT FIELDS / ROUTING

Field1:

SAMEFSAM

Cheshire Name:

( PMQ1255 )

PMRO.SAMEFSAM

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 PM2 - (PMQ1550 )

English text: YES
No

PM8A - SAMEFORM ( PMQ1260 )

English text: NO
Attribute

Route

Don't know

PM8A - SAMEFORM ( PMQ1260 )

Refusal

PM8A - SAMEFORM ( PMQ1260 )

BACKGROUND VARIABLE ASSIGNMENTS
If PM8AA - SAMEFSAM = 1/Yes, copy the prescription medicine form, strength, and
amount from the previous round PMRO fields to the current round fields.
PMFORM

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.PMFORM = previous round PMRO.PMFORM.

PMFORMOS

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.PMFORMOS = previous round
PMRO.PMFORMOS.

STRNUNIT

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.STRNUNIT = previous round
PMRO.STRNUNIT.

11:35:35 AM Tuesday, May 21, 2013

Page 64 of 139

PM8AA
STRNUNOS

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.STRNUNOS = previous round
PMRO.STRNUNOS.

STRNNUM

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.STRNNUM = previous round
PMRO.STRNNUM.

STRNPER

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.STRNPER = previous round
PMRO.STRNPER.

STRNUNI2

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.STRNUNI2 = previous round
PMRO.STRNUNI2.

STRNUNO2

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.STRNUNO2 = previous round
PMRO.STRNUNO2.

STRNNUM2

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.STRNNUM2 = previous round
PMRO.STRNNUM2.

STRNPER2

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.STRNPER2 = previous round
PMRO.STRNPER2.

COMPFLAG

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.COMPFLAG = previous round
PMRO.COMPFLAG.

AMTUNIT

If PM8AA- SAMEFSAM = 1/Yes, set current round
PMRO.AMTUNIT = previous round PMRO.AMTUNIT.

AMTUNOS

If PM8AA - SAMEFSAM = 1/Yes, set current round
PMRO.AMTUNOS = previous round
PMRO.AMTUNOS.

AMTNUM

If PM8AA - SAMEFSAM = 1/Yes, set current round
PMRO.AMTNUM = previous round PMRO.AMTNUM.

TABNUM

If PM8AA - SAMEFSAM = 1/Yes, set current round
PMRO.TABNUM = previous round PMRO.TABNUM.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
181

PrevRndForm

Previous round form for PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT= EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM form = PMRO.PMFORM, PMRO.PMFORMOS.

183

PrevRndStrength

Previous round strength for PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round).
Strength =STRNUNIT, STRNUNOS, STRNNUM,
STRNPER
If compound, 2nd strength= STRNUNI2, STRNUNO2,
STRNNUM2, STRNPER2.

11:35:35 AM Tuesday, May 21, 2013

Page 65 of 139

PM8AA
188

PrevRndAmount

The previous round amount for the PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM amount = PMRO.AMTUNIT, PMRO.AMTUNOS,
PMRO.AMTNUM.

472

PrevRndNumber

The previous round amount for the PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM number = PMRO.TABNUM.

DESIGN NOTES

11:35:35 AM Tuesday, May 21, 2013

Page 66 of 139

PM8A

PM8A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

SAMEFORM

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

250

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about. Refering to the previous round form, PMRO.PMFORM, for
PM currently being asked about:
If previous round PMRO.PMFORM = 91/Other, display other specify

text, PMRO.PMFORMOS.

Else display PMRO.PMFORM response.

Display form in lower case letters.

Question display:

If PM8AA-SAMEFSAM = 2/No, display "I would…".
Else do not display.
Display name and strength of medicine that is currently being asked

about.

Refering to the previous round form, PMRO.PMFORM, for PM

currently being asked about:

If previous round PMRO.PMFORM = 91/Other, display other specify

text, PMRO.PMFORMOS.

Else display PMRO.PMFORM response.

Display form in lower case letters.

Multi Field display:

Roster/Grid Instructions:

11:35:36 AM Tuesday, May 21, 2013

Page 67 of 139

PM8A
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)
MEDICINE FORM: (MEDICINE FORM)

Int. Instr I:

CODE “YES” WITHOUT ASKING IF STATEMENT, RECEIPT,
BOTTLE OR BAG IS PRESENT AND FORM IS SAME AS
PREVIOUS INTERVIEW.

Question Text:

(I would like to record what is different about this medicine.)
At the time of the last interview, [you/(SP)] purchased (MEDICINE
NAME) in the form of (MEDICINE FORM). Is this medicine in the
same form?

Int. Instr II:
INPUT FIELDS / ROUTING

11:35:37 AM Tuesday, May 21, 2013

Page 68 of 139

PM8A

Field1:

SAMEFORM

Cheshire Name:

( PMQ1260 )

PMRO.SAMEFORM

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 PM1B-2 - (PMQ1270 )

English text: YES
No

BOX PM1B-2A - (PMQ1280 )

English text: NO
Attribute

Route

Don't know

BOX PM1B-2A - (PMQ1280 )

Refusal

BOX PM1B-2A - (PMQ1280 )

BACKGROUND VARIABLE ASSIGNMENTS
If PM8A - SAMEFORM = 1/Yes, copy the prescription medicine form from the previous
round PMRO fields to the current round fields.
PMFORM

If PM8A - SAMEFORM = 1/Yes, set current round
PMRO.PMFORM = previous round PMRO.PMFORM.

PMFORMOS

If PM8A - SAMEFORM = 1/Yes, set current round
PMRO.PMFORMOS = previous round
PMRO.PMFORMOS.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
181

PrevRndForm

11:35:38 AM Tuesday, May 21, 2013

Previous round form for PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT= EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
Page 69 of 139

PM8A
PM form = PMRO.PMFORM, PMRO.PMFORMOS.
DESIGN NOTES

11:35:38 AM Tuesday, May 21, 2013

Page 70 of 139

BOX PM1B-2

BOX PM1B-2

Page Order # :

260

BOX INSTRUCTIONS
( PMQ1270 )

IF SP REPORTED THE PRESCRIPTION MEDICINE IN THE PREVIOUS
ROUND AND THE PREVIOUS ROUND STRENGTH WAS ASKED AND DID
NOT EQUAL DK, GO TO PM9A - SAMESTRN ( PMQ1320 ).
ELSE GO TO PM10 - STRNUNIT ( PMQ1340 ).

ASSIGNMENTS

TECHNICAL NOTES
176

PMPrevRnd

SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.

183

PrevRndStrength

Previous round strength for PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round).
Strength =STRNUNIT, STRNUNOS, STRNNUM,
STRNPER
If compound, 2nd strength= STRNUNI2, STRNUNO2,
STRNNUM2, STRNPER2.

184

StrengthEqualDK

Previous round PM Strength was asked and did not equal
DK =
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round & PMRO.STRNUNIT
^= EMPTY & (STRNUNIT, STRNUNI2, STRNNUM,
STRNUM2, STRNPER, & STRNPER2 ^= DK)).

DESIGN NOTES

11:35:38 AM Tuesday, May 21, 2013

Page 71 of 139

BOX PM1B-2A

BOX PM1B-2A

Page Order # :

270

BOX INSTRUCTIONS
( PMQ1280 )

IF PM8 - PMBOTTLE=1/Yes, GO TO PMINTROC - PMINTC ( PMQ1290 ).
ELSE GO TO PM9 - PMFORM ( PMQ1300 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

11:35:39 AM Tuesday, May 21, 2013

Page 72 of 139

PMINTROC

PMINTROC

Page Order # :

Design Screen Type:

No Entry

Fields:

Field 1:

PMINTC

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:

Multi Field display:

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:
Int. Instr I:

COMPLETE PM9 -- PM16 USING INFORMATION FROM
STATEMENT, RECEIPT, MEDICINE BOTTLE OR CONTAINER. IF
THERE IS MORE THAN ONE FOR THE SAME MEDICINE, USE
THE MOST RECENT CONTAINER.

Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

11:35:39 AM Tuesday, May 21, 2013

Page 73 of 139

PMINTROC

Field1:

PMINTC

Cheshire Name:

( PMQ1290 )

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
PM9 - PMFORM ( PMQ1300 )

English text: CONTINUE
Attribute

Route

Empty

PM9 - PMFORM ( PMQ1300 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

11:35:40 AM Tuesday, May 21, 2013

Page 74 of 139

PM9

PM9

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

PMFORM

Field 2:

PMFORMOS

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:

290

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

MEDICINE NAME: (MEDICINE NAME)

Int. Instr I:

IN WHAT FORM IS THE MEDICINE?

Question Text:

Int. Instr II:

INPUT FIELDS / ROUTING

11:35:41 AM Tuesday, May 21, 2013

Page 75 of 139

PM9

11:35:43 AM Tuesday, May 21, 2013

Page 76 of 139

PM9

Field1:

PMFORM

Cheshire Name:

( PMQ1300 )

PMRO.PMFORM

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated

TPmform
1
No
No

Number Label
1 Pills

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM10 - STRNUNIT ( PMQ1340 )

2

English text: PILLS (TABLETS, CAPSULES)
Liquid

3

English text: LIQUID (TO BE TAKEN ORALLY)
Drops
PM10 - STRNUNIT ( PMQ1340 )

4

English text: DROPS (EYE/EAR/NOSE)
TopicalOintment

5

English text: OINTMENT, CREAM, LOTION (TOPICAL OR INTERNAL)
Suppositories
PM10 - STRNUNIT ( PMQ1340 )

6

English text: SUPPOSITORIES
ArerosolSpray

7

English text: AEROSOL/SPRAY, INHALANT, SOLUTIONS, DISKUS
ShampooSoap
PM10 - STRNUNIT ( PMQ1340 )

8

English text: SHAMPOO, SOAP
Injection

PM10 - STRNUNIT ( PMQ1340 )

9

English text: INJECTION
IV

PM10 - STRNUNIT ( PMQ1340 )

10

English text: IV INJECTION
Patches

PM10 - STRNUNIT ( PMQ1340 )

11

English text: PATCHES
Gel

PM10 - STRNUNIT ( PMQ1340 )

12

English text: GEL OR JELLY (TOPICAL OR INTERNAL)
Powder
PM10 - STRNUNIT ( PMQ1340 )

91

English text: POWDER, GRANULES
Other

PM10 - STRNUNIT ( PMQ1340 )

PM10 - STRNUNIT ( PMQ1340 )

PM10 - STRNUNIT ( PMQ1340 )

PM9 - PMFORMOS ( PMQ1310 )

English text: OTHER
11:35:47 AM Tuesday, May 21, 2013

Page 77 of 139

PM9

Attribute
Don't know

Route
BOX PM1B-4 - (PMQ1430 )

Field2:
Cheshire Name:

PMFORMOS

( PMQ1310 )

PMRO.PMFORMOS

Item Text display:

Display (SPECIFY) in the same blue font used for

interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

String

TOthrspec
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
PM10 - STRNUNIT ( PMQ1340 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

11:35:48 AM Tuesday, May 21, 2013

Page 78 of 139

PM9A

PM9A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

SAMESTRN

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

300

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about. Refering to the previous round form, PMRO.PMFORM, for
PM currently being asked about:
If previous round PMRO.PMFORM = 1/Pill, display "each pill".

Else if previous round PMRO.PMFORM = 5/Suppository, display

"each suppository".

Else if previous round PMRO.PMFORM = 10/Patch, display "each

patch".

Else then

Display "the (MEDICINE FORM)".
If previous round PMRO.PMFORM = 91/Other, medicine form =
Other Specify text, PMRO.PMFORMOS.
Else display PMRO.PMFORM response.

Question display:

Refering to the previous round form, PMRO.PMFORM, for PM
currently being asked about:
If previous round PMRO.PMFORM = 1/Pill, display "each pill".

Else if previous round PMRO.PMFORM = 5/Suppository, display

"each suppository".

Else if previous round PMRO.PMFORM = 10/Patch, display "each

patch".

Else then

Display "the (MEDICINE FORM)".
If previous round PMRO.PMFORM = 91/Other, medicine form =
Other Specify text, PMRO.PMFORMOS.
Else display PMRO.PMFORM response.
Refering to the previous round strength, PMRO.STRNUNIT &
PMRO.STRNUNI2, for PM currently being asked about:

11:35:48 AM Tuesday, May 21, 2013

Page 79 of 139

PM9A
STRENGTH 1:
If previous round PMRO.STRNUNIT=91/Other, display other specify
text response, PMRO.STRNUNOS.
Else if previous round PMRO.STRNUNIT = 6/Percent, display
PMRO.STRNPER + PMRO.STRNUNIT response.
Else display PMRO.STRNNUM + PMRO.STRNUNIT response.
STRENGTH 2:
If prescription medicine entered as a compound in the previous
round, PMRO.COMPFLAG=1/Indicated, then,
If previous round PMRO.STRNUNI2=91/Other, display other
specify text response, PMRO.STRNUNO2.
Else if previous round PMRO.STRNUNI2 = 6/Percent, display
PMRO.STRNPER2 + PMRO.STRNUNI2 response.
Else display PMRO.STRNNUM2 + PMRO.STRNUNI2 response.
Else do not display.
Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)
MEDICINE FORM: (MEDICINE FORM)

Int. Instr I:

CODE “YES” WITHOUT ASKING IF STATEMENT, RECEIPT,
BOTTLE OR BAG IS PRESENT AND STRENGTH IS SAME AS
PREVIOUS INTERVIEW.

Question Text:

At the time of the last interview, the strength of [each pill/each
suppository/each patch/the (MEDICINE FORM)] was [READ
STRENGTH BELOW].
(STRENGTH 1)
(STRENGTH 2)
Is this medicine in the same strength?

Int. Instr II:
INPUT FIELDS / ROUTING

11:35:49 AM Tuesday, May 21, 2013

Page 80 of 139

PM9A

Field1:

SAMESTRN

Cheshire Name:

( PMQ1320 )

PMRO.SAMESTRN

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 PM1B-4 - (PMQ1430 )

English text: YES
No

PM10 - STRNUNIT ( PMQ1340 )

English text: NO
Attribute

Route

Don't know

PM10 - STRNUNIT ( PMQ1340 )

Refusal

PM10 - STRNUNIT ( PMQ1340 )

BACKGROUND VARIABLE ASSIGNMENTS
If PM9A - SAMESTRN = 1/Yes, copy the prescription medicine strength from the previous
round PMRO fields to the current round fields.
STRNUNIT

If PM9A - SAMESTRN = 1/Yes, set current round
PMRO.STRNUNIT = previous round
PMRO.STRNUNIT.

STRNUNOS

If PM9A - SAMESTRN = 1/Yes, set current round
PMRO.STRNUNOS = previous round
PMRO.STRNUNOS.

STRNNUM

If PM9A - SAMESTRN = 1/Yes, set current round
PMRO.STRNNUM = previous round
PMRO.STRNNUM.

STRNPER

If PM9A - SAMESTRN = 1/Yes, set current round
PMRO.STRNPER = previous round
PMRO.STRNPER.

STRNUNI2

If PM9A - SAMESTRN = 1/Yes, set current round
PMRO.STRNUNI2 = previous round
PMRO.STRNUNI2.

11:35:50 AM Tuesday, May 21, 2013

Page 81 of 139

PM9A
STRNUNO2

If PM9A - SAMESTRN = 1/Yes, set current round
PMRO.STRNUNO2 = previous round
PMRO.STRNUNO2.

STRNNUM2

If PM9A - SAMESTRN = 1/Yes, set current round
PMRO.STRNNUM2 = previous round
PMRO.STRNNUM2.

STRNPER2

If PM9A - SAMESTRN = 1/Yes, set current round
PMRO.STRNPER2 = previous round
PMRO.STRNPER2.

COMPFLAG

If PM9A - SAMESTRN = 1/Yes, set current round
PMRO.COMPFLAG = previous round
PMRO.COMPFLAG.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
181

PrevRndForm

Previous round form for PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT= EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM form = PMRO.PMFORM, PMRO.PMFORMOS.

183

PrevRndStrength

Previous round strength for PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round).
Strength =STRNUNIT, STRNUNOS, STRNNUM,
STRNPER
If compound, 2nd strength= STRNUNI2, STRNUNO2,
STRNNUM2, STRNPER2.

DESIGN NOTES

11:35:50 AM Tuesday, May 21, 2013

Page 82 of 139

PM10

PM10

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

STRNUNIT

Field 2:

STRNUNOS

Field 3:

STRNNUM

Field 4:

STRNPER

Field 5:

STRNUNIT96

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No

No

No

No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

320

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.

Question display:

The prescription medicine current round form was either collected
at PM9 or was copied from the previous round PMRO.PMFORM.
Refering to the current round form, PMRO.PMFORM, for PM
currently being asked about:
If PMFORM = 1/Pill, display "EACH PILL".
Else if PMFORM = 5/Suppository, display "EACH SUPPOSITORY".
Else if PMFORM = 10/Patch, display "EACH PATCH".
Else then
Display "THE (MEDICINE FORM)".
If PMFORM = 91/Other, medicine form = Other Specify text,
PMRO.PMFORMOS.
Else medicine form = PMFORM response.

Multi Field display:

Vertical Alignment
Display fields in order specified.
When screen is first displayed, display 1st field, STRNUNIT96 and
2nd field, STRNUNIT, at one time.

11:35:51 AM Tuesday, May 21, 2013

Page 83 of 139

PM10
Display remaining fields, STRNUNOS, STRNNUM, and STRNPER,
as specified on the route.
Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)

Int. Instr I:

WHAT IS THE STRENGTH OF [EACH PILL/EACH PATCH/THE
(MEDICINE FORM)]?
IF COMPOUND MEDICINE: ENTER STRENGTH OF 1ST
MEDICINE, THEN CHECK THE BOX BELOW.

Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

11:35:53 AM Tuesday, May 21, 2013

Page 84 of 139

PM10

Field1:

STRNUNIT

Cheshire Name:
Item Text display:

( PMQ1340 )

PMRO.STRNUNIT

Do not display response option 96/Compound.

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated

TStrnunit
1
No
No

Number Label
1 Micrograms

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM10 - STRNNUM ( PMQ1350 )

2

English text: MICROGRAMS (mcg, mc)
Milligrams

PM10 - STRNNUM ( PMQ1350 )

3

English text: MILLIGRAMS (mg)
Grains

PM10 - STRNNUM ( PMQ1350 )

4

English text: GRAINS (gr)
Milliequivalents

PM10 - STRNNUM ( PMQ1350 )

5

English text: MILLIEQUIVALENTS (meq)
Grams

PM10 - STRNNUM ( PMQ1350 )

6

English text: GRAMS (g, gm)
Percent

PM10 - STRNPER ( PMQ1370 )

7

English text: PERCENT (%)
InternationalUnits

PM10 - STRNNUM ( PMQ1350 )

8

English text: INTERNATIONAL UNITS (IU)
Units

PM10 - STRNNUM ( PMQ1350 )

91

English text: UNITS (U)
Other

PM10 - STRNUNOS ( PMQ1345 )

96

English text: OTHER
Compound
DO NOT DISPLAY.
English text: COMPOUND/MORE THAN ONE MEDICINE COMBINED

Attribute

Route

Don't know

PM10 - STRNUNIT96 ( PMQ1375 )

11:35:55 AM Tuesday, May 21, 2013

Page 85 of 139

PM10

Field2:

STRNUNOS

Cheshire Name:

( PMQ1345 )

PMRO.STRNUNOS

Item Text display:

Display (SPECIFY) in the same blue font used for
interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

String
TOthrspec

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]
STRNNUM

Field3:
Cheshire Name:

30

Route
PM10 - STRNNUM ( PMQ1350 )
( PMQ1350 )

PMRO.STRNNUM

Item Text display:
Item Text:
Label:

Label Position:

NUMBER:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Real
TNumunit
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

PM10 - STRNUNIT96 ( PMQ1375 )

11:35:58 AM Tuesday, May 21, 2013

FieldSize:

Min Value:
Max Value:
Mask:

0.001

9999999

Route
PM10 - STRNUNIT96 ( PMQ1375 )

Page 86 of 139

PM10

Field4:

STRNPER

Cheshire Name:

( PMQ1370 )

PMRO.STRNPER

Item Text display:
Item Text:
Label:
Label Position:

PERCENT:
Left

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Real
TStrnper
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

PM10 - STRNUNIT96 ( PMQ1375 )

11:36:00 AM Tuesday, May 21, 2013

FieldSize:
Min Value:
Max Value:
Mask:

0.001
100
Percent

Route
PM10 - STRNUNIT96 ( PMQ1375 )

Page 87 of 139

PM10

Field5:

STRNUNIT96

Cheshire Name:

( PMQ1375 )

NONE
REPLACES THE FOLLOWING CHESHIRE VALUE:

If STRNUNIT96 = 1/Compound, set PMRO.STRNUNIT =

96/Compound.

Item Text display:
Item Text:
Label:

Label Position:

COMPOUND/MORE THAN ONE MEDICINE COMBINED

Right

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TStrnUnit96
1
No
No

Number Label
1 Compound

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX PM1B-3 - (PMQ1385 )

English text: COMPOUND/MORE THAN ONE MEDICINE COMBINED
Attribute
Empty

Route
BOX PM1B-3 - (PMQ1385 )

BACKGROUND VARIABLE ASSIGNMENTS
COMPFLAG

If PM10 - STRNUNIT96 = 1/Compound, set
PMRO.COMPFLAG=1/Indicated.

SOFT EDIT CHECKS
Edit #1

If STRNUNIT = 1/Micrograms, and PMFORM=6/Aerosol Spray, then

STRNNUM =.001-150, DK.

Else if STRNUNIT =1/Micrograms, then STRNNUM= .001-50, DK.

Else if STRNUNIT = 2/Milligrams, then STRNNUM = .005-800, DK.

Else if STRNUNIT = 3/Grains, then STRNNUM = .001-10, DK.

Else if STRNUNIT = 4/Milliequivalents, then STRNNUM = .01-100,

DK.

Else if STRNUNIT = 5/Grams, then STRNNUM = .01-30, DK.

Else if STRNUNIT = 6/Percent, then STRNPER = .001-5, DK.

Else if STRNUNIT = 7/International Units, then STRNNUM = .1­
50,000, DK.

Else if STRNUNIT = 8/Units, then STRNNUM = 1-1,500, DK.

Else if STRNUNIT = 91/Other, then STRNNUM = .001-1,000, DK.

If not true, display message "THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
11:36:01 AM Tuesday, May 21, 2013

Page 88 of 139

PM10
Edit #1

If STRNUNIT = 4/Milliequivalents, then STRNNUM = .01-9,999,999,

DK.

Else if STRNUNIT = 5/Grams, then STRNNUM = .01-9,999,999, DK.

If not true, display message "INVALID RESPONSE. ENTRY NOT IN

RANGE. PLEASE REENTER”.

TECHNICAL NOTES
185

CurrRndForm

The current round form for the PM =
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT= EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Form = PMRO.PMFORM.
Other Specify Form = PMRO.PMFORMOS.

DESIGN NOTES

11:36:01 AM Tuesday, May 21, 2013

Page 89 of 139

BOX PM1B-3

BOX PM1B-3

Page Order # :

321

BOX INSTRUCTIONS
( PMQ1385 )

IF PM10 - STRNUNIT96 = 1/Compound, GO TO PM10B - STRNUNI2 (
PMQ1420 ).
ELSE GO TO BOX PM1B-4 - (PMQ1430 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

11:36:01 AM Tuesday, May 21, 2013

Page 90 of 139

PM10B

PM10B

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

STRNUNI2

Field 2:

STRNUNO2

Field 3:

STRNNUM2

Field 4:

STRNPER2

HELP
COMMENTS
JUMPBACK

No
No
No

Enable Functions:

324

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 name and strength of medicine that is currently being asked
about.

Question display:
Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)
2ND MEDICINE IN COMPOUND

Int. Instr I:

WHAT WAS THE STRENGTH OF THE 2ND MEDICINE IN THE
COMPOUND?

Question Text:
Int. Instr II:
11:36:02 AM Tuesday, May 21, 2013

Page 91 of 139

PM10B
INPUT FIELDS / ROUTING

11:36:04 AM Tuesday, May 21, 2013

Page 92 of 139

PM10B

Field1:

STRNUNI2

Cheshire Name:
Item Text display:

( PMQ1420 )

PMRO.STRNUNI2

Do not display response option 96/Compound.

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated

TStrnunit
1
No
No

Number Label
1 Micrograms

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM10B - STRNNUM2 ( PMQ1422 )

2

English text: MICROGRAMS (mcg, mc)
Milligrams

PM10B - STRNNUM2 ( PMQ1422 )

3

English text: MILLIGRAMS (mg)
Grains

PM10B - STRNNUM2 ( PMQ1422 )

4

English text: GRAINS (gr)
Milliequivalents

PM10B - STRNNUM2 ( PMQ1422 )

5

English text: MILLIEQUIVALENTS (meq)
Grams

PM10B - STRNNUM2 ( PMQ1422 )

6

English text: GRAMS (g, gm)
Percent

PM10B - STRNPER2 ( PMQ1423 )

7

English text: PERCENT (%)
InternationalUnits

PM10B - STRNNUM2 ( PMQ1422 )

8

English text: INTERNATIONAL UNITS (IU)
Units

PM10B - STRNNUM2 ( PMQ1422 )

91

English text: UNITS (U)
Other

PM10B - STRNUNO2 ( PMQ1421 )

96

English text: OTHER
Compound
DO NOT DISPLAY.
English text: COMPOUND/MORE THAN ONE MEDICINE COMBINED

Attribute

Route

Don't know

BOX PM1B-4 - (PMQ1430 )

11:36:06 AM Tuesday, May 21, 2013

Page 93 of 139

PM10B

Field2:

STRNUNO2

Cheshire Name:

( PMQ1421 )

PMRO.STRNUNO2

Item Text display:

Display (SPECIFY) in the same blue font used for
interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

String
TOthrspec
1
No
No

Number Label
1 [Continuous answer.]
STRNNUM2

Field3:
Cheshire Name:

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
PM10B - STRNNUM2 ( PMQ1422 )
( PMQ1422 )

PMRO.STRNNUM2

Item Text display:
Item Text:
Label:

Label Position:

NUMBER:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Real
TNumunit
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

BOX PM1B-4 - (PMQ1430 )

11:36:08 AM Tuesday, May 21, 2013

FieldSize:

Min Value:
Max Value:
Mask:

0.001

9999999

Route
BOX PM1B-4 - (PMQ1430 )

Page 94 of 139

PM10B

Field4:

STRNPER2

Cheshire Name:

( PMQ1423 )

PMRO.STRNPER2

Item Text display:
Item Text:
Label:
Label Position:

PERCENT:
Left

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Real
TStrnper
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

BOX PM1B-4 - (PMQ1430 )

FieldSize:
Min Value:
Max Value:
Mask:

0.001
100
Percent

Route
BOX PM1B-4 - (PMQ1430 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If STRNUNI2 = 1/Micrograms, and PMFORM=6/Aerosol Spray, then

STRNNUM2 =.001-150, DK.

Else if STRNUNI2 =1/Micrograms, then STRNNUM2= .001-50, DK.

Else if STRNUNI2 = 2/Milligrams, then STRNNUM2 = .005-800, DK.

Else if STRNUNI2 = 3/Grains, then STRNNUM2 = .001-10, DK.

Else if STRNUNI2 = 4/Milliequivalents, then STRNNUM2 = .01-100,

DK.

Else if STRNUNI2 = 5/Grams, then STRNNUM2 = .01-30, DK.

Else if STRNUNI2 = 6/Percent, then STRNPER2 = .001-5, DK.

Else if STRNUNI2 = 7/International Units, then STRNNUM2 = .1­
50,000, DK.

Else if STRNUNI2 = 8/Units, then STRNNUM2 = 1-1,500, DK.

Else if STRNUNI2 = 91/Other, then STRNNUM2 = .001-1,000, DK.

If not true, display message "THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1

If STRNUNI2 = 4/Milliequivalents, then STRNNUM2 = .01-9,999,999,

DK.

Else if STRNUNI2 = 5/Grams, then STRNNUM2 = .01-9,999,999, DK.

If not true, display message "INVALID RESPONSE. ENTRY NOT IN

RANGE. PLEASE REENTER”.

11:36:09 AM Tuesday, May 21, 2013

Page 95 of 139

PM10B
TECHNICAL NOTES

DESIGN NOTES

11:36:09 AM Tuesday, May 21, 2013

Page 96 of 139

BOX PM1B-4

BOX PM1B-4

Page Order # :

330

BOX INSTRUCTIONS
( PMQ1430 )

IF PM9A - SAMESTRN = 1/Yes AND SP REPORTED THE PRESCRIPTION
MEDICINE IN THE PREVIOUS ROUND AND THE PREVIOUS ROUND
AMOUNT WAS ASKED AND DID NOT EQUAL DK, GO TO PM15A SAMEAMNT ( PMQ1510 ).
ELSE IF THE PRESCRIPTION MEDICINE FORM IS PILLS,
SUPPOSITORIES OR PATCHES, GO TO PM11 - TABNUM ( PMQ1440 ).
ELSE GO TO PM16 - AMTUNIT ( PMQ1520 ).

ASSIGNMENTS

TECHNICAL NOTES
187

PillsSuppPatches

PM form is stored on PMRO where PMRO.PMRORND =
round # checking and PMRO.PMROEVNT =
EVNT.EVNTNUM of PM being asked about:
Pills: PMRO.PMFORM = 1/Pills
Suppositories: PMRO.PMFORM = 5/Suppositories.
Patches: PMRO.PMFORM=10/Patches.

176

PMPrevRnd

SP reported PM purchase(s) in previous round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=previous round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM>0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.

188

PrevRndAmount

The previous round amount for the PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM amount = PMRO.AMTUNIT, PMRO.AMTUNOS,
PMRO.AMTNUM.

189

AmountEqualDK

Previous round PM Amount was asked and did not equal
DK =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM &
PMRO.PMRORND = previous round & PMRO.AMTUNIT
^= EMPTY & (PMRO.AMTUNIT ^= DK &
PMRO.AMTNUM ^= DK)).

DESIGN NOTES

11:36:09 AM Tuesday, May 21, 2013

Page 97 of 139

PM11

PM11

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

TABNUM

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:

Display name and strength of medicine that is currently being asked
about.

Question display:

Refering to the current round form, PMRO.PMFORM, for PM
currently being asked about:
If PMFORM = 1/Pill, display "PILLS".
Else if PMFORM = 5/Suppository, display "SUPPOSITORIES".
Else if PMFORM = 10/Patch, display "PATCHES".

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)

Int. Instr I:

HOW MANY (PILLS/SUPPOSITORIES/PATCHES) WERE IN THE
CONTAINER WHEN IT WAS OBTAINED?

Question Text:
Int. Instr II:

11:36:10 AM Tuesday, May 21, 2013

Page 98 of 139

PM11
INPUT FIELDS / ROUTING
( PMQ1440 )

TABNUM

Field1:
Cheshire Name:

PMRO.TABNUM

Item Text display:
Item Text:
Label:
Label Position:

NUMBER:
Left

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TTabnum

FieldSize:
Min Value:
Max Value:
Mask:

1
No
No

Number Label
1 [Continuous answer.]

1
999

Route
BOX PM1C - (PMQ1450 )

Attribute

Route

Don't know

BOX PM1C - (PMQ1450 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

TABNUM = 1-270, DK.

If not true, display message, "THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS

TECHNICAL NOTES
185

CurrRndForm

The current round form for the PM =
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT= EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Form = PMRO.PMFORM.
Other Specify Form = PMRO.PMFORMOS.

DESIGN NOTES

11:36:11 AM Tuesday, May 21, 2013

Page 99 of 139

BOX PM1C

BOX PM1C

Page Order # :

350

BOX INSTRUCTIONS
( PMQ1450 )

IF PRESCRIPTION MEDICINE FORM IS PILLS OR SUPPOSITORIES AND
PM11 - TABNUM = DK, GO TO PM12 - TABSADAY ( PMQ1460 ).
ELSE GO TO BOX PM2 - (PMQ1550 ).

ASSIGNMENTS

TECHNICAL NOTES
187

PillsSuppPatches

PM form is stored on PMRO where PMRO.PMRORND =
round # checking and PMRO.PMROEVNT =
EVNT.EVNTNUM of PM being asked about:
Pills: PMRO.PMFORM = 1/Pills
Suppositories: PMRO.PMFORM = 5/Suppositories.
Patches: PMRO.PMFORM=10/Patches.

DESIGN NOTES

11:36:11 AM Tuesday, May 21, 2013

Page 100 of 139

PM12

PM12

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

TABSADAY

Field 2:

TABSADAY95

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

Enable Functions:

360

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.

Question display:

Refering to the current round form, PMRO.PMFORM, for PM
currently being asked about:
If PMFORM = 1/Pill, display "PILLS".
Else if PMFORM = 5/Suppository, display "SUPPOSITORIES".

Multi Field display:

Vertical Alignment
Display all fields at one time.

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)

Int. Instr I:

HOW MANY (PILLS/SUPPOSITORIES) ARE TO BE TAKEN IN A
DAY?

Question Text:
Int. Instr II:
11:36:12 AM Tuesday, May 21, 2013

Page 101 of 139

PM12
INPUT FIELDS / ROUTING
TABSADAY

Field1:
Cheshire Name:

( PMQ1460 )

PMRO.TABSADAY

Item Text display:
Item Text:
Label:

Label Position:

NUMBER:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
TTabsaday
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Empty

PM12 - TABSADAY95 ( PMQ1462 )

Don't know

PM12 - TABSADAY95 ( PMQ1462 )

11:36:14 AM Tuesday, May 21, 2013

FieldSize:

Min Value:
Max Value:
Mask:

1

96

Route
PM12 - TABSADAY95 ( PMQ1462 )

Page 102 of 139

PM12

Field2:

TABSADAY95

Cheshire Name:

( PMQ1462 )

NONE
REPLACES THE FOLLOWING CHESHIRE VALUE:

If TABSADAY95 = 1/LessThanWhole, set

PMRO.TABSADAY=95.

Else if TABSADAY95=2/TakeAsNeeded, set

PMRO.TABSADAY=96.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated

TTabs9596
1
No
No

Number Label
1 LessThanWhole
2

English text: LESS THAN WHOLE
TakeAsNeeded

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX PM1D - (PMQ1463 )
BOX PM1D - (PMQ1463 )

English text: TAKE AS NEEDED
Attribute

Route

Empty

BOX PM1D - (PMQ1463 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

TABSADAY = 1-8, DK.

If not true, display message, “THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1

TABSADAY and TABSADAY95 cannot both be EMPTY.

If not true, display message, "ENTRY REQUIRED. PLEASE ENTER

THE CORRECT DOSAGE."

Edit #2

TABSADAY and TABSADAY95 cannot both be FILLED.

11:36:16 AM Tuesday, May 21, 2013

Page 103 of 139

PM12
If not true, display message, "INVALID ENTRY. PLEASE ENTER

THE NUMBER OF (PILLS/SUPPOSITORIES) OR SELECT

RESPONSE."

If PMFORM = 1/Pill, display "PILLS".

Else if PMFORM = 5/Suppository, display "SUPPOSITORIES".

Edit #3

TABSADAY = 1-12, DK.

If not true, display message, "INVALID RESPONSE. ENTRY NOT

IN RANGE. PLEASE REENTER”.

TECHNICAL NOTES
185

CurrRndForm

The current round form for the PM =
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT= EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Form = PMRO.PMFORM.
Other Specify Form = PMRO.PMFORMOS.

DESIGN NOTES

11:36:16 AM Tuesday, May 21, 2013

Page 104 of 139

BOX PM1D

BOX PM1D

Page Order # :

365

BOX INSTRUCTIONS
( PMQ1463 )

IF PM12 - TABSADAY = DK, GO TO BOX PM2 - (PMQ1550 ).
ELSE IF PM12 - TABSADAY95 = 2/TakeAsNeeded, GO TO PM13 ­
TABTAKE ( PMQ1470 ).
ELSE GO TO PM14 - TAKEUNIT ( PMQ1480 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

11:36:16 AM Tuesday, May 21, 2013

Page 105 of 139

PM13

PM13

Page Order # :

Design Screen Type:

Numeric

Fields:

Field 1:

TABTAKE

Field 2:

TABTAKE96

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:

370

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.

Question display:

Refering to the current round form, PMRO.PMFORM, for PM
currently being asked about:
If PMFORM = 1/Pill, display "pills".
Else if PMFORM = 5/Suppository, display "suppositories".
If SP is deceased or institutionalized, display "did".
Else if SP is the respondent, display "do".
Else if Proxy is the respondent, display "does".
Display "usually" in bold.

Multi Field display:

Vertical Alignment
Display all fields at one time.

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:
11:36:17 AM Tuesday, May 21, 2013

MEDICINE NAME: (MEDICINE NAME)
Page 106 of 139

PM13
Int. Instr I:
How many (pills/suppositories) (do/did/does) [you/(SP)] usually take
in a day?

Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

Field1:

TABTAKE

Cheshire Name:

( PMQ1470 )

PMRO.TABTAKE

Item Text display:
Item Text:
Label:

Label Position:

NUMBER:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Integer
TTabtake
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Empty

PM13 - TABTAKE96 ( PMQ1472 )

Don't know

PM13 - TABTAKE96 ( PMQ1472 )

11:36:19 AM Tuesday, May 21, 2013

FieldSize:

Min Value:
Max Value:
Mask:

1

96

Route
PM13 - TABTAKE96 ( PMQ1472 )

Page 107 of 139

PM13

Field2:

TABTAKE96

Cheshire Name:

( PMQ1472 )

NONE
REPLACES THE FOLLOWING CHESHIRE VALUE:
If TABTAKE96=1/DontTakeEveryDay, set
PMRO.TABTAKE=96.

Item Text display:
Item Text:
Label:

Label Position:

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TTabTake96
1
No
No

Number Label
1 DontTakeEveryDay

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX PM1E - (PMQ1473 )

English text: DON'T TAKE EVERY DAY
Attribute
Empty

Route
BOX PM1E - (PMQ1473 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

TABTAKE = 1-15, DK.

If not true, display message, “THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit#1

TABTAKE and TABTAKE96 cannot both be EMPTY.

If not true, display message "ENTRY REQUIRED. PLEASE ENTER

THE CORRECT DOSAGE.”.

Edit#2

TABTAKE and TABTAKE96 cannot both be FILLED.

If not true, display message, "INVALID ENTRY. PLEASE ENTER

THE NUMBER OF (PILLS/SUPPOSITORIES) OR SELECT

RESPONSE."

If PMFORM = 1/Pill, display "PILLS".

11:36:20 AM Tuesday, May 21, 2013

Page 108 of 139

PM13
Else if PMFORM = 5/Suppository, display "SUPPOSITORIES".
Edit #3

TABTAKE = 1-30, DK.

If not true, display message, "INVALID RESPONSE. ENTRY NOT

IN RANGE. PLEASE REENTER”

TECHNICAL NOTES
185

CurrRndForm

The current round form for the PM =
For this PM EVNT, there is PMRO where
(PMRO.PMROEVNT= EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Form = PMRO.PMFORM.
Other Specify Form = PMRO.PMFORMOS.

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.

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

11:36:20 AM Tuesday, May 21, 2013

Page 109 of 139

BOX PM1E

BOX PM1E

Page Order # :

375

BOX INSTRUCTIONS
( PMQ1473 )

IF PM13 - TABTAKE96 = 1/DontTakeEveryDay, GO TO BOX PM2 ­
(PMQ1550 ).
ELSE GO TO PM14 - TAKEUNIT ( PMQ1480 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

11:36:20 AM Tuesday, May 21, 2013

Page 110 of 139

PM14

PM14

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

TAKEUNIT

Field 2:

TAKENUM

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:

380

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.

Question display:

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:

Roster/Grid display:

Report display:

TEXT:

Context Header:

MEDICINE NAME: (MEDICINE NAME)

Int. Instr I:

HOW MANY DAYS OR WEEKS WAS THE MEDICINE TO BE
TAKEN?

Question Text:
Int. Instr II:
INPUT FIELDS / ROUTING

11:36:21 AM Tuesday, May 21, 2013

Page 111 of 139

PM14

Field1:

TAKEUNIT

Cheshire Name:

( PMQ1480 )

PMRO.TAKEUNIT

Item Text display:
Item Text:
Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TTakeunit
1
No
No

Number Label
1 Days

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM14 - TAKENUM ( PMQ1490 )

2

English text: DAYS
Weeks

PM14 - TAKENUM ( PMQ1490 )

3

English text: WEEKS
TakeUntilGone

BOX PM2 - (PMQ1550 )

4

English text: TAKE UNTIL GONE
TakeAsNeeded

BOX PM2 - (PMQ1550 )

5

English text: TAKE AS NEEDED
TakeEveryDay

BOX PM2 - (PMQ1550 )

English text: TAKE EVERY DAY
Attribute

Route

Don't know

BOX PM2 - (PMQ1550 )

11:36:23 AM Tuesday, May 21, 2013

Page 112 of 139

PM14

Field2:
Cheshire Name:

TAKENUM

( PMQ1490 )

PMRO.TAKENUM

Item Text display:
Item Text:
Label:
Label Position:

NUMBER:
Left

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Integer
TTakenum
1
No
No

Number Label
1 [Continuous answer.]

FieldSize:

Min Value:
Max Value:
Mask:

1

99

Route
BOX PM2 - (PMQ1550 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS
Edit #1

If TAKEUNIT = 1/Days, then TAKENUM = 1-30.

Else if TAKEUNIT =1/Weeks, then TAKENUM= 1-4.

If not true, display message "THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

11:36:24 AM Tuesday, May 21, 2013

Page 113 of 139

PM15A

PM15A

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

SAMEAMNT

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

400

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about. Refering to the previous round form, PMRO.PMFORM, for
PM currently being asked about:
If previous round PMRO.PMFORM = 91/Other, display other specify

text, PMRO.PMFORMOS.

Else display PMRO.PMFORM response.

Refering to the previous round amount, PMRO.AMTUNIT, for PM

currently being asked about:

If previous round PMRO.AMTUNIT=91/Other, display other specify

text response, PMRO.AMTUNOS.

Else display PMRO.AMTNUM + PMRO.AMTUNIT response.

Question display:

Refering to the previous round form, PMRO.PMFORM, for PM
currently being asked about:
If previous round PMRO.PMFORM = 91/Other, display other specify

text, PMRO.PMFORMOS.

Else display PMRO.PMFORM response.

Refering to the previous round amount, PMRO.AMTUNIT, for PM

currently being asked about:

If previous round PMRO.AMTUNIT=91/Other, display other specify

text response, PMRO.AMTUNOS.

Else display PMRO.AMTNUM + PMRO.AMTUNIT response.

11:36:24 AM Tuesday, May 21, 2013

Page 114 of 139

PM15A
Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)
MEDICINE FORM: (PREVIOUS ROUND MEDICINE FORM)
MEDICINE AMOUNT: (PREVIOUS ROUND MEDICINE AMOUNT)

Int. Instr I:

CODE “YES” WITHOUT ASKING IF STATEMENT, RECEIPT,
BOTTLE OR BAG IS PRESENT AND AMOUNT IS SAME AS
PREVIOUS INTERVIEW.

Question Text:

At the time of the last interview, the amount of the (PREVIOUS
ROUND MEDICINE FORM) was (PREVIOUS ROUND MEDICINE
AMOUNT). Is this medicine in the same amount?

Int. Instr II:
INPUT FIELDS / ROUTING

11:36:26 AM Tuesday, May 21, 2013

Page 115 of 139

PM15A

Field1:

SAMEAMNT

Cheshire Name:

( PMQ1510 )

PMRO.SAMEAMNT

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 PM2 - (PMQ1550 )

English text: YES
No

PM16 - AMTUNIT ( PMQ1520 )

English text: NO
Attribute

Route

Don't know

PM16 - AMTUNIT ( PMQ1520 )

Refusal

PM16 - AMTUNIT ( PMQ1520 )

BACKGROUND VARIABLE ASSIGNMENTS
If PM15A - SAMEAMNT = 1/Yes, copy the prescription medicine amount from the previous
round PMRO fields to the current round fields.
AMTUNIT

If PM15A - SAMEAMNT = 1/Yes, set current round
PMRO.AMTUNIT = previous round PMRO.AMTUNIT.

AMTUNOS

If PM15A - SAMEAMNT = 1/Yes, set current round
PMRO.AMTUNOS = previous round
PMRO.AMTUNOS.

AMTNUM

If PM15A - SAMEAMNT = 1/Yes, set current round
PMRO.AMTNUM = previous round PMRO.AMTNUM.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
181

PrevRndForm

11:36:27 AM Tuesday, May 21, 2013

Previous round form for PM =
Page 116 of 139

PM15A
For this PM EVNT, there is a PMRO where

(PMRO.PMROEVNT= EVNT.EVNTNUM and

PMRO.PMRORND = previous round).

PM form = PMRO.PMFORM, PMRO.PMFORMOS.

188

PrevRndAmount

The previous round amount for the PM =
For this PM EVNT, there is a PMRO where
(PMRO.PMROEVNT = EVNT.EVNTNUM and
PMRO.PMRORND = previous round).
PM amount = PMRO.AMTUNIT, PMRO.AMTUNOS,
PMRO.AMTNUM.

DESIGN NOTES

11:36:27 AM Tuesday, May 21, 2013

Page 117 of 139

PM16

PM16

Page Order # :

Design Screen Type:

Quantity Unit

Fields:

Field 1:

AMTUNIT

Field 2:

AMTUNOS

Field 3:

AMTNUM

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:

410

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:

Display name and strength of medicine that is currently being asked
about.

Question display:

Always display "[PLEASE ENTER…]" in brackets.

Multi Field display:

Vertical Alignment

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

MEDICINE NAME: (MEDICINE NAME)

Int. Instr I:

HOW MUCH MEDICINE WAS IN THE CONTAINER WHEN IT WAS
OBTAINED?

Question Text:
Int. Instr II:

11:36:28 AM Tuesday, May 21, 2013

[PLEASE ENTER THE AMOUNT IN THE CONTAINER, NOT THE
STRENGTH OF THE MEDICINE.]

Page 118 of 139

PM16
INPUT FIELDS / ROUTING
AMTUNIT

Field1:
Cheshire Name:

( PMQ1520 )

PMRO.AMTUNIT

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated

TAmtunit
1
No
No

Number Label
1 Ounces

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM16 - AMTNUM ( PMQ1530 )

2

English text: OUNCES (oz)
Grams

PM16 - AMTNUM ( PMQ1530 )

3

English text: GRAMS (g, gm)
Milliliters

PM16 - AMTNUM ( PMQ1530 )

4

English text: MILLILITERS (ml, cc)
Milliequivalents

PM16 - AMTNUM ( PMQ1530 )

5

English text: MILLIEQUIVALENTS (meq)
Milligrams

PM16 - AMTNUM ( PMQ1530 )

6

English text: MILLIGRAMS (mg)
Micrograms

PM16 - AMTNUM ( PMQ1530 )

7

English text: MICROGRAMS (mcg)
Puffs

PM16 - AMTNUM ( PMQ1530 )

English text: PUFFS, DOSES, BLISTERS
Other

PM16 - AMTUNOS ( PMQ1525 )

91

English text: OTHER
Attribute
Don't know

Route
BOX PM2 - (PMQ1550 )

11:36:32 AM Tuesday, May 21, 2013

Page 119 of 139

PM16

Field2:

AMTUNOS

Cheshire Name:

( PMQ1525 )

PMRO.AMTUNOS

Item Text display:

Display (SPECIFY) in the same blue font used for
interviewer instructions.

Item Text:

OTHER (SPECIFY)

Label:
Label Position:
Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

String
TOthrspec
1
No
No

Number Label
1 [Continuous answer.]
AMTNUM

Field3:
Cheshire Name:

FieldSize:
Min Value:
Max Value:
Mask:

30

Route
PM16 - AMTNUM ( PMQ1530 )
( PMQ1530 )

PMRO.AMTNUM

Item Text display:
Item Text:
Label:

Label Position:

NUMBER:
Left

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Real
TNumunit
1
No
No

Number Label
1 [Continuous answer.]
Attribute

Route

Don't know

BOX PM2 - (PMQ1550 )

FieldSize:

Min Value:
Max Value:
Mask:

0.001

9999999

Route
BOX PM2 - (PMQ1550 )

BACKGROUND VARIABLE ASSIGNMENTS

11:36:34 AM Tuesday, May 21, 2013

Page 120 of 139

PM16

SOFT EDIT CHECKS
Edit #1

If AMTUNIT= 1/Ounces, then AMTNUM =.01-16, DK.

Else if AMTUNIT =2/Grams, then AMTNUM= .01-60, DK.

Else if AMTUNIT = 3/Milliliters, then AMTNUM = .01-480, DK.

Else if AMTUNIT = 4/Milliequivalents, then AMTNUM = .01-100, DK.

Else if AMTUNIT = 5/Milligrams, then AMTNUM = .005- 800, DK.

Else if AMTUNIT = 6/Micrograms, then AMTNUM = .001- 50, DK.

Else if AMTUNIT = 91/Other, then AMTNUM = .01-1,000, DK.

If not true, display message "THE AMOUNT ENTERED SEEMS

UNLIKELY. PLEASE VERIFY."

HARD EDIT CHECKS
Edit #1

If AMTUNIT= 1/Ounces, then AMTNUM =.01-9,999,999, DK.

Else if AMTUNIT =2/Grams, then AMTNUM = .01-9,999,999, DK.

Else if AMTUNIT = 3/Milliliters, then AMTNUM = .01-9,999,999, DK.

Else if AMTUNIT = 4/Milliequivalents, then AMTNUM = .01­
9,999,999, DK

If not true, display message "INVALID RESPONSE. ENTRY NOT IN

RANGE. PLEASE REENTER."

TECHNICAL NOTES

DESIGN NOTES

11:36:34 AM Tuesday, May 21, 2013

Page 121 of 139

BOX PM2

BOX PM2

420

Page Order # :

BOX INSTRUCTIONS
( PMQ1550 )

IF (NOT ADMINISTERING ST AND NOT ADMINISTERING NS) AND (SP IS
ALIVE AND NOT INSTITUTIONALIZED) AND (UTILIZATION IS NOT BEING
COLLECTED FOR THE FIRST TIME FOR THIS SP) AND (THIS IS ROUND
67) AND (AT LEAST ONE RESPONSE AT PM6AB = 1/OFTEN OR
2/SOMETIMES) AND (AT LEAST TWO PRESCRIPTION MEDICINES
DISPLAYED AT PM6A HAVE NUMBER OF PURCHASES > 0 OR EQUAL TO
DK OR RF) AND (THIS IS ONE OF THE FIRST 15 MEDICINES BEING
ASKED ABOUT IN PM), GO TO PM16A1 - NOFILLED ( PMQ1551 ).
ELSE GO TO BOX PM3 - (PMQ1558 ).

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.

48

FirstUtilization

Ulization being collected for the first time =
(MRES.INTTYPE = 7/SupSmp1stTimeUtil or
MRES.INTTYPE = 10/SumSmp1stTimeUtilSkipped or
MRES.INTTYPE = 2/NewFromFacility) on MRES where
MRES.MRESRND = current round.

375

First15PMs

This PM is one of the first 15 medicines being asked
about in PM =
PM16A1 - TOTALPMASK < 15.

441

PMOftenSometimes

AT LEAST ONE RESPONSE AT PM6AB = 1/OFTEN OR
2/SOMETIMES =
PM6AB - RXNOFILL = 1/OFTEN OR 1/SOMETIMES, OR
PM6AB - RXDELAY = 1/OFTEN OR 1/SOMETIMES, OR
PM6AB - RXSKIP = 1/OFTEN OR 1/SOMETIMES, OR
PM6AB - RXDOSE = 1/OFTEN OR 1/SOMETIMES.

182

NumberOfPurchases

The number of purchases for PM or OM =
For the OM or PM EVNT, there is PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND = current round).
Number of purchases = PMRO.GETNUM.

DESIGN NOTES

11:36:34 AM Tuesday, May 21, 2013

Page 122 of 139

PM16A1

PM16A1

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

NOFILLED

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

425

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 name and strength of medicine that is currently being asked
about.

Question display:

Display name and strength of medicine that is currently being asked
about.
Display "because it cost too much" in BOLD.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

REFERENCE DATE: (REFERENCE DATE)
MEDICINE: (MEDICINE NAME)

Int. Instr I:

SHOW CARD PM1

Question Text:

Since (REFERENCE DATE), how often did [you/(SP)] decide not to
fill or refill (MEDICINE) because it cost too much?

Int. Instr II:

11:36:35 AM Tuesday, May 21, 2013

Page 123 of 139

PM16A1
INPUT FIELDS / ROUTING
NOFILLED

Field1:
Cheshire Name:

( PMQ1551 )

PMRO.NOFILLED

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated

TNoFilled
1
No
No

Number Label
1 OftenDidNotFill

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM16A - DELAYFIL ( PMQ1552 )

2

English text: OFTEN
SometimesDidNotFill

PM16A - DELAYFIL ( PMQ1552 )

3

English text: SOMETIMES
NeverDidNotFill

PM16A - DELAYFIL ( PMQ1552 )

English text: NEVER
Attribute

Route

Don't know

PM16A - DELAYFIL ( PMQ1552 )

Refusal

PM16A - DELAYFIL ( PMQ1552 )

BACKGROUND VARIABLE ASSIGNMENTS
Each time PM16A1 - NOFILLED is asked for a prescription medicine in PM, increment
counter as specified below. This counter is used to control how many times we ask the fall
round series: PM16A1, PM16A, PM16B and PM16C. We only ask these questions for the
1st 15 medicines reported in PM section if at least one response at PM6AB = 1/Often or
2/Sometimes.
TOTALPMASK

TOTALPMASK = TOTALPMASK + 1.

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

11:36:36 AM Tuesday, May 21, 2013

Page 124 of 139

PM16A1

DESIGN NOTES

11:36:36 AM Tuesday, May 21, 2013

Page 125 of 139

PM16A

PM16A

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

DELAYFIL

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

430

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 name and strength of medicine that is currently being asked
about.

Question display:

Display name and strength of medicine that is currently being asked
about.
Display "because it cost too much" in BOLD.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

REFERENCE DATE: (REFERENCE DATE)
MEDICINE: (MEDICINE NAME)

Int. Instr I:

SHOW CARD PM1

Question Text:

Since (REFERENCE DATE), how often did [you/(SP)] delay filling or
refilling a prescription for (MEDICINE NAME) because it cost too
much?

Int. Instr II:

11:36:38 AM Tuesday, May 21, 2013

Page 126 of 139

PM16A
INPUT FIELDS / ROUTING
DELAYFIL

Field1:
Cheshire Name:

( PMQ1552 )

PMRO.DELAYFIL

Item Text display:

Item Text:

Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated

TDelayFil
1
No
No

Number Label
1 OftenDelayedFilling

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM16B - SKIPDOSE ( PMQ1554 )

2

English text: OFTEN
SometimesDelayedFilling

PM16B - SKIPDOSE ( PMQ1554 )

3

English text: SOMETIMES
NeverDelayedFilling

PM16B - SKIPDOSE ( PMQ1554 )

English text: NEVER
Attribute

Route

Don't know

PM16B - SKIPDOSE ( PMQ1554 )

Refusal

PM16B - SKIPDOSE ( PMQ1554 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES

DESIGN NOTES

11:36:39 AM Tuesday, May 21, 2013

Page 127 of 139

PM16B

PM16B

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

SKIPDOSE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

440

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 name and strength of medicine that is currently being asked
about.

Question display:

Display name and strength of medicine that is currently being asked
about.
Display "to make the medicine last longer" in BOLD.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

REFERENCE DATE: (REFERENCE DATE)
MEDICINE: (MEDICINE NAME)

Int. Instr I:

SHOW CARD PM1

Question Text:

Since (REFERENCE DATE), how often did [you/(SP)] skip doses of
(MEDICINE NAME) to make the medicine last longer?
[IF THE RESPONSE IS "NEVER", PROBE: Do you mean that
[you/(SP)] never skipped doses of the medicine to make it last
longer, or that (you/he/she) never took the medicine at all?]

11:36:40 AM Tuesday, May 21, 2013

Page 128 of 139

PM16B
Int. Instr II:

INPUT FIELDS / ROUTING

SKIPDOSE

Field1:
Cheshire Name:

( PMQ1554 )

PMRO.SKIPDOSE

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TSkipDose
1
No
No

Number Label
1 OftenSkippedDose

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM16C - CUTDOSE ( PMQ1556 )

2

English text: OFTEN
SometimesSkippedDose

PM16C - CUTDOSE ( PMQ1556 )

3

English text: SOMETIMES
NeverSkippedDose

PM16C - CUTDOSE ( PMQ1556 )

4

English text: NEVER
NeverTookPM

BOX PM3 - (PMQ1558 )

English text: NEVER TOOK THE MEDICINE AT ALL
Attribute
Don't know

Route
PM16C - CUTDOSE ( PMQ1556 )

Refusal

PM16C - CUTDOSE ( PMQ1556 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
11:36:41 AM Tuesday, May 21, 2013

Page 129 of 139

PM16B

DESIGN NOTES

11:36:41 AM Tuesday, May 21, 2013

Page 130 of 139

PM16C

PM16C

Page Order # :

Design Screen Type:

Code 1

Fields:

Field 1:

CUTDOSE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
No
No

450

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 name and strength of medicine that is currently being asked
about.

Question display:

Display name and strength of medicine that is currently being asked
about.
Display "to make the medicine last longer" in BOLD.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

TEXT:
Context Header:

REFERENCE DATE: (REFERENCE DATE)
MEDICINE: (MEDICINE NAME)

Int. Instr I:

SHOW CARD PM1

Question Text:

Since (REFERENCE DATE), how often did [you/(SP)] take smaller
doses of (MEDICINE NAME) to make the medicine last longer?
[IF THE RESPONSE IS "NEVER", PROBE: Do you mean that
[you/(SP)] never took smaller doses of the medicine to make it last
longer, or that (you/he/she) never took the medicine at all?]

11:36:42 AM Tuesday, May 21, 2013

Page 131 of 139

PM16C
Int. Instr II:

INPUT FIELDS / ROUTING

CUTDOSE

Field1:
Cheshire Name:

( PMQ1556 )

PMRO.CUTDOSE

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TCutDose
1
No
No

Number Label
1 OftenCutDose

FieldSize:
Min Value:
Max Value:
Mask:

Route
BOX PM3 - (PMQ1558 )

2

English text: OFTEN
SometimesCutDose

BOX PM3 - (PMQ1558 )

3

English text: SOMETIMES
NeverCutDose

BOX PM3 - (PMQ1558 )

4

English text: NEVER
NeverTookPm

BOX PM3 - (PMQ1558 )

English text: NEVER TOOK THE MEDICINE AT ALL
Attribute
Don't know

Route
BOX PM3 - (PMQ1558 )

Refusal

BOX PM3 - (PMQ1558 )

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS

TECHNICAL NOTES
11:36:44 AM Tuesday, May 21, 2013

Page 132 of 139

PM16C

DESIGN NOTES

11:36:44 AM Tuesday, May 21, 2013

Page 133 of 139

BOX PM3

BOX PM3

Page Order # :

460

BOX INSTRUCTIONS
( PMQ1558 )

GO TO PM6A_IN - NAVIGATOR ( PMQ1183 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

11:36:44 AM Tuesday, May 21, 2013

Page 134 of 139

BOX PM3A

BOX PM3A

Page Order # :

465

BOX INSTRUCTIONS
( PMQ1559 )

IF CURRENTLY ADMINISTERING ST, GO TO BOX ST43 - (STQ1930 ).
ELSE IF CURRENTLY ADMINISTERING NS, GO TO BOX NS43 ­
(NSQ1930 ).
ELSE GO TO PM17 - PMMORE ( PMQ1560 ).

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES
If adminstering ST or NS, BOX PM3A is routed back to ST/NS.
Else probe for more PMs.

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PM17

PM17

Page Order # :

Design Screen Type:

Yes/No

Fields:

Field 1:

PMMORE

Enable Functions:

HELP
COMMENTS
JUMPBACK

No
Yes
Yes

Roster Functions:

Add Item
Edit Item
Delete Item
Search Item

No
No
No
No

Grid Functions:

Add Line
Delete Line

No
No

470

Roster Name:
Roster Type:

DISPLAY INSTRUCTIONS:
Context header display:
Question display:

If SP reported any Prescription Medicine purchases during the
current round, display "[THE NAMES OF ALL MEDICINES
REPORTED FOR THE CURRENT REFERENCE PERIOD ARE
DISPLAYED BELOW.]".
Else display "[NO MEDICINES HAVE BEEN REPORTED FOR (SP)
FOR THE CURRENT REFERENCE PERIOD.]".
If SP reported any Prescription Medicine purchases during the

current round, display "MORE".

Else do not display.

Multi Field display:

Roster/Grid Instructions:
Roster/Grid display:
Report display:

Display the names of all prescription medicine purchases reported in
the current round.
Display report below question text.

Column 1, column header= MEDICINES REPORTED FOR

CURRENT REFERENCE PERIOD

Column 1, display = Display the name and strength of the medicine,

EVNT.PMEDNAME + ' ' + EVNT.PMSTRUNI.

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PM17
TEXT:
Context Header:

CURRENT REFERENCE PERIOD: (REFERENCE DATE) ­
(TODAY/DATE OF DEATH/DATE OF INSTITUTIONALIZATION)

Int. Instr I:

([NO MEDICINES HAVE BEEN REPORTED FOR (SP) FOR THE
CURRENT REFERENCE PERIOD/THE NAMES OF ALL
MEDICINES REPORTED FOR THE CURRENT REFERENCE
PERIOD ARE DISPLAYED BELOW.])
REVIEW THIS INFORMATION WITH THE RESPONDENT.
[REVIEW THE INFORMATION BELOW WITH THE
RESPONDENT. ASK, OR CODE AS APPROPRIATE IF R
ALREADY INDICATED: Are there any (more) medicines since
(REFERENCE DATE) that we haven't talked about?]

Question Text:

Int. Instr II:

INPUT FIELDS / ROUTING

PMMORE

Field1:
Cheshire Name:

( PMQ1560 )

TEMP

Item Text display:
Item Text:
Label:

Label Position:

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TYesNo
1
No
No

Number Label
1 Yes
2

English text: YES
No

FieldSize:
Min Value:
Max Value:
Mask:

Route
PM6 - MEDICINE_PM3 ( PMQ1140 )
BOX PMEND - (PMQ1580 )

English text: NO

BACKGROUND VARIABLE ASSIGNMENTS

SOFT EDIT CHECKS

HARD EDIT CHECKS
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PM17

TECHNICAL NOTES
178

PMCurrRnd

SP reported PM purchase(s) in current round =
There is an EVNT & PMRO where
(PMRO.PMROEVNT=EVNT.EVNTNUM &
PMRO.PMRORND=current round &
PMRO.PMROTYPE='PM' & PMRO.PMRODFLG^=1/Yes
& (GETNUM > 0 or GETNUM = DK or RF)).
Medicine Name=EVNT.PMEDNAME.

180

PMCondition

Condition reported for the PM =
For this PM EVNT, there is an XCON where
(XCON.XCONEVNT=EVNT.EVNTNUM) and
(XCON.XCONCOND = COND.CONDNUM of condition
linked to PM EVNT).
Condition Name = COND.CONDTION.

DESIGN NOTES
End Loop 1:
PM17 is a larger loop that is initiated the first time PM17 is asked. If PM17
= 1/Yes, return to PM6 to collect additional current round prescription
medicines.

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BOX PMEND

BOX PMEND

Page Order # :

480

BOX INSTRUCTIONS
( PMQ1580 )

GO TO NEXT SECTION .

ASSIGNMENTS

TECHNICAL NOTES

DESIGN NOTES

11:36:46 AM Tuesday, May 21, 2013

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